A case of disseminated Lyme disease in a child with skin of color.

Disseminated Lyme disease requires treatment to prevent severe sequelae, particularly neurologic. We report here a case of disseminated Lyme disease in a patient with skin of color. Pediatric dermatologists must maintain a high clinical suspicion for Lyme disease and be aware of how typical cutaneous findings may appear differently in skin of color.

Pityriasis rosea after administration of Pfizer-BioNTech COVID-19 vaccine.

Pityriasis rosea (PR) is an acute papulosquamous cutaneous disorder that classically presents with a herald patch rapidly followed by a widespread rash along skin cleavage lines. Although the exact pathogenesis of PR is unknown, current evidence suggests that an inflammatory reaction due to a viral trigger may lead to the cutaneous manifestations. COVID-19 has been reported as one such viral trigger for PR. Previously, PR has been reported in temporal association with various viral inoculations. This article presents a case of PR in a 66-year-old black male 1 week after administration of the Pfizer-BioNTech COVID-19 vaccine.

Bowel-associated dermatosis-arthritis syndrome in a child with very early onset inflammatory bowel disease.

A 6-year-old boy with severe very early-onset inflammatory bowel disease (VEO-IBD) was admitted for 1 week of high fevers, loose stools, joint pains, and myalgias. He subsequently developed a progressive, papular, and vesiculopustular eruption on his face with rapid spread to his trunk and extremities. Histopathology demonstrated dense dermal neutrophilic inflammation. Findings were consistent with bowel-associated dermatosis-arthritis syndrome (BADAS), which is rarely reported in children and requires further characterization.

The role of hypothalamus-pituitary-adrenal (HPA)-like axis in inflammatory pilosebaceous disorders.

Skin is the largest peripheral endocrine organ and functions as a hormone target and endocrine gland. A cutaneous hypothalamus-pituitary-adrenal (HPA)-like axis enables the skin to respond to stress and regulates its steroidogenic activity. The pilosebaceous unit is a site for production and metabolism of a number of steroid hormones, including stress and sex hormones. This is an overview of the important role that the cutaneous HPA-like-axis plays in the pathogenesis and treatment of inflammatory pilosebaceous disorders, including acne, rosacea, seborrheic dermatitis, and hidradenitis suppurativa.

Quantification of ultraviolet (UV) radiation in the shade and in direct sunlight.

Ultraviolet (UV) radiation is associated with negative health effects, including sun damage and skin cancer. The purpose of this study is to compare the protective effects of the shade provided by a sun umbrella versus that provided by a tree. Sun sensors that register the level and dose of UV radiation were placed in the shade and in direct sunlight. Measurements were recorded every half hour between the hours of 12:30 p.m. and 3:00 p.m. in Sacramento, California. The results suggest that the level of UV radiation in the shade is not zero. The sensors located in tree shade indicated that over 5% of UV radiation was detected in the shade. The sensors located in sun-umbrella shade showed that greater than 17% of UV radiation reached the shade. The sun sensors used in our study collected UV radiation data relevant to UV index; however, they did not differentiate between UVA, UVB, visible, and infrared light. The amount of UV radiation detected in the shade is not zero, thus regular sunscreen use and other sun protective practices should be followed to reduce the risk of sun damage and skin cancer.

Use of 5-0 Fast Absorbing Gut versus 6-0 Fast Absorbing Gut during cutaneous wound closure on the head and neck: A randomized evaluator-blinded split-wound comparative effectiveness trial.

BACKGROUND: Absorbable suture material (Fast Absorbing Gut [FG], Ethicon, Somerville NJ) is often used for patient convenience; however, the optimal diameter of FG sutures is debatable. OBJECTIVE: To determine whether the use of 6-0 FG during repair of linear cutaneous surgery wounds on the head and neck improves scar cosmesis compared with the use of 5-0 FG. METHODS: This was a prospective, randomized, split-scar intervention in patients undergoing repair of linear cutaneous wounds on the head and neck. The scar was assessed 3 months after surgery via the Physician Observer Scar Assessment Scale (POSAS), a validated instrument. RESULTS: The difference in the sum of the POSAS component scores for 6-0 FG (12.03) compared with that for 5-0 FG (13.11) was not statistically significant (P = .26). Observer overall opinion was similar for both interventions, at 2.49 for 6-0 FG vs 2.64 for 5-0 FG (P = .54). The difference in the number of complications in the 5-0 FG group (15) vs the 6-0 FG group (10) was not statistically significant (P = .40). LIMITATIONS: Single-center study with wounds limited to the head and neck in white individuals, with a predominance of men. CONCLUSION: For linear repair of cutaneous wounds, 6-0 FG was not statistically different for cosmetic outcomes, scar width, and complications compared with 5-0 FG.

Dietary supplementation with turmeric polyherbal formulation decreases facial redness: a randomized double-blind controlled pilot study.

BACKGROUND: Facial redness is multifactorial in nature and may be a sign of many different conditions, including rosacea, photo damage and flushing. Herbal medicines have been used for thousands of years to treat a variety of dermatological conditions. Turmeric (Curcuma longa) and its constituents have been shown to mediate dilation and constriction of peripheral arterioles and have demonstrated anti-oxidant, anti-inflammatory and wound-healing properties. OBJECTIVE: To investigate the effects of turmeric and turmeric-containing polyherbal combination tablets versus placebo on facial redness. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: This was a prospective, double-blind, randomized pilot study. Thirty-three healthy participants were recruited from the dermatology clinic at the University of California, Davis and nearby community from 2016 to 2017. Thirty participants were enrolled, and 28 participants completed the study. The enrolled participants were randomized to receive one of three interventions (placebo, turmeric or polyherbal combination tablets) and were told to take the intervention tablets by mouth twice daily for 4 weeks. Facial redness was assessed at baseline and 4 weeks after intervention by clinical grading and by image-based analysis. MAIN OUTCOME MEASURES: The primary outcome measure was image-based facial quantification of redness using a research camera and software analysis system. The investigators performed an intention-to-treat analysis by including all subjects who were enrolled in the trial and received any study intervention. Differences were considered statistically significant after accounting for multiple comparisons. Effect sizes for clinical grading were calculated with a Hedges' g where indicated. RESULTS: Twenty-eight participants completed the study and there were no reported adverse events. Based on clinical grading, facial redness intensity and distribution down trended in the polyherbal combination group after 4 weeks (P = 0.1). Under photographic image analysis, the polyherbal combination group had a significant decrease in redness of 40% compared to baseline (P = 0.03). The placebo and turmeric groups had no statistically significant changes in image analysis-based facial redness. CONCLUSION: Polyherbal combination tablet supplementation improved facial redness compared to the turmeric or placebo. Overall, our findings suggested further investigations into the effects of turmeric and polyherbal formulations in skin conditions associated with facial redness would be warranted. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03065504.

Randomized Controlled Pilot Study of Dietary Supplementation with Turmeric or Herbal Combination Tablets on Skin Barrier Function in Healthy Subjects.

To compare the effects of turmeric tablets and turmeric-containing herbal combination tablets versus placebo on skin barrier function and sebum production by measuring facial sebum and transepidermal water loss (TEWL) in healthy subjects. This study was a prospective, double-blinded, rater-blinded, randomized pilot study. Thirty-three generally healthy participants were recruited from the UC Davis Department of Dermatology clinic and the surrounding community from 2016 to 2017, 30 participants were enrolled, and 28 participants completed the study. Thirty individuals were recruited and randomized to the placebo, turmeric, or herbal combination tablet groups. The participants were instructed to take the intervention tablets by mouth twice daily for 4 weeks. Facial sebum production and TEWL were assessed at baseline and 4 weeks. Twenty-eight participants completed the study and there were no adverse events. There were no significant changes in sebum excretion rate in any group after 4 weeks compared with baseline. In the herbal combination tablet group, there was a significant decrease in TEWL (P = .003). No significant changes in TEWL were detected in the turmeric or placebo groups. Turmeric-containing herbal combination tablets significantly decreased TEWL after 4 weeks of twice-daily supplementation. There were no adverse events in any of the three intervention arms. Overall, our findings spark future interest in determining how oral supplementation with herbal formulations may improve skin barrier function and skin appearance, and potentially offer alternative or complementary treatment options.

Systematic review of mobile phone-based teledermatology.

Teledermatology is an expanding field within dermatology that has grown and become more clinically accepted by both patients and doctors. With approximately 260 million mobile phone users in the US and 4-6 billion worldwide with access to mobile phones, teledermatology serves as a potentially useful tool for diagnosis and management (Samkange-Zeeb and Blettner in Emerg Health Threats J, https://doi.org/10.3134/ehtj.09.005 , 2009). In this review, we provide a detailed overview of mobile phone technology and the accumulating evidence for its incorporation into dermatology. Key questions addressed include accuracy and concordance between mobile teledermatology and face-to-face dermatology for the diagnosis of skin conditions. Similarly, accuracy and concordance were compared for the management of skin conditions. To track the development of mobile phone technology, we also assessed how data were captured, stored, and displayed in teledermatology studies.

Progestins and acne vulgaris: a review.

The role of exogenous progestin in the development of acne is unclear. Progestins are known for their androgenic potential, but newer generations of progestins have low or anti-androgenic activity. This review will evaluate the association between progestins found in hormonal long-acting reversible contraceptives (intrauterine devices and subdermal implants) and acne, as well as the role of oral contraceptives in acne management. Our review demonstrates that the cause and effect relationship between progestins and acne is difficult to establish and future studies that seek to understand how progestins modulate acne are necessary.

Acne Scars: How Do We Grade Them?

Acne vulgaris is a chronic inflammatory skin disease that can lead to permanent scarring. Although grading scales exist for acne scarring, there are many limitations, and there is still a need for a well validated gold standard scale for use in clinical practice or research trials. An objective measure of scar severity should be a component of global acne severity evaluations. This manuscript reviews currently available acne scar grading modalities: lesion counting; subjective self-assessment; Acne Scar Rating Scale (ASRS); evaluator-based qualitative and quantitative scarring grading systems; Echelle d'Evaluation Clinique des Cicatrices d'acne (ECCA); Global Scale for Acne Scar Severity (SCAR-S); and imaging. Despite the varying tools, most of the currently available scales do not account for scar color, depth, or change over time. A new, validated scale is needed that would allow for a more objective and accurate assessment of scar progression over time to assist with effective treatment and research.

New and emerging targeted systemic therapies: a new era for atopic dermatitis.

PURPOSE: This is a review of emerging targeted, systemic therapies for atopic dermatitis (AD). The information presented aims to provide dermatologists with updated therapeutic options, stimulate academic interest, and spark future research. MATERIAL AND METHODS: Extensive search of ClinicalTrials.gov, the National Eczema Association, and PubMed was performed for clinical trials examining the effect of emerging targeted, systemic therapies in patients with AD. Results were included if they demonstrated efficacy in reversing AD symptoms. Studies that did not demonstrate clinical benefit were excluded. RESULTS: A number of emerging systemic agents targeting specific mediators involved in the pathogenesis of AD were found. These targets include IL-4, IL-13, IgE, B-cells, IL-5, IL-31, JAK-STAT, SYK, IL-6, PDE-4, IL-12, IL-17, IL-23, IL-22, H4R, NKR1, κOR, TSLP, PPAR-γ, and DGLA. Treatment of AD patients with these therapies has, in many cases, led to statistically significant improvements in clinical severity scores and patient-reported outcomes. CONCLUSIONS: While multiple agents have demonstrated efficacy, only dupilumab is currently approved for adults with AD. Large-scale, randomized, placebo-controlled, double-blind trials, especially in children, are needed. As we enter the dawn of targeted therapy for AD, a comprehensive clinical trial registry is needed to facilitate data pooling and comparison among international registries.

Circadian rhythm in atopic dermatitis-Pathophysiology and implications for chronotherapy.

Circadian rhythm is a biological clock that controls a wide range of physiological functions throughout the body, including various skin functions. A 24-h diurnal cycle, governed by an endogenous clock in the brain, largely controls cutaneous diurnal rhythm, which external factors, including temperature, humidity, diet, and stress, also modulate locally. Circadian rhythm influences cutaneous blood flow and properties of skin barrier function, such as transepidermal water loss and capacitance, and has important implications in atopic dermatitis (AD). This review explores how aberrations in circadian rhythm may play a role in the pathogenesis of AD and proposes implementation of chronotherapy to improve treatment outcomes in patients with AD.

Sweat mechanisms and dysfunctions in atopic dermatitis.

Skin barrier dysfunction is inherent to atopic dermatitis (AD), causing dryness, irritation, and increased permeability to irritants, allergens and pathogens. Eccrine sweat functions as part of the skin's protective barrier. Variations in sweat responses have been observed in patients with AD, and altered sweat composition and dynamics are under-recognized as important factors in the disease cycle. This review discusses the role that sweat plays in the pathogenesis of AD, examines evidence on abnormal sweat composition, secretion, and neuro-immune responses to sweat in atopic skin, and highlights the value of sweat management.