Acaros cambian los fosfolipidos en piel para exacerbar la Dermatitis Atopica.

Mechanism for dust mite–triggered atopic dermatitis identified

Researchers have identified a possible mechanism by which house dust mites could trigger the development of atopic dermatitis in individuals with a genetic predisposition.

The study, published online Feb. 10 in Science Translational Medicine, took skin and blood samples from individuals with atopic dermatitis and healthy controls, then exposed the samples to house dust mite allergen.

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They found that in individuals with atopic dermatitis, this exposure modified phospholipids in the skin to release lipid antigens that then drove T-cell reactivity and inflammation (Sci Transl Med. 2016 Feb 10. doi: 10.1126/scitranslmed.aad6833).

Furthermore, the study suggested that the skin barrier protein filaggrin can inhibit the modified phospholipid activity and decrease the skin inflammation caused by allergen exposure in atopic dermatitis; however, individuals with atopic dermatitis are more likely to have defective filaggrin. 

"The data would support therapeutic approaches to inhibit allergen-derived PLA2 [phospholipase A2] activity, together with treatments that target the downstream immunological effector pathways," wrote Dr. Rachael Jarrett of the University of Oxford (England) and coauthors.

The study was funded by the U.K. Medical Research Council and National Institute for Health Research Biomedical Research Centre, the National Institutes of Health, and the Burroughs Wellcome Fund in Translational Medicine. Several of the researchers acknowledged grants and pharmaceutical company support. No conflicts of interest were declared.

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

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Apoyando el uso del laser co2 fraccionado en la remodelación de cicatrices.

Apoyando el uso del laser co2 fraccionado en la remodelación de cicatrices., inclusive en la población pediátrica y adolescente.

Published in Dermatology

Journal Scan / Review · February 22, 2016

Scar Management in Pediatric and Adolescent Populations

Pediatrics

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• This review article addresses new scar treatment strategies for scar management in the pediatric and adolescent populations. Intralesional corticosteroids and intralesional 5-fluorouracil have both proven effective in the treatment of keloids and hypertrophic scars, but 5-fluorouracil is "off-label" in pediatrics. Autologous fat transfer (AFT) is used for scars associated with volume loss and for the treatment of facial malformations. Additionally, AFT combined with composite grafting offers benefits beyond volume replacement alone. Surgical excision and revision may be necessary when conservative management fails or when scars are associated with debilitating contractures. Pulsed dye laser targets hemoglobin and can reduce scar erythema, pain, itch, and prominence. Fractional ablative laser treatments have established a new gold standard in acne, surgical, and traumatic scar treatment due to their high efficacy and safety. They work by inducing scar remodeling with the resulting architecture closer to that of normal skin.

• Data on laser-assisted delivery of topical corticosteroids are limited, but this technique shows promise. Theoretical treatments on the horizon include reactivation of fetal pathways, stem cells, autologous fibroblasts injections, interleukin-10, basic fibroblast growth factor, and MMPs. Several safe and efficacious treatment modalities are available for scar treatment in pediatrics and adolescents. Novel treatments that target specific molecular and cellular pathways are on the horizon.

– Anna Wile, MD

Abstract

This abstract is available on the publisher's site.

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For most children and adolescents who have developed symptomatic scars, cosmetic concerns are only a portion of the motivation that drives them and their caregivers to obtain treatment. In addition to the potential for cosmetic disfigurement, scars may be associated with a number of physical comorbidities including hypertrichosis, dyshidrosis, tenderness/pain, pruritus, dysesthesias, and functional impairments such as contractures, all of which may be compounded by psychosocial factors. Although a plethora of options for treating scars exists, specific management guidelines for the pediatric and adolescent populations do not, and evidence must be extrapolated from adult studies. New modalities such as the scar team approach, autologous fat transfer, and ablative fractional laser resurfacing suggest a promising future for children who suffer symptomatically from their scars. In this state-of-the-art review, we summarize cutting-edge scar treatment strategies as they relate to the pediatric and adolescent populations.

Examenes Cutáneos completos

Los canceres de piel, se detectan durante los exámenes cutáneos completos y es por esto que se deben realizar por lo menos una vez al año. La publicación de abajo justifica con números...Published in Dermatology

Expert Opinion / Commentary · February 22, 2016

The Case for Total Body Skin Examination: The Evidence Is Sufficient

Written by

 

 Jane Grant-Kels MD

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The recommendation by the USPSTF is mind boggling (http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement168/skin-cancer-screening2)! Skin cancers are on the rise in our country, resulting in potential mutilation and even death if not diagnosed early! There is absolutely no denying the fact that skin cancer is now of epidemic proportions, with increasing numbers every year. The 2015 estimate in the United States alone is 5.4 million cases of treated non-melanoma skin cancer (NMSC).1 Those who participated in penning the conclusion of this USPSTF recommendation have not accepted the reality that there are more new skin cancers treated in the United States (not only this year but over the last 3 decades) than all other cancers combined! 2,3 The National Cancer Institute has reported that between 40% and 50% of Americans who live to the age of 65 years will develop a NMSC at least once.4

Some might counter with the argument that skin cancer, although the most common cancer, is not generally life-threatening. I would retort that this is due to continued vigilance and skin screening performed by dermatologists. Nevertheless, despite our best efforts, 2% of patients in the United States diagnosed with cutaneous squamous cell carcinoma will die annually from their skin cancer.5 Additionally, approximately 3000 patients with advanced basal cell carcinoma will die this year of metastatic basal cell carcinoma.6 Finally, 1 American expires every 57 minutes in the United States from malignant melanoma.7

I have been practicing dermatology for almost 40 years. The majority of patients I care for do not get full skin cancer examinations by their primary care physicians. The skin cancers that I diagnose are generally asymptomatic, and the patients and their partners are completely unaware of these lesions. Publications by others have substantiated my own experiences. For example, Daniel Federman's group noted that incidental skin cancers were identified by a full skin exam performed by a dermatologist who, in addition to examining the specific lesion on the patient referred to them by a primary care physician, also performed a total body skin examination. They concluded that there was no substitute for complete skin examinations.8

Erin Washaw and her group in Minnesota published their findings this year regarding the rate of incidental cutaneous malignancies on routine dermatology exams at a Veterans Affairs medical center. They performed a retrospective chart review and found that, of 17,174 dermatology exams, over 13% of the patients had an incidental lesion biopsied—of which, 50.3% were malignant, leading them to conclude that an in-person skin examination by a dermatologist was still the standard of care.9

Lastly, a 2013 study from the University of Edinburgh also stressed the importance of a total body skin examination. These authors reported that over one-third of melanomas are detected as incidental lesions on complete skin examination.10

The take-away message is clear: a total body skin examination must be performed annually on all patients and, if discontinued, will likely lead to melanomas and NMSCs being missed. I would favor more educational opportunities for family and internal medicine physicians regarding the skin so that they can perform these full skin exams as part of their annual screenings of their patients. High-risk patients should then be appropriately referred to dermatologists for further and specialized surveillance.

Effects of Bleach and Water Baths on Skin Barrier Function in Atopic Dermatitis | PracticeUpdate

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Journal Scan / Research · February 18, 2016

Effects of Bleach and Water Baths on Skin Barrier Function in Atopic Dermatitis

The British Journal of Dermatology

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• This study compares bleach baths with water baths on skin barrier function in atopic dermatitis using a split-body method as control. Neither bleach baths nor tap water baths were shown to disrupt barrier function. There was no difference observed in mean hydration, transepidermal water loss, and pH status between tap water and bleach baths. No discomfort was reported with either method. 

• Previous studies have shown bleach baths to significantly improve atopic dermatitis severity, and this study emphasizes the safety and tolerability of bleach baths. 

– Anna Wile, MD

Abstract

This abstract is available on the publisher's site.

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Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with defective epidermal barrier function, characterized by decreased stratum corneum (SC) hydration, and increased TEWL (transepidermal water loss) and pH. Staphylococcus aureus (SA) skin colonization is present in nearly all cases of AD exacerbation and correlates with disease severity, suggesting an infection – inflammation cycle. The use of sodium hypochlorite (bleach) bath alone and as an adjunct to intranasal mupirocin ointment is associated with reduction in AD severity, and decreases annual skin infection cases by ten-fold. In a Cochrane review on various interventions to reduce SA colonization, including oral antibiotics, topical steroids and antibiotic ointments, only bleach bath showed a significant improvement in AD severity.

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

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2208-8206

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Filtor mas ropa protector, no sólo filtro.

Combination Approach May Increase Chances Of Proper Sun Protection For Kids.

HealthDay (2/16, Preidt) reports that research published online in JAMA Pediatrics suggests "a combination approach boosts the chances of proper sun protection for" kids. Half of participants were assigned to a "sun safety program" that "included a 13-page, read-along book that featured child characters highlighting sun safety, a sun-protective swim shirt, and four sun protection reminders sent weekly by text message." Kids in this group had a higher likelihood of wearing shirts with sleeves and using sunscreen when it was sunny outside. Kids "in the program also had smaller sun-related changes in skin pigment."

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

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2208-8206

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Brote por Zika

INFECTIONS, INFESTATIONS & BITES

Dermatologic features may help distinguish Zika infection

Dermatologists may be seeing patients who have recently traveled to an area affected by the current Zika outbreaks, who present with a rash and possibly a fever. 

Dr. Stephen K. Tyring

Before serology and possibly virology confirms the diagnosis, there are certain distinguishing characteristics that may help distinguish Zika initially from dengue and Chikungunya, according to Dr. Stephen K. Tyring. 

Dr. Tyring, clinical professor of dermatology at the University of Texas, Houston, said in an interview that serology is required to confirm the diagnosis, and should be obtained via state and local health departments, which are increasingly being provided with test kits. Virology via polymerase chain reaction also may be needed to diagnose the infection.

About 20% of people infected with Zika virus develop symptoms. In Texas, by early February, 10 cases had been diagnosed statewide.

The Zika rash is characterized by blanchable macules and papules, which may start on the face or trunk 3-5 days after the febrile phase, and become more diffuse, said Dr. Tyring.

The erythematous macules with areas of sparing is similar to the rash seen with Chikungunya and dengue, two other viral infections that have cutaneous manifestations. With a Zika rash, macules are more likely than papules, but papules are certainly possible, he said. 

Dr. Stephen K. Tyring, Dr. Zeena Nawas, The University of Texas Health Science Center at Houston Blanchable macules and papules, seen here on the feet, tend to start on the face or trunk, 3-5 days after the febrile phase, and become more diffuse.

In addition, someone with a Zika infection is more likely to have conjunctivitis than someone with dengue or Chikungunya, and may have red sclera, he noted. But all the other symptoms associated with dengue and Chikungunya, such as the arthralgias, headaches, and myalgias, could certainly be present with Zika as well, as the three diseases have similar clinical features.

Dr. Tyring referred to a study published in 2009 describing 31 cases in a 2007 Zika outbreak in Micronesia, which reported that 90% (28 patients) had a macular or papular rash. In addition, 20 (65%) had a mild fever, 20 (65%) had arthralgia of the small joints, and 17 (55%) had nonpurulent conjunctivitis (N Engl J Med. 2009 Jun 11;360[24]:2536-43).

In September, when Dr. Tyring was attending the Brazilian Society of Dermatology meeting in Sao Paolo, he visited some clinics and saw some of the first patients diagnosed with Zika virus – before the connection with the microcephaly or Guillain-Barre had been made. Serologic testing had confirmed that the cases were Zika infections, not Chikungunya or dengue. 

At that time, cases were being viewed as a mild versions of Chikungunya or dengue, "in other words, nothing that they were fearing any more than all the other arboviruses that are so common," Dr. Tyring said in an interview.

Dr. Stephen K. Tyring, Dr. Zeena Nawas, The University of Similar blanchable macules and papules are seen here on the fingers.

With some of the patients, "we saw a bit of desquamation of the extremities, such as the fingertips," he said. (See photos.) "But generally, it's not very distinguishable between dengue and Chikungunya."

Health care providers are encourage to report suspected cases to their state health departments. 

emechcatie@frontlinemedcom.com

 

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Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

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Interesante respuesta a la pregunta de una paciente...

Jueves 4 de Febrero 2016 

• Portafolio.co

• Negocios

• Empresas

Negocios 

11:57 am

'Fórmula de Cicatricure crema no tiene respaldo científico'

Por solicitud de Unilever, Superindustria ordenó a Genomma Lab retirar del comercial que se emite en televisión la expresión "comprobamos que la exclusiva fórmula Cicatricure crema con pentápeptidos ayudó a un 76 % la mejoría de las arrugas y las líneas de expresión, aún en las áreas más difíciles".

La Superintendencia de Industria y Comercio (SIC)decretó medida cautelar judicial contra Genomma Lab Colombia Ltda., ordenándole retirar inmediatamente de su comercial de televisión, la afirmación que asegura que la fórmula de su producto Cicatricure crema tiene sustento científico.

Unilever fue quien solicitó a la Superindustria revisar el caso. La SIC determinó que, al no tener sustento lo asegurado en el comercial de Genomma,  podría constituir un acto desleal de engaño que afecta a su competidor.

La SIC también encontró, preliminarmente, que la emisión de la frase mencionada en el comercial analizado también estaría mintiendo al asegurar que su fórmula está sustentada en el estudio Reducción de los signos de envejecimiento facial. Estudio Clínico e Instrumental, elaborado por Medcin Instituto de Pele Ltda. del Brasil en junio de 2010," pero en realidad este estudio no sustenta dicha conclusión y, por lo tanto, resultaría engañosa para los consumidores", asegura la entidad.

"Por tratarse de una medida cautelar, la decisión adoptada es de inmediato cumplimiento", puntualizó la SIC en un comunicado.

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Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

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2208-8206

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