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Melanoma Research Aug 2024A standard metric for melanoma detection is the number needed to biopsy (NNB). This metric has been used to evaluate practicing dermatologists, dermatology advanced...
A standard metric for melanoma detection is the number needed to biopsy (NNB). This metric has been used to evaluate practicing dermatologists, dermatology advanced practice professionals, and primary care providers. This metric, however, has rarely been applied to residency clinics. We aimed to determine the NNB at the University of Colorado residency clinics. Moreover, we sought to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on NNB. This study is a retrospective analysis of biopsies performed from 2016 to 2022 at the Denver Health Medical Center and the Rocky Mountain Regional Veteran Affairs dermatology clinics. Differential diagnosis at the time of biopsy was searched for keywords including melanoma, melanoma in situ, and lentigo maligna. Skin biopsies that included re-excisions were excluded. The NNB was subsequently generated by dividing the number of biopsied lesions with suspected melanoma by the number of histologically confirmed melanomas. The data was further separated by pre-COVID-19 (2016-February 2020), COVID-19 shutdown period (March 2020-July 2020), and post-COVID-19 (March 2020-present). Demographic data, including age, sex, race, and Fitzpatrick type, were collected. There were 2230 biopsies with suspected melanoma in the differential diagnosis at both clinic sites from 2016 to 2022. Of these, 362 were histologically confirmed melanoma. Total NNB was 6.16. The pre-COVID-19 NNB was 5.86, and the post-COVID-19 NNB was 6.91. Residency clinics have NNB similar to published values of practicing dermatologists. Furthermore, within these clinics, the impact of the COVID-19 pandemic was appreciated by a relative, although statistically insignificant, increase in NNB.
Topics: Humans; Melanoma; Skin Neoplasms; COVID-19; Retrospective Studies; Biopsy; Dermatology; Female; Male; Melanoma, Cutaneous Malignant; Middle Aged; SARS-CoV-2
PubMed: 38934061
DOI: 10.1097/CMR.0000000000000979 -
Skin Research and Technology : Official... Jul 2024The delicate periorbital region is susceptible to skin dehydration, wrinkles, and loss of elasticity. Thus, targeted and effective anti-aging interventions are necessary... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The delicate periorbital region is susceptible to skin dehydration, wrinkles, and loss of elasticity. Thus, targeted and effective anti-aging interventions are necessary for the periorbital area.
AIM
To evaluate the efficacy and safety of a new anti-aging eye cream formulated with the active complex (Yeast/rice fermentation filtrate, N-acetylneuraminic acid, palmityl tripeptide-1, and palmitoyl tetrapeptide-7).
METHODS
The cell viability and expressions of key extracellular matrix (ECM) components of the active complex were evaluated using a human skin fibroblast model. In the 12-week clinical trial, skin hydration, elasticity, facial photographs, and collagen density following eye cream application were assessed using Corneometer, Cutometer, VISIA, and ultrasound device, respectively. Dermatologists and participants evaluated clinical efficacy and safety at baseline, and after 4, 8, and 12 weeks.
RESULTS
PCR and immunofluorescent analyses revealed that the active complex significantly stimulated fibroblast proliferation (p < 0.05) and markedly promote the synthesis of collagen and elastin. Clinical findings exhibited a substantial enhancement in skin hydration (28.12%), elasticity (18.81%), and collagen production (54.99%) following 12 weeks of eye cream application. Dermatological evaluations and participants' assessments reported a significant improvement in skin moisture, roughness, elasticity, as well as fine lines and wrinkles by week 8.
CONCLUSION
The new anti-aging eye cream, enriched with the active complex, demonstrates comprehensive rejuvenating effects, effectively addressing aging concerns in the periorbital area, coupled with a high safety profile.
Topics: Humans; Skin Aging; Fibroblasts; Female; Middle Aged; Skin Cream; Adult; Elasticity; Collagen; Cell Survival; Elastin; Male; Skin; Treatment Outcome; Administration, Topical; Cell Proliferation; Aged
PubMed: 38932444
DOI: 10.1111/srt.13790 -
Life (Basel, Switzerland) May 2024The differential diagnosis of atypical melanocytic skin lesions localized on palms and soles represents a diagnostic challenge: indeed, this spectrum encompasses...
Pattern Analysis of Benign and Malignant Atypical Melanocytic Skin Lesions of Palms and Soles: Variations of Dermoscopic Features According to Anatomic Site and Personal Experience.
The differential diagnosis of atypical melanocytic skin lesions localized on palms and soles represents a diagnostic challenge: indeed, this spectrum encompasses atypical nevi (AN) and early-stage melanomas (EN) displaying overlapping clinical and dermoscopic features. This often generates unnecessary excisions or delayed diagnosis. Investigations to date were mostly carried out in specific populations, focusing either on acrolentiginous melanomas or morphologically typical acquired nevi. To investigate the dermoscopic features of atypical melanocytic palmoplantar skin lesions (aMPPLs) as evaluated by variously skilled dermatologists and assess their concordance; to investigate the variations in dermoscopic appearance according to precise location on palms and soles; to detect the features with the strongest association with malignancy/benignity in each specific site. A dataset of 471 aMPPLs-excised in the suspect of malignancy-was collected from 10 European Centers, including a standardized dermoscopic picture (17×) and lesion/patient metadata. An anatomical classification into 17 subareas was considered, along with an anatomo-functional classification considering pressure/friction, (4 macroareas). A total of 156 participants (95 with less than 5 years of experience in dermoscopy and 61 with ≥than 5 years) from 17 countries performed a blinded tele-dermoscopic pattern analysis over 20 cases through a specifically realized web platform. A total of 37,440 dermoscopic evaluations were obtained over 94 (20%) EM and 377 (80%) AN. The areas with the highest density of EM compared to AN were the heel (40.3% EM/aMPPLs) of the sole and the "fingers area" (33%EM/aMPPLs) of the palm, both characterized by intense/chronic traumatism/friction. Globally, the recognition rates of 12 dermoscopic patterns were non statistically different between 95 dermatology residents and 61 specialists: aMPPLs in the plantar arch appeared to be the most "difficult" to diagnose, the was poorly recognized and patterns often misinterpreted. Regarding the aMPPL of the "heel area", the ( = 0.014) and ( = 0.001) significantly discriminated benign cases, while ( = 0.002) and ( = 0.025) malignant ones. In aMPPLs of the "plantar arch", the ( = 0.012) was significant for benignity and , or for malignancy. In palmar lesions, no data were significant in the discrimination between malignant and benign aMPPLs. This study highlights that (i) the pattern analysis of aMPPLs is challenging for both experienced and novice dermoscopists; (ii) the histological distribution varies according to the anatomo-functional classification; and (iii) different dermoscopic patterns are able to discriminate malignant from benign aMPPLs within specific plantar and palmar areas.
PubMed: 38929643
DOI: 10.3390/life14060659 -
Medicina (Kaunas, Lithuania) Jun 2024: Lichen planus of the lip (LPL) is a chronic inflammatory condition that resembles actinic cheilitis, discoid lupus erythematosus, graft-versus-host disease, and... (Review)
Review Observational Study
: Lichen planus of the lip (LPL) is a chronic inflammatory condition that resembles actinic cheilitis, discoid lupus erythematosus, graft-versus-host disease, and lichenoid reaction to dental materials or drugs. The purpose of this study was to conduct a literature review on lichen planus lip involvement and to report a retrospective observational study that characterises and explores the clinical, histopathological, and evolution of the lesions in a group of patients with unique involvement of LPL. : Clinical data of patients diagnosed with LPL was retrieved from the medical charts of the patients referred to the Oral Pathology Department of the "Carol Davila" University of Medicine and Pharmacy. A concurrent electronic literature research was carried out using PubMed and Web of Science from 2003 to 2023. : Eleven patients diagnosed with unique LPL were analysed (male/female ratio was 1.75, mean age 63.64 years ± 12.52). All patients presented lesions of the lower lip; the clinical forms were atrophic (six cases) and erosive (five cases), and the histopathological exam confirmed the diagnosis. After topical treatment with corticosteroids, most of the patients had complete remission. The literature review revealed 24 studies (sixteen case reports and eight case series) which comprised 84 patients. Isolated lip involvement was reported in 17 studies, and five articles with concomitant oral lichen planus, while two articles did not mention this criterion. : Our study brings new data on isolated lichen planus of the lip that primarily affects the lower lip with predominance in male patients. It was reported worldwide in patients between 22 and 75 years old. Topical corticosteroids were the main treatment prescribed and they usually brought remission of the lesions. Lichen planus of the lip is a challenging diagnosis for oral health practitioner providers as well as for dermatologists.
Topics: Humans; Male; Middle Aged; Female; Aged; Retrospective Studies; Lichen Planus, Oral; Lip; Lichen Planus; Adult; Lip Diseases; Aged, 80 and over
PubMed: 38929604
DOI: 10.3390/medicina60060987 -
Antibiotics (Basel, Switzerland) May 2024Staphylococcal scalded skin syndrome (SSSS) is a rare, toxin-mediated, desquamating bacterial infectious dermatosis. So far, data from Southwestern China is scarce. This...
Staphylococcal scalded skin syndrome (SSSS) is a rare, toxin-mediated, desquamating bacterial infectious dermatosis. So far, data from Southwestern China is scarce. This study aimed to investigate the clinical characteristics of SSSS patients in our hospital, the relative proportion of methicillin-resistant (MRSA) in skin and soft tissue secretions, and the drug sensitivity of to better assist dermatologists in the diagnosis and treatment of SSSS. We reviewed the demographic characteristics, clinical manifestations, treatment regimens, therapeutic efficacy, laboratory test results, drug sensitivity, and outcome data of 79 SSSS patients from January 2012 to December 2021. Statistical analysis was performed using tests and chi-square tests. Among the 79 SSSS patients, MRSA was detected in 35 (44.3%) isolates: 34 community-acquired (CA)-MRSA (97.1%) and 1 hospital-acquired (HA)-MRSA. The SSSS incidence increased annually from 2012 to 2014 and then decreased gradually after peaking in 2015. All the isolates were sensitive to vancomycin, tigecycline, linezolid, moxifloxacin, levofloxacin, and ciprofloxacin; were completely resistant to penicillin; and had low sensitivity to clindamycin and erythromycin. Interestingly, the sensitivity of MRSA to tetracycline increased annually after 2015. The resistance rates to common drugs previously used to treat SSSS increased. These findings may accelerate diagnosis and improve empirical antibiotic use, suggesting that clinicians should prescribe drugs according to antimicrobial susceptibility.
PubMed: 38927182
DOI: 10.3390/antibiotics13060516 -
Clinics in Dermatology Jun 2024Non-melanoma skin cancers (NMSC) cancers are among the top five most common cancers globally. NMSC is an area with great potential for novel application of diagnostic...
Non-melanoma skin cancers (NMSC) cancers are among the top five most common cancers globally. NMSC is an area with great potential for novel application of diagnostic tools including artificial intelligence (AI). In this scoping review, we aimed to describe the applications of AI in diagnosis and treatment of NMSC. Twenty-nine publications described AI applications to dermatopathology including lesion classification and margin assessment. Twenty-five publications discussed AI use in clinical image analysis, showing that algorithms are not superior to dermatologists and may rely on unbalanced, nonrepresentative, and nontransparent training datasets. Sixteen publications described use of AI in cutaneous surgery for NMSC including use in margin assessment during excisions and Mohs surgery, as well as predicting procedural complexity. Eleven publications discussed spectroscopy, confocal microscopy, and thermography and the AI algorithms that analyze and interpret their data. Ten publications pertained to AI application for discovery and utilization of NMSC biomarkers. Eight publications discussed the use of smart phones and AI, specifically how they enable clinicians and patients to have increased access to instant dermatological assessments but with varying accuracies. Five publications discussed large language models and NMSC, including how they may facilitate or hinder patient education and medical decision-making. Three publications pertained to skin of color and AI for NMSC discussed concerns regarding limited diverse datasets for training of CNNs. AI demonstrates tremendous potential to improve diagnosis, patient and clinician education, and management of NMSC. Despite excitement regarding AI, datasets are often not transparently reported, may include low quality images, and may not include diverse skin types, limiting generalizability. AI may serve as a tool to increase access to dermatology services for patients in rural areas and save healthcare dollars. These benefits can only be achieved, however, with consideration of potential ethical costs.
PubMed: 38925444
DOI: 10.1016/j.clindermatol.2024.06.016 -
Computers in Biology and Medicine Jun 2024Skin cancer (SC) significantly impacts many individuals' health all over the globe. Hence, it is imperative to promptly identify and diagnose such conditions at their...
Skin cancer (SC) significantly impacts many individuals' health all over the globe. Hence, it is imperative to promptly identify and diagnose such conditions at their earliest stages using dermoscopic imaging. Computer-aided diagnosis (CAD) methods relying on deep learning techniques especially convolutional neural networks (CNN) can effectively address this issue with outstanding outcomes. Nevertheless, such black box methodologies lead to a deficiency in confidence as dermatologists are incapable of comprehending and verifying the predictions that were made by these models. This article presents an advanced an explainable artificial intelligence (XAI) based CAD system named "Skin-CAD" which is utilized for the classification of dermoscopic photographs of SC. The system accurately categorises the photographs into two categories: benign or malignant, and further classifies them into seven subclasses of SC. Skin-CAD employs four CNNs of different topologies and deep layers. It gathers features out of a pair of deep layers of every CNN, particularly the final pooling and fully connected layers, rather than merely depending on attributes from a single deep layer. Skin-CAD applies the principal component analysis (PCA) dimensionality reduction approach to minimise the dimensions of pooling layer features. This also reduces the complexity of the training procedure compared to using deep features from a CNN that has a substantial size. Furthermore, it combines the reduced pooling features with the fully connected features of each CNN. Additionally, Skin-CAD integrates the dual-layer features of the four CNNs instead of entirely depending on the features of a single CNN architecture. In the end, it utilizes a feature selection step to determine the most important deep attributes. This helps to decrease the general size of the feature set and streamline the classification process. Predictions are analysed in more depth using the local interpretable model-agnostic explanations (LIME) approach. This method is used to create visual interpretations that align with an already existing viewpoint and adhere to recommended standards for general clarifications. Two benchmark datasets are employed to validate the efficiency of Skin-CAD which are the Skin Cancer: Malignant vs. Benign and HAM10000 datasets. The maximum accuracy achieved using Skin-CAD is 97.2 % and 96.5 % for the Skin Cancer: Malignant vs. Benign and HAM10000 datasets respectively. The findings of Skin-CAD demonstrate its potential to assist professional dermatologists in detecting and classifying SC precisely and quickly.
PubMed: 38925085
DOI: 10.1016/j.compbiomed.2024.108798 -
Journal Der Deutschen Dermatologischen... Jun 2024Tinea incognita (TI) can mimic other dermatoses, presenting a diagnostic challenge for dermatologists. In some uncertain cases, it is crucial to accurately identify the...
Tinea incognita (TI) can mimic other dermatoses, presenting a diagnostic challenge for dermatologists. In some uncertain cases, it is crucial to accurately identify the causative agent using internal transcribed spacer (ITS) sequencing. The global issue of drug-resistant dermatophytosis is increasing, with Trichophyton (T.) indotineae being the main cause. This study presents four cases of TI (diagnosed as eczema) by terbinafine-resistant T. indotineae strains and reviews the current global TI epidemiology based on geographical continent and related conditions. Furthermore, squalene epoxidase (SQLE)-associated resistance mechanisms are evaluated. Lesions caused by terbinafine-resistant T. indotineae strains do not respond to allylamine antifungals, thus allowing the infection to spread. Among T. indotineae isolates, the SQLE F397L substitution is the most prevalent mutation contributing to azole resistance. F397L and L393F replacements in SQLE were detected in all isolates that exhibited high-level resistance. L393S was seen in isolates with low-resistant strains. Interestingly, and for the first time, an L393F amino acid substitution in the SQLE gene product was detected in the Iranian clinical T. indotineae strain. Also, a genomics-based update on terbinafine resistance that focuses on T. indotineae is discussed in this study.
PubMed: 38924688
DOI: 10.1111/ddg.15440 -
International Journal of Dermatology Jun 2024Acquired cutis laxa (ACL) is a rare, nonhereditary cutaneous disorder characterized by saggy inelastic skin. It has been associated with various inflammatory,... (Review)
Review
Acquired cutis laxa (ACL) is a rare, nonhereditary cutaneous disorder characterized by saggy inelastic skin. It has been associated with various inflammatory, autoimmune, and neoplastic diseases, in addition to certain infections and medication. This article reviews ACL the demographical, clinical, and histological features of ACL, focusing on all associated disorders. Additionally, this review article provides an in-depth discussion of all the mechanisms implicated in the pathogenesis of ACL and all therapeutic options available; we also present an algorithm for the workup of patients with ACL. A systematic literature review was performed on PubMed/Medline and EMBASE databases, searching for all available articles on ACL with no limits on participant age, race, sex, nationality, or publication date. Ninety-eight articles were included. The total number of included patients was 110, with a mean age of 36.4 years at presentation (range 0.25-78) and a M:F sex ratio of 1.24. ACL was most commonly associated with inflammatory disorders (43%) followed by neoplastic disorders (27%). In 73% of the neoplastic-associated cases, ACL occurred on average 2.4 years before malignancy onset. ACL occurs months to years after an underlying inflammatory disorder. In 10% of the cases, ACL was associated with a particular drug, and in 2%, it was associated with specific infections. Data were derived from case reports, case series, letters to editors, observational studies, and abstracts. Limitations include the accuracy of published data, potential patient selection, and reporting bias. Dermatologists should be alert to these associations to provide adequate screening and management of patients with ACL.
PubMed: 38924070
DOI: 10.1111/ijd.17338 -
Journal of Cosmetic Dermatology Jun 2024TikTok is one of the fastest-growing social media platform, and its short-form videos have become a widely used source of health information. "Dermarolling" is a form of...
BACKGROUND
TikTok is one of the fastest-growing social media platform, and its short-form videos have become a widely used source of health information. "Dermarolling" is a form of roller microneedling often practiced at home, and patients may be using TikTok to inform their decision to pursue this treatment and their practice of it.
AIMS
This study assessed the informational content quality, source, and engagement of TikTok dermarolling videos to highlight potentially harmful social media trends.
METHODS
On a predetermined date, "dermarolling" was searched on TikTok. The top 75 results were screened. Number of views, creator type, type of video, and whether risks were discussed were recorded. Information quality was assessed using the DISCERN tool. The data were stratified by creator type, and statistical analysis was performed using R version 4.3.2. Median viewership and DISCERN scores were compared using Kruskal-Wallis tests with post hoc pairwise Wilcoxon tests. Fisher's exact test was used to compare rates of risk discussion between groups.
RESULTS
Sixty-one of the reviewed videos met the inclusion criteria. Influencer videos engaged the largest overall audience and had higher median viewership than other creators. Physicians, primarily dermatologists, created exclusively educational content and influencers created mostly experience-based content. Overall content quality was generally low-moderate, with a median (IQR) DISCERN score of 30.5 (26.5-33.5). Physician content had higher median DISCERN scores than influencers (p = 0.004) and others (p = 0.004). Physicians were more likely to discuss risks compared to influencers (p = 0.02).
CONCLUSIONS
TikTok content on "dermarolling" was of relatively low quality, and nonphysicians command a large viewership. Physician-created content is often of higher informational quality, and dermatologists should escalate their efforts to engage patients in this space to mitigate the effects of potential misinformation.
PubMed: 38923153
DOI: 10.1111/jocd.16399