Black peel in facial dermatoses

Summary

Background

Melasma (facial dermatoses) is an acquired chronic disorder of hyperpigmentation over sun exposed parts and continues to be a therapeutic challenge due to the presence of melanin at varying depths in the epidermis and dermis, and many researchers are working hard to find a solution. The main culprit to remain is direct sun exposure, with other factors like drugs, genetic predisposition, thyroid abnormalities, pregnancy, phototoxic and photoallergic cosmetics. Melasma continues to have a remarkable impact on the well-being of affected patients causing deep psychological and social anguish, and with the expansion of cosmetic dermatology globally, treatments that are successful against skin diseases and boost beauty without prolonged recovery periods, or exposing patients to the risks of surgery, are increasingly recognised and acknowledged. Many clinicians have used various peeling in facial acne, scarring, and hyperpigmentations, and there have been no well-controlled studies comparing them with other conventional agents. Case presentation: a unique case of facial hyperpigmentation in a black female who presented seeking help which can be attributed to increased aesthetic awareness among people nowadays. A single session of black peel several passes was performed and the lady noted a lightening effect in the following weeks.

Objective

The aim of this paper is to improve, advance and expand our understanding and the knowledge beyond what is already known to wider colleagues, to impact society at large and to disseminate the findings to wider audiences. Also, the objective of the present paper is to examine the different effect of black peel in the treatment of facial dermatoses, and it gives realistic tips on performing black peeling safely and effectively in ethnic skin groups. This is meant to shed light on some ways for clinical handling and improving our understanding scientifically and educationally. It is the first original case report of interest in the existing literature for the best of my knowledge that had a positive impact for my female patient.

Method

A single pass of black peel was applied on the lady's face.

Results

A pleasing brightening effect was examined and boosted the lady confidence.

Conclusion

The patient had a positive pleasing experience that she had noticed from a single session application of the black peel.

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Preliminary audiologic and peri-operative outcomes of the Sophono™ transcutaneous bone conduction device: A systematic review

Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Aren Bezdjian, Hanneke Bruijnzeel, Sam J. Daniel, Wilko Grolman, Hans G.X.M. Thomeer
ObjectiveTo delineate the auditory functional improvement and peri-operative outcomes of the Sophono™ transcutaneous bone conduction device.MethodsEligible articles presenting patients implanted with the Sophono™ were identified through a comprehensive search of PubMed and Embase electronic databases. All relevant articles were reviewed to justify inclusion independently by 2 authors. Studies that successfully passed critical appraisal for directness of evidence and risk of bias were included.ResultsFrom a total of 125 articles, 8 studies encompassing 86 patients using 99 implants were selected. Most patients (79.1%) were children. Ear atresia (67.5%) was the most frequently reported indication for Sophono™ implantation. Overall pure tone average auditory improvement was 31.10 (±8.29) decibel. During a mean follow-up time of 12.48 months, 25 patients (29%) presented with post-operative complications from which 3 were deemed as serious implant-related adverse events (3.5%).ConclusionsThe Sophono™ transcutaneous bone conduction device shows promising functional improvement, no intra-operative complications and minor post-operative skin related complications. If suitable, the device could be a proposed solution for the rehabilitation of hearing in children meeting eligibility criteria. A wearing schedule must be implemented in order to reduce magnet-related skin complications.



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A case of congenital lipomatous overgrowth, vascular malformations, epidermal nevi, spinal/skeletal anomalies and/or scoliosis syndrome with lipoatrophy as an important clinical manifestation

Abstract

Congenital lipomatous overgrowth, vascular malformations, epidermal nevi, spinal/skeletal anomalies and/or scoliosis syndrome is a PIK3CA-related overgrowth spectrum presenting with congenital, asymmetric, disproportionate overgrowth associated with dysregulated adipose tissue, enlarged bony structures, and mixed primarily truncal vascular malformations. We present this case to raise awareness that very thin body habitus (lipoatrophy) contrasting with areas of overgrowth can be an important clinical feature of this syndrome and, if not recognized, can lead to unnecessary investigations.

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Chronic Airway Fibrosis in Orthotopic Mouse Lung Transplantation Models - An Experimental Reappraisal.

Background: Several mouse lung transplantation (Tx) models have been proposed for the study of chronic airway fibrosis (CAF), the most prevalent complication seen in human lung transplant recipients, termed chronic lung allograft dysfunction (CLAD). Alternatively, it has been called for to establish an experimental animal model for restrictive allograft syndrome (RAS), another phenotype of CLAD. However, these mouse transplant models exhibit significant heterogeneity in consistency and reproducibility. We therefore aimed at reevaluating current available models. Methods: 4 different Tx combinations were employed that manifest CAF: 2 minor antigen-mismatched Tx combinations (MINOR, donor: C57BL/10, recipient: C57BL/6J); or MINOR-N using recipient C57BL/6N, major histocompatibility antigen-mismatched immunosuppressed Tx (MAJOR, donor: BALB/c, recipient: C57BL/6J) and syngeneic Tx (SYN, donor and recipient: C57BL/6J) as control. The recipients were harvested and analyzed at week 8. Oxygenation, histology, reverse transcription polymerase chain reaction (RT-PCR), and magnetic resonance imaging were performed to analyze outcome of those models. Results: The most prominent manifestation of CAF, thickest subepithelial fibrotic changes, worst oxygenation and the most severe acute rejection were detected in the MAJOR group, compared to all other (p

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Features of asthma which provide meaningful insights for understanding the disease heterogeneity

Abstract

Background

Data-driven methods such as hierarchical clustering (HC) and principal component analysis (PCA) have been used to identify asthma subtypes, with inconsistent results.

Objective

To develop a framework for the discovery of stable and clinically meaningful asthma subtypes.

Methods

We performed HC in a rich dataset from 613 asthmatic children, using 45 clinical variables (Model 1), and after PCA dimensionality reduction (Model 2). Clinical experts then identified a set of asthma features/domains which informed clusters in the two analyses. In Model 3, we re-clustered the data using these features to ascertain whether this improved the discovery process.

Results

Cluster stability was poor in Models 1 and 2. Clinical experts highlighted four asthma features/domains which differentiated the clusters in two models: age of onset, allergic sensitization, severity, and recent exacerbations. In Model 3 (HC using these four features), cluster stability improved substantially. The cluster assignment changed, providing more clinically interpretable results. In a 5-cluster model, we labelled the clusters as: "Difficult asthma" (n=132); "Early-onset mild atopic" (n=210); "Early-onset mild non-atopic: (n=153); "Late-onset" (n=105); and "Exacerbation-prone asthma" (n=13). Multinomial regression demonstrated that lung function was significantly diminished among children with "Difficult asthma"; blood eosinophilia was a significant feature of "Difficult", "Early-onset mild atopic", and "Late-onset asthma". Children with moderate-severe asthma were present in each cluster.

Conclusions and clinical relevance

An integrative approach of blending the data with clinical expert domain knowledge identified four features, which may be informative for ascertaining asthma endotypes. These findings suggests that variables which are key determinants of asthma presence, severity or control, may not be the most informative for determining asthma subtypes. Our results indicate that exacerbation-prone asthma may be a separate asthma endotype, and that severe asthma is not a single entity, but an extreme end of the spectrum of several different asthma endotypes.

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Corticosteroid and Long-Acting ß-Agonist Therapy Reduces Epithelial Goblet Cell Metaplasia

Abstract

Background

Bronchial epithelial goblet cell metaplasia (GCM) with hyperplasia is a prominent feature of asthma, but the effects of treatment with corticosteroids, alone or in combination with a long-acting β₂-adrenergic receptor agonist (LABA) on GCM in the bronchial epithelium are unknown.

Objectives

To determine if corticosteroid alone or in combination with a LABA alter protein and gene expression pathways associated with IL-13-induced goblet cell metaplasia.

Results

We evaluated the effects of Fluticasone Propionate (FP) and of Salmeterol (SM), on the response of well-differentiated cultured bronchial epithelial cells to interleukin-13 (IL-13). Outcome measures included gene expression of SPDEF/FOXa2, gene expression and protein production of MUC5AC/MUC5B, and morphologic appearance of cultured epithelial cell sheets. We additionally analyzed expression of these genes in bronchial epithelial brushings from healthy, steroid-naïve asthmatic, and steroid-treated asthmatic subjects. In cultured airway epithelial cells, FP treatment inhibited IL-13-induced suppression of FOXa2 gene expression and upregulation of SPDEF, alterations in gene and protein measures of MUC5AC and MUC5B, and induction of GCM. The addition of SM synergistically modified the effects of FP modestly—only for gel-forming mucin MUC5AC. In bronchial epithelial cells recovered from asthmatic vs. healthy human subjects, we found FOXa2 and MUC5B gene expression to be reduced and SPEDF and MUC5AC gene expression to be increased; these alterations were not observed in bronchial epithelial cells recovered after treatment with inhaled corticosteroids.

Conclusion and Clinical Relevance

Corticosteroid treatment inhibits IL-13-induced GCM of the airways in asthma, possibly through its effects on SPDEF and FOXa2 regulation of mucin gene expression. These effects are modestly augmented by the addition of a long-acting ß-agonist. As we found evidence for drug treatment counter-acting the effects of IL-13 on the epithelium, we conclude that further exploration into the mechanisms by which corticosteroids and long-acting β₂-adrenergic agonists confer protection against pathologic airway changes is warranted.

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Quality and Safety in Anesthesia and Perioperative Care.

No abstract available

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