Editorial board

The Editor's Choice

Biofilm-based photobioreactors: Their design and improving productivity through efficient supply of dissolved inorganic carbon

Abstract

The potential of biofilm-based photobioreactors (PBRs) for various applications has long been recognized and various types of biofilm-based PBRs have been developed for different applications. Compared to suspension-based PBR reactors, biofilm-based systems offer several advantages, including a significantly higher biomass concentration. However, due to the immobilization of the cells, in contrast to suspension-based systems, dissolved inorganic carbon (DIC) has to be transferred into the biofilm for consumption. Thus, to ensure efficient operation of these systems under a given lighting scheme (e.g. depending on geographical location), availability of DIC should be optimized. To achieve this, the dynamics of DIC inside the various biofilm-based PBRs, as well as the operational principles of these PBRs, need to be understood. The mini-review summarizes the designs of existing biofilm-based PBRs and reviews previous studies on DIC dynamics in various biofilms. Strategies to enhance DIC availability for the immobilized cells in biofilm-based PBRs are also discussed.

Inflammatory skin disorders and self-esteem

"I think you have ringworm. We can't accept a donation from you." The entire room went silent as everyone stared at Jennifer, age 34, who has suffered from severe plaque psoriasis since the age of 15 years and is now a patient advocate for the National Psoriasis Foundation (NPF). Jennifer was inspired to donate blood after her uncle received a lifesaving transfusion and hoped to help others like him, but she will likely never try again after this traumatizing experience. This was not the first time strangers had treated her as if she had a contagious skin infection.

Physiologic changes of pregnancy: A review of the literature

Throughout pregnancy, the body undergoes a variety of physiologic changes. The cutaneous findings can be most noticeable and often worrisome to both physicians and patients. Obstetricians and dermatologists must be able to differentiate between changes that are benign and those that may be pathologic. Most physicians recognize benign changes that are commonly described in literature such as hyperpigmentation, melasma, striae gravidarum, and telogen effluvium; however, they may be unaware of changes that tend to be less frequently discussed.

Radiation-induced circumscribed superficial morphea after brachytherapy for endometrial adenocarcinoma

Radiation-induced morphea (RIM) is a rare and underrecognized complication of radiation therapy that most commonly occurs in women after treatment for breast cancer. Although not fully understood, RIM is hypothesized to arise from an increase in cytokines that stimulate collagen production and extracellular matrix formation. Most documented cases of RIM occur 1 year after radiation therapy and are localized to areas that were treated for breast cancer. We report on a case of a female patient with stage IB endometrial adenocarcinoma who was treated with 24 Gray of adjuvant brachytherapy.

Aquagenic pruritus in polycythemia vera: a cross-sectional study

Cutaneous dermatomyositis disease course followed over time using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI)

Limited studies describe the longitudinal course of cutaneous dermatomyositis (DM).

SELF-HEALING JUVENILE CUTANEOUS MUCINOSIS: Clinical and histopathologic findings of nine cases: the relevance of long-term follow-up

Self-healing juvenile cutaneous mucinosis (SHJCM) is a rare disorder and the pathogenesis and long-term prognosis are unknown.

The Art of Being in Two Rooms at One Time: Ethical Issues with Overlapping Surgery

Effect of secukinumab on quality of life and psoriasis-related symptoms: a comparative analysis versus ustekinumab from the CLEAR 52-week study

Secukinumab has demonstrated greater sustained skin clearance versus ustekinumab through Week 52, greater improvement in symptoms and health-related quality of life (HRQOL), and comparable safety profile.

The spectrum of manifestations in DSP (desmoplakin) SR6 domain mutations: immunophenotyping and response to ustekinumab

The immune abnormalities underlying the ichthyoses are poorly understood.

Job Tasks as Determinants of Thoracic Aerosol Exposure in the Cement Production Industry

Abstract

Background

The aims of this study were to identify important determinants and investigate the variance components of thoracic aerosol exposure for the workers in the production departments of European cement plants.

Methods

Personal thoracic aerosol measurements and questionnaire information (Notø et al., 2015) were the basis for this study. Determinants categorized in three levels were selected to describe the exposure relationships separately for the job types production, cleaning, maintenance, foreman, administration, laboratory, and other jobs by linear mixed models. The influence of plant and job determinants on variance components were explored separately and also combined in full models (plant&job) against models with no determinants (null). The best mixed models (best) describing the exposure for each job type were selected by the lowest Akaike information criterion (AIC; Akaike, 1974) after running all possible combination of the determinants.

Results

Tasks that significantly increased the thoracic aerosol exposure above the mean level for production workers were: packing and shipping, raw meal, cement and filter cleaning, and de-clogging of the cyclones. For maintenance workers, time spent with welding and dismantling before repair work increased the exposure while time with electrical maintenance and oiling decreased the exposure. Administration work decreased the exposure among foremen. A subjective tidiness factor scored by the research team explained up to a 3-fold (cleaners) variation in thoracic aerosol levels. Within-worker (WW) variance contained a major part of the total variance (35–58%) for all job types. Job determinants had little influence on the WW variance (0–4% reduction), some influence on the between-plant (BP) variance (from 5% to 39% reduction for production, maintenance, and other jobs respectively but an 79% increase for foremen) and a substantial influence on the between-worker within-plant variance (30–96% for production, foremen, and other workers). Plant determinants had little influence on the WW variance (0–2% reduction), some influence on the between-worker variance (0–1% reduction and 8% increase), and considerable influence on the BP variance (36–58% reduction) compared to the null models.

Conclusion

Some job tasks contribute to low levels of thoracic aerosol exposure and others to higher exposure among cement plant workers. Thus, job task may predict exposure in this industry. Dust control measures in the packing and shipping departments and in the areas of raw meal and cement handling could contribute substantially to reduce the exposure levels. Rotation between low and higher exposed tasks may contribute to equalize the exposure levels between high and low exposed workers as a temporary solution before more permanent dust reduction measures is implemented. A tidy plant may reduce the overall exposure for almost all workers no matter of job type.

A Phase 2a Randomized Controlled Study to Evaluate the Pharmacokinetic, Safety, Tolerability, and Clinical Effect of Topically Applied Umeclidinium in Subjects with Primary Axillary Hyperhidrosis

Abstract

Background

Hyperhidrosis is a common medical condition which can have a significant impact on quality of life. Umeclidinium (UMEC) is a long acting muscarinic antagonist (LAMA) developed as a dermal formulation.

Objectives

This 2-week, double-blind, randomized, vehicle-controlled study evaluated systemic exposure, safety, and tolerability of topically administered UMEC in subjects with primary axillary hyperhidrosis. Clinical effect was a secondary objective, measured by gravimetry and the hyperhidrosis disease severity scale (HDSS). Vehicle was included to evaluate safety.

Methods

Twenty-three subjects were randomized to either 1.85% UMEC (N=18) or vehicle (N=5) once daily.

Results

Measurable plasma concentrations were observed in 78% of subjects after treatment. Nine subjects (50%) on UMEC and 2 subjects (40%) on vehicle reported AEs, most commonly application site reactions. At Day 15, 7 subjects (41%) in UMEC and 2 subjects (40%) in vehicle had at least a 50% reduction in sweat production. Eight subjects (47%) in UMEC and 1 subject (20%) in vehicle had at least a 2-point reduction in HDSS. No comparisons of treatment arms were planned prospectively.

Conclusions

The measurable exposure, acceptable safety, and preliminary clinical activity observed in this proof-of-concept study suggest the potential clinical utility of topical UMEC in subjects with axillary hyperhidrosis.

This article is protected by copyright. All rights reserved.

The implementation of knowledge dissemination in the prevention of occupational skin diseases

Abstract

Background

Occupational skin diseases (OSD) have a high medical, social, economic and political impact. Knowledge dissemination from research activities to key stakeholders involved in health care is a prerequisite to make prevention effective.

Objectives

To study and prioritize different activity fields and stakeholders that are involved in the prevention of OSD, to reflect on their inter-relationships, to develop a strategic approach for knowledge dissemination and to develop a hands-on tool for OSD prevention projects

Methods

Seven different activity fields that are relevant in the prevention of OSD have been stepwise identified. This was followed by an impact analysis. Fifty-five international OSD experts rated the impact and the influence of the activity fields for the prevention of OSD with a standardized questionnaire.

Results

Activity fields identified to have a high impact in OSD prevention are the political system, mass media and industry. The political system has a strong but more indirect effect on the general population via the educational system, local public health services or the industry. The educational system, mass media, industry and local public health services have a strong direct impact on the OSD "at risk" worker. Finally, a hands-on tool for future OSD prevention projects has been developed that addresses knowledge dissemination and different stakeholder needs.

Conclusion

Systematic knowledge dissemination is important to make OSD prevention more effective and to close the gap between research and practice. This paper provides guidance to identify stakeholders, strategies and dissemination channels for systematic knowledge dissemination which need to be adapted to country-specific structures, for example the social security system and health care systems. A key for successful knowledge dissemination is building linkages among different stakeholders, building strategic partnerships and gaining their support right from the inception phase of a project.

This article is protected by copyright. All rights reserved.

Reflectance confocal microscopy identification of subclinical basal cell carcinomas during and after vismodegib treatment

Abstract

Background

Recently, it has been shown that reflectance confocal microscopy (RCM) could identify subclinical basal cell carcinoma (BCC) during vismodegib treatment of locally-advanced BCC.

Objectives

To evaluate specificity and sensitivity of clinical, dermoscopic and RCM examination for BCC in patients with multiple BCCs treated by vismodegib.

Methods

94 BCCs had 710 clinical, dermoscopic and RCM examinations during 72 weeks of vismodegib treatment. 38 were biopsied at the end of the treatment. Sensitivity and specificity for these 38 lesions were calculated. BCC diagnoses of clinical, dermoscopic and RCM examination on all the 710 investigations were compared using Chi- 2 test.

Results

RCM was extremely more sensitive than dermoscopy and clinical examination and slightly less specific (sensitivity of 95%, 35% and 33% and specificity of 81%, 88% and 86% for RCM, dermoscopy and clinical examination, respectively) for the identification of residual BCC in the 38 biopsied cases. Considering all the 710 observations, RCM correctly diagnosed more BCCs than dermoscopy and clinical examination.

Conclusion

RCM is a non-invasive technique that can detect subclinical residual BCC during and after vismodegib treatment helping the clinician to identify incomplete tumor regression.

This article is protected by copyright. All rights reserved.

Defining the actinic keratosis field: a literature review and discussion

Abstract

Background

Despite the chronic and increasingly prevalent nature of actinic keratosis (AK) and existing evidence supporting assessment of the entire cancerization field during clinical management, a standardized definition of the AK field to aid in the understanding and characterization of the disease is lacking.

Objectives

The objective of this review is to present and appraise the available evidence describing the AK cancerization field, with the aim of determining a precise definition of the AK field in terms of its molecular (including genetic and immunological), histological, and clinical characteristics.

Methods

Eight European dermatologists collaborated to conduct a review and expert appraisal of articles detailing the characteristics of the AK field. Articles published in English before August 2016 were identified using PubMed and independently selected for further assessment according to predefined preliminary inclusion and exclusion criteria. In addition, a retrospective audit of patients with AK was performed to define the AK field in clinical terms.

Results

A total of 32 review articles and 47 original research articles provided evidence of sun-induced molecular (including genetic and immunological), and histological skin changes in the sun-exposed area affected by AK. However, the available literature was deemed insufficient to inform a clinical definition of the AK field. During the retrospective audit, visible signs of sun damage in 40 patients with AK were assessed. Telangiectasia, atrophy and pigmentation disorders emerged as 'reliable or very reliable' indicators of AK field based on expert opinion, whereas 'sand paper' was deemed a 'moderately reliable' indicator.

Conclusion

This literature review has revealed a significant gap of evidence to inform a clinical definition of the AK field. Therefore, the authors instead propose a clinical definition of field cancerization based on the identification of visible signs of sun damage that are reliable indicators of field cancerization based on expert opinion.

This article is protected by copyright. All rights reserved.

Increased prevalence of diabetes mellitus in bullous pemphigoid patients during the last decade

Abstract

Bullous pemphigoid (BP) is a rare autoimmune blistering disease. The association between BP and diabetes mellitus (DM) has been previously reported with inconsistent results^1-4. Dipeptidyl peptidase (DPP)-IV inhibitors, approved in Europe by EMA in 2007 to treat type-2 DM, are antihyperglycemic drugs that could induce BP disease^5-9.

This article is protected by copyright. All rights reserved.

Development of tripe palms and soles in a patient with long pre-existing systemic mastocytosis and newly developed non-small cell lung cancer

Abstract

A 71-year old woman with systemic mastocytosis presented to our department with an apoplectic insult one year ago and a 100 pack year smoking history. Skin manifestation of mastocytosis had started at the age of 50 years accompanied by a substantial increase of serum tryptase since the age of 60. Bone marrow involvement was confirmed 16 years later. Therapy of mastocytosis included antihistamines, montelukast, sodium cromoglycate, and PUVA therapy, all with limited success.

This article is protected by copyright. All rights reserved.

Apremilast for the treatment of moderate to severe palmoplantar psoriasis: results from a double-blind, placebo-controlled, randomized study

Abstract

Background

Palmoplantar psoriasis is a variant of psoriasis vulgaris which can severely impair quality of life.

Objectives

The main objectives of this double-blind, placebo-controlled, randomized study were to assess the efficacy and impact on quality of life and work productivity of apremilast for the treatment of moderate to severe palmoplantar psoriasis.

Methods

A total of 100 patients with moderate to severe palmoplantar psoriasis were randomized to either apremilast 30mg bid or placebo for 16 weeks. At Week 16, all patients received apremilast 30mg bid until Week 32. The primary endpoint was the proportion of patients who achieved a Palmoplantar Psoriasis Physician Global Assessment (PPPGA) of 0/1 at Week 16.

Results

There was no significant difference in the proportion of patients who achieved a PPPGA of 0/1 at Week 16 between patients randomized to apremilast (14%) and placebo (4%; p=0.1595). After 32 weeks of treatment with apremilast, 24% of patients achieved a PPGA of 0/1. In addition, apremilast was superior to placebo in achieving Palmoplantar Psoriasis Area Severity Index (PPPASI) 75 (apremilast: 22%; placebo: 8%; p=0.0499), in improving PPPASI (apremilast: -7.4±7.1; placebo: -3.6±5.9; p=0.0167), Dermatology Life Quality Index score (apremilast: -4.3±5.1; placebo: -0.8±4.5; p=0.0004), and in reducing activity impairment (apremilast: -11.0±22.3; placebo: 2.5±25.5; p=0.0063).

Conclusion

Despite the absence of a significant difference between apremilast and placebo in proportion of patients achieving a PPPGA of 0/1, the presence of significant differences observed for several secondary endpoints suggest that apremilast may have a role in the treatment of moderate to severe palmoplantar psoriasis.

This article is protected by copyright. All rights reserved.

Treatment of prurigo with methotrexate: a multicenter retrospective study of 39 cases Running head: Treatment of prurigo with methotrexate

Abstract

Background

Prurigo is a common primary pruritic condition. Treatment is challenging. Methotrexate (MTX) is effective for the treatment of pruriginous dermatoses, but its use in prurigo has been little studied.

Objectives

To investigate the efficacy and safety of MTX in the treatment of difficult-to-treat prurigo.

Methods

Patients from six university dermatology departments treated with MTX between 2006 and 2016 for difficult-to-treat prurigo (i.e. with failure to conventional therapies) were included in this retrospective multicenter study. Patients with other pruritic dermatoses were excluded. Clinical efficacy was recorded after 3, 6, and 12 months of treatment: 1/ subjective efficacy, i.e. evaluation of the pruritus by the patient and 2/ objective efficacy, i.e. assessment of cutaneous lesions by the physician: complete or almost complete remission (CR) (healing of lesions), partial remission (PR) (incomplete improvement of lesions), or failure (no improvement or worsening). The overall response rate (ORR) included CR and PR.

Results

Thirty-nine patients with previous failure of topical steroids, H1-antihistamine drugs, or phototherapy were included. The median weekly dose of MTX was 15 mg (range 5-25 mg). The median follow-up was 16 months (2-108). The mean time between onset of MTX and objective efficacy was 2.4 +/- 1.2 months and the mean duration of response was 19 +/- 15 months. The ORR was 91% at three months (n=36, CI95% [81.2%-100.8%], CR 44%), 94% at six months (n=32, CI95% [85.7%-102.2%], CR 56%), and 89% at 12 months (n=28, CI95% [77.4%-100.6%], CR 57%). Seven patients stopped MTX because of failure, and five because of the discovery of hepatocarcinoma (n=1), elevated transaminases (n=1), infectious pneumonitis (n=1), or gastrointestinal symptoms (n=2).

Conclusion

MTX is a therapeutic option in difficult-to-treat prurigo.

This article is protected by copyright. All rights reserved.

Gram-negative bacterial toe web infection – a systematic review

Abstract

Gram-negative bacterial toe web infection (GNBTWI) is a frequent therapeutic challenge in clinical practice with high recurrence rates and frequent need of systemic drugs.

The aim of this systematic review was to provide an updated overview and evidence-based data on pathogens, risk-factors and treatment of GNBTWI along with promoting a consistent international terminology.

This systematic review is based on a search in PubMed database for English and German articles published between 1980 and 2016. A total of 7 articles were considered appropriate for inclusion in this review regarding to treatment and outcome.

Throughout the medical literature, a variety of terms for bacterial toe web infections is used. Only few data on the incidence of GNBTWI were published. GNBTWI has been shown to have a significant male predominance. Pseudomonas aeruginosa is the most commonly identified organism beside a high mixed infection rate. We identified the following predisposing factors: interdigital tinea, occlusion and humidity, history of self-medication with antifungals, antibiotics, and glucocorticosteroids. As for treatment, debridement of macerated skin lesions and the hyperkeratotic rim showed good response in three published cases. Bacteriological workup of swabs including an antibiogram is recommended for identification of the proper topical and systemic therapy. Autosensitization dermatitis and frequent recurrences are common complications of GNBTWI.

Despite the fact, that GNBTWI is an accepted disease entity, scarce data on GNBTWI exist in the medical literature. Randomized controlled trials are missing though needed for evidence-based therapy. To facilitate communication and exchange of updates of GNBTWI, we promote the suggested terminology for bacterial toe web diseases.

This article is protected by copyright. All rights reserved.

Reply to “Topical ionic contra-viral therapy comprised of digoxin and furosemide as a potential novel treatment approach for common warts”

Absract

I read with great interest a preliminary study on new treatment for common warts conducted by Kolk et al.¹ The authors studied, for the first time, the clinical response of common warts to topical application of a fixed dose of 980 mg topical gel containing 0.125% (w/w) digoxin and 0.125% (w/w) furosemide for 7 consecutive days on the patients' lower back. Basically, topical therapy for a common dermatosis is generally welcomed particularly if showed a higher degree of safety profile and less potential off-target adverse effects. Though promising, few queries should be addressed by the authors.

This article is protected by copyright. All rights reserved.

Use of oral antidepressants in patients with chronic pruritus: A systematic review

Chronic pruritus is a common skin symptom with marked impact on quality of life. Adequate treatment can be challenging for clinicians, demanding the exploration of new treatment options such as oral antidepressants.

Progressive reticulate skin pigmentation and anonychia in a patient with bone marrow failure

An 18-year-old man presented to the National Institutes of Health (NIH) Clinical Center in Bethesda, Maryland, with dyspigmentation and nail dystrophy. His birth history was notable for intrauterine growth restriction (IUGR) and microcephaly. He was hospitalized at 6 weeks of age for respiratory distress and was found to have severe anemia, dilated cardiomyopathy, and cerebellar atrophy (Fig 1). At age 1 year he developed oral leukoplakia and esophageal strictures requiring multiple dilations. By age 3 he developed thrombocytopenia that progressed to multilineage bone marrow failure (BMF).

Obesity and risk for incident rosacea in US women

The relationship between obesity and rosacea is poorly understood.

Multiple verrucous lesions of the feet in Waldenström macroglobulinaemia

Traumatic subungual neuroma

Preservation of Stem Cells in Androgenetic Alopecia

Abstract

Androgenetic alopecia is characterized by progressive, patterned hair loss from the scalp that occurs in both men and women. Suggested that genetically predisposed hair follicles are target for androgen-stimulated follicle miniaturization, with gradual replacement of terminal hairs by vellus hairs. We aimed at evaluating the expression of stem and progenitor cell markers using IHC in scalp biopsies from affected and unaffected areas of patients with AGA.

This article is protected by copyright. All rights reserved.

Immediate antiretroviral therapy decreases mortality among patients with high CD4 counts in China: a nationwide, retrospective cohort study

Abstract

Background

Clinical trials have demonstrated that immediate initiation of antiretroviral therapy (ART) reduces AIDS-related morbidity and mortality. We tested the hypothesis that initiating ART ≤30 days after HIV diagnosis would be associated with reduced mortality among people living with HIV (PLWH) with CD4 counts >500 cells/mm³.

Methods

PLWH enrolled in the Chinese National Free ART Program between January 2012 and June 2014 were evaluated. The cohort was restricted to PLWH with CD4 counts >500 cells/mm³. Participants were followed for 12 months. Cox proportional hazards model was used to determine hazard ratios (HRs) for PLWH who initiated ART after HIV diagnosis. ART initiation was treated as a time-dependent variable.

Results

We enrolled 34,581 PLWH with CD4>500 cells/mm³. 1,838 (5.3%) initiated ART ≤30 days after HIV diagnosis (Immediate ART Group), and 19 deaths were observed with a mortality rate of 1.04 per 100 PY. A total of 58 deaths were documented among the 5,640 PLWH in the Delayed ART Group with a mortality rate of 2.25 per 100 PY. There were 713 deaths among the 27,103 PLWH in the No ART Group with a mortality rate of 2.39 per 100 PY. After controlling for potential confounding factors, ART initiation at ≤30 days (adjusted HR=0.37, CI=0.23–0.58) was a statistically significant protective factor.

Conclusions

We found that immediate ART is associated with a 63% reduction in overall mortality among PLWH with CD4 cell counts >500 cells/mm³ in China. These results support the recommendation to initiate ART immediately following HIV diagnosis.