ABSTRACT
Purpose of Study: Teledermatology, defined as the use of technology to provide dermatology services to individuals in a remote setting, has grown considerably in popularity since the onset of the COVID-19 era. Teledermoscopy utilizes a dermatoscope attachment paired with a smartphone camera to visualize colors and microstructures within the epidermis and superficial dermis that cannot be seen with the naked eye alone. When combined with store-and-forward technology, teledermoscopy of lesions concerning for skin cancer can improve virtual referral and triage workflow. Methods Used: Our retrospective case-control study evaluated the efficacy of a smartphone dermatoscope borrow program in the remote triage of individuals with self-selected skin lesions of concern and its effect on subsequent in-person follow-up visits. A retrospective medical record review was conducted of all Oregon Health and Science University (OHSU) Department of Dermatology spot check image submissions utilizing the smartphone dermatoscopes between August 2020-2022. Dermoscopic images of skin lesions that included corresponding non-dermoscopic clinical images in their submission were included in our review (n=70). A blinded expert dermoscopist then reviewed the clinical and dermoscopic images separately and utilized standard clinical algorithms for skin cancer (ABCD criteria: asymmetry, irregular borders, multiple colors, diameter>= 6mm for clinical images;3-point checklist: dermoscopic asymmetry, atypical network, blue-white structures for dermoscopy images) to determine whether the imaged lesion should translate to an in-person visit for further evaluation. Summary of Results: Of the 70 skin lesions submitted, 59 warranted in-person evaluation from clinical (non-dermoscopic) image review compared to 29 warranting in-person evaluation from dermoscopic images of the same lesion. Thus, this is a 51% reduction of conversion to in-person consultation with the addition of smartphone dermatoscope images in virtual lesion triage (P<0.001, McNemar's Test). Conclusion(s): Implementing patient-led teledermoscopy may reduce frequency of in-person visits for benign lesions, and thus, may decrease wait times for other patients with concerning and possibly malignant lesions. Decreasing the frequency of unnecessary visits may not only improve patient quality of life, but also promote cost-effective expenditures for health systems at large.
ABSTRACT
Pinellia ternata (Thunb.) Breit. (P. ternata) is a very important plant that is commonly used in traditional Chinese medicine. Its corms can be used as medicine and function to alleviate cough, headache, and phlegm. The epidermis of P. ternata corms is often light yellow to yellow in color; however, within the range of P. ternata found in JingZhou City in Hubei Province, China, there is a form of P. ternata in which the epidermis of the corm is red. We found that the total flavonoid content of red P. ternata corms is significantly higher than that of yellow P. ternata corms. The objective of this study was to understand the molecular mechanisms behind the difference in epidermal color between the two forms of P. ternata. The results showed that a high content of anthocyanidin was responsible for the red epidermal color in P. ternata, and 15 metabolites, including cyanidin-3-O-rutinoside-5-O-glucoside, cyanidin-3-O-glucoside, and cyanidin-3-O-rutinoside, were screened as potential color markers in P. ternata through metabolomic analysis. Based on an analysis of the transcriptome, seven genes, including PtCHS1, PtCHS2, PtCHI1, PtDFR5, PtANS, PtUPD-GT2, and PtUPD-GT3, were found to have important effects on the biosynthesis of anthocyanins in the P. ternata corm epidermis. Furthermore, two transcription factors (TFs), bHLH1 and bHLH2, may have regulatory functions in the biosynthesis of anthocyanins in red P. ternata corms. Using an integrative analysis of the metabolomic and transcriptomic data, we identified five genes, PtCHI, PtDFR2, PtUPD-GT1, PtUPD-GT2, and PtUPD-GT3, that may play important roles in the presence of the red epidermis color in P. ternata corms.
Subject(s)
Pinellia , Transcriptome , Anthocyanins/genetics , Anthocyanins/metabolism , Pinellia/genetics , Gene Expression Profiling , Glucosides/metabolismABSTRACT
Case report Introduction: Toxic epidermal necrolysis (TEN), is an immune-mediated disease characterized by severe mucocutaneous symptoms and is the result of an inflammatory response that leads to keratinocyte necrosis and perivascular lymphocyte infiltration, mostly drug-related. Case report: A 35-year- old male, with a history of recently diagnosed systemic lupus under treatment with prednisone, hydroxychloroquine, mycophenolate and cotrimoxazole forte evolves with persistent proteinuria, it is decided to add losartan, chlorthalidone and atorvastatin. Nevertheless despite immunosuppression, proteinuria and skin involvement persisted, so mycophenolate was suspended and a bolus of cyclophosphamide 1 g was administered. Eight weeks after adjusting treatment, the patient went to the emergency department due to a confluent, pruritic, maculopapular rash with blistering lesions on the trunk, upper limbs, face, and oral mucosa, associated with fever over 38degreeC, that evolved during one week. On admission, the following was confirmed: confluent erythematous macular exanthem associated with multiple flaccid blisters on the chest, upper limbs and neck, Nikolsky's sign (+), keratoconjunctivitis and dryness on the lips. Admission tests included complete blood count with no leukocytosis or eosinophilia, ESR 29 mm/hr, C-RP 19.8 mg/L, no liver profile abnormalities, creatinine 0.8 mg/dl, and urine test with proteinuria 300 mg/dl. Negative infectious study for mycoplasma, herpes 6 virus, cytomegalovirus, Epstein barr virus, hepatitis A, B, C, E and SARS-COV2 virus. Due to severe mucosal skin involvement, TEN/SJS was suspected v/s (TEN)-like Lupus presentation, drugs used prior to admission (chlorthalidone, losartan, atorvastatin) were discontinued, and treatment was started with Hydrocortisone 100 mg every 8 hours IV, Immunoglobulin 2 g/kg daily IV for 4 days, plus skin and mucous membrane care. Patient had a favorable evolution, with resolution of skin and mucosal lesions and no signs of infection. Skin biopsy showed necrotic epidermis, necrotic basal keratinocytes, and sparse lymphocytic inflammatory infiltrate in the papillary dermis, consistent with erythema multiforme/toxic epidermal necrolysis. Conclusion(s): Extensive mucosal involvement is one of the cardinal signs of the presentation of SJS/ETN and given its severity, a high index of suspicion is important with the consequent suspension of suspected drugs and support management for a favorable evolution. In this case the suspected culprit drug was the combination of cyclophosphamide and chlorthalidone, due to reports of increased toxicity of cyclophosphamide in combination with diuretic drugs.
ABSTRACT
Seborrhoeic keratosis is a benign brownish-black skin lesion that is almost always seen in middle-aged and elderly populations. The sudden onset and rapid increase in size and/ or number of seborrhoeic keratoses is called the Leser-Trelat sign, suggesting a paraneoplastic manifestation of internal malignancy. However, eruptive seborrhoeic keratoses are also described in some nonmalignant conditions such as human papillomavirus infection and HIV infection. Herein, we report a case with Leser-Trelat sign in a patient following COVID-19 infection. A 50-year-old man presented to our dermatology clinic complaining of the sudden appearance of multiple warty-like lesions on his back, which had occurred 2 months after recovery from COVID-19 infection. According to his medical history, the patient presented with cough, fever and dyspnoea about 2 months prior to the appearance of his skin lesions. He was referred to a health centre, where a nasopharyngeal swab was taken, and his polymerase chain reaction test for COVID-19 was positive. In addition, bilateral patchy ground-glass infiltration was reported in his high-resolution computed tomography (HRCT) scan, all in favour of COVID- 19 infection. The patient was then treated with acetaminophen, dexamethasone (intramuscular injection), salmeterol and a fluticasone inhaler, and his symptoms improved. Two months after recovery from his mild COVID-19 infection, several small asymptomatic pigmented verrucous papules appeared on his back. Physical examination revealed multiple rough, oval-shaped, brownish papules of varying size. Dermatoscopy of the lesions was also performed. Both clinical and dermoscopic findings were in favour of seborrhoeic keratosis. In order to reach a final diagnosis, a skin biopsy was performed, and microscopic examination of the biopsy specimen showed hyperkeratosis and well-defined epidermal hyperplasia composed mainly of the proliferation of benignlooking basaloid cells and fewer squamoid cells and horn cysts and increased melanin, mostly at the dermoepidermal junction. The dermis showed no significant change. Based on the above findings, the patient was diagnosed with eruptive seborrhoeic keratosis. To determine the possible cause of this eruption, the patient was further evaluated. In his past medical history, he was generally healthy before his COVID-19 infection and had no history of comorbidities. The patient underwent a workup to rule out any internal malignancies. Laboratory tests revealed normal results and included a complete blood count, liver and kidney function tests, electrolytes, prostate-specific antigen and urine analysis. Gastrointestinal endoscopy and colonoscopy ruled out any gastrointestinal malignancy. Chest X-ray and HRCT revealed no malignant lesion. In addition, the patient's abdominopelvic sonography was normal. The patient had no family history of similar skin lesions and gave no history of any chronic inflammatory skin diseases or viral conditions. Therefore, the appearance of the Leser-Trelat sign after COVID- 19 infection was a possibility in this patient. The role of transforming growth factor-alpha and tumour necrosis-alpha in eruptive seborrhoeic keratoses, as well as in COVID-19 infection, can be a common area of interest to explore in the aetiology of this entity.
ABSTRACT
Spitzoid melanoma is very rare tumour in the pediatric population, with clinical and non-uniform behaviour, different from adult melanoma [1]. It can be difficult to differentiate an atypical Spitz nevus from a Spitzoid melanoma, resulting in diagnostic problems. In addition, in our clinical case, the COVID-19pandemiccaused significant delays both in the diagnosis and in the surgical treatment of our patient. We present the clinical case of a 4-year-old child suffering from a localized polypoid cutaneous neoformation on the dorsum of the left hand, which started immediately before the lockdown and steadily increased during the COVID-19 pandemic. After a general clinical framing, the child underwent an excisional biopsy at our Department of Plastic and Reconstructive Surgery, at the Policlinico of Foggia. Subsequently, two independent anatomic pathology groups examined the specimen. Definitive diagnosis was made only after careful genetic analysis in combination with supporting histological and immunohistochemical examinations. This clinical case shows how during the pandemic we have been facing advanced forms of tumours, compared to the previous period and highlight show an interdisciplinary and multicenter collaboration allowed a quick diagnosis of certainty, demonstrating the utility of molecular pathology as a fundamental aid in clinical/surgical practice. © 2022 The Authors
ABSTRACT
A 73-year-old man presented with left shin ulceration two weeks after receiving his first dose of the Oxford-AstraZeneca vaccine. Within 24 h of vaccination, the patient became generally unwell with fever and headache. On the third day after vaccination, he developed left shin erythema and blistering, which rapidly ulcerated. This formed two superficial ulcers with a necrotic base and a violaceous edge on the lateral aspect of his left shin, measuring approximately 2 cm × 3 cm. He had a background of atrial fibrillation and ischemic cardiomyopathy, and had been on several longstanding medications including apixaban. Blood tests revealed normal clotting, full blood count, liver and renal function. The differential diagnosis included pyoderma gangrenosum, vasculitic ulceration, and a cutaneous adverse drug reaction to vaccination. A punch biopsy was obtained from the edge of an ulcer, which revealed microthrombi within blood vessels, an ischemic epidermis, and fat necrosis of subcutaneous tissue. The patient experienced slow healing of ulceration with topical clobetasol propionate 0.05%, neomycin sulphate and nystatin ointment, and compression bandaging treatment. To our knowledge, this is the first reported case of cutaneous thrombosis associated with skin necrosis following Oxford/AstraZeneca vaccination. Recently there have been concerns related to reports of thrombotic events at atypical sites (including cerebral and splanchnic vascular beds) associated with thrombocytopenia following Oxford/ AstraZeneca vaccination (Greinacher A, Thiele T, Warkentin TE et al. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021;384: 2092-101). These findings extend the range of atypically located thromboses associated with COVID-19 vaccination and reinforce the necessity for physicians to be vigilant for signs and symptoms related to thromboses at atypical sites in recently vaccinated patients.
ABSTRACT
A 44-year-old man of Pakistani origin presented to emergency 6 days following his first dose of the AstraZeneca (AZ) SARSCoV- 2 vaccine. He developed flu-like symptoms followed by erythematous pruritic rash. Physical examination showed a maculopapular rash associated with purpura and targetoid lesions affecting his distal extremities, trunk and mucous membranes. He also had crusting and ulceration of his oral and genital mucosal areas. He had no other significant past medical history. A biopsy was taken from his right arm and sent for urgent histology and direct immunofluorescence. Histology revealed parakeratotic scale with interface dermatitis comprising basal layer vacuolation and lymphocyte exocytosis. The epidermis showed prominent dyskeratotic keratinocytes scattered throughout the epidermis. The papillary dermis showed a mild perivascular lymphocytic infiltrate including eosinophils and melanophages. Other investigations showed leucocytosis (12 × 109 L-1), high eosinophils (0.9 × 109 L-1), raised liver enzymes with alkaline phosphatase 159 U L-1 and alanine aminotransferase 172 U L-1. A full infection screen, including herpes simplex virus, SARS-CoV-2 and atypical viral infection, was negative. Immunology was also reported as negative. Based on the findings, a diagnosis of erythema multiforme (EM) secondary to AZ vaccine was made. He was treated with topical steroids and emollients, leading to resolution of his skin and mucosal areas in 4-6 weeks. Recently, there have been a few reported cases of EM in patients with COVID-19 (Jimenez-Cauhe J, Ortega-Quijano D, Carretero- Barrio I et al. Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings. Clin Exp Dermatol 2020;45: 892-5) and two patients who have had the Pfizer-BioNTech vaccine [Kim M, Kim J, Kim M et al. Generalized erythema multiforme-like skin rash following the first dose of COVID-19 vaccine (Pfizer-BioNTech). J Eur Acad Dermatol Venereol 2021], but the information is limited. Our case emphasizes the need for further studies into the cutaneous adverse effects related to COVID-19vaccines.
ABSTRACT
There is global interest in both the beneficial and detrimental health effects of ultraviolet-C (UVC) radiation in the wavelength range 200-230 nm (known as Far-UVC). Technology using Far-UVC is proposed as a highly effective control measure for reducing the transmission of COVID-19. Far-UVC, and other wavelengths of UVC, are well-known to efficiently inactivate pathogens in air and on surfaces. Although studies have shown irradiation of skin with 254 nm UV results in DNA damage in the epidermal basal layer, irradiation with Far-UVC (222 nm) shows minimal DNA damage and only in the granular layer, which is comprised of non-proliferating keratinocytes. Therefore, accumulation of these DNA photoproducts would not be expected to be associated with cancer risk. It has also been shown that even high doses of Far-UVC exposure to human skin do not induce erythema. However, the effects of Far-UVC on the immune system are, to the best of our knowledge, unknown. It is well-reported that both ultraviolet B (UVB 280-315 nm) and ultraviolet-A (UVA 315-400 nm) have effects on cutaneous Langerhans cells (LC), inducing migration from the epidermis to the draining lymph nodes, thereby suppressing skin immune function. Here we present data generated in a range of skin types (Fitzpatrick II-V) demonstrating little or no impact of Far-UVC on the cutaneous immune system, as assessed by Langerhans cell migration, at doses of up to 3,000 mJ/cm2 (US daily limit is 450 mJ/cm2). These results support the safety of filtered Far-UVC use, which could have a transformative effect on public health, allowing effective virus inactivation and reduction of transmission independent of human behavior. Conflict of interest disclosure: the authors state no conflict of interest. However, MJC and RPH are directors of Ten Bio Ltd, a company focused on developing human skin explant models.
ABSTRACT
Far UV-C, informally defined as electromagnetic radiation with wavelengths between 200 and 230 nm, has characteristics that are well-suited to control of airborne pathogens. Specifically, Far UV-C has been shown to be highly effective for inactivation of airborne pathogens;yet this same radiation has minimal potential to cause damage to human skin and eye tissues. Critically, unlike UV-B, Far UV-C radiation does not substantially penetrate the dead cell layer of skin (stratum corneum) and does not reach germinative cells in the basal layer. Similarly, Far UV-C radiation does not substantially penetrate through corneal epithelium of the eye, thereby preventing exposure of germinative cells within the eye. The most common source of Far UV-C radiation is the krypton chloride excimer (KrCl*) lamp, which has a primary emission centered at 222 nm. Ozone production from KrCl* lamps is modest, such that control of indoor ozone from these systems can be accomplished easily using conventional ventilation systems. This set of characteristics offers the potential for Far UV-C devices to be used in occupied spaces, thereby allowing for improved effectiveness for inactivation of airborne pathogens, including those that are responsible for COVID-19.
ABSTRACT
This study aimed to describe the histo-anatomy of Tussilago farfara L. species from the Asteraceae family, with medicinal importance in Romania for the alternative treatment of respiratory diseases (asthma, laryngitis, cough, emphysema) and other disorders. The chemical composition of Coltsfoot includes more than 150 chemical substances (triterpenoids, sesquiterpenoids, alkaloids) with different medicinal proprieties (expectorant, antimicrobial, antitussive) and contraindications (pregnancy, lactation, hepatic disorders). The vegetal material used in this study was collected from the waterside of river Sireţel in the village Sireţel from Sireţel commune in Iaşi County. The cross-sections were performed manually through vegetative organs (rhizome, stem, and leaf) with the help of a hand microtome and a botanic razor. The structures of the sections were highlighted by double coloration (iodine green and ruthenium red), the observation was performed on a Novex microscope. The characteristics structures observed by us (epidermis, vascular bundles, trichomes, angular collenchyma, assimilating parenchyma, stomata, mesophyll) correspond with Toma and Rugină (1998) observations and descriptions.
ABSTRACT
The proceedings contain 48 papers. The topics discussed include: development of cosmetic hair and body formulations using pineapple (Ananas comosus L) peel juice;non-invasive technological platform for evaluating cosmetic dermal redensification;in vitro development methodology to assess blue light protection;safety and efficacy assessment of astaxanthin nanoparticles to anti-aging cosmetic formulation;hand hygiene and skin health in times of COVID-19;immunocompetent RHE platform adding functionalities to your cosmetic products;reconstructed human epidermis model as an advanced platform to assess cosmetic product safety and performance;guayusa extract as a protector of the epidermal barrier, inflammatory response and oxidative stress induced by hair colorations: an in vitro, ex vivo and clinical approach;and characterization of bacterial cellulose obtained from different carbon sources.
ABSTRACT
Many claims from herbal medicines have been developed to manage COVID-19. Tests for identity and purity are important parameters in the quality assurance of herbal medicines. The aim of this study is to confirm the presence of Artemisia annua as a component of COVID-ORGANICS, an acclaimed herbal product for the management of COVID-19 in comparism with A. annua cultivated at NIPRD, Abuja, Nigeria. Pharmacognostic and physicochemical investigations, thin layer and high-performance Liquid chromatography of Covid-Organics along with A. annua were carried out using standard procedures. Similar microscopic features viz T-shaped, glandular, unicellular and uniseriate trichomes, wavy epidermal cells with anomocytic stomata and prismatic calcium oxalate crystals characteristic of A. annua were observed. Moisture, total ash and sulphated ash contents ranged from 8.5 ± 0.0 to 10.4 ± 0.2%w/w;7.8 ± 0.5 to 12.1 ± 0.1%w/w and 9.7 ± 0.3 to 15.9 ± 0.4%w/w, respectively while water and alcohol soluble extractive values ranged from 20.6 ± 0.5 to 33.7 ± 0.7%w/w;and 23.4 ± 0.6 to 38.2 ± 0.6%w/w respectively. TLC and HPLC profiles showed artemisinin in evaluated samples. The findings confirm that Covid-Organics contain A. annua. The domestication of A. annua in Nigeria along with studies carried out has shown the capacity and technical know-how to develop a phytomedicine from A. annua for management of COVID-19 associated symptoms. This is possible with the provision of the enabling environment in order to provide medicines’ security. Relevant policies are therefore needed to prioritise the development of the sector.
ABSTRACT
Angiotensin converting enzyme 2 (ACE2), a component of the renin-angiotensin system (RAS), has been identified as the receptor for the SARS-CoV-2. Several RAS components including ACE2 and its substrate Ang II are present in both eye and skin, two stratified squamous epithelial tissues that isolate organisms from external environment. Our recent findings in cornea and others in both skin and eye suggest contribution of this system, and specifically of ACE2 in variety of physiological and pathological responses of these organ systems. This review will focus on the role RAS system plays in both skin and cornea, and will specifically discuss our recent findings on ACE2 in corneal epithelial inflammation, as well as potential implications of ACE2 in patients with COVID-19.