Dermatological Research and Reviews

Introduction: Diabetic foot ulcer (DFU) is a typical dermatological complication often found in patients with diabetes mellitus (DM). Chronic hyperglycemia state causes microvascular impairment that leads to loss of peripheral sensory, motor, and autonomous functions. The current diabetic ulcer therapy has not yet provided a satisfactory reduction of the ulcer area; thus, several adjuvant therapies were tried, such as using ozone therapy, either systematically or topically. Ozone increases the cell membrane permeability to glucose, increases oxygen metabolism, improves oxidative preconditioning, stimulates endogenous antioxidant systems, and has anti-inflammatory and antibacterial effects. Methods: This study was an analytic observational study, with systematic review and meta-analysis. Data searching were conducted online at Pubmed-MEDLINE, Scopus, EBSCOhost, ProQuest, Cochrane library, ClinicalTrials.gov, and Google Scholar, as well as hand-searching from libraries in Indonesia. Five most relevant articles included in the qualitative (systematic review) (n = 449) and three of those five articles included in the quantitative analysis (meta-analysis) (n = 211). Reduction of ulcer area was assessed. Results: The meta-analysis of effectiveness of ozone intervention group compared to the control group showed a homogeneity in data (Q=95.547, df=2; p=0.000, Tau2=5.276). Meta-analysis showed the value of Q statistic was z value = -9.478; (p=0.000). This shows that the overall administration of ozone can significantly improve the diabetic ulcer repair. The overall standardized mean difference showed an increase in the reduction of ulcer area following ozone therapy was -1.740 (95% CI [-2.100 to -1.380], p=0.00). These results indicate that the ulcer healing of the intervention group was significantly better than the control group. Conclusion: Systematic review and meta-analysis results show that the application of ozone therapy significantly improves DFU repair.

Introduction: Skin aging is a complex biological process with cumulative structural and physiological changes, progressive changes in each layer of the skin, and changes in the appearance of the skin. Human skin undergoes 2 types of skin aging, that are intrinsic and extrinsic skin aging. Skin aging is characterized by a decrease in skin hydration and elasticity, as well as an increase in skin wrinkles. Anti-aging strategies are still being developed. A new anti-aging therapy modality that has been widely used is nutraceutical supplementation, such as fish collagen. Fish collagen is a new alternative source of collagen with a high degree of homology to human collagen structure and high bioavailability. The aim of this study was to assess the efficacy of oral fish collagen supplementation on skin aging. Methods: This study was an analytic observational study, with systematic review and meta-analysis. Data searching was conducted online at Pubmed-MEDLINE, EBSCO (CINAHL), Scopus, SpringerLink, ProQuest, Cochrane Library, ClinicalTrials.gov, Cambridge Core, and Google Scholar, as well as hand searching from libraries in Indonesia. Twelve studies were included in the qualitative analysis (systematic review) (n=753 subjects) and 6 of them were included in the quantitative analysis (meta-analysis) (n=426 subjects). Results: The results of the meta-analysis showed that the increase in skin hydration in the group given oral fish collagen supplementation was greater significantly than in the placebo group, with standardized mean difference (SMD) (95% CI)=0.56 (0.32 to 0.81), Z=4.47 (p

Background: Harboring many melanocytic nevi is a risk factor for melanoma. The prevalence of micro-nevi, melanocytic nevi that can only be detected microscopically, has been studied scarcely and the significance is unknown. Objectives: To systematically analyze the presence of micro-nevi in cutaneous excisions from cutaneous melanoma and basal cell carcinoma to achieve an insight in the density of micro-nevi per mm peri-tumoral skin. Also to speculate in the relevance and significance of micro-nevi for evolving melanoma at the same anatomical site. Methods: We re-examined histologically peri-tumoral skin of primary and re-excised melanomas and primary excisions of basal cell carcinomas for comparison. The size of a micro-nevus was defined to a diameter < 2 mm, of either a junctional, compound or intradermal nevus. Results: 104 melanoma and 208 basal cell carcinoma cases were microscopically re-examined. In the melanoma group 6 micro-nevi were found. The sum of the peri-tumoral skin was 1768 mm, giving a density of 1 nevus per 295 mm. In the basal cell carcinoma group 5 micro-nevi were found. The sum of the peri-tumoral skin was 1370 mm, giving a density of 1 nevus per 274 mm. No difference in the density of micro-nevi in the two groups of skin cancer was found. Conclusions: The significance of these micro-nevi remains unclear. The aim with this study is to draw attention to the existence of micro-nevi and further studies are needed to determine the significance of the presence of micro-nevi.

Background: Drug reactions are a fundamental issue in many branches of medicine. Adverse drug reactions result in high mortality and morbidity globally. There is always the risk of unwanted side effects associated with the use of any substance that has a therapeutic effect. The safe use of drugs remains a critical issue for all health care professionals. Objective: The current study investigates the level of drug reaction awareness among the public in northern Saudi Arabia. Materials/methods: This was a questionnaire-based cross-sectional study. Data were collected using Google Forms, which were coded and processed using Microsoft Excel and SPSS version 23. Results: Altogether 475 people participated in this study including 382 women [80.4%] and 93 men [19.6%]. Of the 475 participants, 83.6% were aware of drug reactions, 40.4% believed drug reactions are hereditary, 50.9% had received a previous skin allergy test, and 21.3% had received a previous blood test for an allergy. Conclusion: The public in northern Saudi Arabia are aware of drug reactions. We found that only half of the participants in our study had received a skin allergy test. It is the responsibility of physicians to provide the community with a valuable database of information on the adverse effects of drugs. We recommend that health care institutions carry out more studies with a larger sample to improve the understanding and awareness of drug reactions.

Background: Bacterial vaginosis (BV) is one the main causes of fluor albus in women which is found in 15 – 50% of all reproductive age in the world. Regimen therapy for bacterial vaginosis consists of antibiotics, but the recurrence rates remain high. Probiotics appear to have an effect on treating or preventing bacterial vaginosis recurrence. One of the probiotics is Lactobacillus crispatus. Methods: The result of online searching on Pubmed-MEDLINE, Scopus, EBSCOhost, Cambridge Core, ProQuest, Cochrane library, ClinicalTrials.gov, and Google Scholar databases had found 4 relevant articles included in this systematic review (n = 516 subjects), from which 3 articles were used in meta-analysis (n = 350 subjects). Results: The meta-analysis of effectiveness of L. crispatus probiotics intervention group compared to the placebo group showed a homogeneity in data (Q=2.170, df=2; p=0.338, Tau2=0.026). Meta-analysis showed the value of Q statistic was z value = -2.683; (p=0.007) and overall risk ratio is 0.694 (95% CI= 0.532 to 0.906) with p=0.007. This demonstrated that the group with L. crispatus probiotics had 0.694 times lower risk in having bacterial vaginosis recurrence compared to the placebo group. The test for overall effect found the time to recurrence of placebo group was shorter compared to probiotics group with overall mean time to recurrence between probiotics group and placebo group was -0.960±0.20 (Z value= -4.730; p

Background: Glabellar lines have social and psychological implication since oftentimes generate negative facial expressions that could be misunderstood, such as anger, anxiety, fear or sadness, and others related to extrinsic aging signs. Botulinum toxin type A has been used for more than 20 years in aesthetic medicine and one of many options to improve dynamic facial lines on upper third of the face, including glabellar lines. On April 2009. FDA approved abobotulinum toksin A (Dysport) as the latest botulinum toxin type A, a purified complex diluted with human serum albumin and lactose. Aim: The purpose of this study is to analyze the effectiveness of botulinum toxin type A (abobotulinum toxin A) as a therapy for moderate to severe glabellar lines. Methods: searching the electronic database Pubmed-MEDLINE, Scopus, ProQuest, Cochrane library, ClinicalTrials.gov, and Google Scholar, found five articles (n=1.134) included in qualitative and quantitave analysis. Result: Metaanalysis showed the value of Q statistic was z value = 9,079 (p=0,000). Glabellar lines improvement according to Glabellar Lines Scale were more prominent in botulinum toxin type A injection group compared to control group on the 30th day after botulinum toxin type A injection (relative risk 23,007; CI 95%,11,692 – 45,274). The result of the overall metanalysis showed that glabellar lines severity in the group with botulinum toxin type A injection was significantly improved compared to control group. Conclusion: Botulinum toxin type A 50 U (abobotulinum toxin type A) is effective in significantly improving glabellar lines severity compared to placebo group

Background: Onychomycosis is the most prevalent nail disease, accounting to about 50% of all onychopathies. The diagnosis is still a challenge considering that the gold standard complementary test (direct microscopy and culture) may be false negative in many cases. Objectives: The study aimed to evaluate the role of dermoscopy in diagnosis of onychomycosis in comparison with scrap microscopic examination, mycological culture and histopathology and to detect how close the dermoscopic examination to the previous diagnostic findings. Patients and Methods: The present study included 20 patients suffered from onychomychosis and they were subjected to clinical, KOH microscopic, dermoscopic, mycological and histological examinations. Results: Jagged edge with spikes, longitudinal striations, distal irregular termination and ruin appearance are dermoscopic criteria of onychomychosis observed in 75% of cases. KOH examination was positive in only 20% of patients showing spores and hyphae. Culture was positive in only 35% of cases with M. canis, T. violaceum, T. rubrum, Chaetomium sp. and Scopulariopsis brumpt and there were no difference between the dermoscopic features caused by different organisms. The histologic evaluation showed found septate hyphea and blastoconidias within the amorphous keratin of the nail in 65%. Conclusions: Dermoscopy may be considered an easy, helpful, quite simple, quick and inexpensive technique for increasing the diagnostic accuracy of onychomycosis and could be a practical and effective diagnostic tool when mycology is not readily available. Mycology can, on the other hand, be avoided when nail dermoscopy fail to show any diagnostic sign of onychomycosis.

Background: Androgenetic alopecia (AGA) is the most common form of hair loss in men, wherein systemic androgen disorders and genetic factors lead to progressive miniaturization of hair follicles due to changes in the duration of hair growth cycle, characterized by shorter anagen phase and longer telogen phase, resulting in smaller, thinner, and less pigmented terminal hair. The main goal of treatment in AGA is to prevent the miniaturization process. The therapeutic options commonly used in the treatment of male AGA, such as topical minoxidil and oral finasteride, have yet to produce satisfactory results. Currently, many new therapeutic modalities are being developed for AGA, one of which is platelet-rich plasma (PRP). Multiple growth factors secreted by PRP are thought to support hair growth by prolonging the anagen phase, preventing apoptosis, delaying induction of the catagen phase, triggering angiogenesis and increasing follicular vascularization. Methods: A systematic literature search was performed using PubMed-MEDLINE, Cochrane library, Embase, AMED, Clinicaltrials.gov, dan WHO ICTRP with the search terms “platelet rich plasma” and (“male androgenetic alopecia” or “male pattern hair loss”). Eight RCT were included in the qualitative synthesis and seven of them were included in the meta-analysis. Results: The overall SMD in hair density was -0.889 (95% CI: -1.630 – -0.147, p

Background: Atopic Dermatitis (AD) is a chronic, recurring inflammatory skin disease affecting 15-30% of childhood population. Its standard management entails the right skin care, avoidance of triggers, and topical corticosteroid treatment. However, long term topical corticosteroid usage produces significant side effects. Pathogenesis of AD is mainly influenced by the response of one of the main immune cells, type Th2. In AD, a change of intestinal microbiome composition takes place, which influences gut-skin axis. Probiotics are living organisms, which when consumed regularly and in adequate amount, promotes health benefits for the host. Probiotics modulate the immune system and cytokine production, causing a balance in Th1 and Th2 immune responses. This also regulates intestinal and skin microbiome homeostasis in AD. Methods: Online database research is conducted in Pubmed-MEDLINE, Cochrane Library, ProQuest, EBSCOhost, and Scopus. Seven articles are included in qualitative analysis (n = 701), between which four (n = 473) are included in quantitative analysis. Results: SCORAD Index meta-analysis with random effect model shows heterogenity test of I2 = 73% (p=0.003). Standardized mean difference is found to be -0.42 with CI 95%, -0.76 to -0.08. This shows a significant decrease in SCORAD Index in probiotic group, compared to placebo (p=0.01). Meta-analysis of serum IgE with fixed effect model shows heterogenity test of I2 = 0% (p=0.71). The standardized mean difference of IgE is -0.03 with CI 95%, -0.24 to 0.17. This shows a non-significant decrease on IgE serum in probiotic group, compared to placebo (p=0.74). Meta-analysis of serum IL-4 with fixed effect model shows heterogenity test of I2 = 0% (p=0.76). The standardized mean difference of IL-4 is -0.16, with CI 95%, -0.35 to 0.02. The result shows a greater but statistically non-significant decrease of serum IL-4 in probiotic group, compared to placebo (p=0.09). Conclusion: Probiotic supplementation may reduce AD lesion severity,…

Background: Acne vulgaris of infants is a well-recognized medical and cosmetic problem as it may cause severe scarring of the face. Hence medical treatment is essentially needed. Objective: To record all patients with infantile acne vulgaris and to do full demographic and clinical evaluation. Patients and methods:This is case series clinical descriptive study with interventional therapeutic trial that included all patients with infantile acne vulgaris that were seen during the period from Jan 2021 – September 2021 years. All demographic and clinical features were recorded. The clinical scoring of acne severity was done as follow:mild when the rash was mainly comedones,moderate mainly papules and pustules and severe mainly nodules and scarring. Any triggering factors were recorded including hormonal changes. Therapy was started by giving topical 2% clindamycin twice a day and oral trimethoprim-sulfamethoxazole suspension one teaspoonful twice a day for 1-2 months. Results: This study included 28 patients with infantile acne, with 19(67.86%) males and 9(32.14%) females with male to female ratio;2.1. The age of patients ranged from 1-24 months, with a mean 14.6 ±6.1.The duration of rash was ranged from 4-8 weeks. The commonest sites affected were cheeks in 27(96.4%) cases, followed by forehead in 8 (28.6%), then chin in 6 (23.1%), and nose 6 (23.1%) of the cases. Scoring of severity of acne showed moderate in 13(46.4%), followed by mild in 9 (32.1%), and sever in 6 (21.4%). The response to treatment was complete clearance in 15(53.6%) and partial response in 13(46.4%) of the patients while no adverse effects were observed. Conclusions: Infantile acne is not uncommon disease among infants where medical therapy is essentially needed especially in severe cases as to prevent facial scarring. Early diagnosis and treatment with oral trimethoprim-sulfamethoxazole suspension and topical 2% clindamycin lotion is an effective mode of therapy.