Prevalence and causative allergens of contact cheilitis in Thailand

BACKGROUND

Cheilitis is an inflammatory condition of the lips. Its causes can be exogenous (irritants, allergens), endogenous (atopic dermatitis, systemic disorders) or unknown.

OBJECTIVES

To determine the prevalence of allergic contact cheilitis (ACC), its risk factors, and common allergens in patients with cheilitis at a Thai university-based tertiary care hospital.

METHODS

A retrospective chart review was conducted on patients with cheilitis referred for patch testing between January 2007 and December 2021.

RESULTS

Among 5366 patients referred for patch testing, 410 (7.6%) had cheilitis. ACC was diagnosed in 32% of the cheilitis patients. Compared to non-ACC cases, the patients with ACC were more likely to be young and female and have a disease duration of <3 months, no underlying disease and a white-collar job (p-value <0.05). The most common contact allergens were patient's products (73.3%), nickel sulfate (29.8%), potassium dichromate (14.5%), castor oil (14.3%) and benzalkonium chloride (13.0%). Lip cosmetics and toothpastes were major ACC sources.

CONCLUSIONS

ACC should be considered in cheilitis patients, especially in patients with specific risk factors. Castor oil is an emerging allergen. Patch testing using commercial allergen series and patients' own products is crucial for identifying causative agents. The development of a specific cheilitis series is warranted.

Efficacy of panthenol- and bisabolol-containing lip care as monotherapy for mild-to-moderate cheilitis

BACKGROUND

Cheilitis is a chronic inflammatory condition of the lips, and frequent or prolonged use of topical corticosteroids may lead to various adverse events. Therefore, alternative therapies with fewer side effects are beneficial for the treatment of this condition.

AIM

To evaluate the efficacy of a lip care formulation containing both panthenol and bisabolol as a monotherapy for mild-to-moderate cheilitis.

METHODS

This single-centre prospective pilot open-label study included 20 patients with mild-to-moderate cheilitis who were treated with the tested lip care for 8 weeks and evaluated by physician and patient assessments before the final efficacy was determined using the Visioscan score.

RESULTS

Of the 20 patients, 13 (65.0%) presented with moderate cheilitis with dry and chapped lips. All parameters, including physician and patient clinical scores and bioengineering measurements, showed significant improvements as early as week 2 and sustained until week 8 following the application of the tested lip care. The frequency of cheilitis flareups also decreased significantly. The tested product was well tolerated without any adverse effects.

CONCLUSIONS

Lip care with panthenol and bisabolol was safe and effective. It can be used as monotherapy for the treatment of mild-to-moderate cheilitis.

Effect of Platelet-Rich Plasma and other Key Factors on Hair Follicle Preservation

Background

Hair graft preservation is an important factor that influences graft survival in hair transplantation.

Objective

To investigate the benefits of adding platelet-rich plasma (PRP), and the effect of different storage solutions and temperatures on hair follicle preservation.

Materials and Methods

This randomized-controlled study included 10 androgenetic alopecia patients who underwent hair transplantation. Forty-five hair grafts were collected from each patient and then randomized to 8 different culture conditions for 7 days. Hair grafts were cultured in Williams' Medium E or Ringer's lactate solution (RLS) at either 4°C or 37°C, and with or without 10% PRP supplementation.

Results

In vitro hair growth in Williams' Medium E was significantly greater than in RLS. The 37°C temperature condition was found to be significantly better than the 4°C condition. The growth of hair grafts cultured with PRP was not significance difference from those without PRP. However, immunofluorescence staining for cytokeratin 15 showed greater expression in hair graft cultured with PRP.

Conclusion

PRP may have a beneficial effect for preserving the viability of hair grafts. Williams' Medium E and 37°C temperature were found to be superior to RLS and 4°C relative to hair follicle growth in organ culture.

A 30-year Patch Testing Experience at Siriraj Dermatology

Objective:  To identify trends of contact allergy and patch testing amendments at the Contact Dermatitis Clinic, Department of Dermatology, Siriraj Hospital. Materials and Methods: Medical records of 6,862 patients referred to our clinic between January 1992 and December 2021for patch testing were reviewed. Results: The number of patients patch tested increased and reached a peak of 600 patients/year in 2019 before the COVID-19 pandemic.  The most frequently used series was baseline, while the most used specific series was cosmetics. The overall positivity rate was 69%. The highest positivity rate was in the cosmetics series (70.2%). Nickel sulfate was the most common contact allergen found (24.2%). Conclusion:  Our patch test service has been growing in the last 30 years.  The series of allergens used for patch testing has been amended every few years to be up-to-date with current global trends of contact allergies. Continual surveillance of contact prevalence and periodic updating of those series are necessary to enhance our ability to detect culprit contact allergens, which could help us improve care of our patients.

Impact of the COVID-19 Pandemic on Tertiarycare University Dermatology Outpatient Clinic and Dermatology Procedures

Objective: This study aimed to determine the changes in patient characteristics, disease prevalence, and dermatology procedures during the COVID-19 pandemic. Materials and Methods: We retrospectively reviewed the demographic data, diagnoses, and dermatology procedures of the patients who visited an outpatient dermatology clinic between March 1, 2018, and December 31, 2021. Changes in the number of patients, the patterns of diagnosis, and the dermatology procedures were analyzed. Results: The number of patients decreased at the start of each of the 4 COVID-19 waves that occurred during the study period. Older adults increased their dermatology visits during the pandemic. The skin disease with the highest proportional increase in the frequency of visits was cutaneous T-cell lymphoma. The proportion of noncosmetic procedures significantly increased, in contrast to a decrease in the proportion of cosmetic procedures. Conclusion: The COVID-19 pandemic significantly affected outpatient dermatology by changing the setting and frequency of patient visits to the outpatient clinic, the pattern of the diseases, and the dermatology procedures.

Topical diphenylcyclopropenone plus topical 0.5% anthralin versus topical diphenylcyclopropenone alone for the treatment of chronic extensive alopecia areata: A split-scalp, double-blind, controlled study

Background:

The combination of diphenylcyclopropenone (DCP) and anthralin may demonstrate synergistic effects in the treatment of chronic extensive alopecia areata (AA).

Objective:

The objective of the study was to compare the efficacy of the combination therapy of topical DCP and topical 0.5% anthralin versus topical DCP alone for the treatment of chronic extensive AA.

Materials and Methods:

Ten patients were included in the study. Of these, 1, 2, and 7 patients were diagnosed with alopecia totalis, severe AA (>50% hair loss), and alopecia universalis, respectively. For each patient, one side of the scalp was treated with a DCP solution and 0.5% anthralin for 6 months, while the other side was treated with DCP and a cream base for the same duration. The clinical responses were assessed at baseline and then monthly until the end of the 6-month study period using the Severity of Alopecia Tool score. The side effects were evaluated at each follow-up visit.

Results:

The difference in the efficacies of the combination treatment and DCP alone was not statistically significant (P = 0.59). Regarding the side effects, DCP plus 0.5% anthralin caused significantly more excessive dermatitis than DCP alone (7 patients vs. 2 patients; P = 0.02). Eight patients reported temporary hyperpigmentation at the combination-treatment site, whereas no hyperpigmentation was reported at the DCP-alone site of any patient (P < 0.001).

Conclusions:

The combination of DCP and 0.5% anthralin was not superior to DCP alone for the treatment of chronic extensive AA. An increase in side effects – excessive dermatitis and hyperpigmentation – was observed in the combination-treatment group.

Reliability, Validity and Feasibility of the Vitiligo Extent Score (VES) and Self-Assessment Vitiligo Extent Score (SA-VES) Among Vitiligo Patients: A Cross-Cultural Validation

Background

The Vitiligo Extent Score (VES) and Self-Assessment Vitiligo Extent Score (SA-VES) have not been formally validated in Thai population.

Objective

To evaluate reliability, validity and feasibility of the VES and SA-VES in Thai vitiligo patients.

Methods

Vitiligo lesions from 100 patients were evaluated by 2 independent dermatologists using VES and Vitiligo Area Scoring Index (VASI). Reliability was assessed by comparing VES scores between physicians. Validity was determined by comparison among the VES, VASI, and SA-VES instruments. Patients scored their vitiligo severity using the SA-VES.

Results

The reliability of the VES was excellent (inter-rater reliability: 0.997, 95% confidence interval: 0.995–0.998). There was very strong correlation between the VES and VASI (r=0.976, p<0.001), and strong correlation between the VES and SA-VES (r=0.890, p<0.001), and between the VASI and SA-VES (r=0.866, p<0.001). Moderate correlation among the VES, VASI, and SA-VES was observed in patients with segmental or <1% body surface area (BSA) vitiligo. Ninety-five percent of patients rated the SA-VES as easy to moderately easy.

Conclusion

The VES has reliability and validity comparable to that of the VASI. The SA-VES is an user-friendly instrument that correlated well with physicians’ scoring methods in patients with non-segmental or >1% BSA vitiligo.

Facial hair shaving behavior and skin problems of shaved areas of males

Unwanted facial hair is a common problem and requires different grooming regimens or treatments. Shaving beard hair can cause undesirable skin effects, such as irritation, razor burn, razor nick, and pseudofolliculitis barbae. This study explores male behaviors related to shaving facial hair and the consequential effects on the shaved skin. A questionnaire-based, cross-sectional, analytical study was conducted on 340 healthy men. Most of the participants were manual shavers. Approximately one-third of the manual shavers prepared their skin for shaving, compared to 13% of the electric shavers. The most common shaving-related skin problems were irritation and dryness, razor burn, razor nicks, and pseudofolliculitis barbae. The shaving-related skin problems resulted from individual skin conditions and their shaving techniques. Appropriate skin preparation should be undertaken before shaving, and post-shaving care products should be used to avoid problems.

Associated factors of widespread pattern of dermatitis among patch test population: 12-Year retrospective study

BACKGROUND/OBJECTIVE

Widespread dermatitis is often associated with diagnostic and therapeutic challenges. Multiple factors influence this widespread pattern of dermatitis. We aim to study the associated factors in patch-tested patients who presented with widespread pattern of dermatitis.

METHOD

This retrospective, case-control study was conducted on patients with dermatitis who were patch tested during January 2005 to December 2016. The demographic data, patient and family histories, diagnoses, and patch test findings were recorded and analyzed.

RESULTS

Of the 3201 included patients, 645 (20.2%) had widespread pattern of dermatitis. Being male, age >60, and history of either atopic dermatitis (AD) or metal allergy were significantly associated with the widespread dermatitis pattern. A multivariate analysis demonstrated that preservatives were the significant offending allergens, especially methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), and methylisothiazolinone (MI) alone.

CONCLUSION

Widespread pattern of dermatitis is associated with gender, age, underlying atopic dermatitis and a history of metal allergy. Preservatives are the significant offending allergens of widespread dermatitis, especially MCI/MI, and MI alone. A thorough history taking and patch testing, including preservatives, are necessary to determine the cause of widespread pattern of dermatitis.

Randomized investigator-blinded comparative study of moisturizer containing 4-t-butylcyclohexanol and licochalcone A versus 0.02% triamcinolone acetonide cream in facial dermatitis

BACKGROUND

Facial dermatitis can result from various conditions, some of which are of a chronic and relapsing nature. The use of topical corticosteroid therapy may lead to additional adverse effects.

OBJECTIVE

To compare the efficacy of moisturizer containing 4-t-butylcyclohexanol, which acts as a sensitivity regulator, and licochalcone A, an anti-inflammatory agent from the licorice plant Glycyrrhiza inflata, with that of 0.02% triamcinolone acetonide (TA) for the treatment of facial dermatitis.

METHODS

This was a randomized, prospective, investigator-blinded study. Eighty participants with mild to moderate facial dermatitis were randomly treated with either the test facial moisturizer or 0.02% TA twice daily for the first 2 weeks. For the subsequent 2 weeks, all patients used only the test moisturizer. Clinical assessment by investigators, bioengineering measurements, patients' subjective evaluation, and clinical photography were performed at baseline, week 2, and week 4.

RESULTS

Both treatments showed a statistically significant improvement with regard to physician clinical assessment, skin hydration, transepidermal water loss, and patient-assessed visual analog scale after 2 and 4 weeks of treatment compared with baseline. The test facial moisturizer produced better skin hydration than TCS. The improvement in TEWL after 4 weeks of using the test moisturizer was comparable with 2-week treatment with 0.02% TA cream. However, subjective evaluation by patients indicated that TA more rapidly improved sensation sensitivity.

CONCLUSION

The test facial moisturizer was slower than 0.02% TA in improving facial dermatitis, but showed greater benefit in erythema control and skin hydration.

Cyclosporine for Chronic Spontaneous Urticaria: A Meta-Analysis and Systematic Review

BACKGROUND

Despite widely recommended usage of cyclosporine A (CsA) in chronic spontaneous urticaria (CSU), there is no meta-analysis concerning its efficacy and safety.

OBJECTIVE

To meta-analyze and review the efficacy and safety of CsA in CSU.

METHODS

Efficacy was assessed by the relative change in urticaria activity score at 4 weeks and response rates at 4, 8, and 12 weeks. Safety was assessed by analyzing the number of patients with 1 or more adverse event.

RESULTS

Eighteen studies (909 participants) including 2 randomized controlled trials were included, with 125, 363, and 266 patients with CSU receiving very low (<2 mg/kg/d), low (from 2 to< 4 mg/kg/d), and moderate (4-5 mg/kg/d) doses of CsA, respectively. After 4 weeks, the mean relative change in urticaria activity score of CsA-treated patients was -17.89, whereas that of controls was -2.3. The overall response rate to CsA treatment with low to moderate doses at 4, 8, and 12 weeks was 54%, 66%, and 73%, respectively. No studies of very low-dose CsA evaluated response rates at 4, 8, and 12 weeks. Among patients treated with very low, low, and moderate doses of CsA, 6%, 23%, and 57% experienced 1 or more adverse event, respectively.

CONCLUSIONS

Given the limited number and quality of studies, our results should be interpreted with caution. CsA is effective at low to moderate doses. Adverse events appear to be dose dependent and occur in more than half the patients treated with moderate doses of CsA. We suggest that the appropriate dosage of CsA for CSU may range from 1 to 5 mg/kg/d, and 3 mg/kg/d is a reasonable starting dose for most patients.

Metabolic syndrome and psoriasis severity in South-East Asian patients: An investigation of potential association using current and chronological assessments

Although studies regarding prevalence of metabolic syndrome (MS) in Asian psoriatic patients are limited and show varying results, a previous report describes a significant increase in prevalence of MS in Thai psoriatic patients, as compared with rates in the general population. However, no significant association between MS and psoriasis severity using the Psoriasis Area and Severity Index (PASI) was found, which differs from the findings of Korean and Japanese studies. This study aimed at re-evaluating the association between MS and psoriasis severity in Thai patients using current assessment (PASI) and chronological assessment (historical course and interventions). A total of 273 psoriatic patients were recruited. After controlling for age and sex, 96 patients were assigned to the MS group and 96 patients to the non-MS group. Similar to the previous study, no significant differences were identified between metabolic and non-metabolic patients regarding PASI, age of onset, disease duration and family history of psoriasis. However, the numbers of hospitalizations (P = 0.018) and interventions (P = 0.028) were significantly higher in metabolic patients than in non-metabolic patients. Further, a greater number of metabolic components was significantly associated with a higher number of hospitalizations (P = 0.012), pustular or erythrodermic psoriasis episodes (P = 0.049), and interventions (P = 0.005). Body mass index of 23 kg/m² or more, abdominal obesity and high blood pressure were associated with an increased risk of treatment failure. Using chronological assessment, our study supported that MS negatively affects psoriasis severity and treatment outcomes. Screening for MS is highly recommended for psoriatic patients.