Factors influencing methoxsalen phototoxicity in vitiliginous skin.

A series of experiments were conducted to determine the optimum conditions required to induce methoxsalen phototoxicity in vitiliginous skin. The results revealed that optimum phototoxicity could be obtained only when a lapse of at least 15 minutes was allowed between the application of the drug and exposure to long-wave ultraviolet light (UVA). The duration of methoxsalen's phototoxic potentially, after its application to skin, varied in direct proportion to chemical concentration. Although a high chemical concentration and low dosage of UVA was a less time-consuming method of inducing phototoxicity, our results indicate that lower concentration and longer UVA exposure were less likely to induce undersirable blistering reactions.     

Factors influencing skin cancer excision rates in Scottish primary care

Skin cancer incidence rates are rising in the UK, yet many areas are experiencing a shortage of dermatologists. We sought to compare skin cancer excision rates between general practice (GP) surgeons to identify factors associated with good practice, through a retrospective analysis of GP skin cancer histopathology reports in three Scottish Health Boards over a 4‐year period. Postal questionnaires were used to explore factors affecting surgeons’ excision rates. GPs excised 895 skin cancers (4.5% of the 19 853 regional total) during the period. Of the basal cell carcinomas, 308 would be classified as low‐risk by current National Institute for Health and Care Excellence criteria. Of the returned questionnaires, 58 accounted for 631 (70.5%) of the excised skin cancers. Analysing completeness of skin cancer excision, there was a statistically significant difference between GPs performing excision on ≥ 11 lesions/month compared with those performing excision on ≤ 10/month. Policymakers may wish to consider systems to facilitate low‐risk patients being treated by GPs who undertake frequent surgical procedures.     

The risk and risk factors of a second non-melanoma skin cancer: a study in a Mediterranean population

BACKGROUND: Non-melanoma skin cancer (NMSC) patients often develop second primary skin tumours. Studies assessing the risk and risk factors on the appearance of a second NMSC are scarce, especially in European countries. OBJECTIVES: To assess the 5-year risk of a second NMSC in a Mediterranean population, and to find patient characteristics predicting second tumours. METHODS: NMSC patients at our institution were studied retrospectively. In situ tumours, recurrences, follow-up shorter than 2 months and mucosal lesions were excluded. Data analysed included age, gender, anatomical site, histological subtype, number of tumours and months of follow-up. Disease-free interval was defined as time from histological documentation of the first NMSC to the date of the last follow-up or to the date of histological documentation of the second NMSC. Survival analysis was conducted with the life-table analysis. Cox's proportional hazards regression model was used to assess risk factors. RESULTS: The study group comprised 535 cases. Of these, 120 patients presented a second NMSC (22.4%). Hazard rates remained high in all yearly intervals. Multivariate analysis showed older age, multiple tumours and male sex as significant prognostic factors. When the second NMSC was diagnosed in the first year of follow-up, a trend to a high risk of further NMSCs was observed. CONCLUSIONS: The risk of a second NMSC is similar to other studies, although in the lower range. Prognostic factors are also similar to other studies. Yearly hazard rates not falling suggests that long-term follow-up is needed. Prospective studies including whole-body examination could define the exact risk of a second NMSC.     

Stiffness measurement is a biomarker of skin ageing in vivo

Human skin is particularly vulnerable to age-related deterioration and undergoes profound structural and functional changes, reflected in the external skin appearance. Skin ageing is characterized by features such as wrinkling or loss of elasticity. Even if research advances have been done concerning the molecular mechanisms that underlie these changes, very few studies have been conducted concerning the structure stiffness of the skin organ as a whole. In this study, we showed, thanks to human skin reconstructs and the Japanese Medaka fish model, that biomechanics is a new biomarker of skin ageing. We revealed that global stiffness measurement by Atomic Force Microscopy, since modulated through ageing in these models, can be a new biomarker of skin ageing, and reflects the profound reorganization of the dermis extracellular matrix, as shown by Transmission Electron Microscopy. Moreover, our data unveiled that the Japanese Medaka fish could represent a highly relevant integrated model to study skin ageing in vivo.     

Association between smoking and cutaneous ageing in a Brazilian population

Objective This study aims to determine the relationship between smoking and cutaneous ageing. Methods A cross‐sectional study was carried out on 301 subjects (191 women and 110 men, aged between 25 and 86 years), of which 165 were non‐smokers and 136 were smokers and ex‐smokers. The association between tabagism and cutaneous ageing was controlled for other variables (solar exposure, age, skin phototype, sex, sunscreen use, alcohol consumption, coffee consumption, sports participation, body mass index, and history of relatives with precocious ageing). Results Analysis revealed that age, chronic solar exposure, skin phototype and tobacco load significantly contributed to the formation of facial wrinkles. The larger the tobacco load, the larger was the amount of facial wrinkling, with an odds ratio of 3.92 in ‘heavy’ smokers (> 40 packs/year) in relation to non‐smokers. Conclusion The results of this study point to smoking as one of the main factors involved in facial wrinkling. The relationship between smoking and cutaneous ageing is an important element in educational campaigns against tabagism.     

Receptors in skin ageing and antiageing agents

Skin ageing is an irreversible process during which ultrastructural and physiologic alterations happen. Dermatology has focused a lot of attention on the reversal of signs of ageing and photodamage, with the purposes of achieving cosmetic benefits and preventing photocancerogenesis. Recent advances in skin biology have clarified the mechanisms by which photoageing occurs and have given rise to new treatments to prevent and reverse this process. The understanding of the role of key receptors involved in the complex pathomechanism of skin ageing probably will lead to the development of the new therapeutic agents in the near future.     

Pediatric skin disorders encountered in a dermatology outpatient clinic in Turkey

Abstract:  This study documents the spectrum and frequency of skin disorders in a total of 2370 children encountered in a dermatology outpatient clinic in Turkey. Infectious skin diseases were most frequently observed (27.6%) followed by, eczemas (17.9%), acne (14,5%), papulosquamous diseases (6.9%), hair diseases (4.1%), pigmentation disorders (3.8%), generalized pruritus (2.8%), urticaria (2.7%), and insect bite (2.3%). Epidemiologic data are useful in planning of the health care and taking preventive measures to decrease the prevalence of skin disorders in children.     

Peeling skin diseases: 21 cases from Turkey and a review of the literature

Background Peeling skin diseases (PSD) refer to a group of rare autosomal recessive dermatosis which are characterized by spontaneous, continual peeling of the skin. Three different clinical pictures can be distinguished: Inflammatory PSD also referred to as peeling skin syndrome (PSS) type B, non‐inflammatory PSD also referred to as PSS type A, and localized forms i.e. acral type PSS. Objective To characterize the clinical and histopathological features of PSD in Turkey. Methods We retrospectively reviewed the medical records and clinical photographs of patients who were given diagnosis of PSD and conducted histopathological evaluation of skin biopsies to identify the site of cleavage. Also we evaluated the cases including age, gender, age onset, clinical and histological findings, family history, associated disorders and PSD type. Results Twenty‐one patients with PSD were seen at Gulhane School of Medicine in Ankara between the years 1994 and 2010 in this retrospective study. All patients were men. Their ages were between 20 and 26 years (22.44 ± 2.30, Mean age ± SD). Of the patients, eight cases (40%) were type A, eight cases (40%) were type B, and five cases (20%) were acral type PSS. Eleven cases (52%) had parental consanguinity. Keratoderma, cheilitis, keratosis pilaris, melanonichia, clubbing, hyperhidrosis, onychodystrophy were observed in eight cases as an accompanying disorder. Conclusions In this case series, PSD occurred rarely and also showed generally mild course of disease in Turkey and most likely related to consanguineous of marriages. Future investigations on PSD will contribute to our progressing alternative targets for pathogenesis‐based therapy.     

Pemphigus in the Mediterranean region of Turkey: a study of 148 cases

BACKGROUND: The purpose of this study was to describe the epidemiological and clinical features, course, response to treatment, and prognosis of pemphigus in the Mediterranean region of Turkey. METHODS: All patients with confirmed pemphigus were prospectively enrolled in two major dermatology departments in the cities of Adana and Antalya in the Mediterranean region between March 1998 and March 2004. Details including demography, findings of clinical examinations, treatment, course, and prognosis were recorded. RESULTS: One hundred and forty-eight patients with pemphigus were diagnosed during the 6-year period, with a prevalence of 1.46 and an annual incidence of 0.24 per 100,000 in this region. There was a female predominance with a male to female ratio of 1:1.4. Pemphigus vulgaris (PV) was the most common clinical subtype, identified in 123 patients (83%). The mean age of onset was 43. In 101 (82%) patients with PV, disease began as persistent oral ulcers. The majority of the patients with PV could be managed with middle or high-dose steroids (60-140 mg/day). Complete clinical remission was obtained in 41 (39.4%) patients. The mortality rate was 4.8%. CONCLUSIONS: A moderately high incidence of pemphigus was found in the Mediterranean region of Turkey as compared with that encountered in other countries. The commonest clinical subtype was PV with a 9.5-fold higher incidence than pemphigus foliaceus. It is more frequent in middle-aged people and has a female predominance. Although a relatively higher dose of steroid was needed to control the PV, the disease completely remitted in a significant proportion of the patients.     

Trends of nonmelanoma skin cancer from 1960 through 2000 in a Canadian population

Nonmelanoma skin cancer (NMSC) is the most common malignancy diagnosed in Caucasian populations, but little is known about its occurrence in Canada. We sought to determine the historical change of the occurrence and risk of NMSC. All first diagnoses of NMSC reported in Manitoba between 1960 and 2000 were identified. Rates were reported as well as lifetime risk of developing the disease. Basal cell carcinoma was the predominant form of NMSC, accounting for 79% of all NMSCs. The annual percentage change of basal cell and squamous cell carcinoma increased 2.4%, mainly in people older than 40 years of age from the early 1970s to 2000. The lifetime risk of being diagnosed with NMSC increased by two to three times in the 1990s compared to the 1960s. We concluded that because of the potentially high impact of NMSC on resource utilization and treatment-related costs as well as its easily preventable character, priority should be given to prophylactic measures.     

Factors influencing venereal infection in a war environment

376 soldiers leaving for Australia after 12 months in Vietnam were interviewed about their sexual behavior while in Vietnam and while on a 7 day rest and recreation leave spent in Australia, or in Hong Kong, Bangkok or Taipei. Over 85% of soldiers were younger than 26; 65.5% had intercourse while in Vietnam, the percentage being 74.5% among unmarried, and 51% among married soldiers. Mean age at 1st intercourse was 17; 74% had been circumcised. Venereal infection before service in Vietnam had been acquired by 9.6% of soldiers; in contrast, 27% of those having intercourse in Vietnam or during the leave acquired venereal disease (VD); of these, only 7% were married. Only 15% of single soldiers used a condom as compared to 39.5% of married soldiers; no solder who used a condom on all occasions acquired VD. 29% of those having intercourse usually did so under the influence of alcohol. Reasons for abstinence from intercourse was fidelity in 67% of married men, followed by religiouis or ethical reasons and fear of VD; fear of VD was the major deterrent from intercourse also among unmarried soldiers. It is possible to see from this study that some of the factors influencing the high incidence of VD in wartime have to do with altered behavior patterns, mainly the promiscuity with prostitutes who are known to have a high rate of venereal infection, and the influence of alcohol. The findings also suggest that the condom is a very effective prophylactic; nevertheless a condom was used routinely by only 22.5% of soldiers. The findings also show that in wartime circumcision may become a significant influence on the total morbidity from sexual relations.     

Factors influencing HIV progression in a seroconverter cohort in Madrid from 1985 to 1999

OBJECTIVE: To study HIV progression from seroconversion over a 15 year period and measure the population effectiveness of highly active antiretroviral therapy (HAART). METHODS: A cohort study of people with well documented dates of seroconversion. Cumulative risk of AIDS and death were calculated by extended Kaplan-Meier allowing for late entry. Cox proportional hazards models were used to study variables associated with HIV progression. To assess the impact of HAART, calendar time was divided in three periods; before 1992, 1992-6, and 1997-9. RESULTS: From January 1985 to May 2000, 226 seroconverters were identified. The median seroconversion interval was 11 months, median seroconversion date was March 1993. 202 (89%) were men, 76% of whom were homo/bisexual. A 66% reduction in progression to AIDS was observed in 1997-9 compared to 1992-96 (HR 0.34 95% CI: 0.16 to 0.70). People with primary education appeared to have faster progression to AIDS compared to those with university studies (HR 2.69 95%CI: 1.17 to 6.16). An 82% reduction in mortality from HIV seroconversion was observed in 1997-9 (HR 0.18 95% CI: 0.05 to 0.68) compared to 1992-6. Progression to death for people with primary education was twice as fast as for those with university education (p 0.0007). People without confirmation of an HIV negative test had faster progression (HR 4.47 95% CI: 1.18 to 16.92). CONCLUSIONS: The reduction in progression to AIDS and death from seroconversion from 1992-6 to 1997-9 in Madrid is likely to be attributable to HAART. HIV progression was faster in subjects with primary education; better educational level may be associated with better adherence to medication.