Chemical and physical treatments damage Caucasian and Afro-ethnic hair fibre: analytical and image assays.

BACKGROUND: Sensory and structural characteristics of hair can be modified by chemical and physical treatments, as dyeing, brushing, but also by external factors, as sunlight radiation. However, quantitative data relating damage to the degree of hair curliness and treatments are missing. OBJECTIVE: To evaluate the effect of chemical and physical treatments on different types of hair. METHODS: In this study, we compared the effects of bleaching/dyeing, thioglycolate-based straightening, brushing/flat iron and UVA/Vis radiation on different types of hair: Caucasian (straight dark brown, straight blond, wavy dark brown and curly dark brown) and Afro-ethnic hair. RESULTS: Bleaching/dyeing and UVA/Vis radiation increased combing work of Afro-ethnic hair tresses, indicating damage to the cuticle scales, which was confirmed by SEM images. Further, bleaching/dyeing caused wear on cuticles with high protein loss and reduction on the tryptophan content, independently of the hair curliness, which characterizes those procedures as very aggressive to hair structure. Straightening using ammonium thioglycolate, due to the oxidative treatment evolved, caused significant colour fading in brown/black tresses, while UVA/Vis radiation affected the colour of only blond hair tresses since they are poor in eumelanin, the photoprotective and photostable melanin molecule. CONCLUSION: The combination of analytical and image techniques contributed to understanding how the hair shape is related to the type of damage caused by several chemical and physical treatments. These findings contribute to the development of safety cosmetics that insure the beauty of curly hair, both Caucasian and Afro-ethnic hair.

A randomized split-scalp study comparing calcipotriol-assisted methyl aminolaevulinate photodynamic therapy (MAL-PDT) with conventional MAL-PDT for the treatment of actinic keratosis.

BACKGROUND: Topical photodynamic therapy (PDT) is an approved treatment for actinic keratosis (AK). To enhance the efficacy of PDT for AKs, physical and chemical pretreatments have been suggested. OBJECTIVES: To compare the efficacy and safety of the combination of topical calcipotriol (CAL) before methyl aminolaevulinate (MAL)-PDT for AKs of the scalp vs. conventional MAL-PDT in a randomized controlled clinical trial. METHODS: Twenty patients with multiple AKs on the scalp were randomized to receive conventional MAL-PDT with previous curettage on one side of the scalp and CAL-assisted MAL-PDT once a day for 15 days before illumination on the other side. After 3 months, patients were evaluated for clearance of AKs, side-effects and histopathology before and after the procedure. Protoporphyrin IX (PpIX) fluorescence was measured before and after illumination on both sides. RESULTS: All 20 patients completed the study. Overall AK clearance rates were 92·1% and 82·0% for CAL-PDT and conventional PDT, respectively (P < 0·001). Grade 1 AKs showed similar response rates for both sides (P = 0·055). However, grade II AKs showed more improvement on the CAL-PDT side (90%) than on the MAL-PDT side (63%) (P < 0·001). Before illumination, PpIX fluorescence intensity was higher on the CAL-assisted side (P = 0·048). The treatment was more painful on the CAL-PDT side, although well tolerated. The mean visual analogue scale score was 5·4 ± 1·4 on the CAL-PDT side and 4·0 ± 0·69 on the conventional MAL-PDT side (P = 0·001). Side-effects such as erythema (P = 0·019), oedema (P = 0·002) and crusts (P < 0·001) were more pronounced on the CAL-assisted side. Histopathological analyses were obtained from five patients and both sides showed improved keratinocyte atypia following PDT, with slightly more improvement on the CAL-assisted side. CONCLUSIONS: CAL-assisted PDT proved to be safe and more effective than conventional MAL-PDT for the treatment of AKs on the scalp. CAL pretreatment increased PpIX accumulation within the skin and may have enhanced the efficacy in this first human trial.

International Working Group consensus response evaluation criteria in lymphoma (RECIL 2017).

In recent years, the number of approved and investigational agents that can be safely administered for the treatment of lymphoma patients for a prolonged period of time has substantially increased. Many of these novel agents are evaluated in early-phase clinical trials in patients with a wide range of malignancies, including solid tumors and lymphoma. Furthermore, with the advances in genome sequencing, new "basket" clinical trial designs have emerged that select patients based on the presence of specific genetic alterations across different types of solid tumors and lymphoma. The standard response criteria currently in use for lymphoma are the Lugano Criteria which are based on [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography or bidimensional tumor measurements on computerized tomography scans. These differ from the RECIST criteria used in solid tumors, which use unidimensional measurements. The RECIL group hypothesized that single-dimension measurement could be used to assess response to therapy in lymphoma patients, producing results similar to the standard criteria. We tested this hypothesis by analyzing 47 828 imaging measurements from 2983 individual adult and pediatric lymphoma patients enrolled on 10 multicenter clinical trials and developed new lymphoma response criteria (RECIL 2017). We demonstrate that assessment of tumor burden in lymphoma clinical trials can use the sum of longest diameters of a maximum of three target lesions. Furthermore, we introduced a new provisional category of a minor response. We also clarified response assessment in patients receiving novel immune therapy and targeted agents that generate unique imaging situations.

Evaluation of efficacy and effectiveness of live attenuated zoster vaccine.

Herpes zoster (HZ) is a viral disease characterized by a dermatologic and neurologic involvement caused by the reactivation of the latent varicella zoster virus (VZV) acquired during primary infection (varicella). HZ incidence increases with age and is related to waning specific cell-mediated immunity (CMI). The most frequent complication of HZ is post-herpetic neuralgia (PHN) characterized by chronic pain lasting at least 30 days, with impact on patients' quality of life. Available treatments are quite unsatisfactory in reducing pain and length of the disease. The evaluation of the epidemiology, the debilitating complications (PHN), the suboptimal available treatments and the costs related to the diagnosis and clinical/therapeutic management of HZ patients have been the rationale for the search of an adequate preventive measure against this disease. The target of this intervention is to reduce the frequency and severity of HZ and related complications by stimulating CMI. Prevention has recently become possible with the live attenuated vaccine Oka/Merck, with an antigen content at least 10-fold higher than the antigen content of pediatric varicella vaccines. Clinical studies show a good level of efficacy and effectiveness, particularly against the burden of illness and PHN in all age classes. Accordingly to the summary of the characteristics of the product the zoster vaccine is indicated for the prevention of HZ and PHN in individuals 50 years of age or older and is effective and safe in subjects with a positive history of HZ.

Clinical and immunological profile of umbilical involvement in pemphigus vulgaris and pemphigus foliaceus.

BACKGROUND: Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are autoimmune vesicobullous disorders with IgG autoantibodies directed against desmoglein (Dsg)1 and 3, which lead to intraepidermal acantholysis. AIM: To characterize the clinical and immunological profile of patients with PF or PV with umbilical involvement. METHODS: In total, 10 patients (7 women, 3 men; age range 24-70 years, disease duration 3-16 years) diagnosed with either PV (n = 5) or mucocutaneous PF (n = 5) were assessed according to their clinical features, histopathology and immunological findings [direct and indirect immunofluorescence (DIF and IIF) and ELISA with recombinant Dsg1 and Dsg3]. RESULTS: Erythema, erosions, crusts and vegetating skin lesions were the main clinical features of the umbilical region. DIF of the umbilical region gave positive results for intercellular epidermal IgG and C3 deposits in eight patients and for IgG alone in the other two. Indirect immunofluorescence with IgG conjugate showing the typical pemphigus pattern was positive in all 10 patients, with titres varying from 1 : 160 to 1 : 2560. ELISA with recombinant Dsg1 gave scores of 24-266 in PF and 0-270 in PV. Reactivity to recombinant Dsg3 was positive in all five patients with PV (ELISA 22-98) and was negative in all PF sera. CONCLUSIONS: All 10 patients with pemphigus with umbilical presentation had the clinical and immunopathological features of either PF or PV. This peculiar presentation, not yet completely elucidated, has rarely been reported in the literature. A possible explanation for this unique presentation may be the presence of either novel epitopes or an association with embryonic or scar tissue located in the umbilical-cord region.

Clinical, histopathological and immunohistochemical assessment of human skin field cancerization before and after photodynamic therapy.

BACKGROUND: The field cancerization concept in photodamaged patients suggests that the entire sun-exposed surface of the skin has an increased risk for the development of (pre)-malignant lesions, mainly epithelial tumours. Topical photodynamic therapy (PDT) is a noninvasive therapeutic method for multiple actinic keratosis (AK) with excellent outcome. OBJECTIVES: To evaluate the clinical, histological and immunohistochemical changes in human skin with field cancerization after multiple sessions of PDT with methyl-aminolaevulinate (MAL). METHODS: Twenty-six patients with photodamaged skin and multiple AK on the face received three consecutive sessions of MAL-PDT with red light (37 J cm(-2)), 1 month apart. Biopsies before and 3 months after the last treatment session were taken from normal-appearing skin on the field-cancerized area. Immunohistochemical stainings were performed for TP-53, procollagen-I, metalloproteinase-1 (MMP-1) and tenascin-C (Tn-C). RESULTS: All 26 patients completed the study. The global score for photodamage improved considerably in all patients (P < 0·001). The AK clearance rate was 89·5% at the end of the study. Two treatment sessions were as effective as three MAL-PDT sessions. A significant decrease in atypia grade and extent of keratinocyte atypia was observed histologically (P < 0·001). Also, a significant increase in collagen deposition (P = 0·001) and improvement of solar elastosis (P = 0·002) were noticed after PDT. However, immunohistochemistry showed only a trend for decreased TP-53 expression (not significant), increased procollagen-I and MMP-1 expressions (not significant) and an increased expression of Tn-C (P = 0·024). CONCLUSIONS: Clinical and histological improvement in field cancerization after multiple sessions of MAL-PDT is proven. The decrease in severity and extent of keratinocyte atypia associated with a decreased expression of TP-53 suggest a reduced carcinogenic potential of the sun-damaged area. The significant increase of new collagen deposition and the reduction of solar elastosis explain the clinical improvement of photodamaged skin.

Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature.

Leprosy still is an important public health problem in several parts of the world including Brazil. Unlike the diseases caused by other mycobacteria, the incidence and clinical presentation of leprosy seems little affected in immunosuppressed patients. We report the first case, to our knowledge, of a liver transplant patient who developed multi-bacillary leprosy. The patient presented with papules and infiltrated plaques with loss of sensation suggestive of leprosy 3.5 years after living-related liver transplantation for autoimmune hepatitis. A skin biopsy showing non-caseating macrophagic granulomas, neuritis, and intact acid-fast bacilli on Fite-Faraco stain, confirmed the diagnosis of borderline lepromatous leprosy. The donor of the liver did not show any evidence of leprosy. During follow-up, the patient presented 2 episodes of upgrading leprosy type I reactions, 1 mild before leprosy treatment, and 1 moderate 3 months after receiving standard multi-drug treatment (rifampicin, clofazimine, and dapsone). These reactions were accompanied by increase in liver function tests, especially of canalicular enzymes. This reaction occurred despite the patient's triple immunosuppression regimen. The moderate reaction was successfully treated with further immunosuppression (prednisone, 0.5 mg/kg). Currently, the patient is asymptomatic, off leprosy medication, with routine liver transplant follow-up. The dilemmas in diagnosis and management of such a case are discussed and the literature on leprosy in transplant recipients is reviewed.

Evaluation of levels of cortisol in saliva using electro-chemical luminescence in low-risk and high-risk pregnancies / Avaliação do cortisol salivar por electroquimioluminecência em gestantes de baixo e de alto risco

OBJECTIVES: to compare the levels of cortisol (cortisolemia refers to the level of cortisol in blood) in women with a high-risk pregnancy compared with those with a low-risk pregnancy, by way of evaluation of levels of cortisol in saliva, using the electrochemical luminescence technique (ECL). METHODS: 38 women aged between 17 and 40 years in the third trimester of pregnancy were divided in two groups: 20 low-risk pregnancies and 18 high-risk ones. Cortisol in saliva was collected at midnight and measured using ECL. The mean levels of cortisol in saliva in the two groups were compared using the Kruskal-Wallis test. RESULTS: the mean systolic and diastolic pressure was normal in both groups. The levels of cortisol in the saliva of women with high-risk pregnancies was significantly higher than those for the low-risk pregnancy group (20.2 (±21,1) nmol/L vs 11.4(±16.2) nmol/L; p=0.007). CONCLUSIONS: a high risk pregnancy involves higher levels of cortisol than a low-risk one. The levels of cortisol in saliva, as measured using ECL, can be used to identify hypercortisolism in pregnancy.

OBJETIVOS: comparar os níveis de cortisol em mulheres com gravidez de alto risco em relação às gestantes de baixo risco, por meio da avaliação do cortisol salivar utilizando a técnica da electroquimioluminescência (EQL). MÉTODOS: foram estudadas 38 mulheres de 17a 40 anos de idade, no terceiro trimestre de gestação, divididas em dois grupos: 20 gestantes de baixo risco e 18 gestantes de alto risco. O cortisol salivar foi coletado à meia-noite e medido através da EQL. As médias do cortisol salivar foram comparadas entre os dois grupos de gestantes através do teste de Kruskal-Wallis. RESULTADOS: a média das pressões sistólica e diastólica foi normal nos dois grupos. O cortisol salivar das gestantes de alto risco foi significativamente mais elevado do que das gestantes baixo risco: (20,2 (±21,1) nmol/L vs 11,4(±16,2) nmol/L; p=0,007). CONCLUSÕES: a gestação de alto risco cursa com níveis mais elevados de cortisol quando comparada à gestação de baixo risco. O cortisol salivar, medido pelo EQL mostrou-se promissor para identificar o hipercortisolismo na gestação.

Chloroquine -induced hair depigmentation.

A case of hair depigmentation induced by chloroquine diphosphate subacute overdosage in an 11-year-old patient with dermatomyositis is presented. Normal coloured hair growth occurred after normalisation of chloroquine dosage. A discussion on possible pathomechanisms of this phenomenon is made based on experimental data and previously reported patients with the same condition.