A rare interesting case of seborrheic keratosis of pinna

Seborrheic keratosis is a benign tumour of external ear originating from proliferative epithelial cells. Its most common site ranges from the retroauricular region to the helical rim. Diagnosis is made on the basis of clinical & histopathological examination. Here, we discuss the clinical presentation, differential diagnosis, pathological diagnosis and management of such a case.

Cryotherapy versus Hydrogen Peroxide in the Treatment of Seborrheic Keratosis

Seborrheic keratosis has a varying degree of pigmentation. In pigmented seborrheic keratosis, the proliferating keratinocytes trigger the activation of neighboring melanocytes by secreting melanocyte-stimulating cytokines. The etiology of seborrheic keratosis is not known. Epidermal growth factors or their receptors have been implicated in the development of seborrheic keratosis. Seborrheic keratoses can safely be left alone, but ugly or easily traumatized ones can be removed with cryotherapy, electrodesiccation, curettage, or shave excision. The present work aims to compare two modalities of treatment for seborrheic keratosis, namely cryotherapy and hydrogen peroxide (30%). Methods: 30 patients with seborrheic keratosis were included in this study. They were divided into two groups, each with 15 patients. The treatment modalities that have been used include cryotherapy and hydrogen peroxide in three different concentrations (30%, 35%, and 40%). Result: The cryotherapy group consisted of 15 patients, 7 males and 8 females. Their ages ranged from 38 to 80 years, with a mean of 56.1 ± 11.4. Clinical and photographic assessments showed complete removal in all 15 patients in this group (100%). As regards the hydrogen peroxide group, this group included 15 patients, distributed among 7 males and 8 females. Their ages ranged from 39 to 90 years, with a mean of 53.9 ± 14.4. Clinical and photographic assessments showed response in only one small superficial lesion in one patient (6.7%) and no response in 14 patients (93.3%). Conclusion: Cryotherapy is an effective, easy, and relatively cheap method for treating seborrheic keratosis.

Solasodine Glycosides: A Topical Therapy for Actinic Keratosis. A Single-Blind, Randomized, Placebo-Controlled, Parallel Group Study with Curaderm^BEC5

Background: Untreated actinic keratosis can advance to squamous cell carcinoma, which in turn is associated with a risk of metastasis. Current treatments for actinic keratosis have many shortcomings. This communication describes the efficacy and safety of a topical cream therapy, CuradermBEC5, containing solasodine glycosides (0.005%) for actinic keratosis.Methods: Randomly assigned patients with actinic keratosis on the face, trunk or extremities received so-lasodine glycosides cream (CuradermBEC5) or placebo (vehicle) that was self-applied to the lesions and covered with an occlusive dressing (micropore) twice daily for 3 consecutive days. Complete clearance and local reactions were as-sessed at 56 days with follow-up periods of 6 months and 1 year. Results: The rate of complete clearance at day 56 was higher with solasodine glycosides than with placebo (92% vs. 38%, P 0.001). The absolute success rates after 1 year follow-up were 82% for solasodine glycosides and 18% for placebo. No differences in local reactions were obtained when solasodine glycosides and placebo were compared. Local reactions in both groups peaked at days 2 and 3 with local pain as the major event. The pain associated with treatments lasted approximately 10 minutes after application of solasodine glycosides and placebo. Complete reepithelialization occurred two weeks after treatment. Adverse events were generally mild to moderate in intensity and resolved without sequelae. Conclusions: Solasodine glycosides cream applied topically twice daily with a dressing for 3 days is effective for the treatment of actinic keratoses.

Clinical outcomes and 5-year follow-up results of keratosis pilaris treated by a high concentration of glycolic acid

BACKGROUND Keratosis pilaris is a hereditary abnormal keratosis of the hair follicle orifice.Gray-brown keratotic plugs in the pores and dark red keratotic papules at the openings of hair follicles can be seen,which contain coiled hair and are often accompanied by perifollicular erythema and pigmentation.Glycolic acid can correct the abnormalities of hair follicular duct keratosis and eliminate excessive accumulation of keratinocytes.It also promotes skin metabolism and accelerates the melanin metabolism.The therapeutic effect is related to the glycolic acid concentration.AIM To evaluate the efficacy and safety of a high concentration of glycolic acid in the treatment of keratosis pilaris,and to observe the outcomes at 5-year of follow-up.METHODS Twenty-five participants were recruited and areas with typical keratosis pilaris were selected as testing sites.High concentrations of glycolic acid(50%or 70%)were applied to a circular area(d=8 cm,S=50 cm2)and repeated four times,on days 0,20,40 and 60.Before each treatment and 20 d after the last treatment,on days 0,20,40,60,and 80 and at a 5-year follow-up,The number of follicular keratotic papules were counted and the extent of perifollicular erythema and pigmentation was determined.At the same time,the participants provided subjective evaluations of treatment efficacy and safety.RESULTS Treatment effectiveness was indicated by the percentage of keratotic papules in the test site,on days 20,40,60 and 80,which were 8%,12%,36%,and 60%,respectively.Compared with day 0,each difference was significant(P<0.05).Compared with day 0,differences in melanin content(M)in the skin and skin lightness(L)on days 40,60 and 80,the were statistically significant(P<0.05);skin hemoglobin content(E)on days 60 and 80 was statistically different as compared with before treatment(P<0.05).There were no significant differences in the number of keratotic papules,M,L,and E in 9 participants at the 5-year follow-up compared with before treatment(P>0.05%).CONCLUSION A high concentration of glycolic acid significantly improved skin roughness as well as follicular hyperpigmentation of patients with keratosis pilaris.The treatment was relatively safe,but there was no significant difference at the 5-year follow-up compared to before treatment.

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 cm^2 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.

Effects of a New Human Recombinant MnSOD in the Treatment of Photoaging and Actinic Keratosis

Physiological processes, as aerobic metabolism and inflammatory response, generate reactive oxygen species (ROS) that may induce cellular injury when their amount is increased and antioxidant defense mechanisms are overwhelmed. Also, ROS are generated following UV skin irradiation able to deplete the natural antioxidant defenses in the skin. The increase in exposure to UV may lead to photoaging and precancerous skin lesions (actinic keratosis). New antioxidant strategies in the prevention and therapy of skin lesions are urgently needed. In this study, we evaluated the antioxidant efficacy of a recombinant form of human manganese superoxide dismutase able to inhibit reactive oxygen species production in some patients affected by severe photoaging and actinic keratosis.

Holistic Approach in the Treatment of Actinic Keratosis: Benefits and Disadvantages of 5-Fluorouracil, Imiquimod, Diclofenac and Curaderm

Background Actinic keratosis is the most prevalent premalignant skin disorder in the white population. Current guidelines provide no clear recommendations about preferred treatments. Methods The parameters;effectiveness, treatment duration, recurrence, side effects and cost of treatment were investigated for three frequently used topical therapies which were then compared with a most recent developed topical therapy. Published clinical data obtained from the literature was used to compare these parameters for 5-fluorouracil, imiquimod and diclofenac and relate them with the newly developed Curaderm. Results A wide variation in the concentrations of the active anti-keratotic ingredients, application frequency, duration of treatment, recurrence rates and cost of treatment exist between the different topical therapies. The efficacy rates and side effects were less variable. Overall, Curaderm is the most suitable treatment for actinic keratosis. Clinical evidence is presented illustrating the effects of Curaderm on field-directed treatments and solitary treatments of actinic keratoses. Conclusions Current medical guidelines do not provide clear recommendations on which treatment approach for actinic keratosis is preferred. Direct head-to-head comparison between treatments with emphasis on efficacy, safety, treatment duration, compliance, convenience, cosmetic outcome, patient acceptance and cost should be available to the patient, the practising physician, healthcare system and should assist in therapeutic treatment guidelines and policymaking. Given the very favourable profiles of these parameters with Curaderm when compared with other home-based treatments, it should be considered that Curaderm is first-in-line.

Discussion on the Treatment of Palmoplantar Keratosis by TCM Soaking and Washing

By combing the mechanism and advantages of traditional Chinese medicine(TCM)soaking and washing and combining TCM syndrome differentiation with western medicine differentiation of diseases,guided by the view that"the principle of external treatment is that of internal treatment",this article discusses the differentiation and treatment ideas of palmoplantar keratosis by TCM soaking and washing,which will provide a reference for clinical treatment.

Identification of core compositions of traditional Chinese medicine for Seborrheic Dermatitis using data mining techniques

Objective:To explore the clinical medication rule of seborrheic dermatitis in modern Chinese medicine by data mining,in order to benefit the clinical treatment of seborrheic dermatitis in traditional Chinese medicine.Methods:From January 1,2010 to September 4,2019,articles on Chinese medicine for seborrheic dermatitis were searched systematically in CNKI,VIP and Wan Fang databases.Prescription databases were established through the Chinese Medicine Inheritance assistant system to mine and analyze the rules of data.Results:69 researches were screened out,72 prescriptions for seborrheic dermatitis.13 drugs were used more than or equal to 15 times,and 9 pairs of commonly used drugs with correlation coefficient above 0.045 were selected.Six core combinations and two new prescriptions were obtained.Conclusion:Data mining method was used to analyze the high-frequency drugs and drug pairs,which reflected the treatment principle of clearing heat and removing dampness,nourishing blood and moistening dryness,promoting qi and strengthening spleen in the clinical treatment of seborrheic dermatitis,and provided more intuitive research evidence for the follow-up clinical treatment.

Chinese herbal medicine for seborrheic dermatitis complicated by allergy to topical agent: A case report

Seborrheic dermatitis is a common inflammatory dermatosis.Conventional medical treatments include corticosteroids,calcineurin inhibitors,and other therapeutic modalities.However,the use of the conventional medicine sometimes is limited by adverse effects,such as allergic reaction.We report the case of a 13-year-old girl with seborrheic dermatitis,who was allergic to topical agents and was cured successfully with Chinese herbal medicine.Her Chinese medical syndrome pattern was diagnosed as wind-heat invading the skin and herbs with wind-dispelling and heat-clearing properties were prescribed.Chinese herbal medicine is an alternative modality that can be considered for seborrheic dermatitis,in particular for cases complicated by adverse reactions from conventional topical agents.

Curative Effect of 30% Supramolecular Salicylic Acid Combined with Yufa Spray Dressing on Moderate to Severe Scalp Seborrheic Dermatitis

Objective:To observe the clinical efficacy of 30%supramolecular salicylic acid combined with Yufa spray dressing in the treatment of moderate to severe seborrheic dermatitis(seborrheic dermatitis of the scalp,SDS).Methods:From January 2020 to December 2021,150 patients with SDS,who were treated in the Dermatology Clinic of the First Affiliated Hospital of Xi’an Medical University,were randomly divided into two groups,a treatment group and a control group,with 75 cases in each group.The treatment group was given 30%supramolecular salicylic acid combined with Yufa spray dressing on the basis of external medicine given to the control group,while the control group was given oral medicine combined with external medicine.Results:The difference in scores of erythema,scales,pruritus,and folliculitis of the treatment group before and after treatment was significant(P<0.01),indicating that supramolecular salicylic acid combined with Yufa spray dressing can relieve the symptoms of SDS.The difference in scores of erythema of the control group before and after treatment was significant as well(P<0.05),indicating that traditional antibiotics are also effective in treating SDS;however,there was no significant difference(P>0.05)in the scores of other signs and symptoms,such as scales,pruritus,and folliculitis,before and after treatment,indicating that traditional antibiotics have no obvious curative effect on SDS.After 12 weeks of treatment,the improvement in erythema,scaling,and folliculitis was significantly greater in the treatment group compared with the control group(P<0.05).Curative effect comparison showed that the total effective rate of the treatment group was 80.00%,compared with 25.67%of the control group,and the difference was statistically significant(P<0.05).Conclusion:30%supramolecular salicylic acid combined with Yufa spray dressing can significantly improve the therapeutic effect in moderate to severe SDS;the recurrence rate is lower,the course of treatment is shorted,and patients generally feel better;thus,it is a new option for the treatment of dermatitis.

Actinic keratosis and field cancerization

While actinic keratoses(AKs) have been considered precancerous until recently for being able to turn into squamous cell carcinomas(SCCs), it is now agreed that it would be more appropriate to call them cancerous. Although not all AKs turn into SCC and some of them may even have a spontaneous regression, there is an obvious association between SCC and AK. Approximately 90% of SCs have been reported to develop from AKs and AKs are the preinvasive form of SCCs. The presence of two or more AKs on a photodamaged skin is an indicator of field cancerization and represents an increased risk of invasive SCC. All lesions should be treated since it cannot be foreseen which of the lesions will regress and which will progress to SCC. AK can be a single lesion or it can involve multiple lesions in a field of cancerization; thus, AK treatment is grouped under two headings:(1) Lesion-specific treatment; and (2) Field-targeted treatment. Lesion-specific treatments are practicable in patients with a small number of clinically visible and isolated lesions. These treatments including cryotherapy, surgical excision, shave excision, curettage and laser are based on physical destruction of the visible lesions. Field-targeted treatments are effective in the treatment of visible lesions, subclinical lesions and keratinocyte changes in the areas surrounding the visible lesions. Field targeted treatment options are topical imiquimod cream, 5% 5-fluorouracil cream, ingenol mebutate, diclofenac gel, resimiquimod and photodynamic therapy.

High Staphylococcus epidermidis Colonization and Impaired Permeability Barrier in Facial Seborrheic Dermatitis

Background：Seborrheic dermatitis （SD） is a common inflammatory skin condition.The etiology is unclear,although overgrowth of Malassezia on the skin has been suggested to cause SD.This study investigated whether colonization with Staphylococcus plays a role in facial SD,which was not well addressed previously.Methods：The study was conducted from September 1,2011 to February 20,2012 in the First Hospital of China Medical University.In the first phase,the study evaluated the level of transepidennal water loss （TEWL） and the number of colony-forming units （CFU） of Staphylococcus in defined skin areas of SD patients who were human immunodeficiency virus （HIV） seropositive （HIV [＋] SD [＋] group,n =13）,classical SD （HIV [-] SD [＋] group,n =24） patients,H IV seropositive-non-SD （HIV [＋] SD [-] group,n =16） patients,and healthy volunteers （HIV [-] SD [-] group,n 16）.In the second phase,we enrolled another cohort of HIV （-） SD （＋） patients who applied topical fusidic acid （n =15）,tacrolimus （n =16）,or moisturizer （n =12）.Changes in the Seborrheic Dermatitis Area Severity Index （SDASI）,TEWL,and Staphylococcus density were evaluated 2 weeks later.Comparisons of each index were performed using analysis of variance （ANOVA） and least significant difference method.Results：The level of TEWL was greater through lesional sites in the HIV （＋） SD （＋） group than that in HIV （＋） SD （-） and HIV （） SD （-） groups （95% confidence interval [CI]：18.873-47.071,P 〈 0.001 and 95% CI：28.755-55.936,P 〈 0.001,respectively）.The number of CFU of Staphylococcus was greater in the HIV （＋） SD （＋） group than that in HIV （＋） SD （-） and HIV （-） SD （-） groups （95% CI：37.487-142.744,P =0.001 and 95% CI：54.936-156.400,P 〈 0.001,respectively）.TEWL was significantly more improved in patients treated with tacrolimus and fusidic acid than that in those treated with moisturizers （95% CI：7.560 38.987,P =0.004 and 95% CI：4.659-37.619,P =0.01 1,respectively）.Topical tacrolimus and fusidic acid were significantly associated with decreased SDASI as compared with moisturizer （95% CI：0.03-0.432,P =0.025 and 95% CI：0.033 0.44,P =0.024,respectively）.Conclusions：High colonization with Staphylococcus epidermidis,along with impaired skin permeability barrier function,contributes to the occurrence of SD.

Case report of seborrheic dermatitis

One case of seborrheic dermatitis,male patient,aged 73 years is reported.After treated with acupuncture,penetrating moxibustion and bloodletting therapies,skin lesions on the neck and shoulder regions disappeared,the epidermis returned to normal and itching disappeared.There was no recurrence in the follow-up visit 3 months later.Hence,acupuncture,combined with penetrating moxibustion and bloodletting has a definite effect on this case in the patient and it is worthy of promotion and application in clinical practice.

Application of topical gentamicin ointment in the treatment of Nagashima-type palmoplantar keratosis in children with a nonsense mutation

Importance:Nagashima-type palmoplantar keratosis(NPPK)is a hereditary dermatosis mostly caused by a nonsense mutation in SERPINB7.Despite the increasing interest in readthrough gentamicin treatment of NPPK,clinical evidence for this treatment is limited.Objective:This study aimed to provide further evidence for the use of topical gentamicin in the treatment of NPPK in children with nonsense mutations.Methods:We designed a bilaterally controlled study of topical gentamicin ointment.Children diagnosed with NPPK carrying nonsense mutations were enrolled in this study.A 0.1%gentamicin ointment was applied to one hand and an emollient to the other for 3 months.A bilateral comparison of the visual analog scale scores for clinical manifestations and safety was performed.Results:Ten children with NPPK were included in this study.In comparison with the emollient side,the topical gentamicin side showed significant improvements in hyperkeratosis,erythema,maceration,and desquamation after 1 and 3 months of treatment(P<0.05).However,hyperhidrosis and odor did not improve significantly.No adverse events were observed during the systemic safety monitoring examinations.Interpretation:Topical gentamicin ointment showed good safety in the treatment of NPPK with nonsense mutations,indicating that it is a promising therapeutic choice in children with NPPK.

Concurrence of Merkel Cell Carcinoma and Squamous Cell Carcinoma in A Patient with Generalized Actinic Keratosis: A Case Report

Introduction:Merkel cell carcinoma(MCC)is a rare,aggressive cutaneous malignancy,and its pathogenesis might relate to ultraviolet light and Merkel cell polyomavirus infection.MCC in the Chinese population is uncommon.Here,we present a case of MCC that occurred based on widespread actinic keratosis(AK)in a Chinese female.Case report:An 82-year-old woman presented with two rapidly enlarging and rupture lesions on the face for 1 year.Biopsy was suggestive of squamous cell carcinoma(SCC)on the forehead and MCC on the left cheek.The patient had a history of generalized AK for 3 years.The lesion on the left cheek was also revealed as an AK by histopathological examination 1 year ago.Complete surgical resection was performed to remove the two malignancies.Discussion:The co-occurrence of AK,SCC,and MCC in a Chinese woman is unusual.Immunohistopathological examination is vital for correct diagnosis.The three tumors,in this case,may originate from two different precursor cells and are affected by the same carcinogen.Alternatively,they may come from the same pluripotent epidermal stem cells,and chronic exposure to ultraviolet light and Merkel cell polyomavirus lead to the formation of different types of tumors.The coexist of MCC with other cutaneous tumors provided a train of thought for exploring the origin of MCC.Conclusion:We reported a rare co-existence phenomenon of MCC associated with AK and SCC.Hence,long-term follow-up and early treatment are imperative for patients with premalignant lesions,such as widespread AK.

Oculocutaneous Albinism with Squamous Cell Carcinoma, Bowen’s Disease and Actinic Keratosis: A Case Report

IntroductionOculocutaneous albinism (OCA) is an autosomal recessive disorder characterized by defects in melanin synthesis that affect the skin,eyes,ears,and hair to varying degrees.Because of the melanin deficiency,albino patients are at high risk for sun-induced skin cancers.Herein,we report a rare case of an OCA type 4 combined with a progressive carcinogenesis for precancerous (actinic keratosis,AK),in situ (Bowen's disease),and invasive status of squamous cell carcinoma (SCC).

梅花针叩刺、针灸联合米诺地尔搽剂治疗男性脂溢性脱发疗效观察

目的:观察梅花针叩刺、针灸联合米诺地尔搽剂治疗男性脂溢性脱发的临床疗效。方法:选取2019年1月-2022年1月笔者医院收治的105例男性脂溢性脱发患者为研究对象,按随机数字表法分为对照组(n=52)和观察组(n=53),对照组给予针灸治疗,观察组在对照组基础上给予梅花针叩刺治疗。比较两组临床疗效、症状积分、发中微量元素水平、不良反应发生率及复发率。结果:共100例患者完成全部治疗。治疗后观察组总有效率为90.00%,显著高于对照组的68.00%(P<0.05);治疗后观察组脱发、瘙痒及脱屑积分均显著低于对照组(P<0.05);治疗后观察组头发中Fe、Cu、Zn水平均显著高于对照组(P<0.05),两组Ca水平比较差异无统计学意义(P>0.05);治疗后观察组复发率为4.00%,低于对照组的20.00%(P<0.05)。结论:梅花针叩刺、针灸联合米诺地尔搽剂治疗男性脂溢性脱发的临床疗效显著,能够减轻临床症状,改善发中微量元素含量,减少复发率。

重组牛碱性成纤维细胞生长因子凝胶联合调Q激光治疗面部脂溢性角化病

目的:探讨重组牛碱性成纤维细胞生长因子(Recombinant bovine basic fibroblast grow,rb-bFGF)凝胶联合调Q激光治疗面部脂溢性角化病(Seborrheic keratosis,SK)的效果。方法:选笔者医院2020年6月-2023年6月收治的82例面部SK患者为研究对象。按随机数字表法分为对照组(n=41)与观察组(n=41),两组均进行调Q激光治疗(波长532 nm),观察组在对照组基础上给予rb-bFGF凝胶治疗。观察对比两组疗效、疼痛程度、痂皮完全脱落时间、遗留红斑持续时间、皮肤病生活质量量表(Dermatology life quality index,DLQI)及不良反应发生情况。结果:观察组有效率较对照组高,差异有统计学意义(P<0.05);观察组疼痛视觉模拟评分法(Visual analogue scale,VAS)评分较对照组低,创面痂皮完全脱落时间、遗留红斑持续时间均较对照组短,差异均有统计学意义(P<0.05)。治疗后,两组DLQI除治疗维度外其他维度评分均较治疗前降低(P<0.05),且观察组均低于对照组(P<0.05);观察组不良反应发生率为0.93%,对照组为6.03%,差异无统计学意义(P>0.05)。结论:rb-bFGF凝胶联合调Q激光治疗面部SK疗效显著,可促进创面恢复,减轻恢复期疼痛,提高患者生活质量。

The Value of Excipients and the Required Understanding of the Biological System in Product Development: An Impactful Example of Curaderm, a Topical Skin Cancer Treatment

The incidences of nonmelanoma skin cancer are increasing worldwide, and the ongoing war on its treatment necessitates the development of effective and non-invasive methods. Through basic and clinical research, non-invasive treatments like Curaderm have been developed, leading to improved quality of life for patients. Excipients, previously considered inactive ingredients, play a crucial role in enhancing the performance of topical formulations. The development of Curaderm emphasizes the importance of understanding the interactions between active ingredients, excipients, and the biological system to create effective and affordable pharmaceutical formulations. The systematic approach taken in the development of Curaderm, starting from the observation of the anticancer activity of natural solasodine glycosides and progressing through toxicological and efficacy studies in cell culture, animals, and humans, has provided insights into the pharmacokinetics and pharmacodynamics of solasodine glycosides. It is crucial to determine these pharmacological parameters within the skin’s biological system for maximal effectiveness and cost-effectiveness of a skin cancer treatment. Curaderm, as a topical treatment for nonmelanoma skin cancer, offers benefits beyond those obtained from other topical treatments, providing hope for improved quality of life for patients.