CIndU is a common inflammatory skin condition characterized by the recurrence of itchy wheals and/or angioedema that lasts more than 6 weeks and is induced by specific physical or environmental stimuli (cold, heat, exercise, pressure, sunlight, vibration, water, etc.) (1-7). The more common types include dermographism, cholinergic urticaria, and delayed-pressure urticaria/angioedema, whereas rare disorders are urticaria/angioedema caused by heat, exercise, water, sunlight, or vibration.According to the current international classification, there are two types of CIndU: physical urticarias and non-physical urticarias (Table 2) (4, 8-14). The physical urticaria group includes dermographism (the most common), delayed-pressure urticaria (the third most frequent type), exercise-induced urticaria, cold urticaria, heat urticaria, solar urticaria, and vibratory urticaria. The non-physical urticaria group comprises cholinergic urticaria (the second most frequent type), contact urticaria, and aquagenic urticaria (4,(8)(9)(10)(11)(12)(13)(14). Physical urticarias are generally more common and occur in 10 to 50% of chronic urticaria patients and in up to 5% of the general population (12). The most frequent types in the physical urticaria group are dermographism and delayed-pressure urticaria ( 12). According to study data, in comparison to chronic spontaneous urticaria, CIndU equally often affects men and women, but it is generally more common in the younger population; less frequently, it is associated with angioedema (1).With respect to diagnostics, CIndU can often be diagnosed on the basis of patient history and physical examination, as well as provocation testing (2, 9, 12). Management begins with accurate identification and avoidance of triggers. The initial treatment includes primarily non-sedating H1 antihistamines (e.g., desloratadine, fexofenadine, bilastine, levocetirizine, loratadine, cetirizine, etc.). Therefore many patients require doubling of the standard dose. In cases unresponsive to antihistamines, a stepwise approach is suggested: H2 antihistamines, first-generation H1 antihistamines, systemic corticosteroids (for a short time), and omalizumab (a humanized monoclonal anti-immunoglobulin E, approved for refractory chronic urticarias). In persistent refractory cases, other therapies may include phototherapy, physical desensitization, and immunomodulatory agents.
SUMMARY -When taking diff erent drugs, their possible side eff ects on the skin should be considered, including skin reactions connected to photosensitivity. Th is photosensitivity caused by drugs can appear as phototoxic reactions (which occur more often) or photoallergic reactions (which occur less often and include allergic mechanisms). Th e following drugs stand out as medications with a high photosensitivity potential: nonsteroidal anti-infl ammatory drugs (NSAIDs), cardiovascular drugs (such as amiodarone), phenothiazines (especially chlorpromazine), retinoids, antibiotics (sulfonamides, tetracyclines, especially demeclocycline and quinolones), etc. In recent years, photosensitive reactions to newer drugs have appeared, e.g., targeted anticancer therapies such as BRAF kinase inhibitors (vemurafenib, dabrafenib), EGFR inhibitors, VEGFR inhibitors, MEK inhibitors, Bcr-Abl tyrosine kinase inhibitors, etc. In patients taking drugs over a longer period of time (e.g., NSAIDs, cardiovascular drugs, etc.), a particular problem arises when an unrecognized drug-induced photosensitivity on the skin manifests in summer months. When taking patient histories, the physician/dermatovenereologist should bear in mind that any drug the patient is currently taking may be the cause of skin reactions. Th erefore, patients who use potentially photosensitive drugs and treatments on a long term basis should be warned of the possibility of these side eff ects on their skin and advised to avoid direct exposure to sunlight and to use adequate photoprotection. If patients carefully protect themselves from the sun, it is often not necessary to stop treatments that include photosensitive drugs. If such reactions appear, anti-infl ammatory and antiallergic therapies should be introduced.
SUMMARY -Since the working medical personnel including dentists and dental technicians mainly use their hands, it is understandable that the most common occupational disease amongst medical personnel is contact dermatitis (CD) (80%-90% of cases). Development of occupational CD is caused by contact of the skin with various substances in occupational environment. Occupational etiologic factors for dental personnel are foremost reactions to gloves containing latex, followed by various dental materials (e.g., metals, acrylates), detergents, lubricants, solvents, chemicals, etc. Since occupational CD is relatively common in dental personnel, its timely recognition, treatment and taking preventive measures is needed. Achieving skin protection at exposed workplaces is of special importance, as well as implementing necessary measures consequently and suffi ciently, which is sometimes diffi cult to achieve. Various studies have shown the benefi t of applying preventive measures, such as numerous protocols for reducing and managing latex sensitivity and other forms of CD in dentistry. Active involvement of physicians within the health care system, primarily dermatologists, occupational medicine specialists and general medicine doctors is needed for establishing an accurate medical diagnosis and confi rmation of occupational skin disease.
Many relatively common chronic inflammatory skin diseases manifest on the face (seborrheic dermatitis, rosacea, acne, perioral/periorificial dermatitis, periocular dermatitis, etc.), thereby significantly impairing patient appearance and quality of life. Given the yet unexplained pathogenesis and numerous factors involved, these diseases often present therapeutic challenges. The term “microbiome” comprises the totality of microorganisms (microbiota), their genomes, and environmental factors in a particular environment. Changes in human skin microbiota composition and/or functionality are believed to trigger immune dysregulation, and consequently an inflammatory response, thereby playing a potentially significant role in the clinical manifestations and treatment of these diseases. Although cultivation methods have traditionally been used in studies of bacterial microbiome species, a large number of bacterial strains cannot be grown in the laboratory. Since standard culture-dependent methods detect fewer than 1% of all bacterial species, a metagenomic approach could be used to detect bacteria that cannot be cultivated. The skin microbiome exhibits spatial distribution associated with the microenvironment (sebaceous, moist, and dry areas). However, although disturbance of the skin microbiome can lead to a number of pathological conditions and diseases, it is still not clear whether skin diseases result from change in the microbiome or cause such a change. Thus far, the skin microbiome has been studied in atopic dermatitis, seborrheic dermatitis, psoriasis, acne, and rosacea. Studies on the possible association between changes in the microbiome and their association with skin diseases have improved the understanding of disease development, diagnostics, and therapeutics. The identification of the bacterial markers associated with particular inflammatory skin diseases would significantly accelerate the diagnostics and reduce treatment costs. Microbiota research and determination could facilitate the identification of potential causes of skin diseases that cannot be detected by simpler methods, thereby contributing to the design and development of more effective therapies.
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