Dermatology Research and Practice The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Leprosy Continues to Occur in Hilly Areas of North India Sun, 24 Jan 2016 13:09:00 +0000 Background. The aim of present study was to describe the profile of leprosy patients attending the outpatient department of dermatology in tertiary care hospital in Srinagar, Uttarakhand, North India. Methodology. This descriptive retrospective study. Patient data at the time of diagnosis were retrieved onto a predesigned proforma, which concerned the following variables at the time of registration: age, sex, and residence. Newly registered outpatients leprosy cases between 2009 and 2014 were included in the study. Results. It was found that 65 were multibacillary leprosy cases. Males constituted 62.8% of all leprosy cases. The majority (83.7%) belonged to the age group of 18–60 years. Of the total 48.8% of the new leprosy cases were from the Pauri district. The leprosy incidence rate in this population was 2.71 per 1000 patients. Conclusion. Leprosy still continues to be a communicable disease of concern. The lower incidence in women and children provokes the need to strengthen contact screening, early case detection, and referral activities in the population to sustain elimination. Deepak Dimri, Arti Gupta, and Amit Kumar Singh Copyright © 2016 Deepak Dimri et al. All rights reserved. Clinicoepidemiological Observational Study of Acquired Alopecias in Females Correlating with Anemia and Thyroid Function Wed, 20 Jan 2016 09:44:14 +0000 Alopecia can either be inherited or acquired; the latter, more common, can be diffuse, patterned, and focal, each having cicatricial and noncicatricial forms. This observational study of 135 cases in a semiurban Indian population aimed to detect the prevalence of various forms of acquired alopecia in females and correlate the same with levels of hemoglobin, serum ferritin, triiodothyronine, thyroxin, and thyroid stimulating hormone. The majority (84, 62.2%) of our cases of alopecia had telogen effluvium followed by female pattern alopecia (32, 23.7%). Stress (86, 63.7%), topical application of chemicals (72, 53.3%), systemic medications for concurrent illnesses (62, 5%), and pregnancy (14, 10.3%) were the common exacerbating factors. Neither low hemoglobin (<12 gm%, 73.4%) nor low serum ferritin (<12 μg/L, 6.7%) was found to be statistically significant. A majority (90, 90.9%) of 99 cases with anemia (hemoglobin levels of <12 gm%) had serum ferritin levels >12 μg/L. Though lack of vitamin B12 testing was a limitation of our study, its deficiency could be the probable cause of iron deficiency as the majority (58, 64.4%) of these cases, as indeed majority (89, 65.4%) of our study population, were vegetarians. Thyroid disorders (23, 17%, including 9 newly diagnosed) were not of significance statistically. Kirti Deo, Yugal K. Sharma, Meenakshi Wadhokar, and Neha Tyagi Copyright © 2016 Kirti Deo et al. All rights reserved. Skin Protection Behaviors among Young Male Latino Day Laborers: An Exploratory Study Using a Social Cognitive Approach Mon, 04 Jan 2016 09:02:05 +0000 Latino Day Laborers (LDLs) are employed in occupations where multiple work hazards exist. One such hazard is the overexposure to solar ultraviolet radiation for continuous periods of time. Regular sun exposure can put individuals at increased risk of developing skin cancers, especially without adequate protection. The purpose of this cross-sectional exploratory study was to use a social cognitive framework to assess skin protective behaviors among LDLs. A community-based nonrandom and purposive sample of LDLs was recruited in two states: Mississippi and Illinois. The study sample consisted of 137 male participants, of which the majority were of Mexican ancestry (72%). The average age was 35.40 () years. Results demonstrated that a substantial number of LDLs do not adequately practice sun protection behaviors on a regular basis. The skin cancer knowledge scores were very modest. The most frequently indicated barriers towards sun protection were “inconvenient,” “forget to use,” and “not being able to reapply sunscreen.” Overall, LDLs had moderate confidence in their abilities to adopt successful sun protection strategies. This study underscores the need for intervention programs aimed at LDLs to reduce extended time in the sun and increase use of sun protective measures when working outdoors. Javier F. Boyas, Vinayak K. Nahar, and Robert T. Brodell Copyright © 2016 Javier F. Boyas et al. All rights reserved. Cryoglobulinaemia in Egyptian Patients with Extrahepatic Cutaneous Manifestations of Chronic Hepatitis C Virus Infection Tue, 29 Dec 2015 12:35:41 +0000 Background. Hepatitis C is a global major health problem with extremely variable extrahepatic manifestations. Mixed cryoglobulinaemia (MC) shows a striking association with hepatitis C virus (HCV) infection, and it is sometimes asymptomatic. The skin is a frequently involved target organ in MC. Objective. To investigate the prevalence of cryoglobulinaemia in a sample of Egyptian patients with cutaneous manifestations of chronic HCV infection and to correlate its presence with clinical criteria and liver function tests. Methods. One hundred and eighteen patients with skin manifestations of chronic compensated hepatitis C were included. Venous blood was tested for liver function tests and serum cryoglobulins. Results. Twelve patients (10.169%) were positive for serum cryoglobulins (2 with pruritus, 4 with vasculitic lesions, 3 with livedo reticularis, one with oral lichen, one with chronic urticaria, and another with Schamberg’s disease). Vasculitic lesions and livedo reticularis of the legs showed higher prevalence in cryoglobulin-positive than in cryoglobulin-negative patients. Presence of serum cryoglobulins did not relate to patients’ demographic or laboratory findings. Conclusions. Fortunately, MC is not markedly prevalent among Egyptians with cutaneous lesions of chronic hepatitis C, and cryopositivity was commonly, but not exclusively, detected with cutaneous vasculitis and livedo reticularis. Laboratory testing for cryoglobulins in every HCV patient is advisable for earlier MC detection and management. Doaa Salah Hegab and Mohammed Abd El Rahman Sweilam Copyright © 2015 Doaa Salah Hegab and Mohammed Abd El Rahman Sweilam. All rights reserved. Evaluation of Subcision for the Correction of the Prominent Nasolabial Folds Wed, 16 Dec 2015 11:31:54 +0000 Background. A prominent nasolabial fold (NLF) is a cosmetic problem. Currently, numerous therapeutic modalities are available for pronounced NLFs with variable efficacy. Objective. To determine the efficacy and safety of subcision using a hypodermic needle for the correction of the prominent NLFs and its effect on skin elasticity. Methods. Sixteen patients with prominent NLFs underwent subcision. The investigators’ assessment of improvement and the patients’ satisfaction were both recorded 1 and 6 months after the procedure. Also, we evaluate the skin elasticity of NLFs before and after the treatment using a sensitive biometrologic device with the measurement of cutaneous resonance running time (CRRT). Results. Thirteen (81.25%) patients showed a moderate improvement at 1st month and 13 (81.25%) patients had at least a mild improvement at 6th month. There was no persistent side effect lasting more than a few days. Mean CRRT at 1 and 6 months after the treatment was significantly higher compared to the baseline. Conclusion. Subcision may be considered effective for the correction of pronounced NLFs. However, further controlled studies with larger sample size are necessary to assess the efficacy of this technique in particular with use of more objective assessment of skin biometric characteristics. This trial is registered with IRCT201108097270N1 (registered on January 27, 2012). R. M. Robati, F. Abdollahimajd, and A. M. Robati Copyright © 2015 R. M. Robati et al. All rights reserved. Decreased Circulating T Regulatory Cells in Egyptian Patients with Nonsegmental Vitiligo: Correlation with Disease Activity Tue, 15 Dec 2015 12:54:12 +0000 Background. Vitiligo is an acquired depigmentary skin disorder resulting from autoimmune destruction of melanocytes. Regulatory T cells (Tregs), specifically CD4+CD25+ and Forkhead box P3+ (FoxP3+) Tregs, acquired notable attention because of their role in a variety of autoimmune pathologies. Dysregulation of Tregs may be one of the factors that can break tolerance to melanocyte self-antigens and contribute to vitiligo pathogenesis. Methods. In order to sustain the role of Tregs in pathogenesis and disease activity of vitiligo, surface markers for CD4+CD25+ and FoxP3+ peripheral Tregs were evaluated by flow cytometry in 80 Egyptian patients with nonsegmental vitiligo in addition to 60 healthy control subjects and correlated with clinical findings. Results. Vitiligo patients had significantly decreased numbers of both peripheral CD4+CD25+ and FoxP3+ T cells compared to control subjects (11.49%  ± 8.58% of CD4+ T cells versus 21.20%  ± 3.08%, and 1.09%  ± 0.96% versus 1.44%  ± 0.24%, resp., for both). Peripheral numbers of CD4+CD25+ and FoxP3+ Tregs correlated negatively with VIDA score. Conclusion. Treg depletion with impaired immune downregulatory function might play a key role in the autoimmune conditions beyond nonsegmental vitiligo particularly in active cases. Effective Treg cell-based immunotherapies might be a future hope for patients with progressive vitiligo. Doaa Salah Hegab and Mohamed Attia Saad Attia Copyright © 2015 Doaa Salah Hegab and Mohamed Attia Saad Attia. All rights reserved. Clinical Features and Drug Characteristics of Patients with Generalized Fixed Drug Eruption in the West of Iran (2005–2014) Thu, 10 Dec 2015 13:36:42 +0000 Background. Generalized fixed drug eruption is a specific variant of fixed drug eruption with multifocal lesions. Diagnosis of this drug reaction is straightforward, but occasionally recognition of the causative drug is not possible. This study was aimed at evaluating the clinical features and culprit drugs in generalized fixed drug eruptions in the west of Iran. Method. This cross-sectional study was carried out on 30 patients with criteria of generalized fixed drug eruption over 9 years. Demographic, clinical, and drug intake information were collected. Results. Out of 30 patients (17 females and 13 males) with the mean age of years, 28 (93.3%) and 2 (6.7%) cases had plaque and bullous clinical presentation, respectively. Upper limbs were the most common (90%) site of involvement. The antibiotic group, especially cotrimoxazole (26.1%), was reported to be the most common offending drug, but the causative drug was not determined in 7 (23.3%) patients. Conclusion. Many cases of generalized fixed drug eruption firstly presented as limited lesions and led to generalized lesion due to repeated intake of the causative drug. No causative drug was found in some patients, which might be associated with concurrent intake of several drugs, multiple FDE, and peculiarity of the patch test. Hossein Kavoussi, Mansour Rezaei, Katayoun Derakhshandeh, Alireza Moradi, Ali Ebrahimi, Harif Rashidian, and Reza Kavoussi Copyright © 2015 Hossein Kavoussi et al. All rights reserved. Five-Year Retrospective Review of Acute Generalized Exanthematous Pustulosis Thu, 10 Dec 2015 13:07:35 +0000 Background. Acute generalized exanthematous pustulosis (AGEP) is an acute pustular eruption characterized by widespread nonfollicular sterile pustules. The aim of this study is to characterize the etiology, clinical features, laboratory findings, management, and outcome of patients with AGEP in Asians. Patient/Methods. A retrospective analysis was performed on patient who presented with AGEP between August 2008 and November 2012 in a tertiary center in Thailand. Results. Nineteen patients with AGEP were included. AGEP was generally distributed in seventeen patients (89.5%) and localized in two (10.5%). Fever and neutrophilia occurred in 52.6% and 68.4%, respectively. Hepatitis was found up to 26.3%. The most common etiology was drugs (94.7%), comprising of antibiotics (73.6%), proton pump inhibitors (10.5%), nonsteroidal anti-inflammatory drugs (5.3%), and herbal medicine (5.3%). Beta-lactams were the most common causal drug, particularly carbapenems and cephalosporins. This is the first report of Andrographis paniculata as an offending agent for AGEP. We found no differences between various treatment regimens (topical corticosteroid, systemic corticosteroid, and supportive treatment) regarding the time from drug cessation to pustules resolution (). Conclusions. We have highlighted the presentation of AGEP among Asians. We found high association with systemic drugs. Carbapenems were one of the leading culprit drugs. Finally, a localized variant was observed. Chitprapassorn Thienvibul, Vasanop Vachiramon, and Kumutnart Chanprapaph Copyright © 2015 Chitprapassorn Thienvibul et al. All rights reserved. Relationship between Vitamin D Status and Striae Distensae: A Case-Referent Study Mon, 09 Nov 2015 09:33:41 +0000 Vitamin D (VD) plays a role in the skin regulation. Striae Distensae (SD) are manifestations of epidermal atrophy that occurs after tissue tearing due to overstretching or rapid growth. The objective of this study was to investigate the relation between serum VD and occurrence of SD in women who had undergone mammaplasty with silicone implants. A case-referent study was conducted. The blood values of 25-hydroxyvitamin D (25OHD) were measured before the surgery. For each patient postoperatively diagnosed with SD, four other participants submitted to the same surgery, without the development of SD, were enrolled as the healthy controls. 67 women with SD after the surgery entered the study. 268 formed the control group. In the serum of healthy controls 25OHD mean was 27 ng/mL, and SD cases presented 20 ng/mL (). Scarce values of VD have been observed in 56.71% of the cases presenting SD and in 39.91% without SD (). Chance of having VD values lower than 20 ng/mL amongst cases with SD is 2.38 (). Lower serum levels of VD are linked to a higher occurrence of SD. Rafaela Koehler Zanella, Denis Souto Valente, Leo Francisco Doncatto, Daniele Dos Santos Rossi, Aline Grimaldi Lerias, and Alexandre Vontobel Padoin Copyright © 2015 Rafaela Koehler Zanella et al. All rights reserved. Epidemiological, Clinical, and Paraclinic Aspect of Cutaneous Sarcoidosis in Black Africans Sun, 08 Nov 2015 06:42:46 +0000 The specific objectives were to identify the epidemiology of cutaneous sarcoidosis and describe the clinical and laboratory aspects of the disease. Materials and Methods. We performed a descriptive cross-sectional study involving 24 referred cases of cutaneous sarcoidosis in 25 years (1990–2014) collected at Venereology Dermatology Department of the University Hospital of Treichville (Abidjan) both in consultation and in hospitalization. Results. The hospital frequency was one case per year. The average age was 42 years, ranging from 9 to 64. The sex ratio was 1. The shortest time interval between the appearance of the skin lesion and consultation of Dermatology Department at CHU Treichville was 3 months. The elementary lesions were represented primarily by a papule (18 cases), placard (3 cases), and nodule (2 cases) and mainly sat on the face and neck in 8 cases (38%). Extra cutaneous lesions were dominated by ganglion and respiratory involvement with 5 cases each followed by musculoskeletal damage in 3 cases. Chest radiography showed abnormality in 13 cases (54%). The pulmonary function test performed in 13 patients found 7 cases (54%) having restrictive ventilatory syndrome and 6 cases (46%) being normal. A tuberculin anergy was found in 11 cases (61%). Mamadou Kaloga, Ildevert Patrice Gbéry, Vagamon Bamba, Yao Isidore Kouassi, Elidjé Joseph Ecra, Almamy Diabate, Sarah Kourouma, Kouadio Celestin Ahogo, Kouassi Alexandre Kouamé, Komenan Kassi, Kanga Kouame, and Abdoulaye Sangaré Copyright © 2015 Mamadou Kaloga et al. All rights reserved. Is There Really Relationship between Androgenetic Alopecia and Metabolic Syndrome? Wed, 04 Nov 2015 12:08:52 +0000 Background. There are several studies investigating the relationship between androgenetic alopecia (AGA) and metabolic syndrome (MS) with conflicting results. Objective. We sought to investigate whether there is a relationship between AGA and MS. Methods. A case-control study including 74 male patients with AGA and 42 male controls was conducted. Age, duration of AGA, AGA onset age, anthropometric measures, body mass index, lipid parameters, fasting blood glucose, blood pressure, and presence of MS were recorded. Results. Of the 74 male AGA patients (age range 20–50 years, mean 32.14), 24 were in stage 2, 26 were in stage 3, 17 were in stage 3V, 1 was in stage 5, and 6 were in stage 7. There was no significant difference in the rate of MS between AGA and control groups . Among the evaluated parameters, only systolic blood pressure in AGA group was significantly higher than control group. Conclusion. In contrast to the most of the previous studies, our study does not support the link between AGA and MS. To exclude confounding factors such as advanced age and therefore metabolic disturbances, further studies are needed with large group of AGA patients including different age groups and varying severity. Seyran Ozbas Gok, Asli Akin Belli, and Emine Dervis Copyright © 2015 Seyran Ozbas Gok et al. All rights reserved. Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy Mon, 02 Nov 2015 12:32:00 +0000 Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy. Christine Sävervall, Freja Lærke Sand, and Simon Francis Thomsen Copyright © 2015 Christine Sävervall et al. All rights reserved. Effect of Narrow-Band Ultraviolet B Phototherapy and Methotrexate on MicroRNA (146a) Levels in Blood of Psoriatic Patients Thu, 29 Oct 2015 06:54:48 +0000 Background. Recently, some miRNAs have been proven to show aberrant expression in psoriasis and play a role in the pathogenesis of the disease. Objective. To find out whether NB-UVB or methotrexate treatment affects whole blood levels of human miRNA (146a) in patients with psoriasis and demonstrate its correlation with disease severity. Methods. Blood samples were obtained from healthy control and from psoriatic patients before and 12 weeks after treatment with NB-UVB, methotrexate. Quantification of human miRNA (146a) by Real Time PCR (RT-PCR). Results. Blood human miRNA (146a) levels were higher in patients with psoriasis than those in healthy controls (); it had no significant positive relation with PASI scores in patients (, ). Real Time PCR showed that, after 12 weeks of treatment with NB-UVB phototherapy or treatment with methotrexate, there was significantly decreased level of miR146a (; , resp.). Conclusion. The expression of miRNA146a is increased in whole blood samples from psoriasis patients, so we can evaluate its possibility to work as a future therapeutic objective in the treatment of psoriasis. With these markers, it is able to screen therapeutics effect or changes to a further aggressive treatment for psoriasis. Asmaa M. Ele-Refaei and Fatma M. El-Esawy Copyright © 2015 Asmaa M. Ele-Refaei and Fatma M. El-Esawy. All rights reserved. Exploring the Physiological Link between Psoriasis and Mood Disorders Thu, 15 Oct 2015 13:16:57 +0000 Psoriasis is a chronic, immune-mediated skin condition with a high rate of psychiatric comorbidity, which often goes unrecognized. Beyond the negative consequences of mood disorders like depression and anxiety on patient quality of life, evidence suggests that these conditions can worsen the severity of psoriatic disease. The mechanisms behind this relationship are not entirely understood, but inflammation seems to be a key feature linking psoriasis with mood disorders, and physiologic modulators of this inflammation, including the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, demonstrate changes with psychopathology that may be contributory. Cyclical disruptions in the secretion of the sleep hormone, melatonin, are also observed in both depression and psoriasis, and with well-recognized anti-inflammatory and antioxidant activity, this aberration may represent a shared contributor to both conditions as well as common comorbidities like diabetes and cardiovascular disease. While understanding the complexities of the biological mechanisms at play will be key in optimizing the management of patients with comorbid psoriasis and depression/anxiety, one thing is certain: recognition of psychiatric comorbidity is an imperative first step in effectively treating these patients as a whole. Evidence that improvement in mood decreases psoriasis severity underscores how psychological awareness can be critical to clinicians in their practice. Cody J. Connor, Vincent Liu, and Jess G. Fiedorowicz Copyright © 2015 Cody J. Connor et al. All rights reserved. Leprosy Reaction in Thai Population: A 20-Year Retrospective Study Mon, 05 Oct 2015 06:31:09 +0000 Background. Leprosy is a chronic infectious disease that presents with varying dermatological and neurological symptoms. The leprosy reactions occur over the chronic course of the disease and lead to extensive disability and morbidity. Objective. To analyze and identify the risk factors which contribute to leprosy reactions. Methods. In a retrospective study, we reviewed the medical records of leprosy patients registered at the leprosy clinic, Ramathibodi Hospital, Thailand, between March 1995 and April 2015. One hundred and eight patients were included; descriptive analysis was used for baseline characteristics and a binary logistic regression model was applied for identifying risk factors correlated with leprosy reactions. Results. Of the 108 cases analyzed, 51 were male and 57 were female. The mean age of presentation was 45 years. The borderline tuberculoid type was the most common clinical form. Leprosy reactions were documented in 61 cases (56.5%). The average time to reaction was 8.9 months. From multivariate analysis, risk factors for leprosy reactions were being female, positive bacillary index status, and MB treatment regimen. Conclusions. Leprosy reactions are common complications in leprosy patients. Being female, positive bacillary index status, and multibacillary treatment regimen are significantly associated with the reactions. Early detection in cases with risk factors followed by appropriate treatment could prevent the morbidity of leprosy patients. Poonkiat Suchonwanit, Siripich Triamchaisri, Sanchawan Wittayakornrerk, and Ploysyne Rattanakaemakorn Copyright © 2015 Poonkiat Suchonwanit et al. All rights reserved. Study of the Etiological Causes of Toe Web Space Lesions in Cairo, Egypt Mon, 21 Sep 2015 12:29:48 +0000 Background. The etiology of foot intertrigo is varied. Several pathogens and skin conditions might play a role in toe web space lesions. Objective. To identify the possible etiological causes of toe web space lesions. Methods. 100 Egyptian patients were enrolled in this study (72 females and 28 males). Their ages ranged from 18 to 79 years. For every patient, detailed history taking, general and skin examinations, and investigations including Wood’s light examination, skin scraping for potassium hydroxide test, skin swabs for bacterial isolation, and skin biopsy all were done. Results. Among the 100 patients, positive Wood’s light fluorescence was observed in 24 and positive bacterial growth was observed in 85. With skin biopsy, 52 patients showed features characteristic for eczema, 25 showed features characteristic for fungus, 19 showed features characteristic for callosity, and 3 showed features characteristic for wart while in only 1 patient the features were characteristic for lichen planus. Conclusion. Toe web space lesions are caused by different etiological factors. The most common was interdigital eczema (52%) followed by fungal infection (25%). We suggest that patients who do not respond to antifungals should be reexamined for another primary or secondary dermatologic condition that may resemble interdigital fungal infection. Hussein Mohamed Hassab-El-Naby, Yasser Fathy Mohamed, Hamed Mohamed Abdo, Mohamed Ismail Kamel, Wael Refaat Hablas, and Osama Khalil Mohamed Copyright © 2015 Hussein Mohamed Hassab-El-Naby et al. All rights reserved. Some Epidemiological Aspects of Cutaneous Leishmaniasis in a New Focus, Central Iran Mon, 21 Sep 2015 08:42:57 +0000 Following the epidemic of cutaneous leishmaniasis in Khatam County, Yazd Province, this study was carried out to determine vector, and animal reservoir host(s) and investigate the human infection during 2005-2006. Four rural districts where the disease had higher prevalence were selected. Sticky paper traps were used to collect sand flies during April to November, biweekly. Meanwhile rodents were captured using Sherman traps from August to November. Households and primary schools were visited and examined for human infection in February 2006. The parasite was detected by RAPD-PCR method. The rate of ulcers and scars among the inhabitants was 4.8% and 9.8%, respectively. Three rodent species were captured during the study: Meriones libycus, Rhombomys opimus, and Tatera indica. Six sand fly species were also collected and identified; among them Phlebotomus papatasi had the highest frequency. Leishmania major was detected as the agent of the disease in the area. It was detected from R. opimus and native people. M. R. Yaghoobi-Ershadi, N. Marvi-Moghadam, R. Jafari, A. A. Akhavan, H. Solimani, A. R. Zahrai-Ramazani, M. H. Arandian, and A. R. Dehghan-Dehnavi Copyright © 2015 M. R. Yaghoobi-Ershadi et al. All rights reserved. Actinic Keratosis Clinical Practice Guidelines: An Appraisal of Quality Wed, 16 Sep 2015 09:25:00 +0000 Actinic keratosis (AK) is a common precancerous skin lesion and many AK management guidelines exist, but there has been limited investigation into the quality of these documents. The objective of this study was to assess the strengths and weaknesses of guidelines that address AK management. A systematic search for guidelines with recommendations for AK was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE II) was used to appraise the quality of guidelines. Multiple raters independently reviewed each of the guidelines and applied the AGREE II tool and scores were calculated. Overall, 2,307 citations were identified and 7 fulfilled the study criteria. The Cancer Council of Australia/Australian Cancer Network guideline had the highest mean scores and was the only guideline to include a systematic review, include an evidence rating for recommendations, and report conflicts of interest and funding sources. High-quality, effective guidelines are evidence-based with recommendations that are concise and organized, so practical application is facilitated. Features such as concise tables, pictorial diagrams, and explicit links to evidence are helpful. However, the rigor and validity of some guidelines were weak. So, it is important for providers to be aware of the features that contribute to a high-quality, practical document. Joslyn S. Kirby, Thomas Scharnitz, Elizabeth V. Seiverling, Hadjh Ahrns, and Sara Ferguson Copyright © 2015 Joslyn S. Kirby et al. All rights reserved. Collagen and Elastic Fiber Content Correlation Analysis between Horizontal and Vertical Orientations of Skin Samples of Human Body Mon, 14 Sep 2015 11:20:49 +0000 Background. Unequal distribution of dermal collagen and elastic fibers in different orientations of skin is reported to be one of the multifocal causes of scar related complications. Present study is to understand the correlation pattern between collagen in horizontal () and in vertical () directions as well as that of elastic in horizontal () and vertical () directions. Materials and Method. A total of 320 skin samples were collected in two orientations from suprascapular, anterior chest, lateral chest, anterior abdominal wall, and inguinal regions of 32 human cadavers. Spearman correlation coefficient (r) was calculated between the variables (, , , and ). Results. Significant positive correlation between and , and between and observed in all 5 areas tested. A negative correlation between and at suprascapular, lateral chest, and inguinal regions and negative correlation between and at anterior chest and anterior abdominal wall have been identified. Conclusion. Knowledge of asymmetric content of dermal collagen and elastic fibers together with the varied strength and degree of association in the given area provides guidelines to the dermatologists and aesthetic surgeons in placing elective incisions in the direction maximally utilizing the anatomical facts for aesthetically pleasing result. Naveen Kumar, Pramod Kumar, Satheesha Nayak Badagabettu, Ranjini Kudva, Sudarshan Surendran, and Murali Adiga Copyright © 2015 Naveen Kumar et al. All rights reserved. A Comparative Study Examining the Management of Bowen’s Disease in the United Kingdom and Australia Wed, 09 Sep 2015 06:44:37 +0000 Background and Aim. The optimum management of Bowen’s Disease (BD) is undefined. A review of current practice is required to allow the development of best practice guidelines. Methods. All BD cases, diagnosed in one UK centre and one Australian centre over a year (1 July 2012–30 June 2013), were analysed retrospectively. Patients with BD were identified from histopathology reports and their medical records were analysed to collect demographic data, site of lesion, and treatment used. Results. The treatment of 155 lesions from the UK centre and 151 lesions from the Australian centre was analysed. At both centres BD was most frequently observed on the face: UK had 70 (45%) lesions and Australia had 83 (55%) lesions (). The greatest number of lesions was managed by the plastic surgery department in the UK centre, 72 (46%), and the dermatology department in the Australian centre, 121 (80%). The most common therapy was surgical excision at both centres. Conclusions. In both UK and Australia, BD arises on sun-exposed sites and was most commonly treated with surgical excision despite a lack of robust evidence-based guidelines. G. L. Morley, J. H. Matthews, I. Verpetinske, and G. A. Thom Copyright © 2015 G. L. Morley et al. All rights reserved. Sun Protection Behaviors Associated with Self-Efficacy, Susceptibility, and Awareness among Uninsured Primary Care Patients Utilizing a Free Clinic Sun, 06 Sep 2015 11:34:14 +0000 Background. Skin cancer is the most commonly diagnosed form of cancer in the United States (US). However, knowledge, behaviors, and attitudes regarding sun protection vary among the general population. The purpose of this study is to examine sun protection behaviors of low-income primary care patients and assess the association between these health behaviors and the self-efficacy, susceptibility, and skin cancer awareness. Methods. Uninsured primary care patients utilizing a free clinic () completed a self-administered survey in May and June 2015. Results. Using sunscreen was the least common tactic among the participants of this study. Skin cancer awareness and self-efficacy are important to improve sun protection behaviors. Spanish speakers may have lower levels of skin care awareness compared to US born and non-US born English speakers. Male and female participants use different sun protection methods. Conclusion. It is important to increase skin cancer awareness with self-efficacy interventions as well as education on low-cost sun protection methods. Spanish speaking patients would be a target population for promoting awareness. Male and female patients would need separate gender-specific sun protection education. Future studies should implement educational programs and assess the effectiveness of the programs to further promote skin cancer prevention among underserved populations. Akiko Kamimura, Maziar M. Nourian, Jeanie Ashby, Ha Ngoc Trinh, Jennifer Tabler, Nushean Assasnik, and Bethany K. H. Lewis Copyright © 2015 Akiko Kamimura et al. All rights reserved. Comment on “Metabolic Changes and Serum Ghrelin Level in Patients with Psoriasis” Wed, 22 Apr 2015 09:02:04 +0000 Mehmet Agilli, Fevzi Nuri Aydin, Tuncer Cayci, and Yasemin Gulcan Kurt Copyright © 2015 Mehmet Agilli et al. All rights reserved. A Left-Sided Prevalence of Lentigo Maligna: A UK Based Observational Study and Review of the Evidence Wed, 01 Apr 2015 08:56:15 +0000 Skin cancer has been shown to present asymmetrically, prevalent on the left side of the body, more so in subtypes of cutaneous melanoma such as lentigo maligna. Biases have been linked to cumulative UV light exposure and automobile driving patterns. Though left-right ratios have previously correlated with the side men or women tend to position themselves or countries drive on, more recent trends indicate a consistent left-sided bias. To clarify reasons for changing trends, a review of the evidence base and LM’s laterality in a UK cohort (99 cases 2000–2011) was conducted for the first time. The strong correlation of left-sided excess, found in both genders (ratios 1.381–1.5,    0.841), is congruent with more recent findings. Though evidence indicates that driving position is no longer a risk factor for LM, due most likely to improved car window UV protection, it remains the most commonly attributed cause. Understanding phenomena such as UV lights “scatter effect” or that cumulative exposure may not be a significant risk factor helps rationalize older conclusions that would otherwise appear contradictory. The reasons for left-sided excess remain unclear but may be due to factors requiring further research such as the body’s anatomical/embryological asymmetry. Mark Gorman, Andrew Hart, and Bipin Mathew Copyright © 2015 Mark Gorman et al. All rights reserved. A 3-Month, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Ability of an Extra-Strength Marine Protein Supplement to Promote Hair Growth and Decrease Shedding in Women with Self-Perceived Thinning Hair Wed, 25 Mar 2015 13:46:42 +0000 An oral marine protein supplement (MPS) is designed to promote hair growth in women with temporary thinning hair (Viviscal Extra Strength; Lifes2good, Inc., Chicago, IL). This double-blind, placebo-controlled study assessed the ability of MPS to promote terminal hair growth in adult women with self-perceived thinning hair associated with poor diet, stress, hormonal influences, or abnormal menstrual cycles. Adult women with thinning hair were randomized to receive MPS () or placebo () twice daily for 90 days. Digital images were obtained from a 4 cm2 area scalp target area. Each subject’s hair was washed and shed hairs were collected and counted. After 90 days, these measures were repeated and subjects completed Quality of Life and Self-Assessment Questionnaires. MPS-treated subjects achieved a significant increase in the number of terminal hairs within the target area () which was significantly greater than placebo (). MPS use also resulted in significantly less hair shedding () and higher total Self-Assessment () and Quality of Life Questionnaires scores (). There were no reported adverse events. MPS promotes hair growth and decreases hair loss in women suffering from temporary thinning hair. This trial is registered with Identifier: NCT02297360. Glynis Ablon Copyright © 2015 Glynis Ablon. All rights reserved. Management of Pruritus in Chronic Liver Disease Tue, 10 Mar 2015 08:59:15 +0000 Background. There continues to be uncertainty on the ideal treatment of pruritus in chronic liver disease. The aim of this study was to gather the latest information on the evidence-based management of pruritus in chronic liver disease. Methodology. A literature search for pruritus in chronic liver disease was conducted using Pubmed and Embase database systems using the MeSH terms “pruritus,” “chronic liver disease,” “cholestatic liver disease,” and “treatment.” Results. The current understanding of the pathophysiology of pruritus is described in addition to detailing research into contemporary treatment options of the condition. These medical treatments range from bile salts, rifampicin, and opioid receptor antagonists to antihistamines. Conclusion. The burden of pruritus in liver disease patients persists and, although it is a common symptom, it can be difficult to manage. In recent years there has been greater study into the etiology and treatment of the condition. Nonetheless, pruritus remains poorly understood and many patients continue to suffer, reiterating the need for further research to improve our understanding of the etiology and treatment for the condition. Angeline Bhalerao and Gurdeep S. Mannu Copyright © 2015 Angeline Bhalerao and Gurdeep S. Mannu. All rights reserved. Epidermal Permeability Barrier in the Treatment of Keratosis Pilaris Tue, 24 Feb 2015 12:04:59 +0000 Objectives. To evaluate and compare the efficacy, safety, hydrating properties, and tolerability of 10% lactic acid (LA) and 5% salicylic acid (SA) in the therapy of keratosis pilaris (KP). Material and Method. Patients with KP were randomized for treatment with either 10% LA or 5% SA creams being applied twice daily for 3 months. The patients were clinically assessed at baseline and after 4, 8, and 12 weeks of treatment and 4 weeks after treatment. The functional properties of the stratum corneum (SC) were determined before treatment, 12 weeks, and follow-up phase by high-frequency conductance and transepidermal water loss (TEWL). Results. At the end of the trial, the mean reduction of the lesions from baseline was statistically significant for 10% LA (66%) and 5% SA (52%). During the treatment, higher conductance values were found on both group and this improvement was maintained until the follow up period. No significant differences in transepidermal water loss were observed after treatment. The adverse effects were limited to mild irritation localized on the skin without systemic side effect. Conclusion. The study demonstrated that 10% LA and 5% SA are beneficial to treat KP with the significantly clearance and marked improvement as by instrumental evaluation. Tanawatt Kootiratrakarn, Kowit Kampirapap, and Chakkrapong Chunhasewee Copyright © 2015 Tanawatt Kootiratrakarn et al. All rights reserved. Erratum to “Quantitative Fraction Evaluation of Dermal Collagen and Elastic Fibres in the Skin Samples Obtained in Two Orientations from the Trunk Region” Mon, 05 Jan 2015 09:10:47 +0000 Naveen Kumar, Pramod Kumar, Satheesha Nayak Badagabettu, Keerthana Prasad, Ranjini Kudva, and Coimbatore Vasudevarao Raghuveer Copyright © 2015 Naveen Kumar et al. All rights reserved. Sporotrichosis: An Overview and Therapeutic Options Mon, 29 Dec 2014 00:10:23 +0000 Sporotrichosis is a chronic granulomatous mycotic infection caused by Sporothrix schenckii, a common saprophyte of soil, decaying wood, hay, and sphagnum moss, that is endemic in tropical/subtropical areas. The recent phylogenetic studies have delineated the geographic distribution of multiple distinct Sporothrix species causing sporotrichosis. It characteristically involves the skin and subcutaneous tissue following traumatic inoculation of the pathogen. After a variable incubation period, progressively enlarging papulo-nodule at the inoculation site develops that may ulcerate (fixed cutaneous sporotrichosis) or multiple nodules appear proximally along lymphatics (lymphocutaneous sporotrichosis). Osteoarticular sporotrichosis or primary pulmonary sporotrichosis are rare and occur from direct inoculation or inhalation of conidia, respectively. Disseminated cutaneous sporotrichosis or involvement of multiple visceral organs, particularly the central nervous system, occurs most commonly in persons with immunosuppression. Saturated solution of potassium iodide remains a first line treatment choice for uncomplicated cutaneous sporotrichosis in resource poor countries but itraconazole is currently used/recommended for the treatment of all forms of sporotrichosis. Terbinafine has been observed to be effective in the treatment of cutaneous sporotrichosis. Amphotericin B is used initially for the treatment of severe, systemic disease, during pregnancy and in immunosuppressed patients until recovery, then followed by itraconazole for the rest of the therapy. Vikram K. Mahajan Copyright © 2014 Vikram K. Mahajan. All rights reserved. Metabolic Changes and Serum Ghrelin Level in Patients with Psoriasis Thu, 18 Dec 2014 00:10:32 +0000 Background. Serum ghrelin levels may be related to metabolic and clinical changes in patients with psoriasis. Objective. This study was performed to determine the possible effects of serum ghrelin in patients with psoriasis. Methods. The study population consisted of 25 patients with plaque psoriasis. The patients were questioned with regard to age, gender, age of onset, duration of disease, height, weight, and body mass index (BMI). In addition, fasting blood sugar, triglyceride, cholesterol levels, insulin, and ghrelin levels were measured. Results. The mean serum ghrelin level was 45.41 ± 22.41 in the psoriasis group and 29.92 ± 14.65 in the healthy control group. Serum ghrelin level was significantly higher in the psoriasis group compared with the controls (). The mean ghrelin level in patients with a lower PASI score was significantly higher than in those with a higher PASI score (). Conclusion. The present study was performed to determine the effects of ghrelin in psoriasis patients. We found a negative correlation between severity of psoriasis and ghrelin level. Larger and especially experimental studies focusing on correlation of immune system-ghrelin levels and severity of psoriasis may be valuable to clarify the etiopathogenesis of the disease. Haydar Ucak, Betul Demir, Demet Cicek, Ilker Erden, Suleyman Aydin, Selma Bakar Dertlioglu, and Mustafa Arica Copyright © 2014 Haydar Ucak et al. All rights reserved. Expression of Maspin and Ezrin Proteins in Periocular Basal Cell Carcinoma Mon, 15 Dec 2014 09:28:05 +0000 Background. The aim of this study was to investigate maspin and ezrin expression in different subtypes of periocular basal cell carcinoma (BCC). Methods. Tissue samples from 43 patients with periocular BCC. Our cases were comprised of 10 morpheaform, 25 nodular, and 8 adenoid type BCCs. Immunohistochemical staining for maspin and ezrin was performed by Envision detection system. Results. There was no difference between different subtypes of BCC in maspin expression regarding positivity, intensity, and pattern of expression. Ezrin was expressed in all subtypes of BCC but the intensity was significantly higher in morpheaform BCC compared to nodular and adenoid types ( and , resp.); ninety percent of morpheaform samples showed strong ezrin intensity, while this strong intensity was only present in 25% and 12% of adenoid and nodular subtypes, respectively. There was no correlation between age, sex, or tumor margin involvement and expression of neither maspin nor ezrin. There was no correlation between maspin and ezrin expression except in nodular type, in which an inverse correlation was found . Conclusion. Ezrin is expressed intensely in morpheaform BCC of periocular region. Further studies are needed to show the significance of this finding in prognosis of morpheaform BCC. Mansooreh Bagheri, Masoomeh Eghtedari, Mandana Bagheri, Bita Geramizadeh, and Mohammadreza Talebnejad Copyright © 2014 Mansooreh Bagheri et al. All rights reserved.