Articulo sobre micorinjuria y regeneracion del cabello y pigmento. Gracias!

Stem Cells and Development VOL. 0, NO. ja | normal

Micro-injury Induces Hair Regeneration and Vitiligo Repigmentation Through Wnt/β-catenin Pathway

Xiaofeng Han

,

Li Chang

,

Zhijin Qiu

,

Mao Lin

,

Yuyi Wang

,

Deming Liu

,

Qingchun Diao

,

Julia Li Zhong

, and

Prof. David Wei Xu

Published Online: 19 Jan 2022 https://doi.org/10.1089/scd.2021.0276

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Abstract

Extrinsic injury can evoke intrinsic stimulation and subsequently initiate the physiological repair process. This study aims to investigate whether clinically acceptable micro-injury could be employed to create local stimuli to induce hair regeneration and vitiligo repigmentation. A novel device was designed and manufactured to precisely control the micro-injury parameters. Then the most appropriate extent of micro-injury without over-damaging the skin was evaluated. Finally, the effects of micro-injury on hair regeneration and vitiligo repigmentation were examined by macroscopical observation, histological staining, gene and protein expression analysis. We discover that proper micro-injury effectively induces hair regeneration by activating the hair follicle stem cell proliferation and migration downwards to the hair matrix, finally shifting the hair follicle stage from telogen into anagen. On vitiligo model mice, micro-injury also induces the hair follicle melanocyte stem cells to migrate upwards to the interfollicular epidermis, activating and giving rise to melanocytes to repopulate the vitiligo lesion. Mechanistic analysis indicates that the canonical Wnt/-catenin pathway plays a key role in the micro-injury-induced repair process. The present study demonstrates that micro-injury has great potential in inducing hair regeneration and vitiligo repigmentation, laid a foundation to develop a micro-injury-based treatment method in alopecia and vitiligo.

Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients

Consensus Statement 

September 1, 2021

A Delphi Consensus Statement

Paul R. Massey, MD, MPH¹; Chrysalyne D. Schmults, MD, MSCE¹; Sara J. Li, BS¹; et alSarah T. Arron, MD, PhD²; Maryam M. Asgari, MD, MPH^3,4; Jan Nico Bouwes Bavinck, MD, PhD⁵; Elizabeth Billingsley, MD⁶; Travis W. Blalock, MD⁷; Katie Blasdale, MBBS⁸; Bryan T. Carroll, MD, PhD^9,10; John A. Carucci, MD, PhD¹¹; Alvin H. Chong, MBBS, MMed^12,13; Sean R. Christensen, MD, PhD¹⁴; Christina Lee Chung, MD^15,16; Jennifer A. DeSimone, MD¹⁷; Emilie Ducroux, MD¹⁸; Begoña Escutia-Muñoz, MD, PhD¹⁹; Carla Ferrándiz-Pulido, MD, PhD^20,21; Matthew C. Fox, MD²²; Roel E. Genders, MD, PhD⁵; Alexandra Geusau, MD²³; Petter Gjersvik, MD, PhD^24,25; Allison M. Hanlon, MD, PhD²⁶; Edit B. Olasz Harken, MD, PhD²⁷; Günther F.L. Hofbauer, MD²⁸; R. Samuel Hopkins, MD²⁹; Justin J. Leitenberger, MD²⁹; Manisha J. Loss, MD³⁰; Veronique Del Marmol, MD, PhD³¹; José M. Mascaró Jr, MD³²; Sarah A. Myers, MD³³; Bichchau T. Nguyen, MD, MPH^34,35; Walmar R. P. Oliveira, MD, PhD³⁶; Clark C. Otley, MD³⁷; Charlotte M. Proby, MA³⁸; Emőke Rácz, MD, PhD³⁹; Veronica Ruiz-Salas, MD, PhD⁴⁰; Faramarz H. Samie, MD, PhD⁴¹; Deniz Seçkin, MD⁴²; Syed N. Shah, MBBS⁴³; Thuzar M. Shin, MD, PhD⁴⁴; Stephen P. Shumack, MBBS⁴⁵; Seaver L. Soon, MD⁴⁶; Thomas Stasko, MD⁴⁷; Elisa Zavattaro, MD, PhD⁴⁸; Nathalie C. Zeitouni, MD^49,50; Fiona O'Reilly Zwald, MD^51,52,53; Catherine A. Harwood, MBBS, PhD^54,55; Anokhi Jambusaria-Pahlajani, MD, MSCE²²

Author Affiliations

JAMA Dermatol. 2021;157(10):1219-1226. doi:10.1001/jamadermatol.2021.3180

Key Points

Question  What are the recommended medical interventions for skin cancer prevention in solid organ transplant recipients?

Findings  On the basis of the results of the Delphi study, cryotherapy is recommended as first-line therapy for actinic keratosis, with the exception of thin actinic keratoses grouped in 1 area. In that scenario and for field cancerization, field therapy should be performed.

Meaning  Oral chemoprevention and discussion with the transplant team regarding modification of immunosuppression should be initiated when the patient develops multiple low-risk cutaneous squamous cell carcinoma (>10 tumors per year) or a high-risk cutaneous squamous cell carcinoma.

Abstract

Importance  There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs).

Objective  To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs.

Evidence Review  Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses.

Findings  The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage–based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC.

Conclusions and Relevance  Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.

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Studies assess association between 3 doses of COVID-19 vaccine and infection and death caused by SARS-CoV-2 Omicron and Delta variants

Findings from a study published in JAMAsuggest that receipt of 3 doses of mRNA vaccine, relative to being unvaccinated and to receipt of 2 doses, was associated with protection against both the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron and Delta variants, although the higher odds ratios for Omicron suggest less protection for Omicron than for Delta.

"For 3 doses vs unvaccinated, the ORs corresponded to an estimated effectiveness (1 – odds ratio [OR]) of 67.3% (95% confidence interval [CI], 65.0%-69.4%) for Omicron and 93.5% (95% CI, 92.9%-94.1%) for Delta. For 3 doses vs 2 doses, the ORs corresponded to an estimated relative effectiveness of 66.3% (95% CI, 64.3%-68.1%) for Omicron and 84.5% (95% CI, 83.1%-85.7%) for Delta," reported Emma K Accorsi, Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, and colleagues. 

"For Omicron, the similarity between ORs for 3 doses using the unvaccinated referent group and the 2-dose referent group is consistent with the attenuation of the OR for 2 doses vs unvaccinated with time since second dose, which reflected no significant association by 6 months after second dose for both products. For Delta, the association between infection and 2 doses vs unvaccinated also attenuated over time since second dose, which is consistent with previous reports; however, the ORs were statistically significant even up to 11 months after the second dose," the researchers noted. 

The researchers performed a test-negative case-control analysis among adults 18 years or older with COVID-like illness tested from December 10, 2021, through January 1, 2022, by a national pharmacy-based testing programme (4,666 COVID-19 testing sites across 49 US states).

Overall, 23,391 cases (13,098 Omicron; 10,293 Delta) and 46,764 controls were included (mean age, 40.3 [SD, 15.6] years; 42 050 [60.1%] women). Prior receipt of 3 mRNA vaccine doses was reported for 18.6% (n = 2,441) of Omicron cases, 6.6% (n = 679) of Delta cases, and 39.7% (n = 18,587) of controls. Meanwhile, prior receipt of 2 mRNA vaccine doses was reported for 55.3% (n = 7,245) of Omicron cases, 44.4% (n = 4,570) of Delta cases, and 41.6% (n = 19,456) of control; meanwhile, being unvaccinated was reported for 26.0% (n = 3412), 49.0% (n = 5,044), and 18.6% (n = 8,721) of cases, respectively. 

For vaccination history, the most common combination of 2 doses was BNT162b2/BNT162b2 (63.4% of 2-dose regimens), followed by mRNA-1273/mRNA-1273 (36.4%), while the most common 3-dose combination was BNT162b2/BNT162b2/BNT162b2 (57.5% of 3-dose regimens). Among individuals receiving 2 vaccine doses only, the median time between the second dose and test date was 8 months. Among those receiving 3 vaccine doses, the median time between the second and third dose was 7 months, and between the third dose and test date was 1 month.

The adjusted odds ratio for individuals who received 3 doses of vaccine compared with those who were unvaccinated was 0.33 (95% CI, 0.31-0.35) for Omicron and 0.065 (95% CI, 0.059-0.071) for Delta. In comparison with individuals who received 2 vaccine doses, the adjusted odds ratio among those receiving 3 vaccine doses was 0.34 (95% CI, 0.32-0.36) for Omicron and 0.16 (95% CI, 0.14-0.17) for Delta.

The researchers also observed that median cycle threshold values were significantly higher in cases occurring in individuals who had received 3 vaccine doses compared to those who received 2 vaccine doses for both Omicron and Delta (Omicron N gene: 19.35 vs 18.52; Omicron ORF1ab gene: 19.25 vs 18.40; Delta N gene: 19.07 vs 17.52; Delta ORF1ab gene: 18.70 vs 17.28; Delta S gene: 23.62 vs 20.24).

"Although these findings provide evidence supporting that 3-dose schedules are protective and that booster doses are more protective than primary series alone, the significantly higher OR for Omicron suggests that booster doses are less protective against Omicron than against Delta. These results are consistent with in-vitro neutralisation assays that suggested the potential for immune evasion with Omicron," the researchers noted, adding that "[these findings] also highlight that, in the setting of Omicron, higher booster coverage rates may be needed to achieve the same public health benefit as during Delta predominance. Additionally, nonpharmaceutical interventions may provide an important adjunct to slow the spread of Omicron."

Similarly, findings from the US Centers for Disease Control and Prevention's (CDC) latest Morbidity and Mortality Weekly Report show that protection against infection and death during the Delta-predominant period against infection during Omicron emergence were higher among booster vaccine dose recipients, and especially among persons aged 50–64 and ≥65 years.

To assess the impact of full vaccination with additional and booster doses (booster doses), case and death rates and incidence rate ratios (IRRs) were estimated among unvaccinated and fully vaccinated adults by receipt of booster doses during pre-Delta (April–May 2021), Delta emergence (June 2021), Delta predominance (July–November 2021), and Omicron emergence (December 2021) periods in the United States. Weekly COVID-19 cases (April 4–December 25, 2021) and associated deaths (April 4–December 4, 2021) by vaccination status, including additional and booster doses starting October 3, were reported from 25 state and local health departments that routinely link case surveillance to vaccination data from immunisation registries. 

During April 4–December 25, 2021, a total of 6,812,040 COVID-19 cases among unvaccinated persons and 2,866,517 cases among fully vaccinated persons were reported among persons aged ≥18 years in 25 US jurisdictions, while 94,640 and 22,567 COVID-19-associated deaths among unvaccinated and fully vaccinated persons, respectively, were reported by December 4. 

The age-standardised IRR for cases in unvaccinated versus fully vaccinated persons was 13.9 during April–May and progressively declined to 8.7 during June, 5.1 during July–November, and 3.1 during December, coinciding with the periods of Delta emergence, Delta predominance, and Omicron emergence, respectively. This decline suggests a change in crude vaccine effectiveness (VE) for infection from 93% during April–May, to 89% during June, 80% during July–November, and to 68% during December. Age-standardised IRRs for deaths among unvaccinated versus fully vaccinated persons were relatively stable; crude VE for deaths was 95% during April–May, 94% during June, and 94% during July–November.

Meanwhile, age-standardised case IRRs among unvaccinated persons compared with fully vaccinated persons with a booster dose declined from 13.9 during October–November to 4.9 during December, representing potential decreases in crude VE for infection from 93% to 80%, respectively. Comparing unvaccinated persons with fully vaccinated persons without a booster dose, age-standardised case IRRs during October–November and December were 4.0 and 2.8 respectively, representing decreases in VE from 75% to 64%. During October–November, age-standardised IRRs for deaths among unvaccinated persons were 53.2 compared with those in fully vaccinated persons with a booster dose and 12.7 compared with persons without a booster dose; these results represented crude VE against death of 98% and 92%, respectively.

Further, the report noted that booster doses provided the largest gains in protection among persons aged ≥65 years followed by persons aged 50–64 years when compared with those aged 18–49 years.

"Early analysis of surveillance data provided crude signals of VE that were consistent with other studies reporting decreased VE against Omicron infection compared with Delta and increased protection from booster doses compared with a primary series of COVID-19 vaccination alone. Ongoing analyses will help monitor the impact of the Omicron variant and other emerging variants on VE against COVID-19 cases and associated deaths," the report concluded.

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Allergic Contact Dermatitis

Eczema types: Contact dermatitis tips for managing

If you have contact dermatitis, the right skin care and prevention strategies can help heal your skin and prevent another itchy, painful rash. Here are the tips that dermatologists give their patients who have contact dermatitis.

1. Avoid what's causing your rash. To heal your skin and prevent another rash, you need to: 1) Know what's causing your rash and 2) Avoid touching what causes it.
   
   For example, if you have an allergy to nickel, you need to know what often contains nickel and how to avoid it. You'll find five tips that can help you avoid nickel at, Nickel allergy: How to avoid exposure and reduce symptoms.
   
   If you're uncertain what's causing your rash, a board-certified dermatologist can help. To find out how, see Contact dermatitis: Diagnosis and treatment.
   
   Until you see a dermatologist, you may be able to get an idea of what's causing your rash by going to, Itchy rash could be contact dermatitis.

2. Stop scratching. The rash can be itchy, but scratching tends to worsen the rash. Scratching can also lead to an infection. 

3. Relieve the itch with cool compresses, anti-itch medication, or oatmeal baths. To make a cool compress, run cold water over a clean towel, then apply the cool, damp towel to the area for 10-15 minutes a few times daily.
   
   Other ways to get relief are to apply an anti-itch medication that contains 1% hydrocortisone to your rash, slather calamine lotion on your itchy skin, or soak in a cool oatmeal bath. You can buy all these without a prescription.
   
   Calamine lotion and oatmeal baths can also help dry oozing skin.

4. Apply a fragrance-free moisturizer or barrier repair cream after washing. This helps seal in moisture, which your skin needs. Of course, you want to test this product before applying it widely. When you find a product that won't cause a skin reaction, apply the moisturizer or barrier repair cream while your skin is still damp after washing.
   
   To get the best results, it helps to apply your moisturizer (or barrier repair cream) throughout the day when your skin feels dry.

5. Wash new clothes before you wear them. Washing new clothes helps to remove chemical residues and dyes that could cause a reaction.

6. Remember two key facts about contact dermatitis. If you suddenly develop a new rash, you can miss a likely cause, unless you know the following:

   • The rash may not be caused by what's touching your skin when you first see the rash. Something that touched your skin hours or days ago may be the cause. A rash from an antibiotic ointment may show up 4 days later.
   • You can develop an allergic reaction to a product that you've used for years. This can happen for one of two reasons. If the product has been reformulated, it can contain different ingredients. The second reason is that you've developed a new allergic reaction.

7. Get your skin care advice from your dermatologist. If you have raw, irritated skin or have a skin hypersensitivity, your skin needs special care. Dermatologists are the medical doctors who specialize in skin care. A dermatologist can tell you which products would be best for you and which ones to avoid.

How dermatologists help people who have contact dermatitis

Contact dermatitis can affect your life. A rash can come and go unexpectedly, making it difficult to do your job or enjoy life to the fullest. By teaming up with a dermatologist you can get treatment, often find out what causes your rash, and feel more comfortable. 

If you have a rash that blisters, comes and goes, or causes discomfort, see a board-certified dermatologist.

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References
Carol R. "Are you a rash whisperer?" Dermatol World. 2019:29(1):44-9.

Mowad CM, Anderson B, et al. "Allergic contact dermatitis: Patient diagnosis and evaluation." J Am Acad Dermatol. 2016;74:1029-40.

Mowad CM, Anderson B, et al. "Allergic contact dermatitis: Patient management and education." J Am Acad Dermatol. 2016;74:1043-54.

Usatine RP and Riojas M. "Diagnosis and management of contact dermatitis." Am Fam Physician. 2010 Aug 1;82(3):249-55.

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Written by:
Paula Ludmann, MS

Reviewed by:
Matthew Elias, MD, FAAD
Iltefat Hamzavi, MD, FAAD
Benjamin Stoff, MD, FAAD

Last updated: 1/22/21

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Platelet Count, Mean Platelet Volume, and Red Cell Distribution Width as Markers for Psoriasis Severity

Abstract

Background: Psoriasis is a chronic, inflammatory skin condition that is growing in prevalence globally. Routinely available options to assess psoriasis severity and progression are limited. More options are needed to monitor disease progression as therapeutic management is based on disease severity. 
Objectives: This study evaluates the usage of complete blood count components (CBC) including platelet count, mean platelet volume (MPV), and red cell distribution width (RDW) as hematological markers for assessing psoriasis severity. 
Materials and Methods: In this cross-sectional study of 120 patients with psoriasis, disease severity was assessed using the PASI score followed by a blood draw to determine whether correlations existed between each marker and PASI score. 
Results: A significant, positive correlation was found between total platelet count and PASI while no such correlation was found in MPV and RDW. When stratifying for age, duration of disease, sex, and body parts involved, we found intriguing relationships and offer potential explanations for their occurrence. 
Conclusion: Our findings suggest that hematological parameters MPV, platelet count, and RDW found in the CBC are useful in identifying psoriasis severity to some extent. We foresee the use of RDW, MPV, and platelet count biomarkers as a complement to the PASI score in assessing severity for psoriasis patients, while also as a gauge for likelihood of developing comorbidities such as cardiovascular disease. 

J Drugs Dermatol. 2022;21(2): doi:10.36849/JDD.6127 

The prevalence of dermatologic disease is rising in Southeast Asia. As such, clinicians in this region search to identify risk factors and diagnostic markers to better understand these conditions and develop appropriate diagnostic criteria.¹ One such condition includes psoriasis, a chronic inflammatory skin disease affecting nearly 2% of individuals of European descent and 0.2â€"4% of the world population.² The prevalence of psoriasis in dermatological departments in Southeast Asia was reported to be nearly 3.8%.¹ One hallmark of psoriasis is its tendency to wax and wane, with flares related to systemic and environmental factors including stress and infection. Thus, the prevalence of psoriasis may be underreported in certain areas due to its undulating nature.³ 

Genetics and immunological mechanisms are thought to play a significant role in psoriasis.⁴Furthermore, many comorbidities are associated with symptom onset and progression to severe disease. Psoriasis has been associated with metabolic syndromes including obesity, dyslipidemias, diabetes, hypertension, and cardiovascular disease (CVD). Patients with psoriasis may have hematological, biochemical, and immunological abnormalities characterized by markers varying amongst psoriasis subtypes.⁵ Determining which of these indicators are associated with psoriasis may improve diagnostic confidence, help classify between various subtypes, serve as a prognostic marker, better prepare the clinician for treatment options, and aid in monitoring progression of disease. Two hematological markers which can reflect the inflammatory status of psoriasis patients include red blood cell distribution width (RDW) and mean platelet volume (MPV).⁶ 

The objective for this study was to find the correlation of platelet count, MPV, and RDW with severity of disease in psoriasis patients as measured by the Psoriasis Area and Severity Index

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Psoriasis en niños

Study Reveals Seven Criteria That May Improve Discrimination Of Psoriasis Between Other Inflammatory Skin Conditions In Children, Adolescents

Dermatology Advisor (1/11, May) reported, "Findings from the DIPSOC study reveal 7 criteria that could prove useful in discriminating psoriasis from other inflammatory skin disorders in children and adolescents." The criteriapublished in the British Journal of Dermatology include: "scaling and erythema involving the hairline; external auditory canal or extensor surfaces of the elbows and knees; persistent well-demarcated erythematous rash anywhere on the body; persistent well-demarcated erythema involving the umbilicus or napkin area and crural folds; and family history of psoriasis."

        AAD Resource: Psoriasis & Psoriatic Arthritis Pamphlet

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Laser y PRR para alopecia androgenetica...

A study to assess the efficacy of fractional carbon dioxide laser with topical platelet-rich plasma in the treatment of androgenetic alopecia

Sujirod Hanthavichai, Nutthinee Archavarungson et al.

Lasers Med Sci. 2022 Jan 4 [Epub ahead of print]

Owing to the inadequate response to and limitations of the approved medications for androgenetic alopecia, novel therapies are warranted to enhance outcomes. The objective of this paper is to ascertain the effectiveness of fractional carbon dioxide laser followed by platelet-rich plasma application on hair regrowth and to compare the two laser settings. Seven participants were enrolled in this half-head pilot study based on different laser pulse energy and density values (12 mJ, 800 spots/cm 2 and 22 mJ, 400 spots/cm 2 ). Ten treatment sessions were performed every 2 weeks with 12-week follow-up. The evaluation methods were based on hair density from standardized phototrichograms, global photographic assessment, and patient satisfaction. Significantly increased total and terminal hair densities were observed during treatment in both groups as compared with baselines. The mean total hair density has weekly increased significantly with high pulse energy (1.42 hair/cm 2 ) as compared to low pulse energy (1.04 hair/cm 2 ) throughout the study period (p = 0.023; 4.89 hair/cm 2 ). Global photographs and patient satisfaction scores demonstrated improvement, but only the latter showed statistical significance (p = 0.029). The average pain intensity scores were not different between the groups (p = 0.760) all over the procedure. The adverse events were minor and well tolerated. This synergistic treatment remarkably leads to hair restoration and high patient satisfaction. The parameters of 22-mJ beam energy with 400 spots/cm 2 density are appropriate and superior to 12-mJ beam energy with 800 spots/cm 2 . Albeit higher energy, no more pain is indicated in the high pulse energy group. Trial registration number (TRN): TCTR20180619004, Thai Clinical Trials Registry (TCTR) since 2018-05-15 13:39:48.



SOURCE : Lasers in Medical Science

Isotretinoina no toxicidad ocular.

Cross-sectional assessment of the ellipsoid zone and the retinal pigment epithelium-Bruch membrane complex after systemic isotretinotin use

İrem Genç Işık, Mehmed Uğur Işık

Cutan Ocul Toxicol. 2022 Jan 3 1-14 [Epub ahead of print]

PURPOSE To evaluate the cross-sectional areas of the retinal pigment epithelium-Bruch membrane complex (RPE-B) and ellipsoid zon (EZ) and the thickness of the macula, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GC-IPL) in patients using short-term systemic isotretinoin.

METHOD A total of 43 right eyes of 43 patients treated with systemic isotretinoin for acne vulgaris were included in this prospective study. Macula, GC-IPL, RNFL thicknesses and central cross-sectional EZ and RPE-B areas were evaluated with optical coherence tomography (Zeiss, Cirrus HD OCT 5000) prior to treatment and in 1st, 2nd and 3rd months after the onset of isotretinoin treatment. For measurement of EZ and RPE-B area, foveal EDI-OCT scans were binarized by using the public domain software ImageJ 1.51s.

RESULTS Mean duration of isotretinoin treatment was 77 ± 15 days and mean dose was 2228 ± 574 milligrams. There was a statistically significant increment in central cross-sectional EZ and RPE-B areas in each follow-up examination, when analyzed by repeated measurement analysis (p:0.002 and p:0.006, respectively). There was no correlation between total isotretinoin dose and the difference between final and basal EZ and RPE-B areas (p > 0.05, for both). When repeated measurements in follow-up examinations were compared, GC-IPL thicknesses except the superotemporal region (p:0.040) and RNFL thicknesses didn't show a significant difference (p > 0.05). There wasn't any significant relation between total isotretinoin dose and 3rd month and basal measurement differences in macula, GC-IPL and RNFL thicknesses in any area (p > 0.05, for all).

CONCLUSION There has been an increase in the area of RPE-B and EZ with short-term use of isotretinoin therapy. Future studies examining the relationship between functional tests and the RPE-B and EZ areas may provide more in-depth information on the effects of isotretinoin in the eye.



SOURCE : Cutaneous and Ocular Toxicology

Oral vs SC en psoriasis finalmente hay prueba.

Comparison of the clinical efficacy of subcutaneous versus oral administration of methotrexate in patients with psoriasis vulgaris: a randomized controlled trial

Charoen Choonhakarn, Suteeraporn Chaowattanapanit et al.

Clin Exp Dermatol. 2022 Jan 11 [Epub ahead of print]

BACKGROUND Evidence demonstrates that parenteral administration of methotrexate (MTX) has a higher drug bioavailability with respect to the oral route of administration. This difference is even more pronounced for medium-to-high dosages.

OBJECTIVES To compare the efficacy, safety, and tolerability of oral and subcutaneous (SC) MTX for treatment of psoriasis.

METHODS A randomized, comparative, single-blind, 32-week study was conducted. The clinical response was evaluated using the Psoriasis Area Severity Index (PASI) and the patient global assessment was assessed using the Visual Analog Scale (VAS).

RESULTS Seventy-seven patients had completed the study, 38 in SC and 39 in oral MTX group. No significant between-group differences were found in PASI 75 (p=0.14, 0.21), PASI 90 (p=0.23, 0.18), and PASI 100 (p=0.62, 0.22) responses at week 16 and 32, respectively. The mean VAS, however, throughout the 32-week study according to the multivariable analysis showed that SC MTX was superior to oral MTX for patient evaluation of disease improvement. Adverse events were comparable in both groups.

CONCLUSIONS Subcutaneous and oral administration of MTX had similar efficacies in improving the PASI score even at the highest tolerable dose. The SC MTX group, however, had higher overall patient satisfaction than the oral MTX group. No difference in tolerability was found.



SOURCE : Clinical and Experimental Dermatology

Most Hand Sanitizers Contain Allergens

NEW YORK (Reuters Health) - A new analysis of 160 hand sanitizers found that 71% contain at least one allergen listed by the North American Contact Dermatitis Group (NACDG).

"There are many products out there with an ideal formulation from a medical perspective (compliant with CDC guidelines and devoid of any common irritant or allergens), but it is very challenging for lay people to identify these products because ingredient labels are hard to interpret, and marketing claims are so commonly misleading," Dr. Carina Woodruff, associate director of the Contact Dermatitis Unit at the University of California, San Francisco, told Reuters Health by email.

"For example, many well-intentioned and thoughtful consumers opt for 'natural products,' unwittingly exposing themselves to highly sensitizing fragrances/botanical extracts and increasing their risk of irritant or allergic reactions. I believe our study points to a need for more regulatory oversight of personal product packaging," Dr. Woodruff said.

She and her colleagues analyzed 160 highly reviewed hand sanitizers sold online in May 2021 by Walmart, Target, Amazon, Walgreens and CVS. Their findings appear in the Journal of the American Academy of Dermatology.

All of the sanitizers had correctly labeled their active ingredients, such as isopropyl or ethyl alcohol. Another correctly labeled property was "moisturizing," as every sanitizer that claimed to moisturize indeed contained a humectant, according to the researchers.

Most products, however, contained at least one allergen listed in the NACDG 2017-2018 standard series, including 70% of the sanitizers labeled "hypoallergenic."

Tocopherol, or vitamin E, was the most common allergen, appearing in 73 products. Tocopherol has low allergenic potential with a sensitization rate of 0.7%, the researchers write. But 60% of the products examined contain ingredients with a sensitization rate of 1% or higher.

"Fragrance chemicals were among the most common potential allergens in the products we reviewed and as a class, they have a high sensitization rate, so recommending fragrance-free sanitizers makes a lot of sense," Dr. Woodruff said.

However, nearly 40% of products labeled "fragrance free" actually contained a fragrance or cross-reactor listed in the American Contact Dermatitis Society's Contact Allergen Management Program database.

Other items on labels can be misleading, as well.

"The phrases 'dermatologist recommended' and 'hypoallergenic' are essentially marketing terms that have no relationship to any regulatory authority," said Dr. Joel DeKoven, associate professor of dermatology at the University of Toronto, in Canada, who was not involved in the research.

"Labels like 'no parabens, sulfates, phthalates or dyes' have no bearing on whether the product contains common allergens that could cause a skin reaction in sensitized consumers," he told Reuters Health by email.

To guide patients and dermatologists, Dr. Woodruff and Dr. Nina Botto, a co-author of the paper who is also a dermatologist at UCSF, recommend ten hand sanitizers: SupplyAID, Hello Bello, Wave Gel, SanitizeRx, Hydra Pearl, Suave, Adam's Pipette and Avagard D.

Their criteria were included meeting recommendations from the Centers for Disease Control and Prevention (CDC) for active ingredients, low cost, high customer reviews, no NACDG allergens and containing emollients.

The study had no funding, and the researchers declare no conflicts of interest.

SOURCE: https://bit.ly/32HATfA Journal of the American Academy of Dermatology, online November 24, 2021.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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Aging





1. What Slows Aging Down

   Doctors can't yet prescribe a life-extending pill. They can offer an Rx for a life-extending way of living.

   Fruits and vegetables

   There are more than 20,000 different phytonutrients in fruits and vegetables, and each has a unique role in fighting age-related damage to our bodies.

   Lean protein

   Studies have shown that people hold on to muscle better if they eat enough protein — at least 25 to 30 grams per meal.

   Strength training

   This can help improve metabolism and mobility, by maintaining muscle.

   Aerobic exercise

   Walk, run, bike — move for a minimum of 30 minutes, five times a week.

   Sunscreen and shades

   They help reduce the sun exposure that activates free radicals and damages DNA.

   Weight loss

   Losing extra pounds, especially around the midsection, can help reduce inflammation.

   Vacation

   Offset chronic stress, which speeds aging by producing inflammation. For acute stress, such as grief, counseling may help.

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.