Assessment of the general quality of sunscreen products available in Palestine and method verification of the sun protection factor using Food and Drug Administration guidelines

Summary

Background

Sunlight exposure affects all skin types causing skin tanning, burns or even skin cancer. Sunscreens were invented to prevent these outcomes by scattering or absorbing the UV light.

Aims

This study aimed to verify the effectiveness of Mansur method in SPF measurement and to find out how much reliable the labeled sun protection factor (SPF) value for the products that are imported to Palestine knowing that they are considered as cosmetics and they don't undergo tests by the Ministry Of Health (MOH).

Materials

In this research, sun protection factor (SPF) was determined for 16 commercially available sunscreen products using Mansur equation which was also validated; moreover sunscreen classification, product phase determination and pH measurement were also done.

Results

Sun protection factor values were mostly 50, 43.75% of the analyzed samples were close to the labeled SPF, 31.25% were under the labeled value, and 25% SPF value above the labeled value. All samples exhibited a pH close to skin pH. 62% of them were found to be O/W. Cosmetic companies and importers should focus on pediatric sunscreens, since only 12.5% are pediatric sunscreens.

Conclusions

Ministry Of Health should ask prove about the quality of an SPF value of sunscreens for final registration of these products. More instructions should be available on the label regarding the proper use especially, if they are not water proof.

Chronology of regional lymph node metastases in cutaneous melanoma: a model based on mitotic rate

Abstract

Recently, the MSLT-II¹ and DeCOG² clinical trials have failed to demonstrate a benefit for the lymphadenectomy vs. observation in the setting of a patient with positive sentinel lymph node biopsy. Therefore, it is expected in the short term an increase in the patients with a more conservative management and obviously, more regional recurrences.

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Sonochemical degradation of triclosan in water in a multifrequency reactor

Abstract

Degradation of triclosan (TCS) by multifrequency ultrasound (US) was studied at high and low frequencies. Frequency effect on initial degradation rates was analyzed, and an optimum frequency was found. Power density always has a positive effect on degradation rates over the whole equipment work range. A reaction mechanism similar to that proposed by Serpone resulted in a pseudo-linear model that fitted statistically better than the nonlinear model proposed by Okitsu. Pulsed US showed a positive effect on degradation rates; however, simultaneous analysis of the effect of power, frequency, pulse time, and silent time did not show a clear trend for degradation as a function of pulse US variables. According to these results and those for degradation in the presence of radical scavengers, it was concluded that US TCS degradation was taking place in the bubble/liquid interface. A toxicity test was conducted by Microtox®, showing a decrease in toxicity as TCS concentration decreased and increase in toxicity after total depletion of TCS. Eight possible degradation by-products were identified by GC-MS analysis, and a degradation pathway was proposed.

Topical Paromomycin for treating solitary mucosal leishmaniasis

Clinical features and management of schwannoma affecting the upper and lower lips

Abstract

Head and neck schwannomas comprise 25–40% of all schwannomas, with presentation on the lips as the rarest and most surgically complicated site for perioral tumors. A systematic literature review was conducted to include 21 cases of patients with schwannoma of the upper or lower lips. The majority of patients presented with a single, painless, well-encapsulated nodule on the upper or lower lips. The nodules were consistently slow-growing, with an average 29.3 months from symptom onset to clinical presentation. Most cases were complicated by profound cosmetic disfigurement as well as dysphagia, dysarthria, snoring, and/or sleep apnea. Overall, histological analysis was consistent with classic schwannoma, and all cases were treated via complete surgical excision, and for malignant tumors, additional therapy was utilized. All but four cases achieved full remission by final follow-up. Recurrence rate for benign lip schwannomas was 5.3%, which is remarkably different from the standard recurrence rate of 8–24% for benign peripheral schwannomas. Additionally, the proportion of malignant tumors was greater for lip schwannomas than other schwannomas. Lip schwannomas demonstrate different characteristics than schwannomas from other locations on the body, and these remarkable differences highlight significant implications for clinical practice. Complete excision is the primary mode of treatment with overall excellent postoperative prognosis and rare instances of recurrence. Given the rarity of this tumor, this review of available cases serves to comprehensively describe clinical presentation and surgical treatment approaches to upper and lower lip schwannomas.

Impact of climate change on dermatological conditions related to flooding: update from the International Society of Dermatology Climate Change Committee

Abstract

Climate change contributes to the increase in severity and frequency of flooding, which is the most frequent and deadly disaster worldwide. Flood-related damage can be very severe and include health effects. Among those health impacts, dermatological diseases are one of the most frequently encountered. Both infectious and noninfectious dermatological conditions are increasing after flooding. We searched PubMed using the search term climate change OR global warming OR rainfall OR flooding OR skin. Articles published in the English-language literature were included. We also searched the International Society of Dermatology website library on climate change for additional articles. There is an increased risk of trauma during the course of a natural disaster. The majority of post-tsunami wound infections were polymicrobial, but gram-negative bacteria were the leading causes. Infectious diseases with dermatological manifestations, such as impetigo, leptospirosis, measles, dengue fever, tinea corporis, malaria, and leishmaniasis, are important causes of morbidity among flood-afflicted individuals. Insect bites and stings, and parasite infestations such as scabies and cutaneous larva migrans are also frequently observed. Inflammatory conditions including irritant contact dermatitis are among the leading dermatological conditions. Dermatological conditions such as alopecia areata, vitiligo, psoriasis, and urticaria can be induced or exacerbated by psychological conditions post disaster. Prevention is essential in the management of skin diseases because of flooding. Avoiding exposure to contaminated environments, wearing protective devices, rapid provision of clean water and sanitation facilities, prompt vector controls, and education about disease risk and prevention are important.

Pathogenesis and treatment options for chemotherapy-induced alopecia: a systematic review

Abstract

Chemotherapy-induced alopecia (CIA) is one of the most troubling long-lasting side effects of cancer treatment. An estimated 65% of patients undergoing classic chemotherapy will experience hair loss, which is an extremely upsetting adverse event for many. CIA has been traditionally considered to be a diffuse, nonscarring alopecia; however, there are increasing reports of permanent hair loss post chemotherapy. Despite its large impact on patients, there are few proven treatments for CIA. Recent advancements in understanding the pathogenesis of hair loss are promising novel preventative and therapeutic strategies. Currently, scalp cooling during chemotherapy is the most effective preventive intervention with response rates ranging from 50 to 80%. To avoid patient morbidity, clinicians should be aware of the pathogenesis of CIA, characteristic patterns of hair loss associated with specific drug regimens, preventive measures that may be taken, and therapeutic options post chemotherapy. The following represents an updated systematic review of CIA, including characteristic clinical patterns, pathophysiology of the disease, therapeutic approaches, as well as a cost-effective analysis to assess the significance of this toxicity.

Incidence of diseases primarily affecting the skin by age group: population-based epidemiologic study in Olmsted County, Minnesota, and comparison with age-specific incidence rates worldwide

Abstract

Understanding the effects of age on the epidemiology of diseases primarily affecting the skin is important to the practice of dermatology, both for proper allocation of resources and for optimal patient-centered care. To fully appreciate the effect that age may have on the population-based calculations of incidence of diseases primarily affecting the skin in Olmsted County, Minnesota, and worldwide, we performed a review of all relevant Rochester Epidemiology Project–published data and compared them to similar reports in the worldwide English literature. Using the Rochester Epidemiology Project, population-based epidemiologic studies have been performed to estimate the incidence of specific skin diseases over the past 50 years. In older persons (>65 years), nonmelanoma skin cancer, lentigo maligna, herpes zoster, delusional infestation, venous stasis syndrome, venous ulcer, and burning mouth syndrome were more commonly diagnosed. In those younger than 65 years, atypical nevi, psoriatic arthritis, pityriasis rosea, herpes progenitalis, genital warts, alopecia areata, hidradenitis suppurativa, infantile hemangioma, Behçet's disease, and sarcoidosis (isolated cutaneous, with sarcoidosis-specific cutaneous lesions and with erythema nodosum) had a higher incidence. Many of the incidence rates by age group of diseases primarily affecting the skin derived from the Rochester Epidemiology Project were similar to those reported elsewhere.

Harlequin ichthyosis due to novel splice site mutation in the ABCA12 gene: postnatal to prenatal diagnosis

Abstract

Background

Harlequin ichthyosis (HI) is a severe genetic disorder caused by the mutation in the ABCA12 gene. Infants born with this condition have markedly thickened, hard stratum corneum skin all over the body.

Methods

A female child born with a thick white plate of skin with deep cracks all over the body was investigated for genes associated with congenital Ichthyosis by Next Generation sequencing. The variant relevant to the clinical indications was identified using Picard and GATK version 3.6. Variant's pathogenicity was predicted by "in silico" tools like Mutation Taster 2, Mutation Assessor and LRT. Bidirectional Sanger sequencing further validated the same variant detected in the proband and confirmed in the parental blood and CVS.

Results

A homozygous 5′ splice site variation that affects the position at 4 nucleotides downstream to the donor proximal splice site of intron 40 (c.5939+4A>G; ENST00000272895) of the ABCA12 gene was detected in the proband, and the parents were heterozygous for the same variant. This led to the confirmation of diagnosis of Harlequin ichthyosis in the proband. "In silico" prediction of the variant was found to be damaging by MutationTaster2. The CVS sample during subsequent pregnancy was confirmed to be heterozygous for the same variant.

Conclusions

The novel intronic mutation found in the proband confirmed the clinical diagnosis as a severe type of HI and has helped the family in providing precise genetic counseling for further prevention of the disease and carrier screening of other family members.

GAPO syndrome: a rare genodermatosis presenting with unique features

No difference in UVB-induced changes in antigen-presenting cells and in cytokines between subjects with and without loss-of-function mutations in FLG

Abstract

Ultraviolet B (UVB) irradiation-induced skin inflammation leads to epidermal depletion of Langerhans cells (LCs), which is followed by a rapid influx of monocytes.(1) Approximately 10% of Northern Europeans carry loss-of-function mutations in the filaggrin gene (FLG) which cause partial or complete lack of epidermal filaggrin and filaggrin metabolites.(2) Deficit of the filaggrin metabolite trans-urocanic acid has been shown to cause an increased keratinocyte photosensitivity to UVB irradiation in human skin models.(3)

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A case of facial burn due to the misuse of garlic face mask for acne

A systematic review of pyoderma gangrenosum with pulmonmary involvement: clinical presentation, diagnosis, and management

Abstract

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis that often has extracutaneous manifestations, with lung involvement being the most common (1, 2). In this systematic review we have summarized the clinical presentation, predisposing factors, and treatment of PG patients with pulmonary involvement and compared them to classic neutrophilic disorders. Using the search terms "pulmonary, lung, respiratory, bronchi, or bronchopulmonary" AND "pyoderma gangrenosum" a systematic review was conducted using PubMed and Web of Science.

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Basal cell carcinoma of the scrotum: an important but easily overlooked entity

Abstract

Basal cell carcinoma (BCC) is the most common skin cancer worldwide [1]. In Germany, 82/100.000 inhabitants are yearly diagnosed with BCC [2]. Since chronic exposure to UV-light is the major risk factor for the development of BCC, the tumor is rarely seen in non-sun-exposed anatomical sites such as the genital area [1]. So far, only a few case reports or small case series have been published about BCC in this location, the pathogenic mechanisms underlying the development of scrotal BCCs are unknown.

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Progeria: case report and new drugs perspectives

Abstract

Hutchinson-Gilford progeria syndrome (HGPS) is one of the rarest human diseases, an autosomal dominant premature aging disorder ¹. Its incidence is 1-4 per 8 million newborns ². There are aging-associated symptoms, including lack of subcutaneous fat, hair loss, joint contractures, progressive cardiovascular disease resembling atherosclerosis, and death due to heart attacks and strokes in childhood.

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A fifth subtype of Kaposi's sarcoma, classic Kaposi's sarcoma in men who have sex with men: a cohort study in Paris

Abstract

Background

Classic Kaposi's sarcoma (CKS) occurs predominantly among elderly men and is associated with KSHV (Kaposi's Sarcoma-Associated Herpesvirus). In low endemic countries, KSHV infects predominantly men having sex with men (MSM).

Objectives

To describe a cohort of classic Kaposi sarcoma in a low endemic area for KSHV, to highlight the features of CKS in MSM and identify prognostic factors.

Methods

Retrospective single-center study of CKS cases. We compared MSM to heterosexual patients. Then, we divided the patients into two subgroups, those requiring a systemic treatment and the others, and we performed univariate and multivariate analysis to determine aggressiveness of CKS.

Results

Between 2006 and 2015, seventy-four patients were included. Mean age at diagnosis was 68.9 years, sex ratio (M/F) was 6.4 and 28% were MSM; MSM patients were younger (p=0.02), less often originated from endemic areas (p<0.0001). KS was less severe (p=0.04), required more often a local treatment than a systemic one (p=0.03). On multivariate analysis, CD4 T cell count> 500/mm³ at baseline was associated with a reduced risk of severe evolution.

Conclusion

First CKS cohort in low endemic zone. We describe a fifth subtype of KS: KS in MSM. The CD4 T-cell count was found to correlate with prognosis.

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Hypertrichosis of the pinnae in a patient using panitumumab

Abstract

Various subgroups of epidermal growth factor receptor inhibitors (EGFRIs) are increasingly being used in the treatment of several cancers. However, as a generalized class effect, they are frequently associated with a wide spectrum of dermatological adverse reactions affecting skin, hair and nail of varying severity.A 53-year-old male with metastatic rectal cancer receiving every two weeks infusions of panitumumab, a human monoclonal antibody targeting EGFR, presented with a generalized acneiform papulopustular eruption (Grade 3 according to the Common Terminology Criteria for Adverse Events version 4.03).

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Reversed actinic damage in two children with xeroderma pigmentosum treated with topical imiquimod

Abstract

Xeroderma pigmentosum (XP) is a group of genetic diseases with high incidence of ultraviolet-related skin cancers that usually appear in childhood. Treatment options for skin cancer in XP include surgery, electrocoagulation, topical 5-fluorouracil or imiquimod 5% cream¹. Oral retinoids have been used for skin cancer prevention, alone or in combination with topical imiquimod, with good response².

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Diagnostic approach to subcutaneous nodules in patients with neuroendocrine tumors treated with depot somatostatin analogs: a cross-sectional study

Abstract

Background

The presence of cutaneous nodules in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) receiving depot somatostatin analogs (SSAs) is a diagnostic challenge as differential diagnosis between injection site reactions and metastases is essential.

Objective

To characterize the clinical, radiological, cytological and histopathological features of subcutaneous nodules in patients with GEP-NETs treated with SSAs.

Materials and Methods

Retrospective, cross-sectional study of patients with GEP-NETs treated with SSAs in whom subcutaneous nodules were detected on routine abdominal CT scans. High resolution and color Doppler ultrasonography was performed. Those patients with inconclusive radiological studies went through fine-needle aspiration cytology (FNAC) and/or biopsy.

Results

Twelve patients (5 males, 7 females) were included (6 midgut carcinoid NETs, 6 pancreatic NETs). Three patients received intramuscular depot octreotide, 7 subcutaneous lanreotide, and 2 both treatments. CT scan findings were nonspecific. Sonography revealed a hyperechoic pattern in recent injections, and a hypoechoic pattern with a characteristic hyperechoic peripheral rim in long-term injections (more than 3 months after injection). On color Doppler sonography, nodules showed no signs of intralesional vascularity. Fine-needle aspiration cytology (FNAC) was performed in 5 patients, revealing a characteristic acellular proteinaceous material. Biopsy in 4 patients showed different reactional infiltrates around the acellular material.

Conclusions

High resolution and color Doppler ultrasonography may be very useful for the differential diagnosis of subcutaneous nodules in patients with GEP-NETs treated with SSAs. FNAC and a biopsy are useful tests for confirmation of the diagnosis in patients with inconclusive findings. We propose a management algorithm.

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Atopic Dermatitis and Alcohol Use: A Meta-Analysis and Systematic Review

Abstract

While several maternal exposures have been associated with an increased risk of atopic dermatitis (AD) in offspring, the effect of alcohol use during pregnancy on the risk of AD in offspring is unclear. Furthermore, it is unclear whether adults with AD have an increased alcohol use, though other poor health behaviors have been associated with AD including smoking and physical inactivity as well as psychiatric disease. In this systematic review and meta-analysis, the association between alcohol use and AD were investigated in two ways: 1) whether alcohol use (drinkers versus abstainers) during pregnancy is associated with AD in offspring, and 2) whether AD is associated with increased alcohol use. The medical databases Pubmed, Embase and Web of Science were searched and data extraction was done by two independent reviewers. Eighteen studies were included in the qualitative analysis (comparing alcohol drinkers to abstainers) and 12 studies were included in the quantitative analysis. There was a positive association between alcohol use during pregnancy and development of AD in offspring (pooled odds ratio [OR] 1.16; 95% confidence interval [CI] 1.09-1.24). However, there was no consistent association between AD in adults and adolescents and alcohol use (pooled OR 1.06; 95% CI 0.92-1.23). There is a need for future well-designed prospective studies to firmly establish the association between alcohol use and AD.

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