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   Table of Contents - Current issue
Coverpage
July-September 2022
Volume 40 | Issue 3
Page Nos. 127-193

Online since Thursday, September 29, 2022

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EDITORIAL  

Next-generation bioinformatics in dermatology research p. 127
Yi-Ju Chen
DOI:10.4103/1027-8117.357359  
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REVIEW ARTICLES Top

Skin microbiome in acne vulgaris, skin aging, and rosacea: An evidence-based review Highly accessed article p. 129
Yu-Ching Weng, Yi-Ju Chen
DOI:10.4103/ds.ds_28_22  
The goal of this systematic review was to explore emerging perspectives on the role of skin microbiota in acne vulgaris, skin aging, and rosacea. We searched the literature for published clinical trials, randomized controlled trials, cross-sectional studies, and cohort studies, both experimental and observational, whose primary main purpose was to ascertain the associations between the skin microbiome and chronic skin disease, acne vulgaris, rosacea, and skin aging, using the Embase and PubMed databases. Fifty-one relevant published articles were identified for systematic review (up to December 2021). The possible roles of the skin microbiome in these skin diseases were explored to shed light on its development and to identify potential therapeutic targets for treatment. However, the mechanisms of microbial interaction in these diseases are still under-studied. The results of this evidence-based review suggest that it may be possible to develop individualized therapies targeting the pathogenic strains within the skin microbiome involved in these diseases. This alternative therapeutic approach, involving modifications of the microbiome, may form the basis of the next generation of treatment, known collectively as “ecobiological” anti-inflammatory therapies.
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Coronavirus disease 2019 in dermatology practice: Perspective of three levels of prevention on public health p. 143
Chengwen Luo, Cai-Zheng Geng, Yung-Hsien Tung, Bing-Long Wang, Tao-Hsin Tung
DOI:10.4103/ds.ds_33_22  
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has become a major public exigency of international concern. The COVID-19 epidemic has spread rapidly around the world, profoundly impacting people's lives. Patients are among those most affected by the pandemic. COVID-19 has adversely affected health-care systems, and the effects are long-lasting and devastating. Most medical institutions in the impacted countries and regions have been imbued with COVID-19 cases, both confirmed and suspected, leading to an overburdened health-care workforce like never before. While most of the critical situations involved internal medicine departments, such as infectious diseases, and intensive care units, other specialties, including dermatology, have also been profoundly affected by this pandemic. Dermatoepidemiology, the application of epidemiological methods to dermatology practice, is an important emerging discipline in dermatology. In this review, we discussed the influence of the COVID-19 epidemic on dermatology practice, as well as the application of public health strategies in dermatology. These findings from genetic epidemiological research, clinical trial networks, and pharmacovigilance research suggested that further research in dermatology requires collaborative studies across different fields, institutions, and countries. To solve the highly complex unsolved problems that we face, dermatologists and epidemiologists should be dynamic team members with multiple approach skills.
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Polypoid basal cell carcinoma: A scoping review p. 148
Po-Chien Wu, Ying-Xiu Dai, Yu-Ju Chou, Yun-Ting Chang, Chih-Chiang Chen, Sheng-Hsiang Ma
DOI:10.4103/1027-8117.354330  
Polypoid basal cell carcinoma (BCC) is characterized by a stalk connecting the tumor and skin surfaces, with neoplastic cells restricted in the polypoid zone microscopically. A thorough review of polypoid BCC is still lacking. Thus, we performed this scoping review to investigate the clinical manifestations, dermoscopic features, histopathology, treatment, and prognosis of polypoid BCC. A literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane databases until December 23, 2021. Studies reporting at least one patient with polypoid BCC following the pathology and clinical criteria were included. A total of 47 studies with 54 patients with solitary polypoid BCC and 13 patients with multiple polypoid BCCs were included. Solitary polypoid BCC occurred at a relatively younger age, with an equal sex ratio. These tumors most commonly presented as red or flesh-colored pedunculated papules and were commonly distributed over nonsun-exposed areas. Most tumors were managed with excision, and recurrence or metastasis was seldom reported. Most patients with multiple polypoid BCCs had basal cell nevus syndrome and presented with generalized distributed, flesh-colored, or brown papules mimicking skin tags. Typical dermoscopic features of BCC could still be observed in these lesions, including arborizing vessels, blue-gray globules, and ovoid nests, which could aid in early diagnosis. In conclusion, polypoid BCC is a distinct variant of BCC with pedunculated morphology. Physicians should be aware of polypoid BCC and may use dermoscopy to aid in early diagnosis and treatment.
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ORIGINAL ARTICLES Top

YouTube as a source of information for hidradenitis suppurativa treatment p. 156
Milosz Lewandowski, Zuzanna Swierczewska, Wioletta Baranska-Rybak
DOI:10.4103/ds.ds_27_22  
Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by a significant decrease in the patients' quality of life. Patients are increasingly looking for information about HS on social media, including YouTube (YT). However, the quality of the videos in some other diseases has been often scored as poor. Objectives: The aim of this study was to evaluate the usefulness and the quality of the most viewed acne inversa videos on YT. Methods: YT was searched for the keywords “HS” and “acne inversa.” For videos, quality assessment validated DISCERN instrument and the global quality score (GQS) were applied. Furthermore, the popularity of each video using the video power index (VPI) score was evaluated. Results: After applying the exclusion criteria, 34 videos were analyzed. We found that video quality was poor regardless of video type. The mean DISCERN score between the raters was 34.65 ± 10.7, and the mean GQS score was 2.6 ± 0.98. There was no significant correlation between the DISCERN, GQS and VPI, the number of views, likes, dislikes, comments, and video duration. Conclusion: Our study highlights the gaps in knowledge regarding HS treatment on YT. Hence, this information can be used to create superior educational content in the future.
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Identification of immune-related genes in atopic dermatitis, contact dermatitis, and psoriasis: A bioinformatics analysis p. 162
Lian Zhang, Hai-Liang Wang, Xue-Qiu Tian, Wei-Lan Liu, Yue Hao, Lei Gao
DOI:10.4103/ds.ds_26_22  
Background: The exact mechanisms and targeted therapies for atopic dermatitis (AD), contact dermatitis (CD), and psoriasis (PS) remain unknown. Objectives: This study aimed to identify the biomarkers related to immune and novel therapeutic drugs for AD, CD, and PS. Methods: The GSE153007 dataset including 12 AD, 9 CD, and 14 PS samples and 40 control samples, which was obtained from the Gene Expression Omnibus database and analyzed. The immune infiltration level of each sample was then evaluated using the single-sample gene set enrichment analysis (ssGSEA). Then, we screened for immune-related differentially expressed genes (DEGs) that overlapped. The Database for Annotation, Visualization, and Integrated Discovery database was used to perform the gene ontology (GO) biological process. Furthermore, using search tool for the retrieval of interaction gene (STRING), the protein-protein interaction (PPI) was predicted on immune-related DEGs. We also searched the DGIdb database for novel therapeutic drugs for AD, CD, and PS. Results: According to ssGSEA results, most immune cells were highly infiltrated in the disease group. GO analysis indicated that AD, CD, and PS were enriched in signal transduction, inflammatory response, immune response, and innate immune response. We further found hub genes related to AD (CD4, ITGAM), CD (CD8A, CD86), and PS (CD4, CD8A) from PPI network. Moreover, the drug prediction indicated that drugs targeting CSF1R was the most effective for AD, whereas drugs targeting FCGR3A and CD86 were more effective for CD and PS. Conclusion: These immune-associated genes such as FCGR3A, CD86, and CSF1R might be regarded as therapeutic targets for patients with AD, CD, and PS.
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Prevalence and associated factors of skin diseases among geriatric outpatients from a metropolitan dermatologic clinic in Thailand p. 168
Jedpakorn Laopakorn, Sujirod Hanthavichai
DOI:10.4103/1027-8117.354329  
Background: The importance of the geriatric population has been increasing expeditiously in the health-care system. The epidemiology of skin disorders is an interesting subject to challenge physicians to comprehensively manage the elderly. Objectives: The objective of the study was to determine the prevalence of the most frequent dermatologic disorders among elderly outpatients and identify major associated determinants. Methods: This retrospective observational study recruited subjects aged 60 years and older attending the dermatologic clinic at the Faculty of Medicine, Vajira Hospital, in Thailand. The medical records were collected between January 2017 and December 2020. The data were analyzed according to age, sex, season, underlying medical diseases, and areas of involvement to identify the associated factors for the frequently presented dermatologic diagnoses. Results: In this study, 521 outpatients (including 218 males and 303 females) with a mean age of 71.34 years (range, 60–04 years) were enrolled. The most common dermatoses were eczematous dermatitis (35.7%), cutaneous infection (18.2%), xerosis (15.5%), and psoriasis (7.3%). The distribution of the prevalent dermatologic disorders still did not change during the COVID-19 pandemic. A significant association was found between xerosis and age of 80 years and older (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.09–3.78; P = 0.026). The risk of developing xerosis cutis significantly decreased with dyslipidemia (OR, 0.45; 95% CI, 0.26–0.78; P = 0.004). Conclusion: The three foremost cutaneous disease groups are eczematous dermatitis, skin infection, and xerosis cutis. Dry skin is strongly connected with the age of 80 years and above; however, xerosis is coincidentally correlated with dyslipidemia.
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Comorbid laboratory abnormalities in female pattern hair loss patients p. 174
Hsin-Jou Wang, Jui-Wen Yeh, Yin-Fan Chang, Jin-Shang Wu, Chao-Chun Yang
DOI:10.4103/1027-8117.357357  
Background: Female pattern hair loss (FPHL) is the main cause of alopecia in women and has a debilitating impact on the quality of life. However, certain comorbid conditions causing hair loss are often masked by FPHL and may remain undetected. Hence, it is imperative to identify them to administer appropriate treatment. The necessity of laboratory tests to evaluate these comorbidities in patients with FPHL has not been established. Objectives: This study aimed to identify the frequency of comorbid abnormalities detected by laboratory tests in patients with FPHL. Methods: Routine laboratory test results of patients with FPHL, who visit our hair clinic for the first time, were retrospectively collected and analyzed. These tests assessed the serum testosterone, thyroid-stimulating hormone, free thyroxin, zinc and ferritin levels, hemoglobin, as well as antinuclear antibody (ANA), and rapid plasma reagin test results. The correlation between age and hair loss severity and the frequency of comorbidities was evaluated using subgroup analysis. Results: Among the 356 patients with FPHL, coexisting zinc deficiency, iron depletion, and thyroid abnormalities were common and present in 41.7%, 39.7%, and 11.3% of them, respectively. The rate of concomitantly increased ANA titers was relatively low (4.4%), while that of syphilis and high serum testosterone levels was extremely low (0.3% and 0%, respectively). Younger patients (<50 years) with FPHL had a higher rate of coexisting iron deficiency than patients in the older age group. Conclusion: Testing for concomitant iron depletion, zinc deficiency, and thyroid disease is recommended in female patients with FPHL.
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BRIEF REPORT Top

Three monthly doses of corticosteroid pulse therapy yields a satisfactory but temporary response in severe alopecia areata patients p. 178
Heng-An Lu, Chao-Chun Yang, Yu-Chen Chen
DOI:10.4103/1027-8117.357355  
Alopecia areata (AA) is a common, nonscarring type of alopecia that can cause chronic and severe hair loss in some cases. Although there is no standard established protocol for the use of corticosteroid pulse therapy, it has been reported to be an effective and well-tolerated treatment option for patients with severe AA. This study retrospectively analyzed 29 patients who were diagnosed with severe AA (>50% hair loss) from January 2010 to December 2020 and treated with 3 monthly sessions of intravenous corticosteroids. Methylprednisolone (500 mg/day) was administered for 3 consecutive days during the first session, followed by a 1-day treatment regimen for the second and third sessions. The treatment had an overall satisfactory response rate of 58.6% and a complete response rate of 13.8%. Eleven of the 13 patients who achieved a satisfactory response experienced relapse. A subgroup analysis showed that patients with a shorter duration of AA (≤6 months) had a significantly better response to corticosteroid pulse therapy. This study highlights that 3 monthly sessions of corticosteroid therapy are sufficient to induce satisfactory but temporary response.
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CORRESPONDENCES Top

Papuloerythroderma of Ofuji as a paraneoplastic phenomenon in a patient with lung cancer p. 182
Wei-Yao Wang, Yue-Chiu Su, Cheng-Che E Lan, Szu-Hao Chiu
DOI:10.4103/ds.ds_25_22  
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A case of papuloerythroderma of Ofuji possibly associated with a combination drug of losartan potassium/hydrochlorothiazide p. 184
Gyohei Egawa, Kenji Kabashima
DOI:10.4103/ds.ds_30_22  
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Apremilast for lithium-associated psoriasis p. 186
Joohyung Youh, Hajime Miyazawa, Hiroaki Iwata, Ken Natsuga, Hideyuki Ujiie
DOI:10.4103/ds.ds_32_22  
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A novel mutation in Keratin 10 passed down in a family with familial steatocystoma multiplex p. 188
Kun-Lin Lu, Chuang-Wei Wang, Wen-Hung Chung, Fang-Ying Wang
DOI:10.4103/1027-8117.357356  
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Cutaneous annular erythema associated with Sjögren's syndrome successfully treated by baricitinib p. 190
Sheng-Wen Liu, Wei-Ming Wang, Chien-Ping Chiang, Chih-Tsung Hung, Yi-Hsien Chen
DOI:10.4103/1027-8117.355702  
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Folliculotropic mycosis fungoides successfully treated with bath psoralen plus ultraviolet a therapy p. 192
Yu-Ting Hung, Meng-Sui Lee, Tai-Chung Huang, Su-Ying Wen, Ruey-Yi Lin, I-Ling Liu
DOI:10.4103/1027-8117.354328  
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