Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study.

BACKGROUND: Prevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated. METHODS: We performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay ≥ 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) ≥ 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain. RESULTS: Eight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 (± 17) years with a SAPS 2 score of 32 (± 16) (mean ± SD). The median ICU length of stay was 6 [4-12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1-5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1-2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3-4]), prone positioning (OR 3 95% CI [1.4-6.4]) and the presence of pain symptoms on ICU discharge (NRS ≥ 3) (OR 2.4 95% CI [1.7-3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1-6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months. CONCLUSIONS: Persistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain. TRIAL REGISTRATION: NCT04817696. Registered March 26, 2021.

The conundrum of skin pores in dermocosmetology.

'Skin pore' is a term used by lay people and in the field of cosmetology. It remains misleading when it is not clearly defined. Indeed, lay people use it with at least 3 different meanings. Basically, invisible pores represent the openings of the sweat gland apparatus. By contrast, the visible pores represent enlarged empty funnel-shaped or cylindrical horny impacted openings of pilosebaceous follicles. This review describes some of the current objective methods used to describe skin pores.

Coping with mild inflammatory catamenial acne: a clinical and bioinstrumental split-face assessment.

BACKGROUND: Acne is a multifactorial disease exhibiting distinct clinical presentations. Among them, the catamenial type is a matter of concern for young women. Some oral contraceptives may help without, however, clearing the skin condition. AIM: The present open study aimed at evaluating the effect of overnight applications of a paste made of petrolatum,15% zinc oxide and 0.25% miconazole nitrate. METHOD: The split-face trial was conducted in 35 women. A non-medicated cream was used as control. Clinical evaluations and biometrological assessments on cyanoacrylate follicular biopsies were performed monthly for 3 months. Comedometry and the density in autofluorescent follicular casts were used as analytical parameters. In addition, the five most severe cases at inclusion were tested at the completion of the study for follicular bacterial viability using dual flow cytometry. RESULTS: Compared with baseline and to the control hemi-face, the medicated paste brought significant improvement of acne. The number of papules and their redness were reduced beginning with the first treatment phase. A reduction in the follicular fluorescence was yielded beginning with the second treatment phase. The ratios between injured and dead bacteria, on the one hand, and live bacteria, on the other hand were significantly increased at completion of the study. CONCLUSION: A miconazole paste applied for 1 week at the end of the ovarian cycle has a beneficial effect on catamenial acne.

Mosaic subclinical melanoderma: an Achilles heel for UV-related epidermal carcinogenesis?

Cutaneous cancers are not uncommon on the face of elderly patients. Melanin should protect, at least in part, against the ultraviolet (UV)-induced neoplastic damage. However, the density in melanin chromatophores is heterogeneous in the epidermis of Caucasian adults. The computerized UV light-enhanced visualization (ULEV) method is a sensitive tool to assess non-invasively this mosaic pattern of intra-epidermal melanin load. In this study, the combination of ULEV pattern analysis and image analysis were performed involving four groups of phototype III Caucasian subjects. The first group was composed of 55 patients aged from 65 to 75 years who suffered from several malignancies of facial skin. The second control group of 55 patients who never had developed skin cancers were matched with the first group for age, sex and phototype. The third group was composed of 80 patients aged from 49 to 59 years who had developed a single basal cell carcinoma. The fourth group comprised 80 age, sex and phototype-matched healthy control subjects. Irrespective of the groups of subjects, a correlation was found between the pattern grading and the objectively determined relative area of subclinical melanoderma. Patients with multiple skin cancers differed from the other groups by the fact that a significantly higher proportion of them exhibited an extensive type of subclinical melanoderma. This feature was also seen in a minority of patients with a single basal cell carcinoma. The extensive subclinical melanoderma pattern is interpreted as a clue for risk, but not as a cause of UV-induced skin carcinogenesis.

Skin weathering and ashiness in black Africans.

Ashiness describes a common physiological skin condition that may develop in people with dark skin complexion. Environmental influences, particularly cold and dry weather, seem obvious. This condition has seldom been studied so far. In the present study, skin ashiness was assessed in 37 black African women by means of colorimetric assessments and xerosis ratings. Colour changes were measured by the parameters a* and the individual typology angle ITA degrees. Xerosis was assessed by visual inspection, the ultraviolet light-enhanced visualization (ULEV) method, and the cyanoacrylate skin surface stripping (CSSS) method. The assessments were performed on ashy skin of the legs and on the normal looking forehead during the winter season. Ashy skin was lighter but not erythematous. The ITA-revealed colour changes were correlated with xerosis severity as assessed by dry dermoscopy and by the ULEV and CSSS methods. In conclusion, ashiness due to skin weathering does not appear to be related to mild inflammation. It corresponds to a peculiar type of xerosis with reduction in Fresnel reflection by the stratum corneum.

Subclinical speckled perifollicular melanosis of the scalp.

Based on the clinical presentation of some skin pigmentation disorders it is thought that a bicompartmental functional system exists in the epidermal melanocyte population. It corresponds to the perifollicular and interfollicular compartments, respectively. The present study was undertaken looking for the presence of such a system on scalp unaffected by pigmentary disorders. The scalps of 100 men with incipient to severe androgenic alopecia were examined using a videocamera equipped with an internal ultraviolet light-emitting unit. The face, trunk and limbs were similarly examined in 45 of these adults and in 13 children of both sexes. In 92 men, a subclinical hypermelanosis was found as a speckled pattern centered on every single follicle. With increasing baldness severity, another epidermal hyperpigmentation pattern involving the interfollicular area was superimposed to the perifollicular pattern. These stereotyped patterns of subclinical melanoderma were also disclosed on the face of adults, but not in children. In addition, the spotty perifollicular pattern was discrete or not apparent on the other parts of the body. It is concluded that the perifollicular subclinical melanotic pattern is a regional characteristic of cephalic skin, perhaps related to the local production of melanocortins, particularly alpha-MSH by the pilosebaceous unit.