Actinic Superficial Folliculitis after Sun Exposure in a 29-Year-Old Woman

The authors report the clinical case of a 29-year-old Caucasian woman who presented with clinicopathological findings and a previous outbreak all suggestive of actinic superficial folliculitis, a rarely reported and probably misdiagnosed phototoxic sun-induced dermatosis first described by Nieboer in 1985. Despite the exuberance of this cutaneous eruption, it is usually auto-limited, reinforcing the importance of its knowledge, for eviction of unnecessary diagnostic tests and therapies. Mechanisms of pathogenesis postulated include ultraviolet A radiation and local heat. This photodermatosis presents as monomorphic, superficial, pustular, and non-pruritic folliculitis affecting the upper body but not the face, usually arising on neck, back, shoulders and upper trunk. The follicular pustules emerge 24 - 72 h after intense exposure to heat and/or sunlight and fade spontaneously in 5 - 10 days, without scarring. This patient showed a 48-hour latency period;the number of pustules and area of the body affected were proportional to the duration of the sunlight exposure;the eruption lasted approximately 10 days. Actinic superficial folliculitis has a specific histology with follicular subcorneal sterile pustules and a mixed inflammatory infiltrate around hair follicles, probably secondary to keratinocytes and Langerhans cells involvement in the immunomodulatory actions of ultraviolet radiation. Recurrence under identical conditions may occur, after a latency period of at least 4 weeks, but usually about 1 year. Actinic superficial folliculitis and related follicular conditions are probably underdiagnosed and subsequently there is insufficient scientific information available to clinicians. Being familiar with these entities is of the utmost importance, since it can be crucial for their management.

Neglected features of lifestyle: Their relevance in nonalcoholic fatty liver disease

AIMTo investigated in non-alcoholic-fatty-liver-disease (NAFLD), with ultrasound (US)-detected fatty liver, and in a group of non-alcoholic and otherwise healthy subjects, relationship of neglected features of lifestyle with NAFLD and obesity. METHODSFive hundred and thirty-two NAFLD and 667 non-NAFLD healthy subjects, age 21-60 years were studied. Severity of liver steatosis was assessed by US bright liver score. The adherence to mediterranean diet score (AMDS) was assessed on the basis of a 1-wk recall computerized questionnaire which included a detailed physical activity reports (Baecke questionnaire). The western dietary profile score, as a simplified paradigm of unhealthy diet, a questionnaire quantifying sun exposure score and a sleep habits questionnaires provided a further comprehensive lifestyle assessment. RESULTSBody mass index (BMI), insulin resistance (HOMA), and triglycerides, poorer adherence to a mediterranean diet profile, sedentary habits, minor sun exposure and use of “western diet” foods are greater in NAFLD. Multiple linear regression analysis, weighted by years of age, displays BMI, HOMA and AMDS as the most powerful independent predictors of fatty liver severity; however, also the physical activity score, the western diet habit and the sun exposure score are acting inside the model with significant independent effects. CONCLUSIONArticulated clinical intervention, according to our results, are justified in NAFLD and can be pursued addressing by focused intervention nutritional profile, physical exercise mainly in open-air subsets for enhancing sun exposure and healthier sleep duration and rhythm.

Vitamin D and Bone Health

The vitamin D3 molecule, or cholecalciferol, is now considered a hormone that acts on multiple homeostatic fronts, either skeletal or extra-skeletal. After 100 years since from its identification as a protective and curative factor of rickets, during the last decade the interest in vitamin D among scientists and general public increased substantially and the use of vitamin D supplements has increased nearly exponentially in many countries. The aim of the present review is to clarify the mechanisms of action of vitamin D compounds on bone health through well-known concepts identified, and readily available, in the scientific literature. Taking advantage of our multi-year and consolidated experience in the pathophysiology of bone and mineral metabolism, we aim to briefly describe those few “hot” topics that we have perceived not to be easy to understand both for health professionals engaged on metabolic bone disorders and for those that are non-experts in this field and who should approach it. We describe, through basic pathophysiology concepts, the relationships between vitamin D and skeletal health: the main sources of vitamin D in humans, the vitamin D metabolites, evaluation of vitamin D status, tissue distribution of vitamin D, natural factors affecting the half-life of vitamin D3, the effects of cholecalciferol on calcium homeostasis and bone tissue, the relationship between vitamin D3 and bone cells and physical performance in the elderly, the effects of low vitamin D3 levels on bone loss and increased risk of fracture. Although currently different international institutional-academic positions exist about which is the best threshold value of serum vitamin D to be considered as adequate, it is important to bring out and lay a solid foundation supporting at least the crucial role played by it in the pathophysiology of skeletal tissue, despite the difficulties arising from the current lack of the specific molecular basis that clearly explain the balance between bone formation, mineralization and skeletal resorption. Finally, it should be also taken into consideration also the numerous reports, more recently identifiable in PubMed, in which, even in presence of very high levels of circulating values of 25OHD, clinically and biochemically observable toxic effects are not reported.

Actinic Cheilitis: Clinical Characteristics Observed in 75 Patients and a Summary of the Literature of This Often Neglected Premalignant Disorder

Actinic cheilitis can progress to squamous cell carcinoma in 20% of cases. The purpose of this study was to identify the clinical characteristics of 75 patients with actinic cheilitis and to summarise the current literature concerning actinic cheilitis. A total of 75 patients were evaluated over a 3-year period. The medical history, physical examination results and images were collected from each patient. Demographic data were collected and analysed. To review the literature, the relevant data were collected from scientific journals in the last 30 years. The mean age of the patients was 56 years old;42 patients (56%) were female, and 66 patients (88%) were white. Nineteen (25.3%) patients reported at least one symptom, including pain, burning and itching. Sixty-five (86.7%) patients presented actinic cheilitis only in the lower lip. All of the patients reported sun exposure, and 44 (58.6%) patients were exposed for more than 10 years. The main clinical aspects investigated and analysed included dryness (100%), flaking (72%) and white lesions (57.3%). Lip assessment is extremely important in medical and dental care. From the 15 lesions assessed in the presence of actinic cheilitis, the most common clinical characteristics observed were dryness, flaking and white lesions. It is imperative to know the clinical aspects that may be encountered in actinic cheilitis in order to achieve early diagnosis, thus avoiding lip squamous cell carcinoma transformation.

Photoprotection Knowledge and Photoprotective Behavior of University Students:A Cross-sectional Study in Indonesia

Objective:Awareness regarding the negative effects of ultraviolet radiation are commonly neglected in Asian countries.This study sought to evaluate the ultraviolet radiation knowledge and photoprotective behaviors of university students in Indonesia.Methods:This observational cross-sectional was conducted at Pelita Harapan University,Indonesia.Results:A total of 89(45.4%)medical students and 107(54.6%)nonmedical students participated in this study.Their mean age was 21.03±2.03 years,and 46.4%of them had Fitzpatrick type III skin.Medical students as well as older students exhibited a higher level of knowledge regarding photoprotection(P≤0.05).Factors related to good photoprotective behaviors were sex,older age,and average expenditure on skincare.Further analysis revealed that a high level of knowledge regarding photoprotection was related to acceptable photoprotective behaviors(P=0.01;odds ratio=1.97;95%confidence interval=1.13-3.54).Conclusions:Knowledge regarding sun-related damage and practice of photoprotective behaviors were low among the participants.The results indicate that formal education and academic subjects should incorporate the topic of sun-related damage and promote the practice of photoprotective behaviors early on to increase awareness among populations.