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Concept: Keratosis pilaris


Abstract Background: Keratosis pilaris (KP) is a very common disorder; yet, very few treatment options are available. Objectives: To evaluate the efficacy of long-pulsed 1064-nm Nd:YAG laser for the treatment of KP. Materials and methods: Eighteen patients with untreated KP on the upper outer arms were enrolled in a randomized clinical trial. One arm was treated with long-pulsed 1064-nm Nd:YAG laser at 30 msec pulse width and fluence of 34 J/cm(2), while the contralateral arm served as control. Patients received three consecutive treatments at 4-week intervals. Three blinded dermatologists assessed digital photographs using a quartile grading system to separately rate global improvement, erythema and the number of keratotic papules. Results: Seventeen patients completed the study. There were statistically significant improvements in global assessment, erythema and the number of keratotic papules at 4 weeks after the last treatment (p < 0.05). All patients also stated that their lesions improved and were satisfied with the laser treatment. Conclusion: Long-pulsed 1064-nm Nd:YAG laser has been shown to improve KP in Thai patients compared with control after three treatment sessions.

Concepts: Better, Clinical trial, Improve, Randomized controlled trial, Laser, Clinical research, Keratosis pilaris, Laser hair removal


Ingenol mebutate is the main active constituent of sap from the plant Euphorbia peplus, which has traditionally been used as a home remedy for various skin conditions. Ingenol mebutate gel is approved in the US, EU, Australia and Brazil for the topical treatment of actinic keratosis. A short course of field-directed therapy with topical ingenol mebutate gel was effective in the treatment of actinic keratoses on the face or scalp (ingenol mebutate gel 0.015% once daily for 3 consecutive days) and on the trunk or extremities (ingenol mebutate gel 0.05% once daily for 2 consecutive days), according to the results of four randomized, double-blind, vehicle-controlled, multicentre studies. Significantly higher complete clearance rates (primary endpoint) and partial clearance rates were seen at day 57 in patients receiving ingenol mebutate gel than in those receiving vehicle gel. Treatment with ingenol mebutate gel was generally associated with sustained clearance of actinic keratoses in the longer term. Topical ingenol mebutate gel was generally well tolerated in the treatment of patients with actinic keratoses on the face or scalp and on the trunk or extremities. Application-site conditions were the most commonly occurring adverse events.

Concepts: Euphorbia, Actinic keratosis, Keratosis, Keratosis pilaris


Abstract Background: Although hyperseborrhea, follicular hyperkeratinization, Propionibacterium acnes colonization and inflammation are found to be responsible in the pathogenesis of acne, the exact mechanisms are unknown. Vitamin A and E are basic antioxidants vital for health. Zinc is also an essential element for human. But these parameters of the effects on skin are not fully understood. We aimed to evaluate plasma levels of vitamin A, E and zinc in acne patients in relation to the severity of the disease. Material and method: There were 94 acne patients who were referred to our clinic, all new diagnosed, and 56 age and sex matched healthy volunteers as control group. All patients are assessed according to Global Acne Grading System and grouped as mild, moderate, severe and very severe. Acne patients further grouped as group 1 consist of patients with mild to moderate disease; and group 2 consist of patients with severe to very severe acne. The patients with the controls and group 1 with group 2 was compared. Results: The level of vitamin E, vitamin A and zinc were significantly lower than the control group (Table 1,p < 0.001). When the patient group is compared among each other there was no statistically significant difference for plasma vitamin A levels between group 1 and 2 whereas vitamin E and zinc levels were significantly low in group 2 than group 1. Thus there was a negative correlation between acne severity and vitamin E and zinc levels. Conclusion: Our study marks the importance of diet in patients with acne. We offer supportive dietary measures with foods rich in vitamin A and E and zinc in the acne prophylaxis and treatment. Supportive treatment with these vitamins and zinc in severe acne may lead to satisfactory results.

Concepts: Nutrition, Dietary mineral, Zinc, Vitamins, Acne vulgaris, Propionibacterium acnes, Vitamin A, Keratosis pilaris


Salicylic acid has been used to treat various skin disorders for more than 2,000 years. The ability of salicylic acid to exfoliate the stratum corneum makes it a good agent for peeling. In particular, the comedolytic property of salicylic acid makes it a useful peeling agent for patients with acne. Once considered as a keratolytic agent, the role of salicylic acid as a desmolytic agent, because of its ability to disrupt cellular junctions rather than breaking or lysing intercellular keratin filaments, is now recognized and is discussed here. Salicylic acid as a peeling agent has a number of indications, including acne vulgaris, melasma, photodamage, freckles, and lentigines. The efficacy and safety of salicylic acid peeling in Fitzpatrick skin types I-III as well as in skin types V and VI have been well documented in the literature. This paper reviews the available data and literature on salicylic acid as a peeling agent and its possible indications. Its properties, efficacy and safety, the peeling procedure, and possible side effects are discussed in detail. An account of salicylism is also included.

Concepts: Skin, Salicylic acid, Acne vulgaris, Keratin, Stratum corneum, Keratosis pilaris, Hyperpigmentation, Azelaic acid


We describe 25 cases of erythromelanosis follicularis faciei et colli from India. The male:female ratio was 5.25:1 and the average age of onset was 12.3 years. The cheeks, preauricular area, and submandibular region were the sites most commonly affected. Keratosis pilaris was seen in 22 (88%) of the patients.

Concepts: Keratosis pilaris


Photodynamic therapy with daylight (DL-PDT) is efficacious in treating actinic keratosis (AK), but the efficacy of field-directed, repetitive DL-PDT for the treatment and prophylaxis of AK in photodamaged facial skin has not yet been investigated.

Concepts: Randomized controlled trial, Effectiveness, Efficacy, Self-efficacy, Actinic keratosis, Keratosis, Keratosis pilaris


Poor adherence to acne treatment may lead to unnecessary treatments, increased healthcare costs, and reduced quality of life (QoL). This multicenter study evaluated the effect of supplementary patient education material (SEM) (a short video, information card, and additional information available online) on treatment adherence and satisfaction among acne patients treated with the fixed-dose combination adapalene 0.1%/benzoyl peroxide 2.5% gel (A/BPO) in primary care clinics versus (1) standard-of-care patient education (SOCPE) (package insert and oral instruction) and (2) SOCPE plus more frequent clinic visits.

Concepts: Health care, Health care provider, Clinical trial, Hospital, Pharmaceutical industry, Acne vulgaris, Adapalene, Keratosis pilaris


All-trans retinoic acid (ATRA) is a vitamin A derivative and plays an important role in the regulation of cell aggregation, differentiation, apoptosis, proliferation, and inflammatory response. In recent years, some progress has been made in the role of ATRA in renal diseases, especially its protective effect on podocytes. This article reviews the research advances in podocyte injury, characteristics of ATRA, podocyte differentiation and regeneration induced by ATRA, and the protective effect of ATRA against proliferation, deposition of fibers, and apoptosis.

Concepts: Glomerulus, Acne vulgaris, Retinol, Vitamin A, Retinoic acid, Tretinoin, Retinoid, Keratosis pilaris


All-trans retinoic acid (atRA), the main biologically active metabolite of vitamin A, has been implicated in immunoregulation and anti-cancer. A recent finding that vitamin A could decrease the risk of melanoma in human indicates the beneficial role of atRA in melanoma. However, it remains unknown whether topical application of atRA could inhibit melanoma growth by influencing tumor immunity. We here demonstrated topical application of tretinoin ointment (atRA as the active ingredient) effectively inhibited B16F10 melanoma growth. This is accompanied by markedly enhanced CD8(+) T cell responses, as evidenced by significantly increased proportions of effector CD8(+) T cells that expressing granzyme B, TNF-α, or IFN-γ, and Ki67(+) proliferating CD8(+) T cells in atRA-treated tumors compared with vaseline controls. Furthermore, topical atRA treatment promoted the differentiation of effector CD8(+) T cells in draining lymph nodes (DLN) of tumor-bearing mice. Interestingly, atRA did not affect tumoral CD4(+) T cell response, and even inhibited the differentiation of IFN-γ-expressing Th1 cells in DLN. Importantly, we demonstrated that the tumor-inhibitory effect of atRA was partly dependent on CD8(+) T cells, as CD8(+) T cell depletion restored tumor volumes in atRA-treated mice, which, however, was still significantly smaller than those in vaseline-treated mice. Finally, we demonstrated that atRA up-regulated MHCI expression in B16F10 cells, and DLN cells from tumor-bearing mice had a significantly higher killing rate when culturing with atRA-treated B16F10 cells. Thus, our study demonstrates topical atRA treatment effectively inhibits melanoma growth partly by promoting the differentiation and the cytotoxic function of effector CD8(+) T cells. This article is protected by copyright. All rights reserved.

Concepts: Immune system, Cancer, Natural killer cell, Retinol, Retinoic acid, Tretinoin, Retinoid, Keratosis pilaris


Actinic keratoses (AKs) are dysplastic proliferations of keratinocytes. Studies evaluating nonfacial dermatoscopic pattern of AKs are scarce.

Concepts: Pattern, Actinic keratosis, Keratosis, Keratosis pilaris