All Articles

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.

Flora Canzona¹, Mammucari Massimo²*, Arianna Tuzi³, Enrica Maggiori², Maria Gabriella Grosso⁴, Luciano Antonaci², Stefania Santini³, Anna Rosa Catizzone³, Fiammetta Troili³, Alessandra Gallo³, Teresa Paolucci³, Piergiovanni Rocchi³, Costanza Guglielmo³, Domenico Russo⁵, Chiara Giorgio⁶, Dario Dorato³, Raffaele Di Marzo³, Giovanna Viglione³, Anna G Fiorentini³, Manuela Giardini³, Silvia Natoli⁷

¹Istituto Dermopatico dell'Immacolata, IRCCS Foundation, Rome, Italy

²Primary Care Unit ASL RM 1, Rome, Italy

³Member of the Italian Society of Mesotherapy, Rome, Italy

⁴Ospedale Israelitico, Rome Italy

⁵San Marco Hospice and Palliative Care, Latina, Italy

⁶Rehabilitation Unit, F Pirinei Hospital, Altamura (BA), Italy

⁷Department of Clinical Science and Translational Medicine, Tor Vergata University, Rome, Italy

Mesotherapy consists of a series of micro injections in the superficial layer of the skin of active ingredients that slowly diffuse into the underlying tissues. This technique is applied in different clinical conditions and also in dermatology it could play a useful role in the treatment path of many patients. However, further clinical studies are needed to standardize its application in various dermatological pathologies. The recommendations of the Italian Mesotherapy Society aim at personalized therapy based on evidence, efficacy and safety.

Rebecca Liu¹, Braden M. Candela², Joseph C English III²*

¹University of Pittsburgh School of Medicine

²Department of Dermatology, University of Pittsburgh, Pittsburgh, PA

Psoriatic arthritis (PsA) may affect up to a third of patients with psoriasis. It is characterized by diverse clinical phenotypes and as such, is often underdiagnosed, leading to disease progression and poor outcomes. Nail psoriasis (NP) has been identified as a risk factor for PsA, given the anatomical connection between the extensor tendon and nail matrix. Therefore, it is important for dermatologists to screen patients exhibiting symptoms of NP for joint manifestations. On physical exam, physicians should be evaluating for concurrent skin and nail involvement, enthesitis, dactylitis, and spondyloarthropathy. Imaging modalities, including radiographs and ultrasound, may also be helpful in diagnosis of both nail and joint pathology. Physicians should refer to Rheumatology when appropriate. Numerous systemic therapies are effective at addressing both NP and PsA including DMARDs, biologics, and small molecule inhibitors. These treatments ultimately can inhibit the progression of inflammatory disease and control symptoms, thereby improving quality of life for patients.

Nicholas X. Williams¹, Aaron D. Franklin^1,2*

¹Department of Electrical and Computer Engineering, Duke University, Durham NC 27708, USA

²Department of Chemistry, Duke University, Durham NC 27708, USA

Real-time monitoring of relevant biological signals, in combination with the timely delivery of target drugs, would be ideal for treating most medical conditions. However, access to biological fluids without a bulky, costly, and cumbersome apparatus remains challenging, as does the ability to deliver drugs of controlled dosage in a similarly unobtrusive fashion. The skin provides a promising medium for access and dosing using biomedical electronics, colloquially dubbed electronic tattoos. Recent developments in biologically compatible, flexible materials and devices have brought electronic tattoos closer to reality for sensing biomarkers extracted from the skin and delivering target drugs through the dermis. In this review, the materials and engineering requirements, fabrication developments, and sensing and therapeutic advancements of electronic tattoos are presented. Three components are required for a complete theragnostic electronic tattoo system: 1) supporting electronics for control and data transmission; 2) diagnostic sensors, categorized as mechanical (measure an internal stimulus) and chemical (measure a chemical change); and 3) therapeutics for drug delivery. The leading approaches for fabrication are summarized, including the transfer of flexible devices to the skin and the direct printing of devices onto the epidermis. Altogether, while significant obstacles remain, the advancements in this field show great promise for realizing electronic tattoo theragnostics to revolutionize point-of-care medicine.

Dillon D Clarey, Adam V Sutton, Ryan M Trowbridge*

University of Nebraska Medical Center, Department of Dermatology, Omaha, NE

Cryptococcal cellulitis is a rare dermatologic diagnosis most often seen in immunocompromised patients. We present a case of disseminated Cryptococcus presenting as cellulitis in a patient with decompensated cirrhosis. We discuss various presentations of Cryptococcus in the skin, both as primary and disseminated disease.

Rattan L. Mittal*

Emeritus Professor, Orthopaedic Department, GOMCO, Patiala, India

Introduction: Congenital clubfoot, the commonest orthopaedic defect and with very high prevalence rate in LMICs with tremendous GBD (80% global population), still remains unsolved, with 95% relapses/ under-corrections, in extreme deformities (Mittal¹), besides the umpteen uncorrected deformities. Author has researched this unexplored area for over fifty years, still continuing. AIM: Cosmetology/ Plastic surgery are the deep routed foundations of this high rise, evidence based, research. Being need based, it was destined to happen in three phases. This is, FIRST EVER, successful use of the four popular plastic procedures in a single incision¹ (Rotation, Z-plasty, vY-plasty and Fillet flaps), nicknamed as FUSION 4-in1, by any surgeon (including plastic and orthopaedic surgeons) on any part of HUMAN BODY, leave aside CLUBFOOT. This is A LOUD AWARENESS CALL for improving looks, function and avoiding complications.

Methods: These were need based, 3 phased, persistent, sequential endeavors: PHASE 1, the anatomical dissections² and years of clinical observations, leading to discovery of heterogeneous 3D skin contractures (foot being a 3D organ) as the reason for all failures. Rotation flap was used for the first time in CLUBFOOT for correcting grade 1 of this deformity with an authentic publication of a series of one hundred cases documented in SICOT JOURNAL (Mittal)³. With a thumbs-up start, it progressed to higher evolutionary stage of PHASE 2, in more extreme deformities: combining Z- plasties (1, 2 or even 3 Zs) with rotation flap as 2-in-1 incision and then to PHASE 3 for even more rigid deformities, adding VY-plasty also with rotation + Z-plasty, as 3-in-1 incision and even adding fillet flap as 4-in-1 in a lone OCTOPUS CLUBFOOT, World’s first case. RESULTS and CONCLUSIONS: The Triple or even Tetra skin expanding incision gave consistently gratifying results with longer, flexible, better functioning and pleasing looking feet, with long term follow up as reported and published in a Landmark SICOT publication of 1080 cases over a 40 years period with a long term follow up averaging 12½ years (Mittal)¹.

Cosmetology and plastic surgery, in this evidence based, cutting edge research, achieved the distinction of, FIRST EVER use of the 4 procedures in a single incision transforming “CROOKED TO ROZY FEET”. ROZY is an acronym and stands for ROtation, Z-plasty and vY-plasty (Mittal)⁴. This is also a LOUD Awakening Call to disseminate this surgical concept for correcting the more rigid and severe deformities, with relapses and under-corrections at any age, including the uncorrected ones for the Global clubfoot community.

Katarzyna Smejda¹, Agnieszka Brzozowska¹, Daniela Podleck¹, Kinga Polanska², Joanna Jerzynsk¹*

¹Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland

²Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland

During pregnancy, women are more prone to stress and at risk of distress due to deep hormonal and physiological changes. The aim of this systematic review was to examine whether maternal stress during pregnancy increases the risk of atopic diseases in the children.

A review of the literature was performed using three databases: PubMed, Web of Science, EBSCO. We limited the results to human-subject studies published in English between January 2010 and September 2019. This systematic review suggests a relationship between maternal stress during pregnancy and allergic diseases in the child. The findings highlight the importance of the implementation of stress reduction programs for pregnant women and those in their postpartum period within communities in order to enable these individuals to relieve stress effectively.