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Cureus Feb 2024The relationship between skin diseases and psychiatric illnesses is bi-directional and is manifested as cause and effect. Psychiatric disorders such as stress, anxiety,...
BACKGROUND
The relationship between skin diseases and psychiatric illnesses is bi-directional and is manifested as cause and effect. Psychiatric disorders such as stress, anxiety, and depression are seen to be instrumental in the development and progression of dermatological diseases on one hand, while on the other hand, cosmetic disfigurement caused by dermatological diseases is responsible for psychological distress in patients. The present study was conducted to investigate the spectrum of dermatological disorders in psychiatric patients to offer them holistic treatment and provide them with a better quality of life.
METHODS
This cross-sectional, observational study was conducted at a tertiary medical care center. A total of 170 psychiatric patients referred to the dermatology department for different dermatological manifestations were enrolled in the study. A demographic profile of the patients was done, and an association between dermatological diseases and psychiatric illnesses was done.
RESULTS
Out of 170 study participants, 88 (51.8%) were females, and the rest (82, 48.2%) were males. A total of 13 major types of dermatological conditions were noted; among them, fungal infection (43, 25.3%) was the most common, followed by eczema (18, 10.6%), parasitic infestation (17, 10.0%), pigmentary disorder (13, 7.6%), acne (11, 6.5%), bacterial infection (11, 6.5%), pruritic disorder (11, 6.5%), hair disorder (9, 5.3%), drug reaction (9, 5.3%), papulosquamous disorder (7, 4.1%), and viral infection (6, 3.5%). Skin conditions other than the above-mentioned were present in 15 (8.8%) patients. The most common psychiatric illness in the present study was major depressive disorder (41, 24.1%), followed by generalized anxiety disorder (38, 22.4%) and psychosis not otherwise specified (34, 20.0%). Other psychiatric illnesses included in the study were bipolar affective disorder (22, 12.9%), schizophrenia (18, 10.6%), obsessive-compulsive disorder (12, 7.1%), and mixed anxiety depressive disorder (5, 2.9%).
CONCLUSION
The findings of the present study depict that psychiatric patients with dermatological manifestations show a spectrum of dermatological conditions, primarily of infectious (fungal, parasitic, or viral) nature. This might be associated with a relatively poor hygienic status of psychiatric patients and thus their increased susceptibility to these disorders. Most of the time, the susceptibility to these skin conditions seemed to be opportunistic and unaffected by the type, duration, and level of control of psychiatric illness.
PubMed: 38550494
DOI: 10.7759/cureus.55020 -
International Health Mar 2024Lymphatic filariasis (LF) is a neglected tropical disease affecting >120 million people worldwide. LF has debilitating effects on humans and leads to morbidity and...
Lymphatic filariasis (LF) is a neglected tropical disease affecting >120 million people worldwide. LF has debilitating effects on humans and leads to morbidity and sometimes irreversible disability. A significant proportion of persons affected by LF morbidity also suffer from ill health, such as depression, anxiety, pain, stigma and social isolation due to disfigurement, as well as loss of mobility, livelihood and income. Mental health is often overlooked as a component of morbidity management and disability prevention (MMDP) services, despite the high prevalence of depression and anxiety among people affected by LF. To address this gap, Christian Blind Mission (CBM) piloted a comprehensive approach providing morbidity management and disability prevention by integrating mental health as part of the MMDP care package. The participatory evaluation of the project reviewed the project documents and a review meeting, small group discussions and in-depth interviews with project stakeholders. Findings suggest that project training and service delivery targets were exceeded in most cases. In addition, the disability and gender disaggregated data highlights the interplay of gender and disability in accessing care and the existence of unmet mental health needs. The financial cost of transportation to utilise referrals or access other MMDP services, such as replenishing treatment supplies, was a major constraint in accessing services for LF morbidity patients and low levels of awareness, fear of hydrocoele surgery and social stigmatisation were reported. The project outcomes demonstrate the feasibility and effectiveness of integrating mental health as part of a comprehensive MMDP package of care. Integration strategies should target training of MMDP providers in basic mental health skills, screening for mental health issues and the provision of mental health services and other MMDP services within the same facilities. Integration is an important step towards comprehensive care for people affected by LF and other NTD morbidities and disabilities.
Topics: Humans; Elephantiasis, Filarial; Mental Health; Nigeria; Morbidity; Prevalence
PubMed: 38547349
DOI: 10.1093/inthealth/ihae002 -
Journal of Economic Entomology Jun 2024The Douglas-fir twig weevil (Cylindrocopturus furnissi Buchanan) (Coleoptera: Curculionidae) has recently emerged as a significant pest of Christmas trees grown in the...
The Douglas-fir twig weevil (Cylindrocopturus furnissi Buchanan) (Coleoptera: Curculionidae) has recently emerged as a significant pest of Christmas trees grown in the Pacific Northwest United States. The larvae girdle and disfigure twigs, which adversely affects tree marketability. Trees produced for export are also routinely destroyed for phytosanitary reasons when C. furnissi is discovered at border crossings. Due to historically being a sporadic and benign pest on planted and natural Douglas-fir (Psuedotsuga menziesii), there is a lack of chemical management options. In laboratory experiments, we assessed the knockdown effects (ability to kill or incapacitate) of 4 insecticides commonly used on Christmas trees: one assay tested knockdown after direct contact for 24 h, and the other assay tested knockdown after being allowed to feed on treated twigs with 2 days, 7 days, and 14 days residuals. Concurrently, we monitored temperature and adult C. furnissi emergence at a noble fir bough farm for 2 years to estimate the ideal degree-day window for applying insecticides. Bifenthrin and esfenvalerate knocked down all weevils on contact within just 4 h, whereas chlorpyrifos and acephate failed to achieve 100% knockdown within 24 h. Only acephate failed to knock down more weevils than the control (water) after feeding on treated twigs, regardless of the insecticide residue age. Degree-day modeling revealed a variable emergence window between the 2 years but 50% of adult emergence occurred between approximately 1,000-1,100 degree days (1st January, 50 °F (10 °C), single sine). Future work should assess the resulting management recommendation: apply bifenthrin or esfenvalerate once annually just after 1,000 growing degree days for 2 or more years prior to harvest.
Topics: Weevils; Animals; Insecticides; Pseudotsuga; Larva; Insect Control; Pyrethrins
PubMed: 38547050
DOI: 10.1093/jee/toae048 -
Journal of Clinical Medicine Mar 2024: Plexiform neurofibromas (pNFs) are benign neoplasms, primarily originating from Schwann cells, posing challenges in patients with type 1 neurofibromatosis (NF1) due to...
: Plexiform neurofibromas (pNFs) are benign neoplasms, primarily originating from Schwann cells, posing challenges in patients with type 1 neurofibromatosis (NF1) due to pain, disfigurement, compression of vital structures and potential for malignancy. Selumetinib, a MEK1/2 inhibitor, has shown promising results in treating inoperable pNFs, with clinical trials demonstrating tumor volume reduction and improved patient-reported outcomes. Despite its efficacy, dermatologic toxicities may impact the quality of life and treatment adherence. Evaluating the frequency and spectrum of such effects is crucial for effective management. : In a four-year retrospective and prospective study, pediatric NF1 patients with symptomatic, inoperable plexiform neurofibromas (pNFs) were treated with selumetinib. Eligibility criteria included significant morbidity, pNF size exceeding 3 cm or surgical inoperability, and performance status >70%. Hematological, liver, lung and cardiac assessments established baseline health. Selumetinib, orally administered at 25 mg/m twice, was administered for two years unless a response warranting extension occurred. Cutaneous AEs were documented and graded by severity according to CTCAE v5.0, with evaluations every three to six months. The impact on symptoms and pNF size was systematically recorded, and biopsies characterized histopathological features in those patients requiring surgery. : Twenty patients were enrolled, with an average age at therapy initiation of 11.6 years. Cutaneous side effects were common, with all patients experiencing at least one and a median of two per patient. Xerosis, paronychia and acneiform rash were prevalent. Notably, pre-pubertal individuals were more susceptible to xerosis. Acneiform rash had a higher incidence in older patients and those with skin phototypes II and III. Successful management involved tailored approaches, such as clindamycin for acneiform rash and topical agents for paronychia. Hair abnormalities, including color changes and thinning, occurred, with female patients at higher risk for the latter. Paronychia presented challenges, necessitating various interventions, including surgical approaches. AEs led to treatment suspension in 20% of patients, with tumor rebound observed in 75%. : According to our experience, successful management of selumetinib-induced cutaneous AEs requires tailored strategies including surgery. AEs might indirectly determine pNF regrowth due to therapy suspension. We thus emphasize the pivotal role of addressing cutaneous reactions for effective selumetinib management in pediatric patients.
PubMed: 38542016
DOI: 10.3390/jcm13061792 -
World Neurosurgery: X Jul 2024The aesthetic reconstruction of disfiguring cranio-facial defects after tumour excision can be quite challenging to the neurosurgeon with limited resources. The choice...
BACKGROUND
The aesthetic reconstruction of disfiguring cranio-facial defects after tumour excision can be quite challenging to the neurosurgeon with limited resources. The choice of cranioplasty implant, intraoperative technicalities and the patients' postoperative appearance are critical considerations in management. There are a number of synthetic materials available for cranioplasty, however, the customised implants are not readily available in our practice setup. They are also mostly constructed and contoured after the bony defect has been created or require sophisticated software construction pre-operatively.
METHODS
Eight patients with cranio-facial tumour pathologies who presented to our neurosurgical service, and had titanium mesh cranioplasty for the correction of cosmetically disfiguring cranio-facial tumours.
RESULTS
There were 6 females, and 2 male patients respectively, with an age range between 28 and 74years. The histological diagnoses were meningioma, frontal squamous cell carcinoma, fibrous dysplasia, frontal mucocoele, cemeto-ossifying fibroma, osteoma, and naso-ethmoidal squamous cell carcinoma. The patient with naso-ethmoidal squamous cell carcinoma had post-operative subgaleal empyema which was amenable to incision and drainage procedure. The patient with a frontal cemento-ossifyng fibroma had a transient immediate post-operative mechanical ptosis, which resolved completely in 3months. All of the total eight patients (100%) had satisfactory cosmetic outlook at a minimum follow up period of 1month post-operatively (Numeric Rating Scale of at least 7/10). One of the patients required a revision surgery on account of implant displacement.
CONCLUSION
Cranioplasty is a common reconstructive neurosurgical procedure. It is important to the neurosurgeon for its neuro-protective function, and in the restoration of intra-cranial CSF dynamics. However, the cosmetic outlook appears to be more important to patients in the absence of pain and/or neurological deficits. Titanium mesh reconstruction is commonly used globally, and is becoming the preferred choice in low resource settings.
PubMed: 38533234
DOI: 10.1016/j.wnsx.2024.100362 -
The Journal of Dermatological Treatment Dec 2024Trichodysplasia spinulosa (TS) is a rare, disfiguring skin condition which presents with widespread asymptomatic or pruritic, skin-colored papules with white protruding...
Trichodysplasia spinulosa (TS) is a rare, disfiguring skin condition which presents with widespread asymptomatic or pruritic, skin-colored papules with white protruding keratin spiculations in immunocompromised individuals. Due to its rarity, there is little data to guide treatment decisions. The purpose of this article is to report a case of TS that completely resolved after treatment with topical cidofovir. A 19-year-old immunosuppressed female presented with widespread painful, itchy bumps on the nose and face. Upon examination, there were erythematous papules with hyperkeratinized spicules affecting the central face. Biopsy of the lesions was consistent with TS which was confirmed via PCR analysis. The tenderness of this patient's eruption was highly atypical for TS. Once daily topical application of compounded 1% cidofovir cream was prescribed. The patient's symptoms resolved completely after 4 weeks of therapy with topical cidofovir 1% cream, without reduction of immunosuppression. Topical cidofovir 1% cream may be a valuable treatment for this rare disease.
Topics: Female; Humans; Young Adult; Cidofovir; Immunocompromised Host; Polyomavirus Infections; Pruritus; Skin Diseases
PubMed: 38493799
DOI: 10.1080/09546634.2024.2328180 -
Dermatologie (Heidelberg, Germany) May 2024With a prevalence of 0.5-2%, vitiligo is one of the most common skin disorders worldwide with loss of pigment. The skin disease has a disfiguring, often stigmatising... (Review)
Review
BACKGROUND
With a prevalence of 0.5-2%, vitiligo is one of the most common skin disorders worldwide with loss of pigment. The skin disease has a disfiguring, often stigmatising character and is often associated with psychosocial distress.
OBJECTIVE
To provide an overview of the psychosocial impairment, disease burden and resulting health care needs of patients with vitiligo.
MATERIALS AND METHODS
Narrative review based on a literature search in PubMed for the years 1996-2022 on disease burden, quality of life and stigmatization is provided.
RESULTS
The search yielded 175 relevant original papers including clinical studies, meta-analyses and systematic reviews (n = 65) for the search period. A large number of studies document that vitiligo is associated with considerable psychosocial stress and relevant losses in quality of life. Problem areas particularly concern stigmatisation, sexual dysfunction, anxiety, reduced self-esteem and problems at work. The observed increased levels of anxiety and depression correlate with the severity and activity of vitiligo. Often, comorbidity also contributes to reduced self-esteem and social isolation. These factors determine a high need for care in a relevant proportion of those affected.
CONCLUSION
Vitiligo is not primarily a cosmetic problem, but a disease requiring treatment according to the World Health Organisation's definition of health as physical, mental and social well-being. The benefits of treatment options are to be measured by their effects on patient-reported outcomes.
Topics: Vitiligo; Humans; Quality of Life; Cost of Illness; Social Stigma; Health Services Needs and Demand
PubMed: 38466405
DOI: 10.1007/s00105-024-05312-z -
Journal of Ophthalmology 2024Basal cell carcinoma (BCC) is the most frequent malignant periocular tumor. It is associated with exposure to ultraviolet radiation, and its incidence is gradually...
PURPOSE
Basal cell carcinoma (BCC) is the most frequent malignant periocular tumor. It is associated with exposure to ultraviolet radiation, and its incidence is gradually increasing. It may occasionally display more aggressive behavior and result in orbital or intracranial invasion. Mortality from periocular BBC with orbital invasion is very low, but the associated morbidity can be significant, from disfigurement to blindness. Traditionally, these cases have been treated with orbital exenteration or with radiotherapy (RT), but in recent years, hedgehog pathway inhibitors (HPIs) have emerged, are effective in more serious cases, and are used primarily or combined with surgery, changing our perspective on the management of these patients.
METHODS
We studied 24 cases of periocular BCC with orbital invasion, some primary and others recurrent, which were treated between 2011 and 2021 in the same hospital. All patients had clinical or radiological evidence of orbital invasion. Orbital exenteration was performed on 9/24 of the patients (1 received vismodegib after surgery), and 12/24 were treated, surgically preserving the eyeball, with 3 of them receiving adjuvant vismodegib. Three of the twenty-four patients were treated exclusively with vismodegib (Erivedge®, Genentech).
RESULTS
One patient died due to poor tumor evolution, but the rest evolved favorably and they have had no recurrences. Vismodegib was generally well tolerated, except for in one patient who discontinued treatment due to the side effects.
CONCLUSIONS
In advanced BBC with orbital invasion, mutilating surgical treatments such as exenteration or potentially vision-threatening treatments such as RT remain as options. In recent years, however, very promising new medical therapies have emerged, such as HPI, which can be used effectively instead of surgery or in combination with it, preserving the eye and vision, which implies a new approach to treatment.
PubMed: 38456099
DOI: 10.1155/2024/4347707 -
Indian Journal of Plastic Surgery :... Feb 2024Cutis verticis gyrata (CVG) is a rare skin condition characterized by ridges and furrows resembling the brain. CVG falls under three categories: primary essential,...
Cutis verticis gyrata (CVG) is a rare skin condition characterized by ridges and furrows resembling the brain. CVG falls under three categories: primary essential, primary nonessential, and secondary. This case report focuses on primary essential CVG, where approximately a fourth of the scalp and a significant portion of the forehead and eyelid were involved. Flap advancement after skin expansion was performed to rectify the disorder. This technique adequately covers the residual defect postexcision and preserves hair growth in affected regions. It is a successful skin expansion technique to cover the exposed scalp, preserve hair growth, and achieve excellent cosmetic results. Our approach demonstrates a promising solution for severe cosmetic disfigurement in primary essential CVG, positively impacting both the physical appearance and psychosocial well-being of the patient.
PubMed: 38450019
DOI: 10.1055/s-0043-1777075