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Griffiths Acha J, Gamo Villegas R, Floristán Murúzabal U, Pampín Franco A, Sarró Fuente C, Pinedo Moraleda F, López Estebaranz JL. Extrafacial lentigo maligna: A progression model and enhanced diagnostic techniques using dermatoscopy and reflectance confocal microscopy. J Cutan Pathol 2024. [PMID: 38837796 DOI: 10.1111/cup.14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/18/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
Lentigo maligna (LM) is a subtype of lentiginous melanoma confined to the epidermis, which is associated with chronic sun exposure. Its clinical, dermatoscopic, and histopathological diagnosis can be challenging, particularly in the early and advanced stages, requiring appropriate clinicopathological correlation. This article reviews the clinical presentation, diagnosis through noninvasive methods (dermoscopy and confocal microscopy), and provides insights for diagnosis of extrafacial LM through the presentation of four representative clinical cases from different phases of a theoretical-practical progression model. Recognizing these lesions is crucial, as once they invade the dermis, they can behave like any other type of melanoma.
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Samaniego González E, González Morán MA, Onecha Vallejo V, de la Hera Magallanes AI, Navedo de Las Heras M, Rodríguez Prieto MÁ. [Translated article] Thirty-Five-Case Retrospective Observational Study of Lentigo Maligna and Acral Lentiginous Melanoma Surgically Treated With a Modified Spaghetti Technique>. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T632-T635. [PMID: 38648937 DOI: 10.1016/j.ad.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/13/2023] [Indexed: 04/25/2024] Open
Affiliation(s)
- E Samaniego González
- Servicio de Dermatología, Complejo Asistencial de León, León, Spain; Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain.
| | - M A González Morán
- Servicio de Anatomía Patológica, Complejo Asistencial de León, León, Spain
| | - V Onecha Vallejo
- Servicio de Dermatología, Complejo Asistencial de León, León, Spain
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3
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Samaniego González E, González Morán MA, Onecha Vallejo V, de la Hera Magallanes AI, Navedo de Las Heras M, Rodríguez Prieto MÁ. Thirty-Five-Case Retrospective Observational Study of Lentigo Maligna and Acral Lentiginous Melanoma Surgically Treated With a Modified Spaghetti Technique. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:632-635. [PMID: 38373608 DOI: 10.1016/j.ad.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 02/21/2024] Open
Affiliation(s)
- E Samaniego González
- Servicio de Dermatología, Complejo Asistencial de León León, España; Institute of Biomedicine (IBIOMED), Universidad de León, León, España.
| | - M A González Morán
- Servicio de Anatomía Patológica, Complejo Asistencial de León, León, España
| | - V Onecha Vallejo
- Servicio de Dermatología, Complejo Asistencial de León León, España
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Rudolph V, Leven AS, Eisenburger R, Schadendorf D, Wiegand S. Interdisciplinary management of skin cancer. Laryngorhinootologie 2024; 103:S100-S124. [PMID: 38697144 DOI: 10.1055/a-2171-4570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The interdisciplinary treatment of skin cancer in the head and neck area requires close collaboration between different specialist disciplines. The most common non-melanoma skin cancer tumor entities are cutaneous squamous cell carcinoma and basal cell carcinoma as well as their precursor lesions. One of the less common tumors is Merkel cell carcinoma, which also occurs primarily in light-exposed areas and, in contrast to squamous and basal cell carcinoma, is more likely to metastasize. Due to the low tendency of basal cell carcinoma as well as cutaneous squamous cell carcinoma to metastasize, a cure can often be achieved by surgery. If the tumor growth exceeds certain levels it may require collaboration between dermatology and otorhinolaryngology. The primary goal of this interdisciplinary collaboration is to achieve a functional, cosmetically and aesthetically acceptable result in addition to adequate tumor treatment. Depending on the stage of the tumor and the clinical course, a case may be discussed in an interdisciplinary tumor board in order to determine a personalised, appropriate and adequate treatment concept for each patient, including prevention, therapy and follow-up.
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Affiliation(s)
- Victoria Rudolph
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Anna-Sophia Leven
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Robin Eisenburger
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Klinik für Dermatologie, Universitätsmedizin Essen & Westdeutsches Tumorzentrum, Essen & Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partnerstandort Essen/Düsseldorf & Nationales Centrum für Tumorerkrankungen (NCT)-West, Campus Essen, & Research Alliance Ruhr, Research Center One Health, Universität Duisburg-Essen, Essen, Germany
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
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Ungureanu L, Vasilovici AF, Trufin II, Apostu AP, Halmágyi SR. Lentigo Maligna Treatment-An Update. J Clin Med 2024; 13:2527. [PMID: 38731056 PMCID: PMC11084749 DOI: 10.3390/jcm13092527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/06/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Lentigo maligna (LM) is a melanoma in situ that is prevalent in chronically sun-damaged skin. Characterized by a slow growth pattern and high mutation rates due to chronic UV exposure, LM poses diagnostic and therapeutic challenges, particularly given its tendency to mimic other skin lesions and its occurrence in cosmetically sensitive areas. Its diagnosis is based on an integrated approach using dermoscopy and reflectance confocal microscopy (RCM). Despite its slow progression, LM can evolve into lentigo maligna melanoma (LMM), making its treatment necessary. Treatment modalities encompass both surgical and non-surgical methods. Surgical treatments like Wide Local Excision (WLE) and Mohs Micrographic Surgery (MMS) aim for clear histological margins. WLE, a standard melanoma surgery, faces challenges from LM's subclinical extensions, which increase the recurrence risk. MMS, effective for large or poorly defined lesions, is defined by precise margin control while considering cosmetic outcomes. Non-surgical options, including radiotherapy and imiquimod, are alternatives for non-surgical candidates. Radiotherapy has been effective since the 1950s, offering good control and cosmetic results, especially for older patients. Imiquimod, an immunomodulator, shows promise in treating LM, though its application remains off-label. The increasing incidence of LM/LMM necessitates a balance in treatment choices to minimize recurrence and maintain cosmetic integrity. A multidisciplinary approach, integrating clinical examination with dermoscopy and RCM and histological assessment, is essential for accurate diagnosis and effective LM management.
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Affiliation(s)
- Loredana Ungureanu
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Alina Florentina Vasilovici
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | | | - Adina Patricia Apostu
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases, 400000 Cluj-Napoca, Romania
| | - Salomea-Ruth Halmágyi
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases, 400000 Cluj-Napoca, Romania
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Drakensjö IRT, Hedblad MA, Colón Cervantes E, Girnita A. Nevus-associated Lentigo Maligna and Lentigo Maligna Melanoma, Clinicopathological Features. Acta Derm Venereol 2024; 104:adv18381. [PMID: 38629956 DOI: 10.2340/actadv.v104.18381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
Nevus-associated lentigo maligna and lentigo maligna melanoma (NALMM) are rarely described in the literature and are considered an incidental finding. This study aimed to evaluate the frequency of NALMM and its clinicopathological features. A total of 201 histopathology reports were reviewed and among them 20% of the samples corresponded to NALMM, with females overrepresented in this group (p = 0.02). A significant association was also observed between NALMM with the presence of multiple nevi (p = 0.01), and dysplastic nevi (p = 0.04). Moreover, the risk of developing a second melanoma of nevus-associated type was 4.3 times higher in patients with NALMM. These results indicate that NALMM is more frequent than previously reported, suggesting that the associated nevus could interact or even act as a precursor for LM/LMM. Future studies with larger samples allied to techniques like confocal microscopy and molecular analysis are essential to determine this biological link between nevus and LM/LMM.
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Affiliation(s)
- Iara R T Drakensjö
- Skin Cancer Center, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical and Surgical Pathology, Unilabs, Stockholm, Sweden.
| | - Mari-Anne Hedblad
- Department of Clinical and Surgical Pathology, Unilabs, Stockholm, Sweden
| | | | - Ada Girnita
- Skin Cancer Center, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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Marrapodi R, Bellei B. The Keratinocyte in the Picture Cutaneous Melanoma Microenvironment. Cancers (Basel) 2024; 16:913. [PMID: 38473275 DOI: 10.3390/cancers16050913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Melanoma progression is a multistep evolution from a common melanocytic nevus through a radial superficial growth phase, the invasive vertical growth phase finally leading to metastatic dissemination into distant organs. Melanoma aggressiveness largely depends on the propensity to metastasize, which means the capacity to escape from the physiological microenvironment since tissue damage due to primary melanoma lesions is generally modest. Physiologically, epidermal melanocytes are attached to the basement membrane, and their adhesion/migration is under the control of surrounding keratinocytes. Thus, the epidermal compartment represents the first microenvironment responsible for melanoma spread. This complex process involves cell-cell contact and a broad range of secreted bioactive molecules. Invasion, or at the beginning of the microinvasion, implies the breakdown of the dermo-epidermal basement membrane followed by the migration of neoplastic melanocytic cells in the superficial papillary dermis. Correspondingly, several experimental evidences documented the structural and functional rearrangement of the entire tissue surrounding neoplasm that in some way reflects the atypia of tumor cells. Lastly, the microenvironment must support the proliferation and survival of melanocytes outside the normal epidermal-melanin units. This task presumably is mostly delegated to fibroblasts and ultimately to the self-autonomous capacity of melanoma cells. This review will discuss remodeling that occurs in the epidermis during melanoma formation as well as skin changes that occur independently of melanocytic hyperproliferation having possible pro-tumoral features.
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Affiliation(s)
- Ramona Marrapodi
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, IRCCS, Via Elio Chianesi 53, 00144 Rome, Italy
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Longo C, Sticchi A, Curti A, Kaleci S, Moscarella E, Argenziano G, Thomas L, Guitera P, Huang C, Tiodorovic D, Apalla Z, Peris K, Del Regno L, Guida S, Lallas A, Kittler H, Pellacani G, Navarrete-Dechent C. Lentigo maligna and lentigo maligna melanoma in patients younger than 50 years: a multicentre international clinical-dermoscopic study. Clin Exp Dermatol 2024; 49:128-134. [PMID: 37758301 DOI: 10.1093/ced/llad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Lentigo maligna/lentigo maligna melanoma (LM/LMM) is usually diagnosed in older patients, when lesions are larger. However, it is important to detect it at an earlier stage to minimize the area for surgical procedure. OBJECTIVES To determine and define clinical, dermoscopic and reflectance confocal microscopy (RCM) features of LM/LMM in patients < 50 years old. METHODS This was a multicentre study involving tertiary referral centres for skin cancer management. The study included cases of consecutively excised LM/LMM arising in patients < 50 years of age with a histopathological diagnosis of LM/LMM and a complete set of clinical and dermoscopic images; RCM images were considered when present. RESULTS In total, 85 LM/LMM of the face from 85 patients < 50 years were included in the study. A regression model showed a direct association with the size of the lesion (R2 = 0.08; P = 0.01) and with the number of dermoscopic features at diagnosis (R2 = 0.12; P < 0.01). In a multivariable analysis, an increasing number of dermoscopic features correlated with increased patient age (P < 0.01), while the presence of grey colour was a predictor of younger age at diagnosis (P = 0.03). RCM revealed the presence of melanoma diagnostic features in all cases (pagetoid cells and atypical nesting). CONCLUSIONS LM is not a disease limited to older people as previously thought. LM presenting in young adults tends to be smaller and with fewer dermoscopic features, making its diagnosis challenging. Careful evaluation of facial pigmented lesions prior to cosmetic procedures is imperative to avoid incorrectly treating early LM as a benign lesion.
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Affiliation(s)
- Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Alberto Sticchi
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Alex Curti
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Shaniko Kaleci
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elvira Moscarella
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luc Thomas
- Department of Dermatology, Claude Bernard University Lyon 1, and Cancer Research Center Lyon, Lyon, France
| | - Pascale Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Melanoma Institute Australia, Sydney, NSW, Australia
| | - Chen Huang
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Danica Tiodorovic
- Clinic of Dermatovenereology, Clinical Centre Nis, Medical Faculty, University of Nis, Serbia
| | | | - Ketty Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Laura Del Regno
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Stefania Guida
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Dermatology Clinic, IRCCS San Raffaele Hospital, Milan, Italy
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Austria
| | - Giovanni Pellacani
- Department of Dermatology and Venereology at the University of La Sapienza, Rome, Italy
| | - Cristian Navarrete-Dechent
- Department of Dermatology
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Hoang MP, Karpinski P, Zúñiga-Castillo M, Foreman RK, Emerick KS, Sober AJ. Histologic margin status is a predictor of relapse in lentigo maligna melanoma. J Am Acad Dermatol 2023; 89:959-966. [PMID: 37454699 DOI: 10.1016/j.jaad.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/03/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Most surgical margins for lentigo maligna melanomas reported in the literature are clinical and not histologic. OBJECTIVES We sought to determine whether histologic margin status is an independent predictor of progression. METHODS Clinicopathologic information of 268 invasive lentigo maligna melanomas diagnosed from 1990-2019 were analyzed. Statistical analyses were performed using Cox proportional hazards model and Boruta method. RESULTS A total of 75% of the lesions were located on the head and neck. The range of follow-up for all patients was 0 to 31.8 years (median, 10.2 years). Time to local recurrence ranges from 0 to 20 years (median, 3 years). Progression developed in 54 (20.1%) of 268 patients. Local recurrence was seen only in 36 (13.4%), both local recurrence and subsequent metastasis in 7 (2.6%), and only metastasis in 11 (4.1%) of 268 patients. Histologic margin status (positive and close/<3 mm) and tumor site (head and neck location) significantly correlated with worse progression-free survival. LIMITATIONS Single institution and retrospective study. CONCLUSIONS Histologic margin status is the strongest predictor of progression for lentigo maligna melanoma. Patients with positive or close/<3 mm histologic margins should consider a re-excision due to the increased risk of relapse.
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Affiliation(s)
- Mai P Hoang
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Pawel Karpinski
- Department of Genetics, Wroclaw Medical University, Wroclaw, Poland; Laboratory of Genomics and Bioinformatics, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Miguel Zúñiga-Castillo
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ruth K Foreman
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kevin S Emerick
- Department of Surgery, Massachusetts Eye and Ear Institute and Harvard Medical School, Boston, Massachusetts
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Liu Z, Qiu D, Yang T, Su J, Liu C, Su X, Li A, Sun P, Li J, Yan L, Ding C, Zhang S. Research Progress of Dihydroquercetin in the Treatment of Skin Diseases. Molecules 2023; 28:6989. [PMID: 37836832 PMCID: PMC10574795 DOI: 10.3390/molecules28196989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Skin is a barrier to maintaining the stability of the human environment and preventing the invasion of pathogens. When skin tissue is exposed to the external environment, it will inevitably develop defects due to trauma, injury, burns, ulcers, surgery, and chronic diseases. Rapid skin repair is the key to reducing infection, relieving pain, and improving quality of life. Dihydroquercetin is a kind of flavonoid that has a wide range of pharmacological activities and can improve skin repair, skin inflammation, skin cancer, and so on. In this paper, the application of dihydroquercetin in medical dressings and the research progress in the treatment of skin-related diseases are reviewed, so as to provide reference for further developing dihydroquercetin as a drug for the treatment of skin diseases.
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Affiliation(s)
- Ziyang Liu
- College of Traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132109, China; (Z.L.); (D.Q.); (T.Y.); (J.S.); (C.L.); (X.S.)
| | - Dengjun Qiu
- College of Traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132109, China; (Z.L.); (D.Q.); (T.Y.); (J.S.); (C.L.); (X.S.)
| | - Tong Yang
- College of Traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132109, China; (Z.L.); (D.Q.); (T.Y.); (J.S.); (C.L.); (X.S.)
| | - Jingxu Su
- College of Traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132109, China; (Z.L.); (D.Q.); (T.Y.); (J.S.); (C.L.); (X.S.)
| | - Chengyuan Liu
- College of Traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132109, China; (Z.L.); (D.Q.); (T.Y.); (J.S.); (C.L.); (X.S.)
| | - Xinyue Su
- College of Traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132109, China; (Z.L.); (D.Q.); (T.Y.); (J.S.); (C.L.); (X.S.)
| | - Anning Li
- Jilin Aodong Yanbian Pharmaceutical Co., Ltd., Yanbian Korean Autonomous Prefecture, Dunhua 133700, China; (A.L.); (P.S.); (J.L.); (L.Y.)
| | - Pingping Sun
- Jilin Aodong Yanbian Pharmaceutical Co., Ltd., Yanbian Korean Autonomous Prefecture, Dunhua 133700, China; (A.L.); (P.S.); (J.L.); (L.Y.)
| | - Jianguo Li
- Jilin Aodong Yanbian Pharmaceutical Co., Ltd., Yanbian Korean Autonomous Prefecture, Dunhua 133700, China; (A.L.); (P.S.); (J.L.); (L.Y.)
| | - Li Yan
- Jilin Aodong Yanbian Pharmaceutical Co., Ltd., Yanbian Korean Autonomous Prefecture, Dunhua 133700, China; (A.L.); (P.S.); (J.L.); (L.Y.)
| | - Chuanbo Ding
- College of Traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132109, China; (Z.L.); (D.Q.); (T.Y.); (J.S.); (C.L.); (X.S.)
- Jilin Aodong Yanbian Pharmaceutical Co., Ltd., Yanbian Korean Autonomous Prefecture, Dunhua 133700, China; (A.L.); (P.S.); (J.L.); (L.Y.)
| | - Shuai Zhang
- College of Chinese Medicinal Materials, Jilin Agricultural University, Changchun 130118, China
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