Dr. Silapunt is a specialist in varicose vein treatment, surgical dermatology, laser procedures, facial rejuvenation, injectables and cosmetic dermatology. She completed her residency training at The University of Texas Medical School at Houston, Houston, Texas, and then pursued a fellowship in phlebology (vein treatment), laser, and dermatologic procedures in Charlotte, North Carolina. Dr. Silapunt is board certified in Dermatology (ABD), and she is certified by the American Board of Venous and Lymphatic Medicine (ABVLM). She is a certified Phlebology Sonographer (RPhS, ultrasound testing for leg veins) and an invited speaker on varicose veins at national meetings. Dr. Silapunt is editor of the textbook “Treatment of Leg Veins, 2nd edition” as well as an author of the chapter called “Sclerotherapy and Laser Vein Treatment” in the textbook “The Art of Aesthetic Surgery: Principles and Techniques”. She is also an author of the chapter called “Repair of the Split Earlobe, Ear Piercing, and Earlobe Reduction” in the 1st, 2nd and 3rd editions of the textbook “Surgery of the Skin”.

Neuroendocrine tumors arise from neuroendocrine cells, and are relatively uncommon. These tumors are grouped into a relatively broad class of malignancies due to their inherent ability to synthesize and secrete peptide hormones. Cutaneous metastases secondary to neuroendocrine tumors are rare. Herein we report a case of a 75-year-old woman who presents with a rare cutaneous metastatic disease. She presented to our clinic with a 1-year history of an enlarging asymptomatic lesion on her left anterior shoulder. Four years previously she had been diagnosed with metastatic low-grade neuroendocrine carcinoma of unknown primary, with metastases to liver, lung and bone. The patient had no personal history of skin cancer. Physical examination revealed an 8-mm, well-demarcated, dome shaped, erythematous nodule with a smooth surface and speckled black pigmentation at its center. (Fig. 1) Histology demonstrated multiple nodular dermal aggregates of cells with atypical small round nuclei and scant cytoplasm. (Fig. 2) Immunohistochemical studies showed that the tumor cells stained strongly positive for chromogranin A and synaptophysin, but stained negative for cytokeratin 20. The patient started palliative chemo-radiation therapy and passed away soon after.

Michael Migden is a distinguished US-based Dermatologist and an Associate Professor, Departments of Dermatology, Division of Internal Medicine, and Head and Neck Surgery, Division of Surgery, at the University of Texas MD Anderson Cancer Center, Houston, TX, USA. At MD Anderson, he is a Program Director of the ACGME Fellowship: Micrographic Surgery and Dermatologic Oncology. He also serves as a Faculty Member in the Department of Ophthalmic Plastic and Reconstructive Surgery. He has served as a Principal Investigator for studies on the smoothened inhibitors sonidegib, vismodegib, and taladegib, and on immune therapy trials in non-melanoma skin cancer. He has published numerous primary and expert review articles on basal cell carcinoma.

Statement of the Problem: While most BCCs, accounting for ≈75% of skin cancers in the UK, are treated effectively with surgery and/or radiotherapy, limited data exist for the prevalence/burden of BCCs that become locally advanced (laBCC), thus potentially not amenable to surgery or radiotherapy (NATSOR). The burden of laBCC(NATSOR) was evaluated based on UK population, patterns of recurrence and per-patient cost. Methodology & Theoretical Orientations: Linked records from primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care UK databases were used to extract demographic, medical history, prescription and cost data for BCC patients. In the absence of unique laBCC diagnosis codes, an exclusion-based patient identification algorithm was developed by UK experts. Patients first treated for laBCC between 1/2007-12/2012 with ≥2 years follow-up were indexed. Non-laBCC controls were propensity matched for birth year, BCC diagnosis, sex, and comorbidities. Pairs where controls had BCC-related events ≤2 years before case indexing were excluded. Findings: Of the 64,126 patients with BCC whose linked records were assessed, 159 patients (0.25%) were identified as having laBCC(NATSOR). In 29 control-matched cases, recurrence rates at 1, 2, 3 and 4 years post-indexing were 21%, 41%, 62%, and 76%, respectively. Patients with laBCC(NATSOR) used significantly more healthcare resources (range, £301-5,743) than controls (range, £18-4,491), with a difference in overall annualized burden per patient of £1,242 (P=0.0002). Conclusions & Significance: In this UK-based analysis, only 0.25% of patients with BCC with linked records were identified as having laBCC(NATSOR). Recurrence rates in this population were high and likely contributed to the increased per-patient cost compared with patients without laBCC(NATSOR). Given the stringent exclusion algorithm and limitations of the analysis (lack of laBCC diagnosis codes and missing data [resource use, cancer drug therapy/radiotherapy]), the burden of laBCC(NATSOR) in the UK estimated in this analysis is conservative. Control-Match Cases of BCC Recurrence in the UK (n=29) Year 1 21% Year 2 41% Year 3 62% Year 4 76% UK Costs Patients with IaBCC(NATSOR) range, £301-5,743 Non-IaBCC Controls range, £18-4,491 Figure 1: IaBCC=locally advanced basal cell carcinoma; NATSOR=not amenable to surgery or radiotherapy.

Ali Ansaripour is a fourth year Medical student at King’s College London with a great interest in Dermatology and Dermatological Surgeries. He completed his Undergraduate Dermatology Training from St. John's Institute of Dermatology under the supervision of Dr. Raj Mallipeddi and Professor John McGrath. He recently won the Student Prize from the British Society of Dermatological Surgery (BSDS) for his article on Mohs’ micrographic surgery in non-melanoma cancer treatment in the UK.

Introduction: MMS is arguably the most revolutionary dermatosurgical technique of the last century and it is regarded as the gold standard for the treatment of NMSC, which has an increasing incidence and presents a huge financial challenge to the NHS. However, MMS is not always the most appropriate treatment option. Aim: This review article provides an opportunity to examine the appropriate use criteria (AUC) for MMS specifically looking at the cost and complexity of the lesion determined by the location, subtype and size of the lesion. Method: 25 relevant publications were identified on Medline, PubMed, AMED and CIAHL. These publications were analyzed for cost-effectiveness, selection criteria, patient experience and outcomes following MMS in NMSC patient cohort. Results: MMS is shown to be superior when compared to standard surgical excision (SSE) in terms of safety, recurrence rates and aesthetic outcomes. Although the immediate cost is much higher than SSE, it has been shown that given the reduced future costs incurred due to less subsequent procedures, MMS is the more cost effective technique, if used in complex and recurrent NMSC. SSE is however the most appropriate option for less complex cancers. Conclusion: Expanding the use of MMS for inappropriate indications raises the cost of medical expenses to the NHS. MMS should only be reserved for more complex and recurrent NMSC and when it is deemed inappropriate there are other evidence based medical treatment options that can be offered. Recent advances in molecular pathways may inevitably represent a paradigm shift towards medical management of NMSC.

Stacy Vason has over 30 years of extensive experience in the Beauty Industry. During her career, she has consulted with thousands of women concerning their hair care needs, problems and concerns. Her experience includes: studying trichology, platform artist, orator, entrepreneur, educational hair care seminars, community college educational advisor, etc. Her passion, ambition and ability to connect with people has provided her with an array of opportunities to collaborate with Dermatologists, Acupuncturists, Compound Pharmacists, Trichologists to raise awareness regarding hair and scalp disorders, treatments and beneficial hair care regiments for women and men.

Use of hair extensions has been associated with increased incidence of premature hair loss and scalp disorders. Potential mechanisms include: tension on hair and scalp, insufficient maintenance and allergic reactions. Knowledge on the different styling techniques and their adverse effects will allow the Dermatologist to make more specific diagnosis and tailor recommendations. Hair extensions have gained increased usage over the pass 10-15 years. They are now being worn by women of all income levels, ethnicities and ages. When hair and scalp problems occur they may consult a Dermatologist. This presentation will illustrate the most common techniques used, pertinent questions to include in assessment, factors that may affect a client’s compliance with treatment recommendations and the different types of adhesives used to apply the extensions.

Franco Gasparri graduated from the University of Bologna in Industrial Chemistry, here after improving his knowledge for cosmetics at the University of Urbino and Ferrara, whereby he attended specialised courses in Phytochemistry, Herbalist, Chemistry and Cosmetic Technology. After thirty years in the cosmetic sector, Franco now has extensive experience in the field. He has further worked in other sectors such as Research & Development, Quality Control, Technical Management and General Management of cosmetic and pharmaceutical companies. Currently he is a professor at the University of Salerno within the Pharmacy Faculty, teaching Master level students in Cosmetic Science and Technology. Moreover Franco Gasparri is the author of several academic articles published in both national and international journals, in addition to presenting at scientific congresses.

Introduction: Candida is usually present in the vaginal microbioma in which lactobacilli (LB) are predominant. Its growth is controlled by LB function. An imbalance in LB production leads to an overgrowth of yeast, and the occurrence of vulvovaginal candidiasis. This is a vaginal yeast infection, a common female condition, caused by Candida species, associated with intense itching, swelling, and irritation. Candida infection frequently relapses. Different formulations of detergents for feminine intimate hygiene are available, and their antimicrobial and pharmacological activity need scientific evidence supporting the claim. Aim: This study evaluated the effect on Candida spp. of a cleanser indicated for feminine hygiene, with active ingredients from plant extracts in a mucous-adhesive system at acid pH (SAnew) compared with a reference cleanser (C) based on traditional surfactants in a double blind design. Methods: The main components of the tested formula are: the microbiologically active Thymus vulgaris extract and Zinc Coco Sulfate, and Xanthan Gum and Chondrus Crispus extract, mucous-adhesive agents. The anti-mycological activity of the products described below was evaluated in 12 strains of Candida spp. isolated from vaginal swabs from women with vaginitis, and in two strains from the American Type Culture Collection (ATCC-MYA 276 C. glabrata, ATCC-24433 C. albicans) belonging to the same species as the wild samples. Quantitative testing determined the minimum inhibitory concentration (MIC), i.e. the lowest concentration at which an absence of visible growth is observed and expressed in % of product using the broth microdilution test. SAnew ingredients: Aqua, Zinc Coco Sulfate, Propylene Glycol, Glycerin, Disodium Capryloyl Glutamate, Lactic Acid, Caprylyl Glycol, Xanthan Gum, Thymus vulgaris (Thyme) Extract, Coco-glucoside, Glyceryl Oleate, Chondrus crispus, α-Ketoglutaric Acid, Sodium Benzoate. Results: MIC values (14 strains of Candida spp) showed a statistically significant difference (p=0.034 at Student’s t test one-tail) in favour of SAnew. SAnew MIC: 0.18%±0.01. Reference cleanser (C) MIC: 0.29%±0.05. Conclusion: Detergents for feminine intimate hygiene should have effective formulations for maintaining genital health and preventing bacterial and fungal contamination. The data here presented suggest that formulation tested have inhibitory activity against Candida albicans and Candida glabrata. Recent Publication 1. Bing MA, Fornay MJ, Ravel J. (2012) The Vaginal Microbiome: Rethinking Health And Diseases. Annu Rev Microbiol 66:371-389. 2. Rossi S, Bonferoni M, D’Autilia F, Sandro G, Ferrari G, Caramella C, Mortara E, Giannini V, Gasparri F. (2014) Associations Of Natural Polymers To Modulate Mucoadhesion Of Vaginal Rinse-Off And Leave-On Formulations. J Drug Del Sci Tech. 24(5):496-502. 3. Gasparri F, Giannini V, Benvenuti C. (2012) In Vitro Evaluation Of The Protective And Reparative Effect In Relation To Damage Caused By The External Agents On The Vaginal Epithelium. Giorn It Ost Gin. XXXIV:184-185. 4. Vardar-Unlu G, Candan F, Sokmen A, Daferera D, Polissiou M, Sokmen M, Donmez E, Tepe B. ( 2003) Antimicrobial And Antioxidant Activity Of The Essential Oil And Methanol Extracts Of Thymus Pectinatus Fisch. Et Mey. Var. Pectinatus (Lamiaceae), J Agric Food Chem 51:63-67. 5. Braga PC, Alfieri M, Culici M, Dal Sasso M, (2007) Inhibitory Activity Of Thymol Against The Formation And Viability Of Candida Albicans Hyphae. Mycoses 50:502–506.

Ravinder Kaur is a Professor and the Head of Mycology Division at the Lady Hardinge Medical College, India. She was the Principal Investigator of 28 research projects and Co-investigator of 35 research projects in Mycology and Microbiology. She has also worked on the diagnosis of fungal infections in immunocompromised patients, and was involved in the development of different standards and new techniques in isolation and identification of fungi and standardization of molecular identification and characterization. She has presented 35 papers in international conferences and 70 papers in national conferences, and has published more than 85 papers in different international and national journals.

Onychomycosis is one of the most frequent conditions seen in dermatology clinics. The nail disease usually starts as a cosmetic concern progressing to have a major physical and psychological effect on the patients both in young and adults. The causative agent of onychomycosis can be dermatophyte, non-dermatophyte moulds (NDM), or yeasts. A mycological study of onychomycosis was undertaken in 550 patients from January 2016 to December 2016 in the Department of Microbiology, Lady Hardinge Medical College. The patients belonged to a wide range of age spectrum. Males were seen to be predominantly affected (53.5%), male to female ratio being1.4:1. After clinical suspicion, nail clippings were sent for direct KOH microscopy and fungal culture. Direct microscopy of the nail clips in 20% KOH solution was positive in 183 (33.27%) and culture was positive in 396 (72%) cases. Non-dermatophyte moulds (NDM) were isolated in 232 (42.18%), yeasts in 91 (16.55%), dermatophytes in 52 cases (9.45%). Amongst the NDMs, Aspergillus spp. was the most prevalent species followed by Alternaria spp., Cladosporium spp., Penicillium spp. and Fusarium spp. There is a shift in the aetiology of onychomycosis from yeasts and dermatophytes to non-dermatophyte moulds (NDMs) in our study. Change in the causative aetiology of onychomycosis as well as the emergence of drug resistant fungi and consequent treatment failures make it mandatory for culture of the mycological agents to know the distribution and epidemiology of fungal agents of onychomycosis.

Filipa Henriques da Silva has a degree in Medicine and she is a 1st year resident of Family Medicine. She has done an elective of 2 months in Dermatology in the Local/Regional Hospital. During this period she developed a passion for the study and diagnose of skin disorders.

Case report: In the context of our dermatology internship, a 30-year-old man presented with a 16-year history of recurrent boils and abscesses under both arms, neck, inter- mammary and perianal regions. They flared, causing pain, suppuration and an offensive odor. Scarring has developed in the neck, axillary and perianal area, and chronically draining sinus tracts were interspersed with normal skin (Hurley stage III). Treatment with short courses of antibiotics or with incision and drainage has had no effect, and he became socially isolated because of embarrassment about his condition. The patient didn't have any contact with his family doctor for years and he was overweight, had a positive family history and was a smoker. He is now on the 6 month of treatment with Monoclonal Antibody. Introduction: Hidradenitis suppurativa is a chronic, recurrent and debilitating skin condition. It is an inflammatory disorder of the follicular epithelium and the etiology is not clearly defined. The diagnosis is made clinically based on typical lesions (nodules, abscesses, sinus tracts), locations (predominantly axillae, groin and perianal area), and nature of relapses and chronicity. Although the lack of curative therapy and the recurrent nature makes HS treatment challenging, there are effective symptomatic management options. Findings: The man in this case report had a little response to Adalimumab in the first 6 months of treatment, although he stopped it during1month. Conclusion: Family physicians play an important role in early detection/diagnosis and treatment before HS progresses to end-stage disease. As future Family physicians, we were very sensitized about this case and we pretend to play a role in our community to improve early diagnosis of HS. Family physicians should suspect of HS in patients that presents with recurrent skin abscesses, in order to prevent late direct complications, such as scarring and impaired quality of life.

Mawaddah Tallab is a Medical intern, King Abdulaziz university hospital, Jeddah, Saudi Arabia

Objective: To Asses Attitudes and behavior of female medical students related to facial skin care routine and to study factors that influence buying-decisions of skin care products. Study design: Cross-sectional study. Setting: King abdulaziz university hospital. Subjects and Methods: Self-administered questionnaire was conducted randomly to 301 female medical students from February 2016 to May 2016. Descriptive analysis was done for all the data in order to obtain the frequencies and percentages needed Results: Results indicated that majority of students (76.7%) do not follow regular skin care routine, Further analysis indicated that (66%) don’t use sunblock and (29%) reported to have history of sunburn. Most commonly used skin products were body lotions and moisturizers (74%). The use of makeup was obviously higher than the use of skin care facials. Among the study sample, factors that were distinguished as being the evaluative criteria to participants when buying products were greatly affected by brand of product (68.7%) followed by friend’s recommendations (51.3%), one of the factors that can have an effect on buying behaviour is the price of a product, our Students had a little concern regarding price (32%) in comparison to other factors. Results also revealed that majority of respondents never cared to check ingredients of their products (48%). Conclusion: Our society needs to be more educated about the importance of getting a proper skin care routine, further studies with wider distribution of the questioner in different cities and to different age groups is advisable.

Habibi Iman is a medical doctor(MD) graduated from the Shahid Beheshti University of Medical Sciences, Tehran, Iran. His fields of interest are researching on wound care in diabetic foot ulcer, burning and fabricating topical products such as ointment, cream, hydrogel and scaffold for wound healing. He has one iranian patent for treatment of keloid and hyper trophic scars titled "The topical formulation for the treatment of keloids and hypertrophic scars" and another iranian patent for skin pain assesment in microneuropathies titled "Digital device for pain assessment in human". He is also working on two research projects regarding Diabetic Wound Healing and Keloid Treatment. He had published an ISI article about Glioma diagnosis in 2016 titled "Predictive and prognostic value of TLR9 and NFKBIA gene expression as potential biomarkers for human glioma diagnosis".

Background: Diabetic foot ulcer as a chronic wound is a major problem. Matrix metalloproteinase (MMP-2) and pro-inflammatory cytokines such as (IL-1b and TGF-b) are increased in chronic wound. Doxycycline inhibits MMPs and pro-inflammatory cytokines in different ways. Chitosan is a natural polymer that enhances the process of wound healing. PVA is a synthetic, non-toxic and biodegradable polymer that increases the mechanical properties of chitosan. Less is known about the effects of nanofiber wound dressing containing Doxycycline, chitosan and PVA. Objective: The purpose of this study was to fabricate and treat diabetic ulcer in rat models. Methods: Four wound dressing with formulation (C/PVA-C/PVA/DOX 1%, C/PVA/DOX 1%, Genipin 1%- C/PVA/DOX 1%, Genipin 0.05%) was designed. Each wound dressing was evaluated by antimicrobial test, water vapor transmission rate (WVTR), FTIR, SEM, water absorption, release test and cytotoxicity test. 45 male rats were randomly selected and divided into three groups (A: diabetic-C/PVA/DOX 1% wound dressing, B: diabetic-C/PVA/wound dressing and C: non diabetic-not received wound dressing). Each group divided into three sub groups (n=5). In anesthetic condition a full thickness with diameter of 15 mm was excised from the dorsal area of skin. For assessment the rate of wound contraction and healing digital photography was taken during the study. In days of 3, 7 and 14 the rats were euthanized and samples were obtained from the wound for evaluating histopathology. Results: Our results showed that the C/PVA/DOX 1% has better function compared to other formulations in vitro tests. In addition in vivo tests rats wound healing were faster with C/PVA/DOX 1%.

Background: There are several questionnaires to screen for psoriatic arthritis (PsA), but none of them are informative enough. In practice dermatologists usually see patients with psoriasis before arthritis develops. This study aimed to compare effectiveness, sensitivity, specificity screening questionnaire to diagnose early PsA (ePsA) in patients with severe psoriasis (PsO). Objectives: To evaluate and to compare effectiveness, sensitivity, specificity of two PsA screening questionnaires {early arthritis for psoriatic patients (EARP), psoriatic arthritis questionnaire (PAQ)} in a hospital-based cohort of patients (pts) with severe PsO. Methods: 40 pts {19 Male (M) and 21 Female (F)}, mean age 50.3±29 years accordingly, mean PASI>10, PsO duration 8±2.8. 7 PsO pts with clinically diagnosed PsA (L 40.5). To diagnose ePsA we have used EARP and PAQ questionnaires in cohort of pts with severe PsO in the Dermatological Hospital “Clinica Korolenko” in 2016. M±m, t-test, (%) were calculated (55.5±7.7). The diagnostic accuracy of the two questionnaires for the diagnosis of ePsA was compared by receiving operating characteristics curves. Results: In total, 40 patients (100%) with psoriasis were invited to participate and all of them returned the questionnaires. Of these, 7 pts (%) were diagnosed with PsA earlier and 33 PsO (%) pts who earlier were not diagnosed PsA, of which 10 pts increased with the number of positive questionnaires. Of these, 10 pts responded positively to the EARP questionnaire, as for PAQ only 3 pts of the same group responded positively all of them have not been previously diagnosed with PsA. The majority of patients with a false positive response had degenerative or osteoarthritis. At the same time in the group of pts who earlier were diagnosed PsA (7 pts), we have 4 pts who did not respond positively to the PAQ and only 2 pts to the EARP of the same group. Conclusion: Although the EARP questionnaire performed slightly better than the PAQ questionnaire at identifying PsA, there is a big difference between these instruments. These screening tools identify many cases of musculoskeletal disease other than PsA.