Category: Hyperhidrosis

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Psychodermatology in clinical practice: An examination of physician attitudes, beliefs and interventions towards psychocutaneous disease

Abstract

Background
Fifteen days post‐conception, the embryonic ectoderm simultaneously gives rise to the central nervous system and the epidermis of the integumentary system. The connections between the two organ systems manifests in both the psychiatric and dermatologic setting.

Objectives
To examine the current awareness of psychiatric comorbidity in dermatologic practice and its management in a sample of dermatologists across the United States.

Methods
A survey was conducted that explored physician perspective on psychiatric comorbidity, clinical practice, and management i.e., use of survey screening measures, employment of psychological interventions and coordination with mental health services. SPSS v25 was used for descriptive statistical analysis and to calculate Pearson’s correlation coefficients between familiarity with dermatologic/psychiatric comorbidity and its management.

Results
98% of respondents believed a relationship between mental and dermatological health. 61.7% of respondents reported seeing patients with known psychological problems more than once a week. The administration of a psychiatric questionnaires was noted in 23% of practices and only 6.38% administer the questionnaire at every appointment.

Conclusion
Management of comorbid disease is best done through the collaboration of dermatology and psychiatry. Implications for streamlining practice includes the routine administration of quality of life surveys, utilization of brief psychotherapeutic strategies and regular interdisciplinary referrals.
This article is protected by copyright. All rights reserved.

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Novel pharmacological treatments for generalized anxiety disorder: Pediatric considerations

Abstract

Background
Pediatric anxiety disorders such as generalized anxiety disorder (GAD) are common, impairing, and often undertreated. Moreover, many youth do not respond to standard, evidence‐based psychosocial or psychopharmacologic treatment. An increased understanding of the gamma‐aminobutyric acid (GABA) and glutamate neurotransmitter systems has created opportunities for novel intervention development for pediatric GAD.

Methods
This narrative review examines potential candidates for pediatric GAD: eszopiclone, riluzole, eglumegad (LY354740), pimavanserin, agomelatine.

Results
The pharmacology, preclinical data, clinical trial findings and known side effects of eszopiclone, riluzole, eglumegad (LY354740), pimavanserin, agomelatine, are reviewed, particularly with regard to their potential therapeutic relevance to pediatric GAD.

Conclusion
Notwithstanding numerous challenges, some of these agents represent potential candidate drugs for pediatric GAD. Further treatment development studies of agomelatine, eszopiclone, pimavanserin and riluzole for pediatric GAD also have the prospect of informing the understanding of GABAergic and glutamatergic function across development.

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Psychopharmacology in dermatology: Treatment of primary psychiatric conditions in dermatology

Abstract
The role of psychotropic drugs in Psychodermatology is still debatable, due to the quality of the evidence that supports it. There are several case reports and open trials with variable results. There is an additional difficulty in finding therapists trained in effective psychotherapy techniques, justify the need for more research on the available pharmacological options. The present review emphasizes pharmacological treatment in Psychodermatology, specifically in cases of primary psychiatric disorders that are expressed with self‐inflicted cutaneous signs and symptoms, in which drugs can play a central role in ameliorating symptoms or be useful in combination with psychotherapeutic approach of these disorders.
This article is protected by copyright. All rights reserved.
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Previous recreational cold exposure does not alter endothelial function or sensory thermal thresholds in the hands or feet

New Findings

What is the central question of this study?

Does recreational cold exposure result in cold sensitivity and is this associated with endothelial dysfunction and impaired sensory thermal thresholds?

What is the main finding and its importance?

Previous cold exposure was correlated with foot cold sensitivity which may indicate the development of a subclinical non‐freezing cold injury. Endothelial function and thermal detection were not impaired in cold sensitive individuals therefore further research is required to understand the pathophysiology of subclinical and clinical forms of non‐freezing cold injury.

Abstract
This study investigated whether cold sensitive (CS) individuals, who rewarm more slowly following a mild cold challenge, have impaired endothelial function and sensory thermal thresholds (STT) and whether this was related to reported cold exposure. Twenty seven participants with varying previous cold exposure undertook three tests: STT: warm and cold STT of the fingers and dorsal foot. Endothelial function: measurement of cutaneous vascular conductance (CVC) during iontophoresis of acetylcholine on the forearm, finger and foot. CS test: involving immersion of a foot for 2 minutes in 15°C water followed by 10 minutes of rewarming in 30°C air. Toe skin temperature (Tsk) measured during the CS test was used to form a CS group ( 32°C; n = 9 [4 women] for both groups). A moderate relationship was found between cold exposure ranking and Tsk rewarming (r = 0.408, P = 0.035, n = 27) but not STT or endothelial function. Tsk and blood flow were lower in CS compared to CONTROL before and after foot immersion (Tsk, mean [sd]: 30.3 [0.9]°C v 34.8 [0.8]°C; 27.9 [0.8]°C v 34.3 [0.8]°C; P 

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Anatomic variations of the intrathoracic nerves and the neural connections of the second and third thoracic sympathetic ganglia to the brachial plexus

Abstract

Introduction
This study investigated morphological variations of the intrathoracic nerves and the neural connections of the second and third thoracic sympathetic ganglia to the brachial plexus based on the existence of the intrathoracic nerves and the rami communicantes.

Materials and Methods
Fifty thoracic sympathetic trunks from 26 Korean adult cadavers were used.

Results
The first intrathoracic nerve connecting the first and second thoracic nerves was observed on 36 sides (72%), and the second intrathoracic nerve connecting the second and third thoracic nerves was found on 3 sides (6%). There were either one (62%) or two (10%) first intrathoracic nerves, and only one second intrathoracic nerve (6%). The neural connections of the second and third thoracic sympathetic ganglia to the first thoracic nerve were classified into three types based on the existence of the intrathoracic nerves: type I (68%) had only the first intrathoracic nerve, type II (26%) had no intrathoracic nerve, and type III (6%) had both the first and second intrathoracic nerves. Types I, II, and III were further subdivided into ten, six, and three types, respectively, according to the types of the rami communicantes arising from the second and third thoracic sympathetic ganglia.

Conclusions
Improved knowledge of the variations in intrathoracic nerves and upper thoracic sympathetic ganglia will be helpful to thoracic surgeons when they are disrupting the sympathetic supply to the hand for treating palmar hyperhidrosis, and contribute to successful diagnoses and treatments.

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Topographic Computer Analysis for Acne Scar Treatment on Face accompanying Biopsy Study after Dermal Injection of Hydrotoxin Mixture

Abstract

Background
Acne during youth can leave permanent facial scarring. The depressed acne scars can be treated by injection of stabilized hyaluronic acid (S‐HA) into the dermis. Due to the large number of acne scars, manual injection methods are technically difficult, and bear high risk of lump formation in the dermis. Therefore, the author designed a specific injection method to solve the two abovementioned problems.

Materials/Methods
102 Patients who suffered from acne scars were treated with a mixture of S‐HA (Restylane Vital®) and abobotulinumtoxinA (Dysport®). Using an automatic injector, microdroplets of the mixture (0.001cc of S‐HA and 0.125 U abobotulinumtoxinA) were delivered into 1000 intradermal sites on whole face except eyelids. This instrument radically reduced injection amounts per site (0.001cc), lessened manual operator efforts, and ensured consistent injection depth (from 0.8mm to 1.2mm depending on individual dermal thickness) into the facial dermis. The changes in each depression site of acne scars were evaluated by topographical computer analysis (point‐roughness), based on the 40 magnification microscopic photos generated. Depth measurements of each small acne scar point were taken one by one at the exact same point before and after the treatments. Global Aesthetic Improvement Scale (GAIS) was measured for improvement of acne scars at 1 and 6 months post‐treatment. Additionally, serial histologic examinations of the biopsy specimens evaluated neocollagenesis, neoelastinogenesis, and longevity state of the S‐HA.

Results
78 patients showed improvements of depressed acne scars in physical examinations, medical photos, and dermascopic photos.
Using topographic computer analysis, the average point‐roughness decreased 27.48 % (at 1‐month) from 29.042±6.85 (baseline) to 21.05±6.30 µm (P

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Which dermatology patients attend to Dermatology Outpatient Clinics during the SARS‐CoV‐2 outbreak in Turkey and what happened to them?

ABSTRACT
Coronavirus disease, first emerged in Wuhan, rapidly spread all over the world since December 2019. There are concerns about elective dermatology appointments and its results. Herein, we aimed to find out which type of dermatologic patients attended to dermatology outpatient clinic. The patients visiting the clinics for elective dermatologic diseases between March 11 and 18, 2020, were included in this study. Their age, sex, diagnosis of disease, requirement for emergent intervention, and their medical records about COVID‐19 were obtained. There were 390 patients attending to the dermatology outpatient clinic in this period. The most common disease was acne (N: 94, 24%), only 19% of patients need emergent interventions or dose adjustment. There were 40 (10%) patients over the age of 65. After their visits, five patients were diagnosed as COVID‐19 in 2weeks. Dermatologic examinations may be a vector for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission since being closed to the patient. Five of our patients were diagnosed as COVID‐19 after their elective visit to hospital. Since the asymptomatic course of some young patients, most of our patients were not screened for COVID‐19. Our findings support the concerns of elective physician examinations.