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Kulcsarova K, Baloghova J, Necpal J, Skorvanek M. Skin Conditions and Movement Disorders: Hiding in Plain Sight. Mov Disord Clin Pract 2022; 9:566-583. [PMID: 35844274 PMCID: PMC9274368 DOI: 10.1002/mdc3.13436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 11/09/2022] Open
Abstract
Skin manifestations are well-recognized non-motor symptoms of Parkinson's disease (PD) and other hypokinetic and hyperkinetic movement disorders. Skin conditions are usually well visible during routine clinical examination and their recognition may play a major role in diagnostic work-up. In this educational review we: (1) briefly outline skin conditions related to Parkinson's disease, including therapy-related skin complications and their management; (2) discuss the role of skin biopsies in early diagnosis of PD and differential diagnosis of parkinsonian syndromes; and focus more on areas which have not been reviewed in the literature before, including (3) skin conditions related to atypical parkinsonism, and (4) skin conditions related to hyperkinetic movement disorders. In case of rare hyperkinetic movement disorders, specific dermatological manifestations, like presence of angiokeratomas, telangiectasias, Mongolian spots, lipomas, ichthyosis, progeroid skin changes and others may point to a very specific group of disorders and help guide further investigations.
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Affiliation(s)
- Kristina Kulcsarova
- Department of Neurology, Medical FacultyUniversity of Pavol Jozef SafarikPavolSlovak Republic
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovak Republic
| | - Janette Baloghova
- Department of DermatovenerologyMedical Faculty, University of Pavol Jozef SafarikKosiceSlovak Republic
- Department of DermatovenerologyUniversity Hospital L. PasteurKosiceSlovak Republic
| | - Jan Necpal
- Department of NeurologyZvolen HospitalZvolenSlovak Republic
| | - Matej Skorvanek
- Department of Neurology, Medical FacultyUniversity of Pavol Jozef SafarikPavolSlovak Republic
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovak Republic
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2
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Tomic S, Kuric I, Kuric TG, Popovic Z, Kragujevic J, Zubonja TM, Rajkovaca I, Matosa S. Seborrheic Dermatitis Is Related to Motor Symptoms in Parkinson’s Disease. J Clin Neurol 2022; 18:628-634. [DOI: 10.3988/jcn.2022.18.6.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Svetlana Tomic
- Department of Neurology, Osijek University Hospital Centre, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Igor Kuric
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department for Dermatology and Venereology, Osijek University Hospital Centre, Osijek, Croatia
| | - Tihana Gilman Kuric
- Department of Neurology, Osijek University Hospital Centre, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Zvonimir Popovic
- Department of Neurology, Osijek University Hospital Centre, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jagoda Kragujevic
- Department of Neurology, Osijek University Hospital Centre, Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Tea Mirosevic Zubonja
- Department of Neurology, Osijek University Hospital Centre, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ines Rajkovaca
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Gastroenterology, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia
| | - Sara Matosa
- Department of Neurology, Osijek University Hospital Centre, Osijek, Croatia
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3
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Coloman II, Levin OS. [Thermoregulatory dysfunction in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:69-75. [PMID: 34870917 DOI: 10.17116/jnevro202112110269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Thermoregulatory dysfunction is considered to be the least investigated among all the autonomic disorders in Parkinson disease. Pathophysiological mechanisms of this phenomena involve as central, as peripheric parts of nervous system. Dopamine deficiency in combination with peripheric autonomic dysfunction leads to temperature balance disturbance, which may be expressed by various clinical symptoms. Dopaminergic innervation of preoptic-anterior hypothalamus area plays a crucial role in thermoregulation function of central nervous system. Current thermoregulatory tests give possibility not only to reveal sudomotor and heat dissipation disorders in patients with Parkinson disease, but also to make differential diagnosis with other neurodegenerative disorders. Early detection and treatment of thermoregulatory dysfunction may improve quality of life in patients with Parkinson disease.
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Affiliation(s)
- I I Coloman
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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4
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Briganti S, Truglio M, Angiolillo A, Lombardo S, Leccese D, Camera E, Picardo M, Di Costanzo A. Application of Sebum Lipidomics to Biomarkers Discovery in Neurodegenerative Diseases. Metabolites 2021; 11:metabo11120819. [PMID: 34940576 PMCID: PMC8708591 DOI: 10.3390/metabo11120819] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
Lipidomics is strategic in the discovery of biomarkers of neurodegenerative diseases (NDDs). The skin surface lipidome bears the potential to provide biomarker candidates in the detection of pathological processes occurring in distal organs. We investigated the sebum composition to search diagnostic and, possibly, prognostic, biomarkers of Alzheimer’s disease (AD) and Parkinson’s disease (PD). The observational study included 64 subjects: 20 characterized as “probable AD with documented decline”, 20 as “clinically established PD”, and 24 healthy subjects (HS) of comparable age. The analysis of sebum by GCMS and TLC retrieved the amounts (µg) of 41 free fatty acids (FFAs), 7 fatty alcohols (FOHs), vitamin E, cholesterol, squalene, and total triglycerides (TGs) and wax esters (WEs). Distributions of sebum lipids in NDDs and healthy conditions were investigated with multivariate ANOVA-simultaneous component analysis (ASCA). The deranged sebum composition associated with the PD group showed incretion of most composing lipids compared to HS, whereas only two lipid species (vitamin E and FOH14:0) were discriminant of AD samples and presented lower levels than HS sebum. Thus, sebum lipid biosynthetic pathways are differently affected in PD and AD. The characteristic sebum bio-signatures detected support the value of sebum lipidomics in the biomarkers search in NDDs.
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Affiliation(s)
- Stefania Briganti
- Laboratory of Cutaneous Physiopathology, San Gallicano Dermatological Institute—IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (S.B.); (M.T.); (M.P.)
| | - Mauro Truglio
- Laboratory of Cutaneous Physiopathology, San Gallicano Dermatological Institute—IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (S.B.); (M.T.); (M.P.)
| | - Antonella Angiolillo
- Centre for Research and Training in Medicine of Aging, Department of Medicine and Health Science “V. Tiberio”, University of Molise, Via De Santis, 86100 Campobasso, Italy; (A.A.); (S.L.); (D.L.); (A.D.C.)
| | - Salvatore Lombardo
- Centre for Research and Training in Medicine of Aging, Department of Medicine and Health Science “V. Tiberio”, University of Molise, Via De Santis, 86100 Campobasso, Italy; (A.A.); (S.L.); (D.L.); (A.D.C.)
| | - Deborah Leccese
- Centre for Research and Training in Medicine of Aging, Department of Medicine and Health Science “V. Tiberio”, University of Molise, Via De Santis, 86100 Campobasso, Italy; (A.A.); (S.L.); (D.L.); (A.D.C.)
| | - Emanuela Camera
- Laboratory of Cutaneous Physiopathology, San Gallicano Dermatological Institute—IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (S.B.); (M.T.); (M.P.)
- Correspondence: ; Tel.: +39-06-5266-6241; Fax: +39-06-5266-6247
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology, San Gallicano Dermatological Institute—IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy; (S.B.); (M.T.); (M.P.)
| | - Alfonso Di Costanzo
- Centre for Research and Training in Medicine of Aging, Department of Medicine and Health Science “V. Tiberio”, University of Molise, Via De Santis, 86100 Campobasso, Italy; (A.A.); (S.L.); (D.L.); (A.D.C.)
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5
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Rho NK, Gil YC. Botulinum Neurotoxin Type A in the Treatment of Facial Seborrhea and Acne: Evidence and a Proposed Mechanism. Toxins (Basel) 2021; 13:817. [PMID: 34822601 PMCID: PMC8626011 DOI: 10.3390/toxins13110817] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Intradermal injection of botulinum neurotoxin is a frequently performed procedure in aesthetic dermatology to improve facial skin tone, texture, fine wrinkles, and enlarged pores. In practice, botulinum neurotoxin type A is also used to reduce skin oiliness of the face. There is increasing evidence that acetylcholine plays specific roles in sebum production, suggesting that botulinum neurotoxin type A may reduce sebum production by interfering with cholinergic transmission between sebaceous glands and autonomic nerve terminals. Botulinum neurotoxins can also inhibit several pathogenetic components of acne development, suggesting that botulinum neurotoxins can be used as a safe and effective treatment modality for acne and other skin disorders related to overactivity of sebaceous glands. This review aims to explore the current evidence behind the treatment of facial seborrhea and acne with botulinum neurotoxin type A.
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Affiliation(s)
- Nark-Kyoung Rho
- Department of Dermatology, Sungkyunkwan University School of Medicine, Seoul 06355, Korea;
- Leaders Aesthetic Laser & Cosmetic Surgery Center, Seoul 06014, Korea
| | - Young-Chun Gil
- Department of Anatomy, Chungbuk National University School of Medicine, Cheongju 28644, Korea
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6
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Uehara Y, Ueno SI, Amano-Takeshige H, Suzuki S, Imamichi Y, Fujimaki M, Ota N, Murase T, Inoue T, Saiki S, Hattori N. Non-invasive diagnostic tool for Parkinson's disease by sebum RNA profile with machine learning. Sci Rep 2021; 11:18550. [PMID: 34545158 PMCID: PMC8452747 DOI: 10.1038/s41598-021-98423-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disease presenting with motor and non-motor symptoms, including skin disorders (seborrheic dermatitis, bullous pemphigoid, and rosacea), skin pathological changes (decreased nerve endings and alpha-synuclein deposition), and metabolic changes of sebum. Recently, a transcriptome method using RNA in skin surface lipids (SSL-RNAs) which can be obtained non-invasively with an oil-blotting film was reported as a novel analytic method of sebum. Here we report transcriptome analyses using SSL-RNAs and the potential of these expression profiles with machine learning as diagnostic biomarkers for PD in double cohorts (PD [n = 15, 50], controls [n = 15, 50]). Differential expression analysis between the patients with PD and healthy controls identified more than 100 differentially expressed genes in the two cohorts. In each cohort, several genes related to oxidative phosphorylation were upregulated, and gene ontology analysis using differentially expressed genes revealed functional processes associated with PD. Furthermore, machine learning using the expression information obtained from the SSL-RNAs was able to efficiently discriminate patients with PD from healthy controls, with an area under the receiver operating characteristic curve of 0.806. This non-invasive gene expression profile of SSL-RNAs may contribute to early PD diagnosis based on the neurodegeneration background.
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Affiliation(s)
- Yuya Uehara
- Biological Science Research, Kao Corporation, Tochigi, Japan
- Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shin-Ichi Ueno
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | - Yoko Imamichi
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Motoki Fujimaki
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Noriyasu Ota
- Biological Science Research, Kao Corporation, Tochigi, Japan
| | | | - Takayoshi Inoue
- Biological Science Research, Kao Corporation, Tochigi, Japan.
| | - Shinji Saiki
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
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7
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Niemann N, Billnitzer A, Jankovic J. Parkinson's disease and skin. Parkinsonism Relat Disord 2020; 82:61-76. [PMID: 33248395 DOI: 10.1016/j.parkreldis.2020.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/18/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
Parkinson's disease is associated with a variety of dermatologic disorders and the study of skin may provide insights into pathophysiological mechanisms underlying this common neurodegenerative disorder. Skin disorders in patients with Parkinson's disease can be divided into two major groups: 1) non-iatrogenic disorders, including melanoma, seborrheic dermatitis, sweating disorders, bullous pemphigoid, and rosacea, and 2) iatrogenic disorders related either to systemic side effects of antiparkinsonian medications or to the delivery system of antiparkinsonian therapy, including primarily carbidopa/levodopa, rotigotine and other dopamine agonists, amantadine, catechol-O-methyl transferase inhibitors, subcutaneous apomorphine, levodopa/carbidopa intestinal gel, and deep brain stimulation. Recent advances in our understanding of the role of α-synuclein in peripheral tissues, including the skin, and research based on induced pluripotent stem cells derived from skin fibroblasts have made skin an important target for the study of Parkinson's disease pathogenesis, drug discovery, novel stem cell therapies, and diagnostics.
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Affiliation(s)
- Nicki Niemann
- Muhammad Ali Parkinson Center, Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA.
| | - Andrew Billnitzer
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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8
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Shah P, Sagar PR, Alhumaidi N, Bollampally VC, Malik BH. Parkinson's Disease and Its Dermatological Associations: Is Your Skin Whispering You a Diagnosis? Cureus 2020; 12:e9933. [PMID: 32968594 PMCID: PMC7505647 DOI: 10.7759/cureus.9933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disease characterized clinically by the triad of resting tremor, rigidity, and bradykinesia. Although PD is primarily known for motor disturbance, 98.6% of patients experience one or more non-motor symptoms at all stages of the disease. Dermatological disorders are discussed as common non-motor associations of PD since the 20th century. Many studies have shown that patients of PD are predisposed to skin disorders. This article is a traditional review done to analyze the association between PD and its dermatological manifestations. We did a literature search using six keywords in the PubMed database and took the relevant articles published in the last 10 years. We reviewed more than 100 articles, which also included animal studies. On meticulous review, we observed an increased incidence of certain skin disorders like seborrheic dermatitis, bullous pemphigoid, rosacea, and melanoma in patients of PD. These disorders share either common risk factors or underlying mechanisms revolving around genetics, immunology, inflammation, and pathophysiology of PD, but the exact causation yet seems obscured. We believe that this opens a horizon for more research in the link between the skin and nervous system. We also emphasize that the dermatologists, neurologists and general physicians should address the cutaneous disorders in PD timely, educate their patients, help them lessen the psychosocial distress, and improve their quality of life.
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Affiliation(s)
- Puja Shah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Prem Raj Sagar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Norah Alhumaidi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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9
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Adalsteinsson JA, Kaushik S, Muzumdar S, Guttman-Yassky E, Ungar J. An update on the microbiology, immunology and genetics of seborrheic dermatitis. Exp Dermatol 2020; 29:481-489. [PMID: 32125725 DOI: 10.1111/exd.14091] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 02/07/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022]
Abstract
The underlying mechanism of seborrheic dermatitis (SD) is poorly understood but major scientific progress has been made in recent years related to microbiology, immunology and genetics. In light of this, the major goal of this article was to summarize the most recent articles on SD, specifically related to underlying pathophysiology. SD results from Malassezia hydrolysation of free fatty acids with activation of the immune system by the way of pattern recognition receptors, inflammasome, IL-1β and NF-kB. M. restricta and M. globosa are likely the most virulent subspecies, producing large quantities of irritating oleic acids, leading to IL-8 and IL-17 activation. IL-17 and IL-4 might play a big role in pathogenesis, but this needs to be further studied using novel biologics. No clear genetic predisposition has been established; however, recent studies implicated certain increased-risk human leucocyte antigen (HLA) alleles, such as A*32, DQB1*05 and DRB1*01 as well as possible associations with psoriasis and atopic dermatitis (AD) through the LCE3 gene cluster while SD, and SD-like syndromes, shares genetic mutations that appear to impair the ability of the immune system to restrict Malassezia growth, partially due to complement system dysfunction. A paucity of studies exists looking at the relationship between SD and systemic disease. In HIV, SD is thought to be secondary to a combination of immune dysregulation and disruption in skin microbiota with unhindered Malassezia proliferation. In Parkinson's disease, SD is most likely secondary to parasympathetic hyperactivity with increased sebum production as well as facial immobility which leads to sebum accumulation.
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Affiliation(s)
| | - Shivani Kaushik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sonal Muzumdar
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Clayton RW, Langan EA, Ansell DM, de Vos IJHM, Göbel K, Schneider MR, Picardo M, Lim X, van Steensel MAM, Paus R. Neuroendocrinology and neurobiology of sebaceous glands. Biol Rev Camb Philos Soc 2020; 95:592-624. [PMID: 31970855 DOI: 10.1111/brv.12579] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022]
Abstract
The nervous system communicates with peripheral tissues through nerve fibres and the systemic release of hypothalamic and pituitary neurohormones. Communication between the nervous system and the largest human organ, skin, has traditionally received little attention. In particular, the neuro-regulation of sebaceous glands (SGs), a major skin appendage, is rarely considered. Yet, it is clear that the SG is under stringent pituitary control, and forms a fascinating, clinically relevant peripheral target organ in which to study the neuroendocrine and neural regulation of epithelia. Sebum, the major secretory product of the SG, is composed of a complex mixture of lipids resulting from the holocrine secretion of specialised epithelial cells (sebocytes). It is indicative of a role of the neuroendocrine system in SG function that excess circulating levels of growth hormone, thyroxine or prolactin result in increased sebum production (seborrhoea). Conversely, growth hormone deficiency, hypothyroidism, and adrenal insufficiency result in reduced sebum production and dry skin. Furthermore, the androgen sensitivity of SGs appears to be under neuroendocrine control, as hypophysectomy (removal of the pituitary) renders SGs largely insensitive to stimulation by testosterone, which is crucial for maintaining SG homeostasis. However, several neurohormones, such as adrenocorticotropic hormone and α-melanocyte-stimulating hormone, can stimulate sebum production independently of either the testes or the adrenal glands, further underscoring the importance of neuroendocrine control in SG biology. Moreover, sebocytes synthesise several neurohormones and express their receptors, suggestive of the presence of neuro-autocrine mechanisms of sebocyte modulation. Aside from the neuroendocrine system, it is conceivable that secretion of neuropeptides and neurotransmitters from cutaneous nerve endings may also act on sebocytes or their progenitors, given that the skin is richly innervated. However, to date, the neural controls of SG development and function remain poorly investigated and incompletely understood. Botulinum toxin-mediated or facial paresis-associated reduction of human sebum secretion suggests that cutaneous nerve-derived substances modulate lipid and inflammatory cytokine synthesis by sebocytes, possibly implicating the nervous system in acne pathogenesis. Additionally, evidence suggests that cutaneous denervation in mice alters the expression of key regulators of SG homeostasis. In this review, we examine the current evidence regarding neuroendocrine and neurobiological regulation of human SG function in physiology and pathology. We further call attention to this line of research as an instructive model for probing and therapeutically manipulating the mechanistic links between the nervous system and mammalian skin.
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Affiliation(s)
- Richard W Clayton
- Centre for Dermatology, School of Biological Sciences, University of Manchester, and NIHR Manchester Biomedical Research Centre, Stopford Building, Oxford Road, Manchester, M13 9PT, U.K.,Skin Research Institute of Singapore, Agency for Science, Technology and Research, 11 Mandalay Road, #17-01 Clinical Sciences Building, 308232, Singapore
| | - Ewan A Langan
- Centre for Dermatology, School of Biological Sciences, University of Manchester, and NIHR Manchester Biomedical Research Centre, Stopford Building, Oxford Road, Manchester, M13 9PT, U.K.,Department of Dermatology, Allergology und Venereology, University of Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany
| | - David M Ansell
- Centre for Dermatology, School of Biological Sciences, University of Manchester, and NIHR Manchester Biomedical Research Centre, Stopford Building, Oxford Road, Manchester, M13 9PT, U.K.,Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Michael Smith Building, Oxford Road, Manchester, M13 9PT, U.K
| | - Ivo J H M de Vos
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, 11 Mandalay Road, #17-01 Clinical Sciences Building, 308232, Singapore
| | - Klaus Göbel
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, 11 Mandalay Road, #17-01 Clinical Sciences Building, 308232, Singapore.,Department of Dermatology, Cologne Excellence Cluster on Stress Responses in Aging Associated Diseases (CECAD), and Centre for Molecular Medicine Cologne, The University of Cologne, Joseph-Stelzmann-Straße 26, Cologne, 50931, Germany
| | - Marlon R Schneider
- German Federal Institute for Risk Assessment (BfR), German Centre for the Protection of Laboratory Animals (Bf3R), Max-Dohrn-Straße 8-10, Berlin, 10589, Germany
| | - Mauro Picardo
- Cutaneous Physiopathology and Integrated Centre of Metabolomics Research, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, Rome, 00144, Italy
| | - Xinhong Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore
| | - Maurice A M van Steensel
- Skin Research Institute of Singapore, Agency for Science, Technology and Research, 11 Mandalay Road, #17-01 Clinical Sciences Building, 308232, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore
| | - Ralf Paus
- Centre for Dermatology, School of Biological Sciences, University of Manchester, and NIHR Manchester Biomedical Research Centre, Stopford Building, Oxford Road, Manchester, M13 9PT, U.K.,Dr. Phllip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, RMSB 2023A, Miami, FL, 33136, U.S.A.,Monasterium Laboratory, Mendelstraße 17, Münster, 48149, Germany
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11
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Dutkiewicz J, Szlufik S, Friedman A. "New methods of assessing autonomic disorders in Parkinson disease patients: skin-galvanic reaction". J Neural Transm (Vienna) 2019; 126:1421-1424. [PMID: 31563969 DOI: 10.1007/s00702-019-02060-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 07/27/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to assess quantitatively sweating in PD patients. In the study, the galvanic-skin reaction (GSR) was used. The GSR was tested using eSense Skin Reaction device. The results show that sweating in patients with Parkinson's disease on drugs (PD ON) and control patients is similar, while patients with PD without levodopa (PD OFF) have higher perspiration.
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Affiliation(s)
- Justyna Dutkiewicz
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, ul. Kondratowicza 8, 03-242, Warsaw, Poland.
| | - Stanisław Szlufik
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, ul. Kondratowicza 8, 03-242, Warsaw, Poland
| | - Andrzej Friedman
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, ul. Kondratowicza 8, 03-242, Warsaw, Poland
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12
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Laurence M, Benito-León J, Calon F. Malassezia and Parkinson's Disease. Front Neurol 2019; 10:758. [PMID: 31396143 PMCID: PMC6667642 DOI: 10.3389/fneur.2019.00758] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 07/01/2019] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) is a common debilitating neurodegenerative disease caused by a loss of dopamine neurons in the substantia nigra within the central nervous system (CNS). The process leading to this neuronal loss is poorly understood. Seborrheic dermatitis (SD) is a common benign inflammatory condition of the skin which mainly affects lipid-rich regions of the head and trunk. SD is caused by over proliferation of the lipophilic fungus Malassezia. PD and SD are strongly associated. The increased PD risk following an SD diagnosis (OR = 1.69, 95% CI 1.36, 2.1; p < 0.001) reported by Tanner and colleagues remains unexplained. Malassezia were historically considered commensals confined to the skin. However, many recent studies report finding Malassezia in internal organs, including the CNS. This raises the possibility that Malassezia might be directly contributing to PD. Several lines of evidence support this hypothesis. AIDS is causally associated with both parkinsonism and SD, suggesting that weak T cell-mediated control of commensal microbes such as Malassezia might contribute to both. Genetic polymorphisms associated with PD (LRRK2, GBA, PINK1, SPG11, SNCA) increase availability of lipids within human cells, providing a suitable environment for Malassezia. Four LRRK2 polymorphisms which increase PD risk also increase Crohn's disease risk; Crohn's disease is strongly associated with an immune response against fungi, particularly Malassezia. Finally, Malassezia hypha formation and melanin synthesis are stimulated by L-DOPA, which could promote Malassezia invasiveness of dopamine neurons, and contribute to the accumulation of melanin in these neurons. Although Malassezia's presence in the substantia nigra remains to be confirmed, if Malassezia play a role in PD etiology, antifungal drugs should be tested as a possible therapeutic intervention.
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Affiliation(s)
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain.,Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas, Madrid, Spain
| | - Frédéric Calon
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.,Neurosciences Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
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Assessing Biophysical and Physiological Profiles of Scalp Seborrheic Dermatitis in the Thai Population. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5128376. [PMID: 31360714 PMCID: PMC6644260 DOI: 10.1155/2019/5128376] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/02/2019] [Indexed: 12/19/2022]
Abstract
Background Scalp seborrheic dermatitis (SD) is a common and chronic inflammatory skin disease which tends to recur over time. By measuring biophysical properties of the stratum corneum, many studies report abnormal biophysical profiles and their association in various dermatologic diseases. The aim of the study is to analyze the biophysical properties and skin barrier defects of scalp SD compared to healthy controls. Materials and Methods This study is a cross-sectional study assessing the correlation of various biophysical and physiological profiles in scalp SD. Forty-two Thai participants with scalp SD were enrolled in the study and 40 healthy participants were also enrolled as the control group. Both SD and control group were subjected to a one-time biophysical and physiological properties' measurement of transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin surface pH, skin surface lipid, and skin roughness. Results The mean TEWL of lesional skin of SD cases were significantly higher than those of control group (P<0.05). Relating to high mean TEWL, the mean SCH was found to be significantly lower in SD cases (P<0.05). Skin surface lipid was also found to be significantly higher in SD group (P<0.05). However, there were no differences in skin surface pH (P=0.104) and roughness (P=0.308) between the two groups. Pairwise comparison of each subgroup found that moderate and severe SD demonstrated significantly higher mean skin surface lipid than that of control group (P<0.05). Conclusion Scalp SD may be associated with seborrhea in Thai population. Monitoring of SCH, TEWL, and skin surface lipid could be helpful in assessing severity and evaluating the treatment outcome in patients with scalp SD.
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Preclinical signs of Parkinson's disease: A possible association of Parkinson's disease with skin and hair features. Med Hypotheses 2019; 127:100-104. [DOI: 10.1016/j.mehy.2019.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 11/24/2022]
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van Wamelen DJ, Leta V, Podlewska AM, Wan YM, Krbot K, Jaakkola E, Martinez-Martin P, Rizos A, Parry M, Metta V, Ray Chaudhuri K. Exploring hyperhidrosis and related thermoregulatory symptoms as a possible clinical identifier for the dysautonomic subtype of Parkinson's disease. J Neurol 2019; 266:1736-1742. [PMID: 30997572 PMCID: PMC6586713 DOI: 10.1007/s00415-019-09325-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 12/01/2022]
Abstract
Objective To identify associated (non-)motor profiles of Parkinson’s disease (PD) patients with hyperhidrosis as a dominant problem. Methods This is a cross-sectional, exploratory, analysis of participants enrolled in the Non-motor Longitudinal International Study (NILS; UKCRN No: 10084) at the Parkinson’s Centre at King’s College Hospital (London, UK). Hyperhidrosis scores (yes/no) on question 28 of the Non-Motor Symptom Questionnaire were used to classify patients with normal sweat function (n = 172) and excessive sweating (n = 56) (Analysis 1; n = 228). NMS scale (NMSS) question 30 scores were used to stratify participants based on hyperhidrosis severity (Analysis 2; n = 352) using an arbitrary severity grading: absent score 0 (n = 267), mild 1–4 (n = 49), moderate 5–8 (n = 17), and severe 9–12 (n = 19). NMS burden, as well as PD sleep scale (PDSS) scores were then analysed along with other correlates. Results No differences were observed in baseline demographics between groups in either analysis. Patients with hyperhidrosis exhibited significantly higher total NMSS burden compared to those without (p < 0.001). Secondary analyses revealed higher dyskinesia scores, worse quality of life and PDSS scores, and higher anxiety and depression levels in hyperhidrosis patients (p < 0.001). Tertiary analyses revealed higher NMSS item scores for fatigue, sleep initiation, restless legs, urinary urgency, and unexplained pain (p < 0.001). Conclusions Chronic hyperhidrosis appears to be associated with a dysautonomia dominant subtype in PD patients, which is also associated with sleep disorders and a higher rate of dyskinesia (fluctuation-related hyperhidrosis). These data should prompt the concept of hyperhidrosis being used as a simple clinical screening tool to identify PD patients with autonomic symptoms.
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Affiliation(s)
- Daniel J van Wamelen
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neurosciences, De Crespigny Park, London, SE5 8AF, UK. .,Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. .,Radboud University Medical Centre, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
| | - Valentina Leta
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neurosciences, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Aleksandra M Podlewska
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neurosciences, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Yi-Min Wan
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neurosciences, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Katarina Krbot
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neurosciences, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.,Klinik fur Gerontopsychiatrie, Asklepios Nord-Ochsenzoll, Hamburg, Germany
| | - Elina Jaakkola
- Division of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Pablo Martinez-Martin
- National Centre of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Alexandra Rizos
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neurosciences, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Miriam Parry
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neurosciences, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Vinod Metta
- Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Kallol Ray Chaudhuri
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neurosciences, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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Skorvanek M, Bhatia KP. The Skin and Parkinson's Disease: Review of Clinical, Diagnostic, and Therapeutic Issues. Mov Disord Clin Pract 2017; 4:21-31. [PMID: 30363435 PMCID: PMC6174479 DOI: 10.1002/mdc3.12425] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) and the skin are related in a number of ways, including clinical abnormalities of the disease itself and skin-related side effects of dopaminergic medication, pumps, and surgical therapies. Recent advances in understanding the role of α-synuclein suggest skin biopsies as a potential diagnostic or even a premotor marker of PD. METHODS The PubMed database was searched for publications up to October 2015, and the current evidence on skin-related issues in PD was comprehensively summarized. RESULTS The evidence was summarized on the prevalence, etiology, and management of seborrheic dermatitis, sweating dysfunctions, bullous pemphigoid, and malignant melanoma, as well as therapy-related skin disorders, especially those observed in amantadine, rotigotine, apomorphine, and levodopa/carbidopa intestinal gel therapies and deep-brain stimulation. Skin biopsies evaluating the presence of α-synuclein, the density and morphology of cutaneous nerves, and skin fibroblast functions also are discussed. CONCLUSIONS Skin disorders are a common manifestation of PD. However, the exact pathophysiology and prevalence of these disorders are not well understood, and more systematic research is needed in this regard. Peripheral tissue biopsies as a diagnostic marker of PD are an exciting avenue in future PD research, although multiple caveats and pending issues need to be solved before they can be used in routine clinical practice.
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Affiliation(s)
- Matej Skorvanek
- Department of NeurologyP. J. Safarik UniversityKosiceSlovakia
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovakia
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
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Min P, Xi W, Grassetti L, Trisliana Perdanasari A, Torresetti M, Feng S, Su W, Pu Z, Zhang Y, Han S, Zhang YX, Di Benedetto G, Lazzeri D. Sebum Production Alteration after Botulinum Toxin Type A Injections for the Treatment of Forehead Rhytides: A Prospective Randomized Double-Blind Dose-Comparative Clinical Investigation. Aesthet Surg J 2015; 35:600-10. [PMID: 25825422 DOI: 10.1093/asj/sju150] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research has investigated the decrease in human skin sebum after the application of botulinum toxin. Few studies of the mechanism and objective assessments of this phenomenon have been conducted and the correlation between the sebum production and injection dosages or techniques remains unclear. OBJECTIVES We prospectively investigated the sebum regulation and its gradient around the injection site in patients who received intramuscular injections of botulinum toxin A (BTX-A) for forehead rhytides, comparing two injection doses. METHODS Forty-two female volunteers with rhytides on the forehead region were randomly assigned to receive 10 or 20 units of BTX-A, which was administered in five standard injection sites. The baseline and post-treatment sebum production was measured using a Sebumeter. RESULTS Treatment with BTX-A exhibited significant sebum alteration at the injection site of both groups, with a sebum gradient surrounding the injection point. The efficacy did not improve at higher injection doses, with the four-unit regimen generally not being more potent than the two-unit regimen. The sebum production recovered to normal levels at the 16 week follow-up for both treatment groups, indicating that a higher dosage (four units) did not result in a longer duration until relapse compared with the two-unit dose. CONCLUSIONS We determined that the sebum production has a positive correlation with the distance away from the injection point. Intramuscular injection of BTX-A significantly reduces sebum production at the injection site but increases the sebum production of the surrounding skin at a radius of 2.5 cm at the 2, 4, and 8 week follow-ups. LEVEL OF EVIDENCE 2 Therapeutic.
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Affiliation(s)
- Peiru Min
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Wenjing Xi
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Luca Grassetti
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Aurelia Trisliana Perdanasari
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Matteo Torresetti
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Shaoqing Feng
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Weijie Su
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Zheming Pu
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Yan Zhang
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Sheng Han
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Yi Xin Zhang
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Giovanni Di Benedetto
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
| | - Davide Lazzeri
- Drs Min, Xi, and Trisliana Perdanasari are Residents, Drs Feng and Su are Attending Surgeons, Profs Pu and Y Zhang are Associate Professors, and Prof YX Zhang is a Professor and Assistant Chief of the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Prof YX Zhang is also Chief of the Division of Reconstructive Microsurgery. Dr Grassetti is a Consultant Plastic Surgeon, Dr Torresetti is a Resident, and Prof Di Benedetto is a Professor and Chief of the Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy. Dr Han is a Plastic Surgeon in private practice in Shanghai, China. Dr Lazzeri is a Plastic Surgeon in private practice, Villa Salaria Clinic, Rome, Italy
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Arsic Arsenijevic VS, Milobratovic D, Barac AM, Vekic B, Marinkovic J, Kostic VS. A laboratory-based study on patients with Parkinson's disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production. BMC DERMATOLOGY 2014; 14:5. [PMID: 24628775 PMCID: PMC3995588 DOI: 10.1186/1471-5945-14-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/28/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Seborrheic dermatitis (SD) and Parkinson's disease (PD) are frequently associated conditions. Aims of this study were: to determine severity of SD, presence of different species and density of Malassezia yeasts; to assess yeast lipases and phosphatases production in vitro and to compare these results between SD patients with and without PD. METHODS This case-control prospective study was conducted at the Dermatology and Neurology Units, Clinical Centre of Serbia and at the National Medical Mycology Reference Laboratory, University of Belgrade Medical School, Serbia. A total of 90 patients and 70 healthy controls (HC) were investigated: 60 patients with SD (SDN) and 30 patients with SD and PD (SDP). Culture-based mycological examination was carried out on lesional skin (LS) and non-lesional skin (NLS). A yeasts density was determined by counting the Malassezia colony forming units per tape (CFU/tape). Enzymes production by isolated Malassezia was investigated. RESULTS The most patients with SD were male (76.7%; SDP and 63.3%; SDN) and the intensity of SD was dominantly severe or moderate (76.7%; SDP and 75%; SDN). The presence of Malasseziа was high on LS in both groups (87.3%; SDP and 86.7%; SDN) (p=0.667).The highest yeasts density (mean CFU/tape=67.8) was detected on LS in 53% of SDP group and in 21.7% of SDN group (mean CFU/tape=31.9) (p < 0.01). The presence of negative cultures was lower in SDP group (13.3%) in comparison to HC and SDN groups (37% and 31.7%, respectively). Malassezia density on NLS in SDP group (mean CFU/tape=44.3) was significantly higher in comparison to SDN and HC (p=0.018). M. globosa was the most abundant species identified amongst isolates from the SDP group (42.3%) and exhibited high production of phosphatase and lipase in vitro. CONCLUSION From this laboratory-based study a positive correlation between SD, PD, M. globosa incidence, high yeast density and high phosphatase and lipase activity was established. Our data lead to conclusion that local skin performance of PD patient's characterized with increased sebum excretion ratio play a role in SD by stimulation of yeasts replication and enzyme production.
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Dessinioti C, Katsambas A. Seborrheic dermatitis: Etiology, risk factors, and treatments:. Clin Dermatol 2013; 31:343-351. [DOI: 10.1016/j.clindermatol.2013.01.001] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Sampaio ALSB, Mameri ÂCA, Vargas TJDS, Ramos-e-Silva M, Nunes AP, Carneiro SCDS. Dermatite seborreica. An Bras Dermatol 2011; 86:1061-71; quiz 1072-4. [DOI: 10.1590/s0365-05962011000600002] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 03/24/2011] [Indexed: 01/14/2023] Open
Abstract
A dermatite seborreica é uma doença eritêmato-escamativa de caráter crônico-recidivante que acomete entre 1 e 3% da população geral dos Estados Unidos. Possui dois picos de incidência - o primeiro, durante os três primeiros meses de vida, e o segundo, a partir da puberdade, atingindo seu ápice entre os 40 e 60 anos de idade. Os indivíduos HIV positivos têm maior prevalência da doença, que apresenta maior intensidade e tendência à refratariedade ao tratamento. Doenças neurológicas e outras doenças crônicas também estão associadas ao desenvolvimento da dermatite seborreica. Como mecanismo fisiopatogênico, reconhece-se que o fungo Malassezia sp., presente na pele de indivíduos suscetíveis, leve a uma irritação não-imunogênica a partir da produção de metabólitos à base de ácidos graxos insaturados deixados na superfície cutânea. Este artigo faz uma revisão da literatura sobre dermatite seborreica, com ênfase nos aspectos imunogenéticos, formas clínicas e tratamento.
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Mostile G, Jankovic J. Treatment of dysautonomia associated with Parkinson's disease. Parkinsonism Relat Disord 2009; 15 Suppl 3:S224-32. [DOI: 10.1016/s1353-8020(09)70820-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Nakashima T, Sato E, Niwano Y, Kohno M, Muraoka W, Oda T. Inhibitory or scavenging action of ketoconazole and ciclopiroxolamine against reactive oxygen species released by primed inflammatory cells. Br J Dermatol 2007; 156:720-7. [PMID: 17493071 DOI: 10.1111/j.1365-2133.2006.07655.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reactive oxygen species (ROS) released from inflammatory cells constitute one of the critical causative factors in inflammatory skin diseases such as seborrhoeic dermatitis and atopic dermatitis. OBJECTIVES To investigate inhibitory effects of ketoconazole (KCZ) and ciclopiroxolamine (CPO), both of which have been used for the treatment of seborrhoeic dermatitis, on ROS released from inflammatory cells. METHODS The methyl-Cypridina-luciferin analogue-dependent chemiluminescence method was employed for the detection of ROS production by phorbol 12-myristate 13-acetate (PMA)-stimulated inflammatory cells. Moreover, the radical scavenging activities of both agents were examined by using a hypoxanthine-xanthine oxidase system and the stable radical 1,1-diphenyl-2-picrylhydrazyl (DPPH). NADPH oxidase activity was determined in particulate (membrane) fractions prepared from PMA-stimulated RAW 264 x 7 cells, a macrophage-like cell line. RESULTS Both of these antifungal agents inhibited PMA-stimulated ROS production. However, only CPO significantly scavenged both ROS generated by the hypoxanthine-xanthine oxidase system and DPPH, and the scavenging activity of CPO seemed to act on ROS other than superoxide anions. Although KCZ inhibited PMA-stimulated ROS production, it did not show radical-scavenging activities. The inhibition of ROS production by KCZ is probably attributable to the inhibition of NADPH oxidase activity. CONCLUSIONS The mechanism of the inhibitory action of KCZ against PMA-stimulated ROS production is distinct from that of CPO. Knowledge of the inhibitory or scavenging effects of both antifungal agents on ROS released from inflammatory cells may be useful in developing a therapeutic strategy for dermatitis.
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Affiliation(s)
- T Nakashima
- NITE Biological Research Center (NBRC), National Institute of Technology and Evaluation, Chiba, Japan.
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Abstract
BACKGROUND Many endogenous and exogenous factors are known to cause enlarged pilosebaceous pores. Such factors include sex, genetic predisposition, ageing, chronic ultraviolet light exposure, comedogenic xenobiotics, acne and seborrhoea. This study was an attempt to determine the factors related to enlarged pores. OBJECTIVES To assess the relationship of sebum output, age, sex, hormonal factors and severity of acne with pore size. METHODS A prospective, randomized, controlled study was designed. A total of 60 volunteers, 30 males and 30 females, were recruited for this study. Magnified images of pores were taken using a dermoscopic video camera and measured using an image analysis program. The sebum output level was measured with a Sebumeter. RESULTS Using multiple linear regression analysis, increased pore size was significantly associated with increased sebum output level, sex and age. Among the variables, sebum output level correlated most with the pore size followed by male sex. In comparing male and female participants, males had higher correlation between the sebum output level and the pore size (male: r = 0.47, female: r = 0.38). Thus, additional factors seem to influence pore size in females. Pore size was significantly increased during the ovulation phase (P = 0.008), but severity of acne was not significantly associated with the pore size. CONCLUSIONS Enlarged pore sizes are associated with increased sebum output level, age and male sex. In female patients, additional hormonal factors, such as those of the menstrual cycle, affect the pore size.
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Affiliation(s)
- M Roh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, 120-752, Seoul, Korea
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Segal S, Narayanan R, Dalton JT. Therapeutic potential of the SARMs: revisiting the androgen receptor for drug discovery. Expert Opin Investig Drugs 2006; 15:377-87. [PMID: 16548787 DOI: 10.1517/13543784.15.4.377] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Selective androgen receptor modulators (SARMS) bind to the androgen receptor and demonstrate anabolic activity in a variety of tissues; however, unlike testosterone and other anabolic steroids, these nonsteroidal agents are able to induce bone and muscle growth, as well as shrinking the prostate. The potential of SARMS is to maximise the positive attributes of steroidal androgens as well as minimising negative effects, thus providing therapeutic opportunities in a variety of diseases, including muscle wasting associated with burns, cancer, end-stage renal disease, osteoporosis, frailty and hypogonadism. This review summarises androgen physiology, the current status of the R&D of SARMS and potential therapeutic indications for this emerging class of drugs.
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Abstract
UNLABELLED Seborrheic dermatitis is a common inflammation of the skin, occurring most often on the face, scalp and chest. It is closely related to infantile seborrheic dermatitis, or diaper rash. Seborrheic dermatitis is particularly common in patients with Parkinson's disease or with HIV/AIDS. The recent resurgence of interest in Malassezia yeasts has revived the old hypothesis that seborrheic dermatitis is caused by an altered relationship between these skin commensals and the host. Moreover, the success of antifungal medications in treating seborrheic dermatitis provides new evidence for this view. LEARNING OBJECTIVE Upon completing this paper, the reader should be aware of the clinical presentation of seborrheic dermatitis and which populations are at particular risk of developing this disorder. In addition, s/he will be aware of the role of Malassezia yeasts in seborrheic dermatitis and the way in which knowledge of the importance of these yeasts has altered the treatment of this disorder.
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Affiliation(s)
- A K Gupta
- Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook site) and the University of Toronto, Toronto, Canada.
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Biro K, Thaçi D, Ochsendorf FR, Kaufmann R, Boehncke WH. Efficacy of dexpanthenol in skin protection against irritation: a double-blind, placebo-controlled study. Contact Dermatitis 2003; 49:80-4. [PMID: 14641355 DOI: 10.1111/j.0105-1873.2003.00184.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dexpanthenol is popular in treating various dermatoses and in skin care, but few controlled clinical trials have been performed. We investigated the efficacy of dexpanthenol in skin protection against irritation in a randomized, prospective, double-blind, placebo-controlled study. 25 healthy volunteers (age 18-45 years) were treated for the inner aspect of both forearms with either Bepanthol Handbalsam containing 5% dexpanthenol or placebo x2 daily for 26 days. From day 15-22, sodium lauryl sulfate (SLS) 2% was applied to these areas x2 daily. Documentation comprised sebumetry, corneometry, pH value and clinical appearance (photographs). 21 volunteers completed the study, 3 were excluded because of non-compliance and 1 experienced a non-study-related, severe, adverse event. Only corneometry yielded a statistically significant difference, with decreased values following SLS challenge at the placebo sites (P < 0.05). Intraindividual comparisons showed superior results at the dexpanthenol-treated sites in 11 cases and in only 1 case at the placebo site. 6 volunteers experienced an irritant contact dermatitis, with more severe symptoms at the placebo site in 5 cases. In conclusion, dexpanthenol exhibits protective effects against skin irritation. The initiation of a study to evaluate the efficacy of dexpanthenol in preventing irritant occupational contact dermatitis under real workplace conditions is validated.
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Affiliation(s)
- Kathrin Biro
- Department of Dermatology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
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Mastrolonardo M, Diaferio A, Logroscino G. Seborrheic dermatitis, increased sebum excretion, and Parkinson's disease: a survey of (im)possible links. Med Hypotheses 2003; 60:907-11. [PMID: 12699724 DOI: 10.1016/s0306-9877(03)00094-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The concept of skin as a mirror of parkinsonism, dates back at the beginning of the last century. Since then, much evidence has been accumulated supporting a causal association between the neurological disturbance and changes detectable on areas of the integument with the richest sebaceous gland supply, namely seborrheic dermatitis and/or seborrhea. However, the many persisting sources of perplexity weighing on some general aspects of the skin condition itself (lack of standardized diagnostic criteria, high variability of estimates of prevalence, and controversies on etiology and pathomechanisms) must have to date hampered assessment of the real nature, and significance (if any) of the links observed. The three major pathogenical pathways so far conceived in this context will be critically reviewed on the basis of evidences provided in the literature.
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Affiliation(s)
- M Mastrolonardo
- Department of Dermatology, Azienda ospedaliero-universitaria 'Ospedali Riuniti', Foggia, Italy.
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Fischer M, Gemende I, Marsch WC, Fischer PA. Skin function and skin disorders in Parkinson's disease. J Neural Transm (Vienna) 2001; 108:205-13. [PMID: 11314773 DOI: 10.1007/s007020170088] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cutaneous symptoms (seborrhoea and hyperhidrosis) in Parkinson's disease were investigated. In 70 treated patients with Parkinson's disease and 22 control subjects, non-invasive bioengineering methods (sebumetry, corneometry, pH) were carried out on the forehead, sternum and forearm. In addition, concomitant dermatoses and medication were recorded. 18.6% of the patients had seborrhoea on the forehead (>220 microg/cm2), 51.4% showed normal sebum values (100-220 microg/cm2) and 30% a sebostasis (<100 microg/cm2). Males has significantly higher sebum values than females. No relationship between the seborrhoea and the therapy for Morbus Parkinson was found. Patients with hyperhidrosis (n = 36) had significantly lower pH values (p < 0.05) on the forehead than those without hyperhidrosis. 22 patients (31.9%) reported a cold/hot flush and a further 13 (18.8%) had clinical rosacea. Seborrhoea is rare in treated Parkinsonian patients but hyperhidrosis is frequently found. Furthermore, a particular lack of vasostability (flush) appears to be an autonomic dysregulation in the skin related to Morbus Parkinson, which has not been studied to any extent to date.
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Affiliation(s)
- M Fischer
- Department of Dermatology and Venerology, Martin-Luther-University, Halle, Saale, Federal Republic of Germany.
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Wikberg JE, Muceniece R, Mandrika I, Prusis P, Lindblom J, Post C, Skottner A. New aspects on the melanocortins and their receptors. Pharmacol Res 2000; 42:393-420. [PMID: 11023702 DOI: 10.1006/phrs.2000.0725] [Citation(s) in RCA: 257] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Knowledge of melanocortins and their receptors has increased tremendously over the last few years. The cloning of five melanocortin receptors, and the discovery of two endogenous antagonists for these receptors, agouti and agouti-related peptide, have sparked intense interest in the field. Here we give a comprehensive review of the pharmacology, physiology and molecular biology of the melanocortins and their receptors. In particular, we review the roles of the melanocortins in the immune system, behaviour, feeding, the cardiovascular system and melanoma. Moreover, evidence is discussed suggesting that while many of the actions of the melanocortins are mediated via melanocortin receptors, some appear to be mediated via mechanisms distinct from melanocortin receptors.
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Affiliation(s)
- J E Wikberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Box 591 BMC, SE751 24, Sweden.
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