From decoding the perception of tightness to a clinical proof of soothing effects derived from natural ingredients in a moisturizer.

OBJECTIVE: To decode the feeling of skin tightness after application of a cosmetic product and how to soothe this discomfort. To pursue this aim, we considered the ingredient's effect on stratum corneum (SC) biomechanics to differentiate between consumers prone to tightness from those that are not and correlate these effects with mechanoreceptor activation. METHODS: In vivo clinical trials were used to assess the tightness perception dichotomy between groups of Caucasian women; in vitro experiments were used to measure the mechanical stresses induced in the SC after cleanser and moisturizer application; and in silico simulations were used to illustrate how the measured mechanical stresses in the SC result in the development of strains at the depth of cutaneous mechanoreceptors, triggering tightness perceptual responses. RESULTS: Before any cream application, women prone to tightness tend to have a more rigid SC than their less sensitive counterparts, however cleanser application increases SC stiffness in all women. Surprisingly, no correlation was found between tightness perception and hydration measurements by the Corneometer or barrier function, as evaluated by transepidermal water loss. Self-declared tightness and dryness scores were strongly associated with a self-described sensitive skin. After application of the optimized moisturizing formula, Osmoskin® containing natural waxes with good filming properties, consumers report a strong decrease in tightness and dryness perception. These results match with laboratory experiments where the cleanser was shown to increase SC drying stresses by 34%, while subsequent application of Osmoskin® decreased stresses by 48%. Finite element modelling, using experimental results as input, elucidates the differences in perception between the two groups of women. It makes clear that Osmoskin® changes the mechanical status of the SC, producing strains in underlying epidermis that activates multiple cutaneous mechano-receptors at a level correlated with the self-perceived comfort. CONCLUSION: Integration of the in vivo, in vitro and in silico approaches provides a novel framework for fully understanding how skin tightness sensations form and propagate, and how these sensations can be alleviated through the design of an optimized moisturizer.

OBJECTIF: Décoder l'impression de tiraillement de la peau après l'application d'un produit cosmétique et la manière d'apaiser cette sensation désagréable. Pour poursuivre cet objectif, nous avons pris en compte l'effet de l'ingrédient sur la biomécanique de la couche cornée afin de différencier les consommatrices sujettes à un tiraillement de celles qui ne le sont pas et de corréler ces effets avec l'activation des mécanorécepteurs. MÉTHODES: Des essais cliniques in vivo ont été utilisés pour évaluer la dichotomie de perception de tiraillement entre des groupes de femmes de race caucasienne; des expériences in vitro ont été utilisées pour mesurer les contraintes mécaniques induites dans la couche cornée après application d'un produit nettoyant et d'un produit hydratant; et des simulations in silico ont servi à illustrer comment les contraintes mécaniques mesurées dans la couche cornée entraînent le développement de souches à la profondeur des mécanorécepteurs cutanés, qui déclenchent les réponses perceptives de tiraillement. RÉSULTATS: Avant toute application de crème, les femmes sujettes au tiraillement tendent à avoir une couche cornée plus rigide que leurs homologues moins sensibles, mais l'application d'un produit nettoyant augmente la raideur de la couche cornée chez toutes les femmes. Étonnamment, aucune corrélation n'a été observée entre la perception de tiraillement et les mesures d'hydratation réalisées par le cornéomètre ou la fonction barrière, évaluée par la perte d'eau transépidermique. Les scores de tiraillement et de sécheresse auto-déclarés étaient fortement corrélés à une peau décrite par les sujets elles-mêmes comme sensible. Après application de la formule hydratante optimisée, Osmoskin®, qui contient des cires naturelles ayant de bonnes propriétés de dépôt de film, les consommateurs rapportent une forte diminution de la sensation de tiraillement et de sécheresse. Ces résultats concordent avec les expériences en laboratoire où le produit nettoyant s'est avéré augmenter les contraintes de séchage de la couche cornée de 34 %, tandis que l'application ultérieure d'Osmoskin® a réduit les contraintes de 48 %. La modélisation à éléments finis, en utilisant les résultats expérimentaux comme données, élucide les différences de perception entre les deux groupes de femmes. Il est clair qu'Osmoskin® modifie l'état mécanique de la couche cornée, et produit des souches dans l'épiderme sous-jacent qui activent plusieurs mécano-récepteurs cutanés à un niveau corrélé au confort perçu par la patiente. CONCLUSION: La combinaison des approches in vivo, in vitro et in silico fournit un nouveau cadre pour comprendre pleinement comment les sensations de tiraillement de la peau se forment et se propagent, et comment elles peuvent être soulagées en mettant au point une crème hydratante optimisée.

Sensory neuron activation from topical treatments modulates the sensorial perception of human skin.

Neural signaling of skin sensory perception from topical treatments is often reported in subjective terms such as a sensation of skin "tightness" after using a cleanser or "softness" after applying a moisturizer. However, the mechanism whereby cutaneous mechanoreceptors and corresponding sensory neurons are activated giving rise to these perceptions has not been established. Here, we provide a quantitative approach that couples in vitro biomechanical testing and detailed computational neural stimulation modeling along with a comprehensive in vivo self-assessment survey to demonstrate how cutaneous biomechanical changes in response to treatments are involved in the sensorial perception of the human skin. Strong correlations are identified between reported perception up to 12 hours post treatment and changes in the computed neural stimulation from mechanoreceptors residing deep under the skin surface. The study reveals a quantitative framework for understanding the biomechanical neural activation mechanism and the subjective perception by individuals.

Are college campuses superspreaders? A data-driven modeling study.

The COVID-19 pandemic continues to present enormous challenges for colleges and universities and strategies for save reopening remain a topic of ongoing debate. Many institutions that reopened cautiously in the fall experienced a massive wave of infections and colleges were soon declared as the new hotspots of the pandemic. However, the precise effects of college outbreaks on their immediate neighborhood remain largely unknown. Here we show that the first two weeks of instruction present a high-risk period for campus outbreaks and that these outbreaks tend to spread into the neighboring communities. By integrating a classical mathematical epidemiology model and Bayesian learning, we learned the dynamic reproduction number for 30 colleges from their daily case reports. Of these 30 institutions, 14 displayed a spike of infections within the first two weeks of class, with peak seven-day incidences well above 1,000 per 100,000, an order of magnitude larger than the nation-wide peaks of 70 and 150 during the first and second waves of the pandemic. While most colleges were able to rapidly reduce the number of new infections, many failed to control the spread of the virus beyond their own campus: Within only two weeks, 17 campus outbreaks translated directly into peaks of infection within their home counties. These findings suggests that college campuses are at risk to develop an extreme incidence of COVID-19 and become superspreaders for neighboring communities. We anticipate that tight test-trace-quarantine strategies, flexible transition to online instruction, and-most importantly-compliance with local regulations will be critical to ensure a safe campus reopening after the winter break.

Psoriasis triggered by mefloquine.

A 46-year-old Caucasian man living on the central Mediterranean island of Gozo (Malta) was started on mefloquine 250 mg once weekly before a trip to lower Egypt. He took his medication 1 week before starting his holiday and was advised to continue it for 4 weeks after returning. He did not take any other medication and enjoyed the holiday, which he initially intended to repeat in the near future. His medical history revealed a number of episodes of psoriasis for which he sought dermatologic advice. He had been given systemic therapy on at least one occasion, but the condition had been fairly quiescent for some time and he had not needed to consult a dermatologist for more than 4 years. Soon after the third tablet of mefloquine and effectively just after his return home to Gozo, the patient noticed that the psoriasis was "creeping back." He noted progressive deterioration in his skin problem but nevertheless finished the recommended course of therapy considering that "being sure about not developing malaria was far more important than a touch of psoriasis." The psoriasis worsened to the extent that he had taken off work for 2 weeks from his job as a self-employed carpenter at the time of referral. On examination, clearly there was a significant flare up of his psoriasis with severe involvement of the hands (Figure 1) and feet and less so over the rest of his body. He had been off work and matters were steadily getting worse in spite of topical treatment with a combination of calcipotriol-betamethasone ointment. Oral methotrexate 15 mg once weekly was commenced together with topical therapy with good results (Figure 2).

Design, Implementation, and Evaluation of an Integrative Pain Management Program in a Primary Care Safety-Net Clinic.

OBJECTIVE: To design, implement, and evaluate a comprehensive Integrative Pain Management Program (IPMP) for patients with chronic pain in a safety-net primary care clinic. DESIGN: We used a quality improvement "Plan Do Study Act" (PDSA) framework to design, refine, and evaluate an integrative chronic pain program. SETTING: An urban federally qualified health center located in a community with high rates of chronic pain, substance use, and opioid overdose. SUBJECTS: Eligible participants included individuals with pain for greater than 3 months who were prescribed opioid therapy. OUTCOME MEASURES: We designed IPMP using a PDSA framework that promotes continuous evaluation and adaptation of the program to meet the needs of the clinical system. We assessed feasibility and acceptability with program referrals and attendance and evaluated program satisfaction. RESULTS: The IPMP delivered a 12-week group-based intervention that involved group support, education on pain etiology and treatments, movement-based interventions, mindfulness-based therapies, acupuncture, and massage therapy. One hundred forty-six patients were referred to IPMP; 58 individuals participated in one of the first three cohorts of the program. Sixty-two percent of participants attended at least half of the sessions. Staff and participants reported high levels of satisfaction with IPMP and demand for longitudinal services. CONCLUSIONS: An IPMP delivered within a safety-net primary care clinic could be implemented in a way feasible and acceptable to staff and participants with the support of the local health care system. The application of a PDSA cycle allowed for rigorous implementation and evaluation of a multimodal pain program. Quality improvement frameworks are a strategy to improve and expand the delivery of high-quality patient-centered integrative pain treatments.

Acne - a potential skin marker of internal disease.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in adult women. Hyperandrogenism is the crux of the pathogenesis of both acne and hirsutism, the most frequent clinical presentations of the syndrome. The chronic anovulation that may occur, often but not always associated with enlarged cystic ovaries, has long been recognized as an important feature of PCOS. In recent years major changes have occurred with regard to PCOS: Although management of the common cutaneous manifestations, mainly acne, hirsutism, alopecia, and acanthosis nigricans, remains strictly within the realm of daily dermatologic practice, the pendulum is shifting toward greater awareness of the longer-term systemic implications of PCOS, with emphasis on the unique opportunity and privileged position of the dermatologist to diagnose this potentially serious problem at an early stage, when effective long-term treatment can be instituted. Patients need to be advised that PCOS cannot be cured but can be controlled. Management should involve a multidisciplinary team with emphasis on lifestyle change, insulin sensitizing agents, androgen blockers, and attention to specific cutaneous manifestations.

HIV-seropositive individuals' optimistic beliefs about prognosis and relation to medication and safe sex adherence.

OBJECTIVE: The study objective was to characterize respondents' prognostic perceptions of HIV infection and to explore how perceptions might affect medication and safe sex nonadherence. METHODS: Surveys were mailed to 295 clients of an HIV-specific case management organization. Participants were asked to describe experience with HIV/AIDS right after serostatus knowledge and currently, using provided word lists, after which they were asked to assess current life expectancy. Self-reported information on antiretroviral medication and safe sex nonadherence was obtained. RESULTS: A total of 220 (75%) clients (66% nonwhite, 73% male, 63% gay/bisexual, 50% educated >12 years, and 53% with incomes <$10,000/year) returned surveys. Negative descriptors from word lists were significantly less common and positive descriptors significantly more common now compared to right after serostatus knowledge. Current perceptions about life expectancy indicated that most respondents thought they would live many years, many believing they would live well into old age. Whites (odds ratio [OR], 0.34; P =.01) were less likely and those with >12 years education (OR, 2.76; P =.02) and with CD4 cell counts >200 (OR, 2.70; P =.01) were more likely to have optimistic prognostic beliefs. The optimistic subgroup, when compared with the pessimistic subgroup, was more likely to report medication (26% vs 13%, P =.04) and safe sex (57% vs 29%, P =.004) nonadherence. CONCLUSIONS: Seropositive individuals, including persons of color (adjusted) as well as women and drug users (unadjusted), self-reported optimistic beliefs about their prognosis. Those with more optimism about their prognosis were significantly more likely to report medication and safe sex nonadherence. A better understanding of seropositive patients' prognostic beliefs and the factors determining them is warranted.

Characteristics of superficial mycoses in Malta.

BACKGROUND: A study was conducted to determine the chief agents of superficial mycoses in Malta. Data were collected over a 5-year period from mycologic investigations carried out on all dermatologic specimens sent to the Mycology Laboratory at St. Luke's Hospital in Malta. METHODS: In the period between January 1995 and December 1999, a total of 1271 specimens from skin, nails, or hair were collected from 1200 clinically suspected cases of dermatomycoses. RESULTS: The fungi cultivated included dermatophytes (n = 371), yeasts (n = 33), and nondermatophyte filamentous fungi (n = 12). Trichophyton rubrum (n = 121) was the most prevalent, followed by Microsporum canis (n = 109), T. mentagrophytes (n = 80), M. gypseum (n = 27), Epidermophyton floccosum (n = 17), T. soudanense (n = 10), T. tonsurans (n = 2), T. verrucosum (n = 2), M. persicolor (n = 1), and T. violaceum (n = 1). Candida species were also cultivated, with C. parapsilosis (n = 14) being the most common, followed by C. albicans (n = 12) and C. tropicalis (n = 6). Nondermatophyte filamentous fungi were isolated from nail specimens only. CONCLUSIONS: In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients.