The close relationship between the intestine and the skin has been widely stated, seen from gastrointestinal (GI) disorders often accompanied by skin manifestations. Exactly how the gut microbiome is related to skin inflammation and influences the pathophysiology mechanism of skin disorders are still unclear. Many studies have shown a two-way relationship between gut and skin associated with GI health and skin homeostasis and allostasis. This systematic review aimed to explore the associations between the gut microbiome with inflammatory skin disorders, such as acne, psoriasis, atopic dermatitis, and urticaria, and to discover the advanced concept of this relationship. Methods: The literature search was limited to any articles published up to December 2020 using PubMed and EBSCOHost. The review followed the PRISMA guidelines for conducting a systematic review. Result: Of the 319 articles screened based on title and abstract, 111 articles underwent full-text screening. Of these, 23 articles met our inclusion criteria, comprising 13 AD, three psoriasis, four acne vulgaris, and four chronic urticaria articles. Discussion: Acne vulgaris, atopic dermatitis, psoriasis, and chronic urticaria are inflammation skin disorders that were studied recently to ascertain the relationship of these disorders with dysbiosis of the GI microbiome. All acne vulgaris, psoriasis, and chronic urticaria studies stated the association of gut microbiome with skin manifestations. However, the results in atopic dermatitis are still conflicting. Most of the articles agree that Bifidobacterium plays an essential role as anti-inflammation bacteria, and Proteobacteria and Enterobacteria impact inflammation in inflammatory skin disorder.

Non-cultured epidermal cell suspension (NCECS) is a relatively new cellular grafting technique for vitiligo. Platelet rich fibrin (PRF) is a platelet and immune concentrate gather on a single fibrin membrane which can be used in conjunction with grafts and has several advantages, such as promoting wound healing, haemostasis, and give better handling properties to graft materials. This study was conducted to determine the efficacy of NCECS combined with PRF in patients with stable vitiligo. Seven patients with stable vitiligo which not responding to topical and phototherapy for more than 12 months were included in the study. The melanocytes were harvested as an autologous melanocyte rich suspension from a donor skin. The non cultured melanocyte transplanted to recipient area that had been superficially dermabraded and smeared with PRF gel. Of all 7 patients, 1 patients showed excellent pigmentation (90-100%), 2 had good repigmentation (60-89%), 1 had fair repigmentation (25-59%) and 3 patients had a poor response (0-24%). The procedure is safe and promising surgical modality for stable vitiligo.

Epidermolysis bullosa (EB) is characterized by skin fragility with blister formation occurring spontaneously or following minor trauma such as gentle pressure or friction. Current physiotherapy practice is based on anecdotal care, clinical expertise and creative problem solving with caregivers and individuals with EB. Evidence based intervention is needed to establish a foundation of knowledge and to guide international practitioners to create and improve standards of care to effectively work with individuals living with EB. This clinical practice guideline (CPG) was created for the purpose of providing evidence based interventions and best clinical practices for the physiotherapy management of individuals with EB. A survey was conducted within the EB community and six outcomes were identified as a priority to address in physiotherapy management, including (1) attaining developmental motor milestones, (2) identifying safe and functional mobility in the natural environment, (3) encouraging ambulation endurance, (4) supporting safe ability to bear weight, (5) improving access to physiotherapy services, and (6) optimizing interaction with the community. A systematic literature review was conducted and articles were critically analyzed by an international panel consisting of thirteen members: healthcare professionals (including physiotherapist, doctors, and occupational therapist), caregivers, and individuals with EB. Recommendations were formulated from evidence and panel consensus. An external panel of twelve were invited to improve the quality and gather feedback on draft manuscript and recommendations. This CPG describes the development of recommendations for physiotherapy management including several best practice interventions. This guideline lays the foundational work for physiotherapist throughout the world to provide high quality services while improving and maintaining functional mobility and independence within the EB community. The CPG outlines limitations in the evidence available and possible future research needed to improve physiotherapy practice.

clinical diagnostic matrix, Kindler syndrome, junctional epidermolysis bullosa, dystrophic epidermolysis bullosa, Malayo-Polynesian ethnic group Epidermolysis bullosa (EB) is a group of inherited blistering skin diseases known to have heterogenicity of phenotypes and genotypes. There are four main types of EB: simplex, junctional, dystrophic, and Kindler syndrome, which are further classified into 34 distinct subtypes. Twenty different gene mutations are responsible for the loss of function and integrity of the basal membrane zone. In limited-resource settings such as Indonesia, diagnoses of hereditary skin disease often rely on clinical features. This limitation was managed by using the Clinical Diagnostic Matrix EB for clinical diagnosis support and whole-exome sequencing for genetic analysis. This study is the first wholeexome sequencing analysis of Javanese Indonesian patients with EB. The genetic analysis from four patients with EB identified all novel mutations unreported in the dbSNP database. There are Kindler syndrome with FERMT1 frameshift mutation in exon 4, at c.388A (p.I130fs), which causes truncated protein; junctional EB generalized intermediate (JEB-GI) subtype with missense mutation at LAMB3 gene position c.A962C (p.H321P); and recessive dystrophic EB (RDEB) a missense mutation at COL7A1 gene position c.G5000T (p.G1667V). The whole-exome sequencing was further verified by Sanger sequencing. The new mutations' finding is possibly due to the limited genetic database in the Malayo-Polynesian ethnic group. Indonesia has hundreds of ethnic groups, and the Javanese is the largest ethnic group that populates Indonesia. Genetic data of these ethnic groups is important to be established in the international genetic database. This combination of clinical diagnostic and genetic analysis tools with whole-exome sequencing confirmed the challenging diagnosis of epidermolysis bullosa.

Linked Comment: A.W. Lucky and E. Pope. Br J Dermatol 2022; 186:602–603. Plain language summary available online

Background: Obesity affect significant populations on all ages. The relationship between obesity and metabolic diseases is known but a dermatological link is rarely explained. Transepidermal water loss (TEWL) is one of the measurement tools used to define the skin’s barrier function by measuring the amount of water that evaporates through the skin in aspecific amount of time. Although several studies on TEWL are available but discussion about the correlation between TEWL and body mass index (BMI) is still limited. This study aims to evaluate the correlation between TEWL and BMI. Methods: This research is a single-center study with analytical cross-sectional design that includes healthy subjects among medical students aged 18 to 23 years old in Universitas Sebelas Maret. A questionnaire was used to ensure that all subjects met the criteria. Chi-square and Pearson were used to analyze the observed variables. Results: The total sample in this study was 62 participants, with a majority of female (59.7%) and ranged from 21 to 23 years (74.2%). The ratio of normoweight and overweight/obese was 1:1. The results demonstrated significant difference and positive correlation between increased BMI with TEWL (p<0.05; r=0.510). Conclusion: This study showed a significant correlation between increased body mass index and transepidermal water loss. Overweight participants tend to develop high values of TEWL which reflect a disruption of skin barrier. Further research on other influencing factors with larger samples and more study centers are needed. Keywords: BMI; skin barrier; TEWL

Background: Hygiene behaviour is a person’s actions in maintaining cleanliness to prevent the spread of infectious disease by cutting off the transmission of microorganisms that cause infection both in the community and in the health service. Various diseases caused by poor hygiene behaviour are diarrhea, dengue fever, leptospirosis, acute respiratory tract infections, typhoid fever, and various skin infections. One of the infectious skin diseases that affects almost the entire population is acne vulgaris. It is the highest disease prevalence worldwide and ranked 8th with 645.499.139 sufferers. Purpose: To determine the relationship between hygiene behaviour and acne vulgaris incidence in medical students at Sebelas Maret University. Methods: This study was an observational analytical study with a cross-sectional approach. This study was conducted on 45 male medical students at Sebelas Maret University. The questionnaire used was Hygiene Inventory (HI23). Data were analyzed using Fisher's Exact correlation test. Result: There is no relationship (p = 0.720) between hygiene behaviour and acne vulgaris incidence in medical students of the Sebelas Maret University. Conclusion: Hygiene behaviour has no relationship with acne vulgaris incidence in medical students at Sebelas Maret University.

Scabies is a skin disease caused by Sarcoptes scabiei infestation and is classified as a neglected tropical disease (NTD). Permethrin 5% is the first-line treatment for scabies. However, adherence and accuracy in topical creams are common problems. Thus, it is necessary to think of alternative medication that is more accessible, more straightforward, and lower the risk of resistance. Albendazole appears to be an alternative therapy for eradicating scabies in the community base. Sixty subjects diagnosed with scabies were recruited and divided into two groups with randomization. The first group was given 400 mg oral albendazole for three consecutive days on the first and second week. The second group was applied permethrin 5% to the whole body once on the first night of the first and second week. The evaluation was carried out for four weeks, and improvement was stated absence of new lesions and healing of old lesions and pruritus. Data were analyzed using SPSS software (version 25, SPSS Inc., Chicago., IL). The X 2 test was used to examine the difference between groups, and p < 0.05 was considered significant. The cure rate of albendazole was significantly superior to permethrin topical (90.0% vs. 63.3%) with a p-value of 0.015. This study revealed the effectiveness of oral albendazole 400 mg/day for three consecutive days in the first and second weeks for treating scabies to topical permethrin 5%. No side effect seen in the use of albendazole and topical permethrin during the study. Albendazole could be an alternative drug option to eradicate scabies in low-middle-income countries.