Development of actinic lentigines due to multiple sub-erythemal exposure to UVA1 radiation in Asian skin.

The appearance of actinic lentigines mainly found on face, back of the hands, upper back and décolleté is associated with chronic sun exposure. However, there is no study looking at the role of long UVA specifically in the development of actinic lentigines. This study was conducted in 20 Japanese adult women exposed on the upper back area three times per week for 6 weeks to incremental sub-erythemal UVA1 doses (5 J/cm2 at weeks 1 and 2, 10 J/cm2 at weeks 3 and 4 and 15 J/cm2 at weeks 5 and 6). Clinical assessment, performed on day 0 (before any exposure), and on days 14, 28 and 42, included the evaluation of skin pigmentation (pigmented spots), chromametry of the pigmented skin lesions and measurement of dyschromy. The number of pigmented spots and uniformity of the skin's pigmentation were clearly increased in comparison with baseline, statistical significance of the difference (p < 0.05) being reached at D 28 and D 42 in both cases. In conclusion, repeated sub-erythemal UVA1 exposure induces the development of actinic lentigines. Thus, a suitable protection including long UVA coverage is also needed to prevent from the damages induced by low, sub-erythemal doses of UV exposure.

The impact of visible scars on well-being and quality of life: An international epidemiological survey in adults.

INTRODUCTION: Scars are visible marks from various causes, including surgery, skin injury, burning or dermatological disease, and may impact the quality of life. OBJECTIVE: To assess the impact of scars on quality of life (QoL). MATERIAL AND METHODS: Data about sociodemography, presence, origin, and symptoms of scars were collected using an Internet survey between April and May 2020. Overall, 11,100 individuals answered the survey. In total, 48.5% of the responders had at least one scar of less than 1 year of age. Scars were mainly reported on the abdomen and face. Globally, 28.9% of subjects with recent scars reported pain, 23.7% reported burning, 35.0% reported itching, and 44.1% reported redness. Subjects were most frequently bothered by the visibility of their scars and the presence of marks. Incidences were significantly higher than for those with older scars. The average DLQI score was 7.44; it decreased to 2.90 after 1 year. Subjects with scars aged less than 3 months had their QoL more frequently impacted (33.9%) than those with scars aged 12 months or more (10.2%). In subjects reporting skin discomfort, clinical symptoms significantly impacted body movement, choice of clothes, leisure activities, and sexual life more than in those reporting no skin discomfort. Moreover, subjects felt significantly more impacted in their daily lives due to their skin discomfort. When feeling bothered by the visibility of their scars, significantly more subjects were also impacted in their body movement, choice of clothes, leisure activities, and sexual life than those subjects who did not feel bothered. Moreover, significantly more subjects felt embarrassed. CONCLUSION: Scars significantly impact the subjects' quality of life. This impact is even more important when caused by recent and visible scars, with a lower DLQI score in subjects with more aged than in those with recent scars.

A Salicylic Acid-Based Dermocosmetic is Effective as an Adjunct to Benzoyl Peroxide for Mild to Moderate Acne and as Monotherapy in Maintenance Post Benzoyl Peroxide.

BACKGROUND: A dermocosmetic (DC) containing salicylic acid, niacinamide, and thermal spring water has been developed for the management of mild to moderate acne. AIM: To assess the efficacy of DC as an adjunct to benzoyl peroxide (BPO) every other day compared with BPO over 3 months, and its efficacy as maintenance post-BPO care compared with vehicle for another 3 months. METHODS: Single-center, randomized, double-blind study in 100 patients with mild to moderate facial acne according to the Global Acne Severity (GEA) Scale. During phase 1, subjects received either BPO + vehicle (vehicle group) or BPO + DC (DC group) for 12 weeks. During phase 2, patients were re-randomized to receive either the vehicle or the DC for 12 weeks. Assessments included inflammatory and non-inflammatory lesion count, acne severity using the GEA Scale, local tolerance, quality of life, and quantity of product used. RESULTS: During phase 1, both groups, DC and vehicle, reached the same level of efficacy at month 3, although the quantity of BPO used was significantly reduced in the DC group (P=0.0001). During phase 2, acne continued to significantly improve (all P<0.05) in the DC group, as did clinical signs and symptoms; while patients randomized to vehicle reported relapses of their acne and related symptoms. CONCLUSION: The use of DC significantly reduces the need for BPO with no impact on the efficacy of mild to moderate acne. The use of DC as a maintenance post-BPO allowed a significant reduction of acne relapse compared with vehicle after 3 months of follow-up, with a good tolerance. J Drugs Dermatol. 2023;22(12):1172-1177. doi:10.36849/JDD.7449R1.

Association of Sensitive Eyes with Sensitive Skin: A Worldwide Study of 10,743 Subjects.

INTRODUCTION: Sensitive eyes are commonly reported by patients, but there are very few epidemiological studies on this disorder. The aim of this study was the evaluation of the self-reported frequency of sensitive eyes and the association with sensitive skin. METHODS: A survey was performed on a representative sample of the population aged more than 18 years in five different countries (Brazil, China, France, Russia, and the USA). All participants answered a questionnaire on sociodemographic characteristics; skin phototype; eye color; tobacco consumption; exposure to sunlight, air pollution, or having pets; and sleep disorders. The presence of sensitive eyes, eyelids, or skin and their triggering factors were assessed with specific questions. RESULTS: A total of 10,743 individuals (5,285 men and 5,458 women) were included in the study. Among them, 48.2% reported having sensitive skin and 46.0% reported having sensitive eyes. Sensitive eyes were more frequently reported by women (46.5%) than men (39.4%) in all countries, with the exception of China. The presence of sensitive eyes was more frequent if skin was very sensitive. More than half of subjects with sensitive eyes declared that their triggering factors were exposure to sunlight, dust, touch pad screens, or computer screens or dry air. They were more exposed to pollution and tobacco. Their phototype (including eye color) was lighter. DISCUSSION/CONCLUSION: This large study shows that self-declared sensitive eyes are very frequent and commonly associated with sensitive skin. Triggering factors of sensitive eyes are more specific.

Cost-effectiveness of Emollients in the Prevention of Relapse among French Patients with Atopic Dermatitis.

Atopic dermatitis affects up to 20% of children and quite frequently persists in adulthood. Follow-up, treatment, and prevention of relapses have an impact on healthcare spending. The aim of this study was to assess the cost-effectiveness of different emollients prescribed for patients with atopic dermatitis in France. A 3-health state Markov model was designed, using French data for resource utilization, price and transition probabilities. The effects of the use of 5 different emollients (A, B, C, D, E) or no emollient were compared. The selected outcome was time (years) without flare-up (YWFU). The 5-year cost for emollient A is 1,575.64€, and the effectiveness is 3.89 YWFU. Strategy A is the most effective. Compared with treatment E, which was the least expensive emollient, A is more expensive (+481.84€) and more effective (0.082 YWFU). The incremental cost-effectiveness ratio is 5,877.48€/YWFU. In conclusion, treating atopic dermatitis with emollients is a cost-effective strategy.

Topical S. aureus - Targeting Endolysin Significantly Improves Symptoms and QoL in Individuals With Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic skin condition affecting an increasing number of children and adults whose quality of life is impacted by chronic itch and pain. It is characterized by an altered epidermal barrier, skin inflammation, and skin microbiome dysbiosis particularly over-colonization of Staphylococcus aureus. The efficacy and tolerance of a cream containing a S. aureus-targeting technology (endolysin) was assessed in an open-label, two-week study in children and adults with mild-to-moderate atopic dermatitis. A total of 43 patients ranging from 7 months to 57 years old were included and all patients finished the study without any tolerance problem. Disease severity, measured with SCORAD, quickly reduced by 43% in 7 days and by 68 % in 14 days. The benefit was perceived by the whole panel with a marked improvement in overall QoL. This study shows the efficacy of a highly specific S. aureus-targeted technology in alleviating symptoms and improving QoL in children and adults with atopic dermatitis. It could also be beneficial in reducing and preventing flares in subjects with S. aureus load due to its good tolerance and specific action. J Drugs Dermatol. 2021;20(12):1323-1328. doi:10.36849/JDD.6363.

Pain in Atopic Dermatitis: An Online Population-based Survey.

Pruritus in atopic dermatitis has been studied extensively; however, evaluation of skin pain has been very limited. The aim of this study was to evaluate the presence, frequency and characteristics of skin pain in patients with atopic dermatitis. A survey was conducted of a representative sample of 5,000 18-80-year-old individuals selected from the French population according to sex, age, geographical area and socioprofessional status. Data on socio-demographic status and the presence of any skin disease were collected. Pain in the past month and health-related quality of life were evaluated. Average intensity of skin pain during the previous month was assessed with a horizontal visual analogue scale (0-10). Skin pain was reported by more than half of the patients with atopic dermatitis, at a pain intensity of almost 6/10. A neuropathic component was suggested by the Douleur Neuropathique - 4 questions (DN4) questionnaire (a tool for detection of neuropathic pain), as well as the presence of pain inside and outside of skin lesions. Severe alterations to health-related quality of life were assessed with the Dermatology Life Quality Index and Short Form 12 Health Survey (SF-12). Pain is reported frequently by patients with atopic dermatitis. Healthcare professionals should question patients about pain and provide effective treatments. Future clinical trials must take skin pain into account.

Development and accuracy of an artificial intelligence algorithm for acne grading from smartphone photographs.

We developed an artificial intelligence algorithm (AIA) for smartphones to determine the severity of facial acne using the GEA scale and to identify different types of acne lesion (comedonal, inflammatory) and postinflammatory hyperpigmentation (PIHP) or residual hyperpigmentation. Overall, 5972 images (face, right and left profiles) obtained with smartphones (IOS and/or Android) from 1072 acne patients were collected. Three trained dermatologists assessed the acne severity for each patient. One acne severity grade per patient (grade given by the majority of the three dermatologists from the two sets of three images) was used to train the algorithm. Acne lesion identification was performed from a subgroup of 348 images using a tagging tool; tagged images served to train the algorithm. The algorithm evolved and was adjusted for sensibility, specificity and correlation using new images. The correlation between the GEA grade and the quantification and qualification of acne lesions both by the AIA and the experts for each image were evaluated for all AIA versions. At final version 6, the GEA grading provided by AIA reached 68% and was similar to that provided by the dermatologists. Between version 4 and version 6, AIA improved precision results multiplied by 1.5 for inflammatory lesions, 2.5 for non-inflammatory lesions and by 2 for PIHP; recall was improved by 2.6, 1.6 and 2.7. The weighted average of precision and recall or F1 score was 84% for inflammatory lesions, 61% for non-inflammatory lesions and 72% for PIHP.

Body Piercing: A National Survey in France.

BACKGROUND: There are no recent data available in France regarding body piercing (BP). OBJECTIVE: We examined the demographics, motivations, quality of life, cutaneous conditions, and cutaneous side effects after BP within the French population. METHODS: A representative sample of 5,000 individuals (aged 15 and over) from the general population responded to a survey online between April and August 2017. Data regarding demographics, BP characteristics (location, age at first piercing, hesitation, regrets, motivations, cutaneous side effects), tobacco, skin conditions (acne, contact eczema, atopic eczema, rosacea, psoriasis, vitiligo), and tattoos were collected. Respondents also filled an SF-12 quality of life questionnaire. RESULTS: Overall, 12% of the respondents reported at least one BP (women: 19.4%, men: 8.4%, p < 0.01). The prevalence was highest among those aged between 25 and 34 years (25.8%). Individuals with BP were more likely to smoke (p < 0.01). The most common body parts for piercings were the external part of the ear (42%), the navel (24%), the tongue (15%), and the nose (11%). Gender differences included localization (belly button and nose for women, eyebrows for men) and motivations (embellishment of the body for women, individuality and sexuality for men). A total of 33.6% of the study participants reported having skin problems after BP, primarily infection (44%). Individuals with BPs were more likely to report having contact eczema, atopic dermatitis, and acne. BP was associated with a lower mental quality of life score. CONCLUSION: This is the largest epidemiological study on BP in France to date. It allows us to draw a precise current snapshot of French indi viduals with BP.

Connecting the Dots: From Skin Barrier Dysfunction to Allergic Sensitization, and the Role of Moisturizers in Repairing the Skin Barrier

The skin is one of the largest immunologic organs in the body and a continuous target for allergic and immunologic responses. Impairment of the skin barrier increases the likelihood of external antigens and pathogens entering and creating inflammation, which can potentially lead to skin infections, allergies, and chronic inflammatory diseases such as atopic and contact dermatitis. Functionally, the skin barrier can be divided into four different levels. From outermost to innermost, these highly interdependent levels are the microbiome, chemical, physical, and immune levels. The objective of this review is to provide an update on current knowledge about the relationship between skin barrier function and how dysfunction at each level of the skin barrier can lead to allergic sensitization, contact dermatitis, and the atopic march, and examine how to best repair and maintain this barrier through the use of moisturizers. J Drugs Dermatol. 2019;18(6):581-586.

Skin sensitivity and skin microbiota: Is there a link?

Sensitive skin is defined by the occurrence of unpleasant sensations, accompanied or not by erythema, in response to stimuli which normally should not provoke such sensations and that cannot be linked to skin disease. Even if its pathophysiology is not completely known, hyper-reactivity of the cutaneous nervous system associated with an abnormal skin barrier has been hypothesized as a primary culprit including more recently a role of the cutaneous microbiota. The objective of this short review is to discuss the relationship between the skin microbiota, skin sensitivity and the skin barrier function.

From Probiotic to Prebiotic Using Thermal Spring Water.

BACKGROUND: La Roche-Posay Thermal Spring Water (LRP-TSW) exhibits both probiotic and prebiotic properties enhancing the diversity of the skin microbiota. METHODS: A review was undertaken to explore the role of LRP-TSW as a topical probiotic and prebiotic therapy in improving the diversity of the skin microbiota and reducing dryness and pruritus in inflammatory skin diseases. RESULTS: The concentration of minerals and non-pathogenic microbes in LRP-TSW may explain its therapeutic benefit when used for inflammatory skin diseases. Clinical studies have shown that topical LRP-TSW treatment results in increases in Gram-negative bacteria with reduction of Gram-positive bacteria, and improvements in skin microbial diversity. At the same time skin condition in atopic dermatitis, psoriasis, and general dryness in otherwise healthy skin, has been shown to improve. CONCLUSIONS: Enhancement of skin microbiota diversity using topical LRP-TSW may offer a valuable option for the treatment and maintenance of inflammatory skin diseases. J Drugs Dermatol. 2018;17(6):657-662.

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Effect of an Emollient on the Mycobiome of Atopic Dermatitis Patients.

INTRODUCTION: Atopic dermatitis (AD) is associated with changes in skin bacterial microbiome. Emollient treatment induces change in bacterial microbiome in AD, but its effect on fungal microbiome ("mycobiome") and their inter-kingdom correlations is unknown. We used Ion-Torrent sequencing to characterize the mycobiome of AD patients in response to emollient treatment. METHODS: Skin swabs were collected from lesional and non-lesional skin of AD patients suffering from moderate AD, after informed consent and according to GCP guidelines. Genomic DNA was extracted from each swab using the MoBio PowerSoil DNA Isolation kit and used for mycobiome sequencing analyses as described in our earlier publications. Principal coordinates analyses (PCoA), diversity, abundance, and correlations analyses were conducted in R and relevant packages using non-parametric tests (P less than .05 was significant). RESULTS: Swab samples from 10 patients (7 females, 3 males; mean age, 10.5 years) were analyzed. Emollient treatment induced a significant reduction of Scoring Atopic Dermatitis (SCORAD) score (P less than .001). PCoA showed pre-treatment and post-treatment samples clustered differently at all taxa levels. Six genera were detected in only non-lesional samples, while four were detected in only lesional samples. In non-lesional samples, Shannon diversity index was significantly increased after emollient treatment (P less than equal to .04), while lesional skin exhibited non-significant decrease. Ascomycota was the most abundant phylum and Dothideomycetes was the most abundant Class in most samples. Eight fungal species were either significantly different (P less than .05) or showed a strong trend (P less than .1) between pre- and post-treatment samples of lesional and non-lesional skin. In lesional skin, Gram-negative Pseudomonas spp. correlated significantly with pathogenic fungal species (Aspergillus, Candida spp.) in pre-treatment samples; these correlations were not detected in post-treatment samples. Moreover, lesional skin exhibited significant correlations between Gram-positive bacteria (Corynebacterium kroppenstedtiian and Staphylococcus pettenkoferi) and pathogenic Candida species in pre-treatment samples, but not in post- treated samples. DISCUSSION: Emollient treatment may induce beneficial microbial changes in the mycobiome and augment host-microbe balance on skin in AD. Clinical relevance of these results need to be investigated. J Drugs Dermatol. 2018;17(10):1039-1048.

A Time-Series Study of the Effect of Air Pollution on Outpatient Visits for Acne Vulgaris in Beijing.

BACKGROUND/AIMS: There is increasing evidence that exposure to air pollutants, including particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2), might aggravate preexisting skin diseases such as eczema and urticaria. Here we investigated if a possible link exists between air pollution and acne vulgaris. We assessed the association between ambient air pollutant concentrations and the number of visits of patients for acne vulgaris to a dermatological outpatient clinic in Beijing, China, from April 1, 2012 to April 30, 2014. METHODS: In this time period, 59,325 outpatient visits were recorded because of acne vulgaris. Daily air pollution parameters for PM10, PM2.5, SO2, and NO2 were obtained from the Beijing Municipal Environmental Monitoring Center. RESULTS: Increased concentrations of ambient PM2.5, PM10, and NO2 were significantly associated with increased numbers of outpatient visits for acne vulgaris over the 2 years. These effects could be observed for NO2 in a single-pollutant model and for PM2.5, PM10, and NO2 in 2-pollutant models, which are closer to real-life exposure. Of note, these effects were specific because they were not observed for increased SO2 concentrations, which even showed negative correlations in all test models. CONCLUSION: This study provides indirect evidence for a link between acne vulgaris and air pollution.

Skin microbiome and acne vulgaris: Staphylococcus, a new actor in acne.

Propionibacterium acnes (P. acnes), the sebaceous gland and follicular keratinocytes are considered the three actors involved in the development of acne. This exploratory study investigated the characteristics of the skin microbiota in subjects with acne and determined microbiota changes after 28 days of application of erythromycin 4% or a dermocosmetic. Skin microbiota were collected under axenic conditions from comedones, papulo-pustular lesions and non-lesional skin areas from subjects with mild to moderate acne according to the GEA grading using swabs. Samples were characterized using a high-throughput sequencing approach that targets a portion of the bacterial 16S rRNA gene. Overall, microbiota samples from 26 subjects showed an overabundance of Proteobacteria and Firmicutes and an under-representation of Actinobacteria. Staphylococci were more abundant on the surface of comedones, papules and pustules (P=.004 and P=.003 respectively) than on non-lesional skin. Their proportions increased significantly with acne severity (P<.05 between GEA-2 and GEA-3). Propionibacteria represented less than 2% of the bacteria on the skin surface. At Day 28, only the number of Actinobacteria had decreased with erythromycin while the dermocosmetic decreased also the number of Staphylococci. A significant reduction (P<.05) from Day 0 of comedones, papules and pustules with no significant difference between the products was observed. The bacterial diversity on all sampling areas was similar. The dermocosmetic decreased the number of Actinobacteria and Staphylococcus spp. after 28 days. Staphylococcus remained the predominant genus of the superficial skin microbiota. No significant reduction in Staphylococcus spp. was observed with the topical antibiotic.

Efficacy of a Daily Protective Moisturizer with High UVB and UVA Photoprotection in Decreasing Ultraviolet Damage: Evaluation by Reflectance Confocal Microscopy.

Patients with photodermatoses or actinic keratosis benefit from very high ultraviolet B-ultraviolet A (UVB-UVA) photoprotection. However, poor compliance is an issue that jeopardizes adequate protection, leading to disease recurrence. This study evaluated the efficacy of a daily protective moisturizer with high UVB and UVA photoprotection applied 8 h before irradiation. A monocentric, open-label, prospective, control pilot study was performed including 10 patients. Patients were irradiated with UVB and UVA before and 8 h after topical application of the product. Reflectance confocal microscopy (RCM) assessment was performed 24 h later. Clinical assessment showed a statistically significant increase in minimal erythema dose (MED) after application of the product (p <0.001). Signs of UV damage according to RCM were not observed on photoprotected skin (p <0.05). Skin irradiated 8 h after applying a daily protective moisturizer presented an increase in MED and RCM findings that equal the findings for non-irradiated skin.

The Role of Cutaneous Microbiota Harmony in Maintaining a Functional Skin Barrier.

The skin is constantly exposed to various endogenous and exogenous factors that may impact its barrier function at the physical, mechanical, immunological, and microbial levels. These factors have the potential to initiate or exacerbate a variety of inflammatory skin conditions, especially those associated with barrier dysfunction. The barrier function of the skin depends upon a symbiotic relationship between resident microbial communities and host tissue. This symbiosis results from complex signals involved in both the innate and adaptive immune responses. Recent research indicates that both bacterial diversity and the relative abundance of different microbes present on and in the skin, may contribute to skin barrier stability or dysfunction. The objectives of this review are to discuss the relationship between the skin microbiota and skin barrier function and to consider mechanisms that may help its preservation. J Drugs Dermatol. 2017;16(1):12-18..