Gender matter in isotretinoin therapy for acne vulgaris? A retrospective study

Introduction: Gender differences have been recently highlighted for several aspects of acne vulgaris such as epidemiology, pathogenesis, clinical course, quality of life and treatment outcome. In particular a shorter but more severe clinical course has been reported in males than in females; nevertheless, usually men have their quality of life less affected. Aim: To determine if the response and the adverse events to 1 cycle of oral isotretinoin therapy can be influenced by gender. Methods: A retrospective study was conducted on consecutive patients affected by acne vulgaris and treated with oral isotretinoin. Global acne grading system (GAGS), acne-related quality of life (AQoL) and isotretinoin-related adverse events were considered as outcome measures and were evaluated before (T0), every month during administration and 4 weeks after the withdrawal (T1) of oral isotretinoin therapy. Mann-Whitney U test and Wilcoxon signed-rank test were used for quantitative parameters and Fisher exact test for qualitative ones. Results: Forty-nine acneic patients were retrospectively selected (33 males 67.3% and 16 females -32.7%; median age: 19 years). Patients had received a median dosage of isotretinoin of 0.4 mg/kg/die for a median period of 5 months; no differences in outcome measures among genders were reported. Limitations: The study is retrospective and the sample is small and not homogenously distributed among genders, as males are double in number than females. Conclusions: In our study population gender didn't influence neither the clinical and the quality of life outcome measures nor the occurrence of adverse events to oral isotretinoin therapy for acne

Factors influencing response to ingenol mebutate therapy for actinic keratosis of face and scalp

AIM To determine factors independently influencing response to ingenol mebutate therapy and assess efficacy on clinical setting of non-hypertrophic non-hyperkeratotic actinic keratosis (AK). METHODS Consecutive patients affected by non-hypertrophic non-hyperkeratotic AKs of the face or scalp were enrolled to receive ingenol mebutate 0.015% gel on a selected skin area of 25 cm2 for 3 consecutive days. Local skin reactions were calculated at each follow up visit using a validated composite score. Efficacy was evaluated by the comparison of clinical and dermoscopic pictures before the treatment and at day 57, and classified as complete, partial and poor response. RESULTS A number of 130 patients were enrolled, of which 101 (77.7%) were treated on the face, while 29 (22.3%) on the scalp. The great majority of our study population (n = 119, 91.5%) reached at least a 75% clearance of AKs and, in particular, 58 patients (44.6%) achieved a complete response while 61 (46.9%) a partial one. Logistic backward multivariate analysis showed that facial localization, level of local skin reaction (LSR) at day 2, the highest LSR values and level of crusts at day 8 were factors independently associated with the achievement of a complete response. CONCLUSION Ingenol mebutate 0.015% gel, when properly applied, is more effective on the face than on the scalp and efficacy is directly associated to LSR score

Self‐healing triggering mechanism in epoxy‐based material containing microencapsulated amino‐polysiloxane

This work combines non-destructive X-ray micro-computed tomography (µCT) and scanning electron microscopy (SEM) to study the self-healing triggering mechanism in a system consisting of an epoxy resin, based on diglycidyl ether of bisphenol A, with embedded poly(urea-formaldehyde) (PUF) microcapsules filled with an amino-functional polysiloxane (PDMS-a) as a healing agent. µCT and SEM analyses proved that PDMS-a was effective in filling the microcrack areas, providing an efficient self-healing process, and confirmed that the main mechanisms for increasing fracture toughness are due to crack bowing and deflections. It was also observed that the diameter and shell thickness of the microcapsules are essential factors for their dispersion and integrity into the polymer matrix. PUF microcapsules with shell thickness of ca. 0.4 µm and diameters <60 µm were stable and well dispersed within the matrix. These findings shed light for understanding the increase of the fracture toughness, after self-healing, reported in our previous study of this system

Hikayat Awang Sulung Merah Muda dari perspektif pendekatan pengurusan

Makalah ini akan menekuni unsur pengurusan yang terdapat dalam cerita lipur lara, iaitu Hikayat Awang Sulung Merah Muda. Pendekatan yang digunakan dalam kajian ini ialah Pendekatan Pengurusan dengan memberi fokus terhadap Prinsip Kepimpinan, iaitu salah satu prinsip dalam Pendekatan Pengurusan yang diutarakan oleh Mohamad Mokhtar Abu Hassan. Kaedah kepustakaan dan kaedah analisis teks merupakan dua kaedah yang diaplikasi dalam kajian ini. Objektif utama kajian ini adalah untuk menganalisis Prinsip Kepimpinan yang digunakan dalam Hikayat Awang Sulung Merah Muda. Hasil analisis memperlihatkan Prinsip Kepimpinan dalam Hikayat Awang Sulung Merah Muda amat dominan dan signifikan dalam menggambarkan pengurusan kepimpinan bertitik tolak daripada analisis terhadap struktur karya. Pengurusan kepimpinan ini menyerlah daripada dasar dan mekanisme pentadbir yang berwawasan dan berpandangan jauh, berjiwa rakyat, kebijaksanaan berkomunikasi dan bersemangat waja. Secara kesimpulannya, Prinsip Kepimpinan yang dipaparkan dalam Hikayat Awang Sulung Merah Muda ini dapat mengangkat aspek pengurusan dalam teks karya sastera tradisional sejak zaman tradisi lisan

Therapeutic Options for the Treatment of Actinic Keratosis with Scalp and Face Localization

Actinic keratosis (AK) is a common skin disease related to ultraviolet chronic exposure, that is now considered a squamous cell carcinoma in situ. Primary skin cancer prevention strategies should be recommended for high risk patients. There is a wide spectrum of treatment options available for AKs, and several variables should be taken into account regarding the best therapeutic choice for each patient. The purpose of this article is to review the current treatment strategies for AKs localized on the face and scalp, with a focus on the practical point of view that could be useful for choosing the best therapeutic option. The two main therapeutic approaches will be distinguished first: lesiondirected and field-directed. Afterwards, the treatment based on clinical type and patient comorbidity will be discussed

Face and scalp basal cell carcinoma treatment: A review of the literature

Basal cell carcinoma (BCC) is the most frequent skin cancer and is characterized by slow growth, even if it can be locally invasive and rarely metastasizes. Many different phenotypic presentations and histopathologic subtypes have been described, and the current guidelines subdivide BCCs into low-risk (nodular and superficial) and high-risk subtypes (micronodular, infiltrating, and morphoeic BCC and those with squamous differentiation). Dermoscopy allows the identification of the features associated with these different subtypes. Compared with the low-risk forms of BCC, more aggressive ones tend to undergo more frequently incomplete surgical excision and perineural invasion, so the identification of these lesions before surgery is extremely important. The gold standard of treatment is surgery, particularly for the H region of the face and infiltrative lesions, but other options are available and selected according to many variables, including body area, age, comorbidities, and clinical, dermoscopic, and histopathological features of the lesion. Moreover, the possible complications of surgical approaches, namely healing defects, failure of skin grafts, and wound infection, should be considered. In this review we discuss the management of BCC localized on the face and scalp, according to the currently available treatment options. </p

Therapeutic Options for the Treatment of Actinic Keratosis with Scalp and Face Localization

Actinic keratosis (AK) is a common skin disease related to ultraviolet chronic exposure, that is now considered a squamous cell carcinoma in situ. Primary skin cancer prevention strategies should be recommended for high risk patients. There is a wide spectrum of treatment options available for AKs, and several variables should be taken into account regarding the best therapeutic choice for each patient. The purpose of this article is to review the current treatment strategies for AKs localized on the face and scalp, with a focus on the practical point of view that could be useful for choosing the best therapeutic option. The two main therapeutic approaches will be distinguished first: lesiondirected and field-directed. Afterwards, the treatment based on clinical type and patient comorbidity will be discussed

Therapeutic Options for the Treatment of Actinic Keratosis with Scalp and Face Localization

Actinic keratosis (AK) is a common skin disease related to ultraviolet chronic exposure, that is now considered a squamous cell carcinoma in situ. Primary skin cancer prevention strategies should be recommended for high risk patients. There is a wide spectrum of treatment options available for AKs, and several variables should be taken into account regarding the best therapeutic choice for each patient. The purpose of this article is to review the current treatment strategies for AKs localized on the face and scalp, with a focus on the practical point of view that could be useful for choosing the best therapeutic option. The two main therapeutic approaches will be distinguished first: lesiondirected and field-directed. Afterwards, the treatment based on clinical type and patient comorbidity will be discussed

Cardiovascular Risk Evaluation through Heart Rate Variability (HRV) Analysis in Patients with Psoriasis before and after 12 Weeks of Etanercept Therapy: A Preliminary Prospective Study

Background The association between psoriasis and cardiovascular diseases is suggested by epidemiological studies. The sub-inflammatory systemic state that characterizes both psoriasis and atherosclerosis has been proposed as the link between these conditions; it cannot, however, explain the increased incidence of sudden cardiac death reported in young patients with severe psoriasis without common cardiovascular risk factors. In a previous study we reported higher levels of autonomic dysregulation in psoriatic patients, concluding that the prevalence of the sympathetic arm over the para-sympathetic one could increase cardiovascular risk. Objectives To assess the influence of etanercept, an anti-TNFα agent, on the autonomic cardiovascular regulation in young patients with moderate-to-severe psoriasis without cardiovascular risk factors. Methods Five-minute ECG recordings were collected at rest conditions before and after 12 weeks of therapy with etanercept in 19 young psoriatic patients without cardiovascular risk factors. The Cardiolab CE pocket PC ECG system was used for linear methods of heart rate variability (HRV) analysis. Results No significant change in HRV analysis parameters was apparent after 12 weeks of etanercept therapy. Conclusion Our data suggest that treatment with etanercept in patients with moderate-to-severe psoriasis doesn\u27t affect cardiovascular autonomic regulation, and subsequently the cardiovascular risk.</p

Genetic Determinants of Lipids and Cardiovascular Disease Outcomes: A Wide-Angled Mendelian Randomization Investigation.

BACKGROUND: Evidence from randomized trials has shown that therapies that lower LDL (low-density lipoprotein)-cholesterol and triglycerides reduce coronary artery disease (CAD) risk. However, there is still uncertainty about their effects on other cardiovascular outcomes. We therefore performed a systematic investigation of causal relationships between circulating lipids and cardiovascular outcomes using a Mendelian randomization approach. METHODS: In the primary analysis, we performed 2-sample multivariable Mendelian randomization using data from participants of European ancestry. We also conducted univariable analyses using inverse-variance weighted and robust methods, and gene-specific analyses using variants that can be considered as proxies for specific lipid-lowering medications. We obtained associations with lipid fractions from the Global Lipids Genetics Consortium, a meta-analysis of 188 577 participants, and genetic associations with cardiovascular outcomes from 367 703 participants in UK Biobank. RESULTS: For LDL-cholesterol, in addition to the expected positive associations with CAD risk (odds ratio [OR] per 1 SD increase, 1.45 [95% CI, 1.35-1.57]) and other atheromatous outcomes (ischemic cerebrovascular disease and peripheral vascular disease), we found independent associations of genetically predicted LDL-cholesterol with abdominal aortic aneurysm (OR, 1.75 [95% CI, 1.40-2.17]) and aortic valve stenosis (OR, 1.46 [95% CI, 1.25-1.70]). Genetically predicted triglyceride levels were positively associated with CAD (OR, 1.25 [95% CI, 1.12-1.40]), aortic valve stenosis (OR, 1.29 [95% CI, 1.04-1.61]), and hypertension (OR, 1.17 [95% CI, 1.07-1.27]), but inversely associated with venous thromboembolism (OR, 0.79 [95% CI, 0.67-0.93]) and hemorrhagic stroke (OR, 0.78 [95% CI, 0.62-0.98]). We also found positive associations of genetically predicted LDL-cholesterol and triglycerides with heart failure that appeared to be mediated by CAD. CONCLUSIONS: Lowering LDL-cholesterol is likely to prevent abdominal aortic aneurysm and aortic stenosis, in addition to CAD and other atheromatous cardiovascular outcomes. Lowering triglycerides is likely to prevent CAD and aortic valve stenosis but may increase thromboembolic risk