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PubMed2001

Skin signs in anorexia nervosa.

BACKGROUND: Eating disorders are becoming an epidemic in Europe, particularly among young women, but European studies concerning this topic are few. In eating disorders, significant medical complications occur in all of the primary human organ systems, including the skin. OBJECTIVE: The purpose of this study was to improve the knowledge of skin signs in anorexia nervosa (AN) and verify whether cutaneous differences exist between the restrictive type and the bulimic type. METHODS: A noncontrolled clinical study was performed in 24 consecutive patients with the restrictive and the bulimic types of AN in order to verify whether the cutaneous signs are different in the two types. The dermatological examination included the entire skin, oral cavity, hair and nails, with attention to skin pathologies prior to the development of AN. RESULTS: In all the patients, the most frequent skin manifestations were xerosis (58.3%), hair effluvium (50%), nail changes (45.8%), cheilitis (41.6%), acne (41.6%), gingivitis (33.3%), acrocyanosis (29%), diffuse hypertrichosis (25%), carotenoderma (20.8%), generalized pruritus (16.6%), hyperpigmentation (12.5%), striae distensae (12.5%), factitial dermatitis, seborrheic dermatitis (8.3%), poor wound healing, melasma and Russell's sign (4.1%). In the patients with the bulimic type of AN, hair effluvium, acne, gingivitis, nail changes and generalized pruritus were more frequent than in the patients with the restrictive type. Russell's sign and seborrheic dermatitis were exclusively detected in the bulimic type. Hyperpigmentation, striae distensae, factitial dermatitis, poor wound healing and melasma were exclusively observed in the restrictive type. Cheilitis, diffuse hypertrichosis and carotenoderma were more represented in the restrictive type. Two patients with restrictive type of AN were followed up for a period of 3 years. In both, xerosis, cheilitis, acrocyanosis, hyperpigmentation and acne improved in relation to the increase in BMI. Hair effluvium and diffuse hypertrichosis appeared not to be linked to this parameter. CONCLUSION: Skin changes are prevalent among patients with AN. Some changes seem to depend on the type of AN or to be linked to the BMI.

Adolescent↗
PubMed1995

[Linear focal elastosis (elastotic striae)].

Linear focal elastosis is the term used to denote asymptomatic, palpable, striae-like lines extending horizontally across the middle and lower back. Histologically these lesions present a focal increase in elastic fibres separating the dermal collagen bundles. To date, this disorder has been described only in male patients, with onset after 60 years of age. A case of linear focal elastosis in a young female patient is presented. In the differential diagnosis the clinical variants of connective tissue naevi, of the elastolyses, and of actinic elastosis are discussed. Considering that this disorder may be merely an unusual form of striae distensae with a distinctive process of "elastotic" regeneration, the term elastotic striae seems appropriate.

Adult↗
PubMed2002

Dermatological complications of obesity.

Obesity is a health problem of considerable magnitude in the Western world. Dermatological changes have been reported in patients with obesity, including: acanthosis nigricans and skin tags (due to insulin resistance); hyperandrogenism; striae due to over extension; stasis pigmentation due to peripheral vascular disease; lymphedema; pathologies associated with augmented folds; morphologic changes in the foot anatomy due to excess load; and complications that may arise from hospitalization. Acanthosis nigricans plaques can be managed by improved control of hyperinsulinemia; the vitamin D3 analog calcipitriol has also been shown to be effective. Skin tags can be removed by snipping with curved scissors, by cryotherapy or by electrodesiccation. Hyperandrogenism, a result of increased production of endogenous androgens due to increased volumes of adipose tissue (which synthesizes testosterone) and hyperinsulinemia (which increases the production of ovarian androgens) needs to be carefully assessed to ensure disorders such as virilizing tumors and congenital adrenal hyperplasia are treated appropriately. Treatment of hyperandrogenism should be centred on controlling insulin levels; weight loss, oral contraceptive and antiandrogenic therapies are also possible treatment options. The etiology of striae distensae, also known as stretch marks, is yet to be defined and treatment options are unsatisfactory at present; striae rubra and alba have been treated with a pulsed dye laser with marginal success. The relationship between obesity and varicose veins is controversial; symptoms are best prevented by the use of elastic stockings. Itching and inflammation associated with stasis pigmentation, the result of red blood cells escaping into the tissues, can be treated with corticosteroids. Lymphedema is associated with dilatation of tissue channels, reduced tissue oxygenation and provides a culture medium for bacterial growth. Lymphedema treatment is directed towards reducing the limb girth and weight, and the prevention of infection. Intertrigo is caused by friction between skin surfaces, combined with moisture and warmth, resulting in infection. This infection, most commonly candidiasis, is best treated with topical antifungal agents; systemic antifungal therapy may be required in some patients. Excess load on the feet can result in morphological changes that require careful diagnosis; insoles may offer some symptom relief while control of obesity is achieved. Obesity-related dermatoses associated with hospitalization, such as pressure ulcers, diminished wound healing, dermatoses secondary to respiratory conditions, and incontinence, must all be carefully managed with an emphasis on prevention where possible. Recognition and control of the dermatological complications of obesity play an important role in diminishing the morbidity of obesity.

Acanthosis Nigricans↗
PubMed2006

Striae gravidarum in primiparae.

BACKGROUND: Striae distensae are widely known to occur in pregnancy and aesthetically they can be a cause of great concern for many women. Various factors have been reported to be associated with the development of striae but the results are conflicting. OBJECTIVES: To observe the prevalence of striae gravidarum in primiparae and identify independent associated risk factors. METHODS: An observational analysis of 324 primiparae was conducted within 48 h of delivery. Data was collected in the form of a questionnaire and physical examination. Seventy-two primiparae participated in a pilot study in 1999 and the remaining were assessed over a 4-month period in 2000. Seventeen variables were recorded, and striae graded according to quantity and severity. Fifteen primiparae were excluded prior to analysis. RESULTS: Fifty-two per cent (161 of 309) of primiparous white women had striae of which 12% (20 of 161) were classified as severe. The most significant risk factor was low maternal age (P < 0.0001). Twenty per cent (14 of 71) of teenagers had severe striae, a finding not seen in women over 30 years of age. Other significant risk factors included maternal body mass index greater than 26 (P = 0.0003), maternal weight gain of more than 15 kg (P = 0.0121) and high neonatal birth weight (P = 0.0135). CONCLUSIONS: Logistic regression analysis demonstrated that maternal age, body mass index, weight gain and neonatal birth weight were independently associated with the occurrence of striae. It appears that the group at highest risk of developing severe striae are teenagers. This finding is important and may provide impetus to explore the pathomechanisms of striae.

Adolescent↗
PubMed2003

Treatment of striae rubra and striae alba with the 585-nm pulsed-dye laser.

BACKGROUND: The treatment of striae distensae has recently been reported with various lasers such as the 585-nm pulsed dye laser. At lower fluences (2.0 to 4.0 J/cm2), this laser has been purported to increase the amount of collagen in the extracellular matrix. OBJECTIVE: To determine whether the 585-nm pulsed dye laser is effective in both striae rubra and striae alba after two treatments and, in addition, to determine whether there is a net effect on collagen density in treated samples. METHODS: Twenty patients (skin types II to VI) with either striae rubra (9) or striae alba (11) were treated at baseline and at week 6. The total length of the study was 12 weeks. Untreated striae on the same patient were used as control subjects. Striae clinical parameters such as color and area were measured before the first and after the last treatment by an independent examiner using a visual analog scale. A hydroxyproline assay was used to measure collagen changes in two of the striae quantitatively. RESULTS: The 585 nm had a moderate beneficial effect in reducing the degree of erythema in striae rubra. There was no apparent clinical change on striae alba. Total collagen per gram of dry weight of sampled tissue increased in striae treated with pulsed dye laser versus control subjects. CONCLUSION: We recommend the use of the 585-nm pulsed dye laser for striae rubra in patients skin types II to IV. Extreme caution or avoidance should be observed in pulsed dye laser treatments for patients with phototypes V to VI even with the use of low fluences. Tissue collagen changes measured may be an early change, which precedes significant clinical improvement.

Adolescent↗
PubMed1995

Fibrillin abnormalities and prognosis in Marfan syndrome and related disorders.

Marfan syndrome (MFS), a multisystem autosomal-dominant disorder, is characterized by mutations of the fibrillin-1 (FBN1) gene and by abnormal patterns of synthesis, secretion, and matrix deposition of the fibrillin protein. To determine the sensitivity and specificity of fibrillin protein abnormalities in the diagnosis of MFS, we studied dermal fibroblasts from 57 patients with classical MFS, 15 with equivocal MFS, 8 with single-organ manifestations, and 16 with other connective tissue disorders including homocystinuria and Ehlers-Danlos syndrome. Abnormal fibrillin metabolism was identified in 70 samples that were classified into four different groups based on quantitation of fibrillin synthesis and matrix deposition. Significant correlations were found for phenotypic features including arachnodactyly, striae distensae, cardiovascular manifestations, and fibrillin groups II and IV, which included 70% of the MFS patients. In addition, these two groups were associated with shortened "event-free" survival and more severe cardiovascular complications than groups I and III. The latter included most of the equivocal MFS/single manifestation patients with fibrillin abnormalities. Our results indicate that fibrillin defects at the protein level per se are not specific for MFS, but that the drastically reduced fibrillin deposition, caused by a dominant-negative effect of abnormal fibrillin molecules in individuals defined as groups II and IV, is of prognostic and possibly diagnostic significance.

Cardiovascular Diseases↗
PubMed2002

[Sports as a risk factor and therapeutic principle in dermatology].

Sporting activities may exert positive and negative health effects. This applies not only to the cardiovascular and musculoskeletal system, but also to skin. During sporting activities a person is exposed to environmental factors such as temperature, irradiation, and allergens. These factors may play a key role in the development of skin diseases. Mechanical trauma is caused by acute injury as well as chronic damage. Infectious skin diseases caused by viruses, bacteria or fungi can be transmitted by body contact or the use of communal showers or locker rooms. Intake of performance-enhancing substances may provoke skin changes such as striae distensae, androgenetic alopecia, hypertrichosis and acne. Preexisting skin diseases such as psoriasis, lichen planus, vitiligo, polymorphous light eruption, lupus erythematosus, porphyria, urticaria, and acne rosacea may be aggravated by sporting activities. On the other hand, physical exercise has a therapeutic potential which has hardly been exploited by dermatologists. Especially in chronic skin diseases positive effects have been observed. Therapeutic use of team sports has been shown to decrease suffering, depression, and emotional disturbances and increase life quality in patients with atopic eczema, psoriasis, and venous leg ulcers.

Combined Modality Therapy↗
PubMed1984

Pruritic urticarial papules and plaques of pregnancy. Clinical experience in twenty-five patients.

During the past eight years, twenty-five patients with pruritic urticarial papules and plaques of pregnancy (PUPPP) have been prospectively evaluated at our institution. This distinct eruption of the third trimester was most frequently seen in primigravidas. Lesions began on the abdomen in all patients, and 48% specified that initial lesions were localized to periumbilical striae distensae. Other common sites of involvement included the buttocks, hips, thighs, legs, and upper inner arms. The face was uniformly spared. Initial lesions were 1- to 2-mm erythematous papules that quickly coalesced to form urticarial plaques. Although pruritus was the major complaint of all patients, excoriations were very rare. Frequent applications of high-potency topical corticosteroids were generally effective in relieving pruritus and controlling the eruption. Systemic corticosteroids were efficacious in three patients with extensive disease. No severe maternal complications were documented. There were no cases of prematurity, postmaturity, or spontaneous abortion. Two congenital abnormalities and one developmental problem have been documented in children of these patients, but patient numbers preclude definitive interpretation of these findings. As much as 6 years of follow-up on nineteen patients revealed no recurrence of PUPPP in the postpartum period, during eight subsequent pregnancies, or upon exposure to oral contraceptives.

Abdomen↗
PubMed1997

Laser treatment of hypertrophic scars, keloids, and striae.

Lasers are now being used successfully to improve various types of scars and striae. It is not only imperative to properly categorize the type of scars and striae present, but to determine which laser or lasers can best treat them. A 585-nm flashlamp pumped pulsed dye laser is preferred for the treatment of hypertrophic scars, keloids, and striae distensae. CO2 laser vaporization of scars that are proliferative, such as hypertrophic scars and keloids, is not advised due to the high rate of recurrence or worsening. When properly used, lasers can effect the best clinical responses in hypertrophic scars and keloids ever observed. Future laser technologic advances as well as the addition of concomitant lasers or other treatments may enhance clinical results. It appears evident that by promoting the remodeling phase of wound healing, abnormal scarring may be prevented or improved. Laser surgery may best be able to accomplish this by triggering regression of blood vessels and, therefore, fibroblasts within the scar. By so doing, further deposition of connective tissue may be halted.

Cicatrix, Hypertrophic↗
PubMedDate not supplied

Clotrimazole/betamethasone diproprionate: a review of costs and complications in the treatment of common cutaneous fungal infections.

The use of antifungal/corticosteroid combinations as topical therapy for dermatophytoses has been criticized as being less effective, more expensive, and the cause of more adverse cutaneous reactions than antifungal monotherapy. The combination of clotrimazole and betamethasone diproprionate (Lotrisone) is a mix of an azole antifungal and a high-potency corticosteroid, and is one of the most widely prescribed of these combinations. Our objective was to describe the beneficial and deleterious effects of Lotrisone in the treatment of common cutaneous fungal infections and its relative cost-effectiveness. We did a literature review documenting clinical trial data and adverse reactions to Lotrisone and collected a cost analysis of topical antifungal prescribing data over a 2-month period from a large midwestern staff-model health maintenance organization (HMO). Lotrisone is approved by the U.S. Food and Drug Administration (FDA) for the treatment of tinea pedis, tinea cruris, and tinea corporis in adults and children more than 12 years of age. Treatment is limited to 2 weeks in the groin area and 4 weeks on the feet. The most concerning adverse effects of Lotrisone were reported in children and included treatment failure, striae distensae, hirsuitism, and growth retardation. This combination was also reported to have decreased efficacy in clearing candidal and Trichophyton infections as compared to single-agent antifungals. Lotrisone was considerably more expensive than clotrimazole alone and was found to account for more than 50% of topical antifungal expenditures as prescribed by primary care physicians, but only 7% of topical antifungals prescribed by dermatologists. We found that Lotrisone was shown to have the potential to induce many steroid-related side effects and to be less cost effective than antifungal monotherapy. This combination should be used judiciously in the treatment of cutaneous fungal infections and may not be appropriate for use in children.

Administration, Topical↗
PubMed2001

Skin diseases in children with organ transplants.

BACKGROUND: Skin diseases are frequent in organ transplant recipients, but studies concerning children are sparse. OBJECTIVE: We assessed skin diseases in children who had received organ transplants. METHODS: A total of 145 children referred to our dermatologic consultation were studied. RESULTS: Steroid-induced striae distensae and acne occurred only in adolescents; severe cyclosporine-related side effects were more frequent in younger children. The most common findings were warts (53.8%), tinea versicolor (14.5%), herpes simplex/zoster (9.6%), molluscum contagiosum (6.9%), and impetigo contagiosum and folliculitis (6.2%). Other notable disorders included a diffuse hyperpigmentation with a "dirty" appearance of the skin, pyogenic granulomas, melanocytic nevi proliferation, and skin tags. Two of 20 further adult patients who received transplants during childhood had squamous cell carcinomas. CONCLUSION: Children who have received organ transplants frequently present side effects of immunosuppressive drugs and infectious diseases. Most disorders are related to the age of the patients rather than to the length of immunosuppression, whereas others are favored by the reinforcement of immunosuppression. Skin cancers were not encountered, but the risk of carcinomas in early adulthood should be considered.

Adolescent↗
PubMed2003

ED2000: 585 nm collagen remodelling pulsed dye laser.

The wavelength of 585nm corresponds to an absorption peak of haemoglobin. The heating effect in these skin layers triggers the release of various growth factors that stimulate collagen remodelling and tightening. We report our experience with a 585nm collagen remodelling, double flashlamp excited pumped dye laser was used (ED2000, Deka MELA, Calenzano, Italy), spot size 5 mm, energy density (fluence J/cm(2)) from 2 to 4 J/cm(2), emission modality (repetition rate) at 0.5 Hz, with a short pulse duration of 250 microsec. The efficiency of 585 nm collagen remodelling pulsed dye laser is controversial in only one session. It is probably reasonable to inform patients that 3-4 treatment sessions are necessary, and that 10% of the patients have no response to nonablative photorejuvenation. Because of its low fluence and its shorter pulse duration, the 585 nm collagen remodelling pulsed dye laser has limited efficacy for the treatment of port wine stains. However, it may offer patients with erythematous, raised or hypertrophic acne scars or striae distensae a permanent cosmetic solution. This laser is safe and effective in the treatment of surgical scars starting as soon as possible, on the day of suture removal if possible. We found that 96.3% of molluscum contagiosum healed after the first treatment, the other 3.7% after the second.

Cicatrix↗
PubMed2005

Commentary on cellulite: skin mechanobiology and the waist-to-hip ratio.

Cellulite is a gender-related condition which is the clinical expression of conformational changes taking place in the fibrous strands partitioning the hypodermis. The affected skin areas are those where fat deposition is under the influence of estrogens. Some hypodermal fibrous strands become enlarged and others become loose and look similar to striae distensae. Cellulite is not a result of increased body mass, but its aspect may be influenced by the waist-to-hip ratio.

Journal Article↗
PubMed1993

Centella asiatica (Indian pennywort), an effective therapeutic but a weak sensitizer.

The sensitizing capacity of Centella asiatica (raw extract) and its triterpenic constituents asiaticoside, asiatic acid and madecassic acid has been studied in guinea pigs. The extract itself as well as the 3 acids were found to be very weak sensitizers. Centella asiatica extract is used effectively in the treatment of keloids, leg ulcers, phlebitis, slow-healing wounds, leprosy, surgical lesions, striae distensae and cellulitis. Although applied frequently to damaged skin, the risk of acquiring contact sensitivity to this plant or its constituents is low.

Adult↗
PubMedDate not supplied

Effects of mometasone furoate on human keratinocytes and fibroblasts in vitro.

The long-term treatment of inflammatory skin diseases with topical glucocorticoids is limited by their side effects such as skin atrophy, delayed wound healing and striae distensae. Mometasone furoate (MF) is a newly synthesized glucocorticoid with the advantage of increasing efficacy and reducing the number of adverse effects. The aim of our study was to compare the effects of MF and conventional fluorinated corticosteroids on a human keratinocyte cell line (HaCat) and human skin fibroblasts in vitro. Monolayer cultures of these cell lines were exposed to different concentrations of the active compounds for 5 days to analyze the influence on morphology and proliferation. Chemotaxis of HaCat cells and fibroblasts was studied in blind-well Boyden chambers using collagen type I and fibroblast-conditioned medium as a chemoattractant. Additionally, fibroblasts were used to investigate the contraction of collagen gels since lattice contraction appears to model the contraction of skin wounds. All glucocorticoids tested influenced fibroblast and keratinocyte proliferation in a dose-dependent manner, yet the effect was clearly more marked with fluorinated corticosteroids than with MF. Similar effects were obtained using the chemotaxis assay. At low concentrations (10(-9) M) MF exerted almost no influence, while the conventional fluorinated substances inhibited direct migration significantly. Contraction of collagen gels was inhibited completely by betamethasone valerate at high concentrations (10(-5)-10(-3) M), but only partially inhibited by MF at its highest concentration (10(-3) M). Although MF reveals high anti-inflammatory activity similar to that known for conventional fluorinated derivatives of corticosteroids, the study shows that MF has less effect in the tested in vitro systems. Therefore, it remains to be seen whether these data might indicate the possibility of a dissociation between the inflammatory activity and the inhibition of the biosynthetic capacities of fibroblasts and keratinocytes by modification of the steroidal structure of corticosteroids.

Administration, Topical↗
PubMed2005

Dermatologic signs in patients with eating disorders.

Eating disorders are significant causes of morbidity and mortality in adolescent females and young women. They are associated with severe medical and psychological consequences, including death, osteoporosis, growth delay and developmental delay. Dermatologic symptoms are almost always detectable in patients with severe anorexia nervosa (AN) and bulimia nervosa (BN), and awareness of these may help in the early diagnosis of hidden AN or BN. Cutaneous manifestations are the expression of the medical consequences of starvation, vomiting, abuse of drugs (such as laxatives and diuretics), and of psychiatric morbidity. These manifestations include xerosis, lanugo-like body hair, telogen effluvium, carotenoderma, acne, hyperpigmentation, seborrheic dermatitis, acrocyanosis, perniosis, petechiae, livedo reticularis, interdigital intertrigo, paronychia, generalized pruritus, acquired striae distensae, slower wound healing, prurigo pigmentosa, edema, linear erythema craquele, acral coldness, pellagra, scurvy, and acrodermatitis enteropathica. The most characteristic cutaneous sign of vomiting is Russell's sign (knuckle calluses). Symptoms arising from laxative or diuretic abuse include adverse reactions to drugs. Symptoms arising from psychiatric morbidity (artefacta) include the consequences of self-induced trauma. The role of the dermatologist in the management of eating disorders is to make an early diagnosis of the 'hidden' signs of these disorders in patients who tend to minimize or deny their disorder, and to avoid over-treatment of conditions which are overemphasized by patients' distorted perception of skin appearance. Even though skin signs of eating disorders improve with weight gain, the dermatologist will be asked to treat the dermatological conditions mentioned above. Xerosis improves with moisturizing ointments and humidification of the environment. Acne may be treated with topical benzoyl peroxide, antibacterials or azaleic acid; these agents may be administered as monotherapy or in combinations. Combination antibacterials, such as erythromycin with zinc, are also recommended because of the possibility of zinc deficiency in patients with eating disorders. The antiandrogen cyproterone acetate combined with 35 microg ethinyl estradiol may improve acne in women with AN and should be given for 2-4 months. Cheilitis, angular stomatitis, and nail fragility appear to respond to topical tocopherol (vitamin E). Russell's sign may decrease in size following applications of ointments that contain urea. Regular dental treatment is required to avoid tooth loss.

Adolescent↗