ISRN Dermatology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Correlation of Vitamin D Levels with Pigmentation in Vitiligo Patients Treated with NBUVB Therapy Sun, 23 Mar 2014 08:50:23 +0000 Cholecalciferol (vitamin D) might play a physiological role in photo-induced melanogenesis in human skin. We estimated the levels of 25-hydroxy vitamin D [25(OH)D] before, during, and after Narrow Band Ultraviolet B (NBUVB) radiation in patients of vitiligo and their correlation with NBUVB induced pigmentation. Thirty patients of vitiligo and equal number of age and sex matched controls were recruited for the study. Vitiligo patients were treated with NBUVB thrice weekly for 12 weeks. [25(OH)D] levels and Vitiligo Area and Severity Index (VASI) were calculated at 0 (baseline), 6, and 12 weeks. Baseline [25(OH)D] levels were measured in controls. Significant reduction in VASI score was observed after 12 weeks of therapy. Comparison and correlation between mean improvement in VASI and [25(OH)D] levels at 12 weeks showed moderate correlation, and the results were statistically insignificant. Mean reduction in VASI and increase in [25(OH)D] levels after 12 weeks of NBUVB showed moderate correlation. Thus, vitamin D might play a significant role in photo-induced melanogenesis. However, there might be additional effects of the phototherapy on melanogenesis. The complete mechanism of NBUVB induced pigmentation in vitiligo needs to be elucidated. Manu Sehrawat, Tarlok Chand Arora, Amrita Chauhan, Hemanta Kumar Kar, Amitabh Poonia, and Vijayeeta Jairath Copyright © 2014 Manu Sehrawat et al. All rights reserved. Histological Comparison of Two Cryopeeling Methods for Photodamaged Skin Wed, 12 Mar 2014 10:00:36 +0000 Background. Cryopeeling is a technique that uses cryotherapy not only on actinic keratoses lesions, but also all over the photodamaged skin. Objectives. To investigate the histological changes induced by two cryopeeling methods (liquid nitrogen (LN) and portable system (PS)). Methods. Sixteen patients with multiple actinic keratoses on the forearms were treated with cryopeeling technique using LN for one forearm and PS for the other, randomly. Skin biopsies were taken before and after the procedures. Results. There was no statistical difference between the epidermal and Grenz zone thicknesses or density of elastic fibers after treatments. The amount of melanin pigment was lower after PS treatment . In a blind analysis of paired pre- and postprocedure slides, it was not possible to identify cases which underwent treatment, both in global analysis of quality of the skin and in specific analysis (considering only the aspect of stratum corneum). Discussion. The results indicate the inconsistency of histological improvement after treatments, and, likely, since the method causes superficial exfoliation, a reliable marker was not found in the analysis. Conclusions. Despite cosmetic benefits on photodamaged skin and efficient treatment of actinic keratoses lesions, cryopeeling was not able to induce measurable histological changes in solar elastosis, epidermal organization, or epidermal and Grenz zone thicknesses. One should keep in mind the possibility of hypopigmentation risk of the method. Janyana Deonizio, Betina Werner, and Fabiane A. Mulinari-Brenner Copyright © 2014 Janyana Deonizio et al. All rights reserved. Prevalence of Psychological Disorders in Patients with Alopecia Areata in Comparison with Normal Subjects Sun, 09 Mar 2014 12:38:25 +0000 Alopecia areata is a chronic disease with a great impact on the patient’s quality of life. In this study we reviewed the frequency of psychological disorders in patients with alopecia areata in comparison to a control group. We enrolled 40 patients with alopecia areata and a 40-volunteer random age-sex matched control group. The study is based on anxiety and Beck Depression Inventory (BDI) and the Eysenck Personality Questionnaire (EPQ). Analytical evaluation was done by Mann-Whitney, Kruskal Wallis, and -tests. There was a significant difference between the case and control group regarding the prevalence of depression ( value = 0.008), anxiety ( value = 0.003), and neuroticism ( value = 0.05). There was no significant differences regarding extraversion ( value = 0.249), psychosis ( value = 0.147), and lying ( value = 0.899) between the two groups. In alopecia areata involving the head, there was a significant relation only between neuroticism ( value = 0.045) and lying ( value = 0.005). The facial involvement had a significant relation with depression ( value = 0.020), anxiety ( value = 0.019), and neuroticism ( value = 0.029). The frequency of psychological disorders in the case group is significantly greater than the control group. Shahin Aghaei, Nasrin Saki, Ehsan Daneshmand, and Bahare Kardeh Copyright © 2014 Shahin Aghaei et al. All rights reserved. The Effect of Gynostemma pentaphyllum Extract on Mouse Dermal Fibroblasts Tue, 04 Mar 2014 08:29:23 +0000 Background. The objective of this paper is to demonstrate the effect of Gynostemma pentaphyllum extract on mouse dermal fibroblasts. Recent studies have shown that this plant may possess great antioxidant properties, which can be very beneficial in combating oxidative stress. Methods. Gynostemma pentaphyllum extract was prepared and mouse dermal fibroblasts were obtained and cultured as per our laboratory protocols. Twelve samples of cells were cultured under the same conditions and both negative and positive controls were established. Induction of oxidative stress was carried out using ultraviolet C (UVC) light. Viable cell count was carried out, using microscopy. The analysis of the overall results was processed using SPSS version 16.0. Results. Statistical analysis showed strong positive correlation between the concentration of Gynostemma pentaphyllum and the mean duration of cell viability (rs = 1), with a high level of statistical significance (). Likewise, strong positive correlation existed between trials of cell viability (rs = 0.988–1), with statistical significance (). Conclusion. Gynostemma pentaphyllum extract prolongs viability of mouse dermal fibroblasts damaged by UVC light-induced oxidative stress. The results show the potential benefits of this extract on dermal cell aging. Sara Nadia Lobo, Yu Qing Qi, and Quan Zhong Liu Copyright © 2014 Sara Nadia Lobo et al. All rights reserved. Serum Prolactin Levels in Psoriasis Vulgaris Sun, 23 Feb 2014 13:09:49 +0000 Background. Psoriasis is a chronic inflammatory skin disease affecting approximately 1–3% of Caucasians. Prolactin has proliferative effects on human keratinocytes, a dominant feature of psoriasis, and it is thought that this hormone may play a role in the pathogenesis of the disease. This study was conducted to confirm or refute these findings in order to better understand the disease pathogenesis. Methods. The subjects were 90 individuals aged between 15 and 47 years. They were divided into three groups of 30 individuals each: psoriatic patients, atopic dermatitis patients, and control group. A questionnaire was filled regarding their demographic and medical history. All of the study subjects underwent venous blood sampling (5 mL), and serum TSH and prolactin levels were checked. Subjects with abnormal TSH were omitted. Results. None of the patients in the study had raised prolactin, and there was no significant difference in the serum prolactin level between patients with psoriasis and atopic dermatitis and the control group. There was no relationship between the severity of psoriasis and serum levels of prolactin. Conclusion. Prolactin does not seem to play a role in the pathogenesis of psoriasis as its serum levels are comparable with atopic dermatitis patients and that of the normal population. Farhad Handjani, Nasrin Saki, Iman Ahrari, Mehdi Ebrahimi, Mohammad Mehdi Khorrami, and Parastoo Nematollahi Copyright © 2014 Farhad Handjani et al. All rights reserved. Anolunula in Fingernails among Patients Infected with HIV Sun, 23 Feb 2014 00:00:00 +0000 Lunula is the white, half-moon shaped area seen in proximal ends of some nails. Though a few studies have described the nail changes that can occur in association with HIV infection, none of these paid much attention to lunula. Aims and Objectives. To study the lunula in fingernails among HIV infected patients. Materials and Methods. An observational, cross-sectional study to record presence of lunula in 168 HIV-positive patients and compare it with age and sex matched 168 healthy HIV-negative control. Anolunula (absence of lunula) in HIV-positive patients was correlated with CD4 counts, stages of HIV infection, time since patient was diagnosed as HIV-positive, and status of antiretroviral therapy. Results. Anolunula was present in significantly more fingernails in HIV-positive patients compared to HIV-negative controls. There was a highly significant difference for total anolunula (anolunula in all fingernails) in study and control group. Incidence of total anolunula was directly proportional to the stage of HIV infection, increasing progressively as the HIV infection advances from stage 1 to stage 4. Conclusion. Absence of lunula is related to not only HIV infection per se but also the stages of HIV infection. Pratik Gahalaut, Nitin Mishra, Sandhya Chauhan, Mir Mubashir Ali, Madhur Kant Rastogi, and Richa Thakur Copyright © 2014 Pratik Gahalaut et al. All rights reserved. Efficacy and Side Effects of Narrowband-UVB in Early Stage Cutaneous T-Cell Lymphoma in Jordanian Patients Wed, 19 Feb 2014 11:16:20 +0000 Background. Many studies, on light-skinned patients, suggested narrowband-UVB to be effective and safe for the treatment of early stage cutaneous T-cell lymphoma. Objectives. To evaluate the efficacy and side effects of narrowband-UVB in treatment of early stage cutaneous T-cell lymphoma in patients with skin phototypes III, IV, and V. Methods. A total of 27 patients with the diagnosis of early stage cutaneous T-cell lymphoma were involved in this prospective study. All patients received narrowband-UVB as monotherapy until clearance or a maximum of 42 sessions. Patients with complete clearance were followed for six months or relapse. Rate of clearance, number of sessions, and cumulative narrowband-UVB dose needed to achieve clearance, percentage of patients remaining in remission at 6 months, and side effects were analyzed. Results. Within 5–14 weeks (15–42 sessions), using cumulative narrowband-UVB dose ranging from 17.3 to 48.2 J/cm2, complete remission was achieved in 76.4% of patients. The rest of the patients achieved partial remission. Six months after discontinuation of the treatment, 42.8% of patients with complete remission remained in remission. Transient erythema in 11.1% of patients and mild hyperpigmentation in 14.8% of patients were the only side effects encountered during this study. Conclusion. We conclude that narrowband-UVB phototherapy is safe and effective for the treatment of early stage cutaneous T-cell lymphoma in darker-skinned patients. Salah A. Abdallat, Ayman S. Alqaqaa, Nidal A. Obaidat, and Rameh F. Alnueimi Copyright © 2014 Salah A. Abdallat et al. All rights reserved. Gender Differences in Clinicoepidemiological Features of Vitiligo: A Cross-Sectional Analysis Thu, 13 Feb 2014 15:28:49 +0000 Background. Vitiligo has important clinical and social consequences particularly in the pigmented skin. The present study was conducted to assess the differences in clinicoepidemiological presentation of vitiligo in males and females and to understand the factors associated with spread of vitiligo in them. Methods. This is a cross-sectional analysis of secondary clinical data of 168 vitiligo patients at a tertiary medical centre at Navi Mumbai. We used logistic regression models to estimate the association between gender and clinical characteristics of vitiligo and to evaluate the factors associated with spread of vitiligo. Results. There were no significant differences between the mean ages of males and females; however, males reported a longer duration of disease (6.9 (10.4) years) compared with females (4.9 (7.4) years). Males were significantly more likely to report a family history of vitiligo compared with females (adjusted OR (aOR): 16.87, 95% CI: 2.16 to 131.69). Even though females were more likely to report spread of lesions, the association was not statistically significant (OR: 1.21, 95% CI: 0.62 to 2.36). Discussion. The differences in the clinical presentations between genders highlight the need to understand the different factors (possibly genetic) that may play a part in the pathogenesis of this multifactorial disease in males and females. Sharmila Patil, Manjyot Gautam, Nitin Nadkarni, Neha Saboo, Kiran Godse, and Maninder Singh Setia Copyright © 2014 Sharmila Patil et al. All rights reserved. Increasing the Efficacy of SLNB in Cases of Malignant Melanoma Located in Close Proximity to the Lymphatic Basin Mon, 10 Feb 2014 11:14:01 +0000 Background. Being predictive of the entire nodal bed, sentinel lymph node biopsy (SLNB) is invaluable in the surgical management of melanoma. Although the concept is simple, sentinel lymph node (SLN) identification and removal can be technically challenging. Methods. A total of 102 consecutive patients have undergone SLNB in the Division of Plastic and Reconstructive Surgery of Soroka University Medical Center from 2009 to 2012. Patients have undergone SLNB using a radioactive tracer and blue stain in order to identify the SLN. Although SLNB usually precedes the wide excision of melanoma, primary lesions in close proximity (10 cm) to the lymph basin require wide excision before beginning the SLN quest. Results. All pathology reports confirmed the excision of lymph nodes. Conclusions. When treating MM in close proximity to the lymph basin, changing the sequence of the SLNB procedure seems to increase the efficacy of the method. Alexander Bogdanov-Berezovsky, Vasileios A. Pagkalos, Eldad Silberstein, Yaron Shoham, Arsinoi A. Xanthinaki, and Yuval Krieger Copyright © 2014 Alexander Bogdanov-Berezovsky et al. All rights reserved. Evaluation of the Efficacy of Topical Tetracycline in Enhancing the Effect of Narrow Band UVB against Vitiligo: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial Sun, 09 Feb 2014 09:58:50 +0000 Background. Vitiligo is a pigmentary disorder characterized by depigmented macules due to absence of melanocytes. Increased levels of tumor necrosis factor alpha and interleukin-1 in the epidermis of lesions may play a role in keratinocyte apoptosis and less production of melanogenic cytokines. Tetracyclines reduce production of tumor necrosis factor alpha and interleukin-1. Objective. To evaluate the effect of topical tetracycline on vitiligo patients on phototherapy. Methods. Thirty cases of generalized stable vitiligo were chosen randomly and pigmentation of two assigned lesions on right and left sides (same size and location) was determined by vitiligo area severity index, and medication and placebo were randomly assigned to be applied twice daily on either right or left side, respectively. Images were taken of the lesions at the end of the 4th, 8th, and 12th weeks and pigmentations were compared to baseline using aforementioned index. The patients also took narrow band ultraviolet B two to three times a week. Results. Mean pigmentation, based on vitiligo area severity index, changed significantly from 90.1667 to 86.6667 () and on placebo side from 89.6667 to 86.8333 (). There was no significant difference between medication and placebo sides in terms of pigmentation (). Conclusions. No significant difference in improving repigmentation between medication and placebo sides was seen. Amir Kalafi and Farideh Jowkar Copyright © 2014 Amir Kalafi and Farideh Jowkar. All rights reserved. Quality of Life in Patients with Focal Hyperhidrosis before and after Treatment with Botulinum Toxin A Thu, 06 Feb 2014 12:38:50 +0000 The aim of this study is to assess the effectiveness of treatment with BTX-A in quality of life of patients suffering from primary focal hyperhidrosis. Materials and Methods. A total of 119 patients (62 females and 57 males) between 18 and 65 years suffering from moderate to severe focal hyperhidrosis were treated with BTX-A. Thirty-nine patients suffered from axillary hyperhidrosis, 47 patients from palmar hyperhidrosis, 12 patients from plantar hyperhidrosis, and 21 patients from palmar and plantar hyperhidrosis. A baseline and posttreated examination of patients 6 months after BTX-A is included. The Hyperhidrosis Disease Severity Scale (HDSS) was chosen to assess the disease severity and the modified Dermatology Life Quality Index was used (DLQI) to assess the quality of life. Results. Quality of life showed a significant improvement after treatment with BTX-A. The total DLQI score resulted significantly lower than the basal value (). The seriousness of hyperhidrosis significantly decreased after the treatment (). In addition, there was notable difference between the posttreatment DLQI scores and pretreatment severity of hyperhidrosis by sex. Conclusions. Treatment with BTX-A led to the reduction of disease severity and improvement of quality of life, while it is a safe, easy to use method with minimal side effects. Anargyros Kouris, Kalliopi Armyra, Christos Christodoulou, Polixeni Karimali, Dimitrios Karypidis, and George Kontochristopoulos Copyright © 2014 Anargyros Kouris et al. All rights reserved. Clinical and Contrast-Enhanced Ultrasound Echography Outcomes in Psoriatic Arthritis Patients after One Year of Continuous Therapy with Anti-TNF Drugs Thu, 06 Feb 2014 08:44:40 +0000 Background. We wanted to verify retrospectively the proportion of patients with psoriatic arthritis who were in remission after 1 year of continuous therapy with either etanercept or adalimumab. Remission was defined as the absence of both clinical and contrast-enhanced ultrasound (CEUS) findings suggestive of joint inflammation. Patients and Methods. The data of twenty-five patients with psoriatic arthritis were available for the clinical and CEUS evaluations before and after 1 year of continuous therapy with etanercept or adalimumab. The count of swollen (ACR66), tender (ACR68), and active inflamed joints (AJC) was used to measure the severity of joint involvement. PASI was used to score the severity of psoriasis. HAQ, DLQI, VAS pain, and VAS itching were administered to each patient before starting therapy and every 3 months, up to 1 year. Results. Eight (32%) out of twenty-five patients were in remission after 1 year of therapy with etanercept or adalimumab. A significant reduction of all clinical variables analysed was seen during the course of therapy. Conclusion. Although a significant proportion of patients achieved remission of arthritis after 1 year of effective anti-TNF therapy, the majority of them continued to have either clinical or CEUS findings suggestive of persistence of joint inflammation. Claudio Bonifati, Fulvia Elia, Dario Graceffa, Fabrizio Ceralli, Elisa Maiani, Carlo De Mutiis, and Francesco M. Solivetti Copyright © 2014 Claudio Bonifati et al. All rights reserved. The Region Centromeric to HLA-C Is a Key Region for Understanding the Phenotypic Variability of Psoriatic Arthritis Thu, 30 Jan 2014 08:20:25 +0000 With the aim of clarifying the role of several polymorphisms around the HLA-C locus in the clinical expression of PsA, the distribution of several polymorphic markers and genes located around the HLA-C locus was analyzed in a well-established cohort of 110 patients with PsA, 50 patients with psoriasis alone, and 110 healthy controls. The frequency of these genes was also analyzed by PsA articular models, based on three main subgroups: oligoarthritis, polyarthritis, and spondylitis. Distal interphalangeal joint (DIP) involvement was associated with the presence of MICB-CA20 (OR 6.0, 95% CI: 1.58–22.69, ). HLA-DRB07 was associated with oligoarticular forms of PsA (OR 4.1, 95% CI: 1.8–9.3, ). The spondylitic forms overexpressed the antigen HLA-B27 (OR 5.7, 95% CI: 2.4–13.6, ). MICA-A5.1 showed association with polyarthritis (OR 3.7, 95% CI: 1.5–8.8, ). Genes telomeric to HLA-C were overexpressed in psoriasis but not in PsA subphenotypes. This study shows that the region centromeric to HLA-C is a key region that expresses not only disease risk genes but also genes that help explain the phenotypic variability of PsA. Rubén Queiro, Patricia Tejón, Sara Alonso, Pablo Coto, Carlos López-Larrea, Jesús Martínez-Borra, and Segundo González Copyright © 2014 Rubén Queiro et al. All rights reserved. Comparison of Topical Anesthetics for Radiofrequency Ablation of Achrocordons: Eutectic Mixture of Lignocaine/Prilocaine versus Lidocaine/Tetracaine Wed, 29 Jan 2014 00:00:00 +0000 Introduction. Topical application of local anesthetics is currently considered to be the easiest, most effective, and convenient way for treatment of patients who may be undergoing superficial dermatosurgical procedures. Materials and Methods. This study compares the anesthetic potential of 2.5% lidocaine and 2.5% prilocaine topical cream with 7% lignocaine and 7% tetracaine combination cream for radio ablative dermatosurgery when applied, under occlusion, for 30 minutes. 40 subjects of achrocordons were enrolled in this split-side randomized trial. Result. The pain severity experienced by subjects in terms of visual analogue scale score was significantly lesser for lignocaine/tetracaine combination cream as compared to lidocaine/prilocaine combination. Conclusion. This small study proves the efficacy of lidocaine/tetracaine combination as a topical anesthetic cream when applied for a short time interval of 30 minutes. This will help a dermatosurgeon to perform various dermatological procedures in a better and efficient manner with a shorter waiting period for analgesia to set in. Pratik Gahalaut, Nitin Mishra, Sandhya Chauhan, and Madhur Kant Rastogi Copyright © 2014 Pratik Gahalaut et al. All rights reserved. Knowledge of Acne among Medical Students: Pretest and Posttest Assessment Tue, 28 Jan 2014 10:57:29 +0000 Background. Acne vulgaris is a disorder of sebaceous glands mainly affecting the adolescent population. There are some misconceptions about acne not only in the general population but also among the medical students. Methods. Second year medical undergraduate students attending dermatology postings for the first time were included in the study. A questionnaire (in yes or no answer format) with 20 questions on acne, each carrying one mark, was to be answered by the students. The students were categorized into 4 grades based on the marks obtained: Grade I 90% marks and above, Grade II 75%–90%, Grade III 50%–74%, and Grade IV <50% marks obtained. Results. Of the 144 students of the batch, 95 (69.5%) completed both pretest and posttest questionnaires. The average pretest score was 14.1 and that of the posttest was 16.9. The percentage of improvement in mean score from pretest to posttest was 16.5. Fischer’s exact test was applied to analyze the improvement in scores between pretest and posttests which is significant at (). In the paired -test the improvement in mean scores between pretest and posttest was significant at . Kanakapura Nanjundaswamy Shivaswamy, Arakali Lakshminarayana Shyamprasad, Tharayil Kunneth Sumathy, Chandrashekaran Ranganathan, and Shanmugan Praveen Kumar Copyright © 2014 Kanakapura Nanjundaswamy Shivaswamy et al. All rights reserved. Assessment of Leptin Gene Polymorphism rs2060713 in Psoriasis Vulgaris Tue, 28 Jan 2014 08:46:21 +0000 Psoriasis is a lifelong disorder characterized by approximately 8-fold reduction of the duration of normal skin keratinocyte cell cycle and 2-fold increase of the number of dividing cells. Multiple genes, several environmental factors, and immune system alterations are involved in the pathogenesis of psoriasis. Hyperleptinemia is associated with psoriasis and leptin acts as an angiogenic factor. Angiogenetic processes precede the epidermal hyperplasia in psoriasis, indicating possible involvement of leptin in the pathogenesis of psoriasis. Leptin gene polymorphisms and their association with psoriasis have been given very little attention. We present a study of the rs2060713C/T genetic polymorphism in the pathogenesis of psoriasis vulgaris in 263 vulgaris patients and 252 unrelated matched healthy controls. No statistically significant differences were observed between patients and controls. A statistically nonsignificant trend was observed in males with the early onset type of psoriasis (11.1% C/T in patients versus 5.6% in controls) and in females with the late onset type of the disease (12.8% C/T in patients versus 3.3% in controls). Still, there is no hard evidence on correlation of psoriasis vulgaris with this polymorphism. Possible association with specific forms of the disease and either gender needs further investigation in larger studies. Anthony Karpouzis, Gregory Tripsianis, Elisavet Gatzidou, and Stavroula Veletza Copyright © 2014 Anthony Karpouzis et al. All rights reserved. Perceptions and Portrayals of Skin Cancer among Cultural Subgroups Tue, 28 Jan 2014 08:36:46 +0000 Health communication scholars have a responsibility to be certain that both healthcare practitioners and government agencies accurately communicate health information to the public. In order to carry out this duty, health communication scholars must assess how messages are being received and if they are being received at all by the public. This paper details a two part study which assesses this phenomenon within the context of skin cancer. Study 1 utilized 29 in depth qualitative interviews to identify subcultures among college students whose communication puts them at risk for skin cancer by encouraging poor sun exposure behaviors. The results indicate that farmers, African Americans, and individuals who regularly participate in outdoor athletics are at risk groups. Study 2 reports a content analysis of the known population of skin cancer Public Service Announcements (PSAs) available via the internet in 2013. The aforementioned groups were not present in any of the PSAs. Detailed results and implications are discussed. Stephanie Kelly, Laura E. Miller, Ho-Young Ahn, and J. Eric Haley Copyright © 2014 Stephanie Kelly et al. All rights reserved. p16 Expression Is Lost in Severely Atypical Cellular Blue Nevi and Melanoma Compared to Conventional, Mildly, and Moderately Atypical Cellular Blue Nevi Wed, 22 Jan 2014 08:06:26 +0000 Background. Significant decreases in p16 expression have been shown to occur in melanoma compared to Spitz tumors, and loss of p16 staining has been found to correlate with melanoma tumor progression. However, comparison of p16 between atypical cellular blue nevi (CBN) and melanoma has not been reported previously. Methods. p16 immunohistochemical staining was evaluated in 14 atypical CBN, 8 conventional and atypical melanocytic nevi, and 16 melanomas, including 4 malignant CBN. p16 staining intensity was graded on a scale of 0–3 and the percentage of melanocytes stained with p16 was determined. Results. p16 staining was significantly higher in all CBN as a group when compared to melanomas () and malignant CBN (). Higher p16 expression was also seen in mildly () and moderately atypical (), but not severely atypical, CBN compared to melanomas. Conclusions. p16 immunohistochemical expression is higher in mildly and moderately atypical CBN compared to severely atypical CBN and melanomas. In conjunction with additional markers and histology, p16 staining may be useful in confirming the benign nature of these tumors, but is not useful in distinguishing severely atypical CBN from malignant cases, consistent with the overlapping histologic features between these tumors. Laura M. Chang and David S. Cassarino Copyright © 2014 Laura M. Chang and David S. Cassarino. All rights reserved. A Cross-Sectional Prospective Study of Cutaneous Lesions in Newborn Mon, 20 Jan 2014 13:45:08 +0000 Background. Cutaneous alterations are common in neonates. The majority of lesions are physiological, transient, or self-limited and require no therapy. Although much has been reported on the various disorders peculiar to the skin of infant, very little is known about variations and activity of the skin in neonates. Objective. To study the various pattern of skin lesions in newborn and to estimate the prevalence of physiological and pathological skin lesions in newborn. Methods. A total of 1000 newborns were examined in a hospital-based, cross-sectional prospective study in the period of November 2007 to May 2009. Results. The physiological skin changes observed in order of frequency were sebaceous gland hyperplasia (89.4%), Epstein pearls (89.1%), Mongolian spot (84.7%), knuckle pigmentation (57.9%), linea nigra (44.5%), hypertrichosis (35.3%), miniature puberty (13.3%), acrocyanosis (30.9%), physiological scaling (10.8%), and vernix caseosa (7.7%). Of the transient noninfective conditions, erythema toxicum neonatorum was seen in 23.2% newborns and miliaria crystallina in 3% newborns. The birthmarks in descending order of frequency were salmon patch (20.7%), congenital melanocytic nevi (1.9%), and café-au-lait macule (1.3%). Cutaneous signs of spinal dysraphism were sacral dimple (12.8%), meningomyelocele (0.5%), acrochordons (0.1%), and dermoid cyst (0.1%). Conclusion. The physiological and transient skin lesions are common in newborns particularly sebaceous gland hyperplasia, Epstein pearls, Mongolian spots, and erythema toxicum neonatorum. It is important to differentiate them from other more serious skin conditions to avoid unnecessary therapeutic interventions. Farhana Tahseen Taj Sameer Haveri and Arun C. Inamadar Copyright © 2014 Farhana Tahseen Taj Sameer Haveri and Arun C. Inamadar. All rights reserved. Knowledge, Beliefs, and Psychosocial Effect of Acne Vulgaris among Saudi Acne Patients Sun, 29 Dec 2013 11:30:11 +0000 Objective. This study was conducted to assess the knowledge, beliefs, and psychosocial effect of acne vulgaris among acne patients attending referral dermatology clinic in Al-Khobar city. Material and Methods. A cross-sectional study was conducted on all Saudi acne patients (males and females) attending referral dermatology clinic in Al-Khobar Governmental Hospital. The data were collected by using a structured self-administered questionnaire. Results. Like other studies conducted before, we found that 58.33% of our sample have poor knowledge about factors that affect acne vulgaris with a significant correlation with both age and gender ( and resp.). There was significant association of reporting affected social activities with age and educational level ( and resp.). Variation between both genders regarding reporting feeling stressed due to acne was significant (). The majority of our sample sought medical advice after one year. The most commonly used treatment for acne vulgaris before seeking medical help was peeling products. The majority of our patients thought that acne needs no treatment by physicians. Doctors' treatment is considered guaranteed and safe by the vast majority of our patients. Conclusion. This study showed that knowledge about acne is still insufficient among acne patients. Magdy A. Darwish and Ahmed A. Al-Rubaya Copyright © 2013 Magdy A. Darwish and Ahmed A. Al-Rubaya. All rights reserved. A Study on Evaluation of Apoptosis and Expression of Bcl-2-Related Marker in Wound Healing of Streptozotocin-Induced Diabetic Rats Mon, 07 Oct 2013 14:19:16 +0000 Uncontrolled blood sugar is a major cause of vascular complications and delayed wound healing in diabetes mellitus. During wound healing process, normally, apoptosis is responsible for events such as removal of inflammatory cells and evolution of granulation tissue into scar which occur during the late phase of wound healing. Early apoptosis can lead to abnormal wound healing by removing granulation tissue including fibroblast, endothelial cell, and small vessels. To determine the role of apoptosis in association with hyperglycemia in diabetic wound healing, apoptosis-related intracellular marker such as expression of Bcl-2 protein by immunohistochemistry and normal histology has been studied. Histological findings show higher level of apoptosis and diminished granulation tissue formation in diabetic rats wounds along with minimal expression of Bcl-2 in diabetic rats wounds when compared with nondiabetic rats wounds. It can be concluded from this study that elevated blood sugar level may be associated with increased apoptosis and the least expression of Bcl-2 protein which might cause deregulation of the wound healing processes in streptozotocin-induced diabetic rats. Surya Bhan, Rahul Mitra, A. K. Arya, H. P. Pandey, and K. Tripathi Copyright © 2013 Surya Bhan et al. All rights reserved. The Role of 39 Psoriasis Risk Variants on Age of Psoriasis Onset Mon, 23 Sep 2013 15:44:01 +0000 Recent genome-wide association studies (GWAS) have identified multiple genetic risk factors for psoriasis, but data on their association with age of onset have been marginally explored. The goal of this study was to evaluate known risk alleles of psoriasis for association with age of psoriasis onset in three well-defined case-only cohorts totaling 1,498 psoriasis patients. We selected 39 genetic variants from psoriasis GWAS and tested these variants for association with age of psoriasis onset in a meta-analysis. We found that rs10484554 and rs12191877 near HLA-C and rs17716942 near IFIH1 were associated with age of psoriasis onset with false discovery rate < 0.05. The association between rs17716942 and age of onset was not replicated in a fourth independent cohort of 489 patients (). The imputed HLA-C*06:02 allele demonstrated a much stronger association with age of psoriasis onset than rs10484554 and rs12191877. We conclude that despite the discovery of numerous psoriasis risk alleles, HLA-C*06:02 still plays the most important role in determining the age of onset of psoriasis. Larger studies are needed to evaluate the contribution of other risk alleles, including IFIH1, to age of psoriasis onset. Yingchang Lu, Sinae Kane, Haoyan Chen, Argentina Leon, Ethan Levin, Tien Nguyen, Maya Debbaneh, Jillian W. Millsop, Rishu Gupta, Monica Huynh, Daniel Butler, Kelly Cordoro, and Wilson Liao Copyright © 2013 Yingchang Lu et al. All rights reserved. Skin Photoaging and the Role of Antioxidants in Its Prevention Thu, 12 Sep 2013 18:08:12 +0000 Photoaging of the skin depends primarily on the degree of ultraviolet radiation (UVR) and on an amount of melanin in the skin (skin phototype). In addition to direct or indirect DNA damage, UVR activates cell surface receptors of keratinocytes and fibroblasts in the skin, which leads to a breakdown of collagen in the extracellular matrix and a shutdown of new collagen synthesis. It is hypothesized that dermal collagen breakdown is followed by imperfect repair that yields a deficit in the structural integrity of the skin, formation of a solar scar, and ultimately clinically visible skin atrophy and wrinkles. Many studies confirmed that acute exposure of human skin to UVR leads to oxidation of cellular biomolecules that could be prevented by prior antioxidant treatment and to depletion of endogenous antioxidants. Skin has a network of all major endogenous enzymatic and nonenzymatic protective antioxidants, but their role in protecting cells against oxidative damage generated by UV radiation has not been elucidated. It seems that skin’s antioxidative defence is also influenced by vitamins and nutritive factors and that combination of different antioxidants simultaneously provides synergistic effect. Ruža Pandel, Borut Poljšak, Aleksandar Godic, and Raja Dahmane Copyright © 2013 Ruža Pandel et al. All rights reserved. Emptying of Intracellular Calcium Pool and Oxidative Stress Imbalance Are Associated with the Glyphosate-Induced Proliferation in Human Skin Keratinocytes HaCaT Cells Thu, 29 Aug 2013 08:55:55 +0000 We demonstrated that glyphosate possesses tumor promoting potential in mouse skin carcinogenesis and SOD 1, calcyclin (S100A6), and calgranulin B (S100A9) have been associated with this potential, although the mechanism is unclear. We aimed to clarify whether imbalance in between levels and oxidative stress is associated with glyphosate-induced proliferation in human keratinocytes HaCaT cells. The levels, ROS generation, and expressions of G1/S cyclins, IP3R1, S100A6, S100A9, and SOD 1, and apoptosis-related proteins were investigated upon glyphosate exposure in HaCaT cells. Glyphosate (0.1 mM) significantly induced proliferation, decreases , and increases ROS generation in HaCaT cells, whereas antioxidant N-acetyl-L-cysteine (NAC) pretreatment reverts these effects which directly indicated that glyphosate induced cell proliferation by lowering levels via ROS generation. Glyphosate also enhanced the expression of G1/S cyclins associated with a sharp decrease in G0/G1 and a corresponding increase in S-phases. Additionally, glyphosate also triggers S100A6/S100A9 expression and decreases IP3R1 and SOD 1 expressions in HaCaT cells. Notably, Ca2+ suppression also prevented apoptotic related events including Bax/Bcl-2 ratio and caspases activation. This study highlights that glyphosate promotes proliferation in HaCaT cells probably by disrupting the balance in between levels and oxidative stress which in turn facilitated the downregulation of mitochondrial apoptotic signaling pathways. Jasmine George and Yogeshwer Shukla Copyright © 2013 Jasmine George and Yogeshwer Shukla. All rights reserved. Antidermatophytic Properties of Ar-Turmerone, Turmeric Oil, and Curcuma longa Preparations Mon, 26 Aug 2013 15:31:40 +0000 Curcuma longa L. or turmeric of the family Zingiberaceae is widely used in Thai traditional medicines for the treatment of rash, itching, tinea, and ringworm. Previous studies on turmeric oil reported effective antifungal activity against dermatophytes, a group of fungi that causes skin diseases. In this study, turmeric creams containing 6 and 10% w/w turmeric oil were prepared and tested against clinical strains of dermatophytes using broth dilution technique. Minimum fungicidal concentrations of 6 and 10% w/w turmeric creams were found to be 312 μg/mL. Ar-turmerone, a major compound separated from turmeric oil, promoted more effective antidermatophytic activity with the MICs of 1.56–6.25 μg/mL, compared to 3.90–7.81 μg/mL of standard ketoconazole. The results indicated that 6% w/w turmeric oil in the cream was suitable to be formulated as antidermatophytic preparation. Further research should be done on long-term chemical and antifungal stabilities of the preparation. Mukda Jankasem, Mansuang Wuthi-udomlert, and Wandee Gritsanapan Copyright © 2013 Mukda Jankasem et al. All rights reserved. In Vivo Evaluation of the Skin Tensile Strength by the Suction Method: Pilot Study Coping with Hysteresis and Creep Extension Mon, 05 Aug 2013 11:06:44 +0000 From an engineering standpoint, both the skin and subcutaneous tissue act as interconnected load-transmitting structures. They are subject to a variety of intrinsic and environmental influences. Changes in the cutaneous viscoelasticity represent an important aspect in a series of skin conditions. The aim of this work was to explore the methodology of biomechanical measurements in order to better appreciate the evolution and severity of some connective tissue diseases. The Cutometer MPA 580 (C+K electronic) was used in the steep and progressive suction procedures. Adapting measurement modalities was explored in order to mitigate any variability in data collection. The repeat steep suction procedure conveniently reveals the creep phenomenon. By contrast, the progressive suction procedure highlights the hysteresis phenomenon. These viscoelastic characteristics are presently described using the 2 and 4 mm probes on normal skin and in scleroderma, acromegaly, corticosteroid-induced dermatoporosis, and Ehlers-Danlos syndrome. The apposition of an additional outer contention on the skin altered differently the manifestations of the creep extension and hysteresis among the tested skin conditions. Any change in the mechanical test procedure affects the data. In clinical and experimental settings, it is mandatory to adhere to a strict and controlled protocol. Gérald E. Piérard, Sébastien Piérard, Philippe Delvenne, and Claudine Piérard-Franchimont Copyright © 2013 Gérald E. Piérard et al. All rights reserved. Hemostatic and Wound Healing Properties of Chromolaena odorata Leaf Extract Thu, 01 Aug 2013 10:38:36 +0000 Chromolaena odorata (L.) King and Robinson (Siam weed) extract has been used to stop bleeding and in wound healing in many tropical countries. However, its detailed mechanisms have not been elucidated. In this study, we examined the molecular mechanisms by which Siam weed extract (SWE) affected hemostatic and wound healing activities. SWE promoted Balb/c 3T3 fibroblast cell migration and proliferation. Subsequently, we found that heme oxygenase-1 (HO-1), the accelerating wound healing enzyme, was increased at the transcriptional and translational levels by SWE treatments. The HO-1 promoter analyzed with luciferase assay was also increased by treatment of SWE in a dose-dependent manner. This induction may be mediated by several kinase pathways including MEK, p38MAPK, AKT, and JNK. Quantitative real-time PCR using undifferentiated promonocytic cell lines revealed that thromboxane synthase (TXS), a potent vasoconstrictor and platelet aggregator, was increased and MMP-9, an anti platelet aggregator, was decreased in the presence of SWE. Our studies presented that SWE accelerated hemostatic and wound healing activities by altering the expression of genes, including HO-1, TXS, and MMP-9. Hataichanok Pandith, Xiaobo Zhang, Jason Liggett, Kyung-Won Min, Wandee Gritsanapan, and Seung Joon Baek Copyright © 2013 Hataichanok Pandith et al. All rights reserved. Endothelin-1 Levels in Scleroderma Patients: A Pilot Study Tue, 30 Jul 2013 09:44:48 +0000 Endothelin-1 (ET-1) is a potent endogenous vasoconstrictor, which mediates vascular wall cells proliferation, fibrosis, and inflammation through two types of ET-1 receptors (ET-A and ET-B). In our retrospective study the serum levels of ET-1 in 18 systemic sclerosis (SSc) patients with and without digital ulcers (DUs) were assessed to observe possible correlation between the levels of ET-1, the evolution of SSc, and the therapy with an ET-1 antagonist (bosentan). In all our patients, the levels of ET-1 were found higher than normal range and correlate with the severity of the disease. Furthermore we also observed that in patients without DUs the levels of ET-1 were higher and did not correlate with new DUs development. In conclusion, the levels of ET-1 in our studied patients do not correlate with the possible development of DUs. The reduction of ET-1 levels in DUs patients in therapy with bosentan confirms the efficacy of this molecule both for treatment and prevention of digital ulcers. The inhibition of ET-A receptor by its antagonist may activate the opposite ET-B receptors, with well-known function ET-1 degradation and reducing of ET-1 serum level as confirmed in our pilot study. Emanuele Cozzani, Sanja Javor, Erika Laborai, Massimo Drosera, and Aurora Parodi Copyright © 2013 Emanuele Cozzani et al. All rights reserved. Transforming Growth Factor-Beta and Urokinase-Type Plasminogen Activator: Dangerous Partners in Tumorigenesis—Implications in Skin Cancer Thu, 18 Jul 2013 08:11:23 +0000 Transforming growth factor-beta (TGF-β) is a pleiotropic factor, with several different roles in health and disease. TGF-β has been postulated as a dual factor in tumor progression, since it represses epithelial tumor development in early stages, whereas it stimulates tumor progression in advanced stages. During tumorigenesis, cancer cells acquire the capacity to migrate and invade surrounding tissues and to metastasize different organs. The urokinase-type plasminogen activator (uPA) system, comprising uPA, the uPA cell surface receptor, and plasminogen-plasmin, is involved in the proteolytic degradation of the extracellular matrix and regulates key cellular events by activating intracellular signal pathways, which together allow cancer cells to survive, thus, enhancing cell malignance during tumor progression. Due to their importance, uPA and its receptor are tightly transcriptionally regulated in normal development, but are deregulated in cancer, when their activity and expression are related to further development of cancer. TGF-β regulates uPA expression in cancer cells, while uPA, by plasminogen activation, may activate the secreted latent TGF-β, thus, producing a pernicious cycle which contributes to the enhancement of tumor progression. Here we review the specific roles and the interplay between TGF-β and uPA system in cancer cells and their implication in skin cancer. Juan F. Santibanez Copyright © 2013 Juan F. Santibanez. All rights reserved. Clinical Presentation, Pathogenesis, Diagnosis, and Treatment of Epidermolysis Bullosa Acquisita Mon, 15 Jul 2013 09:22:28 +0000 Epidermolysis bullosa acquisita (EBA) is a chronic mucocutaneous autoimmune skin blistering disease. The pathogenic relevance of autoantibodies targeting type VII collagen (COL7) has been well-documented. Therefore, EBA is a prototypical autoimmune disease with a well-characterized pathogenic relevance of autoantibody binding to the target antigen. EBA is a rare disease with an incidence of 0.2 new cases per million and per year. The current treatment of EBA relies on general immunosuppressive therapy, which does not lead to remission in all cases. Therefore, there is a high, so far unmet medical need for the development of novel therapeutic options. During the last 10 years, several novel in vitro and in vivo models of EBA have been established. These models demonstrated a critical role of the genetic background, T cells, and cytokines for mediating the loss of tolerance towards COL7. Neutrophils, complement activation, Fc gamma receptor engagement, cytokines, several molecules involved in cell signaling, release of reactive oxygen species, and matrix metalloproteinases are crucial for autoantibody-induced tissue injury in EBA. Based on this growing understanding of the diseases’ pathogenesis, several potential novel therapeutic targets have emerged. In this review, the clinical presentation, pathogenesis, diagnosis, and current treatment options for EBA are discussed in detail. Ralf J. Ludwig Copyright © 2013 Ralf J. Ludwig. All rights reserved.