Evaluating dietary considerations in hidradenitis suppurativa: a critical examination of existing knowledge.

Hidradenitis suppurativa (HS) is a chronic condition that can overwhelm patients, and the effectiveness of supplementary dietary treatments remains uncertain. The primary aim of this review is to explore the connection between diet and HS progression. However, it is imperative to note that the evidence supporting a substantial role of the diet in HS remains weak. Dietary alterations alone should not be considered independent solutions for managing HS. Medical therapy continues to be indispensable for adequate treatment. Research indicates that the Mediterranean lifestyle and diet may provide cost-effective and beneficial adjustments when combined with traditional therapies. Conversely, foods with a high glycemic index and dairy could worsen HS symptoms, conceivably through mechanisms linked to insulin resistance and inflammation. Zinc, known for its antioxidant properties, shows promise as an adjunct therapy. Moreover, evidence suggests a connection between vitamin D deficiency and HS severity, although the findings are inconclusive. Brewer's yeast-free diet, B12 supplementation, intermittent fasting, and reducing the intake of refined sugar and dairy merit further investigation. In conclusion, this review highlights the need for additional research because of the lack of standardized reporting of clinical effects in the studies under scrutiny. A deeper exploration of the pathophysiology focusing on dietary modifications and their potential associations with HS severity is essential. Furthermore, it is crucial to recognize that patients' willingness to experiment with new diets makes them vulnerable to fraudulent interventions, highlighting the importance of evidence-based dietary guidance.

The Comparative Dermal Stimulation Potential of Constant-Volume and Constant-Amount Diluted Calcium Hydroxylapatite Injections Versus the Concentrated Form.

INTRODUCTION: Biostimulation properties of diluted and hyperdiluted calcium hydroxylapatite (CaHA) injections have become increasingly popular. However, the existing data are insufficient to certify a particular dose-response pattern. OBJECTIVE: To assess and compare the dermal stimulation potentials of different concentrations of CaHA injections. MATERIALS AND METHODS: Two independent experiments (Experiment-1: constant injection volume vs Experiment-2: constant CaHA amount) included 4 study groups each, and these experimental groups were placed consecutively on the abdominal skin of a juvenile Yorkshire pig. Histopathological and immunohistochemical stainings were performed on punch biopsy materials collected 4 months after the injection day. RESULTS: The fibroblast count significantly decreased upon dilution from 1:3 to 1:19 in experiment 1 ( p = .000) but still higher than the control group. In experiment 1, the collagen density of the concentrated form was more elevated than the 1:19 dilution and the negative control groups ( p = .034 and .000, respectively) but similar to the 1:3 dilution ( p = .123). No significant difference was observed between the groups regarding collagen density with a standard amount of CaHA (0.2 mL, 30%) ( p > .05). CONCLUSION: Despite the efficacy being more pronounced till 1:3 dilution, hyperdiluted CaHA at any dilution ratio up to 1:19 can provide a higher fibroblast count than the negative control group.

Increased Prevalence of Bipolar Disorders in Hidradenitis Suppurativa: More Than a Striking Co-existence?

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of the hair follicle characterized by intense discharge and pain. Recently, HS intrinsic association with neuropsychiatric disorders has become a focus of attention, and bipolar disorder (BD) emerged as a relevant topic for such an association. Objectives: This study aimed to evaluate BD prevalence among HS patients and present the HS and BD overlap patients demographics, detailed clinical characteristics with a discussion on aggravating factors. Methods: A retrospective chart review of 247 HS outpatients (Group-1) identified nine patients with BD. The frequency of BD in HS patients is compared to psoriasis patients (Group-2) and controls (Group-3) in age- and gender-matched groups. The demographic and clinical features of the 9 patients revealing HS-BD co-existence were analyzed. Results: BD (N = 9) was the 7th most common co-morbidity in the HS cohort. The frequency of BD is detected as 3.6% in group 1, 0.7% (N = 1) in group 2, and 0.6% (N = 1) in group 3, respectively. Group 1 demonstrated an increased prevalence of BD compared to other groups (P = 0.001). Of the 9 patients revealing HS and BD co-existence, 66.6% were active smokers, 66.6% were obese and 44.4 % had metabolic syndrome. Conclusions: This study results reveal that the prevalence of BD in HS patients is higher than psoriasis patients and controls. The pathogenetic mechanisms underlying BD and HS co-existence needs to be investigated further.

An Anti-Interleukin-17A Monoclonal Antibody, Ixekizumab, in the Treatment of Resistant Hidradenitis Suppurativa: A Case Series.

Introduction: Although adalimumab is the only approved biologic for the treatment of hidradenitis suppurativa (HS), the treatment response may not be satisfactory in all patients. Recently, many other biological agents, including interleukin 17 inhibitors such as ixekizumab, have shown promise. Case Presentations: Five severe HS (Hurley stage III) patients resistant to conventional treatments and adalimumab for at least 3 months were recruited. Patients were prescribed ixekizumab with a scheme approved for psoriasis (160 mg once, followed by 80 mg at weeks 2, 4, 6, 8, 10, and 12.) The primary outcome measure was achieving the Hidradenitis Suppurativa Clinical Response (HiSCR) score following 12 weeks. Secondary outcome measures included the patient-reported Dermatology Life Quality Index (DLQI) and visual analog scale (VAS). Four of 5 patients (80%) achieved HiSCR. While improvement was observed in the VAS and DLQI scores of 4 patients, the decline was limited in 1 patient. No adverse event was recorded related to ixekizumab. Conclusion: The result of our observation suggests that ixekizumab may be effective for HS, especially in challenging cases.

Can we increase the success of scabies treatment? The effect of removing tunnels from patients in the success of scabies treatment.

Recently, there has been an increase in scabies infestations. Moreover, the number of patients who do not benefit from conventional treatment regimens is increasing rapidly worldwide. This situation leads clinicians to seek new treatments. To evaluate the contribution of mechanical parasite removal to treatment success when applied prior to topical permethrin 5% treatment. The mechanical removal process was applied once during diagnosis. Two groups of 30 people each were included in the study. Permethrin treatment was given directly to the first group without any procedure. In the second group, the maximum number of tunnels that could be detected were removed from patients. After this procedure, the group received permethrin treatment. All patients were called for control after 10 days, and treatment response rates were evaluated. Sixteen (53.3%) patients who received permethrin treatment directly without any procedure responded to the treatment. In the remaining 14 (46.6%) patients, tunnels and Sarcoptes mites were still present. In the second group, which underwent tunnel removal, complete recovery was observed in 26 (86.6%) patients. The patients who did not benefit from the treatment in the study group had relatively less tunnel removal from their bodies. Removing the tunnel from the patient before the treatment increases the success of the treatment. Considering that there are 8-10 parasites on average in scabies patients, it has been determined that the tunnel removal method is not difficult and contributes to therapeutic success.

Role of exosomes in skin diseases.

BACKGROUND: Exosomes, as a family member of extracellular vesicles, are cell-secreted nanoscale structures that play pivotal roles in regulating physiological and pathophysiological processes of the skin. Exosomes induce communication between cells and are responsible for transporting cellular components such as microRNAs, mRNAs, DNA, lipids, metabolites, and cell-surface proteins. Numerous preclinical and clinical trials searched the contribution of exosomes to skin functions and disorders. Thus, exosomes are gaining increasing attention within investigational dermatology. In advance, stem-cell-derived exosomes were integrated into the functional cosmetics industry nominated as cell-free regenerative medicine. OBJECTIVE: This review aims to demonstrate the roles of exosomes in inflammatory skin disorders, stem cell, and tumor biology through a comprehensive evaluation of the diagnostic, prognostic, and therapeutic perspectives. METHODS: A comprehensive literature search was performed using electronic online databases "PubMed" and "Google Scholar" using key words ''exosomes'', ''skin'', ''wound healing''. CONCLUSION: Exosomes are regarded as promising diagnostic and prognostic biomarkers for various skin diseases. Future prospects are repurposing exosomes to treat skin disorders, either as drug carriers or drugs themselves.

Comparison of fractional erbium:YAG laser-assisted tranexamic acid delivery alone and in combination with oral tranexamic acid in melasma.

Tranexamic acid (TA) emerged as a promising agent for melasma. However, due to its hydrophilic structure, topical TA should be combined with a penetration-enhancing strategy to augment efficacy. To evaluate the efficacy of fractional erbium:YAG laser-assisted delivery (LAD) of topical TA 5% either with or without oral TA treatment in recalcitrant melasma patients. The authors retrospectively assessed the treatment outcomes of melasma patients treated by fractional erbium:YAG LAD of topical TA 5%. Patients receiving a standard protocol including four biweekly laser sessions were eligible. The study included two groups: group 1 patients received oral TA and LAD of topical TA 5%, and group 2 patients received only LAD of topical TA 5%. Two blinded dermatologists reported pre-treatment and post-treatment modified MASI (mMASI) scores. Mean mMASI scores in both group 1 (n = 15) and group 2 (n = 19) were significantly lower at the end of the treatment than baseline values (p = 0.001; p = 0.022, respectively). The decrease of mMASI scores were higher in group 1 (median = 2.1) (64.7%) than in group 2 (median = 1.2) (41.8%) (p = 0.027). Fractional erbium:YAG LAD of topical TA 5% is an efficient treatment regimen for melasma patients recalcitrant to conventional treatment approaches. The implementation of oral TA to this regimen improves the therapeutic outcomes.

Therapeutic outcomes of one-minute application of sodium hydroxide versus phenol in the chemical cauterization of ingrown toenails.

BACKGROUND: Ingrown nails are frequently encountered in dermatology practice. The recurrence tendency of the disorder makes chemical cauterization essential during surgical procedures. In studies comparing nail matrix cauterization with sodium hydroxide (NaOH) versus phenol, phenol's application time was highly variable. OBJECTIVE: To compare the therapeutic outcomes of matrix cauterization for a standard duration of one minute for NaOH versus phenol in stage II and III ingrown nails. MATERIAL AND METHODS: The medical records of patients undergoing matrix cauterization with 10% NaOH or 88% phenol were evaluated. The primary outcome measure was the lack of recurrences on long-term follow-up. The secondary outcome measures were complete healing duration, patient-reported pain scores, and adverse effects related to the procedure. RESULTS: Enrolled in this study were 62 ingrown toenail sides treated with 10% NaOH and 56 ingrown toenail sides treated with 88% phenol. The mean follow-up duration was 25.17 months. Recurrence was observed in four nail sides of the NaOH group (%6.45) and three nail sides of the phenol group (%5.35). The difference between the recurrence rates did not reach statistical significance. Patients treated with both methods were free of pain on the post-procedural tenth day. The visual analog scale pain scores and complete healing duration were similar between the two groups (p>0.05). CONCLUSION: In a large group with long-term follow-up results, the short-term and long-term post-operative treatment outcomes were similar between the one-minute applications of 10% NaOH versus 88% phenol groups.

Evaluation of dermatoscopic findings of alopecia areata and tinea capitis in pediatric patients.

OBJECTIVE: Pediatric patients often reveal localized alopecic foci on the scalp. The essential point upon approaching a child with localized alopecia is distinguishing the two most common causes, alopecia areata and tinea capitis, as their treatments are entirely different. Although potassium hydroxide examination is the preferred method for their clear distinction, dermatoscopy is also emerging as a rapid diagnostic tool. This study aimed to assess and compare the dermatoscopic findings of alopecia areata and tinea capitis. MATERIALS AND METHODS: Enrolled in this study were 34 children with tinea capitis and 21 children with alopecia areata admitted to a single-center outpatient clinic between 2017 and 2021. The authors confirmed all children's diagnoses by an integrative evaluation of clinical features, potassium hydroxide examination results, and treatment response patterns. Clinical features and the variables of interest (dermatoscopic findings) were investigated through the medical records and the baseline dermatoscopic images. RESULTS: The most common dermatoscopic finding within the tinea capitis cohort was comma hairs, detected in 33 (97.1%) of the patients. Other findings of the tinea capitis group included squamation (n = 31, 91.2%), broken and dystrophic hairs (n = 30, 88.2%), corkscrew hairs (n = 24, 70.6%), zigzag hairs (n = 18, 52.9%), and pigtail hairs (n = 9, 26.5%). The most common dermatoscopic finding within the alopecia areata cohort was exclamation mark hairs (n = 13, 61.9%), that was followed by black dots (n = 9, 42.9%), yellow dots (n = 8, 38.1%), vellus hairs (n = 6, 28.6%), and broken and dystrophic hairs (n = 5, 23.8%). CONCLUSION: Among the detailed evaluation of dermatoscopic findings of tinea capitis and alopecia areata patients, the only overlapping feature was dystrophic and broken hairs that could be present in both diseases; but were more common within the TC group than within the AA group (88.2% vs. 23.8%).

The comparative in vitro killing activity of tea tree oil versus permethrin on Demodex folliculorum of rosacea patients.

BACKGROUND: Demodex mites have been implicated in several cutaneous disorders compelling the research efforts for effective anti-Demodex therapy. OBJECTIVE: Compare the survival time (ST) of Demodex folliculorum exposed to six different concentrations of tea tree oil (TTO) versus a positive control (permethrin 5%) and a negative control (immersion oil) group. MATERIALS AND METHODS: The wastes of rosacea patients' standardized superficial skin biopsy samples were recruited for the trial. The primary outcome measure of this study was the survival time, defined as the period between the exposure of study agents to the complete cessation of Demodex movements. RESULTS: All differences between the mean survival times of 2.5% (54.0 ± 6.1), 5% (39.0 ± 3.9), 10% (22.0 ± 2.5), 25% (13.0 ± 2.5), 50% (7.8 ± 0.6), and 100% TTO (3.3 ± 1.3) were significant (p < 0.05). The ST of the negative control group was 196.0 ± 23.6 min. The ST of permethrin 5% was 12.5 ± 1.9 that did not show a statistically significant difference from the ST of TTO 25% (p = 0.628). CONCLUSION: The survival times of the six different TTO groups confirmed a dose-related pattern, all of which had survival times shorter than the negative control (immersion oil). TTO 25% had comparable efficacy to the positive control agent (permethrin 5%).

Erbium:YAG laser augments the penetration of cryotherapy.

Cryotherapy is commonly used during dermatologic practice. Several modifications such as an "add-on" to topicals or intralesional applications have been already defined to enhance efficacy. The aim of this study is to test our hypothesis that ablative laser application before cryotherapy would increase the depth of freezing.Throughout this experiment, target points received either cryotherapy alone or a combination of erbium:yttrium-aluminum garnet (erbium:YAG) laser and cryotherapy. Freezing durations of 10 (C10), 20 (C20), and 30 seconds (C30) were investigated. Erbium:YAG laser groups received equal high energy shots with different pulse durations (100 µs versus 1500 µs) before freezing. The treatment points were arranged on the peripheral side of porcine skin specimens, and dermoscopic images revealing the iceball visible from the lateral side were immediately captured. Repeated experimental results were compared by Wilcoxon's test. The comparison of the vertical length of the iceball between the three different freezing durations of 10 seconds, 20 seconds, and 30 seconds was statistically significant (p<0.05). The vertical length of the iceball was higher in both laser groups receiving 30-second freezing (mean ± SD: 4.32±0.53, 3.9±0.38 for micro-short pulse (MSP) and extra-long pulse (XLP), respectively) when compared with 30-second freezing alone (mean ± SD:3.51±0.44) (p=0.016). The two laser settings did not reveal a difference for the penetration of 30-second freezing (p=0.122). In this study, through visual monitorization of the iceball, erbium:YAG laser is found to augment the penetration of cryotherapy. The defined combination regimen has the potential to ameliorate treatment outcomes of cryotherapy.

Combination of Full-Field and Fractional Erbium: YAG Laser for Nonhealing Wounds.

BACKGROUND: To evaluate the outcomes of a heterogeneous group of patients with chronic ulcer receiving a combination regimen of full-field and fractional erbium-doped yttrium aluminum garnet (erbium: YAG) laser applications. METHODS: Enrolled in this study were patients with chronic ulcer who had received at least 2 erbium: YAG laser sessions. Fractional applications followed the initial full-field application for debridement. The therapeutic outcomes were evaluated by serial photographs. The primary outcome measure was the proportion of patients achieving complete re-epithelialization at the first year. RESULTS: Forty-three treatment regions from 23 patients between 40 and 90 years (F: M = 11:12; age: 60.3 ± 15.5 years, mean ± SD) were eligible. The ulcers' median duration was 24 months (min-max: 2-240 months). The median number of laser sessions was 5 (min-max: 2-12). Of arterial (n = 13), immunologic (n = 9), venous (n = 8), diabetic (n = 8), and mechanical ulcers (n = 5), the primary outcome measure was achieved in 69%, 77.7%, 75%, 88.8%, and 100% of the groups, respectively. CONCLUSION: Full-field erbium: YAG laser applications preserve the vascular architecture and enable delicate debridement. Ongoing maintenance fractional laser sessions promote wound healing. Similar to the previous reports of erbium: YAG laser in venous and diabetic ulcers, arterial ulcers, and ulcers of immunologic origin demonstrated an objective treatment response along with different adjuvant approaches.

COVID-19-related oral mucosa lesions among confirmed SARS-CoV-2 patients: a systematic review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for coronavirus disease 2019 (COVID-19), which manifests as a flu-like respiratory infection affecting multiple organ systems, including the gastrointestinal system, central nervous system, cardiovascular system, skin, and mucosa. In this review, we investigated the literature on specific manifestations of COVID-19 in the oral mucosa. An online literature search in PubMed, Scopus, Google Scholar, and Medline was conducted to retrieve relevant studies on confirmed COVID-19 patients with oral mucosa findings published between December 31, 2019, and April 07, 2021. After an independent review by two authors, 39 articles considering 59 laboratory-confirmed cases of SARS-CoV-2 infection were included in the final analysis. The most common finding, reported in 29 patients (43.9%), was Kawasaki-like syndrome. In addition, oral ulcers including aphthous, hemorrhagic, and necrotic ulcers were reported in 24 patients (36.3%). Other lesions reported included pustules, macules, bullae, maculopapular enanthema, and erythema multiforme-like lesions. Concomitant skin lesions were present in 60.6% of patients. Fever was reported in 86.2% of patients. Forty-eight patients (76.1%) were hospitalized. Loss of taste and smell was present in 30.8% of the patients. A comprehensive understanding of the dermatologic manifestations of COVID-19 can improve and facilitate patient management and referrals.

Safety and Efficacy of High-Dose Fractional Erbium: Yttrium Aluminium Garnet Laser in Stable Vitiligo.

Objective: Evaluate the treatment outcome of vitiligo patients receiving a standard regimen of high-dose biweekly fractional 2940 nm erbium:yttrium aluminium garnet (YAG) laser applications as an add-on to various treatment modalities. Materials and methods: The authors extracted the study population's clinical images before treatment and 3rd-month control from their clinical archive and used the medical records. The primary outcome measure was 50% repigmentation at 3rd-month follow-up. Institutional ethical committee approved the study. Results: Of the evaluated 28 patients, 18 were eligible with 31 treatment regions. All patients received at least one topical agent [steroids, calcineurin inhibitors, or 5-fluorouracil (5-FU)] and 11 patients received either targeted ultraviolet B (UVB) or narrow-band UVB. Of the 31 study regions, 88.8% (8/9) of facial; 77.7% (7/9) of dorsal hand; 75% (3/4) of limb; and 25% (2/8) of finger lesions achieved 50% repigmentation at 3rd-month control. The facial and dorsal hand lesions' treatment responses were higher than finger lesions (p = 0.008 and 0.03, respectively). Upon evaluating adjuvant treatment modalities, all of the treatment regions receiving targeted UVB (n = 4) or topical 5-FU (n = 5) achieved the primary endpoint, whereas severe irritation limited the topical use of 5-FU. The most common adverse effects were mild oozing and crusting related to laser treatments. Conclusions: Even with high-energy settings, fractional erbium: YAG laser does not induce the Koebner phenomenon. Although controlled trials are required to make firm conclusions, fractional erbium: YAG laser was an effective and safe adjunctive option for stable vitiligo in a real-life setting.

Management of nail psoriasis with a single injection of abobotulinum toxin.

Nail psoriasis is challenging; as topical agents generally fail and systemic therapies are doubted especially when the involvement of the skin is rather localized. The response of chronic plaque-type psoriasis to botulinum toxin injections is reported in case series that is essentially explained through the modulation of neurogenic inflammation. Herein, we report the successful treatment results of two cases demonstrating different features of nail psoriasis treated by abobotulinum toxin.

Anti-TNF agent etanercept augments UV-induced skin cancer development in SKH-1 mice.

BACKGROUND: Despite being employed in the treatment of inflammatory disorders for more than 20 years all over the world, data regarding photocarcinogenic risks of anti-TNF agents is scarce. OBJECTIVE: To assess photocarcinogenic potential of anti-TNF agents. METHODS: This was a placebo controlled, split-body (UVB-treated versus -untreated) study on mice. Treatment groups were infliximab (n = 11), etanercept (n = 11), cyclosporine (n = 11) and vehicle control (n = 11). Agents were introduced on the 10th week of phototherapy and continued through 24th week. The macroscopic, histological and immunohistochemical analysis of test sites were carried out. RESULTS: Overall 132 tumors were detected on test sites. All of these tumors developed on UV-exposed sides. Histologic examination of these tumors was compatible with keratinocytic neoplasia in 128, mastocytosis in 3, epidermal cyst in 1. Median tumor burden in the UVB exposed areas for ETN, IFX, CYC, and control groups were 14.91, 10.20, 6.28, and 3.14 cm2, respectively. ETN group demonstrated both higher tumor burden and keratinocytic neoplasia numbers than controls (p = .03, p = .025). Although there were 1.8 and 1.7 times more keratinocytic neoplasms in IFX and CYC groups compared to controls, these differences didn't reach statistically significant levels (p = .14; p = .19). CONCLUSION: This study points out to a significant photocarcinogenic potential of anti-TNF agent etanercept.