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Dysregulation of melanin homeostasis is implicated in causing skin pigmentation disorders, such as melasma due to hyperpigmentation and vitiligo due to hypopigmentation. Although the synthesis of melanin has been well studied, the removal of the formed skin pigment requires more research. We determined that β-mangostin, a plant-derived metabolite, induces the degradation of already-formed melanin in the mouse B16F10 cell line. The whitening effect of β-mangostin is mediated by macroautophagy/autophagy, as it was abolished by the knockdown of ATG5 or RB1CC1/FIP200, and by treatment with 3-methyladenine, a phosphatidylinositol 3-kinase complex inhibitor. However, the exact autophagy mechanism of melanosome degradation remains unknown. Selective autophagy for a specific cellular organelle requires specific E3-ligases and autophagic receptors for the target organelle. In this study, an E3-ligase, RCHY1, and an autophagy receptor, OPTN (optineurin), were identified as being essential for melanophagy in the β-mangostin-treated B16F10 cell line. As per our knowledge, this is the first report of a specific mechanism for the degradation of melanosomes, the target organelle of melanophagy. These findings are expected to broaden the scope of melanin homeostasis research and can be exploited for the development of therapeutics for skin pigmentation disorders. [ABSTRACT FROM AUTHOR]

In traditional Brazilian medicine, tubers extracts from Alocasia macrorrhizos are widely used in the treatment of skin pigmentation disorder. However, studies that evaluate its benefits in the treatment of this disorder are non-existent. Thus, this work aims to investigate the bioactivity of A. macrorrhizos extracts in cell culture and murine model of Vitiligo and correlating with its phenolic profile. The metabolic profiling from the bioactive extracts was obtained by LC-DAD-MS, FTIR, NMR, and CE-UV. The murine model of Vitiligo was induced with 5% hydroquinone in C57BL/6 male mice, which were treated or not with 100 mg/kg of roasted tuber aqueous extract. In Vitiligo model assay was observed hair follicle repigmentation and reduction of the epidermal layer thickness at the histopathological level, in the animals treated with aqueous extract of roasted tubers. The present study provides new molecular insight and scientific evidence on the potential utility of the extract of A. macrorrhizos against Vitiligo. [ABSTRACT FROM AUTHOR]

Human has used plants to treat many civilisation diseases for thousands of years. Examples include reserpine (hypertension therapy), digoxin (myocardial diseases), vinblastine and vincristine (cancers), and opioids (palliative treatment). Plants are a rich source of natural metabolites with multiple biological activities, and the use of modern approaches and tools allowed finally for more effective bioprospecting. The new phytochemicals are hyaluronidase (Hyal) inhibitors, which could serve as anti-cancer drugs, male contraceptives, and an antidote against venoms. In turn, tyrosinase inhibitors can be used in cosmetics/pharmaceuticals as whitening agents and to treat skin pigmentation disorders. However, the activity of these inhibitors is stricte dependent on their structure and the presence of the chemical groups, e.g. carbonyl or hydroxyl. This review aims to provide comprehensive and in-depth evidence related to the anti-tyrosinase and anti-Hyal activity of phytochemicals as well as confirming their efficiency and future perspectives. [ABSTRACT FROM AUTHOR]

As aberrant IL-17 signaling plays a critical role in the pathogenesis of psoriasis, biologic agents targeting this pathway have become an important weapon against this disease. Some biologic agents such as IL-17 inhibitors (secukinumab and ixekizumab) and the IL-17 receptor (IL17R) inhibitor (brodalumab) are relatively safe, tolerable and efficacious drugs. Nevertheless, side effects of IL-17 pathway inhibition occur. This review focuses on the dermatological manifestations linked to these treatments. Paradoxical psoriasis and atopic-like eczema may be the most common cutaneous adverse events, while manifestations such as neutrophilic dermatoses, hypersensitivity reactions, lichenoid eruptions, vasculitides, bullous diseases, lupus-like reactions, pigmentation disorders, adnexal diseases and granulomatous dermatoses have been described less frequently. [ABSTRACT FROM AUTHOR]

Melasma is a common chronic refractory disorder of pigmentation affecting people with darker skin types. Overall prevalence varies between 8.8% and 40%, depending on the ethnicity of the population and the geographical area. Therapeutic management of melasma is challenging, with high recurrence rates which significant impacts on the quality of life. No single treatment is universally efficacious. Systemic treatments with tranexamic acid and polypodium leucotmatous had promising results, although the former was related to systemic side effects. Microneedling and peeling were also efficacious, although their superiority to topical hydroquinone, the gold standard in melasma treatment, remains to be established. Similarly, laser and light devices have been beneficial. However, recurrence rates remain high in all treatment groups. Combination therapies, either in double or triple combinations yielded the best results when compared to single terapies. Treatment choice should be made after Wood's lamp examination, as well as dermatoscopic evaluation, in order to select the best treatment option, targeted at each melasma subtype. [ABSTRACT FROM AUTHOR]

The photothermal effect of lasers is minimized and the photoacoustic effect is maximized as the pulse duration is shortened. Therefore, picosecond lasers with a short pulse and high peak power can be used to effectively treat various pigment disorders by reducing tissue damage. The first picosecond lasers were used for tattoo removal; they are also widely used for pigment treatment because of their reduced side effects compared with nanosecond lasers. Recently, picosecond lasers have been shown to be effective in the treatment of various skin conditions such as acne scars and large pores. There are many studies on picosecond lasers; however, there are no studies on a laser with a pulse duration of 300 ps. This report describes the use of a 300 ps Nd:YAG laser for treating pigment disorders and for skin rejuvenation in four Asians, with no side effects. Determining the clinical significance of the 300 ps pulse duration through comparative studies with various picosecond lasers is needed. [ABSTRACT FROM AUTHOR]

A series of novel calix[4]azacrown substituted sulphonamide Schiff bases was synthesised by the reaction of calix[4]azacrown aldehydes with different substituted primary and secondary sulphonamides. The obtained novel compounds were investigated as inhibitors of six human (h) isoforms of carbonic anhydrases (CA, EC 4.2.1.1). Their antioxidant profile was assayed by various bioanalytical methods. The calix[4]azacrown substituted sulphonamide Schiff bases were also investigated as inhibitors of acetylcholinesterase (AChE), butyrylcholinesterase (BChE) and tyrosinase enzymes, associated with several diseases such as Alzheimer, Parkinson, and pigmentation disorders. The new sulphonamides showed low to moderate inhibition against hCAs, AChE, BChE, and tyrosinase enzymes. However, some of them possessed relevant antioxidant activity, comparable with standard antioxidants used in the study. [ABSTRACT FROM AUTHOR]

Aims: Owhadi is a popular commercial pistachio cultivar in Iran which could be an attractive source for natural bioactive compounds with health-promoting activity. Methods: The hulls subjected to fractionation and ethyl acetate fraction was a phenolic-enriched fraction (PEF). The PEF was encapsulated in nanoliposomes (PEF-NLs) as a newly developed delivery system. The phytochemical analysis of PEF-NLs confirmed the presence of phenolic and flavonoid compounds. Results: The PEF-NLs indicated the strong antioxidant activity through up-regulation of the antioxidant-related genes in the murine hepatocyte. The PEF-NLs indicated the notable anti-inflammatory activity by scavenging the nitric oxide (NO) and reducing the NO production in the murine macrophage cells. The PEF-NLs have also exhibited the anti-melanogenic activity through direct tyrosinase enzyme inhibition and by modulating melanin biosynthesis genes in B16F10 melanoma cells. Conclusion: The PEF-NLs possessed the promising potential to be used for controlling skin pigmentation disorders and as a skin-whitening agent in the cosmetic industry. [ABSTRACT FROM AUTHOR]

Background: Melasma is a cosmetically disfiguring disorder of facial pigmentation. Objectives: We evaluated the value of platelet-rich plasma (PRP) in the treatment of melasma using two different delivery techniques: microneedling using dermapen versus microinjections using mesoneedles. Patients and methods: Twenty-three adult Egyptian melasma patients were enrolled. Wood's light was used to determine the histological type of melasma. Autologous PRP was delivered into the lesional melasma skins through microneedling with dermapen on the right side of the face and intradermal microinjections using mesoneedles on the left side of the face (for each patient). The treatment was done regularly (three sessions, each month). The response to PRP therapy was measured using melasma area and severity index (MASI) and modified melasma area and severity index (mMASI) that were calculated before and after three treatment sessions. Hemi-MASI was used to compare the effectiveness of the two delivery techniques. Results: Following PRP treatment, MASI and mMASI scores decreased significantly from 11.86 ± 5.25 to 6.96 ± 4.82, and from 5.71 ± 2.56 to 2.90 ± 2.05, respectively (p <.000,). A statistically significant decrease was noted in the hemi-MASI score on each side of the face following PRP treatment (p <.000), but there was no significant difference in comparing both sides. Conclusions: Our study provides the first indication about the value of PRP as a useful and new therapeutic option in melasma. Moreover, our study was the first to compare PRP delivery through microneedling versus microinjections. [ABSTRACT FROM AUTHOR]

Lichen planus pigmentosus (LPP) is a cosmetically disfiguring condition. Many treatment options are available which are effective in halting the progression of the disease. The treatment of persistent pigmentation is still a challenge. We describe the use of Q-switched Nd-YAG laser in 13 patients with stable LPP using a standard protocol. Most of our patients showed complete to near-complete resolution of pigment without much complications. [ABSTRACT FROM AUTHOR]

1. During the long history of chicken domestication, eyelid colour, like skin colour and shank colour, has been one of the physical traits of Chinese indigenous chickens that influence consumer buying behaviour. In China, the Lindian chicken, which has coloured feathers, is renowned for the appetizing flavour of its meat and eggs, and its eyelid colours vary from deep (black) to light shades (light yellow). 2. To investigate genes involved in eyelid colour, the expression profiles of black and light-yellow eyelids of Lindian chickens were analysed with transcriptome sequencing. 3. A total of 13 466 genes were detected in the eyelids, among which 14 were differentially expressed. Among these differentially expressed genes (DEGs), three key genes, premelanosome protein (PMEL), dopachrome tautomerase (DCT), and tyrosinase (TYR), encoded proteins that positively regulate melanogenesis and melanin deposition. PMEL, DCT and TYR were expressed much more strongly in the black eyelids than in the light-yellow eyelids. A Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that tyrosine metabolism and melanogenesis genes were significantly enriched among these DEGs (corrected P < 0.05). 4. In conclusion, melanin may be one of the main factors involved in Lindian chicken eyelid colour. Furthermore, these results provide a valuable resource for the future study of the physical traits of Lindian chicken. [ABSTRACT FROM AUTHOR]

Background: Several terms have been used to characterize skin types. However, these are not based on evident dermatologic definitions, which usually include subjective and psychological properties. Objective: The objective of this study is to establish a new practical questionnaire to classify skin subtypes in Korean women to establish treatment and skin care guidance. Methods: Eight experts developed consensus statements about skin types and created a questionnaire. The content was categorized into four major subtypes: dry or non-dry; oily or nonoily; sensitive or nonsensitive; and pigmented or nonpigmented. A total of 512 patients completed the questionnaire. Correlations with age, skin Fitzpatrick's phototypes, and dermatologic comorbidities were analyzed. Results: Korean women commonly have oily skin but complain of dryness after cleansing. They are especially sensitive to skin care products and prone to developing pigmentary lesions. There was a trend in the proportion of dry skin subtype that increased as pigmented skin increased and oily skin decreased with advanced age. The proportion of sensitive skin was higher in patients with dermatologic comorbidities. The proportion of the pigmented skin was higher in darker Fitzpatrick skin phototypes. Conclusion: This is the first questionnaire established for Korean women to classify practical skin subtypes and may provide a basis for treating various skin conditions. [ABSTRACT FROM AUTHOR]

A blemish free, even-toned skin is universally associated with healthy skin. This reasoning makes people desire to have a flawless skin. Melanin is a naturally occurring pigment in humans. This pigment is responsible for skin, hair, and eye color, therefore determines our race and phenotypic appearance. On darker skin types, it is common that melanin production processes malfunctions. These malfunctions often lead to overproduction and secretion of melanin. As a result, unwanted pigmentary problems such melasma occur. Due to unknown etiology and its recurrence in nature, melasma is challenging to treat. The current available melasma treatment options often produce undesired side effects and suboptimum results. First-line topical treatments usually involve hydroquinone or topical steroids. Apart from the irritant reactions, this treatment mode is not suitable for all skin types. Skin care specialists are in search of an effective long-term cosmetics and cosmeceuticals to address hypermelanosis problems. Understanding of naturally occurring depigmenting agents provides an opportunity for more effective ways to manage melasma in all skin types. This review considers the benefits of naturally occurring ingredients which could help address skin pigmentation problems and broaden the choice for skin-lightening treatments. [ABSTRACT FROM AUTHOR]

Background: This study was done to demonstrate the safety and efficacy of a novel fractional 1550 nm laser device with a rolling mechanism (FRAX1550 Ellipse Medical, Horsholm, Denmark). Objectives: To evaluated the effectiveness of the 1550 nm device for improvement in wrinkles, pigmentation, and texture on a six point (−1 to 4) global improvement scale. Methods: Five female subjects between the ages of 44 and 71 years, with visible wrinkles and/or dyspigmentation were enrolled in the study. Two full face treatments were performed four weeks apart Follow-up visits at 1 and 3 months posttreatment were scheduled for photographic assessments. Assessment of improvement were performed by the investigators and two blinded evaluators through use of a six-point scale. Results: All subjects demonstrated improvement in all monitored parameters. The mean improvement scores were: wrinkles 1.6, skin texture 1.8, and pigmentation 1.7. All score improvements were statistically significant. Biopsy was performed on one patient immediately post-treatment and showed 800 μ penetration depth at a treatment level of 88 mJ and 400 μ at 44 mJ. Conclusions: The new rolling fractional 1550 nm laser device from this study offers improvement of aging facial skin with short downtime and minimal side effects. [ABSTRACT FROM AUTHOR]

Background and objective: To evaluate the progression of retinitis pigmentosa (RP) caused by mutations in either PDE6A or PDE6B by measuring the progressive constriction of the hyperautofluorescent ring and shortening of the ellipsoid zone (EZ)-line width. Patients and methods: Fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT) images were obtained from seven patients with autosomal recessive RP caused by mutations in either PDE6A or PDE6B. Measurements of the EZ line width on SD-OCT images and horizontal, vertical diameter, and ring area on FAF images were performed by two independent graders. The measurements of these four parameters were correlated with one another. Results: We observed that the EZ line width decreased by an average of 91 ± 64 µm per year, while the horizontal and vertical diameters decreased by 103 ± 53 µm and 92 ± 49 µm per year, respectively. The ring area decreased by a rate of 0.3 ± 0.18 mm2 per year. Progression rates were similar for the left eye. Conclusions: We observed a progressive loss of EZ line width and Short-wavelength fundus autofluorescence (SW-AF) ring constriction over time. These results may serve as reference for better prognostic prediction and patients selection for clinical trials promoting cone rescue. [ABSTRACT FROM AUTHOR]

Background: We present a macular dystrophy of differing severity in a single kindred caused by a heterozygous nonsense mutation in CRX. Case report: A 21-year-old Caucasian male from a Swiss family was investigated for decreasing central visual acuity associated with dischromatopsia. Clinical examination revealed posterior pole atrophy, including the maculopapillary bundle. Multimodal imaging, including autofluorescence, showed a hyperautofluorescent paramacular ring in both eyes. Genetic analysis identified a c.313C>T, p.Q105* nonsense mutation in CRX. The same mutation was identified in his father and uncle. Both of them showed signs of the disease, however with different severity. Conclusion: We describe an intrafamilial variable expressivity of a CRX mutation causing an isolated macular dystrophy. [ABSTRACT FROM AUTHOR]

Purpose: to report phenotypic and genotypic features in a group of autosomal recessive retinitis pigmentosa (arRP) patients associated with EYS mutations. Methods: we retrospectively reviewed the clinical records and the molecular genetic data of arRP patients carrying mutations in the EYS gene. All the patients underwent a comprehensive opthalmological examination. Additional investigation included color fundus photography, fundus autofluorescence, Goldmann visual field, OCT scans and full-field standard electroretinography. Results: we studied 10 RP patients (20 eyes) characterized by mutations in the EYS gene. Thirteen different sequence variants in the EYS gene were identified. In total, nine mutations found in our series had not previously been reported in the literature. All patients in our series complained of typical RP symptoms at the onset of the disease, namely night blindness and progressive constriction of the visual field. Visual acuity ranged from light perception to 20/20. Relevant findings reported in our series are Interdigitation-zone (IZ band) involvement, present even in the milder phenotypes and an estimated prevalence of 6.2% of arRP associated with EYS mutations. Conclusions: we reported the mutation spectrum of a group of EYS-related RP patients including nine novel mutations and the associated clinical phenotypes. Our series is the largest group of EYS-related arRP patients in the Italian population. [ABSTRACT FROM AUTHOR]

Introduction: Biallelic mutations in low-density lipoprotein-related protein 2 (LRP2) cause the multi-system Donnai-Barrow syndrome (facio-oculo-acoustico-renal syndrome). Although Donnai-Barrow syndrome is recognized as a form of vitreo-retinopathy, the ocular phenotype has not been well defined. The purpose of this study is to document the disk and peripapillary appearance in Donnai-Barrow syndrome. Methods: Retrospective cases series (five children with low vision from a consanguineous Emirati family known to harbor LRP2 mutation (NM_004525.2: c.7564T>C; p.Y42522H)). Results: All five children had high myopia (spherical equivalent from −15 to −22). One had an ophthalmic phenotypic pathognomonic for Knobloch syndrome, and genetic testing confirmed a homozygous novel COL18A1 mutation (NM_130455.3: c.2978_2987del; p.Pro993Leufs*35) with heterozygosity for the LRP2 mutation. The other four children, confirmed to be homozygous for the LRP2 mutation, had hypertelorism and down-slanting palpebral fissures. Three had spontaneous retinal detachment (two bilateral and one unilateral) with complicated post-surgical courses following retinal detachment repair. The three eyes (two children) without retinal detachment had a consistent unique optic nerve head appearance, with thin emanating vessels and multiple rings of depigmentation that made it difficult to discern the edge of the apparently small and recessed neuroretinal rim. This distinct appearance was also present in the post-surgical eyes which were not phthisical and seemed present in the single published posterior pole image found during literature review. Conclusions: A distinctive optic nerve head dysgenesis is part of Donnai-Barrow syndrome and can help distinguish its ocular phenotype from other vitreo-retinopathies associated with high myopia. [ABSTRACT FROM AUTHOR]

Background and objective: Q-switched (QS) lasers are the gold standard for tattoo removal. The purpose of the present study was to gain a more comprehensive understanding of the factors that influence the efficacy of QS lasers and their associated complications in the removal of tattoos in China. Patients and methods: Clinical data of 266 patients were analyzed retrospectively. The tattoo clearance rate was evaluated using the 4-point scale. The Cox regression model was applied to analyze the factors that affected the efficacy of QS lasers in tattoo removal. In addition, treatment-related adverse reactions were analyzed. Results: The results showed that several variables had a statistically significant effect (p < 0.05) on the efficacy of QS laser-mediated tattoo removal treatment, including the patients’ age, the tattoo’s age, type, color, or ink density and the number of treatments. A variety of adverse responses occurred during the laser treatment. The overall incidence of adverse responses was approximately 24.06%, including pigmentation, hypopigmentation, bulla formation, allergic reactions, and skin texture changes or hypertrophic scarring. Conclusion: Some factors may influence the efficacy of QS lasers in the treatment of tattoos and certain adverse reactions may occur during this process. [ABSTRACT FROM AUTHOR]

Background: Acquired, bilateral nevus of Ota-like macules (ABNOM) is one of the most common dermal melanocytoses. Although there are some literatures on ABNOM, its clinical features and etiopathogenetic factors have not been fully understood. Objective: To determine the prevalence and characteristics of ABNOM among the Chinese patients. Methods: A survey was carried out using the clinical examination and a questionnaire on 3212 first-time outpatients in our dermatology department, and 102 cases of ABNOM were subsequently enrolled. Results: The outpatient prevalence of ABNOM was 3.18%, and the age of the onset was 27.2 years on average. They all presented as speckled macules on the face alone or coexisted with patchy lesions (17.7%) or a band-like pigmentation (1.0%). Unprecedentedly, we found the zygomatic arch, the infraorbital, the cheek and the parotid region can be involved, and 52.0% cases had sclera pigmentation. ABNOM commonly coexisted with the pigmented fungiform papillae of the tongue, the melasma, the acne, prementstrual syndrome (female) and breast cystic hyperplasia (female) with the rates of 33.3%, 20.6%, 26.5%, 47.0% and 43.0% separately. Triggering factors’ investigation disclosed screen irradiation (47.1%), pregnancy (32.0%), cosmetics (29.4%), sensitive skin (22.6%), and positive family histories (21.6%) were highly related. Conclusions: Our study confirms that ABNOM is a relatively common disorder among adult Chinese’s outpatients. It is commonly distributed over the malar, lateral forehead and temple’s areas. The sclera pigmentation is another common finding that is overlooked in previous research. ABNOM is concomitant with melasma and some other disorders. Excessive sun exposure, hormonal disturbances and hereditary susceptibility are the main potential triggering factors of ABNOM. [ABSTRACT FROM PUBLISHER]

Objective: To determine the degree of acute skin damage and the time required for the recovery of facial skin barrier function after the skin was treated with micro-needles and nanochips of various tip lengths.Methods: For this split face comparative study, a total of 16 subjects were enrolled and randomly divided into 2 groups. In the first group, one of the facial side of each subject was treated with 0.25-mm long nanotips for a total of 6 times while the other facial side was treated with 0.25-mm traditional micro-needles with a straight blade for a total of 6 times. In the second group, one of the facial side was treated with 0.5-mm nanotips for a total of 6 times while the other facial side was treated with 0.5-mm traditional micro-needles with a straight blade for a total of 6 times. Evaluations for trans-epidermal water loss (TEWL), skin hydration and erythema were carried out at baseline, 0, 4, 8, 24, 48 and 72 hours after the treatment.Results: There was no significant difference in TEWL, skin hydration and erythema between the two facial sides of the subjects in the Group one who were treated with 0.25 mm nanochips and traditional micro-needles. However, in the subjects of the Group two, the mean TEWL of the facial side treated with 0.5 mm nanochips was relatively lower than that of the 0.5 mm traditional micro-needles treated facial side at 0, 4, 8 and 24 hours after the treatment. Mean erythema of the facial side treated with 0.5-mm nanochips micro-needles was also relatively lower than that of the 0.5-mm traditional micro-needles treated facial side at 8 hours after the treatment. Rapid recovery of skin barrier function was observed within 4–8 hours after treatment with various lengths of nanochips while it took at least 48–72 hours for recovery of skin barrier function after treatment with various lengths of traditional micro-needles as measured by TEWL.Conclusion: The skin disruption caused by nanotips treatment recovers quicker than the traditional microneedle treatment at equal lengths. [ABSTRACT FROM PUBLISHER]

N-Acetyl-d-glucosamine (NAG) has been recently considered for topical treatment of hyperpigmentation disorders due to its inhibitory effect on thyrosinase enzymes in melanocytes. NAG is a precursor of hyaluronic acid, increasing its amount in skin, and consequently, preserving the skin hydration and elasticity. It may also act as an emulsion stabilizer. Solid lipid nanoparticles (SLN) are advanced delivery systems successfully used in pharmaceutical and cosmetic formulations for the improvement of active molecules penetration into the skin. Therefore, this work aimed to develop and characterize stable and scalable topical formulations containing NAG-loaded SLN. NAG was incorporated in SLN which were prepared by two high shear homogenizers and characterized regarding its morphology and particle size by transmission electron microscopy and photon correlation spectroscopy, respectively. Oil emulgel and hydrogel were used as carriers of NAG-loaded SLN. Several parameters were evaluated, including the droplet size distribution, rheology, pH and topical delivery by different techniques. It was observed that SLN size was significantly dependent on NAG incorporation and homogenization process. Most tested SLN parameters appeared to be quite suitable, that is, spherical and well-defined SLN with approximately 258 nm and −30 mV. Hereafter, both gels containing SLN presented a pseudoplastic flow. Emulgel formulation containing NAG-loaded SLN allowed a higher NAG permeation through theSCcompared to the respective control (about 0.8 μgcm−2 h−1). According to the results obtained, it can be suggested that NAG acts as an emulsion stabilizer. This stabilization was also particularly dependent on the homogenizer type which is quite important for scale-up process. This study demonstrated the potential of scalable SLN formulations to improve NAG topical delivery contributing to the improvement of skin properties on several skin disorders. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this study was to compare the efficacy that ocular melanin confers in protecting the retina of juvenile and adult rats exposed to a bright luminous environment. Methods: Juvenile (JLE) and adult (ALE) Long–Evans pigmented rats were thus exposed to a bright cyclic light (10,000lux; white light) from postnatal day 14–28 or for 6 consecutive days, respectively. Flash electroretinograms (ERG) and retinal histology were performed at different predetermined ages, post-light exposure. Results: Despite a significant reduction in ERG responses immediately following light exposure, with time, retinal function fully recovered in JLE compared to a 54% recovery for the ALE. In ALE, we noted a region of the supero-temporal quadrant that was highly vulnerable to light damage. This region was also devoid of melanin granules prior to the light exposure. This melanin-free zone increased in size in the days that followed the end of exposure, a process that was accompanied by the gradual degeneration of the thus uncovered photoreceptors. In contrast, melanin and photoreceptor losses were minimal in JLE. Conclusion: Our results suggest that the light-induced photoreceptor degeneration in ALE would be secondary to the initial destruction of the RPE and ensuing loss of melanin protection. In contrast, the melanin granules of JLE appear to be significantly more resistant to light damage, a characteristic that would explain the higher resistance of JLE photoreceptors to light damage. Our results would thus suggest that the efficacy of ocular melanin protection against light damage declines with age. [ABSTRACT FROM PUBLISHER]

Background: Taxanes and anthracyclines are considered as fundamental drugs for the treatment of a broad range of cancers. They have several side effects, which may limit their usage. Drug-induced nail pigmentation (DHNP) has been reported as one of the most striking dermatological side effect of both taxanes and doxorubicin. Objective: This study aimed to evaluate and compare pigmentary side effects of taxanes and doxorubicin with the help of onychoscopy. Methods: Forty-one consecutive patients (30 women, 11 men) with a diagnosis of cancer (16 gastric cancer, 25 breast cancer) were prospectively enrolled in a period of six months. Patients were categorized according to the chemotherapy regimens they had been administered: docetaxel received group [docetaxel (60 mg/m2, day 1), cisplatin (60 mg/m2, day 1) and fluorouracil (500 mg/m2, days 1–5) every 3 weeks], paclitaxel received group [paclitaxel (80–175 mg/m2) every 21 days with or without trastuzumab/zoledronic acid] and doxorubicin received group [doxorubicin 50–60 mg/m2and cyclophosphamide 600–750 mg/m2every 21 days]. All the patients were asked whether they had diabetes mellitus (DM) and peripheral neuropathy. At the 16 weeks of chemotherapy, for each patient, all fingernails and toenails were evaluated in clinical and dermoscopic examinations for nail pigmentation. Dermoscopic examination was performed using a videodermatoscope. Descriptive statistics were computed for means, standard deviations, and frequencies. Chi-square test or Fisher’s exact tests were used for the statistical analysis, with a significance threshold ofp < 0.05. Results: 34.1% of the patients (14/41) demonstrated clinical signs of nail pigmentation. Nail pigmentation was observed in 4 of 13 patients (30.8%), who had received doxorubicin; 10 of 28 patients (35.7%), who had received taxanes (docetaxel and paclitaxel). There was no statistically significant relationship between the nail pigmentation and the type of the chemotherapeutic regimen administered (Fisher’s exact test,p = 1.000). In addition, no statistically significant results were observed between nail pigmentation and DM (Fisher’s exact test,p = 0.393), and nail pigmentation and peripheral neuropathy (Fisher’s exact test,p = 1.000). Conclusions: DHNP may cause considerable distress to patients. Dermoscopy is a noninvasive imaging method that increases diagnostic accuracy of both pigmented and nonpigmented lesions. Typical dermoscopic features of DHNP consist of a homogeneous brownish-gray coloration of the background with thin, longitudinal, gray lines, which allow the examiner to clearly make the correct diagnosis. Further studies are needed to assess both clinical and dermoscopical findings of DHNP. [ABSTRACT FROM AUTHOR]

Background:Idiopathic guttate hypomelanosis (IGH) is a common hypopigmentation affecting a large amount of older population. However, there is no standard treatment. Cryotherapy has been reported as an alternative therapy for years; nevertheless, there is no randomized controlled study to determine its efficacy. Objectives:To evaluate the efficacy and side effects of tip cryotherapy in IGH treatment. Material and methods:Total 101 lesions were included. Forty-three lesions were treated with cryotherapy and 58 lesions were assigned as control. A single session of tip cryotherapy was delivered and remained for 5 s. Colorimeter was used to measure lesional luminosity at baseline and then monthly until 4 months. Digital photographs were evaluated by two blinded dermatologists. In addition, patients’ assessments and side effects were assessed. Results:Mean luminosity scale gradually decreased from baseline. Also, the score of the treated lesions has been significantly lower than that of the control lesions since week 8 (p = .005). At the fourth month, dermatologists’ assessment revealed that 82.3% of the treated lesions comparing to only 2% of the control showed more than 75% improvement (p < .001). Burning sensation was the most common side effect. Conclusion:Tip cryotherapy appears to be an effective therapy with minimal adverse effect for IGH. [ABSTRACT FROM AUTHOR]

Background:To date, autologous punch grafting appears to be the easiest and least expensive surgical technique for stable vitiligo and piebaldism. Punch grafting is available worldwide, with no need for specialised instruments. However, no reliable data on efficacy and safety of different punch depths and punch sizes are available. Objective/methods:To compare the efficacy and safety of different punch depths and punch sizes in autologous punch grafting, a randomised controlled trial was performed in 33 patients with vitiligo or piebaldism. In each patient, four depigmented regions were allocated to: 1.5 mm deep grafts, 1.5 mm superficial grafts, 1.0 mm deep grafts, and 1.0 mm superficial grafts. Primary outcome was the total pigmented surface area. Secondary outcomes were Patients’ Global Assessment (PGA) and side effects. Results:Six months after grafting, 1.5 mm grafts showed a significantly larger pigmented surface area compared to 1.0-mm grafts (p < 0.001), though more side effects as well. No significant differences in the total pigmented surface between different punch depths were found. Deep grafts showed more erythema compared to superficial grafts. Conclusion:We recommend 1.5 mm superficial grafts in autologous punch grafting for trunk and proximal extremities in patients with stable vitiligo and piebaldism. [ABSTRACT FROM AUTHOR]

Joubert syndrome (JS) is a spectrum of genetic disorders characterised by cerebellar and brainstem malformation called “molar tooth sign”, resulting in hypotonia, developmental delay, and intellectual disability. Here we describe a young female JS patient with “salt-and-pepper” fundus and inner segment–outer segment junction (IS/OS line) discontinuity, with a lack of external limiting membrane. Ocular coherence tomography (OCT) detected blurred external retinal layers in the macula centre. Although JS patients often have retinal degeneration with varying severity, few investigators have utilised OCT in their investigations. Our findings will help clarify the precise mechanisms of retinal involvement in JS. [ABSTRACT FROM AUTHOR]

Oral macule and mucosal melanoma are often difficult to differentiate from each other, and a conclusive diagnosis of mucosal melanoma is difficult to make, either clinically or pathologically, in younger adults. We report the case of a 26-year-old female who presented with a black pigmented lesion of the left upper gingiva. The lesion was finally diagnosed as a mucosal melanoma 10 months after the patient’s first visit to a hospital. She received partial left maxillectomy. She has been alive without active disease for 3 years after first operation. Considering that in general, subepithelial invasion is seen even from the early phase in cases of mucosal melanoma, prompt and precise pathological diagnosis is necessary to ensure appropriate therapy. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid (TNA) is a novel therapeutic agent for hyperpigmented skin disorders. The efficacy and safety of topical TNA in patients with melasma has not been heretofore studied. The main objective of this study is to evaluate the efficacy and safety of topical TNA combined with intense pulsed light (IPL) treatment in Asians with melasma. Methods: A randomized, split-face (internally controlled) study was conducted in 15 women who received four monthly sessions of IPL to both sides of the face. Topical TNA or vehicle was applied to a randomly assigned side during and after IPL treatment. Patients were followed up for 12 weeks after completing the IPL treatments. Baseline and follow-up melanin index (MI; measured by Mexameter®, Courage and Khazaka, Cologne, Germany) and modified melasma area and severity index (mMASI) scores were determined. Results: Thirteen subjects completed the study without serious adverse events. MI and mMASI decreased significantly from baseline to 12 weeks after the last IPL treatment on the topical TNA side but not on the vehicle side. The efficacy of topical TNA in preventing rebound pigmentation after IPL treatment was also statistically significant. Conclusion: Topical TNA can be considered an effective and safe adjuvant to conventional treatment for melasma. [ABSTRACT FROM PUBLISHER]

Background: Intense pulsed light (IPL) has a well-recognized role in the treatment of photodamaged skin. Objective: To assess the safety and efficacy of a novel single-band IPL handpiece versus dual-band IPL handpiece in the treatment of photodamage. Study design/Materials and methods: This was a prospective, single-center split-face study with 20 enrolled participants. Three treatments, 21 days apart, were administered to the subjects and follow-up was performed for 20 weeks. The left side of the face was treated with the single-band handpiece. The right side of the face was treated with the dual-band handpiece. Blinded investigators assessed the subjects' skin texture, pigmented components of photodamage, and presence of telangiectasia both before and after treatment, utilizing a five-point scale. Results: Pigmented components of photodamage, skin texture, and presence of telangiectasias on the left and right side of the face were improved at the end of treatment. At 20-week follow-up, the side treated with single-band handpiece showed improvement in telangiectasia and pigmentation that was statistically superior to the contralateral side treated with the dual-band handpiece. Both devices equally improved textural changes. No adverse effects were noted with either device. Conclusion: Both single-band and dual-band IPL technology are safe and effective in the treatment of photodamaged facial skin. IPL treatment with a single-band handpiece yielded results comparable or superior to dual-band technology. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy of blister roof grafting (BG), cultured melanocytes transplantation (CMT) and non-cultured epidermal cell suspension transplantation (NCES) in the treatment of stable vitiligo.Methods: In each person of 83 vitiligo patients one vitiligo macule was selected and divided in three areas for separate treatment with BG, CMT and NCES in the same session. The results were evaluated 12-month post-surgery for the extent of repigmentation and color match.Results: A satisfactory result (>50% repigmentation) was achieved in 92%, 82% and 81% of the 83 patients with the BG, CMT and NCES methods, respectively. Significant differences between the BG and CMT groups (p = 0.038), and between BG and NCES groups (p = 0.017) were observed, but not between the CMT and NCES groups (p = 0.986). The extent of repigmentation on the head neck and trunk was superior to that of the extremities by all the three methods. A difference in the time of onset of repigmentation was observed, with repigmentation first appearing after 10 days, 20–30 days and >30 days in the BG, CMT and NCES groups, respectively.Conclusions: All the three methods are safe and effective to treat vitiligo. Future studies with larger groups are warranted to confirm our results. [ABSTRACT FROM PUBLISHER]

Skin pigmentary disorders and uneven skin tone represent common cosmetic concerns in Japan where fairer skin is culturally desirable. As the demographics of Asian countries continue to evolve, there is a need to understand the impact of cosmetic skin concerns on quality of life (QoL). 199 Japanese women self-claiming facial skin pigmentation disorders were asked to complete theBeautyQoLquestionnaire, and the results were compared with those of a control group of 200 women. Of the five dimensions of theBeautyQoLquestionnaire, the dimension “mood” appeared to be significantly lower in the group presenting facial dark spots, as compared with the control group (p< 0.05). In the group presenting facial dark spots, the five dimensions and the global score showed that subjects concerned had lower scores than subjects less concerned, even if statistical significance was not reached. This study confirms that common pigmentary disorders such as facial black spots may negatively impact QoL. Further comparative studies with a controlled randomized design would be necessary to confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine whether the effects of gamma rays on the regeneration of hair follicles are carried over to later hair cycles. Materials and methods: The whole bodies of C57BL/10JHir mice in the 1st telogen phase were irradiated with60Co γ-rays. Mice were examined for the effects on hair follicles, including their number, morphology and pigmentation in the 3rd anagen phase. Effects of γ-rays on hair follicle stem cells were investigated by the indirect immunolabeling of keratin 15 (K15). Results: Decreased hair follicle density and induction of curved hair follicles were observed in the dermis of irradiated skin. In addition, white hair and hypopigmented hair bulbs were found. The number of K15-positive hair follicle stem cells in the hair bulge region of irradiated skin appeared to decrease slightly but not significantly. Conclusions: These results suggest that the effects of γ-rays are carried over to a later hair cycle to affect the number, structure and pigmentation of hair follicles in the 3rd anagen phase when stem cells and committed progenitors for keratinocytes and melanocytes are irradiated in the 1st telogen phase. [ABSTRACT FROM AUTHOR]

Objective: Examine clinical trials performed for depigmenting agents in order to determine the most effective and well-tolerated depigmenting agent. Methods: We searched clinical trials, published and unpublished, performed for hydroquinone, ascorbic acid, azelaic acid, retinol and niacinamide in the period 2009 till present. Studies were examined based on participant information, design, duration, intervention, outcome measurements and statistical significance. Results: Sixty-one studies were examined, 40 published and 21 unpublished. Design, outcome measures and intervention showed sources of bias were not avoided. Only 30% of published trials were double-blind, 27% used a placebo and 80% used subjective measurements for their results. Unpublished trials follow similar outcomes, however, did not provide any significant results. Conclusion: Based on these results, we are unable to recommend a safer, more effective depigmenting agent. Lack of thorough trials limits us from accepting depigmenting agent full evaluation. To accept a depigmenting agent, its duration must test for long-term safety, clinical trial must be double-blind and comparative, use participants of the correct skin type and measure outcomes objectively. In addition, lack of results for parallel unpublished studies leaves room for discussion. Efforts toward creating more effective formulations are welcomed. [ABSTRACT FROM AUTHOR]

Background:Intense pulsed light (IPL) has been reported to effectively treat melasma in previous studies, but an aggravation of pigmentation was noted. Fractionated IPL is a novel technique in which microsecond-domain fractionated pulses are delivered to the target area.Objective:To compare the safety and efficacy of low-fluency, frequently scheduled fractionated IPL and conventional IPL for melasma treatment.Materials and Methods:This was a 14-week, split-face study in which 30 Asian women were treated with weekly fractionated IPL on one side of the face and biweekly conventional IPL on the other side.Results:The non-inferiority of a weekly fractionated IPL regimen to a biweekly conventional IPL regimen was verified by a lower margin of the 95% confidence interval for the difference in the Melasma Area and Severity Index (MASI) change from baseline of 2.61 for each side. This value was greater than the previously determined non-inferiority margin of –2.68 (P< 0.025). On the fractionated IPL side, the modified MASI score decreased continuously, but in the conventional IPL group, the MASI score rebounded during the treatment course.Conclusion:Fractionated IPL shows moderate efficacy as a melasma treatment and is therefore a good alternative to conventional IPL as there is no indication of melasma exacerbation. Fractionated IPL can also be used as a maintenance treatment for melasma. [ABSTRACT FROM AUTHOR]

Background: Copy Number Variants (CNVs) contribute to a large fraction of genetic diversity and some of them have been reported to offer an evolutionary advantage. Aim: To identify CNVs in pigmentary loci that could contribute to human skin pigmentation diversity. Subjects and methods: This study assessed the existence of CNVs in every exon of candidate genes: TYR, TYRP1, DCT, MC1R and SLC24A5, using the Multiplex Amplifiable Probe Hybridization technique (MAPH). This study analysed a total of 99 DNA samples of unrelated individuals from different populations. Validation and further analysis in a larger Spanish sample were performed by RT-qPCR. Results: Five CNVs were identified by MAPH: DCT exons 4 and 8, TYR exon 1 and SLC24A5 exons 1 and 4. Real-time quantitative PCR (RT-qPCR) confirmed the CNV in exon 1 of SLC24A5. This study further analysed the 5′ promoter region of SLC24A5 and found another CNV in this region. However, no association was found between the CNV and the degree of pigmentation. Conclusion: Although the functional role of these structural variants in pigmentation should be the subject of future work, the results emphasize the need to consider all classes of variation (both SNPs and CNVs) when exploring the genetics of skin pigmentation. [ABSTRACT FROM AUTHOR]

Background:Acral vitiligo (AV) is resistant to treatment.Aim:To evaluate efficacy and safety of combining carbon dioxide (CO2) laser and 5-fluorouracil (5FU) in treating AV.Methods:This study included 68 adult patients with AV. After randomly assigning patients into 3 groups, patients in group I were treated using 5FU, group II were treated using CO2laser, and group III were treated using CO2laser followed by 5FU for a maximum period of 5 months. The lesions were then evaluated both qualitatively and quantitatively.Results:Almost half (49.8%) of the lesions in group III achieved G4, and 6.1% of lesions achieved G3 re-pigmentation. This response was statistically significantly higher than that in the other two groups. This was not achieved in periungual areas in the hands and feet. The pain was tolerable during sessions or at sites of 5FU application. Transient hyperpigmentation, brownish spot on nail plates, itching, and infection were temporary side effects; however, Koebnerization was not detected.Conclusion:We concluded that prior use of CO2laser skin ablation, followed by 5FU application for AV is a safe and tolerable technique that improves the outcome and increases patient compliance. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to improve our understanding of the prevalence of acanthosis nigricans (AN) and its clinical relevance in our mixed-ancestry population and to investigate its association with abnormal glucose metabolism, obesity and hypertension. Design: This was a cross-sectional study. Settings and subjects: A total of 390 healthy mixed-ancestry females were recruited from the dermatology outpatient clinic at Tygerberg Hospital. Outcomes measured: A short questionnaire was administered, whereafter participants were inspected for the presence and degree of AN. Height, weight, blood pressure and random fingerpick blood glucose were measured. Results: AN was observed in 30% (n = 116) of participants, and most commonly found in the nape of the neck (94%, n = 109). Participants with AN were younger (p = 0.005), and of higher body mass (p < 0.001) with a higher random blood glucose (p = 0.04). AN was more commonly seen in diabetics (p = 0.004). The presence and severity of AN in the neck correlated far better with BMI and blood glucose than other sites, including the axilla. Conclusion: AN was found to be extremely common, with a prevalence of 30% in this group. An association with blood glucose levels, diabetes and obesity was demonstrated, proving that it is not just a normal ethnic phenomenon. No association with blood pressure or hypertension was found. [ABSTRACT FROM AUTHOR]

Background: It has long been assumed that in retinitis pigmentosa, disease presentation and progression are symmetrical. This study investigated whether hyperautofluorescent ring size, one known marker of disease progression, is symmetrical in typical RP patients. Materials and Methods: A total of 88 patients with typical retinitis pigmentosa were enrolled in the study. Each presented with a hyperautofluorescent ring when imaged at baseline with fundus autofluorescence (AF). Vertical and horizontal diameters were analyzed according to mode of inheritance and age group. Seven of 88 patients had data missing in one eye and were excluded from further analysis. Results: There was no significant relationship between hyperautofluorescent ring diameter and inheritance mode. There was a tendency toward smaller ring size with age and 3.7% of subjects displayed marked asymmetry in ring size between right and left eyes, although their electroretinogram results did not differ. Overall, when patients were considered as a group, there was a high correlation between right and left eyes' horizontal and vertical diameters (r = 0.99, p < 0.0001; r = 0.98, p < 0.0001). Comparing individual patients' eyes, and accounting for measurement error, a smaller majority of patients displayed symmetry of the hyperautofluorescent ring in both dimensions (85.7% in the vertical dimension, 87.3% in the horizontal dimension). Conclusion: This study confirmed the highly symmetrical nature of the hyperautofluorescent ring in RP patients, except in a small subgroup. AF results, which provide less variability per image, and are consistently interpreted between different observers, may be a more sensitive and reliable method for testing symmetry than many functional tests. [ABSTRACT FROM AUTHOR]

Background: Ketoconazole cream and adapalene gel are effective drugs against pityriasis versicolor. However, there are no reports on combination treatment with both compounds in pityriasis versicolor. Objective: To evaluate the efficacy and safety of combination therapy with adapalene 0.1% gel and ketoconazole 2% cream against pityriasis versicolor. Methods: Participants with pityriasis versicolor were randomly assigned to two groups: the combination group was treated with adapalene 0.1% gel and ketoconazole 2% cream once daily, and the monotherapy group received ketoconazole 2% cream twice daily. The treatment lasted 2 weeks in both groups. Outcomes were assessed at baseline and 1, 2 and 4 weeks after the initiation of treatment. Results: We noted clinically significant differences in total improvement rates between groups Weeks 1 and 2. A statistically significant difference was obtained Week 4. The treatment was well tolerated by all participants. Conclusions: The combination of adapalene 0.1% gel and ketoconazole 2% cream is effective and safe in the treatment of pityriasis versicolor. This therapeutic regimen was rapid, providing a valuable option for patients with pityriasis versicolor. [ABSTRACT FROM AUTHOR]

Among the pigmentary disorders, melasma is the prototype disorder characterized by hyperpigmentation. Although, conventionally, triple combination creams are used, there is a need for alternatives to hydroquinone as the drug has restrictions on its widespread use. This needs an understanding of the steps involved in the melanogenesis and the drugs that inhibit the key steps. The data on in vitro inhibition need to be then translated into clinical in vivo results, before a rationale compounded fixed drug preparation is marketed that inhibits the major steps in the pigmentation pathway. There is also a need to look for drugs that are superior to hydroquinone, as only then will they have a meaningful clinical utility. For now, a few drugs like deoxyarbutin, ellagic acid, dioic acid, n-butylresorcinol and azelaic acid have such properties in clinical trials, while metformin is a recent addition. [ABSTRACT FROM AUTHOR]

Melasma is a common pigmentation in Asian women. Lasers have been used to lighten melasma, although with variable outcomes and complications. In Asia, laser toning is a common technique used to safely lighten melasma. However, no large studies have been performed to validate efficacy. In our study, we demonstrate that in 38 970 Asian women, at least 35 890 patients (92.1%) had noticeable to excellent improvement in their melasma. [ABSTRACT FROM PUBLISHER]

Background:Atopic dermatitis (AD) or eczema is an inflammatory skin disease associated with significant impairment of quality of life. It is important to objectively quantify cutaneous biophysical measurements in research and therapeutics of this disease. Objective:To evaluate if skin redness (erythema) and pigmentation (melanin) correlate with disease severity and quality of life. Methods:Redness and pigmentation were measured under standardized condition at the antecubital flexure. Nottingham Eczema Severity Score (NESS) and Children’s Dermatology Life Quality Index (CDLQI) were documented. Results:Pigmentation correlated with age (r = 0.38,p = 0.02), but not with disease severity (NESS) or quality of life (CDLQI). Erythema correlated with age (r = 0.53,p = 0.001), NESS (r = 0.44,p = 0.006), pigmentation (r = 0.62,p< 0.0001), but not CDLQI (r = 0.3, trendp = 0.087). Conclusions:Skin erythema and pigmentation increase with age. Erythema correlates with disease severity but pigmentation correlates with neither severity nor quality-of-life score. The objective measurement of these two signs does not replace the clinical measurements of severity and quality of life, and may be of limited scope in eczema research and therapeutics. [ABSTRACT FROM AUTHOR]

Background: Although low-fluence 1064-nm Q-switched Nd:YAG laser (QSNYL) is widely used for the treatment of melasma, multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Jessner's solution has been used for treatment of melasma conventionally. Objectives: To evaluate the additional therapeutic effect and adverse effects of Jessner's peel when combined with 1064-nm QSNYL for melasma patients in a double-blind, placebo-controlled design. Methods: Total of 52 patients were included. Patients who received 10 sessions of 1064-nm QSNYL plus chemical peeling with placebo (group A) in a two-week interval and those who received 10 sessions of 1064-nm QSNYL plus chemical peeling with Jessner's solution (group B) in a two-week interval were analyzed. Responses were evaluated using the Melasma Area and Severity Index (MASI) score, physician's global assessment (PGA) and subjective self-assessment. Results: At 8 weeks, the mean MASI score decreased from 8.68 ± 4.06 to 8.60 ± 3.88 in group A and from 8.98 ± 3.72 to 7.13 ± 2.57 in group B, showing a significant difference ( p < 0.001). But at 20 weeks, there was no significant difference on reduction of MASI, self-assessment and PGA between the two groups. No serious adverse effects were reported with the additional Jessner's peeling. Conclusion: This study suggests Jessner's peel is a safe and effective method in the early course of treatment for melasma when combined with low-fluence 1064-nm Q-switched Nd:YAG laser. [ABSTRACT FROM AUTHOR]

Aim: The mucocutaneous changes observed during vitamin B12 deficiency in children have been published only as case studies and small case series. In this study, we aimed to demonstrate the frequency of mucocutaneous changes (particularly hyperpigmentation) seen during vitamin B12 deficiency and resolving time of these symptoms with vitamin B12 treatment. Material and methods: This prospective study was conducted at the pediatrics outpatient clinic of Harran and Yuzuncu Yil University Faculty of Medicine, among 57 patients, aged between 6 and 24 months, who were diagnosed with vitamin B12 deficiency following various examinations and tests. A detailed examination was performed in respect to skin and mucosal findings. Patients with vitamin B12 deficiency were administered intramuscular cyanocobalamin. Prospective examination was continued, and resolving time of symptoms after treatment was recorded. Results: The mean age of the patients enrolled in the study was found to be 12.75 ± 4.75. Hyperpigmentation was reported in 49 (85.96%) patients enrolled in the study; atrophic glossitis in 40 (70.17%), brittle and matt hair in 13 (22.80%), skin lesions (particularly diaper dermatitis) in eight (15.78%) and cheilosis in four (7.01%) patients. Three months after the treatment initiation, hyperpigmentation improved in 87.75%, atrophic glossitis in 97.5% and brittle and matt hair in 92.3% of the patients. Five patients (8.77%) with continuing pigmentation by the end of sixth months were considered as nonresponsive to the treatment. Conclusion: Deficiency of vitamin B12 should be considered in the differential diagnosis of infants who present with skin and mucosal lesions. [ABSTRACT FROM AUTHOR]

Dowling-Degos disease (DDD) is a rare, benign, autosomal dominant disorder characterized by reticulated pigmentation on flexural areas. Recently, a report of successful Er:YAG ablative laser treatment without any adverse effects was issued. A 49-year-old Korean woman presented with numerous small, hyperpigmented macules in a reticular pattern on her face, axillae, and inguinal folds of several years duration. Histologic examination revealed acanthosis with thin elongated rete ridges, basal branching, and widening. She was diagnosed as having DDD and was treated successfully without any adverse effects using a fractional 2,940-nm Er:YAG ablative laser (LOTUSII, Laseroptek, Sungnam, Korea). Er:YAG ablative laser treatment could be an effective treatment modality for DDD, but in Asians, who have darker skins than Caucasians, or in patients with skin lesions on the face, post-inflammatory hyperpigmentation could be problematic after treatment. Fractional Er:YAG ablative laser treatment should be viewed as an alternative therapeutic option for DDD. [ABSTRACT FROM AUTHOR]

Background: Studies of lasers or intense pulsed light (IPL) on facial port wine stain (PWS) were frequently reported. Neck PWS was seldom concerned. Objective: This paper was aimed to identify the efficacy and safety of IPL in the treatment of neck PWS in Chinese patients. Methods: Twenty-nine Chinese patients with neck PWS were enrolled to receive IPL therapy for five sessions at an interval of 4- to 5 weeks. The parameters were set as cut-off filters of 560 nm, single pulse with pulse width of 6 ms and fluence of 20-24 J/cm2 or double pulse with pulse width of 4.5-5.0 ms, pulse delay of 15-30 ms, and fluence of 18-25 J/cm2. The efficacy was evaluated using subjective assessment and non-invasive measurement. The adverse effects were recorded. Results: Over 60% patients achieved more than 50% improvement and over 50% participants were very satisfied or satisfied with the treatment. The participants less than 18 years old achieved better efficacy than the participants over 18 years old. The red or purple lesions gained better response to IPL treatment than the pink lesions. Adverse effects were limited. Conclusion: IPL is effective in neck PWS of Chinese population. Adverse effects were minimal and acceptable. [ABSTRACT FROM AUTHOR]

Introduction: Laser hair removal is becoming an increasingly popular alternative to traditional methods such as shaving, waxing, among other methods. Semiconductor diode lasers are considered the most efficient light sources available and are especially well suited for clinical applications including hair reduction. The effectiveness of laser hair reduction depends on many variables, including the skin type of the patient. Material and Methods: A patient with Fitzpatrick Skin Type IV was submitted to laser hair removal of the arms with a high-power diode laser system with long pulses with a wavelength of 800 nm, a fluence of 40 J/cm2 and a pulse width of 20 ms. A 12-month follow-up assessment was performed and included photography and questionnaire. Results: Hypopigmentation was observed after a single laser hair removal section. After 6 months with the area totally covered, a gradual suntan with a sun screen lotion with an SPF of 15 was prescribed by the dermatologist. After 12 months of the initial treatment, a complete recovery of the hypopigmentation was achieved. Conclusion: Although a safe procedure, lasers for hair removal may be associated with adverse side effects including undesired pigment alterations. Before starting a laser hair removal treatment, patients seeking the eradication of hair should be informed that temporary, and possibly permanent, pigmentary changes may occur. [ABSTRACT FROM AUTHOR]

Background: Although many Asian atopic patients have orbital darkening symptom and the demand to treat this condition is increasing, little has been reported in the literature on the treatment of infraorbital dark circles in atopic dermatitis. Objective: To evaluate the clinical efficacy and safety of 2790-nm erbium:yttrium scandium gallium garnet (Er:YSGG) laser therapy for reducing infraorbital dark circles in atopic dermatitis patients. Materials and methods: Ten Korean patients over 21 year with mild atopic dermatitis and infraorbital dark circles were enrolled in this study. Patients who need active atopic dermatitis treatments are excluded because of the possibility of aggravation after laser treatment. They were treated for dark circles using a 2790-nm Er:YSGG laser. The treatment parameters were 1.8-2.2 J/cm² fluence, 6-mm spot size, and 0.3-ms pulse width with 10% overlap over the infraorbital areas once with a 4-week interval between treatments. Efficacy was assessed with a quartile grading score ranging from 0 to 5 by a blinded investigator, and the patients also documented their degree of satisfaction with the same grading score. All possible side effects were evaluated. Results: The clinical assessment showed 74.5% (2.7) and 72.5% (2.5) improvements, and the patient satisfaction scale scores improved an average of 74% (2.4) and 71.5% (2.3) at 2 months and 4 months after treatment, respectively. There were no severe side effects or aggravation of atopic dermatitis. Conclusion: Our study suggests that 2790-nm Er:YSGG laser therapy can be effectively and safely used in the treatment of infraorbital dark circles in atopic dermatitis patients. [ABSTRACT FROM AUTHOR]

Background: Fractional ablative CO2 laser therapy is based on the theory of fractional photothermolysis. It can be effective in treating acne scars in a less invasive fashion than conventional ablative CO2 laser therapy. Objective: In this clinical study, the safety and efficacy of a novel CO2 fractional ablative laser was investigated for the treatment of facial atrophic acne scarring in Chinese individuals. Materials and methods: A total of 31 patients (11 females, 20 males, Fitzpatrick skin phototypes III-IV) with facial acne scarring received three sequential fractional treatments over a 6-month period. Outcome measurements included blinded evaluations of before and after photographs by two physicians at 3 and 12 months after the final treatment. Global improvement was noted as well as any untoward events. Results: At the 12 months follow-up time period, 12.9% of the patients showed excellent improvement in their acne scars, while 38.71% noted good to fair results. The clinical response at the 12-month follow-up visit tended to be better than at the 3-month follow-up visit, but was not statistically significant. Four patients experienced post-treatment and transient PIH but three patients were noted to have prolonged erythema. There was no evidence hypopigmentation or worsening of the scarring in any of the study patients. Conclusion: This high-energy pulsed and cool-scanned fractional ablative CO2 laser system is safe and effective for facial atrophic acne scarring. Improvement in scarring was noted in the majority of patients with minimal discomfort and minimal downtime. Continued improvement over time is also an important clinical finding. [ABSTRACT FROM AUTHOR]