Search

Cristina García-Millan,1 Ander Pino,2 Rita Rodrigues,1 Gonzalo Segurado-Miravalles,1,3 Adrián Alegre-Sánchez,1 Pedro Jaén,1,3 Eduardo Anitua2 1Grupo de Dermatología Pedro Jaén, Madrid, Spain; 2BTI Biotechnology Institute, Vitoria, Spain; 3University Hospital Ramon y Cajal, Madrid, SpainCorrespondence: Eduardo Anitua, BTI Biotechnology Institute, Jacinto Quincoces 39, Vitoria, Spain, Email eduardo@fundacioneduardoanitua.orgBackground: Although the underlying pathophysiology of sensitive skin remains unknown, it presents clinical symptoms like erythema, burning and dryness associated with other inflammatory dermatoses such as dermatitis or rosacea.Objective: The aim of the present report was to provide preliminary data about the efficacy of Endoret-Serum (ES) as an autologous therapy for the topical management of sensitive skin alterations.Materials and Methods: Five patients underwent a daily topical ES treatment that was maintained for three months. Clinical assessment was carried out using validated dermatological surveys (DLQI, IGA, Likert, PGI-I). Additionally, skin hydration measurement and high-resolution topographic and reflectance confocal imaging analysis were carried out.Results: No adverse events were observed during the treatment. At the end of the follow-up period, surveys highlighted a significant therapeutic effect compared to baseline. Skin hydration was also improved, and topographic images showed a decrease in patient’s underlying inflammatory and vascular condition.Conclusion: This preliminary report suggests that Endoret-Serum may be useful in the management of clinical symptoms derived from sensitive skin alterations.Keywords: platelet-rich plasma, growth factors, sensitive skin, topical formulation, case report

Daylight photodynamic therapy (dlPDT) is a painless and increasingly cost-effective treatment for actinic keratosis (AK). New protocols avoid incubation, minimizing pain and adverse events. However, it is time-consuming and dependent on specific weather conditions. In patients with AK of the scalp, we evaluated the efficacy of indoor photodynamic therapy (PDT) using a wearable low-level light therapy (LLLT) device, without pre-incubation with a photosensitizing agent.In this pilot study, 27 patients with thin and moderately thick AK (Olsen Grades I-II) underwent a single 15-minute session of LLLT using a wearable cap-like device immediately after application of methyl-aminolevulinate (MAL) cream, with no prior preparation of the affected area. Treatment efficacy was quantified by measuring the reduction in AK lesion number and the AK quality of life (AKQoL) score. All AK lesions were mapped at baseline for follow-up 2 months later. Paired pre/post scalp biopsies from 5 patients were analysed using histological and immunohistochemical techniques (p53, p27, cyclin D1, p63, and Ki67 expression). Data were analysed using the Wilcoxon signed-rank test.In all patients we observed a global reduction in the number of AK lesions (71%; p 0.0001) and AKQoL score (from 5.6 to 4.4; p = 0.034) 2 months after treatment. Histology and immunohistochemistry of skin biopsies from 5 patients also revealed marked improvements after LLLT. No patients reported any pain during treatment.PDT using LLLT is a rapid, painless, and efficacious modality for the treatment of AK.

Background Folliculitis decalvans (FD) is a rare neutrophilic cicatricial alopecia that poses a therapeutic challenge. Objectives To describe the therapeutic response in a large number of cases of FD with long-term follow-up and analyze potential prognostic factors associated with severity of form and with a better therapeutic response. Methods This multicenter prospective study included patients with FD who had a minimum of 5 years of follow-up. Severity was assessed by the maximum diameter of the cicatricial area. Therapeutic response was evaluated according to stabilization of the size of the cicatricial areas and the improvement in clinical symptoms. Results A total of 60 patients (37 men [61.7%] and 23 women [38.3%]) with a mean age of 40 years were included. Earlier age of onset (P = .01) was statistically associated with severity of form. Treatment with rifampicin and clindamycin, tetracyclines, and intralesional steroids was the most effective. No statistically significant prognostic factors predicting a better therapeutic response were found. Limitations Because FD is a rare disease, the main limitation was the sample size. Conclusions An earlier age of onset was associated with the severe form of the disease. The proposed specific therapeutic protocol can be a very useful tool in clinical dermatologic practice.

The objective of our study was to describe the effectiveness and safety of oral dutasteride (OD) for male androgenetic alopecia in real clinical practice. A retrospective, monocentric, and descriptive study was designed. Male patients with androgenetic alopecia that had received OD for at least 12 months were included. Three or less capsules of 0.5 mg per week were considered low doses. Therapeutic response was assessed by comparison of pre- and post-treatment (at month 12) clinical images by three independent dermatologists with expertise in hair disorders, using a four-point scale (worsening, stabilization, mild improvement or marked improvement). In all, 307 patients with a mean age of 35.3 years (range 18-79) were included. Eight patients (2.6%) required the discontinuation of the drug due to decreased libido (n = 4), gynecomastia (n = 2), mood disorder (n = 1) and erectile dysfunction (n = 1). All these AE resolved after stopping the medication. No AE were detected in patients receiving low doses of OD. The effectiveness was evaluated in the subgroup of 42 patients (13.7%) who received OD in monotherapy: 38 patients improved (90%), 10 of them (23.8%) presenting a marked improvement, 4 patients (9.5%) were stable and none patient worsened. In conclusion, OD is an effective treatment for male androgenetic alopecia in real clinical practice, presenting a good safety profile, especially at lower doses.

Background Alopecia areata on the beard area (BAA) is a common clinical manifestation, but there are no studies about its characteristics. Objective To describe the epidemiology, comorbidities, clinical presentation, evolution, diagnostic findings and therapeutic choices in a series of patients with BAA. Methods This retrospective multicentre review included patients diagnosed with BAA as the first and unique clinical manifestation with at least 12 months of follow-up. Diagnosis was performed based on the typical clinical features. Extra-beard involvement was monitored in all cases. Results Overall, 55 male patients with a mean age of 39.1 years (range 20–74) were included. Twenty-five patients (45.5%) developed alopecia of the scalp during follow-up and more than 80% of cases appeared in the first 12.4 months. Clinical presentation of AA on the scalp was patchy AA (less than 5 patches) (52%), multifocal AA (28%), AA totalis (12%) and AA universalis (8%). Multivariate analysis revealed a trend of association between scalp involvement and family history of AA without statistical significance. Conclusions According to this study, BAA may progress to scalp AA in a significant number of patients (45.5% of the patients with a follow-up interval of at least 12 months). In the group of patients who developed scalp AA, 80% of them did it within the first 12 months, so follow-up of patients with BAA is highly encouraged.

Background: Optimal skin repair has been a desired goal for many researchers. Recently, plasma rich in growth factors (PRGF) has gained importance in dermatology proving it is beneficial effects in wound healing and cutaneous regeneration. Objective: The anti-fibrotic, pro-contractile and photo-protective effect of PRGF on dermal fibroblasts and 3D skin models has been evaluated. Method: The effect against TGFβ1 induced myofibroblast differentiation was tested. Cell contractile activity over collagen gel matrices was analyzed and the effect against UV derived photo-oxidative stress was assessed. The effectiveness of PRGF obtained from young aged and middle aged donors was compared. Furthermore, 3D organotypic skin explants were used as human skin models with the aim of analyzing ex vivo cutaneous preventive and regenerative photo-protection after UV exposure. Results: TGFβ1 induced myofibroblast levels decreased significantly after treatment with PRGF while the contractile activity increased compared to the control group. After UV irradiation, cell survival was promoted while apoptotic and ROS levels were noticeably reduced. Photo-exposed 3D explants showed higher levels of metabolic activity and lower levels of necrosis, cell damage, irritation and ROS formation when treated with PRGF. The histological integrity and connective tissue fibers showed lower signals of photodamage among PRGF injected skin models. No significant differences for the assessed biological outcomes were observed when PRGF obtained from young aged and middle aged donors were compared. Conclusion: These findings suggest that this autologous approach might be useful for antifibrotic wound healing and provide an effective protection against sun derived photo-oxidative stress regardless the age of the patient.

Primary cutaneous anaplastic large cell lymphoma is a rare type of cutaneous T-cell lymphoma, and the involvement of the ocular adnexa is extremely rare. Secondary xanthoma-like changes after radiation therapy or chemotherapy have been rarely reported in association with large-cell T-cell anaplastic lymphoma. We report one case of a primary C-anaplastic large cell lymphoma affecting the eyelid with fast progression with multiple nodules in various anatomic sites and development of xanthoma-like lesions after treatment.

Even though the efficacy of photodynamic therapy (PDT) for treating premalignant and malignant lesions has been demonstrated, resistant tumor cells to this therapy occasionally appear. Here, we describe the published methods to isolate resistant cancer cells to PDT and propose new procedures that may be used, as laboratory models allow a better understanding of resistance mechanisms. For this purpose, the treatment conditions, the photosensitizer (PS) or pro-drug, the cell line and the final selection – clonal of total population – must be taken into account. In general, high and repeated treatment doses are used. The resistant cell population characterization may include cell morphology, response to PDT, expression of death proteins or survival related genes and cell proliferation analysis. In addition, in vivo models such as the resistant cell transplantation to mice, allow evaluating tumorigenicity and aggressiveness, leading to the determination of the in vivo resistance. Summarizing, in order to improve clinical results, cellular models can help understand PDT-resistance mechanisms in vivo and in vitro., The work was supported by the Ministerio de Economía y Competitividad (MINECO, FIS PI12/01253, FIS PI12/01131), and Comunidad de Madrid (CAM, S2010/BMD-2359), Spain. AZ is a recipient of a PhD contract from CAM, and SL and NS have a fellowship from UAM (Universidad Autónoma de Madrid).

Background Folliculitis decalvans (FD) is a rare neutrophilic scarring alopecia that represents a therapeutic challengefor dermatologists.Objective To describe the epidemiology, comorbidities, clinical presentation, diagnostic !ndings and therapeuticoptions in a large series of patients with FD.Methods This retrospective multicentre review includes patients diagnosed with FD based on clinical and histopatho-logic !ndings. The clinical severity was determined by the maximum diameter of the largest alopecic patch (slight

Background Melasma is a dermatosis with significant repercussions on patients' quality of life, and there is currently no standard treatment. Hydroquinone is deemed the treatment of choice, but its safety has been questioned in certain cases. Aims To determine the efficacy and safety of a new combination of retinoids in the improvement of melasma. Patients/methods Prospective, double-blind, vehicle-controlled, and randomized study in 30 patients with melasma. The product was applied on one side of the face and the vehicle on the other, twice daily during 3 months. Standardized photographs were taken using RBX technology on the three visits (basal, at one and a half months and at 3 months). The main variable to determine the efficacy was the improvement of the hemifacial Melasma Area Severity Index (MASI). Other variables were determined such as improvement perceived by the investigator, improvement perceived by the patient, impact on quality of life or side effects. Results The MASI improvement at 3 months of treatment was significant on the treated side vs. the vehicle side, reaching an improvement of 70%, which is comparable to the percentage of improvement described with hydroquinone. No notable side effects were detected, in spite of a significant percentage of patients included in the study citing a history that could be compatible with sensitive skin. Conclusions This new combination of retinoids and depigmenting agents proved to be effective and safe in the treatment of melasma.

Kaposi's sarcoma (KS) is an angioproliferative disorder caused by human herpesvirus 8 (HHV-8). Current research efforts have focused on the study of the relative role of KSHV-encoded genes in Kaposi's sarcomagenesis in order to identify novel mechanism-based therapies for patients suffering from this tumor. Although several viral genes have potential for KS pathogenesis, compelling data point to the KSHV-encoded G protein-coupled receptor (vGPCR) as a leading candidate viral gene for the initiation of KS. Interestingly, the oncogenic potential of vGPCR seems to correlate with its capacity to activate the mammalian target of rapamycin (mTOR) signaling pathway. Rapamycin, the prototypical inhibitor of the mTOR signaling pathway, has recently emerged as an effective treatment for KS when administered orally. In this case report, we present an immunocompetent patient with KS lesions treated with topical rapamycin achieving clinical and histologic healing after 16 weeks of treatment. The topical application of rapamycin could be a novel therapeutic option for the treatment of KS.

Background To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment. Objective We sought to describe the epidemiology, comorbidities, clinical presentation, diagnostic findings, and therapeutic choices in a large series of patients with FFA. Methods This retrospective multicenter study included patients given the diagnosis of FFA. Clinical severity was classified based on the recession of the frontotemporal hairline. Results In all, 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included. Early menopause was detected in 49 patients (14%), whereas 46 (13%) had undergone hysterectomy. Severe FFA was observed in 131 patients (37%). Independent factors associated with severe FFA after multivariate analysis were: eyelash loss, facial papules, and body hair involvement. Eyebrow loss as the initial clinical presentation was associated with mild forms. Antiandrogens such as finasteride and dutasteride were used in 111 patients (31%), with improvement in 52 (47%) and stabilization in 59 (53%). Limitations The retrospective design is a limitation. Conclusions Eyelash loss, facial papules, and body hair involvement were associated with severe FFA. Antiandrogens were the most useful treatment.

Background A better knowledge of the dynamic biological changes that the skin undergoes in response to ionizing radiation is advisable to improve the management of radiation dermatitis, allowing selection of patients needing treatment or close monitoring. Objective To describe the evolution of the skin in response to ionizing radiation through the reflectance confocal microscopy (RCM) features of acute radiation dermatitis. Methods In this prospective descriptive study, six women (median age, 55 years; range, 45‐80 years) diagnosed with breast cancer in stages IA-IB undergoing adjuvant radiotherapy were included in the study through consecutive sampling. Clinical, dermoscopic and RCM evaluation of the skin were performed prior to treatment and on days 1, 15, 30 and 45 after radiotherapy. Results While clinical features of radiation dermatitis emerged after 30 days on average, histopathological changes were detectable by RCM after a mean time of 15 days. The main RCM features included initial appearance of spongiosis, exocytosis and inflammatory cells followed by the presence of dendritic-shaped cells, ‘streaming-like figures’, ‘broken geographic papillae’, epidermal architectural disarray, effacement of rete ridges, melanophages and, finally, hyperpigmentation of the basal layer. Conclusions RCM may safely detect the dynamic biological changes that the skin undergoes in response to ionizing radiation, even before than clinical onset of acute radiation dermatitis. Therefore, RCM may be useful to make an early and non-invasive diagnosis of radiation dermatitis during radiotherapy, allowing an early selection of patients needing treatment or close monitoring and avoiding skin biopsies.

Background & objective Venous malformations (VM) represent a localized error in the embryological development of the venous branch of the circulation. The management of VM is complex and challenging. The aim of this study was to assess the efficacy and safety of combined sequential pulsed dye laser (PDL)-Nd:YAG laser in patients with cutaneous or mucosal VM. Methods Thirty patients (age from 8 to 65 years) with cutaneous or mucosal VM treated with dual wavelength PDL-Nd:YAG laser were retrospectively analyzed. Laser parameters were 10 mm spot size with 10 ms pulse and 8–10 J/cm2 of PDL, followed with a second delay by Nd:YAG with 15 or 20 ms at 35–70 J/cm2; or 7 mm spot size with 10 ms pulse and 5–10.5 J/cm2 of PDL, followed with a second delay by Nd:YAG with 15 or 20 ms at 50–100 J/cm2. Laser sessions were repeated approximately every 2–6 months. Air cooling was applied during treatment. Three dermatologists evaluated treatment effectiveness by means of photographs of the patients before and after laser treatment (scale from 0 to 4). Differences in the degree of clinical improvement between patients with cutaneous or mucosal VM were also assessed. Adverse events were registered. Patient satisfaction was also assessed in 19 cases (scale from 0 to 10). Results Mean global improvement was rated as 3.37. Mean improvement in patients with cutaneous VM was 3.35 and 3.38 in patients with mucosal VM. No significant difference between both groups was observed (P = 0.53). Long-lasting side effects included partial epilation of the eyelashes in one patient, ulceration in two patients and permanent scarring in three patients. Mean patient satisfaction was 8.55. Conclusions Our study concludes that dual wavelength PDL-Nd:YAG laser was effective for treatment of the superficial component of cutaneous and mucosal VM.

Photodynamic therapy using methyl 5-aminolevulinate (MAL) as a precursor of the photosensitizing agent protoporphyrin IX is widely used in clinical practice for the treatment of different pathologies, including cancer. In this therapeutic modality, MAL treatment promotes the forced accumulation of the endogenous photoactive compound protoporphyrin IX in target malignant cells. Subsequent irradiation of treated tissues with an appropriate visible light source induces the production of reactive oxygen species (ROS) that, once accumulated above a critical level, promote cell death. Here we demonstrate that a photodynamic treatment with low MAL concentrations can be used to promote a moderate production of endogenous ROS, which efficiently stimulates cell growth in human immortalized keratinocytes (HaCaT). We also show that this proliferative response requires Src kinase activity and is associated to a transient induction of cyclin D1 expression. Taken together, these results demonstrate for the first time that a combination of light and a photoactive compound can be used to modulate cell cycle progression through Src kinase activation and that a moderate intracellular increase of photogenerated ROS efficiently stimulates cell proliferation. © 2011 Elsevier GmbH., This work was supported by Grants SAF2008-00609 (Ministerio de Ciencia e Innovación, Spain) to J. Espada and FIS PS09/01099 (Ministerio de Sanidad; Spain) to A. Juarranz. A. Blázquez-Castro and E. Carrasco are recipients of FPU fellowships (Ministerio de Ciencia e Innovación, Spain). J. Espada is a hired investigator under the Programa Ramón y Cajal (Ministerio de Ciencia e Innovación, Spain).

Summary Background Photodynamic therapy (PDT) has been shown to be effective in treating nonmelanoma skin cancer (NMSC), especially actinic keratosis (AK). Moreover, there is sufficient evidence of its effectiveness in preventing the appearance of premalignant and malignant lesions in organ transplant recipients. Objectives To describe the molecular and genetic changes underlying this preventive effect. Methods Twenty-two patients with AK were treated with methyl aminolaevulinate and red light. Biopsies were performed before and 6 weeks after the treatment. Conventional histopathology and immunohistochemistry were carried out. Results Not only was a reduction in the dysplasia and elastosis observed, but also a decreased expression of Ki-67 and p53. The abnormal findings did not disappear completely in all cases. The expression of cyclin D1 remained stable. Conclusions These findings show that PDT has the potential to reduce the histological signs of photoageing. Moreover, the reduction of Ki-67, a marker of proliferation and of p53, a marker of early skin carcinogenesis, indicates a reversal of the carcinogenic process. On the other hand, the fact that one treatment does not clear dysplasia and expression of p53 completely, and the persistence of cyclin D1, indicate that one single treatment, despite showing good clinical results, is not sufficient to clear completely the signs of chronic actinic damage, and thus the risk of NMSC.

This study examined changes in cognitive style based on the use of reflecting-team couples therapy with couples in which one spouse is a gambler. The grid technique was used in the cases of 20 couples to assess personal constructs related to cohabitation and the role of gambling. Results suggest that reflecting-team couples therapy brings about significant change in participants by allowing them to develop a more positive image of themselves and their environment.

An otherwise healthy man has had asymptomatic swelling of his lower lip for 10 months. What is the cause? What is the treatment?

The Cynergy™ vascular workstation with MultiPlex™ technology (Cynosure, MA, USA) combines 595 nm pulsed dye laser (PDL) with 1064 nm Nd:YAG laser. This is done with a unique machine, having two laser heads, one fiber, and one handpiece. It is a synchronized dual wavelength laser system, with a sequential application of 595 nm PDL- and 1064 nm Nd:YAG-laser irradiation. This device may be more effective than single wavelength lasers because it targets structures at different dermal levels using two different wavelengths. A great deal of interest has been generated recently in methemoglobin formation and the absorption characteristics of a blood clot. In this paper we review our experience with this machine for cutaneous and subcutaneous vascular anomalies (PDL-resistant port-wine stains, venous malformations, telangiectasia, hyperkeratotic vascular anomalies, hemangiomas, angiolymphoid hyperplasia with eosinophilia).

Background Unilesional mycosis fungoides (MF) is a rare variant of cutaneous T-cell lymphoma (CTCL), characterized clinically by a solitary lesion and by histopathological features indistinguishable from multilesional MF. The photodynamic therapy (PDT) is a new and effective treatment of precancerous lesions and non-melanoma skin cancers. In recent years it has been used successfully for the treatment of MF. Methods We present two cases of unilesional MF treated with 5-Aminolevulinic acid-PDT (ALA-PDT). We used twenty per cent ALA, applied topically to the lesion, and a well defined laser irradiation at 585 nm wavelength from C-Beam laser. Treatment was repeated three times at monthly intervals. Skin biopsies were taken before and after therapy. Results Both patients showed clinical remission. The biopsies confirmed a regression of the infiltrate after treatment. Conclusions PDT is effective and can be used successfully for MF treatment, particularly for patch and plaque stage MF, including unilesional MF.

An otherwise healthy man has had itchy, grayish-brown patches on his back for 2 years, characteristic of notalgia paresthetica.

Summary Glomovenous malformations are disseminated variants of cutaneous glomus tumors. These malformations are subdivided into regional or localized, disseminated, and congenital plaque-like forms. The congenital plaque-like form is the rarest variant. Most treatment modalities have been disappointing in the treatment of large glomangiomas, leading to high recurrence rates. We report a case of a 34-year-old man with a congenital plaque-like glomangioma on his left arm and forearm treated successfully with sequential pulsed-dye neodymium yttrium aluminum garnet laser.

Lipschütz ulcer (LU) is an uncommon condition that usually affects prepubertal and pubertal girls. It can be misdiagnosed as a sexually transmitted disease or even as a sign of child abuse, causing great anxiety to patients and their families. We present two cases of LU consecutively affecting twin sisters. To our knowledge, this is the first case in two family members, supporting infectious transmission. We propose airborne transmission as the most probable cause in our cases.