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Biomedicines Oct 2022Vitiligo is a complex disorder with an important effect on the self-esteem and social life of patients. It is the commonest acquired depigmentation disorder... (Review)
Review
Vitiligo is a complex disorder with an important effect on the self-esteem and social life of patients. It is the commonest acquired depigmentation disorder characterized by the development of white macules resulting from the selective loss of epidermal melanocytes. The pathophysiology is complex and involves genetic predisposition, environmental factors, oxidative stress, intrinsic metabolic dysfunctions, and abnormal inflammatory/immune responses. Although several therapeutic options have been proposed to stabilize the disease by stopping the depigmentation process and inducing durable repigmentation, no specific cure has yet been defined, and the long-term persistence of repigmentation is unpredictable. Recently, due to the progressive loss of functional melanocytes associated with failure to spontaneously recover pigmentation, several different cell-based and cell-free regenerative approaches have been suggested to treat vitiligo. This review gives an overview of clinical and preclinical evidence for innovative regenerative approaches for vitiligo patients.
PubMed: 36359263
DOI: 10.3390/biomedicines10112744 -
Frontiers in Medicine 2021Cowden syndrome (CS) is an autosomal dominant condition caused by mutations in the phosphatase and tensin homolog () gene, and is characterized by multiple hamartomas... (Review)
Review
Cowden syndrome (CS) is an autosomal dominant condition caused by mutations in the phosphatase and tensin homolog () gene, and is characterized by multiple hamartomas and a predisposition to malignant tumors. Characteristic skin lesions include trichilemmomas, acral keratosis, mucocutaneous neuromas, oral papillomas, and penile macules, and are often the first clues to the underlying diagnosis. Here, we discuss the mucocutaneous manifestations of CS, differential diagnoses of genetic causes of each cutaneous finding, genetic analyses for patients with skin manifestations, management of patients with CS, and potential new targeted therapies for CS.
PubMed: 34179044
DOI: 10.3389/fmed.2021.658842 -
Giornale Italiano Di Dermatologia E... Apr 2020Lentigo maligna (LM) is an in situ subtype of melanoma, clinically presenting as a pigmented, asymmetric macule that originates mostly on the head and neck and spreads... (Review)
Review
Lentigo maligna (LM) is an in situ subtype of melanoma, clinically presenting as a pigmented, asymmetric macule that originates mostly on the head and neck and spreads slowly. The diagnosis may be challenging both for clinicians and pathologists. Dermatoscopy and reflectance confocal microscopy represent a useful tool in the differentiation of LM from other pigmented lesions, such as pigmented actinic keratosis, solar lentigines, seborrheic keratosis and lichen planus-like keratosis. Moreover, those non-invasive diagnostic technique may be crucial in the selection of optimal biopsy sites in equivocal lesions, in pre-surgical mapping and in evaluating and monitoring response to non-surgical treatments. Histologic examination remains the gold standard for the diagnosis of LM, showing a lentiginous proliferation of basal atypical melanocytes on a severe sun-damaged skin. The management of LM is constantly evolving. Treatments include surgery (the first choice, when available), radiotherapy and imiquimod cream (in patients not candidates to surgery). Many other possible treatments for LM have been tested, but they are not yet supported by strong evidences. We collected current guidelines and PubMed available reviews, studies and case-reports in order to make an overview on diagnosis and treatment of LM.
Topics: Humans; Hutchinson's Melanotic Freckle; Skin Neoplasms
PubMed: 29683288
DOI: 10.23736/S0392-0488.18.06003-0 -
Cureus Apr 2020Tinea nigra is an uncommon superficial dermatomycosis precipitated by , a halophilic and halothermic yeast-like fungus capable of producing a melanin-like substance....
Tinea nigra is an uncommon superficial dermatomycosis precipitated by , a halophilic and halothermic yeast-like fungus capable of producing a melanin-like substance. This pathogen infiltrates the stratum corneum in the setting of microtrauma and produces an asymptomatic brown to black macule or patch that appears similarly to melanocytic nevi or melanoma. We present a case of a 52-year-old woman who presented to clinic several months after developing a painless, nonpruritic dark brown patch in her left foot inside the fourth toe web. The coloration and location of this lesion would typically prompt biopsy; however, Wood's lamp examination and potassium hydroxide (KOH) preparation were pursued first and demonstrated evidence of infection by . The patient was treated with topical clotrimazole cream and miconazole powder for one month, and her lesions cleared completely. Her lesions did not recur at her three-month follow-up appointment.
PubMed: 32391228
DOI: 10.7759/cureus.7579 -
Cureus Sep 2022Vitiligo, a common depigmenting cutaneous condition, is thought to affect 0.5%-2% of the world's population. During this condition, melanocytes are selectively lost,... (Review)
Review
Vitiligo, a common depigmenting cutaneous condition, is thought to affect 0.5%-2% of the world's population. During this condition, melanocytes are selectively lost, resulting in non-scaly, chalky-white macules. Achromic macules and patches are side effects of the multifaceted disease vitiligo, defined as the absence of epidermal pigmentation. The causes of this disaster are three significant factors. A suppressed reaction to touch allergens is one of many abnormal activities of the hypopigmented epidermis, which has also been observed in hypopigmented rats. The white epidermis of people with albinism, which is the same color as vitiligo, is more vulnerable to skin carcinoma; the white epidermis of people with vitiligo does not develop non-melanoma skin carcinoma. The overall etiology of vitiligo, which is now categorically recognized as an immunological illness, has made significant strides in recent years. Even though vitiligo is frequently dismissed as an esthetic issue, it can have serious mental consequences and significantly interfere with daily life. A global consensus in 2011 classified segmental vitiligo separately from all other types of vitiligo. The term vitiligo has been repurposed to refer to various types of nonsegmental vitiligo. There are numerous pharmaceutical procedures available on the market that aim to stop the development of and induce epidermal repigmentation. Variable levels of skin pigmentation have been observed with such therapies, either alone or in combination, and their predominance was safe and efficient. There are few vitiligo treatments available, and none of them can reliably cause repigmentation in every individual. Individualized management is required depending on geography, physical appearance, and the presence of illness activities. The preceding study aims to provide insight into the potential prospects of vitiligo medication while also summarizing the current body of knowledge on the condition.
PubMed: 36304341
DOI: 10.7759/cureus.29307 -
Biomedicines Jul 2022Vitiligo is an acquired immune-mediated disorder of pigmentation clinically characterized by well-defined depigmented or chalk-white macules and patches on the skin. The... (Review)
Review
Vitiligo is an acquired immune-mediated disorder of pigmentation clinically characterized by well-defined depigmented or chalk-white macules and patches on the skin. The prevalence of vitiligo varies by geographical area, affecting 0.5% to 2% of the population. The disease imposes a significant psychological burden due to its major impact on patients' social and emotional aspects of life. Given its autoimmune background, vitiligo is frequently associated with other autoimmune diseases or immune-mediated diseases. Vitiligo is a multifaceted disorder that involves both genetic predisposition and environmental triggers. In recent years, major predisposing genetic loci for the development of vitiligo have been discovered. The current findings emphasize the critical role of immune cells and their mediators in the immunopathogenesis of vitiligo. Oxidative-stress-mediated activation of innate immunity cells such as dendritic cells, natural killer, and ILC-1 cells is thought to be a key event in the early onset of vitiligo. Innate immunity cells serve as a bridge to adaptive immunity cells including T helper 1 cells, cytotoxic T cells and resident memory T cells. IFN-γ is the primary cytokine mediator that activates the JAK/STAT pathway, causing keratinocytes to produce the key chemokines CXCL9 and CXCL10. Complex interactions between immune and non-immune cells finally result in apoptosis of melanocytes. This paper summarizes current knowledge on the etiological and genetic factors that contribute to vitiligo, with a focus on immunopathogenesis and the key cellular and cytokine players in the disease's inflammatory pathways.
PubMed: 35884944
DOI: 10.3390/biomedicines10071639 -
Diabetes, Metabolic Syndrome and... 2020Diabetic dermopathy is a cutaneous manifestation commonly seen in diabetes patients and was initially described by Melin in 1964. These lesions are well-demarcated,... (Review)
Review
Diabetic dermopathy is a cutaneous manifestation commonly seen in diabetes patients and was initially described by Melin in 1964. These lesions are well-demarcated, hyperpigmented macules or papules with atrophic depression and were commonly sighted on shins of the tibia with bilateral asymmetrical distribution and rarely seen on arms, thighs and abdomen. The incidence of DD ranges from 0.2 to 55%. It has been frequently associated with microangiopathic complications of diabetes such as nephropathy, retinopathy and polyneuropathy. Although the exact mechanism of occurrence is unknown, it may be related to impaired wound healing due to decreased blood flow, local thermal trauma or local subcutaneous nerve degeneration. Diagnosis is made by clinical examination and the differential diagnosis includes stasis dermatitis, early lesion of necrobiosis lipoidica and purpuric dermatitis. Prevention of dermopathy lesions includes optimized glucose control. No active treatment is recommended or proven effective and DD is known to resolve on its own as time passes. Modified collagen and high glycerine-based lotion have shown marked improvement in skin color changes due to diabetic dermopathy. Diabetic dermopathy is known to have a strong association with microangiopathic complications; the presence of such lesions must raise strong suspicion and prompt investigation for severe underlying pathology. Enhanced scrutinized glycemic control in diabetic dermatopathy patients can even lead to abatement in further progression to microvascular complications and improved long-term patient outcomes.
PubMed: 33324080
DOI: 10.2147/DMSO.S286887 -
Frontiers in Cellular and Infection... 2019Post-kala-azar dermal leishmaniasis (PKDL) follows visceral leishmaniasis (VL, kala-azar) in 10-60% of cases. It is characterized by an asymptomatic skin rash, usually... (Review)
Review
Post-kala-azar dermal leishmaniasis (PKDL) follows visceral leishmaniasis (VL, kala-azar) in 10-60% of cases. It is characterized by an asymptomatic skin rash, usually starting in the face and consisting of macules, papules, or nodules. Diagnosis is difficult in the field and is often made clinically. There is an extensive differential diagnosis, and parasitological confirmation is preferred particularly when drug treatment is considered. The response to treatment is difficult to assess as this may be slow and lesions take long to heal, thus possibly exposing patients unnecessarily to prolonged drug treatment. Biomarkers are needed; these may be parasitological (from microscopy, PCR), serological (from blood, or from the lesion), immunological (from blood, tissue), pathological (from cytology in a smear, histology in a biopsy), repeated clinical assessment (grading, photography), or combinations. In this paper, we will review evidence for currently used biomarkers and discuss promising developments.
Topics: Biomarkers; Biopsy; Humans; Leishmaniasis, Cutaneous; Leishmaniasis, Visceral; Parasitology; Skin
PubMed: 31417876
DOI: 10.3389/fcimb.2019.00228 -
Canadian Family Physician Medecin de... Jul 2022Children who present with rashes with "target" lesions are frequently diagnosed with erythema multiforme (EM). This is a self-limiting condition in most children; how...
QUESTION
Children who present with rashes with "target" lesions are frequently diagnosed with erythema multiforme (EM). This is a self-limiting condition in most children; how should primary care providers differentiate between this and urticaria or Stevens-Johnson syndrome, and what is the recommended course of treatment?
ANSWER
While EM is common in children, urticaria is also very common and tends to be more "waxing and waning" compared with EM's fixed lesions. Stevens-Johnson syndrome and toxic epidermal necrolysis are more severe and distinct conditions; they have much more substantial mucous membrane involvement and contain widespread erythematous or purpuric macules with blisters. Since EM is a self-limiting condition, treatment of EM in children is generally supportive, and rarely do children need hospital admission for rehydration. In more severe cases involving mucous membranes or substantial pain, some patients will benefit from topical steroids or antihistamines. When children present with signs of herpes infection, antiviral treatment (acyclovir) may be of benefit. Systemic steroids should be reserved for the most challenging cases.
Topics: Child; Erythema Multiforme; Exanthema; Humans; Steroids; Stevens-Johnson Syndrome; Urticaria
PubMed: 35831090
DOI: 10.46747/cfp.6807507