John Plante*, Chelsea Eason, Alan Snyder, Dirk Elston

Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina

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Jason S Seidman1, Dawn Z Eichenfield2, Charisse M Orme2*

1School of Medicine, University of California San Diego, San Diego, California, USA

2Department of Dermatology, University of California San Diego, San Diego, California, USA

Bullous pemphigoid (BP) is an autoimmune blistering condition, often presenting in elderly individuals with pruritis and tense bullae. While standard treatment involves steroids, steroid sparing agents, and anti-inflammatory therapies, clinicians are increasingly utilizing novel biologics off-label for refractory cases. We recently reported a case of successful treatment of BP using dupilumab, a monoclonal interleukin 4 receptor alpha (IL-4Rα) antibody that modulates type 2 inflammation through dual inhibition of IL-4 and IL-13 signaling. Here, we discuss how the reported efficacy of dupilumab and certain other biologics in treating BP implicates type 2 inflammation as an important driver of BP pathogenesis. Furthermore, reports of dupilumab successfully treating patients with other pruritic dermatologic diseases highlight the importance of type 2 inflammation, particularly through IL-4Rα signaling, in chronic pruritis. The rapid development of these biologic therapies presents new opportunities for research and treatment of inflammatory dermatologic disorders.

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Ruri D. Pamela

Department of Dermatology, Dr. Suyoto Hospital Ministry of Defense, Jakarta, Indonesia

Air pollution as an impact of modern urbanization and industrialization continues to increase and has become a global problem. The human skin organ acts as a barrier and frontline to external environment, so it is frequently directly exposed to pollution. A Greenpeace report released in early 2019 listed Jakarta as South Asia’s most polluted city. The effect of major air pollutants such as nitric oxide, polycyclic aromatic hydrocarbons, volatile organic compounds, and particulate matter to human skin has been investigated in few studies. This article reviews how air pollutants currently perceived as a major cause of skin aging through their mechanism in damaging skin barrier and increase accumulation of reactive oxygen species.

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Andreas Nikolis1,2*, Kaitlyn M. Enright2

1Associate professor of Plastic Surgery, Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada

2Erevna Innovations Clinical Research Unit, Westmount, Quebec, Canada

Hyaluronic acid (HA) substrates in facial rejuvenation have been a long-standing staple in the aesthetic injector’s offerings. The development of different technologies, variability in the concentration of HA within the gels and different types of cross-linking methodologies have led to the development of many skews across multiple companies. When addressing micro-droplet techniques whereby small aliquots of HA are deposited in the dermis, few have developed a safety and efficacy profile that supports claims of improved skin quality. The concept of adding HA into the dermis is inherently a correct one, as this glycosaminoglycan is able to bind and retain water in a significant fashion. Successful management of skin quality requires specific quantities of HA to be precisely placed at the appropriate depth using a reproducible volume. These aforementioned factors all contribute to successful skin quality improvements. We present a clinical summary of pearls and pitfalls in managing skin quality with micro-droplet HA that we have identified over the last 4 years.

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Flora Canzona1, Mammucari Massimo2*, Arianna Tuzi3, Enrica Maggiori2, Maria Gabriella Grosso4, Luciano Antonaci2, Stefania Santini3, Anna Rosa Catizzone3, Fiammetta Troili3, Alessandra Gallo3, Teresa Paolucci3, Piergiovanni Rocchi3, Costanza Guglielmo3, Domenico Russo5, Chiara Giorgio6, Dario Dorato3, Raffaele Di Marzo3, Giovanna Viglione3, Anna G Fiorentini3, Manuela Giardini3, Silvia Natoli7

1Istituto Dermopatico dell'Immacolata, IRCCS Foundation, Rome, Italy

2Primary Care Unit ASL RM 1, Rome, Italy

3Member of the Italian Society of Mesotherapy, Rome, Italy

4Ospedale Israelitico, Rome Italy

5San Marco Hospice and Palliative Care, Latina, Italy

6Rehabilitation Unit, F Pirinei Hospital, Altamura (BA), Italy

7Department of Clinical Science and Translational Medicine, Tor Vergata University, Rome, Italy

Mesotherapy consists of a series of micro injections in the superficial layer of the skin of active ingredients that slowly diffuse into the underlying tissues. This technique is applied in different clinical conditions and also in dermatology it could play a useful role in the treatment path of many patients. However, further clinical studies are needed to standardize its application in various dermatological pathologies. The recommendations of the Italian Mesotherapy Society aim at personalized therapy based on evidence, efficacy and safety.

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Rebecca Liu1, Braden M. Candela2, Joseph C English III2*

1University of Pittsburgh School of Medicine

2Department of Dermatology, University of Pittsburgh, Pittsburgh, PA

Psoriatic arthritis (PsA) may affect up to a third of patients with psoriasis. It is characterized by diverse clinical phenotypes and as such, is often underdiagnosed, leading to disease progression and poor outcomes. Nail psoriasis (NP) has been identified as a risk factor for PsA, given the anatomical connection between the extensor tendon and nail matrix. Therefore, it is important for dermatologists to screen patients exhibiting symptoms of NP for joint manifestations. On physical exam, physicians should be evaluating for concurrent skin and nail involvement, enthesitis, dactylitis, and spondyloarthropathy. Imaging modalities, including radiographs and ultrasound, may also be helpful in diagnosis of both nail and joint pathology. Physicians should refer to Rheumatology when appropriate. Numerous systemic therapies are effective at addressing both NP and PsA including DMARDs, biologics, and small molecule inhibitors. These treatments ultimately can inhibit the progression of inflammatory disease and control symptoms, thereby improving quality of life for patients.

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Nicholas X. Williams1, Aaron D. Franklin1,2*

1Department of Electrical and Computer Engineering, Duke University, Durham NC 27708, USA

2Department of Chemistry, Duke University, Durham NC 27708, USA

Real-time monitoring of relevant biological signals, in combination with the timely delivery of target drugs, would be ideal for treating most medical conditions. However, access to biological fluids without a bulky, costly, and cumbersome apparatus remains challenging, as does the ability to deliver drugs of controlled dosage in a similarly unobtrusive fashion. The skin provides a promising medium for access and dosing using biomedical electronics, colloquially dubbed electronic tattoos. Recent developments in biologically compatible, flexible materials and devices have brought electronic tattoos closer to reality for sensing biomarkers extracted from the skin and delivering target drugs through the dermis. In this review, the materials and engineering requirements, fabrication developments, and sensing and therapeutic advancements of electronic tattoos are presented. Three components are required for a complete theragnostic electronic tattoo system: 1) supporting electronics for control and data transmission; 2) diagnostic sensors, categorized as mechanical (measure an internal stimulus) and chemical (measure a chemical change); and 3) therapeutics for drug delivery. The leading approaches for fabrication are summarized, including the transfer of flexible devices to the skin and the direct printing of devices onto the epidermis. Altogether, while significant obstacles remain, the advancements in this field show great promise for realizing electronic tattoo theragnostics to revolutionize point-of-care medicine.

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Dillon D Clarey, Adam V Sutton, Ryan M Trowbridge*

University of Nebraska Medical Center, Department of Dermatology, Omaha, NE

Cryptococcal cellulitis is a rare dermatologic diagnosis most often seen in immunocompromised patients. We present a case of disseminated Cryptococcus presenting as cellulitis in a patient with decompensated cirrhosis. We discuss various presentations of Cryptococcus in the skin, both as primary and disseminated disease.

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Rattan L. Mittal*

Emeritus Professor, Orthopaedic Department, GOMCO, Patiala, India

Introduction: Congenital clubfoot, the commonest orthopaedic defect and with very high prevalence rate in LMICs with tremendous GBD (80% global population), still remains unsolved, with 95% relapses/ under-corrections, in extreme deformities (Mittal1), besides the umpteen uncorrected deformities. Author has researched this unexplored area for over fifty years, still continuing. AIM: Cosmetology/ Plastic surgery are the deep routed foundations of this high rise, evidence based, research. Being need based, it was destined to happen in three phases. This is, FIRST EVER, successful use of the four popular plastic procedures in a single incision1 (Rotation, Z-plasty, vY-plasty and Fillet flaps), nicknamed as FUSION 4-in1, by any surgeon (including plastic and orthopaedic surgeons) on any part of HUMAN BODY, leave aside CLUBFOOT. This is A LOUD AWARENESS CALL for improving looks, function and avoiding complications.

Methods: These were need based, 3 phased, persistent, sequential endeavors: PHASE 1, the anatomical dissections2 and years of clinical observations, leading to discovery of heterogeneous 3D skin contractures (foot being a 3D organ) as the reason for all failures. Rotation flap was used for the first time in CLUBFOOT for correcting grade 1 of this deformity with an authentic publication of a series of one hundred cases documented in SICOT JOURNAL (Mittal)3. With a thumbs-up start, it progressed to higher evolutionary stage of PHASE 2, in more extreme deformities: combining Z- plasties (1, 2 or even 3 Zs) with rotation flap as 2-in-1 incision and then to PHASE 3 for even more rigid deformities, adding VY-plasty also with rotation + Z-plasty, as 3-in-1 incision and even adding fillet flap as 4-in-1 in a lone OCTOPUS CLUBFOOT, World’s first case. RESULTS and CONCLUSIONS: The Triple or even Tetra skin expanding incision gave consistently gratifying results with longer, flexible, better functioning and pleasing looking feet, with long term follow up as reported and published in a Landmark SICOT publication of 1080 cases over a 40 years period with a long term follow up averaging 12½ years (Mittal)1.

Cosmetology and plastic surgery, in this evidence based, cutting edge research, achieved the distinction of, FIRST EVER use of the 4 procedures in a single incision transforming “CROOKED TO ROZY FEET”. ROZY is an acronym and stands for ROtation, Z-plasty and vY-plasty (Mittal)4. This is also a LOUD Awakening Call to disseminate this surgical concept for correcting the more rigid and severe deformities, with relapses and under-corrections at any age, including the uncorrected ones for the Global clubfoot community.

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Katarzyna Smejda1, Agnieszka Brzozowska1, Daniela Podleck1, Kinga Polanska2, Joanna Jerzynsk1*

1Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland

2Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland

During pregnancy, women are more prone to stress and at risk of distress due to deep hormonal and physiological changes. The aim of this systematic review was to examine whether maternal stress during pregnancy increases the risk of atopic diseases in the children.

A review of the literature was performed using three databases: PubMed, Web of Science, EBSCO. We limited the results to human-subject studies published in English between January 2010 and September 2019. This systematic review suggests a relationship between maternal stress during pregnancy and allergic diseases in the child. The findings highlight the importance of the implementation of stress reduction programs for pregnant women and those in their postpartum period within communities in order to enable these individuals to relieve stress effectively.

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