Reappraising the Use of Systemic Immunomodulators for Psoriasis and Eczema in the Military.

INTRODUCTION: Psoriasis and atopic dermatitis are chronic, immune-mediated skin disorders that are disqualifying for entrance into the military. Both conditions can cause difficulty wearing body armor and other protective equipment when poorly controlled, limiting a service member's ability to train and deploy worldwide. In addition, these conditions may be exacerbated by military service because of increased exposure to austere environments, extreme temperatures, stress, skin injury, bug bites, and vaccinations Service members have limited treatment options because of restrictions on systemic medications that can be used while deployed. Newer systemic medications-in particular, biologics and oral immunomodulators-have evolved to be both extremely effective and safe. We review more recent treatment options for psoriasis and atopic dermatitis in the context of DoD's regulations guiding entry and retention of personnel with psoriasis and eczema and make recommendations regarding updating DoD policy for systemic treatment options. MATERIALS AND METHODS: A literature search was performed using PubMed, Embase, and Ovid with the last search done in the fall of 2023 from all years to date. These articles were further screened based on inclusion and exclusion criteria. In total, 25 articles were included in this review. An Internet search was also performed on the DoD's regulations guiding entry and retention of personnel with psoriasis and eczema. In addition, we examined medical requirements for deployment to the U.S. Central Command and U.S. European Command. RESULTS: Currently, U.S. Central Command and U.S. European Command do not allow the use of medications with special storage and handling requirements on deployments. Newer biologics are safe and efficacious but require refrigeration, although other immunomodulators like deucravacitinib and apremilast are oral pills and do not have cold-storage requirements. However, the use of biologics in austere environments may be feasible because of increased intervals between dosing and the ability to store refrigerated medical supplies in most deployed environments. For military service members with psoriasis, risankizumab and deucravacitinib are excellent options given their favorable safety and efficacy profiles. Of the biologics available for atopic dermatitis, dupilumab is the safest and effective systemic medication available. The Janus kinase inhibitors have also demonstrated excellent efficacy in treating atopic dermatitis, but more safety data are needed because of potential adverse events to include heart-related events, blood clots, and cancers. CONCLUSIONS: Systemic treatments have evolved to become highly specific for both eczema and psoriasis. These newer biologics and immunomodulators may be compatible with use in the deployed setting, especially those that have long dosing intervals and proven efficacy and safety. Of the biologics, dupilumab and risankizumab offer the best efficacy, safety, and dosing intervals for atopic dermatitis and psoriasis, respectively. Deucravcitinib is a recently FDA-approved oral immunomodulator for psoriasis that has an excellent safety profile and efficacy. Allowing the use of these medications on deployments will enable more people with moderate to severe psoriasis and eczema to join and remain in the military while receiving effective treatment.

We Can Do Better at Protecting Our Service Members From Skin Cancer.

Skin cancer rates have been steadily increasing among the American public for decades, but multiple studies have demonstrated that the U.S. military suffers from higher rates of skin cancer than the general public. As with so many aspects of health, simple preventive measures made early on can dramatically improve long-term health outcomes. Ample research has demonstrated that ultraviolet protection reduces skin damage and cancer rates. Although further research is needed to fully understand current barriers to soldiers' use of sun protection, we recommend a variety of simple measures the U.S. military can implement to reduce skin cancer risk for our soldiers. Early education and intervention to reduce skin cancer risk and promote sun-protective strategies is critical. These include improving sun protection offered by uniform items, such as increasing the availability of the sun hat, using eye protection with tinted inserts, and testing and publicizing the ultraviolet protection level of uniform items. We also recommend increasing sunscreen access for soldiers. Options to do so include issuing soldiers small portable packets or bottles of sunscreen to carry on their person, incorporating small packets of sunscreen in MREs, and issuing sunscreen to commands to distribute before field exercises. Unit and medical leadership should encourage the use of sunscreen and sun-protective strategies when possible; leadership engagement is critical to overcoming current behavioral barriers to change. Finally, we recommend that units attempt to reduce sun exposure during training by encouraging soldiers to seek shade and avoiding outdoor training in the middle of the day.

Recent Progress in Conducting Polymers for Hydrogen Storage and Fuel Cell Applications.

Hydrogen is a clean fuel and an abundant renewable energy resource. In recent years, huge scientific attention has been invested to invent suitable materials for its safe storage. Conducting polymers has been extensively investigated as a potential hydrogen storage and fuel cell membrane due to the low cost, ease of synthesis and processability to achieve the desired morphological and microstructural architecture, ease of doping and composite formation, chemical stability and functional properties. The review presents the recent progress in the direction of material selection, modification to achieve appropriate morphology and adsorbent properties, chemical and thermal stabilities. Polyaniline is the most explored material for hydrogen storage. Polypyrrole and polythiophene has also been explored to some extent. Activated carbons derived from conducting polymers have shown the highest specific surface area and significant storage. This review also covers recent advances in the field of proton conducting solid polymer electrolyte membranes in fuel cells application. This review focuses on the basic structure, synthesis and working mechanisms of the polymer materials and critically discusses their relative merits.

Injection of oral medication into the skin confirmed by infrared spectroscopy.

"Skin popping" refers to the practice of injecting drugs, most commonly heroin, subcutaneously or into granulation tissue. Pharmaceutical tablets meant for oral consumption are modified into solutions for injection. Excipients-inactive substances that serve as vehicles for medication-are often not filtered out before injection and result in abscess formation, granulomatous inflammation, and scarring. Common excipients used in the production of pharmaceutical tablets include starch, microcrystalline cellulose, magnesium stearate, silica, and polyvinylpyrrolidone (PVP). Identification of these exogenous materials is valuable in confirming the diagnosis of skin popping, especially when patients may not be forthcoming about their drug use. We present a case of subcutaneous oral medication injection in which PVP and cellulose were identified by Fourier transform infrared spectroscopy. Considering the variable cutaneous manifestations of injection drug abuse, recognition of histopathologic and chemical characteristics of exogenous material from oral medications is helpful for diagnosis and intervention.

Comparative Studies on Two-Electrode Symmetric Supercapacitors Based on Polypyrrole:Poly(4-styrenesulfonate) with Different Molecular Weights of Poly(4-styrenesulfonate).

Poly(4-styrenesulfonate)-conducting polymer (PSS-CP) is advantageous for thin-film electrode manufacturing due to its high conductivity, high charge storage, structural stability, and excellent ink dispersion. In this work, comparative studies of two-electrode symmetric supercapacitors using Polypyrrole:Poly(4-styrenesulfonate) (PPy:PSS), with different molecular weights (Mw's) of Poly(4-styrenesulfonate) (PSS) as the electrodes, were performed. PPy:PSS can be easily prepared using a simple solution process that enables the mass production of thin-film electrodes with improved electrical and electrochemical properties. As-prepared PPy:PSS, with different PSS molecular weights, were assembled into two-electrode supercapacitors based on coin cell structures. It was confirmed that the electrical and electrochemical properties of PPy:PSS were improved with increasing PSS molecular weight. The coin cell, using PPy:PSS with a PSS molecular weight of 1.0 × 106 g/mol, exhibited higher areal capacitance (175.3 mF/cm²), higher volumetric capacitance (584.2 F/cm³), and longer cycling stability (86.3% after 5000 cycles) compared to those of PPy:PSS with PSS molecular weights of 2.0 × 105 and 7.0 × 104 g/mol. This work provides an efficient approach for producing cost-effective and miniaturized supercapacitors with high conductivity and high specific capacitance for practical applications in a variety of electronic devices.

Ex Situ Fabrication of Polypyrrole-Coated Core-Shell Nanoparticles for High-Performance Coin Cell Supercapacitor.

Silica-conducting polymer (SiO2-CP) has the advantages of high electrical conductivity, structural stability, and the facile formation of thin-film. This work deals with the preparation and optimization of polypyrrole (PPy)-encapsulated silica nanoparticles (SiO2 NPs) using an ex situ method. The SiO2-PPy core-shell NPs prepared by the ex situ method are well dispersed in water and facilitate the mass production of thin-film electrodes with improved electrical and electrochemical performances using a simple solution process. As-prepared SiO2-PPy core-shell NPs with different particle sizes were applied to electrode materials for two-electrode supercapacitors based on coin cell batteries. It was confirmed that the areal capacitance (73.1 mF/cm²), volumetric capacitance (243.5 F/cm³), and cycling stability (88.9% after 5000 cycles) of the coin cell employing the ex situ core-shell was superior to that of the conventional core-shell (4.2 mF/cm², 14.2 mF/cm³, and 82.2%). Considering these facts, the ex situ method provides a facile way to produce highly-conductive thin-film electrodes with enhanced electrical and electrochemical properties for the coin cell supercapacitor application.

Effect of Miscanthus sinensis var. purpurascens Flower Extract on Proliferation and Molecular Regulation in Human Dermal Papilla Cells and Stressed C57BL/6 Mice.

OBJECTIVES: To investigate the hair growth-promoting effect of Miscanthus sinensis var. purpurascens (MSP) flower extracton on in vitro and in vivo models. METHODS: MSP flower extract was extracted in 99.9% methanol and applied to examine the proliferation of human dermal papilla cells (hDPCs) in vitro at the dose of 3.92-62.50 µg/mL and hair growth of C57BL/6 mice in vivo at the dose of 1000 µg/mL. The expression of transforming growth factor ß1 (TGF-ß1), hepatocyte growth factor (HGF), ß-catenin, substance P was measured by relative quantitative realtime polymerase chain reaction. Histopathological and immunohistochemical analysis were performed. RESULTS: MSP (7.81 µg/mL) down-regulated TGF-ß1 and up-regulated HGF and ß-catenin in hDPCs (P<0.01). MSP (1000 µg/mL)-treated mice showed the earlier transition of hair follicles from the telogen to the anagen phase. The number of mast cells was lower in the MSP-treated mice than in other groups (P<0.05 vs. NCS group). Substance P and TGF-ß1 were expressed in hair follicles and skin of the MSP group lower than that in negative control. Stem cell factor in hair follicles was up-regulated in the MSP-treated mice (P<0.01). CONCLUSIONS: The MSP flower extract may have hair growth-promotion activities.

Atypical Histiocyte-Rich Sweet's Syndrome.

Sweet's Syndrome is a rare neutrophilic dermatosis thought to be a result of immune dysregulation occurring in the setting of drug exposure, recent infection, pregnancy, and underlying malignancy or idiopathic with specific and widely accepted diagnostic criteria established in the literature. Other organ systems can be involved with varying degrees of severity. An unusual case of Sweet's Syndrome associated with myopericarditis, acral involvement, and atypical histological findings with predominance of histiocytes is described here.

A Phytochemical Approach to Promotion of Self-renewal in Murine Spermatogonial Stem Cell by Using Sedum Sarmentosum Extract.

Spermatogonial stem cells (SSCs) are the basis of spermatogenesis, which is dependent on the ability to self-renew and differentiation. Controlling self-renewal and differentiation of SSCs could apply to treatment of disease such as male infertility. Recently, in the field of stem cell research, it was demonstrated that effective increase in stem cell activity can be achieved by using growth factors derived from plant extracts. In this study, our aim is to investigate components from natural plant to improve the self-renewal of SSCs. To find the components, germ cells were cultured with comprehensive natural plant extracts, and then the more pure fraction, and finally single compound at different concentrations. As a result, we found 5H-purin-6-amine at 1 µg/mL, originated from Sedum sarmentosum, was a very effective compound induced SSCs proliferation. Our data showed that germ cells cultured with 5H-purin-6-amine could maintain their stable characteristics. Furthermore, transplantation results demonstrated that 5H-purin-6-amine at 1 µg/mL increased the activity of SSCs, indicating the compound could increase true SSC concentration within germ cells to 1.96-fold. These findings would be contributed to improve further reproductive research and treat male infertility by using natural plant extracts.

Hair growth-promoting effect of Geranium sibiricum extract in human dermal papilla cells and C57BL/6 mice.

BACKGROUND: Geranium sibiricum L. has been used as a medicinal plant to treat diarrhea, bacterial infection, and cancer in Bulgaria, Peru, and Korea. However, its hair growth-promoting effect was not investigated so far. This study examined the effects of Geranium sibiricum L. extract (GSE) on hair growth, using in vitro and in vivo models. METHODS: Antioxidant, proliferation and migration assay of GSE was performed with human dermal papilla cells (hDPCs). Hair-growth promoting effect was measured in animal model. Relative expression of interleukin-1, vascular endothelial growth factor, hepatocyte growth factor, and transforming growth factor beta 1 was determined by real time RT-PCR. Expression of Ki-67 and stem cell factor were analyzed by immunohistochemistry. RESULTS: GSE treatment proliferated and migrated human dermal papilla cells (hDPCs) more than treatment of 10 µM minoxidil. GSE significantly stimulated the expression of Ki-67 protein and the mRNA levels of hepatocyte growth factor and vascular endothelial growth factor in hDPCs. Topical application of 1,000 ppm GSE for 3 weeks promoted more significant hair growth on shaved C57BL/6 mice than did 5% minoxidil. The histological morphology of hair follicles demonstrated an active anagen phase with the induction of stem cell factor. GSE treatment significantly reduced the number of mast cells and the expression of transforming growth factor beta 1 in mouse skin tissues. CONCLUSIONS: These results demonstrated that GSE promotes hair growth in vitro and in vivo by regulating growth factors and the cellular response.

Realization of a High Sensitivity Microphone for a Hearing Aid Using a Graphene-PMMA Laminated Diaphragm.

Microphones for hearing aid systems are required to have high sensitivity, an appropriate bandwidth, and a wide dynamic range. In this paper, a high sensitivity microphone, 4 mm in diameter and using a multilayer graphene-PMMA laminated diaphragm that can be applied in hearing aids, is designed, optimized, and implemented. Typically, polyphenylene sulfide (PPS) has been used for the diaphragm of electret condenser microphones (ECM), and this method provides simple, low cost mass production. Generally, the sensitivity of the commercial 4 mm diameter ECM is about -30 to 35 dB (0 dB = 1 V/Pa). A microphone using a nanometer-thick graphene diaphragm has been found to have higher sensitivity than the conventional ECM. However, nanometer-thick multilayer graphene is vulnerable to large mechanical shocks or high sound pressures, and the practical production of nanometer-thick diaphragms also poses a challenge. However, if a multilayer graphene diaphragm of the same thickness as the conventional ECM is used, displacement during diaphragm vibration will be severely attenuated due to the high elastic modulus of graphene, and the microphone sensitivity will be greatly reduced. In this paper, we fabricate a multilayer graphene/poly(methyl methacrylate) (PMMA) laminated diaphragm with sensitivity higher than that of any other microphones currently available for hearing aids, with the appropriate bandwidth in the auditory range. The high sensitivity arises from the laminated structure of the thin graphene membrane with high elastic modulus and from the PMMA membrane with lower elastic modulus and higher dielectric constant. The optimal thickness ratio of the graphene-PMMA layered diaphragm was studied by both analytical and experimental methods, and then a fabricated diaphragm was assembled in a 4 mm diameter microphone package. The performance of the implemented microphone was evaluated, including the sensitivity and total harmonic distortion. It is demonstrated that the microphone using a multilayer graphene-PMMA diaphragm has an excellent sensitivity of -20 dB and a dynamic range of 90 dB, which is on average 9 dB higher than the microphone using the conventional ECM diaphragm.

Multidimensional hybrid conductive nanoplate-based aptasensor for platelet-derived growth factor detection.

In the development of disease diagnoses, rapid responses to and accurate selectivity for target analytes are critical aspects. As one diagnostic approach, biosensors with high sensitivity and selectivity are investigated to detect disorder factors (e.g., endocrine disruptors and cancer oncoproteins). In this report, we demonstrate an aptamer-functionalized multidimensional hybrid conducting-polymer (3-carboxylated polypyrrole) plate (A_MHCPP) based field-effect transistor (FET) sensor to detect a platelet-derived growth factor (PDGF-BB). The multidimensional hybrid conducting-polymer plates (MHCPPs) are formed on the graphene surface by using electrodeposition and vapor deposition polymerization (VDP) steps. The amine-functionalized PDGF-B binding aptamers are then immobilized on the carboxylated polypyrrole surface by means of covalent bond formation (-CONH). The prepared FET sensors present high sensing ability toward PDGF-BB - as low as 1.78 fM among interfering biomolecules at room temperature.

Porous palladium coated conducting polymer nanoparticles for ultrasensitive hydrogen sensors.

Hydrogen, a clean-burning fuel, is of key importance to various industrial applications, including fuel cells and in the aerospace and automotive industries. However, hydrogen gas is odorless, colorless, and highly flammable; thus appropriate safety protocol implementation and monitoring are essential. Highly sensitive hydrogen leak detection and surveillance sensor systems are needed; additionally, the ability to maintain uniformity through repetitive hydrogen sensing is becoming increasingly important. In this report, we detail the fabrication of porous palladium coated conducting polymer (3-carboxylate polypyrrole) nanoparticles (Pd@CPPys) to detect hydrogen gas. The Pd@CPPys are produced by means of facile alkyl functionalization and chemical reduction of a pristine 3-carboxylate polypyrrole nanoparticle-contained palladium precursor (PdCl(2)) solution. The resulting Pd@CPPy-based sensor electrode exhibits ultrahigh sensitivity (0.1 ppm) and stability toward hydrogen gas at room temperature due to the palladium sensing layer.

Polypropylene/Polyaniline Nanofiber/Reduced Graphene Oxide Nanocomposite with Enhanced Electrical, Dielectric, and Ferroelectric Properties for a High Energy Density Capacitor.

This work demonstrates a ternary nanocomposite system, composed of polypropylene (PP), redoped PANI (r-PANI) nanofibers, and reduced graphene oxides (RGOs), for use in a high energy density capacitor. r-PANI nanofibers were fabricated by the combination methods of chemical oxidation polymerization and secondary doping processes, resulting in higher conductivity (σ≈156 S cm(-1)) than that of the primarily doped PANI nanofibers (σ≈16 S cm(-1)). RGO sheets with high electron mobility and thermal stability can enhance the conductivity of r-PANI/RGO (σ≈220 S cm(-1)) and thermal stability of PP matrix. These findings could be extended to combine the advantages of r-PANI nanofibers and RGO sheets for developing an efficient means of preparing PP/r-PANI/RGO nanocomposite. When the r-PANI/RGO cofillers (10 vol %) were added to PP matrix, the resulting PP/r-PANI/RGO nanocomposite exhibited high dielectric constant (ε'≈51.8) with small dielectric loss (ε″≈9.3×10(-3)). Furthermore, the PP/r-PANI/RGO nanocomposite was used for an energy-harvesting device, which demonstrated high energy density (Ue≈12.6 J cm(-3)) and breakdown strength (E≈5.86×10(3) kV cm(-1)).

Topical eflornithine hydrochloride improves the effectiveness of standard laser hair removal for treating pseudofolliculitis barbae: a randomized, double-blinded, placebo-controlled trial.

BACKGROUND: Pseudofolliculitis barbae (PFB) significantly impacts the military population, especially deployed personnel. OBJECTIVE: This study was designed to determine whether the addition of topical eflornithine to hair laser treatment would improve efficacy in treating PFB. METHODS: This was a randomized, double-blinded, placebo-controlled, paired (right and left neck) comparison study examining a combination of eflornithine and hair laser versus placebo and hair laser for the treatment of PFB. In all, 27 male patients with clinical PFB were treated with a long-pulsed neodymium:yttrium-aluminum-garnet laser with an energy fluence of 25 to 30 J/cm(2), a pulse duration of 20 to 30 milliseconds, and a 10-mm spot size to the entire bearded neck region. The laser treatment was performed every 4 weeks for a total of 16 weeks. Between laser treatments, patients applied eflornithine and placebo creams twice daily to opposite sides of the bearded neck region. The number of hairs and inflammatory papules were counted bilaterally at each visit. RESULTS: The eflornithine side had a statistically significant decrease in the number of hairs and inflammatory papules compared with the placebo side. At 16 weeks, the eflornithine side had a median hair reduction of 99.5% from baseline (range 48.5%-100.0%), whereas the placebo side had an 85.0% median hair reduction from baseline (range 50.5%-94.5%), P less than .001. LIMITATIONS: Patients were not followed up beyond 16 weeks. CONCLUSION: The addition of topical eflornithine to hair laser treatment decreased hairs and inflammatory papules faster when compared with hair laser therapy alone in the treatment of PFB.

Milia: a unique reaction to tattoos.

Tattoo-related dermatoses are varied and uncommon. Although rare, reactions to tattoos have been reported with a multitude of tattoo pigments and most commonly present with an eczematous reaction pattern. Milia are small keratinous cysts that may arise as primary lesions or secondary to some other trauma to the skin. We report the case of a 28-year-old man who presented with a papular eruption of 3 months' duration confined to the area of recently placed tattoos; the eruption was diagnosed as milia.

Infection rates of wound repairs during Mohs micrographic surgery using sterile versus nonsterile gloves: a prospective randomized pilot study.

BACKGROUND: Mohs micrographic surgery (MMS) is a multistep outpatient procedure that has become the treatment of choice for the removal of many cutaneous malignancies. The surgeon initially removes the tumor with nonsterile gloves in MMS. Sterile or nonsterile gloves are then used during the final repairs. OBJECTIVE: This prospective patient-blinded single-institution pilot study was performed to evaluate whether there is a difference in infection rate when using clean, nonsterile gloves versus sterile gloves during tumor removal and the wound repair phases of MMS. MATERIALS AND METHODS: This study randomized 60 patients undergoing MMS. Data on age, sex, anatomic location, number of Mohs stages, closure type, size of final defect, operative time, number of pairs of gloves used, and type of glove used were recorded and evaluated. RESULTS: Three infections were identified. Two infections occurred in the sterile glove arm and one in the clean glove arm. Overall, there was no greater infection rate when using clean, nonsterile gloves than sterile gloves (p=.99). CONCLUSIONS: Our study supports the use of clean, nonsterile gloves as a safe alternative to sterile gloves during all steps of MMS, at a significant cost savings. A larger confirmatory study comparing the equivalence in infection rates between clean and sterile gloves is warranted.

Evaluation of the vacuum-assisted handpiece compared with the sapphire-cooled handpiece of the 800-nm diode laser system for the use of hair removal and reduction.

BACKGROUND: A handpiece with a 35 × 22-mm treatment window that uses vacuum technology has been designed for the diode laser system. Vacuum suction stretches the skin and brings the hair follicle closer to the surface with the intent to damage the hair follicle at a lower surface fluence. The objective of this study was to compare the degree of follicular thermal damage between the sapphire-cooled smaller handpiece at a higher fluence versus the larger vacuum-assisted handpiece at a lower fluence. METHODS: Five male patients with Fitzpatrick skin types I-IV were enrolled in the study. Three test spots on the right back were treated with the vacuum-assisted laser handpiece at a setting of 10-12 J/cm², and 61-ms pulse duration. Three test spots on the left back were treated with the sapphire-cooled handpiece with a setting of 30-34 J/cm² and a pulse duration of 14-16 ms. A punch biopsy was obtained from one treated area for each handpiece type. The biopsies were sectioned horizontally and examined for the degree of thermal damage to the hair follicle at the level of the isthmus and the bulb. Immediate treatment response, pain score, and total treatment time were recorded. RESULTS: Biopsies from the skin treated with the sapphire-cooled handpiece and the vacuum-assisted handpiece showed the mean hair follicle diameter was 258.3 µm (SE [standard error] 41.7) and 225.1 µm (SE 17.1), respectively. The mean thermal damage diameter to hair diameter ratio was 0.91 (SE 0.10) and 0.72 (SE 0.12), respectively. The mean immediate treatment response, the mean pain severity, and the mean total treatment time were all lower for the vacuum-assisted handpiece. CONCLUSION: Treatment with the vacuum-assisted handpiece is faster and has a tendency to be more comfortable. Thermal damage to the hair follicle was greater with the sapphire-cooled handpiece.

Acroangiodermatitis secondary to chronic venous insufficiency.

Acroangiodermatitis (AAD) is a benign uncommon vasoproliferative disorder that affects the lower extremities. It appears to be a reactive phenomenon related to severe chronic Venous insufficiency and stasis of the lower extremities. The clinical presentation of this condition often is similar to Kaposi sarcoma. We report a case of AAD in a patient with severe hypertension and chronic venous insufficiency.