Search

Abstract To meet regulatory requirements, and avoid or minimize animal testing, there is a need for non-animal methods to assess the potential of chemicals to cause skin sensitization. It is widely assumed that no one test will be sufficient and that combined data from several assays spanning key events from the adverse outcome pathway will be required. This paper challenges that assumption. The predictive performance of a single assay, the Genomic Allergen Rapid Detection (GARD™) assay, was compared with the performance, singly and in combination, of three formally validated non-animal approaches that appear as OECD test guidelines: the direct peptide reactivity assay (DPRA), the ARE-Nrf2 luciferase test method, and the human cell line activation test (h-CLAT). It is shown here that GARD™ alone outperforms each of DPRA, ARE-Nrf2 luciferase or h-CLAT, alone or in any combination as a 2 out of 3 strategy, in terms of sensitivity, specificity and accuracy. Based on the datasets analysed here, the sensitivity and specificity of GARD™ alone are 90–92% and 79–84% ("2 out of 3", 86% and 76%). Thus, in any situation where the 2 out of 3 strategy is considered adequate, GARD™ alone could be used with equal or better performance. Highlights • Prediction of skin sensitization potential does not need multiple assays representing Key Events of the AOP. • This has been argued on theoretical grounds and is now tested against published data. • A single assay, GARD™, can outperform combinations of OECD test guideline assays. [ABSTRACT FROM AUTHOR]

Anisakis simplex spp. sensitization rates have increased worldwide, with a significant impact on health-care systems. To date, no clear-cut diagnostic criteria and laboratory algorithm have been established, so anisakiasis still represents an under-reported health problem whose clinical manifestations, when present, mimic the much more common allergic and digestive disorders. Aim of the study was to systematically review the available literature on the prevalence of sensitization against Anisakis in the general population and in specific population groups, taking into account the impact of the different available diagnostic techniques on the epidemiological data. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, relevant papers reporting Anisakis sensitization epidemiological data were found covering a period ranging from 1996 to February 2017. Overall, 41 studies comprising 31,701 participants from eleven countries were included in the qualitative synthesis. General asymptomatic population resulted sensitized to Anisakis in 0.4 to 27.4% of cases detected by means of indirect ELISA or ImmunoCAP specific IgE detection, and between 6.6% and 19.6% of the samples by Skin prick test (SPT). Occupationally exposed workers (fishermen, fishmongers and workers of fish-processing industries) documented specific IgE between 11.7% and 50% of cases, whereas SPT positivity ranged between 8% and 46.4%. Symptomatic allergic patients to any kind of allergen were found to be positive to Anisakis specific IgE detection between 0.0% (in children with mastocytosis) to 81.3% (among adults with shellfish allergy). Results highlighted that hypersensitivity prevalence estimates varied widely according to geographical area, characteristics of the population studied, diagnostic criteria and laboratory assays. Further studies are needed to overcome the documented misdiagnosis by improving the diagnostic approach and, consequently, providing more affordable estimates in order to address public health interventions on populations at high risk of exposure to Anisakis and to tailor health services related to specific groups. [ABSTRACT FROM AUTHOR]

Background: Aesthetics remains a novel, poorly-regulated field of medicine. Objectives: This study compared the scientific backgrounds of speakers at major conferences related to aesthetic medicine. Methods: Records from conferences that took place in 2015 in aesthetics (Facial Aesthetic Conference and Exhibition [FACE]), plastic surgery (British Association of Aesthetic Plastic Surgeons [BAAPS]), and dermatology (British Association of Dermatologists [BAD]) were reviewed for professional backgrounds and publication histories of conference speakers. Results: FACE 2015 was the largest conference and included "aesthetics doctors" among speakers from diverse professional backgrounds. Speakers at BAD 2015 and BAAPS 2015 were mostly dermatologists and plastic surgeons. Overall and when grouped by profession, speakers at FACE 2015 had fewer authorships and were less likely to have authored any peer-reviewed papers. Only 17 percent of speakers at FACE 2015 had contributed to relevant publications. Aesthetics doctors only averaged 0.37 authorships versus plastic surgeons (6.76) and dermatologists (13.92). Conclusion: Most of the talks at FACE 2015 were presented by individuals with limited scientific backgrounds. The publication profiles of both FACE 2015 and aesthetic doctors were inconsistent with their fellow congresses and medical specialities. The results for aesthetic doctors might fall below the threshold deemed acceptable for doctors presenting themselves as experts in a branch of medicine, and might reflect a critical dearth of evidence-based practices in aesthetic medicine. [ABSTRACT FROM AUTHOR]

Abstract: Background: Associations between daily amounts of drinking water and skin hydration and skin physiology receive increasingly attention in the daily life and in clinical practice. However, there is a lack of evidence of dermatological benefits from drinking increased amounts of water. Materials and methods: Pubmed and Web of Science were searched without any restrictions of publication dates. References of included papers and related reviews were checked. Eligibility criteria were primary intervention and observational studies investigating the effects of fluid intake on skin properties in English, German, Spanish or Portuguese language, including subjects being healthy and 18+ years. Results: Searches resulted in 216 records, 23 articles were read in full text, and six were included. The mean age of the samples ranged from 24 to 56 years. Overall the evidence is weak in terms of quantity and methodological quality. Disregarding the methodological limitations a slight increase in stratum corneum and “deep” skin hydration was observed after additional water intake, particularly in individuals with lower prior water consumption. Reductions of clinical signs of dryness and roughness were observed. The extensibility and elasticity of the skin increased slightly. Unclear associations were shown between water intake and transepidermal water loss, sebum content, and skin surface pH. Conclusions: Additional dietary water intake may increase stratum corneum hydration. The underlying biological mechanism for this possible relationship is unknown. Whether this association also exists in aged subjects is unclear. Research is needed to answer the question whether increased fluid intake decreases signs of dry skin. [ABSTRACT FROM AUTHOR]

Palliative care is aimed at reducing the physical, mental, social and spiritual pain of the critically ill patients irrespective of the diagnosis. Dermatologists are rarely involved in palliative works currently, but recent literature demands an active involvement. In this paper, we tried to review literature linking palliative care and dermatology. We also attempted to define the need and scope of palliative dermatology as a subspecialty of palliative care. Policymakers of palliative medicine should seriously consider the role of dermatologists in the team and a dermatologist may avail basic training in palliative care as it may aid them to address certain clinical situations in a better way. [ABSTRACT FROM AUTHOR]

Background: Using the Khoros® image processing software environment, we developed a software-based system capable of extracting wheal size from skin prick tests (SPTs) in mm2 for research and routine purposes. Methods: At 20 min, the outlines of up to 20 wheals were marked with a pen and transferred with translucent adhesive tapes to a white paper form carrying predefined markings. The form was scanned at 200 dpi. The software automatically analysed the scanned image and calculated the sizes of the wheals. In a pilot study, serial SPTs with histamine in increasing dilutions were performed in 12 healthy volunteers in duplicate on both volar forearms. We matched the application results with a reference created from the scanned pictures. Results: Bland–Altman analysis showed reference and software calculation reaching very high agreement. The comparison of reference/software resulted in a low centred coefficient of variation (COV) of 11.9%. This was superior to the conventional measurement of horizontal (COV 37.9%) or maximal/minimal diameter (COV 25.9%). Conclusion: We present an accurate tool for exactly calculating SPT wheal size in mm2. [ABSTRACT FROM AUTHOR]

Presents several abstracts related to dermatology presented during the annual meeting of British Association of Dermatologists in Great Britain. 'Preliminary Report on the Skin of Ancient European Mummies From the Silk Road in China,' by K. Liddell and L.J. Liddell; 'Hippocrates of Cos— The First Dermatologist 9460–370 BC),' by L. Liddell.

Presents several abstracts related to dermatology presented during the annual meeting of British Association of Dermatologists in Great Britain. 'Early Diagnosis of Netherton's Syndrome: A Clinical and Molecular Genetic Study,' by A.D. Irvine, S. Chavanas, M. Malone, A. Hovnanian and J.I. Harper; 'The Melanocortin 1 Receptor Gene Determines Cutaneous Prototype in Individuals Without Red Hair,' by N. Flanagan, E. Healy, A.J. Ray, C. Todd, J.N.S. Matthews, M.A. Birch-Machin and J.L. Rees.

The article offers information on the new section of the "British Journal of Dermatology" (BJD) entitled "Putting Papers into Practice." It states that the new section aimed to alert busy readers regarding the important papers from the broader dermatological and general medical literature which are significant to the clinical research or practice in dermatology. Moreover, it will discuss observational studies in dermatology, randomized controlled trials, and advancement in research reporting.

References 1 Raahimi M, Sheppeard R, Livesey A. Monitoring for methotrexate induced liver fibrosis in many UK dermatology centres is out of date and needs reform. Comment on: 'Monitoring for methotrexate-induced liver fibrosis in many UK dermatology centres is out of date and needs reform' Dear Editor, I read with great interest the recent paper by Raahimi I et al i . in I Clinical and Experimental Dermatology i on the subject of noninvasive monitoring for methotrexate-induced liver fibrosis.1 The British Association of Dermatologists (BAD) guidelines, which advocate monitoring of Type III procollagen peptide (PIIINP) in patients taking methotrexate, are out of alignment not just with the British Society of Gastroenterology (BSG)2 but also with the European Association for the Study of the Liver (EASL)3 and the American Academy of Dermatology (AAD)4, all of which recommend serial measurement of the Fibrosis (Fib)-4 score for patients at risk of liver fibrosis. [Extracted from the article]

In this open, controlled, multicentre and prospective observational study, smartphone teledermoscopy referrals were sent from 20 primary healthcare centres to 2 dermatology departments for triage of skin lesions of concern using a smartphone application and a compatible digital dermoscope. The outcome for 816 patients referred via smartphone teledermoscopy was compared with 746 patients referred via the traditional paper-based system. When surgical treatment was required, the waiting time was significantly shorter using teledermoscopy for patients with melanoma, melanoma in situ, squamous cell carcinoma, squamous cell carcinoma in situ and basal cell carcinoma. Triage decisions were also more reliable with teledermoscopy and over 40% of the teledermoscopy patients could potentially have avoided face-to-face visits. Only 4 teledermoscopy referrals (0.4%) had to be excluded due to poor image quality. Smartphone teledermoscopy referrals allow for faster and more efficient management of patients with skin cancer as compared to traditional paper referrals. [ABSTRACT FROM AUTHOR]

Since its introduction in dermatology in the late 1990s optical coherence tomography (OCT) has been used to study many skin diseases, in particular non-melanoma skin cancer and it s precursors. Special attention has been paid to superficial basal cell carcinoma (BCC), and a number of smaller observational studies have been published. The diagnostic criteria for BCC of these studies are systematically reviewed. A systemic review of English language studies was performed using PubMed, Google Scholar and Royal Danish Library, to search for primary papers on OCT and BCC. The references of retrieved papers were searched by hand for further relevant papers. A total of 39 papers were identified (search date: 2014-01-15). 22 were excluded because they did not meet the inclusion criteria, leaving 17 papers for analysis. In 100 % of the studies, rounded dark structures in the upper dermis surrounded by a hyperreflective halo possibly surrounded by a hyporeflective border and disruption of epidermal layering were described. In 53 % of the reports a hyporeflective lateral tumour border was described. A range of other features were mentioned in a minority of the studies. It is suggested that these diagnostic criteria could be characteristic for identifying BCC lesions using OCT. [ABSTRACT FROM AUTHOR]

Background China has been experiencing huge changes in all aspects, including dermatologic research, since its reform in 1978. However, it is not known how the economic and intellectual development has influenced the publication trends in the field of dermatology, which could mirror the scientific development in other medical disciplines. In the present study, we analyzed publication trends from dermatology departments in mainland China from 2002 to 2011. Methods All publication data were obtained from . Only papers published from dermatology departments in mainland China were used for analysis. Results The number of publications increased 10-fold over this 10-year period. A total of 1231 articles were published in English in 251 journals between 2002 and 2011. A total of 129 journals published only one paper from dermatology departments in mainland China. Over 60% of articles were original research, and 21.7% were case reports. Among these 251 journals, foremost was the Journal of Clinical Experimental Dermatology, which published 5.9% of all papers from mainland China; 2.7% of papers were published in the Journal of Investigative Dermatology. The number of publications positively correlated with the changes in gross domestic product per capita during the study period. Conclusions These results suggest that the number of publications in the dermatology field has increased markedly in mainland China over the last 10 years. This dramatic increase in publications could be attributed, at least partially, to the significant improvement in economic conditions in mainland China. [ABSTRACT FROM AUTHOR]

Objectives Extracting useful visual clues from medical images allowing accurate diagnoses requires physicians’ domain knowledge acquired through years of systematic study and clinical training. This is especially true in the dermatology domain, a medical specialty that requires physicians to have image inspection experience. Automating or at least aiding such efforts requires understanding physicians’ reasoning processes and their use of domain knowledge. Mining physicians’ references to medical concepts in narratives during image-based diagnosis of a disease is an interesting research topic that can help reveal experts’ reasoning processes. It can also be a useful resource to assist with design of information technologies for image use and for image case-based medical education systems. Methods and materials We collected data for analyzing physicians’ diagnostic reasoning processes by conducting an experiment that recorded their spoken descriptions during inspection of dermatology images. In this paper we focus on the benefit of physicians’ spoken descriptions and provide a general workflow for mining medical domain knowledge based on linguistic data from these narratives. The challenge of a medical image case can influence the accuracy of the diagnosis as well as how physicians pursue the diagnostic process. Accordingly, we define two lexical metrics for physicians’ narratives—lexical consensus score and top N relatedness score—and evaluate their usefulness by assessing the diagnostic challenge levels of corresponding medical images. We also report on clustering medical images based on anchor concepts obtained from physicians’ medical term usage. These analyses are based on physicians’ spoken narratives that have been preprocessed by incorporating the Unified Medical Language System for detecting medical concepts. Results The image rankings based on lexical consensus score and on top 1 relatedness score are well correlated with those based on challenge levels (Spearman correlation >0.5 and Kendall correlation >0.4). Clustering results are largely improved based on our anchor concept method (accuracy >70% and mutual information >80%). Conclusions Physicians’ spoken narratives are valuable for the purpose of mining the domain knowledge that physicians use in medical image inspections. We also show that the semantic metrics introduced in the paper can be successfully applied to medical image understanding and allow discussion of additional uses of these metrics. [ABSTRACT FROM AUTHOR]

The article introduces scientific conference papers on T cells and skin to be presented at the 22nd Scientific meeting 2014 of the Fondation René Touraine (FRT), a European non-governmental organization that promotes therapeutic progress in dermatology, on 5th December 2014 in Paris, France. Papers by researchers Shimon Sakaguchi, Federica Sallusto and Thomas Gebhardt are included. Specific topics include immune abnormalities found in atopic dermatitis and adoptive transfer of dendritic cells.

Eponyms are used almost daily in the clinical practice of dermatology. And yet, information about the person behind the eponyms is difficult to find. Indeed, who is? What is this person's nationality? Is this person alive or dead? How can one find the paper in which this person first described the disease? Eponyms are used to describe not only disease, but also clinical signs, surgical procedures, staining techniques, pharmacological formulations, and even pieces of equipment. In this article we present the symptoms starting with (S) and other. The symptoms and their synonyms, and those who have described this symptom or phenomenon. [ABSTRACT FROM AUTHOR]

The content-based image retrieval (CBIR) in dermatological diagnosis context, the information matching is the major concern in terms of feature vector-based classification. The discrimination of the feature vector leads to better classification as well as retrieval rate. Better retrieval results help the dermatologist to improve the diagnosis. In this paper, we proposed a support vector machine weight map (SVM W-Map)-based feature selection along with multi-class particle swarm optimization (PSO) presented for multi-class dermatological imaging dataset. The performance of the system was tested on a dataset including 1450 images and obtained 99.7% for specificity and 95.89% for sensitivity. The analysis and evaluations of results show that the proposed system has higher diagnosis ability when compared with other works. [ABSTRACT FROM AUTHOR]

Few if any natural resource systems are completely understood and fully observed. Instead, there almost always is uncertainty about the way a system works and its status at any given time, which can limit effective management. A natural approach to uncertainty is to allocate time and effort to the collection of additional data, on the reasonable assumption that more information will facilitate better understanding and lead to better management. But the collection of more data, either through observation or investigation, requires time and effort that often can be put to other conservation activities. An important question is whether the use of limited resources to improve understanding is justified by the resulting potential for improved management. In this paper we address directly a change in value from new information collected through investigation. We frame the value of information in terms of learning through the management process itself, as well as learning through investigations that are external to the management process but add to our base of understanding. We provide a conceptual framework and metrics for this issue, and illustrate them with examples involving Florida scrub-jays (Aphelocoma coerulescens). [ABSTRACT FROM AUTHOR]

Summary: Background: Psoriasis affects over two million people in the U.K. It has a significant psychological and social impact on individuals and an associated high economic cost to the U.K. National Health Service. There are many unanswered questions about psoriasis. Objectives: To develop a protocol in order to work with patients, families, carers and healthcare professionals to identify psoriasis uncertainties; to agree by consensus a top‐10 list of psoriasis uncertainties; and to disseminate prioritized unanswered questions to researchers and funders so as to promote work that will focus on answering the uncertainties considered most important by stakeholders. Methods: A Psoriasis Priority Setting Partnership has been established to gather psoriasis uncertainties following the transparent methodology advocated by the James Lind Alliance. A steering group composed of stakeholders has disseminated an initial survey to patients, families, carers and healthcare professionals to collect information on important psoriasis questions. After removing duplications, uncertainties will be collated and checked against existing evidence to determine whether any have already been resolved. ‘True uncertainties’ will be circulated to stakeholders in a second survey where they will be ranked by importance. At a final workshop, information will be distilled to generate a top‐10 list of uncertainties. Results: By following the protocol outlined in this paper a prioritized list of uncertainties will be identified that will be used to inform the psoriasis research agenda. Conclusions: Research targeted to address priorities identified by a range of stakeholders is imperative. This project will inform policy makers and research funding bodies about what really matters to these groups. [ABSTRACT FROM AUTHOR]

Introduction: Lichen sclerosus et atrophicus (LSA) and an inversed type of psoriasis belong to a group of benign dermatoses usually located within the region of female external genitalia. The most common subjective symptoms reported by patients are itching, pain and changes in the color and structure of the skin. Aim: This paper presents 3 cases of patients suffering from selected dermatoses located within the external female genitalia treated at the Department of Dermatology, Poznan University of Medical Sciences. Case reports: Case 1. A 78-year-old patient admitted to the Department of Dermatology diagnosed with lichen sclerosus and atrophic as well as scleroderma, which had already been confirmed by histopathological examination in 2014. Laboratory tests demonstrated an increased level of glycemia, elevated ESR and lymphopenia. In the treatment of TFX (Thymus factor X) therapy (immunomodulating treatment), vitamins A + E containing cream and Protopic 0.1% ointment twice daily were recommended. Case 2. A patient aged 49 was admitted to the Department of Dermatology due to exacerbation of skin inflammation in the course of psoriasis. She presented with severe erythematous and papular lesions covered with silvery scales, with the highest intensity within the palmar surfaces of both hands, in the folds of under the breasts, groins, and therefore, the clinical picture was characteristic of inversed psoriasis (psoriasis inversa). Case 3. A 20-year-old patient admitted to the Department of Dermatology in order to proceed with the treatment of a diffuse type of scleroderma. Clinical diagnosis has been already confirmed by the skin biopsy (typical histological features of scleroderma), however exclusion of other dermatoses such as LSA was not possible. Conclusions: While analyzing the available scientific reports, the physician in charge must adjust therapeutic options individually, taking into account the clinical condition of the patient in case of dermatological diseases within the female genital region. [ABSTRACT FROM AUTHOR]

Erythema ab igne (EAI) is an asymptomatic dermatosis caused by prolonged exposure to localized heat. Affected areas have net-like hyperpigmentation that may resemble more serious conditions such as livedo racemosa or vasculitis. We report three cases of EAI in pediatric sickle cell disease (SCD) patients who were initially suspected of having a more severe, life-threatening disorder before Dermatology was consulted. Clinicians caring for pediatric SCD patients who regularly use heating pads/devices for pain relief should consider EAI in the differential diagnosis of large areas of net-like hyperpigmentation. This paper aims to increase recognition of EAI and patient education on safe practices while using heating pads. [ABSTRACT FROM AUTHOR]

The use of teledermatology in primary care has been shown to be reliable, offering the possibility of improving access to dermatological care by using telecommunication technologies to connect several medical centers and enable the exchange of information about skin conditions over long distances. This paper describes the main points of a teledermatology project that we have implemented to promote and facilitate the diagnosis of skin diseases and improve the quality of care for rural and remote areas. Moreover, we present a blockchain-based approach which aims to add new functionalities to an innovative teledermatology platform which we developed and tested in the Sardinian Region (Italy). These functionalities include giving the patient complete access to his/her medical records while maintaining security. Finally, the advantages that this new decentralized system can provide for patients and specialists are presented. [ABSTRACT FROM AUTHOR]

This paper presents a novel two-stage image segmentation method using an edge scaled energy functional based on local and global information for intensity inhomogeneous image segmentation. In the first stage, we integrate global intensity term with a geodesic edge term, which produces a preliminary rough segmentation result. Thereafter, by taking final contour of the first stage as initial contour, we begin second stage segmentation process by integrating local intensity term with geodesic edge term to get final segmentation result. Due to the suitable initialization from the first stage, the second stage precisely achieves desirable segmentation result for inhomogeneous image segmentation. Two stage segmentation technique not only increases the accuracy but also eliminates the problem of initial contour existed in traditional local segmentation methods. The energy function of the proposed method uses both global and local terms incorporated with compacted geodesic edge term in an additive fashion which uses image gradient information to delineate obscured boundaries of objects inside an image. A Gaussian kernel is adapted for the regularization of the level set function and to avoid an expensive re-initialization. The experiments were carried out on synthetic and real images. Quantitative validations were performed on Multimodal Brain Tumor Image Segmentation Benchmark (BRATS) 2015 and PH2 skin lesion database. The visual and quantitative comparisons will demonstrate the efficiency of the proposed method. [ABSTRACT FROM AUTHOR]

Retinoids are a class of compounds derived from vitamin A or having structural and/or functional similarities with vitamin A. They are classified into three generations based on their molecular structures. Inside the body, retinoids bind to several classes of proteins including retinoid-binding proteins and retinoid nuclear receptors. This eventually leads to the activation of specific regulatory regions of DNA – called the retinoic acid response elements – involved in regulating cell growth, differentiation and apoptosis. Several clinical trials have studied the role of topical and systemic retinoids in disease, and research is still ongoing. Currently, retinoids are used in several fields of medicine. This paper aims to review the structure, mechanisms of action, and adverse effects of retinoids, as well as some of their current uses in Dermatology. [ABSTRACT FROM AUTHOR]

Approximately 70 years ago, the first topical dexpanthenol-containing formulation (Bepanthen™ Ointment) has been developed. Nowadays, various topical dexpanthenol preparations exist, tailored according to individual requirements. Topical dexpanthenol has emerged as frequently used formulation in the field of dermatology and skin care. Various studies confirmed dexpanthenol’s moisturizing and skin barrier enhancing potential. It prevents skin irritation, stimulates skin regeneration and promotes wound healing. Two main directions in the use of topical dexpanthenol-containing formulations have therefore been pursued: as skin moisturizer/skin barrier restorer and as facilitator of wound healing. This 70th anniversary paper reviews studies with topical dexpanthenol in skin conditions where it is most frequently used. Although discovered decades ago, the exact mechanisms of action of dexpanthenol have not been fully elucidated yet. With the adoption of new technologies, new light has been shed on dexpanthenol’s mode of action at the molecular level. It appears that dexpanthenol increases the mobility of stratum corneum molecular components which are important for barrier function and modulates the expression of genes important for wound healing. This review will update readers on recent advances in this field. [ABSTRACT FROM AUTHOR]

Since its approval by the US Food and Drug Administration in 2002 for glabellar wrinkles, botulinum toxin (BTX) has been widely used to correct facial wrinkles. As a result, many consider BTX synonymous with cosmetic dermatology. Recent studies indicate that BTX elicits biological effects on various skin cell types via the modulation of neurotransmitter release, and it seems that BTX has a wider zone of dermatologic influence than originally understood. Clinicians and researchers are now beginning to explore the potential of BTX beyond the amelioration of facial lines and encouraging results are seen with BTX in a variety of skin conditions. In this paper, we review novel dermatological indications of BTX which includes (but not limited to) scar prevention, facial flushing, post-herpetic neuralgia and itch. These areas show great promise, but there is definite need for larger, double-blinded, randomized control trials against established treatments before BTX becomes a clinical reality. [ABSTRACT FROM AUTHOR]

Background: Cutaneous leishmaniasis (CL) is a major public health problem in Libya. In this paper, we describe the eco-epidemiological parameters of CL during the armed conflict period from January 2011 till December 2012. Current spatiotemporal distributions of CL cases were explored and projected to the future using a correlative modelling approach. In addition the present results were compared with our previous data obtained for the time period 1995–2008. Methodology/Principal findings: We investigated 312 CL patients who presented to the Dermatology Department at the Tripoli Central Hospital and came from 81 endemic areas distributed in 10 districts. The patients presented with typical localized lesions which appeared commonly on the face, arms and legs. Molecular identification of parasites by a PCR-RFLP approach targeting the ITS1 region of the rDNA was successful for 81 patients with two causative species identified: L. major and L. tropica comprised 59 (72.8%) and 22 (27.2%) cases, respectively. Around 77.3% of L. tropica CL and 57.7% of L. major CL caused single lesions. Five CL patients among our data set were seropositive for HIV. L. tropica was found mainly in three districts, Murqub (27.3%), Jabal al Gharbi (27.3%) and Misrata (13.7%) while L. major was found in two districts, in Jabal al Gharbi (61%) and Jafara (20.3%). Seasonal occurrence of CL cases showed that most cases (74.2%) admitted to the hospital between November and March, L. major cases from November till January (69.4%), and L. tropica cases mainly in January and February (41%). Two risk factors were identified for the two species; the presence of previously infected household members, and the presence of rodents and sandflies in patient’s neighborhoods. Spatiotemporal projections using correlative distribution models based on current case data and climatic conditions showed that coastal regions have a higher level of risk due to more favourable conditions for the transmitting vectors. Conclusion: Future projection of CL until 2060 showed a trend of increasing incidence of CL in the north-western part of Libya, a spread along the coastal region and a possible emergence of new endemics in the north-eastern districts of Libya. These results should be considered for control programs to prevent the emergence of new endemic areas taking also into consideration changes in socio-economical factors such as migration, conflicts, urbanization, land use and access to health care. [ABSTRACT FROM AUTHOR]

The patient is the centre of a web of relationships, and the impact of his/her disease on family members and caregivers must be taken into account. The aim of this study was to identify the specific instruments that measure the impact of a dermatological disease on the quality of life (QoL) of family members, by performing a systematic search of the literature. Fifteen papers were identified, describing the creation and validation of nine instruments. Four of them concerned atopic dermatitis (Dermatitis Family Index, DFI; Parents' Index QoL Atopic Dermatitis, PiQoL- AD; QoL in primary caregivers of children with atopic dermatitis, QPCAD; Childhood Atopic Dermatitis Impact Scale, CADIS), two measured the impact of psoriasis in family members (Psoriasis Family Index, PFI; FamilyPso), one the impact of epidermolysis bullosa (Epidermolysis Bullosa Burden of Disease, EB-BoD), one of ichthyosis (Family Burden Ichthyosis, FBI), and one was generic for dermatological conditions (Family Dermatology Life Quality Index, FDLQI). The European Academy of Dermatology and Venereology quality of life taskforce recommends that the impact of a skin disease on family and caregivers should be measured as part of any thorough evaluation of the burden of a disease. Guidelines are given to choose the most appropriate instruments. [ABSTRACT FROM AUTHOR]

Presents several abstracts on dermatology published in the July 1998 issue of the 'British Journal of Dermatology.' 'Treatment of Chronic Plaque Psoriasis With Photodynamic Therapy,' by A.J.A. Bamujally, H. Judodihardjo, M. Gonzalez, S. Varma, H. Wilson, R. Marks and A. Anstey; 'Persistent Light Reactivity Following Photocontact Allergy to Benzophenone-3,' by S.H. Ibbotson, M.E. Kesseler and P.M. Farr.

Purpose: To evaluate the equivalence of electronic and paper versions of the Psoriasis Symptom Inventory and to examine measurement properties of the electronic version. Methods: In a prospective, randomized, crossover, non-interventional study in adult subjects (age ≥18 years) with plaque psoriasis conducted over a period of 15 days, subjects were randomized to two groups, completing either the paper or electronic Psoriasis Symptom Inventory daily for 7 consecutive days followed by the alternate version. Equivalence was assessed by the intraclass correlation coefficient (ICC) between both administration modes. Differences in scores were also tested using paired Student's t test. Measurement properties included internal consistency reliability, test-retest reliability, and convergent and discriminant validity between the Psoriasis Symptom Inventory and (1) disease-specific (Dermatology Life Quality Index) and (2) general health (SF-36v2) status. Results: Eighty subjects [74 % (59/80) moderate-to-severe psoriasis; 26 % (21/80) mild psoriasis receiving systemic treatment] were enrolled from 8 sites in the USA. The two modes were highly concordant for both total (ICC = 0.97) and individual item scores (ICC range = 0.93-0.97). Response bias testing showed no differences based on completion order with all ICC values >0.91. All mean score differences, except for one item ('flaking'), were non-significant ( P > 0.05). Minimum values for reliability (>0.70) and validity (convergent, r ≥ 0.40) were exceeded for the electronic Psoriasis Symptom Inventory. Conclusions: Equivalence between paper and electronic versions of the Psoriasis Symptom Inventory and strong measurement properties of the electronic mode indicated a successful migration from paper to electronic format of the Psoriasis Symptom Inventory. [ABSTRACT FROM AUTHOR]

Background: The confirmatory diagnosis of Osteogenesis Imperfecta (OI) requires invasive, commonly bone biopsy, time consuming and destructive methods. This paper proposes an alternative method using a combination of two-photon excitation fluorescence (TPEF) and second-harmonic generation (SHG) microscopies from easily obtained human skin biopsies. We show that this method can distinguish subtypes of human OI. Methodology/Principal Findings: Different aspects of collagen microstructure of skin fresh biopsies and standard H&E-stained sections of normal and OI patients (mild and severe forms) were distinguished by TPEF and SHG images. Moreover, important differences between subtypes of OI were identified using different methods of quantification such as collagen density, ratio between collagen and elastic tissue, and gray-level co-occurrence matrix (GLCM) image-pattern analysis. Collagen density was lower in OI dermis, while the SHG/autofluorescence index of the dermis was significantly higher in OI as compared to that of the normal skin. We also showed that the energy value of GLCM texture analysis is useful to discriminate mild from severe OI and from normal skin. Conclusions/Significance: This work demonstrated that nonlinear microscopy techniques in combination with image-analysis approaches represent a powerful tool to investigate the collagen organization in skin dermis in patients with OI and has the potential to distinguish the different types of OI. The procedure outlined in this paper requires a skin biopsy, which is almost painless as compared to the bone biopsy commonly used in conventional methods. The data presented here complement existing clinical diagnostic techniques and can be used as a diagnostic procedure to confirm the disease, evaluate its severity and treatment efficacy. [ABSTRACT FROM AUTHOR]

Abstract: Cultural factors can influence the experience and presentation of diseases, including psychosomatic diseases. Psychosomatic dermatology refers to skin diseases in which psychogenic causes, consequences, or concomitant circumstances have an essential and therapeutically important influence. Indian culture is one of the oldest and most diverse, and encompasses the various traditions and beliefs of people all over the vast Indian subcontinent. This paper discusses how cultural factors can influence the clinical course of some dermatologic problems and reviews the cultural dimension of some common skin conditions in India, including vitiligo, facial hypermelanosis, acne, atopic dermatitis, psoriasis, and leprosy. The paper illustrates some examples of the contributions of a patient''s cultural values, beliefs, and practices to the biopsychosocial model of psychosomatic skin disorders. [Copyright &y& Elsevier]

Somatic symptom disorder (SSD) is defined by the prominence of somatic symptoms associated with abnormal thoughts, feelings, and behaviors related to the symptoms, resulting in significant distress and impairment. Individuals with these disorders are more commonly encountered in primary care and other medical settings, including dermatology practice, than in psychiatric and other mental health settings. What defines the thoughts, feelings, and behaviors as abnormal is that they are excessive, that is, out of proportion to other patients with similar somatic symptoms, and that they result in significant distress and impairment. SSD may occur with or without the presence of a diagnosable dermatologic disorder. When a dermatologic disorder is present, SSD should be considered when the patient is worrying too much about his or her skin, spending too much time and energy on it, and especially if the patient complains of many nondermatologic symptoms in addition. The differential diagnosis includes other psychiatric disorders, including depression, anxiety disorders, delusions of parasitosis, and body dysmorphic disorder. This paper describes SSD and its applicability in dermatologic practice, with illustrative cases. [ABSTRACT FROM AUTHOR]

Bruxism is a diurnal or nocturnal parafunctional activity that includes unconscious clenching, grinding, or bracing of the teeth. An extensive medical history should be taken in these patients so proper diagnosis can be made. Habits such as biting the tongue, cheeks or lips, chewing gum or eating seeds for many hours per day, biting nails, and/or biting hard objects, will cause and/or exacerbate pre-existing bruxism. The etiology of bruxism is uncertain, but it is hypothesized to be associated with genetic, structural, and psychosocial factors. Over time, chronic clenching of the jaw leads to hypertrophy of masseters and temporalis musculature causing the face to take on a masculine and square appearance. Patients commonly present to dermatology cosmetic practices wishing to have a more slim, softer appearing face. This review is the first paper to discuss aesthetic treatment options for complications of bruxism including masseter and temporalis hypertrophy and the associated accelerated aging of the lower face. [ABSTRACT FROM AUTHOR]

Background: over the last two decades, only few dermatology research papers have been published in Saudi Arabia provided the small number of experts -in this field -enlisted in higher education institutions. Hence a compelling need to review the recent publications and define the current prevalence, status and interventions needed. Objective: To present an overview of the common dermatological diseases, particularly eczema and dermatitis, in Saudi community as well as their effects and ways to mitigate them. Methods: Review of Randomized Controlled Trials (RCTs) researches conducted and published in Saudi Arabia. Results: Empirical findings revealed that Acne, Eczema and Psoriasis are the most common dermatological disorders among the Saudi community while Atopic Dermatitis was the most common mostly affecting children. In the meantime, Vitiligo emerged to be the most rampant pigmentary ailment, also viral warts appeared predominant covering up to 12% of the patients in the subject. On the other hand, dermatophytoses occurred commonly among the fungal conditions, while psoriasis arose as the most recurrent papulosquamous condition. Conclusion: The prevalence of dermatological disorders in Saudi Arabia is rather high with the issue being overlooked and deprioritized in favor of graver pathological conditions despite the significant social, psychological and quality of life impact on the patients. Thus, we recommended that proper education and awareness campaigns on skin diseases should be provided at all academic and social levels as one way of prevention and alleviation of skin diseased in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background: Onchocerca volvulus infection can result in blindness, itching and skin lesions. Previous research concentrated on blindness. Methods: A clinical classification system of the cutaneous changes in onchocerciasis was used for the first time in this study within the context of an early ivermectin drug trial in the savanna region of Kaduna State, northern Nigeria. Skin examinations were performed in 6,790 individuals aged 5+ years in endemic communities and 1,343 individuals in nonendemic communities. Results / Discussion: There was increased risk for all forms of onchocercal skin disease in endemic communities with the most common finding being the presence of nodules (1,438 individuals, 21.2%), followed by atrophy (367, 6.1% of those < 50 years), acute papular onchodermatitis, APOD (233, 3.4%), depigmentation (216, 3.2%) and chronic papular onchodermatitis, CPOD (155, 2.3%). A further 645 individuals (9.5%) complained of pruritus but had completely normal skin. APOD was more common in males whereas atrophy, hanging groin and nodules were more common in females. After controlling for age and sex, microfilarial positivity was a risk factor for CPOD, depigmentation, hanging groin and nodules (OR 1.54, p = 0.046; OR 2.29, p = 0.002; OR 2.18, p = 0.002 and OR 3.80, p <0.01 respectively). Comparable results were found using presence of nodules as the marker for infection. Microfilarial load showed similar, though weaker, results. A total of 2621(38.6%) endemic residents had itching with normal skin, or had one or more types of onchocercal skin disease including nodules, which may be considered as a composite index of the overall prevalence of onchocercal skin disease. Conclusion: Significant levels of onchocercal skin disease were documented in this savanna area, which subsequently resulted in a reassessment of the true burden of skin disease in onchocerciasis. This paper represents the first detailed report of the association of onchocercal skin disease with markers for onchocercal infection. [ABSTRACT FROM AUTHOR]

The skin being the largest organ of the integumentary systems shows a very active redox system which main role is to modulate not only energy metabolism (two-electron transfer reactions) but also cell signalling and defence (one-electron transfer reactions). Exogenous and/or endogenous factors can impair such system leading to a condition of oxidative distress. This latter can be considered as an emerging health risk factor which detection is possible only by means of specific test that have been recently included in the novel Redoxomics. Lifestyle plays a relevant role in the prevention and in the treatment of oxidative distress that can take advantage of physiological redox modulators under medical control. This review is an update of a previous paper that has been published one years ago on this Journal [EJAMED. 2016. 6 (1): 9-47]. [ABSTRACT FROM AUTHOR]

Drug reactions and systemic diseases often involve the skin. In particular, most drug-induced reactions and many infectious diseases present with dermatologic manifestations localized acrally, that is on distal portions of limbs (hand, foot) and head (ears, nose). A detailed review of all acral dermatologic signs of drug reactions and systemic diseases is beyond the scope of this paper, although some of these disorders will be discussed specifically here. [ABSTRACT FROM AUTHOR]

This paper presents a newly developed dermatological laser (with a central wavelength 975 nm) for application in therapies requiring deep penetration of tissue, e.g., cutaneous (dermal) neurofibroma (von Recklinghausen disease) and hemangiomas. This laser can work either in pulses or continues wave mode. Laser radiation is transmitted toward the application region by optical fiber with a diameter of 0.6 mm. The compact design of the laser facilitates its transport and increases the comfort of use. [ABSTRACT FROM AUTHOR]

Eponyms are used almost daily in the clinical practice of dermatology. And yet, information about the person behind the eponyms is difficult to find. Indeed, who is? What is this person's nationality? Is this person alive or dead? How can one find the paper in which this person first described the disease? Eponyms are used to describe not only disease, but also clinical signs, surgical procedures, staining techniques, pharmacological formulations, and even pieces of equipment. In this article we present the symptoms starting with (R) and other. The symptoms and their synonyms, and those who have described this symptom or phenomenon. [ABSTRACT FROM AUTHOR]

Eponyms are used almost daily in the clinical practice of dermatology. And yet, information about the person behind the eponyms is difficult to find. Indeed, who is? What is this person's nationality? Is this person alive or dead? How can one find the paper in which this person first described the disease? Eponyms are used to describe not only disease, but also clinical signs, surgical procedures, staining techniques, pharmacological formulations, and even pieces of equipment. In this article we present the symptoms starting with (R) and other. The symptoms and their synonyms, and those who have described this symptom or phenomenon. [ABSTRACT FROM AUTHOR]

The intense pulsed light (IPL) and laser technologies are widely used for skin rejuvenation and for treating several dermatological disorders such as skin dyschromia and acne, and for non-ablative dermal remodeling of rhytides and hypertrophic scars. Technological evolution is rapid. The High Power Pulsed Light™ [HPPL™] and Incoherent Fast Light™ technologies [IFL™, Novavision Group S.p.A., 20826 Misinto (MB), Italy] are recent innovations in the field of IPL technologies; IFL™ is a further evolution of the already advanced HPPL™ system. The paper presents a selection of case histories of dermatological lesions treated with the HPPL™ and IFL™ technologies. All study materials were appropriately peer-reviewed for ethical problems. [ABSTRACT FROM AUTHOR]

Background and objectives:Superficial cutaneous vascular lesions (SCVLs) are quite common. Several types of lasers have been used to treat these lesions; however, there are no dedicated treatment guidelines and few studies in the literature addressed their treatment.Aims:In this paper, we aimed to report our clinical experience with potassium titanyl phosphate (KTP) laser treatment on different types of facial SCVLs including telangiectasia, spider angioma, and erythema.Methods:Data were retrospectively collected from 146 patients with SCVLs, who had been treated with the 532-nm wavelength laser at our outpatient dermatology clinic. Treatment responses were graded as four groups: clearance (> 75% improvement compared with the previous session), marked improvement (50–75%), partial improvement (25–50%), and no response (< 25%).Results:The rate of clearance plus marked improvement (favorable outcome) was 66.1% for telangiectasia group, 93.5% for spider angioma group, and 26.7% for erythema group. Mean number of treatments was 2.9 ± 1.4 for telangiectasia group, 1.4 ± 0.8 for spider angioma group, and 2.9 ± 1.7 for facial erythema group. Only minimal adverse effects related to treatment procedure were detected in 5 out of 146 (3.4%) patients.Conclusions:Our results demonstrated that KTP laser might be a safe and effective laser modality for SCVLs, which may be associated with physiological problems due to cosmetic concerns. [ABSTRACT FROM PUBLISHER]

Skin conditions are common and patients will present in all care settings. Nurses observe the skin on a daily basis while caring for their patients, so it is important to have an understanding of the skin and its function. Skin conditions can be extremely uncomfortable and cause a great deal of distress, anxiety and embarrassment. This paper will the cover the principles of assessment of a patient presenting with a skin problem. [ABSTRACT FROM AUTHOR]

Malpractice risk is a common source of concern for the practicing physician. Dermatologists experience fewer lawsuits than most other specialists in medicine, but the risk is not negligible. All physicians should familiarize themselves with areas of potential risk and avoid medico-legal pitfalls. We present Part I of a two-part series addressing medico-legal questions common to most practitioners that cause a great deal of anxiety. Part I will focus upon risk management and prevention of future malpractice lawsuits, and Part II deals with suggestions and guidance once a lawsuit occurs. Herein, we discuss the primary sources of malpractice lawsuits delivered against healthcare practitioners including issues with informed consent, patient noncompliance, medical negligence, and inappropriate documentation, including use of electronic medical records. The overall goal is to effectively avoid these common sources of litigation. The risk management strategies discussed in this paper are relevant to the everyday practitioner and may offer physicians some degree of protection from potential liability. [ABSTRACT FROM AUTHOR]

Facing a malpractice lawsuit can be a daunting and traumatic experience for healthcare practitioners, with most clinicians naïve to the legal landscape. It is crucial for physicians to know and understand the malpractice system and his or her role once challenged with litigation. We present part II of a two-part series addressing the most common medicolegal questions that cause a great deal of anxiety. Part I focused upon risk-management strategies and prevention of malpractice lawsuits, whereas part II provides helpful suggestions and guidance for the physician who has been served with a lawsuit complaint. Herein, we address the best approach concerning what to do and what not to do after receipt of a legal claim, during the deposition, and during the trial phases. We also discuss routine concerns that may arise during the development of the case, including the personal, financial, and career implications of a malpractice lawsuit and how these can be best managed. The defense strategies discussed in this paper are not a guide separate from legal representation to winning a lawsuit, but may help physicians prepare for and cope with a medical malpractice lawsuit. This article is written from a US perspective, and therefore not all of the statements made herein will be applicable in other countries. Within the USA, medical practitioners must be familiar with their own state and local laws and should consult with their own legal counsel to obtain advice about specific questions. [ABSTRACT FROM AUTHOR]