All Articles

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.

Amit Shivaji Kerure¹, Shaurya Roahtgi²*, Shashank Bansod³, Umesh Bilewar⁴

¹Consultant dermatologist and hair transplant surgeon, Dr. Amit Kerure skin clinic, Navi Mumbai 400703, Maharashtra, India

²Consultant dermatologist and hair transplant surgeon. Dr. Shaurya’s skin clinic, A6, Ratandeep CHS, SV road, Andheri west, Mumbai-400058

³Consultant dermatologist and hair restoration surgeon, Hi-Tech Skin clinic and hair transplant Centre, Nagpur, Maharashtra, India

⁴Consultant dermatologist and hair transplant surgeon, Ozone clinic, Navi Mumbai, Maharashtra, India

Kanthi Bommareddy¹, Rabah Alreshq¹, David Jones², Gurpreet Singh¹*

¹Department of Medicine, Albany Medical Center, Albany, NY 12208

²Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208

Immunoglobulin A vasculitis, formerly known as Henoch-Schönlein purpura, is an IgA-mediated small-vessel vasculitis that predominantly affects children with an incidence of 10-20 per 100,000 per year. It is very unusual in adults; however, cirrhosis has been associated with immunoglobulin A vasculitis because of the cirrhotic liver’s inability to metabolize circulating IgA complexes, resulting in systemic deposition particularly in the skin and kidney. In cirrhosis, the most common causes of acute kidney injury are those of prerenal azotemia including hepatorenal syndrome followed by intrarenal causes. Our very rare case of kidney injury in a cirrhotic patient is due to deposition of circulating IgA complexes. We present a very rare case of palpable purpura and acute kidney injury consistent with immunoglobulin A vasculitis in an adult with alcoholic cirrhosis. This patient’s skin and renal findings improved with oral prednisone.

Irène Tatischeff*

Honorary CNRS (Centre National de la Recherche Scientifique, Paris, France) and UPMC (Université Pierre et Marie Curie, Paris, France) Research Director; Founder of RevInterCell (www.revintercell.com), a Scientific Consulting Service, Orsay, 91400, France

Cell-derived extracellular vesicles (EVs) are newly uncovered messengers for intercellular communication. They are released by almost every cell type in the three domains of life, i.e. Archea, Bacteria and Eukarya. They are known to mediate important biological functions and to be increasingly involved in cell physiology and in many human diseases, especially cancers. The aim of this review is threefold: (1) to stress the outstanding characteristics of Extracellular Vesicles (EVs) as Intercellular Communication Messengers; (2) to focus on some interesting papers searched in PubMed, specifically dealing with EV involvement in skin physiology and in a few important skin diseases treated in dermatology; (3) to mention the potential of EVs as future theranostic agents for diagnosis, prognosis and therapy of some major skin illnesses, such as Melanoma and Merkel Cell Carcinoma - an ongoing goal for achieving skin-devoted liquid biopsy and future individual patient precision medicine. However, many challenging points about EV research must still be resolved before reaching this promising perspective.

Whitney M. Longmate*

Department of Surgery, Albany Medical College, Albany, NY 12208, USA

Roohi Vinaik¹, Marc G. Jeschke^1,2,3,4*

¹Sunnybrook Research Institute, Toronto, Canada

²Department of Surgery, Division of Plastic Surgery, University of Toronto, Canada

³Department of Immunology, University of Toronto, Canada

⁴Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada

Thermal injury is a severe form of trauma that is accompanied by significant, persistent metabolic and immune dysregulation. The extent of altered post-burn metabolism and inflammation is correlated with severity of injury, with severe burns demonstrating a more significant hypermetabolic, hyperinflammatory response. This in turn delays re-epithelialization and exacerbates poor post-burn wound healing, which is the most important factor in patient mortality outcomes. Recently, stem cells have gained interest in burn wound healing applications due to their capacity to produce multiple cellular subtypes and improve the rate and quality of healing. Here, we focus on applications of mesenchymal stem cells in wound healing. In particular, we highlight the characteristics and efficacy of burn-derived mesenchymal stem cells (BD-MSCs), which improve healing in animal models. Discarded burn tissue is a source of pro-healing BD-MSCs, providing a safe, non-invasive therapeutic option for burn patients.

John M. Pawelek

Department of Dermatology and the Yale Comprehensive Cancer Center, New Haven, CT

Adam Strohl

Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, Philadelphia, PA

John Plante*, Chelsea Eason, Alan Snyder, Dirk Elston

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

Ruri D. Pamela

Department of Dermatology, Dr. Suyoto Hospital Ministry of Defense, Jakarta, Indonesia

Air pollution as an impact of modern urbanization and industrialization continues to increase and has become a global problem. The human skin organ acts as a barrier and frontline to external environment, so it is frequently directly exposed to pollution. A Greenpeace report released in early 2019 listed Jakarta as South Asia’s most polluted city. The effect of major air pollutants such as nitric oxide, polycyclic aromatic hydrocarbons, volatile organic compounds, and particulate matter to human skin has been investigated in few studies. This article reviews how air pollutants currently perceived as a major cause of skin aging through their mechanism in damaging skin barrier and increase accumulation of reactive oxygen species.

Jason S Seidman¹, Dawn Z Eichenfield², Charisse M Orme²*

¹School of Medicine, University of California San Diego, San Diego, California, USA

²Department of Dermatology, University of California San Diego, San Diego, California, USA

Bullous pemphigoid (BP) is an autoimmune blistering condition, often presenting in elderly individuals with pruritis and tense bullae. While standard treatment involves steroids, steroid sparing agents, and anti-inflammatory therapies, clinicians are increasingly utilizing novel biologics off-label for refractory cases. We recently reported a case of successful treatment of BP using dupilumab, a monoclonal interleukin 4 receptor alpha (IL-4Rα) antibody that modulates type 2 inflammation through dual inhibition of IL-4 and IL-13 signaling. Here, we discuss how the reported efficacy of dupilumab and certain other biologics in treating BP implicates type 2 inflammation as an important driver of BP pathogenesis. Furthermore, reports of dupilumab successfully treating patients with other pruritic dermatologic diseases highlight the importance of type 2 inflammation, particularly through IL-4Rα signaling, in chronic pruritis. The rapid development of these biologic therapies presents new opportunities for research and treatment of inflammatory dermatologic disorders.

Andreas Nikolis^1,2*, Kaitlyn M. Enright²

¹Associate professor of Plastic Surgery, Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada

²Erevna Innovations Clinical Research Unit, Westmount, Quebec, Canada

Hyaluronic acid (HA) substrates in facial rejuvenation have been a long-standing staple in the aesthetic injector’s offerings. The development of different technologies, variability in the concentration of HA within the gels and different types of cross-linking methodologies have led to the development of many skews across multiple companies. When addressing micro-droplet techniques whereby small aliquots of HA are deposited in the dermis, few have developed a safety and efficacy profile that supports claims of improved skin quality. The concept of adding HA into the dermis is inherently a correct one, as this glycosaminoglycan is able to bind and retain water in a significant fashion. Successful management of skin quality requires specific quantities of HA to be precisely placed at the appropriate depth using a reproducible volume. These aforementioned factors all contribute to successful skin quality improvements. We present a clinical summary of pearls and pitfalls in managing skin quality with micro-droplet HA that we have identified over the last 4 years.