Pigmented Deposits in the Skin

Cardiodermatology: the heart of the connection between the skin and cardiovascular disease

The skin and cardiovascular systems are connected in unique and meaningful ways, and many diseases conventionally considered as being limited to one organ system are more closely related than previously believed. Major cardiovascular diseases and phenomena such as infective endocarditis, congestive heart failure, Kawasaki disease and thromboembolism are associated with specific skin findings, and advances in genetics, immunology and clinical epidemiology show that inflammatory dermatological diseases, such as psoriasis, have serious cardiovascular and cardiometabolic consequences. Additionally, commonly used cardiovascular therapies, such as antihypertensive medications, are associated with important cutaneous adverse effects, including photosensitivity, photocarcinogenesis and eczematous skin reactions. Moreover, systemic dermatological therapies, including retinoids, Janus kinase inhibitors and biologics, can alter the risk of cardiovascular and cardiometabolic diseases. In this Review on cardiodermatology, we provide interdisciplinary insights from dermatology and cardiology that will be of practical use to both cardiologists and generalists who manage cardiovascular and cardiometabolic diseases in patients with dermatological findings or histories. We discuss specific skin findings associated with cardiovascular diseases to aid in diagnosis; important cutaneous adverse effects of common cardiovascular therapies, for the purpose of treatment monitoring; and the effect of dermatological diseases and dermatological treatment on cardiovascular risk.

Drug-Induced Pigmentation: A Review

Drug-induced pigmentation (DIP) is estimated to account for 20% of all cases of acquired hyperpigmentation. Over 50 agents have been implicated, including antibiotics, antimalarials, antiretrovirals, antipsychotics, prostaglandin analogs, heavy metals, and chemotherapeutic agents. The skin, mucosal surfaces, nails, and hair can all be affected, with the color, distribution, onset, and duration of pigmentation varying between offending agents. Both a thorough physical examination and medication history are necessary to determine the offending agent. In terms of mechanism, DIP occurs most frequently through the accumulation of melanin within the dermis but also by drug accumulation, pigment synthesis, and iron deposition. Photoprotection, including applying a broad-spectrum sunscreen, wearing photoprotective clothing, and seeking shade, plays an important role in the prevention of exacerbation of DIP. Multiple lasers, including the picosecond alexandrite, Q-switched Nd:YAG, Q-switched alexandrite, and Q-switched ruby lasers, have been successful in obtaining clearance of DIP. In this review, we examine the unique characteristics of each of the inciting agents in terms of incidence, clinical presentation, time to onset and resolution, and pathogenesis.

Social media influenced self-application of cyanoacrylate for double chin reduction in an adolescent girl: an unusual case of post-inflammatory hyperpigmentation

INTRODUCTION

Cyanoacrylate, used as a topical adhesive for wound closure in clinical settings, can result in poor cosmetic outcome on application to skin. Lack of formal medical or dermatological training among social media influencers poses risks of improper diagnosis, incorrect treatments, ineffective home remedies, and potential self-injury or long-term skin effects, especially among adolescents.

CASE PRESENTATION

The authors present a case of a young girl with a persistent post-inflammatory hyperpigmentation after using cyanoacrylate on her chin as a home remedy to reduce her double chin problem after learning from a video on social media. Biopsy findings were consistent with post-inflammatory hyperpigmentation in dermis.

CLINICAL DISCUSSION

Application of cyanoacrylate over skin can result in allergic reactions, burn injuries, infections, itching, skin blistering, and aesthetic issues. Persistent post-inflammatory hyperpigmentation can be a poor cosmetic outcome on application of cyanoacrylate over skin.

CONCLUSION

Inadequate social media safety regulations require healthcare professionals to be aware of social trends among adolescents and to encourage them for open conversations and professional help-seeking during times of distress in this digital era.

In vitro anti-melanogenic effect of Perilla frutescens leaf extracts

Introduction: Perilla frutescens (L.) Britt leaves contain various phenolic compounds, especially flavonoids, which potentially inhibit tyrosinase, the key enzyme catalyzing the melanin synthesis pathway. This work aimed to investigate the anti-melanogenic effect of Perilla frutescens extracts through the inhibition of non-cellular as well as cellular tyrosinase activities. Methods: The total extract from Perilla frutescens leaves was obtained by percolation method with 50% ethanol followed by liquid–liquid partition with ethyl acetate (EA) and chloroform (CF) to obtain the EA, CF and EA/CF extracts. The mushroom tyrosinase inhibitory effect of the obtained extracts was screened by dopachrome formation reactions from its substrate 3,4-dihydroxy-L-phenylalanine. The extracts with potential activity were further evaluated for the anti-melanogenic effects in the B16F10 melanoma cell line. Results: EA and EA/CF extracts significantly inhibited mushroom tyrosinase activity with the IC50s of 0.14 and 0.07 mg/mL, respectively, in the same range of that from kojic acid (0.12 mg/mL). Consistently, in B16F10 cells, these extracts inhibited tyrosinase enzyme; their IC50 values were 2 times lower than that of kojic acid. Moreover, both EA and EA/CF extracts remarkably reduced melanin levels in a concentration-dependent manner. Conclusion: The EA and EA/CF extracts from Perilla frutescens leaves were able to inhibit melanogenesis by reducing tyrosinase activity.

Health Implications and Counseling Considerations for Individuals With Piercings and Tattoos

Body art has become common and mainstream. Tattoos and body piercings represent highly individual expressions of identity and personal values. Health care services are enhanced when clinicians understand the anatomy and physiology, common discomforts, and real but rare serious risks of body modification and are prepared to provide compassionate support for individuals' choices. Special consideration must be given to the needs of childbearing women. By opening channels of communication, clinicians can engage with clients in shared decision making to help those who possess or desire body art take steps to reduce the risk of adverse effects and obtain prompt and effective medical care when problems arise. Through respectful discussion of existing body art, the therapeutic relationship is strengthened, and greater insight into an individual's health needs may be achieved.