Expert consensus on holistic skin care routine: Focus on acne, rosacea, atopic dermatitis, and sensitive skin syndrome.

BACKGROUND: Treatment, cleansing, moisturizing, and photoprotection are four major components of holistic skin care for dermatological conditions. While treatment (T) is recognized as a key component in the management of dermatological conditions, there is a lack of practical guidance on the adjunctive role of cleansing, moisturizing, and photoprotection ("CMP"). Limited patient knowledge, confusion over product selection, and lack of guidance on how to choose and use CMP skin care products (in conjunction with pharmacological therapy) are the main barriers to establishing a holistic skin care routine for dermatological conditions. AIMS: This study aimed to review current clinical evidence, identify gaps, and provide practical guidance on conceptualization and implementation of CMP routine in the management of sensitive skin due to underlying acne, atopic dermatitis, or rosacea, including conditions with idiopathic causes referred to as idiopathic sensitive skin syndrome. METHODS: An expert panel comprising of 10 dermatologists from Australia, China, Hong Kong, Taiwan, India, Indonesia, Philippines, Singapore, South Korea, and Thailand convened to develop consensus statements on holistic skin care in acne, rosacea, atopic dermatitis, and idiopathic sensitive skin syndrome using the Delphi approach. RESULTS: Consensus was defined as ≥80% of panel rating statement as ≥8 or median rating of ≥8. The final statements were collated to develop consensus recommendations on holistic skin care. CONCLUSION: A dermatologist-guided holistic skin care routine is essential to improve patient confidence and reduce confusion over product selection. The consensus recommendations presented here highlight the importance of cleansing, moisturization, and photoprotection in holistic skin care and how it can be utilized as a communication tool for physicians and patients to achieve overall better patient compliance, satisfaction, and treatment outcomes.

National Cervical Cancer Screening in Thailand.

BACKGROUND: Cervical cancer is an important public health problem in Thailand. It was the most common cancer in Thai women with the incidence rate of 23.4 per 100,000 women in 1990. OBJECTIVE: The aim of this study was to share the experiences and summary the outcome of cervical cancer screening program in Thailand. METHODS: The Ministry of Public Health in cooperation with the National Health Security Office, launched the National Cervical Cancer Screening Program, covering 76 provinces nationwide under Universal Coverage Scheme in 2005. The screening method are Pap smear and Visual Inspection with Acetic acid (VIA) for women aged 30-60 and 35-45 respectively with a 5-year screening interval. Detecting cervical pre-cancerous lesions will follow by day care treatment such as cryotherapy, Loop Electrosurgical Excision Procedure, etc. Results: The first phase (2005-2009), was carried out on 3,124,855 women, the coverage reached 77.5%. For the second phase (2010-2014), 7,637,226 women were screened, reaching 53.9% coverage of target women. However, we have few data of follow up examination after abnormal screening. Therefore, we conducted new system to get more follow up data in 2019. Under the coordination of many related partners, 10,762,081 women have been screened during 2005-2014. The incidence rate declined to 11.7 per 100,000 women which is ranked as the third most common in women in 2014. CONCLUSION: This article briefly reviews the challenge of implementing an efficient cervical cancer screening in Thailand. In 2020, HPV testing has been introduced as a primary screening test for all Thai women attending public health sector instead of conventional Pap test.

Unilateral Linear Punctate Palmoplantar Keratoderma: A Case Report.

Punctate palmoplantar keratoderma (PPPK) is a rare entity with an estimated prevalence rate of 1.17/100,000. PPPK usually presents with bilateral asymptomatic, tiny, hyperkeratotic punctate papules and plaques on the palmoplantar surface. Among the PPPK varieties, the linear presentation is much rarer, and so far there have been only 3 case reports. Here, we report the case of a 27-year-old female Thai patient who presented to our outpatient clinic with unilateral asymptomatic linear thickening lesions on her right sole since childhood. There were no similar lesions on other parts of the body. A histopathologic examination revealed epidermal hyperplasia and hyperkeratosis without columns of parakeratosis or cornoid lamella. The other examinations were normal. The clinical and histological contexts were consistent with a diagnosis of unilateral linear PPPK. The patient was treated with topical 10% urea cream and 10% salicylic acid cream twice daily. To the best of our knowledge, this is the first reported case of unilateral linear PPPK in Thailand, and the fourth reported case worldwide.

A Comparative Split-Face Study Using Different Mild Purpuric and Subpurpuric Fluence Level of 595-nm Pulsed-Dye Laser for Treatment of Moderate to Severe Acne Vulgaris.

BACKGROUND: Various forms of laser therapy including the pulsed-dye laser (PDL) have been reported to reduce acne lesion counts. OBJECTIVE: In this study, the benefits and complications when using a 595-nm PDL for the treatment of acne vulgaris were evaluated when comparing a subpurpuric (low) fluence level with a purpuric (high) fluence level. MATERIALS AND METHODS: This study was a prospective, single-blinded split-face clinical trial. Inclusion criteria included subjects with moderate to severe facial acne. All participants were treated with PDL, with each half of the face receiving either high or low fluence at 3-week intervals for a total of 4 treatments. Standardized facial photographs were obtained and blindly evaluated. RESULTS: Sixty-two subjects were enrolled with a mean age of 22.3 years. Fifty-five patients completed the study. The results showed a significant decrease in lesion counts compared with baseline after all treatments. However, the study did not demonstrate a statistically significant difference between the fluence parameters. The only treatment-related adverse event was temporary hyperpigmentation. CONCLUSION: This study demonstrates that PDL is effective in reducing acne lesions using purpuric and subpurpuric fluences. However, there was no statistically significant difference in acne lesion count between the higher and lower fluences.

Treatment of inflammatory facial acne vulgaris with intense pulsed light and short contact of topical 5-aminolevulinic acid: a pilot study.

BACKGROUND: Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) and red light (550-700 nm) has been introduced for effective treatment of facial acne. Untoward side effects are common, however. OBJECTIVE: To evaluate the efficacy and safety of the short contact of topical ALA and intense pulsed light (IPL) in treatment of inflammatory facial acne. METHODS: Fourteen patients with inflammatory facial acne were treated with IPL on the left side and combination of IPL and topical ALA on the right side at 3- to 4-week intervals for three sessions. Clinical photographs and lesion counts were obtained for evaluation. RESULTS: All patients revealed a reduction in number of acne lesions on both sides. On the ALA-pretreated side, lesion counts decreased 87.7% at 12 weeks after the last treatment (p < .01). Meanwhile, lesion counts on the nonpretreated side decreased 66.8% (p < .01). In addition, a number of lesion counts on the ALA-pretreated side decreased. Mild edema and minimal crust developed on the combined-treatment side. CONCLUSION: Short contact of topical ALA and IPL or IPL alone showed some beneficial effect in treatment of inflammatory facial acne; however, degree of improvement was better and remained longer with the combined regimen. Side effects were mild and reversible.