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Nivolumab‐induced localized genital bullous pemphigoid in a 60‐year‐old male

J Cutaneous Pathology - чт., 13/01/2022 - 06:48
Abstract

A 60-year-old man with metastatic renal cell carcinoma presented with a 6-month history of a pruritic, exquisitely painful genital eruption appearing 3 months after initiation of nivolumab. Examination demonstrated a poorly defined, lichenified scrotal plaque studded with erosions, yellow crust, and tense vesicles. There was no other lesion on the body or mucosae. Histopathology revealed a subepidermal blister with a mixed lymphocytic, neutrophilic, and eosinophilic infiltrate. Direct immunofluorescence of perilesional skin demonstrated subclinical blister and linear/fibrillary patchy IgG and IgA along the dermoepidermal junction. Bullous pemphigoid (BP) serologies revealed normal IgG BP230 antibodies and minimally elevated IgG BP180 antibodies. Indirect immunofluorescence revealed positive IgG at the basement membrane (“epidermal pattern”) in human split skin and monkey esophagus substrates; no IgA antibodies were detected. The patient was diagnosed with nivolumab-induced localized genital BP (LGBP). BP is a reported adverse effect of immune checkpoint inhibitors including nivolumab; however, cases are typically generalized. LGBP is a rare BP variant typically presenting in children and females; there are few reports of LGBP in adult males. We report a novel case of nivolumab-induced LGBP with unique histopathologic and clinical challenges. LGBP should be considered in patients on immune checkpoint inhibitor therapy with bullous genital eruptions.

Категории: Журналы

Primary cutaneous extraskeletal osteosarcoma of the pretibial leg: A case report and summary of the literature

J Cutaneous Pathology - чт., 13/01/2022 - 06:30
Abstract

Primary cutaneous extraskeletal osteosarcoma is a rare tumor, with fewer than 30 known cases worldwide. We report the case of a 60-year-old female who presented with a solitary right pretibial nodule of 3 mm. She had no known comorbidities, trauma to the area, or prior malignancy. The biopsy specimen showed abundant mineralized osteoid, in which pleomorphic and spindled cells with anaplastic features were embedded. The osteoid matrix in this case contained overtly malignant cells, with frequent mitotic figures, as well as multinucleated giant cells. Immunohistochemistry and imaging led to the conclusion that this nodule represented a primary cutaneous extraskeletal osteosarcoma. The previously reported cases are variable in location, size, gross appearance, and clinical course. The prognosis of osteosarcoma is typically poor, with aggressive behavior; this, however, may be less severe in these strictly cutaneous tumors, though additional follow-up would be beneficial to determine long-term outcomes for the known cases. Ultimately, despite the fact that this is an extremely rare entity, primary cutaneous extraskeletal osteosarcomas should be considered when relevant.

Категории: Журналы

Use of a novel Indentometer to evaluate skin induration in localized scleroderma and psoriasis vulgaris

Skin Research Technology - ср., 12/01/2022 - 22:23
Abstract Introduction

Diseased skin in localized scleroderma (LS) and plaque psoriasis (PPs) is characterized by induration that can be evaluated by non-invasive bioengineering methods. In this study, we applied a new measurement device based on indentometry to determine the changes of skin mechanical properties in patients with LS and PPs.

Material and methods

A total of 30 sclerodermatous plaques in 12 patients with LS and 46 psoriatic plaques in 19 patients with PPs were measured with Indentometer IDM 800 (Courage + Khazaka, Cologne, Germany). The device measures the penetration depth of the probe indenter (pin) into the skin in mm. We used two probes with pin diameters 3 and 5 mm, respectively. The stiffer the skin, the less deep is the displacement by the indenter. The smaller the diameter, the deeper the pin will go into the skin when using the same force. The measurements were made on diseased skin and in adjacent normal skin served as control. In addition, the psoriatic plaques were measured before and after treatment.

Results

The sclerodermatous skin and the psoriatic skin showed lower Indentometer values compared to adjacent normal skin as measured with both probes. This suggests that diseased skin is stiffer than healthy skin. The values of psoriatic plaques increased after treatment applied that correlates with the clinical improvement. The Indentometric readings significantly negatively correlated with clinical scores of skin induration. There was a significant correlation between the measurements with probe 3 mm and probe 5 mm.

Conclusion

The non-invasive method used is appropriate for objective and quantitative determination of the degree of skin induration in LS and PPs as well as for assessment of the disease evaluation and treatment efficacy.

Категории: Журналы

Subsurface detection of hair follicles in alopecia areata using optical coherence tomography

Skin Research Technology - ср., 12/01/2022 - 22:19
Skin Research and Technology, EarlyView.
Категории: Журналы

Infiltration of subcutaneous adipose layer into the dermal layer with aging

Skin Research Technology - ср., 12/01/2022 - 22:13
Abstract Background

The elasticity of the dermal layer decreases with aging, leading to ulcer formation and wrinkling, but the mechanism of this change is not fully understood, because it is difficult to access the complex three-dimensional (3D) internal structure of the dermis.

Objective

To clarify age-dependent changes in the overall 3D structure of the dermal layer by means of 3D analysis technology.

Methods

We observed sun-protected human skin by means of X-ray micro CT, identified the layers of the skin, and reconstructed the 3D structure on computer. Age-dependent structural changes of the dermal layer were evaluated by statistical comparison of young and aged skin.

Results

Histological observations suggested the presence of two types of ectopic fat deposits, namely infiltrated subcutaneous fat and isolated fat, in the lower region of the reticular dermal layer in aged skin. To elucidate their nature, we observed skin specimens by X-ray microCT. The epidermis, dermal layer, and subcutaneous adipose layer were well differentiated on CT images, and 3D skin was digitally reconstructed on computer. This method clearly showed that the isolated fat observed histologically was in fact connected to the subcutaneous fat, namely all ectopic fat is connected to the subcutaneous adipose layer. Statistical analysis showed that the severity of fat infiltration into dermal layer is significantly increased in aged skin compared with young skin.

Conclusion

Our findings indicate that subcutaneous fat infiltrates into the dermal layer of aged skin. Our 3D analysis approach is advantageous to understand changes of complex internal skin structures with aging.

Категории: Журналы

Mild to moderate atopic dermatitis severity can be reliably assessed using smartphone‐photographs taken by the patient at home: A validation study

Skin Research Technology - ср., 12/01/2022 - 22:09
Abstract Background

The use of photographs to diagnose and monitor skin diseases is gaining ground.

Objectives

To investigate the validity and reliability of photographic assessments of atopic dermatitis (AD) severity.

Methods

AD severity was evaluated in the clinic by two assessors using the Eczema Area and Severity Index (EASI), SCOring Atopic Dermatitis (SCORAD), and Investigator's Global Assessment (IGA). Participants photographed the lesions with their own smartphone and completed a questionnaire about the extent of eczema the same day from home. The photographs were assessed twice with an 8 weeks interval by five dermatologists experienced in photographic evaluations. Intraclass correlation coefficients (ICC) with 95% confidence interval (CI) were applied.

Results

Seventy-nine participants were enrolled. The ICC between clinical EASI and photographic EASI was 0.88 (95% CI 0.81–0.93), and 0.86 (0.70–0.93) between clinical SCORAD and photographic SCORAD.

Perfect agreement between clinical IGA and photograph IGA was observed for 62%, with the difference between the two never deviating with more than 1 score.

The inter-rater ICC for photographic EASI and photographic SCORAD, respectively, was 0.90 (0.85–0.94), and 0.96 (0.91–0.98). The intra-rater agreements between the first and second assessments varied from 0.95 to 0.98 for photographic EASI, and from 0.86 to 0.94 for photographic SCORAD.

Conclusion

There was high agreement between mild to moderate AD severity assessed clinically and based on smartphone photographs. Further, the photographic assessments can be reproduced with high reliability.

Категории: Журналы

Systemic Evaluation of Cutaneous Sarcoidosis: 15 year Dermatology Experience at UHL

Clin Exp Dermatol - ср., 12/01/2022 - 22:03
Summary

Sarcoidosis is a multisystem granulomatous disease which can affect almost any organ including skin, liver, ocular, cardiac, renal, nervous system, musculoskeletal and endocrine. Systemic evaluation is indicated in all patients diagnosed with cutaneous sarcoidosis as it is associated with asymptomatic systemic disease in 30-40% of patients. Guidelines recommend patients diagnosed with sarcoidosis undergo baseline and surveillance investigations including FBC, renal and liver profile, Vitamin D, serum calcium, ECG, CXR, pulmonary function tests (PFTs) and ophthalmology exam to assess for systemic involvement. Recommendations for surveillance monitoring vary on interval duration but include regular FBC, biochemistry, CXR, PFTS with additional investigations and prompt referral to respective specialties as indicated. A retrospective analysis was conducted to evaluate extracutaneous involvement and systemic evaluation of patients diagnosed with cutaneous sarcoidosis from 2014 – 2020. We compared our findings to international guidelines. Of the 18 patients included, cutaneous manifestation was the primary presentation for 67% (n=12). Extracutaneous disease subsequently developed in 67% (n=8) of these patients. Baseline investigations included CXR for 94% (n=17), PFTs 39% (n=7), ECGs 25% (n=4/16), FBC 94% (n=17), renal profile 89% (n=16), LFTs 83% (n=15), serum calcium 89% (n=16) with no vitamin D levels recorded. Specialist referral was required for 89% (n=16), including 94% (n=15) respiratory, 69% (n=11) ophthalmology, and 19% (n=3) nephrology. Results highlighted the importance of a structured protocol for the systemic evaluation of patients diagnosed with cutaneous sarcoidosis. We subsequently developed a baseline and surveillance protocol for the assessment of extracutaneous disease in patients at University Hospital Limerick.

Категории: Журналы

The spatiotemporal expression of NRAS and occurrence of giant congenital melanocytic nevi

Experimental Dermatology - ср., 12/01/2022 - 17:54
ABSTRACT

The mechanism underlying giant congenital melanocytic nevus (GCMN) formation is not fully understood. According to recent research, NRAS gene mutation is the main driving factor in GCMN. Melanocytic precursor cells proliferate during the embryonic stage after acquiring NRAS mutations. However, why GCMN undergoes intense proliferation in the embryonic stage and then stops postnatally remains unknown. The current theory for this phenomenon is that the GCMN undergoes oncogene-induced senescence. However, there is not enough evidence to indicate that senescence induces growth arrest in GCMN. In this study, we hypothesized that the expression level of the NRAS gene changes dynamically during the development and differentiation of neural crest cells into melanocytes and that the NRAS expression level determines whether the cell proliferates or becomes quiescent.

Категории: Журналы

GDNF neurotrophic factor signaling determines the fate of dermal fibroblasts in wound‐induced hair neogenesis and skin regeneration

Experimental Dermatology - ср., 12/01/2022 - 17:54
ABSTRACT

We propose that GDNF, a glial cell line-derived neurotrophic factor, can promote hair follicle neogenesis and skin regeneration after wounding by directing the fate of dermal fibroblasts. Our hypothesis is largely based on detailed GDNF and receptor analysis during skin regenerative stages, as well as the induction of GDNF receptors after wounding between the pro-regenerative Spiny mouse (genus Acomys) and its less regenerative descendant, the House mouse (Mus musculus). To characterize the GDNF-target cells, we will conduct a series of lineage-tracing experiments in conjunction with single-cell RNA and Assay for Transposase-Accessible Chromatin sequencing experiments. The heterogenetic dynamics of skin regeneration have yet to be fully defined, and this research will help to advance the fields of regenerative medicine and biology. Finally, we believe that stimulating the GDNF signaling pathway in fibroblasts from less-regenerative animals, such as humans, will promote skin regeneration, morphogenesis, and scarless wound healing.

Категории: Журналы

The sociological basis of the skin cancer epidemic

Int J Dermatol - ср., 12/01/2022 - 17:29
Abstract

Given the precipitous rise in its incidence in recent decades, skin cancer has been recognized as a growing epidemic. We explore the sociological underpinnings of this epidemic, including: (1) aging of the demographic; (2) human ecologic factors (residing in areas with high ambient ultraviolet levels and a depleted ozone layer); (3) large-scale European migration to more equatorial latitudes; (4) social structures that for centuries minimized miscegenation and maximized segregation; (5) gender-based differences in sunbathing, tanning, sunscreen use, and clothing choice; (6) occupational ultraviolet exposure; (7) the complex interplay of socioeconomic status, race, and urbanization on skin cancer incidence and mortality; (8) the effects of war on skin cancer incidence; (9) cultural shifts in clothing, travel, outdoor sports, recreation, and attitudes towards being tan; and (10) the indirect effects of religion. We show that without these sociological factors, the most common type of cancer would not be nearly as common.

Категории: Журналы

Cutaneous dirt‐adherent disease with Sjögren's syndrome

Dermatologic Therapy - ср., 12/01/2022 - 15:29
Dermatologic Therapy, Accepted Article.
Категории: Журналы

Erratum

Dermatology (Karger) - ср., 12/01/2022 - 15:15

Dermatology
Категории: Журналы

Photodynamic therapy for pediatric genital warts: a case report

Dermatologic Therapy - ср., 12/01/2022 - 15:09
Dermatologic Therapy, Accepted Article.
Категории: Журналы

Clinical practice guidelines for pseudoxanthoma elasticum (2017)

J Dermatology (Япония) - ср., 12/01/2022 - 14:53
Abstract

Pseudoxanthoma elasticum (PXE) is a progressive hereditary disease that affects tissues such as the skin, retina, blood vessels, and gastrointestinal tracts. Therefore, comprehensive medical care across clinical departments specialized in specific organs is needed to provide the best clinical practices to PXE patients. The Japanese version of clinical guidelines developed by the Japanese Dermatological Association was published in 2017, and aimed to promote equal accessibility of PXE-related medical care. Here, the English version of Japanese guideline is reported, and is intended to be worldwide reference for medical care of PXE.

Категории: Журналы

Antisperm Antibody Testing: A Comprehensive Review of Its Role in the Management of Immunological Male Infertility and Results of a Global Survey of Clinical Practices

World J Mens Health. 2022 Jan 1. doi: 10.5534/wjmh.210164. Online ahead of print.

ABSTRACT

Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males as early as 1954. Multiple causes of ASA production have been identified, and they are due to an abnormal exposure of mature germ cells to the immune system. ASA testing (with mixed anti-globulin reaction, and immunobead binding test) was described in the WHO manual 5th edition and is most recently listed among the extended semen tests in the WHO manual 6th edition. The relationship between ASA and infertility is somewhat complex. The presence of sperm agglutination, while insufficient to diagnose immunological infertility, may indicate the presence of ASA. However, ASA can also be present in the absence of any sperm agglutination. The andrological management of ASA depends on the etiology and individual practices of clinicians. In this article, we provide a comprehensive review of the causes of ASA production, its role in immunological male infertility, clinical indications of ASA testing, and the available therapeutic options. We also provide the details of laboratory procedures for assessment of ASA together with important measures for quality control. Additionally, laboratory and clinical scenarios are presented to guide the reader in the management of ASA and immunological male infertility. Furthermore, we report the results of a recent worldwide survey, conducted to gather information about clinical practices in the management of immunological male infertility.

PMID:35021297 | DOI:10.5534/wjmh.210164

Категории: MedLine
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