The Spanish version of the Skin Picking Impact Scale (SPIS) and its Short form (SPIS-S)

ABSTRAC Introduction: The Skin Picking Impact Scale (SPIS) is a self-report rating scale that assess the psychosocial impact of excoriation disorder. In this study the SPIS was translated into Spanish and its reliability was measured. Similarly, its short version (SPIS-S) has been translated and tested. Methodology: The recruitment has been performed through a survey launched on social media. All subjects were older than18 years and self-reported being diagnosed with an excoriation disorder. 281 individuals were rated for the validation analysis. SPIS has been translated into Spanish and validated through an exploratory and confirmatory factorial analysis. Participants have been also scored with the Skin Picking Scale-Revised (SPS-R). Results: On factor at the exploratory factorial analysis has a raw eigenvalue greater than 1, with 65.5% of total variance. The confirmatory analysis confirmed that the scale is one-dimensional. Cronbach's alpha also confirmed a good internal consistency (α=0.934 for the SPIS and α=0.882 for the SPIS-S). Scores between the two scales (SPIS and the SPS-R) have shown a good convergence (r=0.592, p<0.0001). Conclusion: The Spanish version of SPIS and its short version show good psychometric properties and adequately reproduce the one-dimensional model of the original English version.

RESUMEN Introducción: la Skin Picking Impact Scale (SPIS) es una escala autoaplicada de que evalúa el impacto psicosocial del trastorno de excoriación. En este estudio se tradujo la SPIS al español y se midió su confiabilidad. Asimismo, se tradujo y se evalúo su versión corta (SPIS-S). Metodología: el reclutamiento se realizó a través de una encuesta distribuida a través de redes sociales. Todos los sujetos participantes fueron mayores de 18 años e informaron haber sido diagnosticados con trastorno de excoriación. 281 individuos calificaron para el análisis de validación. La SPIS fue traducida al español y validada a través de análisis factorial exploratorio y análisis factorial confirmatorio. Los participantes también fueron evaluados con la versión revisada de la Skin Picking Scale - Revised (SPS-R). Resultados: en el análisis factorial exploratorio, un valor tenía un valor propio bruto mayor que 1, con 65,5 % de la varianza total. El análisis confirmatorio determinó que la escala es unidimensional. El alfa de Cronbach también confirmó una buena consistencia interna (α = 0,934 para la SPIS y α = 0,882 para la SPIS-S). Las puntuaciones entre las dos escalas (SPIS y SPS-R) mostraron una buena convergencia (r = 0,592, p <0,0001). Conclusión: la versión en español de la SPIS y de su versión abreviada muestran buenas propiedades psicométricas y reproducen adecuadamente el modelo unidimensional de la versión original en inglés.

Cosmetic Presentations and Challenges of Body Dysmorphic Disorder and Its Collaborative Management.

In recent times, there has been a huge surge in the demand for cosmetology. However, not every patient is an ideal candidate for cosmetic interventions, and this needs to be carefully evaluated at outpatient visit. Various patients have underlying undetected psychiatric co-morbidities which prompt them to seek cosmetic care. One such condition is body dysmorphic disorder in which patients are present with marked anxiety which seems out of proportion to their apparently trivial complaints. These patients are also often unsatisfied with their cosmetic outcome, sometimes turning violent or pressing legal charges against their treatment providers. It is therefore of utmost importance for dermatologists and cosmetic surgeons to be aware of this condition and work in liaison with psychiatrists to provide holistic care to these patients. A literature search of PubMed-indexed journals using keywords "body dysmorphic disorder," "BDD in dermatology," and "BDD in cosmetic surgery" was carried out from the year 2000 up to date for this review.

Classification of psychodermatological disorders.

Currently, psychodermatological disorders are classified under different criteria exhibiting several limitations, and no single universal classification system exists. Herein, we discuss previous suggested classifications in psychodermatology, highlighting their limitations, and we propose a new classification system, without redundant information and with accurate terminology, incorporating the relevance of the terms "disorder," "disease," and "illness" in psychodermatology. In this new classification, the following three groups are then suggested: "primary psychodermatological disease," to include primary dermatoses, where psychological stress, a psychological mechanism, and/or psychopathology are some of the main elements that are recognized in the etiopathogenesis (which may induce and/or worsen a primary dermatosis); "primary psychodermatological illness," to include skin symptoms, with or without secondary self-induced skin lesions (such as excoriations), without a primary dermatosis, and where psychopathology, psychological characteristics, and/or a neuropathic mechanism, where stress plays a relevant role, are key features responsible for the skin symptoms and the secondary skin lesions; and "secondary psychodermatological disorder," to include medications prescribed in dermatology with psychiatric consequences and medications prescribed in psychiatry with dermatologic consequences. Our goal with this system is to broaden the recognition of psychodermatology and improve patient management, with practical and scientific relevance for dermatologists, psychiatrists, and psychologists working in psychodermatology, but also for general practitioners, physicians from other medical and surgical specialties as well as specialists in esthetic dermatology, who frequently encounter patients with psychodermatological disorders.

Bupropion in dermatology: A brief update.

There is currently an interest in evaluating the role that antidepressants may play in the treatment of primary cutaneous disorders. It has been proposed that antidepressants could have anti-inflammatory effects, but the clinical relevance of this effect has not been adequately established. In the case of bupropion, evidence for its specific use in dermatologic conditions currently come only from a pilot study and a case report. While this level of evidence is unlikely to be sufficient to guide clinical practice, the authors of this brief update hope to sort the available information to serve as a guide and provide a structure for future research.

Therapeutic implications of dermoscopic findings in acanthosis nigricans: A clinical and histopathological study.

Acanthosis nigricans is associated with numerous systemic disorders. These include endocrinological conditions such as, diabetes, acromegaly, Cushing's syndrome, thyroid dysfunction, as well as metabolic abnormalities like obesity and polycystic ovarian disease. Its association with visceral malignancy is known. Moreover, Acanthosis nigricans is known to be a cutaneous marker of insulin resistance (IR) and hyperinsulinemia. The primary aim of this study was to study clinical and histopathological patterns of acanthosis nigricans and its correlation with dermoscopic patterns and treatment implications. 103 patients clinically diagnosed as acanthosis nigricans were enrolled in the study. Clinical evaluation, dermoscopy, and skin biopsy was done for histopathological evaluation. Consistency was observed in the changes seen on dermoscopy with clinical and histopathological findings. Common dermoscopy findings were Crista Cutis, Sulcus Cutis, Papillary projections, hyperpigmented dots, crypts, and blotching Dermoscopic findings can be correlated with histopathological features. Dermoscopy allows visualization on higher magnification which helps to pick up subtle changes which are not visible to naked eye. Dermoscopy can be a useful tool to distinguish acanthosis nigricans from other pigmentary disorders in patients who are not willing for histopathological examination and helps in treatment making decisions.

Treatment of vascular soft tissue malformations: A retrospective study of 90 patients from Albania.

Vascular malformations (Vascular Malformation) of soft tissue are a consequence of abnormal development of vascular elements during embryogenesis. They are named after the vessel responsible. Their presence at birth raises the hypothesis of an intrauterine etiology of Vascular Malformation, but the influence of other factors may play an important role in their appearance, localization, and size. The literature suggests that treatment of Vascular Malformation is rarely surgical. Surgery is applied in cases of voluminous malformations and in cases of possible hemorrhagic complications. Meanwhile, patient outcomes have improved with new discoveries in laser technology for the treatment of Vascular Malformation, especially those of capillaries and the results are, in most of the cases, quite satisfactory and without significant complications. After institutional review board approval, we collected and analyzed the medical records of 90 patients diagnosed with Vascular Malformation, between January 2015 and December 2019 at the service of Burns and Plastic Surgery, "Mother Teresa" University Hospital Center of Tirana, Albania and from another private clinic in Tirana. Data were collected from the medical records on patient's charts. The aim of this study is to analyze different treatment modalities and the outcomes achieved for each group.

Postherpetic neuralgia and recalcitrant cystic lesions following herpes zoster: A case report and review of treatment options.

Acute herpes zoster lesions in most cases are self-limited except in older and immunocompromised patients, wherein the pain can cause significant suffering. Postherpetic neuralgia is a painful situation for patients that can compromise the quality of life. Here, we report a 30-year-old healthy young man who developed treatment-resistant postherpetic neuralgia after herpes zoster (fourth/fifth thoracic segment) without any underlying immunocompromised state. He also developed some cystic lesions, which were removed by aspiration and surgery. The skin lesions improved 2 weeks after the surgery and postherpetic neuralgia was completely cured after 5 months, however cystic lesions recurred multiple times and were excised completely during each visit. Postherpetic neuralgia has a significant impact on the health-care cost borne by the society and affected individual, hence, it is essential to select appropriate treatment to manage the pain of postherpetic neuralgia.

Acanthosis nigricans: A review.

BACKGROUND: Acanthosis nigricans (AN) is a cutaneous disorder characterized by symmetric velvety hyperpigmented plaques on intertriginous areas like axilla, neck, inframammary, and groin. AIMS: To summarize the pathophysiology and classification of AN, provide an update of diagnostic testing strategies, and describe the current therapeutic options described so far in the literature for this disease. METHODS: A comprehensive english language literature search across multiple databases (PubMed, EMBASE, MEDLINE, and Cochrane) for keywords (alone and in combination) was performed. MeSH as well as non-MeSH terms such as "acanthosis nigricans," "classification," "pathophysiology," "diagnosis," "treatment," "topical drugs," "systemic drugs," "chemical peeling," and "lasers" were taken into consideration. RESULTS: The pathophysiology of AN revolves around a multifactorial stimulation of proliferation of epidermal keratinocytes and dermal fibroblasts. Various types of AN include benign, obesity-associated, syndromic, malignant, acral, unilateral, medication-induced, and mixed-type. Homeostasis model assessment-insulin resistance (HOMA-IR) is a good tool for assessment of insulin resistance. Management involves general measures (weight reduction and addressing the underlying cause, if any), topical drugs (retinoids, vitamin D analogs, and keratolytics), oral drugs (retinoids and insulin sensitizers), chemical peels (trichloroacetic acid), and lasers (Long pulsed alexandrite, fractional 1550-nm erbium fiber, and CO2 ). CONCLUSION: Acanthosis nigricans is a treatable condition; however, complete cure and disappearance of lesions are difficult to achieve. Weight reduction is the most scientific and practical management strategy. Long-term studies and further research is warranted in the pathophysiology and treatment of this common condition.

A brief synopsis on scalp melanoma.

Melanoma constitutes one of the most sinister and troublesome malignancies encountered by humanity. Generally, the diagnosis of advanced melanoma connotes a grave prognosis, prompting a sense of looming threat of death, however, the early-stage detected disease responds well to robust treatment resulting in reasonable survivorship. Scalp melanomas are even more troublesome, because they typically exhibit more aggressive biologic behavior and are often diagnosed at a late stage. This review tries to comprehensively highlight the various diagnostic, therapeutic, and outcome aspects of scalp melanomas. The literature research includes peer-reviewed articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) till May 2020 and reference lists of respective articles. Only articles published in English language were included.

Therapeutic implications of immunohistochemical expression pattern of the cancer stem cell marker (nestin) in basal and squamous cell carcinomas.

Cancer stem cells (CSC) are populations of cells responsible for tumor initiation, progression and therapeutic resistance in many cancers. In the present study, we aimed to investigate the expression pattern and clinical significance of the stem cell marker nestin, in Squaous cell carcinoma (SCC) and basal cell carcinoma (BCC). The samples (23 cases of BCC and 22 cases of SCC) were immunohistochemically examined for the expression of nestin and its correlation with the corresponding clinical and pathological parameters. Nestin was expressed in four out of the 23 cases of BCC (17.4%) and was expressed in 10 out of the 22 cases of SCC (45.5%). Nestin expression between the two tumors was statistically significant (P = .042). Although a direct relationship was found between the tumor grade and nestin expression, the results were statistically insignificant (P = .495). The results of this study suggest that BCC and SCC may share some cellular origin but with different biologic behavior. The relation of nestin expression to the grade of SCC, although statistically insignificant, may suggest its role in predicting the biologic behavior of this tumor.

Therapeutic implications of personality disorders in dermatology.

There is a significant psychiatric comorbidity that exists in multiple dermatological conditions, stemming from the patient''s own psychological make up. This article reviews personality disorders and their types, which influence the course and prognosis of several psychodermatological disorders. Self-inflicted skin lesions, for example, are usually associated with obsessive-compulsive behavior, but they also share connections to Narcissistic and Borderline personality disorders. Body dysmorphic disorder is another psychodermatological condition seen in dermatology, aesthetic, and cosmetic surgery clinics, which is influenced by patient's personality type. In general, there is a significantly high proportion of personality disorders seen in aesthetic and cosmetic surgery. The management of patients with personality disorders is challenging, but joint liaison between psychiatry and dermatology has proven helpful and can provide patients with the best care for their psychological needs and dermatologic care.

Recent advances in the treatment of trichotillomania (hair-pulling disorder).

Trichotillomania (TTM) is a condition in which affected individuals pull out their hair resulting in hair loss. This disorder affects roughly 0.5% to 2.0% of the population and can have significant psychological morbidity. Behavioral therapy has been used with success in the treatment of TTM, but not all patients are willing or able to comply with this treatment strategy. There is a need for effective pharmacological treatment options. Historically, pharmacotherapy for TTM has been inadequate in most cases, but recent advances have been made in this regard. Fluoxetine, clomipramine, olanzapine, and naltrexone have all been used in the treatment of TTM, but evidence of benefit has varied, and side effect profiles can limit practical utility. Recent advances in the understanding of the pathophysiology of TTM, as well as evidence of benefit seen with some glutamate-modulating agents such as N-acetylcysteine and dronabinol, have provided newer potential pharmacotherapy options.

Psychological aspects of aesthetic and cosmetic surgery: Clinical and therapeutic implications.

Recently there is a surge in cosmetic and aesthetic surgery procedures. Several patient seeking various cosmetics procedures present to aesthetic surgery clinics and demanding procedures which are out of proportion. Several of these patients have under-recognized or untreated psychiatric disorders. Proper screening and evaluation of these patients could save money and resources. This brief review focuses on current trends, clinical and psychological assessment and expectations on the part of patients and recommendations regarding management of these patients.

Advanced fractional radiofrequency for the rejuvenation of face, neck, and décolleté.

Recently great attention has been paid to the rejuvenation of the face, neck, and décolleté of women with advanced radial fractional radiofrequency. We aimed to clinically evaluate the results obtained with this treatment method. We treated 10 women aged 42 to 62, suffering from skin aging. After carrying out the hydration and sebometry skin tests in each patient, collecting the medical history and taking photographs of the face and décolleté in the standard projections, a questionnaire was submitted to each patient. Finally, we have submitted the patients to one session of application of radiofrequency energy, by an Italian device named "Thuzzle" (GMV, Rome, Italy). The obtained results show a high effectiveness in improving the texture and tone of skin, decreasing micro wrinkles and spot reduction. Advanced radial fractional radiofrequency treatment method shows promising results. Further studies are required to confirm the findings.

Remodeling of collagen constituting interlobular septa of subcutaneous adipose tissue following microwaves application.

In this study, the application of a recently introduced device based on electromagnetic energy transfer by microwaves for fat reduction, permitted to study specifically the modifications of thick fibrous collagen interlobular septa in the subcutaneous adipose tissue, related to the formation of large clusters of adipocytes. The use of Picrosirius red staining associated with circularly polarized microscopy gave evidence of appreciable modifications of the fibrous connective tissue forming septa. Compact fibrotic bundles of collagen I forming interlobular septa appeared reduced or dissolved, in part substituted by the increase of more diffuse and finely reticular collagen III. Remodeling of fibrous collagen, which formed bridles involved in the appearance at the surface of the skin of dimpling/orange peer pattern typical of cellulite, was observed.

New technology for coagulation of dilated vessels using the combined effects of several modes of generation and wavelengths in one laser pulse for the treatment of pediatric hemangiomas: Open prospective study.

An open, prospective, nonrandomized study of 122 children with infantile hemangiomas aged 1 to 24 months was conducted to evaluate the effectiveness and safety of treatment with multiline laser equipment using the Nd:YAP Q-Sw/KTP emitters with the combined use of two wavelengths of 1079/540 nm. The average age of the children was (6.3 ± 0.3) months, 22 of them were boys (18.0%) and 100 were girls (82.0%). An erythometry and ultrasound examination were performed to determine the depth of the neoplasm, to assess its blood flow, and the presence and diameter of the supply vessels. Studies of these indicators were conducted for patients before and after the treatment. Laser treatment was performed on 109 patients with 119 hemangiomas. A total of 81 superficial hemangiomas underwent a short course of laser therapy (2-5 procedures) and remaining patients with 38 combined hemangiomas received a long course of laser treatment, consisting of 6 to 10 procedures. Restoration of normal color, skin relief, and the absence of scars were noted in post-treatment sample on evaluation. After the course of treatment, erythometry readings corresponded to the values of normal skin and decreased to 110 to 80 cu. Ultrasound examination showed vascular formation and feed vessels were not visualized.

Papillon-Lefèvre syndrome: Oral aspects and treatment.

Papillon-Lefèvre syndrome (PLS) is a rare disorder characterized by diffuse palmoplantar erythematous, fissured hyperkeratosis, and aggressive periodontal disease that starts in the early periods of childhood. Periodontal disease occurs with the early loss of deciduous teeth at the age of 2 to 4 years, followed by the loss of permanent teeth during adolescence. Prosthodontics management of PLS patients is very complex and sometimes requires invasive therapeutic treatments. Early diagnosis is essential for correct treatment management avoiding the possibility that patients are early edentulous. Management could be a conventional periodontal treatment and pharmacological therapy but in severe cases, digital techniques, could be help the clinician for increased patient comfort and minimized tissue damage.

Treatment of psoriatic skin lesions with a new Er:Yag laser technology: A case series study.

Erbium: YAG (Er:YAG) laser with RecoSMA technology. This laser emits thousands of microbeams of energy causing superficial epidermal ablation and a separation of dermal fibers due to a mechanical-acoustic and resonance effect. The aim of this study is to evaluate the clinical efficacy of Erbium: YAG (Er:YAG) laser with RecoSMA in the treatment of stable psoriasis vulgaris lesions. A questionnaire completed by 112 patients enrolled in the study. Photographs taken before each session, the analysis of the dynamics index PASI and histological studies were analyzed to visually monitor the clinical progress. The analyses were carried out with the help of computer software. The results after treatment of average number of sessions per course showed the complete clinical remission of the skin lesions in over 87% of the patients treated. The Er:YAG laser and RecoSMA have demonstrated the high effectiveness of the laser method of treating skin manifestations of the disease and improving the quality of life of patients.