Prevalence of most common skin diseases in Europe: a population-based study

Improving the quality of life of patients with inflammatory skin diseases: a multicenter evaluation of a ceramide-containing regimen in patients with atopic dermatitis, psoriasis and xerosis

PURPOSE

Atopic dermatitis (AD), psoriasis and xerosis are characterized by alterations in the skin barrier leading to symptoms that severely impair patients' quality of life (QoL). This multicenter, prospective study evaluated the benefits of a 4-week ceramide-containing regimen on the symptoms and QoL of patients with AD, psoriasis, or xerosis.

MATERIALS AND METHODS

Clinical assessments (SCORAD, PASI, VAS), QoL and adherence to the treatment were evaluated at baseline and after 4 weeks.

RESULTS

A total of 312 patients (109 AD, 97 psoriasis and 106 xerosis) participated in the study; 59.3% female, mean age 42.4 years, no family history of AD, psoriasis or xerosis in ∼70% of patients. Significant clinical improvements after 4 weeks were reported: 61.2% reduction in SCORAD in AD; 65.5% reduction in PASI in psoriasis; and reductions in VAS for dryness, erythema and other symptoms in xerosis patients. QoL improved in all groups (67.2% AD, 64.7% psoriasis, 77.3% xerosis), with a significant proportion of patients reducing their concomitant treatments. Most patients adhered to the regimen, and no adverse reactions were reported.

CONCLUSIONS

A ceramide-containing regimen reduced the symptoms commonly associated with AD, psoriasis, and xerosis and improves patients' QoL. Limitations include the lack of control group and limiting conclusions about ceramides' contribution on effectiveness.

Diagnostic ability for common skin diseases among general practitioners working in community health service centers in Shanghai, China: a cross-sectional study

OBJECTIVE

Primary care general practitioners (GPs) play a crucial role in common skin diseases (CSDs) diagnosis and treatment for community residents. This study investigates their clinical diagnostic ability for CSDs and influencing factors among GPs in Shanghai.

METHODS

In 2023, we recruited 5745 GPs in Shanghai, and online survey was conducted among 5745 GPs with written informed consents. Images of ten CSDs was used to evaluate the diagnostic ability among GPs, logistic regression (LR) analysis was applied to explore influencing factors in GPs with a good skin diseases diagnostic ability.

RESULTS

The 5745 GPs included 1740 male (30.3%), the age ranged from 25 to 60 years with an average of age of 40.8 years. The total score for GSDs diagnostic ability ranged from 2 to 10, with a median of 7.5. In this study, GPs who have achieved ≥ 9 scores were identified as GPs with good diagnostic ability, with a prevalence of 26.7%. LR analysis indicated that GPs with 11 to 15 and over 15 years of work experience had a higher prevalence of good diagnostic ability compared with those with <5 years, the OR was 1.23 (95% CI: 1.02-1.48) and 1.25 (95% CI: 1.05-1.49) respectively. GPs with advanced studies [OR = 1.61, 95% CI:1.33-1.95] and work experience [OR = 1.39, 95% CI:1.20-1.61] in dermatology had a higher prevalence of good diagnostic ability.

CONCLUSION

The diagnostic ability for CSDs was good among GPs in Shanghai. GPs with more years of work, advanced studies and work experience in dermatology have better diagnostic abilities CSDs.

Betulinic Acid-Loaded Oleogel as a Novel Pharmaceutical Formulation for Potential Cutaneous Applications: Development, Characterization, and Biosafety Profile

Skin disorders constitute a persistent health problem, covering both acute and chronic conditions that manifest in patients of all ages. Betulinic acid (BA) is a triterpene previously studied as an efficient treatment of skin ailments due to its innate pharmacological properties. Nonetheless, due to its lipophilic nature and low bioavailability, topical delivery systems are necessary for its proper administration. Oleogels are efficient carriers for the incorporation of hydrophobic biomolecules; however, their use for the delivery of BA remains scarce. Therefore, this study was designed to develop, characterize, and evaluate a BA-containing oleogel (BA-O) regarding its cutaneous safety profile as a potential pharmaceutical formulation targeting dermatologic issues. The findings illustrated the efficient formulation of BA as oleogel, the product presenting the specific conditions of topical semi-solid formulations in terms of physico-chemical characteristics and high biocompatibility in vitro and in ovo, as BA-O lacked a cytotoxic effect in HaCaT and JB6 Cl 41-5a skin cells (cell viability percentages being > 70%) and was categorized as non-irritant in EpiDerm™ tissues (viability > 80%) and on the chorioallantoic membrane (Irritation Score = 0.186). These results present the preclinical biosafety profile of BA-O with prospective potential for cutaneous applications that should be investigated in future studies.

Biological Effects of Rosaceae Species in Skin Disorders-An Up-To-Date Overview

The Rosaceae family, comprising over 3000 species, has been extensively investigated for its therapeutic potential, particularly in dermatological applications. Skin illnesses have become in recent years a serious burden worldwide, with more than 3 billion individuals of all ages affected by a skin condition. This review focuses on approximately 50 species from genera such as Rosa, Rubus, Prunus, Potentilla, and especially Eriobotrya japonica, which have shown promising biological effects due to their diverse bioactive compounds. This review provides a current perspective on the recent scientific literature that highlights the role of Rosaceae members in managing various skin disorders. Key dermatological conditions addressed include dermatitis, acne, skin aging, melanoma, and psoriasis. By summarizing both in vitro and in vivo findings, this review underscores the importance of Rosaceae species in the development of plant-based dermatological therapies and encourages further research into their mechanisms of action and clinical potential.

Probiotic Administration Contributes to the Improvement in Intestinal Dysregulation Induced by Allergic Contact Dermatitis

Recent studies have emphasized the impact of gut microbiota on skin health, but the reverse, how skin diseases affect gut homeostasis, has received less attention. Allergic contact dermatitis (ACD), a common skin disorder affecting one in four people worldwide, can be accompanied by intestinal disturbances. To explore this, we used an experimental model of ACD to investigate the intestinal changes induced by the disease. Parameters assessed included intestinal microbiota, short-chain fatty acids (SCFAs), gene expression related to intestinal permeability, inflammatory cytokines, and mucus production. To evaluate potential therapeutic interventions, the probiotic Bifidobacterium longum strain BB536 was administered via gavage, starting 10 days before dermatitis induction and continuing until the last day of disease induction. ACD caused alterations in the composition of intestinal microbiota compared to naïve mice but did not affect SCFA production. The probiotic altered microbiota composition and increased acetate production in dermatitis-induced mice. ACD decreased the gene expression of TjP1, ATHO1, and MUC2, while probiotic treatment restored TjP1 and ATHO1 to normal levels. The cytokine IL-6 increased in the ACD group compared to naïve mice, whereas IL-10 decreased; probiotic treatment also restored these levels. Intestinal mucus production, affected by ACD, was partially restored by probiotic treatment. The findings suggest that probiotics could be a therapeutic strategy to prevent intestinal issues caused by skin diseases.

Bio-active metabolites from Chinese Medicinal Herbs for treatment of skin diseases

Skin diseases have become serious issues to human health and affect one-third of the world's population according to the World Health Organisation (WHO). These consist of internal (endogenous) and external (exogenous) factors referring to genetics, hormones, and the body's immune system, as well as environmental situations, UV radiation, or environmental pollution respectively. Generally, Western Medicines (WMs) are usually treated with topical creams or strong medications for skin diseases that help superficially, and often do not treat the root cause. The relief may be instant and strong, sometimes these medicines have adverse reactions that are too strong to be able and sustained over a long period, especially steroid drug type. Chinese Medicinal Herbs (CMHs) are natural resources and relatively mild in the treatment of both manifestation and the root cause of disease. Nowadays, CMHs are attractive to many scientists, especially in studying their formulations for the treatment of skin diseases.

METHODS

The methodology of this review was searched in nine electronic databases including WanFang Data, PubMed, Science Direct, Scopus, Web of Science, Springer Link, SciFinder, and China National Knowledge Infrastructure (CNKI), without regard to language constraints. All eligible studies are analysed and summarised.

RESULTS

Based on the literature findings, some extracts or active metabolites divided from CMHs, including Curcumin, Resveratrol, Liquorice, Dandelions, Cortex Moutan, and Calendula officinalis L., are effective for the treatment and prevention of skin diseases because of a wide range of pharmacological activities, e.g. anti-bacterial, anti-microbial, anti-virus, and anti-inflammation to enhance the body's immune system. It is also responsible for skin whitening to prevent pigmentation and premature ageing through several mechanisms, such as regulation or inhibition of nuclear factor kappa B (IκB/NF-κB) signalling pathways.

CONCLUSION

This is possible to develop CMHs, such as Curcumin, Resveratrol, Liquorice, Dandelions, Cortex Moutan and Calendula officinalis L. The ratio of multiple CMH formulations and safety assessments on human skin diseases required studying to achieve better pharmacological activities. Nano formulations are the future investigation for CMHs to combat skin diseases.

Psychosocial work exposures as risk factors for skin problems in a general working population: cross-sectional and prospective associations

OBJECTIVE

The potential contribution of psychosocial work exposures to skin problems is largely overlooked in the occupational health literature. To address this knowledge gap, we examined cross-sectional and prospective associations between six psychosocial work exposures (i.e., quantitative demands, job control, social support, emotional demands, role conflict, and interpersonal conflict) and self-reported skin problems.

METHODS

Data came from a probability sample of the general working population in Norway surveyed in 2016 (N = 7833) and 2019 (N = 8038). The prospective sample comprised 3430 participants. Data were analysed with ordered logistic regression, adjusting for age, sex, occupation, and exposure to cleaning products, water, and dry indoor air.

RESULTS

Cross-sectional analyses indicated statistically significant associations with skin problems for emotional demands, role conflict, and interpersonal conflict in 2016 and 2019, and for social support in 2019. In prospective analyses, emotional demands (OR 1.12, 95% CI 1.01-1.23), role conflict (OR 1.14, 95% CI 1.00-1.29), and interpersonal conflict (OR 1.24, 95% CI 1.01-1.52) significantly predicted subsequent skin problems. Interpersonal conflict (OR 1.26, 95% CI 1.01-1.57) was a significant predictor above and beyond baseline levels of skin problems. Quantitative demands and job control was generally non-significant, except for a significant interaction in the 2019 sample.

CONCLUSION

Exposure to certain psychosocial work stressors may be a risk factor for experiencing skin problems, particularly if you are exposed to interpersonal conflict. Preventive efforts to reduce the occurrence of skin problems in work settings should also target psychosocial stressors.

Insights into Liposomal and Gel-Based Formulations for Dermatological Treatments

Dermatological diseases pose a significant challenge due to their chronic nature, complex pathophysiology, and the need for effective, patient-friendly treatments. Recent advancements in liposomal and gel-based formulations have played a crucial role in improving drug delivery, therapeutic efficacy, and patient compliance. Liposomal formulations have garnered considerable attention in dermatology due to their ability to encapsulate both hydrophilic and lipophilic compounds, enabling controlled drug release and enhanced skin penetration. However, challenges such as formulation complexity, stability issues, and regulatory constraints remain. Similarly, gel-based formulations are widely used due to their ease of application, biocompatibility, and ability to retain active ingredients. However, they also face limitations, including restricted penetration depth, susceptibility to microbial contamination, and challenges in achieving sustained drug release. The integration of liposomal and gel-based technologies offers a promising strategy to overcome current challenges and optimize dermatological drug delivery. This review explores both well-established therapies and recent innovations, offering a comprehensive overview of their applications in the treatment of prevalent dermatological conditions. Ultimately, continued research is essential to refine these formulations, expanding their clinical utility and enhancing therapeutic effectiveness in dermatology.

Occupational Risk Perception and Associated Factors Among Textile Workers: A Cross-Sectional Study From Türkiye

BACKGROUND

The textile industry, a vital sector in Türkiye, exposes workers to numerous occupational risks, including physical, chemical, and ergonomic hazards. The weaving stage, in particular, involves prolonged exposure to chemicals, noise, and dust, posing significant health challenges. Identifying workplace hazards is critical to safeguarding employee health and productivity.

METHODS

This cross-sectional study was conducted in two textile factories in Türkiye. This research investigated perceived workplace risks and related factors to which weaving workers are exposed. Sociodemographics, work-related characteristics and perceptions of chemical, noise, and dust exposures were analyzed. A total of 355 people participated in the study.

FINDINGS

Nearly three-quarters of participants were male, 40% were smokers, and 55.8% worked over 45 hours weekly. Chemical exposure was reported in 21.1% of workplaces, 75.5% identified noise as a hazard, and 65.9% noted dusty environments. About 19.3% did not use personal protective equipment (PPE), citing discomfort and perceived inefficacy. Health complaints in the past week included skin issues (10.7%), eye irritation (17.5%), hearing problems (12.7%), and respiratory symptoms (11.5%).

CONCLUSIONS

Weaving workers face significant occupational risks, particularly from chemical, noise, and dust exposures. Long-term exposure to these hazards may lead to chronic diseases, reducing workers' quality of life. Training and preventive measures are essential to mitigate these risks and improve workplace safety.

APPLICATION TO PRACTICE

Implementing targeted interventions, such as enhanced workplace planning, safer technologies, regular maintenance, ergonomic support, and comprehensive training programs, can improve health and safety conditions for weaving workers while boosting productivity and reducing healthcare costs.

Introducing Social Dermatology

Increasing evidence supports the idea that social determinants of health, e.g., educational attainment, employment, and community context, directly affect health status. Researchers are also beginning to explore the impact of social factors on skin diseases, though no formalized research field, to the authors' knowledge, provides a structured framework for such practice. In this article, the novel global research field of "Social Dermatology" is introduced to structure academic knowledge in dermatology. The aim is to outline how this paradigm shift could transform both clinical practice and scientific research. The field will explore subjects studied within the medical field of Social Medicine, adapting and applying them to the context of dermatology. Specifically the article will address the social determinants of health in dermatology, and elaborate on human functioning as an approach to a more comprehensive understanding of health in people with skin diseases. This approach enables the integration of rehabilitative aspects, with the International Classification of Functioning (ICF) guiding research and clinical practice to promote more equitable and patient-centred care. To address methodological and communicative opportunities it is suggested that a theoretical web-based social incubator be developed. A formal agreement on the values, interests, and challenges of this new field is needed for a sustainable research effort.

Evaluating the use of 3D skin models as simulation-based educational tools among nursing students: A quasi-experimental study

BACKGROUND

Teaching dermatology is challenging because of its' highly visible and tactile nature. While images improve visual memory and are valuable teaching aids, even high-quality photographs have limitations in what they can convey.

AIM

Our aim is to validate the use of silicone-based 3D skin models as simulation-based educational tools by assessing their impact on recognition of various skin conditions among nursing students.

DESIGN AND SETTINGS

A quasi-experimental, two-groups study was conducted in a Higher Education Institute in Ireland.

PARTICIPANTS

Participants were third-year undergraduate nursing students enrolled in a bachelor's programme in General Nursing or Children's and General Nursing, registered for a general module. We included 153 participants, 79 were in the control group and 74 were in the interventional group.

METHODS

Nursing students rotated individually among stations to observe both 3D skin models and photographs of the models. At each station, students completed an answer sheet including questions on identifying skin categories and conditions, along with a validated scale to assess satisfaction, confidence, and realism in using these models. Each station illustrated five skin conditions using either models or photographs. Both groups visited both stations; only the sequence of visits varied between them.

RESULTS

The 3D skin models significantly improved nursing students' identification of the papulosquamous skin category (47.8 % interventional group and 24.4 % control group, p = 0.003). Additionally, students exposed to the models had higher scores for categorisation (mean ranks; 85.05 interventional group and 69.46 control group, p = 0.023). Qualitative data revealed students' favourable perceptions of the 3D models as effective learning tools, particularly their realism and sensory aspects.

CONCLUSIONS

Suggestions for model improvements, including skin tone and positioning on the body, are likely to enhance effectiveness. Integrating 3D skin models into nursing education curricula is highly recommended to enhance nursing students' dermatology skills and clinical skin assessment.

The Real-World Burden of Moderate-to-Severe Psoriasis in Patients Under Systemic Treatment from Baltic Countries: Data from the CRYSTAL Observational Study

Background and Objectives: Data on disease control, treatment, and quality of life (QoL) in patients with psoriasis from Baltic countries are lacking. In this study, we aimed to assess the disease control, treatment, and QoL of patients with psoriasis in countries from Central and Eastern Europe, and we report data for the Baltic countries. Materials and Methods: In a cross-sectional, international study (CRYSTAL), we retrospectively assessed the real-world disease severity and QoL in adult patients (18-75 years) from Estonia, Latvia, and Lithuania with moderate-to-severe psoriasis receiving continuous systemic treatment ≥ 24 weeks. Analyses included 50 patients from each country and were descriptive. Results: The median disease duration was 15.2-19.9 years across the countries. Most patients (78.0% in Estonia, 100% in Latvia, and 68.0% in Lithuania) were receiving monotherapy with biological agents, mainly TNF inhibitors. An absolute PASI score ≤ 3 was achieved by 82.0%, 70.0%, and 64.0% of patients in the overall study population and 89.7%, 70.0%, and 61.8% of patients receiving biologic monotherapy in Estonia, Latvia, and Lithuania, respectively. Across the countries, impairments in QoL as expressed by a Dermatology Life Quality Index score > 5 were reported by 14.0-34.0% of patients, while 88.0-96.0% of patients were satisfied with their treatment. Conclusions: Although most patients showed low absolute PASI scores and satisfaction with their evolution after ≥24 weeks of systemic treatment, they still reported an impact on QoL. This finding underlines that further optimization of systemic treatment strategies is needed to improve outcomes in moderate-to-severe psoriasis in Baltic countries.

Synthetically programmed antioxidant delivery by a domesticated skin commensal

Bacteria represent a promising dynamic delivery system for the treatment of disease. In the skin, the relevant location of Cutibacterium acnes within the hair follicle makes this bacterium an attractive chassis for dermal biotechnological applications. Here, we provide a genetic toolbox for the engineering of this traditionally intractable bacterium, including basic gene expression tools, biocontainment strategies, markerless genetic engineering, and dynamic transcriptional regulation. As a proof of concept, we develop an antioxidant-secreting strain capable of reducing oxidative stress in a UV stress model.

Can social media encourage young Polish adults to visit a dermatologist? An original study

Introduction

Social media (SM) play an important role in contemporary world, influencing all areas of life, including dermatology, as people are often obtaining medical knowledge from content-sharing platforms on the Internet.

Aim

The objective of this study was to evaluate if Polish adults aged 18-35 follow dermatological news on SM, which platforms and contents they find the most interesting and to assess if SM content can encourage them to visit a healthcare professional.

Material and methods

Online questionnaires were distributed from January to March 2024 among young adult people from Poland. The collected data were analysed using descriptive and analytical statistics.

Results

44% of respondents confirmed that SM content prompted them to visit a dermatologist. The most popular platform was Instagram. The main reason for visiting a specialist was the desire to improve the appearance of one's skin. In 34% of the cases, the dermatological examination revealed skin disease. According to 92% of respondents, SM can have a positive impact on the willingness to visit a dermatologist.

Conclusions

81% of young Polish adults read dermatology-related content on SM. The main areas of interest were skincare and skin diseases. Almost half of the respondents were encouraged by SM to visit a dermatologist, with 56% consistency of diagnosis made by a healthcare professional and SM user.

Assessing the readability of dermatological patient information leaflets generated by ChatGPT-4 and its associated plugins

Background

In the UK, 43% of adults struggle to understand health information presented in standard formats. As a result, Health Education England recommends that patient information leaflets (PILs) be written at a readability level appropriate for an 11-year-old.

Objectives

To evaluate the ability of ChatGPT-4 and its three dermatology-specific plugins to generate PILs that meet readability recommendations and compare their readability with existing British Association of Dermatologists (BAD) PILs.

Methods

ChatGPT-4 and its three plugins were used to generate PILs for 10 preselected dermatological conditions. The readability of these PILs was assessed using three readability formulas Simple Measure of Gobbledygook (SMOG), Flesch Reading Ease Test (FRET) and Flesch-Kincaid Grade Level Test (FKGLT) and compared against the readability of BAD PILs. A one-way ANOVA was conducted to identify any significant differences.

Results

The readability scores of PILs generated by ChatGPT-4 and its plugins did not meet the recommended target range. However, some of these PILs demonstrated more favourable mean readability scores compared with those from the BAD, with certain plugins, such as Chat with a Dermatologist, showing significant differences in mean SMOG (P = 0.0005) and mean FKGLT (P = 0.002) scores. Nevertheless, the PILs generated by ChatGPT-4 were found to lack some of the content typically included in BAD PILs.

Conclusions

ChatGPT-4 can produce dermatological PILs free from misleading information, occasionally surpassing BAD PILs in terms of readability. However, these PILs still fall short of being easily understood by the general public, and the content requires rigorous verification by healthcare professionals to ensure reliability and quality.

Prevalence of T. rubrum and T. interdigitale Exhibiting High MICs to Terbinafine in Clinical Samples Analyzed in the Portuguese Mycology Reference Laboratory

Cutaneous fungal infections represent a significant burden worldwide with a high impact on public health. Accurate identification of dermatophyte species causing these infections is vital for an appropriate treatment. Terbinafine is the primary agent against Trichophyton species due to its clinical efficacy; however, cases of elevated minimum inhibitory concentration (MIC) have been reported, raising clinical and epidemiological concerns. Herein, we aimed to detect Trichophyton rubrum and Trichophyton interdigitale isolates collected from clinical samples with terbinafine-high MICs (TRB-hMIC). A total of 168 isolates, recovered from 2017 to 2023, were identified as T. rubrum complex (140/83.4%) or T. interdigitale (28/16.7%) and further screened regarding their terbinafine susceptibility. Four isolates with capacity to grow in terbinafine media were detected by screening, and these and a further sixteen random isolates were submitted to the broth microdilution method. This methodology confirmed the four (2.4%) isolates as TRB-hMIC. One T. rubrum and three T. interdigitale showed a minimum inhibitory concentration (MIC) higher than 1 mg/L. Partial sequencing of the SQLE gene identified point mutations in T. rubrum (Phe397Iso) and in one T. interdigitale (Phe397Leu) isolate. Notably, in the other two T. interdigitale isolates with TRB-hMIC, no point mutations in the SQLE gene were identified. In conclusion, TRB-hMIC isolates (T. rubrum and T. interdigitale) were identified in clinical samples analyzed in Portugal, as antifungal susceptibility testing is a crucial routine for identifying treatment failures and also for epidemiological purposes aiming to monitor the dynamics of terbinafine resistance.

Comparison of health-related quality of life in atopic dermatitis, hidradenitis suppurativa, pemphigus and psoriasis

This study aims to explore the measurement agreement between direct and indirect health utility measures in four chronic dermatological conditions (atopic dermatitis, hidradenitis suppurativa, pemphigus, psoriasis). Outpatients survey data collected between 2015 and 2021 were analysed. Health-related quality of life (HRQoL) outcome measures included time trade-off (TTO), EQ-5D-5L and Dermatology Life Quality Index (DLQI). Descriptive statistics were computed for the pooled sample and four diseases. Mean, standard deviation (SD), median, interquartile range (IQR), ceiling and floor effects were calculated for TTO, EQ-5D-5L and DLQI utilities. Bland‒Altman plots and intraclass correlation coefficients (ICC) were applied to investigate the agreement between health utility measures. Sociodemographic characteristics (age, sex, educational level, employment status) and health-related information (disease duration, outpatient care visits in the past 3 months and disease severity) impact on utilities was investigated by Tobit regressions. The sample includes N = 765 patient responses with a mean age of 41.5 (SD = 16.2), majority being males (52.7%). Total sample mean utilities were the highest according to TTO (0.83), followed by EQ-5D-5L and vDLQI (0.81 and 0.81) and lowest in mDLQI (0.77). Measurement agreement was found only between TTO and EQ-5D-5L. Skin-disease severity impacted all health state utilities, though only TTO differentiated utility values according to disease type. The discrepancies between the TTO and DLQI warn to compare DLQI-based utilities in different dermatological conditions with extreme caution.

Utilization and prescription patterns of topical steroids: a study at dessie comprehensive specialized hospital, Ethiopia

BACKGROUND

Topical steroids are widely used in dermatology for their anti-inflammatory and immunosuppressive effects, but misuse can cause skin thinning and systemic issues. In Ethiopia, where skin conditions are common, understanding how topical steroids are prescribed and used is essential for ensuring their safe and effective use.

OBJECTIVE

The study aimed to assess topical steroids' prescription and utilization pattern in Dessie Comprehensive Specialized Hospital (DCSH) from February 1 to May 30, 2024.

METHODOLOGY

The study used a descriptive, cross-sectional design with a quantitative approach, analyzing data from 175 patient records on prescription and utilization patterns of topical steroids at DCSH. Participants were selected using a random sampling technique. Data were categorized and analyzed using Microsoft Excel 2010, with findings presented through descriptive statistics, including tables and figures.

RESULT

Eczematous dermatitis (31.49%) was the most common skin disease observed, followed by dermatophytosis (12.15%). Out of 304 drugs prescribed, averaging 1.73 per prescription, clobetasol (44.4%) and betamethasone (25.0%) were the most common topical corticosteroids. These steroids were primarily prescribed for eczema, dermatitis, pigmentary disorders, psoriasis, urticaria, and lichen planus. The commonly prescribed drugs were topical steroids 108[35.53%]. Generic names were used for 54.63% of the 108 topical steroids prescribed.

CONCLUSION

The study found that dermatitis and eczema are the most common skin conditions treated in dermatology clinics, with topical steroids being the main treatment. However, many prescriptions lacked details on the application site, treatment duration, and quantity. To improve safety and effectiveness, the study recommends community education, better dermatological services, and increased oversight in professional training.

Blocking the adverse outcome pathway of skin sensitization through a N-acetyl cysteine and lysine-loaded hydrogel

Image 1.

E-Staining DermaRepo: H&E whole slide image staining dataset

In the era of artificial intelligence and machine learning, computer-aided diagnostic frameworks are data-hungry and require large amounts of annotated data to automate the disease diagnosis procedure. Moreover, to enhance the performance and accuracy of disease diagnosis, procedures need to be automated to ensure timely and accurate diagnosis. We are providing a whole slide image repository comprising unstained skin biopsy images acquired using a brightfield microscope, along with Hematoxylin and Eosin chemically and virtually stained image samples, to virtualize the staining procedure and enhance the efficiency of the disease diagnosis pipeline. The dataset was utilized to train a Dual Contrastive GAN to generate virtually stained image samples. The trained model achieved an FID score of 80.47 between virtually stained and chemically stained image samples, indicating a high correlation of content between synthesized and original images. In contrast, FID scores of 342.01 and 320.40 were observed between unstained images and virtually stained slides, and between unstained images and chemically stained images, respectively, indicating less similarity in content.

Rocatinlimab Improves Patient-Reported Outcomes in Adults with Moderate-to-Severe Atopic Dermatitis: Results from a Double-Blind Placebo-Controlled Phase 2b Study

INTRODUCTION

In adults with moderate-to-severe atopic dermatitis (AD), rocatinlimab demonstrated significant and progressive improvement in clinical measures of disease severity compared with placebo. This post hoc analysis of a phase 2b study was undertaken to understand the disease burden and to assess the impact of rocatinlimab on patient-reported outcomes (PROs).

METHODS

This analysis used baseline data from a multicenter, randomized, double-blind study of adults with moderate-to-severe AD, who completed a Worst Pruritus numerical rating scale (NRS), Sleep Disturbance NRS, and the Dermatology Life Quality Index (DLQI). A mixed model for repeated measures was used to estimate changes in PRO scores from baseline; scores were also compared with clinically meaningful change benchmarks.

RESULTS

The analysis included 267 subjects, mean (SD) age 37.9 (14.7) years, 40.8% female; 55.1% grade 3 and 44.9% grade 4 Investigator Global Assessment for AD. Mean (SD) scores were: Worst Pruritus NRS 7.5 (1.9), Sleep Disturbance NRS 5.5 (2.9), DLQI total score 12.6 (7.1). Worst Pruritus and Sleep NRS scores had low positive correlations with SCORing AD (SCORAD) score (r = 0.44, r = 0.45 respectively) and negligible correlations with Eczema Area and Severity Index (EASI) score and area affected (r < 0.30). DLQI score varied by sex, study country, race, age, longer disease duration, disease severity (EASI and SCORAD), presence of asthma, and Worst Pruritus NRS, Sleep disturbance NRS, and DLQI scores. Rocatinlimab showed benefit on all three PROs, with significant improvements from baseline at the end of the double-blind period (week 18) and active treatment extension (week 36). Benefits were maintained over 20 weeks' post-treatment follow-up. The benefit of rocatinlimab treatment on PROs is rapid and maintained for at least 20 weeks following treatment completion.

CONCLUSION

This analysis demonstrates the importance of characterizing the burden of moderate-to-severe AD from the patient's perspective, alongside clinical disease measures, to develop a fuller picture of treatment benefit.

TRIAL REGISTRATION

ClinicalTrials.gov identifier, NCT03703102.

Dermatophytes: Update on Clinical Epidemiology and Treatment

Dermatophytes represent the largest and most common group of fungal infections, impacting 25% of the global population. Among them, Trichophyton rubrum has emerged as the predominant species, responsible for a range of conditions such as tinea corporis, tinea pedis, onychomycosis, tinea cruris, and tinea manuum. Although dermatophyte incidence varies geographically, there is a noticeable rise in cases caused by T. indotineae, a strain that exhibits resistance to terbinafine. In the past decade zoophilic dermatophyte T. mentagophytes genotype VII (now known as T. interdigitale) gains a growing importance, due to its increasing frequency, the severity of the clinical manifestation and mode of transmission. Tinea infections present with various clinical symptoms and can affect individuals of all ages, from tinea pedis in adults to tinea capitis in children. Among adults globally, tinea unguium (onychomycosis) is the most common form of dermatophytosis, affecting 5.5% of the general population. Tinea unguium is more frequently seen in developed countries, while tinea capitis is more common in developing nations. The COVID-19 pandemic has led to an increase in cases of tinea faciei, likely due to prolonged mask-wearing. Terbinafine remains the preferred treatment for dermatophyte infections worldwide due to its potent fungicidal properties, minimal risk of drug interactions, and fewer side effects compared to other oral antifungals. Itraconazole and terbinafine appear to be equally effective and safe for treating tinea cruris and tinea corporis. However, the rising resistance of dermatophytes to these antifungal drugs, along with frequent recurrences of dermatophytosis in certain regions, is becoming a significant public health concern.

Prevalence of Plantar Warts, Genital Warts, and Herpetic Infections in Greek Competitive Swimmers

Viral outbreaks are common in the sport community. Data regarding the prevalence of plantar warts, genital warts, herpes simplex type 1 (herpes labialis), herpes zoster, and genital herpes in competitive swimmers are lacking in the literature. The purpose of this study was to determine the prevalence of those viral infections among young competitive swimmers participating in Greek swimming clubs. Swimmers' parents and adult swimmers were asked to complete an anonymous questionnaire. In total, 1047 swimmers enrolled in this study. The measured parameters included gender, age, times of infections, and seasons when athletes may be more susceptible to infections. Practicing information such as type of swimming facility, number of training years, average hours of daily training, behaviors in swimming practice, and sunlight exposure was also recorded. All infections showed a significant difference in relation to "age" and "years of training". The gender significance was observed in herpes labialis (p = 0.016) and plantar warts (p = 0.05). The prevalence of all infections in swimmers who use outdoor facilities was higher. Certain behaviors such as walking barefoot on a pool deck and sharing swimming equipment correlate with herpes simplex and plantar warts. Virus infections can affect swimmers of all ages. In our study, plantar warts and herpes labialis are more common in swimmers. Herpes zoster and sexually transmitted viruses are rarer and affect adult swimmers. The impact of cutaneous infections on swimmers can affect performance and well-being. Effective prevention and management are essential to avoid complications. Proper hygiene, medical guidance, and treatment reduce swimmers' exposure to skin viruses.

International study on prevalence of itch: examining the role of itch as a major global public health problem

BACKGROUND

Very few studies have evaluated the global prevalence of pruritus.

OBJECTIVES

To assess its prevalence according to age, sex, ethnicity and geographic region.

METHODS

An international cross-sectional study was conducted in 20 countries from January to April 2023. Participants were asked to complete a questionnaire on sociodemographics, and to confirm the presence or absence of a skin disease in the last 12 months and the presence or absence of pruritus in the last 7 days.

RESULTS

The studied sample included 50 552 individuals. The worldwide prevalence of pruritus was 39.8%. The age group ≥ 65 years had the highest prevalence (43.3%). The prevalence was 40.7% among women and 38.9% among men (P < 0.001). There was no significant difference between ethnicities (P = 0.14). Compared with North America (41.2%), the prevalence of pruritus was significantly lower in Europe (35.9%, P < 0.001), Australia (38.4%, P = 0.017), East Asia (40.2%, P = 0.04) and Latin America (36.5%, P < 0.001), and higher in Africa (45.7%, P = 0.007). No significant difference was found with the Middle East (40.2%, P = 0.36). The prevalence of pruritus in BRICS countries (40.3%) was significantly higher than that in developed countries (38.7%) (P < 10-3).

CONCLUSIONS

Out analysis is limited because there is no information about the severity or type (acute, chronic) of pruritus. The global prevalence of pruritus revealed age, sex and geographic region differences, with no ethnic differences.

Illness acceptance among young adults with acne: a cross-sectional study

Introduction

The level of acceptance of acne can have a substantial impact on improving patients' mood and quality of life.

Aim

To investigate the level of acne vulgaris acceptance among young patients and its correlation with disease severity, quality of life, and feelings of stigmatization.

Material and methods

The study was conducted on 213 young individuals diagnosed with acne. A variety of questionnaires were employed to measure the psychological aspects of the condition, including illness acceptance, quality of life, and feeling of stigmatization.

Results

Based on the Global Evaluation Acne (GEA) scale, 45% of participants had mild acne, 31.7% had minimal acne, and 23.3% had moderate acne. The Acceptance of Illness Scale (AIS) scores ranged from 13 to 40, with a mean of 37.0 ±5.2 points. Males had higher illness acceptance (mean score: 37.7 vs. 36.5 points; p = 0.027). Most participants (87.6%) had high illness acceptance. The greatest challenge was adjusting to disease limitations. A significant negative correlation was found between acne severity and illness acceptance (r = -0.277; p < 0.001), between AIS scores and both QoL impairment (measured by the Dermatology Life Quality Index (DLQI) and the Cardiff Acne Disability Index (CADI)) (r = -0.499 and r = -0.621, respectively; p < 0.001 for both) as well as between AIS scores and the 6-Item Stigmatization Scale (6-ISS) (r = -0.621, p < 0.001).

Conclusions

The level of acne acceptance depends on gender and the severity of acne lesions. Based on the study results, we hypothesize that an intervention aimed at increasing the level of disease acceptance could improve patients' psychological well-being and ability to cope with the condition.

Frequency of Atopic Dermatitis and Psoriasis in the Elderly: Cross-Sectional Findings from the German AugUR Study

INTRODUCTION

Atopic dermatitis (AD) and psoriasis appear to affect 2-3% (lifetime prevalence) people worldwide. However, there are little epidemiological data on the prevalence of those two chronic inflammatory skin diseases in the elderly. The aim of this study was to provide frequency estimates of AD and psoriasis obtained from an elderly population in Germany.

METHODS

We examined baseline data from the AugUR study, a cohort study focusing on an aging population in the city and the vicinity of Regensburg, Germany. We estimated raw frequencies of physician-diagnosed AD and psoriasis from participants' self-reports in personal interviews. These frequencies were adjusted to reflect the demographic distribution of the Bavarian population, considering both sex and age groupings spanning 5 or 10 years and reported with 95% confidence interval (CI).

RESULTS

Data from 1,133 participants aged 70-95 (median age 76.7 years, 45.1% women) were available for analysis. Physician-diagnosed AD was reported by 3.3% (95% CI: 2.3-4.5) of participants (2.4% from men, 4.3% from women) and 5.6% (95% CI: 4.3-7.1%) reported physician-diagnosed psoriasis (6.6% in men, 4.3% in women). Age- and sex-standardized frequency estimates for AD were 3.4% (95% CI: 2.4-4.6, 2.6% in men, 4.3% in women) and 5.3% for psoriasis (95% CI: 4.1-6.8, 6.3% in men and 4.1% in women).

CONCLUSION

This study indicates a lower than previously reported lifetime prevalence of AD (3.4% vs. 8-10%) and a higher one regarding psoriasis (5.3% vs. 2-4%) in highly aged individuals. More epidemiological research in elderly populations using validated physician diagnoses is desirable.

INTRODUCTION

Atopic dermatitis (AD) and psoriasis appear to affect 2-3% (lifetime prevalence) people worldwide. However, there are little epidemiological data on the prevalence of those two chronic inflammatory skin diseases in the elderly. The aim of this study was to provide frequency estimates of AD and psoriasis obtained from an elderly population in Germany.

METHODS

We examined baseline data from the AugUR study, a cohort study focusing on an aging population in the city and the vicinity of Regensburg, Germany. We estimated raw frequencies of physician-diagnosed AD and psoriasis from participants' self-reports in personal interviews. These frequencies were adjusted to reflect the demographic distribution of the Bavarian population, considering both sex and age groupings spanning 5 or 10 years and reported with 95% confidence interval (CI).

RESULTS

Data from 1,133 participants aged 70-95 (median age 76.7 years, 45.1% women) were available for analysis. Physician-diagnosed AD was reported by 3.3% (95% CI: 2.3-4.5) of participants (2.4% from men, 4.3% from women) and 5.6% (95% CI: 4.3-7.1%) reported physician-diagnosed psoriasis (6.6% in men, 4.3% in women). Age- and sex-standardized frequency estimates for AD were 3.4% (95% CI: 2.4-4.6, 2.6% in men, 4.3% in women) and 5.3% for psoriasis (95% CI: 4.1-6.8, 6.3% in men and 4.1% in women).

CONCLUSION

This study indicates a lower than previously reported lifetime prevalence of AD (3.4% vs. 8-10%) and a higher one regarding psoriasis (5.3% vs. 2-4%) in highly aged individuals. More epidemiological research in elderly populations using validated physician diagnoses is desirable.

Recent Applications of Amphiphilic Copolymers in Drug Release Systems for Skin Treatment

Amphiphilic copolymers (ACs) are versatile systems with self-assembling and aggregating properties, enabling the formation of nanomaterials (NMs) such as micelles, vesicles, nanocapsules, and nanogels. These materials have been extensively explored for the delivery of various drugs and active compounds, enhancing the solubility and permeation of poorly water-soluble drugs into skin tissue. This improvement facilitates the treatment of skin diseases, including chronic conditions like cancer, as well as infections caused by bacteria, fungi, and viruses. This review summarizes recent applications of ACs in skin treatment, with a particular focus on their use in anti-cancer drug therapy. It covers the synthesis, classification, and characterization of ACs using various experimental techniques. Additionally, it discusses recent research on different drug delivery pathways using ACs, including encapsulation efficiency, release behavior, characteristics, applications, and responses to various chemical and physical stimuli (both in vivo and in vitro). Furthermore, this review provides a comprehensive analysis of the effects of ACs NMs on several skin diseases, highlighting their potential as alternative treatments.

Towards the Use of Lichens as a Source of Bioactive Substances for Topical Applications

The increasing incidence of dermatological diseases prompts the search for new natural methods of treatments, and lichens, with their special symbiotic structure, are a little-known and promising source of biologically active substances. Seven lichen species, Cladonia unicialis (L.) Weber ex F.H. Wigg. (Cladoniaceae), Evernia prunastri (L.) Ach. (Parmeliaceae), Hypogymnia physodes (L.) Nyl. (Parmaliaceae), Parmelia sulcata (Taylor) (Parmeliaceae), Physcia adscendens (Fr.) H. Olivier (Physciaceae), Pseudoevernia furfuracea (L.) Zopf (Parmeliaceae), and Xanthoria parietina (L.) Th. Fr. (Teloschistaceae), were used in our experiment. We identified different metabolites in the acetone extracts of all the lichen species. Based on the high-performance liquid chromatography analysis, the content of lichen substances in the extracts was evaluated. The impact of the individual lichen-specific reference substances, compared to the lichen extracts, on the viability of keratinocytes (HaCaT cell line) and fibroblasts (BJ cell line) and on the activity of selected skin-related enzymes was investigated. Our results revealed that only emodin anthrone at a concentration of 200 mg/L was cytotoxic to keratinocytes and fibroblasts in both cell viability assays. In turn, the C. uncialis extract was only cytotoxic to keratinocytes when used at the same concentration. The other tested treatments showed a positive effect on cell viability and no cytotoxicity or indeterminate cytotoxicity (shown in only one of the tests). Elastase and collagenase activities were inhibited by most of the lichen extracts. In turn, the individual lichen compounds (with the exception of evernic acid) generally had an undesirable stimulatory effect on hyaluronidase and collagenase activity. In addition, almost all the tested compounds and extracts showed anti-inflammatory activity. This suggests that some lichen compounds hold promise as potential ingredients in dermatological and skincare products, but their safety and efficacy require further study. The high cytotoxicity of emodin anthrone highlights its potential use in the treatment of hyperproliferative skin diseases such as psoriasis.

Insights from Traditional Chinese Medicine for Restoring Skin Barrier Functions

The skin barrier is essential for maintaining the body's internal homeostasis, protecting against harmful external substances, and regulating water and electrolyte balance. Traditional Chinese Medicine (TCM) offers notable advantages in restoring skin barrier function due to its diverse components, targets, and pathways. Recent studies have demonstrated that active ingredients in TCM can safely and effectively repair damaged skin barriers, reinstating their proper functions. This review article provides a comprehensive overview of the mechanisms underlying skin barrier damage and explores how the bioactive constituents of TCM contribute to skin barrier repair, thereby offering a theoretical framework to inform clinical practices.

General and dermatological population's use and acceptance of digital health in Germany - a representative survey

BACKGROUND AND OBJECTIVES

Adoption and acceptance of digital health services (DHS) in the German population and in persons with skin diseases is unclear. Both factors were analyzed in this survey.

METHODS

A standardized survey with items on digital competences and attitudes, use and acceptance of DHS was applied to a representative sample of the German adult population. Bivariate and multivariate analyses were conducted.

RESULTS

Out of 2,101 participants, 29.9% reported having had skin diseases in the last 12 months. Among them, adoption and acceptance were at 43.6% and 52.3%, respectively. Both values are significantly higher compared to participants without skin diseases (29.2%; p < 0.01 and 45.5%; p < 0.01). 18.9% of participants with a skin disease used digital diagnostic support, but only 9.7% applied it for a skin disease (p < 0.01). For all participants, with and without skin disease, the DHS most commonly used were passive health monitoring (14.3%) and diagnostic support (11.5%), telemedicine was least used (4.7% video-consultation, 2.5% store-and-forward). Use and acceptance were associated with young age, education, low data privacy concerns, digital confidence, having a skin disease, and high severity of skin disease.

CONCLUSIONS

DHS for skin diseases are used rarely but have a high potential.

EADV Task Force Pruritus White Paper on chronic pruritus and chronic prurigo: Current challenges and future solutions

Chronic pruritus (CP) is frequent in general medicine and the most common complaint in general dermatology. The prevalence of CP is expected to rise in the future due to the ageing population. The clinical presentation, underlying aetiology and treatment strategy of CP are heterogeneous. Also, individual treatment aims and physical, psychic and economic burdens of patients might vary. Chronic prurigo (CPG) is the most severe disease in the chronic pruritus spectrum, being associated with long-standing scratch-induced skin lesions and a therapy refractory itch-scratch-cycle. It is thus important to raise disease awareness for CP and CPG in the general public and among decision-makers in the health system. Further, there is a need to support a rational clinical framework to optimize both diagnostics and therapeutics. Currently, there is still a shortcoming regarding approved therapies and understanding CP/CPG as severe medical conditions. Therefore, the EADV Task Force Pruritus decided to publish this white paper based on several consensus meetings. The group consented on the following goals: (a) ensure that CP is recognized as a serious condition, (b) increase public awareness and understanding of CP and CPG as chronic and burdensome diseases that can greatly affect a person's quality of life, (c) clarify that in most cases CP and CPG are non-communicable and not caused by a psychiatric disease, (d) improve the support and treatment given to patients with CP to help them manage their disease and (e) publicize existing therapies including current guidelines. We aim to point to necessary improvements in access and quality of care directed to decision-makers in health policy, among payers and administrations as well as in practical care.

Epidemiology and Healthcare Expenditure for Skin Disease in Emergency Departments in Alberta, Canada

BACKGROUND

There are limited data on the epidemiology and costs associated with managing dermatologic conditions in emergency departments (EDs).

OBJECTIVE

To assess the incidence and mean cost per case of skin diseases in EDs in Alberta.

METHODS

Alberta Health Services' Interactive Health Data Application was used to determine the epidemiology and costs associated with nonneoplastic dermatologic diseases in EDs in the province of Alberta, Canada, from 2018 to 2022. Skin conditions were identified using the International Classification of Disease 10th edition diagnostic groupings.

RESULTS

Skin disease represented 3.59% of all ED presentations in Alberta in 2022. The total costs associated with managing dermatologic conditions have remained stable over time at approximately 15 million Canadian Dollars (CAD) annually, but the mean cost per case has risen from 188.88 (SD 15.42) in 2018 to 246.25 CAD (SD 27.47) in 2022 (7.59%/year). Infections of skin and subcutaneous tissue were the most expensive diagnostic grouping. The most common dermatologic diagnostic groupings presenting to the ED were infections of skin and subcutaneous tissue [mean age-standardized incidence rate (ASIR) of 143.67 per 100,000 standard population (SD 241.99)], urticaria and erythema [mean ASIR 33.57 per 100,000 standard population (SD 59.13)], and dermatitis and eczema [mean ASIR 18.59 per 100,000 standard population (SD 23.65)]. Cellulitis was both the most common and the costliest individual diagnosis. The majority of patients were triaged as less urgent or nonurgent.

CONCLUSIONS

Skin disease represents a substantial public health burden in EDs. Further research into drivers of cost change and areas for cost savings is essential.

Exploring the skin microbiome in atopic dermatitis pathogenesis and disease modification

Inflammatory skin diseases such as atopic eczema (atopic dermatitis [AD]) affect children and adults globally. In AD, the skin barrier is impaired on multiple levels. Underlying factors include genetic, chemical, immunologic, and microbial components. Increased skin pH in AD is part of the altered microbial microenvironment that promotes overgrowth of the skin microbiome with Staphylococcus aureus. The secretion of virulence factors, such as toxins and proteases, by S aureus further aggravates the skin barrier deficiency and additionally disrupts the balance of an already skewed immune response. Skin commensal bacteria, however, can inhibit the growth and pathogenicity of S aureus through quorum sensing. Therefore, restoring a healthy skin microbiome could contribute to remission induction in AD. This review discusses direct and indirect approaches to targeting the skin microbiome through modulation of the skin pH; UV treatment; and use of prebiotics, probiotics, and postbiotics. Furthermore, exploratory techniques such as skin microbiome transplantation, ozone therapy, and phage therapy are discussed. Finally, we summarize the latest findings on disease and microbiome modification through targeted immunomodulatory systemic treatments and biologics. We believe that targeting the skin microbiome should be considered a crucial component of successful AD treatment in the future.

Patients' testimonies, feelings, complaints and emotional experiences with dermatoses on open social media: The French infodemiologic patient's free speech study

BACKGROUND

Dermatoses represent a significant burden. Patients and their caregivers can turn to social media and digital communities to exchange with each other. These public exchanges constitute real-life data that can be analysed to better understand the patients' feelings and expectations, and the daily difficulties encountered.

OBJECTIVE

An infodemiologic study of public testimonies of patients and caregivers related to five dermatoses: eczema, rosacea, vitiligo, acne and psoriasis, over a 3-year time frame (September 2018 to September 2021) in France. To identify main topics of discussion, encountered difficulties and unmet medical needs.

METHODS

Data extraction was performed based on a list of pertinent keywords. Web-users' profiles were determined by a specifically trained machine learning algorithm. Encountered difficulties were identified by manual annotation based on a standardized search grid. Co-occurrence analysis of difficulties allowed contextualization of challenges and unmet needs for each dermatosis.

RESULTS

A total of 20,282 messages coming from 16,800 web users was extracted. The main topics of discussion were 'Impact on self- image and self-confidence' (23.6%), 'Generic discussion about therapeutics' (23.3%) and 'Burden of others' gaze' (12.8%). The top three mentioned difficulties for the five targeted dermatoses were similar and focused on 'Fear of/and management of symptoms', 'Impact on/and mood management' and 'Damaged self-image'.

CONCLUSION

This infodemiologic study highlighted the real-life management of five skin diseases by patients and their caregivers, who turned to social networks to openly express their suffering and seek solutions. The joined analysis of the five diseases enabled a common comprehension of what it is to live with a skin disease, from a patient-centric point of view. The specific analysis of each patient group objectified specific challenges, and main unmet medical needs.

Epidermal barrier impairment predisposes for excessive growth of the allergy-associated yeast Malassezia on murine skin

BACKGROUND

The skin barrier is vital for protection against environmental threats including insults caused by skin-resident microbes. Dysregulation of this barrier is a hallmark of atopic dermatitis (AD) and ichthyosis, with variable consequences for host immune control of colonizing commensals and opportunistic pathogens. While Malassezia is the most abundant commensal fungus of the skin, little is known about the host control of this fungus in inflammatory skin diseases.

METHODS

In this experimental study, MC903-treated mice were colonized with Malassezia spp. to assess the host-fungal interactions in atopic dermatitis. Additional murine models of AD and ichthyosis, including tape stripping, K5-Nrf2 overexpression and flaky tail mice, were employed to confirm and expand the findings. Skin fungal counts were enumerated. High parameter flow cytometry was used to characterize the antifungal response in the AD-like skin. Structural and functional alterations in the skin barrier were determined by histology and transcriptomics of bulk skin. Finally, differential expression of metabolic genes in Malassezia in atopic and control skin was quantified.

RESULTS

Malassezia grows excessively in AD-like skin. Fungal overgrowth could, however, not be explained by the altered immune status of the atopic skin. Instead, we found that by upregulating key metabolic genes in the altered cutaneous niche, Malassezia acquired enhanced fitness to efficiently colonise the impaired skin barrier.

CONCLUSIONS

This study provides evidence that structural and metabolic changes in the dysfunctional epidermal barrier environment provide increased accessibility and an altered lipid profile, to which the lipid-dependent yeast adapts for enhanced nutrient assimilation. Our findings reveal fundamental insights into the implication of the mycobiota in the pathogenesis of common skin barrier disorders.

Balneotherapy using thermal mineral water baths and dermatological diseases: a systematic review

Balneotherapy includes practices and methods using medically and legally recognized mineral-medicinal waters, muds and natural gases from natural springs for therapeutic purposes. One of the most widely used method in balneotherapy is bathing with thermal mineral water. In the course of the years, scientific community has produced an increasing number of evidences that this practice is an effective method for treating signs and symptoms of several pathologies such as rheumatic, cardiovascular and dermatological diseases. This systematic review is aimed at evaluating the effect of balneotherapy with thermal water baths as a treatment to manage signs and symptoms of patients affected by all types of dermatological diseases. The systematic review was conducted according to the PRISMA Statement, and its protocol was registered on PROSPERO platform (CRD42022295913). The research was performed on the databases Pubmed, Scopus, Web of Science and Cochrane. We included clinical trials evaluating the effects of balneotherapy using thermal mineral water baths for managing dermatological diseases in humans, published in English and Italian language. Eight studies were included, seven of them enrolled adults affected by psoriasis and one studied atopic dermatitis patients. The common result of all the articles included was a clear improvement of signs and symptoms of psoriasis and eczematous diseases after use of thermal mineral water baths. These effects seem to be strictly related to physical and chemical properties of thermal water used for balneotherapy. However, studies in this field are still limited to support robust evidence of the effectiveness of balneotherapy using thermal mineral water baths and often their quality is low. Thus, new clinical studies need to be carried out, using more correct methods for conducting the studies and for processing statistical data.

Atopic dermatitis in women: special considerations in the childbearing years

Background

Atopic dermatitis (AD) is one of the most common inflammatory dermatoses in adults. Women are disproportionately impacted by AD and report significant impacts on quality of life compared to men.

Objective

Given the absence of formal guidelines for the treatment of AD in women of childbearing age, we will review special considerations for treating women of childbearing age with AD to ensure consistent care and optimal outcomes for these patients.

Methods

PubMed and Google Scholar databases were searched for relevant articles from database inception through May of 2023.

Results

There are several treatments including topical therapies, systemic therapies, and phototherapy that are considered safe during preconception, pregnancy and breastfeeding. Given the negative consequences of uncontrolled AD for both the mother and the unborn baby, the risks and benefits of potential therapies should be reviewed with all women of childbearing age suffering from AD.

Limitations

The gold standard in recommending therapies is randomized controlled trials; however, pregnant and lactating women are often excluded from these trials.

Conclusion

Through shared decision-making between the dermatologist, obstetrician, and patient, the risks and benefits of any therapy should be thoroughly discussed and considered with all women of childbearing age, to optimize care and outcomes for this unique population.

Validation of the DLQI questionnaire in assessing the disease burden and principal aspects related to life quality of vitiligo patients

According to many studies, vitiligo has a negative psychological influence on the patient's life. Multiple factors contribute to the severity of the vitiligo disease burden, among which the most important are self-esteem, stress, and stigma. We aimed to measure the importance of health-related life quality in assessing disease burden in patients with vitiligo. We formulated an HA, which is the principal hypothesis, claiming a single fundamental factor that characterizes the life quality of patients with vitiligo. We also formulated 10 important research questions related to the quality of life that can be generally formulated for patients with dermatological illnesses but particularly suited for vitiligo patients. These research questions capture fundamental aspects of the health-related quality of life of vitiligo patients influenced by symptoms and feelings, daily activities, leisure, job and education, personal relationships, and treatment. These also cover specific aspects related to the quality of life, such as skin-caused sexual difficulties, difficulties in social relationships, and difficulties in performing sports, among others. The Dermatology Life Quality Index (DLQI) questionnaire measures the health-related quality of life of persons suffering from skin diseases. We applied this generic questionnaire to patients with vitiligo. Following a set of inclusion and exclusion criteria, we obtained 114 carefully selected patients who responded to all the questions. This study also validated the DLQI questionnaire on persons who suffer from vitiligo. We investigated whether DLQI has acceptable internal consistency by applying Cronbach's alpha internal consistency indicator (Cα). The obtained Cα = 0.914 indicates excellent internal consistency. We also examined whether all the questions in the questionnaire were mathematically consistent, which we finally proved. It was not necessary to remove any of the questionnaire questions. To prove our HA, a Principal Axis Factoring (PAF) was applied, verifying the assumptions regarding the Average Variance Extracted (AVE) and Convergent Validity (CV). HA proved that applying PAF on DLQI resulted in extracting a single general vitiligo latent factor of life quality, with an initial eigenvalue = 5.671, SS loadings = 5.2, and 52 % of the total cumulative variance explained. Diverse statistical analyses were applied to analyze the 10 formulated research questions. The results of the analysis of the research questions are presented and discussed in the manuscript. One of the conclusions related to the analysis of a research question was that sex had the lowest correlation with the latent life quality factor identified for vitiligo patients.

Disease severity, treatment patterns, and quality of life in patients with moderate-to-severe psoriasis routinely managed with systemic treatment: results of the CRYSTAL observational study in Central and Eastern European countries

Psoriasis is a common, life-long skin disease with a significant negative health and societal impact. Data on rates of disease control and treatment strategies are lacking in Central and Eastern European countries. We aimed to describe the real-world disease severity, control, and treatment strategies for psoriasis in patients from Central and Eastern European countries. CRYSTAL (EUPAS36459) was a cross-sectional, retrospective study in adults (18-75 years) from Bulgaria, Estonia, Hungary, Latvia, Lithuania, Romania, and Russia. We enrolled patients with moderate-to-severe psoriasis receiving continuous systemic treatment for ≥24 weeks. We used the Psoriasis Area and Severity Index (PASI) to describe disease severity and the Dermatology Life Quality Index (DLQI) to assess quality of life (QoL) and collected other outcomes [psoriasis work productivity and activity impairment (WPAI-PSO), patient satisfaction] at enrollment. Analyses were descriptive. A total of 690 patients were included in the analyses. Median disease duration was 11.8 years. Current treatment was monotherapy for most patients (95.8%) with either biological (BIO group; 88.4%) or conventional (NON-BIO group; 7.4%) agents. Mean (± standard deviation) absolute PASI scores were 3.5 ± 5.7, 3.1 ± 5.3, and 6.6 ± 7.4 in the overall population, the BIO group, and the NON-BIO group, respectively. Among patients treated with monotherapy, absolute PASI scores ≤1, ≤3, and ≤5 were observed for 44.1%, 72.0%, and 82.6% of BIO patients and 21.6%, 33.3%, and 49.0% of NON-BIO patients. Mean DLQI total score was 3.3 ± 5.1; higher scores were noted for higher absolute PASI. The most impacted WPAI-PSO domain was presenteeism; for all domains, impact increased with increased absolute PASI. A total of 91.8% of BIO patients and 74.5% of NON-BIO patients were satisfied with the current treatment. We observed a better disease control in BIO than NON-BIO patients. However, around half of BIO patients did not reach clear skin status and reported an impact on QoL. An improvement in treatment strategies is still needed in Central and Eastern European countries to optimize outcomes of moderate-to-severe psoriasis.

Impact of Atopic Dermatitis on Adult Women's Lives: A Survey of 1,009 French Women

Atopic dermatitis (AD) is one of the most common inflammatory diseases, and has a higher prevalence among females in adulthood. The aim of this observational, cross-sectional, survey-based study was to evaluate the impact of AD on the daily lives of adult women patients. A scientific committee composed exclusively of women constructed a specific questionnaire in partnership with the French Eczema Association. Severity of AD was evaluated with the Patient-Oriented Eczema Measure (POEM). A sample of 1,009 adult women (mean age ± standard deviation: 41.8 ± 14.2 years) with AD was identified from a representative sample of the French population (82% response rate 1,230 women surveyed). According to the POEM, 50.64% (n = 511) of subjects were identified as having mild AD, 39.35% (n = 397) moderate AD, and 10.01% (n = 101) severe AD. Overall, 67.7% (n = 682) reported that their eczema involved a visible area (face, neck or hands), and 19.6% (n = 198) a sensual area (breasts/chest, genital area or buttocks). Of the 720 women with menstrual cycles, exacerbations of AD were reported to occur mostly before (50.6%) and during (48.3%) menstruation. A small proportion of women, 7.3% (n = 74), reported being afraid of  becoming pregnant because of their eczema. If AD involvement was in a visible area it had a greater impact on romantic relationships, sexual relationships and occupation. If AD involvement was in a sensual area it had a greater influence on romantic relationships and sexuality. Particular attention should be given to patients with localization of AD on the face, neck or hands, as they have a higher risk of social exclusion. Moreover, these results should encourage health professionals to ask patients with AD about the possible involvement of sensual areas.

Ex Vivo Confocal Laser Scanning Microscopy in Rare Skin Diseases

While ex vivo confocal laser scanning microscopy has previously demonstrated its utility in most common skin diseases, its use in the assessment of dermatological entities with lower incidence remains unexplored in most cases. We therefore aimed to evaluate the diagnostic efficacy of some rare skin tumors as well as a few inflammatory skin diseases, that have not yet been studied in ex vivo confocal laser scanning microscopy. A total of 50 tissue samples comprising 10 healthy controls, 10 basal cell carcinoma, 10 squamous cell carcinoma, and 20 rare skin conditions were imaged using the newest generation ex vivo confocal microscopy (Vivascope 2500 M-G4, Vivascope GmbH, Munich, Germany). Three blinded investigators were asked to identify characteristic features of rare skin disorders and distinguish them from more common skin diseases in the ex vivo confocal microscopy images. Our findings present the capability of ex vivo confocal microscopy to display distinctive morphologic patterns in common and rare skin diseases. As might be expected, we found a strong correlation between imaging experience and diagnostic accuracy. While the imaging inexperienced dermatohistopathologist reached 60% concordance, the imaging-trained dermatologist obtained 88% agreement with dermatohistopathology. The imaging-trained dermatohistopathologist achieved concordance up to 92% with gold-standard dermatohistopathology. This study highlights the potential of ex vivo confocal laser scanning microscopy as a promising adjunct to conventional dermatohistopathology for the early and precise identification of rare dermatological disorders.

Pharmacological Activities of Lonicerae japonicae flos and Its Derivative-"Chrysoeriol" in Skin Diseases

Chrysoeriol is an active ingredient derived from the Chinese medicinal herb (CMH) "Lonicerae japonicae flos" in the dried flower bud or bloomed flower of Lonicera japonica Thunberg. Dermatoses are the most common diseases in humans, including eczema, acne, psoriasis, moles, and fungal infections, which are temporary or permanent and may be painless or painful. Topical corticosteroids are widely used in Western medicine, but there are some side effects when it is continuously and regularly utilized in a large dosage. Chrysoeriol is a natural active ingredient, nontoxic, and without any adverse reactions in the treatment of dermatological conditions.

METHODS

Nine electronic databases were searched, including WanFang Data, PubMed, Science Direct, Scopus, Web of Science, Springer Link, SciFinder, and China National Knowledge Infrastructure (CNKI), without regard to language constraints. The pharmacological activities of chrysoeriol from Lonicerae japonicae flos to fight against skin diseases were explained and evaluated through the literature review of either in vitro or in vivo studies.

RESULTS

Chrysoeriol decreased the mRNA levels of proinflammatory cytokines IL-6, IL-1β, and TNF-α. These were transcriptionally regulated by NF-κB and STAT3 to combat skin inflammation. It also showed promising actions in treating many skin ailments including wound healing, depigmentation, photoprotection, and antiaging.

CONCLUSION

The cutaneous route is the best delivery approach to chrysoeriol across the skin barrier. However, toxicity, dosage, and safety assessments of chrysoeriol in a formulation or nanochrysoeriol on the human epidermis for application in skin diseases must be further investigated.

The Antioxidant Power of a Diet May Improve the Quality of Life of Young Women with Acne Vulgaris

Acne vulgaris (AV) significantly reduces the quality of life (QoL) of young people, so it is important to look for factors that can improve their QoL. The aim of this study was to assess the relationship between dietary antioxidants measured using the new DAQI index and QoL measured using standardized tests. The DAQI included the following elements: antioxidant vitamins, minerals, carotenoids, polyphenols, phytosterols, lignans, and the total antioxidant capacity of the diet. The study involved 165 young women with AV, mainly students. A self-report survey was used to collect basic data on their sociodemographic status, anthropometric information, and lifestyle. The energy value of the diet and the content of vitamins, minerals, and carotenoids with antioxidant activity in the diet were estimated using 3-day food diaries and the Diet 6.0 program. The antioxidant potential of the diet and the content of polyphenols, phytosterols, lignans, and selenium were calculated based on the consumption of individual food products and available databases. The results of this study showed that the QoL of the young women with AV was impaired. However, greater adherence to an antioxidant diet reduces the risk of AV impact on the QoL by approximately 30-32% and the risk of depression by 33%. The DAQI may be used as a new indicator of diet quality in acne vulgaris.

Patient-reported assessment of medical care for chronic inflammatory skin diseases: an enterprise-based survey

Background

Chronic inflammatory skin diseases (CISDs) are among the most common diseases in the Western world. Current estimates of medical care for CISDs are primarily based on surveys among patients in medical care facilities and on health insurance data.

Aim

Survey-based examination to what extent CISD patients in health-aware environment consider their skin disease to be controlled.

Methods

The survey of CISD patients was carried out in 2022 among the employees of a pharmaceutical company located in Germany and Switzerland. Software-based, anonymous, self-reported questionnaires were used.

Results

The number of employees, who answered the questionnaire, was 905. Of these, 222 participants (24.5%) reported having at least one CISD. 28.7% of participants with CISD described their disease as being hardly or not controlled. Regarding the nature of disease, more than one third of participants suffering from hidradenitis suppurativa (HS) or psoriasis fell into the hardly/not controlled category. In contrast, the largest proportion of participants with chronic spontaneous urticaria (43%) or atopic dermatitis (42%) considered their CISD to be completely or well controlled. Only 35.5% of CISD sufferers stated that they were currently under medical care for their skin condition. Being under medical care, however, had no influence on the extent CISD sufferers considered their skin disease to be controlled. The number of active CISD episodes but not the total number of symptomatic days per year was negatively associated with poor disease control (p = 0.042 and p = 0.856, respectively). Poor disease control had a negative effect on the personal and professional lives of those affected, as deduced from its positive association with the extent of daily activity impairment and presenteeism (p = 0.005 and p = 0.005, respectively). Moreover, 41.4 and 20.7% of participants with hardly/not controlled disease stated that their CISD had a moderate and severe or very severe impact on their overall lives (p < 0.001), respectively. A severe or very severe impact of their CISD on their overall life was most commonly reported by participants with HS.

Conclusion

Medical care for CISDs, even in an environment with high socio-economic standard and high health-awareness, still appears to be limited and has a negative impact on individuals and society.

Line-field confocal optical coherence tomography in dermato-oncology: A literature review towards harmonized histopathology-integrated terminology

Non-invasive diagnostics like line-field confocal optical coherence tomography (LC-OCT) are being implemented in dermato-oncology. However, unification of terminology in LC-OCT is lacking. By reviewing the LC-OCT literature in the field of dermato-oncology, this study aimed to develop a unified terminological glossary integrated with traditional histopathology. A PRISMA-guided literature-search was conducted for English-language publications on LC-OCT of actinic keratosis (AK), keratinocyte carcinoma (KC), and malignant melanoma (MM). Study characteristics and terminology were compiled. To harmonize LC-OCT terminology and integrate with histopathology, synonymous terms for image features of AK, KC, and MM were merged by two authors, organized by skin layer and lesion-type. A subset of key LC-OCT image-markers with histopathological correlates that in combination were typical of AK, squamous cell carcinoma in situ (SCCis), invasive squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and MM in traditional histopathology, were selected from the glossary by an experienced dermatopathologist. Seventeen observational studies of AK (7 studies), KC (13 studies), MM (7 studies) utilizing LC-OCT were included, with 117 terms describing either AK, KC, or MM. These were merged to produce 45 merged-terms (61.5% reduction); 5 assigned to the stratum corneum (SC), 23 to the viable epidermis, 2 to dermo-epidermal junction (DEJ) and 15 to the dermis. For each lesion, mandatory key image-markers were a well-defined DEJ and presence of mild/moderate but not severe epidermal dysplasia for AK, severe epidermal dysplasia and well-defined DEJ for SCCis, interrupted DEJ and/or dermal broad infiltrative strands for invasive SCC, dermal lobules connected and/or unconnected to the epidermis for BCC, as well as single atypical melanocytes and/or nest of atypical melanocytes in the epidermis or dermis for MM. This review compiles evidence on LC-OCT in dermato-oncology, providing a harmonized histopathology-integrated terminology and key image-markers for each lesion. Further evaluation is required to determine the clinical value of these findings.

The epidemiology of acne vulgaris in a multiethnic adolescent population from Rotterdam, the Netherlands: A cross-sectional study

BACKGROUND

Although acne is a prevalent multifactorial inflammatory skin condition, few studies were performed in multiethnic populations.

OBJECTIVES

To study the prevalence and determinants of acne in a multiethnic study at the start of puberty.

METHODS

This cross-sectional study is embedded in Generation R, a population-based prospective study from Rotterdam, the Netherlands. Three-dimensional facial photos at the center visit in 2016-2019 (of ∼13-year-olds) were used to grade acne severity using the Global Evaluation of the Acne Severity (GEA). Analyses were stratified by biological sex and explored through chi-square tests and multivariable ordinal logistic regression.

RESULTS

A total of 4561 children (51% girls) with a median age of 13.5 (IQR 13.3-13.6) were included. The visible acne prevalence (GEA 2-5) for girls vs boys was 62% vs 45% and moderate-to-severe acne (GEA 3-5) 14% vs 9%. Higher puberty stages (adjusted odds ratios: 1.38 [1.20-1.59] and 2.16 [1.86-2.51] for girls and boys, respectively) and darker skin colors V and VI (adjusted odds ratios: 1.90 [1.17-3.08] and 2.43 [1.67-3.56]) were associated with more severe acne in both sexes, and being overweight in boys (adjusted odds ratio: 1.58 [1.15-2.17]).

LIMITATIONS

Cross-sectional design.

CONCLUSIONS

Acne prevalence was high at the age of 13 years and was associated with advanced puberty, darker skin color, and weight status.