Background: Alopecia areata (AA) is a T-cell-mediated autoimmune disease that significantly impacts patient quality of life. The breakdown of hair follicle immune privilege underlies AA pathogenesis. However, the precise mechanism of this breakdown remains unclear. This study investigates the potential role of reactive oxygen species in AA pathogenesis. Summary: A systematic review and meta-analysis were conducted on observational studies and randomized controlled trials from 2000 to 2024. Studies included AA patients and measured oxidative stress index (OSI), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), or paraoxonase-1 (PON1). Extracted data were analyzed using the Cochrane risk-of-bias tool and random-effects models.The review included 21 studies with 743 AA patients. OSI was elevated in AA patients (effect size = 1.58, 95% CI [0.31–2.68], p = 0.00068). MDA levels were also elevated (effect size = 1.60, 95% CI [0.43–2.6], p = 0.00023), while SOD (effect size = -0.97, 95% CI [-1.65 to -0.30], p = 0.00066) and GSH-Px (effect size = -1.41, 95% CI [-2.28 to -0.53], p = 0.00068) activities were reduced. PON1 levels showed no significant difference (effect size = -3.56, 95% CI [-8.63 to 1.51], p = 0.051). Key Messages: The elevated OSI, MDA, and decreased antioxidant activity in AA patients suggest a substantial role for reactive oxygen species and oxidative stress in AA pathogenesis, highlighting oxidative stress as a potential target for therapeutic intervention. These results underscore the importance of oxidative stress in AA and support further research into antioxidant-based therapies.
The Iroquoian and Algonquian-speaking Peoples of North America discovered numerous natural treatments to dermatological conditions long prior to European settlement. Anthropological evidence suggests that treatments for atopic dermatitis, dermatophyte infections, and syphilitic lesions were derived from Sassafras albidum, genus Salix trees, and S assafras officinale. Literature suggests these medicinal properties are attributed to the naturally abundant safrole, salicylic acid, and ascorbic acid in these flora. Numerous instances of these natural medicinal discoveries later being implemented into European literature reaffirms the impact of Indigenous medicine on contemporary dermatology.
Vandetanib is an oral tyrosine kinase inhibitor with cutaneous adverse effects that include the development of acne. We present a patient who underwent vandetanib therapy for stage IV medullary thyroid cancer in conjunction with the use of doxycycline for acne that developed. After vandetanib use, blue-grey pigmentation developed in the acne on his face, chest, back, and arms, which darkened after the use of doxycycline. We review the literature to report that this blue-grey hyperpigmentation was likely vandetanib-induced but may have been the result of both drugs being used in combination.
Women with inflammatory bowel disease (IBD) have an increased risk of postpartum disease activity. We aimed to systematically determine the effect of various risk factors on postpartum IBD disease activity.Electronic databases were searched through January 2021 for studies that reported risk of postpartum disease activity in women with IBD. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the impact of IBD phenotype, disease activity, therapy de-escalation, mode of delivery, and breastfeeding on postpartum disease activity. Study bias was determined using the Quality in Prognostic Studies tool.Twenty-seven observational studies (3825 patients) were included, 15 of which had a high risk of confounding bias. The pooled incidence of women with postpartum active IBD was 31.9% (95% CI, 25.6-38.1). Similar results were seen with ulcerative colitis and Crohn's disease (CD; OR, 0.96; 95% CI, 0.58-1.59). Those with stricturing (OR, 3.64; 95% CI, 1.31-10.08) and penetrating (OR, 4.25; 95% CI, 1.11-16.26) CD had higher odds of postpartum active IBD. Active disease at conception (OR, 10.59; 95% CI, 1.48-76.02) and during pregnancy (OR, 4.91; 95% CI, 1.82-13.23) increased the odds of postpartum disease activity. Similarly, biologic discontinuation in the third trimester (OR, 1.77; 95% CI, 1.01-3.10) and therapy de-escalation after delivery (OR, 7.36; 95% CI, 3.38-16.0) was associated with postpartum disease activity.Complicated Crohn's disease, disease activity at conception and during pregnancy, and de-escalation of biologics during pregnancy or after delivery are associated with postpartum disease activity in women with IBD.
Primary cutaneous B-cell lymphoma (PCBCL) presents only in the skin at the time of diagnosis with no evidence of extracutaneous disease, and primary cutaneous follicle center lymphoma (PCFCL) is the most common subtype. There is currently a lack of prospective randomized control trials and large retrospective studies investigating the efficacy of different treatment options for PCFCL. This retrospective study was conducted to describe our local clinical experience and outcomes of patients treated with rituximab-containing regimens.To describe our local clinical experience and treatment outcomes of patients treated with rituximab-containing regimens.A retrospective study consisting of 25 PCFCL patients treated with different modalities. Patient records were reviewed and analyzed using a Kaplan-Meier estimation and SAS 9.4 software.After the initial treatment, all patients had CR except for 1 patient in the observation group. Further, 60% of patients in surgery, 20% in chemoimmunotherapy, 67% in rituximab monotherapy, 33% in steroid injection/systemic prednisone, and 33% in observation experienced a relapse. Although no significant difference was found between treatment groups due to the small sample size, time to relapse trends provides insight into treatment responses. Chemoimmunotherapy had the lowest relapse rate in the first 5 years post-treatment, whereas surgery had a higher tendency to relapse.Despite the potential for rituximab-containing chemoimmunotherapy to yield adverse effects, it is effective in achieving a prolonged clinical remission in patients with PCFCL. It remains a reasonable treatment option for diffuse, extensive, or treatment-resistant disease.
Low-grade cutaneous carcinoma with squamous and trichoblastic features is an uncommon cutaneous malignancy with follicular differentiation. Alopecia areata (AA) is an autoimmune folliculocentric skin disease. We present an uncommon case of a 50-year-old woman in whom AA developed on the scalp surrounding a low-grade cutaneous carcinoma with squamous and trichoblastic features. Our case study reviews the limited relevant literature and hypothesizes that the CD8+ T lymphocytic infiltrate within our patient's tumor likely instigated the AA.
Introduction: Self-examinations for skin cancer detection are limited by sensitivity. ChatGPT-4 has image recognition capabilities that can be a useful adjunct for screening cancers and tele-health applications. This study investigated the efficacy of ChatGPT-4 in identifying skin lesions. Methods: Dermoscopic images were retrospectively selected from the PH2 dataset, categorized by clinical diagnosis, and uploaded to ChatGPT-4 with a predesigned prompt. Responses were compared against clinical diagnoses. Confidence intervals were calculated using the bootstrap method assessing precision and significance was calculated using McNemar's test. Analyses were performed using Jupyter Notebook and Python. Results: The GPT-4 model showed moderate performance in melanoma detection with 68.5% accuracy, 52.5% sensitivity, and 72.5% specificity, significantly differing from the clinical standard (P = .002). For suspicious lesion detection, it performed better with 68.0% accuracy, 78.0% precision, and 70.0% F-measure, still not closely matching clinical diagnosis for atypical nevi and melanoma (P = .0169). Conclusion: The statistical difference between ChatGPT-4 diagnosis of melanoma and suspicious lesions compared with clinical diagnoses and other AI models suggests the need for improvement in ChatGPT-4 algorithms. This study's limitations included the use of a secondary care database with a higher melanoma incidence, high-quality dermoscopic images that limit generalizability, a small sample size lacking diversity, and the need for larger datasets to validate findings in broader contexts.
