Dermatology Research and Practice The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. IL-1RN VNTR Polymorphism in Adult Dermatomyositis and Systemic Lupus Erythematosus Tue, 19 Aug 2014 13:14:39 +0000 Polymorphisms in the cytokine genes and their natural antagonists are thought to influence the predisposition to dermatomyositis (DM) and systemic lupus erythematosus (SLE). A variable number tandem repeat (VNTR) polymorphism of 86 bp in intron 2 of the interleukin-1 receptor antagonist (IL-1RN) gene leads to the existence of five different alleles which cause differences in the production of both IL-1RA (interleukin-1 receptor antagonist) and IL-1β. The aim of this case-control study was to investigate the association between the IL-1RN VNTR polymorphism and the susceptibility to DM and SLE in Bulgarian patients. Altogether 91 patients, 55 with SLE and 36 with DM, as well as 112 unrelated healthy controls, were included in this study. Only three alleles were identified in both patients and controls ((1) four repeats, (2) two repeats, and (3) five repeats). The IL-2 allele (, OR 2.5, and 95% CI 1.2–5.4) and the 1/2+2/2 genotypes were found prevalent among the SLE patients (, OR 2.6, and 95% CI 1–6.3). No association was found between this polymorphism and the ACR criteria for SLE as well as with the susceptibility to DM. Our results indicate that the IL-1RN VNTR polymorphism might play a role in the susceptibility of SLE but not DM. Zornitsa Kamenarska, Gyulnas Dzhebir, Maria Hristova, Alexey Savov, Anton Vinkov, Radka Kaneva, Vanio Mitev, and Lyubomir Dourmishev Copyright © 2014 Zornitsa Kamenarska et al. All rights reserved. Allergic Contact Dermatitis Is Associated with Significant Oxidative Stress Mon, 11 Aug 2014 12:09:38 +0000 Background. Research has confirmed the involvement of oxidative stress (OxS) in allergic contact dermatitis whilst other inflammation-related biomarkers have been less studied. Objective. To evaluate systemic levels of selected inflammatory markers, OxS indices and adipokines as well as their associations in allergic contact dermatitis. Methods. In 40 patients, interleukin- (IL-) 6, monocyte chemoattractant protein (MCP-1), and IL-10 levels were measured in sera with the Evidence Investigator Cytokine & Growth factors High-Sensitivity Array, total peroxide concentration (TPX) and total antioxidant capacity (TAC) by means of spectrophotometry, and the plasma concentrations of adiponectin and leptin by the quantitative sandwich enzyme immunoassay technique. Results. TNF-α level (P < 0.01) and TPX (P < 0.0001) were increased whilst IL-10 (P < 0.05) and TAC (P < 0.0001) were decreased in the patients as compared to controls. Correlation and multiple linear regression analysis identified both, TPX and TAC (inversely), as possible independent markers for evaluating allergic contact dermatitis. Adiponectin level in patients was increased (P < 0.0001), but neither adiponectin nor leptin correlated significantly with the biomarkers of inflammation or OxS. Conclusion. OxS parameters, especially TPX and OSI, reflect the degree of systemic inflammation associated with allergic contact dermatitis in the best way. The relation between OxS and adiponectin level warrants further studies. S. Kaur, K. Zilmer, V. Leping, and M. Zilmer Copyright © 2014 S. Kaur et al. All rights reserved. The Incidence and Risk Factors for Lower Limb Skin Graft Failure Tue, 15 Jul 2014 13:07:40 +0000 Lower limb skin grafts are thought to have higher failure rates than skin grafts in other sites of the body. Currently, there is a paucity of literature on specific factors associated with lower limb skin graft failure. We present a series of 70 lower limb skin grafts in 50 patients with outcomes at 6 weeks. One-third of lower limb skin grafts went on to fail with increased BMI, peripheral vascular disease, and immunosuppressant medication use identified as significant risk factors. Sumeet Reddy, Falah El-Haddawi, Michael Fancourt, Glenn Farrant, William Gilkison, Nigel Henderson, Stephen Kyle, and Damien Mosquera Copyright © 2014 Sumeet Reddy et al. All rights reserved. Cosmetic Contact Sensitivity in Patients with Melasma: Results of a Pilot Study Mon, 14 Jul 2014 09:58:37 +0000 Background. Some of the patients with melasma perhaps have pigmented cosmetic dermatitis. However, cosmetic contact sensitivity in melasma remains poorly studied particularly in the Indian context. Objectives. To study cosmetic contact sensitivity in patients with melasma. Materials and Methods. 67 (F : M = 55 : 12) consecutive patients with melasma between 19 and 49 years of age were patch tested sequentially during January–December, 2012, with Indian Cosmetic and Fragrance Series, Indian Sunscreen Series, p-phenylenediamine, and patient’s own cosmetic products. Results. 52 (78%) patients were in the age group of 20–40 years. The duration of melasma varied from 1 month to 20 years. Centrofacial, malar, and mandibular patterns were observed in 48 (72%), 18 (27%), and 1 (1%) patients, respectively. Indian Cosmetics and Fragrance Series elicited positive reactions in 29 (43.3%) patients. Cetrimide was the most common contact sensitizers eliciting positivity in 15 (52%) patients, followed by gallate mix in 9 (31%) patients and thiomersal in 7 (24%) patients. Only 2 of the 42 patients showed positive reaction from their own cosmetics while the other 5 patients had irritant reaction. Indian Sunscreen Series did not elicit any positive reaction. Conclusion. Cosmetics contact sensitivity appears as an important cause of melasma not associated with pregnancy, lactation, or hormone therapy. Neel Prabha, Vikram K. Mahajan, Karaninder S. Mehta, Pushpinder S. Chauhan, and Mrinal Gupta Copyright © 2014 Neel Prabha et al. All rights reserved. Pathogenesis of Chronic Urticaria: An Overview Thu, 10 Jul 2014 08:36:32 +0000 The pathogenesis of chronic urticaria is not well delineated and the treatment is palliative as it is not tied to the pathomechanism. The centrality of mast cells and their inappropriate activation and degranulation as the key pathophysiological event are well established. The triggering stimuli and the complexity of effector mechanisms remain speculative. Autoimmune origin of chronic urticaria, albeit controversial, is well documented. Numerical and behavioral alterations in basophils accompanied by changes in signaling molecule expression and function as well as aberrant activation of extrinsic pathway of coagulation are other alternative hypotheses. It is also probable that mast cells are involved in the pathogenesis through mechanisms that extend beyond high affinity IgE receptor stimulation. An increasing recognition of chronic urticaria as an immune mediated inflammatory disorder related to altered cytokine-chemokine network consequent to immune dysregulation resulting from disturbed innate immunity is emerging as yet another pathogenic explanation. It is likely that these different pathomechanisms are interlinked rather than independent cascades, acting either synergistically or sequentially to produce clinical expression of chronic urticaria. Insights into the complexities of pathogenesis may provide an impetus to develop safer, efficacious, and targeted immunomodulators and biological treatment for severe, refractory chronic urticaria. Sanjiv Jain Copyright © 2014 Sanjiv Jain. All rights reserved. Zinc Therapy in Dermatology: A Review Thu, 10 Jul 2014 00:00:00 +0000 Zinc, both in elemental or in its salt forms, has been used as a therapeutic modality for centuries. Topical preparations like zinc oxide, calamine, or zinc pyrithione have been in use as photoprotecting, soothing agents or as active ingredient of antidandruff shampoos. Its use has expanded manifold over the years for a number of dermatological conditions including infections (leishmaniasis, warts), inflammatory dermatoses (acne vulgaris, rosacea), pigmentary disorders (melasma), and neoplasias (basal cell carcinoma). Although the role of oral zinc is well-established in human zinc deficiency syndromes including acrodermatitis enteropathica, it is only in recent years that importance of zinc as a micronutrient essential for infant growth and development has been recognized. The paper reviews various dermatological uses of zinc. Mrinal Gupta, Vikram K. Mahajan, Karaninder S. Mehta, and Pushpinder S. Chauhan Copyright © 2014 Mrinal Gupta et al. All rights reserved. Synergistic Effect of Elastic Stockings to Maintain Volume Losses after Mechanical Lymphatic Therapy Thu, 19 Jun 2014 05:27:51 +0000 The objective of the current study was to assess whether Venosan elastic stockings have a synergistic effect on the maintenance of results after Mechanical Lymphatic Therapy. Eleven patients with grade II lymphedema of the legs, regardless of cause, were evaluated in the Clinica Godoy between September and November 2012. The participants’ ages ranged from 53 to 83 years old with a mean of 65.1 years. Two groups were formed with Group I using Venosan elastic stockings and Group II not using any type of compression therapy. Evaluations of the lymphedematous legs were performed before and after each drainage session using bioimpedance. Patients who wore elastic stockings had a greater volume reduction than those who did not wear stockings (unpaired -test: value < 0.001). José Maria Pereira de Godoy, Renata Lopes Pinto, Ana Carolina Pereira de Godoy, and Maria de Fátima Guerreiro Godoy Copyright © 2014 José Maria Pereira de Godoy et al. All rights reserved. Different Trichoscopic Features of Tinea Capitis and Alopecia Areata in Pediatric Patients Mon, 16 Jun 2014 00:00:00 +0000 Background. Diagnosis of patchy hair loss in pediatric patients is often a matter of considerable debate among dermatologists. Trichoscopy is a rapid and noninvasive tool to detect more details of patchy hair loss. Like clinical dermatology, trichoscopy works parallel to the skin surface and perpendicular to the histological plane; like the histopathology, it thus allows the viewing of structures not discovered by the naked eye. Objective. Aiming to compare the different trichoscopic features of tinea capitis and alopecia areata in pediatric patients. Patients and Methods. This study included 40 patients, 20 patients with tinea capitis and 20 patients with alopecia areata. They were exposed toclinical examination, laboratory investigations (10% KOH and fungal culture), and trichoscope examination. Results. Our obtained results reported that, in tinea capitis patients, comma shaped hairs, corkscrew hairs, and zigzag shaped hairs are the diagnostic trichoscopic features of tinea capitis. While in alopecia areata patients, the most trichoscopic specific features were yellow dots, exclamation mark, and short vellus hairs. Conclusion. Trichoscopy can be used as a noninvasive tool for rapid diagnosis of tinea capitis and alopecia areata in pediatric patients. Abd-Elaziz El-Taweel, Fatma El-Esawy, and Osama Abdel-Salam Copyright © 2014 Abd-Elaziz El-Taweel et al. All rights reserved. Retrospective Analysis of Corticosteroid Treatment in Stevens-Johnson Syndrome and/or Toxic Epidermal Necrolysis over a Period of 10 Years in Vajira Hospital, Navamindradhiraj University, Bangkok Sun, 15 Jun 2014 12:41:34 +0000 Background. Stevens-Johnson syndrome (SJS) and/or toxic epidermal necrolysis (TEN) are uncommon and life-threatening drug reaction associated with a high morbidity and mortality. Objective. We studied SJS and/or TEN by conducting a retrospective analysis of 87 patients treated during a 10-year period. Methods. We conducted a retrospective review of the records of all patients with a diagnosis of SJS and/or TEN based on clinical features and histological confirmation of SJS and/or TEN was not available at the Department of Medicine, Vajira hospital, Bangkok, Thailand. The data were collected from two groups from 2003 to 2007 and 2008 to 2012. Results. A total of 87 cases of SJS and/or TEN were found, comprising 44 males and 43 females whose mean age was 46.5 years. The average length of stay was 17 days. Antibiotics, anticonvulsants, and allopurinol were the major culprit drugs in both groups. The mean SCORTEN on admission was 2.1 in first the group while 1.7 in second the group. From 2008 to 2012, thirty-nine patients (76.5%) were treated with corticosteroids while only eight patients (22.2%) were treated between 2003 and 2007. The mortality rate declined from 25% from the first group to 13.7% in the second group. Complications between first and second groups had no significant differences. Conclusions. Short-term corticosteroids may contribute to a reduced mortality rate in SJS and/or TEN without increasing secondary infection. Further well-designed studies are required to compare the effect of corticosteroids treatment for SJS and/or TEN. Wanjarus Roongpisuthipong, Sirikarn Prompongsa, and Theerawut Klangjareonchai Copyright © 2014 Wanjarus Roongpisuthipong et al. All rights reserved. Propranolol in Treatment of Huge and Complicated Infantile Hemangiomas in Egyptian Children Thu, 08 May 2014 16:20:40 +0000 Background. Infantile hemangiomas (IHs) are the most common benign tumours of infancy. Propranolol has recently been reported to be a highly effective treatment for IHs. This study aimed to evaluate the efficacy and side effects of propranolol for treatment of complicated cases of IHs. Patients and Methods. This prospective clinical study included 30 children with huge or complicated IHs; their ages ranged from 2 months to 1 year. They were treated by oral propranolol. Treatment outcomes were clinically evaluated. Results. Superficial cutaneous hemangiomas began to respond to propranolol therapy within one to two weeks after the onset of treatment. The mean treatment period that was needed for the occurrence of complete resolution was 9.4 months. Treatment with propranolol was well tolerated and had few side effects. No rebound growth of the tumors was noted when propranolol dosing stopped except in one case. Conclusion. Propranolol is a promising treatment for IHs without obvious side effects. However, further studies with longer follow-up periods are needed. Basheir A. Hassan and Khalid S. Shreef Copyright © 2014 Basheir A. Hassan and Khalid S. Shreef. All rights reserved. Dermatology Residency Selection Criteria with an Emphasis on Program Characteristics: A National Program Director Survey Mon, 17 Mar 2014 07:10:08 +0000 Background. Dermatology residency programs are relatively diverse in their resident selection process. The authors investigated the importance of 25 dermatology residency selection criteria focusing on differences in program directors’ (PDs’) perception based on specific program demographics. Methods. This cross-sectional nationwide observational survey utilized a 41-item questionnaire that was developed by literature search, brainstorming sessions, and online expert reviews. The data were analyzed utilizing the reliability test, two-step clustering, and -means methods as well as other methods. The main purpose of this study was to investigate the differences in PDs’ perception regarding the importance of the selection criteria based on program demographics. Results. Ninety-five out of 114 PDs (83.3%) responded to the survey. The top five criteria for dermatology residency selection were interview, letters of recommendation, United States Medical Licensing Examination Step I scores, medical school transcripts, and clinical rotations. The following criteria were preferentially ranked based on different program characteristics: “advanced degrees,” “interest in academics,” “reputation of undergraduate and medical school,” “prior unsuccessful attempts to match,” and “number of publications.” Conclusions. Our survey provides up-to-date factual data on dermatology PDs’ perception in this regard. Dermatology residency programs may find the reported data useful in further optimizing their residency selection process. Farzam Gorouhi, Ali Alikhan, Arash Rezaei, and Nasim Fazel Copyright © 2014 Farzam Gorouhi et al. All rights reserved. Epidermal Growth Factor Receptor Inhibitors: A Review of Cutaneous Adverse Events and Management Sun, 02 Mar 2014 11:19:52 +0000 Epidermal growth factor inhibitors (EGFRI), the first targeted cancer therapy, are currently an essential treatment for many advance-stage epithelial cancers. These agents have the superior ability to target cancers cells and better safety profile compared to conventional chemotherapies. However, cutaneous adverse events are common due to the interference of epidermal growth factor receptor (EGFR) signaling in the skin. Cutaneous toxicities lead to poor compliance, drug cessation, and psychosocial discomfort. This paper summarizes the current knowledge concerning the presentation and management of skin toxicity from EGFRI. The common dermatologic adverse events are papulopustules and xerosis. Less common findings are paronychia, regulatory abnormalities of hair growth, maculopapular rash, mucositis, and postinflammatory hyperpigmentation. Radiation enhances EGFRI rash due to synergistic toxicity. There is a positive correlation between the occurrence and severity of cutaneous adverse effects and tumor response. To date, prophylactic systemic tetracycline and tetracycline class antibiotics have proven to be the most effective treatment regime. K. Chanprapaph, V. Vachiramon, and P. Rattanakaemakorn Copyright © 2014 K. Chanprapaph et al. All rights reserved. Comparison the Efficacy of Fluconazole and Terbinafine in Patients with Moderate to Severe Seborrheic Dermatitis Tue, 18 Feb 2014 07:12:16 +0000 Background. Topical agents can be unpleasant due to long-term therapies in patients with moderate to severe seborrheic dermatitis. Systemic antifungal therapy is another alternative in treatment. Aim. This study was conducted to compare the efficacy of oral fluconazole and terbinafine in the treatment of moderate to severe seborrheic dermatitis. Methods. 64 patients with moderate to severe seborrheic dermatitis (SD) were enrolled in a randomized, parallel-group study. One study group took terbinafine 250 mg daily () and the other one fluconazole 300 mg () weekly for four weeks. Seborrheic dermatitis area severity index (SDASI) and the intensity of itching were calculated before, at the end of treatment, and two weeks after treatment. Results. Both drugs significantly reduced the severity of seborrheic dermatitis (). Multivariate linear regression revealed that efficacy of terbinafine is more than fluconazole (, 95% CI (0.63–4.7)). Moreover, each index of SD severity reduced 0.9 times after treatment. (, 95% CI (0.8–1.02)). The itching rate significantly diminished (); however, there was no difference between these two drugs statistically. Conclusions. Both systemic antifungal therapies may reduce the severity index of SD. However, terbinafine showed more reduction in the intensity of the disease. In other words, the more the primary intensity of the disease is, the more its reduction will be. This trial is resgistered with 201102205871N1. Narges Alizadeh, Hamed Monadi Nori, Javad Golchi, Shahriar S. Eshkevari, Ehsan Kazemnejad, and Abbas Darjani Copyright © 2014 Narges Alizadeh et al. All rights reserved. Skin Biopsy in the Context of Dermatological Diagnosis: A Retrospective Cohort Study Thu, 30 Jan 2014 09:24:33 +0000 Background. Skin biopsy is an established method for allying the dermatologist in overcoming the diagnostic dilemmas which occur during consultations. However neither do all skin biopsies produce a conclusive diagnosis nor the dermatologists routinely perform this procedure to every patient they consult. The aim of this study was to investigate the favourable clinical diagnoses set by dermatologists when performing skin biopsy, the diagnoses reached by the dermatopathologists after microscopic examination, and the relationship between them and finally to comment on the instances that skin biopsy fails to fulfill the diagnostic task. Methods. Six thousand eight hundred and sixteen biopsy specimens were reviewed and descriptive statistics were performed. Results. The mean age of the patients was years, the most common site of biopsy was the head and neck (38.3%), the most frequently proposed clinical diagnoses included malignancies (19.28%), and the most prevalent pathological diagnosis was epitheliomas (21.9%). After microscopic examination, a specific histological diagnosis was proposed in 83.29% of the cases and a consensus between clinical and histological diagnoses was observed in 68% of them. Conclusions. Although there are cases that skin biopsy exhibits diagnostic inefficiency, it remains a valuable aid for the dermatology clinical practice. Chrysovalantis Korfitis, Stamatis Gregoriou, Christina Antoniou, Andreas D. Katsambas, and Dimitris Rigopoulos Copyright © 2014 Chrysovalantis Korfitis et al. All rights reserved. Type I Interferons: Key Players in Normal Skin and Select Cutaneous Malignancies Sun, 05 Jan 2014 14:01:50 +0000 Interferons (IFNs) are a family of naturally existing glycoproteins known for their antiviral activity and their ability to influence the behavior of normal and transformed cell types. Type I Interferons include IFN-α and IFN-β. Currently, IFN-α has numerous approved antitumor applications, including malignant melanoma, in which IFN-α has been shown to increase relapse free survival. Moreover, IFN-α has been successfully used in the intralesional treatment of cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). In spite of these promising clinical results; however, there exists a paucity of knowledge on the precise anti-tumor action of IFN-α/β at the cellular and molecular levels in cutaneous malignancies such as SCC, BCC, and melanoma. This review summarizes current knowledge on the extent to which Type I IFN influences proliferation, apoptosis, angiogenesis, and immune function in normal skin, cutaneous SCC, BCC, and melanoma. Aimen Ismail and Nabiha Yusuf Copyright © 2014 Aimen Ismail and Nabiha Yusuf. All rights reserved. Health-Care Delay in Malignant Melanoma: Various Pathways to Diagnosis and Treatment Sun, 05 Jan 2014 12:27:15 +0000 We aimed to describe and compare patients diagnosed with malignant melanoma (MM), depending on their initial contact with care and with regard to age, sex, and MM type and thickness, and to explore pathways and time intervals (lead times) between clinics from the initial contact to diagnosis and treatment. The sample from northern Sweden was identified via the Swedish melanoma register. Data regarding pathways in health care were retrieved from patient records. In our unselected population of 71 people diagnosed with skin melanoma of SSM and NM types, 75% of patients were primarily treated by primary health-care centres (PHCs). The time interval (delay) from primary excision until registration of the histopathological assessment in the medical records was significantly longer in PHCs than in hospital-based and dermatological clinics (Derm). Thicker tumors were more common in the PHC group. Older patients waited longer times for wide excision. Most MM are excised rapidly at PHCs, but some patients may not be diagnosed and treated in time. Delay of registration of results from histopathological assessments within PHCs seems to be an important issue for future improvement. Exploring shortcomings in MM patients’ clinical pathways is important to improve the quality of care and patient safety. Senada Hajdarevic, Åsa Hörnsten, Elisabet Sundbom, Ulf Isaksson, and Marcus Schmitt-Egenolf Copyright © 2014 Senada Hajdarevic et al. All rights reserved. Effect of Narrow Band Ultraviolet B Therapy versus Methotrexate on Serum Levels of Interleukin-17 and Interleukin-23 in Egyptian Patients with Severe Psoriasis Tue, 31 Dec 2013 13:16:15 +0000 Background. There is raised interest in the involvement of interleukin-(IL-)23/T-helper 17 cells (Th17) axis in the pathogenesis of psoriasis. Objectives. To compare the effect of narrow band ultraviolet B (NB-UVB) and methotrexate (MTX) therapy on serum levels of IL-17 and IL-23 in psoriatic patients. Methods. Thirty patients with severe plaque psoriasis were included: 15 patients received NB-UVB three times weekly (group I) and 15 patients received MTX 0.3 mg/kg per week (group II), both for 8 weeks. Before and after treatment, serum levels of IL-17 and IL-23 were investigated by ELISA technique and psoriasis area and severity index (PASI) was calculated. Results. After treatment, all patients showed a reduction in their PASI score, IL-17 and IL-23 serum levels with a nonsignificant difference between both therapeutic modalities ( value ). A positive correlation was detected between the percent of reduction of IL-17, IL-23 and the percent of reduction of PASI score for patients receiving both treatments. No correlation was found between the percent of reduction of IL-17, IL-23 and duration of disease or age of all patients in this study. Conclusion. Interleukin-17 and IL-23 serum level may serve as a potential biomarker for predicting the prognosis and therapeutic response of NB-UVB or MTX in treating psoriasis. Tarek Mahmoud Elghandour, Sahar El Sayed Youssef, Dalia Gamal Aly, Mohamed Said Abd Elhameed, and Mehrevan Mostafa Abdel Moneim Copyright © 2013 Tarek Mahmoud Elghandour et al. All rights reserved. Polydeoxyribonucleotide Dermal Infiltration in Male Genital Lichen Sclerosus: Adjuvant Effects during Topical Therapy Mon, 30 Dec 2013 18:14:11 +0000 Background. Lichen sclerosus (LS) is an autoimmune inflammatory skin disease that leads to tissue sclerosis. Actually, the first-line treatment consists of local steroid as clobetasol propionate (CP). Polydeoxyribonucleotide (PDRN) has demonstrated anti-inflammatory effects through the reduction of cytokine production and growth stimulation of fibroblast. Objective. To evaluate the efficacy of intradermal administration of PDRN in male patients suffering from genital lichen sclerosus in addition to topical 0.05% CP, as compared to administering 0.05% CP without PDRN injection. Patients/Methods. A group of male patients ( = 28; aged 25 to 65) suffering from LS were observed during topical therapy or subdermal in addition to topical therapy. Disease activity at baseline was evaluated on Investigator’s Global Assessment (IGA) and the Dermatology Life Quality Index (DLQI). We used polydeoxyribonucleotide in a commercial preparation for human use and a topical CP emulsion. Results. After therapy, in all group A patients there has been a regression of most of clinical pathological signs, while there has been a moderate improvement in all group B patients. Conclusions. On site intradermal administration of PDRN, associated with CP 0.05% cream, seemed to be associated with a clinical improvement of lichen sclerosus better than CP used in single therapy. Luigi Laino, Silvia Suetti, and Isabella Sperduti Copyright © 2013 Luigi Laino et al. All rights reserved. The Effect of Q-Switched Nd:YAG 1064 nm/532 nm Laser in the Treatment of Onychomycosis In Vivo Sat, 14 Dec 2013 10:56:38 +0000 In this prospective clinical study, the Q-Switched Nd:YAG 1064 nm/532 nm laser (Light Age, Inc., Somerset, NJ, USA) was used on 131 onychomycosis subjects (94 females, 37 males; ages 18 to 68 years). Mycotic cultures were taken and fungus types were detected. The laser protocol included two sessions with a one-month interval. Treatment duration was approximately 15 minutes per session and patients were observed over a 3-month time period. Laser fluencies of 14 J/cm2 were applied at 9 billionths of a second pulse duration and at 5 Hz frequency. Follow-up was performed at 3 months with mycological cultures. Before and after digital photographs were taken. Adverse effects were recorded and all participants completed “self-evaluation questionnaires” rating their level of satisfaction. All subjects were well satisfied with the treatments, there were no noticeable side effects, and no significant differences were found treating men versus women. At the 3-month follow-up 95.42% of the patients were laboratory mycologically cured of fungal infection. This clinical study demonstrates that fungal nail infections can be effectively and safely treated with Q-Switched Nd:YAG 1064 nm/532 nm laser. It can also be combined with systemic oral antifungals providing more limited treatment time. Kostas Kalokasidis, Meltem Onder, Myrto-Georgia Trakatelli, Bertrand Richert, and Klaus Fritz Copyright © 2013 Kostas Kalokasidis et al. All rights reserved. Evaluating of Life Quality in Patients with Acne Vulgaris Using Generic and Specific Questionnaires Mon, 25 Nov 2013 09:51:23 +0000 Background. Acne vulgaris is a common skin disease that can adversely affect the quality of life of patients. Objective. The aim of this study was to determine the quality of life in patients with acne vulgaris. Methods. This study was carried out on 70 patients with acne vulgaris (28 males, 42 females). All the patients filled out two Persian versions of questionnaires: short form 36 (SF-36) and Dermatology Life Quality Index (DLQI). The obtained data were analyzed by using SPSS software (version 17). Results. The scores for physical functioning, social functioning, and bodily pain domains in patients were over 70%, but the scores for role physical, general health, vitality, role emotional, and mental health in patients were under 70%. Scores on the DLQI in patients with acne vulgaris ranged from 0 to 22 (mean ± SD, 8.18 ± 4.83). After comparing mean score of DLQI with respect to gender and age, it was found that the difference between the two groups was not statistically significant. Conclusion. Acne vulgaris has a significant effect on the quality of life. There was not any significant gender or age related difference in QOL. Reza Ghaderi, Alireza Saadatjoo, and Faezeh Ghaderi Copyright © 2013 Reza Ghaderi et al. All rights reserved. Efficacy of Onabotulinum Toxin A (Botox) versus Abobotulinum Toxin A (Dysport) Using a Conversion Factor (1 : 2.5) in Treatment of Primary Palmar Hyperhidrosis Tue, 22 Oct 2013 18:40:55 +0000 Background. Two preparations of botulinum A toxin (BTX-A) are commercially available for the treatment of palmar hyperhidrosis (PPH): Botox (Allergan; 100 U/vial) and Dysport (Ipsen Limited; 500 U/vial), which are not bioequivalent. Results regarding an appropriate conversion factor between them are controversial. Objectives. This paper aims to compare the efficacy of Botox and Dysport in PPH using a conversion factor of 1 : 2.5. Methods. Eight patients with severe PPH received intradermal injections of Botox in one palm and Dysport in the other in the same session. Clinical assessment was performed at baseline and posttreatment for 8 months using Minor’s iodine starch test, Hyperhidrosis Disease Severity Scale (HDSS), and Dermatology Life Quality Index (DLQI) test. Results. At 3 weeks, a significant decrease in sweating for both preparations was noted which was more pronounced with Dysport compared with Botox. At 8 weeks, this difference turned insignificant. Continued evaluation showed similar improvement in both palms with a nonsignificant difference. Patients with longer disease duration were more liable to relapse. Conclusion. The efficacy and safety of Botox and Dysport injections were similar using a conversion factor of 1 : 2.5. There was a trend towards a more rapid action after Dysport treatment but without significant importance. Hanan Mohamed El Kahky, Heba Mahmoud Diab, Dalia Gamal Aly, and Nehal Magdi Farag Copyright © 2013 Hanan Mohamed El Kahky et al. All rights reserved. Effect of Capacitive Radiofrequency on the Fibrosis of Patients with Cellulite Thu, 10 Oct 2013 08:53:16 +0000 Background. Cellulite is a type of lipodystrophy that develops primarily from an alteration in blood circulation or of the lymphatic system that causes structural changes in subcutaneous adipose tissue, collagen, and adjacent proteoglycans. The radiofrequency devices used for cutaneous applications have shown different physiological treatment effects, but there is controversy about the suitable parameters for this type of treatment. Objectives. The aim of this study was to evaluate the effects of low-temperature radiofrequency to confirm the thinning of the collagen tissue and interlobular septa and consequent improvement of cellulite. Methods. A sample of eight women was used to collect ultrasonographic data with a 12 MHz probe that measured collagen fiber thickness. The Vip Electromedicina (Argentina) device, frequency of 0.55 MHz and active electrode 3.5 cm in diameter (area = 9.61 cm2), was applied to a 10 cm2 region of the gluteal region for 2 minutes per area of active electrode, during 10 biweekly sessions. Results. The Wilcoxon matched paired test was applied using GraphPad InStat 3.01 for Win95-NT software. Pre- and posttreatment mean collagen fiber thickness showed a 24.66% reduction from 1.01 to 0.67 mm. Statistical analysis using the Wilcoxon matched paired test obtained a significant two-tailed P value of 0.0391. Conclusion. It was concluded that the use of more comfortable temperatures favored a reduction in fibrous septum thickness and consequent cellulite improvement, evidenced by the lower degree of severity and decrease in interlobular septal thickness. Rodrigo Marcel Valentim da Silva, Priscila Arend Barichello, Melyssa Lima Medeiros, Waléria Cristina Miranda de Mendonça, Jung Siung Camel Dantas, Oscar Ariel Ronzio, Patricia Meyer Froes, and Hassan Galadari Copyright © 2013 Rodrigo Marcel Valentim da Silva et al. All rights reserved. Skin Cancer Knowledge, Beliefs, Self-Efficacy, and Preventative Behaviors among North Mississippi Landscapers Mon, 07 Oct 2013 08:27:26 +0000 There are slightly over one million workers in the landscape service industry in the US. These workers have potential for high levels of solar ultraviolet radiation exposure, increasing their risk of skin cancer. A cross-sectional sample of 109 landscapers completed a self-administered questionnaire based on Health Belief Model (HBM). The participants correctly answered 67.1% of the knowledge questions, 69.7% believed they were more likely than the average person to get skin cancer, and 87.2% perceived skin cancer as a severe disease. Participants believed that the use of wide-brimmed hats, long sleeved shirts/long pants, and sunscreen was beneficial but reported low usage of these and other sun protective strategies. The primary barriers to using sun protection were “I forget to wear it” and “it is too hot to wear.” Of the HBM variables, perceived benefits outweighing perceived barrier (, ) and self-efficacy (, ) were correlated with sun protection behaviors. The reasons for absence of the relationship between perceived skin cancer threat and sun protection behaviors could be lack of skin cancer knowledge and low rate of personal skin cancer history. Vinayak K. Nahar, M. Allison Ford, Jeffrey S. Hallam, Martha A. Bass, Amanda Hutcheson, and Michael A. Vice Copyright © 2013 Vinayak K. Nahar et al. All rights reserved. Evaluation of the Quantitative and Qualitative Alterations in the Fatty Acid Contents of the Sebum of Patients with Inflammatory Acne during Treatment with Systemic Lymecycline and/or Oral Fatty Acid Supplementation Thu, 26 Sep 2013 18:12:03 +0000 Background. Acne is a dermatosis that involves an altered sebum pattern. Objectives. (1) To evaluate if a treatment based on antibiotics (lymecycline) can alter fatty acids contents of the sebum of patients with acne; (2) to evaluate if oral supplementation of fatty acids can interfere with fatty acids contents of the sebum of patients with acne; (3) to evaluate if there is any interaction in fatty acids contents of the sebum of patients with acne when they use both antibiotics and oral supplementation of fatty acids. Methods. Forty-five male volunteers with inflammatory acne vulgaris were treated with 300 mg of lymecycline per day, with 540 mg of -linolenic acid, 1,200 mg of linoleic acid, and 510 mg of oleic acid per day, or with both regimens for 90 days. Every 30 days, a sample of sebum from the forehead was collected for fatty acids’ chromatographic analysis. Results. Twelve fatty acids studied exhibited some kind of pattern changes during the study: C12:0, C14:0, C15:0, C16:1, C18:0, C18:1n9c+C18:1n9t, C18:2n6t, C18:3n6, C18:3n3, C20:1, C22:0, and C24:0. Conclusions. The daily administration of lymecycline and/or specific fatty acids may slightly influence some fatty acids levels present in the sebum of patients with inflammatory acne vulgaris. Adilson Costa, Aline Siqueira Talarico, Carla de Oliveira Parra Duarte, Caroline Silva Pereira, Ellem Tatiani de Souza Weimann, Lissa Sabino de Matos, Livia Carolina Della Coletta, Maria Carolina Fidelis, Thaísa Saddi Tannous, and Cidia Vasconcellos Copyright © 2013 Adilson Costa et al. All rights reserved. Chronic Urticaria: Indian Context—Challenges and Treatment Options Tue, 24 Sep 2013 10:46:32 +0000 Urticaria is a common condition that occurs in both children and adults. Most cases have no specific allergic trigger and the aetiology of urticaria remains idiopathic and occasionally spontaneous in nature. Inappropriate advice such as avoidance of foods (milk, egg, prawn, and brinjal) is common place in certain sections of India mostly by nonspecialists that should not be routinely recommended. It is important to look for physical urticarias such as pressure urticaria in chronic cases, which may be present either alone or in combination with other causes. Autoimmune causes for chronic urticaria have been found to play an important role in a significant proportion of patients. Long-acting nonsedating antihistamines at higher than the standard doses is safe and effective. Quality of life is affected adversely in patients with chronic symptomatic urticaria and some may require multidisciplinary management. Sujoy Khan, Anirban Maitra, Pravin Hissaria, Sitesh Roy, Mahesh Padukudru Anand, Nalin Nag, and Harpal Singh Copyright © 2013 Sujoy Khan et al. All rights reserved. Clinical and Capillaroscopic Modifications of the Psoriatic Plaque during Therapy: Observations with Oral Acitretin Mon, 23 Sep 2013 08:46:12 +0000 Psoriasis is considered to be an inflammatory autoimmune disease, where angiogenesis plays an undefined pathogenetic role. The well-known changes of the superficial microvasculature in the psoriatic plaque can be easily assessed in vivo by videocapillaroscopy. In the last years, several studies reported the clinical and capillaroscopic response of the psoriatic plaque during different topical and systemic treatments. In the present work we evaluated the effects of acitretin (0.8 mg/kg/day) on videocapillaroscopic alterations and the clinical response in 11 patients affected by plaque psoriasis at the baseline (T0) and after 4 (T1), 8 (T2), and 12 (T3) weeks. A clinical improvement during the treatment with a complete clinical healing of the plaque in 7 of the 11 patients was observed. The typical “basket-weave” capillaries of the psoriatic lesions showed a reduction of 65.4% in diameter at the end of the study; only 3 patients returned to a normal capillaroscopic pattern. As observed during previous our studies, we found a discrepancy between clinical and capillaroscopic results, with a far greater improvement in the first than in the second. This finding could be in agreement with a secondary role of blood vessels in the pathogenesis and persistence of psoriatic lesions. Giuseppe Stinco, Cinzia Buligan, Enzo Errichetti, Francesca Valent, and Pasquale Patrone Copyright © 2013 Giuseppe Stinco et al. All rights reserved. The Importance of Trichoscopy in Clinical Practice Thu, 19 Sep 2013 08:55:41 +0000 Trichoscopy corresponds to scalp and hair dermoscopy and has been increasingly used as an aid in the diagnosis, follow-up, and prognosis of hair disorders. Herein, we report selected cases harbouring scalp or hair diseases, in whom trichoscopy proved to be a valuable tool in their management. A review of the recent literature on this hot topic was performed comparing the described patterns with our findings in clinically common conditions, as well as in rare hair shaft abnormalities, where trichoscopy may display pathognomonic features. In our view, trichoscopy represents a valuable link between clinical and histological diagnosis. We detailed some trichoscopic patterns, complemented with our original photographs and our insights into nondescribed patterns. Ana Filipa Pedrosa, Paulo Morais, Carmen Lisboa, and Filomena Azevedo Copyright © 2013 Ana Filipa Pedrosa et al. All rights reserved. The Effect of Weight Loss in Obese Patients with Chronic Stable Plaque-Type Psoriasis Wed, 18 Sep 2013 08:17:55 +0000 Background. Chronic plaque psoriasis is frequently associated with obesity. The effect of a low-calorie diet on psoriasis has not been investigated. Objective. The objective was to investigate whether moderate weight loss increases the therapeutic response to topical treatment in obese patients with chronic stable plaque-type psoriasis. Material and Method. A 24-week clinical trial was conducted in 10 patients. The efficacy of a low-calorie diet with topical treatment was compared with baseline in obese patients with chronic stable plaque-type psoriasis. The primary measure of clinical response was the Psoriasis Area and Severity Index at weeks 12 and 24. Results. At week 12, the mean reduction in body weight was 9.6 percent. There was an improvement from baseline of 50 percent or more in the Psoriasis Area and Severity Index in 50 percent of the patients. The responses as measured by improvements in the Psoriasis Area and Severity Index were paralleled by improvements in global assessments by the physician and the patients and in the Dermatology Life Quality Index. Conclusion. Obese patients with chronic stable plaque-type psoriasis increase their response to a low-calorie diet. Lifestyle modifications, including a low-calorie diet, may supplement the pharmacologic treatment of obese psoriasis patients. Wanjarus Roongpisuthipong, Marinya Pongpudpunth, Chulaporn Roongpisuthipong, and Natta Rajatanavin Copyright © 2013 Wanjarus Roongpisuthipong et al. All rights reserved. Cutis Verticis Gyrata in Men Affected by HIV-Related Lipodystrophy Thu, 12 Sep 2013 11:57:52 +0000 We report the occurrence of cutis verticis gyrata (CVG), a disfiguring dermatological condition, in four patients with HIV-related lipodystrophy (HIVLD). These four patients had abnormal metabolic and hormonal lab values which we compare with metabolic and hormonal perturbations cited in previous HIVLD cohorts. In addition, we describe the sole use of poly-L-lactic acid as a potential treatment for decreasing the appearance of CVG-associated ridges. Keshav Khanijow, Patrick Unemori, Kieron S. Leslie, Kathleen Mulligan, Morris Schambelan, and Toby Maurer Copyright © 2013 Keshav Khanijow et al. All rights reserved. Tamarind Seed Xyloglucans Promote Proliferation and Migration of Human Skin Cells through Internalization via Stimulation of Proproliferative Signal Transduction Pathways Mon, 09 Sep 2013 14:41:13 +0000 Xyloglucans (XGs) of Tamarindus indica L. Fabaceae are used as drug vehicles or as ingredients of cosmetics. Two xyloglucans were extracted from T. indica seed with cold water (TSw) and copper complex precipitation (TSc). Both were analyzed in regard to composition and influence on cell viability, proliferation, cell cycle progression, migration, MAPK phosphorylation, and gene expression of human skin keratinocytes (NHEK and HaCaT) and fibroblasts (NHDF) in vitro. TSw and TSc differed in molecular weight, rhamnose content, and ratios of xylose, arabinose, galactose, and glucose. Both XGs improved keratinocytes and fibroblast proliferation, promoted the cell cycle, and stimulated migration and intracellular enzyme activity of NHDF after endosomal uptake. Only TSw significantly enhanced HaCaT migration and extracellular enzyme activity of NHDF and HaCaT. TSw and TSc predominantly enhanced the phosphorylation of molecules that referred to Erk signaling in NHEK. In NHDF parts of the integrin signaling and SAPK/JNK pathway were affected. Independent of cell type TSw marginally regulated the expression of genes, which referred to membrane proteins, cytoskeleton, cytokine signaling, and ECM as well as to processes of metabolism and transcription. Results show that T. indica xyloglucans promote skin regeneration by a direct influence on cell proliferation and migration. W. Nie and A. M. Deters Copyright © 2013 W. Nie and A. M. Deters. All rights reserved.