Keywords Lichen planus; Lichen sclerosus; Lichenoid; Fixed drug eruption; Graft versus host disease; Syphilis; Erythema multiforme; Lupus; Zoon vulvitis The lichenoid tissue reaction pattern ...generally signifies cytotoxic damage to the epithelium. When such reaction pattern occurs on vulvar skin or mucosa, the effects can result in considerable morbidity. None of the entities discussed in this review are entirely unique to the vulva, however, some entities may classically occur at this site, while others tend to be widespread diseases that may incidentally affect vulvar skin and mucosa. Given the complex anatomy of the vulva and the bridging of a site showing both keratinizing squamous epithelium and non-keratinizing squamous mucosa, histopathologic features may display variation in presentation. Although identification of a "lichenoid reaction pattern" alone may provide insight into the disease process, understanding of clinical presentation and specific sites of involvement, along with recognition of the nuanced features of the disease entities can help establish a specific diagnosis. Accurate histopathologic diagnoses by pathologists can improve the ability for treating clinicians to implement timely and effective treatment. Author Affiliation: (a) Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR (b) Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR * Corresponding author: Sara C. Shalin, 5301 W. Markham St. #517, Little Rock, AR, USA 72205. (footnote) adegreesFunding sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Byline: Sara C. Shalin scshalin@gmail.com (a,*), Luann M. Racher (b), Katelynn K. Campbell (a)
UVR is a major etiology for premature skin aging that leads to photoaging and UV-induced skin cancers. In the skin, TGFβ signaling is a growth inhibitor for keratinocytes and a profibrotic factor in ...the dermis. It exerts context-dependent effects on tumor progression. Chronic UV exposure likely causes TGFβ1/SMAD3 signaling activation and contributes to metalloproteinase-induced collagen degradation and photoinflammation in photoaging. UV irradiation also causes gene mutations in key elements of the TGFβ pathway, including TGFβRI, TGFβRII, SMAD2, and SMAD4. These mutations enable tumor cells to escape from TGFβ-induced growth inhibition and induce genomic instability and cancer stem cells, leading to the initiation, progression, invasion, and metastasis of cutaneous squamous cell carcinoma (cSCC). Furthermore, UV-induced mutations cause TGFβ overexpression in the tumor microenvironment (TME) of cSCC, basal cell carcinoma (BCC), and cutaneous melanoma, resulting in inflammation, angiogenesis, cancer-associated fibroblasts, and immune inhibition, supporting cancer survival, immune evasion, and metastasis. The pleiotropic effects of TGFβ provide possible treatment options for photoaging and skin cancer. Given the high UV-induced mutational burden and immune-repressive TME seen in cSCC, BCC, and cutaneous melanoma, treatment with the combination of a TGFβ signaling inhibitor and immune checkpoint blockade could reverse immune evasion to reduce tumor growth.
Objective: To analyze risk factors for peristomal skin complications in elimination stomas. Method: A systematic review and meta-synthesis protocol will be conducted using the Preferred Reporting ...Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the methodological guidelines and recommendations of the Joanna Briggs Institute (JBI). Two independent researchers will search the following databases: Web of Science, Scopus, Embase, PubMed via CAPES, and LILACS. Eligible studies will include observational, experimental, and quasi-experimental studies published in English, Spanish, and Portuguese, focusing on risk factors for peristomal skin complications in elimination stomas. A software will be used to aid in the study selection process. The risk of bias will be presented using weighted bar graphs and traffic light plots to display the results for each assessed domain in each included study. The meta-synthesis will be conducted using qualitative analysis software, employing textual similarity analysis. Descriptors: Risk Factors; Wounds and Injuries; Ostomy; Enterostomal Therapy. Objetivo: Analisar os fatores de risco para complicagoes de lesao periestomal em estomas de eliminacao. Metodo: Uma revisao sistematica e um protocolo de meta-sintese serao conduzidos de acordo com o checklist Principais Itens para Relatar Revisoes Sistematicas e Metanalises (PRISMA) e as diretrizes e recomendagoes metodologicas do Joanna Briggs Institute (JBI). Dois pesquisadores independentes realizarao buscas nas seguintes bases de dados: Web of Science, Scopus, Embase, PubMed via CAPES e LILACS. Os estudos elegiveis incluirao estudos observacionais, estudos experimentais e estudos quase-experimentais publicados em ingles, espanhol e portugues, com foco em fatores de risco para complicagoes da pele periestomal em estomas de eliminacao. Sera utilizado o software Rayyan Intelligent para auxiliar no processo de selecao dos estudos. O risco de vies sera apresentado usando graficos de barras ponderadas e graficos de semaforos para exibir os resultados para cada dominio avaliado em cada estudo incluido. A metassintese sera realizada em software de analise qualitativa, empregando analise de similaridade textual. Descritores: Fatores de risco; Ferimentos e lesoes; Estomia; Estomaterapia.
COVID‐19 had a great impact on medical approaches among dermatologist. This systematic review focuses on all skin problems related to COVID‐19, including primary and secondary COVID‐related cutaneous ...presentations and the experts recommendations about dermatological managements especially immunomodulators usage issues. Search was performed on PubMed, Scopus, Embase and ScienceDirect. Other additional resources were searched included Cochrane, WHO, Medscape and coronavirus dermatology resource of Nottingham university. The search completed on May 3, 2020. Three hundred seventy‐seven articles assigned to the inclusion and exclusion groups. Eighty‐nine articles entered the review. Primary mucocutaneous and appendageal presentations could be the initial or evolving signs of COVID‐19. It could be manifest most commonly as a maculopapular exanthamatous or morbiliform eruption, generalized urticaria or pseudo chilblains recognized as “COVID toes” (pernio‐like acral lesions or vasculopathic rashes). During pandemic, Non‐infected non‐at risk patients with immune‐medicated dermatologic disorders under treatment with immunosuppressive immunomodulators do not need to alter their regimen or discontinue their therapies. At‐risk o suspected patients may need dose reduction, interval increase or temporary drug discontinuation (at least 2 weeks). Patients with an active COVID‐19 infection should hold the biologic or non‐biologic immunosuppressives until the complete recovery occur (at least 4 weeks).
Objectives: This study investigated the presence of mercury in commonly used over the counter skin-lightening creams available in Trinidad and Tobago. The objective of this study was to evaluate if ...skin-lightening creams commonly used in Trinidad and Tobago contained Mercury, and establish the health risks presented by these products. Methods: Nineteen skin-lightening creams were analysed using Cold Capor Atomic Absorption Spectrophotometry (CV-AAS). Margin of Safety (MoS) and Hazard Quotient (HQ) calculations were used to assess risk to users. Results: Of the nineteen creams assessed, sixteen contained high concentrations of mercury (0.294-14414.5 µg/g), only three creams had no mercury detected. 9 of the 19 samples contained levels of mercury that exceed the Minamata convention’s accepted limit of 1µg/g, with 3 samples exceeding 3800.000 µg/g. Risk assessments using MoS and HQ showed that 3 of the samples were unsafe for use and are considered hazardous. The study also revealed that many creams do contain mercury even if it did not constitute part of the product formulation. Conclusions: The data infers that some manufacturers do add mercury to their formulations while others are the victims of contaminated raw materials. MoS and HQ show that 21% of the samples were unsafe and 16% can be considered hazardous for human use. It is possible that with such levels of mercury in these products and the popularity of these products within the Caribbean Community and its diaspora, that there exists a significant amount of members with higher than acceptable mercury levels, with undiagnosed clinical symptoms.
Skin aging is a complex process, and alterations in human skin due to aging have distinct characteristic as compared to other organs. The aging of dermal cells and the biological mechanisms involved ...in this process are key areas to understand skin aging. A large number of biological mechanisms, such as decreasing of protein synthesis of extracellular matrix or increasing of degradation, are known to be altered through skin aging. However, environmental influence can accelerate this characteristic phenotype. In this study, we analyzed primary human dermal fibroblasts in three different in-vitro aging models-UVB irradiation and accelerated proliferation of human dermal fibroblasts from young donors as well as from elderly donors-for the gene expression of COL1A1, COL1A2, COL3A1, COL4A1, COL7A1, MMP1, MMP2, MMP3, MMP7, MMP8, MMP9, MMP10, MMP12, MMP13, MMP14, TIMP1, TIMP2, TIMP3, TIMP4, IL1B, IL1A, IL6, IL8, IL10, PTGS2, TP53, CASP3, LMNA, SIRT1. We compared the gene expression levels with young control. Furthermore, the behavior of skin fibroblasts was also evaluated using cell growth rate. The findings reveal that the gene expression levels in skin fibroblasts was altered in the process of aging in all three in-vitro aging models, and the cell growth rate was reduced, suggesting that these methods can be employed to understand skin aging mechanisms as well as drug discovery screening method.
Lumpy skin disease is a high-consequence disease in cattle caused by infection with the poxvirus lumpy skin disease virus (LSDV). The virus is endemic in most countries in Africa and an emerging ...threat to cattle populations in Europe and Asia. As LSDV spreads into new regions, it is important that signs of disease are recognized promptly by animal caregivers. This study describes the gross, microscopic, and ultrastructural changes that occur over time in cattle experimentally challenged with LSDV. Four calves were inoculated with wildtype LSDV and monitored for 19 to 21 days. At 7 days after inoculation, 2 of the 4 cattle developed multifocal cutaneous nodules characteristic of LSD. Some lesions displayed a targetoid appearance. Histologically, intercellular and intracellular edema was present in the epidermis of some nodules. Occasional intracytoplasmic inclusion bodies were identified in keratinocytes. More severe and consistent changes were present in the dermis, with marked histiocytic inflammation and necrotizing fibrinoid vasculitis of dermal vessels, particularly the deep dermal plexus. Chronic lesions consisted of full-thickness necrosis of the dermis and epidermis. Lesions in other body organs were not a major feature of LSD in this study, highlighting the strong cutaneous tropism of this virus. Immunohistochemistry and electron microscopy identified LSDV-infected histiocytes and fibroblasts in the skin nodules of affected cattle. This study highlights the noteworthy lesions of LSDV and how they develop over time.
AbstractObjectiveTo examine the validity and findings of studies that examine the accuracy of algorithm based smartphone applications (“apps”) to assess risk of skin cancer in suspicious skin ...lesions.DesignSystematic review of diagnostic accuracy studies.Data sourcesCochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, CPCI, Zetoc, Science Citation Index, and online trial registers (from database inception to 10 April 2019).Eligibility criteria for selecting studiesStudies of any design that evaluated algorithm based smartphone apps to assess images of skin lesions suspicious for skin cancer. Reference standards included histological diagnosis or follow-up, and expert recommendation for further investigation or intervention. Two authors independently extracted data and assessed validity using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2 tool). Estimates of sensitivity and specificity were reported for each app.ResultsNine studies that evaluated six different identifiable smartphone apps were included. Six verified results by using histology or follow-up (n=725 lesions), and three verified results by using expert recommendations (n=407 lesions). Studies were small and of poor methodological quality, with selective recruitment, high rates of unevaluable images, and differential verification. Lesion selection and image acquisition were performed by clinicians rather than smartphone users. Two CE (Conformit Europenne) marked apps are available for download. SkinScan was evaluated in a single study (n=15, five melanomas) with 0% sensitivity and 100% specificity for the detection of melanoma. SkinVision was evaluated in two studies (n=252, 61 malignant or premalignant lesions) and achieved a sensitivity of 80% (95% confidence interval 63% to 92%) and a specificity of 78% (67% to 87%) for the detection of malignant or premalignant lesions. Accuracy of the SkinVision app verified against expert recommendations was poor (three studies).ConclusionsCurrent algorithm based smartphone apps cannot be relied on to detect all cases of melanoma or other skin cancers. Test performance is likely to be poorer than reported here when used in clinically relevant populations and by the intended users of the apps. The current regulatory process for awarding the CE marking for algorithm based apps does not provide adequate protection to the public.Systematic review registrationPROSPERO CRD42016033595.
Tissue engineered skin substitutes for wound healing have evolved tremendously over the last couple of years. New advances have been made toward developing skin substitutes made up of artificial and ...natural materials. Engineered skin substitutes are developed from acellular materials or can be synthesized from autologous, allograft, xenogenic, or synthetic sources. Each of these engineered skin substitutes has their advantages and disadvantages. However, to this date, a complete functional skin substitute is not available, and research is continuing to develop a competent full thickness skin substitute product that can vascularize rapidly. There is also a need to redesign the currently available substitutes to make them user friendly, commercially affordable, and viable with longer shelf life. The present review focuses on providing an overview of advances in the field of tissue engineered skin substitute development, the availability of various types, and their application.
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