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Keloids are abnormal skin growths occurring in a significant portion of the global population. Despite their pervasiveness, the underlying pathophysiology of this scarring process is yet to be fully understood. In this review article, we delve into the current literature on the pathophysiological mechanisms of keloids. We take a top-down approach, first looking at host factors such as genetics and endocrine factors and then taking a more granular approach describing specific control factors such as germline keloid predisposition variants, epigenetics and transcriptomics, inflammatory and immune dysregulation, and the role of profibrotic and angiogenic cell signaling pathways. We then discuss current knowledge gaps, propose further research avenues, and explore potential future treatment options considering our increased understanding of keloid pathogenesis.
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COVID-19 procedural restrictions and concerns from both practitioners and patients have led to a decrease in cosmetic procedures performed. Reduced clinic space, the necessity of distancing between people, and patient preference for a smaller care team may restrict trainees from observing, assisting with, or performing procedures. Thus, trainees may be limited in their ability to learn, practice, and meet the required number of cases to achieve competence, subsequently necessitating a sustained demand for alternative methods of learning. In this review, we examine the efforts made thus far by both dermatologists and dermatology organizations to meet the educational procedural needs of trainees and compensate for limitations during the pandemic and highlight areas in which innovation may still be needed.
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Importance: Shared gene variants in benign-malignant process pairs, such as BRAF mutations common to benign nevi and melanoma, are associated with differing phenotypic manifestations. Study of gene mechanisms underlying cherry angioma may uncover previously unknown disease relationships. Objective: To identify somatic mutations present in cherry angioma specimens by using targeted next-generation sequencing. Design, Setting, and Participants: In a single-center case series, 10 formalin-fixed, paraffin-embedded cherry angioma specimens from biopsies performed at Massachusetts General Hospital in Boston from July 10, 2016, to January 23, 2018, were obtained and underwent sequencing across a panel of 323 genes most relevant to cancer. Somatic mutations were curated by excluding variants that were presumed to be germline or of low mapping quality. Main Outcomes and Measures: Identification of somatic mutations associated with cherry angiomas. Results: In 10 cherry angioma tissue samples originating from 6 female and 4 male patients with a median (range) age of 54 (26-79) years, 5 samples (50%) revealed somatic missense mutations in GNAQ (Q209H, Q209R, and R183G) and GNA11 (Q209H). Individually, these mutational hot spots are known to be involved in entities that include congenital and anastomosing hemangiomas, hepatic small-vessel neoplasms (Q209), port-wine stains, and Sturge-Weber syndrome (R183). Both hot spots are associated with blue nevi, melanoma associated with blue nevus, and uveal melanoma. Conclusions and Relevance: In this case series study, the high prevalence of 5 known genetic drivers within the benign cherry angioma entity appears to support the context-dependent role of gene alterations in both benign and malignant proliferations from various cellular origins.
Assuntos
Hemangioma/genética , Hemangioma/patologia , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Mutação de Sentido Incorreto , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Adulto , Fatores Etários , Idoso , Boston , Feminino , Subunidades alfa Gq-G11 de Proteínas de Ligação ao GTP/genética , Predisposição Genética para Doença/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição de Risco , Estudos de Amostragem , Fatores Sexuais , Inclusão do TecidoRESUMO
BACKGROUND: Despite aggressive multitreatment medical acne regimens, many patients demonstrate modest benefit. The 1,450-nm diode laser has been shown to improve acne in a study setting. OBJECTIVE: Herein we evaluate the use of this laser as an adjunctive tool in the management of refractory facial acne vulgaris. MATERIALS AND METHODS: Thirteen patients were treated. Lesion counts, clinical evaluation, and digital photography were performed at baseline and at all follow-up visits. Patients received an average of three treatments. Acne severity index and patient satisfaction were assessed. Patients continued their medical acne regimen where applicable. RESULTS Mean total lesion and inflammatory lesion counts decreased from 66 +/- 14 and 23 +/- 5 at baseline to 34 +/- 12.9 and 14 +/- 7 after three treatments (p<.05). Side effects were mild, including erythema lasting up to 24 hours. CONCLUSION: The 1,450-nm diode laser provides moderate improvement of refractory acne vulgaris. Our findings support the use of this device as an adjunctive treatment for acne management.
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Acne Vulgar/radioterapia , Dermatoses Faciais/radioterapia , Terapia com Luz de Baixa Intensidade/métodos , Acne Vulgar/patologia , Adolescente , Adulto , Dermatoses Faciais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do PacienteRESUMO
OBJECTIVE: Laser treatment of port-wine stain (PWS) might be improved using a deeply penetrating wavelength. METHODS: PWSs in 17 patients were treated 3 times with a 595-nm pulsed dye laser (PDL) and a 1064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Fluences of 1.0, 0.8, and 0.6 times the minimum purpura dose (MPD) were used for Nd:YAG laser. Posttreatment biopsy specimens were taken. Blind assessment and quantitative analysis of PWS clearing were performed from digital photographs. RESULTS: MPD for Nd:YAG laser varied widely, from 40 to 250 J/cm 2 . Purpura lasted longer after PDL. Treatment achieved similar 50% to 75% clearing with both PDL and Nd:YAG laser at 1 MPD. Nd:YAG caused greater perivascular and epidermal injury. Scarring occurred in the only patient treated with a Nd:YAG fluence greater than 1 MPD. Patients preferred Nd:YAG laser because of their faster recovery. CONCLUSION: Nd:YAG laser used at MPD is as effective as PDL for treating PWS. Nd:YAG laser fluences higher than MPD may cause scarring.
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Terapia a Laser , Mancha Vinho do Porto/radioterapia , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Mancha Vinho do Porto/patologiaAssuntos
Calcitriol/análogos & derivados , Faringite , Psoríase , Infecções Estreptocócicas , Triancinolona Acetonida/administração & dosagem , Administração Tópica , Antiestreptolisina/sangue , Calcitriol/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Diagnóstico Diferencial , Humanos , Masculino , Faringite/complicações , Faringite/imunologia , Faringite/microbiologia , Fototerapia/métodos , Prognóstico , Psoríase/diagnóstico , Psoríase/etiologia , Psoríase/fisiopatologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/imunologia , Resultado do Tratamento , Adulto JovemAssuntos
Cicatriz/terapia , Dermabrasão/métodos , Fármacos Dermatológicos/administração & dosagem , Terapia a Laser/métodos , Acne Queloide/patologia , Acne Queloide/terapia , Cicatriz/patologia , Cicatriz Hipertrófica/patologia , Cicatriz Hipertrófica/terapia , Estética , Feminino , Humanos , Queloide/patologia , Queloide/terapia , Masculino , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
Ticks are ectoparasites that cause dermatologic disease directly by their bite and indirectly as vectors of bacterial, rickettsial, protozoal, and viral diseases. In North America, where ticks are the leading cause of vector-borne infection, dermatologists should recognize several tick species. Basic tick biology and identification will be reviewed. Tick bites cause a variety of acute and chronic skin lesions. The tick-borne diseases include Lyme disease, tick-borne relapsing fever, tularemia, babesiosis, Rocky Mountain spotted fever, other spotted fevers, ehrlichiosis, Colorado tick fever, and others. The epidemiology, clinical features, diagnosis, and treatment of these diseases are reviewed with an emphasis on cutaneous manifestations. Finally, the prevention of diseases caused by ticks is reviewed.
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Vetores de Doenças , Dermatopatias/epidemiologia , Doenças Transmitidas por Carrapatos/epidemiologia , Carrapatos/classificação , Doença Aguda , Animais , Babesiose/diagnóstico , Babesiose/epidemiologia , Doença Crônica , Comorbidade , Diagnóstico Diferencial , Educação Médica Continuada , Ehrlichiose/diagnóstico , Ehrlichiose/epidemiologia , Feminino , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/epidemiologia , Masculino , Prognóstico , Febre Recorrente/diagnóstico , Febre Recorrente/epidemiologia , Medição de Risco , Febre Maculosa das Montanhas Rochosas/diagnóstico , Febre Maculosa das Montanhas Rochosas/epidemiologia , Dermatopatias/diagnóstico , Dermatopatias/parasitologia , Doenças Transmitidas por Carrapatos/diagnóstico , Tularemia/diagnóstico , Tularemia/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Ticks are ectoparasites that cause dermatologic disease directly by their bite and indirectly as vectors of bacterial, rickettsial, protozoal, and viral diseases. In North America, where ticks are the leading cause of vector-borne infection, dermatologists should recognize several tick species. Basic tick biology and identification will be reviewed. Tick bites cause a variety of acute and chronic skin lesions. The tick-borne diseases include Lyme disease, tick-borne relapsing fever, tularemia, babesiosis, Rocky Mountain spotted fever, other spotted fevers, ehrlichiosis, Colorado tick fever, and others. The epidemiology, clinical features, diagnosis, and treatment of these diseases are reviewed with an emphasis on cutaneous manifestations. Finally, the prevention of diseases caused by ticks is reviewed.