Efficacy and Tolerance of a Polymeric Surfactant Technology-Based Cleanser for Clinically Diagnosed Sensitive Skin.

BACKGROUND: Cleansing is an important hygiene activity, necessary to prevent bacterial, fungal, yeast, and viral infection. However, in the presence of skin disease, cleansing can take on a new challenge: removing the sebum, sweat, externally applied substances, environmental debris, and organisms from the face without damaging the skin barrier. Since cleansers cannot easily distinguish between sebum and the intercellular lipids required to maintain skin integrity, unique cleansing technologies are necessary to provide mild cleansing for the many manifestations of sensitive skin. OBJECTIVE: This 4-week clinical study aimed to evaluate the appropriateness of a cosmetic facial foaming gel cleanser with a polymeric surfactant technology in a diverse sensitive skin population. METHOD: 85 subjects with sensitive skin due to eczema/atopic dermatitis, rosacea, acne, or cosmetic intolerance syndrome were evaluated via investigator grading, self-assessment questionnaire, noninvasive measurements, and digital photography. RESULTS: The foaming gel cleanser was well tolerated showing no significant increases in investigator-graded irritation endpoints. Sensitive skin subjects saw considerable reduction (P<0.05) in stinging, itching, burning, tightness, and overall sensitivity at 2 and 4 weeks. Improvements in smoothness, softness, clarity, radiance, and overall skin appearance, were observed by both the investigator and patients (P<0.05) at 2 and 4 weeks. CONCLUSION: The polymeric surfactant technology-based foaming gel cleanser provided a rich, foaming lather that felt gentle and left skin feeling comfortable. J Drugs Dermatol. 2024;23(10):889-893. doi:10.36849/JDD.8510.

Nodular skin disease in cattle.

This focus article was prepared by Caroline Fenemore and Vanessa Swinson of the APHA Cattle Species Expert Group, with Aiden Foster of the University of Bristol (Farm Animal Pathology Services).

Comprehensive Assessment of Dermatologic and Dysmorphic Manifestations in Patients With Down Syndrome.

BACKGROUND: Down syndrome (DS), a common chromosomal anomaly caused by trisomy of chromosome 21, is characterized by a broad spectrum of phenotypic characteristics across multiple organ systems, including cardiac defects and leukemia. Dermatological findings are prevalent among individuals with DS; however, these issues are frequently underrecognized and inadequately researched, resulting in a significant gap in the provision of comprehensive healthcare strategies. Given the increased life expectancy of patients with DS and delayed manifestation of many dermatoses, physicians are increasingly encountering dermatological findings in this population. OBJECTIVE: This study aimed to assess the prevalence and types of dermatological findings in individuals with DS, compare them with those in a control group, and emphasize the necessity of incorporating dermatological evaluations into routine health monitoring. METHODS: This prospective cross-sectional study was conducted from June 2023 to June 2024 and involved 100 genetically confirmed individuals with DS and 100 age- and sex-matched controls. Comprehensive demographic, clinical, and karyotype data were collected for the DS group, and all the participants underwent detailed morphological evaluations. RESULTS: The DS group had a mean age of approximately 6.37 years, whereas the controls were around 7 years old, with no significant differences in age or sex distribution between the groups. Karyotype analysis showed that trisomy 21 was present in 92% of the cases, mosaicism in 6%, and translocation in 2%. Common dermatological findings in the DS group included xerosis cutis (49%), thin and sparse hair (48%), dental caries (34%), delayed tooth eruption (28%), nail dystrophy (25%), fissured tongue (23%), and cheilitis (18%). Significant differences were noted in the prevalence of scabies, bacterial infections, and café au lait macules between the DS and control groups (p < 0.01). Dysmorphic findings in the DS group included epicanthal folds (97%), upslanted palpebral fissures (97%), brachycephaly (91%), and single transverse palmar crease (89%). Significant gender differences were noted in the prevalence of brachycephaly and the sandal gap (p < 0.01). CONCLUSIONS: This study highlights the importance of regular dermatological care in enhancing the health management and quality of life of individuals with DS due to the prevalence and variability of dermatological conditions.

Dermatologic Conditions Following Limb Loss.

The use of prostheses in individuals with limb loss increases the risk of maceration, friction, and pressure-induced skin injuries due to the vulnerability of the residual limb and the close contact with the socket. Poorly fitting prostheses exacerbate these issues, especially for those with immunosuppression or vascular conditions. Skin pathologies disrupt daily prosthetic limb use and impact the independence of those with limb loss. Preventive measures, including proper prosthesis socket fitting and meticulous skin care, are crucial. This review explores residual limb-site skin pathologies and details current mitigation and management strategies.

Cutaneous adaptive immunity and uraemia: a narrative review.

Chronic kidney disease affects 1 in 10 people globally, with a prevalence twenty times that of cancer. A subset of individuals will progress to end-stage renal disease (ESRD) where renal replacement therapy is required to maintain health. Cutaneous disease, including xerosis and pruritus, are endemic amongst patients with ESRD. In the uraemia-associated immune deficiency of ESRD, impaired circulating immune responses contribute to increased infection risk and poorer vaccination response. Clinical manifestations of dysregulated adaptive immunity within the skin have been well-described and have been posited to play a role in cutaneous features of ESRD. However, our understanding of the mechanisms by which adaptive immunity within the skin is affected by uraemia is relatively limited. We provide an overview of how the cutaneous adaptive immune system is impacted both directly and indirectly by uraemia, highlighting that much work has been extrapolated from the circulating immune system and often has not been directly evaluated in the skin compartment. We identify knowledge gaps which may be addressed by future research. Ultimately, greater understanding of these pathways may facilitate novel therapeutic approaches to ameliorate widespread cutaneous symptomatology in ESRD.

Anxiety, depression and quality of life in dermatology patients at a tertiary care hospital.

OBJECTIVE: To compare the anxiety, depression and health-related quality of life of dermatology patients with healthy individuals in a tertiary care setting. METHODS: The case-control study was conducted at the Pak-Emirates Military Hospital, Rawalpindi, Pakistan, from April to September 2022, and comprised adult outpatients and inpatients with diagnosed skin diseases. They were designated as group A, while healthy adults who did not suffer from any dermatological condition formed control group B. Data was collected using a questionnaire which in addition to demographic characteristics, comprised the Dermatology Life Quality Index and the Hospital Anxiety and Depression Scale. Data was analysed using SPSS 21. RESULTS: Of the 200 subjects with mean age 30.21±12.09 years, 100(50%) were in group A; 75(75%) males and 25(25%) females with mean age 32.56±13.49 years. The remaining 100(50%) subjects were in group B; 75(75%) males and 25(25%) females with mean age 27.86±10.02. In group A, 71(71%) were outpatients and 29(29%) were inpatients. Quality of life and depression scores were significantly different between inpatients in group A and group B (p<0.05). The difference was significant between outpatients in group A and group B in all categories (p<0.05). CONCLUSIONS: Dermatological diseases had a significant impact on the daily life and psychological health of patients.

Implications of the non-neuronal cholinergic system for therapeutic interventions of inflammatory skin diseases.

The pivotal roles of acetylcholine (ACh) in physiological processes encompass both the nervous and non-neuronal cholinergic systems (NNCS). This review delineates the synthesis, release, receptor interactions, and degradation of ACh within the nervous system, and explores the NNCS in depth within skin cells including keratinocytes, endothelial cells, fibroblasts, macrophages, and other immune cells. We highlight the NNCS's essential functions in maintaining epidermal barrier integrity, promoting wound healing, regulating microcirculation, and modulating inflammatory responses. The potential of the NNCS as a therapeutic target for localized ACh regulation in the skin is discussed, though the translation of these findings into clinical practice remains uncertain due to the complexity of cholinergic signalling and the lack of comprehensive human studies. The review progresses to therapeutic modulation strategies of the NNCS, including AChE inhibitors, nicotinic and muscarinic receptor agonists and antagonists, choline uptake enhancers, and botulinum toxin, highlighting their relevance in dermatology. We highlight the impact of the NNCS on prevalent skin diseases such as psoriasis, atopic dermatitis, rosacea, acne, bullous diseases, hyperhidrosis and hypohidrosis, illustrating its significance in disease pathogenesis and therapy. This comprehensive overview aims to enhance understanding of the NNCS's role in skin health and disease, offering a foundation for future research and therapeutic innovation.

Analysis of registered clinical trials in Italy regarding dermatology (2003-2022): a cross-sectional study on historical trend and prospects for industry investments.

BACKGROUND: This cross-sectional analysis intends to evaluate trend and outlook of industry clinical research in Italy regarding dermatology and its prospects for the next few years. METHODS: A computerized search of ClinicalTrial.gov database was carried out considering the 20-year period 2003-2022 using the following string: "Skin Diseases OR Skin cancer OR Skin Neoplasms OR Skin Infection OR Skin Lesion OR Skin Ulcer OR Skin Laxity OR Skin toxicity OR Dermatologic Complication OR Skin abnormalities". RESULTS: During the last 20 years 690 Industry Clinical Trials (IndCTs) were conducted in Italy regarding dermatological investigations, almost entirely funded by non-Italian pharmaceutical companies, involving 4497 centers, and recruiting an average of 13.0 subjects per site. The number of controlled and randomized studies has grown quite regularly and in the last 5 years they represented 79.6% of IndCTs initiated. Countries most frequently sharing with Italy international protocols were Spain (75.0%), Germany (71.8%), France (68.5%), the USA (67.4%), and the UK (54.8%). These data point to a historical involvement of Italy in dermatology IndCTs lower than in the major European countries. However, the war in Ukraine has deprived IndCTs of the contribution of Russia, Ukraine, and Belarus, meaning a mean of about 40 new IndCTs per year in a population of 200 million inhabitants. In contrast, many indicators point to Italy as a country with potential in dermatology wider than used in the past: an efficient health care system accessible to any citizen or resident, 4.6 million dermatological interventions per year, low density of IndCTs concerning dermatology, good production of scientific papers in indexed medical journals, relatively low cost of services and labour and geopolitical stability. CONCLUSIONS: The European Clinical Trials Information System's (CTIS), mandatory for the EU member states since early 2023 allows common, simplified, and harmonized regulatory procedures over the life cycle of clinical trials in Europe (EMA, 2023) and plays in favor of Italy's greater competitiveness in clinical research.

Role of fibroblasts in nonfibrotic autoimmune skin diseases.

Autoimmune diseases, a disease characterized by immune imbalance caused by the human immune system mistakenly attacking its own components, include vitiligo, psoriasis and atopic dermatitis (AD). Previous studies on autoimmune diseases have focused mainly on immune cells, keratinocytes and endothelial cells. Fibroblasts, the main cells that secrete the extracellular matrix (ECM) in the dermis, have been studied thoroughly in terms of fibrosis and wound healing. However, an increasing number of studies have shown that fibroblasts play an important role in nonfibrotic autoimmune skin diseases. In this article, the previously reported role of fibroblasts in nonfibrous autoimmune skin diseases such as psoriasis, vitiligo and AD is summarized to provide new ideas for the treatment of this disease.

Influencing factors associated with peristomal skin complications after colorectal ostomy surgery: a systematic review and meta-analysis.

BACKGROUND: Peristomal skin complications (PSCs) are the most common complication among patients with ostomies after ostomy creation. PURPOSE: This systematic review and meta-analysis aimed to evaluate the factors influencing the occurrence of peristomal skin complications. METHODS: A systematic review was conducted across multiple databases by using a combination of subject terms and free words for online search. The databases were searched from their inception to October 31, 2023. All studies that met inclusion criteria were examined to identify risk factors for PSCs. Two researchers independently conducted literature screening and information extraction, evaluated the literature quality using the Newcastle-Ottawa Scale, and performed descriptive analysis of the results. RESULTS: Ten studies were included in this review. A total of 3753 patients with ostomies participated in the studies, and 981 patients suffered from PSCs, with PSC incidence ranging from 15.5% to 47.7%. Type of ostomy, diabetes, self-care knowledge, and chemotherapy were significant factors associated with PSCs. CONCLUSION: This review highlighted 4 factors that influence the occurrence of peristomal skin complications. The quality of included literature is generally low, with significant heterogeneity in study design and choice of outcome indicators. Therefore, further research involving high-quality studies with larger sample sizes is needed for deeper investigation.

The ABCs of JAKis: A Clinician's Guide to Safety and Monitoring of the Systemic JAK Inhibitors.

Janus kinase inhibitors (JAKis) have recently emerged in the arsenal of tools to treat dermatological conditions. However, there are some concerns regarding these treatments due to their boxed warning. Here we discuss the safe and effective use of JAKs for the treatment of a wide variety of dermatologic conditions. We will also discuss monitoring guidelines. J Drugs Dermatol. 2024;23(10):852-856. doi:10.36849/JDD.8073.

Relationship Between Cytokines and Face Skin Symptoms in Newborns in Two Japanese Cities.

AIM: Several skin disorder symptoms may appear in infants, each resulting from a different inflammatory response. In this study, we investigated the relationship between skin cytokine levels and skin symptoms in newborns. METHODS: This cross-sectional study was conducted in Tokyo and Oita, two Japanese cities. The participants were healthy, 1-month-old infants and their parents. Symptoms including erythema, papules, dryness, and exudate/yellow scaling on infant faces were evaluated as outcomes. Cytokine levels (interleukin [IL]-4, IL-6, IL-8, and IL-17) were measured by skin blotting. A multilevel analysis using a mixed-effects model was conducted to account for regional differences. RESULTS: A total of 231 infants (119 from Tokyo and 112 from Oita) participated in this study. Erythema, papules, dryness, and exudate/yellow scaling were present in 59 (25.5%), 133 (57.6%), 37 (16.0%), and 16 (6.9%) of the infants, respectively. In terms of the associations between symptoms and cytokines, there was a significant association between papules and IL-8 positivity (adjusted odds ratio [AOR]: 1.94, 95% confidence interval [CI] 1.09-3.47) even after adjustment for differences in barrier function, area, and skin care. CONCLUSIONS: This study demonstrated that cytokines were linked to skin conditions, even after accounting for regional differences and genetic factors. This suggests that different symptoms point to the involvement of various cytokines in skin conditions in neonates, with mechanisms varying based on the symptoms. These findings could aid in developing specific preventive strategies in the future.

Skin diseases among adults in Tasiilaq, East Greenland.

Cold climate and unique genetic and environmental factors may influence the prevalence of skin diseases in Greenland. However, there is a lack of epidemiological studies on skin diseases in the adult Greenlandic population. To address this unmet need a cross-sectional study, run by dermatologists from Denmark, the UK, and Switzerland estimated the prevalence and clinical manifestations of skin diseases among adults in East Greenland in May 2022. All adults ≥18 years in the town of Tasiilaq were invited, and 295 individuals aged 18-78 years participated (22.5% of the overall adult population in Tasiilaq). Two-hundred and three participants (69%) had visible signs of current skin disease, and among these, 242 cases of dermatoses were identified. The most common skin diseases were hand eczema (22.4%), lichen simplex (9.5%), discoid eczema (7.1%), psoriasis, atopic dermatitis and acne vulgaris (5.8% each). Scabies was the most frequent infectious skin disease (4.4%). No cases of skin cancer were identified. Atopic dermatitis and psoriasis presented with disease that was of limited extent and different from the classical presentations. Skin diseases showed a high prevalence among adults in East Greenland, and some of them were severe. This indicates a noteworthy public health problem that warrants better access to dermatologist support.

Optimizing Dermatological Care Triage in a Safety-Net Hospital: Retrospective Analysis of Diagnoses and In-Person Referrals.

OBJECTIVES: Teledermatology is a cost-effective and efficient approach to delivering care and is particularly beneficial for patients with limited access to specialized services. Considering the rapid expansion of telehealth, it is crucial to focus on optimization. The purpose of our study was to evaluate the triaging of dermatologic care in an electronic consultation (e-consultation) service in a safety-net hospital. METHODS: This was a 2-year retrospective review of a dermatology asynchronous store-and-forward e-consultation service. RESULTS: A total of 1425 patients completed 1502 e-consultation. Of these e-consultations, 46% of the patients had Medicaid and 44% were Black or African American. The top three diagnoses were dermatitis unspecified, neoplasm of uncertain behavior, and acne/rosacea. Most (68%) were managed via e-consultation and did not require an in-person appointment. Children and adolescents were more likely to require an in-person appointment (74%) compared with adults (30%, P < 0.0001). Patients with a chief complaint of hair loss or skin lesion were more likely to require in-person evaluation (58% and 41%, respectively) compared with rash (24%) and acne (18%) (P < 0.0001). There was no difference found in recommendations for in-person evaluation based on race, non-English-language preference, or insurance status. CONCLUSIONS: E-consultation services seem well suited for certain concerns, and underserved populations can be evaluated by teledermatology.

Update on protease-activated receptor 2 in inflammatory and autoimmune dermatological diseases.

Protease-activated receptor 2 (PAR2) is a cell-surface receptor expressed in various cell types, including keratinocytes, neurons, immune and inflammatory cells. Activation of PAR2, whether via its canonical or biased pathways, triggers a series of signaling cascades that mediate numerous functions. This review aims to highlight the emerging roles and interactions of PAR2 in different skin cells. It specifically summarizes the latest insights into the roles of PAR2 in skin conditions such as atopic dermatitis (AD), psoriasis, vitiligo and melasma. It also considers these roles from the perspective of the cutaneous microenvironment in relation to other inflammatory and autoimmune dermatological disorders. Additionally, the review explores PAR2's involvement in associated comorbidities from both cutaneous and extracutaneous diseases. Therefore, PAR2 may serve as a key target for interactions among various cells within the local skin environment.