Vitiligo: Pathogenesis and New and Emerging Treatments.

Vitiligo is a complex disease with a multifactorial nature and a high impact on the quality of life of patients. Although there are multiple therapeutic alternatives, there is currently no fully effective treatment for this disease. In the current era, multiple drugs are being developed for the treatment of autoimmune diseases. This review assesses the available evidence on the pathogenesis of vitiligo, and a comprehensive review of treatments available for vitiligo now and in the near future is provided. This qualitative analysis spans 116 articles. We reviewed the mechanism of action, efficacy and safety data of phototherapy, afamelanotide, cyclosporine, phosphodiesterase 4 inhibitors, trichloroacetic acid, basic fibroblast growth factor, tumor necrosis factor (TNF) inhibitors, secukinumab, pseudocatalase and janus kinase (JAK) inhibitors. At the moment, there is no clearly outstanding option or fully satisfactory treatment for vitiligo, so it is necessary to keep up the development of new drugs as well as the publication of long-term effectiveness and safety data for existing treatments.

An Autologous Topical Serum Derived from Platelet-Rich Plasma Therapy for the Management of Sensitive Skin Alterations: A Case Series Report.

Background: Although the underlying pathophysiology of sensitive skin remains unknown, it presents clinical symptoms like erythema, burning and dryness associated with other inflammatory dermatoses such as dermatitis or rosacea. Objective: The aim of the present report was to provide preliminary data about the efficacy of Endoret-Serum (ES) as an autologous therapy for the topical management of sensitive skin alterations. Materials and Methods: Five patients underwent a daily topical ES treatment that was maintained for three months. Clinical assessment was carried out using validated dermatological surveys (DLQI, IGA, Likert, PGI-I). Additionally, skin hydration measurement and high-resolution topographic and reflectance confocal imaging analysis were carried out. Results: No adverse events were observed during the treatment. At the end of the follow-up period, surveys highlighted a significant therapeutic effect compared to baseline. Skin hydration was also improved, and topographic images showed a decrease in patient's underlying inflammatory and vascular condition. Conclusion: This preliminary report suggests that Endoret-Serum may be useful in the management of clinical symptoms derived from sensitive skin alterations.

Use of Cytology in the Diagnosis of Basal Cell Carcinoma Subtypes.

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer in the white population. Nonsurgical treatments are first-line alternatives in superficial BCC (sBCC); therefore, differentiating between sBCC and non-sBCC is of major relevance for the clinician. Scraping cytology possesses several advantages, such as an earlier diagnosis and scarring absence, in comparison to a biopsy. Nevertheless, previous studies reported difficulties in differentiating the different BCC subtypes. The objective of this study was to determine the capability and accuracy of scraping cytology to differentiate between sBCC and non-sBCC. METHODS: In this retrospective study, cytological samples of histologically confirmed BCC were examined. Select cytological features were correlated to BCC subtypes (sBCC or non-sBCC). RESULTS: A total of 84 BCC samples were included (29 sBCC; 55 non-sBCC). An inverse correlation between the diagnosis of sBCC and the presence of mucin, dehiscence, and grade of atypia in the basal cells was observed. The presence of medium and large basal cell clusters correlated directly to a sBCC diagnosis. The presence of clear cells is strongly associated with sBCC. Therefore, Conclusion: Scraping cytology is reliable in differentiating sBCC from other BCC subtypes.

Autologous platelet-rich gel for facial rejuvenation and wrinkle amelioration: A pilot study.

BACKGROUND: The demand for safe and minimally invasive soft tissue augmentation procedures has increased. Recently, a novel injectable gel based on the autologous platelet rich in growth factor (PRGF) technology has been developed to provide long-term shape and volume stability. It can be customized into low (LVG) or high viscosity (HVG) gel forms to meet different dermatological requirements. OBJECTIVES: The mechanical and biological properties of both gel forms have been evaluated. The clinical efficacy and safety of this autologous procedure were also evaluated. METHODS: Growth factor content and biomechanical properties of both gel forms were determined. The in vitro biological capacity on human dermal fibroblasts proliferation was assessed. Clinical performance analysis over ten patients was evaluated by standardized macrophotographs, 3D topographic images, and ultrasound analysis over periocular and nasolabial areas. RESULTS: Both gel types showed similar growth factor concentration. HVG showed a higher stiffness profile indicating its suitability for deeper tissue defect viscosupplementation while LVG showed optimal rheologic characteristics for superficial volumization. Both gels showed a noticeable biostability after catalytic enzyme degradation. Both forms significantly increased the mitogenic activity of dermal fibroblasts. All patients referred to be highly satisfied and presented optimal clinical results after one month. Overall clinical improvement was maintained for 16 weeks. At the end of the study, the ultrasound examination revealed a cutaneous regenerative effect. No adverse events occurred. CONCLUSIONS: This preliminary study suggests that autologous platelet gels have desirable mechanical and bioactive properties and allows moderate wrinkle reduction and efficient facial volume reposition with natural results.

Sequential treatment of actinic keratosis with cryotherapy and ingenol mebutate: reflectance confocal microscopy monitoring of efficacy and local skin reaction.

BACKGROUND: Sequential treatment of actinic keratosis (AK) and cancerization field with cryotherapy and ingenol mebutate (IM) is widely used in clinical practice, however, the order of application of sequential treatment has not been examined yet. OBJECTIVE: To compare different sequential treatments of IM and cryotherapy in AK and to monitor cure rates and local skin reactions (LSR) through reflectance confocal microscopy (RCM). METHODS: Patients with AK were treated with IM and cryotherapy. Group A received treatment with IM before cryotherapy, and group B patients were firstly treated with cryotherapy and secondly IM. RCM evaluation of epidermal dysplasia and LSR was performed prior to the first treatment (Week 0), before the second treatment (Week 2), and one month and two months after initial assessment. RESULTS: The study included 26 patients - 14 patients in group A and 12 patients in group B. In both groups, significant improvement in epidermal dysplasia RCM parameters between the first and last visit was observed. Regarding LSR parameters, group A presented fewer LSR parameters than group B on the second visit. This difference was present even if comparison was made between the third visit of group A and the second visit of group B. CONCLUSIONS: Both sequences of treatment are effective, but IM treatment before cryotherapy is recommended because of the lower LSR. This probably decreases patient discomfort and improves compliance.

Assessment of the Effect of 3% Diclofenac Sodium on Photodamaged Skin by Means of Reflectance Confocal Microscopy.

Treatment of actinic keratosis with 3% diclofenac sodium w/w in hyaluronic acid is associated with a concomitant improvement in signs of photodamaged skin. However this effect has not yet been examined in depth. Twenty patients with actinic keratosis and signs of photodamaged skin were studied. They received treatment with diclofenac sodium w/w in hyaluronic acid for 2 months. Clinical and reflectance confocal microscopy assessment on signs of photodamaged skin were performed. Regarding reflectance confocal microscopy, the most common descriptors were: irregular honeycomb pattern in 18/20 patients (90%), mottled pigmentation in 17/20 (85%), coarse collagen structures in all patients, and huddled collagen and curled bright structures in 16/20 (77.8%). After treatment, significant improvement in clinical parameters: irregular pigmentation and coarseness, and confocal parameters: irregular honeycomb pattern and mottled pigmentation, were noted. Reflectance confocal microscopy is a useful tool in monitoring changes in photodamaged skin after treatment. The use of diclofenac sodium w/w in hyaluronic acid is associated with an improvement in some clinical and reflectance confocal microscopy parameters of photodamaged skin.

Development and validation of the Frontal Fibrosing Alopecia Severity Score.

BACKGROUND: Frontal fibrosing alopecia (FFA) is a scarring alopecia characterized by recession of the frontotemporal hairline and loss of the eyebrows. OBJECTIVE: To design and validate a scoring system to assess the severity of FFA. METHODS: The Frontal Fibrosing Alopecia Severity Score (FFASS) was developed; criterion validity was assessed by the Investigator's Global Assessment, and construct validity was evaluated by the convergence of other measures of severity (the Patient's Global Assessment], the rest of the clinical features, the Lichen Planopilaris Activity Index, and quality of life measures (Dermatology Life Quality Index and Hospital Anxiety Depression Scale). Intraobserver and interobserver reliability were determined. RESULTS: In total, 103 female patients were included. The FFASS showed significant correlation to the Patient's Global Assessment, occipital involvement, and the Lichen Planopilaris Activity Index. Intraobserver reliability was completed for 31 subjects and showed good correlation (intraclass correlation coefficient, 0.86; 95% confidence interval, 0.7-0.95; P < .001). Interobserver reliability showed excellent correlation (intraclass correlation coefficient, 0.97; 95% confidence interval, 0.95-0.99; P < .001). LIMITATIONS: The study was performed at a single institution, and only female patients were assessed. CONCLUSIONS: The FFASS is a statistically validated scale and a reliable measure of FFA severity, and it can be used in clinical practice and future research studies as an assessment tool.