Localized Lichen Myxedematosus With Plasma Cell Light Chain Restriction: Is It the Exception or the Rule?

Lichen myxedematosus is a chronic cutaneous mucinosis that can present on a spectrum from localized cutaneous lesions to systemic disease of scleromyxedema. The clinical presentation of localized cutaneous lichen myxedematosus is waxy lichenoid papules, nodules, and/or plaques that have histopathologic findings of mucin deposition and a variable degree of fibroblast proliferation. There is an absence of serum paraproteins, and there are no other systemic causes of cutaneous mucinosis such as thyroid disease. The pathogenesis of lichen myxedematosus is unknown. We report 3 cases of localized cutaneous lichen myxedematosus with a light chain-restricted plasmacytic component by in situ hybridization. Our findings deliver an insight for disease pathogenesis and highlight for the first time, the significance of plasma cells in lesions of localized cutaneous lichen myxedematosus. We suggest that plasma cell light chain restriction could represent a clue to distinguish localized cutaneous disease from systemic disease.

Clinical Efficacy of a Novel Two-Part Skincare System on Pollution-Induced Skin Damage.

INTRODUCTION: Air pollution continues to be a global health concern and recent studies have shown that air pollutants can cause skin damage and skin aging through several pathways that induce oxidative stress, inflammation, apoptosis, and skin barrier dysfunction. Preventive measures need to be considered to retain optimal skin health, and topical skincare products may be able to alleviate the negative effects of air pollution on skin. A randomized, double-blind, placebo-controlled clinical usage study was conducted to assess the efficacy and tolerability of a novel two-part skincare system (LVS) that was developed to provide protection against environmental skin aggressors including air pollution. After 8 weeks of use in subjects exposed to extremely high levels of pollution, LVS provided significant improvements compared to placebo in all clinical efficacy parameters including crow's feet wrinkles, overall skin damage, skin tone evenness, tactile roughness, and visible redness. Subject self-assessment questionnaires showed that the treatment product was highly rated in self-perceived efficacy. Decreased SQOOH and MDA content in skin swab samples suggest that LVS helped to reduce oxidative stress in patients' skin. Histological analyses of biopsy samples using biomarkers related to skin structure, damage and function (collagen IV, MMP1, CPD, and CD1a) further support the clinical benefits of LVS. Altogether, the presented study is among the first to show that topical skincare products can help to reduce pollution-induced skin damage and improve skin quality, especially when specifically formulated with active ingredients that combat the harmful effects of air pollutants. J Drugs Dermatol. 2018;17(9):975-981.

Study of Facial Sebum Levels and Follicular Red Fluorescence in Patients with Acne Vulgaris in Nigeria.

BACKGROUND: Increased sebum levels are triggering factors of acne vulgaris. No studies on sebum levels exist among acne patients in Africa. AIMS/METHODS: Cross-sectional study to determine facial sebum levels, acne lesions and red fluorescence among adolescents (n = 80) with acne vulgaris in Nigeria, who were interviewed and clinically examined. RESULTS: Facial sebum levels were higher among adolescents with acne than among those without. There was a positive correlation between sebum levels and acne lesions in the U zone but not in the T zone. There was also a positive correlation between the size of red fluorescence and acne lesions and mean sebum levels. Both correlations were highly significant in the U zone but not in the T zone. CONCLUSION: Facial sebum levels are higher among black African acne patients. Sebum is responsible for facial red fluorescence. The U zone may serve as a more reliable site than the T zone for measurements of sebum levels in black African acne patients.

Eruptive Facial Postinflammatory Lentigo: Clinical and Dermatoscopic Features.

The face has not been considered a common site of fixed drug eruption, and the authors lack dermatoscopic studies of this condition on the subject. The authors sought to characterize clinical and dermatoscopic features of 8 cases of an eruptive facial postinflammatory lentigo. The authors conducted a retrospective review of 8 cases with similar clinical and dermatoscopic findings seen from 2 medical centers in 2 countries during 2010-2014. A total of 8 patients (2 males and 6 females) with ages that ranged from 34 to 62 years (mean: 48) presented an abrupt onset of a single facial brown-pink macule, generally asymmetrical, with an average size of 1.9 cm. after ingestion of a nonsteroidal antiinflammatory drugs that lasted for several months. Dermatoscopy mainly showed a pseudonetwork or uniform areas of brown pigmentation, brown or blue-gray dots, red dots and/or telangiectatic vessels. In the epidermis, histopathology showed a mild hydropic degeneration and focal melanin hyperpigmentation. Melanin can be found freely in the dermis or laden in macrophages along with a mild perivascular mononuclear infiltrate. The authors describe eruptive facial postinflammatory lentigo as a new variant of a fixed drug eruption on the face.

Sensitive skin.

Sensitive skin is a clinical condition defined by the self-reported facial presence of different sensory perceptions, including tightness, stinging, burning, tingling, pain and pruritus. Sensitive skin may occur in individuals with normal skin, with skin barrier disturbance, or as a part of the symptoms associated with facial dermatoses such as rosacea, atopic dermatitis and psoriasis. Although experimental studies are still pending, the symptoms of sensitive skin suggest the involvement of cutaneous nerve fibres and neuronal, as well as epidermal, thermochannels. Many individuals with sensitive skin report worsening symptoms due to environmental factors. It is thought that this might be attributed to the thermochannel TRPV1, as it typically responds to exogenous, endogenous, physical and chemical stimuli. Barrier disruptions and immune mechanisms may also be involved. This review summarizes current knowledge on the epidemiology, potential mechanisms, clinics and therapy of sensitive skin.

Sebum Secretion of the Trunk and the Development of Truncal Acne in Women: Do Truncal Acne and Sebum Affect Each Other?

BACKGROUND: There are few published data on truncal acne because most studies have focused on facial acne. AIMS: The objective of this study was to investigate truncal sebum secretion levels in patients with acne vulgaris and to evaluate the relationship between sebum secretion and the development of acne lesions. METHODS: The sebum casual levels at five different facial sites and ten truncal sites were measured in 35 Korean females with acne using a Sebumeter®. We performed an analysis of the correlation between sebum excretion and acne lesion number. RESULTS: We found that all of the truncal sites analyzed had lower sebum secretion levels than the facial sites. There was no significant correlation between sebum secretion and acne lesions on the trunk. CONCLUSION: Pathogenic factors other than sebum may have a predominant role in the development of truncal acne.

A case of extensive hyaline deposition in facial skin caused by erythropoietic protoporphyria.

Although erythropoietic protoporphyria (EPP) is relatively uncommon, affecting approximately 1 in 140 000 individuals in the U.K., it is an important disease not to miss owing to the risk of acute severe liver disease in 2% of cases. EPP occurs with clinical and histological changes in the skin associated with free-radical-associated dermal vascular damage. This also mediates the painful photosensitivity. Severe and disfiguring hyaline deposition is extremely rare. We demonstrate that severe EPP can cause disfiguring hyaline infiltration of the skin on the hands and face, which sheds light on the mechanism of photosensitivity in EPP; it must also be differentiated from conditions such as lipoid proteinosis.

Comparative pharmacokinetics and bioavailability of brimonidine following ocular and dermal administration of brimonidine tartrate ophthalmic solution and gel in patients with moderate-to-severe facial erythema associated with rosacea.

BACKGROUND: Persistent facial erythema is the most common primary pathological feature of rosacea, the only treatment for which is brimonidine tartrate (BT) gel. OBJECTIVES: To assess the relative bioavailability of topical BT gel in comparison with the ophthalmic BT solution. METHODS: A pharmacokinetic study was conducted to compare intraindividual systemic exposures after dermal application of BT gel (0·07%, 0·18% and 0·5%) under maximal use conditions in patients with moderate-to-severe facial erythema associated with rosacea, and administration of BT ophthalmic solution 0·2%. RESULTS: Patients who received BT ophthalmic solution 0·2% three times a day for 1 day had a mean Cmax of 54 ± 28 pg mL(-1) and a mean 0-24-h area under the curve (AUC0-24 h ) of 568 ± 277 pg h mL(-1) . Topical application of BT gel for 29 days resulted in quantifiable systemic exposure in 22%, 48%, 71% and 79% of patients who received BT gel 0·07% twice daily, 0·18% once daily, 0·18% twice daily and 0·5% once daily, respectively. The mean Cmax values for the BT gels ranged between 13 and 25 pg mL(-1) , and mean AUC0-24 h values ranged between 42 and 290 pg h mL(-1) . Systemic exposure increased with applied dose, with no drug accumulation for the duration of treatment. The systemic exposure observed with the highest dose of BT gel (0·5% once daily) was significantly lower than the systemic levels observed for the ophthalmic solution. 0·2% apply for all the concentrations. CONCLUSIONS: The systemic safety profile of BT gel may be considered better than that of the ophthalmic solution.

Long-term topical oestrogen treatment of sun-exposed facial skin in post-menopausal women does not improve facial wrinkles or skin elasticity, but induces matrix metalloproteinase-1 expression.

It is controversial whether treatment with oestrogen stimulates collagen production or accumulation in sun-exposed skin. The aim of this study was to determine the effect of long-term treatment with topical oestrogen on photoaged facial skin, with regard to wrinkle severity, and expression of procollagen and matrix metalloproteinase-1 enzyme. Two groups of 40 post-menopausal women applied either 1 g of 1% oestrone or vehicle cream once daily to the face for 24 weeks. Visiometer R1-R5 values (skin wrinkles) and Cutometer values (skin elasticity) were not significantly improved in the oestrone group after 24 weeks of treatment. Type I procollagen immunostaining did not increase in the oestrone group compared with the control group. However, levels of matrix metalloproteinase-1 mRNA increased robustly (10.3 times) in oestrone-treated skin compared with vehicle-treated skin. Thus, treatment with topical oestrogen may be deleterious in ultraviolet-induced skin ageing, at least in part, through induction of matrix metalloproteinase-1 (MMP-1) expression in human skin.

Novel facial cosmetic area 'O zone' shows unique characteristics in sebum excretion and acne lesion distribution.

BACKGROUND: We usually divided cosmetic facial zone into the T zone and U zone by the level of sebum secretion. Our recent studies suggested that the perioral area showed different characteristics in the aspect of acne development. OBJECTIVE: To investigate the unique characteristics of the O zone (perioral area) among the three facial areas. METHODS: A total of 102 patients clinically diagnosed as acne vulgaris were included. The acne lesions were counted from the clinical digital photographs by facial areas. The sebum level was measured using Sebumeter(®) . Area-weighted (AW) sebum and AW density of three areas of face were calculated. Statistical analysis was performed according to age and gender. RESULTS: There were no differences in the mean AW sebum level between the gender and age groups. Male has higher AW density of acne lesions than female at the O zone. The mean AW density of acne lesions on the NT zone, U zone, and whole face showed decrease by age, but at the O zone, 21-30 years group showed the highest mean AW density of acne. LIMITATIONS: Age- and gender-matched patients do not represent the whole acne patients. CONCLUSION: We suggested that the O zone is an independent facial zone, which showed a moderate-to-high sebum secreting area, maintained the acne lesions development by age, and predominated acne lesions in the male acne patients than female acne patients. Therefore, the O zone should be separated from the usual cosmetic T zone, and NT zone should replace the old T zone.

Changes in villus-like projections of corneocytes from the facial skin in normal infants with or without infantile eczema; useful parameter to assess barrier function.

BACKGROUND/PURPOSE: Skin barrier function changes rapidly during the first year of life in infants. Measuring skin barrier function in infants is difficult because of the burden on patients and their parents or guardians. A simple method for assessing barrier function in infants that can be performed quickly and would enable swift treatment and skin care management. METHODS: We used laser microscopy to investigate villus-like projections (VPs) observed on the lower surface of corneocytes obtained on tape strips from 18 normal Japanese infants at the ages of 1, 3, and 6 months. We also performed transepidermal water loss and corneocyte size measurements. A dermatologist clinically assessed the cutaneous findings. We rapidly measured skin barrier function changes during the first 6 months of life in infants. RESULTS: During the study period, very slight erythema and pityriasis were the primary reasons for skin rash, which were generally most severe at 3 months. The results showed that barrier function declined at approximately 3 months of age in nearly all subjects. Therefore, we found that normal barrier function of infantile skin becomes temporarily impaired after birth. CONCLUSION: We conclude that even in patients with very mild skin rashes, multiple objective indices of skin barrier function deteriorate simultaneously. Observation of VPs on the surface of corneocytes using laser microscopy is a rapid, painless, and effective method of monitoring skin barrier function in infants, and VP score offers a useful index for assessing barrier function.

Effects of water nanodroplets on skin moisture and viscoelasticity during air-conditioning.

BACKGROUND/PURPOSE: In air-conditioned rooms, dry air exacerbates some skin diseases, for example, senile xerosis, atopic dermatitis, and surface roughness. Humidifiers are used to improve air dryness, which often induces excess humidity and thermal discomfort. To address this issue, we investigated the effects of water nanodroplets (mist) on skin hydration, which may increase skin hydration by penetrating into the interstitial spaces between corneocytes of the stratum corneum (SC) without increasing air humidity. METHODS: We examined biophysical parameters, including skin conductance and transepidermal water loss (TEWL), and biomechanical parameters of skin distension/retraction before and after suction at the forehead, lateral canthus, and cheek, with or without mist, in a testing environment (24°C, 35% relative humidity) for 120 min. RESULTS: In the group without mist, TEWL values significantly decreased at all the sites after 1 h compared with the initial values. However, in the presence of mist, TEWL values were maintained at the initial values through the test, yielding significant differences vs. the group without mist. There were no significant differences between mist and mist-free groups in terms of skin conductance. Skin distension was significantly increased in the group with mist compared with that in the group without mist at the forehead and cheek, suggesting a softening effect of mist. CONCLUSION: Skin deformation of the face was improved by mist, suggesting hydration of the SC by mist. The change in TEWL was influenced by mist, suggesting supply of water to the skin, particularly the SC, by mist. These data indicated that a mist of water nanodroplets played an important role in softening skin in an air-conditioned room without increasing excess humidity.

[The changes of skin barrier of patients with different facial dermatitis and the comparison of CE and KLK5].

OBJECTIVE: To study the clinical symptoms and the condition of skin barrier of different facial dermatitis. METHODS: The patients with facial dermatitis were divided into 4 groups based on their diagnosis: hormone-dependent dermatitis (HDD) group, sensitive skin (SS) group, cosmetic intolerance (CI) group and normal control group. All patients received the evaluation on clinical symptoms with measuring scale, measurements of stratum corneum water content (SCWC), sebum, pH, trans-epidermal water loss (TEWL) and blood flow. The skin scales were collected for the measurements of the ratio of immature cornified envelope (CE) via immunofluorescence and the concentration of kallikrein 5 (KLK5) via enzyme-linked immunosorbent assay. RESULTS: There were total 146 patients included (HDD 38, SS 53, CI 15, control group 30), most of them had their symptoms evaluated as moderate to severe. Compared with the control, the disease groups had lower SCWC and sebum (P < 0.05), higher pH, TEWL and blood flow (P < 0.05), higher ratio of immature CE (P = 0.011) and lower concentration of KLK5 (P = 0.000); while these parameters among the disease groups did not show statistical significant difference. CONCLUSION: There is no difference in the clinical symptoms and the condition of skin barrier between facial dermatitis with different inducements. The growth of CE may be inhibited and the concentration of KLK5 decreases in facial dermatitis.

Necrotizing infundibular crystalline folliculitis: a clinicopathological study.

BACKGROUND: Necrotizing infundibular crystalline folliculitis (NICF) is a folliculocentric disorder associated with filamentous crystalline deposits, enclosed by parakeratotic columns within the partly necrotic follicular ostium and infundibulum. There are only very few data published about this disorder of unknown origin. OBJECTIVE: We sought to determine the clinicopathological features and pathogenetic aspects of NICF. METHODS: Clinicopathological characterization of 9 patients with NICF and a second group of 7 patients with coincidental findings of NICF in the vicinity of epithelial skin neoplasms was conducted. RESULTS: Clinically, NICF is characterized by multiple waxy papules with predilection for the forehead (56%), neck, and back. Birefringent crystalline deposits were present in the follicular ostia and enclosed by parakeratotic columns in all cases. The necrosis of follicular epithelium was found in 89% and perifollicular neutrophilic infiltrate in 22% of the biopsy specimens. Both yeasts and gram-positive bacteria were identified within the affected follicles in 56% in the first group and 86% in the second group of coincidental NICF. LIMITATION: This was a single-center retrospective study. CONCLUSIONS: NICF is both a distinct entity and an epiphenomenon in the context of other disorders. In regard to the common association with yeasts and gram-positive bacteria in the affected follicles, we hypothesize that NICF is pathogenetically linked to these organisms, which is supported by resolution of the lesions after topical or systemic antimycotic treatment.

Rosacea treatment with intermediate-dose isotretinoin: follow-up with erythema and sebum measurements.

Isotretinoin is one of the therapeutic options for rosacea. However, the response of erythema to treatment with isotretinoin is usually slow and incomplete with common (0.5-1 mg/kg/day) or low (10 mg/day) doses. This study investigated the efficacy of, and relapse on, 20 mg/day isotretinoin treatment in rosacea, with the aid of instrumental measurement of facial erythema and sebum levels. A 20 mg/day dose of isotretinoin was given for 4 months, and then the dose was tapered off within the following 6 months. A total of 25 patients were included in the study. Papule and pustule counts, erythema index, sebum level, dermatologist's and patient's erythema scores, and dermatologist's sebum scores were significantly lower in the first month of therapy compared with pre-treatment values (p < 0.05). Within a median follow-up of 11 months (95% confidence interval: 8.4-13.5 months) 45% of patients had a relapse. In conclusion, 20 mg/day isotretinoin was rapidly efficient for reducing both inflammatory lesions and erythema in rosacea.

Immunohistochemical expression of matrix metalloproteinases in the granulomatous rosacea compared with the non-granulomatous rosacea.

BACKGROUND: There is a granulomatous variant which is recognized in the rosacea spectrum. However, the pathogenesis of granuloma formation in rosacea has not been clearly demonstrated. Matrix metalloproteinases (MMPs) are required for recruitment of inflammatory cells and for tissue remodelling, making way for the development of well-organized granuloma. OBJECTIVE: The aim of this study was to investigate the expression of transforming growth factor (TGF)-ß, TGF-ß type II receptor (TßRII), Tumour necrosis factor (TNF)-α, MMP-1, 2 and 9 in the granulomatous rosacea (GR) compared with the non-granulomatous rosacea (NGR) and test the hypothesis that the changes of these profiles in GR would be related with chronic ultraviolet radiation (UVR)-exposure. METHODS: Facial skin samples were obtained from 20 patients with GR and NGR (control group). The sections were stained using haematoxylin and eosin, Verhoeff's elastic stain, and antibodies to TGF-ß, TßRII, TNF-α, MMP-1, -2 and -9. RESULTS: The amount of elastotic material was significantly increased in the dermis of GR lesions. Expression of TGF-ß was significantly decreased in the epidermis of GR lesions compared with NGR lesions. In addition, the expression of MMP-9 was significantly increased in the dermis of GR lesions compared with NGR lesions, especially at the centre of the granuloma on a semi-quantitative analysis. MMP-2 expression was also increased in GR lesions, although the difference between the two groups was not statistically significant. CONCLUSIONS: The results of this study suggest that the increased expression of MMPs in the dermis may participate in granuloma formation of GR in association with UVR.

Primary cutaneous localized amyloid elastosis.

Amyloid elastosis is a rare form of cutaneous amyloidosis characterized histologically by the deposition of amyloid-coating elastic fibers of the skin. To date, only 4 cases have been reported, all of them in the setting of systemic amyloidosis. We present the first case of primary cutaneous localized amyloid elastosis.