Dermatological Research and Reviews


    Background: The pH of the skin surface is elevated in the elderly therefore it may cause impaired barrier function manifest as various cutaneous abnormalities, including xerosis, pruritus, dermatitis, and skin infections. Consequently, skin care products for the elderly should contain moisturizing ingredients which are formulated to normalize the skin surface pH. Application of pH 4 emulsion is potentially beneficial to improve barrier function in the elderly and promoting skin health. We aimed to determine the difference of effectiveness of pH 4 emulsion compared to identical non pH 4 emulsion on decreasing TEWL in the elderly. A systematic review and meta-analysis was performed of randomized clinical trials assessing the effects of pH 4 emulsion on skin barrier function in the elderly. Methods: Medline Pubmed, Scopus, ProQuest, Cochrane library,, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Four studies (n=98 subjects) were included in qualitative analysis of which two studies (n=45 subjects) were included in the meta-analysis. The mean age of the participants was 71.1 years old. Interventions use the application of pH 4 water in oil emulsion (n=2) and pH 4 oil in water emulsion (n=2). Duration of intervention (24 hours-7 weeks) and outcomes of interest varied among included studies. Results: Pooling of data using random-effects model found lower TEWL score in the pH 4 emulsion than in non pH 4 emulsion, with no significant difference (overall effect mean difference -0.068, 95% confidence interval -0.485 – 0.348, p = 0.11, I2=60.1, two RCTs). In addition to that, the qualitative analysis found that the application of pH 4 emulsion increased stratum corneum hydration, decreased skin surface roughness and scaliness, decreased DASI, and improved ICLL length and lamellar organization. Conclusion: The meta-analysis result of the mean differences of TEWL scores lowering effect between pH 4 emulsion…


    The 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act terminated the Sunscreen Innovation Act (SIA) that the Food & Drug Administration (FDA) uses to determine sunscreen actives as safe and effective for human use. The Act also nullified a recent FDA proposal that reclassified 14 organic sunscreen actives as either not safe for human use or requires more data before being used in humans. Most sunscreen actives were approved in 1978; since that time the FDA has determined that over the last 20 years several changes have occurred leading to a substantial increase in sunscreen usage and exposure that increases the potential health risks associated with their use. Based on the scientific literature for the actives reviewed, it is clear that the SIA is needed to assure that sunscreen and other over-the-counter drugs are safe and efficacious for human use prior to entering the marketplace.


    Background: Axillary hyperpigmentation is a common and troublesome complaint especially among dark-skinned women. It is believed to be a form of post-inflammatory hyperpigmentation and so far, there is no universally accepted treatment for the disorder. Objective: The aim of this study is to assess the efficacy of fractional CO2 laser in the treatment of axillary hyperpigmentation Patients and methods: Thirty Egyptian females with axillary hyperpigmentation were recruited. The severity of the condition was estimated by both self-assessment and expert dermatologist before treatment. Four sessions of fractional CO2 laser were done. Both the efficacy and complications were assessed by the patient and the dermatologist six month after the last session. Results: There was a statistically significant difference of percentage of improvement of pigmentation before compared to one month after treatment as detected by self-assessment (p value= 0.002) and the observer’s assessment (p value= 0.001). Conclusion: Fractional CO2 laser, in properly chosen parameters, is an effective method for the treatment of axillary hyperpigmentation.


    Background: Treatment of resistant alopecia totalis AT is a major problem in general practice. Some studies reported the use of either excimer-308 or intra-muscular triamcinolone acetonide as a monotherapy, with conflicting results. Objective: To evaluate the therapeutic effect of combining 308-excimer phototherapy and intramuscular triamcinolone acetonide for the treatment of alopecia totalis. Methods and Material: Ten patients with alopecia totalis were evaluated in this prospective interventional study. All patients were assigned to receive the thera-peutic regimen that includes monthly IM triamcinolone acetonide (TAC) for a maximum of six pulses and twice-weekly excimer phototherapy for 24 sessions. Results: The overall response rate for this regimen was 90%, with four patients 40% achieving complete regrowth of hair (100%). Three patients have exhibited a satisfactory response (>70% regrowth). Unsatisfactory response ( >10-< 70% regrowth) was reported in two patients . Younger patients responded better, as did those with a shorter history of the disease P < 0.05. At follow-up, which continued for 8–12 months, recurrence was noted in two (22.2%) of the nine responders. Conclusions: Combining excimer phototherapy with triamcinolone acetonide showed a promising effect on resistant AT. This treatment modality was effective and well tolerated particularly in young patients.


    Background: Most previous research has focused on acne vulgaris characteristics and their association with psychological disorders, such as anxiety and depression. Objective: In the present study, we aimed to show whether acne characteristics are associated with several aspects of psychological well-being namely self-esteem, body satisfaction, anxiety-depression and dermatological life quality. Methods: This was a study of 200 patient with acne and190 healthy controls that was carried out in Antalya, Turkey. Main outcome measures were the Rosenberg’s Self-Esteem Scale, Body Image Concern Inventory (BICI), hospital anxiety and depression scale (HAD) and dermatological life quality index (DLQI). Also we recorded global acne grading score (GAGS) of acne patients. Results: The findings of statistical analysis indicated that patients with acne had lower levels of self-esteem, high depression and HAD score compared with healthy controls (respectively p=0.01, p˂0.01, p=0.01). Also the DLQI scores of severe and very severe group had higher than mild and moderate group (p= 0.013) Conclusion: The emotional well-being of the patients presenting with the acne needs to be recognized more fully, particularly in relation to the low self-esteem, high depression score. The psychosocial impact of acne vulgaris should be valued in the management of patients with this condition. The results of this study raise implications for clinical practice and suggest that a multidisciplinary approach to the management of patient with acne.

  • A study on green cosmetic brand equity and purchase intentions

    The concept of sustainable development has recently become a significant issue among industrial, academic, and government sectors. As consumers have more green awareness of products, the markets of natural and organic products set to be flourish, the organic certification approach is then expected to be a crucial role between consumers and green brands. For the green cosmetic brands, it might bring more benefits to the brand than just being a proof of organic ingredients. The study conducted a quantitative questionnaire survey which was developed for this study and based on the four components of brand equity: brand associations, brand loyalty, perceived quality and brand awareness. Taking COSMOS-standard as an example, the study explores the influence it might have on green cosmetic brand equity and purchase intentions. Using snowball sampling for data collection, the total number of respondents was 867 and the number of valid questionnaires was 623. The statistical software SPSS 22.0 was used for the analysis. The results indicate that COSMOS-Standard organic certification has positive impacts on brand equity and purchase intention; significant differences on brand association and brand loyalty are caused by different disposable income; the effects on improving purchase intention works better on toiletries than facial care products. The cosmetic brands can see the results as suggestions on brand management and marketing strategies.


    Angiokeratomas (AK) are probably the vascular lesions that induce more confusion in the literature. The most accepted classification of AK was performed by Imperial and Helwig , and they divide these lesions into five classical types: Mibelli’s AK, Fordyce’s AK, corporis diffusum AK, circumscribed naeviforme AK and solitary or multiple acquired angiokeratomas. Nevertheless, in the clinical practice, is not unusual to see AK type lesions associated to different types of vascular anomalies, and these lesions have difficult handling. In ISSVA classification AKs have been included as vascular anomalies provisionally unclassified. We perform the differential diagnoses of AKs and according to clinical picture, histopathological aspect, immunohistochemical markers and radiological findings proposed to divide AKs mainly in two groups. Primary AKs are the classical types. The new immunohistochemical findings suggest that these lesions might be included as mixed capillary-lymphatic malformations. Secondary AKs are related with different vascular anomalies, secondary to other process with lymphatic obstruction, related to drugs, or associated with no vascular lesions as lymphoid lesions. Different underlying vascular anomelies might be related with AKs including deep capillary-lymphatic malformations (CLM), venous-lymphatic malformations (VLM), capillary-lymphatic-venous malformations (CLVM) (Klippel-Trenaunauy Sd), deep lymphatic malformations (LM), venous malformations (VM) as hyperkeratotic venous malformation, cavenomatous cerebral malformations, traumatic arteriovenous fistula and eccrine angiokeratomatous hamartoma. Clinical aspect, radiological studies and histopathological examination might help to do a correct diagnosis of this heterogenous entity.

  • Dermatological adverse events of immune checkpoint inhibitors

    Treatment with immune checkpoint inhibitors is a landmark in the treatment of melanoma and other cancers. These treatments have been very effective and have increased the survival of cancer patients. The promise of immunotherapy also comes with a variety of adverse events. One of the common sites of immune related adverse events (irAEs) is skin. The cutaneous irAEs present a unique challenge to the success of immunotherapy. It is important to diagnose and understand the mechanism related to these cutaneous irAEs to increase the effectiveness of immune checkpoint inhibitor therapy. In this review, we have characterized the various cutaneous irAEs associated with immune checkpoint inhibitor therapies and their possible mechanisms.

  • The Cutaneous Manifestations Associated with COVID-19: A review

    Importance: As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic spreads, increasing cases of dermatologic manifestations of the disease continue to be reported. Observations: In this general review of the case reports, case series, and other systematic reviews on this subject, several patterns of cutaneous lesions have been compiled. These include viral exanthems, papulovesicular, pernio-like, vasculopathy-related, and other miscellaneous rashes. Conclusions and Relevance: While clinical observations and subjective cases of rashes associated with SARS-CoV-2 are important to furthering our research and study of this viral disease, we as clinicians must be cautious in attributing causation with correlation. Continued research and study are needed before we can attribute a source for these dermatologic manifestations. Funding: This research was partially support by IMPACT funds to NY from the School of Medicine, University of Alabama at Birmingham.


    Universal acquired melanosis or “Carbon Baby Syndrome” is a progressive condition without any definitive evidence of etiology, long-term prognosis and treatment1. We describe case of a four year old female child presented with blackish discolouration of skin all over body giving a picture similar to “Carbon Baby”.