RESUMO
Wound healing is an intricate process involving coordinated interactions among inflammatory cells, skin fibroblasts, keratinocytes, and endothelial cells. Successful tissue repair hinges on controlled inflammation, angiogenesis, and remodeling facilitated by the exchange of cytokines and growth factors. Comorbid conditions can disrupt this process, leading to significant morbidity and mortality. Stem cell therapy has emerged as a promising strategy for enhancing wound healing, utilizing cells from diverse sources such as endothelial progenitor cells, bone marrow, adipose tissue, dermal, and inducible pluripotent stem cells. In this systematic review, we comprehensively investigated stem cell therapies in chronic wounds, summarizing the clinical, translational, and primary literature. A systematic search across PubMed, Embase, Web of Science, Google Scholar, and Cochrane Library yielded 22,454 articles, reduced to 44 studies after rigorous screening. Notably, adipose tissue-derived mesenchymal stem cells (AD-MSCs) emerged as an optimal choice due to their abundant supply, easy isolation, ex vivo proliferative capacities, and pro-angiogenic factor secretion. AD-MSCs have shown efficacy in various conditions, including peripheral arterial disease, diabetic wounds, hypertensive ulcers, bullous diabeticorum, venous ulcers, and post-Mohs micrographic surgery wounds. Delivery methods varied, encompassing topical application, scaffold incorporation, combination with plasma-rich proteins, and atelocollagen administration. Integration with local wound care practices resulted in reduced pain, shorter healing times, and improved cosmesis. Stem cell transplantation represents a potential therapeutic avenue, as transplanted stem cells not only differentiate into diverse skin cell types but also release essential cytokines and growth factors, fostering increased angiogenesis. This approach holds promise for intractable wounds, particularly chronic lower-leg wounds, and as a post-Mohs micrographic surgery intervention for healing defects through secondary intention. The potential reduction in healthcare costs and enhancement of patient quality of life further underscore the attractiveness of stem cell applications in wound care. This systematic review explores the clinical utilization of stem cells and stem cell products, providing valuable insights into their role as ancillary methods in treating chronic wounds.
Assuntos
Células-Tronco Mesenquimais , Cicatrização , Animais , Humanos , Tecido Adiposo/citologia , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/metabolismo , Células-Tronco Mesenquimais/citologia , Transplante de Células-Tronco/métodosRESUMO
Ex vivo confocal microscope (EVCM) rapidly images freshly excised tissue at a histopathological resolution. EVCM features of keratinocyte skin cancers are well-established, but those of benign clinical mimickers remain scarce. We describe EVCM features of common benign lesions and compare them with their malignant differentials. EVCM was used to image 14 benign and 3 cancer tissues. We compared EVCM features of benign lesions with corresponding histopathology and with those of keratinocyte cancers. Key features of benign lesions were identified and differentiated from malignant lesions. Elastin and fat appeared prominent in EVCM; while koilocytes and melanin were difficult to identify. Visualization of entire epidermis was challenging due to difficulty of tissue flattening during imaging. Benign lesions can be differentiated from keratinocyte cancers with EVCM. Using EVCM, a rapid, bedside diagnosis and management of skin neoplasms is possible, especially in a remote location without a histopathology lab.
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Neoplasias Cutâneas , Humanos , Neoplasias Cutâneas/patologia , Epiderme/patologia , Microscopia Confocal/métodos , Melaninas , Queratinócitos/patologiaRESUMO
BACKGROUND: Reflectance confocal microscopy (RCM) has quickly transitioned from a research tool to an adjunct diagnostic bedside tool, providing the opportunity for noninvasive evaluation of skin lesions with histologic resolution. RCM is an optical imaging technique that uses near-infrared excitation wavelengths and safe low-power lasers. En-face images of different skin layers (up to the superficial dermis) are acquired in grayscale based on the reflective indices of tissue components. Melanin has the highest reflective index (contrast) and appears bright on RCM. AIMS: We present a review of the current literature on the use of RCM in the diagnosis and management of pigmentary disorders. METHODS: We reviewed PubMed and Ovid Medline databases from January 2000 to June 2021, using MeSH key terms: "reflectance confocal microscopy, confocal laser scanning microscopy, pigmentary disorders, treatment, melasma, vitiligo, freckles, solar lentigo, lentigo, tattoo, complications, melanoma, skin cancers, pigmented lesions, post inflammatory, melanin, photoaging" to identify studies and review articles discussing the use of RCM in the diagnosis and management of pigmentary disorders. RESULTS: RCM findings of pigmentary disorders were divided into the following categories: (1) disorders of increased pigmentation (post-inflammatory hyperpigmentation, melasma, Riehl's melanosis, solar lentigines, ephelides, hori nevus, naevus of Ota, café-au-lait macules, melanocytic nevus, melanoma, nevus spilus, labial mucosal melanosis, and mucosal melanoma), (2) disorders of decreased pigmentation or depigmentation (post-inflammatory hypopigmentation, vitiligo, nevus depigmentosus, halo nevus), and (3) exogenous pigmentation (tattoo, ochronosis). CONCLUSION: RCM has been explored and proven valuable for the evaluation and management of pigmentary disorders including melasma, vitiligo, solar lentigines, tattoo, and tattoo-related complications.
Assuntos
Hiperpigmentação , Hipopigmentação , Lentigo , Melanoma , Melanose , Nevo , Neoplasias Cutâneas , Vitiligo , Humanos , Vitiligo/patologia , Melaninas , Melanose/diagnóstico por imagem , Melanose/terapia , Neoplasias Cutâneas/patologia , Nevo/patologia , Lentigo/diagnóstico por imagem , Lentigo/terapia , Microscopia Confocal/métodosRESUMO
Cutaneous malignancies are common malignancies worldwide, with rising incidence. Most skin cancers, including melanoma, can be cured if diagnosed correctly at an early stage. Thus, millions of biopsies are performed annually, posing a major economic burden. Non-invasive skin imaging techniques can aid in early diagnosis and save unnecessary benign biopsies. In this review article, we will discuss in vivo and ex vivo confocal microscopy (CM) techniques that are currently being utilized in dermatology clinics for skin cancer diagnosis. We will discuss their current applications and clinical impact. Additionally, we will provide a comprehensive review of the advances in the field of CM, including multi-modal approaches, the integration of fluorescent targeted dyes, and the role of artificial intelligence for improved diagnosis and management.
RESUMO
BACKGROUND: There is sparse data regarding total body nevus count (TBNC), nevus count in specific locations, phenotypic factors, anthropometric indices, sunburn, and the relation to multiple primary cutaneous melanomas (MPCM) development. We aim to compare these variables in a cohort of patients diagnosed with single primary melanoma (SPM) and MPCM with histologic diagnoses of melanoma in situ, superficial spreading, and nodular melanoma in our clinic. METHODS: Prospective observational studies for the evaluation of nevus counts in biopsy-proven melanoma patients from 2017 to 2020 at Ankara University were conducted. Age, gender, family history of melanoma, increased sun exposure, nonmelanoma skin cancers (NMSC), height, sunburn history, TBNC, and nevi count in specific anatomical locations were evaluated by multivariate logistic regression analysis. RESULTS: A total number of 156 patients consisting of 22 MPCM and 134 SPM were included. Mean TBNC for SPM vs MPCM patients were 96.87 (SD ± 124.71) vs 247.00 (SD ± 261.58), respectively (P < 0.0001). TBNC was correlated to the left arm, trunk, lower extremity, and head and neck nevus counts but not with the right arm nevus count. Multiple regression analysis showed that having more than 10 nevi on the head and neck area is associated with MPCM (OR, 3.882 [95% CI, 1.084-13.899]). TBNC and nevus count in specific locations were found to be significantly higher in MPCM. CONCLUSION: The risk of MPCM was associated with having ≥10 nevi on the head and neck.
Assuntos
Melanoma , Neoplasias Primárias Múltiplas , Nevo Pigmentado , Nevo , Neoplasias Cutâneas , Queimadura Solar , Humanos , Melanoma/epidemiologia , Melanoma/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Queimadura Solar/complicações , Queimadura Solar/epidemiologia , Queimadura Solar/patologia , Estudos Prospectivos , Nevo Pigmentado/epidemiologia , Nevo Pigmentado/patologia , Nevo/patologia , Neoplasias Primárias Múltiplas/epidemiologia , Fatores de Risco , Melanoma Maligno CutâneoRESUMO
INTRODUCTION: Childhood psoriasis is not uncommon, and its prevalence is estimated to be 128 per 100,000 children. There are sparse data regarding intrauterine and environmental tobacco smoke exposure and the development of psoriasis in childhood. In this study, we aimed to investigate these parameters in the Turkish pediatric population. MATERIALS AND METHODS: We included 130 children with psoriasis and 390 children as controls. For each risk factor, odds ratios of psoriasis as an estimate of relative risks and corresponding 95% confidence interval were calculated. Univariate conditional logistic regression analysis was used to determining the crude odds ratio. Subsequently, to evaluate the effects of potential confounding factors, multivariate conditional logistic regression analysis was used. RESULTS: Childhood psoriasis (CP) was found to be associated with environmental tobacco smoke exposure irrespective of intrauterine smoking exposure, family history of psoriasis, and obesity (OR: 2.23, 95% CI = 1.39-3.58), whereas multiple logistic regression analysis did not show a relationship between CP and intrauterine tobacco exposure (OR: 1.61, 95% CI = 0.75-3.43). CONCLUSIONS: Environmental tobacco smoke exposure at home denotes an important preventable risk factor for developing CP. Further studies are needed to elucidate the relationship between CP and environmental tobacco exposure investigating a large cohort of CP patients who have been diagnosed by expert dermatologists.
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Psoríase , Poluição por Fumaça de Tabaco , Estudos de Casos e Controles , Criança , Exposição Ambiental/efeitos adversos , Humanos , Psoríase/epidemiologia , Psoríase/etiologia , Fatores de Risco , Nicotiana , Poluição por Fumaça de Tabaco/efeitos adversosRESUMO
BACKGROUND: Ten-year survival rates in mycosis fungoides (MF) broadly varies, however, there is no standardized prognostic index available. This is presumably due to low prevalence, heterogeneity, and diagnostic challenges in MF. Recent studies have focused on identifying objective prognostic indices by using different parameters for survival determinants. The Cutaneous Lymphoma International Prognostic Index (CLIPI) and the Prospective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) represent prototypical studies that identify prognostic factors, seeking to improve management and outcomes in early-stage MF. Detecting these factors and stratifying MF patients according to their disease progression risk may help to manage these patients more efficiently. AIMS: Review the current literature to determine the risk factors determining prognosis in MF. METHODOLOGY: A Comprehensive literature search was performed using electronic online databases "PubMed" and "Google Scholar" using key words 'prognostic factor', 'prognostic indicator', 'mycosis fungoides', 'Sezary syndrome', 'Skin Lymphoma', 'Cutaneous Lymphoma'. Articles published in English language were considered for the review. RESULTS: The strongest prognostic factor in MF patients is the stage of the disease. T stage and the presence of extracutaneous disease are the most important factors for survival. Other factors that are associated with worse prognosis are male gender, age >60, presence of plaques, folliculotropism, eosinophilia and lymph node stage above N1/Nx. Elevated LDH was associated with later tumor stages and large cell phenotype at diagnosis had a better prognosis. KIR3DL2 was associated with malignant transformation. CONCLUSION: The PROCLIPI study has assessed risk factors collected in MF patients from different countries and across different ethnicities following a rigorous clinicopathologic process. The findings presented here illustrated that disease prognosis in early stages depends on many contributing factors. Detection and stratification of such factors may allow a personalized approach to management of these patients.
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Micose Fungoide , Neoplasias Cutâneas , Feminino , Humanos , Masculino , Micose Fungoide/diagnóstico , Micose Fungoide/terapia , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapiaAssuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Linfoma Cutâneo de Células T/complicações , Linfoma Cutâneo de Células T/diagnóstico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Adulto , Artrite Reumatoide/terapia , Humanos , Linfoma Cutâneo de Células T/terapia , Masculino , Neoplasias Cutâneas/terapiaRESUMO
Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1-6% of all live births and commonly classified based on the projected size in adults. Congenital melanocytic naevi appear in different colours, shapes, and sizes, and occasionally present with complications. In this review, we sought to evaluate congenital melanocytic naevi, their clinical, dermatoscopic, and reflectance confocal microscopic features, behavioural pattern over time, new trends in classification, underlying genetic factors and their influence on clinical manifestations and management, associated risks, complications, magnetic resonance imaging findings and their management in the light of recent literature.