2014.3

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The paper describes a cross-sectional study on dermatological signs of ageing.  It is well designed and written in decent English. It is worth to note that the described conditions do nit certainly reflect the situation in the general population, as all recruited subject sought dermatological consultation actively for a certain dermatological condition. Otherwise the paper is of actuality and reaches the quality to be published in the journal.  Razvigor Darlenski, MD PhD (Bulgaria)

This is an interesting paper that deals with the geriatric population. Results obtained in here are to a certain extent similar to other recent findings. For instance, a high incidence of fungal infections has been noted. This is quite usual and a common global problem. A nice review by Havlickova et al 2008 entitled “Epidemiological trends in skin mycoses worldwide” in Mycoses vol 51 provided some of the factors associated with same. Another study in India “A clinical study of skin changes in geriatric population” among 200 patients aged 65+ years, in Bangalore reported that wrinkling, xerosis were quite common (Grover & Narasimhalu 2009). Similar results were obtained by Bilgili et al 2012 (The prevalence of skin diseases among the geriatric patients in Eastern Turkey). It should be noted that apart from the use of less emollients and harsher soaps by subjects, there are age-related dermal changes, altered physiological changes during normal ageing, environmental factors, genetics, and ethnicity that can be contributing factors to a higher incidence of xerosis.   Dr. Rajesh Jeewon Ph.D. (Mauritius)

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The importance of gender selection of even specialist matters is highlighted in the present study. The number of female patients are reported to be more as the specialists here are females. The other important issue, the present study, point towards, is the need of more awareness. I believe ,the other relevant issue is the timings of STD clinics. In crowded government clinics, timings and days are fixed and STD patients tend to go to private for reasons of more privacy,anonymity, and 24×7 availability. Bharti et al presented a study from Amritsar, in 1992 International AIDS conference,pointing out the same. Health authorities should look into the matters of active surveillance as well.  Dr Rakesh Bharti (India)

A good study, the number of patients included in the study was big. The study achieved its main objective which was the profile of patients in a STD clinic in North India. It would be reasonable if the study has screened the patients for HIV and demonstrate any potential correlation with certain STD.   Dr Amani Tresh (Libya)

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The incidence of complications and treatment given could be elaborated in Immunocompromised patients.  Prof. Sunderamoorthy Srinivasan (India)  

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Interesting and classical case of subcutaneous phaeomycotic cyst. You can find some additional information in our recent papers.   References: 1. Isa-Isa R, García C,  Isa M,  Arenas R. Subcutaneous phaeohyphomycosis (mycotic cyst) Clin. Dermatol. 2012;30:425–31;  2. Vásquez del Mercado E, Lammoglia L, Arenas R. Subcutaneous faeohyphomycosis due to Curvularia lunata in a renal tranplant patient. Rev Ibero Am Micol. 2013;30:116-8.   Prof. Roberto Arenas (Mexico)

Congratulations to the authors is an interesting report, though it would be interesting to know the risk factors of the patient and co-morbidity. Phaeohyphomycosis is a rare mycotic opportunist disease witch usually affects immunodepressed patients. The most frequently encountered etiologic agents of subcutaneous phaeohyphomycosis include Exophiala jeanselmei, Exophiala dermatitidis, Phialophora verrucosa and Phaeoacremonium parasiticum. Which are the most frequent cause espcies Phaeohyphomycosis in India.   Dr Max Carlos Ramírez Soto (Peru)

This is a very interesting case of an infrequent presentation of a subcutaneous pheomycotic cyst in an elderly patient. The authors describe very nicely the typical histopathological findings. It is a shame that cultures could not be taken.  Dr. Manuel Valdebran (Dominican Republic)

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It is very interesting this report overlap syndrome between two different entities in the spectrum of alopecia. The patient is well studied from immunology, which invites further research in this field. The association of two or more types of alopecia clinic pathological is not as uncommon in daily practice, which should be reflected in the literature.  Dra. María Bibiana Leroux (Argentina)  

This interesting manuscript highlights about a fact which is indeed very common in clinical practice: the overlapping syndromes o diseases. Particularly in alopecias, where in some certain cases the diagnosis is complex and there’s a lack of diagnostic criteria, publications on immunohistochemical and fluorencent features in the different types of alopecia may be of help. While the results obtained by authors are preleminary and based on just one single case, the topic warrants further researches to estimate the real prevalence and incidence of these overlapping syndromes.   Dr. Husein Husein-ElAhmed (Spain)

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Nothing more acute and punctual than this double case report: congratulations to the A.A., that have expressed all their own finesse d’esprit tracing the anamnestic profile, I mean, when they concisely  refer: patients do not remember when the lesions occurred: it gives the proper idea that the patient did not suspect the cogency of the disease just when it began to appear and develop itself, so that  it can be easily argued that the ailment is actually devious and deceptive and worthy to be detected and studied. Besides, the A.A. go strenuously countercurrent with regards to the modern medical practice, I mean, the mercantile and commercial fashion  as it is, hélas, intended in the capitalist and industrialised nations, where the human needs are not anymore wants, desires and demands (Christian Bay, sociologist), but all needs are induced and so generated and thus false. If the study had been conducted in the United States of America or in France or in Italy, the therapy suggested should have been a sequence of sophisticated and insulse medicaments based on voidnesses and vain remedies, here the necessary advices and suggestions only an excellent practitioner can dispense.   Lorenzo Martini, M.Sc.  (Italy)

This is very interesting article for all those who are involved in the health care of athletes. Modern sport is aimed at achieving results that were until recently unimaginable with physiological aspects of the human body.   Vjeroslava Slavic, MD PhD (Montenegro)

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This is an interesting overview of facial beauty. What makes a face attractive has always been a matter of debate, especially among psychologists. Facial attractiveness has always intrigued one or more and has even caught the attention of many researchers. This is a nice summary of the different aspects of facial beauty and some of the precautions dermatologists/plastic surgeons should pay attention to. What pops in my mind when reading this paper is another interesting article entitled: Is Beauty in the Face of the Beholder? by Laeng et 2013 published in PLoS ONE 8(7). All of us are, to a certain extent, genetically preprogrammed for facial beauty which can largely be affected by lifestyle and environmental factors. Although from an evolutionary viewpoint, partners chose for phenotypic similarity and a simple glance is enough to trigger a number of emotions, we are still far away from a thorough understanding of how parental genes could have influenced our skin and face and how our preferences are linked to attractive traits.   Dr. Rajesh Jeewon Ph.D. (Mauritius)

This excellent article by Dr Neerja Puri highlights the importance , methods and other aspects of cosmiatric procedures. This is a complicated ethical issue. To achieve comprehensive individualized treatment based on patient anatomy and personal expectation, the dermatologist or plastic surgeon needs proper training and experience. Desire and eagerness for quick profits by poorly trained (by courses on weekends, for example) or – worse – by non-medical professionals has led to tragic cosmetic results worsening the patient self esteem. Beyond that , all commercially available products must be approved by the US Food and Drug Administration (FDA) or a national parallel. The doctor must be a certified specialist to minimize the possibility of side effects and complications of these procedures.   Dr Cesar Bimbi (Brazil)

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Cyclosporine is a potent immunomodulatory drug and best choice in refractory or severe chronic plaque Psoriasis type with immediate improvement in clinical manifestations. Kidney functions test should be monitored before and during therapy. FDA approved that cyclosporine not be used more than one year. Alternation with other forms of treatment should be considered in long term management of patients with lifelong disease.   Dr. Yugandar Inakanti (India)

The effectiveness of cyclosporine in psoriasis was initially reported by Mueller and Herrmann at the end of the 70s.1 Since then its use as a part of the therapeutic armamentum in psoriasis is well recognized. Newer evidence suggests that doses of 2.5-3 mg/kg/day may have better risk/benefit ratio as mentioned by Colombo and coworkers.2 In fact she quotes the article published by Yoon3 where 61 severe psoriasis patients were assigned to an increasing regimen of cyclospornine starting at 2.5mg/kg/day or a decreasing regimen starting at 5 mg/kg/day. The PASI 50 response rates at 12 weeks were slightly higher for the decreasing regimen but not statistically significant. However, the higher is the dosage, the better and quicker are the results of treatment as expressed by the results of PASI 75. The favorable outcome seen in this report reminds us that low cyclosporine doses may be effective in the treatment of severe psoriasis as addressed by other authors. However clinician should not expect a quick result as seen when using higher doses.   References:   1. Mueller W, Herrmann B. Cyclosporin A for psoriasis. N Engl J Med. 1979;301:555;  2. Colombo MD, Cassano N, Bellia G, Vena GA. Cyclosporine regimens in plaque psoriasis: an overview with special emphasis on dose, duration, and old and new treatment approaches. Scient World J. 2013;2013:805705;   3. Yoon HS, Youn JI. A comparison of two cyclosporine dosage regimens for the treatment of severe psoriasis. J Dermatolog Treat. 2007;18:286-90.    Dr. Manuel Valdebran (Dominican Republic)

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Good example of this uncommon pyoderma gangrenosum (PG) form with both typical associations. This type is probably under-recognized because of fast development of ulcers. Due to its grave prognosis, dermatologists should be aware of the presentation of early PG forms and its rare presentations.   Viktoryia Kazlouskaya, MD, PhD (USA)