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Topical Timolol Treatment of Infantile Hemangioma

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Safety and Efficacy of Topical Timolol Treatment of Infantile Hemangioma - A Prospective Trial

The British Journal of Dermatology

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عنوان صفحه ارسال مطلب

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: Cryotherapy Effective Rx for Idiopathic Guttate Hypomelanosis

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Cryotherapy-Effective-Rx-for-Idiopathic-Guttate-Hypomelanosis.docx

مقاله جالبی درباره یک روش درمان ویتیلیگو 

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How to get the most out of methotrexate for Psoriasis:Article

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How-to-get-the-most-out-of-methotrexate-for-psoriasis---Dermatology-News-1.pdf

مقاله بسیار جالبی درباره اثرات متوترکسات در پسوریازیس ارائه شده در کنفرانس درماتولوژی هاوایی است. 

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The use of topical minoxidil to accelerate nail growth: a pilot study Authors Kumpol Aiempanakit MD,

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Abstract

Linear nail growth rate is affected by various conditions, one of which is the level of blood flow. Our supposition was that topical minoxidil, which has vasodilatory properties, can increase the rate of nail growth. The aim of this study was to determine the impact of topical minoxidil on nail growth. A 5% topical minoxidil solution was applied twice daily to the fingernails of 32 participants. Two groups of 16 participants were randomly chosen. In one group, the applications were made to the right index and left ring fingernails, and, in the other, the left index and right ring fingernails. During each visit (weekly during the first month and every 2 weeks during the second month), the nail length of six fingernails (index, middle, and ring of both hands) was measured using a digital caliper. Beginning in the first week, the mean nail length of the treated nails was greater than that of nails in the untreated group with statistical significance. There were no systemic or cutaneous side effects. During the first month, the mean growth of the treated nails was 4.27 mm/month compared with 3.91 mm/month in the untreated nails (P = 0.003). These findings suggest that a 5% concentration of topical minoxidil can stimulate nail growth with increased growth beginning in the first week of application. The results may have important implications for the treatment of nail disorders; however, a comparable study involving participants with nail disorders is highly recommended.

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Injectable DaxibotulinumtoxinA for the Treatment of Glabellar Lines: A Phase 2, Randomized, Dose-Ranging, Double-Blind, Multicenter Comparison With OnabotulinumtoxinA and Placebo.

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BACKGROUND: Injectable daxibotulinumtoxinA (RT002) is an investigational botulinum toxin Type A in clinical development. It is formulated with a proprietary peptide and offers the potential of a longer acting neurotoxin therapy.

OBJECTIVE: To compare the safety, efficacy, and duration of response of daxibotulinumtoxinA with onabotulinumtoxinA and placebo [ www.clinicaltrials.gov NCT02303002].

METHODS: In this Phase 2, randomized, dose-ranging, parallel-group, double-blind, multicenter study, subjects with moderate or severe glabellar lines at maximum frown were randomly assigned to 20U, 40U, or 60U daxibotulinumtoxinA, 20U onabotulinumtoxinA, or placebo. Glabellar line severity was evaluated by investigators and subjects at least every 4 weeks, for at least 24 weeks.

RESULTS: Overall, 268 subjects enrolled. Statistical and clinical superiority were observed for 40U and 60U daxibotulinumtoxinA over 20U onabotulinumtoxinA for a range of efficacy outcomes despite the study not being powered to detect statistically significant differences between these active treatment groups.

CONCLUSION: The 40U dose of daxibotulinumtoxinA was well tolerated (e.g., absence of ptosis) and had the most favorable risk: benefit profile. Compared with 20U onabotulinumtoxinA, it exhibited a significantly greater response rate and a significantly longer duration of response (median of 24 weeks vs 19 weeks; p = .030).

(C) 2017 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

 
 
 
 
 
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thanks for asking about my dementia :

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Exercise may bolster the brain function and
thinking skills of people with dementia,
according to a new report. The study’s findings
suggest that walking a few times per week might
alter the trajectory of the disease and improve
the physical well-being of people who develop a
common form of age-related memory loss that otherwise has few treatments.
 
The study looked at vascular cognitive
impairment, the second most frequent form of
dementia worldwide, after the better-known
Alzheimer’s disease. The condition arises when
someone’s blood vessels become damaged and blood
no longer flows well to the brain. It is often
associated with high blood pressure and heart disease.
 
One of the particular hallmarks of vascular
dementia in its early stages, researchers have
found, is that it tends to make the brain
function less efficiently. In past brain-scan
studies, people with a diagnosis of vascular
cognitive impairment generally showed more neural
activity in parts of their brains that are
involved with memory, decision-making and
attention than did people without the disease,
indicating that their brains had to work harder
during normal thinking than healthier brains did.
 
But while a great deal of research attention has
been devoted to Alzheimer’s disease, less has
been known about the progression of and potential
curbs on vascular dementia. Some research has
indicated that reducing blood pressure lessens the symptoms of the disease.
 
 
Exercise can likewise improve blood pressure and
cardiovascular health. And
research suggests that frequent, brisk walks may
improve memory and physical abilities in those in
the early stages of Alzheimer’s disease. But,
rather surprisingly, few past studies had
examined whether exercise might also improve
brain function in people with vascular dementia.
 
So for the
study, which was published in April in The
British Journal of Sports Medicine, researchers
at the University of British Columbia in Canada
and other institutions decided to look into the
effects of walking on this type of dementia.
 
They began by recruiting 38 older people in
British Columbia who had been given diagnoses of
a mild, early form of vascular cognitive
impairment. None currently exercised. All agreed
to visit the university’s lab frequently for six months.
 
On the participants’ first lab visit, the
scientists measured their general health and also memory and thinking skills.
 
They then scanned each volunteer’s brain while he
or she concentrated on a computerized test of
attention and decision-making skills that
involved rapidly clicking keys to indicate the
direction that an arrow should point. This scan
was designed to reveal neural activity and how
hard different parts of the brain were working during the task.
 
Finally, the scientists randomly assigned their
volunteers to start either walking or, as a
control group, to visit the lab for weekly
education sessions about nutrition and healthy living.
 
The walking program was simple, consisting of
supervised one-hour sessions at the lab three
times a week. The walkers were asked to move
briskly enough during workouts to raise their
heart rates to about 65 percent of their maximum capacity.
 
“We wanted to have some intensity” in the
exercise, says Teresa Liu-Ambrose, the director
of the Aging, Mobility and Cognitive Neuroscience
Lab at the University of British Columbia and the
lead author. Most of the walkers completed all of
the sessions and “seemed to be enjoying the
exercise” by the end of the six months, she says.
 
At that point, the volunteers in both groups
repeated the physical and cognitive tests from
six months earlier, as well as the brain scan.
The results showed that the two groups had
drifted apart, in terms of the functions of their
bodies and brains. Most obviously, the walkers
generally had lower blood pressures now than the
volunteers in the control group.
 
But more striking, their brains also were working
differently. The walkers’ brains showed less
activation in portions of the brain required for
attention and rapid decision-making than did the
brains of those in the control group.
 
The differences were subtle, Dr. Liu-Ambrose
says, but they correlated neatly with
improvements on the cognitive tests. The less
someone’s brain had to work to maintain attention
and make quick decisions, the better that person
typically performed on the tests of general thinking ability.
 
In essence, the walkers had more efficient brains
and better thinking skills now than the control group did, she says.
 
Of course, this study was short term, lasting
only six months, after which the volunteers were
free to stop exercising ­ and most did. Dr.
Liu-Ambrose and her colleagues hope in the future
to study whether and how rapidly the brains and
bodies of exercisers lose any gains if they
become sedentary again. They also want to look
into different “doses” of exercise and whether
shorter or easier workouts would have an effect
on brain function in people with vascular dementia.
64COMMENTS
 
Obviously, anyone with memory or other cognitive
problems should consult with a doctor before
starting to exercise and should probably not
exercise alone, Dr. Liu-Ambrose says.
 
But even with so many questions remaining, the
results of this study are encouraging, she says.
They show that in the early states of vascular
dementia, “something as simple and accessible as
walking may make a meaningful difference” in how well the brain works.
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blue light is ...anti-aging

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>Guardian (UK) (6/1, Wills) reports the blue
>light emitted from the screens of electronic
>devices may age skin, according to experts. The
>article quotes dermatologist Andrew Birnie,
>“There’s a lot of research being done at the
>moment into the effects of visible light. I
>recently got back from the American Academy of
>Dermatology meeting and one of the things that
>was being discussed there was whether visible
>light such as HEV or infra red ought to be
>protected against in sunscreens.” The article
>suggests that “Screen Face” should be added “to
>the list of afflictions allegedly caused by our
>dependence on digital technology – along with Text Neck and Cellphone Elbow.”
undefined
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? cure sepsis

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The
>News (VA) Daily Press (4/14, Canty, Subscription Publication)
>reports Dr. Paul Marik, chief of pulmonary and critical medicine and
>professor of internal medicine at Eastern Virginia Medical School in
>Norfolk, "believes he's found a better way to treat" sepsis, by
>means of "a combination therapy of vitamins C, B and
>corticosteroids." Marik said, "My intention was never to discover
>the cure for sepsis ... It just kind of happened by mistake." He has
>reported "more than 200 successful outcomes on patients at Sentara
>Norfolk General Hospital." He published his results in CHEST.
 
undefined
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new topical for vitiligo

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>Topical Ruxolitinib May Be Tied To Significant Repigmentation In
>Patients With Facial Vitiligo, Study Suggests.
>
>
>
>(4/11, Thiel) reports "patients with facial vitiligo experienced
>significant repigmentation after treatment with topical ruxolitinib
>1.5% cream," according to a
>published in the Journal of the American Academy of Dermatology.
>Researchers found significant improvement in facial Vitiligo Area
>Scoring Index in patients who received the treatment.
 
 
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vitiligo

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Does >Dairy Cause Acne? >.

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Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition.

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bstract

Alopecia areata (AA) is a common autoimmune disease resulting from damage of the hair follicle by T cells. The immune pathways required for autoreactive T cell activation in AA are not defined limiting clinical development of rational targeted therapies. Genome-wide association studies (GWAS) implicated ligands for the NKG2D receptor (product of the KLRK1 gene) in disease pathogenesis. Here, we show that cytotoxic CD8(+)NKG2D(+) T cells are both necessary and sufficient for the induction of AA in mouse models of disease. Global transcriptional profiling of mouse and human AA skin revealed gene expression signatures indicative of cytotoxic T cell infiltration, an interferon-γ (IFN-γ) response and upregulation of several γ-chain (γc) cytokines known to promote the activation and survival of IFN-γ-producing CD8(+)NKG2D(+) effector T cells. Therapeutically, antibody-mediated blockade of IFN-γ, interleukin-2 (IL-2) or interleukin-15 receptor β (IL-15Rβ) prevented disease development, reducing the accumulation of CD8(+)NKG2D(+) T cells in the skin and the dermal IFN response in a mouse model of AA. Systemically administered pharmacological inhibitors of Janus kinase (JAK) family protein tyrosine kinases, downstream effectors of the IFN-γ and γc cytokine receptors, eliminated the IFN signature and prevented the development of AA, while topical administration promoted hair regrowth and reversed established disease. Notably, three patients treated with oral ruxolitinib, an inhibitor of JAK1 and JAK2, achieved near-complete hair regrowth within 5 months of treatment, suggesting the potential clinical utility of JAK inhibition in human AA.ruxolitinib, an inhibitor of JAK1 and JAK2, achieved near-complete hair regrowth within 5 months of treatment, suggesting the potential clinical utility of JAK inhibition in human AA.ruxolitinib, an inhibitor of JAK1 and JAK2, achieved near-complete hair regrowth within 5 months of treatment, suggesting the potential clinical utility of JAK inhibition in human AA.(+)NKG2D(+) T cells are both necessary and sufficient for the induction of AA in mouse models of disease. Global transcriptional profiling of mouse and human AA skin revealed gene expression signatures indicative of cytotoxic T cell infiltration, an interferon-γ (IFN-γ) response and upregulation of several γ-chain (γc) cytokines known to promote the activation and survival of IFN-γ-producing CD8(+)NKG2D(+) effector T cells. Therapeutically, antibody-mediated blockade of IFN-γ, interleukin-2 (IL-2) or interleukin-15 receptor β (IL-15Rβ) prevented disease development, reducing the accumulation of CD8(+)NKG2D(+) T cells in the skin and the dermal IFN response in a mouse model of AA. Systemically administered pharmacological inhibitors of Janus kinase (JAK) family protein tyrosine kinases, downstream effectors of the IFN-γ and γc cytokine receptors, eliminated the IFN signature and prevented the development of AA, while topical administration promoted hair regrowth and reversed established disease. Notably, three patients treated with oral ruxolitinib, an inhibitor of JAK1 and JAK2, achieved near-complete hair regrowth within 5 months of treatment, suggesting the potential clinical utility of JAK inhibition in human AA.

Mark

Mark Crowe, MD
www.PuyallupDermatology.com
Puyallup, Washington
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Re: Calcipotriol + 5-FU Effective Against AKs -- bid for just 4 days

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Re: Calcipotriol + 5-FU Effective Against AKs -- bid for just 4 days

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تشرين2
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Topical tacrolimus significantly promotes repigmentationin idiopathic guttate hypomelanosis: a double-blind,randomized, placebo-c ontrolled study

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  • ORIGINAL ARTICLE
    Topical tacrolimus significantly promotes repigmentation
    in idiopathic guttate hypomelanosis: a double-blind,
    randomized, placebo-c ontrolled study
    P. Rerknimitr,* W. Disphanurat, M. Achariyakul
    Division of Dermatology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
    *Correspondence: P. Rerknimitr. E-mail: pawineererk@yahoo.co.th
    Abstract
    Background Idiopathic guttate hypomelanosis (IGH) is an idiopathic disorder affecting a large number of people.
    Effective treatments are not yet available.
    Objectives To investigate the efficacy of topical 0.1% tacrolimus ointment compared with placebo in the
    treatment of IGH.
    Materials and methods Twenty-six patients were included in the study. Lesions on one side of the body were
    selected to have a treatment with 0.1% tacrolimus ointment, whereas those on the other side served as a control
    with placebo ointment that had the same physical appearance. Colorimeter was used to assess skin colour at
    baseline and at 1, 2, 3, 4 and 6 months of treatment.
    Results Mean luminosity scale after adjusted for baseline from the treated side gradually decreased and reached
    statistical significance compared with the control group after 6 months of treatment (P = 0.019). Physicians’
    improvement grading score showed that 11% of the patients demonstrated improvement of their skin lesions on the
    treated side after 6 months’ treatment.
    Conclusion Topical 0.1% tacrolimus ointment appeared to be an effective and safe treatment for IGH. The
    improvements were best observed by colorimetry, yet, they were not statistically significant upon clinical
    assessments.
    Received: 14 November 2011; Accepted: 13 January 2012
    Conflict of interest
    None.
    Introduction
    Idiopathic guttate hypomelanosis (IGH) is a common condition
    affecting up to 87% of adults aged more than 40 years.
    1
    It is char-
    acterized by multiple round to oval, hypopigmented or porcelain
    white macules measuring 0.2–1.6 cm. The skin lesions are pre-
    dominantly found on the exposed upper and lower extremities.
    The aetiology and pathogenesis of this disorder still remain
    unknown; however, genetic factors, sun exposure, trauma and
    autoimmunity have been suggested as contributing factors.
    2,3
    Although it is an asymptomatic disorder, affected individuals
    may seek medical attention due to aesthetic motivation. Treatment
    modalities reported with variable results, include superficial derm-
    abrasion,
    4
    cryotherapy,
    5,6
    topical retinoids
    7
    and recently, topical
    pimecrolimus.
    8
    We herein investigate the efficacy of topical 0.1% tacrolimus
    ointment, compared with placebo in the treatment of IGH.
    Materials and methods
    The study protocol was approved by Thammasat University Insti-
    tutional Review Board and conducted at the outpatient depart-
    ment, Thammasat University hospital, Pathumthani, Thailand
    between October 2009 and October 2010.
    The inclusion criteria were as follows; age more than 45 years
    old and lesions distributed symmetrically on both sides of the
    body with similar extent. The exclusion criteria were treatment
    with topical vitamin A derivatives within 6 months before the
    study period or allergy to tacrolimus ointment or its vehicle.
    ThediagnosticcriteriausedforIGHinthisstudyincluded
    acquired lesions, round to oval shape, size less than 2 cm, whitish
    or porcelain macules, non-scaly smooth surface, well-demarcated
    margin and scattered distribution.
    1,9
    The IGH lesions on one side were randomly assigned 0.1%
    tacrolimus ointment (Janssen, Titusville, NJ, USA) whereas those
    ª 2012 The Authors
    JEADV 2013, 27, 460–464 Journal of the European Academy of Dermatology and Venereology ª 2012 European Academy of Dermatology and Venereology
    DOI: 10.1111/j.1468-3083.2012.04462.x JEADV
  • on the contralateral side were treated with placebo ointment that
    had the same physical appearance. Block randomization technique
    was used. Patients were instructed to apply either ointment twice
    daily on their skin lesions for 6 months. Sun avoidance and regu-
    lar use of sunscreen (SpectraBan 60; Stiefel Laboratories, Bangkok,
    Thailand) were advised.
    Colorimeter (Chromameter CR-400; Konica Minolta, Osaka,
    Japan) was used to assess lesional skin colour before and at 1, 2, 3,
    4 and 6 months of treatment, on both treated and control sides.
    Same skin lesions were measured at each visit by having reference
    points, i.e. nearby bony prominences and photographic documen-
    tation. All chromameter measurements were mean value of tripli-
    cate readings. They express the colour in the L*a*b* system. The
    ‘a*’ value represents the changes along red-green axis and the ‘b*’
    value yellow-blue axis. Pigment is measured on luminosity (L*)
    scale, from 0 (black) to 100 (white).
    10,11
    Series of photographs of patients’ treatment and control areas
    were taken using standard digital camera (DSLR D50; Nikon,
    Tokyo, Japan) before treatment, and at 1, 2, 3, 4 and 6 months
    during therapy. The pre- and post-treatment photographs were
    evaluated by three blinded experienced dermatologists using a
    quartile grading score (0 = no improvement, 1 = below 25%
    improvement, 2 = 25–50% of improvement, 3 = 51–75% of
    improvement, 4 = more than 75% improvement).
    At every visit, side effects related to topical therapy, its severity
    anddurationwereevaluated.Finally,atthe6months,patients
    were interviewed and self-assessment score of the improvement
    were obtained on both treated and controlled sides (no improve-
    ment, minimal = below 25% improvement, moderate = 25–50%
    improvement, marked = 51–75% improvement, remarkable =
    more than 75% improvement).
    Statistical analysis
    The statistical analysis of the mean difference of colour L* scale
    after adjusted for L* scale value at baseline between the treatment
    and control group was performed using analysis of covariance
    (
    ANCOVA). L* scale value at baseline was analysed as the covariate.
    Improvement scores from experienced dermatologists was analy-
    sed by Fisher’s exact test. P < 0.05 was considered statistically sig-
    nificant.
    Results
    Twenty six patients, 3 male and 23 female completed the study.
    The mean age was 59.1 ± 8.7 years with a range from 46 to 81.
    The patients’ Fitzpatrick skin types were III–IV (type III—26.9%;
    type IV—73.1%).
    Objective measurement
    Mean L* scale measured from colorimeter after adjusted for base-
    line from the treated side gradually decreased after initiation of
    therapy and reach statistical significance compared with the control
    group after 6 months of treatment (P =0.019)asshowninFig.1.
    Subjective assessments
    Improvement scores assessed by three experienced dermatologists
    are summarized in Fig. 2.
    At 6 months, 11% (3 26) of the patients demonstrated
    improvement of their skin lesions on the tacrolimus side. Three
    per cent of the patients (1 26) showed 51–75% improvement
    compared to baseline. However, there was no statistical difference
    between the treatment and control group.
    55
    56
    57
    58
    012346
    Mean L* scale
    Month
    Treatment
    Control
    *P = 0.019
    Figure 1 Mean L* scale after adjusted for baseline between the
    treatment and the control group.
    24 26 23 26 23 26 24 26 23 25
    1
    22
    1
    2
    11111
    0
    5
    10
    15
    20
    25
    Number of paƟents
    12 3 4 6
    Month
    Score = 4 Score = 3
    Score = 2 Score = 1 Score = 0
    1
    Figure 2 Improvement score using quartile grading scale
    assessed by dermatologists score 0 = no improvement, score
    1 = below 25% improvement, score 2 = 25–50% of improve-
    ment, score 3 = 51–75% of improvement, score 4 = more than
    75% improvement.
    ª 2012 The Authors
    JEADV 2013, 27, 460–464 Journal of the European Academy of Dermatology and Venereology ª 2012 European Academy of Dermatology and Venereology
    Tacrolimus promotes repigmentation in IGH 461
  • Patient self-assessment of the degree of improvement after
    6monthsisshowninFig.3.Eighty-onepercent(2126) of the
    patients evaluated that the treated side showed some degree of
    improvement whereas only 58% (15 26) of the control side
    showed some degree of improvement.
    The clinical improvement in one of the patient after 6 months
    of treatment with 0.1% topical tacrolimus ointment is shown in
    Fig. 4.
    The adverse effects of 0.1% tacrolimus ointment on the treated
    side were mild and transient. Burning sensation at the treated area
    wasreportedby19.2%(526) of the patients, all rated as mild
    (5 5) and lasted for a mean of 2.4 ± 0.9 days. No other adverse
    events including pruritus, erythema or pustular eruption were
    reported. On the control side, no adverse reactions were found.
    Discussion
    We demonstrated that application of 0.1% tacrolimus ointment
    gradually promoted repigmentation of IGH lesions which reached
    statistically significant level compared with placebo after 6 months
    of therapy.
    The results of this study are in keeping with previous case series
    by Asawanonda et al.
    8
    They reported the efficacy of 1% pimecroli-
    mus cream as a treatment of IGH in four patients. The lesions
    improved 25–75% compared with baseline in three of four
    patients judged by physicians. However, in their series, the
    improvement was observed within 8 weeks of treatment and less
    well circumscribed and less depigmented lesions correlated with
    better response. In subgroup analysis of our data, we did not find
    any statistical difference in terms of degree of repigmentation
    between hypopigment vs. depigmented lesions (data not shown).
    Histopathological examination of IGH lesions reveals a signifi-
    cant decrease in number of melanocytes as well as melanin pig-
    ment.
    3,5,9
    Under electron microscopy, these melanocytes have
    fragmented or no dendrite and fewer melanosomes, compatible
    with a focal degenerative process.
    5
    However, Wallace et al. demon-
    strated that a block in melanocyte differentiation is not a major
    component in this condition.
    12
    Therefore, the hypopigmentation
    observed might be due to a reduction in number or dysfunction
    of melanocytes.
    9
    The pathogenesis of IGH remains obscure. The proposed aetiol-
    ogies include genetics, ultraviolet exposure, senile changes and
    trauma. In addition, autoimmunity might play a role in the patho-
    genesis. These can be demonstrated in a number of studies.
    Falabella et al. treated IGH lesions with autologous minigrafts of
    normal skin implanted into the centre of IGH lesions with and
    without additional intralesional triamcinolone injection and the
    injection alone.
    3
    The results showed that intralesional steroid
    injectionaloneandautologousminigraftsplusthesteroidinjec-
    tion produced good repigmentation that reached significance
    compared with skin grafting alone. These might be explained by
    the immunosuppressive action of steroids on the local environ-
    ment of IGH lesions. Gilhar et al. grafted depigmented macules of
    IGH lesions onto nude mice skin.
    13
    Repigmentation and increase
    in number of melanocytes of the areas were then observed. These
    suggested that unknown local and or systemic factors might play
    an important role in the pathogenesis. Furthermore, an increased
    number of Langerhans cells in one of the three IGH cases was
    demonstrated by Ortonne et al.
    14
    Inaddition,IGHhasbeenconsideredasasenileskinchanges
    as its prevalence increases with age of patients.
    1,3
    A recent study
    from Shin et al. demonstrated that photoageing might be associ-
    ated with IGH. Besides that, 85% of histopathological sections
    from their patients’ facial IGH lesions revealed mild degree of
    19%
    42%
    19%
    8%
    12%
    19%
    27%
    19%
    23%
    12%
    0
    2
    4
    6
    8
    10
    12
    lortnoCtnemtaerT
    Number of paƟents
    No improvement
    Minimal
    Moderate
    Marked
    Remarkable
    Figure 3 Degree of improvement after 6 months evaluated by
    the patients. No improvement, minimal = below 25% improve-
    ment, moderate = 25–50% improvement, marked = 51–75%
    improvement, remarkable = more than 75% improvement.
    (a) (b)
    Figure 4 (a) Baseline, (b) after 6 months of treatment with 0.1% tacrolimus ointment.
    ª 2012 The Authors
    JEADV 2013, 27, 460–464 Journal of the European Academy of Dermatology and Venereology ª 2012 European Academy of Dermatology and Venereology
    462 Rerknimitr et al.
  • infiltration by mononuclear inflammatory cells localized in
    perivascular region of the upper dermis despite of non-inflamma-
    tory clinical appearance of the skin lesions.
    1
    These findings were
    indicative of dermatoheliosis. Previous studies have shown that in
    photoaged skin, even with clinically non-inflammatory condition,
    it was infiltrated by mononuclear cells and exhibited features of
    chronic skin inflammation.
    15,16
    A number of studies show favourable results of topical calcineu-
    rin inhibitors in treating vitiligo. The effectiveness seems to be
    superior for the facial lesions, compared with other parts of the
    body.
    17
    IGH lesions are mostly found on the exposed upper and
    lower extremities therefore the repigmentation rate might not be
    as high comparing with one in facial vitiligo. This can be explained
    by the fact that topical drug penetration is much higher in facial
    skin than in upper and lower extremities.
    18
    In our study, it took
    6 months to notice the repigmentation of the IGH lesions.
    The mechanism of topical calcineurin inhibitors in inducing
    repigmentation of hypo- or depigmented disorders, such as vitiligo
    and IGH may be mainly due to its ability to increase melanin con-
    tent by stimulating tyrosinase activity and its expression in human
    melanocytes. In addition, proliferation and migration of melano-
    cytes were enhanced.
    19,20
    Furthermore, tacrolimus ointment which
    acts primarily as an immunosuppressant may modulate local
    and or systemic factors and suppress chronic inflammation caused
    by photoageing process involved in the pathogenesis of IGH.
    In our study, the physician improvement scores did not reach
    statistically significant level between the treatment and the control
    group. We hypothesize that the L* scale, measured by chromame-
    ter, may be more sensitive than physicians’ ability to detect any
    clinical response. Nevertheless, 11% (3 26) of the patients demon-
    strated some degree of repigmentation of their skin lesions on the
    treated side judged by the physicians.
    Side effects reported in our study were mild and transient. Skin
    burning was the only adverse event found and lasted for a brief
    period of time.
    Our study was inspired by the trial of Asawanonda et al.
    8
    In
    addition, we conducted a double-blind, randomized, placebo-con-
    trolled trial, left-vs.-right comparison which can eliminate majority
    of possible confounding factors. The results of the treatment were
    not only assessed by physicians’ subjective judgment and patient
    satisfaction but also by objective tools. Furthermore, to our knowl-
    edge,thisistherandomized,controlledtrialontreatmentofIGH
    with the largest number of participants. We did not have any
    drop-outs which indicates patients’ strong adherence and also sig-
    nifies their motivation for treatment.
    The limitation of our study includes participants’ skin types,
    whichwereonlyoftypeIIIandIV,asthestudywasconducted
    among Asian populations and most are female. In addition, The
    L* scale value from chromameter could have intraindividual dif-
    ference and a control side in each subject could be needed. How-
    ever, in hypo or depigmented lesions like IGH, we believe that the
    variability of the skin colour does not fluctuate much from exter-
    nal environment, i.e. sunlight. Yet in further studies, the lightness
    index as used in hyperpigmented condition like melasma should
    be considered.
    In conclusion, topical 0.1% tacrolimus ointment appeared to be
    an effective treatment for IGH. It is noteworthy that the improve-
    ment is best observed by chromameter measurement and the
    result is less significant clinically. It is necessary to apply twice daily
    for several months, as in our study, 6 months to provide apprecia-
    blecosmeticresults.Sideeffectsarefewandtolerable.Onthe
    other hand, the cost of treatment may be a concern.
    Acknowledgement
    We would like to express our deep gratitude to Professor Pra-
    vit Asawanonda who helped revise the manuscript.
    References
    1 Shin MK, Jeong KH, Oh IH, Choe BK, Lee MH. Clinical features of
    idiopathic guttate hypomelanosis in 646 subjects and association with
    other aspects of photoaging. Int J Dermatol 2011; 50: 798–805.
    2 Kaya TI, Yazici AC, Tursen U, Ikizoglu G. Idiopathic guttate hypomela-
    nosis: idiopathic or ultraviolet induced? Photodermatol Photoimmunol
    Photomed 2005; 21: 270–271.
    3 Falabella R, Escobar C, Giraldo N et al. On the pathogenesis of idio-
    pathic guttate hypomelanosis. J Am Acad Dermatol 1987; 16: 35–44.
    4 Hexsel DM. Treatment of idiopathic guttate hypomelanosis by localized
    superficial dermabrasion. Dermatol Surg 1999; 25: 917–918.
    5 Ploysangam T, Dee-Ananlap S, Suvanprakorn P. Treatment of idio-
    pathic guttate hypomelanosis with liquid nitrogen: light and electron
    microscopic studies. J Am Acad Dermatol 1990; 23: 681–684.
    6 Kumarasinghe SP. 3–5 second cryotherapy is effective in idiopathic
    guttate hypomelanosis. J Dermatol 2004;31; 437–439.
    7 Pagnoni A, Kligman AM, Sadiq I, Stoudemayer T. Hypopigmented
    macules of photodamaged skin and their treatment with topical treti-
    noin. Acta Derm Venereol 1999; 79 : 305–310.
    8 Asawanonda P, Sutthipong T, Prejawai N. Pimecrolimus for idiopathic
    guttate hypomelanosis. J Drugs Dermatol 2010; 9: 238–239.
    9 Kim SK, Kim EH, Kang HY, Lee ES, Sohn S, Kim YC. Comprehensive
    understanding of idiopathic guttate hypomelanosis: clinical and histo-
    pathological correlation. Int J Dermatol 2010; 49: 162–166.
    10 Wattanakrai P, Mornchan R, Eimpunth S. Low-fluence Q-switched
    neodymium-doped yttrium aluminum garnet (1,064 nm) laser for
    the treatment of facial melasma in Asians. Dermatol Surg 2010; 36:
    76–87.
    11 Taylor S, Westerhof W, Im S, Lim J. Noninvasive techniques for the
    evaluation of skin color. J Am Acad Dermatol 2006; 54: S282–S290.
    12 Wallace ML, Grichnik JM, Prieto VG, Shea CR. Numbers and differen-
    tiation status of melanocytes in idiopathic guttate hypomelanosis.
    J Cutan Pathol 1998; 25: 375–379.
    13 Gilhar A, Pillar T, Eidelman S, Etzioni A. Vitiligo and idiopathic guttate
    hypomelanosis. Repigmentation of skin following engraftment onto
    nude mice. Arch Dermatol 1989; 125: 1363–1366.
    14 Ortonne JP, Perrot H. Idiopathic guttate hypomelanosis ultrastructural
    study. Arch Dermatol 1980; 116: 664–668.
    15 Bosset S, Bonnet-Duquennoy M, Barre P et al. Photoageing
    shows histological features of chronic skin inflammation without
    clinical and molecular abnormalities. Br J Dermatol 2003; 149:
    826–835.
    16 Hase T, Shinta K, Murase T et al. Histological increase in inflammatory
    infiltrate in sun-exposed skin of female subjects: the possible involve-
    ment of matrix metalloproteinase-1 produced by inflammatory infiltrate
    on collagen degradation. Br J Dermatol
    2000; 142: 267–273.
    ª 2012 The Authors
    JEADV 2013, 27, 460–464 Journal of the European Academy of Dermatology and Venereology ª 2012 European Academy of Dermatology and Venereology
    Tacrolimus promotes repigmentation in IGH 463

 

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Cyclosporin A Inhibits the Propagation of Influenza Virus by Interfering with a Late Event in the Virus Life Cycle

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nfluenza Virus Research Center, National Institute of Infectious Diseases, Tokyo 208-0011; 2Department of Integrated Pulmonology, Tokyo Medical and Dental University, Tokyo 113-8519; 3Department of Life and Environmental Science, Chiba Institute of Technology, Chiba 275-0016; and 4Department of General Medicine, Juntendo University School of Medicine, Tokyo 113-8421, Japan (Received September 24, 2012. Accepted April 3, 2013) SUMMARY: Influenza is a global public health problem that causes a serious respiratory disease. Influenza virus frequently undergoes amino acid substitutions, which result in the emergence of drugresistant viruses. To control influenza viruses that are resistant to currently available drugs, it is essential to develop new antiviral drugs with a novel molecular target. Here, we report that cyclosporin A (CsA) inhibits the propagation of influenza virus in A549 cells by interfering with a late event in the virus life cycle. CsA did not affect adsorption, internalization, viral RNA replication, or synthesis of viral proteins in A549 cells, but inhibited the step(s) after viral protein synthesis, such as assembly or budding. In addition, siRNA-mediated knockdown of the expression of the major CsA targets, namely cyclophilin A (CypA), cyclophilin B (CypB), and P-glycoprotein (Pgp), did not inhibit influenza virus propagation. These results suggest that CsA inhibits virus propagation by mechanism(s) independent of the inhibition of the function of CypA, CypB, and Pgp. CsA may target an unknown molecule that works as a positive regulator in the propagation of influenza virus. Our findings would contribute to the development of a novel anti-influenza virus therapy and clarification of the regulatory mechanism of influenza virus multiplication

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Two Methods of Staging HS :

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ovember 8, 2016
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=38565&F=H>Subscribe
>to Consultant<http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=90&F=H>
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=103&F=H>In
>what year was the first x-ray produced? Answer >>
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=3818&F=H>The
>Hurley and Sartorius Systems: Two Methods of Staging HS
>
>
>Two major classification systems are used to stage the severity of
>HS: the Hurley system, and the Sartorius system. For more on the
>differences between the two methods,
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=3818&F=H>read more.
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=86765&F=H>
>SHARE:
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=86917&F=H>
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=86805&F=H>
>
>
>For more articles, visit
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=3818&F=H>Hidradenitis
>Suppurativa 360.
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=3818&F=H>Is
>Biofilm Linked to Chronic Lesions in HS?
>A recent study set out to determine and quantify the potential
>presence of bacterial aggregates in chronic HS lesions.
>
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=3818&F=H>Is
>Surgical Management of HS Effective?
>A recent study examined surgical management for the inflammatory
>disease hidradenitis suppurativa.
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=3818&F=H>Intrinsic
>Defect Leads to Inflammation in HS
>The use of antibiotics for HS suggest a deregulated immune response
>to microflora.
>
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=3818&F=H>First-line
>Hidradenitis Suppurativa Treatment
><http://hmpemail.net/blaster/link.php?M=2411378&N=11483&L=103&F=H>
>Clinicians may be able to more accurately predict which patients
>with HS will respo

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get rid of tattoo

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get rid of tattoos

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Accutane / osteopenia u

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>Excessive intakes of vitamin A have been shown to have adverse skeletal
effects in animals. High vitamin A intake may lead to an increased risk of
fracture in humans.
OBJECTIVE:

The objective was to evaluate the relation between total vitamin A and
retinol intakes and the risk of incident total and hip fracture in
postmenopausal women.
DESIGN:

A total of 75,747 women from the Women's Health Initiative Observational
Study participated. The risk of hip and total fractures was determined
using Cox proportional hazards models according to different intakes of
vitamin A and retinol.
RESULTS:

In the analysis adjusted for some covariates (age; protein, vitamin D,
vitamin K, calcium, caffeine, and alcohol intakes; body mass index; hormone
therapy use; smoking; metabolic equivalents hours per week; ethnicity; and
region of clinical center), the association between vitamin A intake and
the risk of fracture was not statistically significant. Analyses for
retinol showed similar trends. When the interaction term was analyzed as
categorical, the highest intake of retinol with vitamin D was significant
(P = 0.033). Women with lower vitamin D intake (< or =11 microg/d) in the
highest quintile of intake of both vitamin A (hazard ratio: 1.19; 95% CI:
1.04, 1.37; P for trend: 0.022) and retinol (hazard ratio: 1.15; 95% CI:
1.03, 1.29; P for trend: 0.056) had a modest increased risk of total
fracture.
CONCLUSIONS:

No association between vitamin A or retinol intake and the risk of hip or
total fractures was observed in postmenopausal women. Only a modest
increase in total fracture risk with high vitamin A and retinol intakes was
observed in the low vitamin D-intake group.
PMID: 19056568 PMCID: PMC2715292
<
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2715292/> DOI:
10.3945/ajcn.2008.26451 <https://dx.doi.org/10.3945/ajcn.2008.26451>


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