Patients' self-esteem before and after chemical peeling procedure.

INTRODUCTION: Chemical peeling is a safe method, widely used to treat a variety of skin conditions and reduce the aging effects. This study aims to evaluate self-esteem among adolescents who undergo chemical peelings. MATERIAL AND METHODS: One hundred and twenty six patients constituted the study group. Sixty seven individuals had undergone chemical peeling for therapeutic reasons and 59 individuals for cosmetic reasons. To assess patients' self-esteem, the Rosenberg's Self-esteem Scale (RSES) was used before and after treatment. The control group included 71 healthy, age- and sex-matched volunteers from the general population. They were also asked to complete the RSES, after the same time interval as the patients. RESULTS: The healthy controls (23.01 ± 3.12) presented statistically significantly higher self-esteem than both the groups of individuals who would be submitted to chemical peeling. Furthermore, patients who would undergo peeling for therapeutic reasons (21.58 ± 3.20) had statistically significantly higher self-esteem than those who would undergo the procedure for cosmetic reasons (18.97 ± 3.36). After the chemical peeling sessions, the self-esteem of patients treated for therapeutic reasons (23.48 ± 2.43) and of patients treated for cosmetic reasons (22.83 ± 3.34) improved statistically significantly, while the self-esteem of the healthy controls remained stable, as expected. CONCLUSION: Patients who undergo chemical peelings tend to have low levels of self-esteem. Although facial lesions in skin diseases such as acne, acne scars, rosacea, and melasma seem to have negative effect on individuals' self-consciousness, patients who would be submitted to chemical peeling in order to treat wrinkles, loss of radiance, and skin tone clarity have even lower self-esteem. Chemical peelings were shown to favorably affect patient's self-esteem since all patients showed an increase in self-esteem after treatment, while the control group experienced no change.

Comparative study of quality of life and psychosocial characteristics in patients with psoriasis and leg ulcers.

Psoriasis and leg ulcers have a marked impact on the patient's quality of life and represent a life-long burden for affected patients. The aim of this study is to compare the quality of life, anxiety and depression, self-esteem, and loneliness in patients with psoriasis and leg-ulcer patients. Eighty patients with leg ulcers, eighty patients with psoriasis, and eighty healthy controls were included in this study. The quality of life, depression and anxiety, loneliness of the patient, and self-esteem were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), the UCLA loneliness Scale (UCLA-Version 3), and the Rosenberg's Self-esteem Scale (RSES), respectively. The DLQI score among patients with psoriasis was 12.74 ± 4.89 and leg ulcer patients was 13.28 ± 2.57. The patients with psoriasis presented statistically significant higher anxiety (9.87 ± 4.56) than both leg ulcer patients (8.26 ± 2.82) and controls (6.45 ± 1.89), while leg ulcer patients also presented higher anxiety than controls. Regarding self-esteem, although there were no significant differences between the patients with psoriasis (15.25 ± 3.20) and the ones with leg ulcers (15.89 ± 2.93), they both presented statistically significant lower self-esteem scores than control group (18.53 ± 3.04). The patients with psoriasis presented statistically significant higher levels of loneliness and social isolation (46.18 ± 6.63) compared to leg ulcer patients (43.73 ± 5.68) than controls (42.49 ± 3.41). Psoriasis and leg ulcers are long-term skin diseases associated with significant impairment of the patient's quality of life, anxiety, and self-esteem, which are frequently under-recognized.

Quality of Life and Psychosocial Implications in Patients with Hidradenitis Suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a long-term skin disorder associated with high levels of psychological distress and significant life impact. OBJECTIVE: To evaluate the quality of life, depression, anxiety, loneliness, and self-esteem in patients with HS. METHODS: Ninety-four patients with HS were enrolled in the study. The quality of life, depression, anxiety, loneliness, and self-esteem of the patients were assessed using the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), the UCLA Loneliness Scale (UCLA-Version 3), and the Rosenberg Self-Esteem Scale (RSES), respectively. RESULTS: The DLQI mean score was 11.43 ± 6.61 in patients with HS. The patients with HS presented statistically significantly higher anxiety (6.41 ± 3.31 vs. 5.00 ± 1.59, p < 0.001), depression (5.45 ± 2.79 vs. 4.16 ± 1.54, p < 0.001), and loneliness and social isolation scores (42.86 ± 8.63 vs. 35.57 ± 6.17, p < 0.001) and lower self-esteem scores (18.91 ± 1.79 vs. 19.77 ± 2.53, p = 0.008) than the healthy controls. CONCLUSIONS: HS is a distressing, recurrent disease that impairs quality of life. We can suggest services that allow an integrated approach, which includes psychosocial support, offering the patients relief from isolation and an opportunity to share common experiences.

Combination of microneedling and 10% trichloroacetic acid peels in the management of infraorbital dark circles.

BACKGROUND: Dark circles (DC), seen in the periorbital area, are defined as bilateral, round, homogeneous pigmented macules whose aetiology is thought to be multifactorial. Available treatments include bleaching creams, topical retinoic acid, chemical peels, lasers, autologous fat transplantation, injectable fillers and surgery (blepharoplasty). OBJECTIVE: To evaluate the efficacy and safety of a combination of microneedling and 10% trichloroacetic acid (TCA) peels in the treatment of DC. MATERIALS AND METHODS: Thirteen female patients with mild to severe infraorbital DC were included in the study. The patients were aged between 21 and 61 years. They were treated with Automatic Microneedle Therapy System-Handhold and topical application of 10% TCA solution to each infraorbital area for five minutes. The effect was photo-documented and a Patient and Physician Global Assessment was evaluated. Safety was assessed by evaluating early and delayed adverse events. RESULTS: Almost all patients showed significant aesthetic improvement. Both Physician and Patient Global Assessment rated a fair, good or excellent response in 92.3%. The procedure was well tolerated. Mild discomfort, transient erythema and oedema were quite common during or immediately after the procedure. The patients were followed up regularly every month for four months, and no recurrence was recorded. CONCLUSION: Microneedling and 10% TCA constitute an innovative combination treatment for DC with encouraging results and minor side effects.

Quality of life psychosocial characteristics in Greek patients with leg ulcers: a case control study.

Chronic leg ulcers are a public health problem that can have a significant impact on the patient's physical, socioeconomic and psychological status. The aim of this study is to evaluate the quality of life, anxiety and depression, self-esteem and loneliness in patients suffering from leg ulcers. A total of 102 patients were enrolled in the study. The quality of life, anxiety and depression, self-esteem and loneliness of the patient were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg's Self-esteem Scale (RSES) and the UCLA Loneliness Scale (UCLA-Version 3), respectively. The mean DLQI score was 13·38 ± 2·59, suggesting a serious effect on the quality of life of patients. Those with leg ulcers had statistically significant higher scores according to the HADS-total scale (P = 0·031) and HADS-anxiety subscale (P = 0·015) compared with healthy volunteers. Moreover, a statistically significant difference was found between the two groups concerning the UCLA-scale (P = 0·029). Female patients presented with a higher score of anxiety (P = 0·027) and social isolation (P = 0·048), and worse quality of life (P = 0·018) than male patients. A severe quality of life impairment was documented, reflecting a significant psychosocial impact on patients with leg ulcers.

Quality of life in Greek family members living with leg ulcer patients.

Leg ulcers have been shown to have a significant impact on a patient's quality of life (QoL). Little is known, however, about the secondary impact of the disease on the QoL of the relatives and partners of patients with leg ulcers. The aim of this study was to explore the impact of chronic leg ulcers on the lives of both patients and their family members. Two hundred sixteen patients with leg ulcers and their family members were recruited. All patients entered were evaluated for QoL using the Dermatology Life Quality Index (DLQI) scale, and family members were similarly evaluated using the Family Dermatology Life Quality Index (FDLQI).The study included 56 female and 52 male patients, and 50 female and 58 male family members. The FDLQI score for the latter group was 14.37 ± 2.46 with over 96% of family members reporting a large effect on their QoL due to their relative's disease. The DLQI score in patients with leg ulcers was 13.18 ± 2.88. A significant positive and high correlation between DLQI and FDLQI scores (r = 0.71, p < 0.001) was documented, while DLQI contributed significantly to the prediction of FDLQI (standardized ß = 0.71, p < 0.001). Our study results indicate that the QoL of the family was also affected by the patient's condition of chronic leg ulcers and clearly associated with that of the patients.

Quality of life, anxiety, depression and obsessive-compulsive tendencies in patients with chronic hand eczema.

BACKGROUND: Chronic hand eczema is a common dermatological disorder of multifactorial aetiology. It affects physical, material, social and psychological aspects of life, thereby impairing health-related quality of life. OBJECTIVES: The aim of the present study was to assess quality of life, anxiety, depression and obsessive-compulsive tendencies in patients with chronic hand eczema. MATERIALS AND METHODS: Seventy-one patients with chronic hand eczema were included in the study. Quality of life was evaluated according to the Dermatology Life Quality Index (DLQI). Patients were also assessed for anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), and for compulsive behaviour with the Leyton Trait Scale. RESULTS: The DLQI score was 11.11 ± 1.81 in patients with chronic hand eczema. Scores on the Leyton Trait Scale were significantly higher than those of healthy controls (p < 0.027). As concerns the HADS-Anxiety subscale, patients with hand dermatitis had statistically significantly higher scores than those of volunteers (p = 0.002). In contrast, no statistically significant difference was found between the two groups with regard to the HADS-Depression subscale score and total HADS score. CONCLUSION: Hand eczema treatment should address the severity of skin lesions as well as the psychological impact of hand eczema.

Quality of life and social isolation in Greek adolescents with primary focal hyperhidrosis treated with botulinum toxin type A: a case series.

Primary hyperhidrosis, although extensively documented in adults, typically has onset that dates back to early childhood. It is an unpleasant and socially disabling problem for the affected child, but little attention has been paid to the disease in adolescents. The objective of the current study was to evaluate the effectiveness of botulinum toxin type A (BTXA) in adolescents with primary palmar and axillary hyperhidrosis and to determine its effect on quality of life and social isolation. Thirty-five individuals (17 girls, 18 boys) with moderate to severe palmar and axillary hyperhidrosis were treated with BTXA (onabotulinum). Patients were examined at baseline and 6 months after treatment. The Hyperhidrosis Disease Severity Scale (HDSS) was used to evaluate disease severity and the Children's Dermatology Life Quality Index (CDLQI) was used to assess quality of life. The University of California at Los Angeles loneliness scale (UCLA version 3) was used to assess personal perception of loneliness and social isolation. The median age of the participants was 14 years, and 48.6% were female. Twenty-one had palmar hyperhidrosis, and 14 had axillary hyperhidrosis. Total CDLQI and social isolation scores decreased significantly after treatment with BTXA (both p < 0.001). There was a significant difference between pre- and post-treatment levels of severity of hyperhidrosis. No statistically significant difference was documented for CDLQI and UCLA scores between boys and girls. Treatment of hyperhidrosis with BTXA resulted in improvement in quality of life, social skills, and activities.

Quality of life and psychosocial impact of scarring and non-scarring alopecia in women.

BACKGROUND: Alopecia is a common dermatological condition with mostly cosmetic consequences that, nevertheless, has significant psychological and psychosocial impact. OBJECTIVE: To assess the impact of alopecia on quality of life and certain psychological domains and to compare it between scarring and non-scarring alopecia in Greek adult women. PATIENTS AND METHODS: Forty-four women, aged 18-70 years, with scarring (n = 19) or non-scarring alopecia (n = 25) were recruited. All patients were evaluated by Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-esteem Scale (RSES) and UCLA Loneliness Scale (UCLA-LS). RESULTS: Women with scarring alopecia had higher scores in DLQI, HADS and UCLA- LS and lower scores in RSES, compared to women with non-scarring alopecia. A statistically significant difference between the two groups was documented for DLQI (p = 0.0067), HADS (p = 0.0008), and HADS-Anxiety (HADS-A) (p < 0.05) and HADS-Depression (HADS-D) (p < 0.01) subscales. CONCLUSIONS: The psychological burden is heavier and quality of life is more severely impaired among women with scarring alopecia compared with non-scarring alopecia, probably depicting the poorer prognosis of the former.

Remarkable improvement of relapsing dyshidrotic eczema after treatment of coexistant hyperhidrosis with oxybutynin.

Dyshidrotic hand eczema is a common condition, which can be resistant to various treatments. Although a number of etiologic factors are involved in the pathogenesis of dyshidrotic eczema, hyperhidrosis is assumed to play a significant role. Oxybutynin is an alternative treatment for hyperhidrosis. We present the cases of two patients suffering from hyperhidrosis and dyshidrotic eczema, who were treated with oxybutynin with impressive results.

Muscle weakness in treatment of palmar hyperhidrosis with botulinum toxin type a: can it be prevented?

BACKGROUND: Palmar hyperhidrosis is a chronic disorder, resistant to conventional treatment. Clinical studies suggest the effectiveness of botulinum toxin A in the treatment of primary palmar hyperhidrosis. OBJECTIVE: To evaluate the efficacy of botulinum toxin A in the therapy of palmar hyperhidrosis and the frequency of incurred muscle weakness. MATERIALS AND METHODS: Four hundred seventy-four patients with palmar hyperhidrosis were enrolled in the study. The Hyperhidrosis Disease Severity Scale (HDSS) and the Minor-iodine starch test were chosen to assess the disease severity. In addition, a physician's global assessment scale was used to evaluate the effectiveness of the treatment with BTX-A. RESULTS: There were 312 females and 162 males aged 19-48 (mean 29 years). The improvement following the injection at two weeks and at one, three, six and nine months, as evaluated by physicians, was 82%, 83%, 74%, 48% and 28%, respectively. Two hundred and seventy five patients reported local pain and muscle weakness occurred in 102 patients. CONCLUSIONS: BTX-A led to the reduction of disease severity while transient side effects were reported.

Repeated salicylic acid peels for the treatment of hyperplastic sebaceous glands in hypohidrotic ectodermal dysplasia.

Hypohidrotic ectodermal dysplasia (Christ-Siemens-Touraine syndrome) is the most common type of ectodermal dysplasia. Hypertrophic sebaceous glands (HSGs) are rarely present but they cause an aesthetic problem. We report a case of a patient suffering from hypohidrotic ectodermal dysplasia, treated with salicylic acid peels for the hyperplastic sebaceous glands.

Alexithymia, anxiety and depression in patients with psoriasis: a case-control study.

BACKGROUND: Alexithymia, the difficulty in describing or recognizing emotions, has been associated with various psychosomatic pathologies including psoriasis. The aim of this study was to examine the prevalence of alexithymia and its association with anxiety and depression in patients with psoriasis compared with healthy participants, while taking into consideration demographic and clinical variables. METHODS: One hundred and eight psoriatic patients and 100 healthy participants from the general population completed the Toronto Alexithymia Scale (TAS-20) and the Hospital Anxiety and Depression Scale (HADS). The severity of patients' psoriasis was clinically assessed using the Psoriasis Area and Severity Index (PASI). RESULTS: Psoriatic patients had higher levels of alexithymia compared with healthy participants. While a rather high rate of psoriatic patients presented anxiety and depression as defined by the HADS, the differences that were found in comparison with the control group were not significant. Neither alexithymia nor its dimensions, difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally oriented thinking (EOT), were associated with gender or psoriasis severity. Age was associated only with EOT, which was independent of depression and anxiety. Higher anxiety and depression were connected with higher alexithymia and DIF, while higher anxiety with higher DDF as well. CONCLUSIONS: The alexithymia prevalence was higher in psoriatic patients than that in healthy participants, while it was positively correlated with anxiety and depression. Difficulty in identifying feelings was connected with both anxiety and depression, whereas difficulty in describing them was only with anxiety. Finally, externally oriented thinking was predicted only from age.

Self-Esteem, Depression, Anxiety and Quality of Life in Patients with Melasma Living in a Sunny Mediterranean Area: Results from a Prospective Cross-Sectional Study.

INTRODUCTION: Melasma is a common acquired disorder of hyperpigmentation and has a significant effect on quality of life. The aim of this prospective cross-sectional study was to assess the effect of melasma on depression, social anxiety and self-esteem in the Greek population. METHODS: The study included a total of 254 participants: 127 patients with melasma and an equal sample of healthy controls. Both participant groups completed the following psychometric measures: the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression and Rosenberg's Self-esteem Scale (RSES) for self-esteem. Furthermore, in patients with melasma, quality of life was assessed using Melasma Quality of Life (MELASQoL). RESULTS: Melasma patients (7.47 ± 4.53) presented statistically significantly higher anxiety compared to healthy controls (6.06 ± 3.59, p = 0.006), while no differences emerged with regard to depression or self-esteem. It is important to note that the difference regarding anxiety remained significant (b = 1.25, p = 0.003) even after adjusting for age, depression and self-esteem. A higher disease severity (MASI) correlated statistically significantly with longer disease duration (r = 0.24, p < 0.001), higher depression (r = 0.28, p = 0.002), and a more impaired health-related quality of life (MelasQol; r = 0.29, p < 0.001). Notably, a more impaired health-related quality of life was also correlated with higher depression (r = 0.19, p = 0.027) and lower self-esteem (r = - 0.31, p < 0.001). CONCLUSION: The results of this study highlight the importance of evaluating quality of life, anxiety and depression in patients with melasma. The therapeutic approach should not be based solely on clinical findings; it should also include an evaluation of the patient's psychological aspects. Dermatologists can further improve their patient care by being supportive or requesting psychological intervention when needed, resulting in better compliance with treatment and an improved social and psychological status.

Treatment of Axillary Bromhidrosis with Topical 2% Glycopyrronium Bromide Cream: A Prospective, Non-randomized, Open-label Study.

BACKGROUND: Topical glycopyrrolate is a well-established therapeutic option for focal hyperhidrosis; however, there are no data on its efficacy in the treatment of bromhidrosis. OBJECTIVES: The objective of this open-label, non-randomized study was to investigate the efficacy and safety of a galenic formulation of 2% glycopyrronium bromide cream, in the treatment of bromhidrosis. METHODS: Nineteen patients with bromhidrosis were prescribed a 2% glycopyrronium bromide cream, to apply in both axillae, every night, for 12 weeks. Malodor was assessed on a four-point scale. Scores for the Dermatology Life Quality Index (DLQI), Hyperhidrosis Disease Severity Scale (HDSS), and the Hospital Anxiety and Depression Scale (HADS) were recorded at baseline and after 12 weeks. RESULTS: Statistically significant improvements in malodor and HDSS, DLQI, and HADS scores, respectively, were observed after treatment. One patient reported irritation at the site of application and another reported mydriasis, which resolved spontaneously. All but one of the patients declared that they were either completely (52/6%) or partially (42.1%) satisfied regarding the treatment. CONCLUSION: Our results indicate that 2% glycopyrronium bromide cream is effective and safe for 12 weeks of application in patients with axillary bromhidrosis.

Comparative Study of Quality of Life and Psychological Aspects in Patients with Psoriasis and Hidradenitis Suppurativa.

Psoriasis and hidradenitis suppurativa are two common dermatological diseases that affect physical, social, and psychological aspects of the patients' lives. The aim of this study was to compare quality of life, depression, anxiety, self-esteem, and loneliness in patients with psoriasis and hidradenitis suppurativa. One hundred and eight patients with psoriasis, 113 patients with hidradenitis suppurativa and 116 healthy controls were included in the study. The quality of life, depression, anxiety, and loneliness of the patients as well as their self-esteem were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), the UCLA loneliness Scale (UCLA-Version 3) and the Rosenberg's Self-esteem Scale (RSES), respectively. Patients with psoriasis (12.77±4.43) reported a higher mean impairment in DLQI than patients with hidradenitis suppurativa (11.10±6.53, P=0.028), in the univariate comparisons. Patients with psoriasis presented statistically significantly higher levels of anxiety and depression than both patients with hidradenitis suppurativa and healthy controls, while patients with hidradenitis suppurativa also had higher anxiety and depression compared with healthy controls. Patients with psoriasis (46.31±6.36) reported statistically significantly higher loneliness than both patients with hidradenitis suppurativa (43.18±7.40) and controls (40.42±4.41), while the patients with hidradenitis suppurativa also presented higher loneliness in comparison with controls. Lower levels of self-esteem were found in patients with psoriasis (15.08±3.11) compared with both patients with hidradenitis suppurativa (18.89±1.69) and controls (20.25±2.60), while patients with hidradenitis suppurativa also had lower self-esteem than controls. Significant levels of depression, anxiety, and impaired quality of life were strongly associated with disease severity. When patients with mild disease were compared, those with psoriasis presented with both higher levers of loneliness and lower scores for quality of life. Although both psoriasis and hidradenitis suppurativa are associated with impaired quality of life and psychological aspects, significantly worse scores were recorded in patients with psoriasis.

Combination of 30% Salicylic Acid Peels and Mechanical Comedo Extraction for the Treatment of Favre-Racouchot Syndrome.

Dear Editor, Favre-Racouchot syndrome is a cutaneous disease characterized by cysts, comedones, and elastotic nodules in actinically damaged skin, typically on the face (1). It has been specifically connected to sun exposure and heavy smoking, which may act synergistically (2). Available medical and surgical therapies are of variable efficacy. We present a combined therapeutic approach: 30% salicylic acid peels followed by manual extraction of cystic and comedonal material in the same visit. Five male patients, aged between 60-75 years with the clinical diagnosis of Favre-Racouchot syndrome, were treated with salicylic acid peel 30% followed by cyst and mechanical comedo extraction. Local anesthesia was considered unnecessary. Patients were subjected to the above therapies every two weeks for a series of four treatments. Photographs were taken before the beginning of treatment, as well as before and after each session (Figures 1a, b and 2a, b). At the end of the study, physician and patient global assessment scale was used to evaluate the efficacy of the treatment (0-25% indicated poor response, 25-50% fair, 50-75% good, and 75-100% excellent response). We have previously used this assessment scale in published research. Safety was assessed by evaluating early and delayed adverse events. Physician assessment found a fair to good improvement in 80% of the patients based on the reduction of comedones and solar elastosis, as well as the improvement in overall skin appearance and texture. The numbers for each specific categories of improvement were as follows: 1 patient poor; 3 patients fair, and 1 patient good improvement. Based on the patients' self-assessment, all patients (100%) acknowledged an improvement. Three patients rated the improvement fair (60%) and two rated it good (40%). The treatment was well-tolerated and no side-effects were noted. No clinical progression was observed on 6-month follow-up visit. Favre-Racouchot syndrome was originally described in 1932 by Favre and later reviewed in detail by Favre and Racouchot in 1951. Lesions are usually distributed on the temporal and periorbital areas. However, there have been reports of similar findings in atypical locations such as the forearms and chest. The underlying skin is sun-damaged, diffusely thickened, and furrowed (1). The eruption is usually bilaterally symmetrical. The precise pathogenesis of Favre-Racouchot syndrome is not known. Nevertheless, it most commonly presents in patients with a history of long-term sun exposure, heavy smoking, and, although rare, a history of radiation exposure. Unilateral manifestation of the disease has been previously described and was attributed to prolonged occupational unilateral sun exposure or observed following radiation therapy (3). It is mostly reported in Caucasian men (with a prevalence of 6% in adults older than 50 years). Its incidence increases with age, although it has been reported in younger patients. Differential diagnosis includes dermatoses that present with lesions of similar morphologies, such as acne vulgaris, epidermoid cysts, sebaceous hyperplasia, and colloid milium (4). Diagnosis is primarily clinical. Although the histologic features of the disease are very characteristic, skin biopsy is rarely required. The comedones found are histologically indistinguishable from the primary comedones of acne vulgaris, with the exceptions of a lack of inflammation and the presence of a marked actinic elastosis in the surrounding dermis (epidermal atrophy and massive basophilic degeneration of the upper dermis). Measures to stop the progression of the disease include smoking cessation and sun protection. Treatment options include topical retinoids, excision, curettage, dermabrasion, comedo extraction, and carbon dioxide laser ablation. Daily oral isotretinoin (0.05-0.10 mg/kg/day) used in conjunction with topical tretinoin has also been found effective. Treatment results are usually unsatisfactory when these techniques are used independently, but when used in conjunction with one another they may provide a very favorable outcome (1). For the best therapeutic outcome, solar elastosis, the nodulocystic lesions, and the comedones that require mechanical removal should be targeted. Salicylic acid is a lipophilic beta-hydroxy acid possessing keratolytic, comedolytic, and anti-inflammatory properties. At concentrations between 20% and 30% it is used in the treatment of acne vulgaris and mild photodamage. It decreases sebum secretion and disrupts intercorneocyte cohesion, leading to desquamation (5). Its lipid solubility permits better penetration into the pilosebaceous unit. Salicylic acid extends up to the mid-portion of the follicular canal (upper dermis) where excessive keratinization, the initial event in comedo formation, takes place. Furthermore, it activates epidermal basal cells and underlying fibroblasts, resulting in reorganization of the epidermis and a rebuilding of the superficial dermal connective tissue. The above actions of salicylic acid may be responsible for the reduction in comedonal lesions and the improvement in solar elastosis and overall skin texture. Additionally, its keratolytic effect facilitates comedo extraction. On the basis of our results, we suggest an alternative therapeutic approach with salicylic acid peels followed by mechanical comedo extraction in patients suffering from Favre-Racouchot syndrome.

The Association of Various Metabolic Parameters with Multiple Skin Tags.

Background: Skin tags (STs) are benign skin lesions. Their definite etiology remains unknown. We aim to examine the association of obesity, diabetes mellitus, hyperlipidemia, thyroid abnormalities, acanthosis nigricans, and multiple STs in a Greek primary population. Methods: Phototype and body weight were recorded. Fasting serum blood samples were analyzed for cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, glucose, and thyroid-stimulating hormone. Univariate ordinal logistic regression multivariate analysis was performed. Results: The univariate analysis showed that patients who were overweight with Fitzpatrick Skin Type III, acanthosis nigricans, and hypothyroidism were more likely to present with multiple skin tags as compared with patients at a normal weight with Skin Type I. Statistically significant associations were also found with the presence of cholesterol and triglycerides. In the multivariate analysis, a significant association between hypercholesterolemia and STs was demonstrated. Those with skin tags were more likely to have hypothyroidism. Conclusion: STs are often associated with obesity. An association between lipid profile and STs has been reported. Multiple STs have been independently associated with acanthosis nigricans. Although a possible relationship between STs and thyroid disease has not yet been proved, our review reveals a possible trend. Future investigations with larger sample sizes might clarify the association between skin tags and hypothyroidism.