All Articles

David Solano¹, Kush R. Patel^1#, Adelaida B. Perez^1#, Lindsey Seldin^1-4*

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

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.

Laura Andrews, BS^1*; 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

Deborah H Yates^1,2,3*, Susan E Miles^4,5

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.

Chelsea Shope, BA^1*, 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

Jose Manuel Carrascosa¹, Francisco José Rebollo^2*

¹Hospital Universitario Germans Trias I Pujol, Badalona, Spain

²Pfizer SLU, Madrid, Spain

Katieli da Silva Souza Campanholi^1*, 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.

Loren E Hernandez, BS^1*; 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.

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.

Margaret A. Kaszycki^1*, 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.

Kelly Atherton BS^1*, 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

Jose Salgado Borges^1,2*, C. Vergés², J. Lima¹, March de Ribot F^2,3

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.

Vianna V. Broderick, Linda J. Cowan^*

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

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.

Ann Q. Tran, MD^{1, 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.

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.

Lourdes Franco^1*, 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.

Inge J. Veldhuizen^1-2#, Frederieke F.M. Theelen^1#, Maarten J. Ottenhof¹, Rene R.J.W. van der Hulst², Maarten M. Hoogbergen^1*

¹Department of Plastic and Reconstructive Surgery, Catharina Hospital, Eindhoven, the Netherlands

²Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, the Netherlands

^#These authors contributed equally to this work and are co-first authors

Mónica Ibáñez Barceló^1*, Antonia Teresa Vila Mas², Ana Estremera Rodrigo³, Antonio Juan Mas¹

¹Rheumatology Department, Hospital Son Llàtzer, Palma de Mallorca, Spain.

²Dermatology Department, Hospital Son Llàtzer, Palma de Mallorca, Spain.

³Radiology Department, Hospital Son Llàtzer, Palma de Mallorca, Spain.

Alicia Roso¹, Mickael Puginier^1*, Mathilde Bergal¹, Frederic Nunzi², Alain Alonso³

¹Seppic, 50 boulevard National, CS 90020, 92257 La Garenne Colombes Cedex, France

²Groupe IDEA Lab - Site Montesquieu, 5 rue Jacques Monod, 33652 Martillac, France

³EPISKIN, 4 rue Alexander Fleming, 69007 Lyon, France

Considering all topical applications, products target very different body areas including mucosa, healthy or impaired skin with many specific characteristics in the epithelium composition, structure and barrier functionality. In vitro reconstructed human tissue models are recognized as being sensitive and reliable in preclinical studies. On top of validated methods for skin irritation, new and predictive experimental protocols can be designed to address specific applications. The objective of this study was therefore to investigate the behavior of ingredients with a well-known tolerance profile for specific applications using 3D human reconstructed models: gingival and vaginal focusing on mucosa tolerance, “immature” epidermis intended to be closer to baby skin, and a fourth epidermis model with a physically impaired barrier function. Ingredients with a key function were applied at usual doses and compared to controls and formulation benchmarks to challenge the predictivity of the models.

The analysis of the results of each in vitro model demonstrated their greater sensitivity compared to the standard reconstructed human epidermis, making it possible to evaluate the tolerance of ingredients and select a well-tolerated dosage according to the local application area. The multiparametric approach designed for the “immature” and “impaired” epithelia models enriched basic irritation information with cellular, morphological and functional effects evaluations. It was therefore possible to identify some infra-clinical reactions and study the ingredient mechanisms.

Charalambos Costeris^1*, Maria Petridou², Yianna Ioannou¹

¹School of Humanities and Social Sciences, Department of Social Sciences, University of Nicosia, Cyprus

²Department of Psychology University of Cyprus

Background: At early developmental stages, patients’ sense of self develops under the influence of dermatological disorders and can affect how young patients perceive themselves, as well as the way they interact with those around them. Objective: To investigate the influence of dermatological disorders on self-esteem and perceived social support in two groups of patients with severe visible facial acne and with non-visible psoriasis/eczema. Design: The study engaged patients during their visit to the Dermatologist to seek treatment (prior to dermatological treatment phase), and at a six-month follow-up, when their treatment was completed (post-dermatological phase). Setting: Patients from two Cypriot cities were diagnosed with acne, psoriasis/eczema by their Dermatologists and were encouraged to participate in the study. Participants: 162 adult participants (18-35 years) took part in the study (n = 54 patients with severe visible facial cystic acne; n = 54 patients with non visible psoriasis and eczema; and n = 54 participants without dermatological disorder - control group). Measurements: A sociodemographic questionnaire was administered to all participants. The Rosenberg Self-Esteem Scale and the Interpersonal Support Evaluation List (ISEL-40) were administered prior to and at post-dermatological treatment phase. Results: All dermatological patients showed lower self-esteem and lower perceived social support, compared to the control group. Moreover, patients with acne appeared to have lower levels of self-esteem and perceived social support at both research phases and in comparison with the other groups. Conclusion: Patients’ self-esteem and perceived social support need to be psychologically evaluated before dermatological treatment, as well as after its completion. Findings suggest a comprehensive psychological support during the course of dermatology treatment.

Peter Sweeney, Kyle Vaughn, Hai-Feng Ji^*

Department of Chemistry, Drexel University, Philadelphia, PA 19104, USA

Hydrogels show great potential as biocompatible materials with a wide variety of applications. This includes, but is not limited to, wound dressings, signal detection, tissue repair, and adhesives. This minireview focuses on the recent development of highly stretchable hydrogels for wound healing applications. The hydrogels reviewed display high elasticity and self-healing properties that increase their longevity when in use.

Shane M. Swink, D.O., M.S.¹*, Tanya Ermolovich, D.O.^1,2

¹Division of Dermatology, Lehigh Valley Health Network, Allentown, PA

²Advanced Dermatology Associates, Ltd., Allentown, PA

Ufuk Koca Caliskan*, Methiye Mancak Karakus

Gazi University, Faculty of Pharmacy, Department of Pharmacognosy and Pharmaceutical Botany 06330 Etiler, Ankara, Turkey

Transdermal drug delivery system is an administration route, where active molecules are administered through the skin with advantages of a lesser amount of hepatic first pass effect, constant plasma drug concentration and safety. The skin has a barrier function for the passage of medicines as well as toxic molecules, thus, permeation boosters/enhancers are used to increase the permeability of medication through the skin. In this mini review, recent studies on essential oils that can be used to increase skin penetration in transdermal applications and the possible mechanisms of their effects are reviewed. Essential oils increase skin penetration by interacting with the stratum corneum (SC). They were found to be successful in increasing skin penetration of both lipophilic and hydrophilic drugs. Moreover, essential oils do not accumulate in the body since they are volatile, and also are easily discharged from the body through feces and urine. They are preferred because essential oils are natural, mostly do not damage the skin while increasing skin penetration, less toxic, and less allergenic.

Arthe Rajarajaran, Arivuoli Dakshanamoorthy*

Crystal Growth Centre, Anna University, Chennai

The challenge which grows over time in the chronic wound healing is a self-care wound dressing. These wounds have unfavourable impact on patients wellbeing and also challenging to the health economy. The wound healing requires a complex series of physiological and immunological processes with adequate nutrition. Any derangement of immune signals at any stage can lead to impaired wound healing which alters the key transition point that lies between the inflammatory and proliferation phase that destroys the components of Extracellular matrix. The Extracellular matrix is responsible for regulating the growth factors and its receptors that are important for wound healing. To boost up the growth factor signalling and accelerating the chronic wound healing, a new biomimetic approach of mimicking the role of extracellular matrix helps in the development of instructive wound dressing. Thus this review deals in discussing the tremendous activity of the Natural polysaccharide called β-glucan on wound healing signalling which may help in mimicking the role of extracellular matrix.