Introduction The diagnosis of primary syphilis can be challenging, as direct inoculation at non-genital sites such as the lips may result in extragenital chancres, even though the disease typically presents as a genital ulcer. Case Presentation A 32-year-old man had a lower lip ulcer that was indurated and painless for three weeks. The patient reported a history of orogenital contact with a woman 17 days before the appearance of the lip ulcer. Initially, the lesion was misdiagnosed as a traumatic ulcer and was unsuccessfully treated with topical antibiotics. Examining the lower lip revealed a single, distinct, oval ulcer with a clean base and firm induration. The submental lymph nodes showed a slight non-tender enlargement. A confirmatory Treponema Pallidum Hemagglutination Assay (TPHA) and a positive Venereal Disease Research Laboratory (VDRL) test (1/64) were found through serological testing. Human Immunodeficiency Virus (HIV) and Herpes Simplex Virus immunoglobulins (HSV IgM, IgG) were not detected. After receiving a single intramuscular dose of 2.4 million units of benzathine penicillin G, the patient recovered completely in two weeks. Conclusion Chronic indurated ulcers of the lip may have various etiologies, and the possibility of a primary syphilitic chancre, though rare, should always be considered. Awareness of this presentation is essential, as early diagnosis and appropriate treatment are crucial to prevent disease progression and transmission.
Introduction/Background Annular lichen planus (ALP) is a rare morphological variant of lichen planus that can mimic other annular dermatoses and often poses diagnostic challenges. Although lichen planus has been sporadically linked to systemic diseases, its association with ulcerative colitis is exceedingly rare. This case highlights the coexistence of ALP and ulcerative colitis, suggesting a possible immunopathogenic connection between the two conditions. Case Presentation A 40-year-old woman with a three-year history of ulcerative colitis presented with a six-month history of intensely pruritic, violaceous, annular lesions affecting the dorsal feet, hands, wrists, and face. Examination revealed flat-topped papules, some forming plaques with Wickham striae and annular configurations. Histopathology confirmed the diagnosis of annular lichen planus. The patient had no other known triggers such as new medications, infections, or contact allergens. She was treated with topical corticosteroids and antihistamines, resulting in partial resolution of the lesions over a four-week period. Conclusion This case underscores the importance of considering systemic autoimmune diseases like ulcerative colitis in patients presenting with atypical forms of lichen planus. It adds to the limited literature documenting ALP as a possible cutaneous manifestation associated with inflammatory bowel disease.
Introduction The use of Artificial Intelligence (AI) for image-based diagnosis in dermatology is increasing rapidly. The clinical accuracy of AI in diagnosing different skin conditions remains under evaluation. This study aimed to evaluate the diagnostic performance of an AI application in comparison to confirmed clinical diagnoses by dermatologists. Method A cross-sectional study was carried out on 400 patients with different skin conditions, including acne, alopecia, eczema, pigmentary disorders, psoriasis, immunological disorders, tumors, infections, and infestations. The study analyzed AI-based predictions using the Tibot AI application, comparing them against dermatologists’ diagnoses. Results The AI application demonstrated high diagnostic accuracy for certain dermatological conditions such as adnexal disorders (AUC 0.93–0.98), pigmentary disorders (AUC 0.88–0.94), and cutaneous tumors (AUC 0.87–0.95). Sensitivity for adnexal disorders was 88.9% (top one) and 94.4% (top three), and for Pigmentary disorders, it was 75.8% and 87.9% for top one and top-three predictions, respectively. However, AI performance was lower for immunological disorders (31.3% sensitivity) and cutaneous infestations (22.2%). Overall accuracy improved across all conditions when considering the top-three predictions. Discussion Tibot AI-application demonstrated high diagnostic accuracy for conditions with distinct morphological features such as adnexal, pigmentary disorders, and cutaneous tumors. It showed lower sensitivity for immunological disorders and infestations, indicating the need for further AI training with more diverse datasets. Conclusion AI-based diagnostic accuracy improved significantly when considering the top-three diagnoses, indicating its value as a differential diagnostic tool. It showed promising accuracy in adnexal, pigmentary disorders, and cutaneous tumors. However, it is less robust for immunological skin diseases and infections, highlighting the need for further refinement.
Background Mechanical stresses affect biological processes, cellular homeostasis, and skin wound healing. Objective We investigated the effects of mechanical stretching on epidermal keratinocytes, focusing on its role in wound healing and keloid formation. Methods Epidermal keratinocytes were stretched using a biochemical stretch device with or without a cyclooxygenase-2 inhibitor. Cells and supernatants were collected after 1−24 h of stimulation. Stretched keratinocytes were co-cultured with normal dermal or keloid-derived fibroblasts. Prostaglandin E2 and 12-hydroxyeicosatetraenoic acid were measured via enzyme-linked immunosorbent assay. Prostaglandin E2 receptor EP3 and transforming growth factor-β1 (TGF-β1) were analyzed using qRT-PCR. TGF-β1 was also examined using western blotting. Prostaglandin E2 synthase and TGF-β1 were also stained and analyzed using immunofluorescence microscopy. Results Mechanical stretching of keratinocytes increased the levels of prostaglandin E2, which stimulates keratinocyte proliferation and exerts antifibrotic effects, as well as those of prostaglandin E synthase 2 and prostaglandin E2 receptor 3. In contrast, mechanical stretching did not affect the levels of transforming growth factor-β1 in affected keratinocytes. However, co-culture with keloid-derived fibroblasts markedly increased the levels of transforming growth factor-β1 in mechanically stretched keratinocytes. Discussion These results suggest that the stretching stimulation of keratinocytes promotes epithelialization by increasing prostaglandin E2 production. Furthermore, stretching stimulation of keratinocytes in the presence of keloid-derived fibroblasts possibly promotes keloid formation via the upregulation of TGF-β1 levels in keratinocytes. Conclusion Mechanical stretching induced PGE2 production and increased the TGF-β1 levels in keratinocytes in the presence of keloid-derived fibroblasts. Our results suggest that stretch stimulation in the presence of keloid-derived fibroblasts promotes keloid development.
Introduction Sun exposure is a major risk factor for skin cancer and other skin conditions. Sunscreen use remains a significant public health concern. This study examines awareness and attitudes toward sunscreen use, comparing dermatology patients with the non-dermatology population, examining associated factors and usage patterns. Methodology A cross-sectional study compared sunscreen use between dermatology patients at the University of Jordan Hospital and the non-dermatology population. An online questionnaire covered sociodemographic factors, skin tone, sun exposure, and sunscreen use, with additional questions for dermatology patients. Statistical analysis included descriptive statistics, chi-square tests, and binary logistic regression. Results The study included 1,784 participants, with the majority being females (78.1%) aged 18–24 (51.7%). 75.3% reported using sunscreen, though 42.6% of non-users reported a lack of interest. Women (86.9%), those with higher education (81.7%), and lighter-skinned individuals (84.5%) showed higher usage. Dermatology patients had greater compliance (53.4%) than non-patients. Discussion The findings are consistent with regional and international studies showing that females, younger individuals, and those with lighter skin tones are more likely to use sunscreen. Similar to prior research, cost, forgetfulness, and lack of awareness were major barriers to regular use. Dermatology patients showed higher compliance, supporting evidence that professional counseling improves sun-protective behaviors. Conclusion Demographic factors significantly influence irregular sunscreen use. Females and younger individuals showed higher usage, while males and older adults were less consistent. Educational level and income also played roles. These findings highlight the need for targeted educational efforts and public health campaigns to improve sunscreen adherence, especially among high-risk groups, contributing to better skin health and cancer prevention.
Introduction/Background Mycobacterium marinum is a nontuberculous mycobacterium that can cause rare chronic skin and soft tissue infections in humans. Exposure is most common in individuals who work closely with marine animals or in marine environments, including aquarium caretakers and fishermen, and is typically acquired through a break in the skin or a fish bite. Diagnosis can be challenging due to its indolent nature and requires a high index of suspicion, including the elicitation of a water exposure history. As a result, it is often associated with delayed diagnoses, leading to chronic infections and related complications, such as arthritis, tenosynovitis, osteomyelitis, and bursitis. Case Presentation We present a case of a 59-year-old male who had previously worked as a fisherman and developed a chronic right upper extremity rash that was initially misdiagnosed as psoriasis, only later to be diagnosed as M. marinum infection 10 years after its initial onset. Laboratory confirmation was made through histopathology, tissue culture, and PCR. Conclusion This report highlights the epidemiology, clinical presentation, diagnostic difficulties, and complex management of Mycobacterium marinum infection.
Introduction/ Background Wrestlers often present with cutaneous infections that are acquired through their sport. This case series outlines the dermatological management of several wrestlers from the same team who presented with infections similarly. Case Presentation In the Winter months of 2023, 4 wrestlers from the same northwest Ohio high school team were referred to the dermatologist by their coach because of infection. Through culture and sensitivity testing, it was determined that their infections were all from the same strain of Methicillin-resistant Staphylococcus aureus (MRSA), and all were treated with the same oral antibiotics successfully. The dermatologist soon after made an announcement to the state’s dermatological association and the high school athletic association, describing the infections so that others could monitor for additional cases in the community. Conclusion Dermatologists should perform culture and sensitivity testing on wrestlers who present with suspected infections and notify local agencies in the event of outbreaks. Additionally, they should teach proper hygiene and mat-cleaning techniques to wrestlers and coaches.
Hyperesthesia is characterized by heightened sensitivity to stimuli that typically does not evoke pain, manifesting as allodynia (pain from non-painful stimuli) or hyperalgesia (exaggerated pain from painful stimuli). This condition is commonly linked to neuropathic pain, arising from nerve fiber damage or alterations, particularly affecting A-fibers. Hyperesthesia can result from systemic diseases, mechanical trauma, or hereditary factors, affecting approximately 10% of the population. Mechanical hyperesthesia, the more common type, results from heightened sensitization of the somatosensory system, leading to discomfort from light stimuli like pinpricks or clothing friction. Managing hyperesthesia requires a multidisciplinary approach focusing on both underlying causes and improving quality of life. First-line treatments include antidepressants (TCAs and SNRIs), gabapentinoids, and topical agents like lidocaine and capsaicin. For refractory cases, interventional therapies, such as nerve blocks and neurostimulation, may be considered, though these are not first-line treatments due to limited evidence. Additionally, non-pharmacological approaches like choosing friction-reducing clothing fabrics play a critical role. Clothing materials with low friction coefficients, such as cotton or silk, can significantly improve comfort by reducing sensory triggers for those with hyperesthesia. Further research into fabric technologies, such as friction-reducing treatments and textronics, offers promising avenues for improving comfort and pain management.
Atopic dermatitis (AD) is a common, chronic inflammatory skin condition affecting a substantial number of individuals globally. Managing AD is a common challenge not only for patients but also for primary care practitioners (PCPs), as they are frequently called to help/care for patients who are seeking relief from its distressing symptoms. This paper presents a concise guide to an eczema self-care routine, which may serve as a valuable resource for PCPs seeking to improve long-term AD management in their patients. We discuss the importance of addressing skin barrier dysfunction and highlight using emollients with active ingredients as fundamental components of AD care. Additionally, we introduce an easy-to-follow 3C ( Cleanse , Control , Calm ) approach to daily AD self-care that strengthens skin barrier function, supports steroid-sparing, and helps break the cycle of symptomatic treatment. By equipping PCPs with up-to-date knowledge of AD pathophysiology and evidence-based management strategies, this guide seeks to enhance the quality of care provided by PCPs, thereby improving the well-being of individuals living with AD.
Introduction Cutaneous Pseudolymphoma (CPL) encompasses a heterogeneous group of benign, reversible, and inflammatory lymphocyte proliferation. Case presentation We present a unique instance of CPL triggered by an insect bite in a 42-year-old female who presented to our hospital with a solitary tender erythematous shallow ulcer over her right arm, which was misdiagnosed initially as cutaneous leishmaniasis due to her travel history. A biopsy ultimately revealed cutaneous lymphoid hyperplasia related to an arthropod bite reaction. Moreover, various treatment options were initiated. Conclusion This case highlights the need for clinicians to consider CPL in the differential diagnosis of chronic skin lesions to avoid misdiagnosis and ensure appropriate treatment.
Fibrovascular stromal polyps (fibroepithelial polyps; FEPs) are benign tumors occurring in many parts of the body and are infrequently reported in the vulva. They tend to be small, but few present in giant sizes, which adds diagnostic challenges. A 24-year-old female with a five-year history of a right vulval mass that reached a massive size (35×15×10 cm), complained of a large, painless, soft, pedunculated mass causing discomfort and interference with daily activities. On examination, the mass was firm, not tender, and associated with surface ulceration and infection. The mass was surgically removed and subjected to histological examination to exclude any malignancy. The observation indicated the presence of a fibroepithelial (fibrovascular) polyp; thus, follow-up was advised. This case report has explored giant FEPs’ presentation, diagnosis, therapeutic approaches, and possible consequences, and comprehensively discussed the findings of earlier studies. A better understanding of giant FEPs can improve their management and guide prescription for tailored treatment, which must involve evaluation of the psychological impact on patient mental health for a comprehensive holistic patient approach.
In addition to respiratory symptoms, COVID-19 has been linked to many clinical manifestations, such as changes in skin pigmentation and hair loss. The objective of this research was to examine these manifestations. Cross-sectional research was performed at Afzalipour Hospital in Kerman, Iran, between June and August 2021. COVID-19-recovered patients were included in the study, and data were obtained via medical records, verbal interviews, and self-administered questionnaires. Statistical investigations evaluated the relationships between manifestations, demographic factors, and clinical indications. Among the 190-study population, 76.3% encountered alopecia, while 15.3% indicated changes in skin pigmentation. The prevalence of hair loss was considerably higher among females (P=0.002). The hair loss patterns exhibited characteristics similar to telogen effluvium (TE), with a higher occurrence in the frontal region of the head. There was a relationship between hair loss and the level of arterial oxygen saturation. This research emphasizes a significant prevalence of alopecia after the recovery from COVID-19, especially among females. It is crucial to provide proactive care and support to people who have recovered from COVID-19, including customized therapies that specifically target post-COVID-19 problems.
The convergence of tissue engineering and the cosmetic industry marks a transformative axis in the development of advanced cosmetic products and therapies. The current study explores the recent landscape and future potential of applying tissue engineering techniques within the cosmetic industry. The study highlights key innovations, such as the development of lab-grown skin for product testing and personalized skin grafts for aesthetic enhancements, which not only promise to enhance product efficacy and safety but also offer sustainable and ethical alternatives to traditional methods reliant on animal testing. This study reviews scientific progress in biomaterials, scaffold design, and cellular manipulation that promote skin tissue regeneration and repair, wound healing, breast implants, and oral care, highlighting the capacity to tackle intricate aesthetic issues such as scarring, skin aging, and pigmentation disorders. The ethical, regulatory, and economic implications of integrating tissue engineering into cosmetics are also discussed, providing a comprehensive overview of the challenges and opportunities facing this burgeoning field. By advancing the capabilities of cosmetic applications, tissue engineering not only pioneers innovative solutions for personalized beauty care and dermatology but also sets a precedent for future interdisciplinary collaborations in cosmetic science.
Trichorrhexis nodosa is the most common form of hair breakage with a diagnostic splayed paint brush bristle appearance under light microscopy. It is classified into congenital and four acquired forms. Defects in the hair cuticle and hair keratin have recently been clarified better with more refined instrumentation. The congenital form can be seen in several childhood diseases and syndromes. There are four types of acquired TN that leave hair less protected from environmental irritants. The form with proximal damage in African Americans is by far the most frequent type. Treatment for trichorrhexis nodosa involves avoiding factors that contribute to hair breakage, such as minimizing heat styling and using gentle hair care products. The FDA may initiate sanctions on the use of formaldehyde and related chemicals presently used in hair straightening and keratin hair treatments. This would markedly alter the status quo in treatment for this condition.
Background Striae gravidarum (SG) is a common outcome of pregnancy, often leading to psychosocial distress. TikTok has become a popular source for SG prevention and treatment advice, but the scientific validity of this content remains unclear. Methods A cross-sectional analysis of the 100 most-liked TikTok videos on pregnancy stretch marks was performed. Data on engagement, content source, focus, and SG management recommendations were collected. Results The majority of the TikTok videos in the study featured personal anecdotes from social media influencers. Oil mixtures and cocoa butter were frequently recommended for SG prevention despite lacking efficacy. For existing SG, retinoids were the most mentioned treatment. Overall, non-evidence-based approaches dominated both the prevention and treatment recommendations in these videos. Conclusion Most SG-related TikTok content lacks a scientific basis, which may contribute to the spread of misinformation. There is a need for further research on SG, and healthcare professionals should prioritize promoting accurate, evidence-based content on social media to improve understanding and management of SG.
Background Vitiligo, as a progressive skin disease, is associated with the public's negative attitudes toward this condition, as well as numerous social and familial problems that can lead to psychiatric disorders. Aim The present study was conducted to determine the frequency of depressive illness in patients with vitiligo. Methods This is a cross-sectional descriptive study conducted using census sampling on 178 patients with vitiligo who were referred to the skin clinic of Imam Khomeini Hospital (RA) in Jiroft in 2023. Data were collected face-to-face using the Beck Depression Questionnaire and analyzed using descriptive and inferential statistical tests in SPSS-22 statistical software, with a significance level of p less than 0.05. Results The average age of the examined patients was 31.4 ± 6.8 years. Of the participants, 53.3% were women and 46.7% were men. The frequency of individuals exhibiting moderate and severe depressive symptoms was 17.9% and 28.8%, respectively. The prevalence of depressive illness was higher among married women compared to single women. Conclusion The high prevalence of depressive illness symptoms in these patients underscores the urgent need for effective interventions and treatment strategies to address this mental health concern. The findings of this study highlight the necessity for continuous surveillance and monitoring of depressive illness prevalence and its risk factors, which will inform the development of effective interventions and policies aimed at mitigating this mental health issue.
Background This paper describes a case of necrobiosis lipoidica (NL) which was successfully treated with dupilumab. NL can be a difficult and chronic disease, often with limited treatment options. Dupilumab is a biologic typically used for atopic dermatitis, but given its novel pathway, it has been used in a number of other conditions. Case Presentation We describe a patient with inflammation on her legs, which was biopsied and consistent with NL. Treatments, including topical steroids, were started, but there was no improvement, therefore, dupilumab was discussed. She agreed with the treatment and dupilumab injections, and she reported a decrease in redness and improvement in her NL. Conclusion With this report, hopefully, there will be another option for the treatment of NL and different and novel uses for dupilumab.
Background Atopic dermatitis (AD) is a prevalent, chronic inflammatory skin disorder exacerbated by dietary factors, among other triggers. The disease involves complex interactions between genetic, environmental, and immunological factors, with the gut-skin axis illustrating how intestinal health impacts skin condition. This underscores the potential of dietary management in modifying AD outcomes. Objectives This review synthesizes current knowledge on the impact of dietary factors on AD. It explores the link between food allergies and AD, examines the gut-skin axis, and reviews dietary recommendations for managing AD. Methods A comprehensive review was conducted, focusing on observational and clinical trials published in the last decade. The studies reviewed encompass the role of various foods, including the impact of allergens, dietary patterns, and specific nutrients on the pathophysiology and management of AD. Conclusion Dietary factors significantly influence AD symptoms, with food allergies playing a pivotal role. Gut health, particularly the balance of gut microbiota, also significantly affects AD pathogenesis. Personalized dietary recommendations are essential for effective management. The review highlights research gaps in the understanding of food's role in AD, emphasizing the need for further trials and personalized dietary guidance.
Background The term chronic spontaneous urticaria (CSU) can be defined as urticaria lasting for more than 6 weeks with no established aetiology. Many newer molecules are being tried for managing the CSU cases not responding to conventional treatment as higher doses of antihistamines, oral steroids, oral methotrexate, oral cyclosporine, omalizumab, etc. One such oral agent is tofacitinib. Tofacitinib is known to inhibit the JAK -STAT pathway hence the release of many inflammatory cytokines and so target the pathophysiology of CSU and control symptoms of urticaria. Through this study, we have tried to bring out the efficacy and safety profile of this agent in resolving urticarial symptoms. Methods All cases of CSU who had not responded to higher recommended doses of anti-histamine (as per EACI guidelines) and on one or the other immunosuppressive agents were included in the study and based on baseline investigations and patients’ response to initial doses of tofacitinib and patient’s consent six patients were withdrawn from the study. Results Out of 15 patients of CSU included for final evaluation, 10 patients were completely cured of CSU at 6 months and 3 patients responded partially. Conclusion Tofacitinib is an innovative molecule for treating antihistamine non-responding cases of chronic spontaneous urticaria.
Introduction The histological pattern of pseudo-epitheliomatous hyperplasia (PEH) may be encountered in a large series of verruciform/crateriform skin lesions (VC) with or without central ulceration/crusting. Beside neoplastic and inflammatory processes, this clinico-histological pattern may be associated with an extensive range of infectious agents. Materials and Methods A literature search was performed to identify viral, bacterial, fungal, and parasitic mucocutaneous infections potentially presenting with a clinical/histological VC-PEH pattern. Results A VC-PEH pattern was reported in parasitic (n=5), viral (n=6), bacterial (n=10), and fungal (n=12) mucocutaneous infections. The infection-linked VC-PEH pattern was typically linked to longstanding mucocutaneous processes. The human papillomavirus (HPV) family, Epstein-Barr virus, poxvirus, and polyomavirus-linked VC-PEH patterns seem to act as direct triggers of keratinocytic hyperproliferation whereas the VC-PEH patterns observed during other viral, parasitic, bacterial and fungal infections probably represent a reactive pattern of the epidermis to chronic mucocutaneous infections. The VC-PEH pattern was also more frequently reported in immunocompromised compared to immunocompetent patients. The risk of the development of a cutaneous squamous cell carcinoma in chronic VC-PEH should not be overlooked. Conclusion In the event of longstanding, slowly progressing, isolated, or more profuse VC-PEH skin lesions, a thorough search for infectious agents should be considered, particularly in the immunocompromised patient.
