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Introduction: Parkinson’s disease (PD) is a slowly progressive neurodegenerative disease characterized by: Pill rolling tremors, Akathisia (inability to sit still), Rigidity, Kinesis (akinesia, dyskinesia), Instable (stooped) posture, no arm swinging in rhythm with legs, Sialorrhea Oculogyric crisiseyes are held fixed for a variable length of time), Nervous depression, Involuntary tremors, Seborrhoea and Masked facial expression. Parkinson’s disease is a chronic, progressive, neurodegenerative disorder with an estimated prevalence of 31 to 328 per 100,000 people worldwide. It is estimated that more than 1 percent of the population over age 65 are afflicted with Parkinson’s disease; incidence and prevalence increase with age. There are numerous unanswered questions regarding the diagnosis and management of Parkinson’s disease. Surgical treatment for Parkinson’s disease is generally considered for patients who respond to medications but have intolerable side effects. Surgical options include ablative procedures, deep brain stimulation, and tissue transplantation. This review focused on History and management of Parkinson’s disease. The purpose of this literature review is to gain an understanding of the existing research relevant to history and pharmacotherapy of Parkinson’s disease. Conclusion: Pharmacological treatment of PD should be tailored to the individual patient. Drug therapy is not obligatory in early PD; many patients can be managed for a time with exercise and lifestyle interventions. For patients with mild symptoms, MAO-B inhibitors, amantadine, or (in younger patients) anticholinergics are reasonable choices.

Dry Eye Disease (DED) is a complex and multifactorial disorder of tear homoeostasis that results in pain, visual disturbance, and ocular surface damage. It is highly prevalent around the world and is associated with many co-morbidities that may contribute to or exacerbate symptoms and signs of disease and affect disease phenotype. However, DED is not one disease and can manifest with a variety of symptoms and/or signs. In this review, we discuss relationships between various co-morbidities and DED phenotypes. For example, individuals with immune mediated diseases, like Sjögren's Syndrome and Graft versus Host Disease, often present with aqueous tear deficiency (ADDE) in the setting of lacrimal gland dysfunction. Individuals with disorders that affect the periocular skin, like rosacea and seborrhoeic dermatitis, often present with evaporative dry eye (EDE) in the setting of eyelid and/or meibomian gland abnormalities. Individuals with pain related disorders, such as chronic pain syndrome and migraine, often present with ocular pain out of proportion to tear film abnormalities, often with accompanying corneal nerve hypersensitivity. Individuals with diabetes mellitus often present with an epitheliopathy in the setting of decreased sensation (neurotrophic keratitis). While not absolute, understanding relationships between co-morbidities and DED phenotypes can help tailor a therapeutic plan to the individual patient.

Background: Patients admitted in especial units such as coronary care unit (CCU) require intensive care for different aspects including skin problems. Here in this report we aimed to perform a survey on different skin lesions in patients admitted in CCU by the time of admission and when discharging. Methods: In this cross-sectional study, we had a survey on 200 patients admitted in CCU in AL-Zahra hospital, Isfahan. A dermatologist observed and examined each patients for any skin lesions by the time of admission and when discharging from CCU. Results: Here we showed that 15 percent of patients admitted in CCU have at least one skin lesion and also we indicated that seborrhea dermatitis and then rosacea have the most prevalence by the time of admission in CCU. Other skin lesions were acute skin failure. We also showed that prevalence of bed sore and pressure sores increased amazingly during admission. Conclusion: Rosacea, seborrhea dermatitis and drug allergic reactions after pressure sores are the most frequent skin lesions in CCU and there might be an association between rosacea and cardiovascular diseases.

BackgroundDermatitis is an important global health problem that not only affects social interaction and physical and mental health but also causes economic burden. Health problems or distress caused by dermatitis may be easily overlooked, and relevant epidemiological data are limited. Therefore, a better understanding of the burden of dermatitis is necessary for developing global intervention strategies.MethodsAll data on dermatitis, including atopic dermatitis (AD), contact dermatitis (CD) and seborrhoeic dermatitis (SD), were obtained from the Global Burden of Disease 2019 (GBD2019) database. The extracted age-standardized incidence rates (ASIR) and disability-adjusted life-years (DALYs) rates (ASDR) data were analysed by stratification, including by sex, country or region, and sociodemographic index (SDI) indicators. Finally, we analysed the correlation between the global burden of dermatitis and socioeconomic development status.ResultsAccording to the GBD 2019 estimate, the ASIR and ASDR for the three major types of dermatitis in 2019 were 5244.3988 (95% CI 4551.7244–5979.3176) per 100,000 person-years and 131.6711 (95% CI 77.5876–206.8796) per 100,000 person-years. The ASIR and ASDR of atopic dermatitis, contact dermatitis and seborrhoeic dermatitis are: Incidence (95%CI,per 100,000 person-years), 327.91 (312.76-343.67), 3066.04 (2405.38-3755.38), 1850.44 (1706.25- 1993.74); DALYs (95%CI, per 100,000 person-years), 99.69 (53.09-167.43), 28.06 (17.62-41.78), 3.93 (2.24-6.25). In addition, among the three dermatitis types, the greatest burden was associated with AD. According to the ASDR from 1990 to 2019, the burden of dermatitis has exhibited a slow downward trend in recent years. In 2019, the ASIR showed that the USA had the greatest burden, while the ASDR showed that Asian countries (such as Japan, Mongolia, Kazakhstan, and Uzbekistan) and some European countries (France, Estonia) had the greatest burden. According to SDI stratification and the three major dermatitis types, high ASIR and ASDR corresponded to high SDI areas (especially for AD).ConclusionThe burden of dermatitis is related to socioeconomic development status, especially for AD, which is positively correlated with the SDI. The results based on GBD2019 data are valuable for formulating policy, preventing and treating dermatitis and reducing the global burden of dermatitis.

The terms ‘eczema’ and ‘dermatitis’ are used interchangeably to describe an inflammatory skin disorder with different clinical and histological appearances according to duration (acute versus chronic) and cause. ‘Non-atopic dermatitis’ encompasses various kinds of dermatitis that are usually classified by appearance, such as discoid eczema, or body site, such as seborrhoeic dermatitis. Attempts at classification are often unsatisfactory and different kinds of dermatitis can coexist and overlap with atopic dermatitis. The role of irritant and allergic contact factors should be considered in all cases and patch tests undertaken where allergic contact dermatitis is suspected or cannot be excluded.

Seborrhoeic dermatitis/dandruff (SD/D) is a common, persistent, relapsing inflammatory condition affecting the areas rich in sebaceous glands. SD/D is widely prevalent in India but Malassezia species implicated are not well studied. To estimate the prevalence and spectrum of Malassezia species causing SD/D and understand the sociodemographic characteristics of SD/D in rural and urban populations, a total of 200 SD/D patients and 100 healthy controls (HC) from both rural and urban backgrounds were enrolled in this study. SD/D severity was clinically graded as mild, moderate, severe, and very severe. The isolates were identified by phenotypic characters and confirmed by ITS2 PCR-RFLP and sequencing of the ITS region of rDNA. Severe (59%) and very severe (71%) form of SD/D was higher in the rural population compared to the urban population (P = .004). The isolation rate of Malassezia was significantly higher in overall SD/D patients scalp (82%) compared to HC (67%) (P = .005). From the scalp of SD/D patients, M. globosa (36.2%) was predominantly isolated followed by M. restricta (31.3%), M. furfur (15.7%), a mixture of M. globosa and M. restricta (12%) or M. arunalokei (4.8%). Similarly, M. globosa (49.3%) was predominately isolated from the scalp of HC followed by M. restricta (22.4%). M. restricta was significantly higher in the scalp of SD/D patients compared to HC and/or nasolabial fold of both SD/D patients and HC (P = .0001). Our findings indicate that M. restricta has a high association with SD/D. More severe disease frequency was observed in the rural population. Precis Dandruff is associated with Malassezia restricta and very severe cases are higher in rural population, probably due the poor hygiene. Moderate to severe hair loss and itching were strongly associated with dandruff. Use of soaps to cleanse scalp appears to be better than shampoo in preventing dandruff.

The nervous system communicates with peripheral tissues through nerve fibres and the systemic release of hypothalamic and pituitary neurohormones. Communication between the nervous system and the largest human organ, skin, has traditionally received little attention. In particular, the neuro-regulation of sebaceous glands (SGs), a major skin appendage, is rarely considered. Yet, it is clear that the SG is under stringent pituitary control, and forms a fascinating, clinically relevant peripheral target organ in which to study the neuroendocrine and neural regulation of epithelia. Sebum, the major secretory product of the SG, is composed of a complex mixture of lipids resulting from the holocrine secretion of specialised epithelial cells (sebocytes). It is indicative of a role of the neuroendocrine system in SG function that excess circulating levels of growth hormone, thyroxine or prolactin result in increased sebum production (seborrhoea). Conversely, growth hormone deficiency, hypothyroidism, and adrenal insufficiency result in reduced sebum production and dry skin. Furthermore, the androgen sensitivity of SGs appears to be under neuroendocrine control, as hypophysectomy (removal of the pituitary) renders SGs largely insensitive to stimulation by testosterone, which is crucial for maintaining SG homeostasis. However, several neurohormones, such as adrenocorticotropic hormone and α-melanocyte-stimulating hormone, can stimulate sebum production independently of either the testes or the adrenal glands, further underscoring the importance of neuroendocrine control in SG biology. Moreover, sebocytes synthesise several neurohormones and express their receptors, suggestive of the presence of neuro-autocrine mechanisms of sebocyte modulation. Aside from the neuroendocrine system, it is conceivable that secretion of neuropeptides and neurotransmitters from cutaneous nerve endings may also act on sebocytes or their progenitors, given that the skin is richly innervated. However, to date, the neural controls of SG development and function remain poorly investigated and incompletely understood. Botulinum toxin-mediated or facial paresis-associated reduction of human sebum secretion suggests that cutaneous nerve-derived substances modulate lipid and inflammatory cytokine synthesis by sebocytes, possibly implicating the nervous system in acne pathogenesis. Additionally, evidence suggests that cutaneous denervation in mice alters the expression of key regulators of SG homeostasis. In this review, we examine the current evidence regarding neuroendocrine and neurobiological regulation of human SG function in physiology and pathology. We further call attention to this line of research as an instructive model for probing and therapeutically manipulating the mechanistic links between the nervous system and mammalian skin.

PLEASE NOTE A NEW 4TH EDITION HAS BEEN PUBLISHED AND IS AVAILABLE IN THE LIBRARY AND IN PRINTPruritus is the sensation that leads to the desire to scratch. In veterinary medicine, patients use their paws and mouth to quell an itch. Thus, the veterinary medical definition of pruritus expands to include the desire to chew, lick or bite at the skin. Pruritic skin diseases can be a diagnostic challenge to the clinician. Chronic pruritus typically results in the same set of secondary dermatological skin lesions in any patient, yet multiple dermatological conditions can act as the underlying trigger for the pruritus. Ignoring the underlying cause of the pruritus only results in recurrence when antipruritic medications are discontinued. The aim of this chapter is to present an approach to pruritus that helps the veterinary surgeon with any pruritic patient. The emphasis is on diagnosing the underlying cause of the pruritus. Antipruritic therapies are reviewed briefly to enable the veterinary surgeon to select the most appropriate therapy .The chapter focuses on the following: Pathophysiology; Clinical approach; and Treatment.

Introduction Different aspects of quality of life (QoL) of infants and children with atopic dermatitis (AD) are well studied but there is a lack of studies on seborrhoeic dermatitis (SD) and allergic contact dermatitis (ACD). The aim of this study was to compare the impact of SD, ACD and AD on young children. Parts of questionnaires were filled in during the COVID-19 pandemic and therefore we decided to check if the pandemic affected dermatology-specific health-related quality of life (HRQoL) in our patients. Methods In this cross-sectional study approved by the local ethics committee of the Kiev City Clinical Dermatovenereologic Hospital parents of children with SD, ACD and AD from birth to 4 years old from the same department of dermatology were asked to fill in the dermatology-specific questionnaire the Infants and Toddlers Dermatology Quality of Life (InToDermQoL). Diagnoses were based on clinical manifestations and anamnesis. The study was carried out from 2018 till 2021. Results The InToDermQoL questionnaire was filled in by 176 parents of children with SD, ACD and AD. Mean total InToDermQoL scores were significantly higher in children with AD than in SD and ACD (P

Primary herpes simplex virus 1 (HSV-1) infection in children (beyond the neonatal period) may be asymptomatic or manifest as herpetic gingivostomatitis accompanied by fever and other symptoms. However, severe, health- and life-threatening infection is observed in rare cases, especially in at-risk patients. Children with atopic dermatitis may develop extensive eczema herpeticum (eruptio varicelliformis Kaposi). Herpes simplex eye infection, herpes simplex encephalitis, and disseminated (generalized) herpes infection also pose danger. We present a boy with exacerbated infantile seborrhoeic dermatitis (ISD) and eczema herpeticum complicated by streptococcal sepsis. HSV transmission should be limited if possible by avoiding direct contact with those who recently developed lesions. Communication with parents and explaining how to properly care for the skin in a child with skin diseases that disturb its barrier function protecting against external factors is particularly important. Also, parents should be informed that "red flag" symptoms in a child should be an indication for a pediatric consultation. In the event of infection, the duration of symptoms can be reduced by promptly initiated acyclovir therapy.

While previous studies have characterized the types of dermatological disease among people experiencing homelessness (PEH) in the outpatient setting, dermatological disease among hospitalized PEH has never been evaluated. Therefore, we performed a cross-sectional analysis of hospitalized patients who received dermatology consultations at two San Francisco hospitals between March 2018 and March 2020 and compared the odds of diagnostic categories between PEH and patients with stable housing. In both unadjusted and adjusted analyses, PEH had significantly higher odds of bacterial skin infections [adjusted odds ratio (aOR) = 2.29, 95% CI 1.46-3.61], ectoparasitic disease (aOR = 9.43, 95% CI 3.79-23.47), psoriasis or seborrhoeic dermatitis (aOR = 2.50, 95% CI 1.43-4.36) and venous stasis or lymphoedema (aOR = 2.54, 95% CI 1.23-5.27) and significantly lower odds of drug reactions (aOR = 0.34, 95% CI 0.18-0.67). Overall, these findings highlight the unique dermatological challenges among hospitalized PEH and suggest potential strategies to facilitate equitable dermatology care delivery.

Cutaneous adverse events to dupilumab can be varied; this necessitates keeping a broad differential diagnosis to identify seemingly paradoxical reactions. It may be possible to treat the adverse event concurrently without stopping dupilumab.

Demodicosis is a skin disease of the pilosebaceous unit associated with Demodex folliculorum and Demodex brevis that involves mainly face and scalp. The role of the Demodex mites as agents in skin diseases remains controversial. They are commensal organisms; however, they are also thought to be pathogens in e.g. rosacea. A revised classification was proposed in 2014 dividing demodicosis into primary and secondary form. Secondary demodicosis can be diagnosed when in patients with inflammatory skin disorders or systemic diseases there is an abnormal increase of Demodex mites resulting in skin lesions. Perioral dermatitis, rosacea, seborrhoeic dermatitis, treatment with topical corticosteroids or calcineurin inhibitors are examples of those conditions. Secondary demodicosis is also associated with treatment with epidermal growth factor inhibitors, transplant patients, patients with malignancy, HIV infection, chronic renal failure, diabetes and during phototherapy treatment. Demodicosis should be considered as a differential diagnosis in immunocompromised patients.

Background Tinea capitis (TC) is a dermatophyte infection involving hair and scalp and occurs primarily in prepubertal children. However, data on adults are limited. Objectives The aim of this study was to evaluate epidemiological, clinical and mycological characteristics of TC in adults in Korea. Patients/methods We retrospectively evaluated 82 adults (44.3%) among 185 TC patients at a tertiary hospital during June 2000-2017. Results Mean patient age was 66.9 ± 15.8 (20-90) years with female predominance; mean disease duration until mycological diagnosis, 22.5 (1-144) weeks; and misdiagnosis rate, 65.9%. Most common presumptive initial diagnoses were seborrhoeic dermatitis (24.4%) and bacterial folliculitis (18.3%). Chronic systemic illness and accompanying alopecia were found in 61 (74.4%) and 46 (56.1%) patients, respectively. Pustular type was found in 26.8% patients, followed by seborrhoeic dermatitis-like 25.6%, grey patch 23.2%, kerion celsi 22.0% and black dot 2.4%. Forty-eight patients (58.5%) had tinea infection at other skin areas. Microsporum canis (56.5%) and Trichophyton rubrum (21.7%) were the most common causative organisms; 92.7% patients achieved complete resolution, and seven patients (9.2%) had a recurrence. Conclusions We report the largest, most recent series of case studies of adult TC. Adult TC is not an uncommon problem, especially in elderly women, and has distinctive epidemiological and clinicomycological characteristics compared to those in prepubertal children. Recognising adult TC profile will help clinicians avoid misdiagnosis and provide appropriate treatment.

Gunduz, Ozgur/0000-0003-1021-5219 WOS: 000467799900007 PubMed: 31320850 Introduction: Acne vulgaris (AV) is a multifactorial, inflammatory disease of the pilosebaceous unit. Hormones play a major role in the pathogenesis of acne. In cases of hyperandrogenism; hirsutism, acne, seborrhoea and alopecia appear in women. However, severe acne can also be seen without evidence of hyperandrogenism. In this case, hypersensitivity of the androgen receptor gene (ARG) encoded in the X chromosome, which is the only receptor for androgens, can be considered. ARG contains a polymorphic CAG triple loop encoding the polyglutamine pathway at the 5'end of exon 1. Aim: To investigate CAG repeat polymorphism in the ARG in nodulocystic acne patients in Turkish population. Material and methods: This prospective clinical study was conducted between 2016 and 2017 in accordance with the tenets of the Declaration of Helsinki. DNA isolation from blood was performed using the RTA (R) Genomic DNA Isolation Kit. The fragment lengths obtained from the device to determine CAG repeat numbers were analysed based on -288 bp length 22 CAG repeat content. Results: A total of 199 subjects; 100 patients (51 males, 49 females) and 99 controls (49 males, 50 females) were included in the study. The mean allele length in the patient group was 19.34; and 19.7 in the control group. There was a statistically significant difference between female patients and the control group, when the patients and control groups were compared by gender (p = 0.0059). Conclusions: The CAG trinucleotide repeat count in the ARG may be associated with acne, without hirsutism findings. Kirikkale University Scientific Research Project Support Coordination Unit This study was carried out with the support of the Kirikkale University Scientific Research Project Support Coordination Unit.

Cyproterone acetate (CPA) has in preliminary studies been linked to the development of meningiomas. Possibly, CPA may induce or increase meningioma growth due to antiandrogen and proprogestin properties, as two-thirds of meningiomas express progesterone and androgen receptors.1 Among individuals assigned male sex at birth, CPA is used to treat prostate cancer, hypersexuality disorder, and as feminising hormone therapy. In individuals assigned female sex at birth, it is used in the treatment of acne, hirsutism, seborrhoea, hair loss and in a low-dose variant in combination with ethinylestradiol in birth control pills.2 A recent cohort study comparing females exposed to high cumulative doses versus low cumulative doses of CPA, found a 6–20 fold increased risk of meningioma.3 Subsequently, the European Medicines Agency’s (EMA) issued a recommendation to restrict CPA to less than 10 milligrams per day.4 In this nationwide study, we assessed national trends in use of CPA and the risk of meningioma according to cumulative exposure to CPA, as compared with non-users. ### Study population In this prospective register-based cohort study, we used nationwide Danish registers to identify all individuals born between 1930 and 2000. Individuals were included in the study at age 15, date of immigration to Denmark or 1 January 1995, whichever came last. Study participants were then followed until a diagnosis of meningioma, neurofibromatosis type 2, death, emigration or 31 December 2017, whichever came first. We excluded individuals with prior meningioma, intracranial surgery, neurofibromatosis type 2 or who died before inclusion. Spinal or cerebral meningioma was the event of interest, defined using diagnosis codes in the National Patient Register or the Cancer Register (details in online supplemental file, …

A red face can be an embarrassing and sometimes uncomfortable problem which can often lead to anxiety and social phobia. Management will depend on the underlying cause. Some patients may have more than one problem contributing to the redness on their face. Most patients will be helped by cosmetic camouflage and photoprotection. Rosacea is one of the most common causes of a red face especially in people of Celtic decent. However may other common conditions can present as a red face including seborrhoeic dermatitis, solar damage, telangectasia, flushing, acne, dermatitis, psoriasis, skin infections and lupus.

Seborrhoeic dermatitis (SD) is a common, scaly skin condition that usually occurs on the face, scalp and chest. It may occasionally be associated with underlying illness such as diabetes or HIV, although the majority of patients are quite healthy. Most adults will have coexisting dry scaly scalp. Treatments is usually with an anti dandruff shampoo for the scalp and 1% hydrocortisone for the face, topical calcineurin inhibitors such as tacrolimus or pimecrolimus are excellent substitute for topical steroids. Infantile seborrhoeic dermatitis may be associated with cradle cap, napkin dermatitis and a flexural rash that can resemble atopic dermatitis but with little or no itch.

Airborne dermatoses are complaints linked to external environmental, chemical and biotic agents carried through the air. In general, airborne dermatoses, that are most common in work environment, tend to cause diagnostic problems that are challenging for both the patient and the doctor. It should also be borne in mind that since the external culprit agents are present in the environment, they do not only come in contact with the skin and mucosa, but can also be inhaled or ingested, thus also causing respiratory and systemic symptoms. There is considerable variation in the nature of airborne contactants and in their form of presentation: vapours and gases, droplets, solid nonbiotic particles, and solid biotic particles. Particular physical conditions (low environmental humidity, high temperatures) can often predispose to the development of airborne dermatoses, as well as some constitutional factors (atopic dermatitis, seborrhoeic dermatitis). Among the various clinical forms, airborne contact dermatitis interests the parts of the body exposed to the air: face, neck, upper aspect of the chest, hands, wrists. These cases must firstly be differentiated from photocontact dermatitis; in the latter case, however, shadowed anatomic areas such as the upper eyelids, behind the ears, the submandibular region, and under the hair are not affected. Various examples of airborne irritant and allergic contact dermatitis and airborne photocontact dermatitis are reported in literature. Another common airborne dermatitis, in particular in Mediterranean coastal regions, is the processionary dermatitis due to the caterpillar Thaumetopoea pityocampa, which induces disruptive effects on pines, man and pets. The cutaneous, respiratory and ophthalmic simptoms are due to particular removable urticarial hairs growing dorsally on the first 8 abdominal larva segments. Chloracne, caused by halogenated aromatic hydrocarbons, is a variety of occupational acne. The most potent acnegens are chloro- and bromo-substituted aromatic hydrocarbons (dioxins), used in various work environments. Human exposure to dioxins can occur due to environmental, occupational, or accidental pollution. The skin is a key organ indicating exposure to dioxin chemicals. The characteristic cutaneous manifestations generally appear about two weeks after the exposure, reach a peak after 6–10 months and can persist for years due to the very slow decrease of dioxins in skin.

Background: Adenosine deaminase (ADA) is an aminohydrolase involved in the catabolism of purine nucleotides and irreversibly deaminizes adenosine and deoxyadenosine to inosine and deoxyinosine. ADA enzyme deficiency results in the loss of functional properties of B and T lymphocytes. Demodex species have been reported to be transmitted between humans through close contact and to play a role in the pathogenesis of rosacea, acne vulgaris, perioral dermatitis, seborrhoeic dermatitis, micropapillary-pruritic dermatitis and blepharitis. The present study aimed to compare serum ADA levels in D. folliculorum positive patients with the healthy control individuals. Methods: Serum ADA levels were examined for 30 patients diagnosed with erythematotelangiectatic rosacea and 40 healthy individuals in Malatya Inonu University in 2017. Standardized skin surface biopsy (SSSB) method was used to diagnose D. folliculorum. A significant decrease was found in the ADA levels of Demodex-positive rosacea patients when compared to the control group. Results: ADA levels were decreased in the Demodex-positive group. The mean ADA level in patient group was significantly lower than the mean in the control group (P

A 42-year-old white man presented to our clinic in October, 2015, with itching in the nasolabial fold and around the eyebrows, with accompaying erythema and desquamation consistent with seborrhoeic dermatitis. We noted multiple naevi on whole body dermatological examination, as well as a multicoloured tattoo of a Chinese dragon covering almost his entire back, arms, and chest. On closer inspection he had one clinically dysplastic pigmented naevus, sited within a scale of the dragon’s tail (fi gure). He reported having the tattoo done 1 year previously, but the naevus had been present at least 5 years earlier, and the tattoo artist had purposefully worked around the existing lesion. The patient had type II skin with blonde hair and blue eyes, and had previously worked in the French Foreign Legion during which time he had had prolonged sun exposure. He reported no medical history apart from multiple painful sunburns in childhood, took no medication, and family history for dermatological disease was negative. We did total surgical excision with 1 cm surgical margins. Histological examination confi rmed the diagnosis of superfi cial spreading melanoma with tumour thickness 0·26 mm, and the tumour was classifi ed as IA according to the American Joint Committee on Cancer (AJCC) staging system. Additional screening tests were within the normal range. We have given sun care education and planned follow-up in line with the AJCC recommendations for melanoma stage IA. The patient remains well with no signs of further disease. Many skin lesions have been reported in association with tattoos, both benign and malignant. The pathogenesis of malignant transformation in tattoos is unknown, although hypotheses include the toxic eff ects of the pigments and their part in causing oxidative stress in response to ultraviolet light, chronic infl ammatory response, trauma as a trigger for malignant changes in existing lesions, and seeding of melanoma cells from existing melanomas during the tattoo process. In our case the patient’s existing pigmented lesion had not been aff ected by the needle during the tattoo procedure. Although not considered a risk factor for malignant transformation, physicians should examine tattoos carefully, because they might disguise a malignant lesion.

Patients with flares of seborrhoeic dermatitis were compared with control outpatients seen during the same time-period in a case-control study, and with themselves while in remission in a case-crossover study. All patients consulted the same office-based dermatologist. During the study period, 189 cases and 189 controls were included in the case-control study, and 81 cases in the case-crossover study. Multivariate analysis was performed. Case-control study results were the following: past history of tobacco consumption (odds ratio (OR) 2.2 (95% confidence interval (CI) 1.1–4.6)), conflict as a dispute during the past month (OR 10.6 (95% CI 1.0–114.3)), alcohol consumption on a regular basis (OR 10.2 (95% CI 2.0–52.6)), and higher level of stress during the past month (OR 8.2 (95% CI 3.4–19.9)). Case-crossover study results were the following: higher level of stress during the past month (OR 4.5 (1.7–12.2)), association borderline significant for higher level of alcohol consumption (OR 5.4 (0.8–34.9)). These risk factors for flares of seborrhoeic dermatitis should be taken into account carefully in the daily management of seborrhoeic dermatitis.

Little is known about itch related to the use of face masks. This internet survey study investigated the prevalence, intensity and clinical characteristics of itch related to the use of face masks by the general public during the COVID-19 pandemic. A total of 2,315 replies were received, of which 2,307 were included in the final analysis. Of the respondents, 1,393 (60.4%) reported using face masks during the previous week, and, of these, 273 (19.6%) participants reported having itch. Subjects who reported sensitive skin and atopic predisposition, and those with facial dermatoses (acne, atopic dermatitis or seborrhoeic dermatitis) were at significantly higher risk of itch development. The high-est rating of itch for the whole group on the Itch Numeral Rating Scale was 4.07 ± 2.06 (itch of moderate intensity). Responders who wore masks for longer periods more frequently reported itch. Almost 30% of itchy subjects reported scratching their face without removing the mask, or after removing the mask and then scratching. Wearing face masks is linked to development of itch, and scratching can lead to incorrect use of face masks, resulting in reduced protection.

The pathogenesis of seborrhoeic dermatitis is controversial and remains unclear. Malassezia is considered to be a commensal fungi and is found not only in the stratum corneum but also in hair follicles. It is an important pathogenic factor in seborrhoeic dermatitis. The aim of this study was to clarify the pathogenesis of seborrhoeic dermatitis, morphologically, through comparison with psoriasis vulgaris. Fifteen cases of seborrhoeic dermatitis, 7 of psoriasis, and 6 of normal skin were examined using routine histopathology, immunohistochemistry, and electron microscopy. Macrophages were found to be diffusely distributed in the upper dermis of seborrhoeic dermatitis and psoriasis. In contrast, a significant increase in the number of dendritic cells in the follicular epithelium and dendritic cell clusters in the perifollicular dermis were found only in seborrhoeic dermatitis. Ultrastructural examination of the clusters demonstrated that dendritic cells interacted with lymphocytes, macrophages, and other dendritic cells. In conclusion, folliculotropic distribution of dendritic cells as well as dendritic cell-immune cell clusters play an important role in the pathogenesis of seborrhoeic dermatitis.

Eczema is an inflammatory skin disease which is characterized by itching and scaling plaques and patches on different skin sites. Histopathologically, a characteristic feature is the presence of epidermal edema or spongiosis. Eczema can develop at any age and may be associated with skin inflammation caused by irritation or allergy. Some forms of eczema have no apparent trigger although as our understanding of the molecular basis of skin disease grows, new pathways, such as the role of mutations in the filaggrin gene in atopic eczema, have been found to have a role in pathogenesis, in some individuals. This section will concentrate on two common forms of eczema, atopic dermatitis and contact dermatitis. It will also consider seborrhoeic dermatitis which, although not strictly speaking a form of eczema, shares some common features. This scaly inflammatory dermatosis is largely caused by an inflammatory response triggered by a member of the normal skin microbiome, the yeast Malassezia.

Leishmaniasis is a vector-borne disease caused by protozoal parasites of the genus Leishmania. Parasites are transmitted by Phlebotominae flies (Diptera, Psychodidae). Leishmania infantum is the most important species in Europe. Humans, as well as animals, can become infected. The parasite produces a visceral form of the disease that can end in death if not treated properly. Dogs are considered the main reservoir for human infection. Traditional endemic regions in Europe are the countries of the Mediterranean basin. Slovenia is considered non-endemic. The article reports a case of canine leishmaniasis (CanL) in a Slovenian dog. This particular case was a 5 year old Brandlbracke bitch, born close to the Croatian border, but which had never crossed the Slovenian state borders. She was a regular outdoor sleeper. Beside considerable loss of weight, seborrhoeic and alopecic skin with crusts on the legs and head were noticed. Laboratory tests revealed hyperproteinaemia, hypoalbuminaemia, leucocytosis, anaemia, and thrombocytosis. An immunofluorescence antibody titre test revealed 1: >160 antibody titre against L. infantum. Clinical improvement was achieved following therapy with allopurinol. Real-time PCR performed on conjunctival swab and blood specimens 1.5 years post therapy was negative. Since Phlebotominae flies were found in the south of the country recently, and infection by other routes in this case seems unlikely, this dog was most probably infected by sand fly bites. The possibility that CanL could be spread endemically in Slovenia therefore exists., Lišmanioza je bolest koja se prenosi vektorima, a uzrokuje ju protozoalni parazit iz roda Leishmania. Parazite prenose muhe Phlebotominae (Diptera, Psychodidae). Leishmania infantum najvažnija je vrsta u Europi, kojom se mogu invadirati i ljudi i životinje. Parazit uzrokuje visceralni oblik bolesti koji može završiti smrću ako se odgovarajuće ne liječi. Psi se smatraju glavnim rezervoarom za invaziju u ljudi. Tradicionalne endemijske regije u Europi jesu zemlje koje se nalaze u Mediteranskom bazenu. Slovenija se ne smatra endemijskim područjem. Članak peikazuje slučaj lišmanioze psa (CanL) iz Slovenije. Radi se o pet godina staroj kuji pasmine austrijski ravnodlaki gonič (Brandlbracke) okoćenoj u Sloveniji blizu hrvatske granice, i koja nikad nije napuštala Sloveniju. Kuja je redovito boravila vani. Osim znatnoga gubitka tjelesne mase, uočena je seboroična i alopecična koža s krastama na ekstremitetima i glavi. Laboratorijski testovi pokazali su hiperproteinemiju, hipoalbuminemiju, leukocitozu, anemiju i trombocitozu. Titar protutijela Imunofluorescencijom utvrđen je titar protutijela u vrijednosti 1 : > 160 za L. infantum. Liječenje alopurinolom dovelo je do kliničkog poboljšanja. Lančana reakcija polimerazom u stvarnom vremenu učinjena iz obriska konjunktiva i uzorka krvi 1,5 godina poslije liječenja bila je negativna. Iako je u novije vrijeme dokazano da insekata iz skupine Phlebotominae ima na jugu zemlje i invazija drugim putem ne čini se vjerojatnom, kuja je najvjerojatnije invadirana ubodom pješčane mušice, stoga postoji mogućnost endemijskog širenja lišmanioze psa u Sloveniji.

Background Tinea capitis (TC) is an infection of the scalp hair due to dermatophytes. Most commonly seen in prepubescent children, but data of adults tinea capitis (ATC) in China mainland are limited. Objectives We aimed to evaluate epidemiological, clinical and mycological characteristics of ATC in China from 2000 to 2019. Methods We retrospectively analysed all ATC reported cases in China mainland, confirmed by mycological examination, by searching PubMed, Wanfang, Weipu and CNKI database. Results In sum, 40 papers involving 269 clinical cases were included. The average morbidity of ATC was calculated as 9.04% after standardisation. The sex ratio is 1:5.2 (31 male, 163 female); 76 people between 18 and 44 age level and 137 people between 45 and 89 age level were diagnosed as ATC. Culture or ITS sequencing identified Trichophyton violaceum in 70 cases (35.2%), Microsporum canis in 42 cases (21.1%), Trichophyton mentagrophyte in 32 cases (16.1%), Trichophyton rubrum in 23 cases (11.5%), Microsporum gypseum in 18 cases (9.0%), Trichophyton tonsurans in 6 cases (3.0%), Trichophyton schoenleini in 4 cases (2.0%), Epidermophyton floccosum in 2 cases (1.0%), Trichophyton verrucosum and Microsporum ferrugineum in one case (0.5%). ATC was easily to be diagnosed as furfur, seborrhoeic dermatitis (13%) or pustular and dermatocellulitis (11.15%).Six immunocompromised persons were recorded (2.2%). Conclusions ATC mainly involves postmenopausal women. Trichophyton violaceum, M canis, T mentagrophyte remain the most common aetiological agent of ATC in China. Trichophyton rubrum own the much higher frequency in ATC than in children. For diversified clinical manifestations, recognising ATC profiles will help clinicians avoid misdiagnosis.

Background Dry skin is a frequent and multifaceted condition which can be associated with skin irritation, itch, patient discomfort and manifest skin disease. In spite of being frequent, little is known about the epidemiology of dry skin in the population. Objective To determine the prevalence of dry skin in the German adult population. Methods Data of 48 630 employed persons were assessed on a cross-sectional level in whole-body examinations by experienced dermatologists during company-based skin screenings conducted in 343 German companies. Next to the current dermatologic findings, age, gender, allergies, atopic diseases and the skin type were assessed. Results In total, n = 14 300 persons (29.4%) were rated as having xerotic skin. Older age but not gender was associated with xerosis. In the regression analyses controlling for age and gender, dry skin was a significant predictor for: axillary dermatitis (OR: 4.51; CI 2.70-7.54), atopic eczema (OR: 3.99; CI 3.42-4.65), exsiccation eczema (OR: 2.96; CI 2.40-3.65), psoriasis (OR: 1.57; CI 1.38-1.78), plantar warts (OR: 1.42; CI 1.26-1.60), seborrhoeic dermatitis (OR: 1.28; CI 1.16-1.42) and atopic disposition (OR: 1.17; CI 1.12-1.22). Conclusion Dry skin is a frequent condition in the adult general population and needs special attention. Known risk factors may facilitate identifying patients at risk for deterioration.

Aims: To explore the potential of the skin microbiome as biomarker in six dermatological conditions: atopic dermatitis (AD), acne vulgaris (AV), psoriasis vulgaris (PV), hidradenitis suppurativa (HS), seborrhoeic dermatitis/pityriasis capitis (SD/PC) and ulcus cruris (UC). Methods: A systematic literature review was conducted according to the PRISMA guidelines. Two investigators independently reviewed the included studies and ranked the suitability microbiome implementation for early phase clinical studies in an adapted GRADE method. Results: In total, 841 papers were identified and after screening of titles and abstracts for eligibility we identified 42 manuscripts that could be included in the review. Eleven studies were included for AD, five for AV, 10 for PV, two for HS, four for SD and 10 for UC. For AD and AV, multiple studies report the relationship between the skin microbiome, disease severity and clinical response to treatment. This is currently lacking for the remaining conditions. Conclusion: For two indications - AD and AV - there is preliminary evidence to support implementation of the skin microbiome as biomarkers in early phase clinical trials. For PV, UC, SD and HS there is insufficient evidence from the literature. More microbiome-directed prospective studies studying the effect of current treatments on the microbiome with special attention for patient meta-data, sampling methods and analysis methods are needed to draw more substantial conclusions.

Background: Seborrhoeic dermatitis (SD) is a chronic papulosquamous inflammatory disease which resistant to medical treatment. Various treatment such as topical corticosteroid, antifungal and calcineurin inhibitor has been widely practiced and gives varying results Objective: Our objective was to compare the efficacy of Sebclaira® and topical hydrocortisone 2,5% for management of moderate SD on the face Methods: A randomised clinical trial, controlled, double blind study was performed for four weeks. We assessed the efficacy and side effects of these topical treatment. The severity of SD was evaluated using Seborrhea Area Severity Index-Facial (SASI-F) score. The severity of pruritus was evaluated using Visual Analogue Scale. Demographic characteristics, baseline SASI-F and VAS were recorded in the medical record. Results: A 34 patients (14 males, 20 females) with moderate SD on the face completed the four weeks study. The mean of SASI T2 and VAS score of the Sebclaira® group was significantly lower than Hydrocortisone 2.5% group with p = 0.000 and p = 0.000 respectively. Tolerance between Sebclaira® and Hydrocortisone 2.5% showed insignificant results (p = 1.000) Conclusions: The longer application of Sebclaira® was significantly more effective to improve moderate SD

Background Seborrheic dermatitis is a chronic relapsing inflammatory skin disease with unclear pathophysiological mechanisms. Objective To establish which lifestyle and physiological determinants are associated with seborrheic dermatitis. Methods Seborrheic dermatitis was diagnosed by a trained physician during a full body skin examination within the Rotterdam Study, a prospective population-based cohort study in middle aged and elderly. The current design is a comparative cross-sectional study embedded in the Rotterdam Study. Potential factors were identified from the literature and analysed in a multivariable logistic regression, including: age, sex, obesity, skin colour, stress, depression, education level, hypertension, climate, xerosis cutis, alcohol and tobacco use. Results Of the 5,498 participants, 788 participants were diagnosed with seborrheic dermatitis (14.3%). We found associations between seborrheic dermatitis and male sex (adjusted OR 2.09; 95% CI: 1.77-2.47), darker skin (adjusted OR 0.39; 95% CI: 0.22-0.69), season (summer vs winter: adjusted OR 0.63; 95% CI: 0.48-0.82) and generalized xerosis cutis (adjusted OR 1.41; 95% CI 1.12-1.80). Conclusion Seborrheic dermatitis is one of most common inflammatory dermatoses in middle and elderly aged individuals, especially during winter period. Men, and people with a light and dry skin were most likely to have seborrheic dermatitis. This article is protected by copyright. All rights reserved.

Background While device-based acne treatments are widely applied for patients not tolerating conventional medications, related controlled studies have been still limited. Recently, non-ablative 1450-nm diode laser (DL) and fractional microneedling radiofrequency (FMR) have been effectively used for acne, in addition to well-recognized dermal remodelling effects. Objective To compare the clinical course of acne treatment between DL and FMR. Methods Twenty-five Korean patients with mild-to-moderate facial acne completed treatments with DL and FMR through a 20-week, randomized split-face study. One randomly assigned half side of each patient's face received DL and the other side by FMR. Treatments were scheduled to receive three consecutive sessions at 4-week intervals. Objective assessments including revised Leeds grades, lesion counts, sebum output measurements, and patients' subjective satisfaction were investigated. Results Both DL and FMR demonstrated steady improvement of acne and seborrhoea during treatment sessions. While results between two devices were similar during treatment sessions, FMR was superior to DL in the 12-week follow-up. Patients' subjective assessments for seborrhoea improvement were similar between two devices, while those for acne, skin texture, and acne scars were more satisfactory for FMR. For safety profile, no significant difference was observed between two regimens, while mild postinflammatory hyperpigmentation was observed only in DL side. Conclusion Both DL and FMR demonstrated efficacies for acne and seborrhoea, with reasonable safety profile. FMR was more effective than DL for the long-term maintenance, and subjective assessments for texture and scar improvements. Therefore, a few sessions of these devices would be a viable option for acne treatments.

Seborrhoeic Dermatitis (SD) is a common inflammatory skin disease that presents as itchy, flaking skin in the seborrhoeic areas. Various environmental and intrinsic factors have been identified as predisposing factors for SD, but its aetiology remains poorly understood. Although it was recognized that genetic factors play a role in SD aetiology, there have not been studies that systematically review the literature specifically for causal mutations or protein deficiencies in SD. In this review, we searched various databases for gene mutations and protein deficiencies that cause SD or SD-like phenotype in humans and experimental animals, and summarize 11 gene mutations or protein deficiencies that were described in the literature. Most of the encoded proteins play a role either in the immune response (ACT1, C5, IKBKG/NEMO, STK4, 2C TCR) or epidermal differentiation (ZNF750, MPZL3). Understanding the genetic basis of SD can impart knowledge of the pathobiology of the disease and help identify novel therapeutic targets.

Objective The re-greasing process and kinetics of the human scalp, post-shampooing, have been previously documented, in vivo, on a few Caucasian subjects. The objective of the presented research was to extend such knowledge over seven different ethnic groups. Methods The post-shampooing re-greasing kinetics of the scalp was studied on 1325 subjects (women and men of two distinct age classes) from seven different ethnic groups in their residential and native country. Sebum amounts were determined onto small shaved scalp areas at various times post-shampooing, using the Sebumeter® technique. Results As previously published on Caucasian subjects, scalp re-greasing process follows a hyperbolic-like kinetics over days. However, amounts of collected sebum highly vary with ethnicity. As recorded through the casual level (CL) at the equilibrium phase, 2–3 days post-shampooing, the highest amount of sebum was found in African American subjects, followed in descending order by Caucasian American, Japanese, Chinese, Thai, Caucasian European and Indian subjects, the latter showing very low values. Lower amounts of sebum were recorded in the older age class in all ethnics, as compared to the younger one, and male subjects were found higher sebum producers than women, irrespective of ethnicity. Conclusion The kinetics and slopes of the re-greasing process of the human scalp appear similar in all ethnic groups studied. However, striking quantitative differences are found between the seven ethnic groups, resulting from different sebaceous production levels and scalp hygiene routines.

The paper contains review of studies on microbiota and cutaneous microbiome using modern techniques of methagenomic analysis. The existing data on microflora of normal skin and among the patients with acne, seborrhoeic dermatitis, rosacea atopic dermatitis are consequently analyzed. The interaction between microbiome and innate/adaptive immunity is presented The perspectives of knowledge on microbiome both in dermatology and cosmetology are pointed out.

Der behaarte Kopf kann durch vielfaltige Erkrankungen in ebenso vielfaltiger Weise betroffen werden. Neben Rotung und Schuppung findet sich haufig qualender Juckreiz, der zu massiven Beeintrachtigungen der Patienten fuhrt. Die Kopfpsoriasis und das seborrhoische Kopfekzem gehoren zu den haufigsten Erkrankungen, die im klassischen Fall einfach zu unterscheiden sind, aber auch Uberschneidungen und klinische Ahnlichkeiten zeigen konnen. Die scharf begrenzten, die Stirn-Haar-Grenze uberschreitenden erythematosquamosen Plaques der Psoriasis stehen eher unscharf begrenzten, dusterroten Erythemen mit einer gelblich-fettigen Schuppung des seborrhoischen Ekzems gegenuber. Bei Letzterem findet sich haufig eine diffuse Alopezie, wahrend Haarausfall bei der Psoriasis eher selten ist, aber auch als unerwunschte Wirkung verschiedener Therapeutika auftreten kann. Die Behandlung richtet sich nach Akuitat und Ausdehnung der Erkrankung wie auch Einschrankung der Betroffenen. Sie ist zunachst topisch unter Einsatz von Kortikosteroiden, bei der Psoriasis auch von Vitamin-D-Derivaten, beim seborrhoischen Ekzem von topischen Antimykotika. In schweren Fallen unter Beteiligung des ubrigen Integuments bedarf insbesondere die Psoriasis einer systemischen Therapie mit den klassischen Wirkstoffen Methotrexat, Fumaraten oder Ciclosporin bis zu den Biologika, die Tumornekrosefaktor-α, Interleukin-12/23 oder Interleukin-17 hemmen. Eine Systemtherapie des seborrhoischen Ekzems ist nur selten notig und kann mit Kortikosteroiden, Antimykotika oder Vitamin-A-Derivaten erfolgen. Wichtig ist eine intensive Beratung der Patienten uber die Notwendigkeit einer konsequenten und lang wahrenden Anwendung der Therapeutika sowie zur Anwendung von hautschonenden Pflegeprodukten und Masnahmen.

BACKGROUND: Androgenetic alopecia (AGA) is a patterned hair loss occurring due to systemic androgen and genetic factors. It is the most common cause of hair loss in both genders. In recent years, many studies investigating the relation between systemic diseases and androgenetic alopecia presented controversial results. OBJECTIVES: In this study we aimed to investigate the frequency of androgenetic alopecia, the presence of accompanying systemic diseases, the relation between body mass index and androgenetic alopecia severity and the association of hyperandrogenemia signs with androgenetic alopecia in patients who referred to our outpatient clinic. METHODS: Patients who referred to our clinic between October 2013 and May 2014 were included in the study. Diagnosis of androgenetic alopecia was made upon clinical findings. Presence of seborrhea and acne in both genders, and hirsutism in women, were examined. Age, gender, smoking habit and alcohol consumption, age of onset of androgenetic alopecia, family history, accompanying systemic diseases and abnormalities of menstrual cycle were recorded. RESULTS: 954 patients (535 women, 419 men) were included in the study. Androgenetic alopecia prevalence found was 67.1% in men and 23.9% in women. Androgenetic alopecia prevalence and severity were correlated with age in both genders (p=0,0001). Frequency of accompanying systemic diseases were not significantly different between patients with and without androgenetic alopecia (p=0,087), except for hypertension, which was significantly more frequent in men with androgenetic alopecia aged between 50 and 59 years. Study limitations: Despite the exclusion of other causes of alopecia, differentiation of Ludwig grade 1 AGA from telogen effluvium based on clinical features alone is difficult. CONCLUSIONS: In our study the rate of androgenetic alopecia was found to be higher than the other studies made in Asian and Caucasian populations.

The association of hidradenitis suppurativa with other skin diseases has not yet been investigated in larger studies based on dermatological exams. The objectives of this study are to determine the prevalence and cutaneous comorbidities of hidradenitis suppurativa in the German working population. Between 2014 and 2017, 20,112 people in 343 German companies were examined for the presence of clinical features of hidradenitis suppurativa within the framework of a cross-sectional epidemiological study based on whole-body examinations. In addition, all cutaneous comorbidities were recorded. Point prevalence was calculated and the differences between individuals with and without hidradenitis suppurativa were determined by bivariate analysis. All statistical procedures were performed using SPSS 23.0 for Windows. Of 20,112 people examined, mean age was 43.6 ± 10.5 years; 52.3% were male. In total, n = 57 people (0.3%) with hidradenitis suppurativa were identified; 61.4% (n = 35) being male. In addition, non-inflammatory hidradenitis suppurativa-related lesions were found in 674 other individuals. In a bivariate comparison, patients with hidradenitis suppurativa showed significantly more frequently the following cutaneous comorbidities: acne vulgaris, psoriasis, seborrhoeic dermatitis, excoriations, and folliculitis. We determined a point prevalence of hidradenitis suppurativa of 0.3%. Since we have examined the working population, the healthy worker effect, which could have led to underestimation of prevalence, cannot be ruled out. The point prevalence of 0.3% for employed people in Germany and a prevalence of 3.0% for inflammatory and non-inflammatory hidradenitis suppurativa-related lesions show that hidradenitis suppurativa is an important disease for the whole health system.

BACKGROUND: Seborrhoeic dermatitis is a common but epidemiologically poorly researched chronic skin disease. OBJECTIVES: To characterize the prevalence and dermatological comorbidity of seborrhoeic dermatitis in Germany. METHODS: In the course of voluntary company skin checks, full-body examinations were carried out in more than 500 companies by experienced dermatologists and documented electronically. RESULTS: In total, 161 269 participants were included (men 55·5%, mean age 43·2 ± 10·9 years). Seborrhoeic dermatitis was identified in 3·2% (men 4·6%, women 1·4%). A significant difference was found between age groups (2·0% in < 35; 3·6% in 35-64; 4·4% ≥ 65 years). The most frequent concomitant skin conditions were: folliculitis [17·0%, 95% confidence interval (CI) 15·9-18·1], onychomycosis (9·1%, 95% CI 8·3-10·0), tinea pedis (7·1%, 95% CI 6·3-7·8), rosacea (4·1%, 95% CI 3·6-4·7), acne (4·0%, 95% CI 3·4-4·5) and psoriasis (2·7%, 95% CI 2·3-3·2). Regression analysis revealed the following relative dermatological comorbidities when controlling for age and sex: folliculitis [odds ratio (OR) 2·1, 95% CI 2·0-2·3], contact dermatitis (OR 1·8, 95% CI 1·1-2·8), intertriginous dermatitis (OR 1·8, 95% CI 1·4-2·2), rosacea (OR 1·6, 95% CI 1·4-1·8), acne (OR 1·4, 95% CI 1·2-1·7), pyoderma (OR 1·4, 95% CI 1·1-1·8), tinea corporis (OR 1·4, 95% CI 1·0-2·0), pityriasis versicolor (OR 1·3, 95% CI 1·0-1·7) and psoriasis (OR 1·2, 95% CI 1·0-1·5). CONCLUSIONS: Seborrhoeic dermatitis is a common disease, which is more prevalent in men and older people, and it has an increased rate of dermatological comorbidity. However, absolute differences in the prevalence of comorbidities are small and negligible. Nevertheless, the findings underline the need for integrated, complete dermatological diagnostics and therapy.

Background Commensal bacteria are a major factor in human health and disease pathogenesis. Interest has recently expanded beyond the gastrointestinal microbiome to include the skin microbiome and its impact on various skin diseases. Objectives Here we present current data reviewing the role of the microbiome in dermatology, considering both the gut and skin microflora. Our objective was to evaluate whether the clinical data support the utility of oral and topical probiotics for certain dermatological diseases. Methods The PubMed and ClinicalTrials.gov databases were searched for basic science, translational research and clinical studies that investigated differences in the cutaneous microbiome and the impact of probiotics in patients with atopic dermatitis, acne vulgaris, psoriasis, chronic wounds, seborrhoeic dermatitis and cutaneous neoplasms. Results Few clinical trials exist that explore the utility of probiotics for the prevention and treatment of dermatological diseases, with the exception of atopic dermatitis. Most studies investigated oral probiotic interventions, and of those utilizing topical probiotics, few included skin commensals. In general, the available clinical trials yielded positive results with improvement of the skin conditions after probiotic intervention. Conclusions Oral and topical probiotics appear to be effective for the treatment of certain inflammatory skin diseases and demonstrate a promising role in wound healing and skin cancer. However, more studies are needed to confirm these results. What's already known about this topic? The microbiome plays a role in human health and disease pathogenesis. Probiotics can manipulate the host microbiome and may confer health benefits for patients. Research to date has already begun to explore the utility of oral and topical probiotics for certain dermatological diseases. What does this study add? This review presents basic science and clinical trial data to support the role of the gut and skin microbiome in dermatology. Current data are reviewed on the use of probiotics in the prevention and treatment of skin diseases, including atopic dermatitis, acne vulgaris, psoriasis, seborrhoeic dermatitis, chronic wounds and cutaneous neoplasms. Future probiotic interventions are proposed.

Background The common inflammatory scalp disorders share similar clinical manifestations, and patient work up require invasive, undesirable diagnostic procedures like biopsy to ensure correct diagnosis. Optical coherence tomography (OCT) is a non-invasive high-resolution imaging modality that has found a valuable tool to assist in the diagnose and evaluation of different skin diseases. Objectives To describe the structural and vascular dynamic OCT (D-OCT) findings of inflammatory scalp disorders including scalp psoriasis, seborrhoeic dermatitis and contact dermatitis and to compare trichoscopy and OCT features. Methods Subjects with diagnosis of seborrhoeic dermatitis, psoriasis or contact dermatitis were enrolled in this study. OCT scans were taken on involved scalp, and the same scalp regions were evaluated by trichoscopy and compared with healthy scalp. Results A total of fourteen subjects (two healthy controls, four seborrhoeic dermatitis, five psoriasis and three contact dermatitis) participated. D-OCT imaging of vascular pattern in healthy scalp and the inflammatory scalp disorders were described. D-OCT images could enhance the clinician's ability to distinguish psoriasis from seborrhoeic dermatitis by objectively detect and assess red loop density. In scalp contact dermatitis, the vessels of the deep plexus were more dilated and fewer in number than those found in seborrhoeic dermatitis. Conclusion Dynamic OCT provides information that more clearly elucidates changes at the level of the superficial and deep plexuses without invasively interfering with superficial structures. In the context of inflammatory scalp disorders, this is useful to discern disorders with overlapping symptoms and minimize the use of invasive biopsies to diagnose.

Current treatments for seborrheic dermatitis provide only temporary relief. Therefore, identifying modifiable lifestyle factors may help reduce disease burden. The objective of this study was to determine whether specific dietary patterns or total antioxidant capacity are associated with seborrheic dermatitis. Participants of the Rotterdam Study with a skin examination and a food frequency questionnaire were included. Total antioxidant capacity was assessed on the basis of ferric reducing antioxidant potential of each food item. Dietary patterns were identified with principal component analysis (PCA). Multivariable logistic regression analyses were used to assess the association between total antioxidant capacity, dietary pattern-derived PCA factors, and seborrheic dermatitis adjusted for confounders. In total, 4,379 participants were included, of whom 636 (14.5%) had seborrheic dermatitis. The PCA identified vegetable, Western, fat-rich and fruit dietary patterns. The fruit pattern was associated with a 25% lower risk (quartile 1 vs. quartile 4: adjusted odds ratio = 0.76, 95% confidence interval = 0.58-0.97, P = 0.03), and the Western pattern with a 47% increased risk (quartile 1 vs. quartile 4: adjusted odds ratio = 1.47; 95% confidence interval = 0.98-2.20, P = 0.03), but only for females. Other factors were not associated with seborrheic dermatitis. In conclusion, a high fruit intake was associated with less seborrheic dermatitis, whereas high adherence to a "Western" dietary pattern in females was associated with more seborrheic dermatitis.

A 23-month-old girl with poor growth and decreased appetite over the past year (figure 1) and increased thirst (including night-time) for the last month was admitted with dehydration and somnolence without vomiting/diarrhoea. She appeared to be miserable and in pain. Capillary refill time was about 2 s. A 1 cm liver edge was palpable. Ear discharge was not evident. Her blood pressure was 75/40 mm Hg and pulse was 115 beats/min. A ‘seborrheic’ dermatitis of the scalp and of the suprapubic region—persisting for 1 year despite topical steroids and antibiotics—was evident (figure 2A–C). On biochemical examinations sodium was 143 mmol/L, glucose 4.1 mmol/L, urea 5.7 mmol/L, total serum proteins 43 g/L, albumin 22 g/L, alanine aminotransferase 227 IU/L, aspartate aminotransferase 181 IU/L, γ-glutamyl transferase 397 IU/L, C-reactive protein 89.3 nmol/L, erythrocyte sedimentation rate 80 mm/hour and creatinine 31.8 µmol/L. Urinalysis was normal, as well as international normalised ratio, prothrombin time and partial thromboplastin time. The abdominal ultrasound revealed a splenic hypoechoic area of about 1 cm. The child’s liquid intake and diuresis …

Background:Rheumatologists and Dermatologists usually manage Psoriatic Arthritis (PsA) and Psoriasis (PsO) separately, but early diagnosis and integrated management could achieve better outcomes with gains in quality of life of the patients. A multidisciplinary care is essential to achieve these goals.Objectives:The aim of this study is to describe a model of integrated multidisciplinary approach for early diagnosis of PsA and the multidisciplinary management of PsA patients.Methods:A retrospective study including patients that attended the multidisciplinary clinical from January 2019 to December 2020 was performed. Patients with PsO complaining articular symptoms and patients with articular symptoms with cutaneous lesions suspected to be PsO was referred to this clinical. Demographic, clinical data and disease activity measures were collected. Descriptive, Student’s t and Fisher test and Odds Ratio were estimated.Results:A total of 50 patients were referred to multidisciplinary clinical. Of these, 40 patients met criteria for psoriatic arthritis according to CASPAR criteria: 22 (55%) were male and median age was 49.5 ± 11.5 years. Family history of psoriasis was present in 19 (47.5%) and 7 (17.5%) had spondyloarthritis family history. Obesity and overweight were the comorbidities most found, 42.9% and 37.1%, respectively, followed by hypertension 25%, dyslipidaemia and depression 22.5% and metabolic syndrome 15%. Thirty-three patients (84.6%) were under topical treatment, 23 (59%) were under csDMARDs and 13 (32.5%) were under bDMARDs. After multidisciplinary clinical evaluation, treatment change was made - switch to another bDMARDs in 5 patients and bDMARD was started in 7 patients. All patients had a previous evaluation for infection risk assessment and 11 patients performed 9 months isoniazid for latent tuberculosis treatment.Eleven patients (28.9%) presenting moderate to severe PASI. Thirty-one patients presenting prolonged disease duration (> 10 years) with cutaneous (74.2%) and articular (61.3%) involvement. Peripheral disease without axial involvement was present in 28 patients (90%) while the others (10%) had both axial and peripheral involvement. Severe or moderate articular disease activity (DAS28) was present in 52.6% of the patients. The most frequent extra-articular manifestation was dactylitis (23.3%) and enthesitis (19.4%). The average number of multidisciplinary clinical consultations for these patients was 2.There was a statistically significant difference at the mean age, gender and disease duration > 10 years between patients with psoriatic disease with and without arthritis (p= 0.047; p=0.01 and p=0.03, respectively); there was no statistically significant differences in family history of psoriasis (p=0.711) and spondyloarthritis (p=0.174), nutritional status (p=0.732) and comorbidities such as diabetes mellitus (p=0.545), hypertension (p=0.404), dyslipidaemia (p=0.394) and depression (p=0.089).In the remaining 10 patients screened, the osteoarthritis and/or tendonitis were responsible for the articular complaints in 6 patients and scalp seborrhoea and eczema were responsible for the cutaneous complaints in the rest.Conclusion:Despite the small number of patients observed in our multidisciplinary clinical, we found that this kind of clinical care may facilitate the diagnosis of joint disease and offers a more comprehensive treatment approach for patients with both psoriasis and PsA.References:[1]Luchetti MM, Benfaremo D, Campanati A, Molinelli E, Ciferri M, Cataldi S, Capeci W, Di Carlo M, Offidani AM, Salaffi F, Gabrielli A. Clinical outcomes and feasibility of the multidisciplinary management of patients with psoriatic arthritis: two-year clinical experience of a dermo-rheumatologic clinic. Clin Rheumatol. 2018 Oct;37(10):2741-2749. doi: 10.1007/s10067-018-4238-4[2]Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists? Dermatol Ther. 2020 May;33(3):e13283. doi: 10.1111/dth.13283Disclosure of Interests:None declared.