A focused review on laser- and energy-assisted drug delivery for nail disorders.

The purpose of this review is to consolidate and summarize laser-assisted drug delivery (LADD) for nail diseases, particularly onychomycosis and psoriasis. A PubMed search was conducted in June 2023 using search terms (1) "laser assisted drug delivery" AND "nail," (2) "laser" AND "nail," and (3) "nail disorder" AND "laser treatment." References of papers were also reviewed, yielding 15 papers for this review. Fractional ablative CO2 laser (FACL) and Er:YAG laser can be used for LADD of topical medications such as amorolfine, terbinafine, and tioconazole to treat onychomycosis. A fungal culture should be performed to determine the type of dermatophyte, which will help determine which topical will be most effective. Laser settings varied between studies, but overall LADD tended to be more effective than topical treatments alone. Laser-assisted photodynamic therapy (PDT) was also found to be effective in treating onychomycosis. For psoriatic nails, LADD was used to deliver calcipotriol-betamethasone dipropionate foam, tazarotene, triamcinolone, or methotrexate into the nail. Again, LADD was found to be significantly more effective than topical treatment alone. FACL was the only laser noted for use for LADD in both diseases. Laser-assisted drug delivery for nail disease is a newer approach for onychomycosis and nail psoriasis with several benefits and drawbacks. Dermatologists should discuss the option of LADD with their patients who have recalcitrant onychomycosis or nail psoriasis.

Microplastics in dermatology: Potential effects on skin homeostasis.

BACKGROUND: Microplastics (MPs) and nanoplastics (NPs) have become a growing concern in dermatology due to their widespread presence in cosmetic formulations and the environment. These minuscule synthetic polymer particles prompt an essential exploration of their potential impact on dermatological homeostasis. AIMS: This study aims to investigate the effects of MPs and NPs on the integumentary system. Specifically, it seeks to understand the potential cutaneous alterations, inflammatory responses, and disruptions to the skin's physiological functions caused by these synthetic particles. PATIENTS/METHODS: The investigation involves a comprehensive analysis of emerging research on MPs and NPs. This includes their presence in cosmetic formulations and environmental pervasiveness. The study delves into their capacity to breach the cutaneous barrier, raising concerns about the implications of prolonged exposure. RESULTS: Evidence suggests that MPs and NPs may indeed incite cutaneous alterations, provoke inflammatory responses, and disturb the homeostasis of the skin's physiological functions. Their small dimensions enhance their capability to breach the cutaneous barrier, further emphasizing the apprehensions associated with prolonged exposure. CONCLUSIONS: While a precise understanding of the implications of MPs and NPs on dermatological health remains an ongoing scientific endeavor, this study underscores the growing significance of these synthetic particles. The findings emphasize the need for proactive measures to safeguard both individual well-being and environmental preservation in the context of dermatological health.

Skin reactions to tyrosine kinase inhibitors in pediatric patients with chronic myeloid leukemia.

Cutaneous adverse events are commonly reported in adult patients with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitors (TKIs); however, little is known about the cutaneous reactions in children receiving TKIs for CML. As pediatric patients may require lifelong TKI therapy, it is essential to understand the wide range of potential cutaneous toxicities. We examined all case studies, cohort studies, and clinical trials in PubMed/MEDLINE and Embase that reported cutaneous reactions to first-, second-, and third-generation TKIs in children 18 years or younger with CML. This review article focuses on the TKI drug types and doses, patient demographic characteristics, features of skin reactions, and clinical outcomes.

Tranexamic acid in melasma: A focused review on drug administration routes.

BACKGROUND: Melasma is a disorder of hyperpigmentation and vascularization often found in women between the ages of 20 and 40. The pathogenesis is unknown, but melasma often occurs in sun-exposed areas of the face, forearms, and back. Risk factors include family history, increased estrogen/progesterone, certain medications, and UV exposure. Melasma is typically treated with topical hydroquinone (HQ); however, it is often refractory to treatment. Tranexamic acid (TXA) is a plasmin inhibitor used off-label in the treatment of melasma. TXA can be administered orally, topically, or intralesionally. AIMS: The purpose of this review is to characterize the wide variety of TXA delivery methods for melasma treatment and the efficacy of these methods compared with traditional treatments. PATIENTS/METHODS: A comprehensive PubMed and Embase search was conducted in May 2022 using the phrases tranexamic acid and melasma. Forty-six articles were included in this review. RESULTS: Oral, intralesional, and topical TXA is safe and effective treatments for melasma. They have been studied in a variety of randomized controlled trials and have been compared with several traditional treatments. Overall, MASI scores in patients using TXA in any form improved. CONCLUSIONS: Oral TXA was found to be the most effective, especially in cases of refractory melasma; however, it caused GI upset and menstrual irregularities in many patients. The pro-thrombotic nature of this drug must be considered before safely prescribing to patients. Intralesional injections and microneedling with topical TXA were found to be effective alternatives to oral treatment. Lastly, topical TXA alone was found to be the least effective method but can be combined with other cosmeceuticals to improve outcomes. Topical TXA was also found to be better tolerated than hydroquinone, a traditional topical melasma treatment.

Erosive Pustular Dermatosis of the Leg Successfully Treated With an Oral Retinoid and a Bi-layered Skin Substitute

Erosive pustular dermatosis is a rare inflammatory skin disorder characterized by crusted erosions, sterile pustules, skin atrophy, and scarring alopecia. Cases of involvement of lower extremities, with or without scalp lesions, have been scarcely reported in the literature, and have been denominated Erosive Pustular Dermatosis of the Legs. The disorder usually affects elderly patients associated with chronic venous insufficiency and venous dermatitis. Topical corticosteroids and topical calcineurin inhibitors have been reported to be effective. On the other hand, several treatments have also failed to achieve appropriate results; hence we present a case of erosive pustular dermatosis of the leg, who was unresponsive to compression and antibacterial ointments, but successfully treated systemically with an oral retinoid and locally with the application of a bioengineered bi-layered skin substitute. This condition may be overlooked, which represents its low prevalence in literature. J Drugs Dermatol. 2019;18(3):301-302.

Comparison of 3-dimensional Wound Measurement With Laser-assisted and Hand Measurements: A Retrospective Chart Review.

Wound area measurements provide an objective assessment of wound healing; however, most commonly used measurement techniques are imprecise. PURPOSE: A new portable 3-dimensional (3D) wound measurement device was tested against laser- and hand-measurement methods. METHODS: A retrospective comparative analysis was conducted to analyze the difference in wound measurements using records of patients seen at the University of Miami Hospital (Miami, FL) outpatient wound healing clinic between November 2017 and February 2018 who had wounds of various etiologies measured using 3 different techniques during a single visit: the 3D device, a laser-assisted wound measurement device (laser), and standard hand measurements. Patients with circumferential wounds were excluded (the laser and 3D devices are incapable of assessing these wounds). Differences were compared using paired t tests. RESULTS: The wounds ranged in area from 0.8 cm² (hand measurements) and 0.2 cm² (3D and laser devices) to 100.94 cm², 61.9 cm², and 65 cm² by hand measurement, 3D, and laser device, respectively. Among the 23 wounds measured, the majority (16) were venous ulcers. No statistically significant difference was noted between the 3D measurements compared with the laser (P = .340). Statistically significant differences in the measurements between the 3D device and hand measurements (P = .008) and the laser device and hand measurements (P = .006) were found. CONCLUSION: Measurements of the 3D device appear analogous to laser devices, making it an alternative tool for clinicians interested in monitoring wound progression. Because the 3D device has the capacity to examine wound volume, prospective comparative trials should be used to examine the accuracy and precision of the device to measure volume.

Treatments to prevent primary venous ulceration after deep venous thrombosis.

OBJECTIVE: This systematic review and meta-analysis aimed to assess whether compression stockings or other interventions reduce the incidence of venous ulceration after acute deep venous thrombosis. METHODS: We searched PubMed and Embase for randomized controlled trials (RCTs), restricted to English, Spanish, and Hebrew, related to post-thrombotic syndrome and venous ulceration in participants with confirmed deep venous thrombosis. Our primary statistical assessment was the Peto odds ratio (OR). RESULTS: Our search generated 23 RCTs meeting inclusion and exclusion criteria, summing 6162 patients and 146 ulcerative events. Trials were categorized into compression, low-molecular-weight heparin (LMWH), procedural thrombolysis, medical thrombolysis, or miscellaneous. Six compression trials were identified, of which five were included in meta-analysis. Compression compared with placebo did not reduce venous ulceration (OR, 0.915; 95% confidence interval [CI], 0.475-1.765), and long-term compression was not superior to short-term compression (OR, 1.36; 95% CI, 0.014-1.31). Four LMWH trials were identified but were not subjected to meta-analysis because of intertrial heterogeneity. One trial, comparing extended tinzaparin with warfarin, demonstrated eight ulcers in the warfarin group and one ulcer in the LMWH group (relative risk, 0.125; P < .05). Three procedural thrombolysis trials were pooled into meta-analysis; fewer ulcerative events occurred in procedural thrombolysis patients, but the effect was not significant (OR, 0.677; 95% CI, 0.338-1.358). Eight medical thrombolysis trials were identified. Pooled analysis of five trials demonstrated a protective effect on ulceration in streptokinase patients vs standard heparinization (OR, 0.125; 95% CI, 0.021-0.739). However, these trials were of poor-quality study design, had small sample size, and had poor overall outcomes. Miscellaneous studies included a trial of hidrosmina, a vasoactive flavonoid, and a trial comparing 6-month warfarin treatment with 6 weeks; neither trial had significant outcomes. Intertrial heterogeneity was not adequately assessed with the I2 value as venous ulceration is a rare event; the Grading of Recommendations Assessment, Development, and Evaluation evidence for most trials was very low, with the exception of procedural thrombolysis trials, for which it was low. CONCLUSIONS: We found insufficient evidence to assess whether compression or other interventions protect against venous ulceration. To develop guidelines for treatment decisions related to prevention of venous ulceration, high-powered RCTs investigating venous leg ulcers as a primary outcome are required.

Evaluation of Donor Site Pain After Fractional Autologous Full-Thickness Skin Grafting.

Background: Despite the development of numerous wound treatment alternatives, 25% to 50% of leg ulcers and >30% of foot ulcers are not fully healed after 6 months of treatment. Autologous skin grafting is a time-tested therapy for these wounds; however, the creation of a new wound in the donor area yields a considerable limitation to this procedure. Innovation: Fractional autologous full-thickness skin grafting (FFTSG) is a technique wherein multiple small full-thickness skin grafts (FTSGs) are harvested with possibly minor donor-site comorbidities. The first device used to harvest FFTSG (ART™ system, Medline, Northfield, IL) is a device capable of harvesting >300 small FTSGs and transferring them to a target wound. Objective: To better evaluate patients' clinical experience, we sought to evaluate pain at the donor site associated with this procedure. Approach: Pain was assessed with numeric visual analog pain scales at days 1, 2, 4, and 7. Nine subjects underwent this procedure with only six of them reporting any level of pain on day 1, and none disclosing pain after day 2. Conclusion: In this study, we evidenced that this device manages to harvest FTSGs with minimal associated pain. Future research will need to evaluate other aspects of the procedure as well as long-term outcomes at the donor and recipient areas.

Patients' prediction of their wound healing time.

Understanding and managing patients' expectations can help improve their adherence to treatment for chronic wounds; however, little is known concerning about their expectations regarding healing time. Recruited subjects were asked to predict how long their wounds would take to heal and their charts were reviewed to retrieve real time of healing. We recruited 100 subjects from which 77% have healed. Fifty-three subjects (68.8%) had a longer healing time than they predicted (underestimated), and 17 (22.1%) had a shorter healing time than they predicted (overestimated). Subjects with shorter wound duration history tended to predict shorter healing time than subjects with longer wound duration (p < 0.01). However, wound duration did not affect prediction accuracy (p = 0.65). Subjects with chronic wounds seem more often to underestimate their time of healing. Wound duration significantly influenced patients' prediction time, although it did not make their prediction more accurate. Patient education about expectations may be important as patients often expect their wounds to heal faster than they actually do.

The Role of IL-17 in the Human Immune System and Its Blockage as a Treatment of Rheumatoid Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis.

Interleukin 17 (IL-17) functions as a bridge between the innate and adaptive immunity. In addition to being a crucial defense mechanism against extracellular pathogens, it plays a significant role in inflammation, therefore considered a decisive factor in inflammatory conditions; hence the importance of its understanding for the treatment of autoimmune diseases. Animal models have demonstrated that blockage of the IL-17 receptor (IL-17R) may prevent these pathologies. For instance, there is evidence that IL-17R-deficient mice may be protected against the development of collagen-induced arthritis (CIA) and experimental autoimmune encephalitis (EAE). Furthermore; inflammatory disorders such as rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PSA), and ankylosing spondylitis (AS) have been associated with IL-17, and therapeutically targeting this inflammatory pathway could improve patients' outcomes. The discovery and subsequent studies of this interleukin have aided in the understanding of the immune system, and its potential therapeutic blockage provokes optimism for the treatment of these distressing conditions. J Drugs Dermatol. 2018;17(5):539-542.

Recovery of nail dystrophy potential new therapeutic indication of tofacitinib.

Nail dystrophy is a heterogeneous skin condition and in some subtypes, is associated with autoimmune diseases in particular psoriasis and psoriatic arthritis. In this report, we show that tofacitinib, a novel therapy for rheumatoid arthritis, appears to be beneficial in patients with nail disease refractory to other conventional modes of therapy.

Fracturas vertebrales morfométricas y su relación con 25 OH vitamina D, índice de masa corporal y edad en mujeres seniles / Morphometric vertebral fractures and their relationship with 25 OH-vitamin D, body mass index, and age in elderly women

Objetivo: Determinar la presencia de fracturas vertebrales morfométricas y su relación con 25 OH vitamina D, índice de masa corporal y edad en mujeres seniles. Materiales y métodos: Estudio transversal. Se analizaron 319 mujeres seniles, provenientes del estudio "Salud osteomuscular del anciano". La determinación de fracturas vertebrales morfométricas se realizó de manera radiográfica, en tanto que los niveles de 25 OH vitamina D se midieron por inmunoanálisis por quimioluminiscencia (CLIA) Liaison* 25 OH vitamina D Total Assay Ref 310600, utilizando el equipo Diasorin Liaison* Analyzer. El índice de masa corporal se obtuvo, según las recomendaciones de la Organización Mundial de la Salud, como el peso en kilogramos sobre la talla en metros al cuadrado; la edad fue verificada con el documento de identidad y el ingreso del mismo a las bases de datos nacionales (SISPRO-FOSYGA). Resultados: El promedio de edad fue de 74,3 arios (DE ± 7,2). La prevalencia global de fracturas fue de 17,9%; así mismo, el 54,9% de las participantes tenía valores entre 20 y 29ng/ml de 25 OH vitamina D y el 58,9% tenía valores de índice de masa corporal inferior a 25 kg/m². El promedio de 25 OH vitamina D fue inferior en las participantes fracturadas (19,7 vs. 25,1) (p<0,05); el índice de masa corporal también fue menor en las fracturadas (23,5 vs. 24,6) (p>0,05), pero la edad fue mayor: 78,9 vs. 73,4 (p<0,05). Al comparar los promedios de 25 OH vitamina D en participantes fracturadas y no fracturadas, se encontraron niveles significativamente menores de 25 OH vitamina D en las participantes con fractura mayores de 69 años, y al considerar el índice de masa corporal, los valores de 25 OH vitamina D fueron significativamente inferiores en cada una de las categorías de las participantes con fractura. Conclusión: Se encontró una relación estadísticamente significativa entre poseer fracturas vertebrales morfométricas y tener: 1) niveles bajos de 25 OH vitamina D, 2) mayor edad, y 3) menor índice de masa corporal.

Objective: To determine the presence of morphometric vertebral fractures, as well as their relationship with 25 OH vitamin D, body mass index, and age in elderly women. Materials and methods: A cross-sectional study was conducted on 319 elderly women from the study 'Musculoskeletal Health in the Elderly'. The morphometric determination of vertebral fractures was performed with radiography, while the levels of 25 OH vitamin D were determined by the chemiluminescent immunoassay (CLIA) method using the Liaison® 25 OH Vitamin D Total Assay 25 (Ref 310 600), using the Liaison® Analyser. The body mass index was obtained as recommended by the World Health Organisation; weight in kilograms over height in metres squared. The age of the participants was verified by their identity card, and their income details from the national data bases (SISPRO-FOSYGA). Results: The mean age was 74.3 years (SD ± 7.2). The overall prevalence of fractures was 17.9%; 54.9% of participants had values between 20 and 29ng/ml 25 OH vitamin D, and 58.9% had body mass index values less than 25 kg/m². The mean 25 OH vitamin D was lower in participants with fractures (19.7 vs. 25.1) (P < .05). Body mass index was also lower in those with fractures (23.5 vs. 24.6) (P < .05), but age was higher: 78.9 vs. 73.4 (P < .05). When comparing the mean levels of 25 OH vitamin D in fractured and non-fractured participants, significantly lower levels of 25 OH vitamin D were found in participants with fractures over 69 years-old, and on comparing the body mass index, the values of 25 OH vitamin D were significantly lower in each of the categories of participants with a fracture. Conclusion: A statistically significant relationship was found between morphometric vertebral fractures and: 1) low levels of 25 OH vitamin D, 2) being older and, and 3) a lower body mass index.