Development and Implementation of a Web-Based International Registry Dedicated to Atypical Pigmented Skin Lesions of the Face: Teledermatologic Investigation on Epidemiology and Risk Factors.

Background: Atypical pigmented facial lesions (aPFLs) often display clinical and dermoscopic equivocal and/or overlapping features, thus causing a challenging and delayed diagnosis and/or inappropriate excisions. No specific registry dedicated to aPFL paired with clinical data is available to date. Methods: The dataset is hosted on a specifically designed web platform. Each complete case was composed of the following data: (1) one dermoscopic picture; (2) one clinical picture; (3) two lesion data, that is, maximum diameter and facial location (e.g., orbital area/forehead/nose/cheek/chin/mouth); (4) patient's demographics: family history of melanoma, history of sunburns in childhood, phototype, pheomelanine, eyes/hair color, multiple nevi/dysplastic nevi on the body; and (5) acquisition device (videodermatoscope/camera-based/smartphone-based system). Results: A total of 11 dermatologic centers contributed to a final teledermoscopy database of 1,197 aPFL with a distribution of 353 lentigo maligna (LM), 146 lentigo maligna melanoma (LMM), 231 pigmented actinic keratoses, 266 solar lentigo, 125 atypical nevi, 48 seborrheic keratosis, and 28 seborrheic-lichenoid keratoses. The cheek site was involved in half of aPFL cases (50%). Compared with those with the other aPFL cases, patients with LM/LMM were predominantly men, older (69.32 ± 12.9 years on average vs. 62.69 ± 14.51), exhibited larger lesions (11.88 ± 7.74 mm average maximum diameter vs. 9.33 ± 6.46 mm), and reported a positive history of sunburn in childhood. Conclusions: The iDScore facial dataset currently represents a precious source of data suitable for the design of diagnostic support tools based on risk scoring classifiers to help dermatologists in recognizing LM/LMM among challenging aPFL in clinical practice.

Low rates of neurological abnormalities in patients with pigmentary mosaicism: A retrospective cohort study from a tertiary dermatology center.

BACKGROUND: Pigmentary mosaicism (PM) is a descriptive term encompassing a range of hyper- and hypo-pigmented phenotypes in various patterns. Information from the neurology literature initially noted neurological abnormalities (NA) in up to 90% of children with PM. The dermatology literature suggests lower associated rates (15%-30%) of NA. Variations in terminology, inclusion criteria, and small population sizes makes interpreting existing PM literature complicated. We aimed to assess rates of NA in children presenting to dermatology with PM. METHODS: We included patients <19 years, diagnosed with PM, nevus depigmentosus and/or segmental café au lait macules (CALM) seen in our dermatology department between 1 January 2006 and 31 December 2020. Patients with neurofibromatosis, McCune-Albright syndrome, and non-segmental CALM were excluded. Data collected included pigmentation, pattern, site(s) affected, presence of seizures, developmental delay, and microcephaly. RESULTS: One hundred fifty patients were included (49.3% female), with a mean age at diagnosis of 4.27 years. Patterns of mosaicism were ascertained for 149 patients and included blaschkolinear (60/149, 40.3%), blocklike (79/149, 53.0%), or a combination of both patterns (10/149, 6.7%). Patients with a combination of patterns were more likely to have NA (p < .01). Overall, 22/149 (14.8%) had NA. Nine out of twenty-two patients with NA had hypopigmented blaschkolinear lesions (40.9%). Patients with ≥4 body sites affected were more likely to have NA (p < .01). DISCUSSION: Overall, our population had low rates of NA in PM patients. A combination of blaschkolinear and blocklike patterns, or ≥4 body sites involved were associated with higher rates of NA.

Epidemiological survey of the quantity and anatomical position of facial pigmented spots in relation to age in 454 Japanese women.

Facial pigmented spots are one of the phenotypes of skin aging, but no quantitative analysis of spot features such as color intensity, size, anatomical position, and number on the cheek has yet been performed. In the current study, we conducted an epidemiological survey of 454 Japanese women in their 20s to 70s and analyzed age-related changes and site differences of facial pigmented spots. Using image analysis of high-resolution digital facial photographs, 4912 individual pigmented spots were quantified according to color, size, anatomical position, and total number on the cheek. As a result of color analysis, the color intensity of individual pigmented spots increased with aging, significantly so between ages 30s and 50s. The age-related increase in melanin index of facial spots was confirmed in all sites but did not significantly differ between facial subregions. Regarding the size of pigmented spots, the frequency of large spots increased with age, and large spots were detected in all facial sites. The total number of pigmented spots on the entire cheek increased with aging, significantly so between the 20s and 40s. The number of pigmented spots tended to increase from the region near the canthi to the lower cheeks. The number of spots was markedly increased in the buccal regions compared with the infraorbital and zygomatic regions. The data and methodology presented in the current study can link the state of facial pigmentation with the various factors involved in the histological development of pigmented spots, opening new possibilities in the fields of skin pharmacology and dermatology.

Segmental Pigmentation Disorder: Clinical Manifestations and Epidemiological Features in 144 patients, a Retrospective Case-control Study.

Segmental pigmentation disorder (SPD) is characterized by hypo- or hyper-pigmented patches segmentally distributed, present in infancy, more prominently in darker-skinned children. The aim of this study was to define the demographic and clinical characteristics of SPD in a large series of patients. This was a retrospective case-control study at 2 paediatric dermatology centres in Israel. Data were collected through a telephone questionnaire and medical records. The study group consisted of 144 individuals with SPD and 144 individuals visiting the same institutions matched for age and sex. Median age of onset of SPD was near birth; 51% of patients were Sephardic Jews, and patients were followed up for a median period of 27 years. The patches were located on the torso (43%), mostly hypopigmented (52%), and remained of the same intensity and size in 55% and 41% of cases, accordingly. No differences in extracutaneous morbidities were found between SPD and control patients. This study delineates the demographic and clinical characteristics of SPD, confirms that cutaneous findings in SPD are more prominent in darker skin, tends not to expand in size or accentuate throughout the years, nor to be associated with extracutaneous morbidities.

Evident hypopigmentation without other ocular deficits in Dutch patients with oculocutaneous albinism type 4.

To describe the phenotype of Dutch patients with oculocutaneous albinism type 4 (OCA4), we collected data on pigmentation (skin, hair, and eyes), visual acuity (VA), nystagmus, foveal hypoplasia, chiasmal misrouting, and molecular analyses of nine Dutch OCA4 patients from the Bartiméus Diagnostic Center for complex visual disorders. All patients had severely reduced pigmentation of skin, hair, and eyes with iris transillumination over 360 degrees. Three unrelated OCA4 patients had normal VA, no nystagmus, no foveal hypoplasia, and no misrouting of the visual pathways. Six patients had poor visual acuity (0.6 to 1.0 logMAR), nystagmus, severe foveal hypoplasia and misrouting. We found two novel variants in the SLC45A2 gene, c.310C > T; (p.Pro104Ser), and c.1368 + 3_1368 + 9del; (p.?). OCA4 patients of this Dutch cohort all had hypopigmentation of skin, hair, and iris translucency. However, patients were either severely affected with regard to visual acuity, foveal hypoplasia, and misrouting, or visually not affected at all. We describe for the first time OCA4 patients with an evident lack of pigmentation, but normal visual acuity, normal foveal development and absence of misrouting. This implies that absence of melanin does not invariably lead to foveal hypoplasia and abnormal routing of the visual pathways.

Pigmented purpuric dermatoses: analysis of epidemiological, clinical and histopathological aspects in relation to the prognosis of 70 patients, including infants and adults.

BACKGROUND: Pigmented purpuric dermatoses (PPDs) are a group of chronic-relapsing, inflammatory purpuras without vasculitis that typically involve the lower limbs. Five major types could be distinguished, according to the clinical and histopathologic analysis. The etiopathogenesis is still unknown and multiple factors have been considered. Prognosis seems not to be influenced by the different clinical forms of PPDs; nevertheless, no previous studies have investigated whether it could be influenced by the anatomical distribution of the disease. METHODS: We enrolled 70 consecutive patients, including both adults and children with a clinical and histopathological diagnosis of PPD, to investigate possible correlations between the different types of PPDs, their anatomical distribution and prognosis. RESULTS: We observed that patients, both adults and children, with an uncommon localization of the dermatoses, in particular with a diffuse localization (more than one body area affected), presented more frequently a persistent form of PPDs. CONCLUSIONS: This is the first study that attempts to relate the anatomical extension of PPDs and their evolution over time. According to our analysis, it seems to be a statistical significance for the prognosis only for patients with Schamberg disease and involvement of lower limbs. However, studies on a larger population are needed.

Clinicopathological evaluation of patients with rippled pattern pigmentation of the skin: A single-center study.

The aim of the present study was to investigate the clinical association between rippled pattern pigmentation and the positivity of histopathological analysis for amyloid. A total of 50 patients (90% women) with rippled pattern pigmentation referring to Dermatology Clinic of Shahid Faghihi Hospital, Shiraz, Iran, in 2015 participated in this study. Two biopsies were performed for all the cases from the most frequently affected sites. The specimens were evaluated for amyloid deposits with hematoxylin-eosin (H&E), Congo red (CR), and crystal violet (CV) stains. The upper back was the most frequently affected area in the patients. Family history (28%), atopy (14%), pruritus as a common finding (86%), and history of friction (54%) were positive. The prevalence of disease was higher in patients with skin photo Type 3. Amyloid deposit was not detected in most patients by these stains. No statistically significant difference was found between the amyloid positive cases stained with H&E, CR, and CV (p-value > 0.05). Only the difference in positive results between biopsy number 2 and the total biopsy (1 and 2) was significant (p-value < .05). In conclusion, it seems that it is useful to increase the number of biopsies and other more sensitive staining methods to detect small focal amyloid deposits.

Serum levels of lead and selenium in patients with premature graying of the hair.

BACKGROUND: The exact etiology of premature hair graying (PHG) remains unknown; however, oxidative stress is shown to be involved. Selenium, as an antioxidant, is widely known for its antiaging potentials. Moreover, PGH is more prevalent among addicts and because Lead is a common impurity found in illegal drug. AIMS: We evaluated the serum levels of lead and selenium in patients with PHG and compared it with a control group. PATIENTS/METHODS: In this cross-sectional study, 60 patients referred to Dermatology Clinic of Imam-Reza Hospital of Mashhad, Iran in 2015 were evaluated in two groups with and without PHG. Demographic information and disease characteristics, skin phenotype, and family history of PHG were recorded. Furthermore, 5 mL of brachial blood was drawn for measuring selenium and lead levels. RESULTS: The mean patients' age was 28.1 ± 4.8 years. Age, sex, occupation, and skin phenotype in individuals with and without PHG were not significantly different (P > .05) but family history of PHG was significantly higher in the patients with PHG (P = .001). Similarly, the number of white hairs was significantly higher (P < .001), and the age of onset of hair graying was significantly lower in patients with PHG (P < .001). Serum levels of selenium and lead were not significantly different between two groups (P < .05). However, the serum levels of lead in the patients with PHG were slightly higher. CONCLUSIONS: The results of this study showed that there was no significant difference in lead and selenium serum levels in patients with and without PHG.

Microneedling Treatment of Striae Distensae in Light and Dark Skin With Long-Term Follow-Up.

BACKGROUND: Striae distensae have notoriously been difficult to treat due to their extensive involvement of nonfacial skin. Microneedling with its lack of thermal injury during microneedling treatment renders it a viable treatment option in darker skin tones and nonfacial regions due to the reduced risk of postinflammatory hyperpigmentation. OBJECTIVE: To describe the clinical results and side effects of microneedling in a series of 25 individuals with striae distensae. MATERIALS AND METHODS: Twenty-five consecutive adults (SPT I-V) with striae distensae involving the trunk and extremities were treated using a microneedling device. No additional treatments (topical or intralesional) were applied. Two assessors blinded to treatment protocol rated clinical improvement of striae on a 5-point scale. Side effects were monitored and tabulated. RESULTS: Patients received 1 to 3 consecutive monthly treatments. All striae improved at least 50% after an average of 1.8 treatments, and 28% of patients demonstrated more than 75% clinical improvement. Striae in thicker skin regions (e.g., buttocks/thighs) showed comparable clinical improvement than those in thinner skin areas (e.g., breasts) and did not require additional treatment sessions. Side effects were limited to transient erythema in all skin phototypes. No infections or dyspigmentation were observed. CONCLUSION: The clinical results obtained in this study support the safe and effective treatment of striae distensae with microneedling in light and dark skin tones in various body locations. Standardization of treatment protocols are anticipated with further (ongoing) studies.

Cutaneous sequelae in neonatal lupus: A retrospective cohort study.

BACKGROUND: Cutaneous eruptions in neonatal lupus erythematosus (NLE) are thought to be self-resolving. Limited literature suggests cutaneous changes may persist. OBJECTIVE: To characterize cutaneous residua in NLE and identify predictors for their development. METHODS: A retrospective cohort study of patients with cutaneous NLE born between January 1980 and May 2017 was performed. Primary outcome was the proportion of patients with cutaneous residua. Secondary outcomes included associations/predictors of sequelae. RESULTS: At the last follow-up, at a mean age of 4 years (range, 0.5-18.7 years), 34% of 106 patients had cutaneous sequelae, 13% had telangiectasia, 17% had dyspigmentation, and 9% had atrophic scarring. Scarring at the last follow-up was significantly associated with the presence of skin lesions at birth (P < .001). LIMITATIONS: This study was limited by the retrospective design, short follow-up duration in a subset of patients, and small sample size. CONCLUSION: Cutaneous NLE can exhibit long-term cutaneous residua. These findings underlie the importance of accurate diagnosis, long-term monitoring, and appropriate counseling.

Comparison between distally based peroneal and posterior tibial artery perforator-plus fasciocutaneous flap for reconstruction of the lower extremity.

BACKGROUND: Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps and distally based posterior tibial artery perforator-plus fasciocutaneous (DPTAPF) flaps are widely used to reconstruct soft-tissue defects of the distal lower leg, ankle, and foot. However, a comparative study of both flaps in a considerable sample size is lacking. This retrospective study aimed to compare the efficacy of the flaps and provide referential evidence for selection of flaps. METHODS: Between April 2001 and October 2016, 227 patients underwent reconstruction with DPAPF flaps (peroneal group; n = 150) or DPTAPF flaps (posterior tibial group; n = 82). The distal lower leg, ankle, and foot were divided into Zones I and II. Flap viability-related complications and their risk factors, reconstruction outcomes, and donor-site morbidities were compared. RESULTS: In Zone I, the partial necrosis rate was lower in the peroneal group than in the posterior tibial group (p > 0.05). In Zone II, the partial necrosis rate was significantly lower in the peroneal group (p < 0.05). Significantly lower incidences of donor-site morbidities in terms of hypertrophic scarring, itching, and pigmentation were observed in the peroneal group (p < 0.05). CONCLUSIONS: The DPAPF flap was superior to the DPTAPF flap with respect to reliability and decreased donor-site morbidities. The former is the recommended preferential choice between the two.

Prevalence of Skin Disease in Urban Haiti: A Cross-Sectional Study.

The prevalence of skin disease varies with geographic location and may be affected by cultural factors. In Haiti, the combination of poor health care access, infrastructure lack, and natural disasters may affect the prevalence of skin conditions. Unfortunately, little epidemiological information has been obtained on the prevalence of skin diseases in Haiti. The objective of this study is to describe data on the prevalence of dermatological conditions in urban areas of Haiti. Univariate, bivariate, and χ2 analyses were used to evaluate associations. During February 2016, we documented 137 patients. The mean age was 27.7 years; most of the subjects were women (61.3%) in a cohort mostly adult (67.1%). The infectious and inflammatory dermatoses were the most prevalent (74.2%). Infectious skin diseases were more prevalent in men and in adults in general (p < 0.01). Inflammatory conditions were also more common in adults (p < 0.05). Additionally, alopecia and dyschromia were limited to women (p < 0.01). Infectious skin diseases, in particular fungal infections, were amongst the most common diagnoses in the urban area of Haiti. Therefore, improved access to antimicrobial and anti-inflammatory medications would likely benefit Haitian patients with dermatological conditions. These findings may help local public health officials and future dermatological expeditions better serve this population.

A review of the etiologies, clinical characteristics, and treatment of canities.

Hair pigmentation is regulated by follicular melanogenesis, in which the process consists of melanin formation and transfer to keratinocytes in the hair shaft. Human hair follicles contain two types of melanin: the brown-black eumelanin and yellow-red pheomelanin. Eumelanin is commonly present in black and brown hair while pheomelanin is found in auburn and blonde hair. Hair follicle melanogenesis is under cyclical control and is concurrently coupled to hair growth. Many factors including intrinsic and extrinsic factors affect the follicular melanogenesis. Though many studies have been conducted to identify the pathogenesis and regulation of hair pigmentation, the etiology of canities and hair pigmentation is still unclear. The pathogenesis of canities or gray hair is believed to occur either from insufficient melanin formation due to melanocyte degeneration or a defect in melanosomal transfer. Canities is an aging sign which often interferes with one's socio-cultural adjustment. On the other hand, premature canities correlate with diseases such as osteopenia and cardiovascular disease. Risk factors associated with canities are not only genetic but also external causes. For example, smoking, alcohol consumption, and stress are among the most common factors. Camouflage techniques are still used as the primary treatment of canities. Further treatments for canities are being developed to achieve the true reversal of hair pigmentation.

Pigmentation Disorders in the Elderly.

Aging skin is subject to morphological change due to both intrinsic (skin tone, genetics, endogenous hormones) and extrinsic (chronic sun exposure, medications, exogenous pigments) factors. The broad spectrum of transformation includes both hypo- and hyperpigmentation. Although cutaneous pigmentary disorders are common in younger individuals, certain disorders are more prevalent in the geriatric population. This article reviews the epidemiology, pathophysiology, clinical appearance, treatment, and prognosis of pigmentary lesions that are predominant in the elderly.

The role of recruited minced skin grafting in improving the quality of healing at the donor site of split-thickness skin graft-A comparative study.

INTRODUCTION: The donor area of split thickness skin graft harvest usually takes 2-3 weeks to heal. A few studies have shown that application of minced skin grafting helps to reduce this time. The objective of this comparative study was to find the role of recruited minced skin grafting on the overall quality of healing at the split thickness skin graft donor area. MATERIALS AND METHODS: The study included 30 patients undergoing split thickness skin graft for acute traumatic wounds. We selected two donor areas of nearly equal size on medial and lateral side of either thigh in each case. They were randomly allocated to control area and study area using an envelope technique. Minced graft was applied over the study area. Same dressing and post operative care were done for both the areas. RESULTS: In our study we found average time for complete epithelialization at control area was 28.17+/-5.590days whereas it was 21.93+/-2.420days in the study area. The earlier epithelialisation time of study area compared to control area was significant on statistical analysis. Vancouver scar scale (VSS) comparison at third month and one year follow up showed significant difference of scores (1 versus 0) as the scars were hypopigmented at control area and comparatively better pigmented at study area. We found visual analogue score for Pain and pruritus to be better for study area at the end of first, second and third month. CONCLUSION: In this study we conclude that, recruited minced skin grafting to the donor site of split skin graft leads to better quality of healing in terms of early epithelialisation, better quality of scar, better pigmentation, less pain and pruritus, thus leading to improved quality of healing.

Dermatological manifestations in hemodialysis patients in Iran: A systematic review and meta-analysis.

BACKGROUND: Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity. OBJECTIVES: This meta-analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran. MATERIALS AND METHODS: Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran-Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random-effect meta-analysis model. RESULTS: We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random-effect meta-analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half-and-half nail in hemodialysis patients were 48.03% (95% CI: 45.09-51.01), 52.85% (95%CI: 49.23-56.47), 19.88 (95% CI: 17.57-22.19), 51.14% (95% CI: 48.25-54.02), and 18.50% (95% CI: 16.0-21.0), respectively. CONCLUSIONS: his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common.

Relationship between diet, atopy, family history, and premature hair graying.

AIM: Premature hair graying (PHG) is commonly observed in society, but there are a few studies evaluating risk factors associated with PHG. We aimed to evaluate the socio-clinical risk factors associated with PHG in this study. METHODS: A total of 1192 volunteers between 18 and 20 years old were included in this cross-sectional study. Volunteers were asked to fill in a questionnaire on socio-clinical risk factors associated with PHG such as smoking, alcohol consumption, diet preference, atopy history, and family history of PHG and Perceived Stress Scale (PSS). RESULTS: Three hundred and seventy-seven (31.6%) of the 1192 volunteers had PHG. Vegetarian diet preference, atopy history, and family history of PHG were significantly higher in subjects with PHG. Mean body mass index (BMI) and PSS scores were higher in subjects with PHG, but was not statistically significant. In the ordinal logistic regression analysis according to severity of PHG, male gender, BMI, alcohol consumption, and history of paternal PHG were significantly higher and onset age of PHG was significantly lower in PHG group. CONCLUSION: Our study is the first study reporting a relationship between PHG and diet. It may be possible to prevent PHG or reduce its severity with some lifestyle changes such as diet preference, having normal weight, and decreasing alcohol consumption.