Saint Paul's Thorn in the Flesh: a Dermatological Weakness?

Saint Paul's thorn in the flesh has been the subject of much controversy in medical, historical and religious literature. It was crucial for the development of Paul's theology and, therefore, its study is important for a better understanding of early Christianity. The purpose of this article is to review the available evidence on this issue, perform a historical and medical critical analysis and suggest plausible diagnosis that have not been previously published in scientific literature. Our research on primary sources seem to indicate that in 41-42 AD Paul of Tarsus developed a clinical picture with a pain similar to that of a thorn injury and bad physical appearance. It could also have a chronic course with a limited number of relapses and few global. It could remind Job's illness and provoke humiliation in Paul and repulse in his audience. Multiple diseases could explain some of these data, but fewer explain all of them. Though a definitive diagnosis cannot be achieved, we think that cutaneous disorders are the most obvious candidates for a humiliating and painful disease which, however, would permit long journeys during more than a decade. Disorders with cutaneous involvement like lupus erythematosus, dermatomyositis, urticaria/angioedema, herpes simplex leukocytoclastic vasculitis or nodular vasculitis should be added to other possibilities previously reported

Photoprotection for people with skin of colour: needs and strategies

Skin of colour or pigmented skin has unique characteristics: it has a higher eumelanin-to-pheomelanin ratio, more mature melanosomes, an increased amount of melanin distributed in the upper layers of the epidermis, and more efficient DNA repair compared with lighter skin. However, individuals with skin of colour are at a significant risk of skin damage caused by ultraviolet radiation, including the development of photodermatoses and photoageing changes such as uneven skin tone, and are predisposed to pigmentary disorders. In fact, one of the most common conditions leading to dermatology consultations by patients with skin of colour is photoexacerbated pigmentary disorders. Unfortunately, individuals with skin of colour may be less prone to engage in photoprotective measures, including the use of sunscreens. Physicians are also less likely to prescribe sunscreens for them. There is thus a clear need for better education on photodamage and for more efficient and suitable photoprotection in populations with skin of colour. However, this need has thus far only partially been met, and the development of sunscreen products designed to provide optimal photoprotection for people with skin of colour remains a challenge. Targeted sunscreens for individuals with skin of colour require optimal cosmetic appeal (leaving no white residue and not disrupting skin tone). They should include broad-spectrum [ultraviolet (UV)B/UVA] protection with high sun protection factor, as well as protection against long-wave UVA (UVA1) and visible light, as these wavelengths are capable of inducing or augmenting pigmentary disorders. They may also contain depigmenting agents for patients with pigmentary disorders

Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization

Field cancerization (FC) is a chronic disease involving multiple clinical and subclinical actinic keratoses (AK) on large photo-exposed surfaces with multifocal areas of dysplasia and precancerous changes. Patients and treatment must be properly monitored and managed to avoid aggravation and progression of the disease. Management of actinic keratoses includes lesion-directed treatments, such as cryotherapy and field-directed therapies. Field-directed therapies may have the potential to address subclinical damage, reduce AK recurrence rates and potentially reduce the risk of squamous cell carcinoma development. Multiple studies have demonstrated the efficacy of field-directed treatments, including 5-fluorouracil, photodynamic therapy, imiquimod, chemical exfoliation with trichloroacetic acid and diclofenac gel, for multiple AK and FC. The choice of therapy should be based on multiple factors, such as efficacy, tolerability, patient risk profile, costs and cosmetic results. Management of AK includes not only treatment but also prevention. Medical devices, such as sunscreens containing liposome-encapsulated DNA repair enzymes, can repair DNA damage associated with chronic UV radiation and reduce the number of new AK lesions. Here we provide therapeutic pearls and expert opinions on the treatment of AK and FC (as monotherapy or in combination) with the overall aim to achieve better, faster, and well-tolerated clinical responses

Use of Topical Corticosteroids in the Treatment of Noninfectious Inflammatory Dermatoses of the Scalp: A Survey of Practicing Dermatologists and Dermatology Residents Using Delphi Methodology

Clobetasol; Scalp; Seborrheic dermatitisClobetasol; Cuir cabellut; Dermatitis seborreicaClobetasol; Cuero cabelludo; Dermatitis seborreicaBackground: Noninfectious inflammatory dermatoses of the scalp are common, and their symptomsin particular, those affecting appearance, can have a psychological effect that may be disproportionate to their clinical severity. Effective, cosmetically acceptable treatments are important to manage these conditions. Topical corticosteroids form the cornerstone of acute treatment for many of these conditions. We surveyed practicing dermatologists and dermatology residents to determine the current clinical practice in prescribing topical corticosteroids for these disorders in their various preparation formats. Methods: A Delphi method was used, consisting of 2 questionnaire rounds. The first round contained 34 questions and was completed by 612 dermatologists and dermatology residents via email. The first round of responses was analyzed, and points that had > 70% agreement were used to form a second questionnaire of 21 statements. This second round was completed by 346 participants, and their responses were used to generate a final report. Participants were practicing in both public and private practices. Results: Clobetasol propionate 0.05% topical solution was considered to be the most appropriate treatment for noninfectious inflammatory scalp dermatoses in general, with 75.1% agreement in the second round of questionnaire. The main advantages of clobetasol propionate over other topical corticosteroids were reported as potency, effectiveness, and broad action spectrum (94.8% agreement). The preferred pharmaceutical format was the solution of clobetasol propionate. Conclusion: Clobetasol propionate was the preferred topical treatment for the management of scalp dermatoses, usually as first-line treatment; solution was the preferred preparation.Publication costs funded by ISDIN S.A

The Role of Photoprotection in Optimizing the Treatment of Atopic Dermatitis

Funding: The journal's Rapid Service Fee was supported by ISDIN.Atopic dermatitis (AD) is a chronic inflammatory skin disease with an estimated prevalence of 10-15% in children and 2-10% in adults. Clinically, there is notable phenotypic variability driven by a complex interaction between genetics, immune function, and the environment. Impairment of the skin barrier plays a significant role in the pathogenesis of AD. The apparent beneficial effect of sunlight in patients with atopic eczema is questioned due to its capacity to disrupt the skin barrier and generate free radicals that can damage proteins, lipids, and DNA. The sum of the external factors that an individual is exposed to throughout their lifetime is termed the exposome. Environmental factors such as sun exposure, temperature, and humidity contribute to both AD flares and regional prevalence variation. Literature on photoprotection in atopic dermatitis is very scarce. The use of adequate sunscreens in atopic dermatitis can ensure the level of photoprotection required to prevent skin photoaging and skin cancer and to mitigate skin barrier dysfunction, decrease inflammation, and neutralize facial redness. Herein we discuss and review the role of UV radiation and the exposome in the etiology of AD, as well as the role of adequate photoprotection

Eritema necrolítico migratório associado à síndrome glucagonoma: descrição de um caso

Necrolytic migratory erythema is a rare skin condition that consists of migrating areas of erythema with blisters that heal with hyperpigmentation. It usually occurs in patients with an alpha islet cell tumor of the pancreas-or glucagonoma-and when associated with glucose intolerance, anemia, hyperglucagonemia, and weight loss defines the glucagonoma syndrome. We describe a 52-year-old female patient with necrolytic migratory erythema associated with glucagonoma syndrome who had metastatic disease at presentation and passed away one week after her admission. The autopsy showed a tumor in the body of the pancreas, which was diagnosed as a neuroendocrine tumor and confirmed by immunohistochemistry. The diagnosis of necrolytic migratory erythema is a matter of great importance, since it might be an auxiliary tool for the early detection of glucagonoma.O eritema necrolítico migratório é uma rara condição cutânea que se apresenta como lesões eritematosas, migratórias, com vesículas e bolhas na superfície, evoluindo para cura com hiperpigmentação. É freqüentemente observado em doentes com tumor de células alfa do pâncreas, ou glucagonoma, e quando associado com intolerância a glicose, anemia, hiperglucagonemia, e perda de peso definem a síndrome do glucagonoma. É descrito o caso de uma paciente do sexo feminino, 52 anos, branca, com eritema necrolítico migratório associado à síndrome do glucagonoma com doença metastática na apresentação, vindo a falecer uma semana após sua admissão. A autópsia mostrou um tumor no corpo do pâncreas diagnosticado como tumor neuroendócrino e confirmado pela imuno-histoquímica. O reconhecimento do eritema necrolítico migratório é de grande importância para a possibilidade de diagnóstico precoce do glucagonoma

A systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication?

BACKGROUND: Oral ivermectin is a safe broad spectrum anthelminthic used for treating several neglected tropical diseases (NTDs). Currently, ivermectin use is contraindicated in children weighing less than 15 kg, restricting access to this drug for the treatment of NTDs. Here we provide an updated systematic review of the literature and we conducted an individual-level patient data (IPD) meta-analysis describing the safety of ivermectin in children weighing less than 15 kg. METHODOLOGY/PRINCIPAL FINDINGS: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for IPD guidelines by searching MEDLINE via PubMed, Web of Science, Ovid Embase, LILACS, Cochrane Database of Systematic Reviews, TOXLINE for all clinical trials, case series, case reports, and database entries for reports on the use of ivermectin in children weighing less than 15 kg that were published between 1 January 1980 to 25 October 2019. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42017056515. A total of 3,730 publications were identified, 97 were selected for potential inclusion, but only 17 sources describing 15 studies met the minimum criteria which consisted of known weights of children less than 15 kg linked to possible adverse events, and provided comprehensive IPD. A total of 1,088 children weighing less than 15 kg were administered oral ivermectin for one of the following indications: scabies, mass drug administration for scabies control, crusted scabies, cutaneous larva migrans, myiasis, pthiriasis, strongyloidiasis, trichuriasis, and parasitic disease of unknown origin. Overall a total of 1.4% (15/1,088) of children experienced 18 adverse events all of which were mild and self-limiting. No serious adverse events were reported. CONCLUSIONS/SIGNIFICANCE: Existing limited data suggest that oral ivermectin in children weighing less than 15 kilograms is safe. Data from well-designed clinical trials are needed to provide further assurance

Factores inmunológicos y psicologicos y efecto del tratamiento en pacientes con vitiligo

Antecedentes El vitiligo es una enfermedad autoinmune en la que los melanocitos son destruidos por células T-antígeno-específicas. La inmunidad adaptativa juega un papel importante en la progresión de la enfermedad. Además, los cambios cutáneos del vitiligo tienen efectos significativos en la calidad de vida y la autoestima de los pacientes. La brecha entre la inmunidad adaptativa y celular en el vitiligo requiere una mejor comprensión, así como también es necesario aumentar la conciencia de los efectos psicológicos en los pacientes con vitiligo. Objetivo. El objetivo de este estudio fue mapear los niveles séricos de CXCL10 y células reguladoras T como marcadores celulares y CD91 un receptor inmune innato en pacientes con vitiligo para dilucidar su papel en la patogénesis y la actividad de la enfermedad. Se evaluó DLQI, ansiedad y depresión en los pacientes con vitíligo y su relación con la presentación clínica y gravedad de la enfermedad antes y después de dieciséis semanas de tratamiento y comparándolo con controles. Pacientes y métodos Se trata de un estudio monocéntrico aleatorizado que incluyó a 21 pacientes con vitiligo y 20 voluntarios sanos como grupo control. Se determinaron células T reguladoras, CD91, CXCL10 en sangre periférica antes y después de tratamiento con fototerapia UVB-NB asociado a khellina tópica, tacrolimus y suplementación oral de Polypodium Leucotomus. Conclusión Nuestros hallazgos sugieren que los pacientes con vitíligo tienen niveles elevados de monocitos mCD91 y niveles reducidos de sCD91 en plasma, por lo que podría representar un útil biomarcador para diagnóstico. Demostramos CXCL10 elevado en pacientes con vitíligo y disminución significativa después del tratamiento, por lo que es un útil biomarcador para enfermedad y para el seguimiento al tratamiento. Por otro lado, las células T reguladoras no se expresan de forma diferente en pacientes con vitíligo, sin embargo, sí se observó una disminución luego del tratamiento teniendo en cuenta la variable mejora. Nuestro estudio evidenció alteración de la calidad de vida, ansiedad y depresión antes del tratamiento y mejoría psicológica después de realizar tratamiento aún en los pacientes que no mejoraron clínicamente.Background vitiligo is an autoimmune disease in which melanocytes are destroyed by antigen-specific T-cell. Adaptative immunity plays an important role in progression of the disease. Additionally, the cutaneous changes of vitiligo have significant effects on quality of life and self-esteem. The gap between adaptive and cellular immunity in vitiligo requires a better understanding as well as to increase awareness of the psychological effects of vitiligo. Objective. The aim of this study was to map the serum levels of CXCL10 and T regulatory cells as a cellular markers and CD91 an innate immune receptor in vitiligo patients to declare its role in the pathogenesis and activity of vitiligo. QoL, anxiety and depression of patients with vitíligo, their relationship with clinical presentation and disease severity before and after sixteen weeks treatment and compared with controls were evaluated regarding their role in the pathogenesis of vitíligo. Patients and Methods A randomized monocentric study included 21 patients with vitiligo and 20 healthy volunteers as the control group. CD91, CXCL10 and T regulatory cells were determined on peripheral blood before and after UVB-NB phototherapy treatment associated with topical khellin, topical tacrolimus and oral Pollipodium Leucotomus supplementation. Conclusion Our findings suggest vitiligo patients have increased levels of monocyte mCD91 and reduced levels of plasma sCD91, so could represent an useful biomarker for diagnosis. We demonstrated increased CXCL10 levels and lower CXCL10 levels after treatment so could be a biomarker to follow-up the treatment response. For other hand, T regulatory and T regulatory memory cells are not differently expressed on vitiligo patients. However, shows a decrease after treatment taking into account the improvement variable. Our study noticed high dates of anxiety and depression and psychologycal improvement after the treatment even doesn´t improve clinically