Interleukin-15 is a hair follicle immune privilege guardian.

The autoimmunity-promoting cytokine, Interleukin-15 (IL-15), is often claimed to be a key pathogenic cytokine in alopecia areata (AA). Yet, rhIL-15 promotes human hair follicle (HF) growth ex vivo. We have asked whether the expression of IL-15 and its receptor (IL-15R) isoforms is altered in human AA and how IL-15 impacts on human HF immune privilege (HF-IP) in the presence/absence of interferon-γ (IFNγ), the well-documented key AA-pathogenic cytokine, as well as on hair regrowth after experimental AA induction in vivo. Quantitative immunohistomorphometry showed the number of perifollicular IL-15+ T cells in AA skin biopsies to be significantly increased compared to healthy control skin, while IL-15, IL-15Rα, and IL-15Rγ protein expression within the hair bulb were significantly down-regulated in AA HFs. In organ-cultured human scalp HFs, rhIL-15 significantly reduced hair bulb expression of MICA, the key "danger" signal in AA pathogenesis, and increased production of the HF-IP guardian, α-MSH. Crucially, ex vivo, rhIL-15 prevented IFNγ-induced HF-IP collapse, restored a collapsed HF-IP by IL-15Rα-dependent signaling (as documented by IL-15Rα-silencing), and protected AA-preventive immunoinhibitory iNKT10 cells from IFNγ-induced apoptosis. rhIL-15 even promoted hair regrowth after experimental AA induction in human scalp skin xenotransplants on SCID/beige mice in vivo. Our data introduce IL-15 as a novel, functionally important HF-IP guardian whose signaling is constitutively defective in scalp HFs of AA patients. Our data suggest that selective stimulation of intrafollicular IL-15Rα signaling could become a novel therapeutic approach in AA management, while blocking it pharmacologically may hinder both HF-IP restoration and hair re-growth and may thus make HFs more vulnerable to AA relapse.

An atypical presentation of human monkeypox infection with clinicopathologic correlation.

There is growing evidence to support new modes of transmission for human monkeypox infection. As these methods are being explored, this report delineates the day-to-day clinical sequelae following the initial exposure in an HIV-positive man who had sexual intercourse with another man days preceding his infection. We describe atypical cutaneous manifestations involving widespread erythematous pustules with preceding anogenital ulcerations and concomitant bilateral inguinal lymphadenopathy. Clinicopathologic correlation is used to assist in the workup and establishing the diagnosis. Our case supports others reported in the literature that suggest sexual contact as a means of transmission. More research is needed that investigates the presence of infection in both men and women, including those who could act as carriers, to elucidate other pathways in this evolving yet evasive viral disease.

Perioperative Anxiety Associated With Mohs Micrographic Surgery: A Survey-Based Study.

BACKGROUND: Mohs micrographic surgery (MMS)-associated anxiety is an important issue that remains poorly discussed. Identifying risk factors for MMS-associated anxiety will better equip physicians to manage patients' preoperative anxiety and result in improved patient satisfaction and outcomes. OBJECTIVE: This study aims in identification of risk factors that may play a role in MMS-associated anxiety among patients with nonmelanoma skin cancer. METHODS: A cross-sectional case series was conducted among MMS patients collect information on patient demographics and surgical locations and to measure perioperative anxiety and quality of life (QoL). In addition, adjusted linear and logistic regression analyses were performed to identify potential risk factors that predict MMS-associated anxiety. RESULTS: Significant increases in perioperative anxiety were associated with the eyelid area compared with the noneyelid facial area and nonfacial area ( p ≤ .05). Patients with graduate degrees exhibited less anxiety compared with ones who received less education ( p ≤ .05). Higher perioperative anxiety was associated with a greater impact on QoL ( p ≤ .05). CONCLUSION: This study identified that surgical location and the patient's educational level are 2 critical predicting factors for perioperative anxiety. Furthermore, perioperative anxiety could negatively affect a patient's quality of life and warrants further investigation into effective management.

Laser and light therapies for the treatment of necrobiosis lipoidica.

Necrobiosis lipoidica (NL) is a rare, inflammatory granulomatous skin disorder involving collagen degeneration. In recent years, several light and laser therapies have been proposed and used in the treatment of NL with variable outcomes. The aim of the study was to investigate the efficacy and safety of lasers and light therapies for the treatment of NL. A review of PubMed was conducted to search for studies using laser and light therapies for the treatment of NL. Articles that employed a combination of treatment modalities were excluded. Twenty-four studies were reviewed. Light and laser therapies used in these studies included CO2 laser, pulsed dye laser, methyl aminolevulinate (MAL)-photodynamic therapy (PDT), aminolevulinic acid (ALA)-PDT, ultraviolet A1 (UVA1) phototherapy, and psoralen plus ultraviolet-A (PUVA). PUVA was identified as the modality with the most available evidence (7 studies), followed by MAL-PDT and ALA-PDT (5 studies each), pulsed dye laser and UVA1 (3 studies each), and lastly CO2 laser (2 studies). Most modalities demonstrated variable efficacies and side effects with the exception of PDL, which consistently showed successful outcomes. Multiple dermatologic light and laser therapies have been investigated for the treatment of NL, including PUVA, ALA-PDT, MAL-PDT, pulsed dye laser, UVA1, and CO2 laser. However, a clear consensus on the preferred treatment is yet to be addressed. Each treatment option demonstrates both advantages and disadvantages that should be discussed with patients when selecting the treatment modality.

Comparison of efficacy and safety of a novel 755-nm diode laser with conventional 755-nm alexandrite laser in reduction of axillary hairs.

The aim of this study was to compare the efficacy and safety of a novel diode system emitting 755 nm wavelength with conventional 755 nm alexandrite laser in skin types III and IV. It was a randomized, right-left comparison, assessor-blind, clinical study. Sixteen female volunteers age 29.52 ± 9.52 were randomly assigned to receive six treatment sessions using 755 nm diode laser on one axilla and 755 nm alexandrite on the opposite axilla. Efficacy was assessed by counting of hairs per square centimeter, 6 months after the last treatment. Treatment outcome was also evaluated by blind reviewing of before and after pictures, using Physician Global Assessment scale (GAS). Subject satisfaction was assessed using visual analogue scale (VAS), pain level and adverse effects were recorded. Skin biophysical parameters (transepidermal water loss, skin sebum, and erythema index) were also measured. Significant reduction in hair count was observed, 6 months after the last treatment session, for both devices (- 33% for 755 nm diode and - 35% for 755 nm alexandrite; p value = 0.85). The mean GAS score was 2.66 for alexandrite treated side vs. 2.00 for diode treated side (p value = 0.036). No severe adverse events were reported. The subject satisfaction score was significantly higher after treatment with alexandrite laser. No significant changes were detected in none of skin biophysical parameters. 755 nm diode laser is suitable for hair removal procedures and it is as effective and safe as the 755 nm alexandrite laser in skin types III-IV.

Evaluation of positive patch test reactions using optical coherence tomography: A pilot study.

INTRODUCTION: Patch testing is the gold standard for evaluating allergic contact dermatitis (ACD), yet current interpretation methods are limited by their subjectivity and possible variability between observers. Optical coherence tomography (OCT) imaging enables noninvasive in vivo skin visualization and holds promise as an objective method of patch test interpretation. OBJECTIVE: To evaluate the micromorphological changes of patch test reactions and identify objective, quantitative OCT markers that correlate with clinically graded patch test reactions. RESULTS: A total of 25 patch test reactions (7 grade-0, 4 grade-1+, 14 grade-2+) from 7 patients underwent OCT evaluation. Increased epidermal thickness and density was qualitatively observed in grade 1+ and grade 2+ allergic reactions while well-demarcated, signal-free cavities were observed in all grade 2+ reactions. Attenuation coefficients significantly increased across the three reaction grades (2.58 ± 0.092, 2.96 ± 0.121, 3.05 ± 0.065; P < 0.01). Cutaneous blood flow at 0.35 mm monotonically increased with reaction grade severity and blood measurements significantly differed across the three reaction grades (0.053 ± 0.011 mm/s, 0.078 ± 0.015 mm/s, and 0.121 ± 0.008 mm/s; P < 0.01). CONCLUSIONS AND RELEVANCE: Attenuation coefficient and cutaneous blood flow at 0.35 mm correlate with clinically graded patch test reactions and hold promise as objective, quantitative markers. OCT may help dermatologists differentiate clinical scoring of allergic reactions in patch test and thereby improve their diagnostic accuracy and interpretation of patch test reactions.

Successful Treatment of Lower Extremity Telangiectasias Using 585-nm Pulsed-Dye Laser at Low Fluence Combined With Optical Coherence Tomography: A Case Report

Background: Significant advances have been made in using lasers and intense pulse light sources to treat common vascular lesions such as telangiectasias. However, the treatment of leg telangiectasia, specifically, is more challenging because it involves the clearing of smaller veins as well as the larger feeding veins. The latest guidelines recommend use of short wavelength pulse-dyed lasers (PDL) as an option to treat telangiectasia cases that are unresponsive to sclerotherapy. Methods: A 29-year-old white woman presented with persistent telangiectasia, with multiple telangiectasias ranging from 1 cm to 20 cm in size involving the dorsal feet and both ankles and legs, which developed 10 years prior, associated with paresthesia. Test spots were treated with a 585-nm pulsed dye laser with various energy settings, and treatment was performed at 5.5 J/cm2 with spot size 10 mm and 0.5ms pulse duration. Results: Near complete clearance was achieved 1 month after the single treatment without adverse effects. Optical coherence tomography (OCT) imaging demonstrated a reduction of cutaneous blood flow after treatment. Discussion: We report successful treatment despite using settings that were previously reported to lack efficacy. This treatment resulted in considerable improvement in aesthetics and symptomatology. Also, OCT confirmed decreased vascular flow and bulging. Conclusion: Our results suggest there is still much to learn about the use of PDL in treating telangiectasias of the lower extremities, and that the ideal parameters warrant further investigation. Moreover, the novel use of OCT in auxiliary imaging for identification of treatment spots, as well as monitoring response at a microvascular level, holds great potential for wider application. J Drugs Dermatol. 2019;18(11):1180-1182.

Optical coherence tomography imaging of melanoma skin cancer.

No consensus guidelines exist on the use of optical coherence tomography (OCT) for diagnosis of cutaneous melanoma. The objectives of this review are to provide a descriptive review of the literature on characteristics of cutaneous melanomas seen on high-definition OCT (HD-OCT), speckle variance OCT (SV-OCT), and conventional OCT and to compare their diagnostic ability with that of histopathology. A review of PubMed and Google Scholar identified all available literature on OCT in melanoma skin cancer that included all in vivo and ex vivo studies on human or human tissues and excluded all studies on non-human subjects or animal studies. Two hundred nine abstracts were considered for evaluation, 31 abstracts were selected for manuscript review, and 14 abstracts were included that met all criteria. Diagnoses of MIS and MM using HD-OCT and SV-OCT were consistently reported to correlate with histopathology. However, accuracy of diagnosis using conventional OCT varied. Most authors agreed that it was difficult to differentiate MM from benign nevi using conventional OCT. HD-OCT, SV-OCT, and conventional OCT show promise for visualizing cutaneous melanoma. The use of OCT in diagnosis of melanoma is rarely reported in the literature. There is a need to increase and standardize reporting of OCT for diagnosis of cutaneous melanoma.

Photoacoustic/Ultrasound/Optical Coherence Tomography Evaluation of Melanoma Lesion and Healthy Skin in a Swine Model.

The marked increase in the incidence of melanoma coupled with the rapid drop in the survival rate after metastasis has promoted the investigation into improved diagnostic methods for melanoma. High-frequency ultrasound (US), optical coherence tomography (OCT), and photoacoustic imaging (PAI) are three potential modalities that can assist a dermatologist by providing extra information beyond dermoscopic features. In this study, we imaged a swine model with spontaneous melanoma using these modalities and compared the images with images of nearby healthy skin. Histology images were used for validation.

Effectiveness of photopneumatic technology: a descriptive review of the literature.

Usage of photopneumatic technology has recently increased for treatment of different skin conditions such as acne, keratosis pilaris (KP), and rosacea. Photopneumatic devices combine gentle negative pressure with broad band pulsed light simultaneously to attack multiple targets in the skin for better treatment outcomes. In this literature review, we evaluate the efficacy of photopneumatic therapy on treatment of acne, keratosis pilaris (KP), and rosacea.

Removal of unwanted hair: efficacy, tolerability, and safety of long-pulsed 755-nm alexandrite laser equipped with a sapphire handpiece.

Due to the difference in refraction coefficients between air and the corneal epithelium, irradiation of the skin with a light source can lead to reflection of the energy and its leakage to the skin causes epidermal injury. All of which decreases the efficacy of treatment. We evaluated cooling sapphire handpieces' efficacy in decreasing pain and epidermal injuries and enhancing the treatment outcome in laser hair removal. A total of 49 patients with Fitzpatrick skin types of II to IV were treated for laser hair removal on face, limbs, inguinal, and axillary areas with pulsed 755-nm alexandrite laser equipped with a sapphire handpiece and the cooling system. Hair counts were performed by two independent observers at the baseline and 3 months after the final treatment. A marked reduction in hair regrowth was noted 3 months after the final treatment in all body locations studied. Clinical hair reduction was observed and fully assessed. There were no serious side effects with an average pain score of 4.6 out of 40. The cooled sapphire cylinder tip has been shown to minimize epidermal injury and reduce the system energy leaks to the skin.

Treatment of atrophic facial acne scars with fractional Er:YAG laser in skin phototype III-IV: A pilot study.

BACKGROUND: Fractional ablative lasers have recently been used for the treatment of skin scars. The objective of this study was to assess the efficacy and safety of the fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser (2940 nm) in the treatment of skin scars. MATERIALS AND METHODS: A total of 9 patients (8 female, 1 male) with Fitzpatrick skin types III and IV suffering from atrophic facial acne scars were treated with a fractional Er:YAG laser for 2-5 (mean 3.3) sessions 4-6 weeks apart. One independent investigator assessed the efficacy, using standardized photographs, before and 1 month after the last treatment. The patients' satisfaction rate was also evaluated. RESULTS: The treatment was well tolerated by all patients without any anesthesia. The downtime was 2-3 days. All patients showed improvement in scars: excellent in 1, good in 1, and fair in 7 patients. Six patients were highly satisfied and 3 were satisfied with treatment. No adverse effect was noted. CONCLUSION: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for acne scars.