Katherine L. Baquerizo Nole

Contact dermatitis caused by preservatives.

Preservatives are biocidal chemicals added to food, cosmetics, and industrial products to prevent the growth of microorganisms. They are usually nontoxic and inexpensive and have a long shelf life. Unfortunately, they commonly cause contact dermatitis. This article reviews the most important classes of preservatives physicians are most likely to encounter in their daily practice, specifically isothiazolinones, formaldehyde and formaldehyde-releasers, iodopropynyl butylcarbamate, methyldibromoglutaronitrile, and parabens. For each preservative mentioned, the prevalence of sensitization, clinical presentation of contact dermatitis, patch testing concentrations, cross reactions, and related legislation will be discussed. Mandatory labeling of preservatives is required in some countries, but not required in others. Until policies are made, physicians and patients must be proactive in identifying potential sensitizers and removing their use. We hope that this article will serve as a guide for policy makers in creating legislation and future regulations on the use and concentration of certain preservatives in cosmetics and industrial products.

5α-Reductase inhibitors in androgenetic alopecia.

Purpose of reviewThe authors will review the current literature on efficacy and safety of 5-alpha reductase inhibitors (5&agr;RIs) for androgenetic alopecia (AGA). Recent findingsThe 5&agr;RI finasteride and dutasteride are effective in treating AGA and promoting hair regrowth. 5&agr;RI can be given orally, topically and more recently through mesotherapy. However, there has been an increasing concern about permanent sexual adverse events such as impotence and infertility. Most of these reports are published as case reports, and two studies reporting persistent sexual side-effects after discontinuation of finasteride had serious method limitations, as patients were recruited from a website. To our knowledge, permanent sexual adverse events have yet to be published in higher quality studies, such as randomized controlled trials. Although patients treated with 5&agr;RIs have an increased incidence of sexual adverse events, these events decrease if discontinued or over time with continued therapy. SummarySexual side-effects are uncommon and resolve spontaneously in most patients even without discontinuing therapy. Significant effort is underway to find delivery systems that optimize delivery and reduce systemic absorption of topical 5&agr;Rs including hydroxypropyl chitosan and liposomal and nanoparticulate systems.

Healing Refractory Venous Ulcers: New Treatments Offer Hope

Non-healing wounds are associated with an inflammatory and proteolytic wound environment, and recent therapeutic strategies have been focused on reversing these changes. Connexins, as members of gap junctions, are important in intercellular signaling and wound repair. Connexin 43 (Cx43) downregulation is associated with normal wound healing, and it has been found to be upregulated in non-healing venous leg ulcers (VLUs). Ghatnekar et al. (2014) report findings of a small phase II trial performed in Indian patients with chronic VLUs, reporting that ACT1, a mimetic peptide of Cx43, accelerates healing in the treatment group. Despite standard care with compression therapy and adjuvant therapy for refractory wounds, at present in clinical practice a significant number of patients remain unhealed. The potential for ACT1 exists to help heal refractory VLUs, but it faces additional regulatory hurdles.

Hair follicles and their potential in wound healing.

Chronic wounds affect more than 6 million people annually in the Unites States alone, and the cost to the healthcare system is an estimated

Wound research funding from alternative sources of federal funds in 2012

25 billion (1). Despite recent technology advances in tissue engineering and drugs, more cost-effective treatments are needed. With approximately 5 million hair follicles (HF) (2) continuously generating hair over the body, is it possible to harness this growth potential in wound management? Jimenez et al. (3) Exp Dermatol 2014 provide compelling reasons to engender hope, guiding us first through basic science research supporting the role of HF in wound healing, the influence of hair cycling, follicular stem cells (FSC) and signalling to HF neogenesis, and then providing examples of currently available hair-related therapies in wound management. The importance of follicular stem cells in wound healing Hair follicles display a unique, lifelong cycling process, regulated by complex ectodermal–mesenchymal interactions. HF phases include the anagen (rapid growth), catagen (apoptosis driven regression) and telogen (relative resting), and FSC play an important role in this process. FSC reside in different parts of the HF, and the importance of FSC in wound re-epithelization has been described as a dichotomic process, at least in mice. Initially, a rapid and transient influx of bulge FSC (Krt15+) contribute to early re-epithelization; these are later replaced by a long-lasting population from the isthmus (Lgr6+, Gli1+ and Lrig1+) (4). For more details, see Table 1 and Fig. 1. Additionally, Reynolds et al. in a previous issue of Exp Dermatol found that dermal sheath cells also have a FSC role. Both upper and lower dermal sheath cells are incorporated into the neodermis after skin wounding, but only dermal sheath cells from the lower dermis are assimilated into HF (5). Recently, HF neogenesis in the centre of large wounds has been described after wound re-epithelization. Despite the fact that neo-HF have a prominent Krt15+ population, the origin of these neo-HF and their stem cells (SC) does not appear to come from Krt15+ bulge SC of pre-existing hairs. The exact origins of these neo-HF and from which particular SC populations they originate are not clear, but cellular and molecular markers suggest that they are derived from Lgr6+ FSC (7). As generation of neo-HF is not solely an epithelial process, an intact dermal papillae is required for HF neogenesis, suggesting complex mesenchymal–epithelial interactions are at play (5). These complex mesenchymal–epithelial interactions are the types of interactions seen during wound repair. Plikus et al. (8) recently reported in Exp Dermatol that as opposed to the epigenetic regulation of the interfollicular epidermis, FSC exhibit a greater degree of flexibility in the generation of different hair cell types. This malleability supports the role of FSC in wound healing and highlights their potential for therapeutic benefit. Hair follicles and wound healing As pointed out by Jimenez et al. (9), despite the increasing knowledge regarding the role of HF in wound healing and clinical observations that wounds in high hair density areas heal faster than those in nonhair-bearing or less hairy areas, only selected reports utilizing hair-derived treatments exist. Among these, the generation of epidermal autografts derived from outer root sheath (Epidex ; EurodermBiotec& Aesthetics, Stutgart, Germany) found comparable efficacy in treatment of recalcitrant leg ulcers to the well-established method of split-thickness-meshed skin grafting, with fewer patients having treatment failure (10). More recently, Lough et al. (11), using a murine model, transplanted Lgr6+ FSC in a hydrogel vehicle, comparing this to hydrogel alone, and found that wound beds that received Lgr6 FSC demonstrated increased epithelization, hair growth and angiogenesis. Although promising and supportive of the HF potential for wound healing, these technologies are not necessarily simple or inexpensive.

Educational interventions in venous leg ulcer patients

Chronic wounds represent a major healthcare burden, costing

Ketoconazole-induced Sweet syndrome: a new association.

25 billion annually, and are associated with high mortality. We previously reported that cutaneous wound healing represented only 0.1% (

Advanced wound care therapies in non-healing lower extremity ulcers: high expectations, low evidence

29.8 million) of the National Institutes of Health budget. This current study focuses on quantifying the contribution by federal agencies other than the National Institutes of Health for fiscal year 2012. Federal databases including USA Spending, Veterans Affairs, Tracking Accountability in Government Grants Systems, Health Services Research Projects in Progress, and Patient‐Centered Outcomes Research Institute, were searched for individual projects addressing wound healing. Twenty‐seven projects were identified, totaling funding of

Comparison of sun safety knowledge and behavior of Hispanic and non-Hispanic mothers in Miami: A cross-sectional survey

16,588,623 (median:

Paraspinal morphea (paraspinal fibrosing plaque): differentiation from other paraspinal entities.

349,856). Four sponsor institutions accounted for 74% of awarded funds: Department of the Army, National Science Foundation, Department of Veterans Affairs, and Agency for Healthcare Research & Quality. Research projects and cooperative agreements comprised 44% and 37% of awarded grants. New applications and continuing projects represented 52% and 37%. Wound healing represented 0.15% of total medical research funded by the non‐National Institutes of Health federal sector. Compared with potential impact on US public health, federal investment in wound research is exiguous. This analysis will draw attention to a disproportionately low investment in wound research and its perils to American public health.