Long‐term outcomes of imiquimod‐treated lentigo maligna

Summary

Background

Lentigo maligna (LM) may be disfiguring and can progress to LM melanoma. Surgical excision remains the mainstay of treatment, but may result in disfigurement when used for large facial lesions. Topical imiquimod is a nonsurgical alternative although data on its long‐term efficacy remain limited.

Aim

To assess long‐term outcomes of LM treated with imiquimod cream.

Methods

We collected data retrospectively for 33 patients treated with imiquimod cream for biopsy‐proven LM from 2001 to 2016. Patients initially applied imiquimod once daily, 5 days/week for 6 weeks, aiming to produce a brisk local inflammatory response. If there was no response, the dose was increased to twice daily 7 days/week for 6 weeks and if again there was no response, to twice daily for 10 weeks.

Results

An inflammatory response developed in 29 (88%) of the 33 patients, and of these, 4 patients stopped treatment earlier than planned because they could not tolerate the inflammatory reaction, while 3 patients reported systemic side effects. There was lesion clearance in 21 (72%) of the 29 patients, and they remained clear after a mean follow‐up of 4.1 years. Eight failed to clear; in five the lesion was excised, while the remaining three were managed expectantly.

Conclusions

Our results support the use of imiquimod as an alternative to surgery for the treatment of LM in selected cases. With adequate patient preparation, imiquimod is generally tolerated and can achieve excellent cosmetic results. A clinical response is more likely if there is a brisk inflammatory response, and LM will not resolve if there is no inflammatory response.

http://bit.ly/2MlGBYd

Modified phenol peels for treatment‐refractory hyperpigmentation of lichen planus pigmentosus: A retrospective clinico‐dermoscopic analysis

Abstract

Background

Lichen Planus Pigmentosus (LPP), a disorder with stubborn treatment‐refractory hyperpigmentation predominantly affects the darker skin. Deep dermal pigmentary incontinence of LPP renders the condition treatment‐refractory.

Objectives

Lack of a consistently effective depigmenting treatment protocol of inactive LPP mandates exploration of novel approaches. We analyzed the effect of six sessions of modified phenol peel on reduction of pigmentation of LPP in Indian patients.

Methods

The results of a retrospective analysis of the efficacy and safety of six sessions of Croton oil free phenol combination (CFPC) peel done every 3 weeks, for inactive LPP‐associated hyperpigmentation in 17 patients are presented. Efficacy evaluation was done with patient‐reported improvement, physician‐evaluated improvement (photographic comparison of baseline and post‐treatment clinical images), and pre‐ and posttreatment comparison of dermoscopic images using a simple scale.

Results

Out of 17, 5 (29%) patients sustained excellent improvement with >75% reduction of pigmentation. Overall 13 (76%) patients had moderate to excellent improvement, that is, at least 25% or more reduction in pigmentation. The patient‐reported improvement, physician‐graded improvement, and dermoscopic changes—all three measures showed harmonious overlap. Lightening of the background color and reduction in density and color intensity of pigmented structures was observed on dermoscopy in majority of patients. The treatment was well tolerated with no serious local/systemic adverse effects.

Conclusions

Modified phenol peels seem effective in reduction of hyperpigmentation of LPP. They are safe and well tolerated. Thorough priming, stringent sun protection and use of post‐peel adjuvant topicals boost the peel effect and aid in maintaining the effect for up to a year.

http://bit.ly/2U5wUzL

A comparison of infection rates during skin cancer excisions using nonsterile vs sterile gloves: A prospective randomized pilot study

Summary

Background

Standard surgical skin excision is a routine outpatient procedure commonly performed in Dermatology practice to treat nonmelanoma and melanoma skin cancer. Use of sterile gloves during this procedure has been the standard of care in most Dermatology offices.

Objective

To determine whether the incidence of infection rates was affected when using nonsterile gloves (NSG) instead of sterile gloves (SG) during standard skin excisions in an outpatient Dermatology clinic setting.

Methods

This prospective, subject‐blinded, single‐center trial randomized 93 patients presenting for routine skin cancer excisions into two groups. In the first group, 53 excisions were performed with NSG and in the second group 53 excisions were performed with sterile gloves. Degree of wound inflammation and wound infection at 48‐72 hours postprocedure was measured.

Results

One hundred and six total wounds were included. Zero of 53 were infected in the NSG group, and 0/53 were infected in the SG at the initial screening 48‐72 hours postexcision procedure (P = 0.99). The average wound inflammation score was 0.321 for the NSG group and 0.245 for the SG group.

Conclusions

Our study suggests that NSG are safe to use for simple excisions of cutaneous skin cancers in an outpatient dermatology clinic setting.

http://bit.ly/2DnHj4c

Fueling Ketone Metabolism Quenches Salt-Induced Hypertension

Publication date: Available online 19 January 2019

Source: Trends in Endocrinology & Metabolism

Author(s): David E. Place, Thirumala-Devi Kanneganti

Understanding the molecular mechanisms by which diet and exercise regulate disease has the potential to help identify new treatments. In their recent study, Chakraborty et al. (Cell Reports 2018;25:677–689) discovered that supplementation with a metabolic precursor produced β-hydroxybutyrate (BHB), counteracting the pathological effects of high-salt diet-induced hypertension, suggesting a new treatment modality.

http://bit.ly/2TbMI3G

Pressure Ulcers: Prevention and Management

Publication date: Available online 18 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Joshua S. Mervis, Tania J. Phillips

Abstract

Prevention has been a primary goal of pressure ulcer research. Despite such efforts, pressure ulcers remain common in hospitals and the community. Moreover, pressure ulcers often become chronic wounds that are difficult to treat and tend to recur after healing. Especially given these challenges, dermatologists should have the knowledge and skills to implement pressure ulcer prevention strategies and to effectively treat pressure ulcers in their patients. This continuing medical education article will focus on pressure ulcer prevention and management, with a particular emphasis on the evidence for commonly accepted practices.

http://bit.ly/2FL68st

Pressure Ulcers: Pathophysiology, Epidemiology, Risk Factors, and Presentation

Publication date: Available online 18 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Joshua S. Mervis, Tania J. Phillips

Abstract

Though preventable in the vast majority of cases, pressure ulcers continue to pose a major burden to the individual and society, affecting up to 3 million adults annually in the United States alone. Despite increased national attention over the past 20 years, the prevalence of pressure ulcers has largely remained unchanged, while associated costs of care continue to increase. Dermatologists can play a significant role in pressure ulcer prevention by becoming aware of at-risk populations and implementing suitable preventive strategies. Moreover, dermatologists should be able to recognize early changes that occur prior to skin breakdown and to properly identify and stage pressure ulcers so as to prevent delay of appropriate care. The aim of the first part of this continuing medical education article is to discuss the pathophysiology, risk factors, epidemiology, social and economic burden, and clinical presentation of pressure ulcers.

http://bit.ly/2FCeof5

A novel technique to safely maximize botulinum toxin extraction from 50 unit vials

Publication date: Available online 18 January 2019

Source: Journal of the American Academy of Dermatology

Author(s): Isadore S. Tarantino, Brett C. Neill, Melanie N. Wolf, Anand Rajpara, Daniel J. Aires

http://bit.ly/2FJMEV0

Detection of increased intracerebral lactate in a mouse model of Leigh syndrome using proton MR spectroscopy

Publication date: Available online 19 January 2019

Source: Magnetic Resonance Imaging

Author(s): Yusuke Takahashi, Hidetaka Kioka, Yasunori Shintani, Akiko Ohki, Seiji Takashima, Yasushi Sakata, Takahiro Higuchi, Shigeyoshi Saito

Abstract

Purpose

To establish a brain proton magnetic resonance spectroscopy (¹H MRS) experimental system using a mouse model of Leigh syndrome for monitoring intracerebral lactate levels as a biomarker of mitochondrial disease progression.

Materials and methods

Brain ¹H MRS was performed in the Ndufs4 homozygous knockout (KO) mice, a mouse model of Leigh syndrome, and control mice on a horizontal 7.0-T magnetic resonance imaging system at age 5–9 weeks. In a subset of KO mice, survival analysis was performed according to the median of the intracerebral lactate levels. In addition, in KO mice alive until 9 weeks of age, both ¹H MRS and T₂-weighted imaging (T₂WI) were longitudinally performed in the same individuals at 5, 7, and 9 weeks of age.

Results

Brain ¹H MRS demonstrated increased lactate levels in KO mice compared with control mice (6.4 ± 1.2 mM vs. 3.3 ± 0.8 mM, p < 0.0001). The increased intracerebral lactate levels were already observed at 5 weeks of age, while no obvious abnormal findings were detected in T₂WI. Notably, an increased lactate level of >5.94 mM at week 5 was associated with a poor prognosis (median survival days: 24.5 vs. 42 days, log-rank p = 0.03). Longitudinal ¹H MRS experiments revealed temporal increase of intracerebral lactate levels, peaking at week 7 (mean change: 2.6 ± 0.7 mM, p = 0.001), followed by decrease at week 9 (mean change: −3.8 ± 2.5 mM, p = 0.03), along with further disease progression, with brain lesions being detected on T₂WI.

Conclusion

Using brain ¹H MRS, we demonstrated significant increase in intracerebral lactate levels in a mouse model of Leigh syndrome. Additionally, we demonstrated that intracerebral lactate is a useful biomarker of mitochondrial disease progression at stages preceding the development of brain lesions.

http://bit.ly/2TXc7ya

Mass spectrometry‐based proteomics reveals the distinct nature of the skin proteomes of photoaged compared to intrinsically aged skin

Abstract

Objective

With increasing age skin is subject to alterations in its organisation, which impacts on its function as well as having clinical consequences. Proteomics is a useful tool for non‐targeted, semi‐quantitative simultaneous investigation of high numbers of proteins. In the current study we utilise proteomics to characterise and contrast age‐associated differences in photoexposed and photoprotected skin, with a focus on the epidermis, dermal‐epidermal junction and papillary dermis.

Methods

Skin biopsies from buttock (photoprotected) and forearm (photoexposed) of healthy volunteers (aged 18‐30 or ≥65 years) were transversely sectioned from the stratum corneum to a depth of 250 μm. Following SDS‐PAGE, each sample lane was segmented prior to analysis by liquid chromatography‐mass spectrometry/mass spectrometry. Pathways analysis was carried out using Ingenuity IPA.

Results

Comparison of skin proteomes at buttock and forearm sites revealed differences in relative protein abundance. Ageing in skin on the photoexposed forearm resulted in 80% of the altered proteins being increased with age, in contrast to the photoprotected buttock where 74% of altered proteins with age were reduced. Functionally, age‐altered proteins in the photoexposed forearm were associated with conferring structure, energy and metabolism. In the photoprotected buttock proteins associated with gene expression, free‐radical scavenging, protein synthesis and protein degradation were most frequently altered.

Conclusion

This study highlights the necessity of not considering photoageing as an accelerated intrinsic ageing, but as a distinct physiological process.

This article is protected by copyright. All rights reserved.

http://bit.ly/2DmIQHW

ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ,ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ,ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ

Οπισθωτιαία
Εφαρμόζονται πίσω από το αυτί και συνδέονται με το κατάλληλο εκμαγείο

Ενδοκαναλικά
Αθέατα,Είναι μικρότερα σε μέγεθος και εφαρμόζονται μέσα στον ακουστικό πόρο.

Καθαρή και διαυγή μετάδοση της φωνής των συνομιλούντων
Έξυπνη φραγή των θορύβων

Άριστη ποιοτική ενίσχυση και απόδοση του ήχου,εύκολα στη χρήση,άνετα στην εφαρμογή,όμορφα για καλύτερη αισθητική όσο αφορά το μέγεθος και την εξωτερική εμφάνιση,χωρίς καμμία ιδιαίτερη συντήρηση.

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Ενδοωτιαίο Ακουστικό Βοήθημα όμορφα μικρά αόρατα με άριστες αποδόσεις,
Ενδοωτιαίο Ακουστικό Βοήθημα όμορφα μικρά αόρατα με άριστες αποδόσεις για μεσαίες εως υψηλές βαρηκοΐες,
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