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Objective: We aimed to determine the prevalence of different skin diseases and their seasonal variations at the Razi dermatology hospital from 2019 to 2020. Methods: In this cross-sectional study, we obtained data from the medical records of 3120 patients visiting the dermatology clinic of Razi hospital. The prevalence of skin diseases was evaluated using meteorologically defined seasons. We looked for significant equally distributed results during each season. Results: During all seasons, women were referred to our clinic more frequently than men. Some diseases demonstrated significant seasonality with a peak during the winter, including acne, eczema, wart, seborrheic dermatitis, nevus, vitiligo, lentigo, and dermatophytosis. Atopic dermatitis was more frequent during the spring and winter compared with other seasons (p < .05). Actinic keratosis and lichen planus showed a significant seasonal trend with a peak during the summer (p < .05). Infections, including viral, bacterial, and fungal skin diseases, were more frequent during the winter than the summer (p = .001). Conclusion: This study provides an overview of the seasonal distribution of dermatology visits at our referral hospital, which will aid in developing better policies to prevent and manage skin disorders in outpatient visits.

Background: Epidermolysis bullosa (EB) is an uncommon group of inherited disorders characterized by skin blistering after friction or mechanical trauma. EB affects patients and their families physically, socially, and emotionally. Objective: This study aimed to assess the family quality of life of these patients using the Family Dermatology Life Quality Index (FDLQI) questionnaire. Methods: In this cross-sectional study, we enrolled caregivers of patients with EB registered at the Molecular Dermatology Research Center, affiliated with Shiraz University of Medical Sciences, up to 2020. Participants filled out a demographic data collection form and the FDLQI questionnaire. The data were analyzed using SPSS software, version 22. Results: Overall, 80 participants, consisting of 65 mothers (81.2%) and 15 fathers (18.7%) as primary caregivers, were enrolled in this study. The average FDLQI score was 19.88 ± 4.71. The FDLQI scores of caregivers of patients with EB simplex was significantly lower than scores observed in those with other types of EB (p < .001). There was a significant positive association between the number of patients with EB in the family and FDLQI score (p = .049). FDLQI scores were lower in caregiving mothers who had a higher education (p < .001) and those who were employed (p < .001). Conclusion: Family quality of life is affected in patients with EB. Families with lower socioeconomic status and unemployed caregivers require special attention. More studies are needed to determine the parameters involved in the quality of life of patients with EB and their families.

Unlike other barrier epithelia of internal organs, the stratified squamous epithelium of the skin is always exposed to the external environment. However, the robust barrier structure and function of the skin are highly resistant against external insults so as to not easily allow foreign invasions. Upon sensing danger signals, the innate immunity system is promptly activated. This process is mediated by alarmins, which are released passively from damaged cells. Nuclear alarmins or stressorins are actively released from intact cells in response to various cellular stresses. Alarmins/stressorins are deeply involved in the disease processes of chronic skin disorders of an unknown cause, such as rosacea, psoriasis, and atopic dermatitis. Furthermore, alarmins/stressorins are also induced in the congenital skin disorders of ichthyosis and keratoderma due to defective keratinization. Studies on alarmin activation and its downstream pathways may help develop novel therapeutic agents for intractable skin disorders.

The introduction of TNF blockers in the therapeutic armamentarium of inflammatory bowel diseases (IBD) has largely advanced the way by which clinicians manage these disorders. However, some patients develop de novo immune-mediated diseases during the treatment. We here present the case of paradoxical hidradenitis suppurativa, a chronic inflammatory skin disease characterized by the development of recurrent nodules and abscesses in intertriginous areas, in a 20-year-old, nonsmoker, normal-weight women, with no family history of hidradenitis suppurativa or IBD, diagnosed with nonstricturing nonpenetrating ileocolonic Crohn's disease in 2013, during treatment with infliximab. Infliximab discontinuation was followed by a significant improvement of skin lesions. We also discuss 22 additional cases of paradoxical hidradenitis suppurativa in IBD patients on TNF antagonists reported in the literature with the aim to identify potential risk factors for the development of such a complication. All the patients had Crohn's disease, and the majority of them were women (19/23; 82.6%). All cases occurred during therapy with anti-TNF agents [14/23 (61%) patients were treated with adalimumab and 9/23 (39%) patients were treated with infliximab]. The therapeutic approach directed at maintaining/holding the undergoing biologic therapy is still uncertain. Further studies are needed to determine the most appropriate treatment choice toward ongoing biologic therapy.

BACKGROUND Chloracne is a rare skin condition that is caused by systemic exposure to halogenated aromatic compounds. The main characteristic of chloracne is blackhead, and in severe cases, it can be accompanied by systemic symptoms. Sodium 3,5,6-trichloropyridin-2-ol (STCP) is a necessary precursor compound for the production of chlorpyrifos and triclopyr, which are extensively used as a pesticide and herbicide, respectively. STCP is also a chlorophenol that has been associated with chloracne. STCP poisoning could induce mild myelin sheath damage. We herein report three cases with chloracne due to exposure to STCP. CASE SUMMARY Three young men, aged 29, 33, and 26 years, respectively, in the same workplace had polymorphic skin lesions, characterized mainly by comedones and cysts, and one of them also had acne like lesions in the genital area. These clinical manifestations appeared when they were exposed to STCP for 3 d, 1 wk, and 2 wk, respectively. Among them, polyneuropathy and liver damage occurred. We performed dermoscopy and clinical and laboratory tests on these patients. Additionally, histopathology was used for further diagnosis in the serious patient. These patients were diagnosed with chloracne and separated from STCP. The patients were prescribed oral viaminate capsules, topical adapalene gel, and regular hematologic follow-up for aspartate transaminase and lipids. They are still under follow-up. There was no new lesions and the laboratory tests returned to normal in two patients. Pigmentation and shallow scars remained in the original areas of papules. However, in the most serious patient, new papules still appeared intermittently. All these remind us that the treatment of chloracne caused by STCP is difficult, and we should attach great importance to this new compound related with the neuropathy and chloracne. CONCLUSION STCP is becoming a new chemical product to induce chloracne, which should attract the attention of all medical professionals, especially dermatologists. Due to the lack of knowledge on the new chemical, the diagnosis of chloracne cannot be made in time. Chloracne still deserves our attention.

Altres ajuts: European Academy of Dermatology and Venereology (EADV, No. 2016-012 to MP). Background: Itch is a common symptom in the general population. Affected individuals often do not seek medical consultation and rely on Internet searches to obtain information regarding their itch. Objectives: The aim of this study was to attain insights into common concerns of the general population regarding itch can by analysing itch-related Internet search behaviour. Methods: Google AdWords Keyword Planner was used to assess search volumes for itch-related terms in 15 European countries between September 2014 and August 2018. All identified keywords were qualitatively categorized. Itch-related terms were descriptively analysed and are shown as number of searches/100 000 inhabitants. Results: The search volume for the keyword 'itch' per 100 000 inhabitants was highest in Northern Europe, followed by Eastern, Central and Southern Europe. In 4/15 countries, itch was searched for more often in the autumn/winter months compared to in the spring/summer months. Most itch-related terms were related to dermatological conditions such as inflammatory skin diseases (e.g. psoriasis, atopic dermatitis), allergic or immunologic conditions (e.g. urticaria), and infectious diseases or infestations (e.g. scabies). In terms of body location, genitoanal itch dominated the searches. Symptoms and signs related to itch, possible non-dermatological aetiologies, and treatment options were also among the most searched terms. Conclusions: These analyses provided for the first time insights into the search behaviour patterns related to itch across Europe. People from Northern and Eastern Europe are more likely to seek online information regarding itch. Causes for the itch, especially dermatological conditions, and genitoanal itch are the most important concerns for Internet users. This unconventional and inexpensive method identifies medical needs of people beyond the medical setting, including people who do not seek medical consultation. Accordingly, the data could be used to guide public health interventions and manage respective inhabitants' medical needs.

What is already known about this topic? Skin diseases are common, affect society and individuals, and have high incidences to relapse, which reduces the quality of life. In 2019, skin diseases were the seventh leading global causes of years lived with disability (YLDs). What is added by this report? All-age disability-adjusted life years (DALYs) and YLDs from skin diseases have been steadily increasing in China from 1990 through 2019, although with a decline in the standardized rate of years of life lost (YLLs). In 2019, dermatitis was the leading cause of YLLs among people over the age of 15 years, while viral skin diseases had the greatest burden among people under 15 years. Acne vulgaris increased significantly among people aged 15–49 years, and psoriasis increased among people over 50 years. The male∶female ratio of DALYs lost due to skin disease did not change between 1990 and 2019. What are the implications for public health practice? The lack of data on the total skin disease burden in China called for additional research. The Global Burden of Disease provided a reference for skin disease control and prevention in China.

More than one billion people are affected by neglected tropical diseases (NTDs) and many of these diseases are preventable. While the grouping of these conditions as NTDs has generated vast mapping, mass drug administration and surveillance programmes, there is growing evidence of gaps and weaknesses in purely biomedical approaches, and the need for responses that also recognise the social determinants of health. In order to unpack the social and political determinants of NTDs, it is important to view the problem from a social science perspective. Given this background, the Social Sciences for Severe Stigmatizing Skin Diseases (5S) Foundation has recently been established by the Centre for Global Health Research at Brighton and Sussex Medical School. The broad aim of the 5S Foundation is to incorporate social science perspectives in understanding and addressing the problems around three NTDs, namely, podoconiosis, mycetoma and scabies. This protocol paper sets out the aims and approaches of the 5S Foundation while activities such as research, public engagement, training and capacity building get underway.

Diabetes mellitus is associated with impairment in cognitive functions which can complicate adherence to self-care behaviors. We evaluated the incidence of cognitive impairment in patients with diabetes mellitus to determine the strength of the association between diabetic foot (a complication that occurs in about 10% of diabetic patients), adherence to the clinician&rsquo, s recommendations, glycemic control, and cognitive function. A prospective study was carried out in a probabilistic sample of older patients with diabetic foot living in three nursing homes. Cognitive functions were evaluated by the MMSE (Mini-Mental State Examination), the Trail Making test (TMT), and the Michigan neuropathy screening instrument (MNSI). There were no significant associations between cognitive function and neuropathy or foot alterations, although glycated hemoglobin (HB1Ac &gt, 7%) significantly (p &lt, 0.05) associated with MMSE and adherence to treatment in the 1 month follow-up visit. Receiver operating characteristic curve analysis showed that both HB1Ac and the MNSI score significantly (p &lt, 0.05) discriminate subsequent adherence to treatment for foot complication, with a sensitivity of 80.0&ndash, 73.3% and specificity 70.6&ndash, 64.7%, respectively. Proper control of foot complications in diabetic patients involves appropriate glycemic control and less severe neuropathy, and seems to be unrelated to cognitive dysfunction, and warrants further studies in order to tailor appropriate treatments to central and peripheral nervous system disorders. Poor glycemic control (Hb1Ac level &gt, 7%) and a neuropathy score of 5.5 in the MNSI are the best-cut off points to discriminate poor adherence to the clinician&rsquo, s recommendations for self-care behaviors in people with diabetic foot complication. In this study, we observed that foot disorders were associated with impaired global cognitive function in elderly patients (aged &ge, 65). Podiatrists and physicians should consider cognitive dysfunction as an important chronic complication in the management of diabetic foot.

Objectives As a chronic, recurrent, immunologically mediated systemic disease and a common cause of dermatological problems, psoriasis is often a subject of scientific research. Skin changes located on the hands can cause difficulties and limitations in the performance of professional activities, especially manual ones. The main role in pathogenesis is played by immunological factors – improper functioning of the components of the immune system, among others, T lymphocytes and cytokines like interleukin-12 (IL-12), interleukin-22 (IL-22) and interferon gamma (IFN-γ). Material and Methods The obtained tissue and blood were destined for RNA isolation. The RNA was then subjected to a reverse transcription reaction. The relative gene expression level was evaluated by the real-time polymerase chain reaction for IL-12B , IL-22 and IFN-γ genes, and presented as the relative quantification (RQ) value, relative to the reference gene GAPDH . In addition, a correlation analysis of the expression level of selected genes with the clinical course of the disease, as assessed by the Psoriasis Area and Severity Index (PASI), the Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI) scores was performed. Results Statistical analysis confirmed a significant increase in RQ values for IL-12B , IL-22 and IFN-γ in the group of psoriatic patients vs. the control group. A positive correlation was also found between BSA and PASI and RQ for the IL-12B gene. Conclusions Increased expression levels of IL-12B , IL-22 and IFN-γ genes in psoriatic skin confirm that selected cytokines play an important role in the initiation and sustenance of psoriasis. Int J Occup Med Environ Health. 2020;33(5):635–47

Activation of the NLRP3 inflammasome is critical for host defense as well as the progression of inflammatory diseases through the production of the proinflammatory cytokine IL-1β, which is cleaved by active caspase-1. It has been reported that overactivation of the NLRP3 inflammasome contributes to the development and pathology of acne vulgaris. Therefore, inhibiting activation of the NLRP3 inflammasome may provide a new therapeutic strategy for acne vulgaris. In this study, we investigated whether auranofin, an anti-rheumatoid arthritis agent, inhibited NLRP3 inflammasome activation, thereby effectively treating acne vulgaris. Auranofin suppressed NLRP3 inflammasome activation induced by Propionibacterium acnes, reducing the production of IL-1β in primary mouse macrophages and human sebocytes. In a P. acnes-induced acne mouse model, injection of P. acnes into the ears of mice induced acne symptoms such as redness, swelling, and neutrophil infiltration. Topical application of auranofin (0.5 or 1%) to mouse ears significantly reduced the inflammatory symptoms of acne vulgaris induced by P. acnes injection. Topical application of auranofin led to the downregulation of the NLRP3 inflammasome activated by P. acnes in mouse ear skin. These results show that auranofin inhibits the NLRP3 inflammasome, the activation of which is associated with acne symptoms. The results further suggest that topical application of auranofin could be a new therapeutic strategy for treating acne vulgaris by targeting the NLRP3 inflammasome.

Introduction Psoriasis is a chronic skin disease which can have a detrimental impact on the patient’s life. The correlation between depression, psoriasis and inflammation is a subject of many publications. The depressive and psoriatic symptoms, unhealthy coping strategies and stigmatization might be presented in the mechanism of the vicious circle. The appropriate understanding of this phenomenon might be extremely useful for specialists to improve their bedside manner. Objective The aim of this review is to analyze the current data about the worldwide presence of the major depressive disorder – psoriasis, and the occurrence of depression in patients suffering from psoriasis. Research and analysis were based on searching sources such as PubMed, UpToDate and World Health Organization pages for the integrative publications collected mainly from last 10 years. The data about the origin of the psoriasis disease was taken from as 1979 publication. State of knowledge The study demonstrated that the link between psoriasis and depression is bi-directional. The pro-inflammatory cytokine, such as IL-6, TNF-α, CRP and IL-17, are elevated in both cases, which provokes the exacerbation of sickness symptoms. The inflammation dangerously disturbs the functioning of neuronal system and human homeostasis. Summary According to the cited research, the prevalence of depressive disorders in psoriatic patients is higher in comparison to people without psoriasis. Inflammation plays an essential role by being a peculiar connector between psoriasis and depression. Stress and inflammation are crucial factors in pathogenesis of those two disorders and triggers the pathological mechanisms.

The objectives of this study are to conduct a comprehensive literature search and bibliometric analysis to identify the breadth and volume of pharmacological and clinical studies on pine pollen (Pinus pollen) and to identify the potential effects and the use of pine pollen. Three Chinese electronic databases and two English electronic databases were searched for pharmacological and clinical studies on pine pollen. Data were extracted and analyzed and included publication year, authors, study type, pharmacological research topics or clinical diseases/conditions, usage and type of preparation, authors' conclusions, and adverse effects. Of 239 publications identified, 180 were pharmacological studies, 37 were clinical trials, and 22 were reviews. Numbers of publications increased particularly from 2004 onward. The top 10 most frequent topics in pharmacological studies were immune regulation, antisenility, antioxidation, liver protection, inhibiting prostate hyperplasia, inhibiting tumor cell proliferation, lowering blood glucose, lowering blood lipids, antifatigue, and improving intestinal function. The top 10 most frequent clinical diseases treated or where pine pollen was used as an adjuvant were bedsores, diaper dermatitis, hyperlipidemia, oral mucositis, eczema, hyperplasia of prostate, hypertension, prostatitis, type 2 diabetes mellitus, and radiodermatitis. Eight trials reported no adverse events associated with pine pollen, one reported mild gastrointestinal reactions, but symptoms disappeared without special management. There have been an increasing number of publications on pine pollen during the past 20 years. Pharmacological studies have shown many potential benefits, and clinical studies have indicated some positive effects when it is either used as a single herb or as an adjuvant to treat disease. Its use as a topical agent, especially for skin diseases, was notable.

This research aims to determine the prevalence and severity rate of scabies on goats in Sub-District of Mempawah Hilir, Mempawah, West Kalimantan. The goat livestock used were not determined by age, sex, and breed. The number of goats researched was 100 goats. Scabies prevalence measurement was to divide the number of scabies goats by total goats, then multiplied by 100% and measurement of the severity rate of scabies goats with scoring with grades 1-3 (low), 4-6 (moderate), and 7-9 (heavy). The results obtained scabies prevalence rate of 38% with 38 positive samples from a population of 100 goats and the percentage of severity was 42%, moderate 24%, and 34% severe. This is due to weather factors in the area and the type of cage as well as inadequate maintenance management, thus making many cases of scabies attack goats.

Nowadays, skin disease among humans has been a common disease, especially in America millions of people are suffering from various kinds of skin disease. Usually, these diseases have hidden dangers which lead to human not only lack of self-confidence and psychological depression but also a risk of skin cancer. Diagnosis of these kinds of diseases usually required medical experts with high-level instruments due to a lack of visual resolution in skin disease images. Moreover, manual diagnosis of skin disease is often subjective, time-consuming, and required more human effort. Thus, there is a need to develop a computer-aided system that automatically diagnoses the skin disease problem. Moreover, most of the existing works in skin disease used convolutional neural networks (CNN) with classical loss functions, which limit the model to learn discriminative features from skin images. Thus to address the above mention problem we proposed a new framework by fine-tuning layers of ResNet152 and InceptionResNet-V2 models with a triplet loss function. In the proposed framework, first, we learning the embedding from input images into Euclidean space by using deep CNN ResNet152 and InceptionResNet-V2 model. Second, we compute L-2 distance among corresponding images from euclidean space to learn discriminative features of skin disease images by using triplet loss function. Finally, classify the input images using these L-2 distances. Human face skin disease images used in the proposed framework are acquired from the Hospital in Wuhan China. Experiment results and their analysis shows the effectiveness of the proposed framework which achieve better accuracy than many existing works in skin disease tasks.

Skin disease is a common illness in most tropical regions where the pattern of clinical, presentations is dominated by infections. Along with common diseases such as pyodermas and fungal infections, a group of conditions known collectively as the neglected tropical diseases of the skin or Skin NTDs, which are the targets for worldwide control or elimination are also seen in health care facilities. These diseases range from the common, such a scabies, to those that are less frequent including leprosy and mycetoma. The initiative to use skin presentations of tropical diseases as a route to diagnosis by front line health workers is both logical and welcome. However, this requires training and monitoring and as the work gets under way, it is critically important that time invested in this programme is backed by firm and lasting commitment at regional and national levels.

Night shift workers may have a disrupted circadian rhythm, which may contribute to the development of skin disease. The purpose of this study was to determine whether there is a significant difference in the prevalence and severity of self-reported skin disease between “regular” day shift workers compared to “graveyard” night shift workers. We conducted surveys from 630 call center agents in Manila, the Philippines, and they were analyzed regarding demographics, medical history, dermatologic history, lifestyle, and sleep. No difference was found in the prevalence of skin disease between shifts. However, night shift workers were worse sleepers. When compared to good sleepers, poor sleepers had a higher prevalence of skin disease with worse severity. Graveyard shift workers with poor sleep may have increased skin disease severity.

In health, the non-recirculating nature and long-term persistence of tissue-resident memory T cells (TRMs) in tissues protects against invading pathogens. In disease, pathogenic TRMs contribute to the recurring traits of many skin diseases. We aimed to conduct a systematic literature review on the current understanding of the role of TRMs in skin diseases and identify gaps as well as future research paths. EMBASE, PubMed, SCOPUS, Web of Science, Clinicaltrials.gov and WHO Trials Registry were searched systematically for relevant studies from their inception to October 2020. Included studies were reviewed independently by two authors. This study was conducted in accordance with the PRISMA-S guidelines. This protocol was registered with the PROSPERO database (ref: CRD42020206416). We identified 96 studies meeting the inclusion criteria. TRMs have mostly been investigated in murine skin and in relation to infectious skin diseases. Pathogenic TRMs have been characterized in various skin diseases including psoriasis, vitiligo and cutaneous T-cell lymphoma. Studies are needed to discover biomarkers that may delineate TRMs poised for pathogenic activity in skin diseases and establish to which extent TRMs are contingent on the local skin microenvironment. Additionally, future studies may investigate the effects of current treatments on the persistence of pathogenic TRMs in human skin.

Hidradenitis suppurativa is a chronic and debilitating skin disease, whose lesions can range from inflammatory nodules to abscesses and fistulas in the armpits, groin, perineum, inframammary region. Diagnosis can be confused with a large number of clinical pictures, and although studies on hidradenitis suppurativa are not so scarce in the literature, doctors are often unaware of this disease and therefore its diagnosis is often late. Pharmacological treatment ranges from retinoids to immunosuppression and radiation therapy, and surgical treatment ranges from incision and drainage to more complete excisions and laser therapies. Hidradenitis suppurativa is a disease seen and treated mainly by dermatologists and general surgeons, however, it is necessary for general practitioners to have basic knowledge about this entity, as they are the first line of care in the health system., Highlights • Hidradenitis suppurativa is an entity of necessary recognition by the surgeon. • It is a preventable and treatable condition with a good prognosis. • This condition should be managed by a multidisciplinary team.

Alzheimer’s disease is the most common type of dementia placing a heavy burden on the healthcare system worldwide. Skin diseases are also one of the most common health problems. Several skin diseases are associated with Alzheimer’s disease through different mechanisms. This review summarizes the relationship between Alzheimer’s disease and several types of skin diseases, including bullous pemphigoid, hidradenitis suppurativa, psoriasis, skin cancer, and cutaneous amyloidosis, and provides suggestions based on these associations. Neurologists, dermatologists, and general practitioners should be aware of the relationship between Alzheimer’s disease and skin diseases. Dermatology/neurology consultation or referral is necessary when needed.

Extracellular vesicles (EVs), naturally secreted by cells, act as mediators for communication between cells. They are transported to the recipient cells along with cargoes such as nucleic acids, proteins, and lipids that reflect the changes occurring within the parent cells. Thus, EVs have been recognized as potential theranostic agents for diagnosis, treatment, and prognosis. In particular, the evidence accumulated to date suggests an important role of EVs in the initiation and progression of skin aging and various skin diseases, including psoriasis, systemic lupus erythematosus, vitiligo, and chronic wounds. This review highlights recent research that investigates the role of EVs and their potential as biomarkers and therapeutic agents for skin diseases and aging.

Background Ichthyosis is a heterogeneous group of diseases caused by genetic disorders related to skin formation. They are characterized by generalized dry skin, scaling, hyperkeratosis and frequently associated with erythroderma. Among its different types, harlequin ichthyosis (HI) stands out due to its severity. HI is caused by mutations in the ABCA12 gene, which encodes essential proteins in epidermal lipid transport, and it helps maintain the homeostasis of the stratum corneum of the epidermis. However, due to the wide spectrum of genetic alterations that can cause ichthyosis, holistic medical care, and genetic studies are required to improve the diagnosis and outcomes of these diseases. Case presentation Here, we presented the case of a 19 years old male patient who was a premature infant and exhibited clinical features consistent with HI, including bright yellow hyperkeratotic plates with erythematous fissures that covered his entire body like a collodion baby. Currently, he exhibited erythroderma, photosensitivity, ectropion, auricular pavilion alterations, and musculoskeletal disorders, such as equinovarus feet, fingers, hands, and hypoplastic feet with contractures in flexion and marked difficulty in fine motor skills. In addition, he presented dyschromatopsia, Achilles reflex hyporeflexia, slight speech, dental alteration and deficient cognitive performance. After the genetic sequencing, variants were found in ABCA12 and HRNR which are related to several skin diseases, including ichthyosis. Conclusions Although in clinical practice, ichthyosis is a common entity, a severe type of ichthyosis is presented, highlighting the importance of appropriate genetic diagnosis, given the broad spectrum of genetic alterations with similar phenotypic and clinical characteristics. These pathologies must be known to guarantee initial support measures to prevent complications and offer multidisciplinary management to those patients.

Background Oxylipins are biological lipids that have been implicated in inflammation. We previously found that certain oxylipins correlated with clinical manifestations in psoriatic arthritis (PsA) patients. Here, we compare oxylipin profiles in PsA patients and those with psoriasis (PsO) without inflammatory arthritis to identify oxylipins that associate with specific disease manifestations to better understand disease pathogenesis and identify new biomarkers. Methods Consecutive patients with PsA (who met the CASPAR classification criteria for PsA) and PsO were recruited from the Rheumatology Outpatient Clinic. A thorough clinical examination was performed, including entheseal (Leeds enthesitis index (LEI)) and joint involvement (SJC/TJC 66/68). Patients were evaluated for pain and global disease activity on a visual analog scale (VAS) ranging from 0 to 100. This was followed by disease activity scores calculation: cDAPSA (Disease Activity Index for Psoriatic Arthritis) and Psoriasis Area and Severity Index (PASI). Serum oxylipins were determined by mass spectrometry and their association with clinical characteristics (PASI/LEI and cDAPSA) was analyzed using Metaboanalyst 4.0 and R version 3.6.1. Results Twenty PsO (average age 52 [10.8], 55% males) and 19 PsA patients (average age 60.5 [11.4], 63.1% males) were included. PsO patients had an average body mass index (BMI) of 33.7 (6.84) and an average PASI of 3.8 (4.2). PsA patients had an average BMI of 31.9 (5.6), TJC of 9.3 (10.41), SJC of 3.7 (4.23), with an average cDAPSA of 23.3 (11.4). 63.1% of PsA patients had enthesitis (average LEI 2.2 [3]) and the same percentage had psoriasis (average PASI 3(5]). Sera were analyzed for oxylipin levels. PsO and PsA patients with higher PASI score (> 2.5) had significantly lower serum concentrations of pro-inflammatory oxylipins, most of them arachidonic acid derived (AA). Oxylipin profiling did not associate with cDAPSA. Interestingly, several AA-derived oxylipins (5,15 di-HETE (5S,15S-dihydroxy-6E,8Z,10Z,13E-eicosatetraenoic acid), 5-oxoETE (5-Oxo-eicosatetraenoic acid), PGE2 (prostaglandin E2), 11bPGE2 (11 beta prostaglandin D2), and LTB4 (leukotriene B4)) were significantly increased in PsA patients with enthesitis compared to those without. Conclusions The AA-derived proinflammatory oxylipins were lower in both PsO and PsA patients with higher skin scores. Joint disease activity was not associated with the concentrations of oxylipins. Yet, enthesitis was associated with an increase of AA-derived pro-inflammatory oxylipins in PsA patients. Further studies are needed to determine whether oxylipin profiling can be a good biomarker of enthesitis in PsA patients.

Glycine is an amino acid with unique properties because its side chain is composed of a single hydrogen atom. It confers conformational flexibility to proteins and conserved glycines are often indicative of protein domains involving tight turns or bends. All six beta-type connexins expressed in human epidermis (Cx26, Cx30, Cx30.3, Cx31, Cx31.1 and Cx32) contain a glycine at position 12 (G12). G12 is located about halfway through the cytoplasmic amino terminus and substitutions alter connexin function in a variety of ways, in some cases altering protein interactions and leading to cell death. There is also evidence that alteration of G12 changes the structure of the amino terminus in connexin- and amino acid- specific ways. This review integrates structural, functional and physiological information about the role of G12 in connexins, focusing on beta-connexins expressed in human epidermis. The importance of G12 substitutions in these beta-connexins is revealed in two hereditary skin disorders, keratitis ichthyosis and erythrokeratodermia variabilis, both of which result from missense mutations affecting G12.

The psoriasis is an inflammatory skin disease, chronic and relapsing, characterized by erythematous patches covered by a silvery-white scaly layer, mainly located on elbows, knees, sacral area and scalp. In the literature it emerged that it is associated with a particular difficulty in understanding and communicating one's own and others' emotions, a discomfort that manifests itself mainly on the body. People with psoriasis have an alteration in their body image and this affects the quality of life. The psoriasis as well as other dermatological disorders also seem to be associated with psychological problems, for instance depression, anxiety, sleep disorders and various conditions such as states of strong concern, stress and low self-esteem. In conclusion, this complex of emotional and physical issues highlights the need a multidisciplinary approach to treating both physical and emotional disorders, in a combined treatment to ensure a better quality of life for the patient. The work aims to examine the psychological aspects and consequences of psoriatic patients, in particular, problems related to the regulation and expression of emotions.

Made available in DSpace on 2022-04-29T08:38:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: Erythema multiforme (EM) is an immune-mediated skin disease which may manifest as cutaneous or mucocutaneous lesions. It is uncommon in horses. EM lesions have a symmetrical bilateral distribution; they are usually urticarial, necrotizing, and, less commonly, ulcerative. In equines, the trigger is usually unknown, and cases are often classified as idiopathic. Diagnosis is based on a thorough history and physical and histopathological examination of lesions. According to the clinical presentation and histopathological characteristics of the cutaneous lesions, this case is the first report to describe diagnosis and treatment of a horse with EM in Brazil. Case: A Quarter Horse filly was followed clinically for 12 months after sudden onset of skin lesions at 18 months of age. The initial lesions were non-alopecic papules with a symmetrical bilateral distribution. Six months after onset, the skin lesions maintained the original distribution pattern; however, they had progressed to papules and plaques with varying annular, arciform, serpiginous, targetoid, or alopecic appearance. At 8 months, the same distribution pattern and appearance remained, but the lesions had become more severe and extensive, with involvement of the labial commissures and perineal region, without any erosions/ulcerations, scaling/crusting, pain, or pruritus. At 12 months, new nodular lesions were found on the medial and lateral surfaces of the hind limbs, neck, bilateral trunk, and root of the tail. The lesions were firm, non-pruritic, and non-tender on palpation. Swabs were obtained from the papular lesions. Skin specimens were also obtained with a 6-mm punch and via incisional biopsy and histological sections were made. Bacterial and fungal cultures were negative. Appropriate stains did not identify fungal structures, were negative for acid-fast bacilli, and did not reveal any metachromatic granules in the sampled cell population. The histopathological findings were characteristic of immune-mediated disease, with a vacuolar interface dermatitis affecting the hair follicles more than the epidermis, necrotic keratinocytes, lymphocyte satellitosis, leukocytoclastic mixed vasculitis of the mid-dermis and deep dermis, and variable granulation tissue, consistent with erythema multiforme and leukocytoclastic vasculitis. Immunosuppressive therapy with corticosteroids and oral supplementation with omega-3 and omega-6 fatty acids and vitamin E were prescribed. After institution of therapy, no new lesions developed, the existing lesions remained stable (though permanent), and hair regrew in the previously alopecic areas. All physiological parameters remained normal throughout the follow-up period. Discussion: Erythema multiforme is rarely reported in horses. According to our literature review, this is the first description of EM in horses in Brazil. EM should be included in the differential diagnosis of horses that present with plaques in a diverse, geographic distribution and a negative initial dermatological screening examination. Further clinical investigation is warranted, with special attention to potential antigenic triggers. A thorough drug and dietary history and close attention to comorbidities are essential, as the suppression of potential culprit factors has important prognostic value and contributes to the elucidation of EM triggers. Department of Veterinary Clinical Science School of Veterinary Medicine and Animal Science (FMVZ) São Paulo State University (UNESP), SP Department of Veterinary Clinical Science School of Veterinary Medicine and Animal Science (FMVZ) São Paulo State University (UNESP), SP

The transient receptor potential ankyrin 1 (TRPA1), a member of the TRP superfamily of channels, acts as ‘polymodal cellular sensor’ on primary sensory neurons where it mediates the peripheral and central processing of pain, itch, and thermal sensation. However, the TRPA1 expression extends far beyond the sensory nerves. In recent years, much attention has been paid to its expression and function in non-neuronal cell types including skin cells, such as keratinocytes, melanocytes, mast cells, dendritic cells, and endothelial cells. TRPA1 seems critically involved in a series of physiological skin functions, including formation and maintenance of physico-chemical skin barriers, skin cells, and tissue growth and differentiation. TRPA1 appears to be implicated in mechanistic processes in various immunological inflammatory diseases and cancers of the skin, such as atopic and allergic contact dermatitis, psoriasis, bullous pemphigoid, cutaneous T-cell lymphoma, and melanoma. Here, we report recent findings on the implication of TRPA1 in skin physiology and pathophysiology. The potential use of TRPA1 antagonists in the treatment of inflammatory and immunological skin disorders will be also addressed.

COVID-19 pandemic has a significant impact on public health, whether directly or indirectly. The first case was seen in Turkey on March 11, and the World Health Organization (WHO) declared a pandemic on March 12, 2020. The study aimed to document the effect of pandemic on dermatology outpatient clinics in Turkey. 15 tertiary hospitals from 13 provinces were included in the study, which was conducted between January 12 and May 12, 2020. The International Codes of Diseases (ICD-10) categories and patients' characteristics were evaluated before and after the pandemic. A total of 164878 patients, 133131 before and 31747 after the pandemic, were evaluated. The daily hospital applications were found reduced by 77%. The three of the most frequent diagnoses; dermatitis, acne, and psoriasis remained unchanged after the pandemic. While the frequency of herpes zoster, scabies, urticaria, pityriasis rosea and sexually transmitted diseases increased significantly; allergic and irritant contact dermatitis decreased after the pandemic. The applications regarding cutaneous neoplasms were considerably reduced during the pandemic, and this effect was more pronounced in cities with higher COVID incidence. The pandemic caused a noteworthy reduction in the number of patients accessing dermatological care. The pandemic caused significant changes in the frequency of a wide range of dermatological diseases. The application of cutaneous neoplasms is considerably reduced after the pandemic, and this effect was more pronounced in cities where pandemics are frequent. Therefore, the pandemic has resulted on numerous impacts on many critical issues in dermatology and dermatological care. This article is protected by copyright. All rights reserved.

Background: Diagnosis of skin diseases is often challenging and computer-aided diagnostic tools are urgently needed to underpin decision making. Objective: To develop a convolutional neural network model to classify clinically relevant selected multiple-lesion skin diseases, this in accordance to the STARD guidelines. Methods: This was an image-based retrospective study using multi-task learning for binary classification. A VGG-16 model was trained on 16,543 non-standardized images. Image data was distributed in training set (80%), validation set (10%), and test set (10%). All images were collected from a clinical database of a Danish population attending one dermatological department. Included was patients categorized with ICD-10 codes related to acne, rosacea, psoriasis, eczema, and cutaneous t-cell lymphoma. Results: Acne was distinguished from rosacea with a sensitivity of 85.42% CI 72.24–93.93% and a specificity of 89.53% CI 83.97–93.68%, cutaneous t-cell lymphoma was distinguished from eczema with a sensitivity of 74.29% CI 67.82–80.05% and a specificity of 84.09% CI 80.83–86.99%, and psoriasis from eczema with a sensitivity of 81.79% CI 78.51–84.76% and a specificity of 73.57% CI 69.76–77.13%. All results were based on the test set. Conclusion: The performance rates reported were equal or superior to those reported for general practitioners with dermatological training, indicating that computer-aided diagnostic models based on convolutional neural network may potentially be employed for diagnosing multiple-lesion skin diseases.

AIM: The aim of this systematic review was to investigate heavy metal roles at skin disease of humans in the cement industrial area. METHODS: All research reporting a specific heavy metal, which could be increasing the risk of the disease, cause cement induced to skin. Fourteen selected articles from our inclusion criteria rated using eight quality-appraisal criteria derived from Strengthening the Reporting of Observational Studies in Epidemiology checklist and following preferred reporting items for systematic reviews and meta-analyses methodology. RESULTS: We performed a systematic review of published articles between 2009 and 2019 from ten case–control, two cohort, one ecological study, and one cross-sectional study showed the heterogeneity of the study design. The studies are focusing on the relationship between heavy metal and skin disease that appeared in cement plant areas such as dermatitis, skin cancer, eczema, and other allergies. Chromium, nickel, cobalt, zinc, cadmium, mercury may present and play an important role for human skin disease. CONCLUSION: Heavy metals have been found in the skin of human living and work around the cement industry. Chromium, cobalt, and nickel are almost certainly present in every case of dermatitis and eczema. Signs and mild symptoms of skin disease include redness, itching, starch, and dryness. Elements such as cadmium, lead, and mercury usually are found in chronic skin disease (psoriasis and skin cancer) on a biologic test. These findings should raise an important concern and recommendation policy for controlling raw materials contains heavy metal in cement industrial areas and proper protection for workers and non-worker.

Impetigo herpetiformis is a rare variant of generalized pustular psoriasis that occurs during pregnancy or is triggered by pregnancy, often in association with hypocalcemia. This condition is associated with increased maternal and fetal morbidity and mortality. We report a 29-year-old pregnant woman who presented to hospital at the gestational age of 20 weeks with widespread erythema covered with pustules that coalesced to form lakes of pus. She did not respond to corticosteroids, immunosuppressants, or phototherapy. Finally, intra-amniotic injection of ethacridine lactate was administered to terminate the pregnancy, and the patient showed complete recovery in 3 months. Insight from this case report may facilitate optimal management of this relatively rare entity.

Objective: Skin diseases are a major global health problem associated with high number of people. With the rapid development of technologies and the application of various data mining techniques in recent years, the progress of dermatological predictive classification has become more and more predictive and accurate. Therefore, development of machine learning techniques, which can effectively differentiate skin disease classification, is of vast importance. The machine learning techniques applied to skin disease prediction so far, no techniques outperforms over all the others. Methods: In this research paper, we present a new method, which applies five different data mining techniques and then developed an ensemble approach that consists all the five different data mining techniques as a single unit. We use informative Dermatology data to analysis different data mining techniques to classify the skin disease and then, an ensemble machine learning method is applied. Results: The proposed ensemble method, which is based on machine learning was tested on Dermatology datasets and classify the type of skin disease in six different classes like include C1: psoriasis, C2: seborrheic dermatitis, C3: lichen planus, C4: pityriasis rosea, C5: chronic dermatitis, C6: pityriasis rubra. The results show that the dermatological prediction accuracy of the test data set is increased compared to a single classifier. Conclusion: The ensemble method used on Dermatology datasets give better performance as compared to different classifier algorithms. Ensemble method gives more accurate and effective skin disease prediction.

Background: Gene therapy is a new approach to discover and treat many diseases. It has attracted considerable attention from researchers in the last decades. The gene therapy through RNA interference has been considered one of the most recent and revolutionary approaches used in individualized therapy. In the last years, we have witnessed the rapid development in the field of the gene silencing and knockdown by topical siRNA. Its application in gene therapy has become an attractive alternative for drug development. Methods: This article will address topical delivery of siRNA as a promising treatment for skin disorders. An update on the advances in siRNA-based nanocarriers as a powerful therapeutic strategy for several skin diseases will be discussed giving emphasis on in vitro evaluations. Results: Through the in-depth review of the literature on the use of siRNAs for skin diseases we realize how widespread this use is. We have also realized that nanoparticles as non-viral vectors are increasingly being explored. Skin diseases where the use of siRNA has been explored most are skin cancer (melanoma and nonmelanoma), psoriasis, vitiligo, dermatitis and leprosy. But we also report here other diseases where the use of siRNA has been growing as acne, alopecia areata, cutaneous leishmaniasis, mycoses, herpes, epidermolysis bullosa and oculocutaneous albinism. Also highlighted, the first clinical trial of siRNA for cutaneous diseases, aimed at Pathyounychia Congenita. Conclusion: The treatment of skin diseases based on topical delivery of siRNA, which act by inhibiting the expression of target transcripts, offers many potential therapeutic advantages for suppressing genes into the skin.

Reza Bidaki,1 Niloofar Majidi,2 Amir Moghadam Ahmadi,3 Hamid Bakhshi,4 Rezvan Sadr Mohammadi,5 Seyed-Ali Mostafavi,6 Mohammad Kazemi Arababadi,7 Maryam Hadavi,8 Afshin Mirzaei9 1Research Center of Addiction and Behavioral Sciences, Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 2Department of Psychiatry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; 3Department of Neurology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; 4Continuing Medical Education Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; 5Department of Psychiatry, Lorestan University of Medical Sciences, Khorramabad, Iran; 6Psychiatry Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran; 7Department of Laboratory Sciences, Faculty of Paramedicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; 8Department of Anesthesiology, Paramedical Faculty, Molecular Medicine Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; 9Rafsanjan University of Medical Sciences, Rafsanjan, Iran Background and aim: Vitiligo is a chronic skin disease characterized by a total or partial loss of melanocytes from the epidermis and other tissues of the skin. It is placed in the class of secondary psychiatric disorders and can also lead to psychological problems. The main aim of this study was to assess social acceptance in vitiligo patients. Methods: This cross-sectional study was conducted on all of the patients (n=150) with vitiligo who were referred to dermatology clinics in Rafsanjan, Iran. The patients completed a social acceptability questionnaire (Marlowe–Crowne Social DesirabilityScale), and information regarding their demographic characteristics was also collected. Data were gathered and analyzed with descriptive and inferential statistics using SPSS-19 software. Results: The mean age of the patients was 27.56±10.53 years and 65.9% were female. Mean score of social acceptance among the patients was 13.51±7.08. The results showed that the mean scores of social acceptance were significantly lower in women, in those with single marital status, in those with face and neck lesions, and in those with disease duration less than 5 years. Conclusion: The results showed that certain groups of patients with vitiligo are at greater risk of experiencing lower social acceptance. Keywords: vitiligo, social acceptance, skin disease, secondary psychiatric disorders

Fucosidosis is a rare lysosomal storage disease which has been classified into two subtypes, depending on the severity of clinical signs and symptoms. Fucosidosis patients’ skin abnormalities include angiokeratoma corporis diffusum, widespread telangiectasia, thick skin, hyperhidrosis and hypohidrosis, acrocyanosis and distal transverse nail bands. It has been described that >50% of fucosidosis patients have angiokeratoma. At molecular level, fucosidosis is caused by lysosomal alpha-L-fucosidase (FUCA1) gene mutations. Obtaining samples for functional studies has been challenging due to the inherent difficulty in finding affected individuals. The effect of FUCA1 dysfunction on gene expression is unknown. The aim of this study was to analyse, in keratinocytes, the transcriptomic effect of FUCA1 knock-down for a better understanding of skin lesions’ pathogenesis affecting fucosidosis patients. FUCA1 knock-down (siRNA) was performed in human HaCaT immortalised keratinocytes. Affymetrix arrays and qPCR were used for analysing gene expression. Bioinformatics was used for functional clustering of modified genes. In total, 387 genes showed differential expression between FUCA1 silenced and non-silenced cells (222 up-regulated and 165 down-regulated). Up-regulated genes belonged to two major groups: keratinocyte differentiation/epidermal development (n = 17) and immune response (n = 61). Several transcription factors were up-regulated in FUCA1-siRNA transfected cells. This effect might partly have been produced by abnormal transcription factor expression, that is FOXN1. We thus propose that fucosidosis-related skin lesions (eg angiokeratoma) and those of other diseases (eg psoriasis) might be caused by dysfunctions in common aetiological overlapping molecular cascades. © 2018 John Wiley and Sons A/S. Published by John Wiley and Sons Ltd

Purpose of Review: The worldwide increase in skin infections due to Mycobacterium abscessus, especially in Latin America, and its difficult diagnosis and treatment, makes a review of literature crucial in reminding and updating physicians about its presentation, diagnosing techniques, and management. Recent Findings: Outbreaks are associated with cosmetic surgeries and medical tourism, but any kind of skin lesion can become infected presenting as negative typical cultures and unsuccessful empirical treatments; therefore, a high clinical suspicion is required. Molecular techniques are promising new diagnosing alternatives and treatment should be guided by susceptibility tests. Summary: Mycobacterium abscessus complex skin infections are concerning due to difficult diagnosis, burdensome treatment, drug resistance, and high cost of management. Usually associated to cosmetic procedures, especially medical tourism, it can also be related to other incisions (C-section, injections, laparoscopy, etc.). Diagnosis requires clinical suspicion and consists of phenotypic and molecular methods to recognize the organisms to a subspecies level. Drug treatment frequently involves surgical debridement and antibiotics with special concern about resistance and adverse events.

Vitamin D has many benefits for body and skin health. One of them is to regulate the immune system, both cellular and humoral. The pathogenesis of many skin diseases is associated with disturbance in regulation of cellular immune system. Research on the relationship between blood level of vitamin D and several diseases in dermatology is currently very advanced. Oral vitamin D is known to have many functions that play a role in the pathogenesis of several diseases of the skin. Therefore, its current use as a primary or supplemental therapy has been widely studied. Knowledge on various skin diseases with indication of oral vitamin D use is important to be understood, especially in association with some chronic diseases requiring long-term therapy. The effects of using oral vitamin D analogues are minimal, but hypervitaminosis D might cause uncomfortable symptoms for patients. Therefore, it is important to understand and regulate the amount of doses of oral vitamin D supplements prescribed. Keywords: oral vitamin D, skin disease

Erythroid differentiation regulator 1 (ERDR1) was newly identified as a secreted protein that plays an essential role in maintaining cell growth homeostasis. ERDR1 enhances apoptosis at high cell densities, leading to the inhibition of cell survival. Exogenous ERDR1 treatment decreases cancer cell proliferation and tumor growth as a result of increased apoptosis via the regulation of apoptosis-related gene expression. Moreover, ERDR1 plays a pivotal role in skin diseases; ERDR1 expression in actinic keratosis (AK) is negatively correlated with the increase in apoptosis. Because of its high specificity and efficiency, photodynamic therapy (PDT) is a common therapy for patients with various skin diseases, including cancer. Many studies indicate that apoptosis is mainly induced by PDT treatment. As an apoptosis inducer, the recovery of the ERDR1 expression after PDT is correlated with good therapeutic outcomes. Here, we review recent findings that highlight the function of ERDR1 in the control of apoptosis. Thus, ERDR1 may have a role in the apoptosis regulation of target cells in the lesions, as the recovery of its expression after PDT is correlated with good therapeutic outcomes.

Psoriasis; a chronic inflammatory disease is characterized by symmetric hyperkeratotic plaques affecting any part of the body. Psoriasis is nowadays considered as a systemic inflammation linked with several comorbidities as metabolic syndrome, depression, anxiety and increased prevalence of cardiovascular (CV) disease. The hypothesis that psoriasis is an independent CV risk factor leading to atherosclerosis via inflammation is now widely accepted. Deciphering the underlying mechanisms interconnecting psoriasis and CV disease may have significant implications in treatment decisions. Accumulating evidence suggests that systematic therapies and recently introduced biologic agents, that control psoriasis by suppressing the chronic and systemic inflammation, may alter the progression of CV disease. We herein attempt a review of current evidence analysing the relationship between psoriasis and CV comorbidities, comment on the mechanisms underlying this association and investigate the consequences for the management of psoriasis.

Skin cancer is one of the most common cancers in the world. However, the disease is curable if detected in the beginning stage. Early detection of malignant lesions through accurate techniques and innovative technologies has a significant impact on reducing skin cancer mortality rates. Recently, artificial intelligence has come to the forefront to facilitate skin cancer diagnosis based on medical images. Many deep learning models have been studied and developed, but the imbalance of performance among classes in the multi-class classification is still a challenging problem. This study proposes a hybrid method for handling class imbalance of skin-disease classification. This method combines the data level method of balanced mini-batch logic followed by real-time image augmentation with the algorithm level method of designing new loss function. The training dataset includes 24,530 dermoscopic images of seven skin disease categories, which is by far the largest dataset of skin cancer. The performance metrics of six proposed methods are evaluated on a test dataset of 2,453 images. Our proposed EfficientNetB4-CLF model achieves the highest accuracy of 89.97% and also the highest mean recall of 86.13% with the smallest recalls' standard deviations of 7.60%. Compared to the original methods, our proposed solution not only surpasses 4.65% (86.13% vs 81.48%) of mean recalls but also reduces 4.24% of the recalls' standard deviations (from ±11.84% to ±7.60%). This result indicates that our hybrid method is highly effective in training the Deep CNN network on the skin-disease imbalanced dataset. It addresses the problem of slow learning of the minority classes in the networks by combining the data level method of balanced mini-batch logic followed by the real-time image augmentation with the algorithm level method of the newly designed loss function.

BACKGROUND: Apitherapy is the medical use of honey bee products, "honey, propolis, royal jelly, bee wax, and bee venom to relieve human ailments. Propolis is one of the most well-documented products derived from the honeybee and has always played an important role in traditional folk medicine.AIM: The aim was to justify the consideration of Aloe Vera as an effective remedy for the treatment of psoriasis.METHODS: The study follows (857) patients (354 females, 503 males) with a mean age range from (9 - 62) years, affected with moderate to severe psoriasis in palms and foot soles treated by a combination mixture of propolis and Aloe in the form of an ointment (Aloreed) and Beauty reed cream. The treatment duration was for 12 weeks. Results were evaluated by using clinical, histological and statistical parameters.RESULTS: After the 12 - week treatment, we observed an 86% overall response rate from which 62% showed excellent results and 24% showed good results, therefore proving the efficiency in the use of the mixture of propolis 50% and aloe vera 3% as topically applied ointment in the treatment of mild to moderate psoriasisCONCLUSION: Patients who have palmoplantar psoriasis, who were treated with a topically applied mixture of propolis (50%) and aloe vera (3%), have shown noteworthy improvement thus proving the efficiency of propolis and aloe vera in the treatment of mild to moderate psoriasis.

Indoor tanning is an important risk factor for the development of melanoma and non-melanoma skin cancer. With our nationally representative monitoring, we aimed at describing tanning bed use, user characteristics, reasons for use, and risk awareness over time. In the framework of the National Cancer Aid Monitoring (NCAM), we collected representative data on 12,000 individuals aged 14 to 45 years in annual waves of n = 3,000 participants in Germany between 2015 and 2018. We used descriptive statistics and chi&sup2, tests to uncover group differences. To compare data from the different waves, we calculated confidence intervals. The use of tanning beds decreased from 2015 (11.0%, 95%-CI: 9.9%&ndash, 12.1%) to 2018 (8.8%, 95%-CI: 7.8%&ndash, 9.8%). However, this decrease did not affect all subgroups. For instance, there was an (non-significant) increase in minors and the prevalence remained stable for individuals with immigrant background and males. Attractiveness was an important reason for tanning bed use in each wave. Over time, there was an increase in medical-related reasons for use. Furthermore, monitoring showed a decrease in risk awareness regarding tanning bed use and ultraviolet (UV) radiation. While it is a positive development that the overall use of tanning beds in Germany has decreased over time, the increasing use by minors despite the legal ban is alarming. Due to the declining risk awareness it is necessary to implement prevention and education campaigns specifically targeted at this group.

Pemphigus foliaceus (PF) is an autoimmune blistering skin disease that occurs sporadically across the globe and is endemic in Brazil. Keratinocyte adhesion loss (acantholysis) is associated with high levels of anti-desmoglein 1 IgG autoantibodies, but the role of cell death is poorly understood in PF. Current evidence disqualifies apoptosis as the major cell death mechanism and no other process has yet been investigated. To approach the role of variation in genes responsible for cell death pathways in pemphigus susceptibility, we systematically investigated the frequencies of 1,167 polymorphisms from genes encoding products of all 12 well-established cell death cascades (intrinsic and extrinsic apoptosis, necrosis, necroptosis, ferroptosis, pyroptosis, parthanatos, entotic, NETotic, lysosome-dependent, autophagy-dependent, and immunogenic). By multivariate logistic regression, we compared allelic and genotypic frequencies of 227 PF patients and 194 controls obtained by microarray hybridization. We found 10 variants associated with PF (p < 0.005), belonging to six cell death pathways: apoptosis (TNF, TRAF2, CD36, and PAK2), immunogenic cell death (EIF2AK3, CD47, and SIRPA), necroptosis (TNF and TRAF2), necrosis (RAPGEF3), parthanatos (HK1), and pyroptosis (PRKN). Five polymorphisms were associated with susceptibility: TNF rs1800630*A (OR = 1.9, p = 0.0003), CD36 rs4112274*T (OR = 2.14, p = 0.0015), CD47 rs12695175*G (OR = 1.77, p = 0.0043), SIRPA rs6075340*A/A (OR = 2.75, p = 0.0009), and HK1 rs7072268*T (OR = 1.48, p = 0.0045). Other five variants were associated with protection: TRAF2 rs10781522*G (OR = 0.64, p = 0.0014), PAK2 rs9325377*A/A (OR = 0.48, p = 0.0023), EIF2AK3 rs10167879*T (OR = 0.48, p = 0.0007), RAPGEF3 rs10747521*A/A (OR = 0.42, p = 0.0040), and PRKN rs9355950*C (OR = 0.57, p = 0.0004). Through functional annotation, we found that all associated alleles, with the exception of PRKN rs9355950*C, were previously associated with differential gene expression levels in healthy individuals (mostly in skin and peripheral blood). Further functional validation of these genetic associations may contribute to the understanding of PF etiology and to the development of new drugs and therapeutic regimens for the disease.

The following discussion deals with three emerging infection diseases that any dermatopathologist working in the northern hemisphere can come across. The first subject to be dealt with is gnathostomiasis. This parasitic disease is produced by the third larvarial stage of the parasite that in most patients is associated with the ingestion of raw fish. Epidemiologically, it is most commonly seen in South East Asia, Japan, China, and the American continent, mainly in Mexico, Ecuador, and Peru. Nowadays, the disease is also seen in travelers living in the developed countries who recently came back from visiting endemic countries. The disease produces a pattern of migratory panniculitis or dermatitis with infiltration of eosinophils in tissue. The requirements for making the diagnosis are provided, including clinical forms, common histological findings on skin biopsy as well as the use of ancillary testing. Buruli ulcer, a prevalent mycobacterial infection in Africa, is described from the clinical and histopathological point of view. The disease has been described occasionally in Central and South America as well as in developed countries such as Australia and Japan; Buruli ulcer has also been described in travelers returning from endemic areas. Clinically, the disease is characterized by large, painless ulcerations with undermined borders. Systemic symptoms are usually absent. Classical histological findings include a particular type of fat necrosis and the presence of abundant acid fast bacilli in tissue. Such findings should raise the possibility of this disease, with the purpose of early therapeutically intervention. Lastly, the infection by free living ameba Balamuthia mandrillaris, an emerging condition seen in the US and Peru, is extensively discussed. Special attention is given to clinical and histological characteristics, as well as to the clues for early diagnosis and the tools available for confirmation.

Summary Background Hepatitis D is the most severe form of chronic viral hepatitis. Treatment guidelines recommend 1 year of peginterferon alfa, which is effective in 25–30% of patients only. Whether prolonged therapy with peginterferon alfa-2a for 96 weeks and combination therapy with tenofovir disoproxil fumarate (TDF) would increase hepatitis D virus (HDV) RNA suppression is unknown. We aimed to explore whether prolonged treatment of HDV with 96 weeks of peginterferon would increase HDV RNA response rates and reduces post-treatment relapses. Methods We did two parallel, investigator-initiated, multicentre, double-blind randomised, controlled trials at 14 study sites in Germany, Greece, Romania, and Turkey. Patients with chronic HDV infection and compensated liver disease who were aged 18 years or older were eligible for inclusion. All patients were HBsAg positive for at least 7 months, anti-HDV positive for at least 3 months, and HDV-RNA positive at the local laboratory at the screening visit. Patients were ineligible if alanine aminotransferase levels were higher than ten times above the upper limit of normal and if platelet counts were lower than 90 000 per μL, or if they had received interferon therapy or treatment with a nucleoside and nucleotide analogue within the preceding 6 months. Patients were randomly assigned by blinded stratified block randomisation (1:1) to receive 180 μg of peginterferon alfa-2a weekly plus either TDF (300 mg once daily) or placebo for 96 weeks. The primary endpoint was the percentage of patients with undetectable HDV RNA at the end of treatment assessed by intention to treat. The trials are registered as NCT00932971 and NCT01088659 . Findings Between June 24, 2009, and Feb 28, 2011, we randomly assigned 59 HDV RNA-positive patients to receive peginterferon alfa-2a plus TDF and 61 to receive peginterferon alfa-2a plus placebo, including 48 (40%) patients with cirrhosis to the two treatment groups (23 in the peginterferon alfa-2a plus TDF group and 25 in the peginterferon alfa-2a plus placebo group). The primary endpoint was achieved in 28 (48%) of 59 patients in the peginterferon alfa-2a plus TDF group and in 20 (33%) of 61 patients in the peginterferon alfa-2a plus placebo group (odds ratio 1·84, 95% CI 0·86–3·91, p=0·12). We recorded 944 adverse events (459 in the peginterferon alfa-2a plus TDF group and 485 in the peginterferon alfa-2a plus placebo group). The most common adverse events were haematological, behavioural (eg, fatigue), musculoskeletal, influenza-like syndromes, and psychiatric complaints. Interpretation Addition of TDF resulted in no significant improvement in HDV RNA response rates at the end of treatment. These findings highlight that alternative treatment options are needed for hepatitis D. Funding The HepNet Study-House (a project of the German Liver Foundation founded by the German Liver Foundation, the German Ministry for Education and Research, and the German Center for Infectious Disease Research), Hoffmann-La Roche, and Gilead Sciences.

Mesenchymal stem cell (MSC)-based therapy involving both autologous and allogeneic MSCs shows great promise in treating several conditions. MSCs promote wound healing, and can differentiate into multiple cell lineages, including keratinocytes. Therefore, MSCs can be used for the treatment of congenital or acquired skin defects. Because of their immunomodulatory properties, MSCs may be useful for the treatment of inflammatory and autoimmune skin diseases. In particular, MSCs might be effective for the treatment of large vitiligo lesions as immunosuppressant or cultured grafts. MSCs can also be a novel cell source for regenerating hair in the treatment of scarring alopecia and androgenic alopecia. MSCs might also be an effective treatment for alopecia areata, which is associated with autoimmunity. Stem cell therapies with topical administration of MSCs and bone marrow transplantation were shown to alleviate recessive dystrophic epidermolysis bullosa in both animal models and human subjects. In addition to cell transplantation, the mobilization of endogenous MSCs has been attempted for skin regeneration. Overall, this review highlights the great potential of MSCs for the treatment of skin diseases in the near future.

Introduction : Oxidative stress is a result of an imbalance between endogenous production of free reactive oxygen species and reduced effectiveness of antioxidant defence mechanisms. Advanced glycation end products (AGEs) and advanced oxidation protein products (AOPPs) are compounds formed by transformation of macromolecules, including proteins which can serve as markers of oxidative stress and inflammation in several diseases. Aim : To investigate the role of AGEs and AOPPs as new markers of oxidative stress and inflammation in patients with chronic spontaneous urticaria (CSU). Material and methods : Advanced glycation end products and AOPP levels were determined in the sera of 85 patients with CSU and 64 healthy controls, using spectrofluorimetry and spectrophotometry, respectively. Results : Advanced oxidation protein products levels in patients were statistically higher than those in controls. These levels were not affected by the presence of positive autologous serum test results or autologous plasma test results. No statistically significant differences were found between AGE levels in patients and controls. Conclusions : Formation of AGEs and AOPPs may be accelerated in immunological and allergic disorders. Depending on the sites evaluated, the presence or absence of oxidative stress in chronic urticaria is controversial. To our knowledge, this is the first study showing the possible involvement of AOPPs in CSU. The different behaviour observed for these two biomarkers is very likely due to the activation of specific related biochemical pathways associated with the condition under study.

Atopic dermatitis (AD) is one of the most common skin diseases. Prevalence of AD is highest in childhood. Because of chronicity and often visible lesions, AD may lead to stigmatization and problems with self-perception. However, problems of self-perception and stigmatization in AD children are poorly studied. Literature data on general tendencies of children's development, clinical course, and epidemiologic tendencies of AD in different age groups make it possible to highlight three main periods in the formation of self-perception and stigmatization. The first period is from early infancy till 3 years of age. The child's problems in this period depend on parental exhaustion, emotional distress, and security of the mother-child attachment. The child's AD may form a kind of vicious circle in which severe AD causes parental distress and exhaustion that in turn lead to exacerbation of AD and psychological problems in children. The second period is from 3 till 10 years of age. During this period, development of AD children may be influenced by teasing, bullying, and avoiding by their peers. However, the majority of children in this age group are very optimistic. The third period is from 10 years till adulthood. Problems related to low self-esteem are characteristic during this period. It is important to identify children with AD and their parents who need psychological help and provide them with needs-based consultation and care. Appropriate treatment, medical consultations, and educational programs may help to reduce emotional problems in AD children and their parents.

Lupus erythematosus panniculitis (LEP), an uncommon variant in the clinicopathological spectrum of lupus erythematosus (LE), is rare. There are only a few reported series of patients with this condition; none in individuals of North African ancestry. LEP is characterized by inflammation of the deep dermis and subcutaneous tissue. It usually consists of nodules and hardened subcutaneous plaques on the forehead, cheeks, proximal extremities, and buttocks. Leg involvement is rare and can lead to misdiagnosis. A case of LEP, with unusual involvement of legs, is reported in a 40-year-old woman who had the diagnosis of systemic lupus erythematosus (SLE) four years ago.