Impact of Fluorescent Light Energy on the Quality of Life of Dogs with Dermatologic Disease and Their Owners

Background: Quality of life (QoL) is a term used to evaluate general well-being, and it is defined as ‘the degree to which an individual enjoys his or her life. Within the realm of medicine, the evaluation of QoL frequently involves examining how disease exerts a detrimental impact, diminishing the enjoyment and fulfilment experienced by the individual. Dermatological diseases have been found to exert a substantial negative influence on the QoL of dogs and their owners due to nuisance and stress related to the disease but also due to the caregiver burden. In the management of bacterial skin infections, topical therapy is commonly administered alongside systemic antibiotics. Nonetheless, the protracted duration of treatment and difficulties in ensuring owner compliance can introduce a significant caregiver burden, potentially exacerbating the challenges associated with these conditions. Purpose: This study aimed to evaluate the impact on the quality of life (QoL) of dogs with dermatologic diseases after fluorescent light energy (FLE) treatment. Methods: The study was an open, prospective, multicentric clinical trial that included dogs with various dermatological conditions. The dogs received FLE treatment once weekly until the clinical resolution was achieved. Owners completed a validated questionnaire to assess the QoL of their dogs before and after therapy. Results: Thirty-five dogs with deep pyoderma, interdigital furunculosis, pyotraumatic dermatitis, wounds and perianal fistulas were included. All dogs received two sessions of fluorescent light energy once a week. Median treatment duration was 9 weeks for perianal fistula, 7 weeks for interdigital furunculosis, 5 weeks for deep pyoderma, 3 weeks for wounds and 1.5 weeks for pyotraumatic dermatitis. Complete remission was noted in 86% of dogs, and 14% showed an improvement but partial remission. The majority of owners reported a positive impact on their dogs’ QoL after therapy, and 74% of the dogs showed at least a 50% reduction in QoL scores. Conclusion: Fluorescent light energy has been shown to exert beneficial effects on the healing of dermatological diseases and the quality of life (QoL) in dogs and their owners, whether used as a standalone treatment or in combination with standard care therapies. Additionally, it was well-tolerated by the dogs. This study emphasizes the significance of considering both the owner’s and dog’s QoL when evaluating the therapeutic efficacy of dermatological treatments.

Traditional Uses and Pharmacologically Active Constituents of Dendrobium Plants for Dermatological Disorders:A Review

than 80 Dendrobium species have been reported in China.However,there are only six Dendrobium species,namely,D.bigibbum var.superbum(syn.D.phalaenopsis),D.chrysanthum,D.fimbriatum,D.loddigesii,D.nobile,and D.officinale(syn.D.candidum),listed in the New Inventory of Existing Cosmetic Ingredients in China Launched.Artificial planting of Dendrobium species has been a great success in China.To better utilize Dendrobium resources for medicinal and cosmetic purposes,we summarize their traditional uses and pharmacologically active compounds for treating dermatological disorders in this review.“Orchidaceae”,“Dendrobium”,“traditional use”,“ethnobotany”,“dermatological disorder”,and“skin disease”were used as search terms to screen the literature.Cited references were collected between 1970 and 2020 from the Web of Science,China National Knowledge Internet(CNKI),SciFinder,Google Scholar,and Chinese books.From the search,it was found that there are 22 Dendrobium species with traditional uses in dermatological disorders,and 131 compounds from Dendrobium plants have been reported to possess anti-inflammatory,antimicrobial,antioxidant,antiaging,anti-psoriasis,and tyrosinase-inhibitory activities,implying that Dendrobium plants are important resources for the discovery of active compounds and the development of new drugs and cosmetics.D.crepidatum,D.denneanum,D.loddigesii,D.nobile,and D.officinale have been extensively studied.More research on other Dendrobium species is needed.The major active compounds found in Dendrobium species are phenanthrenes,alkaloids,flavonoids,phenylpropanoids,and lignans.Several compounds,such as loddigesiinol A,(S)-5-methoxy-2,4,7,9-tetrahydroxy-9,10-dihydrophenanthrene,(S)-4-methoxy-2,5,7,9-tetrahydroxy-9,10-dihydrophenanthrene,2,5-dihydroxy-4-methoxy-phenanthrene 2-O-β-d-glucopyranoside,(9R)-1,2,5,9-tetrahydroxy-9,10-dihydrophenanthrene 5-O-β-d-glucopyranoside,(+)-homocrepidine A,and vicenin 2,have significant anti-inflammatory activities and inhibit nitric oxide(NO)production with IC_(50) values less than 5μM,and these compounds are worthy of further study.

Advance in bioequivalence assessment of topica dermatological products

Bioequivalence(BE) assessment of topical dermatological products is a long standing challenge. The development of generic topical dermatological products has often been hampered due to the limited number of acceptable approaches, which are capable of determining the BE between generic products and reference list products. The aim of this manuscript is to review different BE assessment approaches of topical dermatological products. Besides, the advances in BE evaluation and biowaivers are also provided. Currently, except in the case of dermatological corticosteroids, the golden rule to establish the BE of most topical dermatological products still heavily relied on clinical endpoint trials,which are often unreliable, time-consuming and expensive. The regulatory agencies and pharmaceutical industries are forging ahead to the development of new surrogate BE assessment approaches for other topical dermatological products. These promising approaches include dermatopharmacokinetic study(DPK), dermal microdialysis(DMD), in vitro studies, pharmacokinetic study(PK), near-infrared spectrometry(NIR), and confocal Raman spectroscopy(CRS). In addition, the expansion of biowaivers for topical dermatological products has been explored by pharmaceutical scientists. In conclusion, to accelerate the development and approval of topical dermatological products, emphasis should be put on the following areas, i.e., optimizing and standardizing the existing BE assessment methods, exploring novel alternatives of BE assessment approaches, and expanding biowaivers for topical dermatological products.

Psychiatric Comorbidity in Patients with Psoriasis, Vitiligo, Acne, Eczema and Group of Patients with Miscellaneous Dermatological Diagnoses

Background: Dermatological conditions can be associated with high psychiatric comorbidity. Several studies reported high rates of depression and anxiety particularly for specific dermatological disorders such as psoriasis and acne. Aim: The aim of this study was to compare the rates of psychiatric symptoms in patients with psoriasis, acne, vitiligo, and eczema versus patients who had other dermatological conditions;and to compare each dermatological group versus healthy control subjects. Methods: This prospective cross-sectional study was conducted in dermatology outpatient clinics in Khartoum. Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety (HADS-A) and depression (HADS-D). ICD-10 criteria were used for clinical psychiatric diagnosis. Tabulated results were analyzed using Chi-square test. Significance was set at P < 0.05. Results: HADS-D scores above the cut off points were significantly higher in patients with psoriasis (P = 0.0062), vitiligo (P = 0.0054), acne (P = 0.0103) and eczema (P = 0.0359) compared with healthy subjects. Similarly, HADS-A scores above the cut off points were significantly higher in patients with psoriasis (P < 0. 0.0001), vitiligo (P = 0.0001), acne (P = 0.0143) and eczema (P = 0.0281) compared with healthy subjects. No significant difference between the control group and patients with other dermatologic conditions regarding both HADS-D and HADS-A scores. Using ICD-10 criteria for clinical psychiatric diagnoses indicated that 52.3% of dermatology patients had an associated ICD-10 diagnosis;most commonly anxiety disorders (28.6%), and depression (21.9%). ICD-10 diagnoses of anxiety disorders included: OCD (13.3%) generalized anxiety disorder (5.7%), panic disorder (4.8%), phobic anxiety disorder (3.8%) and post-traumatic stress disorder (0.95%). Conclusion: Dermatological conditions are associated with high rates of psychiatric comorbidity. Screening for anxiety and depressive symptoms may be helpful for early diagnosis and management of associated psychiatric symptoms.

Microsponges for dermatological applications:Perspectives and challenges

Dermatological disorders have a huge psychosocial impact, causing significant impairment of patient’s life. Topical therapy plays a pivotal role in management of such disorders.Conventional topical delivery systems result in overmedication/undermedication, leading to adverse effects and reduction in therapeutic efficacy. Consequently, researchers have been striving towards the development of alternative delivery systems for dermatological applications. In the last decade, microsponges emerged as an attractive option for topical delivery. Their characteristic particle size offers enhanced benefits, making them superior to the contemporary microcarriers. The present review furnishes a comprehensive account of state of the art, important factors affecting the performance and mechanism of drug release from topically applied microsponges, along with characterization techniques. Further, a list of marketed products and their applications for common dermatological disorders has been presented. All in all, this paper is an attempt to lay a bibliographic foundation for researchers working in this field and foster further investigations in this arena.

Stress and quality of life in dermatological patients: Are out-patients' needs different?

The debut, progression and maintenance of skin disease are related to stress(acne, alopecia areata, atopic dermatitis, lichen planus, psoriasis, urticaria, vitiligo, herpes, hyperhidrosis, pemphigus, rosacea or seborrheic dermatitis). Environmental, socio-professional, life events are representing external factors. Personality, previous experiences, traits of anxiety are individual factors influencing the state of stress. Perceived stress could be more harmful especially in "high reactors" to stress. Coping abilities to stress could be increased in social programs. There was a recent interest in measuring the quality of life in the last years. There are dermatology and disease specific questionnaires that could help. Out-patients have less time to wait for very sophisticated procedures. They expect faster results. For simple, acute diseases it is important to have a good communication and good understanding of the instructions to get results as soon as possible. For chronic diseases a strong long-term alliance is needed, so the patients should revisit for his benefit and not for giving up. Small questions regarding potential stressful events, impact on the quality of life, stigmatization, the level of symptoms(pruritus), psychiatric comorbidities(anxiety, depression), short questionnaires for quality of life give us a better picture, personalize the doctorpatient relationship and could influence the choice of treatment. Many skin disorders could be seen from a psychosomatic point of view and the final goal, especially for the chronic diseases, is to improve through our treatments the impact on the quality of patient's life.

Side effects of herbal drugs used in dermatologic disorders

Because of the awareness of the environmental damage caused by industrialization, a trend has developed to use products with natural ingredients. Herbal products have been used for the treatment of disease, most commonly in the last century. As herbal supplements become more popular, several adverse side effects have been reported in users who also take other medications. In dermatology ,many botanicals are used especially with regard to cosmetic benefits of natural topical products on skin aging process,so dermatologists should face with higher side effects of these types of drugs.The most common presentation of topical aromatherapy side effects are contact dermatitis and the second in order will be contact urticarial reactions.

Reconstruction of cervical necrotizing fasciitis defect with the modified keystone flap technique:Two case reports

BACKGROUND Cervical necrotizing fasciitis(CNF)is a rare,aggressive form of deep neck space infection with significant morbidity and mortality rates.Serial surgical debridement acts as the cornerstone of CNF treatment;however,it often results in defects requiring complex reconstructions.CASE SUMMARY We report two cases in which the keystone flap(KF)was used for CNF defect coverage:Case 1,an 85-year-old patient with CNF in the anterior neck,and Case 2,a 54-year-old patient with CNF in the posterior neck.Both patients received empirical intravenous antibiotic therapy and underwent serial debridement,enabling adequate wound preparation and stabilization.The final defect size measured 5.5 cm×12 cm in Case 1 and 6 cm×11 cm in Case 2.For defect coverage,we employed an 8 cm×19 cm type II KF based on perforators from the superior thyroid artery in Case 1 and a 9 cm×18 cm type II KF based on perforators from the transverse cervical artery in Case 2.Both flaps showed complete survival.No postoperative complications occurred in both cases,and favorable outcomes were observed at 7-and 6-month follow-ups in case 1 and 2,respectively.CONCLUSION We effectively treated CNF-associated defects using the KF technique;KF is viable for covering CNF defects in carefully selected cases.

Dermatologic Extrahepatic Manifestations of Hepatitis C

Hepatitis C virus (HCV) affects millions of people worldwide,and an estimated 3.2 million people in the United States.HCV is a hepatotropic and lymphotropic virus that causes not only liver disease,but also a significant number of extrahepatic manifestations (EHMs).Up to 74% of patients affected by HCV will have HCV-related EHMs of some severity in their lifetime.The EHMs vary from simple cutaneous palpable purpura to complex lymphoproliferative disorders,including lymphomas and immune-complex deposit diseases causing local and/or systemic complications.Mixed cryoglobulinemia (MC) is manifested by multiple systemic organ involvement,mainly skin,kidney,peripheral nerves,and salivary glands,and less frequently causes widespread vasculitis and malignant lymphoma.MC affects up to 3% of HCV-infected patients with cryoglobulinemia of clinical significance,i.e.>6%.Severe disease requires immunosuppressive or plasma exchange therapy.HCV prevalence in the United States in patients with porphyria cutanea tarda (PCT) was reported to be 66%,much higher than that in general population.Therefore,all patients with PCT should be screened for HCV.The skin rash of PCT varies from large blisters to small vesicles and/or milia on the hands.Skin manifestations due to PCT usually respond to anti-HCV treatment together with reducing skin sun exposure,avoiding triggers,having routine phlebotomy (especially for people with chronic iron overload states),and using chloroquine.Lichen planus (LP),which typically affects both the skin and oral mucosa is a chronic inflammatory disease of squamous cell origin affecting about 1% of the worldwide population.The prevalence of HCV in patients with LP varies based on geographic location.We review here the basic pathophysiology,clinical features,and management of dermatologic manifestations of HCV.

Rare facial dermatological lesions associated with Demodex infection,besides acne vulgaris

I have read with great interest the recent article "A meta-analysis of association between acne vul- garis and Demodex infestation" by Zhao et al. (2012), published in Journal of

Facial basal cell carcinoma:A retrospective study of 67 cases

BACKGROUND Basal cell carcinoma(BCC)is a slow-growing malignant tumor characterized by local invasiveness but an exceptionally rare metastatic potential.It ideally affects sun-exposed skin of older patients with more propensity for the facial region.AIM To evaluate the different clinicopathological characteristics of the facial BCC and the efficacy and safety of diode laser for the treatment of these lesions.METHODS We retrospectively reviewed facial BCC lesions of<1.5 cm in diameter and subjected them to diode laser ablation during the period from September 2016 to August 2021 at Al-Ramadi Teaching Hospital,Ramadi City,Iraq.Data matching the age,gender,duration,site,and clinical and histological types were registered for every subject.The functional and aesthetic outcomes and complications following diode laser ablation for each patient were also recorded.RESULTS Of 67 patients with facial BCC,there was 65.67%from the age group≥60 years and 58.21%males.The mean duration of the lesions was 5.15±1.836 mo.The most involved location was the nose(29.85%).About half of the cases belong to the noduloulcerative type.Solid histological type comprises 40.3%of the cases,while the least was keratotic(13.4%).Moreover,65.2%of the solid cases were from the age group≤60 years and 38.6%of the adenoid type from the age group>60 years(P value=0.007).Excellent aesthetic and functional outcomes were reported in all cases after 6 mo of follow-up.Few complications were reported after diode laser ablation.CONCLUSION Facial BCC was mostly seen in the elderly and men.The mean duration was 5.15 mo.The nose was the commonest involved site.Noduloulcerative lesions were seen in approximately half of the lesions.The age of the patients determined the histological type of the lesion(solid type was mostly seen in the age group≤60 years,while,adenoid in the age group>60 years).Diode laser ablation showed excellent functional and aesthetic outcomes following a 6-mo follow-up.

Dermatology nurse prescribing in China:a Delphi method

Objectives:To identify the dermatological system drugs that may be prescribed by Chinese dermatological nurses through expert consensus.Methods:A 2-round study,consisting of 32 medical and nursing exper ts,was conducted using the Delphi method from September 2019 to June 2020.Microsoft Excel 2019 and IBM SPSS Ver.22 were used to analyze the results of the consultations.Results:A total of 63 drugs across 13 categories were identified as relevant to Chinese nurses working in dermatological departments.Among these drugs,1 drug was generally prescribed independently,17 drugs tended to be prescribed collaboratively,and 45 were prescribed either independently or in collaboration with others.Conclusions:This exper t consensus determines the prescription drugs that may be prescribed by dermatology nurses in China,which can be used as the key content of prescription drug training for dermatology nurses in future.The results of the study could provide a basis for the implementation of nurses'prescription rights in China in future and provide a reference for the formulation of relevant legislation on nurses'prescription rights.

Epidemiological Profile of Autoimmune Diseases in Thiès, Senegal: About a Descriptive Observational Study over 11 Years in 2 Internal Medicine Departments and a Dermatology Department

Introduction: Autoimmune diseases are characterized by a very large clinical polymorphism that can lead to a diagnostic wandering. So, we aimed to determine their epidemiological profile outside the context of Dakar (capital of Senegal) where the technical plateau is more elevated. Methodology: We conducted a retrospective descriptive and observational study from January 1, 2007 to December 31, 2017. All patients admitted or followed in outpatient in the Internal Medicine departments of the Saint Jean de Dieu and Regional Hospitals of Thiès as well as in the dermatology department of the CHRT (Regional Hospital Center of Thiès), and who met the MAI criteria (autoimmune diseases) have been included. The data were collected on a standardised sheet and analysed by EPI INFO version 7.2. Results: A total of 121 patients were included out of 25951 records i.e a prevalence of 0.46% in internal medicine departments. In dermatology, out of 31973 patients, 95 had MAIS (systemic autoimmune diseases): 0.29% as hospital prevalence. The average age was 40.7 years in internal medicine departments compared to 37.66 years 14.8 years in the dermatology department. Patients aged 30 to 59 years represented 57.89% of the study population. The sex ratio (H/F) was 0.3 in the internal medicine departments compared to 0.17 in the dermatology department. Circumstances of discovery were incidental in 16.52% and clinical in 3.30%. Biermer disease accounted for 29.75% of organ-specific MAI. Concerning systemic presentations, rheumatoid arthritis (RA) was present in 23.14%. Lupus was more representative in dermatology (65.2%) as well as systemic scleroderma (21%), dermatomyositis (6.3%). Cytopenia was found in 105 patients, showing in detail anemia (42.9%);leukopenia (14.8%);thrombocytopenia (2.4%). Autoantibodies were tested in 58 patients (47.9%). Skin histology was contributory in all cases of systemic scleroderma and in 5 cases of lupus. The main therapy prescribed was corticosteroid therapy alone or in combination with an immunosuppressant. Conclusion: In addition of infectious diseases, Subsaharan Africa is under the era of changing face of its epidemiology, and cardiovascular diseases shows signs of emergence, like auto-immune presentations. However, the difficult apprehension of these so subtle last diseases suggests that they are few reported. Technical tools in regions should be enhanced associated to a non-binding capacity building system targeting such diseases with an emphasis on good record keeping.

Helicobacter pylori and extragastric diseases: A review

Helicobacter pylori(H. pylori) infection is very common and affects approximately half of the world population. It causes gastric diseases, but some authors have reported an association of H. pylori infection with other systemic manifestations beginning in 1994. The list of potential effects of H. pylori outside the stomach includes a number of extragastric manifestations and we focused on neurological, dermatological, hematologic, ocular, cardiovascular, metabolic, allergic, and hepatobiliary diseases. This review discusses these important reported manifestations that are not related to the gastrointestinal tract.

Hepatitis B and immunosuppressive therapies for chronic inflammatory diseases: When and how to apply prophylaxis, with a special focus on corticosteroid therapy

Currently immunosuppressive and biological agentsare used in a more extensive and earlier way in patients with inflammatory bowel disease, rheumatic or dermatologic diseases. Although these drugs have shown a significant clinical benefit, the safety of these treatments is a challenge. Hepatitis B virus(HBV) reactivations have been reported widely, even including liver failure and death, and it represents a deep concern in these patients. Current guidelines recommend to preemptive therapy in patients with immunosuppressants in general, but preventive measures focused in patients with corticosteroids and inflammatory diseases are scarce. Screening for HBV infection should be done at diagnosis. The patients who test positive for hepatitis B surface antigen, but do not meet criteria for antiviral treatment must receive prophylaxis before undergoing immunosuppression, including corticosteroids at higher doses than prednisone 20 mg/d during more than two weeks. Tenofovir and entecavir are preferred than lamivudine because of their better resistance profile in long-term immunosuppressant treatments. There is not a strong evidence, to make a general recommendation on the necessity of prophylaxis therapy in patients with inflammatory diseases that are taking low doses of corticosteroids in short term basis or low systemic bioavailability corticosteroids such as budesonide or beclomethasone dipropionate. In these cases regularly HBV DNA monitoring is recommended, starting early antiviral therapy if DNA levels begin to rise. In patients with occult or resolved hepatitis the risk of reactivation is much lower, and excepting for Rituximab treatment, the prophylaxis is not necessary.

Prescribing Pattern for Skin Diseases in Dermatology OPD at Borumeda Hospital, North East, Ethiopia

Introduction: Skin diseases are the major contributors of disease burden in society. Dermatological therapy ultimate goal is achieved by administering the safest and least number of drugs. The problem gets compounded with the inappropriate and irrational use of medicines. Therefore, periodic prescription audit in the form of prescribing patterns is away to improve irrational prescription. The objective of this study to assess the prescription patterns of dermatological agents in Borumeda hospital. Method: Hospital based retrospective cross sectional study in which prescribing patterns of dermatological agents are assessed. A total of 385 samples of patient record prescription from November/1/2016 to December/30/2016, and the sample were selected by systematic random sampling technique. Sample prescriptions were reviewed using structural data collection format. The Collected data was analyzed by using SPSS version 20. Result: Regarding rout of administration, the maximum number of drugs was prescribed topically (66.2%). Topical steroids were the most commonly prescribed drugs (25.3%). Use of generic prescribing in single drug prescribing was 81.7%. The prevalence of atopic dermatitis was higher (26.3%, 20.8%) in both male and female respectively followed by scabies in male with 12.2% and Acne vulgaris (12.9%) in female. Number of drugs per prescription was higher (2.46) than WHO standard (Conclusion: The current study reveals that topical corticosteroids were commonly prescribed drugs in the dermatology unit and the prescribing practice imitates incidence of polypharmacy.

Is the Photosuturing Agent, Rose Bengal, a Mutagen?

Rose Bengal (RB) is a potential photosuturing agent that may improve standard dermatologic surgical closure techniques. However, RB produces reactive oxygen species with photoactivation and its photomutagenic potential must be considered in clinical application. We investigated cytotoxicity, mutagenicity, and singlet oxygen (SO) production of RB on epithelial Chinese hamster ovary cell line. Cells were exposed to RB concentrations: 0.1%, 0.01%, 0.001%, 0.0001%, 0.00001%;irradiated for 400 s using a high-intensity visible wavelength lamp or maintained in the dark. Cell viability was assessed by XTT assay, mutagenicity by HPRT gene mutation assay, and SO production by Sensor Green reagent. RB > 0.001% was significantly cytotoxic. Viabilities were uninfluenced by ≤0.0001% RB controls, or 30-min incubation. 49% of irradiated cells died after 24-h in 0.0001% RB. At ≥0.001% RB, >90% of cells died. Irradiating 0.00001% - 0.001% RB increased SO;levels dropped significantly between 0.01% - 0.1%. Controls exhibited negligible SO production. HPRT suggested that RB was not mutagenic (0.0001%, 0.00001%);SO induction increased between 0.00001% - 0.001%, with reduced production at higher concentrations. Pilot studies suggested irradiated 0.0001% RB is mutagenic in vitro;current data suggest RB is not photomutagenic. The contribution of RB’s cytotoxicity on observed clinical improvement of scars and mutagenic potential remains unclear, necessitating further study.

Managing panniculitis in alpha-1 antitrypsin deficiency: Systematic review of evidence behind treatment

AIM To systematically review literature for management of alpha-1 antitrypsin deficiency(AATD) panniculitis. METHODS Multiple databases were searched using combinations of pertinent terms. Articles were selected describing panniculitis treatment in patients with AAT < 11 μmol and/or PiZZ genotype, with no language limitation. All relevant articles were accessed in full text. Independent review of abstracts and full manuscripts was conducted by 2 reviewers, and quality assessment by one reviewer(checked by a second). Data extraction was conducted byone reviewer(checked by a second). Narrative synthesis only was conducted, as data were unsuitable for metaanalysis.RESULTS Thirty-two case reports and 4 case series were found. Augmentation therapy(infusions of plasma-derived AAT) was the most successful, with complete resolution of symptoms in all patients. Dapsone is a less expensive option, and it achieved clinical resolution in 62% of patients, but it is very poorly tolerated. Among other single-agent antibiotics, doxycycline was the most successful with complete clinical resolution seen in 33% of patients. Immunosuppressants were largely unsuccessful; 80% of patients exhibited no response. Liver transplantation and therapeutic plasma exchange displayed complete resolution in 66% of patients. Other strategies, such as non-steroidal anti-inflammatory drugs or antibiotics other than dapsone did not show sufficient response rates to recommend their use. Authors note the risk of bias imposed by the type of evidence(case reports, case series) available in this field.CONCLUSION Dapsone is the recommended first line therapy for AATD panniculitis, followed by augmentation therapy. Plasma exchange may be an alternative in the setting of rapidly progressive disease.

Better Management of Adverse Events Favors Sorafenib Treatment of HCC Patients and Impact on Survival

Introduction: Sorafenib is an orally active multikinase inhibitor approved for the treatment of advanced hepatocellular carcinoma (HCC) and is the only systemic treatment associated with a survival benefit in advanced stage. The aims of this study were to evaluate the tolerance and survival of sorafenib-treated patients, and to identify potential prognostic factors of survival. Methods: A total of 88 HCC patients treated with sorafenib from June 2010 to January 2014 were retrospectively reviewed. Tumour stage, liver function and adverse events to sorafenib were analyzed. Univariate and multivariate analysis were carried out to identify predictors of survival in patients with advanced HCC treated with sorafenib. Results: There were 64 (73%) males included in this study, with a median age of 61.16 years. Eight (91%) patients had Child-Pugh class A cirrhosis. Most patients were classified as BCLC C (82%). Hepatitis C virus was the predominant cause of HCC (68%). Sorafenib was the initial treatment modality in 43%. Median time of sorafenib therapy was 8.23 months. Overall survival in 1 year was 57.3% and 36.7% in 2 years. The median survival was 16.3 months. In the univariate analysis of the OS based on Child-Pugh score did not demonstrate a significant difference in our study (p = 0.62). The presence of dermatologic adverse event predicted a better overall survival in the multivariate analysis. Better survival was also observed in patients with AFP level <100 ng/ml in the start of sorafenib therapy (p = 0.001). Patients that used Sorafenib for ≥6 months had shown better outcome. None of the patients discontinued sorafenib because of adverse effects. Conclusions: Advanced HCC patients treated with sorafenib who experienced dermatologic adverse event and low AFP level <100 ng/ml showed better overall survival. As expected, longer sorafenib therapy (≥6 months) was associated to better survival. Even in the presence of adverse events, the use of sorafenib should be continued because the longer usage time improves survival.

Evaluation of a Barrier Repair Cream Containing Pseudo-Ceramide for Practical Use by Hairdressers with Hand Skin Disorders Due to Daily Exposure to Chemical Irritants

Hairdressers are exposed to numerous skin-damaging factors, such as wet work, skin irritants, and thermal changes. Skin protection is a very important factor for the prevention of occupational skin disorders. Therefore, we evaluated a hand cream that was specially formulated for highly stressed skin with regard to its capability to reduce dry, rough, and scaly skin. The objective of this study was to conduct a controlled use test of a barrier repair cream containing pseudo-ceramide and demonstrate its efficacy for hairdressers with dry, sensitive hands and/or occupational skin disorders. A total of 30 hairdressers (29 females and 1 male, aged 20 - 67) participated in the study. All subjects suffered from dry hands. Subjects applied the test cream on their hands for 28 days (four weeks). For each subject, the skin surface topography of the hands was measured by the Surface Evaluation of Living Skin (SELS) system at day 14 (week 2) and day 28 (week 4). Dryness, scaling, cracking, redness, and itchiness were evaluated and graded by experts at week 2 and week 4, and then compared to baselines. All 30 subjects completed the study. A comparison of the changes from baseline to endpoint revealed a statistically significant reduction in skin roughness, scaling, and volume measured according to SELS. These data were confirmed by photographic documentation. The results were further supported by the expert evaluation. For the symptoms dryness and scaling, improvement could be observed in almost all regions of the hands. In addition, according to subjective assessments of overall hand skin condition and the hand cream, subjects reported clear improvement over time (p value below 0.001) and good efficacy of the product. In this study, the test hand cream showed excellent skin compatibility. Therefore, the hand cream may be effective for hairdressers with dry, sensitive hands and/or occupational skin disorders.