Background Acne vulgaris is a common and chronic disease that impacts on physical and psychological perceptions. Cosmeceutical products are widely used as adjunct therapy to standard treatments. Objective To evaluate the efficacy of cosmeceutical products comprising glycolic acid, salicylic acid, gluconolactone, and licochalcone A as adjunct therapy to adapalene in mild-to-moderate acne vulgaris. Materials and methods A 28-day, double-blind, within-person comparative study was conducted with a total of 25 subjects. Each participant received two products, consisting of (1) a cosmeceutical product mixed with 0.1% adapalene, and (2) 0.1% adapalene, and was asked to apply them separately on each hemi-side once nightly for 28 days. The number of acne lesions, severity of acne vulgaris, physician’s and patient’s global assessment of acne severity, visual analog scale of radiance, skin biophysics, safety assessment, and VISIA ® camera system were evaluated. The primary efficacy outcome was to compare the reduction of inflammatory lesions between two treatments at day 7 by using non-inferiority comparison. Results The mean differences of inflammatory lesions reduction at day 7 between the two groups was 0.391 (90% CI = 0.253–0.530). The differences between two groups fell within our acceptable margin for the 90% CI. The spot score from VISIA ® showed higher statistically significant improvement in the combination side. Conclusion The results showed no hindrance of using a cosmeceutical combined with standard treatment. Nevertheless, this cosmeceutical product showed some benefits in reducing complications from acne. Clinical trial registration Thai Clinical Trials Registry (primary site), no. TCTR20171031005.

Objective We aim to explore the differences of skin signs between juvenile- and adult-onset systemic lupus erythematosus and to identify their associations to the development of systemic involvement. Methods A retrospective chart review of 377 systemic lupus erythematosus patients was performed. Results In total, 171 patients with juvenile systemic lupus erythematosus and 206 with adult systemic lupus erythematosus were studied. All patients were of Southeast Asian descent. The mean duration of follow up was 8.18 ± 6.19 and 9.36 ± 7.68 years for juvenile systemic lupus erythematosus and adult systemic lupus erythematosus, respectively. At diagnosis, most patients presented with acute cutaneous lupus erythematosus, whereas chronic cutaneous lupus erythematosus was twice as common in adult systemic lupus erythematosus ( p < 0.001). The mean Systemic Lupus Erythematosus Disease Activity Index of juvenile systemic lupus erythematosus was significantly higher than that of adult systemic lupus erythematosus (14.29 ± 7.13 vs 11.27 ± 6.53). Multivariate analysis revealed the following associations in juvenile systemic lupus erythematosus: acute cutaneous lupus erythematosus and non-scarring alopecia with increased risk of arthralgia, mucosal ulcers with leukopenia, cutaneous vasculitis with seizure, and finding of granular casts. On the contrary, the associations for adult systemic lupus erythematosus were oral ulcers with arthralgia and cutaneous vasculitis with myositis. Conclusions Cutaneous signs in systemic lupus erythematosus may signal prognostic implication. Interestingly, despite similar cutaneous lesions in systemic lupus erythematosus, different ages of onset are associated with different systemic involvement.

The emergence of bacterial resistance is a global crisis. Prolonged use of antibiotics especially in acne is one issue of concern among dermatologists. Ketoconazole (KTZ) cream, a topical antifungal with anti‐inflammatory and antiandrogenic actions, can decrease lipase activity of Cutibacterium acnes in vitro. We evaluated the efficacy and safety of KTZ cream in mild adult female acne (AFA) by conducting a randomized, double‐blind, placebo‐controlled trial using KTZ 2% and placebo cream twice daily for 10 weeks. We assessed the improvement of clinical severity, measured by AFA score graded by investigators and participants, and the change of acne count. Forty‐one participants enrolled in our study. The proportion of participants with acne improvement from baseline (42.9% vs 9.5%, P = 0.015) and the success rate (45.0% vs 14.3%, P = 0.043) in the KTZ group were significantly higher than that of the placebo group. The most common adverse events were dryness and itching. The percentage change of acne count decreased significantly compared with baseline but did not differ statistically between the two groups (P = 0.268). We concluded that the KTZ monotherapy showed a plausible effect in improving AFA with excellent safety profile. It should be considered as a viable option for mild AFA treatment.

Background Chronic lead toxicity is a worldwide public health problem. Lead possesses deleterious effects on many organ systems. However, little is known regarding its clinical and biophysical effects on the skin. Objective To investigate mucocutaneous signs and biophysical property changes in skin after chronic lead toxicity.Methods One hundred and eighty-seven patients who were car battery workers participated in the study. Complete history and physical examination were performed. Blood was collected for laboratory analyses. Thorough skin examination by dermatologists was carried out in 134 subjects. Additionally, 96 patients with blood lead levels (BLL) >70 lg/dL were further evaluated for skin elasticity, sebum content, transepidermal water loss (TEWL), hydration, pH and pigmentation. An equal number of age-, sex-and skin-type-matched subjects were recruited as controls. ResultsThe mean BLL of all subjects was 74.15 AE 11.58 lg/dL. The most frequently observed signs were gingival brown pigmentation in 112 (83.6%), gingivitis in 111 (82.8%) and lead line in 66 (49.3%) patients. The lead line was found in subjects with significantly higher BLLs (adjusted mean difference 6.45, 95% CI 2.30-10.60 lg/dL, P = 0.003) and in association with gingivitis (adjusted OR 7.32, 95% CI 2.08-25.74, P = 0.002). Mean BLL of the patients who underwent biophysical assessment was 82.77 AE 9.80 lg/dL. Patients exhibited a statistically significant lower skin hydration observed by corneometer as well as elasticity. The adjusted ORs of having dry skin and lower elasticity were 15.32 (95% CI 4.41-53.24), P < 0.001) and 1.96 (95% CI 1.06-3.60), P = 0.031), respectively. These differences were not significant for sebum content, TEWL, pH and pigmentation.Conclusion Importantly, even in normal-appearing skin, level of hydration and elasticity decreased in lead-intoxicated patients. These results suggest that lead might possess harmful effects on the skin at measurable levels. JEADV ResultsOne hundred and eighty-seven subjects who were lead-acid battery workers were recruited in the study. The mean BLL of the subjects was 74.15 AE 11.58 lg/dL. The mean age was 1994 Rerknimitr et al. Steatosis grade S2: fatty change 34%-66% 7 (7.6) Steatosis grade S3: fatty change > 67% 9 (9.8) CAP, controlled attenuation parameter.

target IL-23, including guselkumab, a fully human immunoglobulin G1 monoclonal antibody that binds to the p19 subunit of IL-23. Interleukin 23 is thought to be a potent inhibitor of psoriasis disease activity through its disruption of the IL-23/T H 17 disease axis. Specifically, T H 17 cells depend on IL-23 for their continued maintenance. T helper 17 cells interact with keratinocytes, endothelial cells, and other immune cells, all central to psoriasis pathophysiology. Reactivation of memory T H 17 cells is thought to underlie psoriasis chronicity. 2 The cytokine profile of ACD involves the IL-12/T H 1 cell axis. 3,4 Multiple immune signaling pathways, such as nuclear factor κB and interferon regulatory factor 1, cooperate in allergen-stimulated dendritic cells to result in IL-12 production. Interleukin 12 supports STAT4-mediated interferon γ release by immune cells and is thus crucial to T H 1 pathway activation and differentiation. Neutralization of IL-12 has been found to suppress the response to sensitizing allergens in vivo. 3 Interleukin 23 may be able to modulate T H 1 polarization through disruption of lymphocyte response to IL-12. 5 Thus, inhibition of IL-23 with guselkumab could enrich T H 1 activation and shift the cytokine milieu in favor of ACD development (Fig. 2), similar to the reported mechanism in the case of other dermatologic adverse events. 6 Theoretically, dual IL-12/IL-23 inhibitors, such as ustekinumab, should pose a lower risk in comparison because they block both T H 1 and T H 17 axes.Although we were unable to find a previous report of ACD occurring in the setting of IL-23 blockade for psoriasis, it is noteworthy that the Food and Drug Administration's multidisciplinary review of guselkumab does state that ACD occurs more frequently in patients in treatment arms compared with controls. 7 Notably, adverse events, such as ACD, take time to develop and thus are not likely to have been fully captured during the monitoring period of anti-IL-23 clinical trials, which were designed to evaluate efficacy. In addition, given the overlap in clinical presentation of ACD and psoriasis, it is possible that ACD is an underreported adverse event associated with IL-23 blockade. ZEBRAGiven the overlap in clinical presentation of ACD and psoriasis, it is possible that ACD is an underreported adverse event associated with IL-23 blockade.

Herpes simplex virus (HSV) and varicella zoster virus (VZV) are the most common causes of viral vesicular dermatoses of the skin and mucous membranes (1). Tzanck smear is widely used as a bedside test for herpetic skin infections (1-3). It is performed using skin scrapings and traditionally involves Giemsa stain. Depending on the protocol, the multiple steps of staining, fixation, and washing usually require 15-60 min (4-7). Therefore, it is not always practical to perform this very useful test due to time constraints. Methylene blue (MB) is an alternative and available blue dye (4). There are few reports regarding its use for Tzanck testing as a rapid technique (4,8,9); however, to our knowledge, no clinical studies have examined the diagnostic value of MB in the Tzanck smear. In this study, we evaluated the utility of MB in terms of its potential non-inferiority to the conventional Giemsa stain in the diagnosis of herpesvirus skin infections. The study was designed as a cross-sectional analytical study. The protocol was approved by the local institutional review board (No. 674 59) and the trial was registered with clinicaltrials.gov (Identifier: NCT03178747). Written informed consent was obtained from each patient prior to participation in the study. The inclusion criteria were patients over 18 years of age with suspected HSV and VZV skin lesions. Negative control cases comprised patients with other vesiculobullous eruptions (e.g., acute eczema). Specimens obtained from the lesions were smeared onto 2 different glass slides and allowed to air-dry. Subsequently, 1 slide was stained with MB and the other with Giemsa. MB staining was achieved by putting 2-3 drops of MB solution (Merck KGaA, Darmstadt, Germany) onto the glass slide. No washing was needed and the cover slip was then placed. Final concentration of MB was 1.4 mg ml (10). The entire staining process lasted approximately 10-15 s. In contrast, the Giemsa stain was performed using Giemsa solution (Merck KGaA) (11), but the specimen was not fixed. The slide was immersed in the solution and left for

Background: Juvenile systemic lupus erythematosus (JSLE) and adult SLE (ASLE) patients present with different clinical manifestations, but it is unknown if there are differences in their antinuclear autoantibody (ANA) profiles or if staining patterns are associated with specific autoantibodies and clinical manifestations.Objective: To determine whether distinct types and numbers of ANA-staining patterns are associated with specific autoantibodies and clinical manifestations in JSLE and ASLE patients.Methods: A retrospective study was performed in Thai children (n = 146) and adults (n = 180) diagnosed with SLE using the Systemic Lupus International Collaborating Clinics classification criteria.Results: JSLE patients with a homogeneous pattern of staining and anti-dsDNA or anti-nucleosome antibodies in serum, developed renal involvement, leukopenia and acute/subacute cutaneous LE. Coarse speckled pattern with anti-RNP or anti-Sm showed thrombocytopenia and renal involvement in JSLE patients, but leukopenia in both groups. JSLE patients with fine-coarse speckled pattern and anti-RNP, anti-Sm, anti-Ro-52 or anti-SSA developed leukopenia, thrombocytopenia and renal involvement, whilst hemolytic anemia and serositis were commonly found in those with anti-Ro-52. Median SLEDAI score was higher in JSLE than ASLE patients. Conclusion:Detailed ANA-staining patterns with specific autoantibodies show particular clinical manifestations and hence prompt further clinical investigations in both JSLE and ASLE patients. Therefore, this study demonstrates that distinct patterns of ANA staining and specific autoantibodies are clinically important in both children and adults with SLE.