Potential skin problems of diabetes mellitus patients: a review

Diabetes mellitus (DM) is one of the common metabolic disorders, and a major part of chronic diseases, the prevalence of which tends to increase due to multifactor. Blood vessels, kidneys, lungs, and skin are among the organs that are affected. The first problem that arises, or commonly exists among one-third of diabetics, are problems with their skin, although skin lesions may develop along with the progress of the disease, or can occur during the later phase of DM. The prevalence and symptoms of skin problems in type 1 DM (T1DM) and type 2 DM (T2DM) are often unclear, and at the beginning of the course of the diseases they often go undiagnosed. Several theories regarding the pathophysiology of DM can be used as a logical reference for the early identification and diagnosis of skin problems, aimed at preventing the worsened condition. The use of skin autofluorescence (SAF) and AGEs reader in several cases of skin problems, can also be an important marker as an adjunct to predict the possibility and progressiveness of DM. Skin problems linked to patients with DM can be categorized as strongly related to diabetes, non-specific and related to DM, skin infection in DM, and skin problems due to diabetic medication. With the current COVID-19 pandemic, there are additional demands for more critical investigation of skin problems in patients with DM. The skin problems that occur in DM may need to be examined from the early stage and it is necessary to inhibit the progression of skin problems, as well as to consider the need for multidisciplinary DM therapy

Skin and Gut Microbiota in Psoriasis: A Systematic Review

Paying attention to a microbial approach may lead to improvements in diagnosis, treatment, prevention, and prognosis of psoriasis. A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines searching strategy to identify the pattern of the microbiome and the association of skin and gut microbiota with psoriasis, including the factors that may affect the results of the microbial study. In total, 16 studies were included in this systematic review. Ten studies investigated the skin microbiome, of which six studies were cross-sectional and four studies were prospective studies. Six studies investigated the gut microbiome, including five cross-sectional studies and one prospective study. The understanding of the relationship between microbiota and psoriasis may lead to diagnostics and treatment improvements. Currently, there is a slight consensus on some specific features that define psoriasis. However, no specific taxa have been identified as biomarkers of the disease, even from large-scale cohort studies. Thus, future cohort studies with standardized methodologies and proof-of-concept investigations in animal models may uncover the role of microbiota and the microbial pathways in psoriasis

Cost-effectiveness of omalizumab for the treatment of chronic spontaneous urticaria

Background: Chronic spontaneous urticaria (CSU) is a skin disease with itchy hives and/or angio-oedema that last for at least 6 weeks without an obvious external trigger. Objectives: To determine the cost-effectiveness of omalizumab relative to standard of care (SoC; up to four times the daily dose of H1-antihistamines) in the Netherlands from a societal perspective. Methods: The Markov model used consisted of five healt

Prevalence of cutaneous adverse events associated with long-term disease-modifying therapy and their impact on health-related quality of life in patients with multiple sclerosis: A cross-sectional study

Background: Glatiramer acetate (GA) and interferon-beta (IFN-β) are disease-modifying therapies (DMTs) for multiple sclerosis that are administered through subcutaneous (SC) or intramuscular (IM) injections. Skin reactions associated with DMTs are common and may influence patient's health-related quality of life (QoL). We aimed to determine the prevalence of cutaneous adverse events associated with long-term DMT use, and to assess the impact of cutaneous adverse events on QoL. Methods: A cross-sectional study among patients with multiple sclerosis who had been treated with their first DMT for at least 2 years. Cutaneous events were assessed from photographs of injection-sites by dermatologists blinded for DMT. Generic and dermatology-specific health-related QoL were assessed using validated patient-reported questionnaires. Results: A total of 229 patients were enrolled, of whom 156 (68%) had at least one skin reaction. The prevalence of cutaneous adverse events was higher for SC DMTs (75-82%) compared to IM DMT (41%) (P < 0.001). Erythema and lipoatrophy were the most common skin reactions, observed in 156 (68%) and 45 (20%) patients, respectively. Dermatology-specific, but not generic, QoL was significantly lower among patients with skin reactions compared to those without. Conclusions: The prevalence of cutaneous adverse events was high in long-term DMT-treatment. Patients with cutaneous adverse events had a lower perceived dermatology-specific QoL

Dietary diversity and poverty as risk factors for leprosy in Indonesia: A case-control study

Background: Poverty has long been considered a risk factor for leprosy and is related to nutritional deficiencies. In this study, we aim to investigate the association between poverty-related diet and nutrition with leprosy. Methodology/Principal findings: In rural leprosy-endemic areas in Indonesia, we conducted a household-based case-control study using two controls for each case patient (100 recently diagnosed leprosy patients and 200 controls), matched for age and gender. All participants were interviewed to collect information on their demographics, socioeconomic situation, health, and diet. Body mass index, dietary diversity score, as well as anemia and iron micronutrient profiles were also obtained. By means of univariate, block-wise multivariate, and integrated logistic regression analyses, we calculated odds ratios between the variables and the occurrence of leprosy. Unstable income (odds ratio [OR], 5.67; 95% confidence interval [CI], 2.54–12.64; p = 0.000), anemia (OR, 4.01; 95% CI, 2.10–7.64; p = 0.000), and higher household food insecurity (OR, 1.13; 95% CI, 1.06–1.21; p = 0.000) are significantly associated with an increased risk of having leprosy. Meanwhile, higher education (OR, 0.34; 95% CI, 0.15–0.77; p = 0.009) and land ownership (OR, 0.39; 95% CI, 0.18–0.86; p = 0.019) have significant protective associations against leprosy. Although lower dietary diversity, lack of food stock, food shortage, low serum iron, and high ferritin were found more commonly in those with leprosy, the occurrence of leprosy was not significantly associated with iron deficiency (OR, 1.06; 95% CI, 0.10–11.37; p = 0.963). Conclusions/Significance: Food poverty is an important risk factor for leprosy susceptibility, yet the mechanisms underlying this association other than nutrient deficiencies still need to be identified. With a stable incidence rate of leprosy despite the implementation of chemoprophylaxis and multidrug therapy, improving dietary diversity through food-based approaches should be initiated and directed toward high-prevalence villages. The possible underlying factors that link poverty to leprosy other than nutrient deficiencies also need to be identified