Activography reveals aberrant proteolysis in desquamating diseases of differing backgrounds.

The role of epidermal proteolysis in overdesquamation was revealed in Netherton syndrome, a rare ichthyosis due to genetic deficiency of the LEKTI inhibitor of serine proteases. Recently, we developed activography, a new histochemical method, to spatially localize and semiquantitatively assess proteolytic activities using activity-based probes. Activography provides specificity and versatility compared to in situ zymography, the only available method to determine enzymatic activities in tissue biopsies. Here, activography was validated in skin biopsies obtained from an array of distinct disorders and compared with in situ zymography. Activography provides a methodological advancement due to its simplicity and specificity and can be readily adapted as a routine diagnostic assay. Interestingly, the levels of epidermal proteolysis correlated with the degree of desquamation independent of skin pathology. Thus, deregulated epidermal proteolysis likely represents a universal mechanism underlying aberrant desquamation.

Seborrheic Dermatitis in Skin of Color: Clinical Considerations

Seborrheic dermatitis is a common, relapsing, inflammatory skin condition of unclear etiology. The Malassezia yeast genus are believed to play a role. Seborrheic dermatitis commonly affects areas of the skin with high sebum production, including the scalp, nasolabial folds, glabella, eyebrows, beard, ears, retroauricular skin, sternum, and other skin folds. Seborrheic dermatitis may present differently in individuals with skin of color. Darker-skinned individuals may present with scaly, hypopigmented macules and patches in typical areas of involvement. Arcuate or petal-like patches may be seen, specifically termed petaloid seborrheic dermatitis. Children of color often do not experience the classic "cradle cap" appearance of seborrheic dermatitis, and have erythema, flaking, and hypopigmentation of the affected areas and folds of skin. Seborrheic dermatitis tends to respond well to conventional treatments, although it tends to recur. Skin of color patients may require a modified treatment approach which takes into account differences in hair texture and hair washing frequency. This paper aims to highlight these differences to help reduce disparities in the management of seborrheic dermatitis in patients of color. J Drugs Dermatol. 2019;18(1):24-27.

Analysis of gene expression profiles of multiple skin diseases identifies a conserved signature of disrupted homeostasis.

Triggers of skin disease pathogenesis vary, but events associated with the elicitation of a lesion share many features in common. Our objective was to examine gene expression patterns in skin disease to develop a molecular signature of disruption of cutaneous homeostasis. Gene expression data from common inflammatory skin diseases (eg psoriasis, atopic dermatitis, seborrhoeic dermatitis and acne) and a novel statistical algorithm were used to define a unifying molecular signature referred to as the "unhealthy skin signature" (USS). Using a pattern-matching algorithm, analysis of public data repositories revealed that the USS is found in diverse epithelial diseases. Studies of milder disruptions of epidermal homeostasis have also shown that these conditions converge, to varying degrees, on the USS and that the degree of convergence is related directly to the severity of homeostatic disruption. The USS contains genes that had no prior published association with skin, but that play important roles in many different disease processes, supporting the importance of the USS to homeostasis. Finally, we show through pattern matching that the USS can be used to discover new potential dermatologic therapeutics. The USS provides a new means to further interrogate epithelial homeostasis and potentially develop novel therapeutics with efficacy across a spectrum of skin conditions.

Quality of life and emotional state in chronic skin disease.

The aim of this study was to evaluate the associations between chronic inflammatory skin conditions and patients' emotional state and quality of life. The following self-rated questionnaires were used: Emotional State Questionnaire, a self-report scale assessing depression and anxiety symptoms; Dermatology Life Quality Index (DLQI); and RAND-36, a measure of health-related quality of life. The study group comprised 40 patients with psoriasis, 40 with eczema, 40 with acne, 15 with seborrhoeic dermatitis and 40 healthy controls. Patients with chronic skin diseases had lower DLQI and lower RAND-36 physical functioning scores, more perceived physical limitations and pain, and lower emotional well-being and general health ratings compared with the control group. In conclusion, chronic skin diseases are associated with symptoms of emotional distress, in particular insomnia and general anxiety.

Diagnosis and treatment of seborrheic dermatitis.

Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms-scaling, erythema, and itching-occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis.

A comprehensive pathophysiology of dandruff and seborrheic dermatitis - towards a more precise definition of scalp health.

Despite an increasing knowledge of dandruff and seborrheic dermatitis (D/SD), the pathophysiological understanding is still incomplete but suggests a role of Malassezia yeasts in triggering inflammatory and hyper-proliferative epidermal responses. The objective of this report is to review published literature from in vivo studies of D/SD populations to provide a more complete description of overall scalp health. New biomolecular capabilities establish a depth of pathophysiological understanding not previously achievable with traditional means of investigation. Biomarkers representing inflammation, hyper-proliferation and barrier function are all perturbed by the D/SD condition and robustly respond to therapeutic resolution. These biomarkers can be sampled noninvasively, enabling their use in routine clinical evaluations as either surrogate endpoints or complementary ones to classical signs/symptoms to broaden the etiological learning.

[Meibomian gland dysfunction--review]. / Dysfunkcja gruczolów Meiboma--przeglad pismiennictwa.

Meibomian gland dysfunction is a common ocular disorder affecting from 39 to 50% of population. Despite that, so far a pathophysiology path of the disease remains unknown, moreover there is no distinct border between physiology and the disease. There has been no clear diagnostic criteria. The purpose of this review was to combine a current knowledge of Meibomian gland anatomy, Meibomian gland dysfunction epidemiology, as well as presenting current definition, nomenclature, classification and diagnostic criteria. The importance of diagnosis associated with conditions such as aqueous tear deficiency, seborrheic dermatitis, and rosacea is emphasized. The available treatment methods are discussed. Meibomian gland dysfunction, blepharitis, dry eye syndrome.

Retrospective, observational study on the effects and tolerability of flutamide in a large population of patients with acne and seborrhea over a 15-year period.

The long-term effects and tolerability of flutamide (Flu) in women with acne and seborrhea were evaluated. Over the 15-year period, which spans from January 1991 to January 2006, a total of 230 Caucasian women with acne, 211 of which also with seborrhea, received yearly reducing doses (250, 125, and 62.5 mg/day) of Flu alone or combined with oral contraceptive for a period varying from 3 to 6 years and more. Clinical and endocrine evaluations were performed half-yearly and yearly, respectively, in the first 3 years of the study, and yearly in the following years. Liver function evaluations were performed quarterly. Both the groups of patients under Flu therapy showed a similar, marked decrease in acne and seborrhea scores after 6 months of treatment compared with basal values. The maximum drug effect was observed after 1 year, and it was maintained during the following years of treatment. Androgens were strongly suppressed during treatment. During the first year of treatment with 250 mg/day, 4.8% of patients interrupted the study due to hepatic disorders. During the following years on the 125 and 62.5 mg/day doses, no transaminase elevation was observed. The study supports very low-dose Flu as a first-line therapy for women with acne and seborrhea.

Oily sensitive skin: A review of management options.

BACKGROUND: Due to the ever-increasing demands for the personalized care, people seek for the tailored management according to the accurate identification of their skin type. The Baumann Skin Type Indicator, which was proposed by Leslie Baumann, is composed of four parameters: oily or dry, resistant or sensitive, pigmented or nonpigmented, and wrinkled or tight. Among these, oily sensitive skin experiences significant discomfort and resists ordinary treatment. AIMS: In this article, we will review the clinical manifestations, underlying pathogenesis and recommendations on treatment options that may be utilized to help patients with oily sensitive skin. PATIENTS/METHODS: Literature search was conducted using PubMed. The literature concerning Baumann Skin Type Indicator and oily sensitive skin type were considered. RESULTS: Oily sensitive (OS)-type skin is a complex of oily and sensitive skin that causes significant discomfort and undergoes stubborn resistance to treatments. Sebum dysfunction and hypersensitivity may play a key role in the development of sensitive skin. Considering the pathogenesis of OS-type skin, treatment should focus on both seborrhea and hypersensitivity. CONCLUSION: Clinicians can effectively treat the oily sensitive skin by understanding underlying pathogenesis of it. Further investigations are necessary to reach a consensus on the basic pathophysiology and optimal management guidelines for oily sensitive skin.

Role of topical calcineurin inhibitors in the treatment of seborrheic dermatitis: a review of pathophysiology, safety, and efficacy.

Seborrheic dermatitis (SD) is characterized by erythematous pruritic patches and plaques with greasy scale that occur in sebaceous areas. It is common, affecting up to 3% of the population. Past treatments have relied on a wide variety of anti-inflammatory and antifungal agents, but corticosteroids have limited use because of long-term adverse effects. Topical calcineurin inhibitors provide a safe alternative for the treatment of SD, as these drugs block the inflammatory cascade involved in the disease process and pose no risk of skin atrophy. Studies of topical pimecrolimus and tacrolimus in the treatment of SD have found that improvement occurred within 2 weeks, and if SD recurred after stopping treatment, it was significantly less severe. There have been no studies of the comparative efficacy of pimecrolimus versus tacrolimus for the treatment of SD. Common adverse effects of mild burning and irritation have been associated with the use of both of these agents. Safety profile studies are limited to studies of atopic dermatitis, which show no increase in infection rate, photocarcinogenicity, or signs of immunosuppression in patients using topical calcineurin inhibitors for long-term treatment. This article reviews the clinical trials of pimecrolimus and tacrolimus in the treatment of SD, focusing on efficacy and safety.

Hand-foot syndrome and seborrheic dermatitis-like eruption induced by erlotinib.

Erlotinib is an epidermal growth factor receptor tyrosine kinase inhibitor that is responsible for several cutaneous side effects. We report a case of hand-foot syndrome associated with a papulo-pustular and seborrheic dermatitis-like eruption of the face in a 61-year-old patient treated with erlotinib for lung cancer.

Assessing Biophysical and Physiological Profiles of Scalp Seborrheic Dermatitis in the Thai Population.

BACKGROUND: Scalp seborrheic dermatitis (SD) is a common and chronic inflammatory skin disease which tends to recur over time. By measuring biophysical properties of the stratum corneum, many studies report abnormal biophysical profiles and their association in various dermatologic diseases. The aim of the study is to analyze the biophysical properties and skin barrier defects of scalp SD compared to healthy controls. MATERIALS AND METHODS: This study is a cross-sectional study assessing the correlation of various biophysical and physiological profiles in scalp SD. Forty-two Thai participants with scalp SD were enrolled in the study and 40 healthy participants were also enrolled as the control group. Both SD and control group were subjected to a one-time biophysical and physiological properties' measurement of transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin surface pH, skin surface lipid, and skin roughness. RESULTS: The mean TEWL of lesional skin of SD cases were significantly higher than those of control group (P<0.05). Relating to high mean TEWL, the mean SCH was found to be significantly lower in SD cases (P<0.05). Skin surface lipid was also found to be significantly higher in SD group (P<0.05). However, there were no differences in skin surface pH (P=0.104) and roughness (P=0.308) between the two groups. Pairwise comparison of each subgroup found that moderate and severe SD demonstrated significantly higher mean skin surface lipid than that of control group (P<0.05). CONCLUSION: Scalp SD may be associated with seborrhea in Thai population. Monitoring of SCH, TEWL, and skin surface lipid could be helpful in assessing severity and evaluating the treatment outcome in patients with scalp SD.

Adult-onset lichen striatus versus adult blaschkitis: a clinicopathological review of 40 cases of acquired blaschkolinear inflammatory dermatosis.

BACKGROUND: Since the first description of adult blaschkitis (AB), the existence of this entity has been a matter of great debate. OBJECTIVES: To compare clinicopathological features of lichen striatus (LS) and AB cases. MATERIALS AND METHODS: We retrospectively reviewed the clinicopathological features of patients who clinically showed linear inflammatory dermatosis along Blaschko's lines based on a skin biopsy registry. RESULTS: Through a process of clinicopathological differential diagnosis, 27 cases of LS, three of AB, eight of linear lichen planus, and two of linear psoriasis were identified. Clinicopathological differences between LS and AB were mostly insignificant except for age at onset and multiple site involvement. In these cases, females were affected more frequently than males. The mean age at onset was 31.6 years, and the most common involved site was the leg. The lesions lasted approximately 8.3 months with few relapses. The most common histopathological finding was perivascular infiltration followed by peri-appendageal infiltration. CONCLUSION: Distinction between LS and AB appears to be unnecessary given their overlapping features.

Patient experiences with oily skin: the qualitative development of content for two new patient reported outcome questionnaires.

OBJECTIVE: To develop the content for two new patient reported outcome (PRO) measures to: a) assess the severity of symptoms; and b) the impact of facial skin oiliness on emotional wellbeing using qualitative data from face to face, and internet focus groups in Germany and the US. METHODS: Using input from initial treatment satisfaction focus groups (n = 42), a review of relevant literature and expert clinicians (n = 3), a discussion guide was developed to guide qualitative inquiry using Internet focus groups (IFGs). IFGs were conducted with German (n = 26) and US (n = 28) sufferers of oily skin. Questionnaire items were generated using coded transcript data from the focus groups. Cognitive debriefing was conducted online with 42 participants and face to face with an additional five participants to assess the comprehension of the items. RESULTS: There were equal numbers of male and female participants; mean age was 35.4 (SD 9.3) years. On average, participants had had oily skin for 15.2 years, and 74% (n = 40) reported having mild-moderate acne. Participants reported using visual, tactile and sensory (feel without touching their face) methods to evaluate the severity of facial oiliness. Oily facial skin had both an emotional and social impact, and was associated with feelings of unattractiveness, self-consciousness, embarrassment, irritation and frustration. Items were generated for a measure of oily skin severity (Oily Skin Self-Assessment Scale) and a measure of the impact of oily skin on emotional well-being (Oily Skin Impact Scale). Cognitive debriefing resulted in minor changes to the draft items and confirmed their face and content validity. CONCLUSION: The research provides insight into the experience of having oily skin and illustrates significant difficulties associated with the condition. Item content was developed for early versions of two PRO measures of the symptoms and emotional impact of oily facial skin. The psychometric validation of these measures reported elsewhere.

Incubatory environment of the scalp impacts pre-emergent hair to affect post-emergent hair cuticle integrity.

OBJECTIVES: To determine whether the oxidative stress transmitted to newly grown hair from an unhealthy scalp has physical consequences to the cuticular condition and function. METHODS: A uniquely designed 24-week clinical study included 8 weeks of pretreatment with a cosmetic shampoo and 16 weeks of treatment with either a potentiated zinc pyrithione (ZPT) antidandruff shampoo or a placebo cosmetic shampoo. This clinical design allowed the growth and acquisition of hair samples under conditions of varying but known scalp health as a result of treating a dandruff/seborrheic dermatitis (D/SD) population. Two complementary methods were used to characterize the integrity of the cuticular surface. Hair surface hydrophobicity was assessed by quantifying water wetting force using a Wilhelmy balance method. Surface structure and porosity were assessed using dynamic vapor sorption (DVS) to gravimetrically quantify water sorption. RESULTS: Chemical oxidative stress to pre-emergent hair has been shown to have negative consequences to hair surface structure. Compared to a placebo shampoo control, use of a potentiated ZPT shampoo improved scalp health and significantly improved the following attributes associated with healthy hair: hair surface hydrophobicity (surface energy) and cuticular moisture barrier effectiveness (dynamic vapor sorption). CONCLUSIONS: Pre-emergent hair can be negatively impacted by the oxidative stress that occurs with an unhealthy scalp, possibly due to metabolic activity of resident microbes. Manifestations of the oxidative stress include altered cuticle surface properties that are responsible for its protective function; these effects are similar in type to those observed by bleaching post-emergent hair. These alterations have the potential to make the hair, once emerged from the scalp, more susceptible to the cumulative physical and chemical insults responsible for hair feel and look, fiber integrity, and overall retention.

On top of cradle cap.

Cradle cap is often viewed as the norm in infancy. It is, however, highly amenable to treatment. While cradle cap generally causes no ill-effects to the newborn baby, new parents may experience disappointment in their attempts to resolve the problem and be distressed by others' response to their infant's appearance. Moisturisers have an important role in softening scale, yet baby oil alone is often not sufficient. Greasier emollients may not be cosmetically acceptable and parental choice can be a key factor in the successful treatment of the problem. Parents may benefit from instructions on how to apply topical treatments effectively, and the opportunity to discuss their anxieties. Good skin care (i.e. the use of emollients) will promote general skin health and reduce any dryness associated with co-existing atopic eczema.

Simultaneous occurrence of idiopathic lipemic tears and massive seborrhea.

A 42-year-old man had idiopathic lipemic tears and massive seborrhea. Recent investigations have shown that cholesterol and other lipids occasionally found in tears are produced by meibomian rather than lacrimal glands. The finding in this patient of hypersecretion by both sebaceous glands and meibomian glands, a sebaceous gland variant, suggests that a common mechanism may regulate secretory control of both of these glands.