Dermatitis Artefacta: A Practical Guide for Diagnosis and Management.

Dermatitis artefacta (DA) is a psycho-dermatologic condition based on patients' behavioral patterns, characterized by an intentional production of cutaneous lesions on their own skin. The clinical presentation can be highly variable. Patients with DA seldom seek psychological support or psychiatric consultation. More often, they seek help from their primary care physician or dermatologist. This review article aims to provide a practical guide for the diagnosis and management of AD and affected patients. A broad literature search was performed using the PubMed and Google Scholar electronic online databases, using key words "dermatitis artefacta", "diagnosis", "management", and "psychodermatology". The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. DA can occur in a variety of clinical presentations, and physicians should suspect DA in patients with a history of psychiatric disorders or extensive use of healthcare services. The ultimate goal of DA treatment may be a proper referral to mental health services. However, the prognosis is poor even when successful mental health referrals are achieved, with low recovery rates. A useful approach may include the suggestion that a mental health provider can help with the anxiety and the distress generated by the lesions: in this case in this case it will be crucial to discuss this with the mental health provider after obtaining informed consent from the patient. Considering the difficulty in promoting patients' adherence to treatment, the ideal setting for DA treatment is a psycho-dermatologic clinic, where both dermatologic and psychological interventions can be seamlessly integrated.

Meta-analysis Investigating the Efficacy of Liquid Dressing and Ostomy Powder for the Treatment of Incontinence-Associated Dermatitis.

OBJECTIVE: To study the effect of liquid dressing and ostomy powder on the treatment of incontinence-associated dermatitis (IAD). METHODS: The authors searched PubMed, Web of Science, CNKI (China National Knowledge Internet), and Google Scholar databases for literature through July 28, 2022. After literature screening, two investigators independently extracted data from the included studies and applied the Newcastle-Ottawa Scale to assess the quality of the included studies. The χ2-based Q statistic test and the I2 statistic were used to measure the heterogeneity of the included studies. Publication bias was measured with funnel plots and the Egger test. Sensitivity analysis was conducted by eliminating each study one by one. RESULTS: Four high-quality studies were included in the meta-analysis, involving a total of 307 participants. The meta-analysis results showed that compared with traditional care, treatment with liquid dressing and ostomy powder significantly improved the effective rate (pooled odds ratio, 21.42; 95% CI, 8.58 to 53.44), shortened the healing time (pooled mean difference, -10.73; 95% CI, -12.92 to -8.54), and reduced the recurrence rate (pooled mean difference, -2.03; 95% CI, -2.30 to -1.77) of IAD. Among the included studies, no publication bias was detected. Sensitivity analysis results confirmed the robustness of the pooled estimates. CONCLUSIONS: Treatment with liquid dressing and ostomy powder has clinical value for patients with IAD.

Clinical factors and hair care practices influencing outcomes in central centrifugal cicatricial alopecia.

Central centrifugal cicatricial alopecia (CCCA) is the most common form of primary scarring alopecia in women of African descent, negatively impacting their quality of life. Treatment is often challenging, and we usually direct therapy to suppress and prevent the inflammation. However, factors affecting clinical outcomes are still unknown. To characterize medical features, concurrent medical conditions, hair care practices, and treatments used for patients with CCCA and assess their relationship with treatment outcomes. We analyzed data from a retrospective chart review of 100 patients diagnosed with CCCA who received treatment for at least one year. Treatment outcomes were compared with patient characteristics to determine any relationships. P-values were calculated using logistic regression and univariate analysis with 95% CI P < 0.05 was considered significant. After one year of treatment, 50% of patients were stable, 36% improved, and 14% worsened. Patients without a history of thyroid disease (P = 0.0422), using metformin for diabetes control (P = 0.0255), using hooded dryers (P = 0.0062), wearing natural hairstyles (P = 0.0103), and having no other physical signs besides cicatricial alopecia (P = 0.0228), had higher odds of improvement after treatment. Patients with scaling (P = 0.0095) or pustules (P = 0.0325) had higher odds of worsening. Patients with a history of thyroid disease (P = 0.0188), not using hooded dryers (0.0438), or not wearing natural hairstyles (P = 0.0098) had higher odds of remaining stable. Clinical characteristics, concurrent medical conditions, and hair care practices may affect clinical outcomes after treatment. With this information, providers can adjust proper therapies and evaluations for patients with Central centrifugal cicatricial alopecia.

Dermatitis artefacta.

Dermatitis artefacta (factitious skin disorder) is a rare psychocutaneous disorder that poses a complex clinical challenge to clinicians. The hallmarks of diagnosis include self-inflicted lesions in accessible areas of the face and extremities that do not correlate with organic disease patterns. Importantly, patients are unable to take ownership of the cutaneous signs. It is essential to acknowledge and focus on the psychologic disorders and life stressors that have predisposed the condition rather than the mechanism of self-injury. The best outcomes are achieved via a holistic approach in the setting of a multidisciplinary psychocutaneous team addressing cutaneous, psychiatric, and psychologic aspects of the condition simultaneously. A nonconfrontational approach to patient care builds rapport and trust, facilitating sustained engagement with treatment. Emphasis on patient education, reassurance with ongoing support, and judgment-free consultations are key. Enhancing patient and clinician education is essential in raising awareness of this condition to promote appropriate and timely referral to the psychocutaneous multidisciplinary team.

Continuous positive airway pressure device-associated nonhealing ulcer on the nasal dorsum: chondrodermatitis nodularis nasi.

With increasing use of positive airway pressure devices for disordered breathing during sleep, appreciation for potential associated side effects is essential. Chondrodermatitis nodularis nasi is a rare variant of chondrodermatitis nodularis chronic helicis that presents as a nonhealing erosion or ulcer on the nose and can occur in association with chronic use of positive airway pressure devices. We present a case of symptomatic chondrodermatitis nodularis nasi associated with continuous positive airway pressure use, fully responsive to treatment, and propose that this condition is highly underrecognized. Dermatology referral can assist in diagnosis, management, and exclusion of cutaneous malignancy. CITATION: Reinhart JP, Isaq NA, Peters MS, Vidal NY. Continuous positive airway pressure device-associated nonhealing ulcer on the nasal dorsum: chondrodermatitis nodularis nasi. J Clin Sleep Med. 2023;19(6):1157-1159.

Analysis of factors influencing the determination of indications for allergen-specific immunotherapy

Objective: To develop a questionnaire and a scoring system for evaluating physicians’ knowledge of allergen immunotherapy (AIT). Methods: Questionnaire was designed using the Questionnaire Star tool. A total of 1024 physicians were assessed, and based on the score divided into accurate judgment and inaccurate judgment groups. Statistical analysis was done, and counting data were expressed as frequencies and percentage values. Chi-square test and multi-factor logistic analysis were used to determine influencing factors on the indications for AIT. Results: Physician’s age, grade of the hospital, and pediatric specialty influenced the accurate judgment of AIT indication after adjustment for independent variables (P < 0.05). In all, 80.5% physicians exercised accurate assessment for allergic rhinitis. Allergic conjunctivitis was judged accurately by 47.0% physicians. Bronchial asthma was judged accurately by 71.0% physicians, and atopic dermatitis by 61.3% physicians, with a higher accuracy rate for pediatricians than nonpediatricians for all the mentioned conditions (P < 0.05). There was no significant difference in the accuracy of judgment between pediatricians and non-pediatricians in terms of AIT for food allergy and dust mite sensitization (P > 0.05). Conclusion: The results of our study demonstrated a high accuracy judgment rate among clinicians for rhinitis, asthma, and dermatitis, and a low accuracy rate for desensitization of healthy people with allergic conjunctivitis, food allergies, and allergen sensitization (AU)

Owner reported clinical signs and -treatment decisions in equine pastern dermatitis.

INTRODUCTION: Equine pastern dermatitis has a high prevalence in the equine population, especially in draft breeds. This skin condition is difficult to treat, and it is suspected that owners often decide on a treatment without consulting a veterinarian. The objectives of this study were to describe owner-reported clinical signs, severity, and reasons to consult a veterinarian. Moreover, we inquired about preventive measures and treatments, both instituted by owners without previous consultation or prescribed by their veterinarians. A total of 123 horses (owners recruited over social media) were included in the study. All horses suffered from equine pastern dermatitis at least once in the two years preceding the study. Standardized questionnaires collecting information on management, housing conditions, clinical signs as well as preventive measures and treatments were filled out by participants. The data was recorded, and descriptive statistics were performed. Most horses (71 out of 115 available answers, 62 %) had shown clinical signs of equine pastern dermatitis at least four times in their lives. A total of 113 horses (92 % of all included horses) were affected by equine pastern dermatitis at the time of the interview. For 37 horses (32 %) out of 114 available answers the owners consulted their veterinarian only after the horse showed signs of pain or lameness. Usually, treatments that did not require a medical prescription were applied without consulting their veterinarian (e. g. only 9 % (14 out of 150 prescriptions) of topical creams promoting wound healing were prescribed by a veterinarian). A total of 31 treatment decisions (55 %) with creams containing anti-bacterial, anti-mycotic and/or anti-inflammatory agents and 100 % of systemic medications containing anti-bacterial, anti-parasitic or anti-inflammatory agents were prescribed by veterinarians. Overall, 69 % of treatment decisions were made without consulting a veterinarian, making it then more difficult to determine underlying causes for the pastern dermatitis and rendering the treatment often longer and more onerous. To raise owner awareness of possible consequences if a veterinarian is consulted too late in the disease process, specific information campaigns to improve animal welfare should be considered.

INTRODUCTION: La dermatite du paturon a une prévalence élevée dans la population équine, en particulier chez les races de trait. Cette affection cutanée est difficile à traiter et on soupçonne que les propriétaires décident souvent d'un traitement sans consulter un vétérinaire. Les objectifs de cette étude étaient de décrire les signes cliniques rapportés par les propriétaires, la sévérité et les raisons de consulter un vétérinaire. De plus, nous nous sommes renseignés sur les mesures préventives et les traitements, qu'ils soient mis en place par les propriétaires sans consultation préalable ou prescrits par leurs vétérinaires. Un total de 123 chevaux (propriétaires recrutés via les médias sociaux) ont été inclus dans l'étude. Tous les chevaux ont souffert de dermatite du paturon au moins une fois au cours des deux années précédant l'étude. Des questionnaires standardisés, recueillant des informations sur la gestion, les conditions de logement, les signes cliniques ainsi que les mesures préventives et les traitements, ont été remplis par les participants. Les données ont été enregistrées et des statistiques descriptives ont été réalisées. La plupart des chevaux (71 sur 115 réponses disponibles, 62 %) avaient présenté des signes cliniques de dermatite du paturon au moins quatre fois dans leur vie. Au total, 113 chevaux (92 % de tous les chevaux inclus) étaient atteints de dermatite du paturon équin au moment de l'entretien. Pour 37 chevaux (32%) sur les 114 réponses disponibles, les propriétaires ont consulté leur vétérinaire uniquement après que le cheval a eu montré des signes de douleur ou de boiterie. En général, les traitements qui ne nécessitaient pas de prescription médicale étaient appliqués sans consulter leur vétérinaire (par exemple, seuls 9 % [14 sur 150 prescriptions] des crèmes topiques favorisant la cicatrisation des plaies étaient prescrites par un vétérinaire). Au total, 31 décisions de traitement (55%) avec des crèmes contenant des agents antibactériens, antimycosiques et/ou anti-inflammatoires et 100% des médicaments systémiques contenant des agents antibactériens, antiparasitaires ou anti-inflammatoires ont été prescrits par des vétérinaires. Dans l'ensemble, 69 % des décisions de traitement ont été prises sans consulter un vétérinaire, ce qui rend plus difficile la détermination des causes sous-jacentes de la dermatite du paturon et rend le traitement souvent plus long et plus onéreux. Pour sensibiliser les propriétaires aux conséquences possibles d'une consultation trop tardive d'un vétérinaire dans le processus de la maladie, des campagnes d'information spécifiques visant à améliorer le bien-être des animaux devraient être envisagées.

Photodynamic treatment as a promising strategy applied in lichenoid tissue reaction/interface dermatitis with moderate-to-severe dysplasia: A case report.

Lichenoid tissue reaction/interface dermatitis represents a class of mucocutaneous inflammatory diseases which share common histopathological manifestations. One patient presented to our clinic whose oral lesions could not categorized into a definitely clinical or pathological diagnosis, but could be ascribed to lichenoid tissue reaction/interface dermatitis with moderate-to-severe dysplasia. Photodynamic treatment was applied in this case and a satisfactory result was eventually achieved. Signs of recurrence were not revealed at the follow-up of the tenth month.

Getting to the Core of Contemporary Therapies for Post-Inflammatory Hyperpigmentation.

Post-inflammatory hyperpigmentation (PIH) is a typical complication of inflammatory dermatoses that more frequently and severely affects people with darker skin. External insults to the skin, such as burn injuries, dermatologic treatments, and intrinsic skin disorders (eg, eczema and acne), are common causes of PIH. Individuals with darker skin are prone to develop PIH, which can cause substantial psychological suffering. PIH can be prevented or alleviated. When this happens, it is essential to point out what is causing it and treat it as soon as possible to prevent inflammation and PIH from progressing. If the inflammatory symptoms go away or there is no evidence of inflammation at the time of diagnosis, PIH treatments should be evaluated. To hasten the resolution of PIH, treatment should begin as soon as possible. Treatment begins with the care of the initial inflammatory condition. Topical medications, chemical peels, laser and light-based treatment, phototherapy, and other therapeutic modalities are offered to treat PIH. Understanding the therapy options available helps the physician in choosing the best treatment for each patient. With these backgrounds, the current review aimed to discuss the epidemiology, pathogenesis, clinical presentation, and available treatment options for the PIH. J Drugs Dermatol. 2022;21(3):276-283. doi:10.36849/JDD.6485.

First in human surgical implantation of a leadless pacemaker on the epicardial portion of the right atrial appendage in a patient with a cardiac electronic devices mediated dermatitis.

A 33-year-old woman with Sick Sinus Node syndrome and persistent atrial fibrillation underwent a Maze IV procedure in order treat atrial fibrillation and concomitant atrial epicardial implantation of a leadless pacemaker to manage her sinus node insufficiency. Last option has been chosen due to rare pocket complication after previous classic dual-chamber pacemaker implantation.

Human adipose tissue-derived MSCs improve psoriasis-like skin inflammation in mice by negatively regulating ROS.

BACKGROUND: Psoriasis is chronic incurable skin inflammation. The anti-inflammatory properties of mesenchymal stem cells (MSCs) have been put forward to be involved in several inflammatory diseases. However, little was known about the role of human adipose tissue-derived stem cells (hAD-MSCs) in psoriasis. OBJECTIVE: We sought to explore the feasibility of using hAD-MSCs infusion as a therapeutic approach in psoriatic mice. METHODS: We constructed the psoriasis-like model by IMQ implication, treated with hAD-MSCs by subcutaneous injection. To evaluate the efficacy, we examined the histology, CD45 and ROS positive cells by HE and flow cytometry respectively. We also tested the key cytokines with PCR. Moreover, to achieve a better therapeutic effect, we treated the model by combing with vitamin E application. RESULTS: We found that the classic histological symptoms of psoriasis were relieved after treatment with hAD-MSCs, also, the splenic index, the infiltration of immune cells and several pro-inflammatory cytokines were decreased. Interestingly, we also found that hAD-MSCs could inhibit ROS generation. Moreover, the combination therapy of hAD-MSCs and vitamin E could promote the curative effect with greater ROS inhibition. CONCLUSION: These results suggested that hAD-MSCs could be useful for treating psoriasis by negatively regulating ROS.

Recommendation for preventive and therapeutic skin care of patients undergoing radiotherapy.

BACKGROUND: Radiation dermatitis is a very common reaction to radiotherapy, affecting approx. 95% of patients with varying intensity. It is crucial to minimize its side effects. The working group that prepared this document includes physicians, nurses, representatives of the Society for Radiation Oncology, Biology and Physics of the Czech Medical Association of J. E. Purkyně, the Supportive Treatment and Care Section of the Czech Society for Oncology of the Czech Medical Association of J. E. Purkyně, the Czech Wound Management Association, the Oncological Section of Czech Association of Nurses, and dermatologists. The document has been approved by the committees of these associations. PURPOSE: Recommendation for preventive and therapeutic skin care of patients undergoing radiotherapy in the Czech Republic.

A retrospective analysis of clinical characteristics and management of perianal streptococcal dermatitis in children and adults.

INTRODUCTION: Due to the paucity of recent literature on perianal streptococcal disease (PSD), we performed a comprehensive analysis of clinical characteristics of PSD and its management. METHODS: We conducted a retrospective search in the laboratory information system of the Institute of Microbiology and Immunology, Ljubljana, Slovenia, between January 2006 and December 2016 and identified patients with suspected PSD. We reviewed patients' medical records and obtained data on patient age and sex, concomitant illnesses, duration of complaints, signs and symptoms of PSD, epidemiological history, date of diagnosis, microbiological characteristics of beta-hemolytic streptococcal isolates, additional laboratory findings, duration and type of systemic and/or topical therapy, and recurrence of PSD. RESULTS: We identified 64 pediatric and eight adult PSD cases in total. The most common signs and symptoms were perianal erythema (67/72; 93.1%), anal fissures (28/72; 38.8%), itching (22/72; 30.6%), and blood-streaked stools (19/72; 26.4%). The duration of symptoms varied from < 1 week to > 1 year, with 58.3% of patients experiencing symptoms between 1 week and 6 months. The majority of patients received systemic (63/72; 87.5%) and topical (56/72; 77.8%) treatment. CONCLUSIONS: Although the signs and symptoms of PSD are non-specific, clinicians should be highly suspicious of the disease in adults and especially in preschool children with perianal complaints. Despite being a common disease, there is still considerable delay in correct diagnosis and treatment, prolonging the discomfort of PSD patients.

[Chondrodermatitis nodularis helicis: a practical overview with treatment recommendations for the primary and secondary care]. / Chondrodermatitis nodularis helicis.

Chondrodermatitisnodularishelicis is characterized by a sore nodule of the helix or antihelix of the ear. Pressure plays an important role in the pathogenesis of the benign inflammatory condition. Pressure relieving is a rational first-line treatment modality and could be applied in combination with or followed by intralesional steroid injections. If the condition remains, a surgical procedure is warranted. Cartilage removal without skin excision is the procedure of choice. Particular attention should be paid to the complete removal of all defective cartilage. This procedure is elegant and simple compared to the conventional wedge excision and has a lower risk of recurrence. Because of high recurrence rates of non-surgical treatments, early surgical treatment is recommended.