ABSTRACT
BACKGROUND: Due to relapsing nature of melasma with significant impact on quality of life, an objective measurement score is warranted, especially to follow-up the patients with melasma and their therapy response in a quantitative and precise manner. AIMS: To prove concordance of skin hyperpigmentation index (SHI) with well-established scores in melasma and demonstrate its superiority regarding inter-rater reliability. Development of SHI mapping for its integration in common scores. METHODS: Calculation of SHI and common melasma scores by five dermatologists. Inter-rater reliability was assessed by intraclass correlation coefficient (ICC) and concordance by Kendall correlation coefficient. RESULTS: Strong concordance of SHI with melasma area and severity index (MASI)-Darkness (0.48; 95% CI: 0.32, 0.63), melasma severity index (MSI)-Pigmentation (0.45; 95% CI: 0.26, 0.61), and melasma severity scale (MSS) (0.6; 95% CI: 0.42, 0.74). Using step function for mapping SHI into pigmentation scores showed an improvement of inter-rater reliability with a difference in (ICC of 0.22 for MASI-Darkness and 0.19 for MSI-Pigmentation), leading to an excellent agreement. CONCLUSION: Skin hyperpigmentation index could be an important additional cost-and time-conserving assessment method, to follow-up the patients with melasma undergoing brightening therapies in clinical studies, as well as in routine clinical practice. It is in strong concordance with well-established scores but superior regarding inter-rater reliability.
Subject(s)
Hyperpigmentation , Melanosis , Humans , Quality of Life , Reproducibility of Results , Hyperpigmentation/diagnosis , Hyperpigmentation/etiology , Hyperpigmentation/drug therapy , Melanosis/therapy , Melanosis/drug therapy , Treatment OutcomeABSTRACT
Wound products that reliably support healing of chronic leg ulcers remain a huge unmet need in clinical practice. Due to the lack of standardized comparable protocols and different systems for platelet-rich plasma (PRP) preparation, there is limited data on healing rates in chronic venous ulcers. In our case series with a total of seven chronic leg ulcers in four patients, we investigated the healing rates based on standardized digital photographs of chronic venous ulcers after application of topical PRP using a digital imaging software. In 5 out of 7 ulcers, the PRP-treated wound half showed faster healing as compared the control half of the wound. In this case series, PRP-treated sides of chronic venous leg ulcers showed a tendency for accelerated healing as compared to nontreated collateral wound side. Our data support the evaluation of topical PRP treatment in the management of chronic venous leg ulcers.
Subject(s)
Leg Ulcer , Platelet-Rich Plasma , Varicose Ulcer , Administration, Topical , Humans , Leg , Leg Ulcer/therapy , Varicose Ulcer/therapy , Wound HealingABSTRACT
Chronic pruritus profoundly affects patients' quality of life. The objective of this retrospective cross-sectional study was to characterize patients with chronic pruritus and identify patterns, in order to delineate a better diagnostic approach. Both semantic connectivity map and classical analysis were applied, linking demographic, clinical, laboratory and histopathological data with clinical and aetiological categories of 170 patients with chronic pruritus (median age 72 years, 58.2% women). The semantic map showed clinical categories separated in different hubs associated with distinct patterns concerning sex, aetiology, laboratory findings, and pharmacological treatment. Diabetes, diagnosis of cancer and psychiatric comorbidities were linked with certain clinical categories. Skin eosinophilia was a common finding of chronic pruritus, on both diseased and non-diseased skin. High frequencies of patients with chronic pruritus taking anti-arrhythmics, beta-blockers and AT-II receptor antagonists were noticed among those with underlying systemic, neurological and psychiatric diseases. This study provides a complex analysis of chronic pruritus and thus basic principles for a clinical work-up.
Subject(s)
Pruritus/classification , Aged , Chronic Disease , Comorbidity , Demography , Female , Humans , Male , Pruritus/drug therapy , Pruritus/etiology , Quality of Life , Retrospective Studies , Risk Factors , Sex Factors , SwitzerlandABSTRACT
The Schamroth sign can be used for the detection of nail clubbing and is associated with pulmonary and cardiovascular diseases. This case illustrates a patient with sudden nail clubbing and positive Schamroth sign without any other abnormal clinical or laboratory findings. Radiological workup revealed a pleural tumor, histologically confirmed as a solitary fibrous tumor. After thoracoscopic tumor resection, normalization of the nail clubbing with complete resolution of the Schamroth sign was observed. Our case demonstrates that sudden nail changes with positive Schamroth sign may indicate a new neoplastic pulmonary disease. It is of great importance to increase the awareness of this feature in order to obtain a timely diagnosis, specific treatment, and improved patient care.
ABSTRACT
Onychomycoses in temperate climates are most commonly due to dermatophytes, particularly Trichophyton rubrum. Non-dermatophyte nail infections are much less frequent, and their diagnosis requires a careful and repeated search for a potential dermatophyte that may have been overgrown in culture. A series of histological slides of suspected onychomycoses with uncommon fungal morphology prompted us to search for non-dermatophytic moulds causing dermatophytosis-like nail infections. Thirty cases were identified by culture as F solani, F oxysporum, F dimerum or F spp, and two more were only diagnosed histopathologically. None of these patients was immunocompromised. Treatment was mostly unsuccessful with terbinafine whereas itraconazole showed a moderately better treatment result; in all cases, a topical ciclopirox nail varnish in a hydroxychitosan base was added.
