Expert consensus statement on diagnosis and management of sensitive skin in current clinical practice

<p class="abstract">Sensitive skin is a very commonly seen entity in current dermatological practice that has a significant impact on quality of life. The pathophysiology, classification, diagnosis, and treatment of sensitive skin have evolved over the years, with new studies trying to bring about new robust evidence about the same. The current consensus aims at providing a comprehensive overview on evidence and experience-based approaches for sensitive skin. A total of 35 experts in the field of clinical dermatology participated in expert group meetings organized via teleconference webinar. Current evidence elaborating various aspects like classification, diagnosis, and management of sensitive skin along with clinical experience of experts were discussed in detail. The prerequisites for selecting suitable products, importance of cosmeceuticals as adjunctive therapy and the need for avoiding triggering factors in individuals with sensitive skin as well as associated dermatological disorders were also described. In addition to medical history, physical examination and routine investigations, a draft checklist and its clinical relevance in accurately diagnosing sensitive skin were emphasized upon by the experts. The overall management encompasses avoidance of individual trigger factors, thorough topical therapy using mild, non-irritating ingredients along with adjunctive therapies like moisturizers, sunscreens, and cleansers. The “two-week” strategy was described to be a useful approach for treating sensitive skin. This review article provides a consensus clinical viewpoint of expert dermatologists for effective evaluation, differential diagnosis and appropriate pharmacological as well as non-pharmacological management of sensitive skin in Indian subjects.</p>

Worse cardiovascular and renal outcome in male SLE patients: First sex study from the Swiss SLE Cohort Study

Background: Systemic lupus erythematosus (SLE) in males is rare and poorly understood. Thus, still little is known about sex differences in SLE. We set out to identify sex differences regarding clinical manifestations as well as renal and cardiovascular outcomes of SLE. Methods: We analyzed patient data from the Swiss SLE Cohort Study. Cumulative clinical manifestations according to the updated American College of Rheumatology criteria were recorded at inclusion. Cardiovascular events were recorded within Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC-SDI). Renal failure was defined as eGFR<15 ml/min/1.73m2, initiation of renal replacement therapy or doubling of serum creatinine which were all assessed yearly or documented as end stage renal disease in SLICC-SDI. Risk differences were calculated using logistic regression and cox regression models. Results: We analyzed 93 men and 529 women with a median follow up time of 2 years. Males were significantly older at diagnosis (44.4 versus 33.1 years, p<0.001) and had less often arthritis (57% versus 74%, p=0.001) and dermatological disorders (61% versus 76%, p<0.01). In multivariate analysis female sex remained a significantly associated with arthritis and dermatological disorders. After adjusting for age, disease duration, ethnicity, time to diagnosis, medication and eGFR and SELENA SLEDAI at inclusion men had a significantly higher hazard ratio of 2.5 for renal failure (95% confidence interval (95%-CI) 1.1-6.0, p<0.04). Total SLICC-SDI Score was comparable. Men had significantly more coronary artery disease (CAD) (17% versus 4%, p<0.001) and myocardial infarction (10% versus 2%, p<0.01). In multivariate analysis, male sex remained a significant risk factor for CAD (odds ratio (OR) 5.6, 95%-CI 2.3-13.7, p<0.001) and myocardial infarction (OR 8.3, 95%-CI 2.1-32.6, p=0.002).Conclusion: This first sex study in a western European population demonstrates significant sex differences in SLE. Male sex is an independent risk factor for cardiovascular events and renal failure in SLE. Potential etiological pathomechanisms such as hormonal or X-chromosomal factors remain to be further investigated.

Microbiome and Human Aging: Probiotic and Prebiotic Potentials in Longevity, Skin Health and Cellular Senescence

The role of the microbiome in human aging is important: the microbiome directly impacts aging through the gastrointestinal system. However, the microbial impact on skin has yet to be fully understood. For example, cellular senescence is an intrinsic aging process that has been recently associated with microbial imbalance. With age, cells become senescent in response to stress wherein they undergo irreversible growth arrest while maintaining high metabolic activity. An accumulation of senescent cells has been linked to various aging and chronic pathologies due to an overexpression of the senescence-associated secretory phenotype (SASP) comprised of proinflammatory cytokines, chemokines, growth factors, proteases, lipids and extracellular matrix components. In particular, dermatological disorders may be promoted by senescence as the skin is a common site of accumulation. The gut microbiota influences cellular senescence and skin disruption through the gut-skin axis and secretion of microbial metabolites. Metabolomics can be used to identify and quantify metabolites involved in senescence. Moreover, novel anti-senescent therapeutics are warranted given the poor safety profiles of current pharmaceutical drugs. Probiotics and prebiotics may be effective alternatives, considering the relationship between the microbiome and healthy aging. However, further research on gut composition under a senescent status is needed to develop immunomodulatory therapies.

Alopecia and Dermatitis Caused by Lepoarcarus gibbus in a New Zealand White Rabbit (Oryctolagus cuniculus) – Clinical and Parasitological Diagnosis and Treatment

Aim: Ectoparasites associated dermatological disorders are frequently encountered in laboratory and pet rabbit medicine practice, however, L. gibbus is the only ectoparasite rarely reported in either pet and laboratory rabbits or hares as L. gibbus are usually asymptomatic. The aim of the present report is to describe a case of alopecia and dermatitis associated with Lepoarcarus gibbis in a rabbit from India. Presentation of Case: A 1.5 year old female New Zealand White rabbit was presented to the Dermatology Unit with erythema and poorly demarcated alopecia on the dorsal neck and face. A skin scraping and coat brushings were performed. On microscopic evaluation of hair samples, L. gibbus infestation was confirmed. Treatment with ivermectin (0.3 mg/kg) biweekly once for 3 doses proved effective. Discussion and Conclusion: L.gibbus may be presented with severe hairfall in the absence of other mites and treatment with ivermectin is effective. Based on the literature research this may be the first case report on alopecia and dermatitis due to L.gibbus in rabbit from India. Further studies should be planned on the prevalence of the mite as it is reported to have zoonotic potential.

Revealing the Correlation between Altered Skin Lipids Composition and Skin Disorders

Human skin layers serve as a barrier between the body and the environment, by preventing water loss and blocking the entry of chemicals, allergens, and microbes. Recent data showed that skin lipids are vital ‘key players’ of several functions and mechanisms performing in the skin, such as, barrier function and microbiome composition. Abnormalities in lipid composition have been observed in inflammatory cutaneous diseases with a disrupted skin barrier. This review aims to demonstrate the fundamental role of keratinocytes, sebocytes, and microbiome-derived lipids in the maintenance of the skin barrier. Furthermore, it would reveal the correlation between altered skin lipids’ composition, microbiome, and the occurrence of certain dermatological disorders such as acne vulgaris, atopic dermatitis, psoriasis, and rosacea.

Dermatitis in community pharmacies: a survey on italian pharmacists’ management and implications on corticophobia

Community pharmacists represent an important resource for the promotion of a safer and more effective self-management of common skin diseases, as well as the provision of educational support on therapies prescribed by clinicians, ultimately improving patients’ adherence. In this study, a semi-structured survey was administered to 154 Italian community pharmacists, in order to acquire information on their counseling activity on dermatological disorders. Collected data provide an overview on the frequency and methodology of counseling offered in Italian community pharmacies, identifying knowledge gaps and misbeliefs. In particular, an overall negative opinion on topical corticosteroid therapy emerged among pharmacists, unveiling a phenomenon previously described as corticophobia. Starting from this observation, we discuss the risks for patients’ adherence, associated with corticophobia among pharmacists. Lastly, we briefly report on the main tools desired by pharmacists to improve their education on dermatology, envisioning their implementation with the aim of a more effective counseling.

Lipid Nanoparticles Based Cosmetics with Potential Application in Alleviating Skin Disorders

The lipids mainly oils, fats, waxes and phospholipids are of substantial importance in the development and functioning of cosmetic products. The lipid nanoparticles-based cosmetic product is highly capable of protecting the skin against harmful radiations and is utilized for anti-aging therapy. Naturally derived antioxidants such as carotenoids, retinoids and tocopherols could be employed for their antioxidant properties as therapeutics and skincare active moieties in cosmetic products. Such a lipid nanoparticles-based cosmetic formulation consisting of antioxidants are very effective against irritated and inflamed skin and very promising for treating skin disorders such as atopic dermatitis and psoriasis. Therefore, the present review provides an insight into lipid nanoparticles based cosmetics and the mechanistic of their percutaneous absorption. The manuscript discussion highlights the role of lipid nanoparticles-based cosmetics/cosmeceuticals employing active ingredients of synthetic and natural origin in alleviating dermatological disorders and enhancing skin health and appeal. Furthermore, the manuscript also updates about contemporary research studies carried on the concept of lipid nanoparticles based formulation design of cosmetic preparation and significant outcome to alleviate skin disorders.