Familial case of darier disease with guttate leukoderma: A case series from India

Naveen Kumar Kansal, Neirita Hazarika, Shalinee Rao

Indian Dermatology Online Journal 2018 9(1):62-63

Nail biopsy: A user's manual

Chander Grover, Shikha Bansal

Indian Dermatology Online Journal 2018 9(1):3-15

Nail biopsy is a procedure not routinely resorted to; but when indicated, it is often the only clue left for diagnosis. At such times, it pays to be conversant with it. It is an investigation that not only provides etiologic, diagnostic, and prognostic information but also aids in understanding the pathogenesis of nail diseases. It can be of therapeutic value, especially with respect to nail tumors. This article compiles the procedural techniques for nail biopsy of various types and attempts to summarize the evidence available in the literature. The objective of nail biopsy is to clinch a precise diagnosis of nail pathology with a simple and safe surgical procedure, avoiding pain or permanent nail damage. Patient selection is of utmost importance, wherein, the patient does not have typical skin lesions, yields inadequate information on routine nail investigations, and has no peripheral vascular compromise. The patient needs to be explained about the risks associated, the expected functional handicap, the time required for regrowth, a possibility of permanent nail dystrophy, and a possibility of not achieving a diagnosis even after the biopsy. Techniques and types of various nail biopsies are being discussed in this article. The specimen could be collected as an excision biopsy, punch biopsy, shave biopsy, or longitudinal biopsy. The trick lies in choosing the appropriate area for biopsy. Various biopsy types discussed in this article include nail plate biopsy (easiest and least scarring); nail bed biopsy (elliptical excision or punch); nail matrix biopsy (elliptical excision, punch excision (≤3 mm) or tangential/shave excision); and nail fold biopsy. Complications reported along with means to minimize them are also discussed.

Dermoscopy of post kala-azar dermal leishmaniasis

Abhijeet K Jha, Sidharth Sonthalia, Aimilios Lallas

Indian Dermatology Online Journal 2018 9(1):78-79

Dermoscopic features of distal lateral subungual onychomycosis

Thansiha Nargis, Malcolm Pinto, Manjunath Mala Shenoy, Spandana Hegde

Indian Dermatology Online Journal 2018 9(1):16-19

Background: Onychomycosis is a very common disease and accounts for upto 50% of the diseases affecting the nail apparatus. Diagnosis of onychomycosis is usually confirmed with the help of a potassium hydroxide (KOH) mount and fungal culture. Onychoscopy can be a handy and additional tool for the diagnosis. Aims and Objectives: To determine the dermoscopic findings in distal lateral subungual onychomycosis (DLSO). Materials and Methods: A prospective study of 60 nails with a clinical and mycological diagnosis (KOH with Chicago sky blue positive) of DLSO. Dermoscopic examination was performed using a Heine delta 20 plus dermatoscope and the features were recorded. Results: Longitudinal striae and jagged proximal edges seen in all 60 (100%) patients. Intermittent spiked pattern was seen in 47 nails (78.3%). Chromonychia and distal irregular termination were noticed in 23 (38.3%) and 7 (11.7%) nails, respectively. Conclusions: Onychoscopy can be used as an important diagnostic tool while evaluating nail disease, especially in DLSO. Limitations: Small study sample and lack of comparison with other nail diseases that manifests with distal onycholysis.

Plica polonica following use of homeopathic antidandruff shampoo containing canthalin

Faizan Y Shah, Sameena Batool, Aabid Keen, Iffat H Shah

Indian Dermatology Online Journal 2018 9(1):71-72

Mucocutaneous manifestations in patients with chronic kidney disease: A cross-sectional study

Rattan S Rashpa, Vikram K Mahajan, Pankaj Kumar, Karaninder S Mehta, Pushpinder S Chauhan, Ritu Rawat, Vikas Sharma

Indian Dermatology Online Journal 2018 9(1):20-26

Background: Chronic kidney disease (CKD)-associated mucocutaneous manifestations significantly impair the quality of life but often remain understudied. They may also vary across regions, socioeconomic and nutritional status, and racial differences. Objectives: To study the patterns of mucocutaneous disorders and their prevalence in CKD patients irrespective of clinical stage or dialysis status. Materials and Methods: 122 (M:F = 77:45) patients aged 21‒85 (Mean ± SD = 57.5 ± 14.0) years having CKD for 3 month to 5 years were studied for mucocutaneous manifestations. Fifty (41%) patients were on hemodialysis for 1‒42 months. Detailed medical history, clinical and mucocutaneous examination, and lab investigations were performed. KOH mounts, skin biopsy, Gram's and Giemsa staining, bacterial or fungal cultures were performed as required. Results: Xerosis in 93 (76.2%), skin pallor in 61 (50%), pruritus in 57 (46.7%), pigmentation in 47 (38.5%), and purpura in 18 (14.8%) patients were the major dermatoses. Bullous lesions and perforating folliculitis occurred in 3 (2.5%) patients each. Major nail abnormalities were pallor (in 35.2%), absent lunula (in 23.8%), nail discoloration (in 18%), and "half-and-half nails" in 16.4% patients, respectively. Hair abnormalities included sparse scalp and body hairs (in 35.2% and 13.1%, respectively) and lusterless hair in 12.3% patients. Coated tongue (in 14.8%), xerostomia (in 12.3%), and macroglossia with teeth indention (in 7.4%) patients were the mucosal manifestations. Conclusions: Xerosis, pruritus, skin pallor/pigmentary changes, nail pallor, absent lunula, nail discoloration, sparse hairs, coated tongue, xerostomia, macroglossia, and infections were the most common mucocutaneous manifestations in the studied patients irrespective of hemodialysis status. Cold and dry climates might be additional aggravators for xerosis/pruritus. Lifelong follow-up may be needed to reduce the morbidity associated with CKD/hemodialysis specific dermatoses appearing over a period.

Bilateral periorbital involvement localized to eyelids in lichen planus pigmentosus

Anup K Tiwary, Piyush Kumar

Indian Dermatology Online Journal 2018 9(1):58-59

Effect of an educational and psychological intervention on knowledge and quality of life among patients with psoriasis

Padmavathi Nagarajan, Devinder Mohan Thappa

Indian Dermatology Online Journal 2018 9(1):27-32

Background: Psoriasis is one of the most common skin disorders with a prevalence rate of 0.1%–3%. Chronic nature, frequent relapses, absence of permanent cure, and the cosmetic disfigurement of psoriasis have a negative impact on quality of life (QoL) by causing psychological stress. Patients with psoriasis often have unambiguous ideas about the causes, controllability, consequences, and expected time-course of their disease. Aim: The aim of this study is to assess the effectiveness of a video-assisted teaching program regarding psoriasis on the level of knowledge and relaxation therapy on QoL among patients with psoriasis. Materials and Methods: Experimental design was adapted. One hundred and four participants diagnosed with psoriasis were randomly allocated either to an experimental or to a control group. Fifty-two participants were included in each group by simple random sampling. A video-assisted teaching program on psoriasis and relaxation exercises was taught to the participants over a period of 3 months. The tools used were: Psoriasis Knowledge Assessment Questionnaire, modified psoriasis disability index, and modified psoriasis life stress inventory. Results: In the experimental group, the knowledge score was increased significantly from 9 ± 2.2 at baseline to 23.6 ± 1.5 after the intervention. The disability score was decreased from 15.6 to 9.9 and the stress score related to the illness was decreased from 22.8 to 16.9 after the intervention. Conclusion: Educational intervention about disease process and relaxation exercises was effective in improving the knowledge and QoL of patients with psoriasis.

Hypotrichosis in a child with olmsted syndrome

David Polly, Hima Gopinath, Kaliaperumal Karthikeyan

Indian Dermatology Online Journal 2018 9(1):65-68

A 19-Year retrospective study of adverse drug reactions to multidrug therapy in leprosy requiring a change in regime

Sukumaran Pradeep Nair

Indian Dermatology Online Journal 2018 9(1):33-36

Background and Aims: Multidrug therapy (MDT) in leprosy has brought the prevalence of leprosy to elimination levels. However, these drugs are not without toxicity. The primary aim of this study was to find the prevalence of adverse drug reactions (ADR) to MDT and the secondary aim to study the clinical features of these drug reactions. Materials and Methods: This is a19-year retrospective descriptive study of all new leprosy cases with ADR to MDT, requiring a change in regime. Results: There were 901 new leprosy cases in the study period. There were 28 cases of documented ADR to MDT necessitating a change in regime, thus accounting for a prevalence of 3.11%. There were 24 males (85.71%) and 4 females (14.29%) with a male/female ratio 6:1. Mean age was 39.58 years. Borderline tuberculoid was the commonest type of leprosy in which ADR were seen (46.43%). Dapsone was the commonest drug to cause ADR seen in 17 cases (60.71%). Hepatic involvement in the form of drug-induced hepatitis was the commonest presentation of ADR in this study accounting for 13 cases (46.43%), followed by skin rash, 9 cases (32.14%). There were no ADR reported to clofazimine. No ADR was reported to the alternative regimes given. Conclusions: The prevalence of ADRs was low in this study, with dapsone being the commonest drug. There were no adverse reactions to clofazimine. No adverse reactions were reported with the alternative regimes of ofloxacin and minocycline.

Solitary plaque on the chin

Deepti Kataria, Swagata Tambe, Chitra S Nayak

Indian Dermatology Online Journal 2018 9(1):75-76

Tuberous sclerosis complex and diffuse lipomatosis: Case report of a rare association

Ankit Mittal, Keshavamurthy Vinay, Dipankar De, Sanjeev Handa, Anindita Sinha

Indian Dermatology Online Journal 2018 9(1):37-39

Lipomatosis is characterized by diffuse infiltration of adipocytes in a tissue. A young male patient presented for evaluation of unilateral limb swelling. On evaluation, he was found to have tuberous sclerosis complex with diffuse lipomatosis of the right leg. To the best of the authors' literature search, only two previous reports of association of tuberous sclerosis complex with diffuse lipomatosis were found. The molecular mechanisms behind the co-occurrence of these two entities have not been studied in detail. Abnormalities in lipolysis and lipogenesis pathway may underlie the co-occurrence of tuberous sclerosis complex and diffuse lipomatosis.

Indian Dermatology Online Journal (IDOJ) going the print way!

Sunil Dogra

Indian Dermatology Online Journal 2018 9(1):1-2

Branch duct-type intraductal papillary mucinous neoplasm presenting as paraneoplastic small plaque para-psoriasis

Cyriac A Philips, Philip Augustine, Lijesh Kumar, George Joseph, Pushpa Mahadevan

Indian Dermatology Online Journal 2018 9(1):40-43

To present and discuss a novel association between branch duct-type intraductal papillary mucinous neoplasm and paraneoplastic parapsoriasis. We present the case of a middle-aged male presenting with skin lesions that were suggestive of parapsoriasis, resistant to treatment, and in whom a diagnosis of branch-type intraductal papillary mucinous neoplasm of the pancreas was eventually made. A curative Whipple's surgery led to complete resolution of the skin lesions within 3 weeks. Paraneoplastic parapsoriasis in association with intraductal papillary mucinous pancreatic neoplasm has never been reported before.

Relationship between disease activity and Helicobacter pylori infection in patients with vitiligo

Ola Ahmed Bakry, Mohamed Basha, Sally El Hefnawy, Shaimaa Mekkawy

Indian Dermatology Online Journal 2018 9(1):59-61

Acquired cutis laxa associated with light and heavy chain deposition disease

Reena A Majithia, Leni George, Meera Thomas, NA Fouzia

Indian Dermatology Online Journal 2018 9(1):44-46

Acquired cutis laxa (ACL) is a rare connective tissue disorder characterized by pendulous and coarsely wrinkled skin. There have been few cases of its association to monoclonal immunoglobulin deposition disease (MIDD), which constitutes the light chain (LCDD), heavy chain (HCDD), and light and heavy chain (LHCDD) deposition disease. MIDD predominantly involves the kidney. Skin is the next common organ to be affected by HCDD, which presents as ACL. We report the case of a 40-year-old male who presented with ACL associated with LHCDD. The clinical features of ACL in the present case appeared prior to the development of clinical features related to LHCDD.

Idiopathic eruptive macular pigmentation in an Indian male

Rajiv Joshi

Indian Dermatology Online Journal 2018 9(1):64-65

Livedo racemosa, reticulated ulcerations, panniculitis and violaceous plaques in a 46-year-old woman

Alfredo Agullo, Brian Hinds, Mónica Larrea, Ignacio Yanguas

Indian Dermatology Online Journal 2018 9(1):47-49

Clinically amyopathic dermatomyositis (CADM) is a subset of dermatomyositis (DM) that has conventional cutaneous manifestations of DM, but paradoxically, little or no muscle involvement. In 2005, a novel antibody was described in association with CADM – anti-melanoma differentiation-associated gene 5 (anti-MDA5). Patients with this serologic marker have a characteristic mucocutaneous phenotype consisting of skin ulceration among other signs. We describe the case of a 46-year-old woman with CADM, elevated anti-MDA5 autoantibodies, and unusual clinical features (livedo racemosa, florid acral edema) among the classical phenotype of MDA5 DM (arthralgias, ulcerations, panniculitis) and classical DM lesions (Gottron papules, heliotrope rash). The patients did not develop interstitial lung disease or internal malignancies and experienced a rapid response to prednisolone and intravenous immunoglobulins. After 2 years, she has no relapse of her cutaneous disease and continues 5 mg prednisolone and 2 g/kg kilogram of intravenous immunoglobulin every 3 months for maintenance. Our case highlights the clinical heterogeneity of CADM and underscores the importance of a comprehensive approach to DM patients. It was previously postulated that anti-MDA5 antibody could target vascular cells and compromise vascular function, the presence of livedo racemosa lesions, and MDA5 antibodies in a patient with negative thrombophilia workup, reinforce this idea. This is the first case, to our knowledge, of CADM with acral panniculitis and livedo racemosa.

Granulomatous periorificial dermatitis effectively managed with oral isotretinoin

Swagata Tambe, Hemangi Jerajani, Poonam Pund

Indian Dermatology Online Journal 2018 9(1):68-70

Trauma-induced focal nodular mucinoses: A rare entity

Gunjan Verma, Pooja A Mrig, RK Gautam, Purnima Malhotra

Indian Dermatology Online Journal 2018 9(1):50-52

Cutaneous mucinoses refer to disorders with abnormal accumulation of mucin in the skin. Mucin is an amorphous material that is a part of the extracellular matrix in dermis. Cutaneous mucinoses could be primary or secondary. The latter is associated with systemic disorders such as autoimmune diseases, diabetes mellitus, paraproteinemia, or altered thyroid function. Here, we report an adult female patient with trauma-induced cutaneous focal nodular mucinoses on left-sided scapular region. Histology showed replacement of collagen bundles by mucinous deposits in superficial and mid-dermis. Mucinous substance was present in peri-eccrine location on Alcian blue staining.

Payback: The Custom of Assault and Rape of Sistergirls and Brotherboys; Australia's Trans and Sex/Gender Diverse First Peoples

Violence and Gender , Vol. 0, No. 0.

A Group Lifestyle Intervention Program Is Associated with Reduced Emergency Department Presentations for People with Metabolic Syndrome: A Retrospective Case–Control Study

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

Relationship of Circulating miRNAs with Insulin Sensitivity and Associated Metabolic Risk Factors in Humans

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

Cover Image

The cover image, by P. Aïdan et al., is based on the Technical Note Bilateral vagal automatic periodic stimulation in single-incision transaxillary robotic total thyroidectomy, DOI 10.1111/coa.12698.

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Issue Information

Bridge flap repair for central nasal dorsum defect

Abstract

Surgery of the nose to remove skin cancer often requires the use of local flaps. We present a defect after the extirpation of a previously incompletely excised infiltrative squamous cell carcinoma, which we repaired with a Bridge flap, a bipedicled and subcutaneous islanded flap whose excellent vascularity allows reliable reconstruction and rapid mobilisation, with dependable results.

Hidradenitis suppurativa, a review of pathogenesis, associations and management. Part 2

Abstract

Hidradenitis suppurativa is a chronic, painful, autoinflammatory condition resulting in nodules, abscesses and sinus tracts. We present an evidence-based review providing new understanding of the pathogenesis of hidradenitis suppurativa and associated comorbidities. By the nature of their speciality, dermatologists are uniquely positioned to investigate and treat patients.

Multi-sensor temporal assessment of tropospheric nitrogen dioxide column densities over Pakistan

Abstract

Spatial and temporal distributions of tropospheric NO₂ vertical column densities over Pakistan during the period 2002–2014 are discussed. Data products from three satellite instruments SCIAMACHY, OMI, and GOME-2 are used to prepare a database of tropospheric NO₂ column densities over Pakistan and temporal evolution is also determined. Plausible NO₂ sources in Pakistan are also discussed. The results show a large NO₂ growth over all provinces and the major cities of Pakistan except the megacity of Karachi. Decline in industrial activities due to energy crises, worsening law and order situation, terrorist attacks, and political instability was explored as the main factor for lower NO₂ VCDs over Karachi City. The overall increase can be attributed to the anthropogenic emissions over the areas with high population, traffic density, and industrial activities. Source identification revealed that use of fossil fuels by various sectors including power generation, vehicles, and residential sectors along with agriculture fires are among significant sources of NO₂ emissions in Pakistan. Existing emission inventories such as EDGARv4.2 and MACCity largely underestimate the true anthropogenic NO_x emissions in Pakistan. This study may provide vital information to policy makers and regulatory authorities in developing countries, including Pakistan, in order to devise effective air pollution abatement policies.

Incorporation of corn straw biochar inhibited the re-acidification of four acidic soils derived from different parent materials

Abstract

The effect of corn straw biochar on inhibiting the re-acidification of acid soils derived from different parent materials due to increased soil pH buffering capacity (pHBC) was investigated using indoor incubation and simulated acidification experiments. The incorporation of the biochar increased the pHBC of all four soils due to the increase in soil cation exchange capacity (CEC). When 5% biochar was incorporated, the pHBC was increased by 62, 27, 32, and 24% for the Ultisols derived from Tertiary red sandstone, Quaternary red earth, granite, and the Oxisol derived from basalt, respectively. Ca(OH)₂ and the biochar were added to adjust the soil pH to the same values, and then HNO₃ was added to acidify these amended soils. The results of this simulated acidification indicated that the decrease in soil pH induced by HNO₃ was lower for the treatments with the biochar added than that of the treatments with Ca(OH)₂ added. Consequently, the biochar could inhibit the re-acidification of the amended acid soils due to the increased resistance of the soils to acidification when the pH of amended soil was higher than 5.5. The inhibiting effectiveness of the biochar on soil re-acidification was greater in the Ultisol derived from Tertiary red sandstone due to its lower clay and organic matter contents and CEC than the other three soils. The incorporation of the biochar also decreased the potentially reactive Al, i.e., exchangeable Al, organically bound Al, and sorbed hydroxyl Al, compared with the treatments amended with Ca(OH)₂. Therefore, the incorporation of corn straw biochar not only inhibited the re-acidification of amended acid soils through increasing their resistance to acidification but also decreased the potential of Al toxicity generated during re-acidification.

The pH-dependent toxicity of triclosan to five aquatic organisms ( Daphnia magna , Photobacterium phosphoreum , Danio rerio , Limnodrilus hoffmeisteri , and Carassius auratus )

Abstract

Triclosan (TCS) is an antibacterial and antifungal agent widely used in personal care products, and it has been frequently detected in the aquatic environment. In the present study, the acute toxicity of TCS to Daphnia magna, Photobacterium phosphoreum, Danio rerio, and Limnodrilus hoffmeisteri was assessed under different pH conditions. Generally, TCS was more toxic to the four aquatic organisms in acidic medium. The LC₅₀ values for D. magna and D. rerio were smaller among the selected species, suggesting that D. magna and D. rerio were more sensitive to TCS. In addition, the oxidative stress-inducing potential of TCS was evaluated in Carassius auratus at three pH values. Changes of superoxide dismutase (SOD) and catalase (CAT) activity, glutathione (GSH) level, and malondialdehyde (MDA) content were commonly observed in all TCS exposure groups, indicating the occurrence of oxidative stress in the liver of C. auratus. The integrated biomarker response (IBR) index revealed that a high concentration of TCS induced great oxidative stress in goldfish under acidic condition. This work supplements the presently available data on the toxicity data of TCS, which would provide some useful information for the environmental risk assessment of this compound.

Identification of the driving factors’ influences on regional energy-related carbon emissions in China based on geographical detector method

Abstract

To investigate the influences of different factors on spatial heterogeneity of regional carbon emissions, we firstly studied the spatial-temporal dynamics of regional energy-related carbon emissions using global Moran's I and Getis-Ord Gi and applied geographical detector model to explain the spatial heterogeneity of regional carbon emissions. Some conclusions were drawn. Regional carbon emissions showed significant global and local spatial autocorrelation. The carbon emissions were greater in eastern and northern regions than in western and southern regions. Fixed assets investment and economic output had been the main contributing factors over the study period, and economic output had been decreasing its influence. Industrial structure's influence showed a decrease trend and became smaller in 2015. The results of the interaction detections in 2015 can be divided into two types: enhance and nonlinear, and enhance and bivariate. The interactive influences between technological level and fixed assets investment, economic output and technological level, population size and technological level, and economic output and economic development were greater than others. Some policy recommendations were proposed.

Effect of intermittent operation model on the function of soil infiltration system

Abstract

To enhance denitrification in a process of solute infiltration through a soil, a two-section mixed-medium soil infiltration system (TMSIS) for urban non-point pollution was developed. The artificial aerobic respiration and nitrification took place in the upper aerobic section (AES), while grass powders and sawdust were mixed in the bottom anaerobic section (ANS) to supply organic carbon source for denitrification bacteria, and the reduction was increased by iron addition in the ANS. Measured resident concentrations from the bottom of each ANS column were assumed to represent mean values averaged over the column cross-sectional area. The TMSIS with hydraulic loading rates (HLR) of 0.32, 0.24, and 0.16 m³ m⁻² day⁻¹ and with wetting–drying ratio (R_WD) of 1.0 showed remarkable removal efficiencies for chemical oxygen demand (COD), NH₄⁺-N, and TP, respectively. The hydraulic loading rate of 0.32 m³ m⁻² day⁻¹ was selected as the optimal HLR due to the high contaminated runoff treatment efficiency. When R_WD was 1.0, 0.5, or 0.2 with hydraulic loading rate of 0.32 m³ m⁻² day⁻¹, the TMSIS could treat synthetic urban runoff contaminants very well. The corresponding effluent water met the China's national quality standard for class V surface water. The wetting–drying ratio of 0.5 with hydraulic loading of 0.32 m³ m⁻² day⁻¹ was selected as the optimal operation conditions for the TMSIS. Aerobic respiration and nitrification mainly took place in the upper AES, in which most of the COD and the NH₄⁺-N were removed. Mixed sawdust and grass powders used as a carbon source and heterotrophic denitrification were put at the bottom of the ANS. The developed TMSIS has the potential to be applied for urban non-point pollution removal.

Is Salvage of Recently Infected Breast Implant After Breast Augmentation or Reconstruction Possible? An Experimental Study

Abstract

Introduction

The reinsertion of an infected implant when peri-prosthetic infection occurs early after breast augmentation or breast reconstruction remains controversial. In this experimental study, the authors tried to remove bacteria, and their biofilm, from the colonized surface of breast prostheses, without damaging their integrity.

Materials and Methods

A total of 112 shell samples of silicone breast prostheses, smooth (SPSS) and textured (TPSS), were colonized by S. epidermidis (SE) or S. aureus (SA) strains, all able to produce biofilms. After 15 days, all the samples were removed from the contaminated culture broth and constituted 4 groups of 20 contaminated samples: SPSS/SE (group I), SPSS/SA (group II), TPSS/SE (group III), TPSS/SE (group IV). In another group—group SEM−, 16 colonized samples were used for documentation with scanning electron microscopy (SEM). The remaining 16 samples were used to test the limits of detection of the sterility test. All samples of groups I–IV and 8 samples of group SEM were « washed » with a smooth brush in a povidone-iodine bath and rinsed with saline solution. A subset of the washed samples was sent for SEM and the others were immersed in sterile broth and were incubated at 35 °C for 3 weeks (groups I–IV).

Results

Fifteen days after contamination, all the samples in groups I–IV were colonized. In the SEM group, SEM images attested to the presence of bacteria in biofilm attached to the shells. After cleaning, SEM did not reveal any bacteria and there was no visible alteration in the outer structure of the shell. Sterility tests performed after decontamination in groups I–IV remained negative for all the samples.

Conclusion

Breast prostheses recently contaminated with Staphylococci, frequently involved in peri-prosthetic breast implant infection and capable of producing biofilms, can be efficiently decontaminated by the procedure used in this study. Our decontamination procedure did not alter the surface structure of the prostheses. This decontamination procedure could allow reinsertion of an infected implant when peri-prosthetic infection occurs early after breast augmentation or breast reconstruction and when a salvage procedure is indicated.

No Level Assigned

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

2017 Reviewer Thank You

Laser-Assisted Liposuction (LAL) Versus Traditional Liposuction: Systematic Review

Abstract

Introduction

Liposuction is the most performed surgical procedure in Brazil and the second in the world. In recent years, new technologies have been developed in an attempt to improve liposuction, such as laser. The objective of this study is to evaluate the efficacy and safety of laser-assisted liposuction (LAL) compared to traditional liposuction through a systematic review of the literature.

Method

The search strategy used was the combination of the descriptors [lasers (MeSH Terms)] and (lipectomy [MeSH Terms]) in the PubMed database. Two independent researchers carried out the reading of the abstracts and selection of the studies according to the eligibility criteria. The risks of study bias were evaluated using an instrument similar to that used by the Cochrane Collaboration.

Results

Initially, 80 studies were obtained and, after evaluating the eligibility criteria, seven remained. Five of them observed that LAL has benefits when compared to traditional liposuction, and the main outcomes were compared with regard to histological analysis (2 products), further reduction of subcutaneous fat (2), better retraction of the skin (3), and higher personal satisfaction of the patient (2). The qualitative assessment identified high risks of bias in various areas in the studies.

Conclusion

Although studies have concluded that LAL promotes greater fat reduction, better skin retraction, and greater patient satisfaction compared to traditional liposuction, the high bias impedes a more reliable conclusion.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

A comparison of selenium concentrations in selected organs of wild boar ( Sus scrofa ) from industrialized and non-industrialized regions of Poland

Abstract

The aim of this study was to compare selenium concentration in the liver and kidneys of wild boar inhabiting industrialized and non-industrialized regions of Poland. Selenium concentrations in organs were determined using spectrofluorometric method. In all the animals studied, Se concentrations were a few times lower than in kidneys which may indicate too low content of this element either in the boar's diet or the presence of a poorly absorbable form of Se. No statistically significant differences were noted in the mean Se concentrations in the liver and kidney of wild boar from industrialized and non-industrialized areas. In the case of wild boar, it seems that the level of selenium in their organs is more dependent on geochemical conditions in the specific feeding ground than on the scale of regional industrialization, and that this situation is most likely related to the specificity of wild boar feeding.

Biosimilars: what the dermatologist should know

Abstract

Biosimilars are highly similar versions of approved branded biologics. In contrast to generics, which are identical copies of the originator medicines, biosimilars are considered unique but related molecules that differ from the originator reference product as well as from each other. Owing to the complexity of biologic medicines, such as therapeutic monoclonal antibodies, minor differences between biosimilars and the reference products are acceptable provided these differences do not result in any clinically meaningful differences in safety or efficacy. In addition, minor changes in structure and function may occur over time in originator biologic products as a result of alterations in production materials (e.g., cell lines), processes, or conditions. The developmental process for biosimilars focuses on a 'totality of evidence' approach that emphasizes a stepwise investigational process, including comprehensive structural, functional, pharmacologic, and clinical assessment for similarity. The goal of the phase 3 clinical development program for a biosimilar is not to establish efficacy, per se, but to demonstrate that there are no clinically meaningful differences between the proposed biosimilar and the reference product. The requirement to show clinical similarity informs biosimilar study design, including the selection of the patient population, disease state (indication), study endpoints, and statistical methods. Based on the clinical trials results in a representative patient population, results may be extrapolated to other indications provided scientific justification is demonstrated based on, among other things, similar mechanism of action in the extrapolated indications. This review presents the current state of knowledge with respect to biosimilars. We aim to provide the practicing clinician with a working knowledge of biosimilars as well as provide some practical guidance on their use and potential benefits in treating dermatologic diseases.

This article is protected by copyright. All rights reserved.

Concentration of filaggrin monomers, its metabolites and corneocyte surface texture in individuals with a history of atopic dermatitis and controls

Abstract

Background

Atopic dermatitis (AD) is characterized by skin barrier dysfunction. Notably, a high number of nano-scale protrusions on the surface of corneocytes, which can be expressed by the Dermal Texture Index (DTI), was recently associated with pediatric AD, loss-of-function mutations in filaggrin gene (FLG), and reduced levels of natural moisturizing factors (NMF). No study has so far examined the association between these parameters and monomeric filaggrin levels in adults.

Objective

To determine DTI, monomeric filaggrin and NMF in healthy controls and a group of patients with controlled dermatitis.

Methods

A total of 67 adults (20 healthy controls and 47 dermatitis patients) were included. In the patient population, a personal history of AD was diagnosed by the U.K. Working Party's Diagnostic Criteria. All participants were tested for FLG mutations (R501X, 2282del4, R2447X). Transepidermal water loss, monomeric filaggrin, DTI and NMF were measured.

Results

In the patient population, 78.7% (37/47) had a history of AD and 59.5% (28/47) had FLG mutations. Patients had significantly higher levels of DTI and significantly lower levels of monomeric filaggrin and NMF compared to the 20 healthy controls. Among patients, reduced level of monomeric filaggrin and NMF correlated with the presence of FLG mutations and clinical phenotypes such as xerosis, palmar hyperlinearity and AD. Among healthy controls, DTI was significantly higher in the oldest age group compared to the two younger age groups.

Conclusion

A significant difference in DTI, monomeric filaggrin and NMF levels was found when comparing dermatitis patients with healthy controls. These findings suggest that even mild dermatitis or non-visible inflammation has a significant and negative effect on the skin barrier as inflammation is known to reduce filaggrin levels. DTI was significantly increased in aged individuals in the healthy control group, suggesting a gradual change in corneocyte morphology with age.

This article is protected by copyright. All rights reserved.

Ensemble representation and the contents of visual experience

Abstract

The on-going debate over the 'admissible contents of perceptual experience' concerns the range of properties that human beings are directly acquainted with in perceptual experience. Regarding vision, it is relatively uncontroversial that the following properties can figure in the contents of visual experience: colour, shape, illumination, spatial relations, motion, and texture. The controversy begins when we ask whether any properties besides these figure in visual experience. We argue that 'ensemble properties' should be added to the list of visually admissible properties. Ensemble properties are features that belong to a set of perceptible objects as a whole as opposed to the individuals that constitute that set. They include such features as the mean size of an array of shapes or the average emotional expression of an array of faces. Recent work in vision science has yielded compelling evidence that the visual system routinely encodes such properties. We argue that epistemological considerations provide strong reasons to think that these properties figure in visual experience. Judgements about ensemble properties are immediately warranted by our perceptual experience, and the only plausible way that a perceptual experience could confer this warrant is if it confers awareness of ensemble properties.

Adherence of Clostridium perfringens spores to human intestinal epithelial Caco-2 cells

Abstract

Clostridium perfringens is a gram-positive, spore-forming bacillus, and is a causative agent of foodborne infection, antibiotic-associated diarrhoea and sporadic diarrhoea in humans. In cases of antibiotic-associated and sporadic diarrhoea, C. perfringens colonises the intestine, proliferates and causes disease. However, bacterial colonization of the intestine is not considered necessary in the pathogenesis of foodborne illness, because such pathogenesis can be explained by anchorage-independent production of diarrhoeic toxin by the bacterium in the intestine. In this study, we used an in vitro adherence assay to examine the adherence of C. perfringens spores to human intestinal Caco-2 cells. Adherence of spores from isolates of foodborne illness and nosocomial infection was observed within 15 min, and plateaued 60 min after inoculation. Electron microscopy revealed a tight association of spores with the surface of Caco-2 cells. The adherence of vegetative cells could not be confirmed by the same method, however. These results suggest that C. perfringens spores may adhere to intestinal epithelial cells in vivo, although its biological significance remains to be determined.

Methazolamide-induced toxic epidermal necrolysis in a man carrying HLA-B*59:01: successful treatment with infliximab and glucocorticoid

Cutaneous eruptions by new therapies against hepatitis C virus infection. Not as common as we presumed

A rare cause of blanching red legs: cutaneous collagenous vasculopathy

Onkologie und Versorgung in Fach- und Publikumsmedien

Issue Information

Biodynamic Excisional Skin Tension Lines for Excisional Surgery of the Lower Limb and the Technique of Using Parallel Relaxing Incisions to Further Reduce Wound Tension

Background: Closing of defects of the lower limb after skin cancer excision poses a challenge in lower limb skin. Although the concept of relaxed skin tension lines has been established as ideal on the face, on the lower limb there remains confusion between Langer's lines and wrinkle lines, and this study was done with the task of identifying and mapping biodynamic excisional skin tension (BEST) lines on the lower limb. Methods: Following studies on BEST lines elsewhere on the body, the author investigated BEST lines on the lower limb. Using a specially designed tensiometer, inherent skin tension (pretension) and wound-closing tension were studied along with the force needed to bring the wound edges together after excision of a lesion in 23 cases with defects ranging from 1.5 to 4.5 cm in diameter. Skin tension measurements of skin lines (relaxed skin tension lines (RSTL) versus BEST) and vertical closure (BEST) versus vertical closure with a parallel relaxing incision were undertaken and followed by statistical analyses utilizing the paired t test and the unpaired Student's t tests. Results: BEST lines run in the vertical direction on the lower limb, that is, closure in a vertical direction resulted in a statistically significant reduction in closing tension when compared with other directions. Using a parallel relaxing incision can offer further reduction in tension, if needed. Conclusion: BEST lines of the lower limb are discussed, and a new technique of using parallel relaxing incisions to achieve closure of larger defects is also presented as an alternative to cutaneous flaps or grafts in the lower limb.