Yasmine Oprea1, Patricia Cerri-Droz2, Urmi Khanna1

1 Albert Einstein College of Medicine/Montefiore Medical Center

2 Renaissance School of Medicine at Stony Brook University

The first human infection with monkeypox virus was reported in 1970, and infections have subsequently been recorded in endemic areas such as Central and West Africa or linked to international travel to these regions. However, the emergence of the 2022 monkeypox outbreak has involved multiple non-endemic countries and continents without links to travel to endemic areas. The first cases in the current outbreak were reported in May of 2022. The primary mode of transmission is atypical and is thought to occur through direct contact with infected skin lesions. The rapid increase in case numbers prompted the World Health Organization to declare this disease outbreak as a public health emergency of international concern. Robust efforts are being made by global public health authorities to develop effective antiviral treatment options and vaccination strategies to reduce the spread of this disease. The objective of this manuscript is to provide a comprehensive review of the 2022 mpox outbreak with respect to its unique epidemiology, clinical features, complications, and management options.

DOI: 10.29245/2767-5092/2022/4.1166 View / Download Pdf

Ishita Aggarwal BA; Carolina Puyana MD, MSPH*; Neha Chandan MD, MPH; Roger Haber, MD

University of Illinois at Chicago, Department of Dermatology, 1801 W. Taylor St., Chicago, IL 60612-7307

Introduction: Androgenetic alopecia (AGA) is the most common type of hair loss worldwide and is estimated to affect about 80 million people in the United States. Recent trends suggest that incidence and severity of the disease are increasing across all genders and races. Randomized controlled trials (RCTs) involving diverse patient populations are necessary to individualize treatment.

Objective: Evaluate enrollment and subgroup analysis of people falling in racial/ethnic minority groups in phase II and III RCTs for AGA published in the United States within the past 10 years.

Methods: We examined completed published phase II and III randomized, double-blind, placebo-controlled trials investigating AGA. Race/ethnicity data was extracted for each RCT using US Census Bureau guidelines.

Results: 20 total RCTs with a total of 1855 participants were included in the analysis. 8 (40%) of RCTs included race/ethnicity data. Among these, 3 (15%) studies included only race and 5 (25%) included both. The majority of study patients were white (n= 862/1063, 81.1%) followed by African American (n=127/1063, 11.9%) and Asian (n=33/1063, 3.1%). Six (0.56%) patients identified as American Indian/Alaska Natives, 5 (0.47%) as Hawaiian/Pacific Islander, and 16 (1.5%) as another race or race was unknown. Ethnicity was reported in 5 (25%) of trials, totaling 317 participants; 60 (18.9%) patients identified as Hispanic.

Conclusions: Non-Caucasian patients remain underrepresented in RCTs despite AGA being a highly prevalent condition, reducing the generalizability of trial outcomes to the general population. Future RCTs should update definitions of race/ethnicity and include more diversity among AGA patients.

DOI: 10.29245/2767-5092/2022/4.1164 View / Download Pdf

Alison Tran, M.D., M.A., Ed.M.1* and Lio Yu, M.D., DABR2

1Menter Dermatology Research Institute, Baylor University Medical Center; Heights Dermatology, Dallas, TX

2Director of Radiation Oncology, Laserderm Dermatology, Smithtown, NY

DOI: 10.29245/2767-5092/2022/4.1165 View / Download Pdf

Simon J. Madorsky, MD*, Orr A. Meltzer, BS, Alexander Miller, MD

Skin Cancer and Reconstructive Surgery Center (SCARS Center) at 180 Newport Center Drive, Suite 158, Newport Beach, CA 92660

Superficial radiotherapy (SRT) treatment for non-melanoma skin cancer has been reported to yield variable cure rates. When patients are highly selected, adequate margins of treatment are chosen, and hypofractionation is avoided, cure rates of SRT can approach that of Mohs surgery.

The objective of this study is to evaluate long term results of our center’s SRT selection criteria and define proper decision-making parameters of optimal candidates for treatment, and to review the literature. A retrospective chart analysis was done of all SRT cases from 2012-2018. Location, size, type and depth of the treated tumors were defined. Treatment energy, fractionation, and radiation field size were documented. Recurrences and complications were analyzed. Of 131 treated lesions treated, head and neck lesions (105, 80%) were the most common location, primarily on the lower nose (60, 46%). Of 122 lesions analyzed for recurrence, 2 (1.6%) recurred, with a mean follow-up time of 5 years. Acute ulcerations in 29 (28%) head and neck lesions, 5 (63%) trunk lesions, and 9 (50%) leg lesions occurred. Delayed ulcerations occurred in 5 (28%) leg lesions. In conclusion, when patients are highly selected, long-term SRT cure rates up to 98% can be achieved.

DOI: 10.29245/2767-5092/2022/4.1261 View / Download Pdf

Denise Ann Tsang1*, Chee Leong Cheng2, Laura Hui1

1Singapore General Hospital, Department of Dermatology

2Singapore General Hospital, Department of Pathology

DOI: 10.29245/2767-5092/2022/3.1162 View / Download Pdf

Samantha D. Verling*, Noreen Mohsin#, Loren E Hernandez, Teresa Ju, Keyvan Nouri

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA

DOI: 10.29245/2767-5092/2022/3.1158 View / Download Pdf

Daniela Frasca1,2*, Natasa Strbo1,2

1Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL USA

2Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL USA

Obesity represents a serious health problem as it is rapidly increasing worldwide. Obesity is associated with reduced health span and life span, decreased responses to infections and vaccination and increased frequency of inflammatory conditions. In this review, we summarize published data showing that obesity increases the risk of different types of infections, with a special focus on skin infections. Obesity also induces skin changes and conditions (inflammation-based and hypertrophic) which are often associated with fungi or bacteria overgrowth. The association of obesity with the skin microbiome has been established in both mice and humans. Balance of commensal microbes controls skin homeostasis and the host immune response, while changes in normal physiologic skin microbiome composition and pathologic bacteria contribute to skin diseases. We also summarize the major steps in wound healing and how obesity affects each of them. The role that immune cells have in this process is also described. Although the studies summarized in this review clearly demonstrate the deleterious effects of obesity on wound healing, additional studies are needed to better characterize the cellular and molecular mechanisms involved and identify specific targets of intervention.

DOI: 10.29245/2767-5092/2022/3.1157 View / Download Pdf

David Solano1, Kush R. Patel1#, Adelaida B. Perez1#, Lindsey Seldin1-4*

1Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, USA

2Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA

3Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA

4Atlanta Veterans Affairs Medical Center, Decatur, GA, USA

#Authors contributed equally

DOI: 10.29245/2767-5092/2022/2.1154 View / Download Pdf

Alison M Mackay

Division of Musculoskeletal and Dermatological sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

Photodynamic therapy (aPDT) has become an important component in the treatment of human infection. This report highlights the scientific literature and clinical guidelines on aPDT in the context of dermatology and considers the treatment of skin infection in all settings now, and in the future. Antibiotic resistance, infection control strategies and technologies able to eradicate microbes without building up new resistance are considered, and their mechanisms of action are described. Published work and National Institute for Clinical Excellence (NICE) Technology appraisals (TA) and research recommendations within Clinical Guidelines were used to identify future applications for PDT. Nanotheranostics can include PDT and were found to be highly relevant, and so treatment combinations and their novel applications will be subject to TA and Randomised Clinical Trials (RCTs). The resistance of some microbes to antibiotics can be reversed through use of supplementary drugs, and so they are likely to remain a mainstay of treatment for skin infection.

DOI: 10.29245/2767-5092/2022/2.1153 View / Download Pdf

Laura Andrews, BS1*; Chelsea Shope, BA1; Alan Snyder, MD MSCR2, Manuel Valdebran MD3

1College of Medicine, Medical University of South Carolina

2Department of Dermatology & Dermatologic Surgery, Medical University of South Carolina

3Department of Dermatology & Dermatologic Surgery, Division of Pediatric Dermatology Medical University of South Carolina

DOI: 10.29245/2767-5092/2022/2.1151 View / Download Pdf

Deborah H Yates1,2,3*, Susan E Miles4,5

1Department of Respiratory Medicine, St Vincent’s Public Hospital

2St Vincents Clinical School, UNSW

3Holdsworth House Medical Practice, Sydney, NSW

4Department of General Medicine at Calvary Mater Newcastle

5University of Newcastle, Newcastle, NSW, Australia 2308

Dermatological manifestations of connective tissue diseases (CTDs) are common and frequently precede other symptoms. Thus, dermatologists may be the first clinicians to diagnose these disorders. Silica exposure is an acknowledged cause of several CTDs, but this is under-appreciated by clinicians, who may also be unaware of the wide range of jobs in which silica exposure can occur. The CTDs associated with silica exposure include systemic sclerosis (SSc), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), anti-neutrophil cytoplasmic antibody (ANCA) positive vasculitis and overlap syndromes. Silica-related systemic sclerosis (Si-SSc) is associated with a specific antibody profile and more severe disease. Silicosis has re-emerged worldwide recently due to several new workplace exposures, including a new type of silicosis (artificial stone (AS) silicosis), which is associated with a particularly high rate of auto-antibody formation. Dangerous work practices are still occurring. This article summarises recent literature on the topic of the resurgence of silicosis and silica-induced CTDs and reminds dermatologists of the importance of taking a thorough occupational history in all patients. Early intervention in CTDs and reduction in dust exposure can reduce risk and improve prognosis. Treatment options are rapidly improving.

DOI: 10.29245/2767-5092/2022/2.1147 View / Download Pdf

Chelsea Shope, BA1*, Laura Andrews, BS1, Alan Snyder, MD MSCR2, Manuel Valdebran MD3

1College of Medicine, Medical University of South Carolina

2Department of Dermatology & Dermatologic Surgery, Medical University of South Carolina

3Department of Dermatology & Dermatologic Surgery, Division of Pediatric Dermatology Medical University of South Carolina

DOI: 10.29245/2767-5092/2022/2.1150 View / Download Pdf

Jose Manuel Carrascosa1, Francisco José Rebollo2*

1Hospital Universitario Germans Trias I Pujol, Badalona, Spain

2Pfizer SLU, Madrid, Spain

DOI: 10.29245/2767-5092/2022/1.1149 View / Download Pdf

Katieli da Silva Souza Campanholi1*, Ranulfo Combuca da Silva Junior 1, Gustavo Braga 1,3, Flávia Amanda Pedroso de Morais 1,2, Rodolfo Bento Balbinot2, Wilker Caetano 1

1Chemistry Department, State University of Maringa, Maringa, Parana, Brazil.

2Department of basic health sciences, State University of Maringa, Maringa, Parana, Brazil.

3Federal Institute of Education, Science and Technology of Parana, Telemaco Borba, Parana, Brazil.

The therapeutic benefits of copaiba oil-resin have encouraged its use in developing dermatological emulsions. Here, the anti-inflammatory, healing, antimicrobial, analgesic, and permeation-promoting properties of this medicinal oil are shown by reviewing articles from 2005 to 2021. Their properties encourage research to develop an herbal medicinal effective in treating skin diseases and cutaneous leishmaniasis.

DOI: 10.29245/2767-5092/2022/1.1148 View / Download Pdf

Loren E Hernandez, BS1*; Fabio Stefano Frech, BS1; Noreen Mohsin, BS1; Isabella Dreyfuss, BS2; Keyvan Nouri, MD, MBA1

1Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA

2Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, Florida, USA

Nodular melanoma is the second most common subtype of melanoma. Unlike other subtypes, nodular melanoma is characterized by early vertical growth rather than the typical initial radial growth of most melanomas. As a result, nodular melanoma presents clinically in a more aggressive phenotype. Given its more aggressive nature and intrinsic ability to mimic benign lesions, a modified acronym has been developed to allow clinicians to better evaluate, diagnose and treat nodular melanoma in earlier stages. Surgical excision with wide margins is the gold standard of nodular melanoma therapy; however, an emphasis in early detection, diagnosis, staging, and treatment needs to be emphasized among clinicians due to its dismal prognosis in later stages, as compared to other subtypes. A better understanding of the molecular pathophysiology that allows nodular melanoma to act aggressively very early in diagnosis is necessary for the development of therapeutics that may effectively target lesions in more advanced stages.

DOI: 10.29245/2767-5092/2021/3.1144 View / Download Pdf

Toni O. Mortimer, Rachel Morris, Abigail Schekall, Kai Barlow, Kim L. O’Neill* 

Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah 84602

Cancer is one of the leading causes of death worldwide. In the U.S. alone, almost 2 million people will be diagnosed with cancer each year and just over a quarter of those diagnosed will pass away from the disease. Skin cancers are the most common forms of cancer. Early detection of cancer and cancer biomarkers enables clearer understanding of cancer progression in a patient and more effective treatments in response to the disease. Clinically relevant biomarkers are not only tools for early diagnosis of cancer but may also prove useful as immune targets for various immunotherapies, such as monoclonal antibody-based therapy and chimeric antigen receptor (CAR) T-cell therapy. This review provides a brief overview of the rescue pathway enzyme thymidine kinase 1 (TK1) and its history and biology, as well as discusses its role as a biomarker and potential immune target.

DOI: 10.29245/2767-5092/2021/3.1143 View / Download Pdf

Margaret A. Kaszycki1*, Jonathan Leventhal2 

1Frank H. Netter MD School of Medicine

2Yale School of Medicine

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, and their use in combination with radiation therapy (RT) has become increasingly utilized to optimize positive outcomes. The cutaneous adverse reactions from RT as well as ICIs are both well documented; however, in combination these cutaneous toxicities can be exacerbated. ICIs and RT may work synergistically to create an enhanced immune response against the tumor cells. This synergistic effect has been reported to occur both locally at the site of RT, as well as systemically via an abscopal effect. Fortunately, this combination of treatment does not increase the incidence of cutaneous reactions, although several cases have reported enhanced skin toxicity at the site of RT. RT is thought to create an ‘immunocompromised skin district’ or localized immune dysregulation in irradiated skin. This review summarizes previously published case reports and discusses the cutaneous adverse reactions from ICI and RT combination therapy. Properly identifying ICI and RT induced skin reactions depends on several factors including patient history, sequence of therapies, timing of reaction, and histological findings. Skin reactions from combination therapy can range in severity and include ICI-induced radiation recall dermatitis, as well as uncommon presentations of Stevens-Johnson syndrome, lichen planus, and bullous pemphigoid which are localized to or enhanced within areas of prior radiation exposure. It is important for oncologists and dermatologists alike to be aware of the spectrum of reactions associated with ICI and RT.

View / Download Pdf

Kelly Atherton BS1*, Latiffa Smith BS2, Alan Snyder MD MSCR3, John Plante MD MSCR3, Dirk Elston MD3

1College of Medicine, Medical University of South Carolina, Charleston, South Carolina; College of Graduate Studies, Medical University of South Carolina, Charleston, South Carolina, USA

2College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

3Department of Dermatology and Dermatologic Surgery, Medical University South Carolina, Charleston, South Carolina, USA

DOI: 10.29245/2767-5092/2021/3.1138 View / Download Pdf

Jose Salgado Borges1,2*, C. Vergés2, J. Lima1, March de Ribot F2,3

1Clinsborges. Porto, Portugal

2Department of Ophthalmology. Hospital Universitario Dexeus. Area Oftalmológica Avanzada. Universidad Politécnica de Cataluña. Barcelona, Spain.

3Department of Ophthalmology. Girona Hospital, Girona University. Girona, Spain.

Intense pulsed light (IPL) are medical-esthetical procedures that emit light at a wavelength of 500 – 1200 nm, interacting with epidermal and dermal tissues. IPL is a relatively new treatment of growing popularity thanks to its versatility and efficacy, mainly in dermatology and recently also in ophthalmology. These devices are used to treat dry eye disease, meibomian gland dysfunction, rosacea, and periocular lesions with outstanding results.

DOI: 10.29245/2767-5092/2021/3.1139 View / Download Pdf

Vianna V. Broderick, Linda J. Cowan*

*James A. Haley Veterans Hospital and Clinics, 13000 Bruce B. Downs Blvd, Tampa, FL 33612, USA

DOI: 10.29245/2767-5092/2021/2.1136 View / Download Pdf

María A. Rodríguez-Santiago*, Javier García-Marín, Alfredo Lamela-Domenech, María Vega-Martínez

Internal Medicine, School of Medicine, University of Puerto Rico, USA

There is a well-known shortage of racial diversity in medical textbooks and literature contributing to race-based health care inequalities1. We present the case of a black puertorrican 58-year-old female who developed a painful non-pruritic blistering ulcer in the inner oral mucosa with associated erythema six months prior to the evaluation. She was misdiagnosed on multiple occasions leading to a rapid progression of the disease, and subsequently, her death. Lack of images in medical textbooks and scarce literature describing initial presentation per-skin-tone of Pemphigus Vulgaris (PV) in patients with dark skin color led to misdiagnosis, delay in treatment, and thus, this catastrophic outcome. This case report describes the appearance of PV in patients with dark skin tone and serves as an educational resource by providing images of a rare skin disease in people with dark skin. The purpose of this case report is to fill major gaps in medical literature, highlight the importance of timely recognizing PV in patients with dark skin, and to create awareness among physicians.

DOI: 10.29245/2767-5092/2021/2.1137 View / Download Pdf

Ann Q. Tran, MD1, 2*, Wendy W. Lee, MD, MS1

1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL

2Manhattan Eye Ear Throat Hospital, Northwell Health, New York, NY

Facial aging associated with volume loss can be addressed with soft tissue fillers. This minimally invasive technique has quickly gained popularity and is commonly performed in many outpatient settings. The composition of injectable dermal fillers includes marketed hyaluronic acid, calcium hydroxyapatite, polylactic acid, silicone and polymethylmethacrylate. Complications, such as vision loss, are rare, but can result in a devastating and irreversible sequala from iatrogenic vascular occlusion. Understanding the facial anatomy, specific filler characteristics, and having a safe injection technique is crucial to assure optimal aesthetics results while avoiding complications. Injectors need to be able to recognize early complications and treat them appropriately, especially if vision loss is encountered. This review will focus on vision loss from fillers, techniques to prevent such complications and possible treatment strategies.

DOI: 10.29245/2767-5092/2021/1.1134 View / Download Pdf

Michael Sheetz

Welch Chair of Biochemisty, Molecular Mechanomedicine Program, Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555, USA

Although there is a general appreciation of the mechanical abilities of cells in creating the forms in nature, we understand relatively little about how the mechanobiology of cells can affect behavior. Recent studies of the effects of mechanical activity indicate that exercise and other physical perturbations can inhibit cancer progression and performance loss in aging. Thus, the tumor cell and senescent cell states are mechanically different from normal cells. New tools to measure cellular forces and the downstream biochemical changes that result from mechanical signaling have enabled the description of the matrix rigidity sensor that is missing in the vast majority of tumor cells. Tumor cells no longer form tumors upon its restoration; whereas normal cells have unregulated growth when the sensor is depleted. Further, mechanical strain of tumor cells will cause apoptosis and may have effects on keratinocyte and melanocyte tumors. This could explain some of the anti-tumor benefits of physical activity. In the case of aging, the negative effects of senescent cells on their neighbors appear to be reversed by small but not large mechanical strains in skin. Thus, cells in the tumor or senescent states respond specifically to mechanical perturbations and a deeper understanding of the important aspects of mechanobiology can be used in therapies to augment biochemical therapies to benefit the patient.

DOI: 10.29245/2767-5092/2021/1.1132 View / Download Pdf

Lourdes Franco1*, Ana M Marchena2, Ana B Rodríguez2

1Department of Physiology (Neuroimmunophysiology and Chrononutrition Research Group), Faculty of Medicine, University of Extremadura, Badajoz, Spain.

2Department of Physiology (Neuroimmunophysiology and Chrononutrition Research Group), Faculty of Science, University of Extremadura, Badajoz, Spain.

Skin plays an important role in the protection of our body. It can be damaged by environmental factors, and it suffers from progressive morphological and physiological disorders with time. Melatonin and Lycopene have a lot of properties which protect our skin. In this review, we have investigated about how these substances can help to prevent damage and repair the skin.

DOI: 10.29245/2767-5092/2021/1.1126 View / Download Pdf