Melasma is an acquired, symmetrical hypermelanosis of the face. The pathogenesis of melasma is complex and the treatment is often challenging with frequent relapses. Genetic background, exposure to ...ultraviolet radiation, and female sex hormones are classical influencing factors. To the light of the recent literature, other factors could promote melasma lesions. Moreover, there are increasing evidences showing that melanocytes are not the only cells involved, and that other players probably have a key role in the development and the relapses of melasma. Identifying those associated factors should provide new targets for a more efficient treatment of melasma and a better prevention of the relapses.
The skin exposome. An exciting growing field of research Passeron, T.
JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology,
July 2020, 2020-Jul, 2020-07-00, 20200701, Letnik:
34, Številka:
S4
Journal Article
Clinical and biological impact of the exposome on the skin Passeron, T.; Krutmann, J.; Andersen, M.L. ...
JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology,
July 2020, 2020-Jul, 2020-07-00, Letnik:
34, Številka:
S4
Journal Article
Recenzirano
Odprti dostop
The skin exposome is defined as the totality of environmental exposures over the life course that can induce or modify various skin conditions. Here, we review the impact on the skin of solar ...exposure, air pollution, hormones, nutrition and psychological factors. Photoageing, photocarcinogenesis and pigmentary changes are well‐established consequences of chronic exposure of the skin to solar radiation. Exposure to traffic‐related air pollution contributes to skin ageing. Particulate matter and nitrogen dioxide cause skin pigmentation/lentigines, while ozone causes wrinkles and has an impact on atopic eczema. Human skin is a major target of hormones, and they exhibit a wide range of biological activities on the skin. Hormones decline with advancing age influencing skin ageing. Nutrition has an impact on numerous biochemical processes, including oxidation, inflammation and glycation, which may result in clinical effects, including modification of the course of skin ageing and photoageing. Stress and lack of sleep are known to contribute to a pro‐inflammatory state, which, in turn, affects the integrity of extracellular matrix proteins, in particular collagen. Hormone dysregulation, malnutrition and stress may contribute to inflammatory skin disorders, such as atopic dermatitis, psoriasis, acne and rosacea.
Summary
The use of antibodies against programmed death (PD)1, such as nivolumab and pembrolizumab, has dramatically improved the prognosis of patients with advanced melanoma. Nivolumab is also ...approved in advanced squamous cell nonsmall‐cell lung cancer. These immunotherapies are associated with a unique set of toxicities termed immune‐related adverse events, which are different from toxicities observed with conventional cytotoxic chemotherapy. We report the case of a 56‐year‐old man who was diagnosed with metastatic melanoma and who received nivolumab. One week after the second infusion, he developed pulmonary symptoms, dry eye syndrome and a bilateral swelling of the parotid glands. Investigations were negative for infection. The bronchoalveolar lavage differential cell count showed 32% lymphocytes with an increased CD4 : CD8 ratio, and bronchial biopsies revealed noncaseating epithelioid granulomas, without malignant cells. The clinical and radiological courses were rapidly favourable with oral corticosteroid. This case illustrates that sarcoidosis can be induced by nivolumab treatment. With the increasing use of anti‐PD1 inhibitors in patients with advanced melanoma and squamous cell nonsmall‐cell lung cancer, clinicians should be aware of this potential associated immune‐related adverse event.
What's already known about this topic?
Antiprogrammed death (anti‐PD)1 antibodies such as nivolumab have dramatically changed the landscape of melanoma treatment.
Nivolumab is also indicated in advanced squamous cell nonsmall‐cell lung cancer.
Sarcoid‐like reaction may occur during melanoma treatment, but it has never been reported with anti‐PD1 therapy.
What does this study add?
Pulmonary sarcoid‐like reaction can occur during nivolumab therapy.
With the increasing use of PD1 inhibitors for the treatment of cancers, clinicians should be familiar with this associated adverse event.
Background
Q‐switched nanosecond lasers demonstrated their efficacy in treating most types of tattoos, but complete disappearance is not always achieved even after performing numerous laser sessions. ...Picosecond lasers are supposed to be more efficient in clearing tattoos than nanosecond lasers, but prospective comparative data remain limited.
Objective
To compare on different types of tattoos the efficacy of a nanosecond laser with two types of picosecond lasers.
Methods
We conducted a prospective randomized study performed from December 2014 to June 2016 on adult patients with all types of tattoos. The tattoos were divided into two halves of equal size. After randomization, half of the tattoo was treated with a picosecond laser and the other half with a nanosecond laser. The evaluation was performed on standardized pictures performed before treatment and 2 months after the last session, by two physicians, not involved in the treatment, blinded on the type of treatments received. The main end point was a clearance above 75% of the tattoos.
Results
A total of 49 patients were included. Professional tattoos represented 85.7%, permanent make‐up 8.2% and non‐professional tattoo 6.1%. The majority were black or blue and 10.2% were polychromatic. No patient was lost during follow‐up. A reduction of 75% or more of the colour intensity was obtained for 33% of the tattoos treated with the picosecond lasers compared to 14% with the nanosecond laser (P = 0.008). An improvement superior to 75% was obtained in 34% monochromic black or blue tattoos with the picosecond lasers compared to 9% for the nanosecond laser. Only one of the five polychromic tattoos achieved more than 75% of improvement with the two types of laser.
Conclusion
Our results show a statistically significant superiority of the picosecond lasers compared to the nanosecond laser for tattoo clearance. However, they do not show better efficacy for polychromic tattoos and the difference in terms of side‐effects was also minimal with a tendency of picosecond lasers to be less painful.
Background
Despite a solid rationale, the usefulness of antioxidants in treating vitiligo has not been clearly demonstrated. Combining superoxide dismutase (SOD) with a wheat gliadin biopolymer ...protects it during the passage through the gastrointestinal tract.
Objective
To evaluate the efficacy of gliadin‐protected SOD (GP‐SOD), associated with narrowband ultraviolet B(NB‐UVB), for treating vitiligo.
Methods
We conducted a 24‐week monocentric interventional prospective randomized placebo‐controlled trial in the tertiary center for vitiligo care in the department of Dermatology of Nice University hospital, Nice, France.
Subjects with non‐segmental vitiligo affecting more than 5% of the total body surface were included. The subjects received gliadin‐protected SOD (GP‐SOD; 1 g/day for 12 weeks followed by 0.5 g/day for 12 weeks) or placebo in combination with twice‐weekly sessions of NB‐UVB. The primary endpoint was the total repigmentation rate at 24 weeks, compared with baseline, as assessed by investigator‐assessed Vitiligo Extent Score (VES) on standardized pictures.
Results
A total of 50 patients were included. After 24 weeks, a greater improvement in VES was observed in the GP‐SOD group (19.85%; SE 4.63, P < 0.0001) compared with the placebo group (8.83%; SE 4.72, P = 0.0676). Tolerance was good in both groups. No related side‐effect was reported.
Conclusions
The use of GP‐SOD appears to be a useful add‐on to phototherapy in the treatment of vitiligo patients.
Summary
Background
The associations between disease activity and several clinical signs in vitiligo have been described, but a widely accepted and validated scoring system is lacking.
Objectives
To ...validate the Vitiligo Signs of Activity Score (VSAS) for physicians.
Methods
Three visible clinical signs were scored on 15 body locations: confetti‐like depigmentation (c), Koebner phenomenon (k) and hypochromic areas/borders (h). The inter‐ and intrarater reliability of the global VSAS and VSAS subscores (c‐VSAS, k‐VSAS and h‐VSAS) were tested by four and three raters (physicians), respectively. Construct validity and feasibility were evaluated.
Results
The VSAS demonstrated good inter‐rater reliability, with an intraclass correlation coefficient (ICC) of 0·87 in the first round and 0·90 in the second round. The intrarater reliability ICCs were all ≥ 0·86. The inter‐rater reliabilities of the subscores were excellent for c‐VSAS and fair for k‐VSAS and h‐VSAS (ICC 0·83, 0·51 and 0·53, respectively, in the first round). Evidence for construct validity was provided. The completion time by the raters (median 2·18 min per patient) improved during the second round (median 1·33 min per patient). A limitation of the study is the low number of patients, mainly of skin phototypes II–III, from a single tertiary centre.
Conclusions
The VSAS appears to be a valid and reliable instrument to score visible clinical signs linked to disease activity in a standardized way.
What is already known about this topic?
Evidence exists for a possible link between several visible clinical signs in vitiligo and disease activity.
A widely accepted and validated scoring system to quantify these clinical signs is lacking.
What does this study add?
The Vitiligo Signs of Activity Score (VSAS) underwent preliminary validation and may assist quantification of visible clinical signs linked to disease activity in a standardized way in clinical practice and trials.
What are the clinical implications of this work?
VSAS may be used for future trials that aim to establish the clinical significance of the specific visible clinical signs in vitiligo in a more controlled setting.
Linked Comment: Eleftheriadou. Br J Dermatol 2020; 183:801–802.
What is already known about this topic?
Evidence exists for a possible link between several visible clinical signs in vitiligo and disease activity.
A widely accepted and validated scoring system to quantify these clinical signs is lacking.
What does this study add?
The Vitiligo Signs of Activity Score (VSAS) underwent preliminary validation and may assist quantification of visible clinical signs linked to disease activity in a standardized way in clinical practice and trials.
What are the clinical implications of this work?
VSAS may be used for future trials that aim to establish the clinical significance of the specific visible clinical signs in vitiligo in a more controlled setting.
Linked Comment: Eleftheriadou. Br J Dermatol 2020; 183:801–802.
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