Scabies in infants and children - a narrative review.

Scabies is a human ectoparasitosis caused by Sarcoptes scabei var. hominis. World-wide around 300 million patients are affected. Infants and children have the highest incidence rates. Poverty and overcrowding are social factors contributing to a higher risk of transmission and treatment failure. The leading symptom of the infestation is itch. Complications are bacterial infections that are responsible for mortality. Diagnosis is clinical. Non-invasive imaging technologies like dermoscopy can be used. Polymerase chain reaction (PCR) is less sensitive and specific than microscopy of skin scrapings. Treatment of choice is topical permethrin 5%. Ivermectin is the only oral drug FDA-approved for scabies. It should be used in cases non-responsive to topical therapy and in case of high number of infested patients in addition to topical therapy. Pseudo-resistance to treatment is not uncommon. New drugs are on the horizon. What is Known: • Pruritus is the leading symptom causing sleep disturbances and scratching with the risk of secondary bacterial infections. • Treatment failure is related to inappropriate application of topical drugs and asymptomatic family members. What is New: • COVID-19 pandemic and migration are contributing to an increased incidence of scabies. • New compounds to treat scabies are on the horizon.

Angular cheilitis-an oral disease with many facets.

Cheilitis is a common inflammatory disorder of the vermillion and adjacent skin of the lips. A special type is angular cheilitis. The disease has a mixed etiology, mostly with bacterial and fungal components. Angular cheilitis may be a clinical sign of an underlying disease. It has two age peaks: one during childhood and another in adults. It becomes more frequent with aging. Clinical presentation, differential diagnoses, and treatment are discussed. Angular cheilitis is of importance in primary care of patients, in geriatrics, dentistry, pediatrics, internal medicine, and in dermatology.

Pediatric Dermatitis Seborrhoica - A Clinical and Therapeutic Review.

Pediatric dermatitis seborrhoica (DS) is a common inflammatory disorder of infancy and adolescence distinct from atopic dermatitis. We performed a narrative review on clinical and therapeutic aspects of the disease. The prevalence varies geographically and can reach up to 10%. There is a slight male predominance. Although etiopathology is not well known, both endogenous and exogenous factors contribute. Skin microbiome and its interaction with sebaceous gland function is crucial. The inflammatory pathways include innate immune function and skin barrier disturbances. Malassezia spp. and certain bacteria are increased in lesional skin. DS develops in different clinical subtypes, from localized cephalic to disseminated disease with a risk of erythroderma and eczema herpeticatum. Treatment consists of skin care and topical and rarely systemic medical therapy. Cornerstones of treatment are antifungals and mild corticosteroids. Targeted treatment is on the horizon. Pediatric DS is a common disorder important in the differential diagnosis of skin problems in infants and and children. Due to better understanding of its pathogenesis, new treatment options are developed.

Impurities in Hyaluronic Acid Dermal Fillers? A Narrative Review on Nonanimal Cross-Linked Fillers.

Importance: Nonanimal cross-linked hyaluronic acid (HA) dermal fillers are among the most versatile tools in minimal invasive esthetic medicine. Filler injections aim to volumize, provide contour, and reduce wrinkles and skinfolds. In the hand of the experienced user, HA fillers have an excellent safety profile. Nevertheless, adverse events have been reported related to poor injection techniques, infection, and immune reactions. Observations: In this review, the focus is on filler impurities. Impurities can originate from the fermentation process, crosslinking, packaging, and contamination. Impurities consist of particular and nonparticular matter. We discuss possible risks for the patient to be treated with HA fillers. Conclusions and Relevance: Impurities of dermal fillers bear a potential risk for patients, such as delayed autoimmune and inflammatory reactions, biofilm formation, and exposure to leachable Endocrine Disrupting Chemicals. Amount and quality of impurities can be considered as one of the quality parameters of commercially fillers. Considering patient safety, filler impurities should be further reduced.

Cutaneous borreliosis in children - a challenging problem.

Borreliosis, also known as Lyme disease, is a vector-borne disease caused by different species of the Borrelia burgdorferi complex. It is frequent in Europe and Northern America. The major vectors are ixodoid ticks. Paediatric borreliosis is common and peaks in children between five to nine years. In Europe, the leading symptom of early infection is erythema migrans, in contrast to Northern America where arthritis is the dominating clinical finding. In this review, we focus on Europe, where cutaneous borreliosis is mainly caused by infection with B. afzelii. The cutaneous symptoms include erythema migrans, lymphocytoma, chronic atrophic dermatitis and juxta-articular nodules. In children, lymphocytoma is very common but chronic atrophic dermatitis is rare. Clinical symptoms, diagnosis, peculiarities of childhood disease and treatment are also reviewed. It is important to note that after haematogeneic spread, signs of infection may be non-specific, and this is a challenge for diagnosis.

Newer Therapies in Dermatophytosis.

With the advent of newer drugs and formulations, the armamentarium to combat dermatophytosis is ever-expanding. However, we must be rational and scientific when choosing the drugs. This review is an attempt to summarise the recently approved and upcoming therapeutic options for dermatophytosis.

Acceptance and willingness to purchase a hypothetical COVID-19 vaccine in a region under Shariah law: A cross-sectional study in Aceh, Indonesia.

Vaccines are urgently needed to control the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to determine the acceptance of and willingness to purchase a hypothetical COVID-19 vaccine in the general population of Aceh, a holistic Shariah law implementation province in Indonesia. An online cross-sectional study was conducted using a quota sampling technique between 1 to 24 September 2021. To determine hypothetical vaccine acceptance, respondents were asked if they were willing to accept vaccines with combinations of either 50% or 95% effectiveness and either 5% or 20% risk of adverse effects. Willingness to purchase was assessed by asking whether the participants would pay for such vaccines at certain price points. Logistic regression analysis was used to assess the associated determinants. Out of 377 respondents included in the final analysis, 86.5% were willing to accept a COVID-19 vaccine with 95% effectiveness and 5% adverse effects. The acceptance rate dropped to 45.1% if the risk of adverse effects was 20%. Vaccines with 50% effectiveness and 5% adverse effects were acceptable to 42.2% but the acceptance went down to 17.2% if the risk of adverse effects increased to 20%. Multivariate analysis found that men were twice as likely to accept a vaccine with 95% effectiveness and 5% adverse effects compared to females (aOR: 2.01; 95% CI 1.05-3.86). We found that 156/377 (41.3%) of respondents were willing to purchase a COVID-19 vaccine and of these participants 71.1% were willing to pay between Indonesian Rupiah (IDR) 50,000-150,000 (US$ 3.33-10.00). In conclusion, the acceptance rate of a hypothetical COVID-19 vaccine varied based on effectiveness and the risk of adverse effects.

Monkeypox: Immune response, vaccination and preventive efforts.

Infectious threats to humans are continuously emerging. The 2022 worldwide monkeypox outbreak is the latest of these threats with the virus rapidly spreading to 106 countries by the end of September 2022. The burden of the ongoing monkeypox outbreak is manifested by 68,000 cumulative confirmed cases and 26 deaths. Although monkeypox is usually a self-limited disease, patients can suffer from extremely painful skin lesions and complications can occur with reported mortalities. The antigenic similarity between the smallpox virus (variola virus) and monkeypox virus can be utilized to prevent monkeypox using smallpox vaccines; treatment is also based on antivirals initially designed to treat smallpox. However, further studies are needed to fully decipher the immune response to monkeypox virus and the immune evasion mechanisms. In this review we provide an up-to-date discussion of the current state of knowledge regarding monkeypox virus with a special focus on innate immune response, immune evasion mechanisms and vaccination against the virus.

Adult acne versus adolescent acne: a narrative review with a focus on epidemiology to treatment

Abstract Acne vulgaris is one of the most common chronic inflammatory diseases and is characterized by papules, pustules, comedones, and nodules. Although adolescence is the preferential age group, acne may affect various age groups. Acne shares different properties in adults and adolescents. These differences extend from epidemiology to treatments. Increased awareness of these two subtypes will allow for better management of the disease. In this review, the authors examined all aspects of acne in adults and adolescents under the light of current literature.

Accidental PUVA burns, vitiligo and atopic diathesis resulting in prurigo nodularis: a logical but undocumented rarity / Prurigo nodular induzido por queimaduras acidentais por PUVA, vitiligo e diátese atópica: uma raridade lógica, mas não documentada

Vitiligo is a dreaded disease in India due to its social and cultural consequences. PUVA and PUVAsol are the main treatment modalities for vitiligo vulgaris. To the best of our knowledge, this is the first case of accidental PUVA burns eventuating in prurigo nodularis lesions to be reported in a female patient who was undergoing home PUVA therapy. The itch is so prominent and disabling that the focus of the patient has shifted from treating her vitiligo to ameliorating the pruritus.

O vitiligo é uma doença temida na Índia por suas consequências sociais e culturais. As principais modalidades de tratamento do vitiligo vulgar são as terapias PUVA e PUVAsol. Pelo que sabemos, este é o primeiro relato de caso de prurigo nodular induzido por queimaduras acidentais por PUVA em paciente do sexo feminino em tratamento domiciliar com PUVA. O prurido é tão intenso e incapacitante que o foco da paciente passou do vitiligo à busca constante pela melhora do prurido.

La tuberculosis es un diagnóstico diferencial del síndrome SAPHO / Tuberculosis: a differential diagnosis of SAPHO syndrome

Se presenta un caso clínico de tuberculosis pulmonar y extrapulmonar cuya presentación clínica fue similar a la del síndrome SAPHO. Se destaca la necesidad de incluir a la tuberculosis como un diagnóstico diferencial de esta afección, en especial en los pacientes procedentes de áreas endémicas.

Papulose linfomatóide - relato de dois casos / Lymphomatoid papulosis - Report of two cases

A papulose linfomatóide (PL) constitui uma variante rara dos linfomas cutâneos de células T com a presença de amplo infiltrado intracutâneo de células T positivas para CD30. O exame histológico sugestivo de doença altamente maligna e agressiva opõe-se ao curso crônico-recidivante, muitas vezes auto-limitado, presente na maioria dos casos. São apresentados os relatos de dois pacientes. Uma mulher com 64 anos de idade e história de 10 anos de PL recebeu terapia Puva em creme, sendo a doença controlada. No segundo caso, uma mulher de 42 anos apresentava história de 18 anos de PL tratada com Puva e, posteriormente, com fotoquimioterapia extracorpórea (FEC). Durante a FEC, observou-se rápida disseminação metastática que não pôde ser controlada por poliquimioterapia. A paciente foi a óbito após um ano, em razão de metástase no sistema nervoso central

Células de Merkel em crescimento com mau alinhamento da unha do primeiro pododáctilo / Merkel cells in growth malalignment of the great toe nail

Crescimento congênito com mau alinhamento da unha do primeiro pododáctilo (CGMAUPP)é uma das doenças ungueais congênitas mais comuns e cujas causas não são completamente conhecidas. A matriz ventral, que é rica em células de Merkel (CM) intraepiteliais, é responsável pelo crescimento e direcionamento da placa ungueal. Para esclarecer se as CMs da matriz ventral poderiam ser envolvidas, biópsias ungueais de 3 de casa 12 pacientes com CGMAUPP foram tratados com anticorpos Cam 5.2 contra queratina tipo simples. A densidade de CM na matriz ventral do CGMAUPP foi calculada como sendo 21,2 mais ou menos 9,3 mm2, o que não foi significativamente diferente da densidade da CM em pacientes com paroníquia que não apresentava CGMAUPP. Resumindo, a síndrome congênita CGMAUPP não pode ser explicada por uma alteração da CM paraecrinológica ativa na matriz ungueal ventral

A hydropolymer dressing for chronic wounds: clinical experiences with 478 patients in an open multicenter trial

FUNDAMENTOS - Feridas crônicas säo um problema freqüente. O tratamento convencional precisa ser otimizado para melhorar os resultados nos pacientes e a aceitaçäo do manejo pelos mesmos. OBJETIVOS - A eficácia terapêutica de um novo curativo de hidropolímero (Tielle) para pacientes com feridas crônicas deve ser investigado. MÉTODO - 478 pacientes com feridas crônicas (úlceras venosas das pernas, úlceras de décubito e outras feridas crônicas) e com pelo menos um pré-tratamento anterior foram incluídos neste estudo de quatro semanas. Vários itens foram estudados incluindo percentagem de reduçao da área afetada, efeitos na granulaçäo / epitelizaçäo / risco de infecçäo, manejo e aceitaçäo. Foi um estudo aberto em diversos centros somente para pacientes ambulatoriais. RESULTADOS - Um percentual de fechamento das feridas de 29,8 porcento e uma reduçäo da área das feridas foi obtido em 98 porcento dos casos. A reduçäo média na área de ferida foi de 76,2 porcento. A exsudaçäo e o risco de infecçäo foram reduzidos (p<0,001). O manejo foi considerado melhor ou muito melhor em relaçäo ao pré-tratamento em 90,5 porcento. A aceitaçäo dos pacientes melhorou em 86,2 porcento. CONCLUSAO - O tratamento tópico de feridas pode ser otimizado. O curativo de hidropolímero usado no presente estudo, revelou eficácia terapêutica, facilidade de manejo e melhor aceitaçäo dos pacientes que apresentavam feridas de difícil tratamento

Atopic dermatitis: on the role of epidermal barrier function, cytokine pattern and leukemia inhibitory factor

A dermatite atópica é um dos distúrbios inflamatórioscrônicos mais comuns em dermatologia com uma incidência cada vez maior nos países industrializados. Sua etiologia ainda näo foi definida, mas nosso conhecimento sobre a genética, imunologia e outros fatores da dermatite atópica têm aumentado consideravelmente. Säo discutidos neste artigo o principal papel da interaçäo entre o fator inibitório da leucemia e a interleucina 4. Esta revisäo fornece uma hipótese provocante sobre a natureza desta doença: dermatite atópica - a displasia ectodérmica mais comum?

Mastocitose cutânea difusa na infância: tratamento bem sucedidto com PUVA / Diffuse cutaneous mastocytosis in childhood: sucessful treatment with PUVA

A mastocitose cutânea difusa é distúrbio raro dos mastócitos cutâneos, ocorrendo predominantemente me recém-nascidos ou crianças. O desenvolvimento clínico é sempre complicado pelo surgimento de bolhas e urticária por todo o corpo e pseudo-liquenificação da pele, causada por infiltrações generalizadas de mastócitos na derme. Relata-se o caso de um menino que apresentou urticária factícia ao nascer e que desenvolveu infiltração progressiva da pele aos seis meses de idade. Mais tarde foi observada vesiculação recorrente parcialmente extensiva. As lesões cutâneas foram acompanhadas por episódios de eritema passageiro. O diagnóstico de mascocitose cutânea difusa foi confirmado por exame histológico e resultando positivo par ao sinal de Darier. As tentativas terapêuticas com o cetofileno e outrs anti-histamínicos, prednisolona, bem como a fototerapia com UVA e UVB combinados, apresentam resultados limitados. A terapia com PUVA resultou em inibição da vesiculação e melhora substancial e duradoura dos demais sintomas da pele. Durante acompanhamento de seis anos o menino não apresentou erupções bolhosas

Intravenous immunoglobulin therapy in Dermatology: Overview and center experience

FUNDAMENTOS - Terapia intravenosa com imunoglobulina (IVIGT) é eficaz em imunodeficiêcias e desordens neurológicas de fundo imunológico. Embora a experiência em Dermatologia ainda seja limitada, IVIGT pode ser benéfica em certos tipos de desordens. OBJETIVOS - A experiência com IVIGT em doenças dermatológicas é relatada em dez pacientes do Departamento de Dermatologia da Universidade de Jena. Um breve resumo da literatura relevante é incluída. MÉTODOS - Dez pacientes com diagnósticos dermatológicos diferenciados foram tratados para cura ou profilaxia com IVIGT usando uma média de 400mg de imunoglobulina pasteurizada líquida 7S por kg de peso e por dia: o tratamento inicial foi administrado durante 5-6 dias, seguido de única infusäo mensal até obter resposta. RESULTADOS - Observamos uma cura completa ou parcial em pacientes com imunodeficiências secundárias e nos casos de feridas crônicas recalcitrantes ou profilaxia secundária de erisipela. Uma cura completa ou parcial foi obtida em doenças do tecido conjuntivo como panarterite nodosa (n = 2), morféia pan-esclerótica infantil (1) mas näo para lúpus sistêmico ou urticária vasculite