The impact of blue light and digital screens on the skin.

INTRODUCTION: The skin is frequently subjected to a variety of environmental trauma and stress. It is unavoidably subjected to blue light due to the increased use of electronic equipment, including indoor lighting and digital gadgets like smartphones and laptops, which have a range of detrimental effects. The method of action and numerous harmful consequences of blue light on the skin are the main subjects of this review. MATERIALS AND METHODS: A literature search has been performed using PubMed, GoogleScholar and EmBase databases and an updated review on the topic has been presented. RESULTS: Numerous studies have shown that being exposed to blue light accelerates the aging process and produces cutaneous hyperpigmentation. It also modifies the circadian rhythm. The two main molecules that mediate cellular responses to blue light are nitric oxide (NO) and reactive oxygen species. However, the precise process is still not fully known. CONCLUSION: These negative consequences may eventually cause more general skin damage, which may hasten the aging process. At times, skin protection may be crucial for protection against blue light.

Hyperpigmentation: Looking beyond hydroquinone.

Hyperpigmentation is the most common complaint in the age group 40-45 years, seeking consultation for skin disorders. Hydroquinone is a commonly used depigmenting agent in clinical practice for treating hyperpigmentation. Prolonged use of hydroquinone has been associated with cancer risk and exogenous ochronosis. The CARES (The Coronavirus Aid, Relief, and Economic Security Act) Act of 2020 has instituted significant changes to hydroquinone containing OTC (over the counter) products, and consequently, many hydroquinone-based OTC products had to be withdrawn from the market. Henceforth, products containing hydroquinone would need US Food and Drug Administration approval via new drug application pathways for commercialization. Alternative treatment options to hydroquinone in clinical practice are reviewed in this paper with regard to their safety and efficacy vis a vis hydroquinone. Also, new potential treatment options such as thiamidol, Polypodium leucotomos, and glutathione are discussed. The review shows that these alternative depigmenting agents can be rationally combined to achieve desired treatment goals in the management of hyperpigmentation.

Combination treatment of COVID-19 associated herpes zoster scar with 1540 nm and 755 nm picosecond lasers: a case report.

A 33-year-old female, Fitzpatrick IV phototype, developed varicella zoster eruption over the ophthalmic dermatome of the right trigeminal nerve, confirmed through Polymerase Chain Reaction, 4 weeks after recovering from COVID-19 disease. After the resolution of the acute manifestations, she developed significant atrophic scars on the forehead, about 2 mm deep, with marked post-inflammatory hyperpigmentation. She came to our clinic looking for treatment, as the scars caused significant psychological distress. We decided for a combination treatment with Erbium:glass 1540 nm non-ablative laser and 755 nm Alexandrite picosecond laser. After 16 weeks of starting treatment, significant improvement was observed, with complete resolution of the hyperpigmentation and overall improvement in the atrophic scar. No complications occurred during the treatment period. This strategy may be an effective and safe option to treat these lesions, which may be increasingly found in young individuals after COVID-19 disease or SARS-CoV-2 vaccination, even in darker skin phototypes.

Cronkhite-Canada Syndrome: A Case Report.

Cronkhite-Canada Syndrome is a rare disease characterised by diffuse gastrointestinal polyposis, abdominal pain, diarrhoea, cutaneous and mucosal hyperpigmentation, alopecia, and onychodystrophy. Here we report a case of a 40-year-old female with Cronkhite-Canada Syndrome, who presented with the complaints of diffuse abdominal pain, blood mixed stools, and diarrhoea associated with tenesmus. She had nausea and reduced appetite and lost 10 kgs in 3 months. She had hair fall (alopecia), atrophic changes of nails (onychodystrophy), and hyperpigmentation of the skin in fingers, tongues, and lips. Histopathological biopsy of the gastric and colonic biopsy revealed polypoid edematous mucosa and the colonic biopsies showed scattered dilated glands with inflammatory exudate and mucin. She got Entamoeba histolytica and COVID-19. She received respective antibiotics and protein diets that helped relieve the symptoms. After 4 weeks of steroids, her symptoms improved drastically. Corticosteroids, treating co-infection along with nutritional counselling can be helpful to relieve the symptoms. Keywords: alopecia; case reports; cronkhite-canada syndrome; hyperpigmentation.

Follicular keratosis of the face in pediatric patients of color.

BACKGROUND/OBJECTIVES: Follicular keratosis (FK) is a poorly understood disorder presenting with multiple, grouped hyperkeratotic follicular papules typically affecting the chin or jawline. This study describes the clinical presentation, histopathology, management, and outcomes of a series of pediatric patients of color with FK of the face, thought to be related to rubbing or friction on the skin. METHODS: Retrospective review of 20 pediatric patients with FK of the face who presented to our pediatric dermatology practice between April 2019 and October 2021. RESULTS: Twenty patients (mean age 12.1 years, 13 females), all self-identified as Black/African American, were included. All presented with an initially asymptomatic, hyperpigmented patch containing multiple hyperkeratotic follicular papules, located on the cheek, chin, upper lip, and/or jawline. Five patients endorsed a history of rubbing the site. Nine patients had onset of the lesions during the COVID-19 pandemic. Treatments included topical vitamin D analogs, corticosteroids, and/or retinoids. Topical vitamin D analogs and retinoids improved the texture and hyperpigmentation of the follicular lesions in only four patients, while topical corticosteroids had no effect. Histopathological examination of two patients revealed multiple dilated follicles containing keratinized material and associated with a sparse dermal inflammatory infiltrate in one patient and granulomatous inflammation within the dermis in the other. CONCLUSIONS: In our cohort of pediatric patients with FK, patients of color were preferentially affected, and all cases were associated with hyperpigmentation. Some patients presented during the COVID-19 pandemic suggesting that friction from facial mask wearing may have induced or exacerbated this uncommon condition.

Hyperpigmented patch: an uncommon but early marker of Wilson's disease.

Wilson's disease in childhood could present with features ranging from asymptomatic liver disease to acute liver failure and cirrhosis. Neurological manifestations and psychiatric illness occur more commonly in adults and older children. Skin manifestation with Wilson's disease is not frequently reported in literature but could be an early diagnostic clincher. We present a child with hepatic Wilson's disease and skin hyperpigmentation. We aim to highlight the possible importance of skin lesions as an early marker of Wilson's disease.

COVID-19: The experience from Beijing, China.

The epidemiology of coronavirus disease 2019 (COVID-19) in Beijing, China, is summarized. This presentation highlights its main clinical manifestations, including the skin findings in Beijing and sums up the cutaneous damage to the medical staff in their epidemic preventative work. Although there had been few COVID-19 patients who reported skin lesions in Beijing and even in China, dermatologists still needed to pay attention to self-protection in their daily work. Skin damage caused by protective equipment is very common in the majority of the medical staff in Beijing.

Hydroxychloroquine safety: A meta-analysis of randomized controlled trials.

BACKGROUND: Hydroxychloroquine (HCQ) is currently being examined for COVID-19. No previous meta-analysis has evaluated its side effects versus placebo. We conducted this meta-analysis to compare the safety of HCQ versus placebo. METHODS: Two authors independently searched PubMed and EMBASE databases for randomized controlled trials (RCTs) of adults comparing the adverse events (AEs) of HCQ versus placebo for any indication. Peto odds ratios (Peto ORs) and 95% confidence intervals (CIs) were calculated based on random-effects models. The heterogeneity (I2) was assessed using Cochran's Q test. RESULTS: Nine RCTs (eight were double-blind) with a total of 916 patients were included. HCQ caused significantly more skin pigmentation than placebo (Peto OR, 4.64; 95% CI, 1.13 to 19.00; P-value = 0.033; I2 = 0%). The increase in other AEs did not reach statistical significance: rash (Peto OR, 1.11; 95% CI, 0.3 to 3.77; P-value = 0.03; I2 = 0%); gastrointestinal AEs (Peto OR, 1.43; 95% CI, 0.55 to 3.72; P-value = 0.46; I2 = 15.17%); headache (Peto OR, 1.94; 95% CI, 0.65 to 5.78; P-value = 0.23; I2 = 9.99%); dizziness (Peto OR, 1.32; 95% CI, 0.49 to 3.52; P-value = 0.58; I2 = 0%); fatigue (Peto OR, 2.13; 95% CI, 0.76 to 5.98; P-value = 0.15; I2 = 0%); and visual AEs (Peto OR, 1.61; 95% CI, 0.76 to 3.41; P-value = 0.22; I2 = 0%). Cardiac toxicity was not reported. CONCLUSIONS: This meta-analysis of RCTs found a significantly higher risk of skin pigmentation in HCQ users versus placebo. More data are needed to evaluate HCQ in the context of COVID-19 treatment.