In vivo optical coherence tomography imaging in a case of mucous membrane pemphigoid and a negative Nikolsky's sign

Abstract

There is currently a growing interest in new diagnostic tools of the oral cavity and mucosa which are non-invasive, repeatable and reliable. A diagnosis of a suspected, autoimmune pathology was made regarding a 57-year-old patient with desquamative gingivitis. However, a negative Nikolsky's sign did not seem to indicate a diagnosis of mucous membrane pemphigoid neither was there any indication as to the optimum location for an incisional biopsy. As an imaging method, the use of optical coherence tomography (OCT) has enabled the obtaining of tomographic (cross-sectional) scans of tissue. Such images are acquired prior to and after verifying Nikolsky's sign, thereby enabling the clinician to identify the presence (or not) of subepithelial bullae. Thereafter, an assessment of changes in the subepithelium (the split) can be performed, even in the absence of a suitable clinical picture, such as, for example, a negative Nikolsky's sign. Histological analysis and the use of indirect immunofluorescence have facilitated a diagnosis of mucous membrane pemphigoid, an autoimmune pathology, which can be confirmed with the appearance of subepithelial bullae. OCT was found to be a valid, non-invasive, auxiliary diagnostic device, capable of revealing in vivo and real-time bullae, which were hitherto clinically undetectable.

Phacomatosis pigmentovascularis type 2b (phacomatosis cesioflammea) with double superior vena cava, abdominal varicosities, and natal tooth: Novel associations

Abstract

Phacomatosis pigmentovascularis is characterized by coexistent extensive cutaneous vascular (capillary) and pigmentary anomalies. We describe a 2-month-old infant presenting with classic features of phacomatosis pigmentovascularis 2b (phacomatosis cesioflammea). He was also found to have hitherto unreported associations in the form of extensive venous anomalies presenting as striking abdominal wall varicosities and persistent left superior vena cava and natal tooth.

Retronychia a little-known cause of paronychia: A report of two cases in adolescent patients

Abstract

Retronychia is a clinical condition resulting from embedding of the nail plate into the proximal nail fold. We report two adolescent girls, 14 and 16 years of age, with a history of chronic proximal paronychia of the great toe, one of them developing osteomyelitis. After failure of treatment with several systemic antibiotics, nail avulsion was performed, leading us to the diagnosis of retronychia and with rapid and complete resolution of symptoms in both cases. Delay in diagnosis of retronychia can lead to local complications and prolonged discomfort.

Nipple adenoma in a 2-year-old boy

Abstract

Nipple adenoma is an uncommon proliferative process of the breast and predominantly occurs in women aged 40-50. Its incidence is extremely low in men, and it has not been reported in a boy. Although nipple adenoma is rare and benign, being familiar with it is important because it clinically resembles Paget disease and histologically adenocarcinoma. We report a case of nipple adenoma in a boy.

Efficacy and safety of topical application of 15% and 10% potassium hydroxide for the treatment of Molluscum contagiosum

Abstract

Background/Objectives

Molluscum contagiosum is the most common skin infection in children. One topical treatment used for Molluscum contagiosum is potassium hydroxide. The objective of this study was to compare the efficacy of potassium hydroxide topical treatment at different concentrations with that of placebo in terms of complete clearing of Molluscum contagiosum lesions and to assess the safety and tolerance of potassium hydroxide topical treatment.

Methods

This was a double-blind randomized clinical trial of three treatments (potassium hydroxide 10%, potassium hydroxide 15%, placebo) applied once daily up to complete clearing of lesions (maximum duration 60 days) in 53 children aged 2-6 years in primary health care pediatric offices in Catalonia, Spain.

Results

In the intention-to-treat analysis, potassium hydroxide 10% (58.8%, P = .03) and potassium hydroxide 15% (64.3%, P = .02) had efficacy superior to that of placebo (18.8%). The number of Molluscum contagiosum lesions was significantly reduced with potassium hydroxide 10% and 15%. The main efficacy outcome was achieved in 58.8% of children in the potassium hydroxide 10% group (P = .03 vs placebo) and in 64.3% of children in the potassium hydroxide 15% group (P = .02 vs placebo). Potassium hydroxide 10% and 15% were not significantly different in efficacy from each other. Potassium hydroxide 10% and placebo were better tolerated than potassium hydroxide 15%. No adverse events were reported during the study period.

Conclusions

Potassium hydroxide 10% and 15% demonstrated high rates of efficacy in clearing Molluscum contagiosum lesions, with potassium hydroxide 10% being better tolerated.

Effects of pregnancy on skin properties: A biomechanical approach

Abstract

Background

A woman's skin is dramatically affected by pregnancy. Its biomechanical properties are critical for resisting highly stressed areas. The aim of this work was to evaluate the impact of pregnancy on the mechanical properties of skin, as well as to evaluate the imprint that pregnancy leaves on the skin after delivery.

Materials and Methods

Suction tests using a cutometer were performed on 15 non-pregnant women and 26 pregnant women at 8 months of pregnancy and 4 months after delivery. Areas of abdomen and thighs were studied.

Results

Significant differences between the non-pregnant and 8-month pregnant groups were observed. Our data demonstrate that skin becomes less elastic and less deformable on the abdomen during pregnancy. On the thighs, a loss of elasticity and firmness was also observed. At 4 months after delivery, the skin did not return to its initial state.

Conclusion

This study showed that the mechanical properties of skin changed drastically during pregnancy compared to the non-pregnant condition and that these properties remain altered 4 months after delivery. In addition to alterations in abdominal skin during pregnancy, we also observed mechanical changes on the thighs, which are less subject to stretching.

The report of two cases with multiple sulfatase deficiency resulting from a rare similar gene mutation

Clinical characteristics and management of patients with rosacea in a tertiary dermatology center in Singapore from 2009 to 2013

Abstract

Introduction

Rosacea is a common chronic facial skin disease. A multiethnic society such as Singapore provides an opportunity to evaluate the demographic characteristics and their impact on clinical outcome in rosacea.

Aims

The aim of this study was to evaluate characteristics and outcome of rosacea in a multiracial population in Singapore.

Methods

Records of all rosacea patients between January 2009 and December 2013 were retrospectively retrieved from the electronic medical records (EMR). Descriptive analysis was performed to understand the characteristics of patients with rosacea. Multivariate logistic regression was used to evaluate the associations between the various variables and types of rosacea as well as the clinical outcome.

Results

A total of 1340 patients were identified. The mean age at presentation was 42.8 years with a female predominance (65%). Most of the patients had erythematotelangiectatic rosacea (ETR) (56.3%) followed by papulopustular rosacea (PPR) (37%). With multinomial logistic regression, controlling for age, gender, and known triggers, Indians and Caucasians were more likely to have PPR compared to ETR (OR: 3.4, P = 0.01 and OR: 2.1, P = 0.01 respectively). Patients who had phymatous rosacea are also more likely to be older males (OR: 3.82 95% CI 1.64–8.92, P = 0.002).

Conclusion

The epidemiology and outcome of rosacea among local patients were studied. Rosacea is more common among certain racial groups such as Chinese, Caucasian, and other races. The clinical subtypes also seem to be related to races of certain skin colors and might be related to varied natural intrinsic responses to the sun among different racial groups.

Clinical profile of dermatological emergencies and intensive care unit admissions in a tertiary care center – an Indian perspective

Abstract

Background

Although dermatology is largely considered as an outpatient specialty, dermatological conditions comprise 5–8% of cases presenting to the emergency department. The need for a dermatological intensive care unit is widely acknowledged due to the increasing incidence of acute skin failure. Very few studies have been done to characterize the common conditions seen in the emergency department and intensive care units. We undertook this study to analyze the spectrum of dermatological conditions presenting to the emergency department and the clinical profile of patients admitted to the intensive care unit.

Methods

A prospective study was conducted for 9 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were examined, and their clinical variables were statistically analyzed.

Results

A total of 248 cases were seen in the emergency department, out of which 72 (29.1%) cases were admitted and 176 (70.9%) were treated in the emergency department on an outpatient basis. The most common condition seen in non-admitted patients was acute urticaria (28.9%). The most common cause for admission in patients presenting to the emergency department was erythroderma (23.6%). Sixty-two patients were admitted to the intensive care unit, the most common diagnosis being erythroderma (40.3%).

Conclusions

This prospective study aimed to provide an insight into the types of cases evaluated in the emergency department by dermatologists in a large tertiary care hospital in coastal Karnataka in South India.

Onycholemmal carcinoma: a case report with its molecular profiling

Onycholemmal carcinoma (OC), also called microcystic nail bed carcinoma by some authors¹, is a slow-growing malignant epithelial tumor originating from the nail bed epithelium. Since the first description by Alessi and collegues in 2004², only twelve other cases have been described in the English literature, so far^1,3-7.

Yield improvement of epothilones in Burkholderia strain DSM7029 via transporter engineering

Abstract

Transporter engineering has been shown to be a positive approach for enhancing natural product titers in microbial cell factories by expelling target compounds out of feasible hosts. In this work, two multidrug efflux pumps, Orf14 and Orf3, were modulated in the epothilone production strain Burkholderia DSM7029::Tn5-km-epo (named G32) via Red/ET engineering to increase heterologous polyketide epothilone yields. Compared with the prior G32 strain, the total production of several epothilones in the G32::orf14-orf3 mutant was meaningfully doubled according to high-performance liquid chromatography-mass spectrometer (HPLC-MS) analysis. Typically for epothilone B, in simple and clear liquid medium CYMG, the overall productivity in the engineered high-yield producer G32::orf14-orf3 was improved for almost three-fold, from 2.7 to about 8.1 μg/l. Additionally, the ratio of extracellular to intracellular accumulation of epothilone B was raised from 9.3:1 to 13.7:1 in response to expression of two putative transport genes orf14 and orf3. Hence, we strongly recommend that the Orf14 and Orf3 transporters export epothilone, thus promotes the forward reaction of biosynthesis on epothilone manufacture inside the cells. Our results afford a practical stage for yield improvement of other heterologous natural products in broad chassis cells.

Validation of Reference Genes for RT-qPCR Analysis in the Deep-sea Bacterium Shewanella psychrophila WP2

Abstract

Reference genes are critical to obtain reliable results of RT-qPCR, which is widely used for relative quantification of gene expression. In this study, we evaluated the validity of seven candidate reference genes for normalization in RT-qPCR analysis in the deep-sea bacterium Shewanella psychrophila WP2 under different environmental conditions. Among the set of genes investigated, gyrA, 16S rRNA and rho were identified as the most suitable reference genes for WP2 at different temperatures, hydrostatic pressures and salinities, respectively. Notably, the rho gene is conserved in Shewanella genus and other deep-sea bacteria, thus could be used as a versatile reference gene for RT-qPCR analysis of these microorganisms under extreme environmental conditions.

Optimization of physicochemical parameters of tannase post-purification and its versatile bioactivity

Abstract

The present study investigates the optimization of tannase production from A. nidulans for various physicochemical parameters and harvests tannase for its chemical characterization. The maximum tannase activity was observed on the third day of incubation at 35°C and the stability was observed at pH 5.5 to 6.0 by holding its 100% activity. The tannase was partially purified from A. nidulans [FT10] by ammonium sulfate precipitation at different concentrations and it was found that at 80% of ammonium sulfate concentration, the precipitate exhibited the maximum activity for tannase of 96 U/ml. LCMS showed its M/Z value as 162.3 which was reconfirmed by SDS-PAGE. The UV spectrum and FTIR confirmed the presence of two oxy- and three hydroxyl groups in the benzene ring structure. The antibacterial activity of tannase was enhanced with antibiotics such as streptomycin and ceftazidime whereas the biofilm formation was significantly inhibited by the purified tannase. The scavenging activity was greatly increased with purified component and when the concentration of the purified tannase, TN09 was increased. To the best of our knowledge, this is one of the few reports where microbial species was used as the source for producing tannase enzyme and its role in various bioactivities such as antibacterial, anti-biofilm and antioxidant activity was evaluated.

Exploratory analysis of the association of depth of response and survival in patients with metastatic non-small-cell lung cancer treated with a targeted therapy or immunotherapy

Ann Oncol 2017; 28: 2707–2714 (doi: 10.1093/annonc/mdx414)

Fate of estrogens in a pilot-scale step-feed anoxic/oxic wastewater treatment system controlling by nitrogen and phosphorus removal

Abstract

The control measures for estrogens in the aquatic environment are topics of growing concern. It is a meaningful issue to finding optimal process parameters for efficient removal of estrogens with the purpose of efficient total nitrogen (TN) or total phosphorus (TP) removal in sewage treatment plants. The present paper is concerned with the relationships between the estrogen removal and TN or TP removal in a pilot-scale three-stage anoxic/oxic (A/O) system treating real municipal wastewater. The total removal efficiency for estrone (E1) and 17β-estradiol (E2) and their sulfate and glucuronide conjugates were on average 87% in the pilot-scale system. The concentrations of the sulfate and glucuronide conjugates of estrogens (E1 and E2) in the system were much lower than the estrogens, which might be caused by the rapid degradation of conjugates in the pilot-scale system. The average removal efficiencies of E1 and E2 and their sulfate and glucuronide conjugates were significantly lower under high TP removal conditions than those under high TN removal conditions that suggested that the ammonia oxidation promotes estrogen degradation. When the system achieved efficient TN removal, the concentrations of both E1 and E2 were generally lower in the aerobic zones than those in the anoxic zones. Instead, when the system achieved efficient TP removal conditions, the estrogen concentrations were higher in the aerobic zones than in the anoxic zones. However, it was thought that the variation of the concentrations of the estrogen conjugates had weak influence on concentrations of the free estrogens. The increase of the free estrogens in the aerobic zones could be attributed to the release of the estrogens adsorbed on the sludge. The variation of estrogens in a three-stage A/O system can be properly estimated and measured by a binary linear regression model with the variables of TP and TON (NO₂⁻-N and NO₃⁻-N), which is probably the important information for the improvement and optimization of wastewater treatment processes to obtain higher removal efficiency for estrogens.

Is HPV vaccination of pregnant women really safe?

Altered density, composition and microanatomical distribution of infiltrating immune cells in cutaneous squamous cell carcinoma of organ transplant recipients

Summary

Background

The inflammatory tumor microenvironment is crucial for effective tumor control and long-term immunosuppression has been identified as a major risk factor for skin carcinogenesis. In solid organ transplant recipients (OTR) undergoing long-term pharmacologic immunosuppression an increased incidence of cutaneous squamous cell carcinoma (SCC) and more aggressive tumor growth compared to immunocompetent patients (IC) has been reported.

Objectives

To determine the density and phenotype of immune cells infiltrating SCC and surrounding skin in OTR, and to characterize the microanatomical distribution patterns in comparison to IC.

Methods

We analyzed immune cell infiltrates within SCC and at defined regions of interest (ROI) of tumor- surrounding skin in formalin-fixed paraffin-embedded (FFPE) tissue of 20 renal transplant patients and 18 carefully matched IC by high-resolution semi-automated microscopy on complete tissue sections stained for CD4, CD8, CD20 and CD68.

Results

The overall immune cell density of SCC arising in OTR was significantly reduced compared to IC. Particularly CD4+ infiltrates at the directly invasive margin and tumor vicinity, intratumoral CD8+ T cell densities and the overall density of CD20+ tumor-infiltrating B cells (TIL-B) were significantly reduced in tissue of OTR.

Conclusions

Immune cells infiltrates within SCC and at defined ROI of tumor-surrounding skin in OTR differ markedly in their composition and microanatomical distribution compared to tumors arising in IC. Our findings substantially broaden the understanding of how long-term systemic immunosuppression modulates the local inflammatory microenvironment in the skin and at the site of invasive SCC.

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SSET Project: Cost-effectiveness Analysis of Surgical Specialty Emergency Trays in the Emergency Department

Background: We hypothesize that reusable, on-site specialty instrument trays available to plastic surgery residents in the emergency department (ED) for bedside procedures are more cost-effective than disposable on-site and remote re-usable operating room (OR) instruments at our institution. Methods: We completed a cost-effectiveness analysis comparing the use of disposable on-site kits and remote OR trays to a hypothetical, custom, reusable tray for ED procedures completed by PRS residents. Material costs of existing OR trays were used to estimate the purchasing and use-cost of a custom on-site tray for the same procedures. Cost of per procedure 'consult time' was estimated using procedure and resident salary. Results: Sixteen bedside procedures were completed over a 4.5 month period. A mean of 2.14 disposable kits were used per-procedure. Mean consultation time was 1.66 hours. Procedures that used OR trays took 3 times as long as procedures that used on-site kits (4 vs. 1.1 hours). Necessary, additional instruments were unavailable for 75% of procedures. Mean cost of using disposable kits and OR trays was $115.03/procedure versus an estimated $26.67/procedure cost of using a custom tray, yielding $88.36/procedure cost-savings. Purchase of a single custom tray ($1,421.55) would be redeemed after 2.3 weeks at 1 procedure/day. Purchasing 4 trays has projected annual cost-savings of $26,565.20. Conclusion: The purchase of specialized procedure trays will yield valuable time and cost-savings while providing quality patient care. Improving time efficiency will help achieve the Accreditation Council of Graduate Medical Education (ACGME) goals of maintaining resident well-being and developing quality improvement competency.

Incidence and Prevalence of Rosacea: A Systematic Review and Meta-Analysis

Abstract

Background

The exact prevalence and incidence of rosacea remain unknown, although it is a common condition associated with severe non-cutaneous diseases. We performed a systematic review of published literature to examine the global incidence and prevalence of rosacea.

Methods

A systematic review of population-based studies reporting the incidence and/or prevalence of rosacea was performed using three electronic medical databases, PubMed, EMBASE, and Web of Science. Data were extracted, and a proportion meta-analysis was performed to obtain pooled proportions.

Results

A total of 32 studies were included examining a total of 41 populations with 26,519,836 individuals. 22 populations were from Europe, three from Africa, four from Asia, nine from North America, and three from South America. The pooled proportion of rosacea was 5.46% (95% CI 4.91-6.04) in the general population and 2.39% (95% CI 1.56-3.39) among dermatology outpatients. Self-reported rosacea gave higher prevalence estimates than rosacea diagnosed by clinical examination, suggesting a low specificity of questionnaires based on symptoms. Rosacea affected both women (5.41%, (CI 95% 3.85-7.23)) and men (3.90% (CI 95% 3.04-4.87)), and mostly those aged 45-60 years.

Conclusion

We estimated the global prevalence of rosacea based on published data and found that 5.46% of the adult population is affected. However, the prevalence of rosacea depended on the diagnostic method with higher estimates in questionnaire studies and lower estimates in health registries.

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Effectiveness of Systemic Treatments for Pyoderma Gangrenosum:A Systematic Review of Observational Studies & Clinical Trials

Summary

Background

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis with substantial morbidity. Currently, there is no consensus on gold-standard treatments.

Objectives

Our primary objective was to review the effectiveness of systemic therapy for PG.

Methods

We searched Cochrane Central, Cochrane DSR, EMBASE, MEDLINE, PubMed, and Web of Science for 24 systemic therapies for PG. Primary outcomes were complete healing and clinical improvement; secondary outcomes were time-to-healing and adverse effects.

Results

We found 3,326 citations, of which 375 articles underwent full-text review, and 41 studies met inclusion criteria. There were 704 participants amongst 26 retrospective cohort studies, 3 prospective cohort studies, 7 case series, 1 case-control study, 2 open-label trials, and 2 randomized controlled trials (RCT). Systemic corticosteroids were the most studied (n=32 studies), followed by cyclosporine (n=21), biologics (n=16), and oral dapsone (n=11). One RCT (STOP-GAP, n=121) showed that prednisolone and cyclosporine were similar, with 15-20% complete healing at 6-weeks and 47% at 6-months. Another RCT (n=30) found that infliximab was superior to placebo at 2-weeks (46% vs. 6% response), with 21% complete healing rate at 6-weeks. Two uncontrolled trials showed 60% and 37.5% healing in four months with canakinumab and infliximab, respectively; other data suggest that patients with concurrent IBD may benefit from biologics. The remaining studies were of poor quality and small sample sizes, though supported the use of corticosteroids, cyclosporine, and biologics.

Conclusions

Systemic corticosteroids, cyclosporine, infliximab, and canakinumab had the most evidence in treating PG. However, current literature is limited to small and lower-quality studies with substantial heterogeneity.

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Use of emollients and topical glucocorticoids among adolescents with eczema – datafrom the population-based birth cohort BAMSE

Summary

Background

Knowledge regarding how adolescents treat their eczema is sparse.

Objectives

To explore the use of emollients and topical glucocorticoids in adolescents with eczema in relation to sex and disease severity, and to study dispensing patterns of topical glucocorticoids.

Methods

Questionnaire-based data on symptoms of eczema, eczema severity and treatment with emollients and topical glucocorticoids were obtained from 3,108 adolescents in the Swedish population-based birth cohort BAMSE. Severity of reported eczema was evaluated with the BAMSE Eczema Severity Score (BESS) in a questionnaire and with the Patient-Oriented Eczema Measure in clinically examined subjects with current eczema (n = 247). Information on dispensed topical glucocorticoids was obtained from the Swedish Prescribed Drug Register.

Results

In all, 10% reported eczema in the preceding year: 73% mild, 17% moderate and 10% severe according to BESS. Almost all used emollients, whereas use of topical glucocorticoids was reported by 55%, with no significant difference between sexes. The likelihood of treatment with emollients and topical glucocorticoids increased when the adolescents had symptoms of current eczema (OR_Adj 5.95, 95% CI 1.90-18.8), but not if they had more severe eczema compared to mild eczema (OR_Adj 1.57, 95% CI 0.58-4.25). Among those with reported eczema, 24% had a topical glucocorticoid dispensed in the preceding year and among those with moderate to severe current eczema 25% had dispensed a potent topical glucocorticoid.

Conclusions

This population-based study indicates that adolescents with eczema are undertreated or completely untreated, even those with severe eczema.

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Novel in vivo observations of scrotal Nannizzia gypsea infection

Abstract

Tinea cruris is a common dermatophytosis, which usually firstly involved the intertriginous fold near the scrotum. Although dermatophytes may colonize the scrotum, they typically do not infect scrotal skin. However, tinea of scrotum is seldom reported as a specific type of Microsporum gypseum infection, presenting as white-paint-dot appearance, scutular-like or pseudomembranous-like lesions in immunocompromised or immunocompetent patients^1-6. According to the newest taxonomy, M. gypseum is now called Nannizia gypsea⁷. Herein we report novel in vivo observations of five cases of scrotal tinea caused by N. gypsea (formerly Microsporum gypseum) in immunocompetent patients.

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Association between childhood atopic dermatitis, cutaneous, extracutaneous and systemic infections

Abstract

Atopic dermatitis (AD) is associated with higher risk of skin infections. US population-based studies found that childhood AD is associated with increased risk of caregiver-reported extra-cutaneous infections. We sought to confirm whether AD in childhood is associated with increased rates of healthcare diagnosed cutaneous and extra-cutaneous infections.

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Unique clinical and serological features of bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitors

Abstract

Recently, several cases of bullous pemphigoid (BP) associated with the use of a dipeptidyl peptidase-4 (DPP-4) inhibitor, a type of antihyperglycemic drug, have been reported (DPP4i-BP).^1,2 Béné reported a strong association between DPP-4 inhibitor use and the risk of BP.³ The juxtamembranous extracellular non-collagenous 16a (NC16a) domain of type XVII collagen (COL17, also termed BP180) is a major target epitope of autoantibodies in BP.⁴ A recent study found that BP cases whose autoantibodies bound to BP180 at regions other than NC16a exhibited a non-inflammatory phenotype with fewer erythemas. Intriguingly, half of these cases had taken DPP-4 inhibitors at the time of development of BP.⁵ In this study, we explored whether DPP4i-BP exhibited any unique clinical and serological features as suggested by the previous study.

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Tanning Addiction: Conceptualisation, Assessment, and Correlates

Abstract

Background

Research into problematic tanning (or 'tanning addiction') has markedly increased over the past few years. Although several excessive tanning instruments exist, most of these are psychometrically poor, not theoretically anchored, and have mainly been used on small samples.

Objective

Against this background, a new tanning addiction scale was developed based on a specific theoretical approach utilising core addiction criteria.

Methods

A scale comprising seven items (i.e. salience/craving, mood modification, tolerance, withdrawal, conflict, relapse/loss of control, and problems) was administered online to a cross-sectional convenience sample of 23,537 adults (M_age=35.8 years, SD=13.3), together with an assessment of demographic factors, the five-factor model of personality, and symptoms of obsessive-compulsive disorder, anxiety and depression.

Results

A confirmatory factor analysis showed that a one-factor model showed an optimal fit with the data collected (RMSEA=.050 [90% CI=.047–.053], CFI=.99, TLI=.99). High factor loadings (.781–.905, all p<.001) and coefficient omega indicator of reliability (ω=.941 [95% CI=.939–.944]) were also found using the new scale. In a multiple linear regression analysis, tanning addiction was positively associated with being female, not being in a relationship, extroversion, neuroticism, anxiety and obsessive-compulsiveness. It was also found that educational level, intellect/openness and depression were inversely associated with tanning addiction.

Conclusions

The new scale, Bergen Tanning Addiction Scale (BTAS), showed good psychometric properties, and is the first scale to fully conceptualise tanning addiciton within a contemporary addiction framework. Given this, the BTAS may potentially assist future clinical practice in providing appropriate patient care, prevention and disease management.

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Incidence of Sexual Dysfunction Among Patients with Hidradenitis Suppurativa: a population based retrospective analysis

Abstract

Given the devastating psychological impact of hidradenitis suppurativa (HS), and since the disease process commonly affects intimate body regions, patients with the disease may be at risk for sexual dysfunction (SD). While SD has been established among HS patients through qualitative studies using instruments not validated for this context,the burden of SD has not been described in a population of HS patients.

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Computerized tomographic evaluation of supraorbital notches and foramen in patients with frontal migraine headaches and correlation with clinical symptoms

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Navid Pourtaheri, Bahman Guyuron
PurposeTo correlate the location and size of supraorbital notches (SON) and foramen (SOF) with migraine headache symptoms in a migraine patient population.MethodsA retrospective review was performed on consecutive patients who were candidates for frontal migraine surgery with available pre-operative computed tomography (CT) images of the face/perinasal sinuses. The supraorbital anatomy from CT images was analyzed and correlated with presenting migraine headache symptoms. To assess for anatomic variations associated with migraine headaches, normative anatomic data was obtained through performing a meta-analysis.Results56 patients were included; 95% female, aged 17-80 (mean 47) years. Bilateral SON were present in 58.9% patients, combination of SON/SOF in 25%, and bilateral SOF in 16.1%. SOF mean diameter (1.22 mm) was 45% smaller than SON (2.20 mm, p<0.0001). The mean lateral distance from midline for SOF (2.74 cm) was ~0.5 cm farther than SON (2.25 cm, p<0.0001). Migraine patients with SOF had 178.6% longer mean migraine headache duration (p=0.0020), 9.8% higher intensity (p=0.0052), and 91.4% greater migraine headache index (p=0.0498) compared to those without SOF. Compared to normative patient data, migraine patients are more likely to have SON/SOF (100% vs. 83%, p=0.0047) and have mean SON and SOF diameters that are 34.3-41.5% smaller (p<0.0001).DiscussionNerve compression at SON and especially SOF contributes significantly to migraine headache symptoms and these structures (if present) should be released during frontal migraine surgery. Given the variable presence and location of SON/SOF, analysis of available face/perinasal sinus CT images helps pre-operative planning for foraminotomy and bands release.

A prospective randomised comparison of fixation methods in Tamai's zone I amputation

Publication date: Available online 22 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hyung-Sup Shim, Byung Yeun Kwon, Bommie F. Seo, Ho Kwon, Sung-No Jung
BackgroundThe treatment of choice for fingertip amputation is replantation to restore function and aesthetics. The purpose of this study was to compare the success rates and salvage periods between patients with Tamai's zone I amputation injuries treated with bony fixation and suture fixation.MethodsFifty-five patients with Tamai's zone I amputations with bony involvement were included in this study. The patients were allocated randomly to two groups treated by bony fixation with Kirschner (K-)wire and suture fixation, respectively. In the bony fixation group (n = 21), the distal phalangeal bone was fixed with K-wire; in the suture fixation group (n = 34), the amputated portion was fixed with sutures alone. The success rate was defined as the percentage of fully viable replanted cases, and the salvage period was defined as extending from the first postoperative day to the cessation of salvation.ResultsThe success rates for the bony and suture fixation groups were 90.0% and 91.1%, respectively, with no significant difference. The average salvage period was longer in the bony fixation group than in the suture fixation group (8.7 ± 1.25 vs. 6.4 ± 0.98 days; P = 0.01). No case of non-union of the distal phalangeal bone, limitation of motion, or disfigurement was observed in either group.ConclusionThe average salvage period was significantly longer for the bony fixation group, but the success rate did not differ between groups. We suggest that bony fixation is not mandatory in the treatment of Tamai's zone I amputation.

Invited commentary on “Dutch breast reconstruction guideline”

Publication date: March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 3
Author(s): Jeremy N. Rodrigues

The use of SERI™ Surgical Scaffolds in direct-to-implant reconstruction after skin-sparing mastectomy: A retrospective study on surgical outcomes and a systematic review of current literature

Publication date: Available online 15 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Arjen A.W.M. van Turnhout, Charlotte J.J. Franke, Eline J.C. Vriens-Nieuwenhuis, Wouter B. van der Sluis
IntroductionLittle is reported on surgical outcomes of SERI Surgical Scaffold, a bioresorbable silk-derived surgical scaffold, developed to provide soft-tissue support and repair, in implant/expander breast reconstruction.MethodsA retrospective chart study was conducted of all patients who underwent direct-to-implant reconstruction with a SERI surgical scaffold after skin-sparing mastectomy, recording surgical characteristics, perioperative complications and reoperations. A systematic literature review was conducted focusing on preclinical and clinical studies reporting on use of SERI in breast surgery.ResultsA total of 16 patients (22 breasts) were identified (mean age at surgery was 47 ± 6.8 years, mean BMI 23.1 ± 3.1 kg/m², mean ablation weight 530 ± 221 g, median clinical follow-up time 27 months (range 25–37)). There were no intraoperative complications. Postoperative bleeding, that required reoperation occurred in one (5%) breast, postoperative seroma in 10 (45%) and surgical site infection in 2 (9%). Scaffold-related complications occurred in 3 (14%) breasts, comprising lack of scaffold integration in all, resulting in skin ulceration in 2 and the scaffold lying free in the breast pocket surrounded with seroma in one. Nine articles were selected and reviewed from the 170 identified.DiscussionThe role of silk-derived scaffolds in breast reconstruction is yet to be determined. Though first reports have shown promising results, our and others results suggest that scaffold-related complications, such as lack of scaffold integration, may occur more frequently than previously described. Further research is necessary to determine possible (dis)advantages of the scaffold in specific patient groups.

The U.K. approach to putting patient safety first when receiving non-surgical cosmetic therapies: The cosmetic practice standards authority

Publication date: March 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 71, Issue 3
Author(s): Alexander Armstrong, Lilli Cooper, Katie Young, Alex Woollard, Emma Craythorne, Tamara Griffiths, Simon Withey, Nigel Mercer

Wound irrigation and the lack of evidence-based-practice

Publication date: Available online 23 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Sarvnaz Sepehripour, Baljit S. Dheansa

Breast reconstruction and risk of arm lymphedema development: A meta-analysis

Publication date: Available online 21 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Charalampos Siotos, Mohamad E. Sebai, Eric L. Wan, Ricardo J. Bello, Mehran Habibi, Damon S. Cooney, Michele A. Manahan, Carisa M. Cooney, Stella M. Seal, Gedge D. Rosson
BackgroundLymphedema remains a significant complication following breast cancer surgery when there is axillary lymph node intervention. Previous systematic reviews have identified risk factors for breast cancer-related lymphedema, including increased BMI, number of lymph nodes dissected and radiotherapy. However, they have not examined the effect of breast reconstruction on lymphedema occurrence. In this systematic review and meta-analysis, we sought to evaluate the association between breast reconstruction (BR) and lymphedema.MethodsWe searched PubMed (1966–2016), Embase (1966–2016), Scopus (2004–2016) and Google Scholar (2004–2016) for studies involving breast reconstruction and upper-extremity lymphedema or breast cancer-related lymphedema. Our primary outcome was lymphedema occurrence. We performed a meta-analysis using random effects due to heterogeneity of the studies.ResultsOur search strategy identified 934 articles. After screening, 19 studies were included in our meta-analysis evaluating outcomes based on number of patients (7501) or number of breasts surgically treated (2063). Breast reconstruction was significantly associated with lower odds of lymphedema (p < 0.001) compared to mastectomy only or breast-conserving surgery. Lymphedema rates were not statistically significantly different between patients undergoing implant-based or autologous BR.ConclusionsBreast reconstruction is associated with lower rates of lymphedema compared to mastectomy only or breast conserving surgery patients. Although the study does not prove causation, we hypothesize that this association is likely due to multiple factors, including a self-selecting population and mechanisms through which BR may contribute to primary or secondary prevention of lymphedema. Further prospective studies are needed to clarify this beneficial relationship between breast reconstruction and reduced lymphedema risk.

Anatomical relationship of the right internal jugular vein and the spinal accessory nerve: A word of caution

Publication date: Available online 15 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A.J. Robinson, K. Ekanyanke

Biodurability of poly implant prothèse (PIP) breast implants: a prospective analysis of 1028 prostheses in 514 patients.

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Richard M. Thomson, Samuel E. Healy, Mohammed Haj Basheer, Keith Morris, I.S. Whitaker

Foot reconstruction using a free proximal peroneal artery perforator flap: anatomical study and clinical application

Publication date: Available online 22 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Hyun Ho Han, Yeon Ji Lee, Suk-Ho Moon
BackgroundWhen a small, thin and durable flap is required for coverage of the foot, the proximal peroneal artery perforator (PPAP) free flap may be novel option. However, few clinical results and anatomical studies on the PPAP flap have been published.MethodsA total of 24 PPAP flaps used in 22 patients from January 2013 to December 2016 were analyzed. All flaps were elevated in the subfascial plane based on a single perforator from the peroneal artery between the soleus and peroneus muscles.ResultsThe average harvested flap size was 18.9 cm² (range, 9-40 cm²), pedicle length was 4.3 cm (range, 3.1-5.5 cm), and pedicle artery diameter was 1.1 mm (range, 0.8-1.5 mm). Twenty-three of 24 PPAP flaps survived. Average time to harvest the flap was 35 minutes (range, 20-55 minutes). Perforator location (ratio by fibula length) was confirmed at the 0.32 site (standard deviation, ±0.04) from the fibular head. Percentages of septocutaneous and musculocutaneous types were 42% (10/24) and 58% (14/24), respectively, for perforator vessel course; average intramuscular course was 1.3 cm (range, 0.7-2.4 cm). Vessel graft was conducted in 4 cases, with an average length of 2.2 cm (range, 1.5-3.0 cm).ConclusionsThe PPAP flap is one of the thinnest flaps available and is relatively easy to elevate. Moreover, it can be elevated in the same operative field as the foot, and primary closure is available for the donor site. Thus, the PPAP flap may be a good surgical option for soft tissue coverage of the foot.

A critical review of melanoma self-screening tools on YouTube – a missed opportunity?

Publication date: Available online 21 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Benjamin Smeeton, Justin C.R. Wormald, Agata M. Plonczak, Daniel Butler, Stephen Hamilton

The ‘WiFi’ otoplasty : Combined concentric posterior microchondrectomies and sutures for correction of prominent ears

Publication date: Available online 19 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Benoit I.M.M. Hendrickx, Moustapha Hamdi, Assaf Zeltzer, Andrew Greensmith
BackgroundProminent ears are by far the most common congenital ear deformity. Many techniques have been described using one or a combination of 3 basic methods: cartilage cutting, cartilage weakening and pure cartilage shaping techniques. The ideal otoplasty technique should yield a natural correction of the deformity, with low recurrence rates and with little risk of complications.MethodsA new cartilage shaping technique using closing wedge concentric microchondrectomies through an entirely posterior approach is presented. Between 2006 and 2017, 200 bilateral otoplasties using this 'WiFi' pattern technique were performed. This technique combined with Mustarde sutures is based on the excision of concentric partial thickness cartilage wedges designed in the pattern of the WiFi symbol.ResultsThere were no major complications such as anterior skin necrosis and no returns to theatre for infections or haematomas. 3 patients (1.5%) had complete recurrence of the deformity and 10 patients (5%) had to undergo a minor revision for recurrence at the upper pole. 5 patients have had exposure of the end of the permanent upper pole scapho-temporal suture more than 3 months after surgery requiring simple outpatient suture trimming/removal without any recurrence of results. Palpable or bridging sutures were present upon clinical examination in 10 patients (5%) but did not require revision surgery.ConclusionsHere, we describe a fast, safe and reliable technique for otoplasty with no need for extensive dissection, which is applicable to the full range of deformity.

The impact of a career night information session on medical students' perceptions of the scope of practice of plastic surgeons

Publication date: Available online 15 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Helene Retrouvey, Kevin J. Zuo, Emily S. Ho, Christopher R. Forrest

A fast and improved method of rapid prototyping for ear prosthesis using portable 3d laser scanner

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Nafij Bin Jamayet, Johari Yap Abdullah, Ahmed Mushfiqur Rahman, Adam Husein, Mohammad Khursheed Alam
Conventionally, facial prostheses are developed using wax or clay sculpted patterns. However, recent technological advancements in rapid prototyping systems have shown noteworthy advantages in fabricating facial prostheses that contrast traditional methods. Selective laser sintering technology is an example of this type of technological innovation. This technology can be used as an alternative method in the fabrication of wax patterns for a partial auricular prosthesis. The utilization of this advanced approach greatly reduces manual laboratory steps by directly creating the wax auricular pattern.

RE: MRI anatomical preoperative evaluation of distally based peroneus brevis muscle flap in reconstructive surgery of the lower limb

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rebecca A. Rollett, Rachel M. Clancy, Daniel J. Wilks, Jonathan D. Wiper

Efficacy of a novel strategy for poststernotomy deep sternal infection after thoracic aorta replacement using a prosthetic graft

Publication date: Available online 14 February 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Motone Kuriyama, Yukitaka Yoshida, Hitoshi Ninomiya, Shin Yamamoto, Shiro Sasaguri, Shinsuke Akita, Nobuyuki Mitsukawa
BackgroundPoststernotomy deep sternal wound infections are persistent and occasionally fatal, especially in cases involving prosthetic grafts, because of its complicated structure and virtual impossibility of removal. We aimed to verify the influence of cooperation with plastic surgeons and our novel strategy for treating deep sternal wound infection after aortic replacement on cardiovascular surgery outcomes.Patients and MethodsNine hundred and eighty-three consecutive patients were divided into two groups: an early (2012-2013) and a late group (2014-2015). The late group had received cooperatively improved perioperative wound management: our novel strategy of deep sternal infection, based on radical debridement and immediate reconstruction decided by reference to severities of patient's general condition and widespread infection by early intervention of plastic surgeons. The groups were analysed retrospectively. Binary variables were analysed statistically with a Fisher's exact test and continuous variables with a Mann-Whitney U test. Inter-group differences were assessed with a chi-square test.ResultsTwenty of 390 cases in the early group and 13 of 593 cases in the late group were associated with deep sternal infection. Morbidity rates of deep sternal wound infection and associated mortality rates one-year after reconstruction surgery were significantly less (p<0.05 for both) in the late group.ConclusionsIntervention by plastic surgeons improved perioperative wound management outcomes. Our treatment strategy for deep sternal wound infection also reduced associated mortality rates. Facilities should consider the early inclusion of plastic surgeons in the treatment of patients undergoing aortic replacement to facilitate better outcomes.

Altered epigenetic pathways and cell cycle dysregulation in healthy appearing skin of patients with koebnerized squamous cell carcinomas following skin surgery

Abstract

Background

Koebnerized non-melanoma skin cancer following skin trauma represents a rare and obscure event.

Objectives

To study molecularpathological parameters in koebnerized squamous cell carcinomas (K-SCCs) occurring after complete tumour removal.

Methods

We assessed two patients with multiple sclerosis who were on treatment with dimethylfumarate (DMF) preceded by long-term azathioprine therapy. Both patients rapidly developed several K-SCCs following histopathologically proven complete excision of cutaneous SCCs. We performed immunohistochemistry for p53, p16, Ki-67, TET-2, IDH-2, 5-hmc, and 5-mc. PCR was carried out for the detection of human papilloma viruses. Mutation analysis was performed for BRAF, K-RAS, and EGFR.

Results

All lesions investigated were negative for HPV DNA. Mutations were not detected. Healthy appearing skin of both patients showed relatively high Ki-67, p16, and p53 expression which was comparable to the expression observed in primary SCCs as well as K-SCCs. Protein expression of Ki-67, p16, and mutant p53 was barely detected in the specimens of the healthy controls. A decreased protein expression of TET-2 enzyme was seen in all tumours and healthy appearing skin when compared to the skin of healthy controls.

Conclusions

We observed two patients with K-SCCs developing under DMF treatment. In healthy appearing skin of patients with K-SCCs, wound healing processes, including induction of proliferation and growth factor release, might promote the growth of pre-neoplastic keratinocytes and cancer formation on the basis of pre-existing altered epigenetic pathways and cell cycle dysregulation. Although fumarates can reduce TET-2 expression, the role of DMF intake in the development of K-SCCs remains unclear.

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The measurement of drug-induced interferon-γ releasing cells and lymphocyte proliferation in severe cutaneous adverse reactions

Abstract

Background

The lymphocyte transformation test (LTT) is a standard laboratory method to identify culprit drugs in patients with a history of drug-induced non-immediate hypersensitivity and is mainly performed during the recovery phase. The measurement of drug-specific interferon-γ (IFN-γ)-releasing cells has been introduced to confirm culprit drugs, even during the acute phase of drug allergy.

Objectives

This study aimed to evaluate the capability of the enzyme-linked immunospot assay (ELISpot) to detect drug-specific IFN-γ-releasing cells during the acute phase and the capability of LTT to identify culprit drugs during the recovery phase in patients presenting with severe cutaneous adverse reactions (SCARs).

Methods

Peripheral blood mononuclear cells (PBMCs) from 23 SCAR patients were collected during the acute and recovery phases and assayed for drug-specific IFN-γ-releasing cells and lymphocyte proliferation, respectively.

Results

Drug-specific IFN-γ releasing cells were detectable in 73.9% of SCAR subjects (55.6% and 85.7% in patients who were and were not taking systemic steroids, respectively), whereas LTT results were positive in 52.2% of SCAR subjects. The frequencies of drug-specific IFN-γ-releasing cells were significantly higher in patients with positive LTT than in those with negative LTT (260.1 ± 110.0 and 46.6 ± 20.7 cells/10⁶ PBMCs, P = 0.01). A significant correlation between the results of the IFN-γ ELISpot assay and LTT was demonstrated (r = 0.65, P value < 0.01).

Conclusion

The IFN-γ ELISpot assay could be a useful tool to identify culprit drugs in SCAR patients when culprit drug identification is urgently needed during the acute phase of drug allergy.

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CYLD mutations differentially affect splicing and mRNA decay in Brooke-Spiegler syndrome

Abstract

Brooke-Spiegler syndrome (BSS; OMIM 605041), also known as familial cylindromatosis (OMIM 132700), is an autosomal dominant tumour predisposition disorder characterised by the occurrence of cylindromas, trichoepitheliomas, and spiradenomas.BSS is caused by heterogenous mutations in the CYLD gene. To date, different CYLD mutations have been reported, most of them resulting in a premature termination codon (PTC).² Among these, thirteen splice site mutations have been described. However, it remains largely elusive how such mutations affect splicing.

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Papulopustular rosacea and rosacea-like demodicosis: two phenotypes of the same disease?

Abstract

Background

Papulopustular rosacea and rosacea-like demodicosis have numerous similarities but they are generally considered as two distinct entities, mainly because the causal role of the Demodex mite in the development of rosacea is not yet widely accepted. Several clinical characteristics are traditionally considered to differentiate the two conditions; for example, papulopustular rosacea is typically characterised by central facial papulopustules and persistent erythema, whereas small superficial papulopustules and follicular scales rather suggest rosacea-like demodicosis. However, none of these characteristics is exclusive to either entity.

Objective

To explore differences in Demodex densities according to clinical characteristics traditionally associated with these two conditions.

Methods

Retrospective, observational, case-control study of 242 patients with central face papulopustules. Demodex densities were measured on two consecutive standardised skin surface biopsies.

Results

In the whole cohort, Demodex densities were greater in patients with persistent erythema than in those without. In 132 patients without recent treatment or other facial dermatoses, 120 (91%) had persistent erythema, 119 (90%) small superficial papulopustules, and 124 (94%) follicular scales; 116 (88%) simultaneously had clinical characteristics traditionally associated with both papulopustular rosacea and rosacea-like demodicosis. Higher Demodex densities were linked to the presence of follicular scales, but not to papulopustules size, nor to the presence/absence of persistent erythema.

Conclusion

Our observations highlight the difficulty differentiating between these entities and suggest that rosacea-like demodicosis and papulopustular rosacea should no longer be considered as two separate entities, but rather as two phenotypes of the same disease.

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Influence of cigarette smoking on pemphigus:a systematic review and pooled analysis of the literature

Abstract

Epidemiological evidence suggests that smoking cigarettes may be beneficial in pemphigus, but no systematic evaluation exists to corroborate this assumption. Therefore, a systematic literature review with pooled data analysis of the smoking status in pemphigus patients was conducted. Electronic searches using PubMed from inception to November 2017 identified 13 reports meeting predetermined inclusion and exclusion criteria. Most were case-control studies partly reporting that pemphigus vulgaris and foliaceus occurred less frequently in current and former smokers. Studies also indicated that duration of smoking and number of cigarettes smoked was lower in pemphigus patients than controls and that remission may be achieved sooner in those who smoke. However, although a generally low prevalence of smoking was demonstrated in pemphigus patients, which was lower than in controls by pooled analysis, some investigations found no difference regarding the smoking status compared with non-pemphigus subjects. One study demonstrated more severe mucosal involvement in non-smoking pemphigus patients, whereas another observed no difference in the rate of cutaneous or mucosal lesions between smokers and non-smokers with pemphigus. This review indicates that smoking may be a possible protective factor in pemphigus, although some compromised study methodologies yet hinder any firm conclusion. Further investigations with a refined quality design are required to resolve the so far partly conflicting results in this area.

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Alternative test models for skin aging research

Abstract

Increasing ethical concerns regarding animal experimentation have led to the development of various alternative methods based on the 3Rs (Refinement, Reduction, and Replacement), first described by Russell and Burch in 1959. Cosmetic and skin aging research are particularly susceptible to concerns related to animal testing. In addition to animal welfare reasons, there are scientific and economic reasons to reduce and avoid animal experiments. Importantly, animal experiments may not reflect findings in humans mainly because of the differences of architectures and immune responses between animal skin and human skin. Here we review the shift from animal testing to the development and application of alternative non-animal based methods and the necessity and benefits of this shift. Some specific alternatives to animal models are discussed, including biochemical approaches, two-dimensional and three-dimensional cell cultures, and volunteer studies, as well as future directions, including genome-based research and the development of in silico computer simulations of skin models. Among the in vitro methods, three-dimensional reconstructed skin models are highly popular and useful alternatives to animal models however still have many limitations. With careful selection and skillful handling, these alternative methods will become indispensable for modern dermatology and skin aging research.

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