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1.
J Am Acad Dermatol ; 90(5): 1006.e1-1006.e30, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38300170

RESUMO

BACKGROUND: Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. OBJECTIVE: The objective of this study was to provide evidence-based recommendations for the management of acne. METHODS: A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS: This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. LIMITATIONS: Analysis is based on the best available evidence at the time of the systematic review. CONCLUSIONS: These guidelines provide evidence-based recommendations for the management of acne vulgaris.


Assuntos
Acne Vulgar , Antibacterianos , Peróxido de Benzoíla , Fármacos Dermatológicos , Ácidos Dicarboxílicos , Doxiciclina , Isotretinoína , Ácido Salicílico , Espironolactona , Humanos , Acne Vulgar/tratamento farmacológico , Isotretinoína/administração & dosagem , Isotretinoína/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Peróxido de Benzoíla/administração & dosagem , Peróxido de Benzoíla/uso terapêutico , Ácidos Dicarboxílicos/administração & dosagem , Ácidos Dicarboxílicos/uso terapêutico , Espironolactona/administração & dosagem , Espironolactona/uso terapêutico , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Ácido Salicílico/administração & dosagem , Ácido Salicílico/uso terapêutico , Medicina Baseada em Evidências/normas , Administração Oral , Retinoides/administração & dosagem , Retinoides/uso terapêutico , Tetraciclinas/administração & dosagem , Tetraciclinas/uso terapêutico , Adolescente , Minociclina/administração & dosagem , Minociclina/uso terapêutico , Criança , Administração Cutânea , Anticoncepcionais Orais Combinados/administração & dosagem , Anticoncepcionais Orais Combinados/uso terapêutico , Quimioterapia Combinada , Feminino , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Injeções Intralesionais , Adulto , Cortodoxona/análogos & derivados , Propionatos
2.
J Am Acad Dermatol ; 81(5): 1037-1057, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31610857

RESUMO

Obesity is a worldwide major public health problem with an alarmingly increasing prevalence over the past 2 decades. The consequences of obesity in the skin are underestimated. In this paper, we review the effect of obesity on the skin, including how increased body mass index affects skin physiology, skin barrier, collagen structure, and wound healing. Obesity also affects sebaceous and sweat glands and causes circulatory and lymphatic changes. Common skin manifestations related to obesity include acanthosis nigricans, acrochordons, keratosis pilaris, striae distensae, cellulite, and plantar hyperkeratosis. Obesity has metabolic effects, such as causing hyperandrogenism and gout, which in turn are associated with cutaneous manifestations. Furthermore, obesity is associated with an increased incidence of bacterial and Candida skin infections, as well as onychomycosis, inflammatory skin diseases, and chronic dermatoses like hidradenitis suppurativa, psoriasis, and rosacea. The association between atopic dermatitis and obesity and the increased risk of skin cancer among obese patients is debatable. Obesity is also related to rare skin conditions and to premature hair graying. As physicians, understanding these clinical signs and the underlying systemic disorders will facilitate earlier diagnoses for better treatment and avoidance of sequelae.


Assuntos
Obesidade/complicações , Dermatopatias/etiologia , Dermatite/etiologia , Humanos , Obesidade/fisiopatologia , Pele/fisiopatologia , Dermatopatias/metabolismo , Dermatopatias Infecciosas/etiologia
4.
Dermatol Ther ; 31(1)2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29193602

RESUMO

Acne vulgaris is a chronic disease of the pilosebaceous units presenting as inflammatory or noninflammatory lesions in individuals of all ages. The current standard of treatment includes topical formulations in the forms of washes, gels, lotions, and creams such as antibiotics, antibacterial agents, retinoids, and comedolytics. Additionally, systemic treatments are available for more severe or resistant forms of acne. Nevertheless, these treatments have shown to induce a wide array of adverse effects, including dryness, peeling, erythema, and even fetal defects and embolic events. Zinc is a promising alternative to other acne treatments owing to its low cost, efficacy, and lack of systemic side effects. In this literature review, we evaluate the effectiveness and side-effect profiles of various formulations of zinc used to treat acne.


Assuntos
Acne Vulgar/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Gluconatos/administração & dosagem , Pele/efeitos dos fármacos , Acetato de Zinco/administração & dosagem , Sulfato de Zinco/administração & dosagem , Acne Vulgar/diagnóstico , Administração Cutânea , Administração Oral , Fármacos Dermatológicos/efeitos adversos , Combinação de Medicamentos , Feminino , Gluconatos/efeitos adversos , Humanos , Masculino , Pele/patologia , Resultado do Tratamento , Acetato de Zinco/efeitos adversos , Óxido de Zinco/administração & dosagem , Sulfato de Zinco/efeitos adversos
5.
J Drugs Dermatol ; 17(6): 611-617, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29879248

RESUMO

Complementary and alternative medicine (CAM) therapies are increasing in popularity in the field of dermatology. Natural products and holistic approaches are in high demand among patients and research has begun to support their roles in acne and rosacea pathophysiology. In this article, commonly utilized biologically based complementary and alternative therapies for acne and rosacea are reviewed from an evidence-based perspective. Therapies discussed include vitamin C, nicotinamide, zinc, tea tree oil, green tea, resveratrol, curcumin, feverfew, licorice, chamomile, polypodium leucotomos, and nutrition-based approaches. J Drugs Dermatol. 2018;17(6):611-617.


Assuntos
Acne Vulgar/tratamento farmacológico , Fatores Biológicos/administração & dosagem , Terapias Complementares/tendências , Extratos Vegetais/administração & dosagem , Rosácea/tratamento farmacológico , Acne Vulgar/diagnóstico , Acne Vulgar/metabolismo , Animais , Antioxidantes/administração & dosagem , Antioxidantes/metabolismo , Ácido Ascórbico/administração & dosagem , Ácido Ascórbico/metabolismo , Fatores Biológicos/metabolismo , Terapias Complementares/métodos , Humanos , Fitoterapia/métodos , Fitoterapia/tendências , Extratos Vegetais/metabolismo , Rosácea/diagnóstico , Rosácea/metabolismo
6.
Lasers Med Sci ; 33(8): 1631-1637, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30143923

RESUMO

Usage of photopneumatic technology has recently increased for treatment of different skin conditions such as acne, keratosis pilaris (KP), and rosacea. Photopneumatic devices combine gentle negative pressure with broad band pulsed light simultaneously to attack multiple targets in the skin for better treatment outcomes. In this literature review, we evaluate the efficacy of photopneumatic therapy on treatment of acne, keratosis pilaris (KP), and rosacea.


Assuntos
Fototerapia/métodos , Vácuo , Acne Vulgar/terapia , Humanos , Ceratose/terapia , Rosácea/terapia , Pele , Resultado do Tratamento
7.
Wien Med Wochenschr ; 168(9-10): 236-242, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28181031

RESUMO

Natural and artificial tanning have become very popular in Western culture, yet at the same time, there is still a psychodermatology concern for this activity. Not much has been examined with the psychological aspects of tanning and sunscreen use. The purpose of this study is to examine the psychosocial effects associated with sun protection, natural, and artificial tanning among individuals 18 years old or older visiting the University of Miami Dermatology Outpatient Clinic. We distributed a survey on tanning and sunscreen use to 150 dermatology outpatients, hospital employees, and hospital visitors for three weeks during June/July 2015 asking about how often they tan, use sunscreen, and how they feel about this topic. Demographics, such as gender, ethnicity, and education were taken into consideration to examine the different responses in each category. Our results suggest that people's perception to tanning and sunscreen use have evolved over time. Most people in South Florida nowadays feel guilty when exposed to natural sunlight without sunscreen and do not tan frequently. The majority of the people, specifically women, utilize the recommended amount of sunscreen with a sun protection factor of 30-50. However, we can conclude that communication between social media and the general public can affect people's decision-making on tanning and sunscreen use with physician advice being the most effective method of encouraging people to use sunscreen. This study will add to the growing knowledge about psychodermatology.


Assuntos
Melanoma , Neoplasias Cutâneas , Luz Solar , Protetores Solares , Adulto , Feminino , Humanos , Masculino , Melanoma/prevenção & controle , Melanoma/psicologia , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/psicologia , Inquéritos e Questionários , Raios Ultravioleta
8.
Dermatol Ther ; 30(5)2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28220628

RESUMO

Safe and effective treatment options for acne vulgaris are needed to address side effects and increasing rates of antibiotic resistance from current treatments. Nicotinamide is a vitamin with potent anti-inflammatory properties that could offer a potential treatment option. We aim to summarize the relevant literature on the role of nicotinamide in acne vulgaris and discuss the next steps necessary to move this approach into clinical practice. We searched PubMed for clinical studies using nicotinamide for treatment of acne vulgaris. We summarized the 10 studies that met our search criteria. Six of eight studies using topical nicotinamide led to a significant reduction in acne compared with the patient's baseline or performed similarly to another standard-of-care acne treatment. Both studies using an oral supplement containing nicotinamide resulted in a significant reduction in acne compared with baseline. No major adverse side effects were noted. Our review suggests that topical and oral nicotinamide has an unclear effect on acne vulgaris due to the limited nature of the available literature. Additional studies are needed comparing nicotinamide to other first-line acne treatments and evaluating the efficacy and side effect profile of nicotinamide over an extended period of time.


Assuntos
Acne Vulgar/tratamento farmacológico , Anti-Inflamatórios/administração & dosagem , Niacinamida/administração & dosagem , Acne Vulgar/patologia , Administração Cutânea , Administração Oral , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/farmacologia , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Fármacos Dermatológicos/farmacologia , Humanos , Niacinamida/efeitos adversos , Niacinamida/farmacologia , Resultado do Tratamento
9.
J Am Acad Dermatol ; 74(5): 945-73.e33, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26897386

RESUMO

Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.


Assuntos
Acne Vulgar/diagnóstico , Acne Vulgar/tratamento farmacológico , Antibacterianos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Guias de Prática Clínica como Assunto , Administração Oral , Administração Tópica , Adolescente , Adulto , Medicina Baseada em Evidências , Feminino , Seguimentos , Humanos , Isotretinoína/uso terapêutico , Masculino , Recidiva , Medição de Risco , Resultado do Tratamento , Adulto Jovem
10.
Semin Cutan Med Surg ; 35(2): 103-6, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27416316

RESUMO

Acne and rosacea are common conditions seen every day by dermatologists. This review will discuss the most recent therapeutic options for patients with these conditions. Specifically, for acne, there will be a discussion of the use of isotretinoin at higher cumulative doses as well as a new formulation of isotretinoin, isotretinoin-lidose. Adult women with acne represent a growing population of patients who present for treatment of acne; the use of hormonal therapies as well as topical dapsone gel will be reviewed for these patients. For rosacea patients, the new topical agents - brimonidine gel and ivermectin cream - will be reviewed, with a discussion on possible rebound phenomenon from brimonidine. Finally, future treatments in the pipeline will be discussed.


Assuntos
Acne Vulgar/tratamento farmacológico , Tartarato de Brimonidina/administração & dosagem , Dapsona/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Dermatologia/tendências , Isotretinoína/administração & dosagem , Rosácea/tratamento farmacológico , Géis/administração & dosagem , Humanos , Ivermectina/administração & dosagem , Creme para a Pele/administração & dosagem , Resultado do Tratamento
12.
J Am Acad Dermatol ; 71(4): 814-21, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24906613

RESUMO

The rapid increase in the medical use of probiotics and prebiotics in recent years has confirmed their excellent safety profile. As immune modulators, they have been used in inflammatory skin conditions, such as atopic dermatitis. We review the literature regarding the use of probiotics and prebiotics in dermatology. Probiotics and prebiotics appear to be effective in reducing the incidence of atopic dermatitis in infants, but their role in atopic dermatitis treatment is controversial. Their role in acne, wound healing, and photoprotection is promising, but larger trials are needed before a final recommendation can be made.


Assuntos
Acne Vulgar/tratamento farmacológico , Dermatite Atópica/tratamento farmacológico , Prebióticos , Probióticos/uso terapêutico , Acne Vulgar/diagnóstico , Dermatite Atópica/diagnóstico , Dermatologia/métodos , Humanos , Fatores Imunológicos , Masculino , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
14.
Am J Clin Dermatol ; 25(3): 465-471, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38453786

RESUMO

Acne is one of the most common dermatological conditions to affect women of childbearing age, so it is important to consider the safety of long-term acne treatments on women who could become pregnant. In this review article, we clarify what management options are available to treat acne during pregnancy. Topical treatments, typically first-line for acne, such as azelaic acid, clindamycin, erythromycin, metronidazole, benzoyl peroxide, salicylic acid, dapsone, and retinoids, were reviewed. Systemic treatments, such as zinc supplements, cephalexin, cefadroxil, amoxicillin, azithromycin, erythromycin, and corticosteroids, typically second-line for acne, were also reviewed. Alternative treatments such as light therapy and cosmetic procedures were also evaluated. Due to recommendation of sunscreen utilization during acne treatments, sunscreen usage during pregnancy was also assessed. Management of acne during unplanned pregnancy was discussed in further detail regarding safety and adverse effects. Through summarized tables and examples of studies demonstrating safety and efficacy of treatments, the following is a resource for providers and patients to utilize for management of acne during pregnancy.


Assuntos
Acne Vulgar , Fármacos Dermatológicos , Complicações na Gravidez , Humanos , Acne Vulgar/tratamento farmacológico , Acne Vulgar/terapia , Gravidez , Feminino , Fármacos Dermatológicos/uso terapêutico , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Complicações na Gravidez/terapia , Complicações na Gravidez/tratamento farmacológico , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Protetores Solares/administração & dosagem , Gravidez não Planejada , Fototerapia/métodos , Administração Cutânea
15.
Skin Appendage Disord ; 10(1): 1-9, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38313565

RESUMO

Acne is a chronic inflammatory disease of the pilosebaceous unit with a multifactorial etiology and is one of the most common conditions treated by dermatologists and primary care physicians. Within an extensive and evolving treatment landscape, oral isotretinoin has demonstrated efficacy for treatment of severe, recalcitrant acne. Several side effects of isotretinoin have been reported, including laboratory abnormalities, mucocutaneous, and musculoskeletal effects, which may reduce compliance and patient satisfaction with treatment. In this narrative review, we aim to review the efficacy and safety profile of oral supplements or topical adjuvant therapies in mitigating isotretinoin-associated mucocutaneous and musculoskeletal side effects. Oral supplements reviewed include omega-3 fatty acids, vitamin E, folic acid and vitamin B12, antihistamines, l-carnitine, biotin, and combined oral supplements. Topical adjuvants include a hyaluronic acid, biosaccharide gum-2, and glycerine gel-cream; a nongreasy, noncomedogenic, fragrance-free moisturizing cream; dexpanthenol; trichloroacetic acid; and a combination cream. Most of the supplements and topical adjuvants demonstrated efficacy with an adequate level of supporting evidence and no reported adverse events, indicating an adequate safety profile. Patients on isotretinoin may benefit from using oral supplements and topical adjuvants to minimize primarily mucocutaneous side effects, increase adherence to treatment, and thereby improve overall outcomes.

16.
Cutis ; 113(1): E26-E32, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38478945

RESUMO

Acne vulgaris is a common condition that routinely affects females of childbearing age. Taking into consideration the reproductive journey of women when treating acne is of paramount importance given the safety concerns to both the mother and the fetus associated with certain medications. Therefore, careful consideration of therapeutic choices during pregnancy is crucial. Herein, we summarize the safety of acne treatments during pregnancy and offer practical clinical pearls for routine dermatology practice.


Assuntos
Acne Vulgar , Gravidez , Feminino , Humanos , Acne Vulgar/diagnóstico , Acne Vulgar/tratamento farmacológico
17.
Skin Appendage Disord ; 10(2): 83-91, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38572187

RESUMO

The growing demand for natural treatments has raised concerns among clinicians due to limited scientific evidence supporting their use. This review article addresses the issue by assisting dermatologists and general practitioners in recommending natural treatments for the following common nail disorders: nail brittleness, onychomycosis, periungual verrucae, paronychia, chloronychia, nail psoriasis, nail lichen planus, onychocryptosis, onycholysis, and congenital malalignment of the great toenail. One limitation is the scarcity of existing reviews on natural treatment options for nail disorders in the literature. Through a comprehensive review of existing literature, this article consolidates the available evidence on natural treatment options for these conditions. Although some natural treatments for nail disorders are supported by scientific evidence, the indiscriminate use of such remedies may lead to severe poisoning and health problems. Given the widespread and increasing use of natural treatments, clinicians play a pivotal role in educating patients about evidence-based remedies and debunking misleading claims. By doing so, clinicians can enhance patient safety and improve treatment outcomes. It is essential for healthcare professionals to be well-informed and equipped with the knowledge to differentiate between effective natural treatments and unverified claims, ensuring that patients receive appropriate care.

18.
J Cutan Pathol ; 40(4): 413-8, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23379606

RESUMO

We report the first documented case of an atypical form of transient reactive papulotranslucent acrokeratoderma (TRPA) in a patient heterozygous for the ΔF508 CFTR(cystic fibrosis transmembrane conductance regulator) mutation. TRPA represents a condition that classically presents with translucent to white plaques that become evident after water exposure. An atypical form with persistent lesions has also been described. Our patient is a 16-year-old girl with small, white papules coalescing into pebbly plaques on the palms. This condition is exacerbated after 5-10 min of water exposure and is associated with discomfort. The skin biopsy showed expanded stratum corneum, orthohyperkeratosis and dilation of eccrine ducts consisting with TRPA. A cystic fibrosis carrier state, barrier function defect, hyperhidrosis and the intake of cyclooxygenase inhibitors may have been pathogenic factors in our patient.


Assuntos
Fibrose Cística/complicações , Epiderme/patologia , Ceratodermia Palmar e Plantar/etiologia , Adolescente , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Feminino , Mãos , Heterozigoto , Humanos , Ceratodermia Palmar e Plantar/genética , Ceratodermia Palmar e Plantar/patologia , Mutação , Pele/patologia
19.
J Drugs Dermatol ; 12(4): 434-7, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23652891

RESUMO

In this review, we examine published data reporting the efficacy of pharmaceutical agents to treat associated postinflammatory hyperpigmentation commonly seen in skin of color. Retinoids and azelaic acid have been widely used to treat acne. Now there are increasing data describing their use in skin of color for the treatment of both acne and the subsequent postinflammatory hyperpigmentation. Historically, some dermatologists have been hesitant to use retinoids in skin of color because of perceived hypersensitivity in this patient population. However, recent data support the use of retinoids and azelaic acid in skin of color as both safe and beneficial.


Assuntos
Ácidos Dicarboxílicos/uso terapêutico , Hiperpigmentação/tratamento farmacológico , Retinoides/uso terapêutico , Acne Vulgar/tratamento farmacológico , Acne Vulgar/patologia , Fármacos Dermatológicos/efeitos adversos , Fármacos Dermatológicos/uso terapêutico , Ácidos Dicarboxílicos/efeitos adversos , Humanos , Hiperpigmentação/patologia , Retinoides/efeitos adversos , Pigmentação da Pele
20.
J Cosmet Dermatol ; 22(11): 2902-2909, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37605504

RESUMO

INTRODUCTION: Acne is a common, complex, multifactorial inflammatory skin disease associated with epidermal barrier dysfunction. Beginning in childhood, acne affects many adolescents and adults. Acne is associated with lower self-esteem, anxiety, and depression and may cause scars and pigmentary sequelae. The review explores the relationships between acne and the skin barrier function and discusses nuances in the prevention, treatment, and maintenance of acne and its impact on the skin barrier. METHODS: The advisors' previous publications addressed prescription and nonprescription pediatric acne treatment and skincare using cleansers, moisturizers, and a practical algorithm for treatment and maintenance, including skincare recommendations for pediatric acne patients and an algorithm for skin of color patients with acne. Before the meeting, literature was culled on the relationship between the skin barrier and acne and current best practices in acne, addressing prescription and nonprescription acne products and skincare as monotherapy, adjunctive, and maintenance treatment. RESULTS: After discussing 13 draft statements, the advisors applied the selected literature and drew from their clinical knowledge and experience, and agreed on five statements. The follicular epithelial barrier is directly involved with changes that occur during both comedogenesis and in stages of inflammation, especially with follicular rupture compromising the barrier's integrity. In acne-affected skin, sebaceous glands are larger, sebum excretion and filaggrin expression higher, and stratum corneum lipids are reduced. Educating patients and clinicians about inflammation's central role in acne and measures to reduce inflammation is essential. Skin irritation and xerosis from acne and treatments lead to poor treatment adherence. A skincare regimen should be included in the acne prevention, treatment, and maintenance care regimen and should be ongoing. Maintenance treatment with topical agents and skincare using gentle ceramide-containing cleansers and moisturizers is a recommended strategy after successfully controlling the disease. CONCLUSIONS: Epidermal barrier dysfunction contributes to acne exacerbation. Using the appropriate treatment and skincare helps to minimize irritation and inflammation, enhance treatment adherence, and improve patient outcomes.

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