Skin sensitivity and skin microbiota: Is there a link?

Sensitive skin is defined by the occurrence of unpleasant sensations, accompanied or not by erythema, in response to stimuli which normally should not provoke such sensations and that cannot be linked to skin disease. Even if its pathophysiology is not completely known, hyper‐reactivity of the cutaneous nervous system associated with an abnormal skin barrier has been hypothesized as a primary culprit including more recently a role of the cutaneous microbiota. The objective of this short review is to discuss the relationship between the skin microbiota, skin sensitivity and the skin barrier function.     

Perioperative care and cancer recurrence: Is there a connection?

Cancer is the second most common cause of death in the United States. Metastatic disease is a more important cause of cancer-related death relative to primary tumor progression. Surgical excision is the primary treatment for most malignant tumors. However, surgery itself can inhibit important host defenses and promote the development of metastases. An altered balance between the metastatic potential of the tumor and the anti-metastatic host defenses, including cellmediated immunity and natural killer cell function, is a plausible mechanism of increased cancer metastasis. This article reviews the increasingly recognized concept of anesthetic technique along with perioperative factors and their potential to affect long-term outcome after cancer surgery. The potential effect of intravenous anesthetics, volatile agents, local anesthetic drugs, opiates, and non-steroidal anti-inflammatory drugs are reviewed along with recent literature and ongoing clinical trials in this area. Regional anesthesia is increasingly emerging as a safer option with less cancer recurrence potential as compared to general anesthesia. Blood transfusion, pain, stress, use of beta-blockers, and hypothermia are other potentially important perioperative factors to consider.     

Is there a link between psoriasis and dementia?

Psoriasis and dementia are both common conditions. Because of how both diseases develop within the body, they might have certain shared traits, and it has been suggested that patients with psoriasis may be at greater risk of developing impaired mental function and/or dementia. This study from Taiwan examines the published research to see whether there may be evidence of such a link. The authors carried out a systematic literature search using PubMed and Embase looking for relevant studies published up to July 2019. Initially, a total of 814 publications was screened. Using established research methods to eliminate duplication and minimise bias, eventually only 11 studies met the authors’ inclusion criteria. Of these, 10 studies compared 165 74 patients with psoriasis against over 450 78 controls (people without the disease), and one study compared 7118 dementia sufferers with 213 54 controls. Most of the studies (nine out of 11) found a positive association (a ‘link’) between psoriasis and the risk of developing cognitive impairment and dementia. In one study there was no association, and the remaining paper showed an inverse link (meaning that there was a reduced risk of dementia in patients with psoriasis). The authors suggest that the risk of dementia may be greatest in those with moderate to severe, rather than mild psoriasis. They also indicate that so far there is no published evidence to support the use of any specific anti‐psoriatic treatment based on effectiveness at protecting against dementia. Finally, they support the use of simple screening tools for detecting early cognitive impairment in psoriasis patients. Linked Article:   Yen et al. Br J Dermatol 2021; 184 :34–42 .     

Cellulite: Is there a role for injectables?

Background. Cellulite describes the cutaneous dimpling of the thighs, buttocks, and hips that is seen predominately in women. Current evidence suggests that structural differences in fat architecture between the sexes account for its appearance. Mesotherapy, a method of delivering medication locally with the use of numerous cutaneous injections, has recently become a popular method to purportedly treat the condition.

Methods. An overview of cellulite and adipocyte physiology, with a literature review and appraisal of compounds commonly used in mesotherapy.

Results. Experimental studies using individual mesotherapy ingredients for other conditions suggest a number of mechanisms, including lipolysis, disrupting connective tissue and augmenting circulation, which may theoretically improve cellulite. Peer‐reviewed studies have not evaluated whether these effects translate clinically.

Conclusions. Until further studies are performed, patients considering mesotherapy for cellulite must be aware that the substances currently being injected to treat this cosmetically disturbing, but medically benign, condition have not been thoroughly evaluated for safety or efficacy.     

Scleroderma and the taxanes. Is there really a link?

Scleroderma has been associated with exposure to many substances in the past ranging from vinyl chloride to silicon dioxide. In recent years there have been a number of case reports linking modern chemotherapy agents, such as the taxanes to the development of scleroderma like changes. We present a further case of scleroderma in association with chemotherapy but question the role of some of the agents previously implicated. A brief review of the current literature is included.     

Is there a relationship between homocysteine and vitiligo? A pilot study

Background Pigmentary dilution is observed in patients with homocystinuria. Therefore, it is possible that an increase of local homocysteine (Hcy) interferes with normal melanogenesis and plays a role in the pathogenesis of vitiligo. Vitamin B₁₂ and folic acid, levels of which are decreased in vitiligo, are important cofactors in the metabolism of Hcy. Consequently, a nutritional deficiency in either of these two vitamins will result in an increase in homocysteine in the circulation, a finding that we expect to find in vitiligo. Objective To determine the level of Hcy in the blood of patients with vitiligo as a first step in revealing if it has any relationship with the pathogenesis of vitiligo and consequently if this will have an impact on the treatment of vitiligo. Methods Twenty‐six patients of both sexes with vitiligo (age range 20–50 years, mean 31·4 ± 8·09) and 26 age‐matched healthy controls were included in the study. After excluding factors that may affect serum Hcy levels, blood samples from patients and controls were obtained for homocysteine determination by enzyme immunoassay. Results The mean serum level of Hcy was significantly higher in patients with vitiligo than in controls (21·61 ± 13·28 vs. 13·1 ± 4·88 μmol L^?1; P < 0·001). The Hcy level was significantly higher in male patients than in female patients (28·67 ± 15·95 vs. 15·56 ± 6·2 μmol L^?1; P < 0·001) and in male controls compared with female controls (15·07 ± 4·61 vs. 12·05 ± 4·82 μmol L^?1; P < 0·001). The homocysteine level was related to the activity of vitiligo and was significantly higher in patients with progressive disease than in controls (25·4 ± 14·99 vs. 13·1 ± 4·88 μmol L^?1; P < 0·001). No significant difference in Hcy levels was found between either untreated vitiligo patients (22·77 ± 13·36 μmol L^?1) or patients receiving ultraviolet therapy (20·45 ± 13·73 μmol L^?1) and the total patient group (21·62 ± 13·28 μmol L^?1). Conclusion An elevated homocysteine level may be a precipitating factor for vitiligo in predisposed individuals. In view of the biological role of vitamin B₁₂ and folic acid in Hcy metabolism, we present our recommendations regarding the investigation and treatment of this common disease.     

Acne and smoking: is there a relationship?

Background

There are contradictory reports on the relationship between acne vulgaris and cigarette smoking. The objective of this study was to examine the relation between acne and cigarette smoking in a case-control study.

Methods

A questionnaire on smoking habits was offered to 350 patients with acne vulgaris and 350 patients suffering from skin diseases other than acne, aged 15 – 40 years, attending in a skin clinic in Tehran, Iran. The patients completed the questionnaires anonymously in the waiting room.

Results

Two hundred and ninety-three patients with acne (response rate 83.7 %) and 301 patients with other skin diseases (response rate 86.0 %) completed the questionnaires. Twelve acne patients (4.1 %) and 27 control patients (9.0 %) were current smokers (odds ratio = 0.43, 95% confidence limits 0.22 – 0.87, p < 0.05). But after adjustment for sex, this difference was not significant (odds ratio: 0.61, 95% CI: 0.30–1.26, p > 0.05, Mantel-Haenszel test).

Conclusion

An association between acne and cigarette smoking was not found in this study.     

Pemphigus vulgaris and herpesviruses: is there any relationship?

Background Pemphigus is an autoimmune disorder, which results from interaction of exogenous and endogenous factors. One of these environmental factors is viral infections particularly, herpesviruses. We aimed to detect the presence of HSV 1 and 2 (herpes simplex virus) and HHV8 (human herpesvirus 8) in our patients who were suffering from pemphigus vulgaris. Methods In this cross‐sectional study, 38 patients (19 male and 19 female patients) with pemphigus vulgaris were entered, 32 skins and six peripheral blood cells samples were obtained from the study population. Thereafter, the presence of HHV8 and HSV DNA were evaluated by using polymerase chain reaction (PCR). Results The mean age of patients was 45.05 ± 17.24 years (range: 16–81 years). Twelve patients mentioned history of herpes labial in the past (31.57%). Results of PCR test for detection of HSV and HHV8 DNA in all 32 skin samples and five peripheral blood samples and one case with skin and blood samples were reported negative. Conclusion Inability to detect HHV8 and HSV DNA in this study suggests that herpesviruses may be only occasional factors for development or exacerbation of pemphigus vulgaris.