Correlation between Acanthosis Nigricans Scoring Chart (ANSC) and narrowband reflectance spectrophotometer in assessing severity of acanthosis nigricans.

INTRODUCTION: There is a lack of standardized tool to monitor treatment outcome of acanthosis nigricans. To meet this end, we developed the Acanthosis Nigricans Scoring Chart (ANSC) that evaluates skin color (score range of 1-8) and skin texture (score range of 1-6), which adds up to a total ANSC score (score range of 2-14). We aimed to determine the correlation of ANSC to narrowband reflectance spectrophotometry and to evaluate its reliability. METHODS: A cross-sectional study was conducted in adult acanthosis nigricans patients. Two raters independently graded participants using ANSC twice, in which scores were correlated to readings from Mexameter MX18. Intra- and interrater reliability were also evaluated via intraclass correlation coefficient (ICC). RESULTS: Participants had mean (sd) melanin and erythema indices of 615.8 (176.2) and 451.4 (53.4), respectively. Mean (sd) total ANSC score was 9.43 (2.43). The total ANSC score and skin color subdomain demonstrated strong correlations (r > 0.6) with spectrophotometric results, whereas skin texture showed a moderate correlation (r = 0.4-0.6). Total ANSC score generally had excellent intra- and interrater reliabilities (ICC > 0.85). CONCLUSION: The total ANSC score and its subdomains strongly correlate with spectrophotometer and demonstrate excellent reliability in assessing acanthosis nigricans.

A comparison of the efficacy and safety profiles of 10% salicylic acid and 10% urea creams in treating acanthosis nigricans in adolescents: a randomized double-blinded study.

Acanthosis nigricans is characterized by the presence of velvety hyperpigmentation of the skin over the neck and the flexural areas. Regardless of different modalities of treatment, none provides a definite standard cure. This study aims to assess the efficacy of topical 10% salicylic acid compared to 10% urea cream in treating acanthosis nigricans in adolescents. A randomized comparative, double-blind study is conducted on adolescents with acanthosis nigricans of the posterior neck. Treatment efficacy was assessed via a narrowband reflectance spectrophotometer at individual follow-up visits at weeks 2, 4, and 8, while the overall success rates were evaluated by the investigator-assessed and participant-assessed global evaluation scales (IGE and PGE). Acanthosis nigricans scoring chart (ANSC) and adverse effects are also assessed. A total of 39 participants with acanthosis nigricans enrolled and completed the study. Throughout the 8-week period of treatment, the use of 10% salicylic acid demonstrated strong effectiveness in treatment with 14.6 ± 10.6% improvement, while the 10% urea demonstrated 12.5 ± 10.9% improvement. Findings from the overall global evaluation scales were consistent with the results from the narrowband reflectance spectrophotometer. Treatment with 10% salicylic and 10% urea produced no serious local skin adverse reactions. Both medications improve neck hyperpigmentation associated with acanthosis nigricans in adolescents, in which the 10% salicylic acid and 10% urea cream demonstrate similar efficacy and safety profiles. Clinical Trials Registry: TCTR20201123003.

Comparing the efficacy and safety profiles of 0.025% and 0.05% tretinoin creams in treating acanthosis nigricans: a randomized double-blinded study.

Acanthosis nigricans (AN) is a skin disorder with hyperpigmented and velvety plaques without a standardized treatment regimen. We aimed to compare the efficacy and safety profile of 0.025% and 0.05% tretinoin creams in managing AN. An 8-week, randomized double-blinded study was conducted in adults with AN. Participants were instructed to apply tretinoin cream on their posterior neck. Narrowband reflectance spectrophotometry was used to measure skin improvement through melanin (M) and erythema (E) indices at each follow-up visits at weeks 2, 4, and 8. Improvements in Acanthosis nigricans scoring chart (ANSC), investigator- and patient-global evaluation (IGE and PGE) and adverse cutaneous irritations were also scored. Both the 0.025% and 0.05% tretinoin creams were efficacious in acanthosis nigricans treatment with 17.1 ± 8.0% improvement and 18.4 ± 9.8% improvement after 8 weeks treatment by reflectance spectrophotometry measurement, respectively. There were generally no significant differences in efficacy, improvements in ANSC, IGE, and PGE scores, and local cutaneous irritations between the two groups. The 0.025% and 0.05% tretinoin demonstrate similar efficacy and safety profiles in the management of AN. Both concentrations are well tolerated with mild degree of local cutaneous irritation.

Association Between Staphylococcus Aureus Colonization and Pediatric Atopic Dermatitis: A Systematic Review and Meta-Analysis.

Background: Atopic dermatitis is a chronic inflammatory skin condition common in early childhood. Acute exacerbation is frequently associated with Staphylococcus aureus colonization. Aims and Objectives: This study aims to explore the relationship between S. aureus skin and nasal colonization with pediatric atopic dermatitis. Methods: A systematic review and meta-analysis were conducted by comparing atopic dermatitis patients aged ≤18 years and nondiseased controls. A random-effects model was used to obtain the pooled prevalence and odds ratio of S. aureus colonization at eczematous skin, nonlesional skin, and nasal cavity. Subgroup analyses for colonization with methicillin-resistant S. aureus were also evaluated. Results: A total of 2,670 cases and 1,224 controls from 26 studies were included in the meta-analysis. S. aureus colonization at eczematous skin and nasal cavity is significantly higher in atopic dermatitis compared to control with odds ratios of 10.55 (95% confidence interval [CI]; 4.85-22.92, P < .001) and 2.38 (nasal cavity; 95% CI; 1.46-3.90, P < .001), respectively. The pooled prevalence of skin and nasal colonization were 55.0% (eczematous skin; 95% CI; 38.3-71.7), 23.3% (nonlesional skin; 95% CI; 12.6-33.9), and 56.3% (95% CI; 43.2-69.4), respectively. Methicillin-resistant S. aureus strain was obtained from the nares and eczematous skin with rates of 11.6% (95% CI; 6.5-16.7) and 8.5% (95% CI; 4.3-12.8), respectively. Conclusion: Children with atopic dermatitis are more prone to skin and nasal colonization by S. aureus compared to nondiseased individuals.

The efficacy of infrared filter window film to prevent hyperthermia in neonatal hyperbilirubinemia with conventional phototherapy: a randomized control trial.

BACKGROUND: Phototherapy is the first-line treatment of neonatal hyperbilirubinemia. Possible side effects caused by phototherapy include hyperthermia and dehydration. Currently, there are many types of infrared blocking film for potential use in reducing infrared radiation exposure and preventing hyperthermia. This study aims to evaluate the efficacy of infrared blocking film in preventing hyperthermia during the first 24 h of phototherapy. METHODS: The randomized controlled trial study was carried out in 44 newborns with hyperbilirubinemia. Infrared filter film with 75% visible light transmission and 90% infrared rejection was used in the study. Body temperature was measured for the assessment of the efficacy of filter film from axillary and rectal routes. RESULTS: There was a significantly lower incidence of hyperthermia from the axillary temperature in the group with infrared blocking film compared to the control group (p = 0.031). The axillary temperature between before and after initiation of phototherapy in filter film group was significantly better (p = 0.008). According to efficacy of treatment, the study demonstrated that infrared filter film did not interfere with the efficacy of phototherapy in reducing bilirubin level. CONCLUSIONS: The infrared filter film was significantly more effective in preventing hyperthermia from phototherapy in the first 24 h without causing any significant difference in reduction of bilirubin level. THAI CLINICAL TRIALS REGISTRY: TCTR20190619001.

The efficacy and safety of 20% urea cream and 10% urea cream in the treatment of acanthosis nigricans in adolescents, a randomized comparative double-blind study.

BACKGROUND: Acanthosis nigricans is commonly associated with obesity. It is characterized by brown-black skin thickening on the neck and the flexural areas. This study aimed to assess the efficacy of topical 20% urea cream compared to 10% urea cream in the treatment of acanthosis nigricans in adolescents. MATERIAL AND METHODS: A randomized comparative, double-blind study was conducted on participants aged 12-18 years with acanthosis nigricans of the neck. Treatment efficacy was assessed via narrowband reflectance spectrophotometer, while the overall success rates at weeks 2, 4, and 8 were evaluated by the investigator- and participant-assessed global evaluation scales. RESULTS: A total of 40 participants with acanthosis nigricans were enrolled and completed the study. Throughout the period of 8 weeks of treatment, 20% urea showed greater improvement of hyperpigmentation compared to 10% urea (p = 0.001), with 22.5 ± 11.9% and 10.7 ± 8.1% improvements, respectively. Findings from the overall global evaluation scales were consistent with the results from the narrowband reflectance spectrophotometer. Treatment with 10% urea and 20% urea was well-tolerated without any local serious adverse reactions. CONCLUSION: Urea cream improves neck hyperpigmentation associated with acanthosis nigricans in adolescents, in which the 20% concentration shows superior efficacy to the 10% concentration.

Efficacy of moisturizers in paediatric atopic dermatitis: A systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Topical moisturizer is recommended for atopic dermatitis. AIMS: The aim of the study was to investigate the knowledge gap regarding the efficacy of moisturizer in young patients. METHODS: A systematic review and meta-analysis were conducted on randomised controlled trials comparing participant's ≤15 years with atopic dermatitis, receiving either topical moisturizer or no moisturizer treatment. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. RESULTS: Six trials were included (intervention n= 436; control n= 312). Moisturizer use extended time to flare by 13.52 days (95% confidence interval 0.05-26.99, I2 88%). Greater reduction in risk of relapse was observed during the first month of latency (pooled risk ratio 0.47, 95% confidence interval 0.31-0.72, I2 28%) compared to the second and third months (pooled risk ratio 0.65, 95% confidence interval 0.47-0.91, I2 35% and pooled risk ratio 0.63, 95% confidence interval 0.47-0.83, I2 33%, respectively).Treated patients were 2.68 times more likely to experience a three-six months remission (95% confidence interval1.18-6.09, I2 56%). Moisturizer minimally improved disease severity and quality of life. LIMITATIONS: There is a dire need to conduct randomised controlled trials with more robust and standardised designs. CONCLUSION: Moisturizer benefits young patients with atopic dermatitis. However, more research is needed to better estimate its efficacy.

The randomized trials of 10% urea cream and 0.025% tretinoin cream in the treatment of acanthosis nigricans.

BACKGROUND: Acanthosis nigricans is characterized as hyperpigmented skin and velvety surface on posterior and lateral folds of the neck and the intertriginous areas. This study aimed to assess the efficacy of topical 10% urea cream compared to 0.025% tretinoin cream in the treatment of acanthosis nigricans. MATERIAL AND METHODS: This was an 8-week trial, double-blind, randomized, comparative study of topical 10% urea and 0.025% tretinoin for the treatment of the neck hyperpigmentation. The Mexameter MX18 was used for assessing treatment efficacy. The global evaluation scale was also used to evaluate the overall success rate at weeks 2, 4, and 8 of the study. RESULTS: There was a statistically significant difference between 10% urea and 0.025% tretinoin in the treatment of acanthosis nigricans (p < 0.01). The efficacy of 10% urea and 0.025% tretinoin treatment shows 11.4 ± 5.7% and 20.1 ± 9.7% improvement, respectively. The treatment efficacy using the investigator's global evaluation found that 36.8% of participants treated with 10% urea and 63.2% of participants treated with 0.025% tretinoin had more than 75% skin improvement. CONCLUSION: Both medications significantly improved neck hyperpigmentation. However, the efficacy of 0.025% tretinoin was significantly better than 10% urea in the treatment of acanthosis nigricans. CLINICAL TRIALS REGISTRY: TCTR20180703003.

Comparison of the efficacy and safety of 0.1% adapalene gel and 0.025% tretinoin cream in the treatment of childhood acanthosis nigricans.

BACKGROUND: There have been few published randomized controlled trials for the treatment of childhood acanthosis nigricans (AN) to date. OBJECTIVE: To assess the efficacy of topical 0.1% adapalene gel compared to 0.025% tretinoin cream in the treatment of childhood AN. METHODS: An 8-week, randomized, split-neck, comparative study between topical 0.1% adapalene gel and 0.025% tretinoin cream for the treatment of neck hyperpigmentation associated with AN was performed. M index measured by a narrowband reflectance spectrophotometer and both investigator's global evaluation (IGE) and parent's global evaluation (PGE) scales were used to evaluate efficacy. RESULTS: There was no statistically significant difference between 0.1% adapalene gel and 0.025% tretinoin cream in the treatment of AN-associated hyperpigmentation (P = 0.56). Mean differences in M indices between week 0 and week 8 of 0.1% adapalene and 0.025% tretinoin treatment were 24.2 ± 7.9% and 23.8 ± 8.3% improvement, respectively. Regarding treatment efficacy, 90.0% and 85.0% of participants had more than 75% improvement in IGE in 0.1% adapalene and 0.025% tretinoin treatment sides, respectively. In addition, 75.0% and 65.0% of participants had more than 75.0% improvement in PGE in 0.1% adapalene and 0.025% tretinoin treatment sides, respectively. LIMITATIONS: Lack of histopathological evaluations. CONCLUSIONS: We found no significant difference between topical 0.1% adapalene gel and 0.025% tretinoin in the treatment of AN.

Cutis Marmorata Telangiectatica Congenita: Clinical Features in 7 Cases.

Cutis marmorata telangiectatica congenita (CMTC) is a sporadic congenital vascular anomaly usually presents at birth as a localized or generalized reticulated, erythema and telangiectasia. The pathogenesis of CMTC is unknown. Additional anomalies have been frequently reported in association with CMTC. This article describes the characteristics of the clinical presentations in a series of 7 children with CMTC in HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Thailand. Both genders were almost equally affected (3 male/4 female). The lower limbs were involved in 7 patients (100%), the trunk in 3 patients (42.9%), and the upper limbs in 1 patient (14.3%). There were 2 patients (28.6%) who presented with the involvement of both trunk and limbs. The mean of the body surface area involved was 17% (2-50). Asymmetry of affected limbs were found in 2 patients (28.6%). On follow-up, improvement of reticulated lesions was noted in all patients. The prognosis of uncomplicated cases is good. No specific treatment is needed. The skin lesions usually disappear gradually.

The efficacy of topical 0.1% adapalene gel for use in the treatment of childhood acanthosis nigricans: a pilot study.

AIMS: To assess the degree of improvement of neck hyperpigmentation in childhood acanthosis nigricans (AN) after treatment with topical 0.1% adapalene gel and the assessment of localized tissue tolerance to the gel. SUBJECTS AND METHODS: A split comparison study of the hyperpigmentation on the neck was conducted in patients diagnosed with childhood AN. Patients were treated with topical 0.1% adapalene gel for a period of 4 weeks. The skin color of their neck was evaluated at baseline, 2 weeks and 4 weeks using a skin color chart. Skin color ratio (the skin on their necks compared with the skin on their backs) was calculated for all subjects. The investigator's global evaluation (IGE) scale and the parent's global evaluation (PGE) scale were used to assess the efficacy of the patients' treatment at the end of the 4(th) week. RESULTS: The mean skin color ratio of therapeutic side was significantly decreased from the baseline scores, at weeks 2 and 4, respectively (30.1%, 18.3%, and 12.9%, P < 0.001), with marked skin improvement at 60.7% ± 28.5%. The percentage of changes of skin color ratio was consistent with the efficacy evaluations as performed by the IGE and PGE scales. Treatment-related cutaneous irritation was minimal, predominantly in the first 2 weeks of treatment and was shown to be well-tolerated at week 4 following a modification of the treatment regimen. CONCLUSIONS: The study has shown the efficacy of topical 0.1% adapalene gel in the treatment of AN, specifically, in regards to the skin darkening with minimal cutaneous irritation.

Self-Medication for Dermatologic Diseases among Children Treated at the HRH Princess Maha Chakri Sirindhorn Medical Center.

BACKGROUND: Skin diseases are one of the common problems in Pediatrics Outpatient Department. Because self-medication is practiced, it raises concerns of incorrect self-diagnosis, adverse drug reactions, and the cost of self-treatment. The aim of this study was to investigate the prevalence and the features of self-medicating for skin diseases among children who were observed at the dermatology clinic. MATERIAL AND METHOD: This prospective study was conducted in the Pediatric Outpatient Department. All patients seen on a first visit for skin problems were recruited, interviewed, and examined. RESULTS: Four hundred thirty seven patients were recruited in the study and the mean age was 4.6 years of age. Eczema was the most common diagnosis (43.7%), followed by fungal skin infections (7.1%), insect bites and infestations (6.9%), and bacterial skin infections (6.2%). Of all the patients, 204 (46.7%) had used self-medication. The most common reasons for self-medicating were convenience (82.3%), a friend and/or relative's recommendation (15.2%), and avoiding the cost of doctors' visits (2.0%). The most frequently encountered categories of medicines were topical corticosteroids (25.4%), antifungal agents (13.4%), antibacterial agents (8.2%), and others. Most products were obtained from pharmacies (66.2%). The average cost for self-medications was 204.7 Thai baht. Products applied by the topical route were the most common medications used (81.3%) and most patients had reported dissatisfaction with the results (95.1%). Adverse reactions resulting from self-medications were found to be at a rate of 17.1%. There were no significant relationships (p > 0.05) between the practice of self-medication and the potential factors. CONCLUSION: Self-medication use is most prevalent. Most patients had reported dissatisfaction from the use of self-medications. Adverse reactions resulting from self-medication were also found.

Correlation between skin color evaluation by skin color scale chart and narrowband reflectance spectrophotometer.

CONTEXT: Various methods are available for the evaluation of skin color. A skin color scale chart is a convenient and inexpensive tool. However, the correlation between a skin color scale chart and objective measurement has not been evaluated. AIMS: To assess the correlation between skin color evaluation done by a skin color scale chart (Felix von Luschan skin color chart) and a narrowband reflectance spectrophotometer (Mexameter MX18). MATERIALS AND METHODS: The participants were evaluated for skin color by using the Felix von Luschan skin color chart (range 1-36) and a narrowband reflectance spectrophotometer (Mexameter MX18) in which the results of the measurements were expressed as Erythema (E) and Melanin (M) indices. Skin color was measured on four different anatomical skin sites from each participant on the medial aspect of the volar and the dorsal regions of both forearms. RESULTS: A total of 208 records from 52 participants were established. The majority of participants (19.2%) were rated with the skin color scale at the number 16 (range 14-33). The mean M plus E, M, and E indices were 498.9 ± 143.9, 230.4 ± 74.4, and 268.5 ± 73.2, respectively. The correlation coefficient between the number on the skin color scale and each index: M plus E, M, and E indices were 0.90, 0.90, and 0.86, respectively, with a statistical significance of P < 0.001. CONCLUSIONS: Skin color evaluation using a skin color scale chart has shown a high correlation with skin color evaluation done by the narrowband reflectance spectrophotometer.

Nasal carriage and antimicrobial susceptibility of Staphylococcus aureus among medical students at the HRH Princess Maha Chakri Sirindhorn Medical Center, Thailand: a follow-up study.

OBJECTIVE: The objective of this study is to evaluate the patterns of nasal colonization of Staphylococcus aureus and its susceptibility patterns among medical students before and after their rotations in the hospital. METHODS: Nasal swabs were obtained from 128 medical students for microbiological study and susceptibility testing prior to working in the hospital (the first), following the first rotation (the second) and at the end of the rotation schedule in the hospital (the last). The probable risk factors for nasal carriage were recorded for assessment. RESULTS: S. aureus was isolated at the first, second and last swabs with colonization rates of 29.7%, 30.5% and 39.4%, respectively. The prevalence rate of colonization of S. aureus showed a statistically significant increase (P<0.05). There was a persistent colonization of S. aureus at the rate of 20.3%. No participants showed methicillin-resistant S. aureus. The susceptibility of S. aureus to erythromycin and clindamycin was 36.8%, 41% and 34% at the first, second and last swabs, respectively. There was no significant correlation between nasal carriage of S. aureus and its potential risk factors. CONCLUSIONS: After clinical rotation in the hospital, the prevalence rate of asymptomatic nasal carriage of S. aureus increased and the S. aureus isolated has shown a relatively high resistance to erythromycin and clindamycin.

Nasal carriage and antimicrobial susceptibility of Staphylococcus aureus among medical students at the HRH Princess Maha Chakri Sirindhorn Medical Center, Thailand: a cross sectional study.

OBJECTIVE: To determine the epidemiology of the nasal carriage of Staphylococcus aureus and its susceptibility pattern among preclinical medical students at the HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University. METHODS: Nasal swabs were taken from 128 preclinical medical students prior to working at the hospital. Susceptibility testing of S. aureus was performed using Kirby Bauer's disc diffusion method. RESULTS: Of the 128 participants, 38/128 (29.7%; 95% confidence interval [CI]=21.8%, 37.6%) were carriers of S. aureus. No methicillin-resistant S. aureus was detected by the cefoxitin disk diffusion test. Resistance of S. aureus to erythromycin, clindamycin, tetracycline, chloramphenicol and fusidic acid was observed at the following rates: 63.2% (95% CI; 47.8%, 78.5%), 63.2% (95% CI; 47.8%, 78.5%), 34.2% (95% CI; 19.1%, 49.3%), 2.6% (95% CI; -2.5%, 7.7%) and 2.6% (95% CI; -2.5%, 7.7%), respectively. There was no statistically significant correlation between nasal carriage of S. aureus and possible risk factors. CONCLUSIONS: The prevalence of asymptomatic nasal carriage of S. aureus was higher than reported by previous literature in Thailand, and S. aureus isolates exhibited relatively high resistance to erythromycin and clindamycin.

Early onset and rapid progression of glaucoma in a neonate with Sturge-Weber syndrome.

Sturge-Weber syndrome (SWS) is an uncommon neurocutaneous syndrome usually presenting with a triad of cutaneous, neurological, and ophthalmological symptoms. The cutaneous lesion can be observed at birth in most cases while the symptoms of the nervous and ocular systems involvement usually appear later in life. The most common ocular manifestation in SWS is glaucoma, which can occur in the early-life period. The authors reported a case of SWS in which the symptoms of glaucoma rapidly developed within two weeks following an ophthalmologic evaluation that was initially negative at the age of one week.

Acne-like presentation of recurrent varicella infection in a child with nephrotic syndrome.

Primary infection with varicella zoster virus was assumed to confer lifelong immunity. Nevertheless, cases of varicella reinfection had been reported regardless of immune status. Here the authors described a case of 11-year old girl with nephrotic syndrome, currently on 80 milligrams of prednisolone for one month. She presented with one day of fever, diarrhea and acne-like rash at her forehead, nose and few on the neck. She had a past history of chickenpox. Her vesicles were examined by pediatric dermatologist and Tzanck smear was performed. Multinucleated giant cells were detected and diagnosis of varicella was made. This report infers that positive varicella history alone might not be sufficient to confer immunity, especially in immunocompromised host. Atypical presentation of recurrent varicella in immunocompromised host can be presented.