New indications for topical ivermectin 1% cream: a case series study.

INTRODUCTION: Topical ivermectin is an effective treatment for inflammatory papulopustular rosacea in adults. Positive therapeutic effects of ivermectin due to its potential anti-inflammatory properties could be achieved in the other facial dermatoses. AIM: To assess the efficacy of topical ivermectin 1% cream therapy in mild and moderate perioral dermatitis (PD), seborrheic dermatitis (SD) and acne vulgaris (AV). MATERIAL AND METHODS: The study comprising 20 patients diagnosed with PD (8), SD (8) and AV (4) was conducted between November 2016 and July 2017. Two scales were applied to establish efficacy of the treatment: Investigator Global Assessment score (IGA) and Patient Global Assessment of Treatment (PGA). RESULTS: All patients responded to the treatment with topical ivermectin very well with a gradual reduction in inflammatory skin lesions. Complete or almost complete clearance (IGA score 0-1) was achieved in 20 cases. Four patients with PD achieved IGA 0-1 after 4 weeks of treatment, 1 patient after 5 weeks, 2 patients after 6 weeks and 1 patient after 12 weeks. In the total group of 8 patients with SD, 4 presented IGA 0 after 4 weeks of therapy, while 4 patients demonstrated IGA 1 after 6 weeks. Patients with AV required 8 and 10 weeks to obtain IGA 1. Nineteen patients of the studied group reported "very good" or "excellent" response to the therapy, only one patient with AV assessed therapy with topical ivermectin as "good". The adverse events were transient and manifested as mild-moderate desquamation, stinging and burning in 2 patients with PD. CONCLUSIONS: Topical ivermectin was well tolerated and beneficial for treatment of mild and moderate PD, SD and AV.

Trichoscopy of cicatricial alopecia.

BACKGROUND: Trichoscopy is widely used in differential diagnosis of non-cicatricial alopecia. OBJECTIVE: The aim of this prospective study was to identify possible characteristic trichoscopy patterns of diseases leading to primary cicatricial alopecia. METHODS: Trichoscopy was performed in a total of 1,884 consecutive patients presenting with hair loss. In this group, 84 patients were diagnosed with cicatricial alopecia and 1,800 patients with non-cicatricial alopecia. Sixty healthy persons served as healthy controls. Trichoscopy was performed with the use of Fotofinder II videodermoscopy system. Following unique or characteristic features were identified: scattered dark-brown discoloration of the skin, large yellow dots and thick arborizing vessels in cutaneous (discoid) lupus erythematosus (n=20), tubular perifollicular scaling and elongated blood vessels in lichen planopilaris (n=28), minor perifollicular scaling in frontal fibrosing alopecia (n=19), tufted hairs with starburst pattern perifollicular hyperplasia in folliculitis decalvans (n=9) and large, "3D" yellow dots imposed over dystrophic hairs in dissecting cellulitis (n=8). RESULTS: All patients with cicatricial alopecia trichoscopy showed white and milky-red areas lacking follicular openings. These features were not found in patients with non-cicatricial alopecia or healthy controls. CONCLUSION: These results indicate that trichoscopy may be applied as a quick and non-invasive auxiliary method in differential diagnosis of diverse diseases leading to cicatricial alopecia, such as cutaneous lupus erythematosus, classic lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, and dissecting cellulitis.

Long-Term Use of Silybum marianum fruit extract Contributes to Homeostasis in Acne-Prone Skin-A 12-Month Follow-Up International "Real Life" Cohort Study.

BACKGROUND: Homeostasis in the differentiation programme of sebaceous stem cells has been identified as a key step in comedogenesis and should be a target for acne-prone skin care. OBJECTIVE: To report on a multicentre, year-long/real-life use study of a patented natural product containing S. marianum fruit extract proven to modulate molecular actors in the initial steps of comedogenesis. METHODS: An open-label multicentric international study, with a 12 month follow-up, included 54 teenage and young adult subjects with mild to moderate facial acne. The study was aimed at reproducing a real-life use context. RESULTS: Total lesion count mean was 88.3 at inclusion. There was a sustained, highly significant decrease over the months of clinical lesion counts (45.6% improvement after 6 months and 59.6% at 12 months) and on other efficacy markers, associated with a significant decrease in global microcomedone quantity on cyanoacrylate superficial skin surface biopsies. Importantly, the study protocol allowed the dermatologist to prescribe, if needed as in real life, any of the acne drugs registered in the acne guidelines. The exposure to these acne drugs during the whole year was calculated as a percentage of S. marianum fruit extract/352 days of use and happened to be very limited at less than 4%, which indicates a marginal contribution to the sustained clinical improvement. (Oral and local acne treatments: Lymecycline 1.46%; Doxycycline 0.24%; Adapalene 0.16% or gel association with Benzoyl peroxide 1.17%; Clindamycin 0.04%; Benzoyl peroxide 1.5%; Erythromycin 0.75%). The tolerance with daily S. marianum fruit extract long-term use was good. LIMITATIONS: The association with routine prescription acne drugs when needed, even if limited, does not allow a full evaluation of the intrinsic quantitative efficacy of S. marianum fruit extract in lesion reduction. CONCLUSION: This open, real-life, year-long multicentre study confirms a previous 48-week proof of concept study and qualifies the use of S. marianum fruit extract as a "field-dermo cosmetic" contributing to homeostasis of acne-prone skin in association with acne drugs.

Dermoscopy of Small Diameter Melanomas with the Diagnostic Feasibility of Selected Algorithms-A Clinical Retrospective Multicenter Study.

OBJECTIVE: The aim of the study was to verify two hypotheses. The first concerned the possibility of diagnostic dermoscopic differentiation between cutaneous melanomas of the histopathological category in situ (pTis) and thin melanomas (pT1a) in terms of their diameter. The second assessed the diagnostic feasibility of two dermoscopic algorithms aiming to detect ≤ 5.0 mm-sized melanomas histopathologically confirmed as pTis and pT1a. METHODS: Dermoscopic images of consecutive cases of histopathologically confirmed melanomas were evaluated by three independent investigators for the presence of the predefined criteria. The melanomas were subdivided according to their diameter into small melanomas, so-called micromelanomas (microM)-sized ≤ 5.0 mm and >5.0 mm, according to published definitions of small melanocytic lesions. The Triage Amalgamated Dermoscopic Algorithm (TADA) and the revisited 7-point checklist of dermoscopy (7-point) algorithm were chosen for the diagnostic feasibility. Odds ratios and corresponding 95% confidence limits (CL) were calculated using the logistic regression adjusted for age for the melanoma-specific dermoscopic structures, the dermoscopic patterns and the diagnostic feasibility of the 7-point checklist and TADA algorithms. The p-values of the results were corrected using the Bonferroni method. RESULTS: In total, 106 patients with 109 melanomas, 50 sized ≤ 5.0 mm and 59 exceeding the diameter of 5.0 mm, were retrospectively analyzed. The prevalent general pattern of microM was the spitzoid one (48% vs. 11.86%, p = 0.0013). Furthermore, 40% of microM vs. 6.78% melanomas sized > 5.0 mm (p = 0.0023) did not present melanoma-specific patterns. The asymmetric multicomponent pattern was present in 64.41% melanomas sized > 5.0 mm and in 26.00% microM (p = 0.0034). The asymmetry of structures or colors was detected in 56% microM vs. 89.83% (p = 0.0020) and 56% microM and 94.92% (p = 0.000034) melanoma sized > 5.0 mm, respectively. The differences in frequency of the detected dermoscopic structures specific to melanomas revealed that microM are almost deprived of negative networks (p = 0.04), shiny white structures (p = 0.0027) and regression features (p = 0.00003). Neither prominent skin markings nor angulated lines were found in the entire study group. Out of the vascular structures, microM presented only dotted (32%) or polymorphous (28%) vessels, although more rarely than melanomas sized > 5.0 mm (66.1% p = 0.017 and 49% p > 0.05, respectively). The diagnostic feasibility revealed a score ≥ 3 of the 7-point algorithm (indicative for malignancy) in 60% microM and 98.31% melanomas sized > 5.0 mm (p = 0.000006). The TADA algorithm revealed melanoma-specific patterns in 64% microM and 96.61% > 5.0 mm-sized melanomas (p = 0.00006) and melanoma-specific structures in 72% and 91.53% (p > 0.05), respectively. CONCLUSION: In the dermoscopy, 40% of micromelanomas histopathologically staged as pTis and pT1a did not reveal melanoma-specific patterns. Among the general melanocytic patterns, the spitzoid one was the most frequently found in melanomas sized ≤ 5.0 mm. The 7-point checklist and TADA dermoscopic algorithms were helpful in the identification of the majority of melanomas sized ≤ 5.0 mm.

Hair shaft videodermoscopy in netherton syndrome.

Netherton syndrome is an autosomal recessive disorder, characterized by ichthyosis, atopic manifestations, and hair shaft abnormalities (trichorrhexis invaginata). The diagnosis of Netherton syndrome may be established on the basis of just one abnormal hair, but it is often difficult to find a hair with pathognomonic features on light microscopic examination. Every attempt requires pulling new hairs. We present the case of an 11-year-old female patient with Netherton syndrome in whom hair and scalp videodermoscopy (trichoscopy) was used to visualize typical bamboo hairs and hairs with golf tee type endings in the scalp hairs and eyebrows. Trichoscopy is a method, which allows noninvasive viewing of hair shafts in many-fold magnification without the need of pulling hair for diagnostic purposes. This case shows that trichoscopy may be employed to significantly improve the chance of establishing the diagnosis of Netherton syndrome in patients.

Comparison of treatment standards in Atopic Dermatitis management across selected geographies prior to emerging targeted therapies onset.

Atopic Dermatitis (AD) is a chronic inflammatory disease persisting predominantly in the pediatric population. Treatment is generally supervised by various medical specialists, including primary care practitioners, allergists, and dermatologists. This divergence in disease management allows various therapeutic approaches to be administered to patients by supervised physicians. This article covers etiology of the disease and summarizes dermatologic treatment standards of selected countries binding prior to the registration of dupilumab by both the European Medicines Agency (EMA) and Federal Drug Administration (FDA) in 2017. Before recent development in targeted therapies (small molecules and biologic agents), standards in AD treatment remained unchanged for years with extensive similarities across a sample group of countries in particular geographic and economic regions. The spectrum of available and popular therapeutic options can be categorized into three dominating groups: non-pharmacologic, pharmacologic, and systemic interventions. Their prescription, in principle, was historically driven by disease severity and previous treatment history. However, advances in targeted therapies may change AD management guidelines and medical care standards.

Epidemiology of atopic dermatitis in Europe.

Atopic dermatitis (AD) is a chronic inflammatory disease persisting predominantly in the pediatric population. Its development is most presumably multifactorial and a derivative of interplay between genetic, immunologic, and environmental causes. To the authors' knowledge, no multinational and systematic database of AD prevalence is established and maintained for Europe. Thus, epidemiologic data originating from the multinational studies was compiled to draw a picture of AD in both pediatric and adult populations in Europe. The outcomes of this exercise support the general observation that AD prevalence follows the latitudinal pattern with higher prevalence values in northern Europe and decreases progressively towards southern Europe. Noteworthy, the data shows significant differences on the country-level, with higher prevalence in municipal areas than rural. Finally, and unsurprisingly, the collected data reinforces the observation of AD prevalence being highest in pediatric populations in contrast to adults. Herein, data presented was additionally supplemented with the information on current standing on AD etiology.

Comma hairs: a dermatoscopic marker for tinea capitis: a rapid diagnostic method.

BACKGROUND: Dermatoscopy and videodermatoscopy have been used for several years in the diagnosis of skin disorders. OBJECTIVE: We sought to determine whether tinea capitis (TC) shows characteristic videodermatoscopy features that may facilitate its differentiation from alopecia areata (AA). METHODS: Two patients with TC caused by Microsporum canis, confirmed by mycological culture and fluorescence under Wood lamp, were examined with videodermatoscopy and results were compared with videodermatoscopy results of 12 patients with AA. RESULTS: The distinctive and most prominent feature of TC was presence of commalike structures (comma hairs). These were accompanied by broken and dystrophic hairs. Videodermatoscopy features of AA included exclamation mark hairs, vellus and dystrophic/cadaverized hairs, and yellow dots corresponding to hyperkeratotic hair follicle plugs. LIMITATIONS: This study was conducted on two patients, both with M canis infection. CONCLUSIONS: Comma hairs were observed as a distinctive videodermatoscopy feature of M canis-induced TC. This finding was not observed in AA, typified generally by exclamation mark hairs.

Trichoscopy: a new method for diagnosing hair loss.

Videodermoscopy of hair and scalp (trichoscopy) is gaining popularity as a valuable tool in differential diagnosis of hair loss. This method allows viewing of the hair and scalp at X20 to X160 magnifications. Structures which may be visualized by trichoscopy include hair shafts of different types: vellus, terminal, micro-exclamation mark type, monilethrix, Netherton type, and pili annulati hairs. The number of hairs in one pilosebaceous unit may be assessed. It may be distinguished whether hair follicles are normal, empty, fibrotic ("white dots"), filled with hyperkeratotic plugs ("yellow dots") or containing cadaverized hair ("black dots"). Abnormalities of scalp skin color or structure which may be visualized by trichoscopy include honeycomb-type hyperpigmentation, perifollicular discoloration (hyperpigmentation), and scaling.

Dermoscopy in female androgenic alopecia: method standardization and diagnostic criteria.

OBJECTIVE: Establishing the trichoscopy criteria of female androgenic alopecia (FAGA). DESIGN: Trichoscopy images were retrospectively evaluated. SETTING: Dermatologic hospital-based clinic and private practice offices. PATIENTS AND METHODS: One hundred and thirty-one females (59 with androgenic alopecia, 33 with chronic telogen effluvium (CTE), 39 healthy controls). The diagnosis was based on clinical examination and confirmed by histopatology. MAIN OUTCOME MEASURE: Trichoscopy results obtained in frontal, occipital and both temporal areas of the scalp under a 20-fold and 70-fold magnification, including average hair thickness, number of 'yellow dots' and vellus hairs, number of hairs in one pilosebaceous unit and percentage of follicular ostia with perifollicullar hyperpigmentation. RESULTS: Average hair thickness in frontal area versus occiput was, respectively, 0.061 ± 0.008 mm versus 0.058 ± 0.007 mm in healthy controls, 0.047 ± 0.007 mm versus 0.052 ± 0.008 mm in androgenic alopecia and 0.056 ± 0.007 mm versus 0.053 ± 0.009 mm in CTE. Mean percentage of thin hairs (< 0.03 mm) in androgenic alopecia was 20.9 ± 12% and was significantly higher than in healthy controls (6.15 ± 4.6%, P < 0.001) or in CTE (10.4 ± 3.9%, P < 0.001). The number of yellow dots, pilosebaceous units with only one hair and with perifollicular hyperpigmentation was significantly increased in androgenic alopecia. Classification and Regression Tree Analysis was performed to establish diagnostic criteria for FAGA. CONCLUSION: FAGA may be differentiated from CTE based on trichoscopy criteria. Major criteria are ratio of (1) more than four yellow dots in four images (70-fold magnification) in the frontal area, (2) lower average hair thickness in the frontal area compared to the occiput and (3) more than 10% of thin hairs (below 0.03 mm) in the frontal area. Minor criteria encompass increased frontal to occipital ratio of (1) single-hair pilosebaceous units, (2) vellus hairs and (3) perifollicular discoloration. Fulfillment of two major criteria or one major and two minor criteria allows to diagnose FAGA based on trichoscopy with a 98% specificity.

Trichoscopy in genetic hair shaft abnormalities.

BACKGROUND: Diagnosis of hair shaft abnormalities is based on light microscopic examination of more than 50 plucked hairs. The aim of this study was to verify whether hair shaft abnormalities may be visualized by trichoscopy (hair and scalp videodermoscopy) and to analyze trichoscopic features of common genetic hair shaft dysplasias. METHOD: Patients with known genetic hair shaft disorders were included into the study. Trichoscopy was performed with the use of Fotofinder II videodermoscope. Images performed at 20-fold and 70-fold magnification were analysed. In selected cases 160-fold magnification was used for better visualization of hair shafts. RESULTS: Our results show that characteristic light microscopy features of Netherton syndrome, monilethrix, woolly hair syndrome, pili torti, pili annulati and trichothiodystrophy may be visualized by trichoscopy. CONCLUSION: Genetic hair shaft abnormalities may be diagnosed by trichoscopy in a single diagnostic session without the need of plucking or cutting them for diagnostic purposes.

Cylindroma transforming into basal cell carcinoma in a patient with Brooke-Spiegler syndrome.

BACKGROUND: Brooke-Spiegler syndrome is a rare condition with a predisposition to develop cutaneous adnexal neoplasms, especially cylindromas, trichoepitheliomas and spiradenomas. Malignant transformation of cylindromas is rare. In such cases usually cylindrocarcinomas develop within these lesions. We present an unusual case of basal cell carcinoma developing within a preexisting cylindroma. MAIN OBSERVATIONS: 58-year-old woman with a 30-year history of multiple dermal cylindromas extensively involving her scalp was referred for dermatological treatment. The patient reported that one of the long-lasting lesions, 5.5 cm in size, ulcerated within the foregoing few weeks. Histopathology confirmed cylindromas and basal cell carcinoma within the ulcerating tumor. Surgical excision of largest cylindroma tumors led to cosmetic and functional improvement. Magnetic resonance and computed tomography showed tumor infiltration into the skull lamina externa. Metastases were excluded by chest radiography and abdominal ultrasound examination. CONCLUSION: Patients with Brooke-Spiegler syndrome should be followed-up for malignant transformation of skin tumors to prevent deep penetration and possible metastases.