Subject(s)
Melanosis , Skin Pigmentation , Alitretinoin/adverse effects , Humans , Melanosis/chemically induced , SkinABSTRACT
OBJETIVE: To review and discuss the current evidence of the use of metformin as a therapeutic tool in frequent skin diseases. DESIGN: Original article. Qualitative research. Narrative review. LOCATION: Aragon and Murcia, Spain. PARTICIPANTS: Resident Physicians. Dermatology and Primary Health Care. METHOD: A narrative review has been carried out using the PubMed bibliographic database, being the search date the 27th of January of 2022. RESULTS: Metformin has proven to be effective in the treatment of inflammatory skin diseases such as acne, hidradenitis suppurativa, psoriasis and allergic contact dermatitis. It has also shown antitumor properties regarding basal cell carcinoma, squamous cell carcinoma and melanoma. Additionally, beneficial effects of adjuvant treatment with metformin have been described in patients with basal cell carcinoma receiving photodynamic therapy. In patients with endocrinology-related dermatosis such as hirsutism, acanthosis nigricans and eruptive xanthomas, treatment with metformin has demonstrated therapeutic effectiveness. Topical treatment with metformin has also been useful in the treatment of melasma. Finally, it has been proposed as a drug with anti-aging and wound-healing promoting properties. Severe adverse effects have not been observed for any of the previously described indications, being this a well-tolerated treatment. CONCLUSIONS: Metformin is an effective and safe adjuvant in the therapeutic scheme of various inflammatory dermatoses, skin neoplasms, endocrinology-related dermatosis, melasma, skin aging and wound healing processes.
Subject(s)
Dermatitis , Melanosis , Metformin , Skin Diseases , Humans , Melanosis/chemically induced , Melanosis/drug therapy , Metformin/therapeutic use , Skin Diseases/drug therapy , SpainSubject(s)
Hair Dyes , Melanosis , Humans , Hair Dyes/adverse effects , Melanosis/chemically induced , Melanosis/diagnosis , Melanosis/genetics , DNA DamageABSTRACT
The effect of intradermal TA on melasma was evaluated as a possible treatment modality on all of the 11 patients (fitting the inclusion criteria) presenting in the out-patient department of the Benazir Bhutto Hospital, Rawalpindi during Sep 2019 to Mar 2020. Their pre- and post-interventional results were evaluated after being injected with 4 mg/ml of TA on the lesions once weekly for 6 weeks, using Wilcoxon signed rank test in SPSS v 24. The average duration of melasma in our patients was 25.3±7.6 in months. The mean modified MASI score rating was 12.2 (2.3) and 5.1 (1.4) before and after intervention with intradermal TA respectively. The largest difference obtained in the mMASI scores of the patients was 10.8. TA has a distinctive effect as a treatment modality for melasma, as it is easily employable with very few side effects.
Subject(s)
Melanosis , Tranexamic Acid , Humans , Tranexamic Acid/therapeutic use , Pilot Projects , Outpatients , Public Sector , Hospitals, Public , Melanosis/drug therapy , Melanosis/chemically induced , Treatment OutcomeSubject(s)
Colon/drug effects , Crohn Disease/drug therapy , Drugs, Chinese Herbal/adverse effects , Intestinal Mucosa/drug effects , Melanosis/chemically induced , Pigmentation/drug effects , Biopsy , Colon/metabolism , Colon/pathology , Colonoscopy , Crohn Disease/pathology , Drugs, Chinese Herbal/metabolism , Female , Humans , Intestinal Absorption , Intestinal Mucosa/metabolism , Intestinal Mucosa/pathology , Melanosis/metabolism , Melanosis/pathology , Middle Aged , Treatment OutcomeABSTRACT
Peritoneal melanosis is an uncommon benign condition, the pathophysiology of which is unclear. Macroscopically, it appears as diffuse dark brown or black pigmentation within the peritoneum, mimicking more sinister conditions such as metastatic melanoma. It has been described in a variety of contexts, but only exceedingly rarely in association with metastatic melanoma, with only two previous published case reports. We present a case of peritoneal melanosis associated with metastatic melanoma involving the spleen, previously treated with targeted and immune checkpoint inhibitor therapy. With increasing reports of melanoma regression manifesting as cutaneous tumorous melanosis in patients treated with immune checkpoint inhibitors, we postulate that, similarly, immunotherapy and tumour regression might have a role to play in the pathogenesis of the peritoneal pigmentation in this case.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/adverse effects , Melanoma/therapy , Melanosis/diagnosis , Peritoneal Diseases/diagnosis , Skin Neoplasms/therapy , Splenic Neoplasms/surgery , Biopsy , Chemotherapy, Adjuvant , Humans , Immune Checkpoint Inhibitors/adverse effects , Male , Melanoma/complications , Melanoma/immunology , Melanoma/secondary , Melanosis/chemically induced , Melanosis/immunology , Melanosis/pathology , Middle Aged , Peritoneal Diseases/chemically induced , Peritoneal Diseases/immunology , Peritoneal Diseases/pathology , Peritoneum/drug effects , Peritoneum/immunology , Peritoneum/pathology , Positron-Emission Tomography , Protein Kinase Inhibitors/adverse effects , Skin Neoplasms/complications , Skin Neoplasms/immunology , Skin Neoplasms/pathology , Spleen/diagnostic imaging , Spleen/pathology , Spleen/surgery , Splenectomy , Splenic Neoplasms/diagnosis , Splenic Neoplasms/secondaryABSTRACT
BACKGROUND: Tumoral melanosis clinically resembles metastatic melanoma, occurs in the context of regressed disease, and requires evaluation to rule out underlying melanoma and metastatic disease. Histopathology demonstrates a nodular infiltrate of melanophages in the dermis, subcutaneous tissue, deep soft tissue, or lymph nodes in the absence of viable melanocytes. Recent limited reports of tumoral melanosis in the context of immunotherapy with ipilimumab (monoclonal antibody targeting CTLA-4) as well as nivolumab and pembrolizumab (humanized monoclonal antibodies against programmed death 1 receptor) highlight a unique presentation representative of treatment-related tumor regression and an association with a favorable clinical response. OBJECTIVE: To describe our experience with tumoral melanosis in the setting of immunotherapy for metastatic melanoma and elucidate the clinical and histopathological features. METHODS: Retrospective case series from a single tertiary care institution. RESULTS: We describe 10 cases of patients with metastatic melanoma who received treatment with immunotherapy before the development of tumoral melanosis. Length of time between the initiation of therapy and the onset of tumoral melanosis ranged from 2 to 20 months with a mean time of 10 months. At the end of the follow-up period, 8 patients were classified as having a complete or partial response to treatment with immunotherapy. One patient had progression of visceral and cutaneous disease on ipilimumab despite developing tumoral melanosis, and 1 patient had yet to undergo repeat imaging. Furthermore, at the end of follow-up, 3 patients were alive with no evidence of active disease, 5 patients were alive with disease, and 1 patient was deceased, although this patient died of a cardiovascular event unrelated to his underlying melanoma. Of the patients who were classified as alive with disease, 2 patients had minimal remaining disease, and 2 patients had an almost complete response on immunotherapy with recurrence of visceral metastases after immunotherapy was discontinued. One patient developed new peritoneal and cutaneous metastases on pembrolizumab despite development of tumoral melanosis. CONCLUSIONS: The underlying biologic mechanisms and prognostic implications of tumoral melanosis in the setting of immunotherapy remain to be elucidated. Further prospective studies with a larger cohort and prolonged follow-up are necessary to better understand the incidence, prevalence, and oncologic outcomes in patients with tumoral melanosis who receive immunotherapy.
Subject(s)
Immune Checkpoint Inhibitors/adverse effects , Melanins/metabolism , Melanoma/drug therapy , Melanosis/chemically induced , Skin Neoplasms/drug therapy , Adult , Aged , Aged, 80 and over , Databases, Factual , Diagnosis, Differential , Female , Humans , Male , Melanoma/immunology , Melanoma/metabolism , Melanoma/secondary , Melanosis/metabolism , Melanosis/pathology , Middle Aged , Retrospective Studies , Risk Factors , Skin Neoplasms/immunology , Skin Neoplasms/metabolism , Skin Neoplasms/pathology , Time Factors , Treatment OutcomeABSTRACT
In order to rapidly develop C6 and C8 SAR of our reported tricyclic sulfone series of RORγt inverse agonists, a late-stage bromination was employed. Although not regioselective, the bromination protocol allowed us to explore new substitution patterns/vectors that otherwise would have to be incorporated at the very beginning of the synthesis. Based on the SAR obtained from this exercise, compound 15 bearing a C8 fluorine was developed as a very potent and selective RORγt inverse agonist. This analog's in vitro profile, pharmacokinetic (PK) data and efficacy in an IL-23 induced mouse acanthosis model will be discussed.
Subject(s)
Heterocyclic Compounds, 3-Ring/therapeutic use , Melanosis/drug therapy , Nuclear Receptor Subfamily 1, Group F, Member 3/antagonists & inhibitors , Sulfones/therapeutic use , Animals , Crystallography, X-Ray , Drug Inverse Agonism , Female , Heterocyclic Compounds, 3-Ring/chemical synthesis , Heterocyclic Compounds, 3-Ring/pharmacokinetics , Interleukin-18 , Male , Melanosis/chemically induced , Mice, Inbred BALB C , Mice, Inbred C57BL , Molecular Structure , Nuclear Receptor Subfamily 1, Group F, Member 3/metabolism , Protein Binding , Structure-Activity Relationship , Sulfones/chemical synthesis , Sulfones/pharmacokineticsSubject(s)
Antifibrinolytic Agents , Hypopigmentation , Melanosis , Tranexamic Acid , Antifibrinolytic Agents/therapeutic use , Humans , Hypopigmentation/chemically induced , Hypopigmentation/diagnosis , Hypopigmentation/drug therapy , Melanosis/chemically induced , Melanosis/diagnosis , Melanosis/drug therapy , Microinjections , Tranexamic Acid/adverse effectsABSTRACT
The lesbian, gay, bisexual, transgender, and queer or questioning/sexual and gender minority (LGBTQ/SGM) community is a growing population with unique lifestyles, sexual practices, beliefs, health issues, and concerns. Although significant advances have been achieved in recent years to establish better care for LGBTQ/SGM patients, they still face insurmountable stigmatization and health care inequality. Dermatologists play an important role in LGBTQ/SGM patients' well-being because they not only treat their skin conditions, but also help them achieve desirable physical characteristics. This article discusses historical perspectives and current state of LGBTQ/SGM dermatology and attempts to define directions for future research and improvement.
Subject(s)
Cosmetic Techniques , Dermatology/methods , Postoperative Complications/therapy , Sex Reassignment Procedures/methods , Sexual and Gender Minorities , Skin Diseases/therapy , Societies, Medical/history , Acne Vulgaris/chemically induced , Alopecia/chemically induced , Dermatology/history , Gender Dysphoria/history , Gender Dysphoria/therapy , HIV Infections/complications , HIV Infections/diagnosis , HIV Infections/therapy , Health Services for Transgender Persons , Healthcare Disparities , History, 20th Century , History, 21st Century , Homosexuality/history , Hormone Replacement Therapy/adverse effects , Humans , Melanosis/chemically induced , Sex Reassignment Surgery , Sexually Transmitted Diseases/complications , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/therapy , Skin Diseases/etiologyABSTRACT
Despite an increase in the visibility of the transgender population, those who transition continue to face barriers to receiving care through traditional medical providers. Dermatologists can play an important role in the care of transgender patients, through increased understanding and awareness, better outreach, modified medical forms, improved office procedures, and safer and immediately available minimally invasive aesthetic treatments. Minimally invasive aesthetic enhancements that help align appearance with aesthetic goals and gender identity can enhance confidence and improve quality of life. This article discusses gender transition, applicable minimally invasive procedures for the face and body, and illustrative case examples.
Subject(s)
Cosmetic Techniques , Dermatology , Sex Reassignment Procedures , Transgender Persons , Acne Vulgaris/chemically induced , Acne Vulgaris/therapy , Androgens/therapeutic use , Botulinum Toxins, Type A/therapeutic use , Dermal Fillers/therapeutic use , Estrogens/therapeutic use , Face , Female , Hair Removal , Humans , Laser Therapy , Male , Melanosis/chemically induced , Melanosis/therapy , Neuromuscular Agents/therapeutic useSubject(s)
Benzoates/adverse effects , Hydrazines/adverse effects , Melanosis/chemically induced , Pyrazoles/adverse effects , Aged , Anemia, Aplastic/drug therapy , Benzoates/therapeutic use , Cyclosporine/therapeutic use , Drug Therapy, Combination , Female , Humans , Hydrazines/therapeutic use , Pyrazoles/therapeutic useSubject(s)
Anti-Bacterial Agents/adverse effects , Hemangiosarcoma/diagnosis , Melanosis/diagnosis , Minocycline/adverse effects , Skin Neoplasms/diagnosis , Administration, Oral , Angina Pectoris/surgery , Anti-Bacterial Agents/administration & dosage , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/instrumentation , Diagnosis, Differential , Face , Hemangiosarcoma/pathology , Humans , Male , Melanosis/chemically induced , Melanosis/pathology , Middle Aged , Minocycline/administration & dosage , Prosthesis-Related Infections/drug therapy , Prosthesis-Related Infections/etiology , Skin/pathology , Skin Neoplasms/pathologySubject(s)
Arsenic Poisoning/etiology , Keratoderma, Palmoplantar/chemically induced , Medicine, Mongolian Traditional/adverse effects , Melanosis/chemically induced , Sulfides/poisoning , Arsenic Poisoning/diagnosis , Arsenic Poisoning/drug therapy , Arsenicals/administration & dosage , Chelating Agents/administration & dosage , Child , Dimercaprol/administration & dosage , Epilepsy/drug therapy , Humans , Keratoderma, Palmoplantar/diagnosis , Keratoderma, Palmoplantar/drug therapy , Male , Medicine, Mongolian Traditional/methods , Melanosis/diagnosis , Melanosis/drug therapy , Sulfides/administration & dosageABSTRACT
Immune checkpoint inhibitor therapy has revolutionized the treatment of advanced melanoma, with these agents significantly improving survival for patients with metastatic disease. With the increasing use of these agents, the number of adverse reactions secondary to their use has also increased. Sarcoidosis and sarcoid-like reactions are one such immune checkpoint inhibitor-related adverse event. We report a case of sarcoid-like granulomatous tumoral melanosis in a patient on the programmed cell death-1 (PD-1) receptor inhibitor pembrolizumab for metastatic melanoma. This is, to our knowledge, the first reported case of a sarcoidal form of tumoral melanosis in a patient on anti-PD-1 therapy. We postulate that this reflects tumor regression in response to pembrolizumab-induced immune activation, with concomitant therapy-triggered induction of a sarcoid-like reaction. These findings and the literature review presented herein should alert clinicians and pathologists to the possibility of regressed lesions with sarcoid-like features presenting as mimickers of disease progression in patients undergoing immunotherapy for advanced melanoma.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antineoplastic Agents, Immunological/adverse effects , Melanoma/drug therapy , Melanosis/chemically induced , Skin Neoplasms/drug therapy , Diagnosis, Differential , Disease Progression , Granuloma/chemically induced , Humans , Male , Melanoma/pathology , Middle Aged , Skin Neoplasms/pathology , Melanoma, Cutaneous MalignantABSTRACT
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