{"_id": "WikiPedia_Dermatology$$$corpus_1", "text": "Trichology  is the study of the  hair  and  scalp . [ 1 ]  The term derives from  Ancient Greek  \u03b8\u03c1\u03af\u03be ( thr\u00edx ), \"hair\" [ 2 ]   and -\u03bb\u03bf\u03b3\u03af\u03b1  -logia . In most jurisdictions the title of a  trichologist , not the field of trichology, is considered a para-medical discipline. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2", "text": "The Institute of Trichologists was founded in 1902. [ 3 ]   [ 4 ]  The first journal for the field,  International Journal of Trichology , was founded in 2009. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3", "text": "Trichology includes subspecialties that deal either with certain diseases or diseases of certain parts of the hair. Some of them are:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4", "text": "Hair analysis  may refer to the chemical analysis of a  hair  sample, but can also refer to microscopic analysis or comparison.  Chemical hair analysis may be considered for retrospective purposes when blood and urine are no longer expected to contain a particular contaminant, typically three months or less."}
{"_id": "WikiPedia_Dermatology$$$corpus_5", "text": "Its most widely accepted use is in the fields of  forensic toxicology , in  pre-employment drug testing  and, increasingly, in environmental  toxicology . [ 1 ] [ 2 ]   Several  alternative medicine  fields also use various  hair analyses  for environmental  toxicology , but these uses are controversial, evolving, and not standardized."}
{"_id": "WikiPedia_Dermatology$$$corpus_6", "text": "Microscopic hair analysis has traditionally been used in forensics as well.  Analysts examine a number of different characteristics of hairs under a microscope, usually comparing hair taken from a crime scene and hair taken from a suspect.  It is still acknowledged as a useful technique for confirming that hairs do not match. But DNA testing of evidence has overturned many convictions that relied on hair analysis. Since 2012, the Department of Justice has conducted a study of cases in which hair analysis testimony was given by its agents, and found that a high proportion of testimony could not be supported by the state of science of hair analysis. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_7", "text": "Chemical hair analysis is used for the detection of many therapeutic drugs and  recreational drugs , including  cocaine ,  heroin ,  benzodiazepines  and  amphetamines . [ 3 ] [ 4 ]   Hair analysis is less invasive than a blood test, if not quite as universally applicable.  In this context, it has been reliably used to determine compliance with therapeutic drug regimes or to check the accuracy of a witness statement that an illicit drug has not been taken.  Hair testing is an increasingly common method of assessment in substance misuse, particularly in legal proceedings, or in any situation where a subject may have decided not to tell the entire truth about his or her substance-using history.  Post-mortem hair sample analysis can also be performed, to allow for determination of long-term drug use or poisoning. [ 5 ]  It is also used by employers, who test their employees. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_8", "text": "Hair analysis has the virtue of showing a 'history' of drug use due to hair's slow growth.   Urine analysis  might detect drugs taken in the past 2\u20133 days; hair analysis can sometimes detect use as far as 90 days, although certain cosmetic treatments (e.g. dyeing hair) can interfere with this. [ 7 ] [ 8 ]    \nNotably,  basic  drugs get incorporated into hair to a greater extent than neutral or  acidic  drugs, e.g.  amphetamines  and  cocaine \nare present in higher concentrations in hair compared with\nbenzodiazepines and cannabinoids. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_9", "text": "Large-scale drug screening (or urine, hair and other samples) is usually done using enzyme-linked immunosorbent assays ( ELISA ). [ 10 ]  Positive ELISA findings are followed by confirmatory testing with  liquid chromatography\u2013mass spectrometry  (LC-MS) or  gas chromatography\u2013mass spectrometry  (GC-MS). [ 8 ]  Chromato-mass-spectrometry is less likely to result in false positive findings than ELISA, but the former requires expensive equipment and highly trained personnel."}
{"_id": "WikiPedia_Dermatology$$$corpus_10", "text": "The judicial admissibility of the test in the United States is guided by the  Daubert standard .  A notable court case was  United States v. Medina, 749 F.Supp. 59 (E.D.N.Y.1990) . [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_11", "text": "Microscopic hair analysis consists of the comparison of several strands of hair under a microscope and determining if the physical characteristics of each individual hairs are consistent with each other or not. It was accepted as a forensic science by the 1950s. [ 13 ]   Researchers often monitored more than a dozen attributes, including pigment distribution and scale patterns.  This technique has been used in criminal investigations to try to tie hair found at a crime scene, or other location of note, and confirm if the hair matches that of a suspect.  While a simple hair color match might be  consistent  with a certain suspect having been at the scene \u2013 black hair at the scene when the suspect has black hair \u2013 microscopic hair analysis began to claim a stronger standard by the 1970s. Rather than merely \"narrow the field\" of possibilities, hair analysts claimed to be able to match a specific person, such that the hair could be 'proof' of a specific suspect's presence.  While the typed reports often hedged the certainty of microscopic hair analysis, witnesses in court would not always be as modest. The manager of the Montana state crime lab testified there was a \"1 in 10,000 chance\" that hairs found at a crime scene did not come from the suspect in one case, for example. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_12", "text": "Microscopic hair analysis has a long tradition of being used in crime fiction as well; it was originally popularized in the  Sherlock Holmes  series before being widely used by the police. [ 13 ]   Fictional TV programs involving police procedurals and detectives have continued to use it since, including  Columbo ,  Quincy, ME ,  Dexter , and  CSI . [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_13", "text": "Skepticism about the stronger claims used by witnesses in the 1970s and 1980s existed at the time. Researchers said in 1974 that the whole process was inherently subjective, and the FBI wrote in 1984 that hair analysis cannot positively match one single person. [ 13 ]  In the 1990s,  DNA profiling  was introduced as a key new technique into forensics investigations; it introduced a new level of certainty about matching suspects to evidence. DNA analysis of old cases from the 1970s and 80s, however, contradicted conclusions about a number of earlier matches on the basis of hair analysis. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_14", "text": "In 1994, the Justice Department created a task force which would eventually review 6,000 cases by 2004, focusing on the work of one particularly zealous examiner, Michael Malone. [ 13 ]  These reviews came after reports that sloppy work by examiners at the FBI lab was producing unreliable forensic evidence in court trials.  At first, these investigations were largely kept quiet;  The Washington Post  reported that \"Instead of releasing those findings, they made them available only to the prosecutors in the affected cases.\" [ 13 ]   A study of FBI Laboratory hair analysis cases between 1996 and 2000 was released in 2002 by Max M. Houck and Bruce Budowle. [ 16 ]   The study showed that 11% of hair analysis \"matches\" were contradicted by DNA analysis.  As the set of cases analyzed was one which would be expected to favor matches strongly in any case \u2013 only hair of individuals the police already believed to be potential suspects was sent in \u2013 this error rate was considered to be extremely high. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_15", "text": "Kirk L. Odom  was convicted of rape in Washington, DC in 1982 by no physical evidence except microscopic hair analysis performed by the  FBI Crime Laboratory . [ 13 ]  Combined with a witness's identification in a  line-up  (another technique which modern research has shown to be much less reliable than previously thought), Odom was sentenced to twenty or more years in jail. DNA analysis, however, proved that Odom was entirely innocent. [ 14 ]   While Odom had been released from prison in 2003, he was officially exonerated in 2012 and was paid a large settlement by the city. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_16", "text": "In a similar case,  Santae Tribble  was convicted in 1979 at the age of 17 in Washington, DC of murder due to FBI testimony in a hair analysis match of hair found at the scene. But he had three witnesses who gave him an  alibi  for the time when the crime was committed.  The prosecutor overstated the reliability of hair analysis in identifying a single person, saying in his closing statement that \"There is one chance, perhaps for all we know, in 10 million that it could [be] someone else's hair.\" [ 13 ]   DNA testing in January 2012, however, showed that the prosecution's key piece of evidence, the hair, did not in fact match the defendant. Tribble was fully exonerated in December 2012, having served 28 years in prison that resulted in severe health problems. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_17", "text": "The outcry from defense attorneys about the unreliability of hair analysis and overstatement by FBI experts has resulted in the FBI conducting a review of disputed hair analysis matches since 2012.  Due to what it found, in July 2013 the Justice department began an \"unprecedented\" review of older cases involving hair analysis, examining more than 21,000 cases referred to the FBI Lab's hair unit from 1982 through 1999."}
{"_id": "WikiPedia_Dermatology$$$corpus_18", "text": "By 2015, these cases included as many as 32 death penalty convictions, in which FBI experts may have exaggerated the reliability of hair analysis in their testimony and affected the verdict. Of these, 14 persons have been executed or died in prison. [ 19 ] [ 20 ]  In 2015, DOJ released findings on 268 trials examined so far in which hair analysis was used (the review was still in progress). The review concluded that in 257 of these 268 trials (95 percent), the analysts gave flawed testimony in court that overstated the accuracy of the findings in favor of the prosecution.  About 1200 cases remain to be examined. The department emphasized its commitment to following up on these cases to correct any wrongs, saying that they \"are committed to ensuring that affected defendants are notified of past errors and that justice is done in every instance. The department and the FBI are also committed to ensuring the accuracy of future hair analysis, as well as the application of all disciplines of forensic science.\" [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_19", "text": "In 2017, new Attorney General  Jeff Sessions , appointed by President  Donald Trump , announced that this investigation would be suspended, at the same time that he announced the end of a forensic science commission that had been working to establish standards on several tests and to improve accuracy; it was a \"partnership with independent scientists to raise forensic science standards\". [ 21 ]  Independent scientists, prosecutors, defense counsel and judges criticized ending the commission, saying that the criminal justice system needed to rely on the best science."}
{"_id": "WikiPedia_Dermatology$$$corpus_20", "text": "As of late 2019, 75 people who were convicted of a crime based on microscopic hair comparison were subsequently exonerated. [ 22 ]   Another notable case that received media attention since was  Anthony Broadwater , who had been convicted of raping  Alice Sebold  in 1982, and was formally exonerated in 2021 after finishing his time in 1998.  The only physical evidence the prosecution offered in 1982 was a hair analysis that was \"consistent\" with Broadwater.  More alarmingly, the only reason the case was re-examined was the unusual fact that Sebold had written an extensive memoir of her experiences ( Lucky ), which allowed later investigators to uncover major problems with the case. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_21", "text": "Analysis of hair samples has many advantages as a preliminary screening method for the presence of toxic substances deleterious to health after exposures in air, dust, sediment, soil and water, food and toxins in the environment.  The advantages of hair analysis include the non-invasiveness, low cost, and the ability to measure a large number of, potentially interacting, toxic and biologically essential elements.  Hence, head hair analysis is increasingly being used as a preliminary test to see whether individuals have absorbed poisons linked to behavioral or health problems. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_22", "text": "The use of hair analysis appears to be valid for the measurement of lifelong, or long-term heavy metal burden, if not the measurement of general elemental analysis. Several studies, including the analysis of  Ludwig van Beethoven 's hair, have been conducted in conjunction with the  National Institutes of Health  and  Centers for Disease Control and Prevention . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_23", "text": "In a 1999 study on hair concentrations of  calcium ,  iron , and  zinc  in pregnant women and effects of supplementation, it was concluded that \"From the analyses, it was clear that hair concentrations of Ca, Fe, and Zn could reflect the effects of supplementation... Finally, it could be concluded that mineral element deficiencies might be convalesced by adequate compensations of mineral element nutrients.\" [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_24", "text": "Hair analysis has been used in occupational, [ 25 ]   environmental  and some branches of  alternative medicine  as a method of investigation to assist screening and/or  diagnosis . The hair is sampled, processed and analyzed, studying the levels of mineral and metals in the hair sample. Using the results, as part of a proper examination or test protocol, [ 26 ]  practitioners screen for toxic exposure and  heavy metal poisoning . Some advocates claim that they can also diagnose  mineral   deficiencies  and that people with  autism  have unusual hair mineral contents. [ 27 ]  These uses are often controversial, and the American Medical Association states, \"The AMA opposes chemical analysis of the hair as a determinant of the need for medical therapy and supports informing the American public and appropriate governmental agencies of this unproven practice and its potential for health care fraud.\" [ 28 ] \nA recent review of scientific literature by Dr Kempson highlighted analysis of metals/minerals in hair can be applied in large population studies for researching epidemiology and groups of chronically exposed populations, however any attempt to provide a diagnosis based on hair for an individual is not possible. [ 29 ]  An exception to this can be in advanced analyses for acute poisoning. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_25", "text": "Hair multiplication , or  hair cloning , is a proposed technique to counter hair loss. The technology is in its early stages, but multiple groups have demonstrated pieces of the technology at a small scale, with a few in commercial development."}
{"_id": "WikiPedia_Dermatology$$$corpus_26", "text": "Scientists previously assumed that in the case of complete baldness,  follicles  are completely absent from the scalp, so they cannot be regenerated. However, the follicles are not entirely absent, as there are stem cells in the bald scalp from which the follicles naturally arise. The behavior of these follicles is suggested to be the result of  progenitor cell  deficiency in these areas."}
{"_id": "WikiPedia_Dermatology$$$corpus_27", "text": "The basic idea of hair  cloning  is that healthy follicle cells or  dermal papillae  can be extracted from the subject from areas that are not bald and are not suffering hair loss. They can be multiplied (cloned) by various culturing methods [ 1 ]  and the new cells can be injected back into the bald scalp, where they would produce healthy hair."}
{"_id": "WikiPedia_Dermatology$$$corpus_28", "text": "One of the first companies to begin experimenting with hair cloning was Intercytex. [ 2 ]  Intercytex tried to clone new hair follicles from the stem cells harvested from the back of the neck. They hoped that if they multiplied the follicles and then implanted them back in the scalp in the bald areas, they would be successful in regrowing the hair itself. [ 3 ]  In 2008, Intercytex interpreted that they failed in fully developing the hair cloning therapy and decided to discontinue all research. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_29", "text": "The first time scientists were able to grow artificial hair follicles from stem cells was in 2010. Scientists at the  Technische Universit\u00e4t Berlin  in Germany, with Intercytex and several other research teams, took animal cells and created follicles by using them. As a result, they produced follicles \"thinner than normal\". They were able to clone one or two follicles from an extracted hair."}
{"_id": "WikiPedia_Dermatology$$$corpus_30", "text": "Aderans Research Institute, a Japanese company, worked on what they called the \"Ji Gami\" process, which involved the removal of a small strip of the scalp, which is broken down into individual follicular stem cells. After the extraction, these cells are cultured and injected back into the bald areas of the scalp. [ citation needed ]  The trials continued in 2012. Aderans decided to discontinue the funding of its hair multiplication research in July 2013. [ 4 ] [ better\u00a0source\u00a0needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_31", "text": "In 2012, scientists from the University of Pennsylvania School of Medicine published their own findings regarding hair cloning. [ 5 ]  During their investigation, they found that non-bald and bald scalps have the same number of stem cells, but the  progenitor cell  number was significantly depleted in the case of the latter. Based on this, they concluded that it is not the absence of the stem cells that are responsible for hair loss but the unsuccessful activation of said cells. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_32", "text": "In 2015, initial trials for human hair were successful in generating new follicles, [ 7 ]  but the hairs grew in varying directions."}
{"_id": "WikiPedia_Dermatology$$$corpus_33", "text": "In 2016, scientists in Japan announced they had successfully grown human skin in a lab. [ 8 ]  The skin was created using  induced pluripotent stem cells , and when implanted in a mouse, the skin grew hairs successfully. The group has formed partnerships with Organ Technologies and  Kyocera Corporation  to commercially develop the research. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_34", "text": "dNovo Bio, a  Silicon Valley \u2013based company, was founded in 2018 and has demonstrated growing a patch of human hair on a mouse. [ 10 ] [ better\u00a0source\u00a0needed ]  In July 2019, a researcher from San Diego\u2013based Stemson Therapeutics, partnered with  UCSD , successfully grew his own follicles on a mouse using  iPSC -derived  epithelial  and dermal cell therapy. The hair was aligned properly with a 3D-printed biodegradable shaft. The hairs were permanent and regenerated naturally. [ 11 ]  Stemson intends to enter clinical trials in 2026. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_35", "text": "In October 2022, researchers from the Japan-based Yokohama National University successfully cloned fully-grown mouse hair follicles for the first time in history. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_36", "text": "The  Hamilton\u2013Norwood scale  is used to  classify  the stages of  male pattern baldness . It is one of the widely accepted and reproducible classification system for the male pattern hair loss (androgenetic alopecia). The stages are described with a number from 1 to 7 with a type A variant for the cases with anterior involvement. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_37", "text": "Androgenetic alopecia follows a defined pattern of hair loss, beginning with bitemporal recession of the frontal hairline. Eventually, diffuse thinning over the vertex (top) of the scalp occurs. With progression, complete hair loss in this region is common. The bald patch progressively enlarges and eventually joins the receding frontal hairline."}
{"_id": "WikiPedia_Dermatology$$$corpus_38", "text": "This  measurement  scale was first introduced by James Hamilton in the 1950s and later revised and updated by O'Tar Norwood in the 1970s. [ 2 ]  It is sometimes referred to as the  Norwood\u2013Hamilton scale  or simply the  Norwood scale ."}
{"_id": "WikiPedia_Dermatology$$$corpus_39", "text": "The scale is regularly used by doctors to assess the severity of baldness, but it is not considered very reliable since examiners' conclusions can vary. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_40", "text": "Dermatologists might use the Norwood Scale on patients to assess male pattern baldness. It is especially used to check if hair loss treatments are helping patients regaining hair."}
{"_id": "WikiPedia_Dermatology$$$corpus_41", "text": "This  dermatology  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_42", "text": "The  International Journal of Trichology  is a biannual  peer-reviewed   open access   medical journal  published by  Medknow Publications  on behalf of the  Hair Research Society of India . The journal publishes articles on the subject of  trichology  including forensic trichology. The  editor-in-chief  is Patrick Yesudian."}
{"_id": "WikiPedia_Dermatology$$$corpus_43", "text": "The journal is abstracted and indexed in  Scopus ,  EBSCO databases , and  Expanded Academic ASAP ."}
{"_id": "WikiPedia_Dermatology$$$corpus_44", "text": "This article about a  medical journal  is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_45", "text": "See tips for writing articles about academic journals . Further suggestions might be found on the article's  talk page ."}
{"_id": "WikiPedia_Dermatology$$$corpus_46", "text": "The  Ludwig scale  is a method of classifying  female pattern baldness  (androgenic alopecia), and ranges from stages I to III. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_47", "text": "Stage I begins with thinning on the top of the head. In stage II the scalp starts to show. All of the hair at the crown of the head may be lost when the hair loss progresses to stage III. However, the scale is used merely for general categorization. Many women do not actually fit into the Ludwig stages."}
{"_id": "WikiPedia_Dermatology$$$corpus_48", "text": "Blepharoplasty  ( Greek :  blepharon , \"eyelid\" +  plassein  \"to form\") is the  plastic surgery  operation for correcting defects, deformities, and disfigurations of the  eyelids ; and for aesthetically modifying the eye region of the face. With the excision and the removal, or the repositioning (or both) of excess tissues, such as  skin  and  adipocyte fat , and the reinforcement of the corresponding  muscle  and  tendon  tissues, the blepharoplasty procedure resolves functional and cosmetic problems of the  periorbita , which is the area from the eyebrow to the upper portion of the cheek. The procedure is more common among women, who accounted for approximately 85% of blepharoplasty procedures in 2014 in the US and 88% of such procedures in the UK. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_49", "text": "The operative goals of a blepharoplastic procedure are the restoration of the correct functioning to the affected eyelid(s) and the restoration of the aesthetics of the eye-region of the face, which are achieved by eliminating excess skin from the eyelid(s), smoothing the underlying eye muscles, tightening the supporting structures, and resecting and re-draping the excess fat of the retroseptal area of the eye, in order to produce a smooth anatomic transition from the lower eyelid to the cheek."}
{"_id": "WikiPedia_Dermatology$$$corpus_50", "text": "In an eye surgery procedure, the usual correction or modification (or both) is of the upper and the lower eyelids, and of the surrounding tissues of the eyebrows, the upper nasal-bridge area, and the upper portions of the cheeks, which are achieved by modifying the  periosteal coverings  of the facial bones that form the  orbit  (eye socket). The periosteum comprises two-layer connective tissues that cover the bones of the human body:"}
{"_id": "WikiPedia_Dermatology$$$corpus_51", "text": "The  East Asian blepharoplasty  procedure differs from the classic blepharoplasty. In younger patients, the goal of the surgery is to create a supratarsal fold (\"double eyelid surgery\") whereas in older patients the goals are to create or elevate the supratarsal fold and to resect surplus eyelid skin (\"Asian blepharoplasty\"). [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_52", "text": "The thorough pre-operative  medical  and surgical histories, and the physical examination of the patient's  periorbital area  (eyebrow-to-cheek-to-nose), determine if the patient can safely undergo a blepharoplasty procedure to feasibly resolve (correct or modify, or both) the functional and aesthetic indications presented by the patient. Sequentially, lower eyelid blepharoplasty can successfully address the anatomic matters of excess eyelid skin, slackness of the eye-muscles and of the  orbital septum  (palpebral ligament), excess orbital fat, malposition of the lower eyelid, and prominence of the nasojugal groove, where the orbit (eye socket) meets the slope of the nose. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_53", "text": "Concerning the upper eyelid, a blepharoplasty procedure can resolve the loss of  peripheral vision , caused by the slackness of the upper-eyelid skin draping over the eyelashes; the outer and the upper portions of the field of vision of the patient are affected and cause him or her difficulty in performing mundane activities such as driving an automobile and reading a book. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_54", "text": "In many East Asian countries, double eyelid surgery is the most popular surgery, especially in South Korea. Depending on the methods, directing doctors' experience, and the difficulty of the individual case, this surgery can cost between about  US$ 2,000 to $4,000. The procedure is famous for producing double-eyelid for patients for the long-term. [ citation needed ]  This kind of operation normally takes about 30 minutes to an hour, and patients are not required to stay hospitalized afterward. Stitches are removed 5 to 7 days after surgery. Many foreigners go to South Korea each year for blepharoplasty. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_55", "text": "A blepharoplasty procedure usually is performed through external surgical incisions made along the natural skin lines (creases) of the upper and the lower eyelids, which then hide the surgical  scars  from view, especially when affected by the skin creases below the  eyelashes  of the lower eyelid. The incisions can also be made from the  conjunctiva , the interior surface of the lower eyelid, as in the case of a transconjunctival blepharoplasty. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_56", "text": "Transconjunctival lower blepharoplasty technique was pioneered by Clinical Professor of Surgery at the University of Chicago Medicine, [ 10 ]  Dr. Anthony J. Geroulis [ 11 ]  and introduced to medical trial in 1998. Transconjunctival Technique has become the norm in the plastic surgery field with most surgeons preferring it over the external surgical incisions. This technique is particularly useful for patients with darker skin tones where standard external incision often leaves a visible white scar."}
{"_id": "WikiPedia_Dermatology$$$corpus_57", "text": "Transconjunctival blepharoplasty technique permits the excision (cutting and removal) of the lower-eyelid  adipose tissue  without leaving a visible scar, but the technique does not allow the removal of excess eyelid-skin. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_58", "text": "A blepharoplasty operation usually requires 1\u20133 hours to complete. Post-operatively, swelling and bruising is expected and will usually resolve without further intervention; application of cold compresses can help to reduce the duration and discomfort. [ 12 ]  There are no standardized outcome measures for upper or lower blepharoplasty. [ 12 ]  Blepharoplasty is generally a relatively safe surgery, but possible complications include hematoma/ecchymosis, lagophthalmos (incomplete or abnormal closure of the eyelids), ptosis (drooping of the upper eyelid), scarring, dry eyes, orbital hematoma/compartment syndrome, lymphedema, and ocular motility disorders. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_59", "text": "After the procedure, a type of stitch known as a canthopexy is placed near the outer corner of the lower eyelid, which is inside the tissue. This allows the eyelid's position to remain fixed during the healing process. The canthopexy is dissolved after four to six weeks of use. For particular patients, a mid-face elevation may be required to rejuvenate the lower eyelid-cheek complex. [ 14 ] [ unreliable source? ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_60", "text": "The anatomic condition of the eyelids, the \"wear-and-tear\" quality of the patient's skin, age, and the general condition of the adjacent tissues affect the functional and aesthetic results achieved. Additional to the anatomic conditions of the eye region of the patient, the possible occurrence of  medical complications  is determined by factors including: [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_61", "text": "As techniques began developing the ancient Greeks and Romans began writing down and collecting everything they knew involving these procedures.  Aulus Cornelius Celsus , a first-century Roman, described making an excision in the skin to relax the eyelids in his book  De Medicina . [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_62", "text": "Karl Ferdinand von Gr\u00e4fe  coined the phrase blepharoplasty in 1818 when the technique was used for repairing deformities caused by cancer in the eyelids. [ 16 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_63", "text": "Laser blepharoplasty is the performance of eyelid  surgery using a laser  instead of a scalpel. Laser blepharoplasty is often combined with laser eyelid rejuvenation, as the two procedures can be performed in conjunction."}
{"_id": "WikiPedia_Dermatology$$$corpus_64", "text": "A  CO 2  laser  blepharoplasty offers many benefits over a blepharoplasty performed using a scalpel. Some of these benefits include less bleeding, shortened surgical time, better intraoperative visibility, less bruising and swelling, less pain or discomfort, and smoother healing. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_65", "text": "Historically there has been some contention as to the categorization of laser treatment on upper or lower eyelids as blepharoplasty, which is itself by definition surgical. The statutory definition of surgery and that supported by the American College of Surgeons states that surgery is the \"treatment ... by any instrument causing localized alteration or transportation of live human tissue, which include lasers...\". [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_66", "text": "Comedo extraction  is a widely used method of treatment for  acne vulgaris . [ 1 ]  A  dermatologist  or cosmetologist may extract  blackheads  (open comedones) using gentle pressure around the pore opening, and  whiteheads  (closed comedones) by incision with a large needle or a blade. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_67", "text": "If performed skillfully, this treatment may be beneficial to the patient. [ 2 ]  Possible negative effects of the procedure include incomplete extraction, refilling, scarring and tissue damage. [ 2 ]  There are few articles describing the use of comedo extraction in peer-reviewed dermatology journals. [ 1 ] [ needs update ]  In one 1964 study of extraction of non-inflamed whiteheads on patients' foreheads (the only study of the procedure cited in a 2007  literature review ), the procedure reduced the number of future inflamed lesions and the recurrence rate of comedones, but worsened patients' inflamed cystic lesions. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_68", "text": "Complete circumferential peripheral and deep margin assessment  ( CCPDMA ) is the preferred method for the removal of certain  cancers , especially  skin cancers . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_69", "text": "There are two forms of CCPDMA surgery:  Mohs surgery  and surgical excision coupled with margin assessment. Other examples of CCPDMA are found in classical  pathology  textbooks as techniques of cutting surgical specimens to allow the examination of the inferior and lateral margins of typically elliptical surgical specimens."}
{"_id": "WikiPedia_Dermatology$$$corpus_70", "text": "CCPDMA is superior to standard  bread loafing  due to very low  false negative  error rate.  Bread loafing extrapolates the margin exam of a few representative slides to the entire  surgical margin . CCPDMA allows for the complete examination of the surgical margin without statistical extrapolation and assumptions. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_71", "text": "The first advantage of CCPDMA method is that it allows for the complete examination of the entire surgical margin of the specimen.  The second advantage of CCPDMA is allowing the  surgeon  to remove only a very small surgical margin.  As the CCPDMA surgery is frequently performed using  frozen section  pathology, immediate reporting of positive surgical margin is made, and the tumor can be completely removed in the same day. Traditional pathology processing is called \"bread loafing\", and only allows for the partial examination of the surgical margin.  Some surgeons send the specimen out for processing, and the result of the surgical margin assessment may not be made until days later. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_72", "text": "CCPDMA is subject to the basic principles of histology sectioning. From a physical standpoint, the true margin is never assessed because a thin face margin has to be cut through in order to make the slide for examination.  Therefore, a true and complete assessment of all margins is never achieved. Serial sectioning allows CCPDMA approaches near-complete evaluation of the surgical margin and may be performed by pathologists, dermatologists, and surgeons. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_73", "text": "Dermabrasion  is a type of surgical skin planing, generally with the goal of removing  acne , scarring and other skin or tissue irregularities, typically performed in a professional medical setting by a  dermatologist  or  plastic surgeon  trained specifically in this procedure. Dermabrasion has been practiced for many years (before the advent of lasers) and involves the controlled deeper  abrasion  (wearing away) of the upper to mid layers of the  skin  with any variety of strong abrasive devices including a wire brush, diamond wheel or fraise, sterilized sandpaper, salt crystals or other mechanical means."}
{"_id": "WikiPedia_Dermatology$$$corpus_74", "text": "Dermabrasion procedures are surgical, invasive procedures that typically require a  local anaesthetic . Often, they are performed in surgical suites or in professional medical centers. Since the procedure can typically remove the top to deeper layers of the epidermis and extend into the  reticular dermis , there is always minor skin bleeding. The procedure carries risks of scarring, skin discoloration, infections and facial herpes virus ( cold sore ) reactivation. In aggressive dermabrasion cases, there is often tremendous skin bleeding and spray during the procedure that has to be controlled with pressure. Afterward, the skin is normally very red and raw-looking. Depending on the level of skin removal with dermabrasion, it takes an average of 7\u201330 days for the skin to fully heal ( re-epithelialize ). Often, the procedure is performed for deeper acne scarring and deep surgical scars. Dermabrasion is currently rarely practiced and there are very few doctors who are trained and still perform this surgery. Dermabrasion has largely been replaced by technologies including lasers,  CO 2  or  Erbium:YAG   laser . Laser technologies carry the advantage of little to no bleeding and are often less operator dependent than dermabrasion."}
{"_id": "WikiPedia_Dermatology$$$corpus_75", "text": "The purpose of surgical dermabrasion is to help diminish the appearance of deeper scars and skin imperfections. Often, the goal is to smooth the skin and, in the process, remove small scars (as from acne), uneven skin tone from scars or  birthmarks , sun damage,  tattoos , age spots,  Stretch marks   [ citation needed ]  or fine  wrinkles . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_76", "text": "Dermabrasion is a mechanical surgical skin planing method which has remained popular partially because it may afford an overall lower cost and may provide similar or superior results as newer laser methods for certain skin conditions. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_77", "text": "Microdermabrasion is a light cosmetic procedure that uses a mechanical medium for  exfoliation  to remove the outermost layer of dead  skin cells  from the  epidermis . Most commonly, microdermabrasion uses two parts: an exfoliating material such as crystals or diamond flakes, and a machine-based suction to gently lift up the skin during exfoliation. It is a non-invasive procedure and may be performed in-office by a trained  skin care  professional. [ 3 ]  It may also be performed at home using a variety of products which are designed to mechanically exfoliate the skin. Many salon machines and home-use machines use adjustable  suction  to improve the efficacy of the abrasion tool."}
{"_id": "WikiPedia_Dermatology$$$corpus_78", "text": "Microdermabrasion is considered a relatively simple, easy, painless and non-invasive skin rejuvenation procedure. Typically there are no needles or anesthetics required for microdermabrasion. The vacuum pressure and speed are adjusted depending on the sensitivity and tolerance of the skin. [ citation needed ]  Microdermabrasion is often compared to the feeling of a cat licking the skin - a rough but gentle texture.  Typical microdermabrasion sessions can last anywhere from 5 to 60 minutes. Minimal to no recovery time is required after microdermabrasion and most people immediately return to daily activity after a session. Makeup and non-irritating creams can usually be applied within a few hours or right after microdermabrasion. Since there is an often immediate increased minor skin sensitivity after microdermabrasion, irritating products such as  glycolic acids ,  Alpha Hydroxy Acids ,  Retinoid  products or fragranced creams and lotions are typically avoided right after the procedure. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_79", "text": "Traditionally, a \"crystal\" microdermabrasion system includes a pump, a connecting tube, a hand piece, and a vacuum. While the pump creates a high-pressure stream of inert crystals (aluminum oxide, magnesium oxide, sodium chloride, or sodium bicarbonate) to abrade the skin, the vacuum removes the crystals and exfoliated skin cells. Alternatively, the inert crystals can be replaced by a roughened surface of the tip in the diamond microdermabrasion system. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_80", "text": "Unlike the older crystal microdermabrasion system, the diamond microdermabrasion does not produce particles from crystals that may be inhaled into patients' nose or blown into the eyes. Hence, diamond microdermabrasion is regarded as having higher safety for use on areas around the eyes and lips. Generally, the slower the movement of the microdermabrasion handpiece against the skin and the greater the numbers of passes over the skin, the deeper the skin treatment. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_81", "text": "One of the safest methods of microdermabrasion involves the use of corundum or aluminum oxide crystals suspended in an antioxidant cream.   This version of microdermabrasion is generally the most cost efficient as it involves the use of a small handheld skincare tool instead of expensive equipment used by a salon.  This method of microdermabrasion rose to popularity in the early 2000s and is widely available today."}
{"_id": "WikiPedia_Dermatology$$$corpus_82", "text": "Often called \"microderm\" for short, microdermabrasion is a procedure to help exfoliate or temporarily remove a few of the top layers of the skin called the stratum corneum. Much like brushing one's teeth, microdermabrasion helps to gently remove skin \"plaque\" and skin debris. [ citation needed ]  Since human skin typically regenerates at approximately 30-day intervals, skin improvement with microdermabrasion is temporary and needs to be repeated at average intervals of two - four weeks for continued improvement.  Multiple treatments in combination with sunscreen, sun avoidance and skin care creams yield best results."}
{"_id": "WikiPedia_Dermatology$$$corpus_83", "text": "Dermabrasion is generally used to refer to a true surgical procedure that aggressively abrades away the top to mid layers of the skin. The term microdermabrasion generally refers to a non-surgical procedure that abrades less deeply than dermabrasion. Although the mechanism of the two procedures is similar, the difference in the depth of the abrasion results in different recovery times. Dermabrasion recovery time may take as much as several weeks to several months whereas microdermabrasion recovery time may be as little as one to two days. [ 5 ]  After microdermabrasion, skin will be much more sensitive to sun exposure. It is best to keep out of the sun and wear sunscreen at all times after the procedure. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_84", "text": "Microdermabrasion may be performed to help diminish the appearance of superficial  hyperpigmentation  or  photo-damage  (sunburn), as well as diminish fine lines, wrinkles, acne and shallow acne scars. A further benefit of microdermabrasion is enhanced skin penetration by skin creams and serums. Removing dead skin (stratum corneum of the epidermis) will aid in the penetration of skin care products and medications by up to 10-50%. The controlled skin exfoliation afforded by microdermabrasion will allow make-up and self-tanning products to go on much more smoothly. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_85", "text": "Microdermabrasion treatment carries minimal to very few possible side effects or complications. However, some patients may experience temporary mild dryness, sun sensitivity and rarely temporary bruising or scratches in the area of skin treated. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_86", "text": "The first microdermabrasion unit was developed in  Italy  in 1985, using small inert  aluminium oxide  crystals to abrade the skin. In 1986, other European markets had introduced the technology which was immediately adopted by physicians for mechanical exfoliation. There were 10 microdermabrasion units on the market in Europe by the end of 1992. In 1996,  Mattioli Engineering  partnered with one of the Italian designed machines and started working towards meeting FDA requirements for the USA. By the end of 1996, the  Food and Drug Administration | (FDA) issued the first approval letter for microdermabrasion machines. In January 1997, the first microderm machine was being sold and marketed in the US. The diamond tip was introduced in 1999 and the bristle tip brush was introduced in 2005. [ 7 ]  The first standard vacuum based microdermabrasion system called Vacubrasion was introduced in 2012 in the US and world markets, and provides diamond tip exfoliation and suction. Vacubrasion's patented air regulator delivery system was designed and underwent extensive testing by US dermatologists and physicians. Its straightforward design revolutionized microdermabrasion to permit use of almost any type of suction source (primarily retail brand vacuums with a 1.25\u00a0in (31.8\u00a0mm) standard round hose such as Eureka, Stanley vacuums) with a non-disposable, attached electroplated fine diamond abrasive tip. While traditional, older crystal based microdermabrasion and home microdermabrasion systems are sometimes fraught with clogging issues and potential loss of suction, the crystal-free Vacubrasion systems utilize a universal, larger and more powerful suction source that avoids many of these issues. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_87", "text": "Microdermabrasion has evolved from  rocks , stones and  shells  to  crystals , particle-free diamond tips and particle-free bristle tips. Once the desired amount of exfoliation has been reached, some microdermabrasion units will then spray or infuse a skin enhancing solution into the skin. Since microderm essentially manually removes limited layers of the stratum corneum (dead layers of the outer layer of the skin), any serum or topical product applied in any fashion to the skin following microdermabrasion will potentially have a greater opportunity for penetration into the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_88", "text": "Microdermabrasion crystals are typically made of a very fine, abrasive material like  aluminum oxide . Other inert microderm crystals include magnesium oxide, sodium chloride, and sodium bicarbonate. All ultra-fine white crystals are disposable and should be discarded after each use. The microdermabrasion vacuum removes the crystals and exfoliated skin cells. Inhalation of crystals should be avoided and masks are sometimes worn by the operator doing the treatment. Ocular injury may occur if crystals are inadvertently sprayed in the eye or if crystals remain around the eye and cause a corneal abrasion. There are some possible concerns of inhalation exposure and basic safety precautions should be taken. Patient goggles or eye shields, as well as operator face masks are recommended when treating with crystal based systems. Alternatively, microderm crystals can be safely replaced by the roughened surface of a diamond tip microdermabrasion system. The newer diamond based systems like Vacubrasion utilize a fine  diamond dust  that is essentially electroplated onto a stainless steel round tip that comes in contact with the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_89", "text": "A  dermatome  is a  surgical instrument  for producing thin slices of  skin  from a donor area, for use in  skin grafts . One of its main applications is for reconstituting skin areas damaged by third degree  burns  or  trauma ."}
{"_id": "WikiPedia_Dermatology$$$corpus_90", "text": "Dermatomes can be operated either manually or electrically. The first drum dermatomes, developed in the 1930s, were manually operated. Afterwards, dermatomes which were operated by air pressure, such as the Brown dermatome, achieved higher speed and precision. Electrical dermatomes are better for cutting out thinner and longer strips of skin with a more homogeneous thickness."}
{"_id": "WikiPedia_Dermatology$$$corpus_91", "text": "Those are manual dermatomes and the term  knife  or  scalpel  is used to describe them. Their disadvantages are harvesting of grafts with irregular edges and grafts of variable thickness. Their operator has to be experienced in their use for optimal results. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_92", "text": "There are several types of dermatomes, usually named after their inventor."}
{"_id": "WikiPedia_Dermatology$$$corpus_93", "text": "Duct tape occlusion therapy  (DTOT) is a method of treating  warts  by covering them with  duct tape  for prolonged periods."}
{"_id": "WikiPedia_Dermatology$$$corpus_94", "text": "The manner in which duct tape appears to work is unclear. [ 1 ]  The tape might create a  macerating  and  keratolytic  environment, stimulating an  immune response . [ 1 ]  The type of adhesive in the duct tape is likely to be important as leeching of the adhesive into the skin may be causing the immune system response. [ 2 ]   Side effects  can include skin irritation and peeling. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_95", "text": "There is mixed evidence that occlusive treatment with various types of duct tape is effective. [ 1 ]  Clinical trials in 2012 concluded that no  statistically significant  difference between clear duct tape and  placebo  could be determined within the sample. [ 1 ]  On health information websites, duct tape is referred to as a treatment with mixed evidence of efficacy, no good evidence or described as  alternative medicine . [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_96", "text": "Despite the mixed evidence for efficacy, the simplicity of the method and its limited side-effects leads some researchers to be reluctant to dismiss it. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_97", "text": "In 1978, Jerome Z Litt was the first to suggest that adhesive tape could be used to treat warts on the fingers. He claimed: \"My method is safe, easy, simple, painless, inexpensive, and highly effective. It leaves no scarring or deformed nails. The mystery remains: How and why does this method work? I cannot offer any reasonable or logical explanation. It cannot be all 'hypnotic' or 'suggestive.' Could it be that the airtight occlusion and a chemical reaction set up by the adhesive in the tape might combine to release a chemical or ' toxin ' causing the formation of  antibodies ? Whatever it may be, it works. I recommend that you try it.\" [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_98", "text": "A 2002 study involved 51 individuals (aged 3\u201322) treated with either \"standard duct tape\" (not otherwise specified in the study) or cryotherapy. A piece of duct tape was cut as close to the size of the wart as possible, and applied to the area.  The tape was left on for 6 days and replaced with new duct tape if it fell off. After 6 days, the tape was removed, the area soaked in water, and the wart  debrided  with an  emery board  or  pumice stone . The tape was left off overnight and reapplied on the following morning. This process continued for up to 2 months or until the wart was resolved, whichever occurred first. Progress was monitored every 4 weeks. The researchers found the duct tape treatment significantly more effective than the cryotherapy (P=0.05) with 85% in the duct tape treatment group having a complete resolution of their wart, compared to 60% in the cryotherapy group. [ 10 ]  The study was criticized due to lack of a  placebo control group , [ 11 ]  and because a number of outcome assessments were done by phone. [ 12 ]  There was also no reported long term follow up to ensure no recurrence of the warts. [ 11 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_99", "text": "Two later studies failed to repeat the results of the 2002 study. [ 13 ] [ 14 ]  One compared duct tape with  moleskin , finding no statistically significant difference in results reported between the two groups. [ 14 ]  Both studies used 3M clear duct tape, again concluding no statistically significant effect on wart resolution. [ 13 ]  The  statistical power  of the latter trial has been questioned, [ 15 ]  and it has been suggested that duct tape occlusion therapy only works with rubber-based adhesives, whereas these studies utilized acrylic-based adhesive. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_100", "text": "Electrotrichogenesis  ( ETG ) involves the stimulation of  hair follicles  on the  scalp  with the  electric charge  of an  electrostatic field ."}
{"_id": "WikiPedia_Dermatology$$$corpus_101", "text": "Three studies are listed in the  PubMed  database relating to the technique. [ 1 ] [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_102", "text": "Electrotrichogenesis was approved in Europe with the  CE mark , as a medical device.  It was also approved by Health Canada and the Australian health office. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_103", "text": "Redirect to:"}
{"_id": "WikiPedia_Dermatology$$$corpus_104", "text": "Facial rejuvenation  is a cosmetic treatment (or series of cosmetic treatments), which aims to restore a youthful appearance to the human  face . Facial rejuvenation can be achieved through either  surgical  and/or non-surgical options. Procedures can vary in  invasiveness  and depth of treatment. Surgical procedures can restore  facial symmetry  through targeted procedures and facial restructuring and skin alterations. Non-surgical procedures can target specific depths of facial structures and treat localized facial concerns such as  wrinkles , skin laxity,  hyperpigmentation  and  scars ."}
{"_id": "WikiPedia_Dermatology$$$corpus_105", "text": "Surgical (invasive) facial rejuvenation procedures can include a  brow lift  (forehead lift), eye lift ( blepharoplasty ),  facelift  (rhytidectomy), chin lift and  neck lift . Non-surgical (non-invasive) facial rejuvenation treatments can include  chemical peels , neuromodulator (such as  botox ),  dermal fillers ,  laser resurfacing ,  photorejuvenation ,  radiofrequency  and  Ultrasound ."}
{"_id": "WikiPedia_Dermatology$$$corpus_106", "text": "Human  visual perception  is notable for its sensitivity and accuracy in estimating our perceived age by instant  pattern recognition  of facial features. Often, human faces with no measurable difference in  facial geometry  and appearance are perceived as having different ages. This mechanism is not yet entirely understood, but there may be a relation to the subtle changes in facial bone structure related below. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_107", "text": "Facial symmetry  has a direct relationship to perceived beauty. A guiding approach to facial rejuvenation and balancing facial symmetry is through an application of the  golden ratio . [ 2 ]  Artists and architects have been using this ratio to create works that are pleasing to the eye for centuries. [ 3 ]   Aesthetic medicine  and facial rejuvenation techniques has adopted this mathematical approach to facial restoration and enhancement. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_108", "text": "More recent research has pointed out the influence of changes in the facial  skeleton  with age on the appearance of aging, especially in the mid-face area and the lower part of the  orbits  around the  nose . Quantitative study with  CAT scans  of the faces of men and women in several age brackets has revealed that there is an appreciable amount of   bone  tissue loss in these regions with age, leading to changes in angles, lengths and volumes, and also decreasing the distance between the  eyes . [ 4 ]  It has been hypothesized that skin sagging and wrinkles may occur not only because of loss of soft tissue and fat, but also because bone retraction creates an excess of skin which is no longer flexible. Many of the facial manifestations of aging reflect the combined effects of gravity, progressive  bone resorption , decreased tissue elasticity, and redistribution of subcutaneous fullness. [ 5 ]  Future facial rejuvenation techniques may take into account these findings and restore bone lost by aging processes. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_109", "text": "According to the  American Society of Plastic Surgeons , more than 133,000 facelifts and nearly 216,000 eyelid surgeries were performed in the US in 2013, a six per cent increase from 2012. Facial rejuvenation procedures experienced the most growth, as 2013 marked the highest number of botulinum toxin type A injections to date, with 6.3 million injections. [ 7 ]  A significant upward trend on the number of facial rejuvenation procedures is predicted, [ 5 ]  and could be due to the following factors:"}
{"_id": "WikiPedia_Dermatology$$$corpus_110", "text": "However, while surgical procedures are still preferred to achieve a more dramatic improvement, the current trend is towards less invasive procedures, such as injectables (Botox, fillers) and laser skin treatments. While these treatments achieve temporary results, they tend to be preferred because of their reduced cost and less intensive recovery period. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_111", "text": "Facial rejuvenation procedures can include (but are not limited to):"}
{"_id": "WikiPedia_Dermatology$$$corpus_112", "text": "Grenz rays  are part of the electromagnetic spectrum comprising low energy (ultrasoft)  X-rays . These were first investigated by  Gustav Bucky  in 1923 using a cathode vacuum tube with a lithium borate glass window, which he labeled Grenz rays as he believed that the biological effects resembled those of UV light and traditional X-rays and hence were on the border between the two ( Grenz  = border in German). These rays are also known as  Bucky rays . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_113", "text": "Grenz rays are produced by specially calibrated X-ray machines generally operating in the 10 to 30\u00a0kV range to produce X-rays with HVL less than 0.035\u00a0mm in aluminum. [ 2 ]  (HVL is  half-value layer , and refers to a thickness of a given material that will cut the X-ray flux by 50%). Grenz rays are absorbed by air and therefore treatments must be given at fixed distances for which the machine has been calibrated.  In human tissue Grenz rays have a half-value depth of 0.5\u00a0mm and are essentially absorbed within the first 2\u00a0mm of skin. [ 3 ]   The exact mechanism of action is unknown but it does have effects on the  Langerhans cells  in the epidermis. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_114", "text": "Grenz rays are indicated for treatment of  eczema ,  psoriasis , palmoplantar pustulosis, neurodermatitis,  pruritus ani  and  pruritus vulvae . They have been reported to be helpful for lichen planus, Grover's disease, Darier's disease,  Hailey\u2013Hailey disease [ 6 ]  and histiocytosis X. [ 2 ]  Grenz rays have also been used for treatment of  actinic keratosis  and  Bowen's disease . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_115", "text": "Hydradermabrasion  is a  dermatological  procedure which combines simultaneous dermal infusion of medicinal products and crystal-free  exfoliation . Hydradermabrasion's mechanism of actions includes: (a) mechanical stimulation activates the basal layer, and (b) thickening and smoothing the  epidermis .  Fibroblast  activity results in  extracellular matrix  deposition and dermal thickening.  Antioxidants  introduced through the procedure hydrate and decrease  inflammation  in the skin, reversing photo damage, while protecting lipid membranes, collagen fibers, and enzyme systems. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_116", "text": "It is considered to be a relatively new procedure which combines microdermabrasion with the pneumatic application of antioxidant-based serums. [ 2 ]  The addition of  polyphenolic  antioxidants through hydradermabrasion to a  phototherapy  regimen enhanced the clinical, biochemical, and histological changes seen following phototherapy alone. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_117", "text": "\"Hydradermabrasion has the same indications for use as  microdermabrasion , making it an excellent choice for persons with darker skin tones, aging skin, sensitive skin areas, oily, and dry skin complexions\". [ 4 ]  A study on the efficacy of hydradermabrasion for facial rejuvenation was conducted comparing volunteers who received hydradermabrasion facial treatments using an antioxidant serum or who just received the same antioxidant serum manually applied to the skin. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_118", "text": "Skin treated with Hydradermabrasion demonstrated \"significantly increased epidermal and papillary dermal thickness, and increased fibroblast density (p<0.01)\u201d. [ 5 ]  A study on the efficacy of hydradermabrasion for facial rejuvenation was conducted comparing volunteers who received hydradermabrasion facial treatments using an antioxidant serum or who just received the same antioxidant serum manually applied to the skin. Six treatments were conducted on a 7- to 10-day interval to determine whether antioxidant levels could be increased in the skin and skin quality improved with this technique. Results of this study demonstrated that hydradermabraded skin possessed increased epidermal and papillary dermal thickness as well as greater antioxidant levels. Further histological examination saw a replacement of elastic dermal tissue, collagen hyalinization, and fibroblast density correlating with a decrease in the appearance of fine lines, pore size, and hyperpigmentation in hydradermabrasion treated areas 6 weeks post-treatment with no patient complications. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_119", "text": "Instruments used specially in  dermatology  are as follows:"}
{"_id": "WikiPedia_Dermatology$$$corpus_120", "text": "This article related to  medical equipment  is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_121", "text": "Lupus band test  is done upon  skin biopsy , with  direct immunofluorescence  staining, in which, if positive,  IgG  and  complement  depositions are found at the  dermoepidermal junction . [ 1 ] :\u200a212\u200a   This test can be helpful in distinguishing  systemic lupus erythematosus  (SLE) from cutaneous lupus, because in SLE the lupus band test will be positive in both involved and uninvolved skin, whereas with cutaneous lupus only the involved skin will be positive. [ 1 ] :\u200a212"}
{"_id": "WikiPedia_Dermatology$$$corpus_122", "text": "The minimum criteria for positivity are: [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_123", "text": "The presence of other immunoglobulins (especially  IgA ) and/or complement proteins (especially  C4 ) increases the  specificity  of a positive test. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_124", "text": "The  management of hair loss , includes prevention and treatment of  alopecia ,  baldness , and  hair thinning , and regrowth of hair."}
{"_id": "WikiPedia_Dermatology$$$corpus_125", "text": "Scratching of itchy scalp may contribute to hair loss. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_126", "text": "Prevention of  obesity  helps. Obesity is linked to  hair thinning . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_127", "text": "Oils with fatty acids that has been studied to prevent dermatitis includes: [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_128", "text": "The scalp must be cleaned from  sebum , sweat, and dirt, prior to topical application, for agents to penetrate it."}
{"_id": "WikiPedia_Dermatology$$$corpus_129", "text": "A 2020  systemic review  on agents used to treat androgenic alopecia found that: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_130", "text": "A  humidifier  can be used to prevent low indoor humidity during  winter  (especially with indoor heating), and  dry season . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_131", "text": "Commonly, patients with  seborrhoeic dermatitis  experience mild redness, scaly skin lesions and in some cases  hair loss . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_132", "text": "Low humidity can cause adverse health effects and may cause  atopic dermatitis , [ 8 ]  and  seborrhoeic dermatitis . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_133", "text": "Combinations of finasteride, minoxidil and ketoconazole are more effective than individual use. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_134", "text": "Combination therapy of LLLT or microneedling with finasteride [ 11 ]  or minoxidil demonstrated substantive increases in hair count. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_135", "text": "The topical  bioavailability  of synthetic medicines such as  antiandrogens , as well as phytochemicals such as  quercetin , has been improved with incorporation of drugs in  nanoparticles , or  microneedling . [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_136", "text": "Treatments for the various forms of hair loss have only moderate success. [ 14 ]  Three medications have evidence to support their use in male pattern hair loss:  finasteride ,  dutasteride  and  minoxidil . [ 15 ]  They typically work better to prevent further hair loss than to regrow lost hair. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_137", "text": "They may be used together when hair loss is progressive or further regrowth is desired after 12 months. [ 16 ]  Other medications include  ketoconazole , and in female androgenic alopecia  spironolactone  and  flutamide . [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_138", "text": "In June 2022, the FDA authorized  baricitinib  for the treatment of severe alopecia areata. [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_139", "text": "Minoxidil , applied topically, is widely used for the treatment of hair loss. It may be effective in helping promote hair growth in both men and women with  androgenic alopecia . [ 20 ] [ 21 ]  About 40% of men experience hair regrowth after 3\u20136 months. [ 22 ]  It is the only topical product that is FDA approved in America for androgenic hair loss. [ 20 ]  However, increased hair loss has been reported. [ 23 ] [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_140", "text": "Finasteride  is used to treat  male pattern hair loss . [ 25 ]  Treatment provides about 30% improvement in hair loss after six months of treatment, and effectiveness only persists as long as the drug is taken. [ 20 ]  There is no good evidence for its use in women. [ 14 ]  It may cause  gynecomastia ,  erectile dysfunction  and  depression . [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_141", "text": "Dutasteride  is also used in the treatment of male pattern hair loss and appears to have better effectiveness than finasteride for the condition. [ 27 ] [ 28 ] [ 29 ]  While used off-label for male pattern hair loss in most of the world, dutasteride is specifically approved for this indication in  South Korea  and  Japan . [ 30 ] [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_142", "text": "There is tentative support for  spironolactone  in women. [ 14 ]  Due to its feminising side effects and risk of infertility it is not often used by men. [ 32 ] [ 33 ]  It can also cause  low blood pressure ,  high blood potassium , and  abnormal heart rhythms . Also, women who are pregnant or trying to become pregnant generally cannot use the medication as it is a  teratogen , and can cause ambiguous genitalia in newborn children. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_143", "text": "There is tentative evidence for  flutamide  in women; however, it is associated with relatively high rates of liver problems and strong recommendations have been made against its use. [ 14 ] [ 35 ]  Like spironolactone, flutamide is typically only used by women. [ 36 ]   Bicalutamide  is another option for the treatment of female pattern hair loss. [ 37 ] [ 38 ] [ 39 ]  It has a far lower risk of liver toxicity than flutamide and is said to have an excellent safety profile. [ 38 ] [ 39 ] [ 40 ]  However, bicalutamide retains a small risk of liver toxicity and for this reason periodic liver monitoring is recommended during treatment. [ 38 ] [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_144", "text": "Ketoconazole  may help in women. [ 41 ] [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_145", "text": "Low-level laser therapy  or photobiomodulation is also referred to as red light therapy and cold laser therapy. It is a non-invasive treatment option."}
{"_id": "WikiPedia_Dermatology$$$corpus_146", "text": "LLLT is shown to increase hair density and growth in both genders. The types of devices (hat, comb, helmet) and duration did not alter the effectiveness, [ 43 ]  with more emphasis to be placed on lasers compared to LEDs. [ 44 ]  Ultraviolet and infrared light are more effective for alopecia areata, while red light and infrared light is more effective for androgenetic alopecia. [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_147", "text": "Medical reviews suggest that LLLT is as effective or potentially more than other non invasive and traditional therapies like minoxidil and finasteride but further studies such as RCTs, long term follow up studies, and larger double blinded trials need to be conducted to confirm the initial findings. [ 46 ] [ 11 ] [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_148", "text": "Using ones own cells and tissues and without harsh side effects, PRP is beneficial for alopecia areata [ 48 ]  and androgenetic alopecia and can be used as an alternative to minoxidil or finasteride. [ 49 ]  It has been documented to improve hair density and thickness in both genders. [ 50 ]  A minimum of 3 treatments, once a month for 3 months are recommended, and afterwards a 3-6 month period of continual appointments for maintenance. [ 51 ]  Factors that determine efficacy include amount of sessions, double versus single centrifugation, age and gender, and where the PRP is inserted. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_149", "text": "Future larger randomized controlled trials and other high quality studies are still recommended to be carried out and published for a stronger consensus. [ 46 ] [ 50 ] [ 53 ]  Further development of a standardized practice for procedure is also recommended. [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_150", "text": "Hair transplantation is a  surgical  technique that moves individual  hair follicles  from a part of the body called the donor site to bald or balding part of the body known as the recipient site. It is primarily used to treat male pattern baldness. In this condition, grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. It is also used to restore  eyelashes ,  eyebrows , beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from  skin grafting  in that grafts contain almost all of the  epidermis  and  dermis  surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_151", "text": "Since hair naturally grows in follicles in groups of 1 to 4 hairs,  transplantation  takes advantage of these naturally occurring follicular units. This achieves a more natural appearance by matching hair for hair through  Follicular unit transplantation  (FUT)."}
{"_id": "WikiPedia_Dermatology$$$corpus_152", "text": "Donor hair can be harvested in two different ways. Small grafts of naturally-occurring units of one to four hairs, called  follicular units , can be moved to balding areas of the  hair restoration . These follicular units are surgically implanted in the scalp in very close proximity to one another and in large numbers. The grafts are obtained in one or both of the two primary methods of surgical extraction, follicular unit transplantation, colloquially referred to as \"strip harvesting\", or  Follicular Unit Extraction  (FUE), in which follicles are transplanted individually."}
{"_id": "WikiPedia_Dermatology$$$corpus_153", "text": "In FUT, a strip of skin containing many follicular units is extracted from the patient and dissected under a stereoscopic microscope. The site of the strip removal is stitched closed. Once divided into follicular unit grafts, each unit is individually inserted into small recipient sites made by an incision in the bald scalp. In the newer technique, roots are extracted from the donor area and divided into strips for transplantation. The strip, two to three millimeters thick, is isolated and transplanted to the bald scalp. [ 54 ]  After surgery, a bandage is worn for two days to protect the stitched strip during healing. A small strip scar remains after healing, which can be covered by scalp hair growing over the scar. [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_154", "text": "Scalp reduction is a surgical procedure in which the hairless region of the scalp of a  bald man  is reduced. This procedure can reduce the area of the scalp without hair. [ 56 ] [ 57 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_155", "text": "Bimatoprost  0.03% has been used to grow  eyebrows . [ 58 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_156", "text": "The FP receptor agonist,  bimatoprost , in the form of an 0.03% ophthalmic solution termed  Latisse , is approved by the US  Food and Drug Administration  to treat  hypotrichosis  of the  eyelashes , in particular to darken and lengthen eyelashes for cosmetic purposes. [ 59 ]  Also, bimatoprost may be used to treat small or underdeveloped  eyelashes . [ 60 ] [ 61 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_157", "text": "Some popular plant juices sold as hair serum may instead of growing human hair actually inhibit the growth, including  6-gingerol  found in  ginger . [ 62 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_158", "text": "A small 2002 study demonstrated that treatment twice daily for six weeks with crude onion juice from Australian brown onion, re-growth hair on  alopecia areata  (spot baldness) in 86.9% of the 23 participants. [ 63 ]  Twice as many  flavonols  are found in  red onion  than in  yellow onion . [ 64 ]  Also, non-organic onions might contain pesticides on the peel and in the first scaly leaf. Compounds found in onion that stimulates hair growth:"}
{"_id": "WikiPedia_Dermatology$$$corpus_159", "text": "Dietary supplements are not typically recommended. [ 70 ]  Many people use unproven treatments, [ 15 ]  but there is little evidence of the effectiveness of  vitamins , minerals, or other dietary supplements regrowing hair or retaining hair. [ 14 ]  There is no evidence for  biotin  (vitamin B7). [ 70 ]  While lacking both evidence and expert recommendation, there is a large market for hair growth supplements, especially for products that contain biotin."}
{"_id": "WikiPedia_Dermatology$$$corpus_160", "text": "However, one small trial of  saw palmetto  which shows tentative benefit in those with  mild to moderate androgenetic alopecia. [ 70 ]  There was no good evidence for  gingko ,  aloe vera ,  ginseng ,  bergamot , or  hibiscus  as of 2011. [ 71 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_161", "text": "Radiation induces hair loss through damage to hair follicle stem cell progenitors and alteration of keratin expression. [ 72 ] [ 73 ]  Radiation therapy has been associated with increased  mucin  production in hair follicles. [ 74 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_162", "text": "Studies have suggested electromagnetic radiation as a therapeutic growth stimulant in alopecia. [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_163", "text": "Certain hair shampoos and ointments visually thicken existing hair, without affecting the growth cycle. [ 76 ]  There have also been developments in the fashion industry with  wig  design. The fashion accessory has also been shown to be a source of psychological support for women undergoing chemotherapy, with cancer survivors in one study describing their wig as a \"constant companion\". [ 77 ]  Other studies in women have demonstrated a more mixed psychosocial impact of hairpiece use. [ 78 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_164", "text": "Specialized tattoos, commonly known as scalp micropigmentation, can mimic the appearance of a short buzzed haircut. [ 79 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_165", "text": "Type 1 and 2 5\u03b1 reductase enzymes  are present at  pilosebaceous units  in papillae of individual  hair follicles . They catalyse formation of the androgens testosterone and DHT, which in turn regulate hair growth. Androgens have different effects at different follicles: they stimulate  IGF-1  at facial hair, causing hair regrowth, but stimulate  TGF \u03b21 ,  TGF \u03b22 ,  dickkopf1  and  IL-6  at the scalp, causing hair follicle miniaturisation. [ 80 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_166", "text": "Female androgenic alopecia is characterized by diffuse crown thinning without hairline recession, and like its male counterpart rarely leads to  total hair loss . [ 81 ]   Finasteride  and  minoxidil  are usually first line therapy for its treatment. Other options include topical or systemic  spironolactone  or  flutamide , although they have a high incidence of  feminising   side effects  and are better tolerated in female androgenic hair loss."}
{"_id": "WikiPedia_Dermatology$$$corpus_167", "text": "More advanced cases may be resistant or unresponsive to medical therapy, however, and require  hair transplantation . Naturally-occurring units of one to four hairs, called  follicular units , are excised and moved to areas of hair restoration. These follicular units are surgically implanted in the scalp in close proximity and in large numbers. The grafts are obtained from either  Follicular Unit Transplantation  (FUT)\u00a0\u2013\u00a0colloquially referred to as \"strip harvesting\"\u00a0\u2013 or  Follicular Unit Extraction  (FUE). In the former, a strip of skin with follicular units is extracted and dissected into individual follicular unit grafts. The surgeon then implants the grafts into small incisions, called recipient sites. [ 55 ] [ 82 ]  Specialized scalp tattoos can also mimic the appearance of a short buzzed haircut. [ 83 ]  Androgenic alopecia also occurs in women, and more often presents as diffuse thinning without hairline recession. Like its male counterpart, the condition rarely leads to  total hair loss . Treatment options are similar to those for men, although topical or systemic estrogen is used more often. [ 81 ] [ 84 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_168", "text": "Latanoprost  and  bimatoprost  are specific PGF2a analogues applied topically, and have been found to lengthen eyelashes, [ 85 ] [ 86 ]  darken hair pigmentation [ 87 ]  and elongate hair. [ 17 ]  Bimatoprost is available as treatment for eyelash growth. [ 88 ]  Latanoprost has shown ability to promote scalp hair density and pigmentation, [ 89 ]  and is theorized to function at the  dermal papilla . [ 90 ]  A study found latanoprost ineffective on eyelashes in a patient with  alopecia areata . [ 91 ]  It has also been found ineffective in treatment of eyebrow hair loss. [ 92 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_169", "text": "Estrogens are indirect anti-androgens and can be used to treat androgenetic hair loss in women with  oral contraceptives . Systemic estrogen increases SHBG, which binds androgens, including testosterone and DHT, in turn reducing their bioavailability. Topical formulations are available in  Europe . [ 71 ]  Hair follicles have estrogen receptors and it is theorized that topical compounds act on them directly to promote hair growth and antagonize androgen action. Large clinical studies showing effectiveness are absent. Topical treatment is also usually unavailable in  North America . [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_170", "text": "There is tentative evidence for  cyproterone acetate  in women. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_171", "text": "In December 2012, topical application of  IGF-1  in a liposomal vehicle led to thicker and more rapid hair growth in transgenic mice with androgenic alopecia. The study did not show measurable systemic levels or hematopoietic side effects, suggesting potential for use in humans. [ 93 ]  Low energy radiofrequency irradiation induces IGF-1 in cultured human dermal papilla cells. [ 94 ]  Adenosine stimulates dermal papillae in vitro to induce IGF-1, along with fibroblast growth factors  FGF7 ,  FGF-2  and  VEGF .  \u03b2-catenin  transcription increased, which promotes dermal papillae as well. [ 94 ]  Dietary  isoflavones  increase IGF production in scalp  dermal papillae  in transgenic mice. [ 95 ]  Topical capsaicin also stimulates IGF at hair follicles via release of vanilloid receptor-1, which in turn leads to more CGRP. [ 96 ]  Ascorbic acid has led to increased IGF expression  in vitro . [ 97 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_172", "text": "Although follicles were previously thought gone in areas of complete baldness, they are more likely dormant, as recent studies have shown the scalp contains the  stem cells  from which the follicles arose. [ 98 ]  Research on these follicular stem cells may lead to successes in treating baldness through  hair multiplication  (HM), also known as  hair cloning ."}
{"_id": "WikiPedia_Dermatology$$$corpus_173", "text": "Per a May 2015 review, no successful strategy to generate human\u00a0hair\u00a0follicles, for hair regrowth,  from adult\u00a0stem cells\u00a0has yet been reported. [ 99 ]   However, in April 2016, scientists from Japan published results of their work in which they created human skin from  induced pluripotent stem cells ; implanted into laboratory mice, the cells generated skin with hair and glands. [ 100 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_174", "text": "From 2005 to 2007, Curis and  Procter & Gamble  collaborated on developing a topical  hedgehog   agonist  for hair loss; the agent did not meet safety standards, and the program was terminated. [ 101 ] [ 102 ]  In 2008, researchers at the  University of Bonn  announced they have found the genetic basis of two distinct forms of inherited hair loss. They found the gene  P2RY5  causes a rare, inherited form of hair loss called hypotrichosis simplex. It is the first  receptor  in humans known to play a role in hair growth. [ 103 ] [ 104 ] [ 105 ]  Researchers found that disruption of the  gene   SOX21  in mice caused cyclical hair loss.  Research has suggested SOX21 as a master regulator of hair shaft cuticle differentiation, with its disruption causing cyclical alopecia in mice models. [ 106 ]  Deletion of SOX21 dramatically affects hair lipids. [ 107 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_175", "text": "The  Mantoux test  or  Mendel\u2013Mantoux test  (also known as the  Mantoux screening test ,  tuberculin sensitivity test ,  Pirquet test , or  PPD test  for purified protein derivative) is a tool for  screening  for  tuberculosis (TB)  and for  tuberculosis diagnosis . It is one of the major  tuberculin  skin tests used around the world, largely replacing multiple-puncture tests such as the  tine test . The  Heaf test , a form of tine test, was used until 2005 in the UK, when it was replaced by the Mantoux test. The Mantoux test is endorsed by the  American Thoracic Society  and  Centers for Disease Control and Prevention . It was also used in the  USSR  and is now prevalent in most of the  post-Soviet states , although Soviet mantoux produced many false positives due to children's allergic reaction. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_176", "text": "Tuberculin  is a  glycerol  extract of the tubercle  bacillus .  Purified protein derivative (PPD) tuberculin is a precipitate of species-nonspecific molecules obtained from filtrates of sterilized, concentrated cultures. The tuberculin reaction was first described by  Robert Koch  in 1890. The test was first developed and described by the German physician Felix Mendel in 1908. [ 2 ]  It is named after  Charles Mantoux , a French physician who built on the work of Koch and  Clemens von Pirquet  to create his test in 1907. However, the test was unreliable due to impurities in tuberculin which tended to cause false results. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_177", "text": "Esmond R. Long  and  Florence B. Seibert  identified the active agent in tuberculin as a protein.  Seibert then spent a number of years developing methods for separating and purifying the protein from  Mycobacterium tuberculosis , obtaining purified protein derivative (PPD) and enabling the creation of a reliable test for tuberculosis. [ 3 ]   Her first publication on the purification of tuberculin appeared in 1934. [ 4 ]  By the 1940s, Seibert's PPD was the international standard for tuberculin tests. [ 5 ]  In 1939,  Russian  M.A. Linnikova created a modified version of PPD. In 1954, the Soviet Union started mass production of PPD-L, named after Linnikova. [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_178", "text": "In the Mantoux test, a standard dose of 5 tuberculin units (TU - 0.1\u00a0ml), according to the  CDC , [ 8 ]  or 2 TU of Statens Serum Institute (SSI) tuberculin RT23 in 0.1\u00a0ml solution, according to the  National Health Service , [ 9 ]  is injected intradermally (between the layers of dermis) on the flexor surface of the left forearm, mid-way between elbow and wrist. The injection should be made with a tuberculin syringe, with the needle bevel facing upward. When placed correctly, injection should produce a pale wheal of the skin, 6 to 10\u00a0mm in diameter. The result of the test is read after 48\u201396 hours, ideally after 72 hours/3rd day. This procedure is termed the 'Mantoux technique'. A person who has been exposed to the bacteria would be expected to mount an immune response in the area of skin containing the bacterial proteins. This response is a classic example of 'delayed-type hypersensitivity reaction' ( DTH ), a  type IV  of  hypersensitivities .  T cells  and myeloid cells are attracted to the site of reaction in 1\u20133 days and generate local  inflammation . The reaction is read by measuring the diameter of  induration  (palpable raised, hardened area) across the forearm (perpendicular to the long axis) in millimeters. If there is no induration, the result should be recorded as \"0\u00a0mm\".   Erythema  (redness) should not be measured. [ 10 ]  In the Pirquet version of the test  tuberculin is applied to the skin via  scarification . [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_179", "text": "The results of this test must be interpreted carefully.  The person's medical risk factors determine at which increment (5\u00a0mm, 10\u00a0mm, or 15\u00a0mm) of induration the result is considered positive. [ 12 ]  A positive result indicates TB exposure."}
{"_id": "WikiPedia_Dermatology$$$corpus_180", "text": "A tuberculin test conversion is defined as an increase of 10\u00a0mm or more within a two-year period, regardless of age. Alternative criteria include increases of 6, 12, 15 or 18\u00a0mm. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_181", "text": "TST (tuberculin skin test) positive is measured by size of induration. The size of the induration considered to be a positive result depends on risk factors. For example, a low-risk patient must have a larger induration for a positive result than a high-risk patient. High-risk groups include recent contacts, those with HIV, those with chest  radiograph  with fibrotic changes, organ transplant recipients, and those with immunosuppression. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_182", "text": "A meta-analysis in 2014 found that the  Bacillus Calmette\u2013Gu\u00e9rin (BCG) vaccine  reduced infections by 19\u201327% and reduced progression to active tuberculosis by 71%. [ 15 ]  The Ohio Department of Health states that it give 80% of children protection against  tuberculous meningitis  and  miliary tuberculosis . Therefore, a positive TST/PPD in a person who has received BCG vaccine is interpreted as latent TB infection (LTBI). [ 16 ] \nDue to the test's low specificity, most positive reactions in low-risk individuals are false positives. [ 17 ]  A false positive result may be caused by  nontuberculous mycobacteria  or previous administration of BCG vaccine.  Vaccination with BCG may result in a false-positive result for many years after vaccination. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_183", "text": "False positives can also occur when the injected area is touched, causing swelling and itching. If the swelling is less than 5\u00a0mm, it is possibly due to error by the healthcare personnel causing inflammation to the area. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_184", "text": "Another source of false positive results can be allergic reaction or  hypersensitivity . Although rare (about 0.08 reported reactions per million doses of tuberculin), these reactions can be dangerous and precautions should be taken by having  epinephrin  available. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_185", "text": "Reaction to the PPD or tuberculin test is suppressed by the following conditions:"}
{"_id": "WikiPedia_Dermatology$$$corpus_186", "text": "This is because the immune system needs to be functional to mount a response to the protein derivative injected under the skin. A false negative result may occur in a person who has been recently infected with TB, but whose immune system hasn't yet reacted to the bacteria."}
{"_id": "WikiPedia_Dermatology$$$corpus_187", "text": "In case a second tuberculin test is necessary it should be carried out in the other arm to avoid hypersensitising the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_188", "text": "The role of Mantoux testing in people who have been vaccinated is disputed.  The US recommends that tuberculin skin testing is not contraindicated for BCG-vaccinated persons, and prior BCG vaccination should not influence the interpretation of the test.  The UK recommends that  interferon-\u03b3  testing should be used to help interpret positive Mantoux tests of over 5\u00a0mm, [ 20 ]  and repeated tuberculin skin testing must not be done in people who have had BCG vaccinations. In general, the US recommendation may result in a larger number of people being falsely diagnosed with latent tuberculosis, while the UK approach has an increased chance of missing patients with latent tuberculosis who should be treated. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_189", "text": "According to the US guidelines,  latent tuberculosis  infection diagnosis and treatment is considered for any BCG-vaccinated person whose skin test is 10\u00a0mm or greater, if any of these circumstances are present: [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_190", "text": "In cases of  anergy , a lack of reaction by the body's defence mechanisms when it comes into contact with foreign substances, the tuberculin reaction will occur weakly, thus compromising the value of Mantoux testing. For example, anergy is present in  AIDS , a disease which strongly depresses the immune system. Therefore, anergy testing is advised in cases where there is suspicion that anergy is present. However, routine anergy skin testing is not recommended. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_191", "text": "Some people who have been infected with TB may have a negative reaction when tested years after infection, as the immune system response may gradually wane. This initial skin test, though negative, may stimulate (boost) the body's ability to react to tuberculin in future tests. Thus, a positive reaction to a subsequent test may be misinterpreted as a new infection, when in fact it is the result of the boosted reaction to an old infection. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_192", "text": "Use of two-step testing is recommended for initial skin testing of adults who will be retested periodically (e.g., health care workers). This ensures any future positive tests can be interpreted as being caused by a new infection, rather than simply a reaction to an old infection. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_193", "text": "A person who is diagnosed as \"infected in the distant past\" on two-step testing is called a \"tuberculin reactor\". [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_194", "text": "The US recommendation that prior BCG vaccination be ignored results in almost universal false diagnosis of tuberculosis infection in people who have had BCG (mostly foreign nationals). [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_195", "text": "According to the guidelines published by Centers for Disease Control and Prevention in 2005, the results are re-categorized into 3 parts based on their previous or baseline outcomes: [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_196", "text": "In addition to tuberculin skin tests such as (principally) the Mantoux test,  interferon gamma release assays  (IGRAs) have become common in clinical use in the 2010s. In some contexts they are used instead of TSTs, whereas in other contexts TSTs and IGRAs both continue to be useful. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_197", "text": "The  QuantiFERON-TB Gold  blood test measures the patient's immune reactivity to the TB bacterium, and is useful for initial and serial testing of persons with an increased risk of latent or active tuberculosis infection. Guidelines for its use were released by the CDC in December 2005. [ 26 ]  QuantiFERON-TB Gold is  FDA -approved in the  United States , has  CE Mark  approval in  Europe  and has been approved by the  MHLW  in  Japan . The interferon gamma release assay is the preferred method for patients who have had immunosuppression and are about to start biological therapies. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_198", "text": "T-SPOT.TB  is another IGRA; it uses the  ELISPOT  method. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_199", "text": "The Heaf tuberculin skin test was used in the United Kingdom, but discontinued in 2005. The equivalent Mantoux test positive levels done with 10 TU (0.1\u00a0ml at 100\u00a0TU/ml, 1:1000) are [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_200", "text": "The  Prausnitz\u2013K\u00fcstner test  (PK test, Prausnitz-K\u00fcstner reaction) is an  immunologic  test formerly used by physicians to determine if a patient has an allergic reaction to a specific  antigen . [ 1 ]   The test has been replaced by the safer  skin prick test .  The PK test involves transferring  serum  from the test subject to another healthy person, essentially using the second person as a mixing vessel for antibodies and antigen.  This is a pathway for transmission of blood-borne ailments like  variant Creutzfeldt\u2013Jakob disease ,  AIDS , and others, which is why the test is no longer recommended.\nOr in simple words, a test for the presence of immediate hypersensitivity in humans; test serum from an  atopic  individual is injected intradermally into a normal subject; the normal subject is challenged 24\u201348 hours later with the antigen suspected of causing the immediate hypersensitivity reaction in the atopic individual."}
{"_id": "WikiPedia_Dermatology$$$corpus_201", "text": "Serum, suspected to contain  IgE   antibodies , is drawn from the allergic (atopic) patient. [ 1 ]   This serum is injected  intradermally  into a non-allergic person.  The suspected antigens are then intradermally injected into the non-allergic person 24\u201348 hours later. [ 1 ]   If the person being tested for an allergy has made antibodies for the antigen, this will cause a local reaction in the non-allergic person when the antibodies mix with the antigen.  This demonstrates a  type I hypersensitivity  reaction, and the allergic reaction to the injected antigen is confirmed for the patient being tested.  A positive PK test usually appears as a  wheal and flare ."}
{"_id": "WikiPedia_Dermatology$$$corpus_202", "text": "The test was developed by  Otto Prausnitz  and  Heinz K\u00fcstner . [ 1 ]   The first PK test occurred in 1921 when Prausnitz injected K\u00fcstner's serum into his abdominal skin. [ 2 ] [ 3 ]  K\u00fcstner had previously noted that he developed allergic symptoms after eating fish.  After eating some fish, Prausnitz's skin became hot, red, and swollen at the site of the serum injection, confirming their hypothesis that K\u00fcstner was allergic to fish. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_203", "text": "A  reversed Prausnitz\u2013K\u00fcstner test  involves injecting antibodies into the skin of a person who already has the antigen. [ 1 ]   A wheal and flare in the skin also demonstrates a positive reverse PK test."}
{"_id": "WikiPedia_Dermatology$$$corpus_204", "text": "Skin allergy testing  comprises a range of methods for medical diagnosis of  allergies  that attempts to  provoke  a small, controlled, allergic response."}
{"_id": "WikiPedia_Dermatology$$$corpus_205", "text": "A microscopic amount of an  allergen  is introduced to a patient's skin by various means: [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_206", "text": "If an immuno-response is seen in the form of a  rash ,  urticaria  ( hives ), or  anaphylaxis  it can be concluded that the patient has a  hypersensitivity  (or  allergy ) to that  allergen . Further testing can be done to identify the particular allergen. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_207", "text": "The \"skin scratch test\" as it is called, is not very commonly used due to the increased likelihood of infection. On the other hand, the \"skin scrape test\" is painless, does not leave residual pigmentation, and does not have a risk of infection, since it is limited to the superficial layer of the skin. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_208", "text": "Some allergies are identified in a few minutes but others may take several days. In all cases where the test is positive, the skin will become raised, red, and appear itchy. The results are recorded - larger wheals indicating that the subject is more sensitive to that particular allergen. A negative test does not conclusively rule out an allergy; occasionally, the concentration needs to be adjusted, or the body fails to elicit a response. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_209", "text": "In the prick, scratch and scrape tests, a few drops of the purified allergen are gently pricked on to the skin surface, usually the forearm. This test is usually done in order to identify allergies to  pet dander , dust,  pollen , foods or  dust mites . Intradermal injections are done by injecting a small amount of allergen just beneath the skin surface. The test is done to assess allergies to drugs like  penicillin [ 5 ]  or bee venom."}
{"_id": "WikiPedia_Dermatology$$$corpus_210", "text": "To ensure that the skin is reacting in the way it is supposed to, all skin allergy tests are also performed with proven allergens like  histamine , and non-allergens like  glycerin . The majority of people do react to histamine and do not react to glycerin. If the skin does not react appropriately to these allergens then it most likely will not react to the other allergens. These results are interpreted as falsely negative. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_211", "text": "The patch test uses rectangles of special hypoallergenic adhesive tape with different allergens on them. The patch is applied to the skin, usually on the back. The allergens on the patch include latex, medications, preservatives, hair dyes, fragrances, resins, and various metals. [ 7 ]  Patch testing is used to detect allergic  contact dermatitis  but does not test for  hives  or food allergy. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_212", "text": "Also called an  intradermal test , this skin end point titration (SET) uses an intradermal injection of allergens at increasing concentrations to measure allergic response. [ 9 ]  To prevent a severe allergic reaction, the test is started with a very dilute solution. After 10 minutes, the injection site is measured to look for growth of wheal, a small swelling of the skin. Two millimeters of growth in 10 minutes is considered positive. If 2\u00a0mm of growth is noted, then a second injection at a higher concentration is given to confirm the response. The end point is the concentration of antigen that causes an increase in the size of the wheal followed by confirmatory whealing. If the wheal grows larger than 13\u00a0mm, then no further injections are given since this is considered a major reaction. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_213", "text": "There are no major preparations required for  skin testing . At the first consult, the subject's medical history is obtained and physical examination is performed. All patients should bring a list of their medications because some may interfere with the testing. Other medications may increase the chance of a severe allergic reaction. Medications that commonly interfere with skin testing include the following:"}
{"_id": "WikiPedia_Dermatology$$$corpus_214", "text": "Patients who undergo skin testing should know that  anaphylaxis  can occur anytime. So if any of the following symptoms are experienced, a physician consultation is recommended immediately:"}
{"_id": "WikiPedia_Dermatology$$$corpus_215", "text": "Even though skin testing may seem to be a benign procedure, it does have some risks, including swollen red bumps (hives) which may occur after the test. The  hives  usually disappear in a few hours after the test. In rare cases they can persist for a day or two. These hives may be itchy and are best treated by applying an over the counter  hydrocortisone  cream. [ 11 ] \nIn very rare cases one may develop a full blown allergic reaction. Physicians who perform skin test always have equipment and medications available in case an anaphylaxis reaction occurs. This is the main reason why people should not get skin testing performed at corner stores or by people who have no medical training. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_216", "text": "Antihistamines , which are commonly used to treat allergy symptoms, interfere with skin tests, as they can prevent the skin from reacting to the allergens being tested. People who take an antihistamine need either to choose a different form of allergy test or to stop taking the antihistamine temporarily before the test. The period of time needed can range from a day or two to 10 days or longer, depending on the specific medication. Some medications not primarily used as antihistamines, including  tricyclic antidepressants ,\n phenothiazine -based antipsychotics, and several kinds of medications used for gastrointestinal disorders, can similarly interfere with skin tests. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_217", "text": "People who have severe, generalized  skin disease  or an acute skin infection should not undergo skin testing, as one needs uninvolved skin for testing. Also, skin testing should be avoided for people at a heightened risk of anaphylactic shock, including people who are known to be highly sensitive to even the smallest amount of allergen. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_218", "text": "Besides skin tests, there are blood tests which measure a specific  antibody  in the blood. The  IgE  antibody plays a vital role in allergies but its levels in blood do not always correlate with the allergic reaction. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_219", "text": "There are many alternative health care practitioners who perform a variety of provocation neutralization tests, but the vast majority of these tests have no validity and have never been proven to work scientifically."}
{"_id": "WikiPedia_Dermatology$$$corpus_220", "text": "Skin window technique  is used in  immunology  where the top layer of skin is scraped off making it possible to identify the immune response that would occur with a diminished physical barrier in the  host , and observe mobilization of  leukocytes . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_221", "text": "It was developed by  John Rebuck  in 1955. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_222", "text": "This  immunology  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_223", "text": "Suction blistering  is a technique used in  dermatology  to treat chronic wounds, such as non-healing leg  ulcers . When a wound is not healing properly, an autologous  skin graft  is the best option, to prevent rejection of the tissue. Since autologous transplantation cannot always be performed, a substitute has to be used, such as cultured skin. However, this technique is costly and time-consuming. Other uses of suction blisters are to provide transplantation donor tissue for vitiligo research. Suction blisters are often used in tissue serum research in the pharmaceutical and cosmetic research fields. Many research citations are published worldwide that support these uses."}
{"_id": "WikiPedia_Dermatology$$$corpus_224", "text": "During suction blistering, the  lamina lucida  of the skin is cleaved from the underlying layers. This separates the  epidermis  from the  dermis . With the use of small vacuum pumps, little fluid-filled blisters are created, typically on the  abdomen . Blisters are usually formed within 2 to 3 hours. A well-recognized instrument, the Negative Pressure Instrument, from Electronic Diversities, Finksburg MD, US, is used with heated chambers to produce various-sized suction blisters with less time and improved success. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_225", "text": "[ 1 ]  The blisters are then cut, emptied and the loose skin is transferred side by side to the non-healing wound. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_226", "text": "Subsequently, the donor-site is treated with antiseptic drugs and covered with bandages. The acceptor-site is treated with non-adherent bandages, to prevent the skin graft from sticking to the bandages."}
{"_id": "WikiPedia_Dermatology$$$corpus_227", "text": "Tattoo removal  is the process of removing an unwanted  tattoo . The  process of tattooing  generally creates permanent markings in the skin, but people have attempted many methods to try to hide or destroy tattoos."}
{"_id": "WikiPedia_Dermatology$$$corpus_228", "text": "The standard modern method is the non-invasive removal of tattoo pigment using  Q-switched lasers . [ 1 ]  Different types of Q-switched lasers are used to target different colors of  tattoo ink ; depending on the specific light absorption spectra of the tattoo pigments. Typically, black and other darker-colored inks can be removed completely using Q-switched lasers, while lighter colors, such as yellows and greens, are very difficult to remove. Success depends on a wide variety of factors including skin color, ink color, and the depth at which the ink was applied. [ 2 ] [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_229", "text": "Recent research has investigated the potential of multi-pass treatments and the use of  picosecond  laser technology. [ 3 ] [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_230", "text": "Before tattoo removal with Q-switched lasers began in the early 1990s,  continuous-wave lasers  were the standard method for tattoo removal. Continuous-wave lasers used a high energy beam that ablated the target area and destroyed surrounding tissue structures as well as tattoo ink. Treatment tended to be painful and cause significant scarring. [ 2 ] [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_231", "text": "Prior to the development of  laser  tattoo removal methods, common techniques included  dermabrasion , TCA ( Trichloroacetic acid , an  acid  that removes the top layers of  skin , reaching as deep as the layer in which the tattoo ink resides), Sal abrasion (scrubbing the skin with  salt ),  cryosurgery , and  excision , which is sometimes still used along with skin grafts for larger tattoos. [ 6 ] [ 1 ] [ 7 ]  Many other methods for removing tattoos have been suggested historically, including the injection or application of  tannic acid ,  lemon juice ,  garlic , and  pigeon  dung. [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_232", "text": "Saline  is used to lighten  tattoos  (including  microblading  tattoos) through the process of  osmosis . [ 10 ] [ 11 ] [ 12 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_233", "text": "A poll conducted in January 2012 by  Harris Interactive  reported that 1 in 7 (14%) of the 21% of American adults who have a tattoo  regret  getting one. The poll did not report the reasons for these regrets, but a poll that was conducted four years prior reported that the most common reasons were \"too young when I got the tattoo\" (20%), \"it's permanent,\" \"I'm marked for life\" (19%), and \"I just don't like it\" (18%). An earlier poll showed that 19% of Britons with tattoos experienced regret, as did 11% of Italians with tattoos. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_234", "text": "Surveys of tattoo removal patients conducted in 1996 and 2006 provided more insight. Of those polled, the patients who regretted their tattoos typically obtained their tattoos in their late teens or early twenties and were evenly distributed by gender. Among those seeking removals, more than half reported that they \"suffered embarrassment.\" [ 15 ]  A new job, problems with clothes, and a significant life event were also commonly cited as motivations. [ 15 ]  Tattoos that were once a symbol of inclusion in a group, such as a gang, can make it difficult to gain employment. [ 2 ]  Tattoos that indicate a significant relationship, such as a spouse, girlfriend, or boyfriend, can become problematic if the relationship ends. [ 16 ]  Celebrities that have had these kinds of tattoos removed include  Angelina Jolie ,  Eva Longoria ,  Marc Anthony , and  Denise Richards . [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_235", "text": "Some people decide to cover an unwanted tattoo with a new tattoo. A skillful cover-up may completely hide the old tattoo, or it may partially hide the old tattoo, depending on the size, style, colors and techniques used on the old tattoo and the skill of the tattoo artist. [ 18 ]  Covering up a previous tattoo requires darker tones in the new tattoo to effectively hide the unwanted piece. [ 19 ]  For tattoos that are especially difficult to cover up, a person may choose to get laser tattoo removal to lighten the ink to make the area easier to cover with a new tattoo. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_236", "text": "Tattoo removal is most commonly performed using lasers that break down the ink particles in the tattoo into smaller particles. Dermal  macrophages  are part of the immune system, tasked with collecting and digesting cellular debris. In the case of tattoo pigments, macrophages collect ink pigments, but have difficulty breaking them down. Instead, they store the ink pigments. If a macrophage is damaged, it releases its captive ink, which is taken up by other macrophages. This can make it particularly difficult to remove tattoos. When treatments break down ink particles into smaller pieces, macrophages can more easily remove them. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_237", "text": "Tattoo pigments have specific light absorption spectra. A tattoo laser must be capable of emitting adequate  energy  within the given  absorption spectrum  of the  pigment  to provide an effective treatment. Certain tattoo pigments, such as yellows and fluorescent inks are more challenging to treat than darker blacks and blues, because they have absorption spectra that fall outside or on the edge of the emission spectra of the tattoo removal laser. [ 6 ]  Recent pastel-cultured inks contain high concentrations of  titanium dioxide , which is highly reflective. Such inks are difficult to remove because they reflect a significant amount of the incident light energy out of the skin. [ 22 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_238", "text": "The gold standard of tattoo removal  treatment modality  is considered to be laser tattoo removal using multiple separate  Q-switched lasers  (depending on the specific wavelengths needed for the dyes involved) over a number of repeat visits. There are several types of Q-switched lasers, and each is effective at removing a different range of the  color spectrum . [ 5 ] [ 1 ]  Lasers developed during or after 2006 provide multiple wavelengths and can successfully treat a much broader range of tattoo pigments than previous individual Q-switched lasers. Unfortunately the dye systems used to change the  wavelength  result in significant power reduction such that the use of multiple separate specific wavelength lasers remains the gold standard. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_239", "text": "The energy density ( fluence ), expressed as joules/cm 2 , is determined prior to each treatment as well as the spot size and repetition rate (hertz). To mitigate pain the preferred method is simply to cool the area before and during treatment with a medical-grade chiller/cooler and to use a  topical anesthetic . During the treatment process, the laser beam passes through the skin, targeting the ink resting in a liquid state within. While it is possible to see immediate results, in most cases the fading occurs gradually over the 7\u20138 week healing period between treatments. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_240", "text": "Q-switched lasers are reported by the  National Institutes of Health  to result in scarring only rarely. Areas with thin skin will be more likely to scar than thicker-skinned areas. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_241", "text": "By 2023, the laser tattoo removal market is expected to grow 12.7% annually. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_242", "text": "Experimental observations of the effects of short-pulsed lasers on tattoos were first reported in the late 1960s by  Leon Goldman  and others. [ 26 ] [ 27 ] [ 28 ]  In 1979 an  argon  laser was used for tattoo removal in 28 patients, with limited success. In 1978 a carbon dioxide laser was also used, but because it targeted  water , a  chromophore  present in all cells, this type of laser generally caused scarring after treatments. [ 29 ] [ 6 ] [ 30 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_243", "text": "In the early 1980s, a new clinical study began in  Canniesburn Hospital 's Burns and Plastic Surgery Unit, in Glasgow, Scotland, into the effects of Q-switched ruby laser energy on blue/black tattoos. [ 26 ] [ 31 ]  Further studies into other tattoo colors were then carried out with various degrees of success. [ 32 ]  Research at the University of Strathclyde, Glasgow also showed that there was no detectable  mutagenicity  in tissues following irradiation with the Q-switched ruby laser. [ 33 ]  This essentially shows that the treatment is safe, from a biological viewpoint, with no detectable increase in the risk of the development of cancerous cells. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_244", "text": "It was not until the late 1980s that Q-switched lasers became commercially practical with the first marketed laser coming from Derma-lase Limited, Glasgow. [ 35 ] [ 36 ]   One of the first American published articles describing laser tattoo removal was authored by a group at  Massachusetts General Hospital  in 1990. [ 26 ] [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_245", "text": "Tattoos consist of thousands of particles of tattoo pigment suspended in the skin. [ 38 ]   While normal human growth and healing processes will remove small foreign particles from the skin, tattoo pigment particles are too big to be removed automatically. Laser treatment causes tattoo pigment particles to heat up and fragment into smaller pieces.  These smaller pieces are then removed by normal body processes. Q-switched lasers  produce bursts of infrared light at specific frequencies that target a particular spectrum of color in the tattoo ink. The laser passes through the upper layers of the skin to target a specific pigment in the lower layers. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_246", "text": "Laser tattoo removal is a successful application of the theory of selective  photothermolysis  (SPTL). [ 39 ]   However, unlike treatments for blood vessels or hair, the mechanism required to shatter tattoo particles uses the  photomechanical effect . In this situation the energy is absorbed by the ink particles in a very short time, typically nanoseconds. The surface temperature of the ink particles can rise to thousands of degrees but this energy profile rapidly collapses into a shock wave. This shock wave then propagates throughout the local tissue (the dermis) causing brittle structures to fragment. Hence tissues are largely unaffected since they simply vibrate as the shock wave passes. For laser tattoo removal the selective destruction of tattoo pigments depends on four factors:"}
{"_id": "WikiPedia_Dermatology$$$corpus_247", "text": "Q-switched lasers are the only commercially available devices that can meet these requirements. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_248", "text": "Although they occur infrequently, mucosal tattoos can be successfully treated with Q-switched lasers as well. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_249", "text": "A novel method for laser tattoo removal using a fractionated CO 2  or  Er:YAG laser , alone or in combination with Q-switched lasers, was reported by Ibrahimic and coworkers from the Wellman Center of Photomedicine at the Massachusetts General Hospital in 2011. [ 42 ]  This new approach to laser tattoo removal may afford the ability to remove colors such as yellow and white, which have proven to be resistant to traditional Q-switched laser therapy."}
{"_id": "WikiPedia_Dermatology$$$corpus_250", "text": "Several colors of laser light (quantified by the laser wavelength) are used for tattoo removal, from visible light to near-infrared radiation. Different lasers are better for different tattoo colors. Consequently, multi-color tattoo removal almost always requires the use of two or more laser wavelengths. Tattoo removal lasers are usually identified by the lasing medium used to create the wavelength (measured in nanometers (nm)):"}
{"_id": "WikiPedia_Dermatology$$$corpus_251", "text": "Pulse width or pulse duration is a critical laser parameter. All Q-switched lasers have appropriate pulse durations for tattoo removal. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_252", "text": "Spot size, or the width of the laser beam, affects treatment. Light is optically scattered in the skin, like automobile headlights in fog. Larger spot sizes slightly increase the effective penetration depth of the laser light, thus enabling more effective targeting of deeper tattoo pigments. Larger spot sizes also help make treatments faster. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_253", "text": "Fluence or energy density is another important consideration. Fluence is measured in joules per square centimeter (J/cm 2 ). It is important to be treated at high enough settings to fragment tattoo particles."}
{"_id": "WikiPedia_Dermatology$$$corpus_254", "text": "Repetition rate helps make treatments faster but is not associated with any treatment effect. Faster treatments are usually preferred because the pain ends sooner."}
{"_id": "WikiPedia_Dermatology$$$corpus_255", "text": "The number of treatments necessary to remove a tattoo via laser can be predicted by the Kirby-Desai Scale. [ 48 ]  The number of sessions  depends on various parameters, including the area of the body treated, skin color, ink color present, scarring, and amount of ink present. Effectiveness of the immune system may play a role as well."}
{"_id": "WikiPedia_Dermatology$$$corpus_256", "text": "Complete laser tattoo removal requires numerous treatment sessions, typically spaced at eight weeks or more apart.  Treating more frequently than eight weeks increases the risk of adverse effects and does not necessarily increase the rate of ink absorption. Anecdotal reports of treatments sessions at four weeks leads to more scarring and  dyschromia  and can be a source of liability for clinicians. At each session, some but not all of the tattoo pigment particles are effectively fragmented, and the body removes the smallest fragments over the course of several weeks or months.  The result is that the tattoo is lightened over time.  Remaining large particles of tattoo pigment are then targeted at subsequent treatment sessions, causing further lightening.  Tattoos located on the extremities, such as the ankle, generally take longest. As tattoos fade clinicians may recommend that patients wait many months between treatments to facilitate ink resolution and minimize unwanted side effects."}
{"_id": "WikiPedia_Dermatology$$$corpus_257", "text": "Certain colors have proved more difficult to remove than others. In particular, this occurs when treated with the wrong wavelength of laser light is used. Some have postulated that the reason for slow resolution of green ink in particular is due to its significantly smaller molecular size relative to the other colors. [ 49 ]  Consequently, green ink tattoos may require treatment with 755\u00a0nm light but may also respond to 694\u00a0nm, 650\u00a0nm and 1064\u00a0nm. Multiple wavelengths of light may be needed to remove colored inks."}
{"_id": "WikiPedia_Dermatology$$$corpus_258", "text": "One small Greek study showed that the R20 method\u2014four passes with the laser, twenty minutes apart\u2014caused more breaking up of the ink than the conventional method without more scarring or adverse effects. However, this study was performed on a very small patient population (12 patients total), using the weakest of the QS lasers, the 755\u00a0nm Alexandrite laser. One of the other main problems with this study was the fact that more than half of the 18 tattoos removed were not professional and amateur tattoos are always easier to remove. Proof of concept studies are underway, but many laser experts advise against the R20 method using the more modern and powerful tattoo removal lasers available at most offices as an increase in adverse side effects including scarring and dyschromia is likely. Patients should inquire about the laser being used if the R20 treatment method is offered by a facility as it is usually only offered by clinics that are using the 755\u00a0nm Alexandrite as opposed to the more powerful and versatile devices that are more commonly used. Moreover, dermatologists offering the R20 method should inform patients that it is just one alternative to proven protocols and is not a gold standard treatment method to remove tattoos."}
{"_id": "WikiPedia_Dermatology$$$corpus_259", "text": "Multiple pass treatment methods (R20, as mentioned above, and R0) have generally shown to carry a greater risk of side effects, due to the increased amount of energy used in treatment. One caveat to this, however, is incorporating a  perfluorodecalin  (PFD) patch into the protocol. [ 50 ]  A PFD patch utilizes a clear silicone gel patch, with a small amount of PFD liquid applied to the treatment area immediately before each pass of laser application, and conducting the passes in rapid succession. The combination of the patch and liquid reduce the epidermal scatter, which can limit the predicted side effects typically seen in aggressive laser tattoo removal treatments (hyper and  hypopigmentation , blistering, etc.). [ 51 ]  Additionally, the liquid reduces the laser frosting very quickly, allowing for faster re-treatment, limiting the time of treatment while still improving efficacy. Early studies have been performed to indicate improved clearance with the use of this patch in 3-4 passes, in a single session, utilizing more energy than typically allowable with a traditional treatment methodology. [ 52 ]  All these physical properties of the patch work to substantially reduce the total number of laser treatments required for ink clearance. While the PFD patch is currently FDA cleared for use with all picot and nanosecond domain lasers and wavelengths, it is only cleared for Fitzpatrick Skin Types I-III. Early studies have shown anecdotally that there isn't necessarily increased risks with Fitzpatrick Skin Types IV-VI, though still not FDA cleared as an indication. [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_260", "text": "There are a number of factors that determine how many treatments will be needed and the level of success one might experience. Age of tattoo, ink density, color and even where the tattoo is located on the body, and whether the tattoo was professional, or not, all play an important role in how many treatments will be needed for complete removal. [ 54 ]  However, a rarely recognized factor of tattoo removal is the role of the patient's immune response. [ 55 ]  The normal process of tattoo removal is fragmentation followed by  phagocytosis , which is then drained away via the  lymphatics . Consequently, it is the inflammation resulting from the actual laser treatment and the natural stimulation of the hosts' immune response that ultimately results in removal of tattoo ink. Because of this, the effectiveness of laser tattoo removal varies widely. [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_261", "text": "Laser tattoo removal is painful; many patients say it is worse than getting the tattoo. The pain is often described to be similar to that of hot oil on the skin, or a \"snap\" from an elastic band.  Depending on the patient's  pain threshold , some patients may forgo anesthesia altogether, but most patients will require some form of local anesthesia. Pre-treatment might include the application of an anesthetic cream under occlusion for 45 to 90 minutes or cooling by ice or cold air prior to the laser treatment session. A better method is complete anesthesia which can be administered locally by injections of 1% to 2% lidocaine with epinephrine."}
{"_id": "WikiPedia_Dermatology$$$corpus_262", "text": "A technique which helps to reduce the pain sensation felt by patients has been described by MJ Murphy. [ 57 ]  He used a standard microscope glass slide pressed against the tattooed skin and fired the laser through the glass. This technique may represent a simplest and effective method to reduce the pain sensation when treating small tattoos."}
{"_id": "WikiPedia_Dermatology$$$corpus_263", "text": "Immediately after laser treatment, a slightly elevated, white discoloration with or without the presence of punctuate bleeding is often observed. This white color change is thought to be the result of rapid, heat-formed steam or gas, causing dermal and epidermal vacuolization.  Pinpoint bleeding represents vascular injury from photoacoustic waves created by the laser's interaction with tattoo pigment. Minimal edema and  erythema  of adjacent normal skin usually resolve within 24 hours. Subsequently, a crust appears over the entire tattoo, which sloughs off at approximately two weeks post-treatment. As noted above, some tattoo pigment may be found within this crust. Post-operative wound care consists of simple wound care and a non-occlusive dressing. Since the application of laser light is sterile there is no need for topical antibiotics. Moreover, topical antibiotic ointments can cause allergic reactions and should be avoided. Fading of the tattoo will be noted over the next eight weeks and re-treatment energy levels can be tailored depending on the clinical response observed. [ 58 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_264", "text": "About half of the patients treated with Q-switched lasers for tattoo removal will show some transient changes in the normal skin pigmentation. These changes usually resolve in 6 to 12 months but may rarely be permanent. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_265", "text": "Hyperpigmentation is related to the patient's  skin tone , with skin types IV, V and VI more prone regardless of the wavelength used. Twice daily treatment with  hydroquinones  and broad-spectrum sunscreens usually resolves the hyperpigmentation within a few months, although, in some patients, resolution can be prolonged. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_266", "text": "Hypopigmentation is more commonly observed in darker skin tones. It is more likely to occur with higher fluence and more frequent treatments. Sometimes lighter skin exhibits hypopigmentation after a series of treatments. Allowing more time between treatments reduces chances of hypopigmentation. Since it is more likely to see hypopigmentation after multiple treatments, some practitioners suggest waiting a few additional weeks, after a few sessions. Usually treatment stops until hypopigmentation resolves in a matter of months."}
{"_id": "WikiPedia_Dermatology$$$corpus_267", "text": "Transient textural changes are occasionally noted but often resolve within a few months; however, permanent textural changes and scarring very rarely occur. If a patient is prone to pigmentary or textural changes, longer treatment intervals are recommended. Additionally, if a blister or crust forms following treatment, it is imperative that the patient does not manipulate this secondary skin change. Early removal of a blister or crust increases the chances of developing a scar. Additionally, patients with a history of hypertrophic or keloidal scarring need to be warned of their increased risk of scarring."}
{"_id": "WikiPedia_Dermatology$$$corpus_268", "text": "Local allergic responses to many tattoo pigments have been reported, and allergic reactions to tattoo pigment after Q-switched laser treatment are also possible.  Rarely, when yellow cadmium sulfide is used to \"brighten\" the red or yellow portion of a tattoo, a photoallergic reaction may occur.  The reaction is also common with red ink, which may contain  cinnabar  (mercuric sulfide). Erythema, pruritus, and even inflamed nodules, verrucose papules, or granulomas may develop. The reaction will be confined to the site of the red/yellow ink. Treatment consists of strict sunlight avoidance, sunscreen, interlesional steroid injections, or in some cases, surgical removal. Unlike the destructive modalities described, Q-switched lasers mobilize the ink and may generate a systemic allergic response. Oral antihistamines and anti-inflammatory steroids have been used to treat allergic reactions to tattoo ink."}
{"_id": "WikiPedia_Dermatology$$$corpus_269", "text": "Studies of various tattoo pigments have shown that a number of pigments (most containing iron oxide or titanium dioxide) change color when irradiated with Q-switched laser energy. Some tattoo colors including flesh tones, light red, white, peach and light brown containing pigments as well as some green and blue tattoo pigments, changed to black when irradiated with Q-switched laser pulses. The resulting gray-black color may require more treatments to remove. If tattoo darkening does occur, after 8 weeks the newly darkened tattoo can be treated as if it were black pigment. [ 60 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_270", "text": "Very rarely, non Q-switched laser treatments, like CO 2  or Argon lasers, which are very rarely offered these days, can rupture blood vessels and aerosolize tissue requiring a plastic shield or a cone device to protect the laser operator from tissue and blood contact. Protective eyewear may be worn if the laser operator chooses to do so."}
{"_id": "WikiPedia_Dermatology$$$corpus_271", "text": "With the mechanical or salabrasion method of tattoo removal, the incidence of scarring, pigmentary alteration (hyper- and hypopigmentation), and ink retention are extremely high. [ 61 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_272", "text": "The use of Q-switched lasers could very rarely produce the development of large  bulla . However, if patients follow post care directions to elevate, rest, and apply intermittent icing, it should minimize the chances of bulla and other adverse effects. In addition, health care practitioners should contemplate the use of a cooling device during the tattoo removal procedure. While the infrequent bulla development is a possible side effect of Q-switched laser tattoo removal, if treated appropriately and quickly by the health care practitioner, it is unlikely that long term consequences would ensue. [ 62 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_273", "text": "Although laser treatment is well known and often used to remove tattoos, unwanted side effects of laser tattoo removal include the possibility of discoloration of the skin such as hypopigmentation (white spots, more common in darker skin) and hyperpigmentation (dark spots) as well as textural changes. These changes are usually not permanent when the Nd:YAG is used but it is much more likely with the use of the 755\u00a0nm Alexandrite, the 694\u00a0nm Ruby and the R20 method. Very rarely, burns may result in scarring, but this usually only occurs when patients do not properly care for the treated area.  Occasionally, \"paradoxical darkening\" of a tattoo may occur when a treated tattoo becomes darker instead of lighter.  This may occur with white ink, flesh tones, pink, and cosmetic makeup tattoos. [ 63 ] [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_274", "text": "Some commercially available tattoo inks may contain organic pigments, also known as azo dyes. [ 65 ]  When these pigments are broken down via laser pyrolysis, the potential release of  aromatic amine rings , a known carcinogen, [ 66 ]  into the body, could occur. [ 67 ]  This effect is theorized not to be isolated only to laser tattoo removal, but may also occur with solar radiation. [ 68 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_275", "text": "Laser removal of traumatic tattoos may be dangerous depending on the substance of the material embedded in the skin. In one reported instance, the use of a laser resulted in the ignition of embedded particles of firework debris. [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_276", "text": "Ultraviolet  light therapy  or  ultraviolet phototherapy  is a treatment for  psoriasis ,  atopic skin disorder ,  vitiligo  and other skin diseases."}
{"_id": "WikiPedia_Dermatology$$$corpus_277", "text": "There are two main treatments: UVB that is the most common, and PUVA."}
{"_id": "WikiPedia_Dermatology$$$corpus_278", "text": "There are four UVB types of lamps: Fluorescnt Broad-Band UVB that emit 280-330 nanometer, Fluorescent Narrow-Band that emit 312 nanometer, Excimer that emit 308 nanometer and LED that emit 290-300 nanometer."}
{"_id": "WikiPedia_Dermatology$$$corpus_279", "text": "PUVA  means UVA +  psoralen . It consists of irradiation of the skin with the UVA  ultraviolet  light, from a  fluorescent  bulb or LED lamps."}
{"_id": "WikiPedia_Dermatology$$$corpus_280", "text": "Tanning beds are used both in dermatology practices for the treatment of cosmetic skin conditions (such as psoriasis, acne, eczema and vitiligo) and in indoor tanning salons for cosmetic tanning."}
{"_id": "WikiPedia_Dermatology$$$corpus_281", "text": "Typical treatment regimens involve short exposure to UVB rays 3 to 5 times a week at a hospital or clinic, and repeated sessions may be required before results are noticeable. Almost all of the conditions that respond to UVB light are chronic problems, so continuous treatment is required to keep those problems in check. Home UVB systems are common solutions for those whose conditions respond to treatment. Home systems permit patients to treat themselves every other day (the ideal treatment regimen for most) without the frequent, costly trips to the office/clinic and back, mainly when the area is small, and the price of the lamp is low."}
{"_id": "WikiPedia_Dermatology$$$corpus_282", "text": "Side-effects may include itching and redness of the skin due to UVB exposure, and possibly sunburn, if patients do not minimize exposure to natural UV rays during treatment days. Cataracts can frequently develop if the eyes are not protected from UV light exposure. To date, there is no link between an increase in a patient's risk of skin cancer and the proper use of narrow-band UVB phototherapy. [ 1 ] [ 2 ]  \"Proper use\" is generally defined as reaching the \"Sub-Erythemic Dose\" (S.E.D.), the maximum amount of UVB your skin can receive  without  burning.\nCertain fungal growths under the toenail can be treated using a specific wavelength of UV delivered from a high-power LED (light-emitting diode) and can be safer than traditional systemic drugs. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_283", "text": "The  Asboe-Hansen sign  (also known as \" indirect Nikolsky sign' \" [ 1 ]  or \" Nikolsky II sign \" [ 1 ] ) refers to the extension of a  large blister  to adjacent unblistered skin when pressure is put on the top of it. [ 2 ] [ 3 ]  It is seen along with  Nikolsky's sign , both used to assess the severity of some blistering diseases such as  pemphigus vulgaris  and severe bullous drug reactions. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_284", "text": "This sign is named for the Danish physician  Gustav Asboe-Hansen  (1917\u20131989), who first described it in 1960. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_285", "text": "It is considered an indirect diagnostic tool in  toxic epidermal necrolysis  (TEN). [ definition needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_286", "text": "Auspitz's sign  is the appearance of punctate bleeding spots when  psoriasis  scales are scraped off, named after  Heinrich Auspitz . [ 1 ]  It may also be seen in  Darier's disease  and  actinic keratosis . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_287", "text": "Importantly, as with many eponymous clinical signs, [ 3 ] [ 4 ]  Heinrich Auspitz was not the first to discover the sign named after him. It was Auspitz's mentor at the  Medical University of Vienna  ( Ferdinand von Hebra ) and Parisian dermatologist  Marie Devergie  who first noted the punctate hemorrhages underlying psoriasis scales. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_288", "text": "This pinpoint bleeding results from a thinning of the  epidermal layer  overlying the tips of the  dermal papillae . Blood vessels within the papillae are dilated and tortuous, and often bleed readily when the scale is removed. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_289", "text": "Although classically associated with psoriasis, subsequent research has found Auspitz's sign to be of very little diagnostic value for the disease. This is because several other diseases display the sign (including  Darier's disease  and  actinic keratosis ). Additionally, only a minority of psoriasis scales show it when removed (<18%). [ 7 ]  This overall indicates that Auspitz's sign is neither highly  sensitive nor specific  for psoriasis, and thus should only be used in combination with other findings to make a diagnosis. [ clarification needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_290", "text": "Borsieri's sign  or  Borsieri's line  is a  dermatological  sign that consists of pressure by a sharp object (such as a fingernail) producing a white line on the skin that quickly turns red. It is present in  scarlet fever . [ 1 ] [ 2 ]  It was first described by French physician  Giovanni Battista Borsieri de Kanifeld \u00a0[ it ] . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_291", "text": "This  medical sign  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_292", "text": "Braverman's sign  is a  dermatological  sign that consists of fine  telangiectasias  around the nail (periungually). They may be associated with connective tissue diseases. The sign is named after the dermatologist Irwin M. Braverman. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_293", "text": "The  Casal collar  or  Casal necklace  is a  medical sign  in which there is a  redness  and  darkening  of the skin around the neck, seen in people with  pellagra . [ 2 ]  It becomes prominent following exposure to sun, and can be itchy with a burning feeling and pain. [ 1 ]  It can  blister  and weep, and turn into thick dark skin, with a coppery hue. [ 1 ]  If prolonged, the skin becomes thin, dry and smooth. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_294", "text": "The sign is caused by a lack of the  niacin  (vitamin B 3 ). [ 1 ]   Seborrheic dermatitis  may appear similar. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_295", "text": "Casal collar is named after  Gaspar Casal . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_296", "text": "The  Crowe sign  or  Crowe's sign  is the presence of  axillary  (armpit)  freckling  in people with  neurofibromatosis type I  (von Recklinghausen's disease). These freckles occur in up to 30% of people with the disease and their presence is one of six diagnostic criteria for neurofibromatosis.  Freckles can also be present in the  intertriginous  area in neurofibromatosis, such as the inguinal fold, submammary areas, and nape of the neck."}
{"_id": "WikiPedia_Dermatology$$$corpus_297", "text": "This medical sign is named after  Frank W. Crowe  (July 2, 1919 \u2013 April 29, 1987), an American physician who practiced dermatology in Boise, Idaho. [ 1 ]  In 1956 Crowe et al. recognised the autosomal dominant heredity of neurofibromatosis and the use of 6 or more  caf\u00e9 au lait spots  to diagnose the condition. In 1964 Crowe published work on the use of axillary freckling in its diagnosis, which is now referred to as the Crowe sign. He noticed that axillary freckles are present in about 20-30% of patients with neurofibromatosis, but he did not see any in patients who did not have neurofibromatosis."}
{"_id": "WikiPedia_Dermatology$$$corpus_298", "text": "Axillary freckling also occurs in other disease processes that closely resemble NF1, such as Legius syndrome (cafe-au-lait spots, axillary freckling, and macrocephaly without Lisch nodules, neurofibromas or CNS tumors), and, homozygous HNPCC mutations (cafe-au-lait spots, axillary freckling, and cutaneous neurofibromas in the setting of Hereditary Non-Polyposis Colon Cancer, also known as Lynch syndrome; seen with family history of HNPCC and consanguinity). [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_299", "text": "Darier's sign  is a change observed after stroking lesions on the  skin  of a person with  systemic mastocytosis  or  urticaria pigmentosa . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_300", "text": "In general, the skin becomes  swollen ,  itchy  and  red . This is a result of compression of  mast cells , which are hyperactive in these  diseases . These mast cells release  inflammatory  granules which contain  histamine . It is the histamine which is responsible for the response seen after rubbing the lesional skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_301", "text": "Darier's sign is named after the French dermatologist  Ferdinand-Jean Darier  (1856\u20131938) who first described it. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_302", "text": "Dermatoglyphics  (from  Ancient Greek   derma , \"skin\", and  glyph , \"carving\") is the scientific study of  fingerprints , lines, mounts and shapes of hands, as distinct from the superficially similar  pseudoscience  of  palmistry ."}
{"_id": "WikiPedia_Dermatology$$$corpus_303", "text": "Dermatoglyphics also refers to the making of naturally occurring ridges on certain body parts, namely palms, fingers, soles, and toes. These are areas where hair usually does not grow, and these ridges allow for increased leverage when picking up objects or walking barefoot."}
{"_id": "WikiPedia_Dermatology$$$corpus_304", "text": "In a 2009 report, the scientific basis underlying dermatoglyphics was questioned by the  National Academy of Sciences , for the discipline's reliance on subjective comparisons instead of conclusions drawn from the  scientific method . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_305", "text": "1823 marks the beginning of the scientific study of  papillary ridges  of the hands and feet, with the work of  Jan Evangelista Purkyn\u011b . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_306", "text": "By 1858,  Sir William Herschel, 2nd Baronet , while in India, became the first European to realize the value of fingerprints for identification."}
{"_id": "WikiPedia_Dermatology$$$corpus_307", "text": "Sir  Francis Galton  conducted extensive research on the importance of skin-ridge patterns, demonstrating their permanence and advancing the science of fingerprint identification with his 1892 book  Fingerprints ."}
{"_id": "WikiPedia_Dermatology$$$corpus_308", "text": "In 1893, Sir  Edward Henry  published the book  The classification and uses of fingerprints , which marked the beginning of the modern era of fingerprint identification and is the basis for other classification systems."}
{"_id": "WikiPedia_Dermatology$$$corpus_309", "text": "In 1929,  Harold Cummins  and Charles Midlo M.D., together with others, published the influential book  Fingerprints, Palms and Soles , a bible in the field of dermatoglyphics."}
{"_id": "WikiPedia_Dermatology$$$corpus_310", "text": "In 1945,  Lionel Penrose , inspired by the works of Cummins and Midlo, conducted his own dermatoglyphic investigations as a part of his research into  Down syndrome  and other congenital medical disorders."}
{"_id": "WikiPedia_Dermatology$$$corpus_311", "text": "In 1976, Schaumann and Alter published the book  Dermatoglyphics in Medical Disorders , which summarizes the findings of dermatoglyphic patterns under disease conditions."}
{"_id": "WikiPedia_Dermatology$$$corpus_312", "text": "In 1982, Seltzer, et al., conducted a study on patients with breast cancer, and concluded that the presence of six or more whorls on a woman's fingertips indicated her being at high risk for breast cancer."}
{"_id": "WikiPedia_Dermatology$$$corpus_313", "text": "Although the study of dermatoglyphics has some adjunctive value in the diagnosis of genetic syndromes (see examples below), there is insufficient evidence to indicate that there is any value in the examination of dermal ridge patterns for the diagnosis of disease or for identifying disease susceptibility."}
{"_id": "WikiPedia_Dermatology$$$corpus_314", "text": "Dermatoglyphics, when correlated with  genetic abnormalities , aids in the diagnosis of  congenital malformations  at birth or soon after."}
{"_id": "WikiPedia_Dermatology$$$corpus_315", "text": "The relationship between different dermatoglyphic traits and various medical diseases have been widely evaluated."}
{"_id": "WikiPedia_Dermatology$$$corpus_316", "text": "The  dimple sign  or  Fitzpatrick's sign  is a  dermatological  sign in which lateral pressure on the  skin  produces a depression. [ 1 ] [ 2 ]  It is associated with  dermatofibroma . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_317", "text": "Hutchinson's sign  is a  clinical sign  which may refer to:"}
{"_id": "WikiPedia_Dermatology$$$corpus_318", "text": "Kerr's sign  is a  dermatological  sign characterized by a palpable change in skin texture inferior to the  somatic  level of a  spinal cord  lesion. The skin may feel stiff, dry, or tense. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_319", "text": "The  Koebner phenomenon  or  K\u00f6bner phenomenon  ( UK :  / \u02c8 k \u025c\u02d0 b n \u0259r / ,  US :  / \u02c8 k \u025b b -/ ), [ 1 ]  also called the  Koebner response  or the  isomorphic response , attributed to  Heinrich K\u00f6bner , is the appearance of  skin lesions  on lines of trauma. [ 2 ]   The Koebner phenomenon may result from either a linear exposure or irritation.  Conditions demonstrating linear lesions after a linear exposure to a causative agent include:  molluscum contagiosum ,  warts  and  toxicodendron dermatitis  (a  dermatitis  caused by a genus of plants including  poison ivy ).  Warts and molluscum contagiosum lesions can be spread in linear patterns by self-scratching (\" auto-inoculation \").  Toxicodendron dermatitis lesions are often linear from brushing up against the plant.  Causes of the Koebner phenomenon that are secondary to scratching rather than an infective or chemical cause include  vitiligo ,  psoriasis ,  lichen planus ,  lichen nitidus ,  pityriasis rubra pilaris , and  keratosis follicularis  (Darier disease). [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_320", "text": "The Koebner phenomenon describes skin lesions which appear at the site of injury. It is seen in: [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_321", "text": "A similar response occurs in  pyoderma gangrenosum  and  Behcet's syndrome , and is referred to as  pathergy . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_322", "text": "Rarely Koebner phenomenon has been reported as a mechanism of acute myeloid leukemia dissemination. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_323", "text": "Warts and molluscum contagiosum are often listed as causing a Koebner reaction, but this is by direct inoculation of viral particles. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_324", "text": "The linear arrangement of skin lesions in the Koebner phenomenon can be contrasted to both  lines of Blaschko  and dermatomal distributions.   Blaschko lines follow embryotic cell migration patterns and are seen in some mosaic genetic disorders such as  incontinentia pigmenti  and  pigment mosaicism .   Dermatomal distributions  are lines on the skin surface following the distribution of spinal nerve roots.  The rash caused by herpes zoster ( Shingles ) follows such dermatomal lines. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_325", "text": "The Koebner phenomenon was named after the rather eccentric but renowned German dermatologist  Heinrich Koebner [ 5 ]  (1838\u20131904).  Koebner is best known for his work in  mycology . His intense nature is illustrated by the following: in a medical meeting, he proudly exhibited on his arms and chest three different fungus infections, which he had self-inoculated, in order to prove the infectiousness of the organisms he was studying.  The Koebner phenomenon is the generalized term applied to his discovery that on psoriasis patients, new lesions often appear along lines of trauma. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_326", "text": "Langer's lines ,  Langer lines of skin tension , or sometimes called  cleavage lines , are  topological lines  drawn on a map of the human body. They are parallel to the natural orientation of  collagen  fibers in the  dermis , and generally parallel to the underlying muscle fibers. Langer's lines have relevance to forensic science and the development of surgical techniques."}
{"_id": "WikiPedia_Dermatology$$$corpus_327", "text": "The lines were first discovered in 1861 by  Austrian   anatomist   Karl Langer  (1819\u20131887), [ 1 ] [ 2 ] [ 3 ]  though he cited the surgeon  Baron Dupuytren  as being the first to recognise the phenomenon. Langer punctured numerous holes at short distances from each other into the skin of a  cadaver  with a tool that had a circular-shaped tip, similar to an  ice pick . He noticed that the resultant punctures in the skin had  ellipsoidal  shapes. From this testing he observed patterns and was able to determine \"line directions\" by the longer axes of the ellipsoidal holes and lines."}
{"_id": "WikiPedia_Dermatology$$$corpus_328", "text": "Knowing the direction of Langer's lines within a specific area of the skin is important for  surgical  operations, particularly  cosmetic surgery . If a surgeon has a choice about where and in what direction to place an incision, they may choose to cut in the direction of Langer's lines. Incisions made parallel to Langer's lines may heal better and produce less scarring than those that cut across.  Conversely, incisions perpendicular to Langer's lines have a tendency to pucker and remain obvious, although sometimes this is unavoidable. The orientation of  stab wounds  relative to Langer's lines can have a considerable impact upon the presentation of the wound. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_329", "text": "Langer's lines include breast static tension lines, which mark a guide for  breast surgery  incisions. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_330", "text": "Keloids  are more common when incision is given across Langer's lines. [ citation needed ]  Sometimes the exact direction of the collagen fibers are unknown, because in some regions of the body there are differences between different individuals. Also, the lines described by Kraissl differ in some ways from Langer's lines, particularly on the face."}
{"_id": "WikiPedia_Dermatology$$$corpus_331", "text": "Other authors have created topological skin maps.  Kraissl's lines  differ from Langer's lines in that while Langer's lines were defined in cadavers, [ 6 ]  Kraissl's lines have been defined in living individuals. Also, the method used to identify Kraissl's lines is not traumatic."}
{"_id": "WikiPedia_Dermatology$$$corpus_332", "text": "The  Leser\u2013Tr\u00e9lat sign  is the explosive onset of multiple  seborrheic keratoses [ 1 ]  (many pigmented skin lesions), [ 2 ] [ 3 ]  often with an  inflammatory  base. This can be a sign of internal  malignancy  as part of a  paraneoplastic syndrome . In addition to the development of new lesions, preexisting ones frequently increase in size and become symptomatic."}
{"_id": "WikiPedia_Dermatology$$$corpus_333", "text": "Although most associated  neoplasms  are  gastrointestinal [ 4 ]   adenocarcinomas  ( stomach ,  liver ,  colorectal  and  pancreas ), malignancies of the  breast ,  lung , [ 5 ]  and  urinary tract , [ 6 ]  as well as  lymphoid tissue , have been associated with this impressive rash. It is likely that various  cytokines  and other growth factors produced by the neoplasm are responsible for the abrupt appearance of the seborrheic keratoses."}
{"_id": "WikiPedia_Dermatology$$$corpus_334", "text": "In some cases, paraneoplastic  acanthosis nigricans  (35% of patients),  florid cutaneous papillomatosis ,  ichthyosis acquisita  (acquired hypertrichosis lanuginosa),  Cowden syndrome ,  tylosis ,  acrokeratosis paraneoplastica of Bazex  or  tripe palms  accompany the sign of Leser\u2013Tr\u00e9lat."}
{"_id": "WikiPedia_Dermatology$$$corpus_335", "text": "It is named for German surgeon  Edmund Leser  and French surgeon  Ulysse Tr\u00e9lat . [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_336", "text": "It has been suggested that Leser and Tr\u00e9lat were observing  angiomas  and not seborrheic keratoses, and so the credit should properly go to  Eugen Von Hollander  for his 1900 publication. [ 3 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_337", "text": "Nikolsky's sign  is a clinical  dermatological   sign , named after  Pyotr Nikolsky  (1858\u20131940), a Russian physician who trained and worked in the Russian Empire. The sign is present when slight rubbing of the skin results in  exfoliation  of the outermost layer. [ 1 ] [ 2 ] [ 3 ] [ 4 ]  A typical test would be to place the eraser of a pencil on the roof of a lesion and spin the pencil in a rolling motion between the thumb and forefinger. If the lesion is opened (i.e., skin sloughed off), then the Nikolsky's sign is present/positive."}
{"_id": "WikiPedia_Dermatology$$$corpus_338", "text": "Nikolsky's sign is almost always present in  Stevens\u2013Johnson syndrome / toxic epidermal necrolysis [ 5 ]  and  staphylococcal scalded skin syndrome , caused by the exfoliative toxin of  Staphylococcus aureus . [ 1 ]  It is also associated with  pemphigus vulgaris  and  pemphigus foliaceus . [ 6 ] [ 7 ]  It is useful in differentiating between the diagnosis of  pemphigus vulgaris  or  mucous membrane pemphigoid  (where the sign is present) and  bullous pemphigoid  (where it is absent).\nThe Nikolsky sign is dislodgement of intact superficial epidermis by a shearing force, indicating a plane of cleavage in the skin epidermal-epidermal junctions (e.g., desmosomes). The histological picture involves thinner, weaker attachments of the skin lesion itself to the normal skin \u2013 resulting in easier dislodgement."}
{"_id": "WikiPedia_Dermatology$$$corpus_339", "text": "The formation of new blisters upon slight pressure (direct Nikolsky) and shearing of the skin due to rubbing (indirect Nikolsky) is a sign of pemphigus vulgaris, albeit not a 100% reliable diagnosis. [ 8 ]  In addition, another physical exam, the  Asboe-Hansen signs , must be used to determine the absence of intracellular connections holding epidermal cells together. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_340", "text": "In  medicine ,  nodules  are small firm lumps, usually greater than 1\u00a0cm in diameter. [ 1 ] [ 2 ]  If filled with fluid they are referred to as  cysts . [ 2 ]  Smaller (less than 0.5\u00a0cm) raised soft tissue bumps may be termed  papules . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_341", "text": "The evaluation of a skin nodule includes a description of its appearance, its location, how it feels to touch and any associated symptoms which may give clues to an underlying medical condition. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_342", "text": "Nodules in skin include  dermatofibroma [ 5 ]  and  pyogenic granuloma . [ 6 ]  Nodules may form on  tendons  and  muscles  in response to injury, [ 7 ]  and are frequently found on  vocal cords . [ 8 ]  They may occur in organs such as the  lung , [ 9 ]  or  thyroid , [ 10 ]  or be a sign in other medical conditions such as  rheumatoid arthritis . [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_343", "text": "Nodules are small firm lumps usually greater than 1\u00a0cm in diameter, found in  skin  and other  organs . [ 1 ] [ 2 ]  If filled with fluid they are usually softer and referred to as  cysts . [ 2 ]  Smaller (less than 0.5\u00a0cm) raised soft tissue bumps may be termed  papules . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_344", "text": "Often discovered unintentionally on a chest x-ray, a single nodule in the lung requires assessment to exclude cancer. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_345", "text": "Nodules may form on  tendons  and  muscles  in response to injury, [ 7 ]  and are frequently found on  vocal cords , [ 8 ]  They occur in conditions including  endometriosis , [ 12 ]   neurofibromatosis , [ 6 ]  and in  rheumatoid arthritis . [ 11 ]  They may also feature in  Kaposi's sarcoma [ 13 ]  and  gonorrhea . [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_346", "text": "In the field of  dermatology , the  Renb\u00f6k phenomenon  is a phenomenon where one  skin condition  inhibits another. [ 1 ] [ 2 ]  It is also known as the  reverse Koebner phenomenon . [ 1 ]  The term was first used by Happle et al. in 1991. [ 3 ]  The word \"Renb\u00f6k\" is a neologism, made from a reversal of the letters of the name \"K\u00f6bner\". [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_347", "text": "The  Rumpel\u2013Leede sign  is a historical exam for Dengue fever and scurvy. It presents as a distal shower of  petechiae  that occurs after the release of pressure from a  tourniquet  or  sphygmomanometer . [ 1 ] :\u200a824\u200a [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_348", "text": "The blood pressure cuff should be inflated to a pressure between the systolic and diastolic pressures and kept inflated for 5 minutes. A few minutes after releasing the tourniquet if there are more than twenty petechiae per square inch it is a clinical manifestation of scurvy.  [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_349", "text": "Wickham striae  or  Wickham's striae  are whitish lines visible in the  papules  of  lichen planus  and other  dermatoses , typically in the oral mucosa. [ 1 ]  The  microscopic  appearance shows  hypergranulosis .  They are named after  Louis Fr\u00e9d\u00e9ric Wickham . [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_350", "text": "Wolf's isotopic response [ 1 ] [ 2 ]  is a dermatological sign that is characterized by the appearance of a new dermatosis or cutaneous infection at the site of a previous unrelated and already healed dermatosis (\"isotopic\" means identical location). [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_351", "text": "An  abscess  is a collection of  pus  that has built up within the  tissue  of the body, usually caused by bacterial infection. [ 6 ] [ 7 ]  Signs and symptoms of abscesses include redness, pain, warmth, and swelling. [ 1 ]  The swelling may feel fluid-filled when pressed. [ 1 ]  The area of redness often extends beyond the swelling. [ 8 ]   Carbuncles  and  boils  are types of abscess that often involve  hair follicles , with carbuncles being larger. [ 9 ]  A  cyst  is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall. Abscesses can also form internally on internal organs and after surgery."}
{"_id": "WikiPedia_Dermatology$$$corpus_352", "text": "They are usually caused by a  bacterial infection . [ 10 ]  Often many different types of bacteria are involved in a single infection. [ 8 ]  In many areas of the world, the most common bacteria present is  methicillin-resistant Staphylococcus aureus . [ 1 ]  Rarely,  parasites  can cause abscesses; this is more common in the  developing world . [ 3 ]  Diagnosis of a skin abscess is usually made based on what it looks like and is confirmed by cutting it open. [ 1 ]   Ultrasound  imaging may be useful in cases in which the diagnosis is not clear. [ 1 ]  In abscesses around the  anus ,  computer tomography  (CT) may be important to look for deeper infection. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_353", "text": "Standard treatment for most skin or soft tissue abscesses is cutting it open and drainage. [ 4 ]  There appears to be some benefit from also using  antibiotics . [ 11 ]  A small amount of evidence supports not packing the cavity that remains with  gauze  after drainage. [ 1 ]  Closing this cavity right after draining it rather than leaving it open may speed healing without increasing the risk of the abscess returning. [ 12 ]  Sucking out the pus with a needle is often not sufficient. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_354", "text": "Skin abscesses are common and have become more common in recent years. [ 1 ]  Risk factors include  intravenous drug use , with rates reported as high as 65% among users. [ 2 ]  In 2005, 3.2 million people went to American emergency departments for abscesses. [ 5 ]  In Australia, around 13,000 people were hospitalized in 2008 with the condition. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_355", "text": "Abscesses may occur in any kind of tissue but most frequently within the skin surface (where they may be superficial pustules known as  boils  or deep skin abscesses), in the  lungs ,  brain ,  teeth , kidneys, and tonsils. Major complications may include spreading of the abscess material to adjacent or remote tissues, and extensive regional tissue death ( gangrene ). [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_356", "text": "The main symptoms and signs of a skin abscess are  redness , heat, swelling, pain, and loss of function. There may also be high temperature (fever) and chills. [ 15 ]  If superficial, abscesses may be fluctuant when  palpated ; this wave-like motion is caused by movement of the pus inside the abscess. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_357", "text": "An internal abscess is more difficult to identify and depend on the location of the abscess and the type of infection. General signs include pain in the affected area, a high temperature, and generally feeling unwell. [ 17 ] \nInternal abscesses rarely heal themselves, so prompt medical attention is indicated if such an abscess is suspected. An abscess can potentially be fatal depending on where it is located. [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_358", "text": "Risk factors for abscess formation include  intravenous drug use . [ 20 ]  Another possible risk factor is a prior history of disc  herniation  or other spinal abnormality, [ 21 ]  though this has not been proven."}
{"_id": "WikiPedia_Dermatology$$$corpus_359", "text": "Abscesses are caused by  bacterial infection , parasites, or foreign substances.\nBacterial infection is the most common cause, particularly  Staphylococcus aureus . The more invasive  methicillin-resistant Staphylococcus aureus  (MRSA) may also be a source of infection, though is much rarer. [ 22 ]  Among spinal subdural abscesses, methicillin-sensitive  Staphylococcus aureus  is the most common organism involved. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_360", "text": "Rarely  parasites  can cause abscesses and this is more common in the developing world. [ 3 ]  Specific parasites known to do this include  dracunculiasis  and  myiasis . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_361", "text": "Anorectal abscesses can be caused by non-specific obstruction and ensuing infection of the glandular crypts inside of the  anus  or  rectum . Other causes include  cancer , trauma, or  inflammatory bowel diseases .  [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_362", "text": "An  incisional abscess  is one that develops as a complication secondary to a  surgical incision . It presents as redness and warmth at the margins of the incision with purulent drainage from it. [ 24 ]  If the diagnosis is uncertain, the wound should be aspirated with a needle, with aspiration of pus confirming the diagnosis and availing for  Gram stain  and  bacterial culture . [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_363", "text": "Abscesses can form inside the body. The cause can be from trauma, surgery, an infection, or a pre-existing condition. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_364", "text": "An abscess is a  defensive reaction  of the tissue to prevent the spread of infectious materials to other parts of the body. [ 25 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_365", "text": "Organisms or foreign materials destroy the local  cells , which results in the release of  cytokines . The cytokines trigger an  inflammatory response , which draws large numbers of  white blood cells  to the area and increases the regional blood flow. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_366", "text": "The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_367", "text": "An abscess is a localized collection of pus (purulent inflammatory tissue) caused by suppuration buried in a tissue, an organ, or a confined space, lined by the pyogenic membrane. [ 28 ]   Ultrasound  imaging can help in a diagnosis. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_368", "text": "Abscesses may be classified as either  skin abscesses  or  internal abscesses . Skin abscesses are common; internal abscesses tend to be harder to diagnose, and more serious. [ 15 ]  Skin abscesses are also called cutaneous or subcutaneous abscesses. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_369", "text": "For those with a history of intravenous drug use, an  X-ray  is recommended before treatment to verify that no needle fragments are present. [ 20 ]  If there is also a fever present in this population,  infectious endocarditis  should be considered. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_370", "text": "Abscesses should be differentiated from  empyemas , which are accumulations of pus in a preexisting, rather than a newly formed, anatomical cavity. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_371", "text": "Other conditions that can cause similar symptoms include:  cellulitis , a  sebaceous cyst , and  necrotising fasciitis . [ 3 ]  Cellulitis typically also has an erythematous reaction, but does not confer any purulent drainage. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_372", "text": "The standard treatment for an uncomplicated skin or soft tissue abscess is the act of opening and draining. [ 4 ]  There does not appear to be any benefit from also using  antibiotics  in most cases. [ 1 ]  A small amount of evidence did not find a benefit from packing the abscess with gauze. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_373", "text": "The abscess should be inspected to identify if foreign objects are a cause, which may require their removal. If foreign objects are not the cause, incising and draining the abscess is standard treatment. [ 4 ] [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_374", "text": "Most people who have an uncomplicated skin abscess should not use antibiotics. [ 4 ]  Antibiotics in addition to standard incision and drainage is recommended in persons with severe abscesses, many sites of infection, rapid disease progression, the presence of  cellulitis , symptoms indicating bacterial illness throughout the body, or a health condition causing  immunosuppression . [ 1 ]  People who are very young or very old may also need antibiotics. [ 1 ]  If the abscess does not heal only with incision and drainage, or if the abscess is in a place that is difficult to drain such as the face, hands, or genitals, then antibiotics may be indicated. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_375", "text": "In those cases of abscess which do require antibiotic treatment,  Staphylococcus aureus  bacteria is a common cause and an anti-staphylococcus antibiotic such as  flucloxacillin  or  dicloxacillin  is used. The  Infectious Diseases Society of America  advises that the draining of an abscess is not enough to address community-acquired  methicillin-resistant  Staphylococcus aureus  (MRSA), and in those cases, traditional antibiotics may be ineffective. [ 1 ]  Alternative antibiotics effective against community-acquired MRSA often include  clindamycin ,  doxycycline ,  minocycline , and  trimethoprim-sulfamethoxazole . [ 1 ]  The  American College of Emergency Physicians  advises that typical cases of abscess from MRSA get no benefit from having antibiotic treatment in addition to the standard treatment. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_376", "text": "Culturing the wound  is not needed if standard follow-up care can be provided after the incision and drainage. [ 4 ]  Performing a wound culture is unnecessary because it rarely gives information which can be used to guide treatment. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_377", "text": "In North America, after drainage, an abscess cavity is usually packed, often with special iodoform-treated cloth. This is done to absorb and neutralize any remaining exudate as well as to promote draining and prevent premature closure. Prolonged draining is thought to promote healing. The hypothesis is that though the heart's pumping action can deliver immune and regenerative cells to the edge of an injury, an abscess is by definition a void in which no blood vessels are present. Packing is thought to provide a wicking action that continuously draws beneficial factors and cells from the body into the void that must be healed. Discharge is then absorbed by cutaneous bandages and further wicking promoted by changing these bandages regularly. However, evidence from emergency medicine literature reports that packing wounds after draining, especially smaller wounds, causes pain to the person and does not decrease the rate of recurrence, nor bring faster healing, or fewer physician visits. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_378", "text": "More recently, several North American hospitals have opted for less-invasive loop drainage over standard drainage and wound packing. In one study of 143 pediatric outcomes, a failure rate of 1.4% was reported in the loop group versus 10.5% in the packing group (P<.030), [ 34 ]  while a separate study reported a 5.5% failure rate among the loop group. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_379", "text": "Closing an abscess immediately after draining it appears to speed healing without increasing the risk of recurrence. [ 12 ]  This may not apply to anorectal abscesses as while they may heal faster, there may be a higher rate of recurrence than those left open. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_380", "text": "Appendiceal abscess are complications of appendicitis where there is an infected mass on the appendix. This condition is estimated to occur in 2\u201310% of appendicitis cases and is usually treated by surgical removal of the appendix (appendicectomy). [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_381", "text": "Even without treatment, skin abscesses rarely result in death, as they will naturally break through the skin. [ 3 ]  Other types of abscess are more dangerous. Brain abscesses may be fatal if untreated. When treated, the mortality rate reduces to 5\u201310%, but is higher if the abscess ruptures. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_382", "text": "Skin abscesses are common and have become more common in recent years. [ 1 ]  Risk factors include  intravenous drug use , with rates reported as high as 65% among users. [ 2 ]  In 2005, in the United States 3.2 million people went to the emergency department for an abscess. [ 5 ]  In Australia around 13,000 people were hospitalized in 2008 for the disease. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_383", "text": "The  Latin  medical  aphorism  \" ubi pus, ibi evacua \" expresses \"where there is pus, there evacuate it\" and is classical advice in the culture of Western medicine. [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_384", "text": "Needle exchange programmes  often administer or provide referrals for abscess treatment to  injection drug users  as part of a  harm reduction  public health strategy. [ 40 ] [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_385", "text": "An abscess is so called \"abscess\" because there is an  abscessus  (a going away or departure) of portions of the animal tissue from each other to make room for the suppurated matter lodged between them. [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_386", "text": "The word carbuncle is believed to have originated from the Latin:  carbunculus , originally a small coal; diminutive of  carbon- ,  carbo : charcoal or ember, but also a  carbuncle stone , \"precious stones of a red or fiery colour\", usually  garnets . [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_387", "text": "The following types of abscess are listed in the medical dictionary: [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_388", "text": "A  sacral dimple  (also termed  pilonidal dimple  or  spinal dimple ) [ 1 ]  is a small depression in the skin, located just above the  buttocks . [ 2 ] [ 3 ] [ 4 ] [ 5 ]  The name comes from the  sacrum , the bone at the end of the spine, over which the  dimples  are found.  A sacral dimple is defined as a midline dimple less than 5 mm in diameter and no further than 2.5 cm from the anus without associated visible drainage or hairy tuft. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_389", "text": "Sacral dimples are common  benign congenital anomalies  found in up to 4% of the population. [ 1 ] [ 5 ]   [ 6 ]  Other common benign congenital anomalies include supernumerary digits, third nipples and natal teeth.  [ 7 ]   Most sacral dimple cases are minor and do not relate to any underlying medical problem, [ 1 ] [ 3 ] [ 5 ]  but some can result from disease, notably  spina bifida . [ 3 ] [ 5 ]  If so, this is usually the  spina bifida occulta  form, which is the least serious kind. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_390", "text": "Simple dimples are typically small, measuring less than 5 mm in size. They are positioned in the midline, within 2.5 cm of the anus, and do not have any other associated skin abnormalities. Atypical dimples, on the other hand, have different characteristics. They are larger than 5 mm in size and are located within 25 mm of the anus. Atypical dimples can also be deep, positioned above the gluteal crease, located outside the midline, or occur as multiple dimples. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_391", "text": "Sacral dimples are often spotted in post-natal checks by  pediatricians , [ 3 ] [ 5 ]  who can check:"}
{"_id": "WikiPedia_Dermatology$$$corpus_392", "text": "For clinicians dealing with infants who have sacral dimples, it is essential to be aware of the characteristics of atypical dimples. Careful examinations should be conducted to identify any atypical features in order to appropriately manage and refer these cases in clinical practice.\nUnderstanding the distinction between simple and atypical sacral dimples is crucial for pediatric practitioners because of the potential association with occult spinal dysraphism (OSD). The pooled incidence of OSD in patients with an atypical dimple, as observed in several studies, was significantly higher (8.8%) compared to patients with a simple dimple (0.6%). Given this increased risk, infants with atypical dimples require further evaluation through radiologic imaging and early referrals to neurosurgical specialists. Prompt identification and appropriate management of atypical dimples can help ensure timely intervention and improved outcomes for infants with potential underlying spinal abnormalities.  [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_393", "text": "A sacral dimple could also indicate a  kidney  problem of a kind that can be checked with an  ultrasound . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_394", "text": "Sacral dimples were selected for one study by the  ICD9CM  code of 685.1. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_395", "text": "Skin trauma  is serious and altering physical injury experienced by the  skin  or multiple layers of  epithelial tissues . [ 1 ]   This can be in the form of cuts, burns, sickness or other injury."}
{"_id": "WikiPedia_Dermatology$$$corpus_396", "text": "A  subcutaneous abscess  is an  abscess  located in the  subcutaneous tissue  (also hypodermis). The abscess is formed due to a  hypodermal infection  by a  bacterium , a  fungus  or a  parasite . Typically, this kind of abscess needs drainage, usually for a minimum of 24 hours, by means of gauze packing or a  Penrose drain . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_397", "text": "This cutaneous condition article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_398", "text": "This template is used to identify a  dermatology  stub. It uses {{ asbox }}, which is a meta-template designed to ease the process of creating and maintaining stub templates."}
{"_id": "WikiPedia_Dermatology$$$corpus_399", "text": "Typing  {{Dermatology-stub}}  produces the message shown at the beginning, and adds the article to the following category:"}
{"_id": "WikiPedia_Dermatology$$$corpus_400", "text": "This is a  stub template . A brief explanation of these templates follows; for full details please consult  Wikipedia:Stub ."}
{"_id": "WikiPedia_Dermatology$$$corpus_401", "text": "A stub is an article containing only a few sentences of text which is too short to provide encyclopedic coverage of a subject."}
{"_id": "WikiPedia_Dermatology$$$corpus_402", "text": "Further information can be found at:"}
{"_id": "WikiPedia_Dermatology$$$corpus_403", "text": "New stub templates and categories (collectively \"stub types\") should not be created without prior proposal at  Wikipedia:WikiProject Stub sorting/Proposals . This allows for the proper coordination of all stub types across Wikipedia, and for the checking of any new stub type for possible problems prior to its creation."}
{"_id": "WikiPedia_Dermatology$$$corpus_404", "text": "Acantholysis  is the loss of  intercellular connections , such as  desmosomes , resulting in loss of cohesion between  keratinocytes , [ 1 ]  seen in diseases such as  pemphigus vulgaris . [ 2 ]  It is absent in  bullous pemphigoid , making it useful for  differential diagnosis ."}
{"_id": "WikiPedia_Dermatology$$$corpus_405", "text": "This  histological  feature is also seen in  herpes simplex infections  (HSV 1 and 2) and  varicella zoster infections  (chicken pox and shingles)."}
{"_id": "WikiPedia_Dermatology$$$corpus_406", "text": "Acrodermatitis  /ac\u00b7ro\u00b7der\u00b7ma\u00b7ti\u00b7tis/ [ 1 ]   is a  childhood  form of  dermatitis  selectively affecting the  hands  and  feet  and may be accompanied by mild  symptoms  of  fever  and  malaise . It may also be associated with  hepatitis B  and other  viral   infections . [ 2 ] \nThe lesions appear as small coppery-red, flat-topped firm papules that appear in crops and sometimes in long linear strings, often symmetric.\nIt is a  diffuse   chronic  skin disease usually confined to the  limbs , seen mainly in  women  in  Northern ,  Central , and  Eastern   Europe , and characterized initially by an  erythematous ,  oedematous ,  pruritic  phase followed by  sclerosis  and  atrophy . It is caused by infection with  Borrelia burgdorferi . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_407", "text": "Alloknesis  is an abnormal sensory state where stimuli that do not ordinarily evoke  itch  (such as the light touch of clothing) cause itch. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_408", "text": "Autoeczematization  refers to the development of widespread  dermatitis  or dermatitis distant from a local inflammatory focus. [ 1 ] :\u200a81\u200a \nAutosensitization (autoeczematization or \"id\" reaction) refers to an acute, pruritic papulovesicular eruption that develops at cutaneous sites distant from a primary focus and is unrelated to the inciting cause of the primary inflammation. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_409", "text": "The pathogenesis is not fully understood. One hypothesis is that autoeczematization is due to hyperirritability of the skin induced by immunologic or nonimmunologic stimuli and mediated by epidermal cytokines. Histologic findings are nonspecific and include spongiosis and a dermal lymphohistiocytic infiltrate with eosinophils. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_410", "text": "When skin is  blanched , it takes on a whitish appearance as  blood flow  to the region is prevented.  This occurs during (and is the basis of the physiologic test known as)  diascopy ."}
{"_id": "WikiPedia_Dermatology$$$corpus_411", "text": "Blanching of the fingers is also one of the most clinically evident signs of  Raynaud's phenomenon . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_412", "text": "Blanching is prevented in  gangrene  as the red blood corpuscles are extravasated and impart red color to the gangrenous part."}
{"_id": "WikiPedia_Dermatology$$$corpus_413", "text": "Chromonychia  is an  abnormality  in color of the substance or surface of the  nail plate  or subungual tissues. [ 1 ] :\u200a658"}
{"_id": "WikiPedia_Dermatology$$$corpus_414", "text": "Chromonychia can be induced by  antineoplastic  drugs with few distinct forms, the most frequently seen is  melanonychia . [ 2 ]  Although a few  cytostatics  may cause these changes, the drugs most commonly involved are  adriamycin ,  cyclophosphamide  and  vincristine , or in polychemotherapy [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_415", "text": "Also chromonychia is associated with  AIDS . A significant association (p<0.05) was found between chromonychia and  CD4  counts of below 200 per cubic millimeter. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_416", "text": "Clinical, Cosmetic and Investigational Dermatology  is a  peer-reviewed   medical journal  covering research in  dermatology . The journal was established in 2008 and is published by  Dove Medical Press ."}
{"_id": "WikiPedia_Dermatology$$$corpus_417", "text": "The  cortex  of the hair shaft is located between the  hair cuticle  and  medulla  and is the thickest hair layer. It contains most of the hair's pigment, giving the hair its color. The major pigment in the cortex is  melanin , which is also found in skin. The distribution of this pigment varies from animal to animal and person to person. In humans, the melanin is primarily denser nearer the  cuticle  whereas in animals, melanin is primarily denser nearer the  medulla . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_418", "text": "The  hair cuticle  is the outermost part of the  hair shaft . [ 1 ]  It is formed from dead  cells , overlapping in layers, which form scales that strengthen and protect the hair shaft. [ 2 ] [ 3 ]  These layers are formed of keratin proteins. [ 4 ]  The hair cuticle is also known to contain  anteiso-18-methyleicosanoic acid  which contribute to the hydrophobic properties of hair.  [ 5 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_419", "text": "While the  cuticle  is the outermost layer, it is not responsible for the  color of the hair .  Melanin  is the  pigment  that gives hair its color and is found in the  cortex . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_420", "text": "A  dermal bone  or  investing bone   or  membrane bone  is a bony structure derived from  intramembranous ossification  forming components of the  vertebrate   skeleton , including much of the  skull ,  jaws ,  gill  covers, shoulder girdle,  fin  rays ( lepidotrichia ), and the shells of  turtles  and  armadillos .  In contrast to  endochondral  bone, dermal bone does not form from cartilage that then calcifies, and it is often ornamented. [ 1 ]  Dermal bone is formed within the  dermis  and grows by accretion only \u2013 the outer portion of the bone is deposited by  osteoblasts ."}
{"_id": "WikiPedia_Dermatology$$$corpus_421", "text": "The function of some dermal bone is conserved throughout vertebrates, although there is variation in shape and in the number of bones in the  skull roof  and postcranial structures. In  bony fish , dermal bone is found in the fin  rays  and scales.  A special example of dermal bone is the  clavicle . Some of the dermal bone functions regard biomechanical aspects such as protection against predators. [ 2 ] [ 3 ] [ 4 ]  The dermal bones are also argued to be involved in ecophysiological implications such as the heat transfers between the body and the surrounding environment when basking (seen in crocodilians)  [ 5 ]  as well as in bone respiratory acidosis buffering during prolonged apnea (seen in both crocodilians and turtles). [ 6 ] [ 7 ]  These ecophysiological functions rely on the set-up of a blood vessel network within and straight above the dermal bones.  [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_422", "text": "This  human musculoskeletal system  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_423", "text": "This  vertebrate anatomy \u2013related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_424", "text": "Dermaordinology  (from Ancient Greek \u03b4\u03ad\u03c1\u03bc\u03b1 (derma) \u201cskin\u201d, Latin ordin\u0101re, \u201cto put in order\u201d and Ancient Greek \u03bb\u03cc\u03b3\u03bf\u03c2, \u201cknowledge/study\u201d) is a specialised field in  cosmetics  and  medicine  aimed at finding the optimal permanent solution to superficial  skin  defects, such as  hypertrichosis ,  hirsutism , couperosis,  acne ,  milia  and  fibromata . [ 1 ]  Combining findings from  endocrinology  and  dermatology , dermaordinology serves as the basis for the development of innovative micro-surgical methods to safely and painlessly remove these defects without damaging the surrounding skin tissue. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_425", "text": "DermAtlas  is an  open-access   website  devoted to  dermatology  that is hosted by  Johns Hopkins University 's Bernard A. Cohen and Christoph U. Lehmann.  Its goal is to build a large-high-quality dermatologic  atlas , a  database  of  images  of  skin conditions , and it encourages its users to submit their dermatology images and links for inclusion."}
{"_id": "WikiPedia_Dermatology$$$corpus_426", "text": "It is edited in a collaborative fashion by  physicians  around the globe and includes an online Dermatology Quiz, [ 1 ]  that allows anyone to test their dermatology knowledge."}
{"_id": "WikiPedia_Dermatology$$$corpus_427", "text": "The database currently includes over 10,500 images and consists of both clinical images and  histological  images. Great emphasis is placed on dermatological conditions in pediatric patients."}
{"_id": "WikiPedia_Dermatology$$$corpus_428", "text": "The  dermoepidermal junction  or  dermal-epidermal junction  ( DEJ ) is the interface between the  epidermal  and the  dermal  layers of the skin. The  basal  cells of the epidermis connect to the  basement membrane  by the anchoring filaments of  hemidesmosomes ; the cells of the  papillary layer  of the dermis are attached to the basement membrane by  anchoring fibrils , which consist of  type VII collagen . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_429", "text": "Diascopy  is a test for  blanchability  performed by applying pressure with a finger or glass slide and observing color changes. [ 2 ] [ 3 ] [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_430", "text": "It is used to determine whether a  lesion  is  vascular  ( inflammatory  or  congenital ), nonvascular ( nevus ), or  hemorrhagic  ( petechia  or  purpura ). Hemorrhagic lesions and nonvascular lesions do not  blanch  (\"negative diascopy\"); inflammatory lesions do (\"positive diascopy\"). Diascopy is sometimes used to identify  sarcoid  skin lesions, which, when tested, turn an apple jelly color."}
{"_id": "WikiPedia_Dermatology$$$corpus_431", "text": "The  Eczema Area and Severity Index  ( EASI ) is a validated tool for the measurement of severity of  atopic dermatitis . It ranges from 0 (no disease) to 72 (maximal disease). [ 1 ] [ 2 ]  The EASI was developed in 1998 by modifying the  Psoriasis Area and Severity Index  (PASI), a widely accepted scoring system for psoriasis. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_432", "text": "EASI is one of the core outcome instruments recommended to be included in all  clinical trials  on atopic dermatitis by the Harmonising Outcome Measures for Eczema (HOME) group. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_433", "text": "Similar to the PASI, the EASI divides the body into four regions. The head and neck (H) are assigned 10% of the body surface area, the upper limbs (U) 20%, the trunk (T) 30%, and lower limbs (L) 40%. [ 5 ]  The area of involvement is determined visually for each region, and the percentage of skin affected is converted into an area score as follows:"}
{"_id": "WikiPedia_Dermatology$$$corpus_434", "text": "A severity score is then calculated for each region. The total severity score for a region is equal to the sum of the intensity scores for four clinical signs,  erythema ,  edema / papulation ,  excoriation , and  lichenification . The average intensity for each sign is assigned a score of 0 to 3, with 0 being none and 3 being severe."}
{"_id": "WikiPedia_Dermatology$$$corpus_435", "text": "The region score is then calculated by multiplying the severity score for each region by the corresponding area score and area multiplier (0.1 for head, 0.2 for upper limbs, 0.3 for trunk, and 0.4 for lower limbs)."}
{"_id": "WikiPedia_Dermatology$$$corpus_436", "text": "The final EASI score is the sum of the four regional scores."}
{"_id": "WikiPedia_Dermatology$$$corpus_437", "text": "Evanescent   skin lesions , like  wheals , are those that last for less than 24 hours before resolving. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_438", "text": "Exocytosis  is infiltration of the  epidermis  by inflammatory or circulating  blood cells . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_439", "text": "Film-forming agents  are a group of  chemicals  that leave a  pliable ,  cohesive , and continuous covering over the hair or skin when applied to their surface. This  film  has strong  hydrophilic  properties and leaves a smooth feel on skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_440", "text": "Film-forming agents include  polyvinylpyrrolidone  (PVP),  acrylates ,  acrylamides , and  copolymers ."}
{"_id": "WikiPedia_Dermatology$$$corpus_441", "text": "They are commonly found as ingredients of  cosmetics , particular  hair-care  products, but also  moisturizers  and other  skin-care  products."}
{"_id": "WikiPedia_Dermatology$$$corpus_442", "text": "Film-forming agents can be skin sensitizers for some individuals. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_443", "text": "Ferdinando Gianotti  (1920 \u2013 1984) was an Italian pediatric dermatologist. He is known for describing Gianotti-Crosti syndrome which was named after him. Gianotti published over 190 clinical and experimental studies. [ 1 ] [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_444", "text": "This biography related to medicine in Italy is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_445", "text": "Emma Guttman-Yassky  is the System Chair of the Department of Dermatology and Waldman professor of  dermatology  and  immunology  at the  Icahn School of Medicine at Mount Sinai  in  New York . She is also director of its center for excellence in  eczema , its occupational dermatitis clinic, and its inflammatory skin disease laboratory. [ 1 ] [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_446", "text": "According to  Google Scholar  she has an  h -index  of 106. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_447", "text": "This biography of an American academic is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_448", "text": "The  hair disc  is a  receptor complex  found in hairy  skin . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_449", "text": "The  hair matrix , or simply  matrix , produces the actual  hair shaft  as well as the  inner  and  outer root sheaths  of  hair . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_450", "text": "A  hangnail  is a small, torn piece of  skin  or nail next to a  fingernail  or  toenail . [ 1 ]  Hangnails are typically caused by having  dry skin , trauma to the fingers, or  ingrown nails . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_451", "text": "Hangnails can become infected and cause  paronychia , a type of skin infection that causes inflammation around the nails.  [ 2 ]  Hangnails may also cause pain if pulled as they may remain attached to living skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_452", "text": "Daily use of  hand lotion  (or hand cream) or  cuticle  oil may help prevent the formation of hangnails. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_453", "text": "For home treatment, the  American Academy of Dermatology  recommends clipping the loose piece of skin with a clean  nail clipper  or  nail scissors , and applying  over-the-counter   antibiotic ointment  if the area appears  inflamed . Persistent hangnails should be evaluated by a  physician . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_454", "text": "Huxley's layer  is the second layer of the  inner root sheath  of the  hair  and consists of one or two layers of horny, flattened, nucleated cells. It lies between  Henle's layer  and the  cuticle . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_455", "text": "The layer is named after English biologist  Thomas Henry Huxley . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_456", "text": "Hypergranulosis  is an increased thickness of the  stratum granulosum . It is seen in skin diseases with epidermal  hyperplasia  and  orthokeratotic hyperkeratosis . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_457", "text": "The  inner root sheath  or  internal root sheath  of the hair follicle is located between the  outer root sheath  and the hair shaft. [ 1 ]  It is made of three layers:  Henle's layer ,  Huxley's layer , and the  cuticle . [ 2 ]  The inner root sheaf serves to protect growing hair.  [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_458", "text": "Henle's layer is the outermost layer of the inner root sheath, consisting of a single row of  cubical  cells.  During his original examination, Henle believed the layer lacked  nuclei  because he viewed it at a level where it had already  cornified . [ 3 ]  Huxley's layer is in the middle, made up of approximately two rows of flattened cells with granular  protoplasm . The cuticle of the root sheath is in the center, continuous with the outermost layer of the hair fiber. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_459", "text": "Kraissl's lines  are a set of anatomical  skin lines . They differ from  Langer's lines  in that unlike Langer's lines, which are defined in term of  collagen  orientation, Kraissl's lines are the lines of maximum  skin tension . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_460", "text": "Whereas Langer's lines were defined in  cadavers , [ 2 ]  Kraissl's lines have been defined in living individuals. Also, the method [ which? ]  used to identify Kraissl's lines is not traumatic."}
{"_id": "WikiPedia_Dermatology$$$corpus_461", "text": "The  lamina densa  is a component of the  basement membrane  zone between the  epidermis  and dermis of the skin, and is an electron-dense zone between the  lamina lucida  and dermis, synthesized by the basal cells of the epidermis, and composed of 1) type IV collagen, 2) anchoring fibrils made of type VII collagen, and 3) dermal microfibrils. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_462", "text": "The  lamina lucida  is a component of the  basement membrane  which is found between the epithelium and underlying connective tissue (e.g.,  epidermis  and dermis of the skin).  It is a roughly 40 nanometre wide electron-lucent zone between the plasma membrane of the basal cells and the (electron-dense)  lamina densa  of the basement membrane. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_463", "text": "Similarly, electron-lucent and electron-dense zones can be seen between enamel of teeth and the junctional epithelium.  The electron-lucent zone is adjacent to the cells of the junctional epithelium and might be considered a continuation of the lamina lucida as both are seen to harbour  hemidesmosomes .  However, unlike the lamina densa, the electron-dense zone adjacent to enamel show no signs of hemidesmosomes. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_464", "text": "Some theorize that the lamina lucida is an artifact created when preparing the tissue, and that the lamina lucida is therefore equal to the lamina densa  in vivo . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_465", "text": "The  leishmanin skin test  (LST), also called  Montenegro test , is an  immunologic   skin test  that measures delayed-type  hypersensitivity  to  Leishmania  antigen. [ 1 ] [ 2 ]  It can be used for diagnosis of  cutaneous leishmaniasis . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_466", "text": "It was first described by Brazilian physician Jo\u00e3o Montenegro in 1926. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_467", "text": "Livedo  refers to a form of skin discoloration. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_468", "text": "Svend Lomholt  (18 October 1888 \u2013 17 July 1949) was a  Danish   veterinarian  and  dermatologist ."}
{"_id": "WikiPedia_Dermatology$$$corpus_469", "text": "He published a number of journals of his works, in 1924, he published a report at The University Institute for Theoretical Physics and Pathological Institute, Municipal Hospital, in Copenhagen about the  metal  composition in rodents and other creatures."}
{"_id": "WikiPedia_Dermatology$$$corpus_470", "text": "He was married to Marie Kirstine Siegumfeldt until her death in 1920."}
{"_id": "WikiPedia_Dermatology$$$corpus_471", "text": "His daughter  Kirsten Auken  (1913-1968) was a Danish politician as are his grandchildren  Margrete Auken  and  Svend Auken"}
{"_id": "WikiPedia_Dermatology$$$corpus_472", "text": "."}
{"_id": "WikiPedia_Dermatology$$$corpus_473", "text": "This article about a Danish scientist is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_474", "text": "The  medulla  is the innermost layer of the  hair shaft .\nThis nearly invisible layer is the most soft and fragile, and serves as the pith or marrow of the hair. Some  mammals  don't have a medulla in their hair. The presence or absence of this layer and the characteristics of the medulla can aid taxonomists in identifying what taxa a hair comes from. Characteristics include whether the medulla contains air pockets as well as the  histology  of the medulla.  [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_475", "text": "Scientists are still uncertain about the exact  role  of the medulla, but they speculate that it is primarily an extension that is more prominent in  depigmented  (grey or white) hair\n. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_476", "text": "List of distinct cell types in the adult human body"}
{"_id": "WikiPedia_Dermatology$$$corpus_477", "text": "In  dermatology , a  mole map  is a medical record which records an image and the location of lesions and/or  moles , or dark spots on the human body.  Such a record is useful for diagnosis of  cancer   a priori  or as a baseline which can be compared against later images to determine when there has been a visual change which may indicate cancer."}
{"_id": "WikiPedia_Dermatology$$$corpus_478", "text": "The  outer root sheath  or  external root sheath  of the  hair follicle  encloses the  inner root sheath  and  hair shaft . [ 1 ] \nIt is continuous with the  basal layer  of the interfollicular  epidermis (skin) ."}
{"_id": "WikiPedia_Dermatology$$$corpus_479", "text": "The  panniculus adiposus  is the fatty layer of the  subcutaneous tissues , superficial to a deeper vestigial layer of muscle, the  panniculus carnosus . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_480", "text": "It includes structures that are considered  fascia  by some sources but not by others. Some examples include the  fascia of Camper  and the  superficial cervical fascia . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_481", "text": "A group of disorders of inflammation of this layer is called  panniculitis ."}
{"_id": "WikiPedia_Dermatology$$$corpus_482", "text": "This  anatomy  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_483", "text": "Pigment Cell & Melanoma Research  is a  peer-reviewed   scientific journal  of  dermatology . It is the official journal of the  International Federation of Pigment Cell Societies  (IFPCS) and the  Society for Melanoma Research  (SMR). In 2014, it ranked the 3rd most cited journal of dermatology, out of 62."}
{"_id": "WikiPedia_Dermatology$$$corpus_484", "text": "Pigment Cell & Melanoma Research  is indexed in:"}
{"_id": "WikiPedia_Dermatology$$$corpus_485", "text": "This article about an  oncology   journal  is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_486", "text": "A  scutulum  is a yellow, perifollicular, saucerlike or cup-shaped crust with a cheesy odor, composed of dense mats of mycelia and epithelial debris. Scutula often occur on the scalp and are characteristic of  favus . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_487", "text": "A  sebaceous filament  is a tiny collection of  sebum  and  dead skin cells  around a  hair follicle , which usually takes the form of a small, yellow to  off-white   hair -like strand when expressed from the  skin . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_488", "text": "These filaments are naturally occurring, and are especially prominent on the  nose . [ 3 ] [ 2 ] :\u200a64\u200a  They are typical among those with naturally oily skin and large  pores , even if those individuals have ceased to produce  acne . [ 2 ] :\u200a64\u200a  They are not a sign of  infection  or any other ailment including acne, [ 2 ] :\u200a16\u200a  and are commonly mistaken for, though cannot form, [ 2 ] :\u200a26\u200a   blackheads . Expression, or squeezing, is discouraged as sebaceous filaments are a natural part of healthy human skin. As such, squeezing can lead to unintentional unnecessary harm, such as  scarring  or  inflammation . [ citation needed ]  They help to channel the flow of sebum within a given pore, allowing it to seep gradually to the surface. In 1979, David A. Whiting described them in a review in the  Western Journal of Medicine  as \"a loose, porous mass of  horned  detritus\". [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_489", "text": "Sensitive skin  is a skin condition in which  skin  is prone to  itching  and irritation experienced as a subjective sensation such as when using  cosmetics  and  toiletries .  When questioned, over 50% of women in the UK and US, and 38% of men, report that they have sensitive skin. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_490", "text": "Serpiginous , first known to be used in the 15th century, is a term from Latin  serpere  (\u201cto creep\u201d), usually referring to a creeping, snakelike or slowly progressive skin disease. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_491", "text": "It is used to describe the rash in  cutaneous larvae migrans , [ 3 ]   erythema annulare centrifugum , [ 4 ]   purpura annularis telangiectoides ,  ringworm , [ 5 ]   balanitis circinata , [ 6 ]  and some cases of  bullous pemphigoid . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_492", "text": "It is also used to describe  serpiginous choroiditis , a rare eye condition in which irregularly shaped (serpiginous) lesions are seen in two layers of the eye surface (the  choriocapillaris  and the retinal pigment epithelium). [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_493", "text": "Skin appendages  (or  adnexa of skin ) are anatomical skin-associated structures that serve a particular function including sensation, contractility, lubrication and heat loss in animals. In humans, some of the more common skin appendages are  hairs  (sensation, heat loss, filter for breathing, protection),  arrector pilli  (smooth muscles that pull hairs straight),  sebaceous glands  (secrete sebum onto hair follicle, which oils the hair),  sweat glands  (can secrete sweat with strong odour ( apocrine ) or with a faint odour ( merocrine  or eccrine), and  nails  (protection)."}
{"_id": "WikiPedia_Dermatology$$$corpus_494", "text": "Skin appendages are derived from the  skin , and are usually adjacent to it. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_495", "text": "Types of appendages include hair, glands, and nails."}
{"_id": "WikiPedia_Dermatology$$$corpus_496", "text": "Skin pop scars  are a cutaneous condition caused by intravenous drug abuse. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_497", "text": "Superficial X-rays  are low-energy  X-rays  that do not penetrate very far before they are absorbed. They are produced by  X-ray tubes  operating at  voltages  in the 10\u2013100\u00a0 kV  range, and therefore have peak energies in the 10\u2013100\u00a0 keV  range. [ 1 ]  The  Maximar-100  was a widely-adopted superficial radiation therapy unit."}
{"_id": "WikiPedia_Dermatology$$$corpus_498", "text": "Precise naming and definitions of energy ranges may vary, and X-rays at the lower end of this range may also be known as  Grenz rays . [ 2 ]  They are useful in  radiation therapy  for the treatment of various benign or malignant  skin  problems, including  skin cancer  and severe  eczema . [ 3 ] [ 4 ]  They have a useful depth of up to 5\u00a0mm. [ 2 ] [ 5 ]  In some locations, orthovoltage treatment is being replaced by  electron therapy  or  brachytherapy . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_499", "text": "As well as  teletherapy , X-rays in this energy range (and the low  orthovoltage  range) are used for  imaging  patients, to analyse materials and objects in  industrial radiography  and for  crystallography ."}
{"_id": "WikiPedia_Dermatology$$$corpus_500", "text": "In  dermatology , a  target lesion  or  bull's-eye lesion , named for its resemblance to the  bull's-eye  of a  shooting target , is a  rash  with central clearing. It occurs in several diseases, as follows:"}
{"_id": "WikiPedia_Dermatology$$$corpus_501", "text": "Such lesions may be  idiopathic  or may follow  infections ,  drug therapy , or  immunodeficiency ."}
{"_id": "WikiPedia_Dermatology$$$corpus_502", "text": "Target lesion consists of three zones\u00a0:"}
{"_id": "WikiPedia_Dermatology$$$corpus_503", "text": "the free dictionary\u00a0: medical dictionary  [1]"}
{"_id": "WikiPedia_Dermatology$$$corpus_504", "text": "In  medicine , a  targetoid  object is a structure or  lesion  that has the appearance of a  target  or is target-like."}
{"_id": "WikiPedia_Dermatology$$$corpus_505", "text": "Targetoid lesions are distinguished by a concentric ring-like appearance that resembles a target or bull's-eye. Classic target lesions with three concentric zones are commonly associated with  erythema multiforme  (a type of skin rash), while targetoid lesions with only two zones can appear in various dermatological conditions. [ 1 ] [ 2 ]  Such lesions can be critical in diagnosing numerous skin disorders, ranging from infectious and inflammatory diseases to drug reactions and some  neoplasms . [ 3 ]  Recognizing differences in morphology, distribution, and symptoms of targetoid lesions is important for accurate diagnosis and management of these distinctive skin lesions. [ 1 ]  The differential diagnosis of targetoid lesions is broad and includes conditions such as  hives  (urticaria), fixed  drug eruptions , and  lupus erythematosus . [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_506", "text": "The concept of targetoid structures applies not only to macroscopic skin lesions but also to microscopic features. For instance, the  Michaelis-Gutmann body , a characteristic histological finding in  malakoplakia , exhibits a targetoid or \"bull's-eye\" appearance under light microscopy. [ 4 ] [ 5 ]  These intracellular and extracellular inclusions, composed of mineralized bacterial debris, illustrate how the targetoid pattern can manifest at both clinical and histopathological levels. [ 4 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_507", "text": "Michaelis-Gutmann bodies are generally 1\u201310 \u03bcm in size and appear as laminated or targetoid basophilic inclusions containing iron and calcium salts. [ 5 ]  Under light microscopy, they often exhibit a concentric \"bird's-eye\" or \"owl-eye\" (targetoid) appearance due to a central  hydroxyapatite  core. [ 4 ] [ 7 ]  This targetoid structure results from mineralization of the matrix cores and the peripheral accumulation of phospholipids and microvesicles representing incompletely digested debris. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_508", "text": "Examples of targetoid lesions include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_509", "text": "Vacuolization  is the formation of  vacuoles  or vacuole-like structures, within or adjacent to cells.  Perinuclear  vacuolization of  epidermal   keratinocytes  is most likely inconsequential when not observed  in combination with other pathologic findings. In  dermatopathology  \"vacuolization\" often refers specifically to vacuoles in the  basal cell-basement membrane  zone area, where it is an unspecific sign of disease. [ 1 ]  It may be a sign of for example  vacuolar interface dermatitis , which in turn has many causes."}
{"_id": "WikiPedia_Dermatology$$$corpus_510", "text": "It is one of the components of  koilocytosis , which may be present in potentially pre- cancerous cervical ,  oral  and  anal  lesions. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_511", "text": "Many  skin conditions  affect the human  integumentary system \u2014the  organ system  covering the entire surface of the  body  and composed of  skin ,  hair ,  nails , and related  muscle  and  glands . [ 1 ]  The major function of this system is as a barrier against the external environment. [ 2 ]  The skin weighs an average of four kilograms, covers an area of two square metres, and is made of three distinct layers: the  epidermis ,  dermis , and  subcutaneous tissue . [ 1 ]  The two main types of human skin are:  glabrous skin , the hairless skin on the palms and soles (also referred to as the \"palmoplantar\" surfaces), and hair-bearing skin. [ 3 ]  Within the latter type, the hairs occur in structures called  pilosebaceous units , each with  hair follicle ,  sebaceous gland , and associated  arrector pili  muscle. [ 4 ]   In the embryo , the epidermis, hair, and glands form from the  ectoderm , which is chemically influenced by the underlying  mesoderm  that forms the dermis and subcutaneous tissues. [ 5 ] [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_512", "text": "The epidermis is the most superficial layer of skin, a  squamous epithelium  with several  strata : the  stratum corneum ,  stratum lucidum ,  stratum granulosum ,  stratum spinosum , and  stratum basale . [ 8 ]  Nourishment is provided to these layers by  diffusion  from the dermis since the epidermis is without direct blood supply.  The epidermis contains four cell types:  keratinocytes ,  melanocytes ,  Langerhans cells , and  Merkel cells . Of these, keratinocytes are the major component, constituting roughly 95 percent of the epidermis. [ 3 ]  This stratified squamous epithelium is maintained by cell division within the stratum basale, in which differentiating cells slowly displace outwards through the stratum spinosum to the stratum corneum, where cells are continually shed from the surface. [ 3 ]  In normal skin, the rate of production equals the rate of loss; about two weeks are needed for a cell to migrate from the basal cell layer to the top of the granular cell layer, and an additional two weeks to cross the stratum corneum. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_513", "text": "The dermis is the layer of skin between the epidermis and subcutaneous tissue, and comprises two sections, the  papillary dermis  and the  reticular dermis . [ 10 ]  The superficial papillary dermis  interdigitates  with the overlying  rete ridges  of the epidermis, between which the two layers interact through the basement membrane zone. [ 10 ]  Structural components of the dermis are  collagen ,  elastic fibers , and  ground substance . [ 10 ]  Within these components are the pilosebaceous units, arrector pili muscles, and the  eccrine  and  apocrine glands . [ 8 ]  The dermis contains two vascular networks that run parallel to the skin surface\u2014one superficial and one deep plexus\u2014which are connected by vertical communicating vessels. [ 8 ] [ 11 ]  The function of blood vessels within the dermis is fourfold: to supply nutrition, to regulate temperature, to modulate inflammation, and to participate in wound healing. [ 12 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_514", "text": "The subcutaneous tissue is a layer of fat between the dermis and underlying  fascia . [ 14 ]  This tissue may be further divided into two components, the actual fatty layer, or  panniculus adiposus , and a deeper vestigial layer of muscle, the  panniculus carnosus . [ 3 ]  The main cellular component of this tissue is the  adipocyte , or fat cell. [ 14 ]  The structure of this tissue is composed of septal (i.e. linear strands) and  lobular  compartments, which differ in microscopic appearance. [ 8 ]  Functionally, the subcutaneous fat insulates the body, absorbs trauma, and serves as a reserve energy source. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_515", "text": "Conditions of the human integumentary system constitute a broad spectrum of diseases, also known as  dermatoses , as well as many nonpathologic states (like, in certain circumstances,  melanonychia  and  racquet nails ). [ 15 ] [ 16 ]  While only a small number of skin diseases account for most visits to the  physician , thousands of skin conditions have been described. [ 14 ]  Classification of these conditions often presents many  nosological  challenges, since underlying etiologies and pathogenetics are often not known. [ 17 ] [ 18 ]  Therefore, most current textbooks present a classification based on location (for example,  conditions of the mucous membrane ), morphology ( chronic blistering conditions ), etiology ( skin conditions resulting from physical factors ), and so on. [ 19 ] [ 20 ]  Clinically, the diagnosis of any particular skin condition is made by gathering pertinent information regarding the presenting  skin lesion (s), including the location (such as arms, head, legs), symptoms ( pruritus , pain), duration (acute or chronic), arrangement (solitary, generalized, annular, linear), morphology ( macules ,  papules ,  vesicles ), and  color  (red, blue, brown, black, white, yellow). [ 21 ]  Diagnosis of many conditions often also requires a  skin biopsy  which yields  histologic  information [ 22 ] [ 23 ]  that can be correlated with the clinical presentation and any laboratory data. [ 24 ] [ 25 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_516", "text": "Acneiform eruptions  are caused by changes in the  pilosebaceous unit . [ 27 ] [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_517", "text": "Autoinflammatory syndromes  are a group of inherited disorders characterized by bouts of  inflammatory   skin lesions  and periodic  fevers . [ 29 ] [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_518", "text": "Chronic blistering cutaneous conditions have a prolonged course and present with  vesicles  and  bullae . [ 31 ] [ 32 ] [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_519", "text": "Conditions of the  mucous membranes  involve the moist linings of the eyes, nose, mouth, genitals, and anus. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_520", "text": "Conditions of the  skin appendages  are those affecting the glands of the skin,  hair ,  nails , and  arrector pili  muscles. [ 1 ] [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_521", "text": "Conditions of the  subcutaneous fat  are those affecting the layer of  adipose tissue  that lies between the  dermis  and underlying  fascia . [ 36 ] [ 37 ] [ 38 ] [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_522", "text": "Cutaneous congenital anomalies are a diverse group of disorders that result from faulty  morphogenesis , the biological process that forms the shape of a  human body . [ 35 ] [ 40 ] [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_523", "text": "Connective tissue diseases are caused by a complex array of  autoimmune  responses that target or affect  collagen  or  ground substance . [ 35 ] [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_524", "text": "Abnormalities of dermal fibrous and elastic tissue are caused by problems in the regulation of  collagen  synthesis or degradation. [ 35 ] [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_525", "text": "Dermal and subcutaneous growths result from (1) reactive or  neoplastic  proliferation of cellular components of the  dermis  or  subcutaneous tissue , or (2) neoplasms invading or aberrantly present in the dermis. [ 1 ] [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_526", "text": "Dermatitis  is a general term for \" inflammation  of the skin\". [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_527", "text": "Atopic dermatitis  is a  chronic   dermatitis  associated with a hereditary tendency to develop  allergies  to food and inhalant substances. [ 46 ] [ 47 ] [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_528", "text": "Contact dermatitis  is caused by certain substances coming in contact with the skin. [ 49 ] [ 50 ] [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_529", "text": "Eczema  refers to a broad range of conditions that begin as  spongiotic   dermatitis  and may progress to a  lichenified  stage. [ 26 ] [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_530", "text": "Pustular dermatitis is an  inflammation  of the skin that presents with  pustular   lesions . [ 26 ] [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_531", "text": "Seborrheic dermatitis  is a  chronic , superficial,  inflammatory  disease characterized by  scaling  on an  erythematous  base. [ 54 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_532", "text": "Disturbances of human pigmentation, either loss or reduction, may be related to loss of  melanocytes  or the inability of melanocytes to produce  melanin  or transport  melanosomes  correctly. [ 55 ] [ 56 ] [ 57 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_533", "text": "Drug eruptions are  adverse drug reactions  that present with cutaneous manifestations. [ 58 ] [ 59 ] [ 60 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_534", "text": "Endocrine conditions often present with cutaneous findings as the  skin  interacts with the  endocrine system  in many ways. [ 61 ] [ 62 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_535", "text": "Eosinophilic cutaneous conditions encompass a wide variety of diseases that are characterized histologically by the presence of  eosinophils  in the inflammatory infiltrate, or evidence of eosinophil  degranulation . [ 63 ] [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_536", "text": "Epidermal  nevi ,  neoplasms , and  cysts  are  skin lesions  that develop from the  epidermal layer  of the skin. [ 8 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_537", "text": "Erythemas  are reactive skin conditions in which there is  blanchable  redness. [ 1 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_538", "text": "Genodermatoses  are  inherited  genetic skin conditions often grouped into three categories:  chromosomal , single  gene , and  polygenetic . [ 67 ] [ 68 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_539", "text": "Infection-related cutaneous conditions may be caused by  bacteria ,  fungi ,  yeast ,  viruses , or  parasites . [ 26 ] [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_540", "text": "Bacterium-related cutaneous conditions often have distinct  morphologic  characteristics that may be an indication of a generalized systemic process or simply an isolated superficial infection. [ 69 ] [ 70 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_541", "text": "Mycobacterium -related cutaneous conditions are caused by  Mycobacterium  infections. [ 69 ] [ 71 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_542", "text": "Mycosis-related cutaneous conditions are caused by  fungi  or  yeasts , and may present as either a superficial or deep  infection  of the skin, hair, or nails. [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_543", "text": "Parasitic infestations, stings, and bites in humans are caused by several groups of organisms belonging to the following  phyla :  Annelida ,  Arthropoda ,  Bryozoa ,  Chordata ,  Cnidaria ,  Cyanobacteria ,  Echinodermata ,  Nemathelminthes ,  Platyhelminthes , and  Protozoa . [ 69 ] [ 72 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_544", "text": "Virus-related cutaneous conditions are caused by two main groups of  viruses \u2013 DNA  and  RNA  types\u2013both of which are  obligatory   intracellular   parasites . [ 69 ] [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_545", "text": "Lichenoid eruptions are  dermatoses  related to the unique, common  inflammatory  disorder  lichen planus , which affects the skin,  mucous membranes , nails, and hair. [ 74 ] [ 75 ] [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_546", "text": "Lymphoid-related cutaneous conditions are a group of disorders characterized by collections of  lymphocyte  cells within the skin. [ 77 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_547", "text": "Melanocytic nevi and neoplasms are caused by either a proliferation of (1)  melanocytes , or (2)  nevus cells , a form of melanocyte that lack dendritic processes. [ 78 ] [ 79 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_548", "text": "Melanoma  is a  malignant  proliferation of melanocytes and the most aggressive type of skin cancer. [ 80 ] [ 81 ] [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_549", "text": "Monocyte- and macrophage-related cutaneous conditions are characterized  histologically  by  infiltration  of the skin by  monocyte  or  macrophage  cells, [ 10 ]  often divided into several categories, including  granulomatous disease , [ 83 ]   histiocytoses , [ 84 ]  and  sarcoidosis . [ 85 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_550", "text": "Mucinoses  are a group of conditions caused by  dermal   fibroblasts  producing abnormally large amounts of  mucopolysaccharides . [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_551", "text": "Neurocutaneous conditions are due  organic   nervous system  disease or are  psychiatric  in  etiology . [ 86 ] [ 87 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_552", "text": "Noninfectious immunodeficiency-related cutaneous conditions are caused by  T-cell  or  B-cell  dysfunction. [ 88 ] [ 89 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_553", "text": "Nutrition-related cutaneous conditions are caused by  malnutrition  due to an improper or inadequate  diet . [ 90 ] [ 91 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_554", "text": "Papulosquamous   hyperkeratotic  cutaneous conditions are those that present with  papules  and  scales  caused by a thickening of the  stratum corneum . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_555", "text": "Palmoplantar keratodermas  are a diverse group of hereditary and acquired  keratodermas  in which there is  hyperkeratosis  of the skin of the palms and soles. [ 92 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_556", "text": "Pregnancy-related cutaneous conditions are a group of skin changes observed during  pregnancy . [ 93 ] [ 94 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_557", "text": "Pruritus , commonly known as itchiness, is a sensation exclusive to the skin, and characteristic of many skin conditions. [ 95 ] [ 96 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_558", "text": "Psoriasis  is a common, chronic, and recurrent  inflammatory  disease of the skin characterized by circumscribed,  erythematous , dry, scaling  plaques . [ 97 ] [ 98 ] [ 99 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_559", "text": "Reactive neutrophilic cutaneous conditions  constitute a spectrum of disease mediated by  neutrophils , and typically associated with underlying diseases, such as  inflammatory bowel disease  and  hematologic   malignancy . [ 100 ] [ 101 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_560", "text": "Recalcitrant palmoplantar eruptions are skin conditions of the  palms  and  soles  which are resistant to treatment. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_561", "text": "Skin conditions resulting from errors in metabolism are caused by  enzymatic  defects that lead to an accumulation or deficiency of various cellular components, including, but not limited to,  amino acids ,  carbohydrates , and  lipids . [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_562", "text": "Skin conditions resulting from physical factors occur from a number of causes, including, but not limited to, hot and cold temperatures,  friction , and  moisture . [ 34 ] [ 102 ] [ 103 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_563", "text": "Ionizing radiation-induced cutaneous conditions result from exposure to  ionizing radiation . [ 104 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_564", "text": "Urticaria  is a vascular reaction of the skin characterized by the appearance of  wheals , which are firm, elevated swellings of the skin. [ 105 ]   Angioedema , which can occur alone or with\nurticaria, is characterized by a well-defined, edematous swelling that involves subcutaneous tissues, abdominal organs, or upper airway. [ 106 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_565", "text": "Vascular-related cutaneous conditions result from dysfunction of the  blood  or  blood vessels  in the dermis, or  lymphatics  in the  subcutaneous tissues . [ 9 ] [ 107 ] [ 108 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_566", "text": "A  skin condition , also known as  cutaneous condition , is any  medical condition  that affects the  integumentary system \u2014the  organ system  that encloses the body and includes  skin ,  nails , and related  muscle  and  glands . [ 1 ]  The major function of this system is as a barrier against the external environment. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_567", "text": "Conditions of the human integumentary system constitute a broad spectrum of diseases, also known as dermatoses, as well as many nonpathologic states (like, in certain circumstances,  melanonychia  and  racquet nails ). [ 3 ] [ 4 ]  While only a small number of skin diseases account for most visits to the physician, thousands of skin conditions have been described. [ 5 ]  Classification of these conditions often presents many  nosological  challenges, since underlying causes and pathogenetics are often not known. [ 6 ] [ 7 ]  Therefore, most current textbooks present a classification based on location (for example,  conditions of the mucous membrane ), morphology ( chronic blistering conditions ), cause ( skin conditions resulting from physical factors ), and so on. [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_568", "text": "Clinically, the diagnosis of any particular skin condition begins by gathering pertinent information of the presenting skin lesion(s), including: location (e.g. arms, head, legs); symptoms ( pruritus , pain); duration (acute or chronic); arrangement (solitary, generalized,  annular , linear); morphology ( macules ,  papules ,  vesicles ); and color (red, yellow, etc.). [ 10 ]  Some diagnoses may also require a  skin biopsy  which yields  histologic  information [ 11 ] [ 12 ]  that can be correlated with the clinical presentation and any laboratory data. [ 13 ] [ 14 ]  The introduction of cutaneous  ultrasound  has allowed the detection of cutaneous tumors, inflammatory processes, and skin diseases. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_569", "text": "The skin weighs an average of 4\u00a0kg (8.8\u00a0lb), covers an area of about 2\u00a0m 2  (22\u00a0sq\u00a0ft), and is made of three distinct layers: the  epidermis ,  dermis , and  subcutaneous tissue . [ 1 ]  The two main types of human skin are  glabrous skin , the nonhairy skin on the palms and soles (also referred to as the \"palmoplantar\" surfaces), and hair-bearing skin. [ 16 ]  Within the latter type, hairs in structures called  pilosebaceous units  have a  hair follicle ,  sebaceous gland , and associated  arrector pili  muscle. [ 17 ]   In the embryo , the epidermis, hair, and glands are from the  ectoderm , which is chemically influenced by the underlying  mesoderm  that forms the dermis and subcutaneous tissues. [ 18 ] [ 19 ] [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_570", "text": "The epidermis is the most superficial layer of skin, a  squamous epithelium  with several  strata : the  stratum corneum ,  stratum lucidum ,  stratum granulosum ,  stratum spinosum , and  stratum basale . [ 21 ]  Nourishment is provided to these layers via  diffusion  from the dermis, since the epidermis is without direct blood supply. [ 22 ]  The epidermis contains four cell types:  keratinocytes ,  melanocytes ,  Langerhans cells , and  Merkel cells . Of these, keratinocytes are the major component, constituting roughly 95% of the epidermis. [ 16 ]  This stratified squamous epithelium is maintained by cell division within the stratum basale, in which differentiating cells slowly displace outwards through the stratum spinosum to the stratum corneum, where cells are continually shed from the surface. [ 16 ]  In normal skin, the rate of production equals the rate of loss; about two weeks are needed for a cell to migrate from the basal cell layer to the top of the granular cell layer, and an additional two weeks to cross the stratum corneum. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_571", "text": "The dermis is the layer of skin between the epidermis and subcutaneous tissue, and comprises two sections, the  papillary dermis  and the  reticular dermis . [ 24 ]  The superficial papillary dermis  interdigitates  with the overlying  rete ridges  of the epidermis, between which the two layers interact through the basement membrane zone. [ 24 ]  Structural components of the dermis are  collagen ,  elastic fibers , and  ground substance  also called extra fibrillar matrix. [ 24 ]  Within these components are the pilosebaceous units, arrector pili muscles, and the  eccrine  and  apocrine glands . [ 21 ]  The dermis contains two vascular networks that run parallel to the skin surface\u2014one superficial and one deep plexus\u2014which are connected by vertical communicating vessels. [ 21 ] [ 25 ]  The function of blood vessels within the dermis is fourfold: to supply nutrition, to regulate temperature, to modulate inflammation, and to participate in wound healing. [ 26 ] [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_572", "text": "The subcutaneous tissue is a layer of fat between the dermis and underlying  fascia . [ 5 ]  This tissue may be further divided into two components, the actual fatty layer, or  panniculus adiposus , and a deeper vestigial layer of muscle, the  panniculus carnosus . [ 16 ]  The main cellular component of this tissue is the  adipocyte , or fat cell. [ 5 ]  The structure of this tissue is composed of septal (i.e. linear strands) and  lobular  compartments, which differ in microscopic appearance. [ 21 ]  Functionally, the subcutaneous fat insulates the body, absorbs trauma, and serves as a reserve energy source. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_573", "text": "Diseases of the skin include  skin infections  and  skin neoplasms  (including  skin cancer ). [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_574", "text": "In 1572,  Geronimo Mercuriali  of  Forl\u00ec ,  Italy , completed  De morbis cutaneis  ('On the diseases of the skin'). It is considered the first scientific work dedicated to  dermatology ."}
{"_id": "WikiPedia_Dermatology$$$corpus_575", "text": "The physical examination of the skin and its appendages, as well as the mucous membranes, forms the cornerstone of an accurate diagnosis of cutaneous conditions. [ 29 ]  Most of these conditions present with cutaneous surface changes termed \"lesions,\" which have more or less distinct characteristics. [ 30 ]  Often proper examination will lead the physician to obtain appropriate historical information and/or laboratory tests that are able to confirm the diagnosis. [ 29 ]  Upon examination, the important clinical observations are the (1) morphology, (2) configuration, and (3) distribution of the lesion(s). [ 29 ]  With regard to morphology, the initial lesion that characterizes a condition is known as the \"primary lesion\", and identification of such a lesions is the most important aspect of the cutaneous examination. [ 30 ]  Over time, these primary lesions may continue to develop or be modified by regression or trauma, producing \"secondary lesions\". [ 1 ]  However, with that being stated, the lack of standardization of basic dermatologic terminology has been one of the principal barriers to successful communication among physicians in describing cutaneous findings. [ 21 ]  Nevertheless, there are some commonly accepted terms used to describe the macroscopic morphology, configuration, and distribution of skin lesions, which are listed below. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_576", "text": "\"Configuration\" refers to how lesions are locally grouped (\"organized\"), which contrasts with how they are distributed (see next section)."}
{"_id": "WikiPedia_Dermatology$$$corpus_577", "text": "\"Distribution\" refers to how lesions are localized. They may be confined to a single area (a patch) or may be in several places. Some distributions correlate with the means by which a given area becomes affected. For example, contact dermatitis correlates with locations where allergen has elicited an allergic immune response.  Varicella zoster virus  is known to recur (after its initial presentation as  chicken pox ) as  herpes zoster  (\"shingles\"). Chicken pox appears nearly everywhere on the body, but herpes zoster tends to follow one or two dermatomes; for example, the eruptions may appear along the bra line, on either or both sides of the patient. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_578", "text": "Acne  ( /\u02c8\u00e6kni/   ACK-nee ), also known as  acne vulgaris , is a long-term  skin condition  that occurs when  dead skin cells  and  oil from the skin  clog  hair follicles . [ 10 ]  Typical features of the condition include  blackheads or whiteheads ,  pimples , oily skin, and possible  scarring . [ 1 ] [ 2 ] [ 11 ]  It primarily affects skin with a relatively high number of  oil glands , including the face, upper part of the chest, and back. [ 12 ]  The resulting appearance can lead to lack of confidence,  anxiety , reduced  self-esteem , and, in extreme cases,  depression  or  thoughts of suicide . [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_579", "text": "Susceptibility to acne is primarily genetic in 80% of cases. [ 2 ]  The roles of diet and  cigarette smoking  in the condition are unclear, and neither  cleanliness  nor exposure to sunlight are associated with acne. [ 2 ] [ 13 ] [ 14 ]  In both  sexes ,  hormones  called  androgens  appear to be part of the underlying mechanism, by causing increased production of  sebum . [ 5 ]  Another common factor is the excessive growth of the bacterium  Cutibacterium acnes , which is present on the skin. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_580", "text": "Treatments for acne are available, including lifestyle changes, medications, and medical procedures. Eating fewer  simple carbohydrates  such as  sugar  may minimize the condition. [ 7 ]   Treatments applied directly to the affected skin , such as  azelaic acid ,  benzoyl peroxide , and  salicylic acid , are commonly used. [ 8 ]   Antibiotics  and  retinoids  are available in  formulations  that are applied to the skin and  taken by mouth  for the treatment of acne. [ 8 ]  However,  resistance to antibiotics  may develop as a result of antibiotic therapy. [ 16 ]  Several types of  birth control pills  help prevent acne in women. [ 8 ]  Medical professionals typically reserve  isotretinoin  pills for severe acne, due to greater potential side effects. [ 8 ] [ 17 ]  Early and aggressive treatment of acne is advocated by some in the medical community to decrease the overall long-term impact on individuals. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_581", "text": "In 2015, acne affected approximately 633 \u00a0 million people globally, making it the eighth-most common disease worldwide. [ 9 ] [ 18 ]  Acne commonly occurs in  adolescence  and affects an estimated 80\u201390% of teenagers in the  Western world . [ 19 ] [ 20 ] [ 21 ]  Some rural societies report lower rates of acne than industrialized ones. [ 21 ] [ 22 ]  Children and adults may also be affected before and after puberty. [ 23 ]  Although acne becomes less common in adulthood, it persists in nearly half of affected people into their twenties and thirties, and a smaller group continues to have difficulties in their forties. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_582", "text": "The severity of acne vulgaris (Gr. \u1f00\u03ba\u03bc\u03ae, \"point\" + L.  vulgaris , \"common\") [ 24 ]  can be classified as mild, moderate, or severe to determine an appropriate treatment regimen. [ 20 ]  There is no universally accepted scale for grading acne severity. [ 15 ]  The presence of clogged skin follicles (known as  comedones ) limited to the face with occasional inflammatory lesions defines mild acne. [ 20 ]  Moderate severity acne is said to occur when a higher number of inflammatory  papules  and  pustules  occur on the face, compared to mild cases of acne, and appear on the trunk of the body. [ 20 ]  Severe acne is said to occur when  nodules  (the painful 'bumps' lying under the skin) are the characteristic facial lesions, and involvement of the trunk is extensive. [ 20 ] [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_583", "text": "The lesions are usually, polymorphic, meaning they can take many forms, including open or closed comedones (commonly known as blackheads and whiteheads), papules, pustules, and even nodules or cysts so that these lesions often leave behind sequelae, or abnormal conditions resulting from a previous disease, such as scarring or hyperpigmentation. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_584", "text": "Large nodules were previously called  cysts . The term  nodulocystic  has been used in the medical literature to describe severe cases of inflammatory acne. [ 25 ]  True cysts are rare in those with acne, and the term  severe nodular acne  is now the preferred terminology. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_585", "text": "Acne inversa  (L.  invert\u014d, \"upside-down\") and  acne rosacea  (rosa, \"rose-colored\" + -\u0101ceus, \"forming\") are not forms of acne and are alternate names that respectively refer to the skin conditions  hidradenitis suppurativa  (HS) and  rosacea . [ 27 ] [ 28 ] [ 29 ]  Although HS shares certain overlapping features with acne vulgaris, such as a tendency to clog skin follicles with skin cell debris, the condition otherwise lacks the hallmark features of acne and is therefore considered a distinct skin disorder. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_586", "text": "Typical features of acne include  increased secretion  of oily  sebum  by the skin, microcomedones, comedones, papules, nodules (large papules), pustules, and often results in scarring. [ 30 ] [ 31 ]  The appearance of acne varies with skin color. It may result in psychological and social problems. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_587", "text": "Acne  scars  are caused by  inflammation  within the  dermis  and are estimated to affect 95% of people with acne vulgaris. [ 32 ]  Abnormal healing and dermal inflammation create the scar. [ 33 ]  Scarring is most likely to take place with severe acne but may occur with any form of acne vulgaris. [ 32 ]  Acne scars are classified based on whether the abnormal healing response following dermal inflammation leads to excess  collagen  deposition or loss at the site of the acne lesion. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_588", "text": "Atrophic acne scars have lost collagen from the healing response and are the most common type of acne scar (accounting for approximately 75% of all acne scars). [ 33 ] [ 34 ]  Ice-pick scars, boxcar scars, and rolling scars are subtypes of atrophic acne scars. [ 32 ]  Boxcar scars are round or ovoid indented scars with sharp borders and vary in size from 1.5\u20134\u00a0mm across. [ 33 ]  Ice-pick scars are narrow (less than 2\u00a0 mm  across), deep scars that extend into the dermis. [ 33 ]  Rolling scars are broader than ice-pick and boxcar scars (4\u20135\u00a0mm across) and have a wave-like pattern of depth in the skin. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_589", "text": "Hypertrophic scars  are uncommon and are characterized by increased collagen content after the abnormal healing response. [ 33 ]  They are described as firm and raised from the skin. [ 33 ] [ 35 ]  Hypertrophic scars remain within the original margins of the wound, whereas  keloid scars  can form scar tissue outside of these borders. [ 33 ]  Keloid scars from acne occur more often in men and people with darker skin, and usually occur on the trunk of the body. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_590", "text": "After an inflamed nodular acne lesion resolves, it is common for  the skin to darken  in that area, which is known as  postinflammatory hyperpigmentation  (PIH). The inflammation stimulates specialized pigment-producing skin cells (known as  melanocytes ) to produce more  melanin  pigment, which leads to the skin's darkened appearance. [ 36 ]  PIH occurs more frequently in people with  darker skin color . [ 37 ]  Pigmented scar is a common term used for PIH, but is misleading as it suggests the color change is permanent. Often, PIH can be prevented by avoiding any aggravation of the nodule and can fade with time. However, untreated PIH can last for months, years, or even be permanent if deeper layers of skin are affected. [ 38 ]  Even minimal skin exposure to the sun's  ultraviolet rays  can sustain hyperpigmentation. [ 36 ]  Daily use of  SPF \u00a015 or higher  sunscreen  can minimize such a risk. [ 38 ]  Whitening agents like  azelaic acid ,  arbutin  or else may be used to improve hyperpigmentation. [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_591", "text": "Risk factors for the development of acne, other than genetics, have not been conclusively identified. Possible secondary contributors include hormones, infections, diet, and stress. Studies investigating the impact of smoking on the incidence and severity of acne have been inconclusive. [ 2 ] [ 40 ] [ 41 ]  Cleanliness ( hygiene ) and sunlight are not associated with acne. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_592", "text": "Acne appears to be highly  heritable ;  genetics  explain 81% of the variation in the population. [ 15 ]  Studies performed in affected  twins  and  first-degree relatives  further demonstrate the strongly inherited nature of acne. [ 2 ] [ 15 ]  Acne susceptibility is likely due to the influence of multiple genes, as the disease does not follow a classic  (Mendelian)  inheritance pattern. These gene candidates include  certain variations  in  tumor necrosis factor-alpha (TNF-alpha) ,  IL-1 alpha , and  CYP1A1  genes, among others. [ 19 ]  The 308\u00a0G/A  single nucleotide polymorphism  variation in the gene for  TNF  is associated with an increased risk for acne. [ 42 ]  Acne can be a feature of rare genetic disorders such as  Apert's syndrome . [ 15 ]  Severe acne may be associated with  XYY syndrome . [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_593", "text": "Hormonal activity, such as occurs during  menstrual cycles  and  puberty , may contribute to the formation of acne. During puberty, an increase in sex hormones called  androgens  causes the skin follicle glands to grow larger and make more oily sebum. [ 12 ]  The androgen hormones  testosterone ,  dihydrotestosterone  (DHT), and  dehydroepiandrosterone  (DHEA) are all linked to acne. High levels of  growth hormone  (GH) and  insulin-like growth factor 1  (IGF-1) are also associated with worsened acne. [ 44 ]  Both androgens and IGF-1 seem to be essential for acne to occur, as acne does not develop in individuals with  complete androgen insensitivity syndrome  (CAIS) or  Laron syndrome  (insensitivity to GH, resulting in very low IGF-1 levels). [ 45 ] [ 46 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_594", "text": "Medical conditions that commonly cause a high-androgen state, such as  polycystic ovary syndrome ,  congenital adrenal hyperplasia , and  androgen-secreting tumors , can cause acne in affected individuals. [ 47 ] [ 48 ]  Conversely, people who  lack androgenic hormones  or are  insensitive to the effects of androgens  rarely have acne. [ 47 ]  Pregnancy can increase androgen levels, and consequently, oily sebum synthesis. [ 48 ] [ 49 ]  Acne can be a side effect of  testosterone replacement therapy  or  anabolic steroid  use. [ 1 ] [ 50 ]  Over-the-counter  bodybuilding  and  dietary supplements  often contain illegally added anabolic steroids. [ 1 ] [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_595", "text": "The  anaerobic bacterial  species  Cutibacterium acnes  (formerly  Propionibacterium acnes ) contributes to the development of acne, but its exact role is not well understood. [ 2 ]  There are specific sub-strains of  C. acnes  associated with normal skin and others with moderate or severe inflammatory acne. [ 52 ]  It is unclear whether these undesirable strains evolve on-site or are acquired, or possibly both depending on the person. These strains have the capability of changing, perpetuating, or adapting to the abnormal cycle of inflammation, oil production, and inadequate sloughing of dead skin cells from acne pores. Infection with the parasitic mite  Demodex  is associated with the development of acne. [ 31 ] [ 53 ]  It is unclear whether eradication of the mite improves acne. [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_596", "text": "High- glycemic-load  diets have been found to have different degrees of effect on acne severity. [ 7 ] [ 54 ] [ 55 ]  Multiple  randomized controlled trials  and nonrandomized studies have found a lower-glycemic-load diet to be effective in reducing acne. [ 54 ]  There is weak observational evidence suggesting that dairy milk consumption is positively associated with a higher frequency and severity of acne. [ 53 ] [ 54 ] [ 56 ] [ 57 ] [ 58 ]  Milk contains  whey protein  and hormones such as bovine IGF-1 and precursors of dihydrotestosterone. [ 54 ]  Studies suggest these components promote the effects of insulin and IGF-1 and thereby increase the production of androgen hormones, sebum, and promote the formation of comedones. [ 54 ]  Available evidence does not support a link between eating chocolate or salt and acne severity. [ 56 ] [ 57 ]  Few studies have examined the relationship between  obesity  and acne. [ 2 ]   Vitamin B 12  may trigger skin outbreaks similar to acne (acneiform eruptions), or worsen existing acne when taken in doses exceeding the  recommended daily intake . [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_597", "text": "There are few high-quality studies to demonstrate that stress causes or worsens acne. [ 60 ]  Despite being controversial, some research indicates that increased acne severity is associated with high stress levels in certain contexts, such as hormonal changes seen in  premenstrual syndrome . [ 61 ] [ 62 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_598", "text": "Some individuals experience severe intensification of their acne when they are exposed to hot humid climates; this is due to bacteria and fungus thriving in warm, moist environments. This climate-induced acne exacerbation has been termed  tropical acne .\nMechanical obstruction of  skin follicles  with helmets or chinstraps can worsen pre-existing acne. [ 63 ]  However, acne caused by mechanical obstruction is technically not acne vulgaris, but another  acneiform eruption  known as  acne mechanica ."}
{"_id": "WikiPedia_Dermatology$$$corpus_599", "text": "Several medications can also worsen pre-existing acne; this condition is the  acne medicamentosa  form of acne. Examples of such medications include  lithium ,  hydantoin ,  isoniazid ,  glucocorticoids ,  iodides ,  bromides , and  testosterone . [ 43 ]  When acne medicamentosa is specifically caused by  anabolic\u2013androgenic steroids  it can simply be referred to as  steroid acne ."}
{"_id": "WikiPedia_Dermatology$$$corpus_600", "text": "Genetically susceptible individuals can get acne breakouts as a result of  polymorphous light eruption ; a condition triggered by sunlight and artificial UV light exposure. This form of acne is called  Acne aestivalis  and is specifically caused by intense  UVA light  exposure. Affected individuals usually experience seasonal acne breakouts on their upper arms, shoulder girdle, back, and chest. The breakouts typically occur one-to-three days after exposure to intese UVA radiation. Unlike other forms of acne, the condition spares the face; this could possibly be a result of the pathogenesis of polymorphous light eruption, in which areas of the skin that are  newly  exposed to intense ultraviolet radiation are affected. Since faces are typically left uncovered at all stages of life, there is little-to-no likelihood for an eruption to appear there.  Studies show  that both polymorphous light eruption outbreaks and the acne aestivalis breakout response can be prevented by topical antioxidants combined with the application of a broad spectrum sunscreen. [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_601", "text": "Acne vulgaris is a chronic skin disease of the  pilosebaceous unit  and develops due to blockages in the skin's  hair follicles . [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_602", "text": "Traditionally seen as a disease of adolescence, acne vulgaris is also observed in adults, including post-menopausal women. Acne vulgaris manifested in adult female is called  adult female acne  (AFA), defined as a chronic inflammatory disease of the pilosebaceous unit. [ 26 ]  Particularly in AFA, during the menopausal transition, a relative increase in androgen levels occurs as estrogen levels begin to decline, so that this hormonal shift can manifest as acne; while most women with AFA exhibit few acne lesions and have normal androgen levels, baseline investigations, including an androgen testing panel, can help rule out associated comorbidities such as  polycystic ovarian syndrome ,  congenital adrenal hyperplasia , or tumors. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_603", "text": "The blockages in the skin's  hair follicles  that cause acne vulgaris manifestations occur as a result of the following four abnormal processes: increased oily  sebum  production (influenced by  androgens ),  excessive deposition of the protein keratin  leading to comedo formation, colonization of the follicle by  Cutibacterium acnes  ( C. acnes ) bacteria, and the local release of pro-inflammatory chemicals in the skin. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_604", "text": "The earliest pathologic change is the formation of a plug (a  microcomedone ), which is driven primarily by excessive growth, reproduction, and accumulation of  skin cells  in the hair follicle. [ 1 ]  In healthy skin, the skin cells that have died come up to the surface and exit the pore of the hair follicle. [ 10 ]  In people with acne, the increased production of oily sebum causes the dead skin cells to stick together. [ 10 ]  The accumulation of dead skin cell debris and oily sebum blocks the pore of the hair follicle, thus forming the microcomedone. [ 10 ]  The  C. acnes   biofilm  within the hair follicle worsens this process. [ 47 ]  If the microcomedone is superficial within the hair follicle, the skin pigment  melanin  is exposed to air, resulting in its  oxidation  and dark appearance (known as a blackhead or open comedo). [ 1 ] [ 10 ] [ 20 ]  In contrast, if the microcomedone occurs deep within the hair follicle, this causes the formation of a whitehead (known as a closed comedo). [ 1 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_605", "text": "The main hormonal driver of oily sebum production in the skin is  dihydrotestosterone . [ 1 ]  Another androgenic hormone responsible for increased sebaceous gland activity is  DHEA-S . The  adrenal glands  secrete higher amounts of DHEA-S during  adrenarche  (a stage of  puberty ), and this leads to an increase in sebum production. In a sebum-rich skin environment, the naturally occurring and largely  commensal  skin bacterium  C. acnes  readily grows and can cause  inflammation  within and around the follicle due to activation of the  innate immune system . [ 10 ]   C. acnes  triggers skin inflammation in acne by increasing the production of several pro-inflammatory  chemical signals  (such as  IL-1\u03b1 ,  IL-8 ,  TNF-\u03b1 , and LTB4); IL-1\u03b1 is essential to comedo formation. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_606", "text": "C. acnes'  ability to bind and activate a class of  immune system  receptors known as  toll-like receptors  (TLRs), especially  TLR2  and  TLR4 , is a core mechanism of acne-related skin inflammation. [ 47 ] [ 65 ] [ 66 ]  Activation of TLR2 and TLR4 by  C. acnes  leads to increased secretion of IL-1\u03b1, IL-8, and TNF-\u03b1. [ 47 ]  The release of these inflammatory signals attracts various immune cells to the hair follicle, including  neutrophils ,  macrophages , and  Th1 cells . [ 47 ]  IL-1\u03b1 stimulates increased skin cell activity and reproduction, which, in turn, fuels comedo development. [ 47 ]  Furthermore, sebaceous gland cells produce more  antimicrobial peptides , such as  HBD1  and  HBD2 , in response to the binding of TLR2 and TLR4. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_607", "text": "C. acnes  also provokes skin inflammation by altering the fatty composition of oily sebum. [ 47 ]  Oxidation of the  lipid   squalene  by  C. acnes  is of particular importance. Squalene oxidation activates  NF-\u03baB  (a protein complex) and consequently increases IL-1\u03b1 levels. [ 47 ]  Additionally, squalene oxidation increases  5-lipoxygenase  enzyme activity, which catalyzes the conversion of  arachidonic acid  to  leukotriene B4  (LTB4). [ 47 ]  LTB4 promotes skin inflammation by acting on the  peroxisome proliferator-activated receptor alpha  (PPAR\u03b1) protein. [ 47 ]  PPAR\u03b1 increases the activity of  activator protein 1  (AP-1) and NF-\u03baB, thereby leading to the recruitment of inflammatory  T cells . [ 47 ]   C. acnes'  ability to convert sebum  triglycerides  to pro-inflammatory  free fatty acids  via secretion of the enzyme  lipase  further explains its inflammatory properties. [ 47 ]  These free fatty acids spur increased production of  cathelicidin , HBD1, and HBD2, thus leading to further inflammation. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_608", "text": "This inflammatory cascade typically leads to the formation of inflammatory acne lesions, including  papules , infected  pustules , or  nodules . [ 1 ]  If the inflammatory reaction is severe, the follicle can break into the deeper layers of the dermis and  subcutaneous tissue  and cause the formation of deep nodules. [ 1 ] [ 67 ] [ 68 ]  The involvement of AP-1 in the aforementioned inflammatory cascade activates  matrix metalloproteinases , which contribute to local tissue destruction and scar formation. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_609", "text": "Along with the bacteria  C. acnes , the bacterial species  Staphylococcus epidermidis  ( S. epidermidis ) also takes a part in the physiopathology of acne vulgaris. The proliferation of  S. epidermidis  with  C. acnes  causes the formation of  biofilms , which blocks the hair follicles and pores, creating an  anaerobic  environment under the skin. This enables for increased growth of both  C. acnes  and  S. epidermidis  under the skin. The proliferation of  C. acnes  causes the formation of  biofilms  and a  biofilm matrix , making it even harder to treat the acne. [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_610", "text": "Acne vulgaris is diagnosed based on a medical professional's clinical judgment. [ 15 ]  The evaluation of a person with suspected acne should include taking a detailed medical history about a family history of acne, a review of medications taken, signs or symptoms of excessive production of androgen hormones, cortisol, and growth hormone. [ 15 ]  Comedones (blackheads and whiteheads) must be present to diagnose acne. In their absence, an appearance similar to that of acne would suggest a different skin disorder. [ 29 ]  Microcomedones (the precursor to blackheads and whiteheads) are not visible to the naked eye when inspecting the skin and require a  microscope to be seen . [ 29 ]  Many features may indicate that a person's acne vulgaris is sensitive to hormonal influences. Historical and physical clues that may suggest hormone-sensitive acne include onset between ages 20 and 30; worsening the week before a woman's period; acne lesions predominantly over the jawline and chin; and inflammatory/nodular acne lesions. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_611", "text": "Several scales exist to grade the severity of acne vulgaris, but disagreement persists about the ideal one for diagnostic use. [ 70 ] [ 71 ]  Cook's acne grading scale uses photographs to grade severity from 0 to 8, with higher numbers representing more severe acne. This scale was the first to use a standardized photographic protocol to assess acne severity; since its creation in 1979, the scale has undergone several revisions. [ 71 ]  The Leeds acne grading technique counts acne lesions on the face, back, and chest and categorizes them as inflammatory or non-inflammatory. Leeds scores range from 0 (least severe) to 10 (most severe) though modified scales have a maximum score of 12. [ 71 ] [ 72 ]  The Pillsbury acne grading scale classifies the severity of the acne from grade 1 (least severe) to grade 4 (most severe). [ 70 ] [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_612", "text": "Many skin conditions can mimic acne vulgaris, and these are collectively known as  acneiform eruptions . [ 29 ]  Such conditions include  angiofibromas ,  epidermal cysts ,  flat warts ,  folliculitis ,  keratosis pilaris ,  milia ,  perioral dermatitis , and  rosacea , among others. [ 20 ] [ 74 ]  Age is one factor that may help distinguish between these disorders. Skin disorders such as perioral dermatitis and keratosis pilaris can appear similar to acne but tend to occur more frequently in childhood. Rosacea tends to occur more frequently in older adults. [ 20 ]  Facial redness triggered by heat or the consumption of alcohol or spicy food is also more suggestive of rosacea. [ 75 ]  The presence of comedones helps health professionals differentiate acne from skin disorders that are similar in appearance. [ 8 ]   Chloracne  and  occupational acne  due to exposure to certain chemicals & industrial compounds, may look very similar to acne vulgaris. [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_613", "text": "Many different treatments exist for acne. These include  alpha hydroxy acid , anti-androgen medications, antibiotics, antiseborrheic medications,  azelaic acid ,  benzoyl peroxide ,  hormonal  treatments,  keratolytic  soaps,  nicotinamide  (niacinamide),  retinoids , and  salicylic acid . [ 77 ] [ 78 ]  Acne treatments work in at least four different ways, including the following: reducing inflammation, hormonal manipulation, killing  C. acnes , and normalizing skin cell shedding and sebum production in the pore to prevent blockage. [ 15 ]  Typical treatments include topical therapies such as antibiotics, benzoyl peroxide, and retinoids, and systemic therapies, including antibiotics, hormonal agents, and oral retinoids. [ 20 ] [ 79 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_614", "text": "Recommended therapies for first-line use in acne vulgaris treatment include topical retinoids, benzoyl peroxide, and topical or oral antibiotics. [ 80 ]  Procedures such as light therapy and laser therapy are not first-line treatments and typically have only an  add on  role due to their high cost and limited evidence. [ 79 ]  Blue light therapy is of unclear benefit. [ 81 ]  Medications for acne target the early stages of  comedo  formation and are generally ineffective for visible skin lesions; acne generally improves between eight and twelve weeks after starting therapy. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_615", "text": "People often view acne as a short-term condition, some expecting it to disappear after puberty. This misconception can lead to depending on self-management or problems with long-term adherence to treatment. Communicating the long-term nature of the condition and better access to reliable information about acne can help people know what to expect from treatments. [ 82 ] [ 83 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_616", "text": "In general, it is recommended that people with acne do not wash affected skin more than twice daily. [ 15 ]  The application of a fragrance-free  moisturizer  to sensitive and acne-prone skin may reduce irritation. Skin irritation from acne medications typically peaks at two weeks after onset of use and tends to improve with continued use. [ 15 ]  Dermatologists recommend using cosmetic products that specifically say non-comedogenic, oil-free, and will not clog pores. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_617", "text": "Acne vulgaris patients, even those with oily skin, [ 84 ]  should moisturize in order to support the skin's moisture barrier since skin barrier dysfunction may contribute to acne. [ 84 ]  Moisturizers, especially  ceramide -containing moisturizers, as an adjunct therapy are particularly helpful for the dry skin and irritation that commonly results from topical acne treatment. Studies show that ceramide-containing moisturizers are important for optimal skin care; they enhance acne therapy adherence and complement existing acne therapies. [ 84 ]  In a study where acne patients used 1.2% clindamycin phosphate / 2.5% benzoyl peroxide gel in the morning and applied a micronized 0.05% tretinoin gel in the evening the overwhelming majority of patients experienced no cutaneous adverse events throughout the study. It was concluded that using ceramide cleanser and ceramide moisturizing cream caused the favorable tolerability, did not interfere with the treatment efficacy, and improved adherence to the regimen. [ 85 ]  The importance of preserving the acidic mantle and its barrier functions is widely accepted in the scientific community. Thus, maintaining a pH in the range 4.5 \u2013 5.5 is essential in order to keep the skin surface in its optimal, healthy conditions. [ 86 ] [ 87 ] [ 88 ] [ 89 ] [ 90 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_618", "text": "Causal  relationship is rarely observed with diet/nutrition and dermatologic conditions. Rather, associations \u2013 some of them compelling \u2013 have been found between diet and outcomes including disease severity and the number of conditions experienced by a patient. Evidence is emerging in support of medical nutrition therapy as a way of reducing the severity and incidence of dermatologic diseases, including acne.  Researchers observed a link between high glycemic index diets and acne. [ 91 ]  Dermatologists also recommend a  diet low in simple sugars  as a method of improving acne. [ 54 ]  As of 2014, the available evidence is insufficient to use milk restriction for this purpose. [ 54 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_619", "text": "Benzoyl peroxide  (BPO) is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects (mainly  skin irritation ). In the skin follicle, benzoyl peroxide kills  C. acnes  by oxidizing its proteins through the formation of oxygen  free radicals  and  benzoic acid . These free radicals likely interfere with the bacterium's metabolism and ability to make proteins. [ 92 ] [ 93 ]  Additionally, benzoyl peroxide is mildly effective at breaking down comedones and inhibiting inflammation. [ 80 ] [ 93 ]  Combination products use benzoyl peroxide with a topical antibiotic or retinoid, such as  benzoyl peroxide/clindamycin  and  benzoyl peroxide/adapalene , respectively. [ 37 ]  Topical benzoyl peroxide is effective at treating acne. [ 94 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_620", "text": "Side effects include increased  skin photosensitivity , dryness, redness, and occasional peeling. [ 95 ]  Sunscreen use is often advised during treatment, to prevent  sunburn . Lower concentrations of benzoyl peroxide are just as effective as higher concentrations in treating acne but are associated with fewer side effects. [ 93 ] [ 96 ]  Unlike antibiotics, benzoyl peroxide does not appear to generate  bacterial antibiotic resistance . [ 95 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_621", "text": "Retinoids  are medications that reduce inflammation, normalize the follicle  cell life cycle , and reduce sebum production. [ 47 ] [ 97 ]  They are structurally related to  vitamin A . [ 97 ]  Studies show dermatologists and primary care doctors underprescribe them for acne. [ 15 ]  The retinoids appear to influence the cell life cycle in the follicle lining. This helps prevent the  accumulation of skin cells  within the hair follicle that can create a blockage. They are a first-line acne treatment, [ 1 ]  especially for people with dark-colored skin. Retinoids are known to lead to faster improvement of postinflammatory hyperpigmentation. [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_622", "text": "Topical retinoids include  adapalene ,  retinol ,  retinaldehyde ,  isotretinoin ,  tazarotene ,  trifarotene , and  tretinoin . [ 49 ] [ 98 ] [ 99 ]  They often cause an initial flare-up of acne and facial  flushing  and can cause significant skin irritation. Generally speaking, retinoids increase the skin's  sensitivity to sunlight  and are therefore recommended for use at night. [ 1 ]  Tretinoin is the least expensive of the topical retinoids and is the most irritating to the skin, whereas adapalene is the least irritating but costs significantly more. [ 1 ] [ 100 ]  Most formulations of tretinoin are incompatible for use with benzoyl peroxide. [ 15 ]  Tazarotene is the most effective and expensive topical retinoid but is usually not as well tolerated. [ 1 ] [ 100 ]  In 2019 a tazarotene lotion formulation, marketed to be a less irritating option, was approved by the FDA. [ 101 ]  Retinol is a form of vitamin A that has similar but milder effects and is present in many over-the-counter moisturizers and other topical products."}
{"_id": "WikiPedia_Dermatology$$$corpus_623", "text": "Isotretinoin is an oral retinoid that is very effective for severe nodular acne, and moderate acne that is stubborn to other treatments. [ 1 ] [ 20 ]  One to two months of use is typically adequate to see improvement. Acne often resolves completely or is much milder after a 4\u20136\u00a0month course of oral isotretinoin. [ 1 ]  After a single round of treatment, about 80% of people report an improvement, with more than 50% reporting complete remission. [ 20 ]  About 20% of people require a second course, but 80% of those report improvement, resulting in a cumulative 96% efficacy rate. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_624", "text": "There are concerns that isotretinoin is linked to adverse effects, like  depression ,  suicidality , and  anemia . There is no clear evidence to support some of these claims. [ 1 ] [ 20 ]  Isotretinoin has been found in some studies to be superior to antibiotics or placebo in reducing acne lesions. [ 17 ]  However, a 2018 review comparing inflammatory lesions after treatment with antibiotics or isotretinoin found no difference. [ 102 ]  The frequency of adverse events was about twice as high with isotretinoin use, although these were mostly dryness-related events. [ 17 ]  No increased risk of suicide or depression was conclusively found. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_625", "text": "Medical authorities strictly regulate isotretinoin use in women of childbearing age due to its known  harmful effects in pregnancy . [ 20 ]  For such a woman to be considered a candidate for isotretinoin, she must have a confirmed negative  pregnancy test  and use an effective form of  birth control . [ 20 ]  In 2008, the United States started the  iPLEDGE  program to prevent isotretinoin use during pregnancy. [ 103 ]  iPledge requires the woman to have two negative pregnancy tests and to use two types of birth control for at least one month before isotretinoin therapy begins and one month afterward. [ 103 ]  The effectiveness of the iPledge program is controversial due to continued instances of contraception nonadherence. [ 103 ] [ 104 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_626", "text": "People may apply antibiotics to the skin or take them orally to treat acne. They work by killing  C. acnes  and reducing inflammation. [ 20 ] [ 95 ] [ 105 ]  Although multiple guidelines call for healthcare providers to reduce the rates of prescribed oral antibiotics, many providers do not follow this guidance. [ 106 ]  Oral antibiotics remain the most commonly prescribed systemic therapy for acne. [ 106 ]  Widespread  broad-spectrum antibiotic  overuse for acne has led to higher rates of antibiotic-resistant  C. acnes  strains worldwide, especially to the commonly used  tetracycline  (e.g.,  doxycycline ) and macrolide antibiotics (e.g., topical  erythromycin ). [ 16 ] [ 95 ] [ 105 ] [ 106 ]  Therefore, dermatologists prefer antibiotics as part of combination therapy and not for use alone. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_627", "text": "Commonly used antibiotics, either applied to the skin or taken orally, include  clindamycin , erythromycin,  metronidazole ,  sulfacetamide , and tetracyclines (e.g., doxycycline or  minocycline ). [ 49 ]  Doxycycline 40 milligrams daily (low-dose) appears to have similar efficacy to 100 milligrams daily and has fewer gastrointestinal side effects. [ 15 ]  However, low-dose doxycycline is not FDA-approved for the treatment of acne. [ 107 ]  Antibiotics applied to the skin are typically used for mild to moderately severe acne. [ 20 ]  Oral antibiotics are generally more effective than topical antibiotics and produce faster resolution of inflammatory acne lesions than topical applications. [ 1 ]  The  Global Alliance to Improve Outcomes in Acne  recommends that topical and oral antibiotics are not used together. [ 105 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_628", "text": "Oral antibiotics are recommended for no longer than three months as antibiotic courses exceeding this duration are associated with the development of antibiotic resistance and show no clear benefit over shorter durations. [ 105 ]  If long-term oral antibiotics beyond three months are used, then it is recommended that benzoyl peroxide or a retinoid be used at the same time to limit the risk of  C. acnes  developing antibiotic resistance. [ 105 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_629", "text": "The antibiotic  dapsone  is effective against inflammatory acne when applied to the skin. It is generally not a first-line choice due to its higher cost and a lack of clear superiority over other antibiotics. [ 1 ] [ 15 ]  Topical dapsone is sometimes a preferred therapy in women or for people with sensitive or darker-toned skin. [ 15 ]  It is not recommended for use with benzoyl peroxide due to the risk of causing yellow-orange skin discoloration with this combination. [ 10 ]  Minocycline is an effective acne treatment, but it is not a first-line antibiotic due to a lack of evidence that it is better than other treatments, and concerns about its safety compared to other tetracyclines. [ 108 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_630", "text": "Sarecycline  is the most recent oral antibiotic developed specifically for the treatment of acne, and is FDA-approved for the treatment of moderate to severe inflammatory acne in patients nine years of age and older. [ 109 ] [ 110 ] [ 111 ]  It is a  narrow-spectrum  tetracycline antibiotic that exhibits the necessary antibacterial activity against pathogens related to acne vulgaris and a low propensity for inducing antibiotic resistance. [ 112 ] [ 113 ]  In clinical trials, sarecycline demonstrated clinical efficacy in reducing inflammatory acne lesions as early as three weeks and reduced truncal (back and chest) acne. [ 111 ] [ 114 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_631", "text": "In women, the use of  combined birth control pills  can improve acne. [ 115 ]  These medications contain an  estrogen  and a  progestin . [ 116 ]  They work by decreasing the production of androgen hormones by the ovaries and by decreasing the free and hence biologically active fractions of androgens, resulting in lowered skin production of sebum and consequently reduce acne severity. [ 10 ] [ 117 ]  First-generation progestins such as  norethindrone  and  norgestrel  have androgenic properties and may worsen acne. [ 15 ]  Although oral estrogens decrease IGF-1 levels in some situations, which could theoretically improve acne symptoms, [ 118 ] [ 119 ]  combined birth control pills do not appear to affect IGF-1 levels in fertile women. [ 116 ] [ 120 ]   Cyproterone acetate -containing birth control pills seem to decrease total and free IGF-1 levels. [ 121 ]  Combinations containing third- or fourth-generation  progestins , including  desogestrel ,  dienogest ,  drospirenone , or  norgestimate , as well as birth control pills containing cyproterone acetate or  chlormadinone acetate , are preferred for women with acne due to their stronger antiandrogenic effects. [ 122 ] [ 123 ] [ 124 ]  Studies have shown a 40 to 70% reduction in acne lesions with combined birth control pills. [ 117 ]  A 2014  review  found that oral antibiotics appear to be somewhat more effective than birth control pills at reducing the number of inflammatory acne lesions at three months. [ 125 ]  However, the two therapies are approximately equal in efficacy at six months for decreasing the number of inflammatory, non-inflammatory, and total acne lesions. [ 125 ]  The authors of the analysis suggested that birth control pills may be a preferred first-line acne treatment, over oral antibiotics, in certain women due to similar efficacy at six months and a lack of associated antibiotic resistance. [ 125 ]  In contrast to combined birth control pills,  progestogen-only birth control  forms that contain androgenic progestins have been associated with worsened acne. [ 106 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_632", "text": "Antiandrogens  such as cyproterone acetate and  spironolactone  can successfully treat acne, especially in women with signs of excessive androgen production, such as increased  hairiness  or skin production of sebum, or  scalp hair loss . [ 10 ] [ 49 ]  Spironolactone is an effective treatment for acne in adult women. [ 126 ] [ 127 ]  Unlike combined birth control pills, it is not approved by the United States  Food and Drug Administration  for this purpose. [ 1 ] [ 37 ] [ 126 ]  Spironolactone is an  aldosterone antagonist  and is a useful acne treatment due to its ability to additionally block the  androgen receptor  at higher doses. [ 37 ] [ 106 ]  Alone or in combination with a birth control pill, spironolactone has shown a 33 to 85% reduction in acne lesions in women. [ 117 ]  The effectiveness of spironolactone for acne appears to be dose-dependent. [ 117 ]  High-dose cyproterone acetate alone reportedly decreases acne symptoms in women by 75 to 90% within three months. [ 128 ]  It is usually combined with an estrogen to avoid  menstrual irregularities  and  estrogen deficiency . [ 129 ]  The medication appears to be effective in the treatment of acne in males, with one study finding that a high dosage reduced inflammatory acne lesions by 73%. [ 130 ] [ 131 ]  However, spironolactone and cyproterone acetate's side effects in males, such as  gynecomastia ,  sexual dysfunction , and decreased  bone mineral density , generally make their use for male acne impractical. [ 130 ] [ 131 ] [ 132 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_633", "text": "Pregnant and lactating women should not receive antiandrogens for their acne due to a possibility of  birth disorders  such as  hypospadias  and  feminization  of male babies. [ 49 ]  Women who are sexually active and who can or may become pregnant should use an effective method of contraception to prevent pregnancy while taking an antiandrogen. [ 133 ]  Antiandrogens are often combined with birth control pills for this reason, which can result in additive efficacy. [ 37 ] [ 134 ]  The FDA added a  black-box warning  to spironolactone about possible  tumor  risks based on  preclinical research  with very high doses (>100-fold clinical doses) and cautioned that unnecessary use of the medication should be avoided. [ 80 ] [ 106 ] [ 135 ]  However, several large  epidemiological studies  subsequently found no greater risk of tumors in association with spironolactone in humans. [ 106 ] [ 136 ] [ 137 ] [ 138 ]  Conversely, strong associations of cyproterone acetate with certain  brain tumors  have been discovered and its use has been restricted. [ 139 ] [ 140 ] [ 141 ]  The brain tumor risk with cyproterone acetate is due to its strong  progestogenic  actions and is not related to antiandrogenic activity nor shared by other antiandrogens. [ 139 ] [ 142 ] [ 141 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_634", "text": "Flutamide , a pure  antagonist  of the androgen receptor, is effective in treating acne in women. [ 128 ] [ 143 ]  It appears to reduce acne symptoms by 80 to 90% even at low doses, with several studies showing complete acne clearance. [ 128 ] [ 144 ] [ 145 ]  In one study, flutamide decreased acne scores by 80% within three months, whereas spironolactone decreased symptoms by only 40% in the same period. [ 145 ] [ 146 ] [ 147 ]  In a large long-term study, 97% of women reported satisfaction with the control of their acne with flutamide. [ 148 ]  Although effective, flutamide has a risk of serious  liver toxicity , and cases of death in women taking even low doses of the medication to treat androgen-dependent skin and hair conditions have occurred. [ 149 ]  As such, the use of flutamide for acne has become increasingly limited, [ 148 ] [ 150 ] [ 151 ]  and it has been argued that continued use of flutamide for such purposes is unethical. [ 149 ]   Bicalutamide , a pure androgen receptor antagonist with the same mechanism as flutamide and with comparable or superior antiandrogenic  efficacy  but with a far lower risk of liver toxicity, is an alternative option to flutamide in the treatment of androgen-dependent skin and hair conditions in women. [ 133 ] [ 152 ] [ 153 ] [ 154 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_635", "text": "Clascoterone  is a  topical  antiandrogen that has demonstrated effectiveness in the treatment of acne in both males and females and was approved for clinical use for this indication in August 2020. [ 155 ] [ 156 ] [ 157 ] [ 158 ] [ 159 ]  It has shown no systemic absorption or associated antiandrogenic side effects. [ 158 ] [ 159 ] [ 160 ]  In a small direct head-to-head comparison, clascoterone showed greater effectiveness than topical isotretinoin. [ 158 ] [ 159 ] [ 160 ]   5\u03b1-Reductase inhibitors  such as  finasteride  and  dutasteride  may be useful for the treatment of acne in both males and females but have not been adequately evaluated for this purpose. [ 1 ] [ 161 ] [ 162 ] [ 163 ]  Moreover, 5\u03b1-reductase inhibitors have a strong potential for producing birth defects in male babies and this limits their use in women. [ 1 ] [ 162 ]  However, 5\u03b1-reductase inhibitors are frequently used to treat  excessive facial/body hair  in women and can be combined with birth control pills to prevent pregnancy. [ 161 ]  There is no evidence as of 2010 to support the use of  cimetidine  or  ketoconazole  in the treatment of acne. [ 164 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_636", "text": "Hormonal treatments for acne such as combined birth control pills and antiandrogens may be considered first-line therapy for acne under many circumstances, including desired contraception, known or suspected hyperandrogenism, acne during adulthood, acne that flares premenstrually, and when symptoms of significant sebum production (seborrhea) are co-present. [ 164 ]  Hormone therapy is effective for acne both in women with hyperandrogenism and in women with normal androgen levels. [ 164 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_637", "text": "Azelaic acid  is effective for mild to moderate acne when applied topically at a 15\u201320% concentration. [ 67 ] [ 165 ] [ 166 ] [ 167 ]  Treatment twice daily for six months is necessary, and is as effective as topical benzoyl peroxide\u00a05%, isotretinoin\u00a00.05%, and erythromycin\u00a02%. [ 168 ]  Azelaic acid is an effective acne treatment due to its ability to reduce skin cell accumulation in the follicle and its  antibacterial  and  anti-inflammatory  properties. [ 67 ]  It has a slight skin-lightening effect due to its ability to inhibit melanin synthesis. Therefore, it is useful in treating individuals with acne who are also affected by post-inflammatory hyperpigmentation. [ 1 ]  Azelaic acid may cause skin irritation. [ 169 ]  It is less effective and more expensive than retinoids. [ 1 ]  Azelaic acid also led to worse treatment response when compared to benzoyl peroxide. When compared to tretinoin, azelaic acid makes little or no treatment response. [ 170 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_638", "text": "Salicylic acid  is a topically applied  beta-hydroxy acid  that  stops bacteria from reproducing  and has keratolytic properties. [ 171 ] [ 172 ]  It is less effective than retinoid therapy. [ 20 ]  Salicylic acid opens obstructed skin pores and promotes the shedding of epithelial skin cells. [ 171 ]   Dry skin  is the most commonly seen side effect with topical application, though  darkening  of the skin can occur in individuals with darker skin types. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_639", "text": "Topical and oral preparations of  nicotinamide  (the  amide  form of  vitamin B 3 ) are alternative medical treatments. [ 173 ]  Nicotinamide reportedly improves acne due to its anti-inflammatory properties [ 173 ]  (influencing neutrophil  chemotaxis , inhibiting the release of histamine, suppressing the lymphocyte transformation test, and reducing nitric oxide synthase production induced by cytokines), [ 78 ]  its ability to suppress sebum production, and its wound healing properties. [ 173 ]  Topical and oral preparations of zinc are suggested treatments for acne; evidence to support their use for this purpose is limited. [ 174 ]  Zinc's capacities to reduce inflammation and sebum production as well as inhibit  C. acnes  growth are its proposed mechanisms for improving acne. [ 174 ]   Antihistamines  may improve symptoms among those already taking isotretinoin due to their anti-inflammatory properties and their ability to suppress sebum production. [ 175 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_640", "text": "Hydroquinone  lightens the skin when applied topically by inhibiting  tyrosinase , the enzyme responsible for converting the amino acid  tyrosine  to the skin pigment  melanin , and is used to treat acne-associated post-inflammatory hyperpigmentation. [ 36 ]  By interfering with the production of melanin in the  epidermis , hydroquinone leads to less hyperpigmentation as darkened skin cells are naturally shed over time. [ 36 ]  Improvement in skin  hyperpigmentation  is typically seen within six months when used twice daily. Hydroquinone is ineffective for hyperpigmentation affecting deeper layers of skin such as the  dermis . [ 36 ]  The use of a  sunscreen  with  SPF \u00a015 or higher in the morning with reapplication every two hours is recommended when using hydroquinone. [ 36 ]  Its application only to affected areas lowers the risk of lightening the color of normal skin but can lead to a temporary ring of lightened skin around the hyperpigmented area. [ 36 ]  Hydroquinone is generally well-tolerated; side effects are typically mild (e.g., skin irritation) and occur with the use of a higher than the recommended 4% concentration. [ 36 ]  Most preparations contain the preservative  sodium metabisulfite , which has been linked to rare cases of  allergic reactions , including  anaphylaxis  and severe  asthma  exacerbations in susceptible people. [ 36 ]  In extremely rare cases, the frequent and improper application of high-dose hydroquinone has been associated with a systemic condition known as  exogenous ochronosis  (skin discoloration and  connective tissue  damage from the accumulation of  homogentisic acid ). [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_641", "text": "Combination therapy\u2014using medications of different classes together, each with a different mechanism of action\u2014has been demonstrated to be a more effective approach to acne treatment than monotherapy. [ 10 ] [ 49 ]  The use of topical benzoyl peroxide and  antibiotics  together is more effective than antibiotics alone. [ 10 ]  Similarly, using a topical retinoid with an antibiotic clears acne lesions faster than the use of antibiotics alone. [ 10 ]  Frequently used combinations include the following: antibiotic and benzoyl peroxide, antibiotic and topical retinoid, or topical retinoid and benzoyl peroxide. [ 49 ]  Dermatologists generally prefer combining benzoyl peroxide with a retinoid over the combination of a topical antibiotic with a retinoid. Both regimens are effective, but benzoyl peroxide does not lead to antibiotic resistance. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_642", "text": "Although sebaceous gland activity in the skin increases during the late stages of pregnancy, pregnancy has not been reliably associated with worsened acne severity. [ 176 ]  In general, topically applied medications are considered the first-line approach to acne treatment during pregnancy, as they have little systemic absorption and are therefore unlikely to harm a developing  fetus . [ 176 ]  Highly recommended therapies include topically applied  benzoyl peroxide  ( pregnancy category  C) and azelaic acid (category B). [ 176 ]  Salicylic acid carries a category C safety rating due to higher systemic absorption (9\u201325%), and an association between the use of anti-inflammatory medications in the third trimester and adverse effects to the developing fetus including  too little amniotic fluid in the uterus  and early closure of the babies'  ductus arteriosus  blood vessel. [ 49 ] [ 176 ]  Prolonged use of salicylic acid over significant areas of the skin or under  occlusive (sealed) dressings  is not recommended as these methods increase systemic absorption and the potential for fetal harm. [ 176 ]  Tretinoin (category C) and adapalene (category C) are very poorly absorbed, but certain studies have suggested  teratogenic  effects in the first trimester. [ 176 ]  The data examining the association between maternal topical retinoid exposure in the first trimester of pregnancy and adverse pregnancy outcomes is limited. [ 177 ]  A systematic review of observational studies concluded that such exposure does not appear to increase the risk of major  birth defects ,  miscarriages ,  stillbirths ,  premature births , or  low birth weight . [ 177 ]  Similarly, in studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters. [ 176 ]  Nevertheless, since rare harms from topical retinoids are not ruled out, they are not recommended for use during pregnancy due to persistent safety concerns. [ 177 ] [ 178 ]  Retinoids contraindicated for use during pregnancy include the topical retinoid tazarotene, and oral retinoids isotretinoin and  acitretin  (all category X). [ 176 ]  Spironolactone is relatively contraindicated for use during pregnancy due to its antiandrogen effects. [ 1 ]  Finasteride is not recommended as it is highly teratogenic. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_643", "text": "Topical antibiotics deemed safe during pregnancy include clindamycin, erythromycin, and metronidazole (all category B), due to negligible systemic absorption. [ 49 ] [ 176 ]   Nadifloxacin  and dapsone (category C) are other topical antibiotics that may be used to treat acne in pregnant women but have received less study. [ 49 ] [ 176 ]  No adverse fetal events have been reported from the topical use of dapsone. [ 176 ]  If retinoids are used there is a high risk of abnormalities occurring in the developing fetus; women of childbearing age are therefore required to use effective  birth control  if retinoids are used to treat acne. [ 20 ]  Oral antibiotics deemed safe for pregnancy (all category B) include  azithromycin ,  cephalosporins , and  penicillins . [ 176 ]  Tetracyclines (category D) are contraindicated during pregnancy as they are known to deposit in developing fetal teeth, resulting in yellow discoloration and  thinned tooth enamel . [ 1 ] [ 176 ]  Their use during pregnancy has been associated with the development of  acute fatty liver of pregnancy  and is further avoided for this reason. [ 176 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_644", "text": "Limited evidence supports  comedo extraction , but it is an option for comedones that do not improve with standard treatment. [ 8 ] [ 80 ]  Another procedure for immediate relief is the injection of a corticosteroid into an inflamed acne comedo. [ 80 ]   Electrocautery  and  electrofulguration  are effective alternative treatments for comedones. [ 179 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_645", "text": "Light therapy  is a treatment method that involves delivering certain specific wavelengths of light to an area of skin affected by acne. Both regular and  laser light  have been used. The evidence for  light therapy  as a treatment for acne is weak and inconclusive. [ 8 ] [ 180 ]  Various light therapies appear to provide a short-term benefit, but data for long-term outcomes, and outcomes in those with severe acne, are sparse; [ 181 ]  it may have a role for individuals whose acne has been resistant to topical medications. [ 10 ]  A 2016 meta-analysis was unable to conclude whether light therapies were more beneficial than placebo or no treatment, nor the duration of benefit. [ 182 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_646", "text": "When regular light is used immediately following the application of a  sensitizing substance  to the skin such as  aminolevulinic acid  or  methyl aminolevulinate , the treatment is referred to as  photodynamic therapy  (PDT). [ 106 ] [ 165 ]  PDT has the most supporting evidence of all light therapy modalities. [ 80 ]  PDT treats acne by using various forms of light (e.g., blue light or red light) that preferentially target the pilosebaceous unit. [ 106 ]  Once the light activates the sensitizing substance, this generates  free radicals  and  reactive oxygen species  in the skin, which purposefully damage the sebaceous glands and kill  C. acnes  bacteria. [ 106 ]  Many different types of nonablative lasers (i.e., lasers that do not vaporize the top layer of the skin but rather induce a physiologic response in the skin from the light) have been used to treat acne, including those that use infrared wavelengths of light. Ablative lasers (such as  CO 2  and fractional types) have also been used to treat active acne and its scars. When ablative lasers are used, the treatment is often referred to as  laser resurfacing  because, as mentioned previously, the entire upper layers of the skin are vaporized. [ 183 ]  Ablative lasers are associated with higher rates of adverse effects compared with non-ablative lasers, with examples being post-inflammatory hyperpigmentation, persistent facial redness, and persistent pain. [ 8 ] [ 184 ] [ 185 ]  Physiologically, certain wavelengths of light, used with or without accompanying topical chemicals, are thought to kill bacteria and decrease the size and activity of the glands that produce sebum. [ 165 ]  Disadvantages of light therapy can include its cost, the need for multiple visits, the time required to complete the procedure(s), and pain associated with some of the treatment modalities. [ 10 ]  Typical side effects include  skin peeling , temporary reddening of the skin, swelling, and post-inflammatory hyperpigmentation. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_647", "text": "Dermabrasion  is an effective therapeutic procedure for reducing the appearance of superficial atrophic scars of the boxcar and rolling varieties. [ 33 ]  Ice-pick scars do not respond well to treatment with dermabrasion due to their depth. [ 33 ]  The procedure is painful and has many potential side effects such as skin sensitivity to sunlight,  redness , and  decreased pigmentation of the skin . [ 33 ]  Dermabrasion has fallen out of favor with the introduction of laser resurfacing. [ 33 ]  Unlike dermabrasion, there is no evidence that  microdermabrasion  is an effective treatment for acne. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_648", "text": "Dermal or subcutaneous  fillers  are substances injected into the skin to improve the appearance of acne scars. Fillers are used to increase natural  collagen  production in the skin and to increase skin volume and decrease the depth of acne scars. [ 186 ]  Examples of fillers used for this purpose include  hyaluronic acid ;  poly(methyl methacrylate)   microspheres  with collagen; human and bovine collagen derivatives, and fat harvested from the person's own body (autologous fat transfer). [ 186 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_649", "text": "Microneedling  is a procedure in which an instrument with multiple rows of tiny needles is rolled over the skin to elicit a wound healing response and stimulate collagen production to reduce the appearance of atrophic acne scars in people with darker skin color. [ 183 ]  Notable adverse effects of microneedling include post-inflammatory hyperpigmentation and tram track scarring (described as discrete slightly raised scars in a linear distribution similar to a tram track). The latter is thought to be primarily attributable to improper technique by the practitioner, including the use of excessive pressure or inappropriately large needles. [ 183 ] [ 187 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_650", "text": "Subcision  is useful for the treatment of superficial atrophic acne scars and involves the use of a small needle to loosen the fibrotic adhesions that result in the depressed appearance of the scar. [ 188 ] [ 189 ] [ 190 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_651", "text": "Chemical peels  can be used to reduce the appearance of acne scars. [ 33 ]  Mild peels include those using  glycolic acid ,  lactic acid ,  salicylic acid ,  Jessner's solution , or a lower concentration (20%) of  trichloroacetic acid . These peels only affect the  epidermal layer of the skin  and can be useful in the treatment of superficial acne scars as well as skin pigmentation changes from inflammatory acne. [ 33 ]  Higher concentrations of trichloroacetic acid (30\u201340%) are considered to be medium-strength peels and affect the skin as deep as the  papillary dermis . [ 33 ]  Formulations of trichloroacetic acid concentrated to 50% or more are considered to be deep chemical peels. [ 33 ]  Medium-strength and deep-strength chemical peels are more effective for deeper atrophic scars but are more likely to cause side effects such as skin pigmentation changes, infection, and  small white superficial cysts known as milia . [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_652", "text": "Researchers are investigating complementary therapies as treatment for people with acne. [ 191 ]   Low-quality evidence  suggests topical application of  tea tree oil  or  bee venom  may reduce the total number of skin lesions in those with acne. [ 191 ]  Tea tree oil appears to be approximately as effective as  benzoyl peroxide  or salicylic acid but is associated with  allergic contact dermatitis . [ 1 ]  Proposed mechanisms for tea tree oil's anti-acne effects include antibacterial action against  C. acnes  and anti-inflammatory properties. [ 66 ]  Numerous other plant-derived therapies have demonstrated positive effects against acne (e.g.,  basil oil ;  oligosaccharides  from  seaweed ; however, few well-done studies have examined their use for this purpose. [ 192 ]  There is a lack of high-quality evidence for the use of  acupuncture ,  herbal medicine , or  cupping therapy  for acne. [ 191 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_653", "text": "Many over-the-counter treatments in many forms are available, which are often known as  cosmeceuticals . [ 193 ]  Certain types of  makeup  may be useful to mask acne. [ 194 ]  In those with oily skin, a water-based product is often preferred. [ 194 ] [ 195 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_654", "text": "Acne usually improves around the age of 20 but may persist into adulthood. [ 77 ]  Permanent physical scarring may occur. [ 20 ]  Rare complications from acne or its treatment include the formation of  pyogenic granulomas ,  osteoma cutis , and  acne with facial edema . [ 196 ]  Early and aggressive treatment of acne is advocated by some in the medical community to reduce the chances of these poor outcomes. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_655", "text": "There is good evidence to support the idea that acne and associated scarring negatively affect a person's psychological state, worsen mood, lower self-esteem, and are associated with a higher risk of  anxiety disorders ,  depression , and  suicidal thoughts . [ 3 ] [ 32 ] [ 53 ] [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_656", "text": "Misperceptions about acne's causative and aggravating factors are common, and people with acne often blame themselves, and others often blame those with acne for their condition. [ 197 ] [ 82 ]  Such blame can worsen the affected person's sense of self-esteem. [ 197 ]  Until the 20th century, even among dermatologists, the list of causes was believed to include excessive sexual thoughts and  masturbation . [ 198 ]  Dermatology's association with  sexually transmitted infections , especially  syphilis , contributed to the stigma. [ 198 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_657", "text": "Another  psychological  complication of acne vulgaris is  acne excori\u00e9e , which occurs when a person persistently picks and scratches pimples, irrespective of the severity of their acne. [ 61 ] [ 199 ]  This can lead to significant scarring, changes in the affected person's skin pigmentation, and a cyclic worsening of the affected person's anxiety about their appearance. [ 61 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_658", "text": "Globally, acne affects approximately 650\u00a0million people, or about 9.4% of the population, as of 2010. [ 200 ]  It affects nearly 90% of people in Western societies during their teenage years, but can occur before adolescence and may persist into adulthood. [ 19 ] [ 20 ] [ 23 ]  While acne that first develops between the ages of 21 and 25 is uncommon, it affects 54% of women and 40% of men older than 25\u00a0years of age [ 49 ] [ 201 ]  and has a lifetime prevalence of 85%. [ 49 ]  About 20% of those affected have moderate or severe cases. [ 2 ]  It is slightly more common in females than males (9.8% versus 9.0%). [ 200 ]  In those over 40\u00a0years old, 1% of males and 5% of females still have problems. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_659", "text": "Rates appear to be lower in rural societies. [ 22 ]  While some research has found it affects people of all ethnic groups, [ 202 ]  acne may not occur in the non-Westernized peoples of  Papua New Guinea  and  Paraguay . [ 203 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_660", "text": "Acne affects 40\u201350\u00a0million people in the United States (16%) and approximately 3\u20135\u00a0million in Australia (23%). [ 125 ] [ 204 ]  Severe acne tends to be more common in people of Caucasian or Amerindian descent than in people of African descent. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_661", "text": "Historical records indicate that  pharaohs  had acne, which may be the earliest known reference to the disease.  Sulfur 's usefulness as a topical remedy for acne dates back to at least the reign of  Cleopatra  (69\u201330\u00a0BCE). [ 205 ]  The sixth-century  Greek  physician  A\u00ebtius of Amida  reportedly coined the term \" ionthos \" ( \u03af\u03bf\u03bd\u03b8\u03c9\u03be ,) or \" acnae \", which seems to be a reference to facial skin lesions that occur during \"the ' acme ' of life\" ( puberty ). [ 206 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_662", "text": "In the 16th century, the French physician and botanist  Fran\u00e7ois Boissier de Sauvages de Lacroix  provided one of the earlier descriptions of acne. He used the term \"psydracia achne\" to describe small, red, and hard  tubercles  that altered a person's facial appearance during adolescence and were neither itchy nor painful. [ 206 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_663", "text": "The recognition and characterization of acne progressed in 1776 when  Josef Plenck  (an  Austrian  physician) published a book that proposed the novel concept of classifying skin diseases by their elementary (initial) lesions. [ 206 ]  In 1808 the  English   dermatologist   Robert Willan  refined Plenck's work by providing the first detailed descriptions of several skin disorders using morphologic terminology that remains in use today. [ 206 ]   Thomas Bateman  continued and expanded on Robert Willan's work as his student and provided the first descriptions and illustrations of acne accepted as accurate by modern dermatologists. [ 206 ]   Erasmus Wilson , in 1842, was the first to make the distinction between acne vulgaris and rosacea. [ 207 ]  The first professional medical  monograph  dedicated entirely to acne was written by  Lucius Duncan Bulkley  and published in New York in 1885. [ 198 ] [ 208 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_664", "text": "Scientists initially hypothesized that acne represented a disease of the skin's hair follicle, and occurred due to blockage of the pore by sebum. During the 1880s, they observed bacteria by microscopy in skin samples from people with acne. Investigators believed the bacteria caused comedones, sebum production, and ultimately acne. [ 206 ]  During the mid-twentieth century, dermatologists realized that no single hypothesized factor (sebum, bacteria, or excess keratin) fully accounted for the disease in its entirety. [ 206 ]  This led to the current understanding that acne could be explained by a sequence of related events, beginning with blockage of the skin follicle by excessive dead skin cells, followed by bacterial invasion of the hair follicle pore, changes in sebum production, and inflammation. [ 206 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_665", "text": "The approach to acne treatment underwent significant changes during the twentieth century. Retinoids became a medical treatment for acne in 1943. [ 97 ]  Benzoyl peroxide was first proposed as a treatment in 1958 and remains a staple of acne treatment. [ 209 ]  The introduction of oral tetracycline antibiotics (such as minocycline) modified acne treatment in the 1950s. These reinforced the idea amongst dermatologists that bacterial growth on the skin plays an important role in causing acne. [ 206 ]  Subsequently, in the 1970s,  tretinoin  (original trade name Retin A) was found to be an effective treatment. [ 210 ]  The development of oral  isotretinoin  (sold as Accutane and Roaccutane) followed in 1980. [ 211 ]  After its introduction in the United States, scientists identified isotretinoin as a medication highly likely to cause birth defects if taken during pregnancy. In the United States, more than 2,000\u00a0women became pregnant while taking isotretinoin between 1982 and 2003, with most pregnancies ending in  abortion  or  miscarriage . Approximately 160 babies were born with birth defects due to maternal use of isotretinoin during pregnancy. [ 212 ] [ 213 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_666", "text": "Treatment of acne with topical crushed dry ice, known as cryoslush, was first described in 1907 but is no longer performed commonly. [ 214 ]  Before 1960, the use of X-rays was also a common treatment. [ 215 ] [ 216 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_667", "text": "The costs and social impact of acne are substantial. In the United States, acne vulgaris is responsible for more than 5\u00a0million  doctor  visits and costs over  US$ 2.5\u00a0billion each year in  direct costs . [ 13 ]  Similarly, acne vulgaris is responsible for 3.5\u00a0million doctor visits each year in the  United Kingdom . [ 20 ]  Sales for the top ten leading acne treatment brands in the US in 2015 amounted to $352 \u00a0 million. [ 217 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_668", "text": "Acne vulgaris and its resultant scars are associated with significant social and academic difficulties that can last into adulthood. [ 32 ] [ 218 ]  During the  Great Depression , dermatologists discovered that young men with acne had difficulty obtaining jobs. [ 198 ]  Until the 1930s, many people viewed acne as a trivial problem among middle-class girls because, unlike  smallpox  and  tuberculosis , no one died from it, and a feminine problem, because boys were much less likely to seek medical assistance for it. [ 198 ]  During  World War II , some soldiers in tropical climates developed such severe and widespread  tropical acne  on their bodies that they were declared medically  unfit for duty . [ 198 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_669", "text": "Efforts to better understand the mechanisms of sebum production are underway. This research aims to develop medications that target and interfere with the hormones that are known to increase sebum production (e.g.,  IGF-1  and  alpha-melanocyte-stimulating hormone ). [ 10 ]  Other sebum-lowering medications such as topical antiandrogens,  peroxisome proliferator-activated receptor  modulators, and inhibitors of the  stearoyl-CoA desaturase-1   enzyme  are also a focus of research efforts. [ 10 ] [ 106 ]  Particles that release  nitric oxide  into the skin to decrease skin inflammation caused by  C. acnes  and the  immune system  have shown promise for improving acne in early clinical trials. [ 106 ]  Another avenue of early-stage research has focused on how to best use laser and light therapy to selectively destroy sebum-producing glands in the skin's hair follicles to reduce sebum production and improve acne appearance. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_670", "text": "The use of  antimicrobial peptides  against  C. acnes  is under investigation as a treatment for acne to overcoming antibiotic resistance. [ 10 ]  In 2007, scientists reported the first  genome   sequencing  of a  C. acnes   bacteriophage  (PA6). The authors proposed applying this research toward the development of  bacteriophage therapy  as an acne treatment to overcome the problems associated with long-term antibiotic use, such as bacterial resistance. [ 219 ]  Oral and topical  probiotics  are under evaluation as treatments for acne. [ 220 ]  Probiotics may have therapeutic effects for those affected by acne due to their ability to decrease skin inflammation and improve skin moisture by increasing the skin's  ceramide  content. [ 220 ]  As of 2014, knowledge of the effects of probiotics on acne in humans was limited. [ 220 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_671", "text": "Decreased levels of  retinoic acid  in the skin may contribute to comedo formation. Researchers are investigating methods to increase the skin's production of retinoic acid to address this deficiency. [ 10 ]  A  vaccine  against inflammatory acne has shown promising results in mice and humans. [ 52 ] [ 221 ]  Some have voiced concerns about creating a vaccine designed to neutralize a stable community of normal skin bacteria that is known to protect the skin from colonization by more harmful microorganisms. [ 222 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_672", "text": "Acne can  occur on cats , [ 223 ]  dogs, [ 224 ]  and horses. [ 225 ] [ 226 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_673", "text": "Angiofibroma  ( AGF ) is a descriptive term for a wide range of benign skin or  mucous membrane  (i.e. the outer membrane lining body cavities such as the mouth and nose)  lesions  in which individuals have:"}
{"_id": "WikiPedia_Dermatology$$$corpus_674", "text": "AGF lesions share common  macroscopic (i.e. gross)  and microscopic appearances. Grossly, AGF lesions consist of multiple papules, one or more skin-colored to erythematous, dome-shaped nodules, or usually just a single tumor. Microscopically, they consist of spindle-shaped and stellate-shaped cells centered around dilated and thin-walled blood vessels in a background of coarse bundles of  collagen  (i.e. the main fibrous component of  connective tissue ). [ 2 ]  Angiofibromas have been divided into different types but commonly a specific type was given multiple and very different names in different studies. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_675", "text": "These papule, nodule, and/or tumor lesions occur on the:  1)  face and are typically termed fibrous papules;  2)  penis and are typically termed pearly penile papules; and  3)  underneath a fingernail or toenail and are typically termed periungual angiofibromas. Some of these cutaneous AGF lesions occur in individuals with one or more of 3 different  genetic diseases :  tuberous sclerosis ,  multiple endocrine neoplasia type 1 , and  Birt-Hogg-Dube syndrome . [ 3 ]  The following are examples of these cutaneous angiofibromas and their alternate names."}
{"_id": "WikiPedia_Dermatology$$$corpus_676", "text": "Fibrous papules are also termed facial angiofibromas and were formerly and incorrectly termed adenoma sebaceum (fibrous papules are unrelated to sebaceous glands [ 4 ] ). They develop in up to 8% of the general adult population and occur as 1 to 3 [ 5 ]  pink to red, [ 4 ]  dome-shaped papules in the central areas of the face, nose, and/or lips. [ 6 ]  About 75% of individuals with tuberous sclerosis present with fibrous papules in their infancy or early childhood; when associated with this rare disease, the lesions often occur as multiple papules [ 5 ]  in symmetrical, butterfly-shaped patterns over both cheeks and the nose. [ 7 ]  Fibrous papules also occur in individuals with multiple endocrine neoplasia type 1 (a study done in Japan found that 43% of individuals with this genetic disease bore facial angiofibromas) [ 8 ]  and, uncommonly, in individuals with Birt-Hogg-Dube syndrome. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_677", "text": "Pearly penile papules are also termed  papillae coronae glandis  and  hirsutoid papillomas . The condition of having such papules or papillae is called  hirsuties papillaris coronae glandis  or  papillomatosis coronae glandis  or  papillomatosis coronae penis . [ 10 ]  These lesions develop in up to 30% of males during their puberty or, less commonly, early adulthood. They typically occur as numerous white-colored to skin-colored papules located circumferentially around the  corona of the penis  or, less commonly, the ventromedial aspect of the corona near the  penis's frenulum . [ 11 ]  ( Vestibular papillomatosis , also named hirsutoid vulvar papillomas, vulvar squamous papillomatosis, micropapillomatosis labialis, and squamous vestibular micropapilloma, is the female equivalent of pearly penile papules in men. [ 12 ]  It has not been formally termed an angiofibroma.)"}
{"_id": "WikiPedia_Dermatology$$$corpus_678", "text": "Periungual angiofibromas are also termed Koenen's tumors, periungual fibromas, and subungual fibromas. [ 13 ]  In addition, these tumors were formerly regarded as a type of acral angiofibroma (see below description). [ 14 ]  These lesions present as multiple nodules or tumors under multiple finger and/or toe nails of individuals with tuberous sclerosis [ 4 ]  or in one case the Birt-Hogg-Dube syndrome. [ 15 ]  Periungual angiofibromas have also been reported to occur in individuals that do not have these genetic diseases. [ 16 ]  Periungual angiofibromas tumors can be highly mutilating finger/toe-nail lesions. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_679", "text": "Oral fibromas are also termed irritation fibromas, focal fibrous hyperplasia, and traumatic fibromas. [ 17 ]  These lesions are nodules that occur on the buccal mucosa (i.e. mucous membranes lining the cheeks and back of the lips) or lateral tongue. [ 18 ]  They may be irritating or asymptomatic and are the most common tumor-like lesions in the oral cavity. Oral fibromas are not  neoplasms ; they are hyperplastic (i.e. overgrowth) reactions of fibrous tissue to local trauma or chronic irritation. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_680", "text": "Nasopharyngeal angiofibromas, also termed juvenile nasopharyngeal angiofibromas, fibromatous hamartomas, or angiofibromatous hamartoma of the nasal cavity, are large benign tumors (average size 5.9\u00a0cm in one study) that develop almost exclusively in males aged 9 to 36 years old. They commonly arise in the  nasopharynx  (i.e. upper part of the throat that lies behind the nose) and typically have attachments to the  sphenopalatine foramen ,  clivus , and/or root of the  pterygoid processes of the sphenoid  bone. These tumors may expand into various other nearby structures including the  cranial cavity . [ 20 ]  Nasopharyngeal angiofibromas are highly vascularized tumors consisting of  fibroblasts  (i.e.  connective tissue  cells) in a dense collagen  matrix  (i.e. tissue background). Studies have suggested that these tumors are due to the expression of male sex hormones (i.e.  androgens  and  progesterones ), genetic factors, molecular alterations (i.e. changes in the normal characteristics of cells that lead to abnormal cell growth), and/or  human papillomavirus infection . [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_681", "text": "Angiofibroma of soft tissue is also named angiofibroma, not otherwise specified, by the World Health Organization, 2020. The Organization also classified these lesions as in the category of benign  fibroblastic and myofibroblastic tumors . [ 22 ]  These tumors more often afflict females, [ 23 ]  typically occur in adults (median age 49 years), have a median size of ~3.5\u00a0cm, and develop in a leg near to, and may invade, a large joint. Less uncommonly, they occur in the back, abdominal wall,  pelvic cavity , or breast. Angiofibroma of soft tissue tumors consist of uniform, bland, spindle-shaped cells and a prominent vascular network consisting of small thin-walled branching blood vessels in a variably collagenous tissue background. Its tumor cells contain an  AHRR - NCOA2  fusion gene in 60% to 80% of cases and a  GTF2I - NCOA2  or  GAB1 - ABL1  fusion gene in rare cases. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_682", "text": "Cellular angiofibroma is usually a small, slow-growing tumor arising in the  vulva - vaginal  areas of adult woman and the  inguinal - scrotal  areas of adult men although some of these tumors, especially in men, can grow up to 25\u00a0cm. Affected men are usually older (7th decade) than women (5th decade). [ 25 ]  Less commonly. cellular angiofibromas have occurred in various other superficial soft tissue areas throughout the body. [ 26 ]  These tumors are edematous (i.e. abnormally swollen with fluid), highly vascular, spindle-shaped cell lesions with a variable amount of fibrous stroma. [ 25 ]  In 2020, the World Health Organization classified cellular angiofibroma tumors in the category of benign  fibroblastic/myofibroblastic tumors . [ 22 ]  The tumor cells in these lesions contain chromosome and gene abnormalities including a loss of one of the two  RB1  genes. It has been suggested that the loss of this gene contributes to the development of cellular angiofibroma tumors. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_683", "text": "Acral angiofibromas are also termed superficial acral fibromyxomas, digital fibromyxomas, acquired digital fibrokeratomas, acquired periungual fibrokeratomas, garlic clove fibromas, [ 28 ]  digital fibromas, and cellular digital fibromas. [ 14 ]  At one time, periungual angiofibromas were regarded as a type of acral angiofibroma (see above description). [ 14 ]  Acral refers to distal sites of the ears, nose, hands, fingers, feet, and toes. Acral angifibromeae occur primarily in areas close to the nails of fingers and toes (~80% of cases) [ 28 ]  or, less commonly, palms of the hands or soles of the feet. [ 14 ]  The tissues of this tumor consists of bland spindle-shaped and star-shaped cells within a  collagen fiber -rich stroma containing prominent blood vessels and  mast cells . [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_684", "text": "Angiofibroma of soft tissue  ( AFST ), also termed angiofibroma, not otherwise specified, is a recently recognized and rare disorder that was classified in the category of benign  fibroblastic and myofibroblastic tumors  by the World Health Organization in 2020. [ 1 ]  An AFST tumor is a neoplasm (i.e. growth of tissue that is not coordinated with the normal surrounding tissue and persists in growing even if the original trigger for growth is removed) that was first described by A. Mari\u00f1o-Enr\u00edquez and C.D. Fletcher in 2012. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_685", "text": "AFST tumors typically occur in a leg but can occur in other locations; they develop in older children and adults including elderly individuals. AFSTs are slow-growing, often painless tumors composed primarily of spindle-shaped cells and a prominent vascular network. The spindle-shaped cells are  benign tumor  cells that in almost all cases have  chromosome abnormalities  that are thought to contribute to their abnormal development and/or growth. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_686", "text": "AFST tumors are commonly treated by surgical excision although in uncommon cases they recur at the site of their removal and require further surgical treatment. [ 2 ]  They do not metastasize to distant tissues and overall have a good prognosis. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_687", "text": "AFST tumors commonly present as slowly growing, painless, deep-seated lumps in individuals aged 6 to 86 years old (median age 47-50 years in different studies). [ 4 ]  The tumors are most common in the lower extremities but uncommonly occur in the back, chest wall,  iliac crest ,  groin  and nearby lower lateral abdominal region, [ 4 ]   abdominal cavity ,  pelvic cavity , [ 5 ]  breast, [ 3 ]   cheek ,  temporal region of the head  and, in a report on 24 AFST cases done in Shanghai, the upper limb in 3 cases and, in 1 case each, the  retroperitoneum   and liver. [ 6 ]  The tumors' longest diameters have ranged from 1.2 to 10 cm (mean: 5.1\u2009cm) [ 4 ]  and 0.8 to 14 cm (mean: 4.6 cm) [ 6 ]  in two different studies."}
{"_id": "WikiPedia_Dermatology$$$corpus_688", "text": "Grossly , AFST tumors, when visible on skin, are located in the skin's  subcutaneous tissue  or the  fascia  layer below the subcutaneous tissue. [ 3 ]  They may be infiltrating deeper into these tissues [ 4 ]  and/or into nearby large joints. [ 3 ]  Regardless of location, however, most of these tumors are well-circumscribed. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_689", "text": "Histopathological  microscopic analyses of  hematoxylin and eosin-stained  AFST tissues generally reveal bland appearing spindle-shaped cells and a prominent small, thin-walled blood vessels network in a background of alternating myxoid  connective tissue  areas and more highly cellular collagen fiber-rich connective tissue areas. (Myxoid indicates areas that appear more blue or purple than normal due to their high uptake of the hematoxylin stain.) Typically, these tumors appear well-circumscribed but some cases show them infiltrating into adjacent normal adipose tissues, connective tissues, skeletal muscles, and/or joints. [ 4 ]   Immunohistochemistry  analyses (i.e. identifying specific proteins in cells using antibodies that bind to these proteins) of AFST tissues detect cells bearing  estrogen receptor ,  CD163   and  NCOA2  proteins in 100% of cases;  MUC1  (also termed EMA) protein in 46% of cases;  desmin  protein in 22% of cases;  ACTA2  (also termed \u03b1-SMA),  CD34 , and  STAT6  proteins in 10% or fewer cases, and  S100  and  cytokeratin  proteins in no cases."}
{"_id": "WikiPedia_Dermatology$$$corpus_690", "text": "In 60-80% of cases, the cells in AFST tumors express the  AHRR - NCOA2   fusion gene . A fusion gene is a hybrid gene formed from two previously independent genes as a result of a  translocation ,  interstitial deletion , or  chromosomal inversion . [ 5 ]  The  AHRR  gene (i.e. gene for the aryl hydrocarbon receptor repressor protein) is located at  band  15.33 on the  short (or \"p\") arm  of  chromosome 5  (cite designation: 5p15.33); [ 7 ]  The  NCOA2  gene (i.e. gene for the nuclear receptor coactivator 2 protein) is located at band 13.3 on the long (or \"q\") arm of  chromosome 8  (cite designation: 8q13.3). [ 8 ]  A translocation between these two chromosomes creates the  AHRR-NCOA2  fusion gene (fusion gene designation: t(5;8)(q15;q13)). [ 9 ]   AHRR  is a  tumor suppressor gene  that when fused to other genes is found in the cells of , and thought to promote, various  leukemias  and neoplasms. It is thought to similarly promote the development and/or progression of AFST tumors. [ 4 ]  While most commonly associated with the  AHRR-NCOA2  fusion gene, rare AFST tumor cases have also been shown to be associated with  GAB1 - ABL1 ,  GTF2I -NCOA2, NCOA2- ETV4 , ETV4-AHRR , [ 4 ]  and    NAB2 - STAT6 [ 4 ]  fusion genes."}
{"_id": "WikiPedia_Dermatology$$$corpus_691", "text": "The diagnosis of AFST depends on its presentation (particularly its location), histopathology (particularly the expression of certain proteins by its tumor cells), and the presence of specific fusion genes (e.g.  AGRR-NCOA2 ) in its tumor cells. Among benign tumors,  cellular angiofibroma  and  solitary fibrous tumor  may be confused with AFST. Cellular angiofibroma differs from AFST in its typical location (i.e.  inguinal ,  scrotal , and  vulva  areas), its distinct histology of rounded, non-branching vessels, high cellularity, and cells with small nuclei, and its tumor cells' loss of the  RB1  gene. Solitary fibrous tumors differ from AFST tumors in their common location in the lungs'  pleurae , their characteristic branching dilated, staghorn-shaped blood vessels, and their tumor cells' expression of CD34 and STAT6 proteins in the majority of the cases. AFTS tumors may also be confused with three malignant tumors,  low-grade fibromyxoid sarcoma ,  myxofibrosarcoma , and  myxoid liposarcoma . Low-grade fibromyxoid sarcomas tend to be less cellular and have less prominent blood vessel than AFST; they also differ from AFST in that their tumor cells commonly express the  MUC4  protein and  FUS-CREB3L1 ,  FUS-CREBL2 , or,  EWSR1-CREB3L1  fusion genes. Myxofibrosarcoma tumors commonly show overt malignant features such as highly infiltrating margins, tumor cells with eosinophilic  cytoplasm , atypical  nuclei , and rapid proliferation rates as evidenced by their high  mitotic indexes . Myxoid liposarcoma tumors consist of round or slightly fusiform cells in a myxoid matrix, vacuolated  lipoblasts  (i.e. cells that are precursors to  fat cells ), and arborizing networks of thin-walled capillaries. [ 3 ]  In all of these cases, the presence of one of the AFST-associated fusion genes cited in the previous section lends support for the diagnosis of AFST. [ 3 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_692", "text": "AFST tumors are typically treated by total surgical resection in order to remove all tumor tissue. [ 4 ]  Uncommonly, these tumors have recurred at the site of their removal, particularly in cases where a portion of the original tumor was not removed. [ 5 ]  Recurrences have occurred 4-120 months after the original resections [ 4 ]  and have been treated by a second surgical resection. [ 2 ]  Overall, AFST tumors have a good prognosis. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_693", "text": "Atrophia Maculosa Varioliformis Cutis  (AMVC) is an idiopathic noninflammatory macular  atrophy  subtype that affects young people. Clinically, it is distinguished by a variety of shaped, shallow, sharply demaracated depressions. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_694", "text": "The clinical feature of AMVC is the spontaneous onset of atrophic lesions that are usually on the face of adolescents. These lesions can be round, oval, linear, curvilinear, or rectangular with a regular margin and clearly defined edges. The sites most commonly affected are the bilateral malar regions. However the  mandibular  region and forehead may also be impacted. The absence of prior inflammatory or traumatic events at the lesion site is characteristic of this condition. [ 2 ]  There have been reports of extrafacial involvement, such as lesions on the forearm, posterior aspect of the pinna, and periumbilical area. [ 3 ] [ 4 ]  The lesion may range in size from 0.2-2 cm in length and 0.2-0.5 cm in width; neither exfoliation nor pigmentary changes may be present. They are cicatricial and depressed in comparison to the surrounding skin. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_695", "text": "Although the exact cause of AMVC is unknown, a familial occurrence that has been documented in the past raises the possibility that the condition is inherited rather than the result of an environmental insult. [ 5 ] [ 3 ]  There have been reports of cases linked to  pachydermodactyly  and extrahepatic  biliary atresia , although these links might be accidental. [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_696", "text": "Patients with facial atrophic lesions with well-defined edges and no  erythema , induration, pigmentary changes, or honeycombed pattern are typically diagnosed with AMVC primarily based on clinical findings. With a comparatively normal dermis, a small reduction in or fragmentation of the  elastic fibers , no  fibrosis , and little to no inflammation beneath the shallow depression of the  epidermis , the histological features are nonspecific. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_697", "text": "Autoimmune skin diseases  occur when the  immune system  of an infected animal attacks its own skin. [ 1 ]  In  dogs , autoimmune skin diseases are usually not detected until visible symptoms appear, which differs from detection in humans who are able to verbally express their concerns. [ 2 ]   Genetics , nutrition, and external environmental factors all collectively contribute to increasing the probability an autoimmune skin disease occurring. [ 3 ]  The severity of symptoms varies based on the specific disease present and how far it has progressed. Diagnosis often requires the onset of visible symptoms and for a  biopsy  to be performed. For many diseases, the condition itself cannot be cured, but a veterinarian can prescribe medications and other forms of treatment to help manage the symptoms of the dog. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_698", "text": "The immune system has the ability to differentiate between the  cells  of the body and foreign cells. However, in dogs affected by an  autoimmune disease , the immune system loses the ability to make this distinction, causing the immune system to attack the body. [ 5 ]  Autoimmune diseases in the base layer of the  epidermis  are characterized by damage to the connective tissue and vesicle formation located below the  epidermis  layer and the  dermis  layer below it. [ 6 ] [ 7 ]  There are many autoimmune diseases, and they all vary in impact to the dog and progress at their own rates. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_699", "text": "Dogs suffering from autoimmune diseases of the  skin  may experience a variety of symptoms, including persistent  itching  and scratching, lesions, wounds, blisters, and other skin damage, as well as loss of skin  pigment . [ 5 ]  Two cases of autoimmune diseases that are often found include  Discoid lupus erythematosus  (DLE) and  Pemphigus . DLE can develop into  Systemic Lupus Erythematosus  (SLE). [ 9 ]  The initial stage of DLE is marked by a loss of skin  pigment . The skin becomes red and  sores  appear on the  nose . The  palate  can undergo  erosion , ulceration, and injury to the nasal palate, as well as damage to the nostrils and the tissue around the eyes and ears. In  chronic  and severe cases, visual scar tissue often occurs. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_700", "text": "Most symptoms occur after the outer epidermis and inner dermis of the skin are affected by the disease. When this happens, the layers of the skin begin to separate, leading to painful lesions and pustules. [ 2 ]  The compromised integrity of the skin barrier not only exacerbates the discomfort experienced by the dog, but also heightens the risk of secondary  bacterial  infections. The weakening of the skin's protective layers forms an environment susceptible to  microbial  infiltration, which could lead to severe complications. Intervening within an earlier time frame and targeted management strategies are essential to minimize further adverse effects. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_701", "text": "Another autoimmune skin disease which can occur in dogs is  vitiligo . In addition to humans, vitiligo can be found in a variety of animals, including  cats ,  horses , and  dogs . Vitiligo is a type of autoimmune disease that damages  melanocytes  in the skin, lips, and  oral cavity . Melanocytes are cells that contain pigments such as  melanin . These pigments give rise to an organism's  phenotype , which determines skin and hair color. [ 11 ]  Melanocytes are also found in other parts of the body, such as the oral  mucosa , eye,  cochlea , and the  meninges . In addition to vitiligo, there are other autoimmune diseases that target melanocytes, such as  Vogt-Koyanagi-Harada  (VKH) syndrome, and  Uveodermatological  (UDS) syndrome. [ 12 ]  Vogt-Koyanagi-Harada syndrome is an autoimmune disease that affects the eyes. In addition to depigmentation of the skin, the disease is characterized by a combination of conditions, including uveitis, acute iridocyclitis, choroiditis, and retinal detachment. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_702", "text": "When  pemphigus  occurs in humans, the skin will begin to blister due to  antibodies  attacking the adhesive proteins in epidermal cells, which causes them to separate. Different types of pemphigus can be identified based on the depth of separation present in the skin. Many forms of pemphigus can be identified in dogs using methods similar to those employed for humans. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_703", "text": "Pemphigus vulgaris  is rare in humans and animals, but is often fatal if left untreated. In dogs, the disease presents itself so similarly to the way it occurs in humans that dogs can be used as models for the disease in humans. [ 4 ]  When the disease first begins to manifest itself, lesions are usually evident in the oral cavity of the dog. [ 9 ]  Aside from these blisters, the dog may be mostly  asymptomatic  before the disease progresses further. [ 4 ]  The blisters are easily ruptured and become painful upon doing so, [ 4 ]  which can cause the dog to have difficulty eating. [ 15 ]  As the disease progresses, the infected dog can become severely infirm, and may succumb to further  infection . [ 4 ]  Sometimes symptoms are characterized by  lymphadenopathy , which involves loss of appetite, weakness,  fever , and in rare cases,  sepsis . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_704", "text": "Pemphigus foliaceus  is the most common autoimmune skin disease in dogs, making up around one-third of all canine autoimmune disorders. [ 16 ]  This disease usually affects areas of the ears and face. [ 9 ]  Early symptoms are characterized by  depigmentation  of the nasal  palate , dorsal cleft in the  mouth , the  ear , and the periocular area around the eye. Itching, pain, and weakness of the body have been observed in some cases. Other symptoms of  Pemphigus foliaceus  include hair loss, formation of pustules, and erosions with ulcers. These symptoms can appear on the dog's feet, groin area, and trunk if left untreated. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_705", "text": "The immune system functions in many ways to eliminate foreign substances and particles introduced to the body. This revolves around  T-cell  differentiation, where mature T-cells with receptors for non-self cells target foreign  antigens  and act with other cells to dispose of them. [ 17 ]  There are two mechanisms of tolerance found in the immune system. [ 6 ]  The first mechanism is positive selection by the  thymus , where only  T-cells  are selected. T-cells recognize  peptides  in the  Histocompatibility Complex  (MHC). [ 6 ]  The second mechanism is negative selection, where T-cells that recognize self-antigens with too high an affinity are removed through the process of  apoptosis  and are not allowed to enter the body's circulation."}
{"_id": "WikiPedia_Dermatology$$$corpus_706", "text": "Incidences of autoimmune skin diseases can vary based on several factors. Some of these factors include the  breed , age, and sex of the dog, along with individual genetics and environmental factors. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_707", "text": "In terms of vitiligo, certain breeds of dogs have a higher chance of developing the disease based on their genetics. These breeds include  Rottweilers ,  German Shepherds ,  Old English Sheepdogs ,  Doberman Pinchers ,  Dachshunds , and  German Shorthaired Pointers . [ citation needed ]  However, the exact prevalence of this disease in dogs is currently unknown, as it is likely under-reported. [ 2 ]  Certain dog breeds that have been documented with Vogt-Koyanagi-Harada (VKH) syndrome include Akitas, Samoyeds, Irish Setters, Golden Retrievers, Saint Bernards, Australian Sheepdogs, and Shetland Sheepdogs. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_708", "text": "Pemphigus vulgaris can occur in any breed of dog irrespective of its sex or age. [ 4 ]  However, it appears to occur more often in male dogs than females, which differs slightly from its occurrence in humans. In humans, women are more likely to be affected than men. In terms of age, the disease usually begins when the dog is at least five to seven years old. This correlates to the typical age in which it begins in humans as well, generally occurring in  middle age . [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_709", "text": "Since many autoimmune skin diseases have similar symptoms and usually affect the oral cavity, a biopsy must often be performed in order to correctly diagnose the disease. [ 18 ]  Due to the wide scale of clinical symptoms that can be present, along with the diverse variations of skin autoimmune dermatoses, a single symptom will more than likely not lead to a diagnosis. Instead, the results of the biopsy combined with the canine's history and other clinical signs can help in confirming the diagnosis of the disease. Breed predisposition and the age of the dog can also be indications of the various possibilities of autoimmune skin diseases. [ 19 ]  Some common symptoms that can be used to lead to a confirmed diagnosis include alopecia, crusting, ulcerations, vasculitis, and many more. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_710", "text": "Histopathology evaluations can be done by extracting areas of the skin that show indications of being affected, such as taking biopsies of lesions, pustules, and sites of crustation. These tissue samples would then be typically examined under a microscope, where a clinician will form a conclusive diagnosis based on the observed cellular structures and abnormalities. [ 19 ]  Additionally, other tests such as antinuclear antibody tests (ANA) and complete blood count with white blood cell differential tests can be used to gather more information. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_711", "text": "For Pemphigus vulgaris, after the skin begins to separate,  Nikolsky's sign  can be useful to help diagnose the disease. This involves placing pressure along the edge of a blister and observing if the skin separates further and if the blister increases in size. [ 21 ]  However, to diagnose the disease with complete certainty, biopsies must be taken from the edge of the blisters. The tissue sample must then be analyzed using a direct  immunofluorescence  technique and analyzed  microscopically . The direct immunofluorescence technique should be used instead of indirect, as the results may be inaccurate before the disease has progressed to a certain point. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_712", "text": "For most autoimmune skin diseases, it is imperative to begin treatment as early as possible, as the progression of the disease can lead to severe complications and even death. [ 4 ]  Treatment for many diseases usually involves the use of  immunosuppressants  such as  glucocorticoids . [ 18 ]  The immunosuppressants aid in suppressing the reaction of the immune system fighting against the body's healthy cells and tissues. [ 22 ]  This is done by the inhibition of calcineurin, an enzyme that controls and activates T-cell production. Without the consistent production of T-cells, a decrease of autoimmune activity can be observed, leading to less severe symptoms and potential remission of autoimmune diseases. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_713", "text": "When treatment is first started for Pemphigus vulgaris, the dog will usually be given the  corticosteroid   prednisone  for a limited time. This will be administered orally, and the amount given can vary between 1.5 and 13.3  milligrams  for every  kilogram  of the dog's weight. This amount will continue until symptoms begin to subside. Afterward the dose will be lowered, and other medications will be used. The condition cannot be cured, so the dog will require immunosuppressants and  steroids  for the duration of its lifespan. The specific immunosuppressants used generally include  cyclophosphamide ,  methotrexate , or  azathioprine .  Antibiotics  may also be used to help reduce the risk of infection. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_714", "text": "Balanitis circinata  (also known as  circinate balanitis ) is a skin condition comprising a  serpiginous  ring-shaped  dermatitis  of the  glans penis . [ 1 ]  While circinate balanitis is one of the most common cutaneous manifestations of reactive arthritis, it can also occur independently.  Topical corticosteroid  therapy is the most commonly used treatment, and topical  calcineurin inhibitors  have also been used successfully. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_715", "text": "At the first stages of the condition, patients show pinhead-sized lesions covered by white plaque, which grow into a flat, red region with a white margin. Despite the visible symptoms, patients rarely suffer from  burning  or  itching , and the lesions rarely smell strange. [ 3 ]  Due to its visual appearance, balanitis circinata is often misdiagnosed as a  fungal infection , especially in those that have no other symptoms of  reactive arthritis . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_716", "text": "Reactive arthritis  is characterized by  nongonococcal urethritis ,  conjunctivitis , and  arthritis . Reactive arthritis belongs to the group of arthritides known as the spondyloarthritides. There are two main types of reactive arthritis: post-venereal and post-enteric.  Chlamydia trachomatis  is thought to be the most common cause of reactive arthritis, in general. Until recently, even the terminology for the condition itself was unclear as multiple eponyms and names have been associated with reactive arthritis. In recent years, a great deal has been learnt about the epidemiology, pathophysiology and treatment of reactive arthritis and chlamydia-induced reactive arthritis, specifically. Prospective epidemiologic data suggest that chlamydia-induced reactive arthritis is underdiagnosed. Other truths being actively revealed include data suggesting that the pathogen itself (i.e., chlamydia) might play an equally important role, or perhaps even more important, than the host with disease susceptibility; asymptomatic chlamydial infections might be a common cause of reactive arthritis and the two variants of reactive arthritis might respond differently to treatment in spite of the congruent clinical presentation. However, much about this syndrome remains shrouded in mystery. Recent data has been suggesting that Chlamydia-induced reactive arthritis might be a common condition that clinicians are simply failing to recognise. Therefore, an emphasis is placed on disease awareness since viable treatment options are emerging. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_717", "text": "Balanitis circinata is one out of multiple manifestations of the reactive arthritis.  [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_718", "text": "Right now,  topical corticosteroid  therapy is the most commonly used treatment, and topical  calcineurin inhibitors  have also been used successfully. [ 2 ] \nNewer tests on patients showed that a less harmful  off-label  topical treatment with the  immunomodulator   pimecrolimus  or the  immunosuppressant   tacrolimus  can prevent all visible symptoms of this disease. [ citation needed ]  Since reactive arthritis cannot be healed as such, affected people are forced to a continuous topical treatment \u2013 otherwise they will again note first symptoms after three to four days without it.  [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_719", "text": "However, strong debates and controversies continue regarding the exact indications of immunomodulators like pimecrolimus and their duration of use in the absence of active controlled trials. [ 5 ]  A study released in 2015 (tested were 7,457 children with a total of 26,792 person-years) did not find any evidence that pimecrolimus could cause cancer. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_720", "text": "BPAg1  is an antigen found in human skin.  This antigen should not be confused with  BPAg2 ."}
{"_id": "WikiPedia_Dermatology$$$corpus_721", "text": "Cellular angiofibroma  ( CAF ) is a rare,  benign tumor  of superficial  soft tissues  that was first described by M. R. Nucci et al. in 1997. [ 1 ]  These tumors occur predominantly in the distal parts of the  female  and  male reproductive systems , i.e. in the  vulva - vaginal  and  inguinal - scrotal  areas, respectively, or, less commonly, in various other superficial soft tissue areas throughout the body. [ 2 ]  CAF tumors develop exclusively in adults who typically are more than 30 years old. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_722", "text": "CAF tumors are composed of bland  mesenchymal [ 4 ]  spindle-shaped cells in an edematous (i.e. abnormally swollen with fluid) to fiber-laded connective tissue background. [ 2 ]  Mesenchymal cells are cells in the  cell lineage  that includes  fibroblasts ,  adipocytes  (i.e. fat cells),  macrophages ,  mast cells ,  leucocytes , and the precursor cells which mature into these cell types. In 2020, the World Health Organization classified cellular angiofibroma tumors in the category of benign  fibroblastic and myofibroblastic tumors . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_723", "text": "CAF tumors rarely recur after surgical removal [ 3 ]  and do not  metastasize  to distant tissues. [ 5 ]  Accordingly,  surgical resection is the commonly performed and current standard for treating these tumors. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_724", "text": "CAF tumors commonly present as painless, slowly growing, soft tissue nodules or masses in the vulva-vaginal and inguinal-scrotal areas; less commonly in the  perineum ; and rarely in the  urethra ,  pelvis ,  anus ,  retroperitoneum ,  lumbar region , middle of the trunk, [ 7 ]   rectum , oral mucosa, knee, upper eyelid, [ 6 ]  hip, chest wall,  axilla , breasts, and upper abdomen. [ 2 ]  The tumors are generally centered in the  subcutaneous tissue [ 4 ]  or in the case of internal tumors, such as those located in the mouth, urethra, rectum, or anus, the  submucosa . [ 6 ]  In one study of 51 individuals, these tumors had been noticed for 1 week to 5 years (median time: 5 months) prior to diagnosis in women (median age: 47 years) and men (median age: 60 years). Their tumors ranged from 0.6 to 25.0\u00a0cm in maximum diameter size (median size 2.7\u00a0cm in women and 6.7\u00a0cm in men). [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_725", "text": "Grossly , CAF tumors appear as well-circumscribed, firm to rubbery, white/tan to grayish masses some of which appear to consist of multiple   lobules . [ 7 ]  Rarely, these tumors had infiltrated into adjacent muscles or other nearby tissues. [ 3 ]  As determined by  microscopic  analyses, CAF tumors are composed of bland spindle-shaped cells in an edematous to fibrous  stromal  background containing bundles of  collagen  fibers, small to medium-sized, thick-walled, prominently hyalinized (i.e. glassy appearing) blood vessels, and a minor component of  adipose tissue  (i.e. fat tissue). Numerous  mast cells , moderate numbers of  lymphocytes , and small numbers of  neutrophils  are scattered throughout this stroma; this stroma does not contain the  multinucleated giant cells  or  epithelioid cells  that are often found in certain other types of mesenchymal tumors. [ 2 ]  However, CAF lesions may contain scattered, abnormally-shaped cells,  lipoblasts  (i.e. immature fat cells), and diffuse malignant-appearing  sarcoma -like changes but these findings do not alter the prognosis of CAF as being a purely benign tumor. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_726", "text": "Immunohistochemical  analyses find that the cells in CAF tumors express the  CD34  protein in ~50% of cases, a  smooth muscle actin  protein in occasional cases,  MUC1  (also termed EMA) and  desmin  proteins in a minority of cases, but do not express  S100  or  cytokeratin  proteins. [ 3 ] [ 4 ] [ 6 ]  Most cases of CAF in females contain CAF tumor cells which express  estrogen  and  progesterone receptors [ 4 ]  while limited studies in males reported that 3 of 3 CAF cases contained estrogen receptor-expressing tumor cells while only 1 of 3 cases contained progesterone receptor-expressing tumor cells. [ 8 ]  Detection of one or more of these protein expression patterns can help differentiate CAF from other types of mesenchymal tumors. [ 3 ] [ 4 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_727", "text": "Fluorescence in situ hybridization  analysis shows that the neoplastic cells in all cases of CAF have a  deletion  in or around   band  14 on the  long (or \"q\") arm  of one of their two  chromosomes 13 . This results in a loss of one of the two  RB1  genes (located at band 14.2 on the q arm of this chromosome [ 9 ] ) as well as one of the two  FOXO1  genes (located at band 14.11 on the q arm of this chromosome [ 10 ] ). [ 4 ] [ 11 ]  Deletion of one of the  RB1  genes, it is proposed but not yet demonstrated, may act to promote the development and/or progression of CAF tumors. In any event, loss of this gene in one of the two chromosome 13s is extremely helpful for distinguishing CAF from most other mesenchymal tumor types. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_728", "text": "The diagnosis of CAF generally depends on its typical location in vulva-vaginal and inguinal-scrotal areas, spindle-shaped cell histopathology, tumor cell expressions of marker proteins, and absence of one of the two  RP1  genes. CAF can be hard to distinguish from two other spindle-shaped cell tumors,  myofibroblastoma  and  spindle cell lipoma , that commonly also contain tumors cells with deletions in one of their two  RF1  genes. The characteristic hyalinized blood vessels and the presence of CD34 protein-expressing and desmin protein-expressing cells in CAF help to distinguish it from myofibroblastoma. [ 3 ]  Unlike CAF, spindle cell lipomas seldom contain desmin protein-expressing or progesterone receptor-expressing tumor cells [ 3 ]  and commonly contain  CD99 - and S100-expressing proteins. [ 6 ]  In addition, spindle cell lipomas are rare in the vulvovaginal region and their tumor vasculature consists of capillary-sized, thin-walled blood vessels while those of CAF consist of more numerous blood vessels with thick, hyalinized walls. [ 2 ]  CAR and  angiomyofibroblastoma  can be difficult to distinguish from one another but angiomyofibroblastoma tumor cells show no alterations in their  RB1  and  FOXO1  genes. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_729", "text": "The current standard for treating CAF tumors is total surgical resection (i.e. resection that does not leave any residual neoplastic tissue behind). [ 6 ]  This treatment appears adequate (i.e. curative) even in cases were CAF tumors contain atypical cells and/or sarcoma-like histopathology. [ 2 ]  In many reported cases, CAF tumors treated with simple surgical excision or \u201cshelling out\u201d also appeared to have achieved adequate results. [ 4 ]  CAF tumors rarely recur at the sites of their surgical removal whether treated by total or simple resections [ 3 ]  and have not been reported to metastasize. Consequently, the prognosis for CAF is excellent. [ 2 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_730", "text": "Centurion syndrome  is characterized by anterior malposition of the medial part of the lid, with displacement of  puncta  out of the  lacus lacrimalis  due to a prominent  nasal bridge . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_731", "text": "Childhood granulomatous periorificial dermatitis  ( CGPD ) is a rare benign  granulomatous  skin disease of unknown cause. [ 1 ]  The disorder was first described in 1970 by Gianotti in a  case series  of five children. [ 2 ]  CGPD is more common in boys than girls. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_732", "text": "CGPD is characterized by the presence of small, raised, dome-shaped, flesh-colored or yellow-brown  papules  primarily distributed around the mouth, eyes, and nose. [ 1 ]  Affected children may also have papules on the ears, eyelids, cheeks, forehead, and nose. [ 1 ]  CGPD skin lesions rarely affect areas of the skin other than the face. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_733", "text": "The cause of CGPD is unknown. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_734", "text": "The approach to diagnosing CGPD is controversial. [ 2 ]  Certain  dermatologists  suggest that ruling out infectious and allergic causes of similar skin eruptions and a  skin biopsy  demonstrating features consistent with CGPD is adequate for diagnosis. In contrast, other dermatologists advocate for performing a complete history and physical examination and obtaining laboratories and appropriate imaging to rule out cutaneous  sarcoidosis . [ 2 ]  On microscopy, non- tuberculous  granulomas with surrounding  lymphocytes  clustered around hair follicles may be seen; additionally, infiltrates of epithelioid  macrophages , lymphocytes, and  giant cells  may also be seen. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_735", "text": "Several conditions exhibit skin findings similar to those of CGPD. These conditions include  perioral dermatitis ,  acne vulgaris ,  granulomatous rosacea ,  contact dermatitis ,  folliculitis ,  atopic dermatitis ,  cheilitis , medication-induced  acneiform  eruptions,  lupus miliaris disseminatus faciei ,  benign cephalic histiocytosis ,  granulosis rubra nasi ,  xanthomas ,  zinc deficiency ,  glucagonoma , cutaneous  sarcoidosis , and  scabies . [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_736", "text": "Treatment recommendations for CGPD vary and may include observation without treatment, stopping the use of topical corticosteroids, and the use of topical or oral antibiotics as well as  isotretinoin . [ 2 ]  Topical antibiotics such as  metronidazole  and  erythromycin  have been used for CGPD. [ 2 ]  Oral antibiotics of the  tetracycline  class such as  minocycline ,  doxycycline , and tetracycline have been recommended for CGPD. [ 1 ]   Trimethoprim/sulfamethoxazole  has also been used. [ 2 ]  The use of oral systemic antibiotics is limited by side effects such as  nausea ,  vomiting , and  sensitivity of the skin to sunlight . [ 1 ]  Tetracycline antibiotics are not recommended for children under the age of 8 since tetracyclines are known to deposit in teeth (thereby staining them) and impair bone growth in children. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_737", "text": "The use of  calcineurin inhibitor  creams such as  tacrolimus  or  pimecrolimus  on the skin is controversial and results have been mixed. [ 1 ]  Certain studies found the use of topical calcineurin inhibitors led to resolution of CGPD whereas others saw incomplete resolution or prolonged symptoms. [ 1 ]  Topical  azelaic acid  has been used successfully to treat CGPD. [ 1 ]  Immediate discontinuation of topical  corticosteroids  is recommended since corticosteroids are thought to worsen CGPD. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_738", "text": "CGPD is known to be a temporary skin disease with a benign course. [ 1 ]  The skin papules typically resolve after a few months to a few years. After CGPD resolves, the skin may return to normal without scarring or may have small  atrophic  depressions with  collagen loss ,  milia , or small pit-like scars. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_739", "text": "CGPD occurs most often in children of  Afro-Caribbean  descent  before  puberty  though reports of this disease occurring in  Asian  and  Caucasian  children have also been described. [ 1 ] [ 3 ]  Due to the limited number of reported cases, it remains controversial whether CGPD occurs more often in African children than in children of other races. [ 2 ]  CGPD is more common in boys than girls. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_740", "text": "Gianotti et al. first described CGPD in five Italian children in 1970. [ 3 ]  In 1990, Williams et al. described a similar skin eruption in five children of Afro-Caribbean descent and coined the proposed term \"facial Afro-Caribbean childhood eruption (FACE)\". [ 3 ]  Subsequently, another article by Katz and Lesher first introduced the term CGPD since some reported cases were not found in children of Afro-Caribbean descent and to avoid confusion with perioral dermatitis. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_741", "text": "A number of diseases/syndromes of the human body may be associated with the development of  caf\u00e9 au lait macules ."}
{"_id": "WikiPedia_Dermatology$$$corpus_742", "text": "Corticosteroid-induced lipodystrophy  ( CIL ) is a condition of  abnormal fat deposition  caused by  corticosteroid  medications. [ 1 ]  Fat accumulates in the facial area (\" moon face \"), dorsocervical region (\"buffalo hump\"), and abdominal area (\"pot belly\" or \"beer belly\"), whereas the thickness of  subcutaneous fat  in the limbs is decreased. [ 1 ]  The resulting appearance has been described as \"Cushingoid\", [ 1 ]  in relation to the fact that it also occurs in individuals with  Cushing's syndrome  (abnormally high  cortisol  levels). [ 2 ]  The condition is considered by patients to be the most distressing side effect caused by corticosteroids. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_743", "text": "Short-term therapy (<3 months) with 10 to 30\u00a0mg/day of a  prednisone  equivalent has been reported to be associated with Cushingoid traits in 15 to 40%. [ 1 ]  Long-term therapy (>3 months) with corticosteroids has been associated with Cushingoid features in 32 to 83% of individuals. [ 1 ]  However, these symptoms have mostly been diagnosed in a subjective and observer-dependent manner. [ 1 ]  In a prospective study, the cumulative incidence of CIL with high-dose prednisone therapy was found to be 61% after 3\u00a0months, 65% after 6\u00a0months, 68% after 9\u00a0months, and 69% after 12\u00a0months. [ 1 ]  One study found that even a very low dosage of prednisone of 5\u00a0mg/day was associated with symptoms of \"Cushing's syndrome\". [ 1 ]  It has been said that data on risk factors for CIL, such as corticosteroid dosage or duration of therapy, is surprisingly sparse. [ 1 ]  Possible risk factors for CIL include high residual cortisol secretion, decreased clearance of corticosteroids, female sex, younger age (<50 years), high initial  body-mass index , and high  caloric intake . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_744", "text": "CIL has been found to be usually reversible at prednisone-equivalent dosages of less than 10\u00a0mg/day. [ 1 ]  A  low-calorie diet  may be considered to limit the risk of CIL or to attempt to reverse it. [ 1 ]  CIL is not merely an aesthetic adverse effect, as it has been associated with features of  metabolic syndrome  such as  insulin resistance ,  dyslipidemia , and  high blood pressure . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_745", "text": "This medical  symptom  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_746", "text": "Cutaneous amoebiasis ,  refers to a form of  amoebiasis  that presents primarily in the skin. It can be caused by  Acanthamoeba [ 2 ] [ 3 ]  or  Entamoeba histolytica . [ 4 ] :\u200a421\u200a [ 5 ]  When associated with  Acanthamoeba , it is also known as \"cutaneous acanthamoebiasis\". [ 6 ]   Balamuthia mandrillaris  can also cause cutaneous amoebiasis, but can prove fatal if the amoeba enters the bloodstream  [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_747", "text": "It is characterized by  ulcers . Diagnosis of amebiasis cutis calls for high degree of clinical suspicion. This needs to be backed with demonstration of  trophozoites  from lesions. Unless an early diagnosis can be made such patients can develop significant morbidity. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_748", "text": "This infection-related cutaneous condition article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_749", "text": "Cutaneous manifestations of COVID-19  are characteristic signs or symptoms of the  Coronavirus disease 2019  that occur in the skin. The  American Academy of Dermatology  reports that skin lesions such as  morbilliform  (measles-like rashes, 22%),  pernio  (capillary damage, 18%),  urticaria  (hives, 16%), macular  erythema  (rose-colored rash, 13%), vesicular  purpura  (purplish discolouration, 11%), papulosquamous purpura (discolouration with scale. 9.9%) and  retiform purpura  (blood vessel obstruction and downstream ischaemia, 6.4%) are seen in people with COVID-19. [ 1 ] [ 2 ] [ 3 ]  Pernio-like lesions were more common in mild disease while  retiform purpura  was seen only in critically ill patients. [ 1 ]  The major dermatologic patterns identified in individuals with COVID-19 are urticarial rash, confluent  erythematous / morbilliform  rash,  papulovesicular   exanthem ,  chilbain -like acral pattern,  livedo reticularis  and purpuric \"vasculitic\" pattern. [ 4 ]   Chilblains  and  Multisystem inflammatory syndrome  in children are also cutaneous manifestations of COVID-19. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_750", "text": "Hyperactive immune responses in COVID-19 patients can contribute to the induction \" cytokine storm \" (in particular,  IL-6 ); these cytokines could enter the skin and trigger dermal  dendritic cells ,  lymphocytes ,  macrophages ,  mast cells , and  neutrophils , and can assist in the development of lesions such as  maculopapular rash . This representation of cutaneous lesion has been described earlier in diseases having an overactive immune response and excessive cytokine release (example,  systemic lupus erythematosus , adult  Still's disease , and  antiphospholipid syndrome ). [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_751", "text": "Urticarial rash  (hives) is seen in several bacterial and viral infections, so COVID-19 is no exception. These rashes are more commonly found in the trunk and limbs, relatively sparing the acral sites. Systemic  corticosteroids  are a therapeutic option for urticarial rash induced by COVID-19. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_752", "text": "The  erythematous rashes  (redness caused by increased blood flow through skin capillaries) seen in COVID-19 are mostly present on the trunk and limbs, and associated with itching. [ 4 ]  Exanthems induced by viruses other than COVID-19 and drug reactions should be considered as differential diagnosis in the case of erythematous rashes. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_753", "text": "Livedo reticularis  refers to slowing of blood flow, leading to desaturation of blood and bluish discolouration of the skin. This type of skin rashes may be seen in cold-induced  vasoconstriction  as seen in  polycythemia  or other causes leading up to focal impairment of blood flow. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_754", "text": "From the  histological  (microscopic anatomy) perspective, several features of the  maculopapular  lesion have been recognized. Maculopapular lesions exhibit superficial perivascular dermatitis with lymphocytic infiltrate and dilated vessels in the papillary and mid dermis with neutrophils, eosinophils, and nuclear debris. Epidermis revealed dispersed foci of hydropic changes, accompanied by minimum  acanthosis ,  subcorneal pustules , slight  spongiosis ,  Basal cell   vacuolation , and foci of  parakeratosis . [ 6 ]  A  lichenoid  pattern with eosinophils' presence on biopsy of skin lesions has been observed in some patients. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_755", "text": "Many cutaneous  neoplasms  occur in the setting of systemic syndromes."}
{"_id": "WikiPedia_Dermatology$$$corpus_756", "text": "J Am Acad Dermatol. 1983 May;8(5):639-44.\nPilomatricoma-like changes in the epidermal cysts of Gardner's syndrome.\nCooper PH, Fechner RE."}
{"_id": "WikiPedia_Dermatology$$$corpus_757", "text": "Many conditions of or affecting the human integumentary system have associated abnormalities of the  teeth ."}
{"_id": "WikiPedia_Dermatology$$$corpus_758", "text": "Dermatoosteolysis, Kirghizian type  is a rare presumably autosomal recessive [ 2 ]   genetic disorder  characterized by the infancy-onset recurrence of the following symptoms: cutaneous ulcers, generalized  arthralgia , fevers, peri-articular fistulous osteolysis,  agenesis of all teeth , dystrophied nails, and keratitis. It usually decreases in severity around childhood but around that time complications have already developed, this includes skin scarring,  arthroses , pseudo-acromegalic hands and feet,  scoliosis , and  vision loss . [ 3 ] [ 4 ]  It has been described in 5 siblings born to healthy parents in  Kyrgyzstan . [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_759", "text": "This  genetic disorder  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_760", "text": "In  pathology ,  dermatopathic lymphadenopathy ,  is  lymph node  pathology due to skin disease."}
{"_id": "WikiPedia_Dermatology$$$corpus_761", "text": "Also known as lipomelanotic reticulosis or Pautrier-Woringer disease, represents a rare form of benign lymphatic hyperplasia associated with most exfoliative or eczematoid inflammatory erythrodermas, including pemphigus, psoriasis, eczema, neurodermatitis, and atrophia senilis."}
{"_id": "WikiPedia_Dermatology$$$corpus_762", "text": "Dermatopathic lymphadenopathy is diagnosed by a  lymph node  biopsy.  It has a characteristic pattern of  histomorphology  and  immunohistochemical staining :"}
{"_id": "WikiPedia_Dermatology$$$corpus_763", "text": "The treatment is based on the underlying cause."}
{"_id": "WikiPedia_Dermatology$$$corpus_764", "text": "Dolichonychia  is a medical condition in which the  nail beds  of the fingers and toes are abnormally long and slender, specifically, a finger nail index of 1.30 or more, [ 1 ]  it is a common feature in people with  connective tissue  disorders, such as  Ehlers\u2013Danlos syndromes ,  Marfan syndrome , and  hypohidrotic ectodermal dysplasia ., [ 2 ]  it often appears alongside  arachnodactyly  and/or  dolichostenomelia , which is the condition of having long and slender fingers and toes."}
{"_id": "WikiPedia_Dermatology$$$corpus_765", "text": "An  eschar  ( / \u02c8 \u025b s k \u0251\u02d0r / ;  Greek :  \u1f10\u03c3\u03c7\u03ac\u03c1\u1fb1 ,  romanized :\u00a0 eskhara ;  Latin :  eschara ) is a slough [ 1 ]  or piece of  dead tissue  that is cast off from the surface of the skin, particularly after a   burn injury , but also seen in  gangrene ,  ulcer ,  fungal infections ,  necrotizing spider bite wounds ,  tick bites  associated with  spotted fevers  and exposure to cutaneous  anthrax . The term \u2018eschar\u2019 is not interchangeable with \u2018scab\u2019. An eschar contains necrotic tissue whereas a scab is composed of dried blood and  exudate ."}
{"_id": "WikiPedia_Dermatology$$$corpus_766", "text": "Black eschars are most frequently attributed in medicine to cutaneous anthrax (infection by  Bacillus anthracis ), which may be contracted through herd animal exposure and also from  Pasteurella multocida  exposure in cats and rabbits. A newly identified human rickettsial infection,  R. parkeri   rickettsiosis , can be differentiated from  Rocky Mountain spotted fever  by the presence of an eschar at the site of inoculation. [ 2 ]  \nEschar is sometimes called a  black wound  because the wound is covered with thick, dry, black  necrotic tissue ."}
{"_id": "WikiPedia_Dermatology$$$corpus_767", "text": "Eschar may be allowed to slough off naturally, or it may require surgical removal ( debridement ) to prevent infection, especially in immunocompromised patients (e.g. if a  skin graft  is to be conducted)."}
{"_id": "WikiPedia_Dermatology$$$corpus_768", "text": "If eschar is on a limb, it is important to assess peripheral pulses of the affected limb to make sure blood and lymphatic circulation is not compromised.  If circulation is compromised, an  escharotomy , or surgical incision through the eschar, may be indicated."}
{"_id": "WikiPedia_Dermatology$$$corpus_769", "text": "An  escharotic  is a substance that kills unwanted or diseased tissue, usually skin or superficial growths like warts, leaving them to  slough  off. Examples include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_770", "text": "Escharotics have long been used in medicine. In conventional modern practice some still are useful for topical treatment of growths such as warts. For lack of anything better in the past, escharotics once were more widely used, and for example, popular products included so-called  black salves , with ingredients such as  zinc chloride , plus sanguinarine in the form of bloodroot extract. These and others were traditional as topical treatments for localised skin cancers in  herbal medicine . They combined unreliability in eradication of the cancer, with harmful effects such as scarring, serious injury, and disfigurement. Consequently escharotic salves now are strictly regulated in most western countries, and available on prescription only. Some prosecutions have been pursued over unlicensed sales of escharotic products such as  Cansema ."}
{"_id": "WikiPedia_Dermatology$$$corpus_771", "text": "Focal hyperhidrosis , also known as  primary hyperhidrosis , is a  disease  characterized by an excessive  sweating  localized in certain body regions (particularly palms, feet and underarms). Studies suggest that this condition, affecting between 1% and 3% of the US population, seems to have a genetic predisposition in about two thirds of those affected. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_772", "text": "Focal  hyperhidrosis  is sometimes referred to as  The Silent Handicap , [ 2 ]  as it has a significant impact on the quality of life, affecting the individual socially, psychologically, emotionally and professionally. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_773", "text": "In 2006, researchers uncovered that primary  palmar hyperhidrosis , referring to excess sweating on the palms of the hands and feet, maps to the gene locus 14q11.2-q13. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_774", "text": "Based on previous research using mice and rats, researchers looked towards the role of  aquaporin 5  (AQP5), a water channel protein, in human individuals with primary focal hyperhidrosis. [ 5 ]  AQP5 has been identified as a candidate gene in many hyperhidrosis studies. Using a family that had members with primary focal hyperhidrosis, researchers found that there was no connection between primary focal hyperhidrosis and AQP5. There was also no significant connection between the gene 14q11.2-q13 locus, which was linked to primary palmar hyperhidrosis, and primary focal hyperhidrosis in this family. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_775", "text": "The expression of the AQP5 protein and AQP5  mRNA  was significantly higher in a patient group in comparison to the control group. In 2011, using a control group (individuals without primary focal hyperhidrosis) and a patient group (individuals with primary focal hyperhidrosis) researchers found that there was no difference between the number of sweat coils in the axillary  sweat glands . This indicates that there is nothing  morphologically  different between individuals with and without primary focal hyperhidrosis. The discrepancies between the studies above call on further studies to confirm or deny the role of AQP5, and the role of other proteins, in hyperhidrosis. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_776", "text": "Beyond looking at the genes and individual proteins that play a role in primary focal hyperhidrosis, researchers have looked at the patterns of  heredity  for this trait. In a 2003 study, using multiple families, researchers found that primary focal hyperhidrosis was not a  sex-linked gene , since male-to-male transmission was seen in multiple families. Instead evidence supported an  autosomal dominant  pattern of inheritance with an incomplete disease  penetrance . 21 patients in this study reported a positive family history of hyperhidrosis (62%). Researchers were able to uncover this by creating  pedigrees  of all the participants in the study. Not every member of the pedigree exhibited forms of hyperhidrosis, which allowed the researchers to track the patterns of inheritance. The findings in this study indicated that primary focal hyperhidrosis is typically an hereditary disorder. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_777", "text": "Typical regions of excessive sweating include the hand palms, underarms, the sole of the foot, and sometimes groin, face, and scalp. Indeed, profuse sweating is present mostly in the underarms, followed by the feet, palms and facial region. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_778", "text": "Evidence demonstrates that a positive family history is also present (see the  Genetics  part). [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_779", "text": "The Canadian Hyperhidrosis Advisory Committee has published a comprehensive set of guidelines which outlines key aspects of treatment related to this condition. Topical hyperhidrosis gels containing  aluminum chloride hexahydrate  are usually first choice treatments for this condition. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_780", "text": "In addition to topical  antiperspirants  (whose main active ingredients usually are aluminum or zirconium salts) treatment options include:  iontophoresis  (hands, feet), onabotulinum\u00adtoxinA ( Botox ) injections (underarms, hands, feet, and other localized areas), [ 11 ]  electromagnetic/ microwave energy  thermolysis  of underarm sweat glands ( miraDry ), [ 12 ]  laser-assisted removal of the sweat glands (underarms), [ 13 ]  other local procedures such as liposuction and curettage of the sweat glands (underarms), medications of the anticholinergic type that are taken by mouth, and  sympathectomy  surgery for sweating of the hands or head that can't be controlled by other means. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_781", "text": "Sofpironium bromide  is approved for the treatment of primary axillary hyperhidrosis. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_782", "text": "A number of gene mutations have been linked to conditions of or affecting the human integumentary system."}
{"_id": "WikiPedia_Dermatology$$$corpus_783", "text": "A number of  histologic stains  are used in the field of  dermatology  that aid in the diagnosis of conditions of or affecting the human  integumentary system ."}
{"_id": "WikiPedia_Dermatology$$$corpus_784", "text": "There are many  human leukocyte antigen  (HLA) alleles associated with conditions of or affecting the human integumentary system"}
{"_id": "WikiPedia_Dermatology$$$corpus_785", "text": "Hyposensitivity , also known as  Sensory under-responsitivity , refers to abnormally decreased  sensitivity  to sensory input."}
{"_id": "WikiPedia_Dermatology$$$corpus_786", "text": "Hyposensitivity is especially common for autistic people and is more often seen in children than adults and adolescents due to  masking . Those experiencing this have a harder time stimulating their senses than normally. They may not feel pain as easily as others, may be drawn to loud noises, be attracted to bright lights and colours, among other things. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_787", "text": "Hyposensitivity can lead to an inactivated brain. This can give concentration problems, feeling drained or feckless, depression, procrastination and also  hypersensitivities ."}
{"_id": "WikiPedia_Dermatology$$$corpus_788", "text": "Auditory hyposensitivity  symptoms include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_789", "text": "Tactile hyposensitivity  symptoms include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_790", "text": "Olfactory hyposensitivity  symptoms include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_791", "text": "Taste hyposensitivity  symptoms include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_792", "text": "Visual hyposensitivity  symptoms include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_793", "text": "Vestibular hyposensitivity  symptoms include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_794", "text": "Proprioceptive hyposensitivity  symptoms include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_795", "text": "Several cutaneous conditions can be diagnosed with the aid of  immunofluorescence  studies."}
{"_id": "WikiPedia_Dermatology$$$corpus_796", "text": "Cutaneous conditions with positive direct or indirect immunofluorescence when using salt-split skin include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_797", "text": "For several subtypes of  pemphigus  a variety of substrates are used for indirect immunofluorescence:"}
{"_id": "WikiPedia_Dermatology$$$corpus_798", "text": "This is a list of cutaneous  conditions associated with internal malignancy ; skin markers of internal cancer. [ 1 ]  It does not include skin infections associated with cancer or cancers that spread to skin. [ 1 ]  Some have stronger associations with cancers than others. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_799", "text": "tracts"}
{"_id": "WikiPedia_Dermatology$$$corpus_800", "text": "pancreatic islet cell adenoma"}
{"_id": "WikiPedia_Dermatology$$$corpus_801", "text": "Janeway lesions  are rare, non- tender , small  erythematous  or  haemorrhagic   macular ,  papular  or  nodular  lesions on the palms or  soles  only a few millimeters in diameter that are associated with  infective endocarditis  and often indistinguishable from  Osler's nodes . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_802", "text": "Janeway lesions are painless, frequently haemorrhagic lesions seen most commonly on the palms and soles, particularly on the base of the thumb and little finger, and seen in infective endocarditis. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_803", "text": "Osler's nodes  and Janeway lesions are similar and point to the same diagnostic conclusion. The most significant difference between the two is that Osler's nodes present with tenderness, while Janeway lesions do not. [ 2 ]  Osler's nodes are thought to be due to immunologic phenomenon where deposition of immune complexes provoke inflammatory response, leading to swelling, redness and pain. On the contrary, Janeway lesions are thought to be due to embolic phenomenon in cutaneous blood vessels of palms and soles which does not cause pain or least pain. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_804", "text": "Pathologically, the lesion is described to be a  microabscess  of the  dermis  with marked  necrosis  and inflammatory infiltrate not involving the  epidermis . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_805", "text": "They are caused by septic emboli which deposit bacteria, forming microabscesses. [ 5 ]  Organisms may be cultured from the lesions. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_806", "text": "Janeway lesions present as red, painless macules and papules on the palms and soles. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_807", "text": "They are not common and are frequently indistinguishable from  Osler's nodes . Rarely, they have been reported in cases of  systemic lupus erythematosis  (SLE),  gonococcemia  (disseminated gonorrhoea),  haemolytic anaemia  and  typhoid fever . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_808", "text": "They may last days to weeks before completely resolving. [ 1 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_809", "text": "Janeway lesions are named after  Edward Janeway  (1841\u20131911), a prominent American physician, pathologist and contemporary of Sir  William Osler , who initially described \"peculiar skin lesions\" in some people with endocarditis, in a paper published in 1899. The term was first used by  internist  and pathologist  Emanuel Libman , who reported the lesions in his paper of 1906 and explained his reasoning for using the term \"Janeway lesions\" in a footnote in 1923. Osler never mentioned Janeway lesions. The inclusion into Osler's 1925 textbook came six years after Osler died. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_810", "text": "Mutations of proteins that hold the cells of the skin together can cause disease.  Autoantibodies against proteins that hold the cells of the skin together can also cause disease."}
{"_id": "WikiPedia_Dermatology$$$corpus_811", "text": "Mucocutaneous pemphigus vulgaris [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_812", "text": "Koenen's tumor  ( KT ), also commonly termed  periungual angiofibroma , [ 1 ] :\u200a668\u200a  is a subtype of the  angiofibromas . [ 3 ]  Angiofibromas are benign papule, nodule, and/or tumor lesions that are separated into various subtypes based primarily on the characteristic locations of their lesions. KTs are angiofibromas that develop in and under the toenails and/or fingernails. [ 4 ]  KTs were once considered as the same as another subtype of the angiofibromas viz.,  acral angiofibromas . While the literature may still sometimes regard KTs as acral angiofibromas, acral angiofibromas are characteristically located in areas close to but not in the toenails and fingernails as well as in the soles of the feet and palms of the hands. [ 5 ] [ 6 ]  KTs are here regarded as distinct from acral angiofibromas."}
{"_id": "WikiPedia_Dermatology$$$corpus_813", "text": "KTs most commonly develop in individuals who have the rare  genetic disease ,  tuberous sclerosis [ 7 ]  (a heritable neurocutaneous disorder [ 8 ] ) and uncommonly in individuals that do not have this genetic disease. [ 9 ]  One individual with another rare genetic disease that has similarities to tuberous sclerosis, the  Birt-Hogg-Dube syndrome , has also been reported to have typical KT findings. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_814", "text": "KTs are strictly benign (i.e. do not  metastasize ) but may be painful, disfiguring, and sometimes large and/or incapacitating lesions. They have often been treated by strictly local surgical resections. However, they do have a high rate of recurrence at the site of resection [ 11 ]  and therefore have been treated with various other non-invasive local measures in efforts to avoid recurrences; these other methods have also been preferred to treat numerous tumors in individuals, for cosmetic reasons, and/or to relieve tumor-induce incapacitations. [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_815", "text": "In individuals with tuberous sclerosis, KTs commonly present with multiple firm red-colored to skin-colored nodules or tumors that emanate from the  proximal nail fold  or, less often, proximal skin beneath the nail. They often develop after puberty; increase in number over time; more frequently occur in the toenails than fingernails (the most common sites are on the big toe and thumb); are generally 5 to 10\u00a0mm in length but occasionally grow to far larger sizes; [ 4 ]  and may be or become disfiguring, painful, and/or incapacitating. [ 13 ]  Nearly 50% of post-puberty individuals with tuberous sclerosis have KTs. [ 11 ]  (Tuberous sclerosis is also associated with a second type of angiofibroma,  adenoma sebaceum , also termed facial angiofibroma, in ~75% of cases. [ 14 ] ) Individuals presenting with KTs that do not have tuberous sclerosis commonly present with a single lesion in a nail bed. [ 15 ]  KT may also present as a recurrence of a lesion at the site where it was surgically removed. [ 11 ]  Rare cases of KTs have had a history of crushing trauma at the sites where the KTs later developed. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_816", "text": "Microscopic  histopathological  analyses of KTs commonly reveal a lesion with epidermal acanthosis (i.e. thickening of the skin), hyperkeratosis (i.e. thickening of the outermost layer of the epidermis), and skin features typical of  angiofibroma  viz., spindle-shaped or star-shaped  fibroblasts  and ectatic blood vessels in a dense  collagen  fiber  connective tissue  background. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_817", "text": "In cases associated with tuberous sclerosis, KTs appear to be a result of this disease's associated genetic abnormalities, i.e.  loss-of-function mutations  in one of the two normally paired  TSC1  or one of the two normally paired  TSC2   tumor suppressor genes . As a part of their functions, the  TSC1  and  TSC2  tumor suppressor genes act to suppress the abnormal growth of cells by contributing to the suppression of the  mammalian target of rapamycin  (i.e. mTOR) protein that promotes cell growth and proliferation. Inactivation of one of the  TSC1  or  TSC2  genes appears responsible for unleashing mTor and thereby promoting the growth of the many strictly benign lesions, including KTs, that develop in individuals with tuberous sclerosis. [ 16 ]  mTOR is inhibited by  rapamycin , a drug which has been used as a topical application to successfully treat a few cases of Koenen's tumors. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_818", "text": "A small number of cases in individuals including those that do not have tuberous sclerosis may develop KTs as reactions to local traumas. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_819", "text": "The treatment of KTs has varied depending on their size, numbers, locations, symptoms, damage to tissues, and disfiguring effects. Excision may be the treatment of choice for surgically accessible lesions. [ 15 ]  However, following surgical removal, KTs have a high rate of local recurrence, [ 11 ]  particularly in cases where the lesions are not completely removed. [ 15 ]  Other treatment methods, which may be used in combination with surgical removal and/or with each other include: carbon dioxide-based  laser vaporization ;  electrocauterization ; shave excision of the tumor with phenolization (i.e. excision of the tumor\u2019s protruding portion followed by treatment of the proximal perionych [i.e., skin around a nail] with phenol to eradicate the root of the tumor); [ 11 ]  and in individuals with tuberous sclerosis, topical application of sirolimus, i.e. rapamycin, (1% solution). [ 12 ]  Some of the latter methods have been used in order to preserve the nail matrix and  nailplate  and may be ideal for younger patients with few tumors since they may leave a normal appearing nail. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_820", "text": "A  lick granuloma , also known as  acral lick dermatitis , is a  skin disorder  found most commonly in  dogs , but also in cats. In dogs, it results typically from the dog's urge to lick the lower portion of one of their legs."}
{"_id": "WikiPedia_Dermatology$$$corpus_821", "text": "The  lesion  can initially be red, swollen, irritated, and bleeding, similar to a  hot spot  (wet eczema).  The animal's incessant licking of the lesion eventually results in a thickened, firm, oval  plaque , which is the granuloma."}
{"_id": "WikiPedia_Dermatology$$$corpus_822", "text": "A major cause of lick granuloma appears to be psychological, related to stress, anxiety,  separation anxiety , boredom, or compulsiveness.  Lick granulomas are especially seen in active dogs left alone for long periods of time."}
{"_id": "WikiPedia_Dermatology$$$corpus_823", "text": "One theory about the cause of lick granulomas is that excessive licking causes  endorphin  release, which reduces pain and makes the animal feel comfort temporarily. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_824", "text": "Other triggers include itchy skin, painful conditions caused by trauma to the skin, arthritis, neuralgia, and peripheral neuropathy. A bacterial or fungal infection of the skin can also trigger itching, as can skin mites, allergies, a reaction to an environmental irritant or toxin, hyperthyroidism, and certain types of cancer."}
{"_id": "WikiPedia_Dermatology$$$corpus_825", "text": "Treatment of the primary cause, if known, is essential.  In  psychogenic  cases, psychological factors should be identified and addressed, such as being left alone all day, being confined, and changes in the household."}
{"_id": "WikiPedia_Dermatology$$$corpus_826", "text": "Lick granuloma is a form of self-trauma and  skin disorder  in which most commonly dogs, but also cats, continuously lick a small area of their body until it becomes raw and inflamed. The most common areas affected are the lower ( distal ) portions of their legs, such as the  carpus  (wrist), [ 2 ]  or sometimes another part of their body such as the base of their tail."}
{"_id": "WikiPedia_Dermatology$$$corpus_827", "text": "Seventy percent of the time it occurs on one of the dog's left legs. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_828", "text": "The  lesion  can initially be red, shiny, swollen, hairless, irritated, and bleeding, similar to a  hot spot  (wet eczema). [ 4 ] [ 5 ]  Eventually, a raised hard plaque forms. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_829", "text": "Frequent formations of lick granulomas in the same area due to the constant licking will cause hardening, callous formation, hair loss (the hair may stop growing back), and  hyperpigmentation  to that area. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_830", "text": "Lick granulomas sometimes become infected with  bacteria , causing  abscessed  areas or fistulous tracts ( furuncles ). [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_831", "text": "Lick granulomas are caused by a variety of factors. One common cause of lick granulomas appears to be psychological, related to stress, anxiety,  separation anxiety , [ 7 ]  boredom, or compulsiveness. [ 8 ]   Lick granulomas are especially seen in large active dogs left alone for long periods of time. [ 8 ] [ 9 ]   It is often considered to be a form of canine  obsessive-compulsive disorder . [ 10 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_832", "text": "Other causes include  bacterial  or  fungal  infections,  ectoparasites ,  metabolic  disease,  neoplastic  disease, trauma causing nerve damage, allergies, or joint disease.   Hot spots  may also lead to the formation of lick granulomas."}
{"_id": "WikiPedia_Dermatology$$$corpus_833", "text": "Arthritic and mobility problems in older dogs give them more time to lick and over-groom themselves. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_834", "text": "The condition becomes a vicious cycle\u00a0\u2013 erosion of the skin from licking leads to pain and itching, which leads to more licking."}
{"_id": "WikiPedia_Dermatology$$$corpus_835", "text": "Treatment of the primary cause, if known, is essential."}
{"_id": "WikiPedia_Dermatology$$$corpus_836", "text": "In  psychogenic  cases, dealing with psychological factors is most important.  Factors should be identified such as being left alone all day, being confined, and changes in the household. Correction of these causes may include increased walks, avoiding confinement, and more interaction in the home.  Some veterinarians have  proposed that diet can affect  compulsive behaviors  in dogs. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_837", "text": "Drugs may be used until  behavior modification  has had time to take effect.   Antidepressants  are most commonly used, including  doxepin ,  amitriptyline ,  fluoxetine , and  clomipramine .  If the psychological factors are not corrected, the pet will usually relapse after the drugs are discontinued.   Endorphin blockers  such as  naltrexone  can be used to reduce addiction to licking, or endorphin substitutes such as  hydrocodone  may decrease the urge to lick. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_838", "text": "The animal should be tested for allergies, and treated accordingly if positive ( fatty acids ,  antihistamines , hypoallergic diet, etc.).  It may also be necessary to check  thyroid  levels, as  hypothyroidism  seems to play a role in some cases, particularly in black Labrador retrievers; thyroid medication often will resolve the problem if it is due to hypothyroidism. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_839", "text": "The lesion should also be treated."}
{"_id": "WikiPedia_Dermatology$$$corpus_840", "text": "Class 4 infrared laser treatments have been used with much success, although it may take several treatments to achieve the desired outcome."}
{"_id": "WikiPedia_Dermatology$$$corpus_841", "text": "Licking can be prevented by the use of  Elizabethan collars , dog leggings, battery-enhanced wraps, bandages, anti-licking ointments (which are bad tasting), and anti-lick strips (which are either bad tasting or simply provide a barrier).  It is important to catch lesions early and keep the animal from licking them to then reduce inflammation and development of a habit.  Topical medications  such as  corticosteroids  or  DMSO  may be effective if used early."}
{"_id": "WikiPedia_Dermatology$$$corpus_842", "text": "Small lesions may be injected with  triamcinolone  or  methylprednisolone .  Oral  antibiotics  are used to control infection.  Surgery may be performed to remove whole lesions, but there is risk of continued self-mutilation to the area afterwards.  Other potential treatments include  cryosurgery ,  laser surgery ,  radiation therapy , and  acupuncture .  It is important to note that many dogs will lick at another leg, another area on the same leg, or someplace else, creating a new lick granuloma, if they are prevented from licking at the original one while it heals."}
{"_id": "WikiPedia_Dermatology$$$corpus_843", "text": "Overall, lick granulomas are very difficult to treat, with control only being achieved in about 65 percent of cases. [ 15 ]   Some animals will continue to lick at the area despite the use of anti-lick ointments or sprays to deter them, for instance."}
{"_id": "WikiPedia_Dermatology$$$corpus_844", "text": "Many large breed dogs appear to be predisposed, as well as  golden retrievers [ 16 ]  and other  bird dogs . [ 8 ]  Most of the dogs with the condition are over five years of age. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_845", "text": "[ 17 ] \n [ 13 ] \n [ 18 ] \n [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_846", "text": "Microvascular occlusion  refers to conditions that can present with  retiform purpura . [ 1 ]  It has been suggested that  phenylephrine  may be a cause. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_847", "text": "Microvascular occlusions appears as bland  necrosis  without inflammation and  retiform purpura . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_848", "text": "Microvascular occlusions can be caused by  heparin-induced thrombocytopenia ,  cryoglobulinemia , angioinvasive organisms,  embolization ,  disseminated intravascular coagulation ,  livedoid vasculopathy , cell occlusion syndromes, and  iatrogenic  causes. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_849", "text": "The outcomes of microvascular occlusions are usually influenced by the degree, length, nature of the underlying cause, and prompt and effective treatment. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_850", "text": "A number of cutaneous conditions can occur on the skin and appear to move or migrate through the skin. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_851", "text": "Morgellons  ( / m \u0254\u02d0r \u02c8 \u0261 \u025b l \u0259 n z / ) is the informal name of a self-diagnosed, scientifically unsubstantiated  skin condition  in which individuals have sores that they believe contain fibrous material. [ 1 ] [ 2 ]  Morgellons is not well understood, but the general medical consensus is that it is a form of  delusional parasitosis , [ 3 ]  on the psychiatric spectrum. [ 4 ]  The sores are typically the result of compulsive scratching, and the fibers, when analysed, are consistently found to have originated from cotton and other textiles. [ 2 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_852", "text": "The  condition was named  in 2002 by Mary Leitao, [ 6 ]  a mother who rejected the  medical diagnosis  of her son's delusional parasitosis. She chose the name from a letter written by a mid-17th-century physician. [ 7 ] [ 8 ]  Leitao and others involved in her Morgellons Research Foundation successfully lobbied members of the  U.S. Congress  and the U.S.  Centers for Disease Control and Prevention  (CDC) to investigate the condition in 2006. [ 9 ] [ 10 ]  CDC researchers issued the results of their multi-year study in January 2012, indicating that no disease  organisms  were present in the samples from the individuals examined and that the fibers found were likely cotton. The researchers concluded that the condition was \"similar to more commonly recognized conditions such as delusional infestation\". [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_853", "text": "Morgellons is poorly understood but the general medical consensus is that it is a form of  delusional parasitosis  in which individuals have some form of  skin condition  with sores that they believe contain fibers. [ 1 ] [ 2 ] [ 5 ] [ 13 ]  Its presentation is very similar to delusional parasitosis, with the addition that people with the condition believe there are inanimate objects in their skin lesions. An active online community supports the notion that it is an infectious disease, disputes that it is psychological, and proposes an association with  Lyme disease .  Controversy has resulted; publications \"largely from a single group of investigators\" describe findings of  spirochetes ,  keratin  and  collagen  in skin samples in small numbers of patients; these findings are contradicted by much larger studies conducted by the CDC, which found skin samples mostly contained  cellulose  that came from cotton, with no evidence of infection or other causes. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_854", "text": "In 2001, [ 6 ]  according to Leitao, her then-two-year-old son developed sores under his lip and began to complain of bugs. [ 14 ]  Leitao says she examined the sores with her son's toy microscope and discovered red, blue, black, and white fibers. [ 6 ] [ 7 ]  She states that she took her son to see at least eight different doctors who were unable to find any disease, allergy, or anything unusual about her son's described symptoms. Fred Heldrich, a  Johns Hopkins  pediatrician with a reputation \"for solving mystery cases\", examined Leitao's son. [ 6 ]  Heldrich found nothing abnormal about the boy's skin, and wrote to the referring physician that \"Leitao would benefit from a psychiatric evaluation and support\", and registered his worry about Leitao's \"use\" of her son. [ 6 ]  Leitao last consulted an unnamed Johns Hopkins  infectious disease specialist  who refused to see her son after reviewing his records, and suggested Leitao herself might have \" Munchausen's by proxy , a psychiatric syndrome in which a parent pretends a child is sick or makes him sick to get attention from the medical system\". [ 7 ]  According to Leitao, several medical professionals she sought out shared this opinion of a potential psychological disorder: [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_855", "text": "[Leitao] said she long ago grew accustomed to being doubted by doctors whenever she sought help for her son, who is now seven and still suffering from recurring lesions. \"They suggested that maybe I was neurotic,\" Leitao said. \"They said they were not interested in seeing him because I had Munchausen Syndrome by Proxy.\" [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_856", "text": "Leitao says that her son developed more sores, and more fibers continued to poke out of them. [ 7 ] [ 14 ]  She and her husband, Edward Leitao, an  internist , felt their son had \"something unknown\". [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_857", "text": "Leitao chose the name  Morgellons disease  (with a hard  g ) from a description of an illness in the medical case-history essay,  A Letter to a Friend  (c. 1656, pub. 1690) by Sir  Thomas Browne , where the physician describes several medical conditions in his experience, including \"that endemial distemper of children in  Languedoc , called the  morgellons , wherein they critically break out with harsh hairs on their backs\". [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_858", "text": "Leitao started the Morgellons Research Foundation (MRF) informally in 2002 and as an official non-profit in 2004. [ 7 ] [ 17 ]  The MRF website states that its purpose is to raise awareness and funding for research into the proposed condition, described by the organization as a \"poorly understood illness, which can be disfiguring and disabling\". [ 18 ]  Leitao stated that she initially hoped to receive information from scientists or physicians who might understand the problem, but instead, thousands of others contacted her describing their sores and fibers, as well as neurological symptoms, fatigue, muscle and joint pain, and other symptoms. [ 7 ]   The MRF claimed to have received self-identified reports of Morgellons from all 50  U.S. states  and 15 other countries, including Canada, the UK, Australia, and the Netherlands. It also claimed that it had been contacted by over 12,000 families. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_859", "text": "In 2012, the Morgellons Research Foundation closed down and directed future inquiries to the  Oklahoma State University . [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_860", "text": "In May 2006, a CBS news segment on Morgellons aired in Southern California. [ 20 ]  The same day, the Los Angeles County Department of Health services issued a statement saying, \"No credible medical or public health association has verified the existence or diagnosis of 'Morgellons Disease ' \", and \"at this time there is no reason for individuals to panic over unsubstantiated reports of this disease\". [ 21 ]  In June and July 2006, there were segments on  CNN , [ 22 ]   ABC 's  Good Morning America , [ 23 ]  and  NBC 's  The Today Show . In August 2006, a segment of the ABC show  Medical Mysteries [ 14 ]  was devoted to the subject. Morgellons was featured on  ABC 's  Nightline  on January 16, 2008, [ 24 ]  and as the cover story of the January 20, 2008, issue of  The Washington Post . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_861", "text": "The first article to propose Morgellons as a new disease in a scientific journal was a review article co-authored by members of the MRF and published in 2006 by the  American Journal of Clinical Dermatology . [ 25 ]  A 2006 article in the  San Francisco Chronicle  reported, \"There have been no clinical studies\" of Morgellons disease. [ 25 ]  A  New Scientist  article in 2007 also covered the phenomenon, noting that people are reporting similar symptoms in Europe and Australia. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_862", "text": "In an article published in the  Los Angeles Times  on April 22, 2010, singer-songwriter  Joni Mitchell  claimed to have the condition. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_863", "text": "On June 13, 2011, the  Australian Broadcasting Corporation 's  Radio National  broadcast  The Mystery of Morgellons  with guests including  Mayo Clinic  Professor Mark Davis. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_864", "text": "The Morgellons Research Foundation coordinated a mailing campaign via their website, in which thousands of people sent  form letters  to a  Centers for Disease Control and Prevention  (CDC) task force, which first met in June 2006. [ 9 ] [ 29 ] [ 30 ]  By August 2006, the task force consisted of 12 people, including two pathologists, a toxicologist, an ethicist, a mental health expert, and specialists in infectious, parasitic, environmental and chronic diseases. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_865", "text": "In June 2007, the CDC started a website relating to Morgellons,  CDC Study of an Unexplained Dermopathy , and by November 2007, the CDC opened an investigation into the condition. [ 10 ]   Kaiser Permanente , a health-care consortium in Northern California, was chosen to assist with the investigation, which involved skin biopsies from affected people and characterization of foreign material such as fibers or threads obtained from people to determine their potential source. [ 10 ] [ 32 ]  The U.S. Armed Forces Institute of Pathology and the  American Academy of Dermatology  assisted with pathology. [ 33 ]  In January 2012, the CDC released the results of the study. [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_866", "text": "The CDC concluded that 59% of subjects showed  cognitive deficits  and 63% had evidence of clinically significant symptoms. They stated that 50% of the individuals had drugs in their systems, and 78% reported exposure to  solvents  (potential skin irritants). The study detected no parasites or  mycobacteria  in the samples collected from any individuals. Most materials collected from participants' skin were composed of  cellulose , likely of cotton origin. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_867", "text": "An active online community and publications \"largely from a single group of investigators\" have supported the notion that Morgellons is an infectious disease, and propose an association with  Lyme disease ; these findings are contradicted by the much larger studies conducted by the CDC. [ 5 ]  People usually self-diagnose Morgellons based on information from the internet and find support and confirmation in online communities of people with similar illness beliefs. [ 34 ] [ 35 ] [ 36 ]  In 2006, Waddell and Burke reported the influence of the internet on people self-diagnosed with Morgellons: \"physicians are becoming more and more challenged by the many persons who attempt self-diagnosis on-line. In many cases, these attempts are well-intentioned, yet wrong, and a person's belief in some of these oftentimes unscientific sites online may preclude their trust in the evidence-based approaches and treatment recommendations of their physician.\" [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_868", "text": "Physician Fidel Vila-Rodriguez wrote in a 2008 editorial that the Internet promotes the spreading and supporting of \"bizarre\" disease beliefs because in online communities, \"a belief is not considered delusional if it is accepted by other members of an individual's culture or subculture\". [ 35 ]   Robert Bartholomew , a sociologist who has studied the Morgellons phenomenon, states that the \"World Wide Web has become the incubator for mass delusion and it (Morgellons) seems to be a socially transmitted disease over the Internet.\" According to this hypothesis, people with delusions of parasitosis and other psychological disorders become convinced they have \"Morgellons\" after reading internet accounts of others with similar symptoms. This phenomenon is known as  mass psychogenic illness , where physical symptoms without an organic cause spread to multiple people within the same community or social group. [ 38 ]  The  Dallas Observer  writes that Morgellons may be  memetically  spread via the internet and mass media, and \"[i]f this is the case, then Morgellons is one in a long line of weird diseases that have swept through populations, only to disappear without a trace once public concern subsides\". [ 17 ]  The article draws parallels to several media-spread  mass delusions ."}
{"_id": "WikiPedia_Dermatology$$$corpus_869", "text": "Dermatologist Caroline Koblenzer specifically faults the Morgellons Research Foundation (MRF) website for misleading people: \"Clearly, as more and more of our patients discover this site (MRF), there will be an ever greater waste of valuable time and resources on fruitless research into fibers, fluffs, irrelevant bacteria, and innocuous worms and insects.\" [ 39 ]  A 2005  Popular Mechanics  article stated that Morgellons symptoms are well known and characterized in the context of other disorders, and that \"widespread reports of the strange fibers date back\" only a few years to when the MRF first described them on the Internet. [ 40 ]  The  Los Angeles Times , in an article on Morgellons, notes that \"[t]he recent upsurge in symptoms can be traced directly to the Internet, following the naming of the disease by Mary Leitao, a Pennsylvania mother\". [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_870", "text": "In 2008,  The Washington Post  reported that internet discussions about Morgellons include many  conspiracy theories  about the cause, including  biological warfare ,  nanotechnology ,  chemtrails  and  extraterrestrial life . [ 9 ]   The Atlantic  says it \"even received pop-culture attention\" when it was featured on  Criminal Minds , adding that \"Morgellons patients have further alienated themselves from the mainstream medical community\" by \"linking Morgellons to another illness viewed skeptically by most doctors,  chronic Lyme disease , and by attacking those who doubt their condition\". [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_871", "text": "Mosquito bite allergies , also termed  hypersensitivity to mosquito bites , are excessive reactions of varying severity to  mosquito bites . They are  allergic   hypersensitivity reactions  caused by the non-toxic  allergenic  proteins contained in the  saliva  injected by a female mosquito (male mosquitos do not take blood-meals) at the time it takes its blood meal, and are not caused by any  toxin  or  pathogen .  By general agreement, mosquito bite allergies do not include the ordinary  wheal  and flare responses to these bites although these reactions are also allergic in nature. [ 1 ]  Ordinary mosquito bite allergies are nonetheless detailed here because they are the best understood reactions to mosquito bites and provide a basis for describing what is understood about them."}
{"_id": "WikiPedia_Dermatology$$$corpus_872", "text": "Mosquito bite allergies are informally classified as  1)  the  skeeter syndrome , i.e., severe local skin reactions sometimes associated with low-grade fever;  2)   systemic reactions  that range from high-grade fever,  lymphadenopathy , abdominal pain, and/or diarrhea to, very rarely, life-threatening symptoms of  anaphylaxis ; and  3)  severe and often systemic reactions occurring in individuals that have an  Epstein-Barr virus-associated lymphoproliferative disease , Epstein-Barr virus-negative  lymphoid malignancy , [ 2 ]  or another predisposing condition such as  eosinophilic cellulitis  or  chronic lymphocytic leukemia . [ 3 ]  The term papular urticaria [ 4 ]  is commonly used for a reaction to mosquito bites that is dominated by widely spread  hives . Here, papular urticaria is regarded as a symptom of mosquito bite allergy manifested in individuals with one of the other mosquito bite allergies but particularly in those associated with eosinophilic cellulitis."}
{"_id": "WikiPedia_Dermatology$$$corpus_873", "text": "Mosquitos belong to the biological  order  of  Diptera  (which includes all two-winged insects), suborder  Nematocera , family Culicidea. [ 5 ]  There are >3,500 different mosquito species with the  Aedes  and  Culex  genera being common in North America. It is assumed that any species of mosquito that causes an ordinary mosquito bite reaction in humans is capable of causing mosquito bite allergies. [ 6 ]   In addition to mosquitoes, the Diptera order includes numerous other types of biting insects such as  midges  (e.g.  sand flies ) and  gnats . Bites by the latter insects [ 1 ]  or possibly some other insects [ 7 ]  may cause reactions that are mechanistically and clinically similar to those seen with mosquito bites. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_874", "text": "Mosquito bite allergies occur more often where insect bites are frequent. Consequently, cases (as well as various other allergic disorders) are more prevalent in tropical climates, underdeveloped areas, areas dominated by poverty, poor hygiene, and/or unawareness of these diseases, and urban areas plagued by social inequality, juvenile delinquency, and violence. That is, not only climate but also cultural and socioeconomic conditions play critical roles in facilitating the development and prevalence of diverse allergic disease including mosquito bite allergies. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_875", "text": "The typical reaction to mosquito bites involves the development of an itchy  wheal  that may contain a central red dot and is surrounded by splotchy redness. This \"immediate reaction\" occurs at some time during the first 20 minutes following the bite. Within hours of the bite, a \"delayed reaction\", in which the wheal evolves into a  papule  develops and then dissipates over the next few days or weeks. [ 1 ]  However, there is a wide variability in the type of reaction which individuals mount in response to these bites. The initial mosquito bites in previously unexposed individuals does not cause a skin reaction but does initiate the development of  antibodies  and/or lymphocytes that are directed against the  allergens  in mosquito's saliva. These individuals thereby become sensitized and reactive to subsequent mosquito bites. After repetitive mosquito bites, individuals may become less sensitive or completely insensitive to the bites in the natural process of  allergen desensitization . Individuals therefore progress through 5 stages in which the type of reaction to a mosquito bite depends on the number of their previous bite exposures and levels of acquired sensitization and desensitization to these bites. The 5 stages an individual may undergo in reacting to repetitive mosquito bites are: [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_876", "text": "In a study of 41 Canadian adults experimentally exposed to mosquito bites, 11 individuals exhibited no reaction, 23 individuals exhibited immediate followed by delayed reactions, 6 individuals exhibited only immediate reactions, and 1 individual exhibited only a delayed reaction. [ 3 ]  Overall, 70-90% of individuals experience an immediate reaction and 55-65% experience a delayed reaction to mosquito bites. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_877", "text": "Individuals also vary in the severity of their reactions to mosquito bites. Most individuals show a \"small reaction\" in which a 2\u201310\u00a0mm (0.1-0.4 inches) diameter wheal evolves into a similarly sized papule that dissipates over several days. [ 6 ]  About 2.5% of individuals (based on self reports) [ 6 ]  show a \"large reaction\" in which the wheal is much larger than 10\u00a0mm (it may exceed 3\u00a0cm, i.e. 1.2 inches) in diameter and evolves into an extensive lesion that has black and blue discolorations due to subcutaneous bleeding,  blistering , and/or  necrosis . The latter reactions, which appear to be caused by the development of an inflammatory  Arthus reaction  at the site, may be very painful. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_878", "text": "Mosquito saliva contains >30 potentially allergenic proteins. More than 11 of these have been identified in the saliva of the  Aedes egypti  mosquito. Four such proteins, termed Aed a 1 (an apyrase), Aed 2 (Female-specific protein, D7), Aed 3 (an as yet undefined protein), and Aed a 4 (an \u03b1-glucosidase) have been purified as  recombinant proteins . Each of these recombinants causes immediate and delayed skin reactions when injected into volunteers with a history of mosquito bite reactivity. As exemplified by the Aed proteins, the proteins in the saliva of any biting mosquito are thought to cause individuals who have not been previously bitten to:  a)   make IgE and IgG antibodies that bind the proteins inducing their formation and  b)  develop  T cells  (a type of  lymphocyte ) that react against parts of the inducing proteins that are displayed on the surface of cells at the bite site (see  Antigen presentation ). In subsequent mosquito bites, IgE and IgG appear involved in the development of both immediate and delayed skin reactions while T cells appear involved in development of the delayed skin reactions. [ 8 ]  The acquired IgE binds mosquito saliva proteins and then triggers skin tissue cells such as  mast cells  to release at least two mediators of allergic reactions,  histamine  and  leukotriene C4 . These mediators contribute to the development of the wheal, itch, and other components of the immediate reaction. This part of the immediate reaction is a classical  type I hypersensitivity reaction . The acquired IgG binds mosquito saliva proteins to form an  immune complex -triggered   type III hypersensitivity reaction  that recruits blood  leukocytes , including T cells, into the bite area; this response it thought to be required for developing the early stage of the delayed reaction. T cells present in or recruited to the mosquito bite area appear responsible for mediating the full delayed reaction. The full delayed reaction is a  type IV hypersensitivity reaction . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_879", "text": "The diagnosis of ordinary mosquito reactions is made on the basis of the history and clinical features of mosquito bites. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_880", "text": "Reducing mosquito breeding areas (e.g. eliminating standing water pools, stocking ponds with fish that consume mosquito larva) and the use of other  mosquito control  methods such as insecticides, mosquito traps, protective clothing, bed nets, and repellants (e.g.  DEET  or  permethrin ) are effective, highly recommended means for reducing mosquito bites. [ 6 ]  Daily doses of a non-sedating second-generation  anti-histamines  (e.g.  cetirizine  or  levocetirizine ) can effectively reduce the immediate and delayed reactions to mosquito bites. [ 8 ]  The use of recombinant mosquito saliva proteins to  desensitize  individuals against developing reactions to mosquito bites has yielded variable results and requires further study. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_881", "text": "Treatment of ordinary small or large mosquito bite reactions is limited to the use of non-sedative  H1 antihistamines , e.g.  cetirizine [ 6 ] \nor a drug with combined activity in inhibiting histamine and  platelet-activating factor , e.g.  rupatadine . [ 9 ]  Randomized, double-blinded, placebo-controlled studies are needed to determine if  antileukotriene  drugs or  topical steroids  have beneficial effects in reducing the symptoms of these bites. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_882", "text": "The Skeeter syndrome is by definition a mosquito bite allergy that consists of a large mosquito bite reaction that may be accompanied by a brief or longer-term (i.e. days to weeks) low-grade fever. [ 8 ]  and, on rare occasions, vomiting. [ 10 ]  The bite site shows an intense, large reaction often resembling a  cellulitis  infection that persists for days to weeks. [ 5 ]  The syndrome usually afflicts healthy children, immune-deficient persons, and individuals who are new to an area inhabited by mosquito species to which they have not been exposed. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_883", "text": "Mechanistically, the Skeeter syndrome appears to be a particularly intense variant of the ordinary mosquito bite reaction. It involves sequential Type I, III, and IV hypersensitivity reactions [ 6 ]  that are mediated by the IgE, IgG, and T cells that are directed against mosquito salivary proteins. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_884", "text": "Children afflicted with the syndrome remain healthy although subject to recurrent severe reactions to mosquito bites. The development of desensitization that follows repetitive mosquito bites and reduces the intensity or completely blocks reactions to mosquito bites may take longer to develop and/or be less effective in those with Skeeter syndrome compared to those with ordinary mosquito bite reactions. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_885", "text": "The diagnosis of Skeeter syndrome is based mainly on the appropriate history of severe skin responses to mosquito bites that may be associated with fever. The diagnosis can be supported by the detection, using for example an  ELISA assay ),  IgE  directed against mosquito saliva proteins in the afflicted individuals serum. [ 8 ]  Direct mosquito bite testing is perhaps the best method for diagnosing mosquito bite allergy but difficulty in determining which mosquito species to use for the test, the possibility of transmitting a mosquito-borne disease, and the risk of triggering a very severe response make this test impractical for routine use. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_886", "text": "The preventive measures listed for ordinary mosquito bite reactions are important for avoiding Skeeter syndrome reactions. In addition to second generation, non-sedative H1 antihistamines,  antipyretics  and  nonsteroidal anti-inflammatory drugs  are typically used to treat patients with acute attacks of the syndrome. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_887", "text": "Individuals with systemic mosquito bite allergies respond to mosquito bites with intense local skin reactions (e.g. blisters, ulcers, necrosis, scarring) and concurrent or subsequent systemic symptoms (high-grade fever and/or  malaise ; less commonly,  muscle cramps , bloody diarrhea, bloody urine,  proteinuria , and/or  wheezing ; [ 3 ]  or very rarely, symptoms of overt anaphylaxis such as  hives ,  angioedema  (i.e. skin swelling in non-mosquito bite areas), shortness of breath, rapid heart rate, and low blood-pressure). [ 8 ]  There are very rare reports of death due to anaphylaxis following mosquito bites. [ 6 ]  Individual with an increased risk of developing severe mosquito bite reactions include those experiencing a particularly large number of mosquito bites, those with no previous exposure to the species of mosquito causing the bites, and those with a not fully developed immune system such as infants and young children. [ 8 ]  Individuals with certain  Epstein-Barr virus-associated lymphoproliferative , [ 12 ]  non-Epstein-Barr virus malignant lymphoid, [ 2 ]  or other predisposing disease [ 3 ]  also have an increased rate of systemic mosquito bite reactions but are considered in a separate category ."}
{"_id": "WikiPedia_Dermatology$$$corpus_888", "text": "Systemic mosquito bite reactions appear to be primarily Type I hypersensitivity reactions that are critically mediated by IgE directed against mosquito salivary gland proteins. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_889", "text": "The methods used to diagnose systemic mosquito bite allergies are similar to those used to diagnose the Skeeter syndrome, including typical case history and, in particular, ELISA tests to detect specific IgE directed against mosquito salivary proteins. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_890", "text": "The methods used to avoid  mosquito  bites  are of particularly importance for preventing systemic mosquito bite allergies, given their severity. These include avoiding mosquito-infested areas, the use of repellants such as  DEET  or  permethrin , and mosquito bite desensitization procedures once they have been shown to be safe and effective for this severest form of mosquito allergy. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_891", "text": "Systemic mosquito bite reactions are serious and on rare occasions may be life-threatening. [ 6 ]  Individuals at risk for developing anaphylactic symptoms in response to mosquito bites should carry an  Epinephrine autoinjector  for immediate use following a mosquito bite. These individuals as well as those without self-injecting epinephrine who develop symptoms of  anaphylaxis  following a mosquito bite should be treated as medical emergencies requiring  anaphylaxis management . [ 8 ]  Individuals with less severe symptoms of systemic mosquito bite reactions require monitoring and treatments tailored to their symptoms. These treatments may include systemic corticosteroids, second generation H1 anti-histamines, and anti-pyretics similar to those used to treat the Skeeter syndrome. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_892", "text": "Mosquito bite allergies afflict individuals who have any one of various types of  Epstein\u2013Barr virus-associated lymphoproliferative diseases  (EBV+ LPD). [ 13 ]  About 33% of patients with  chronic active EBV infection  are afflicted by mosquito bite allergies. Other Epstein-Barr virus-associated lymphoproliferative disease reported to predispose individuals to mosquito bite allergies include Epstein-Barr virus-positive  Hodgkin disease , [ 14 ]   hydroa vacciniforme , [ 15 ]   hemophagocytic lymphohistiocytosis , [ 16 ]   aggressive NK-cell leukemia  (also termed aggressive NK-cell leukemia/lymphoma), [ 14 ]  and  extranodal NK/T-cell lymphoma, nasal type . [ 13 ]  Mosquito bite allergies in individuals with chronic active Epstein-Barr virus infection is the best studied of those that occur in Epstein-Barr virus-associated lymphoproliferative disease; much of what is known in this area is based on these individuals. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_893", "text": "Cases of mosquito bite allergies associated with Epstein-Barr virus-associated lymphoproliferative disease have been reported most often in Japan, Taiwan, Korea, and the native populations of Mexico, Central America, and South America. [ 14 ]  This reaction occurs primarily in younger individuals (0\u201318 years old; mean age 6.7 years) who have evidence of one of the predisposing Epstein-Barr virus-associated lymphoproliferative disease. [ 3 ]  Rarely, however, it occurs in individuals who exhibit no signs or symptoms of a predisposing disorder but later develop chronic active Epstein-Barr virus infection. [ 3 ] [ 17 ]  In addition to the signs and symptoms of their specific Epstein-Barr virus-associated lymphoproliferative disease (see  Epstein-Barr virus-associated lymphoproliferative diseases ), these individuals are subject to severe local as well as systemic reactions to mosquito bites. [ 3 ]  The bite sites are infiltrated with  T helper cells ,  CD8+ T cells , and  CD16 +  NK cells . In this mixture of infiltrates, most of the cells exhibiting EBV positivity are  T helper cells . [ 13 ]  The systemic reactions include: fever and  malaise ; [ 12 ]  enlarged lymph nodes, liver, and/or spleen; liver dysfunction; hematuria; and proteinuria. [ 1 ]  The individuals exhibit greatly increased numbers off circulating NK cells, increased levels of T helper cells. and increased levels of  IgE . [ 13 ]  Some of the circulating NK cells are clearly infected with EBV. The mosquito bitten tissues show perivascular infiltrations containing  T  and NK cells; a large percentage of these NK cells are EBV positive. [ 14 ]  Cases associated with chronic active Epstein-Barr virus infection commonly progress to a more serious Epstein-Barr virus-associated lymphoproliferative disease such as  marginal zone B-cell lymphoma  or a Hodgkin lymphoma-like B cell lymphoma. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_894", "text": "The allergenic proteins in the mosquito's salivary are thought to trigger the reactivation of EBV in the NK cells that are  latently infected  with the virus. Upon reactivation, the virus expresses certain of its gene products, particularly that of its  LMP1   oncogene , [ 13 ]  as well as induces its infected cells to release certain of their gene products, particularly  interferon gamma  and  interleukin 10 , [ 3 ]  which cause the cells it infects to lyse and release EBV to infect other cells or, alternatively, to become immortalized, proliferate, and, possibly, become malignant. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_895", "text": "The diagnosis of mosquito bite allergies in Epstein-Barr virus-associated lymphoproliferative disease depends on finding evidence of the lymphoproliferative disease, a compatible clinical presentation, and detection of EBV in the NK and T cells (e.g. T helper cells) in blood and/or mosquito bitten tissues. The presence of high levels of EBV+ circulating NK cells strongly supports the diagnosis. However, an exceptionally high density of EBV+ in the skin lesions and/or blood raises the possibility that the individual has a NK-cell lymphoma/leukemia. [ 6 ]  Lympoid cells at the bite site may also express the EBV1 viral gene,  BZLF1 ; this gene promotes the lyses of its infected cell host and when detected in bite sites is a marker of a poor prognosis. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_896", "text": "The best treatment for mosquito bite allergy in individuals with an Epstein-Barr virus-associated lymphoproliferative disease varies. Mild and clearly uncomplicated cases with, for example, indolent CAEV, are treated conservatively focusing on obtaining relief of symptoms such as skin irritation, fever, and malaise. [ 17 ]  Cases with evidence of significant complications of CAEFV such as the development of hemophagocytosis, NK/T cell lymphoma, or aggressive NK cell lymphoma generally require chemotherapeutic regimens directed at these complications. Individuals with EBV+ systemic mosquito bite allergy and clear evidence of concurrent aggressive chronic active Epstein-Barr virus infection have been treated with relative success by the 3 step regimen used to treat the latter. [ 2 ]  Rare cases of systemic mosquito bite allergy have been reported to occur in individuals who have no apparent predisposing disease but later develop chronic active Epstein-Barr virus infection. [ 14 ] [ 17 ]  Such cases require careful evaluation and follow-up for development of a predisposing disorder. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_897", "text": "Eosinophilic cellulitis , also known as Wells syndrome, is a rare  skin disease  usually occurring on the extremities and/or trunk that is characterized by episodic acute  urticarial  eruptions or  erysipelas -like rashes which proceed to develop over the ensuing ~6 weeks into  granuloma -like or  morphea -like lesions. The initial lesions may be  papules ,  plaques ,  vesicles , or  blisters  and give a burning or itchy sensation. [ 18 ]  The eruptions may be accompanied by fever,  arthralgia  or other systemic symptoms. [ 19 ]  The disorder predominantly affects adults, frequently takes a protracted course, and has a high rate of spontaneous remission but is often recurrent with relapses occurring even long after remissions. One study found a relapse rate of 56% during an observation period of up to 19 months. Relapses are more frequent in adults than in children. While these lesions usually resolve without sequelae, they may result in skin atrophy and hyperpigmentation. [ 18 ]  Individuals afflicted with eosinophilic cellulitis may have a history of other diseases including  various eosinophlic skin diseases ,  abnormally high levels of circulating blood eosinophils , the  hypereosinophilic syndrome ,  eosinophilic granulomatosis with polyangiitis ,  ulcerative colitis ,  arthralgias ,  myalgias ,  facial nerve paralysis ,  photosensitivity , [ 18 ]   polycythemia vera ,  chronic myeloid leukemia , [ 20 ]   chronic lymphocytic leukemia ,  Hodgkin lymphoma ,  nasopharyngeal cancer , and  renal cell carcinoma . [ 18 ]  Episodes of the disorder are sometimes triggered by: drugs (e.g. antimicrobial agents, biologics, antihypertensive agents,  diuretics , thyroid hormones,  analgesics ,  cytostatic agents , and  anesthetics );  vaccines ; skin contact with chemicals (e.g.  p-phenylenediamine ,  thiomersal , [ 18 ]  and  cladribine ); viral, bacterial, fungal, and parasitic infections; and insect bites. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_898", "text": "Mosquitoes trigger mosquito bite allergies in individuals with eosinophilic cellulitis, They are also thought to trigger mosquito bite allergies that are followed by and therefore trigger the development of eosinophilic cellulitis in individuals with no prior evidence of the disease. It is also possible, however, that these individuals have an undiagnosed, latent form of the disease. The acute eruptions, which may be singular or multiple, occur at the bite site and may spread locally or to more  distant skin sites. The classification of all these eosinophilic cellulitis reactions, whether triggered by a mosquito bite, triggered by some other agent, or apparently untriggered, is argued; [ 3 ]  it has been proposed that eosinophilic cellulites is not a distinct clinical entity but rather a set of skin reactions in various diagnosed or yet-to be diagnosed disorders that involve hypereosinophilia, dysfunctional eosinophils, and/or pathological reactions to foreign antigens which predispose individuals to developing these reactions. [ 19 ]  Eosinophilic cellulitis-associated mosquito bite allergies appear to be non-specific  type IV hypersensitivity reactions  in which  T helper cells  release  cytokines  such as IL5 to attract, activate, promote the degranulation, and prolong the survival of eosinophils. These eosinophils discharge  eosinophilic cationic ,  major basic , and other proteins which injure cells and tissues and thereby may contribute to the severity of the skin lesions. [ 18 ]  The lesions typically are scattered red nodules or diffuse areas consisting of eosinophil infiltrates and flame-like figures composed of eosinophil deposits and  collagen  bundles. Over time, these lesions become  granulomatous  and scarred. Patients with the disorder may have numerous scars due to previous bouts of mosquito bite allergies. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_899", "text": "The diagnosis, which may be difficult to distinguish from other skin disorders, is based on a history of mosquito bites and previous or concurrent predisposing diseases, the course taken by the skin lesions, and the pathology of these lesions. Blood eosinophil levels are elevated in about half of these cases. [ 19 ]  The disorder has generally been either untreated or treated with short- or longer-term oral  glucocorticoids ,  topical glucorocoricoids , and/or injections of glucocorticoids into the skin lesions, depending or lesion severity. Oral antihistamines are used to alleviate associated itchiness.  Anti-inflammatory  drugs and  immunomodulatory agents  such as  dapsone ,  hydroxychloroquine ,  cyclosporine ,  interferon alfa ,  tacrolimus ,  TNF inhibitors , various antifungal agents, and numerous other agents [ 18 ]  have been used to treat the disorder in  case reports  but their value in treating the disorder as well as mosquito bite allergies is unclear. [ 18 ]  If a causative disorder triggering or predisposing to the development of eosinophilic cellulitis is identified, the best treatment option is to treat this disorder. [ 18 ]  Patients with eosinophilic cellulitis should be followed to determine if their disorder progresses into a more serious disease such as the  hypereosinophilic syndrome ,  eosinophilic fasciitis , or the  eosinophilic granulomatosis with polyangiitis . [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_900", "text": "Several case reports have found individuals with chronic lymphocytic leukemia are predisposed to develop severe skin reactions to mosquito and other insect bites. However, there are reports that chronic lymphocytic leukemia patients can develop similarly severe skin reactions in the absence of an insect bite history. The pathology of the insect bite sites in these cases resembles the findings in lesions of eosinophilic cellulitis in individuals with mosquito bite allergies but the mechanism behind these reactions is unknown. [ 3 ]  There are too few reports to establish treatment recommendations for mosquito bite allergy I chronic lymphocytic leukemia beyond those generally used to treat other types of mosquito bite allergies. [ 3 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_901", "text": "In rare cases,  mantle cell lymphoma , a subtype of  B-cell lymphomas , has been reported in association with mosquito bite allergies. In several of these cases, the mosquito bite allergies occurred before the diagnosis of mantle cell lymphoma, suggesting that mosquito bite allergies can be a manifestation of early development, and therefore a harbinger of mantle cell lymphoma. While most of these cases have not been associated with EBV infection, some cases of mosquito bite allergies in Asia have been reported to occur in EBV-positive MBL. Because of the rarity of these cases, the difference between EBV-negative and EBV-positive mantle cell lymphoma as well as the best treatments for mosquito bite allergies in these two forms of mantle cell lymphoma have not been determined. [ 3 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_902", "text": "There are many different  keratin  proteins normally expressed in the human integumentary system.  Mutations in keratin proteins in the skin can cause disease."}
{"_id": "WikiPedia_Dermatology$$$corpus_903", "text": "Of note, other structural proteins in the epidermis of the skin that are closely related to keratins may also cause disease if mutated.  Examples include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_904", "text": "Neonatal pustular eruptions  are a group of disorders characterized by various forms of  pustulosis  (rashes consisting at least in part of pustules) seen in the first four weeks of life. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_905", "text": "This grouping can help aid in  differential diagnosis ."}
{"_id": "WikiPedia_Dermatology$$$corpus_906", "text": "Neonatal pustular eruptions can be further divided into  noninfectious  and  infectious  causes, and range from benign to life-threatening. [ 2 ]  In at least some populations, the infectious causes are more common. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_907", "text": "The non-infectious causes are generally benign and self-limited. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_908", "text": "Most commonly these are primary cutaneous infections, caused by  Staphylococcus aureus  or  beta-hemolytic streptococci . This would be called bullous impetigo. When more severe, these cutaneous infections would develop into furuncles (infections run deeper into the skin)."}
{"_id": "WikiPedia_Dermatology$$$corpus_909", "text": "Congenital syphilis  is another bacterial infection of the skin that can cause pustules in the neonatal period."}
{"_id": "WikiPedia_Dermatology$$$corpus_910", "text": "Listeriosis"}
{"_id": "WikiPedia_Dermatology$$$corpus_911", "text": "Nevus comedonicus , also known as a  comedo nevus [ 1 ]  is characterized by closely arranged, grouped, often linear, slightly elevated  papules  that have at their center keratinous plugs resembling  comedones . [ 2 ] :\u200a634\u200a [ 3 ] :\u200a774"}
{"_id": "WikiPedia_Dermatology$$$corpus_912", "text": "This Epidermal nevi, neoplasms, cysts article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_913", "text": "A  non-blanching rash  ( NBR ) is a skin  rash  that does not  fade  when pressed with, and viewed through, a  glass ."}
{"_id": "WikiPedia_Dermatology$$$corpus_914", "text": "It is a characteristic of both  purpuric  and  petechial  rashes. [ 1 ]  Individual purpura measure 3\u201310\u00a0mm (0.3\u20131\u00a0cm,  3 \u2044 32 - 3 \u2044 8 \u00a0in), whereas  petechiae  measure less than 3\u00a0mm. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_915", "text": "A non-blanching rash can be a symptom of  bacterial meningitis , [ 3 ]  but this is not the exclusive cause. [ 1 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_916", "text": "There are several conditions of or affecting the human integumentary system that are associated with an increased risk of developing nonmelanoma skin cancer (i.e.  squamous-cell carcinoma  and  basal-cell carcinoma )."}
{"_id": "WikiPedia_Dermatology$$$corpus_917", "text": "Nonthrombocytopenic purpura  is a type of  purpura  (red or purple skin discoloration) not associated with  thrombocytopenia . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_918", "text": "Nonthrombocytopenic purpura has been reported after smoking mentholated cigarettes. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_919", "text": "Examples/causes include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_920", "text": "Occupational skin diseases  are ranked among the top five occupational diseases in many countries. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_921", "text": "Contact Dermatitis  due to irritation is  inflammation  of the skin which results from a contact with an irritant. [ 2 ]  It has been observed that this type of  dermatitis  does not require prior sensitization of the  immune system . There have been studies to support that past or present  atopic dermatitis  is a risk factor for this type of  dermatitis . [ 3 ]  Common irritants include detergents, acids, alkalies, oils, organic solvents and reducing agents. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_922", "text": "Clinical manifestations of the contact dermatitis are also modified by external factors such as environmental factors (mechanical pressure, temperature, and humidity) and predisposing characteristics of the individual (age, sex, ethnic origin, preexisting skin disease, atopic skin diathesis, and anatomic region exposed. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_923", "text": "Another occupational skin disease is glove-related hand  urticaria ,  believed to be caused by repeated wearing and removal of the gloves. It has been reported as an occupational problem among the health care workers. The reaction is caused by the latex or the  nitrile  present in the gloves. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_924", "text": "The acute form of this dermatitis develops on exposure of the skin to a strong irritant or caustic chemical. This exposure can occur as a result of  accident  at a  workplace  . The irritant reaction starts to increase in its intensity within minutes to hours of exposure to the irritant and reaches its peak quickly. After the reaction has reached its peak level, it starts to heal. This process is known as decrescendo phenomenon. [ 7 ]  The most frequent potent irritants leading to this type of dermatitis are acids and alkaline solutions. [ 8 ]  The symptoms include redness and swelling of the skin along with the formation of blisters."}
{"_id": "WikiPedia_Dermatology$$$corpus_925", "text": "The chronic form occurs as a result of repeated exposure of the skin to weak irritants over long periods of time. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_926", "text": "Prevention measures include avoidance of the irritant through its removal from the workplace or through technical shielding by the use of potent irritants in closed systems or automation, irritant replacement or removal  [ 10 ]  and personal protection of the workers. Low quality evidence exists for the effectiveness of certain therapies and their ability to specifically prevent hand skin irritation in the workplace. The limited evidence that does exist suggests that moisturizers used alone or in combination with a barrier cream can result in a clinically beneficial effect in the long or short-term primary prevention of occupational irritant hand dermatitis. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_927", "text": "An  omphalolith , also known as a  umbolith ,  omphalith , [ 1 ]   navel stone , [ 2 ]  or  umbilical concretion [ 3 ]  is a  periumbilical  mass that may form due to the accumulation of  sebum  and  keratin . [ 4 ]  The colour is black or brown, and may be related to the skin type of the patient. [ 2 ]  It may resemble a  malignant melanoma . [ 5 ] [ page\u00a0needed ]  It may be caused by poor hygiene, [ 6 ] :\u200a121\u200a  and may form in retracted navels in  obese  people. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_928", "text": "The name was derived from the Greek words  omphalos  ( Greek :  \u03bf\u03bc\u03c6\u03b1\u03bb\u03cc\u03c2 ), meaning  navel , and  lithos  ( Greek :  \u03bb\u03af\u03b8\u03bf\u03c2 ), meaning  stone . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_929", "text": "This  medical  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_930", "text": "Penile discharge  is fluid that comes from the  urethra  at the end of the  penis  that is not  urine ,  pre-ejaculate  or  semen . [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_931", "text": "Common causes include infections due to  gonorrhea ,  chlamydia , or  trichomoniasis . [ 3 ]  In gonorrhea the discharge may be white, yellow, or green. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_932", "text": "A swab of the discharge is usually performed. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_933", "text": "Treatment depends on the cause. Spread of infection is reduced by also  treating sexual contacts . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_934", "text": "Risk factors include being sexually active men under the age of 25, having a recent new sexual partner, or having unprotected sex. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_935", "text": "Penile discharge is liquid from the  urethra  at the end of the penis that is not urine or semen. [ 2 ]  The dripping of clear fluid ( pre-ejaculate ) when sexually excited is normal. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_936", "text": "There may be pain or burning when passing urine, soreness inside the penis or feeling of wanting to pass urine frequently. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_937", "text": "Common causes include infections due to  gonorrhea ,  chlamydia , or  trichomoniasis . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_938", "text": "Other causes include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_939", "text": "A swab of the discharge is usually performed. [ 5 ]  Other investigations may include tests for HIV, hepatitis and syphilis. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_940", "text": "Men who have sex with men may also need to have throat and rectal swabs. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_941", "text": "Treatment depends on the cause and any antibiotic prescribed depends on which infection is found. [ 6 ]  Spread of infection is reduced by  informing sexual partners  so that they can also be treated, and not having sex (including oral or anal) until tests are completed and seven days have passed after treatment. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_942", "text": "Risk factors include being sexually active men under the age of 25, having a recent new sexual partner, unprotected sex (without a condom), or having the presence of any sexually transmitted infection. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_943", "text": "3ES6"}
{"_id": "WikiPedia_Dermatology$$$corpus_944", "text": "5304"}
{"_id": "WikiPedia_Dermatology$$$corpus_945", "text": "18716"}
{"_id": "WikiPedia_Dermatology$$$corpus_946", "text": "ENSG00000159763"}
{"_id": "WikiPedia_Dermatology$$$corpus_947", "text": "ENSMUSG00000058499"}
{"_id": "WikiPedia_Dermatology$$$corpus_948", "text": "P12273"}
{"_id": "WikiPedia_Dermatology$$$corpus_949", "text": "P02816"}
{"_id": "WikiPedia_Dermatology$$$corpus_950", "text": "NM_002652"}
{"_id": "WikiPedia_Dermatology$$$corpus_951", "text": "NM_008843"}
{"_id": "WikiPedia_Dermatology$$$corpus_952", "text": "NP_002643"}
{"_id": "WikiPedia_Dermatology$$$corpus_953", "text": "NP_032869"}
{"_id": "WikiPedia_Dermatology$$$corpus_954", "text": "Prolactin-inducible protein  also known as  gross cystic disease fluid protein 15  (GCDFP-15),  extra-parotid  glycoprotein  (EP-GP),  gp17   seminal actin-binding protein  (SABP)  or  BRST2  is a  protein  that in humans is encoded by the  PIP   gene . [ 5 ] [ 6 ] [ 7 ]  It is upregulated by  prolactin  and  androgens  and downregulated by  estrogen ."}
{"_id": "WikiPedia_Dermatology$$$corpus_955", "text": "The protein has a physiological function in regulation of water transport mainly in apocrine glands in the axilla, vulva, eyelid and ear canal, serous cells of the submandibular salivary gland, serous cells of the submucosal glands of the bronchi, and accessory lacrimal glands  as well as cutaneous eccrine glands. [ 8 ]  It is also found in  amniotic fluid  and  seminal fluid ."}
{"_id": "WikiPedia_Dermatology$$$corpus_956", "text": "PIP has the ability to bind  immunoglobulin G (IgG), IgG-Fc, CD4-T cell receptor suggesting a wide range of immunological functions. [ 9 ] [ 10 ]  PIP also binds to  AZGP1 . [ 10 ]  PIP exerts  aspartyl proteinase  activity able to cleave  fibronectin . [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_957", "text": "PIP can bind different species of bacteria showing highest affinity to streptococci thus playing a role in non-immune defense of the body against pathogenic bacterial strains. [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_958", "text": "Mitogenic effect of PIP was observed on both normal and malignant breast epithelial cells. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_959", "text": "Prolactin induced protein (called GCDFP-15 in this context) in breast cyst fluid or breast tissue serves as marker of both benign and malignant apocrine metaplasia as the protein is not normally expressed in breast tissue. [ 16 ] [ 17 ]  It is characteristic of low grade apocrine carcinoma of the breast, high grade apocrine carcinoma frequently lose expression of this marker. [ 18 ] \nPIP gene expression in breast cancer lines was associated with decreased cell proliferation and invasiveness and an increase of the apoptotic pathway. Many of the genes affected by PIP appear to be regulated by  STAT5 . [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_960", "text": "A mitogenic effect of this protein on experimental breast cells lines MCF10A, MCF7, BT474, MDA-MB231 and T47D  was detected. [ 15 ]  Prolactin-induced protein has also been used for identification and detection of disseminated  breast cancer  cells. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_961", "text": "The PIP gene is amplified in some breast cancer lines accounting for some of its overexpression, however additional mechanisms are needed to completely explain its overexpression. [ 21 ] \nIn T47D breast cancer cells, androgen receptor and  RUNX2  interact to synergistically enhance PIP expression. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_962", "text": "In molecular apocrine breast cancer (ER-/AR+) there is a positive feedback loop between  androgen receptor  and  extracellular signal-regulated kinase  (ERK) via  CREB1  which can be inhibited by anti-androgens. PIP expression is necessary for viability and invasiveness of this subtype of breast cancer. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_963", "text": "In ER+ breast cancer, particularly those with very high level of ER expression, PIP appears to play an important role in proliferation and invasion as well as acquired resistance to  tamoxifen . [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_964", "text": "Psoriasis  is a long-lasting, noncontagious  autoimmune disease  characterized by  patches of abnormal skin . [ 4 ] [ 5 ]  These areas are  red , pink, or purple,  dry ,  itchy , and scaly. [ 8 ] [ 3 ]  Psoriasis varies in severity from small localized patches to complete body coverage. [ 3 ]   Injury  to the skin can trigger psoriatic skin changes at that spot, which is known as the  Koebner phenomenon . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_965", "text": "The five main types of psoriasis are plaque,  guttate ,  inverse ,  pustular , and  erythrodermic . [ 5 ]  Plaque psoriasis, also known as psoriasis vulgaris, makes up about 90% of cases. [ 4 ]  It typically presents as red patches with white scales on top. [ 4 ]  Areas of the body most commonly affected are the back of the forearms, shins, navel area, and scalp. [ 4 ]  Guttate psoriasis has drop-shaped lesions. [ 5 ]  Pustular psoriasis presents as small, noninfectious,  pus -filled blisters. [ 10 ]  Inverse psoriasis forms red patches in skin folds. [ 5 ]  Erythrodermic psoriasis occurs when the rash becomes very widespread and can develop from any of the other types. [ 4 ]   Fingernails  and toenails are affected in most people with psoriasis at some point in time. [ 4 ]  This may include pits in the nails or changes in nail color. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_966", "text": "Psoriasis is generally thought to be a  genetic disease  that is triggered by environmental factors. [ 3 ]  If one  twin  has psoriasis, the other twin is three times more likely to be affected if the twins are  identical  than if they are  nonidentical . [ 4 ]  This suggests that genetic factors predispose to psoriasis. [ 4 ]  Symptoms often worsen during winter and with certain medications, such as  beta blockers  or  NSAIDs . [ 4 ]  Infections and  psychological stress  can also play a role. [ 3 ] [ 5 ]  The underlying mechanism involves the  immune system  reacting to  skin cells . [ 4 ]  Diagnosis is typically based on the signs and symptoms. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_967", "text": "There is no known cure for psoriasis, but various treatments can help control the symptoms. [ 4 ]  These treatments include  steroid creams ,  vitamin D 3  cream,  ultraviolet light ,  immunosuppressive drugs , such as  methotrexate , and  biologic  therapies targeting specific immunologic pathways. [ 5 ]  About 75% of skin involvement improves with creams alone. [ 4 ]  The disease affects 2\u20134% of the population. [ 7 ]  Men and women are affected with equal frequency. [ 5 ]  The disease may begin at any age, but typically starts in adulthood. [ 5 ]  Psoriasis is associated with an increased risk of  psoriatic arthritis ,  lymphomas ,  cardiovascular disease ,  Crohn's disease , and  depression . [ 4 ]  Psoriatic arthritis affects up to 30% of individuals with psoriasis. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_968", "text": "The word \"psoriasis\" is from  Greek  \u03c8\u03c9\u03c1\u03af\u03b1\u03c3\u03b9\u03c2, meaning \"itching condition\" or \"being itchy\" [ 11 ]  from  psora , \"itch\", and  -iasis , \"action, condition\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_969", "text": "Psoriasis vulgaris (also known as chronic stationary psoriasis or plaque-like psoriasis) is the most common form and affects 85\u201390% of people with psoriasis. [ 12 ]  Plaque psoriasis typically appears as raised areas of  inflamed  skin covered with silvery-white, scaly skin. These areas are called plaques and are most commonly found on the elbows, knees, scalp, and back. [ 12 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_970", "text": "Additional types of psoriasis comprise about 10% of cases. They include pustular, inverse, napkin, guttate, oral, and seborrheic-like forms. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_971", "text": "Pustular psoriasis  appears as raised bumps filled with noninfectious pus ( pustules ). [ 15 ]  The skin under and surrounding the pustules is red and tender. [ 16 ]  Pustular psoriasis can either be localized or more widespread throughout the body. Two types of localized pustular psoriasis include psoriasis pustulosa palmoplantaris and acrodermatitis continua of Hallopeau; both forms are localized to the hands and feet. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_972", "text": "Inverse psoriasis  (also known as flexural psoriasis) appears as smooth, inflamed patches of skin. The patches frequently affect  skin folds , particularly around the  genitals  (between the thigh and groin), the  armpits , in the skin folds of an overweight abdomen (known as  panniculus ), between the buttocks in the intergluteal cleft, and under the  breasts  in the  inframammary fold . Heat, trauma, and infection are thought to play a role in the development of this atypical form of psoriasis. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_973", "text": "Napkin psoriasis  is a subtype of psoriasis common in infants under the age of two and is characterized by red papules with silver scales in the diaper area that may extend to the torso or limbs. [ 19 ] [ 20 ]  Napkin psoriasis is often misdiagnosed as  napkin dermatitis  (diaper rash). [ 21 ]  It typically improves as children age and may later present in more common forms as  plaque psoriasis  or  inverse psoriasis . [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_974", "text": "Guttate psoriasis  is an inflammatory condition characterized by numerous small, scaly, red or pink, droplet-like lesions (papules). These numerous papules appear over large areas of the body, primarily the trunk, limbs, and scalp, but typically spare the palms and soles. Guttate psoriasis is often triggered by a  streptococcal  infection (oropharyngeal or perianal) and typically occurs 1\u20133 weeks post-infection.  Guttate psoriasis  is most commonly seen in children and young adults and diagnosis is typically made based on history and clinical exam findings. [ 23 ]  Skin biopsy can also be performed which typically shows a psoriasiform reaction pattern characterized by epidermal hyperplasia with elongation of the rete ridges. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_975", "text": "There is no firm evidence regarding the best management for guttate psoriasis; however, first-line therapy for mild guttate psoriasis typically includes topical corticosteroids. [ 23 ] [ 24 ]  Phototherapy can be used for moderate or severe guttate psoriasis. Biologic treatments have not been well studied in the treatment of guttate psoriasis. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_976", "text": "Guttate psoriasis has a better prognosis than plaque psoriasis and typically resolves within 1\u20133 weeks; however, up to 40% of patients with guttate psoriasis eventually convert to plaque psoriasis. [ 23 ] [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_977", "text": "Psoriatic erythroderma  (erythrodermic psoriasis) involves widespread inflammation and exfoliation of the skin over most of the body surface, often involving greater than 90% of the body surface area. [ 17 ]  It may be accompanied by severe dryness, itching, swelling, and pain. It can develop from any type of psoriasis. [ 17 ]  It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic  glucocorticoids . [ 25 ]  This form of psoriasis can be fatal as the extreme inflammation and exfoliation disrupt the body's ability to  regulate temperature  and perform barrier functions. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_978", "text": "Psoriasis in the mouth is very rare, in contrast to  lichen planus , another common papulosquamous disorder that commonly involves both the skin and mouth. [ 27 ]  When psoriasis involves the oral mucosa (the lining of the mouth), it may be asymptomatic, [ 27 ]  but it may appear as white or grey-yellow plaques. [ 27 ]   Fissured tongue  is the most common finding in those with oral psoriasis and has been reported to occur in 6.5\u201320% of people with psoriasis affecting the skin. The microscopic appearance of oral mucosa affected by  geographic tongue  (migratory stomatitis) is very similar to the appearance of psoriasis. [ 28 ]  A recent study found an association between the two conditions, and it suggests that geographic tongue might be a predictor to psoriasis. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_979", "text": "Seborrheic-like psoriasis  is a common form of psoriasis with clinical aspects of psoriasis and  seborrheic dermatitis , and it may be difficult to distinguish from the latter. This form of psoriasis typically manifests as red plaques with greasy scales in areas of higher  sebum  production such as the  scalp ,  forehead ,  skin folds next to the nose , the skin surrounding the mouth, skin on the chest above the  sternum , and in  skin folds . [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_980", "text": "Psoriatic arthritis  is a form of chronic inflammatory  arthritis  that has a highly variable clinical presentation and frequently occurs in association with skin and nail psoriasis. [ 30 ] [ 31 ]  It typically involves painful inflammation of the joints and  surrounding connective tissue  and can occur in any joint, but most commonly affects the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as  dactylitis . [ 30 ]  Psoriatic arthritis can also affect the hips, knees, spine ( spondylitis ), and  sacroiliac joint  ( sacroiliitis ). [ 32 ]  About 30% of individuals with psoriasis will develop psoriatic arthritis. [ 12 ]  Skin manifestations of psoriasis tend to occur before arthritic manifestations in about 75% of cases. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_981", "text": "Psoriasis can affect the nails  and produces a variety of changes in the appearance of fingers and toenails. Nail psoriasis occurs in 40\u201345% of people with psoriasis affecting the skin, and has a lifetime incidence of 80\u201390% in those with psoriatic arthritis. [ 33 ]  These changes include pitting of the nails (pinhead-sized depressions in the nail is seen in 70% with nail psoriasis),  whitening of the nail ,  small areas of bleeding from capillaries under the nail , yellow-reddish discoloration of the nails known as the oil drop or salmon spots, dryness, thickening of the skin under the nail (subungual hyperkeratosis), loosening and separation of the nail ( onycholysis ), and crumbling of the nail. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_982", "text": "In addition to the appearance and distribution of the rash, specific  medical signs  may be used by medical practitioners to assist with diagnosis. These may include  Auspitz's sign  (pinpoint bleeding when the scale is removed),  Koebner phenomenon  (psoriatic skin lesions induced by trauma to the skin), [ 19 ]  and  itching  and pain localized to papules and plaques. [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_983", "text": "The cause of psoriasis is not fully understood. Genetics, seasonal changes, skin damage, climate, immunocompromised state, specific infections, and the use of some medications have been connected with different types of psoriasis. [ 34 ] [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_984", "text": "Around one-third of people with psoriasis report a  family history  of the disease, and researchers have identified genetic  loci  associated with the condition.  Identical twin  studies suggest a 70% chance of a twin developing psoriasis if the other twin has the disorder. The risk is around 20% for fraternal twins. These findings suggest both a genetic susceptibility and an environmental response in developing psoriasis. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_985", "text": "Psoriasis has a strong hereditary component, and many genes are associated with it, but how those genes work together is unclear. Most of the identified genes relate to the immune system, particularly the  major histocompatibility complex  (MHC) and  T cells . Genetic studies are valuable due to their ability to identify molecular mechanisms and pathways for further study and potential medication targets. [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_986", "text": "Classic genome-wide  linkage analysis  has identified nine loci on different chromosomes associated with psoriasis. They are called psoriasis susceptibility 1 through 9 ( PSORS1  through  PSORS9 ). Within those loci are genes on pathways that lead to inflammation. Certain variations ( mutations ) of those genes are commonly found in psoriasis. [ 37 ]   Genome-wide association scans  have identified other genes that are altered to characteristic variants in psoriasis. Some of these genes express inflammatory signal proteins, which affect cells in the immune system that are also involved in psoriasis. Some of these genes are also involved in other autoimmune diseases. [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_987", "text": "The major determinant is  PSORS1 , which probably accounts for 35\u201350% of psoriasis heritability. [ 38 ]  It controls genes that affect the immune system or encode skin proteins that are overabundant with psoriasis.  PSORS1  is located on  chromosome 6  in the MHC, which controls important immune functions. Three genes in the  PSORS1  locus have a strong association with psoriasis vulgaris:  HLA-C  variant  HLA-Cw6 , [ 34 ]  which encodes an MHC class I protein;  CCHCR1 , variant WWC, which encodes a  coiled coil  protein overexpressed in psoriatic epidermis; and  CDSN , variant allele 5, which encodes  corneodesmosin , a protein expressed in the granular and  cornified layers  of the epidermis and upregulated in psoriasis. [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_988", "text": "Two major immune system genes under investigation are interleukin-12 subunit beta ( IL12B ) on  chromosome 5q , which expresses interleukin-12B; and  IL23R  on chromosome 1p, which expresses the interleukin-23 receptor and is involved in T cell differentiation. Interleukin-23 receptor and  IL12B  have both been strongly linked with psoriasis. [ 34 ]  T cells are involved in the inflammatory process that leads to psoriasis. [ 37 ]  These genes are on the pathway that upregulates tumor necrosis factor-\u03b1 and  nuclear factor \u03baB , two genes involved in inflammation. [ 37 ]  The first gene directly linked to psoriasis was identified as the  CARD14   gene located in the  PSORS2  locus. A rare mutation in the gene encoding for the  CARD14 -regulated protein plus an environmental trigger was enough to cause plaque psoriasis (the most common form of psoriasis). [ 39 ] [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_989", "text": "Conditions reported as worsening the disease include chronic infections, stress, and changes in season and  climate . [ 34 ]  Other factors that might worsen the condition include hot water, scratching psoriasis skin lesions,  skin dryness , excessive alcohol consumption,  cigarette smoking , and obesity. [ 34 ] [ 41 ] [ 42 ] [ 43 ]  The effects of stopping cigarette smoking or alcohol misuse have yet to be studied as of 2019. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_990", "text": "The rate of psoriasis in  human immunodeficiency virus -positive (HIV) individuals is comparable to that of HIV-negative individuals, but psoriasis tends to be more severe in people infected with HIV. [ 44 ]  A much higher rate of psoriatic arthritis occurs in HIV-positive individuals with psoriasis than in those without the infection. [ 44 ]  The immune response in those infected with HIV is typically characterized by  cellular signals  from  T h 2 subset of CD4+ helper T cells , [ 45 ]  whereas the immune response in psoriasis vulgaris is characterized by a pattern of cellular signals typical of  T h 1 subset of CD4+ helper T cells  and  T h 17 helper T cells . [ 46 ] [ 47 ]  The diminished CD4+-T cell presence is thought to cause overactivation of CD8+-T cells, which are responsible for the exacerbation of psoriasis in HIV-positive people. Psoriasis in those with HIV/AIDS is often severe and may be untreatable with conventional therapy. [ 48 ]  In those with long-term, well-controlled psoriasis, new HIV infection can trigger a severe flare-up of psoriasis and/or psoriatic arthritis. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_991", "text": "Psoriasis has been described as occurring after  strep throat , and may be worsened by skin or gut colonization with  Staphylococcus aureus ,  Malassezia  spp., and  Candida albicans . [ 35 ]  Guttate psoriasis often affects children and adolescents and can be triggered by a recent  group A streptococcal infection  (tonsillitis or pharyngitis). [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_992", "text": "Drug-induced psoriasis may occur with  beta blockers , [ 10 ]   lithium , [ 10 ]   antimalarial medications , [ 10 ]   nonsteroidal anti-inflammatory drugs , [ 10 ]   terbinafine ,  calcium channel blockers ,  captopril ,  glyburide ,  granulocyte colony-stimulating factor , [ 10 ]   interleukins ,  interferons , [ 10 ]   lipid-lowering medications , [ 14 ] :\u200a197\u200a  and paradoxically  TNF inhibitors  such as  infliximab  or  adalimumab . [ 49 ]  Withdrawal of  corticosteroids  (topical steroid cream) can aggravate psoriasis due to the  rebound effect . [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_993", "text": "Psoriasis is characterized by an abnormally excessive and rapid growth of the  epidermal layer of the skin . [ 51 ]  Abnormal production of skin cells (especially during  wound repair ) and an overabundance of skin cells result from the sequence of pathological events in psoriasis. [ 16 ]  The sequence of pathological events in psoriasis is thought to start with an initiation phase in which an event (skin trauma, infection, or drugs) leads to activation of the immune system and then the maintenance phase consisting of chronic progression of the disease. [ 37 ] [ 17 ]  Skin cells are replaced every 3\u20135 days in psoriasis rather than the usual 28\u201330 days. [ 52 ]  These changes are believed to stem from the premature maturation of  keratinocytes  induced by an inflammatory cascade in the  dermis  involving  dendritic cells ,  macrophages , and T cells (three subtypes of immune cells). [ 12 ] [ 44 ]  These immune cells move from the  dermis  to the epidermis and secrete inflammatory chemical signals (cytokines) such as  interleukin-36\u03b3 ,  tumor necrosis factor-\u03b1 ,  interleukin-1\u03b2 ,  interleukin-6 , and  interleukin-22 . [ 37 ] [ 53 ]  These secreted inflammatory signals are believed to stimulate keratinocytes to proliferate. [ 37 ]  One hypothesis is that psoriasis involves a defect in  regulatory T cells , and in the regulatory cytokine  interleukin-10 . [ 37 ]  The inflammatory cytokines found in psoriatic nails and joints (in the case of psoriatic arthritis) are similar to those of psoriatic skin lesions, suggesting a common inflammatory mechanism. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_994", "text": "Gene mutations of proteins involved in the skin's ability to function as a barrier have been identified as markers of susceptibility for the development of psoriasis. [ 54 ] [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_995", "text": "Deoxyribonucleic acid  (DNA) released from dying cells acts as an inflammatory stimulus in psoriasis [ 56 ]  and stimulates the receptors on certain dendritic cells, which in turn produce the cytokine interferon-\u03b1. [ 56 ]  In response to these chemical messages from dendritic cells and T cells, keratinocytes also secrete cytokines such as interleukin-1, interleukin-6, and tumor necrosis factor-\u03b1, which signal downstream inflammatory cells to arrive and stimulate additional inflammation. [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_996", "text": "Dendritic cells  bridge the  innate immune system  and  adaptive immune system . They are increased in psoriatic lesions [ 51 ]  and induce the proliferation of T cells and type 1 helper T cells (T h 1). Targeted immunotherapy, as well as  psoralen  and  ultraviolet A  ( PUVA ) therapy, can reduce the number of dendritic cells and favors a  T H 2 cell  cytokine secretion pattern over a T h 1/T h 17 cell cytokine profile. [ 37 ] [ 46 ]  Psoriatic T cells move from the dermis into the epidermis and secrete interferon-\u03b3 and  interleukin-17 . [ 57 ]  Interleukin-23 is known to induce the production of interleukin-17 and interleukin-22. [ 51 ] [ 57 ]  Interleukin-22 works in combination with interleukin-17 to induce keratinocytes to secrete  neutrophil -attracting cytokines. [ 57 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_997", "text": "A  diagnosis  of psoriasis is usually based on the appearance of the skin. Skin characteristics typical for psoriasis are scaly,  erythematous  plaques, papules, or patches of skin that may be painful and itch. [ 18 ]  No special blood tests or diagnostic procedures are usually required to make the diagnosis. [ 16 ] [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_998", "text": "The  differential diagnosis  of psoriasis includes dermatological conditions similar in appearance such as  discoid eczema ,  seborrheic eczema ,  pityriasis rosea  (may be confused with guttate psoriasis),  nail fungus  (may be confused with nail psoriasis) or  cutaneous T cell lymphoma  (50% of individuals with this cancer are initially  misdiagnosed  with psoriasis). [ 50 ]  Dermatologic manifestations of systemic illnesses such as the rash of  secondary syphilis  may also be confused with psoriasis. [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_999", "text": "If the clinical diagnosis is uncertain, a skin  biopsy  or scraping may be performed to rule out other disorders and to confirm the diagnosis. Skin from a biopsy shows clubbed  epidermal projections that interdigitate with dermis  on microscopy.  Epidermal thickening  is another characteristic histologic finding of psoriasis lesions. [ 16 ] [ 60 ]  The  stratum granulosum  layer of the epidermis is often missing or significantly decreased in psoriatic lesions; the skin cells from the  most superficial layer of skin  are also abnormal as they never fully mature. Unlike their mature counterparts,  these superficial cells  keep their nuclei. [ 16 ]  Inflammatory infiltrates can typically be seen on microscopy when examining skin tissue or joint tissue affected by psoriasis. Epidermal skin tissue affected by psoriatic inflammation often has many CD8+ T cells, while a predominance of CD4+ T cells makes up the inflammatory infiltrates of the dermal layer of skin and joints. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1000", "text": "Psoriasis is classified as a  papulosquamous disorder  and is most commonly subdivided into different categories based on histological characteristics. [ 3 ] [ 10 ]  Variants include plaque, pustular, guttate, and flexural psoriasis. Each form has a dedicated  ICD-10  code. [ 61 ]  Psoriasis can also be classified into nonpustular and  pustular  types. [ 62 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1001", "text": "Another classification scheme considers genetic and demographic factors. Type 1 has a positive family history, starts before the age of 40, and is associated with the  human leukocyte antigen ,  HLA-Cw6 . Conversely, type 2 does not show a family history, presents after age 40, and is not associated with  HLA-Cw6 . [ 63 ]  Type 1 accounts for about 75% of persons with psoriasis. [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1002", "text": "The classification of psoriasis as an autoimmune disease has sparked considerable debate. Researchers have proposed differing descriptions of psoriasis and psoriatic arthritis; some authors have classified them as autoimmune diseases [ 16 ] [ 34 ] [ 65 ]  while others have classified them as distinct from autoimmune diseases and referred to them as  immune-mediated inflammatory diseases . [ 37 ] [ 66 ] [ 67 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1003", "text": "No consensus exists about how to classify the severity of psoriasis. Mild psoriasis has been defined as a percentage of body surface area (BSA)\u226410, a  Psoriasis Area and Severity Index  (PASI) score \u226410, and a  Dermatology Life Quality Index  (DLQI) score \u226410. [ 68 ]  Moderate to severe psoriasis was defined by the same group as BSA >10 or PASI score >10 and a DLQI score >10. [ 68 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1004", "text": "The DLQI is a 10-question tool used to measure the impact of several dermatologic diseases on daily functioning. The DLQI score ranges from 0 (minimal impairment) to 30 (maximal impairment) and is calculated with each answer being assigned 0\u20133 points with higher scores indicating greater social or occupational impairment. [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1005", "text": "The PASI is the most widely used measurement tool for psoriasis. It assesses the severity of lesions and the area affected and combines these two factors into a single score from 0 (no disease) to 72 (maximal disease). [ 70 ]  Nevertheless, the PASI can be too unwieldy to use outside of research settings, which has led to attempts to simplify the index for clinical use. [ 71 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1006", "text": "Psoriasis is not just a skin disease. The symptoms of psoriasis can sometimes go beyond the skin and can have a negative impact on the quality of life of the affected individuals. [ 72 ]  Additionally, the co-morbidities increase the treatment and financial burden of psoriasis and should be considered when managing this condition. [ 72 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1007", "text": "There is 2.2 times increased risk of cardiovascular complications in people with psoriasis. [ 73 ]  Also, people with psoriasis are more susceptible to myocardial infarction (heart attack) and stroke. [ 73 ]  It has been speculated that there is systemic inflammation in psoriasis, which drives \u201cpsoriatic march\u201d and can cause other inflammatory complications including cardiovascular complications. [ 73 ]  A study used fluorodeoxyglucose F-18 positron emission tomography-computed tomography (FDG PET/CT) to measure aortic vascular inflammation in psoriasis patients, and found increased coronary artery disease indices, including total plaque burden, luminal stenosis, and high-risk plaques in people with psoriasis. Similarly, it was found that there is an 11% reduction in aortic vascular inflammation when there is a 75% reduction in the PASI score. [ 74 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1008", "text": "Depression or depressive symptoms are present in 28\u201355% of people with psoriasis. [ 75 ]  People with psoriasis are often stigmatized due to visible disfigurement of the skin. Social stigmatization is a risk factor for depression, however, other immune system factors may also be related to this observed increased incidence of depression in people with psoriasis. [ 75 ]  There is some evidence that increased inflammatory signals in the body could also contribute to depression in people with chronic inflammatory diseases, including psoriasis. [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1009", "text": "People with psoriasis are at increased risk of developing  type 2 diabetes  (~1.5 odds ratio). [ 76 ]  A genome-wide genetic study found that psoriasis and type 2 diabetes share four loci, namely, ACTR2, ERLIN1, TRMT112, and BECN1, which are connected via inflammatory NF-\u03baB pathway. [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1010", "text": "While no cure is available for psoriasis, [ 50 ]  many treatment options exist. Topical agents are typically used for mild disease, phototherapy for moderate disease, and systemic agents for severe disease. [ 77 ]  There is no evidence to support the effectiveness of conventional topical and systemic drugs, biological therapy, or phototherapy for acute guttate psoriasis or an acute guttate flare of chronic psoriasis. [ 78 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1011", "text": "Topical corticosteroid preparations are the most effective agents when used continuously for eight weeks;  retinoids  and  coal tar  were found to be of limited benefit and may be no better than  placebo . [ 79 ]  Very potent topical corticosteroids may be helpful in some cases, however, it is suggested to only use them for four weeks at a time and only if other less potent topical treatment options are not working. [ 80 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1012", "text": "Vitamin D analogues  (such as  paricalcitol ,  calcipotriol ,  tacalcitol , and  calcitriol ) are superior to placebo. Combination therapy with vitamin D and a corticosteroid is superior to either treatment alone and  vitamin D  is superior to coal tar for chronic plaque psoriasis. [ 81 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1013", "text": "For psoriasis of the scalp, a 2016 review found dual therapy (vitamin D analogs and topical corticosteroids) or corticosteroid monotherapy to be more effective and safer than topical vitamin D analogs alone. [ 82 ]  Due to their similar safety profiles and minimal benefit of dual therapy over monotherapy, corticosteroid monotherapy appears to be an acceptable treatment for short-term treatment. [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1014", "text": "Moisturizers and emollients such as  mineral oil ,  petroleum jelly , and  decubal  (an oil-in-water emollient) were found to increase the clearance of psoriatic plaques. Some emollients are even more effective at clearing psoriatic plaques when combined with phototherapy. [ 83 ]  Certain emollients, though, have no impact on psoriasis plaque clearance or may even decrease the clearance achieved with phototherapy, e.g. the emollient  salicylic acid  is structurally similar to  para-aminobenzoic acid , commonly found in sunscreen, and is known to interfere with phototherapy in psoriasis.  Coconut oil , when used as an emollient in psoriasis, has been found to decrease plaque clearance with phototherapy. [ 83 ]  Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turnover, and clear affected skin of plaques. Ointment and creams containing coal tar,  dithranol , corticosteroids (i.e.  desoximetasone ),  fluocinonide , vitamin D 3  analogues (for example, calcipotriol), and  retinoids  are routinely used. (The use of the  finger tip unit  may be helpful in guiding how much topical treatment to use.) [ 41 ] [ 84 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1015", "text": "Vitamin D analogs may be useful with steroids; steroids alone have a higher rate of side effects. [ 81 ]  Vitamin D analogs may allow lower doses of steroids to be used. [ 85 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1016", "text": "Another topical therapy used to treat psoriasis is a form of  balneotherapy , which involves daily baths in the  Dead Sea . This is usually done for four weeks with the benefit attributed to sun exposure and specifically  UVB  light. This is cost-effective and it has been propagated as an effective way to treat psoriasis without medication. [ 86 ]  Decreases of PASI scores greater than 75% and remission for several months have commonly been observed. [ 86 ]  Side effects may be mild such as itchiness,  folliculitis ,  sunburn ,  poikiloderma , and a theoretical risk of nonmelanoma cancer or melanoma has been suggested. [ 86 ]  Some studies indicate no increased risk of melanoma in the long term. [ 87 ]  Data are inconclusive concerning nonmelanoma skin cancer risk, but support the idea that the therapy is associated with an increased risk of benign forms of sun-induced skin damage such as, but not limited to,  actinic elastosis  or  liver spots . [ 87 ]  Dead Sea balneotherapy is also effective for psoriatic arthritis. [ 87 ]  Tentative evidence indicates that balneophototherapy, a combination of  salt bathes  and exposure to  ultraviolet  B-light (UVB), in chronic plaque psoriasis is better than UVB alone. [ 88 ]   Glycerin  is also an effective treatment for Psoriasis. [ 89 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1017", "text": "Phototherapy  in the form of  sunlight  has long been used for psoriasis. [ 77 ]  UVB wavelengths of 311\u2013313\u00a0 nanometers  are most common. These lamps have been developed for this treatment. [ 77 ]  The exposure time should be controlled to avoid overexposure and burning of the skin. The UVB lamps should have a timer that turns off the lamp when the time ends. The dose is increased in every treatment to let the skin get used to the light. [ 77 ]  Increased rates of cancer from treatment appear to be small. [ 77 ]   Narrowband UVB therapy  has been demonstrated to have similar efficacy to  psoralen and ultraviolet A phototherapy  (PUVA). [ 90 ]  A 2013 meta-analysis found no difference in efficacy between NB-UVB and PUVA in the treatment of psoriasis, but NB-UVB is usually more convenient. [ 91 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1018", "text": "One of the problems with clinical phototherapy is the difficulty many people have gaining access to a facility. Indoor tanning resources are almost ubiquitous today and could be considered as a means for people to get UV exposure when dermatologist-provided phototherapy is not available. Indoor tanning is already used by many people as a treatment for psoriasis; one indoor facility reported that 50% of its clients were using the center for psoriasis treatment; another reported 36% were doing the same thing. However, a concern with the use of commercial tanning is that tanning beds that primarily emit UVA might not effectively treat psoriasis. One study found that plaque psoriasis is responsive to  erythemogenic  doses of either UVA or UVB, as exposure to either can cause dissipation of psoriatic plaques. It does require more energy to reach erythemogenic dosing with UVA. [ 92 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1019", "text": "UV light therapies all have risks; tanning beds are no exception, being listed by the  World Health Organization  as carcinogens. [ 93 ]  Exposure to UV light is known to increase the risks of melanoma and squamous cell and basal cell carcinomas; younger people with psoriasis, particularly those under age 35, are at increased risk from melanoma from UV light treatment. A review of studies recommends that people who are susceptible to skin cancers exercise caution when using UV light therapy as a treatment. [ 92 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1020", "text": "A major mechanism of NB-UVB is the induction of  DNA  damage in the form of  pyrimidine dimers . This type of phototherapy is useful in the treatment of psoriasis because the formation of these dimers interferes with the  cell cycle  and stops it. The interruption of the cell cycle induced by NB-UVB opposes the characteristic rapid division of skin cells seen in psoriasis. [ 90 ]  The activity of many types of immune cells found in the skin is also effectively suppressed by NB-UVB phototherapy treatments. [ 94 ]  The most common short-term side effect of this form of phototherapy is redness of the skin; less common side effects of NB-UVB phototherapy are itching and  blistering  of the treated skin, irritation of the eyes in the form of  conjunctival inflammation  or  inflammation of the cornea , or  cold sores  due to reactivation of the  herpes simplex virus  in the skin surrounding the lips. Eye protection is usually given during phototherapy treatments. [ 90 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1021", "text": "PUVA combines the oral or topical administration of psoralen with exposure to ultraviolet A (UVA) light. The  mechanism of action  of PUVA is unknown but probably involves activation of psoralen by UVA light, which inhibits the abnormally rapid production of the cells in psoriatic skin. There are multiple mechanisms of action associated with PUVA, including effects on the skin's immune system. PUVA is associated with  nausea ,  headache ,  fatigue , burning, and itching. Long-term treatment is associated with  squamous cell carcinoma  (but not with  melanoma ). [ 42 ] [ 95 ]  A combination therapy for moderate to severe psoriasis using PUVA plus  acitretin  resulted in benefit, but acitretin use has been associated with  birth defects  and  liver damage . [ 96 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1022", "text": "Psoriasis resistant to  topical treatment  and  phototherapy  may be treated with systemic therapies including  medications  by mouth or  injectable treatments . [ 97 ]  People undergoing systemic treatment must have regular  blood  and  liver function tests  to check for medication toxicities. [ 97 ]   Pregnancy  must be avoided for most of these treatments. [ medical citation needed ]  The majority of people experience a recurrence of psoriasis after systemic treatment is discontinued. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1023", "text": "Non-biologic systemic treatments frequently used for psoriasis include  methotrexate ,  ciclosporin ,  hydroxycarbamide ,  fumarates  such as  dimethyl fumarate , and  retinoids . [ 98 ]  Methotrexate and ciclosporin are  medications that suppress the immune system ; retinoids are synthetic forms of  vitamin A . These agents are also regarded as first-line treatments for  psoriatic erythroderma . [ 25 ]  Oral  corticosteroids  should not be used as they can severely flare psoriasis upon their discontinuation. [ 99 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1024", "text": "Biologics  are manufactured proteins that interrupt the immune process involved in psoriasis. Unlike generalized immunosuppressive medical therapies such as methotrexate, biologics target specific aspects of the immune system contributing to psoriasis. [ 98 ]  These medications are generally well-tolerated, and limited long-term outcome data have demonstrated biologics to be safe for long-term use in moderate to severe plaque psoriasis. [ 98 ] [ 100 ]  However, due to their immunosuppressive actions, biologics have been associated with a small increase in the risk for infection. [ 98 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1025", "text": "Guidelines regard biologics as a third-line treatment for plaque psoriasis following inadequate response to topical treatment, phototherapy, and non-biologic systemic treatments. [ 100 ]  The safety of biologics during pregnancy has not been assessed. European guidelines recommend avoiding biologics if a pregnancy is planned; anti-TNF therapies such as infliximab are not recommended for use in chronic carriers of the  hepatitis B virus  or individuals infected with  HIV . [ 98 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1026", "text": "Several monoclonal antibodies target cytokines, the molecules that cells use to send inflammatory signals to each other.  TNF-\u03b1  is one of the main executor inflammatory cytokines. Four  monoclonal antibodies  (MAbs) ( infliximab ,  adalimumab ,  golimumab , and  certolizumab pegol ) and one recombinant TNF-\u03b1  decoy receptor ,  etanercept , have been developed to inhibit TNF-\u03b1 signaling. Additional monoclonal antibodies, such as  ixekizumab , [ 101 ]  have been developed against pro-inflammatory cytokines [ 102 ]  and inhibit the inflammatory pathway at a different point than the anti-TNF-\u03b1 antibodies. [ 37 ]  IL-12 and IL-23 share a common domain,  p40 , which is the target of the  FDA-approved   ustekinumab . [ 34 ]  In 2017 the  US FDA  approved  guselkumab  for plaque psoriasis. [ 103 ]  There have been few studies of the efficacy of anti-TNF medications for psoriasis in children. One randomized control study suggested that 12 weeks of etanercept treatment reduced the extent of psoriasis in children with no lasting adverse effects. [ 104 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1027", "text": "Two medications that target T cells are  efalizumab  and  alefacept . Efalizumab is a monoclonal antibody that specifically targets the  CD11a  subunit of  LFA-1 . [ 98 ]  It also blocks the adhesion molecules on the  endothelial  cells that line blood vessels, which attract T cells. Efalizumab was voluntarily withdrawn from the European market in February 2009, and from the U.S. market in June 2009, by the manufacturer due to the medication's association with cases of  progressive multifocal leukoencephalopathy . [ 98 ]  Alefacept also blocks the molecules that dendritic cells use to communicate with T cells and even causes  natural killer cells  to kill T cells as a way of controlling inflammation. [ 37 ]   Apremilast  may also be used. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1028", "text": "Individuals with psoriasis may develop  neutralizing antibodies  against monoclonal antibodies. Neutralization occurs when an antidrug antibody prevents a monoclonal antibody such as infliximab from binding antigen in a laboratory test. Specifically, neutralization occurs when the anti-drug antibody binds to infliximab's antigen binding site instead of TNF-\u03b1. When infliximab no longer binds  tumor necrosis factor alpha , it no longer decreases inflammation, and psoriasis may worsen. Neutralizing antibodies have not been reported against  etanercept , a biologic medication that is a fusion protein composed of two TNF-\u03b1 receptors. The lack of neutralizing antibodies against etanercept is probably secondary to the innate presence of the TNF-\u03b1 receptor, and the development of  immune tolerance . [ 105 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1029", "text": "There is strong evidence to indicate that infliximab,  bimekizumab , ixekizumab, and  risankizumab  are the most effective biologics for treating moderate to severe cases of psoriasis. [ 106 ]  There is also some evidence to support use of  secukinumab ,  brodalumab ,  guselkumab , certolizumab, and ustekinumab. [ 107 ] [ 106 ]  In general, anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha biologics were found to be more effective than traditional systemic treatments. [ 106 ]  The immunologic pathways of psoriasis involve  Th9 ,  Th17 ,  Th1  lymphocytes, and  IL-22 . The aforementioned biologic agents hinder different aspects of these pathways. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1030", "text": "Another set of treatments for moderate to severe psoriasis are  fumaric acid esters  (FAE), which may be similar in effectiveness to  methotrexate . [ 108 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1031", "text": "Apremilast  (Otezla, Celgene) is an oral small-molecule inhibitor of the enzyme  phosphodiesterase 4 , which plays an important role in chronic inflammation associated with psoriasis. [ 109 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1032", "text": "It has been theorized that antistreptococcal medications may improve guttate and chronic plaque psoriasis; however, limited studies do not show that antibiotics are effective. [ 110 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1033", "text": "Limited evidence suggests  removal of the tonsils  may benefit people with chronic plaque psoriasis, guttate psoriasis, and palmoplantar pustulosis. [ 111 ] [ 112 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1034", "text": "Uncontrolled studies have suggested that individuals with psoriasis or psoriatic arthritis may benefit from a diet supplemented with  fish oil  rich in  eicosapentaenoic acid  (EPA) and  docosahexaenoic acid  (DHA). [ 113 ]  A low-calorie diet appears to reduce the severity of psoriasis. [ 43 ]  Diet recommendations include consumption of cold water fish (preferably wild fish, not farmed) such as salmon, herring, and mackerel; extra virgin olive oil; legumes; vegetables; fruits; and whole grains; and avoid consumption of alcohol, red meat, and dairy products (due to their saturated fat). The effect of caffeine consumption (including from coffee, black tea, mate, and dark chocolate) remains to be determined. [ 114 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1035", "text": "Many patients report improvements after consuming less tobacco, caffeine, sugar,  nightshades  (tomatoes, eggplant, peppers, paprika and white potatoes) and taking probiotics and oral Vitamin D. [ 115 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1036", "text": "There is a higher rate of  celiac disease  among people with psoriasis. [ 114 ] [ 116 ]  When adopting a  gluten-free diet , disease severity generally decreases in people with celiac disease and those with  anti-gliadin antibodies . [ 113 ] [ 117 ] [ 118 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1037", "text": "Most people with psoriasis experience nothing more than mild skin lesions that can be treated effectively with topical therapies. [ 79 ]  Depending on the severity and location of outbreaks, people may experience significant physical discomfort and some disability, affecting the person's quality of life. [ 34 ]  Itching and pain can interfere with basic functions, such as self-care and sleep. [ 52 ]  Participation in sporting activities, certain occupations, and caring for family members can become difficult activities for those with plaques located on their hands and feet. [ 52 ]  Plaques on the scalp can be particularly embarrassing, as flaky plaque in the hair can be mistaken for  dandruff . [ 119 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1038", "text": "Individuals with psoriasis may feel self-conscious about their appearance and have a poor self-image that stems from fear of public rejection and psychosexual concerns. Psoriasis has been associated with low self-esteem and  depression  is more common among those with the condition. [ 3 ]  People with psoriasis often feel prejudiced against due to the commonly held incorrect belief that psoriasis is contagious. [ 52 ]  Psychological distress can lead to significant  depression  and  social isolation ; a high rate of  thoughts about suicide  has been associated with psoriasis. [ 21 ]  Many tools exist to measure the quality of life of people with psoriasis and other dermatological disorders. Clinical research has indicated individuals often experience a diminished quality of life. [ 120 ]  Children with psoriasis may encounter  bullying . [ 121 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1039", "text": "Several conditions are associated with psoriasis including obesity, cardiovascular, and metabolic disturbances. These occur more frequently in older people. Nearly half of individuals with psoriasis over the age of 65 have at least three  comorbidities  (concurrent conditions), and two-thirds have at least two comorbidities. [ 122 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1040", "text": "Psoriasis has been associated with  obesity [ 3 ]  and several other cardiovascular and metabolic disturbances. The  number of new cases per year  of diabetes is 27% higher in people affected by psoriasis than in those without the condition. [ 123 ]  Severe psoriasis may be even more strongly associated with the development of diabetes than mild psoriasis. [ 123 ]  Younger people with psoriasis may also be at increased risk for developing diabetes. [ 122 ] [ 124 ]  Individuals with psoriasis or psoriatic arthritis have a slightly higher risk of heart disease and heart attacks when compared to the general population. Cardiovascular disease risk appeared to be correlated with the severity of psoriasis and its duration. There is no strong evidence to suggest that psoriasis is associated with an increased risk of death from cardiovascular events.  Methotrexate  may provide a degree of protection for the heart. [ 42 ] [ 122 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1041", "text": "The odds of having hypertension are 1.58 times  (\u200a i.e.  58%)  higher in people with psoriasis than those without the condition; these odds are even higher with severe cases of psoriasis. A similar association was noted in people who have psoriatic arthritis\u2014the odds of having hypertension were found to be 2.07 times  (\u200a i.e.  107%)  greater when compared to odds of the general population. The link between psoriasis and hypertension is not currently [ when? ]  understood. Mechanisms hypothesized to be involved in this relationship include the following: dysregulation of the  renin\u2013angiotensin system , elevated levels of  endothelin 1  in the blood, and increased  oxidative stress . [ 124 ] [ 125 ]  The number of new cases of the heart rhythm abnormality  atrial fibrillation  is 1.31 times  (\u200a i.e.  31%)  higher in people with mild psoriasis and 1.63 times  (\u200a i.e.  63%)  higher in people with severe psoriasis. [ 126 ]  There may be a slightly increased risk of stroke associated with psoriasis, especially in severe cases. [ 42 ] [ 127 ]  Treating  high levels of cholesterol  with  statins  has been associated with decreased psoriasis severity, as measured by PASI score, and has also been associated with improvements in other cardiovascular disease risk factors such as markers of inflammation. [ 128 ]  These cardioprotective effects are attributed to ability of statins to improve blood lipid profile and because of their anti-inflammatory effects. Statin use in those with psoriasis and  hyperlipidemia  was associated with decreased levels of  high-sensitivity C-reactive protein  and  TNF\u03b1  as well as decreased activity of the immune protein  LFA-1 . [ 128 ]  Compared to individuals without psoriasis, those affected by psoriasis are more likely to satisfy the criteria for  metabolic syndrome . [ 16 ] [ 126 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1042", "text": "The rates of  Crohn's disease  and  ulcerative colitis  are increased when compared with the general population, by a factor of 3.8 and 7.5 respectively. [ 3 ]  People with psoriasis also have a higher risk of  celiac disease . [ 114 ] [ 118 ]  Few studies have evaluated the association of  multiple sclerosis  with psoriasis, and the relationship has been questioned. [ 3 ] [ 129 ]  Psoriasis has been associated with a 16% increase in overall relative risk for non-skin cancer, thought to be attributed to systemic therapy, particularly methotrexate. [ 42 ]  People treated with long-term systemic therapy for psoriasis have a 52% increased risk  cancers of the lung and bronchus , a 205% increase in the risk of developing  cancers of the upper gastrointestinal tract , a 31% increase in the risk of developing  cancers of the urinary tract , a 90% increase in the risk of developing  liver cancer , and a 46% increase in the risk of developing  pancreatic cancer . [ 42 ]  The risk for development of non-melanoma skin cancers is also increased. Psoriasis increases the risk of developing  squamous cell carcinoma of the skin  by 431% and increases the risk of  basal cell carcinoma  by 100%. [ 42 ]  There is no increased risk of  melanoma  associated with psoriasis. [ 42 ]  People with psoriasis have a higher risk of developing cancer. [ 130 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1043", "text": "Psoriasis is estimated to affect 2\u20134% of the population of the western world. [ 7 ]  The rate of psoriasis varies according to age, region and ethnicity; a combination of environmental and genetic factors is thought to be responsible for these differences. [ 7 ]  Psoriasis is about five times more common in people of European descent than in people of Asian descent, [ 131 ]  more common in countries farther from the  equator , [ 49 ]  relatively uncommon in African Americans, and extremely uncommon in Native Americans. [ 50 ]  Psoriasis has been estimated to affect about 6.7 \u00a0 million Americans. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1044", "text": "Psoriasis can occur at any age, although it is more frequent in adults and commonly appears for the first time between the ages of 15 and 25 years. [ 5 ]  Approximately one-third of people with psoriasis report being diagnosed before age 20. [ 132 ]  Psoriasis affects both  sexes  equally. [ 63 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1045", "text": "People with  inflammatory bowel disease  such as Crohn's disease or ulcerative colitis are at an increased risk of developing psoriasis. [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1046", "text": "Scholars believe psoriasis to have been included among the various skin conditions called  tzaraath  (translated as leprosy) in the  Hebrew Bible . [ 133 ]  The person was deemed \"impure\" (see  tumah and taharah ) during their affected phase and is ultimately treated by the  kohen . [ 134 ]  However, it is more likely that this confusion arose from the use of the same Greek term for both conditions. The Greeks used the term lepra (\u03bb\u03ad\u03c0\u03c1\u03b1) for scaly skin conditions. They used the term psora (\u03c8\u03ce\u03c1\u03b1) to describe itchy skin conditions. [ 134 ]  It became known as  Willan's lepra  in the late 18th century when English  dermatologists   Robert Willan  and Thomas Bateman differentiated it from other skin diseases.  Leprosy , they said, is distinguished by the regular, circular form of patches, while psoriasis is always irregular. Willan identified two categories:  leprosa graecorum  and  psora leprosa . [ 135 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1047", "text": "Psoriasis is thought to have first been described in  Ancient Rome  by  Cornelius Celsus . [ 136 ]  The British dermatologist  Thomas Bateman  described a possible link between psoriasis and arthritic symptoms in 1813. [ 136 ]  Admiral  William Halsey  missed out on the  Battle of Midway  because he contracted psoriasis while out at sea in the early months of American participation of  World War II . Admiral  Chester Nimitz  medically ordered Halsey to recover at a hospital in  Hawaii ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1048", "text": "The history of psoriasis is littered with treatments of dubious effectiveness and high toxicity. In the 18th and 19th centuries,  Fowler's solution , which contains a  poisonous  and  carcinogenic   arsenic  compound, was used by dermatologists as a treatment for psoriasis. [ 134 ]   Mercury  was also used for psoriasis treatment during this time. [ 134 ]   Sulfur ,  iodine , and  phenol  were also commonly used treatments for psoriasis during this era when it was incorrectly believed that psoriasis was an infectious disease. [ 134 ]  Coal tars were widely used with ultraviolet light irradiation as a topical treatment approach in the early 1900s. [ 134 ] [ 137 ]  During the same time, psoriatic arthritis cases were treated with intravenously administered gold preparations in the same manner as  rheumatoid arthritis . [ 137 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1049", "text": "The International Federation of Psoriasis Associations (IFPA) is the global umbrella organization for national and regional psoriasis associations and also gathers the leading experts in psoriasis and psoriatic arthritis research for scientific conferences every three years. [ 138 ]  The Psoriasis International Network, a program of the Fondation Ren\u00e9 Touraine, gathers dermatologists,  rheumatologists , and other caregivers involved in the management of psoriasis. Non-profit organizations like the  National Psoriasis Foundation  in the United States, the Psoriasis Association in the United Kingdom, and Psoriasis Australia offer advocacy and education about psoriasis in their respective countries."}
{"_id": "WikiPedia_Dermatology$$$corpus_1050", "text": "The annual cost of treating psoriasis in the United States is estimated as high as $32.5 \u00a0 billion, including $12.2 \u00a0 billion in direct costs. Pharmacy costs are the main source of direct expense, with biologic therapy the most prevalent. These costs increase significantly when co-morbid conditions such as heart disease, hypertension, diabetes, lung disease, and psychiatric disorders are factored in. Expenses linked to co-morbidities are estimated at an additional $23,000 per person per year. [ 139 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1051", "text": "The role of  insulin resistance  in the pathogenesis of psoriasis is under investigation. Preliminary research has suggested that  antioxidants  such as  polyphenols  may have beneficial effects on the inflammation characteristic of psoriasis. [ 140 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1052", "text": "Many novel medications being researched during the 2010s target the  Th17 / IL-23  axis, [ 140 ]  particularly  IL-23p19  inhibitors, as IL-23p19 is present in increased concentrations in psoriasis skin lesions while contributing less to protection against opportunistic infections. [ 141 ]  Other cytokines such as  IL-17  and  IL-22  also have been targets for inhibition as they play important roles in the pathogenesis of psoriasis. [ 141 ]  Another avenue of research has focused on the use of  vascular endothelial growth factor inhibitors  to treat psoriasis. [ 65 ]  Oral agents being investigated during the 2010s as alternatives to medications administered by injection include  Janus kinase inhibitors ,  protein kinase C  inhibitors,  mitogen-activated protein kinase  inhibitors, and  phosphodiesterase 4 inhibitors , all of which have proven effective in various phase 2 and 3 clinical trials. [ 140 ] [ 141 ]  These agents have potentially severe side-effects due to their immunosuppressive mechanisms. [ 141 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1053", "text": "Purple glove syndrome  (PGS) is a poorly understood  skin disease  in which the extremities become  swollen , discoloured and painful. [ 1 ]  PGS is potentially serious and may require  amputation .  PGS is most common among  elderly  patients and those receiving multiple large  intravenous  doses of the  epilepsy  drug  phenytoin . [ 2 ]  Compartment syndrome is a complication of PGS."}
{"_id": "WikiPedia_Dermatology$$$corpus_1054", "text": "Purple glove syndrome is caused by the intravenous anticonvulsant phenytoin. [ 3 ]  This medication has many already established neurological side effects. However, glove syndrome is a rare, with prevalence ranging from 1.7% to 5.9%, but has very serious adverse effect that may lead to limb amputations. This may occur due to the administration of phenytoin with or without extravasation. The defining characteristic is a purplish to black discoloration of the extremity followed by  peripheral edema  and pain distal to the site of infusion. Onset is generally seen within the first few hours of administration. The true pathology of purple glove syndrome is not fully elucidated, however it is believed to be due to the crystallization of phenytoin within the blood and  extravasates  into the surrounding interstitium. Another mechanism may be due to the disruption of endothelial transcellular junctions followed by leaking of phenytoin into the surround soft tissues."}
{"_id": "WikiPedia_Dermatology$$$corpus_1055", "text": "A diagnosis is usually made if symptoms of PSG appear after a dosage of phenytoin, especially if symptoms such as edema are near the injection site. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1056", "text": "Doctors recommend discontinuing the use of phenytoin. The application of heat can help to relieve pain. Limb elevation, compression, and massage are also often used to relieve symptoms. Oral phenytoin can also result in development of purple glove syndrome. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1057", "text": "As of April\u00a02012 [update] , multiple press sources reported an outbreak of an unidentified  skin disease  in the  Ba T\u01a1 District  of  Qu\u1ea3ng Ng\u00e3i Province ,  Vietnam . The disease is reported to begin as a skin rash, and in numerous cases appears to have led to the death of the affected individual through  organ failure . [ 1 ] [ 2 ]  As of 21\u00a0April\u00a02012 [update] , the disease was reported to have affected 170 people, and killed 19. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1058", "text": "The Associated Press reported that Vietnam has asked for assistance from the  World Health Organization . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1059", "text": "Another, separate unknown skin disease was reported from Qu\u1ea3ng Ng\u00e3i's  S\u01a1n H\u00e0 District  in early May 2012. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1060", "text": "Poisonous  heavy metals  in the soil or  toxic mould  on rice have been considered the most likely causes so far. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1061", "text": "Another outbreak of the same disease in the Qu\u1ea3ng Ng\u00e3i area was reported in March 2013. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1062", "text": "This  Vietnam -related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1063", "text": "Many conditions of or affecting the human integumentary system have associated features that may be found by performing an x-ray or CT scan of the affected person."}
{"_id": "WikiPedia_Dermatology$$$corpus_1064", "text": "Rosacea  is a  long-term   skin condition  that typically affects the face. [ 2 ] [ 3 ]  It results in  redness ,  pimples ,  swelling , and  small and superficial dilated blood vessels . [ 2 ]  Often, the nose, cheeks, forehead, and chin are most involved. [ 3 ]  A red, enlarged nose may occur in severe disease, a condition known as  rhinophyma . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1065", "text": "The cause of rosacea is unknown. [ 2 ]  Risk factors are believed to include a family history of the condition. [ 3 ]  Factors that may potentially worsen the condition include heat, exercise, sunlight, cold, spicy food, alcohol,  menopause ,  psychological stress , or  steroid cream  on the face. [ 3 ]  Diagnosis is based on symptoms. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1066", "text": "While not curable, treatment usually improves symptoms. [ 3 ]  Treatment is typically with  metronidazole ,  doxycycline ,   minocycline , or  tetracycline . [ 4 ]  When the eyes are affected,  azithromycin  eye drops may help. [ 5 ]  Other treatments with tentative benefit include  brimonidine  cream,  ivermectin  cream, and  isotretinoin . [ 4 ]   Dermabrasion  or  laser surgery  may also be used. [ 3 ]  The use of  sunscreen  is typically recommended. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1067", "text": "Rosacea affects between 1% and 10% of people. [ 2 ]  Those affected are most often 30 to 50 years old and female. [ 2 ]  Fair-skinned people seem to be more commonly affected. [ 6 ]   The condition was described in  The Canterbury Tales  in the 1300s, and possibly as early as the 200s BC by  Theocritus . [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1068", "text": "Rosacea typically begins with  reddening (flushing)  of the skin in symmetrical patches near the center of the face. [ 10 ]  Common signs can depend on age and sex:  flushing  and  red swollen patches  are common in the young,  small and visible dilated blood vessels  in older individuals, and  swelling of the nose  is common in men. [ 10 ]  Other signs include lumps on the skin ( papules  or  pustules ) and  swelling  of the face. [ 10 ]  Many people experience stinging or burning pain and rarely itching. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1069", "text": "Skin problems tend to be aggravated by particular trigger factors, that differ for different people. Common triggers are  ultraviolet  light, heat, cold, or certain foods or beverages. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1070", "text": "Erythematotelangiectatic rosacea [ 11 ]  rosacea (also known as \"vascular rosacea\" [ 11 ] ) is characterized by prominent history of prolonged (over 10 minutes)  flushing  reaction to various  stimuli , such as  emotional stress , hot drinks, alcohol, spicy foods,  exercise , cold or hot weather, or hot  baths  and  showers . [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1071", "text": "In glandular rosacea, men with thick sebaceous skin predominate, a disease in which the papules are  edematous , and the pustules are often 0.5 to 1.0\u00a0cm in size, with nodulocystic lesions often present. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1072", "text": "The exact cause of rosacea is unknown. [ 2 ]  Triggers that cause episodes of flushing and blushing play a part in its development. Exposure to temperature extremes, strenuous exercise, heat from sunlight, severe  sunburn , stress, anxiety, cold wind, and moving to a warm or hot environment from a cold one, such as heated shops and offices during the winter, can each cause the face to become flushed. [ 2 ]  Certain foods and drinks can also trigger flushing, such as alcohol, foods and beverages containing  caffeine  (especially hot tea and coffee), foods high in  histamines , and  spicy foods . [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1073", "text": "Medications and topical irritants have also been known to trigger rosacea flares. Some  acne  and wrinkle treatments reported to cause rosacea include  microdermabrasion  and  chemical peels , as well as high dosages of  isotretinoin ,  benzoyl peroxide , and  tretinoin ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1074", "text": "Steroid -induced rosacea is caused by the use of topical  steroids . [ 14 ]  These steroids are often prescribed for  seborrheic dermatitis . Dosage should be slowly decreased and not immediately stopped to avoid a flare-up."}
{"_id": "WikiPedia_Dermatology$$$corpus_1075", "text": "In 2007,  Richard Gallo  and colleagues noticed that patients with rosacea had high levels of   cathelicidin , an  antimicrobial peptide , [ 15 ]  and elevated levels of  stratum corneum  tryptic  enzymes  ( SCTEs ).  Antibiotics  have been used in the past to treat rosacea, but they may only work because they inhibit some SCTEs. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1076", "text": "Studies of rosacea and  Demodex  mites have revealed that some people with rosacea have increased numbers of the mite, [ 13 ]  especially those with steroid-induced rosacea.  Demodex folliculitis  (demodicidosis, also known as \"mange\" in animals) is a condition that may have a \"rosacea-like\" appearance. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1077", "text": "A 2007,  National Rosacea Society -funded study demonstrated that  Demodex folliculorum  mites may be a cause or exacerbating factor in rosacea. [ 17 ]  The researchers identified  Bacillus oleronius  as a distinct bacterium associated with  Demodex  mites. When analyzing blood samples using a peripheral blood mononuclear cell proliferation assay, they discovered that  B. oleronius  stimulated an immune system response in 79 percent of 22 patients with subtype 2 (papulopustular) rosacea, compared with only 29% of 17 subjects without the disorder. They concluded, \"The immune response results in inflammation, as evident in the papules (bumps) and  pustules  (pimples) of subtype 2 rosacea. This suggests that the  B. oleronius  bacteria found in the mites could be responsible for the inflammation associated with the condition.\" [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1078", "text": "Small intestinal bacterial overgrowth  (SIBO) was demonstrated to have greater prevalence in rosacea patients and treating it with locally acting antibiotics led to rosacea lesion improvement in two studies. Conversely in rosacea patients who were SIBO negative, antibiotic therapy had no effect. [ 18 ]  The effectiveness of treating SIBO in rosacea patients may suggest that gut bacteria play a role in the pathogenesis of rosacea lesions."}
{"_id": "WikiPedia_Dermatology$$$corpus_1079", "text": "Most people with rosacea have only mild redness and are never formally diagnosed or treated.  No test for rosacea is known. In many cases, simple visual inspection by a trained health-care professional is sufficient for diagnosis.  In other cases, particularly when pimples or redness on less-common parts of the face is present, a trial of common treatments is useful for confirming a suspected diagnosis. The disorder can be confused or co-exist with  acne vulgaris  or  seborrheic dermatitis .  The presence of a rash on the scalp or ears suggests a different or co-existing diagnosis because rosacea is primarily a facial diagnosis, although it may occasionally appear in these other areas."}
{"_id": "WikiPedia_Dermatology$$$corpus_1080", "text": "Four rosacea subtypes exist, [ 20 ]  and a patient may have more than one subtype: [ 21 ] :\u200a176"}
{"_id": "WikiPedia_Dermatology$$$corpus_1081", "text": "Variants of rosacea include: [ 26 ] :\u200a689"}
{"_id": "WikiPedia_Dermatology$$$corpus_1082", "text": "The type of rosacea that a person has will indicate the choice of treatment. [ 27 ]  Mild cases are often not treated at all, or are simply covered up with  normal cosmetics ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1083", "text": "Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of facial redness and inflammatory lesions, a decrease in the number, duration, and intensity of flares, and concomitant symptoms of itching, burning, and tenderness. The two primary modalities of rosacea treatment are topical and oral antibiotic agents. [ 28 ]  Laser therapy has also been classified as a form of treatment. [ 28 ]  While medications often produce a temporary remission of redness within a few weeks, the redness typically returns shortly after treatment is suspended.  Long-term treatment, usually 1\u20132 years, may result in permanent control of the condition for some patients. [ 28 ] [ 29 ]  Lifelong treatment is often necessary, although some cases resolve after a while and go into a permanent remission. [ 29 ]   Other cases, if left untreated, worsen over time. [ 30 ]  Some people have also reported better results after changing diet. This is not confirmed by medical studies, even though some studies relate the histamine production to outbreak of rosacea. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1084", "text": "Certain behavioral changes may improve the symptoms of rosacea or help to prevent exacerbations. Keeping a symptoms diary to document potential symptom triggers and avoiding those triggers is recommended. [ 25 ]  Common exacerbating triggers include ultraviolet light and irritant cosmetics, therefore it is recommended that those with rosacea wear  sunscreen  (with a sun factor protection (SPF) of 30 or greater) and avoid cosmetics. [ 25 ]  If using cosmetics or makeup is desired, then oil free foundation and concealer should be used. [ 25 ]  Skin astringents, products that can dry the skin and impair the skin barrier, including products with alcohol, menthol, peppermint, camphor, or eucalyptus oil, should generally be avoided. People should avoid using exfoliating skin scrubs, cosmetics or soaps containing  sodium laureth sulfate , or waterproof makeup to the affected area as these products can compromise the skin barrier protection and be difficult to remove. [ 25 ]  Using soap-free cleansers and non-oily moisturizers are preferred if used on the affected area. Many skin care products have been specifically formulated for those with sensitive skin or for those with conditions such as rosacea. [ 25 ]  Ocular rosacea may be treated with daily gentle eyelid washing using warm water, and artificial tears to lubricate the eye. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1085", "text": "Managing pre-trigger events such as prolonged exposure to cool environments can directly influence warm-room flushing. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1086", "text": "Medications with good evidence include topical  metronidazole , [ 33 ]   ivermectin  and  azelaic acid . [ 34 ]  Good evidence medications taken by mouth include  brimonidine , and  doxycycline  and  isotretinoin . [ 34 ]  Lesser evidence supports  tetracycline  by mouth. [ 34 ]  Isotretinoin and tetracycline antibiotics, which may be used in more severe cases of inflammatory rosacea, are absolutely contraindicated in women who are pregnant, may become pregnant or lactating as they are highly  teratogenic  (associated with birth defects). Contraception is required for women of child bearing age who are using these medications. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1087", "text": "Metronidazole is thought to act through anti-inflammatory mechanisms, while azelaic acid is thought to decrease cathelicidin production. Oral antibiotics of the  tetracycline  class such as doxycycline, minocycline, and  oxytetracycline  are also commonly used and thought to reduce papulopustular lesions through anti-inflammatory actions rather than through their antibacterial capabilities. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1088", "text": "Topical minocycline applied as a foam is a newer treatment option for rosacea that the FDA has approved. Minocycline shows a targeted approach for managing inflammatory lesions of rosacea while minimizing systemic side effects commonly associated with oral antibiotic use. It is available in foam formulation and is applied to the affected areas once daily. Minocycline belongs to the tetracycline family of antibiotics and exhibits antimicrobial properties and anti-inflammatory activity, similar to other members of this class, such as doxycycline. Topical minocycline reduces inflammatory lesions associated with rosacea; however, rare adverse events such as folliculitis have been reported. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1089", "text": "Topical metronidazole is a commonly used treatment for rosacea; it is available in various formulations such as creams, gels, or lotions and applied to clean, dry skin once or twice daily. Topical metronidazole has been shown to effectively reduce inflammatory lesions and perilesional erythema associated with rosacea by inhibiting both microbial growth and pro-inflammatory mediators generated by neutrophils. Benefits of topical metronidazole include its effectiveness in reducing symptoms, extensive clinical experience supporting its use, and generally good tolerability with minimal systemic side effects; still, some patients may experience mild local irritation upon initial use, and it may have limited impact on persistent facial redness (erythema). [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1090", "text": "Topical azelaic acid is available in gel or cream formulations; it exerts its effects by reducing inflammation through its activity on the cathelicidin pathway, which is upregulated in rosacea-affected skin; it also reduces inflammatory lesions and improves overall symptoms of rosacea; it has been well-studied and shown to be effective in clinical trials; still, some patients may experience mild local irritation during the first few weeks of use. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1091", "text": "Using  alpha-hydroxy acid  peels may help relieve redness caused by irritation, and reduce papules and pustules associated with rosacea. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1092", "text": "Oral  Beta-blockers  are often used for those with flushing due to rosacea. These include  nadolol ,  propranolol  or  carvedilol . The possible adverse reactions of the oral beta-blockers include  low blood pressure ,  low heart rate  or dizziness. [ 25 ]  The oral  \u03b1-2 adrenergic receptor agonist   clonidine  can also be used for flushing symptoms. [ 25 ]  The flushing and blushing that typically accompany rosacea may also be treated with the topical application of  alpha agonists  such as brimonidine which has vasoconstrictor activity and achieves maximal symptom improvement 3\u20136 hours after application, other topicals used for flushing or erythema include  oxymetazoline  or  xylometazoline . [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1093", "text": "Topical ivermectin is a treatment option for rosacea that targets Demodex mites, which are associated with inflammation in the skin of patients with rosacea; the cream is applied once daily to clean, dry skin. Topical ivermectin has been shown to reduce Demodex mite density and improve cutaneous inflammatory markers in clinical studies; overall, it decreases Demodex mite density and improves the symptoms of inflammation associated with rosacea; however, some patients may experience transient burning or itching upon application. Topical ivermectin offers a targeted approach for managing rosacea by addressing the role of Demodex mites in the disease process. [ 33 ]  A review found that ivermectin was more effective than alternatives for treatment of papulopustular acne rosacea. [ 36 ] [ 37 ]  An ivermectin cream has been approved by the  FDA , as well as in Europe, for the treatment of inflammatory  lesions  of rosacea. The treatment is based upon the hypothesis that parasitic mites of the genus  Demodex  play a role in rosacea. [ 38 ]  In a clinical study, ivermectin reduced lesions by 83% over 4 months, as compared to 74% under a  metronidazole  standard therapy. [ 39 ]   Quassia amara extract at 4% demonstrated to have clinical efficacy for rosacea. [ 40 ]  When compared to metronidazole 0.75% as usual care in a randomized, double-blinded clinical trial, Quassia amara extract at 4% demonstrated earlier onset of action, including improvement in telangiectasia, flushing, and papules. Quassia amara showed a sustained reduction of symptoms at 42 days of treatment. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1094", "text": "Cyclosporin  eye drops have been shown to reduce symptoms in those with ocular rosacea. Cyclosporin should not be used in those with an active ocular infection. [ 25 ]  Other options include topical metronidazole cream or topical  fusidic acid  applied to the eyelids, or oral doxycycline in more severe cases of ocular rosacea. If papules and pustules persist, then sometimes isotretinoin can be prescribed. [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1095", "text": "Systemic doxycycline modified-release capsules are commonly used for the treatment of rosacea. The capsules are taken orally once daily, usually in a low dose, to achieve anti-inflammatory effects. Doxycycline acts by inhibiting inflammation and reducing the production of reactive oxygen species associated with rosacea symptoms. The benefits of systemic doxycycline include its effectiveness in reducing inflammatory lesions, improving erythema, and controlling symptoms related to ocular involvement in rosacea patients; it is also well-tolerated at lower doses compared to traditional higher-dose regimens used for other indications. However, potential cons include gastrointestinal side effects such as nausea or abdominal pain, photosensitivity reactions that require sun protection measures during treatment, and rare instances of antibiotic-associated diarrhea or bacterial resistance development with long-term use. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1096", "text": "Encapsulated benzoyl peroxide (E-BPO) cream, a newly FDA-approved topical agent for inflammatory lesions of rosacea, utilizes porous silica microcapsule technology to slow the absorption of benzoyl peroxide and diminish potential irritation. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1097", "text": "Evidence for the use of laser and intense pulsed-light therapy in rosacea is poor. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1098", "text": "The highly visible nature of rosacea symptoms are often psychologically challenging for those affected. People with rosacea can experience issues with self-esteem, socializing, and changes to their thoughts, feelings, and coping mechanisms. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1099", "text": "Rosacea affects around 5% of people worldwide. [ 10 ]  Incidence varies by ethnicity, and is particularly prevalent in those of  Celtic  heritage. [ 10 ]  Men and women are equally likely to develop rosacea. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1100", "text": "Sclerodactyly  is a localized  thickening and tightness  of the  skin  of the  fingers  or  toes  that yields a characteristic claw-like appearance and spindle shape of the affected  digits , and renders them immobile or of limited mobility. [ 1 ] [ 2 ]   The thickened, discolored patches of skin are called  morphea , and may involve  connective tissue  below the skin, as well as  muscle  and other tissues. [ 3 ]  Sclerodactyly is often preceded by months or even years by  Raynaud's phenomenon  when it is part of  systemic scleroderma . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1101", "text": "The term \"sclerodactyly\" comes from  Greek    skleros \u00a0'hard' and   daktylos \u00a0'digit'."}
{"_id": "WikiPedia_Dermatology$$$corpus_1102", "text": "It is generally associated with systemic scleroderma and  mixed connective tissue disease , and  auto-immune disorders ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1103", "text": "Sclerodactyly is one component of the  limited cutaneous form of systemic sclerosis  (lcSSc), also known as CREST syndrome (CREST is an acronym that stands for  calcinosis , Raynaud's phenomenon,  esophageal dysmotility , sclerodactyly, and  telangiectasia .) [ 4 ]  Sclerodactyly is also one component of  Huriez Syndrome , along with palmoplantar keratoderma and skin cancer. [ 5 ]  Sclerodactyly sometimes arises as a complication of the microvascular changes seen in  diabetes mellitus , and is in this case referred to as diabetic sclerodactyly. [ 6 ] [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1104", "text": "Treatment of sclerodactyly is by physical therapy, phototherapy, surgery, topical corticosteroids or vitamin D analogues, and systemic immunosuppressive drugs when the condition is part of systemic scleroderma [ citation needed ] . Localized treatment won't halt systemic disease, but can restore function and cosmetic aspects of the affected digits. The mild to moderate proximal interphalangeal (PIP) joint flexion and extension contractures and stiff distal interphalangeal (DIP) joints in slight flexion often seen in sclerodactyly can be addressed somewhat with physical therapy. [ 9 ]  In a few cases when immune involvement isn't apparent (in these cases environmental causes are suspected), the condition may gradually clear up by itself If the trigger is avoided [ citation needed ] . In other cases, early treatment while the disease is in the inflammatory stage is much more likely to be successful than on established lesions [ citation needed ] ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1105", "text": "A  skin infection  is an  infection  of the  skin  in humans and other animals, that can also affect the associated  soft tissues  such as  loose connective tissue  and  mucous membranes . [ citation needed ]  They comprise a category of infections termed  skin and skin structure infections  (SSSIs), or skin and soft tissue infections (SSTIs), [ 1 ]  and acute bacterial SSSIs (ABSSSIs). [ 2 ]  They are distinguished from  dermatitis  ( inflammation  of the skin), [ 3 ] [ 4 ]  although skin infections can result in skin inflammation. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1106", "text": "Bacterial skin infections affected about 155 million people and cellulitis occurred in about 600 million people in 2013. [ 6 ]  Bacterial skin infections include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1107", "text": "Fungal skin infections may present as either a superficial or deep  infection  of the skin, hair, and/or nails.  Mycetoma  are a broad group of fungal infections that characteristically originate in the skin and subcutaneous tissues of the foot. [ 18 ]  If not treated appropriately and in a timely fashion mycetoma infections can extend to deeper tissues like bones and joints causing osteomyelitis. [ 19 ]  Extensive osteomyelitis can necessitate surgical bone resections and even lower limb amputation. [ 19 ] \nAs of 2010, they affect about one\u00a0billion people globally. [ 20 ]  Some examples of common fungal skin infections include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1108", "text": "Parasitic infestations of the skin are caused by several  phyla  of organisms, including  Annelida ,  Arthropoda ,  Bryozoa ,  Chordata ,  Cnidaria ,  Cyanobacteria ,  Echinodermata ,  Nemathelminthes ,  Platyhelminthes , and  Protozoa . [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1109", "text": "Virus-related cutaneous conditions caused by these obligate  intracellular  agents derive from both  DNA  and  RNA  viruses. [ 29 ]  Some examples of viral skin infections include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1110", "text": "Maceration  is defined as the softening and breaking down of  skin  resulting from prolonged exposure to moisture. It was first described by  Jean-Martin Charcot  in 1877. [ 1 ] [ 2 ]  Maceration is caused by excessive amounts of fluid remaining in contact with the skin or the surface of a wound for extended periods."}
{"_id": "WikiPedia_Dermatology$$$corpus_1111", "text": "Maceration often occurs with the application of a bandage to a wound, regardless of its mildness or severity, particularly if the bandage prevents water from evaporating from the surface of the skin. This occurs because the skin under the bandage becomes wet due to  perspiration ,  urine  or other bodily fluids, or contact with other liquids. The excess moisture is sometimes called hyperhydration."}
{"_id": "WikiPedia_Dermatology$$$corpus_1112", "text": "One may also notice maceration after wearing non-breathable plastic or latex rubber gloves, which trap moisture against the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_1113", "text": "Wrinkles are the first sign that the skin is over-hydrated. In addition, macerated skin becomes extremely soft and takes on a whitish appearance. However, this white skin should not be confused with the pale, whitish appearance of the new  epithelial tissue  in a healing wound."}
{"_id": "WikiPedia_Dermatology$$$corpus_1114", "text": "Although most maceration clears up quickly once the skin is exposed to fresh air and allowed to dry, sometimes skin that experiences long periods of maceration is vulnerable to  fungal  and  bacterial infection . As opportunistic organisms affect the area, it may become itchy or develop a foul odour."}
{"_id": "WikiPedia_Dermatology$$$corpus_1115", "text": "Stasis papillomatosis  is a disease characterized by chronic congestion of the extremities, with  blood circulation  interrupted in a specific area of the body. [ 1 ]  A consequence of this congestion and inflammation is long-term  lymphatic  obstruction ( lymphedema ). [ 2 ]  It is also typically characterized by the appearance of numerous  papules . [ 3 ]  Injuries can range from small to large plates composed of brown or pink, smooth or  hyperkeratotic  papules. [ 4 ]  The most typical areas where injuries occur are the back of the feet, the toes, the legs, and the area around a  venous ulcer  formed in the extremities, although the latter is the rarest of all. [ 2 ]  These injuries include  pachydermia  (thickening of the skin), lymphedema (swelling due to  lymph vessel  blockage),  lymphomastic verrucosis  and  elephantosis verrucosa . The disease can be either localized or generalized; the localized form makes up 78% of cases. [ 2 ]  Treatment includes surgical and pharmaceutical intervention; indications for partial removal include advanced  fibrotic lymphedema  and  elephantiasis . [ 5 ]  Despite the existence of these treatments, chronic venous edema, which is a derivation of stasis papillomatosis, is only partially reversible. The skin is also affected and its partial removal may mean that the skin and the subcutaneous tissue are excised. [ 6 ]  A side effect of the procedure is the destruction of existing cutaneous lymphatic vessels. It also risks papillomatosis, skin necrosis and edema exacerbation. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1116", "text": "All  etiologies  lead to local dermal lymphostasis pathogenesis. A maximum variation was observed after the resection of block subcutaneous tissue in patients with congenital lymphedema. Signals that the current condition are different, either in the dermis or in the subcutaneous area. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1117", "text": "Chronic inflammation can cause long term lymphatic obstruction. [ 4 ]  Typically, patients have disorders that present local nodes, primary lymphedema and chronic venous insufficiency. Erysipelas and trauma are major risk factors. Lymphatic edema can be developed in many acral cases accompanied by a thickening of the folds of the skin, hyperkeratosis and papillomatosis. [ 2 ]  Chronic venous edema is only partially reversible and soon becomes hard, especially confirming tenderness. All structures of the skin are affected. Dilated dermal lymphatic vessels with consequent superior organization and fibrosis result in papillomatosis. As dermal lymphatic stasis progreses, these skin changes become more marked and known as elephantiasis. Occasionally, tissue fibrosis and thickening may become so marked in the later stages of lymphedema that pitting is absent. Recurrent cellulitis, erysipelas and dermato-LAM-adenitis are complications of chronic lymphedema. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1118", "text": "The reason for its occurrence is unknown. Investigations have suspected that obesity and preceding psoriatic lesions cause local lymphatic disturbances, followed by the development of stasis papillomatosis. [ 8 ]  On the other hand, genetic or environmental factors may play a role. Some investigators have speculated that it represents an allergic response to an epidermal protein antigen created through increased hydrostatic pressure, whereas others believe that the skin has been compromised and is more susceptible to irritation and trauma. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1119", "text": "Age is an important factor because as some people get older the veins which carry blood from the legs back to the heart do not work as well as they use to. This causes fluid to settle in the lower legs. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1120", "text": "The most important cause of this condition is insufficient lymphatic drainage, causing soft tissue swelling due to fluid accumulation. Obstruction of lymphatic tissue causes increased intravascular tissue protein; this will increase the production of fibroblasts and mast cells. [ 3 ] [ 6 ]  Lymphatic obstruction due to any cause can increase the amount of proteins in the intravascular tissue, either by root osmotic pressure or because it absorbs a little liquid. The further roteins increase the vascular fluid, fibroblasts and promote the ploriferation of mast cells which produce the clinical symptoms of nonpitting edema. The epidermis may be hyperkeratotic and warty and this predisposes to tissue cracks and allows secondary infection. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1121", "text": "Stasis Papillomatosis is similar to AGEP (Acute generalized exanthematous pustulosis) from pustular psoriasis; criteria for histopathologic distinction have been proposed: papillary edema, vasculitis, exocytosis of eosinophils and single-cell necrosis of keratinocytes in AGEP and acanthosis and papillomatosis in pustular psoriasis. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1122", "text": "An example that illustrates the difference between SP and Stasis Papillomatosis and the histology diagnosis is:  \"a markedly obese, 41-year-old Japanese man who had suffered from psoriasis vulgaris for several years visited hospital with elephantiasis-like swelling of his lower legs of three months' duration. His right lower leg showed marked papillomatosis with thick scales, and the left lower leg was eroded and papillomatous. [ 6 ]  Although direct lymphography of his lower extremities showed no abnormality, indirect lymphography revealed local lymphatic damage in the involved skin\". [ 4 ]  Histological examination showed hyperkeratosis, marked papillomatosis, proliferation of capillaries in the upper dermis, and lymphectasia in the lower dermis. It was suspected that obesity and the preceding psoriatic lesions caused local lymphatic disturbances, followed by the development of stasis papillomatosis. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1123", "text": "This disease is caused by problems in the circulatory system; thus, the legs should be elevated as much as possible to help the return of the blood. At night it is advisable to sleep with a pillow under the lower legs. [ 7 ]  In the evening, it is not unusual for legs to be swollen. The volume of the lower leg can increase to up to 100ml after a long working day or up to 200ml after a long-haul flight without moving. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1124", "text": "In the example of the 41-year-old Japanese man the lesions were much improved by washing and topical use of corticosteroids for two months, also oral antibiotics like cephalexin are used if cellulitis is present. Moist exudative inflammation and moist ulcers respond to tepid wet compresses of Burow's solution or just saline or water for 30 to 60 minutes several times a day. [ 10 ]   But in worse cases, edema that does not disappear spontaneously within a few hours or after a walk, is described as pathological, so it needs to have a special treatment. It is very important to say that Papillamitosis, bilateral and marked edema with few symptoms are mostly caused by the systemic circulation (heart, kidneys, liver). [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1125", "text": "Papillamitosis is associated with symptoms and/or clinical signs such as dilated superficial veins, varicose veins and changes in the skin. [ 4 ]  Edema and its complication Papillamitosis are only partially reversible and soon becomes hard, which is mainly confirmed on palpation. All skin structures are affected and this is characterized by the term. Lymphoedema may develop in many cases accompanied by acral thickening of the skin folds, hyperkeratosis and papillomatosis. [ 4 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1126", "text": "Steroid-induced skin atrophy  is thinning of the skin as a result of prolonged exposure to  topical steroids . In people with  psoriasis  using topical steroids it occurs in up to 5% of people after a year of use. [ 5 ]  Intermittent use of topical steroids for  atopic dermatitis  is safe and does not cause skin thinning. [ 6 ] [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1127", "text": "Skin atrophy can occur with both prescription and over the counter steroids creams. [ 9 ]  Low doses of  prednisone  by mouth can also result in skin atrophy."}
{"_id": "WikiPedia_Dermatology$$$corpus_1128", "text": "It can also present with  telangiectasia , easy bruising,  purpura , and  striae . Occlusive dressings and fluorinated steroids both increase the likelihood of developing atrophy. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1129", "text": "In general, use a potent preparation short term and weaker preparation for maintenance between flare-ups. While there is no proven best benefit-to-risk ratio, [ 11 ]  if prolonged use of a topical steroid on a skin surface is required, a pulse therapy should be undertaken."}
{"_id": "WikiPedia_Dermatology$$$corpus_1130", "text": "Pulse therapy refers to the application of a corticosteroid for 2 or 3 consecutive days each week or two. This is useful for maintaining control of chronic diseases. Generally a milder topical steroid or non-steroid treatment is used on the in-between days. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1131", "text": "For treating  atopic dermatitis , newer (second generation) corticosteroids, such as  fluticasone propionate  and  mometasone furoate , are more effective and safer than older ones. They are also generally safe and do not cause skin thinning when used in intermittently to treat atopic dermatitis flare-ups. They are also safe when used twice a week for preventing flares (also known as weekend treatment). [ 6 ] [ 7 ] [ 8 ]  Applying once daily is enough as it is as effective as twice or more daily application. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1132", "text": "Strong steroids should be avoided on sensitive sites such as the face, groin and armpits. Even the application of weaker or safer steroids should be limited to less than two weeks on those sites."}
{"_id": "WikiPedia_Dermatology$$$corpus_1133", "text": "The obvious priority is immediate discontinuation of any further topical corticosteroid use. Protection and support of the impaired skin barrier is another priority. Eliminating harsh skin regimens or products will be necessary to minimize potential for further purpura or trauma, skin sensitivity, and potential infection. Steroid-induced skin atrophy [ 14 ] [ 15 ]  is often permanent, though if caught soon enough and the topical corticosteroid discontinued in time, the degree of damage may be arrested or slightly improve. However, while the accompanying  telangiectasias  may improve marginally, the  stretch marks  are permanent and irreversible. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1134", "text": "Tegumental angiomyxoma-neurothekeoma  ( TAN syndrome ) [ 1 ]  is a  syndrome , an  acronym , and  eponym [ citation needed ]  proposed by  Malaysian   ophthalmologist  of Chinese Descent, Tan Aik Kah (b. June 1975). [ 1 ]  Angiomyxomas are associated with  LAMB  (lentigines, atrial myxomas, muco-cutaneous myxomas, and blue naevi) syndrome, [ 2 ]  NAME (nevi, atrial myxoma, myxoid neurofibromas, and ephelides) [ 3 ]  syndrome and  Carney syndrome  (atrial, cutaneous and mammary myxomas, lentigines, blue naevi, endocrine disorders and  testicular tumours ). [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1135", "text": "TAN syndrome is characterized by multiple superficial  angiomyxoma  and  neurothekeoma  confined only to the skin (tegument). [ 1 ]   TAN syndrome  may be used to describe myxomas confined to the skin without visceral involvement. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1136", "text": "Tan et al. reported a 10-year-old girl with multiple superficial angiomyxoma associated with neurothekeoma palpebrae. [ 1 ]  There was no evidence of visceral involvement. The lesions were excised with no recurrence during follow up. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1137", "text": "Circulating auto-antibodies in the human body can target normal parts of the skin leading to disease.  This is a list of antigens in the skin that may become targets of circulating auto-antibodies leading to the various types of  pemphigoid ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1138", "text": "Of note, there are also several other diseases that are caused by auto-antibodies that target the same anatomic area of the skin which is termed the  basement membrane zone .  These diseases include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1139", "text": "Circulating auto-antibodies in the human body can target normal parts of the skin leading to disease.  This is a list of antigens in the skin that may become targets of circulating auto-antibodies leading to the various types of  pemphigus ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1140", "text": "Tetter  refers to any skin condition characterized by reddish  vesicular  eruptions and intense  itching . Common diseases called tetter include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1141", "text": "Topical steroid withdrawal , also known as  red burning skin  and  steroid dermatitis , has been reported in people who apply  topical steroids  for 2 weeks or longer and then discontinue use. [ 4 ] [ 5 ] [ 2 ] [ 1 ]  Symptoms affect the skin and include redness, a burning sensation, and itchiness, [ 2 ]  which may then be followed by peeling. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1142", "text": "This condition generally requires the daily application of a topical steroid for more than 2 weeks but sometimes can occur with even less steroid use. It appears to be a specific adverse effect of topical corticosteroid use. [ 6 ]  People with  atopic dermatitis  are most at risk. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1143", "text": "Treatment involves discontinuing the use of topical steroids, [ 2 ]  either gradually or suddenly. [ 2 ]  Counselling and cold compresses may also help. [ 2 ]  Thousands of people congregate in online communities to support one another throughout the healing process, and cases have been reported in both adults and children. [ 2 ] [ 1 ]  It was first described in 1979. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1144", "text": "Topical steroid addiction (TSA) is characterised by uncontrollable, spreading dermatitis and worsening skin  inflammation , which requires a stronger topical steroid to get the same result as the first prescription. This cycle is known as steroid addiction syndrome. [ 7 ]  When topical steroid medication is stopped, the skin experiences redness, burning, a deep and uncontrollable itch, scabs, hot skin, swelling, stinging, hives and/or oozing for a length of time. This is also called 'red skin syndrome' or 'topical steroid withdrawal' (TSW). After the  withdrawal  period is over, the  atopic dermatitis  can cease or is less severe than it was before. [ 8 ]  Topical steroid addiction has also been reported in the male scrotum area. [ 9 ]  Other symptoms include nerve pain, insomnia, excessive sweating, anxiety, severe depression, fatigue, eye problems, and frequent infections."}
{"_id": "WikiPedia_Dermatology$$$corpus_1145", "text": "The duration of acute topical corticosteroid withdrawal is variable; the skin can take months to years to return to its original condition. [ 2 ] [ 10 ]  The duration of steroid use may influence the recovery factor time, with the patients who used steroids for the longest reporting the slowest recovery."}
{"_id": "WikiPedia_Dermatology$$$corpus_1146", "text": "To experience this withdrawal, it generally requires the misuse and/or application of a topical steroid daily for 2 to 4 months, depending on the potency of the topical corticosteroid. In some cases, this has been reported after as little as 2 weeks of use. [ 11 ] [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1147", "text": "Historically, it was believed that  cortisol  was only produced by the  adrenal  glands, but research has shown that  keratinocytes  in human skin also produce cortisol. [ 12 ]  Prolonged topical steroid (TS) application changes the glucocorticoid receptor (GR) expression pattern on the surface of lymphocytes; a patient experiencing resistance to a TS has a low ratio of GR-\u03b1 to GR-\u03b2. In addition, the erythema characteristic of \u2018red skin syndrome\u2019 is due to a release of stored endothelial nitric oxide (NO) and subsequent vasodilation of dermal vessels. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1148", "text": "Diagnosis is based on a rash occurring within weeks of stopping long-term topical steroids. [ 2 ]  Specific signs include \u2018headlight sign\u2019 (redness of the lower part of the face but not the nose or the area around the mouth); \u2018red sleeve\u2019 (a rebound eruption stopping abruptly at the lower arms and hands); and \u2018elephant wrinkles\u2019 (reduced skin elasticity). [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1149", "text": "Differentiating this condition from the skin condition that the steroids were originally used to treat can be difficult. [ 2 ]  Red, burning skin may be misdiagnosed. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1150", "text": "This condition can be avoided by not using steroid creams for periods of time longer than 2 weeks. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1151", "text": "Treatment involves ceasing all use of topical steroids, either gradually or suddenly. [ 2 ]  Keeping affected areas dry and disinfected will speed healing. [ citation needed ] [ dubious  \u2013  discuss ]  Avoid moisturizer, as any dampness elongates the healing process and encourages bacterial growth. [ citation needed ] [ dubious  \u2013  discuss ]  Antihistamines may help for itchiness. [ 3 ]  Immunosuppressants and light therapy may also help some people. [ 3 ]  Psychological support is often recommended. [ 2 ] [ 3 ] [ 11 ]  At this time, treatment options that have been documented in literature include  Tacrolimus ,  Pimecrolimus , and  Dupixent . Some physicians have also seen positive outcomes with oral  Doxycycline  and/or topical  Clindamycin . [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1152", "text": "The prevalence of the condition is unknown. [ 14 ]  Many cases ranging from mild to severe have been reported in both adults and children. One survey of atopic dermatitis patients treated with topical corticosteroids in Japan estimated that approximately 12% of adult patients may appear to be uncontrolled cases, although they are in fact addicted to a topical corticosteroid (TCS). [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1153", "text": "A systematic review ( meta-analysis ) in accordance with  evidence-based medicine  frameworks and current research standards for clinical decision-making was performed in 2016 and was republished with updates in 2020. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1154", "text": "Two feet-one hand syndrome  ( TFOHS ), is a long-term  fungal condition  where  athlete's foot  or  fungal toe nail infections  in both feet is associated with  tinea manuum  in one hand. [ 3 ] [ 7 ]  Often the feet are affected for several years before symptoms of a diffuse scaling rash on the palm of one hand appear, which is when most affected people then seek medical help. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1155", "text": "The most common causative organism is  Trichophyton rubrum . [ 3 ]  The condition is more likely to occur in people who  sweat more . [ 4 ]  Diagnosis is by visualization,  microscopy  and  culture . [ 4 ]  It may appear similar to  dermatitis ,  psoriasis ,  keratoderma ,  hyperkeratosis  and  allergic contact dermatitis . [ 5 ]  Treatment is with long-term systemic  antifungals , typically oral  terbinafine  or  itraconazole . [ 4 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1156", "text": "The condition is frequently seen in  skin  clinics. [ 9 ]  Males are affected more frequently than females. [ 3 ]  One study showed that 65% of cases with tinea manuum were part of TFOHS. [ 6 ] [ 10 ]  TFOHS was first described by Curtis in 1964. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1157", "text": "TFOHS is a long-term  fungal condition  where  athlete's foot  or  fungal toe nail infections  in both feet is associated with  tinea manuum  in one hand. [ 3 ] [ 7 ]  It typically presents with a diffuse scaling rash on the palm of one hand, which is preceded, sometimes by several years, by fungal infection in both feet. [ 3 ]  Palmar creases appear prominent. [ 1 ]  There is typically a sharp demarcation at the wrist. [ 12 ]  Signs in a hand therefore require an examination of feet. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1158", "text": "TFOHS may follow scratching feet infected by  fungi  or occur after a pedicure. [ 3 ]  The most common causative organism is  Trichophyton rubrum . [ 3 ] [ 2 ]  Typically, the hand that is used to scratch the infected feet or toes is the one that contracts tinea manuum. [ 14 ]  Why the other hand is spared is not clear. [ 15 ] [ 16 ]  In a case-control study that also looked at scratching habits, despite concluding that it was likely that tinea manuum develops in the hand that scratches the feet, some cases of TFOHS occurred in the hand that did not scratch the feet. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1159", "text": "Risk factors are the same as for athlete's foot and include excessive sweating and  weakened immune system . [ 4 ] [ 6 ]  Reinfection from contaminated socks may be possible. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1160", "text": "Diagnosis of TFOHS is by visualisation,  microscopy  and culture from skin scrapings of the edge of the rash. [ 2 ] [ 11 ]  The condition may appear similar to  dermatitis ,  psoriasis ,  keratoderma ,  hyperkeratosis  and  allergic contact dermatitis . [ 5 ]  It is sometimes misdiagnosed as  hand eczema . [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1161", "text": "Treatment is with long-term systemic  antifungals , typically oral  terbinafine  or  itraconazole . [ 4 ] [ 8 ]  Other options include  fluconazole  and  griseofulvin . [ 4 ]  Prevention is focused on  hygiene  measures such as keeping feet dry and applying antiseptic powder. [ 4 ]  Using intermittent antifungal treatment in susceptible people, and avoiding scratching the feet or picking at  fungal toenail infections  are further preventative measures. [ 6 ]  Avoiding washing socks in cold water may help, as well as dusting feet with  Tolnaftate  powder. [ 4 ]  Dusting socks with talc, cornstarch or rice powder may help keep feet dry. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1162", "text": "It is not known how many people have TFOHS. [ 6 ]  Males are affected more frequently than females. [ 3 ]  Athlete's foot is the most common fungal disease, with possibly more than 50% of the population affected at some time. [ 2 ] [ 4 ]  Tinea manuum accounts for less than 2% of all superficial fungal infections. [ 2 ]  Tinea manuum  is rare in both hands. [ 2 ]  Scenarios with one foot and two hands, and one foot and one hand, have been described. [ 15 ]  One study showed that 65% of cases with tinea manuum were part of TFOHS. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1163", "text": "The condition was first described by Curtis in 1964. [ 11 ]  It was later designated a syndrome. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1164", "text": "Uremic frost  is a colloquial description for crystallized  urea  deposits that can be found on the skin of those affected by  chronic kidney disease  (CKD). [ 1 ]   Uremic frost was first described in 1865 by  Harald Hirschsprung  (1830-1916), a Danish pediatrician. He was also the first to describe  Hirschsprung's disease  in 1886. The disease now carries his name. [ 2 ]  Uremic frost has become increasingly uncommon with the advent of dialysis in the 1950s. Uremic frost is a classical pre-dialysis era description of crystallized urea deposits over the skin of patients with prolonged kidney failure and severe uremia. High blood urea level leads to high secretion of urea by sweat glands as a component of sweat. As water evaporates off the skin, it results in crystallization of the remaining urea which appear as white salts over the skin. [ 3 ] \nThis condition is more common in severe, untreated uremia and is associated with serum  BUN  levels >200. It is becoming rare in people with chronic kidney disease managed on long-term  hemodialysis , with estimated prevalence between 0.8 and 3%. [ 4 ] [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1165", "text": "This article about an endocrine, nutritional, or metabolic disease is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1166", "text": "Verrucous carcinoma  is a type of  squamous cell carcinoma  that may be associated with HPV infection (may be subtypes 16 or 18, but types 6 and 11 have also been reported, as have HPV negative variants).  Several subtypes of verrucous carcinoma have been described.  Treatment of verrucous carcinoma with radiation therapy should be avoided due to the risk of anaplastic transformation."}
{"_id": "WikiPedia_Dermatology$$$corpus_1167", "text": "Warts  are non-cancerous viral growths usually occurring on the hands and feet but which can also affect other locations, such as the  genitals  or face. [ 1 ] [ 3 ]  One or many warts may appear. [ 3 ]  They are distinguished from  cancerous  tumors as they are caused by a viral infection, such as a  human papillomavirus ,  rather than a  cancer growth . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1168", "text": "Factors that increase the risk include the use of public showers and pools, working with meat,  eczema , and a  weak immune system . [ 1 ] [ 3 ]  The virus is believed to infect the host through the entrance of a skin  wound . [ 1 ]  A number of types exist, including  plantar warts , \" filiform warts \", and  genital warts . [ 3 ]  Genital warts are often  sexually transmitted . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1169", "text": "Without treatment, most types of warts resolve in months to years. [ 1 ]  A number of treatments may speed resolution, including  salicylic acid  applied to the skin and  cryotherapy . [ 1 ]  In those who are otherwise healthy, they do not typically result in significant problems. [ 1 ]  Treatment of genital warts differs from that of other types. [ 3 ]  Infection of a virus, such as  HIV , can cause warts. This is prevented through careful handling of needles or sharp objects that could infect the individual through physical trauma of the skin, plus the practice of  safe sex  or  sexual abstinence . Viruses that are not sexually transmitted, or are not transmitted in the case of a wart, can be prevented through a number of behaviors, such as wearing shoes outdoors and avoiding unsanitized areas without proper shoes or clothing, such as public restrooms or locker rooms."}
{"_id": "WikiPedia_Dermatology$$$corpus_1170", "text": "Warts are very common, with most people being infected at some point in their lives. [ 2 ]  The estimated current rate of non-genital warts among the general population is 1\u201313%. [ 1 ]  They are more common among young people. [ 1 ]  Prior to widespread adoption of the  HPV vaccine , the estimated rate of genital warts in sexually active women was 12%. [ 5 ]  Warts have been described as far back as 400 BC by  Hippocrates . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1171", "text": "A range of types of wart have been identified, varying in shape and site affected, as well as the type of human papillomavirus involved. [ 6 ] [ 7 ]  These include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1172", "text": "Warts are caused by the  human papillomavirus  (HPV). There are about 130 known types of human papillomaviruses. [ 9 ]  HPV infects the  squamous epithelium , usually of the skin or genitals, but each HPV type is typically only able to infect a few specific areas of the body. Many HPV types can produce a  benign  growth, often called a \"wart\" or \"papilloma\", in the area they infect. [ 10 ]  Many of the more common HPV and wart types are listed below."}
{"_id": "WikiPedia_Dermatology$$$corpus_1173", "text": "Common warts have a characteristic appearance under the microscope.  They have thickening of the  stratum corneum  (hyperkeratosis), thickening of the  stratum spinosum  (acanthosis), thickening of the  stratum granulosum ,  rete ridge  elongation, and large  blood vessels  at the  dermoepidermal junction . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1174", "text": "On  dermatoscopic  examination, warts will commonly have fingerlike or knoblike extensions. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1175", "text": "Gardasil  6 is an  HPV vaccine  aimed at preventing cervical cancers and genital warts.  Gardasil is designed to prevent infection with HPV types 16, 18, 6, and 11. HPV types 16 and 18 currently cause about 70% of  cervical cancer  cases, [ 13 ] [ 14 ]  and also cause some  vulvar ,  vaginal , [ 11 ]   penile  and  anal cancers . [ 12 ]  HPV types 6 and 11 are responsible for 90% of documented cases of genital warts. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1176", "text": "Gardasil 9 protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1177", "text": "HPV vaccines do not currently protect against the virus strains responsible for  plantar warts  (verrucae). [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1178", "text": "The virus is relatively hardy and immune to many common  disinfectants . Exposure to 90%  ethanol  for at least 1 minute, 2%  glutaraldehyde , 30%  Savlon , and/or 1%  sodium hypochlorite  can disinfect the pathogen. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1179", "text": "The virus is resistant to drying and heat, but killed by 100\u00a0\u00b0C (212\u00a0\u00b0F) temperature and  ultraviolet  radiation. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1180", "text": "There are many treatments and procedures associated with wart removal. [ 21 ]  A review of various skin wart treatments concluded that topical treatments containing  salicylic acid  were more effective than  placebo . [ 22 ]   Cryotherapy  appears to be as effective as salicylic acid, but there have been fewer trials. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1181", "text": "Daily application of the  latex  of  Chelidonium majus  is a traditional treatment. [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1182", "text": "The acrid yellow  sap  of  Greater Celandine  is used as a traditional wart remedy. [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1183", "text": "According to English  folk belief , touching  toads  causes warts; according to a  German  belief, touching a toad under a  full moon  cures warts. [ 50 ]  The most common  Northern Hemisphere  toads have glands that protrude from their skin that superficially resemble warts. Warts are caused by a virus, and toads do not harbor it. [ 51 ]  A variety of traditional  folk remedies  and rituals claim to be able to remove warts."}
{"_id": "WikiPedia_Dermatology$$$corpus_1184", "text": "In  The Adventures of Tom Sawyer ,  Mark Twain  has his characters discuss a variety of such remedies.  Tom Sawyer proposes \"spunk-water\" (or \"stump-water\", the water collecting in the hollow of a tree stump) as a remedy for warts on the hand.  You put your hand into the water at midnight and say:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1185", "text": "Barley-corn, barley-corn, injun-meal shorts, \nSpunk-water, spunk-water, swaller these warts"}
{"_id": "WikiPedia_Dermatology$$$corpus_1186", "text": "You then \"walk away quick, eleven steps, with your eyes shut, and then turn around three times and walk home without speaking to anybody. Because if you speak the charm's busted.\"  This is given as an example of  Huckleberry Finn 's planned remedy, which involves throwing a dead cat into a graveyard as a devil or devils comes to collect a recently buried wicked person.  Another remedy involved splitting a bean, drawing blood from the wart and putting it on one of the halves, and burying that half at a  crossroads  at midnight.  The  theory of operation  is that the blood on the buried bean will draw away the wart. [ 52 ]  Twain is recognized as an early collector and recorder of genuine  American folklore . [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1187", "text": "Similar practices are recorded elsewhere.  In  Louisiana , one remedy for warts involves rubbing the wart with a  potato , which is then buried; when the \"buried potato dries up, the wart will be cured\". [ 54 ]  Another remedy similar to Twain's is reported from  Northern Ireland , where water from a specific well on  Rathlin Island  is credited with the power to cure warts. [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1188", "text": "Surviving ancient medical texts show that warts were a documented disease since at least the time of  Hippocrates , who lived  c. \u2009460  \u2013  c. \u2009370 BC . In the book  De Medecia  by the Roman physician  Aulus Cornelius Celsus , who lived  c. \u200925 BC  \u2013  c. \u200950 AD , different types of warts were described. Celsus described  Myrmecia , today recognized as  plantar wart , and categorized  acrochordon  (a skin tag) as a wart. In the 13th century, warts were described in books published by the surgeons  William of Saliceto  and  Lanfranc of Milan . The word  verruca  to describe a wart was introduced by the physician  Daniel Sennert , who described warts in his 1636 book  Hypomnemata physicae . [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1189", "text": "The cause of warts was initially disputed in the medical profession. In the early 18th century the physician  Daniel Turner , who published the first book on  dermatology , suggested that warts were caused by damaged  nerves  close to the skin. In the mid-18th century, the surgeon  John Hunter  popularized the belief that warts were caused by a bacterial  syphilis \ninfection. The surgeon  Benjamin Bell  documented that warts were caused by a disease entirely unrelated to syphilis, and established a  causal link  between warts and cancer. In the 19th century, the  chief physician  of Verona Hospital established a link between warts and  cervical cancer . But in 1874 it was noted by the dermatologist  Ferdinand Ritter von Hebra  that while various theories were advanced by the medical profession, the \"influences causing warts are still very obscure\". [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1190", "text": "In 1907 the physician Giuseppe Ciuffo was the first to demonstrate that warts were caused by a virus infection. In 1976 the virologist  Harald zur Hausen  was the first to discover that warts were caused by the  human papillomavirus  (HPV). His continuous research established the evidence necessary to develop a  HPV vaccine , which first became available in 2006. [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1191", "text": "When the  cholesterol  levels in the body  rise above the normal level , a number of  skin lesions  can occur.  Xanthomas  are one of types of skin lesions that may occur in this situation."}
{"_id": "WikiPedia_Dermatology$$$corpus_1192", "text": "Other systemic conditions may also occur with increased levels of cholesterol in the blood."}
{"_id": "WikiPedia_Dermatology$$$corpus_1193", "text": "Allopurinol  is a  medication  used to decrease  high blood uric acid levels . [ 5 ]  It is specifically used to prevent  gout , prevent specific types of  kidney stones  and for the high uric acid levels that can occur with  chemotherapy . [ 6 ] [ 7 ]  It is taken  orally  (by mouth) or  intravenously  (injected into a vein). [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1194", "text": "Common side effects when used orally include itchiness and rash. [ 7 ]  Common side effects when used by injection include  vomiting  and  kidney problems . [ 7 ]  While not recommended historically, starting allopurinol during an attack of gout appears to be safe. [ 8 ] [ 9 ]  In those already on the medication, it should be continued even during an acute gout attack. [ 8 ] [ 6 ]  While use during  pregnancy  does not appear to result in harm, this use has not been well studied. [ 1 ]  Allopurinol is in the  xanthine oxidase inhibitor  family of medications. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1195", "text": "Allopurinol was approved for medical use in the United States in 1966. [ 7 ]  It is on the  World Health Organization's List of Essential Medicines . [ 10 ]  Allopurinol is available as a  generic medication . [ 7 ]  In 2022, it was the 39th most commonly prescribed medication in the United States, with more than 15 \u00a0 million prescriptions. [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1196", "text": "Allopurinol is used to reduce urate formation in conditions where urate deposition has already occurred or is predictable.  The specific diseases and conditions where it is used include gouty arthritis, skin  tophi , kidney stones, idiopathic gout; uric acid lithiasis; acute uric acid nephropathy; neoplastic disease and myeloproliferative disease with high cell turnover rates, in which high urate levels occur either spontaneously, or after cytotoxic therapy; certain enzyme disorders which lead to overproduction of urate, for example:  hypoxanthine-guanine phosphoribosyltransferase , including  Lesch\u2013Nyhan syndrome ;  glucose 6-phosphatase  including  glycogen storage disease ;  phosphoribosyl pyrophosphate synthetase ,  phosphoribosyl pyrophosphate amidotransferase ;  adenine phosphoribosyltransferase ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1197", "text": "It is also used to treat kidney stones caused by deficient activity of  adenine phosphoribosyltransferase ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1198", "text": "Allopurinol was also commonly used to treat  tumor lysis syndrome  in chemotherapeutic treatments, as these regimens can rapidly produce severe acute hyperuricemia; [ 13 ]  however, it has gradually been replaced by  urate oxidase  therapy. [ 14 ]   Intravenous  formulations are used in this indication when people are unable to swallow medication. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1199", "text": "Allopurinol cotherapy is used to improve outcomes for people with  inflammatory bowel disease  and  Crohn's disease  who do not respond to thiopurine monotherapy. [ 15 ] [ 16 ]  Cotherapy has also been shown to greatly improve hepatoxicity side effects in treatment of IBD. [ 17 ]  Cotherapy invariably requires dose reduction of the thiopurine, usually to one-third of the standard dose depending upon the patient's genetic status for  thiopurine methyltransferase . [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1200", "text": "Allopurinol has been tested as an augmentation strategy for the treatment of  mania  in  bipolar disorder . Meta-analytic evidence showed that adjunctive allopurinol was superior to placebo for acute mania (both with and without mixed features). [ 19 ]  Its efficacy was not influenced by dosage, follow-up duration, or concurrent standard treatment. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1201", "text": "There is a correlation between uric acid levels and cardiovascular disease and mortality, and so allopurinol has been explored as a potential treatment to reduce risk of cardiac disease. [ 20 ]  However, the data is inconsistent and conflicting, and the use of allopurinol for use in cardiovascular disease is controversial. Independently of its effects on uric acid, it may also have effects on oxidative stress and inflammation. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1202", "text": "Because allopurinol is not a  uricosuric , it can be used in people with poor  kidney  function.  However, for people with impaired kidney function, allopurinol has two disadvantages. First, its dosing is complex. [ 22 ]  Second, some people are hypersensitive to the drug; therefore, its use requires careful monitoring. [ 23 ] [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1203", "text": "Allopurinol has rare but potentially fatal adverse effects involving the skin. The most serious adverse effect is a hypersensitivity syndrome consisting of fever, skin rash,  eosinophilia ,  hepatitis , and worsened renal function, collectively referred to as  DRESS syndrome . [ 23 ]  Allopurinol is one of the drugs commonly known to cause  Stevens\u2013Johnson syndrome  and  toxic epidermal necrolysis , two life-threatening  dermatological  conditions. [ 23 ]  More common is a less-serious rash that leads to discontinuing this drug. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1204", "text": "More rarely, allopurinol can also result in the depression of bone marrow elements, leading to  cytopenias , as well as  aplastic anemia . Moreover, allopurinol can also cause  peripheral neuritis  in some patients, although this is a rare side effect. Another side effect of allopurinol is  interstitial nephritis . [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1205", "text": "Drug interactions are extensive, and are as follows: [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1206", "text": "Allopurinol may also increase the activity or half-life of the following drugs, in order of seriousness and certainty of the interaction: [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1207", "text": "Co-administration of the following drugs may make allopurinol less active or decrease its half-life: [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1208", "text": "Co-administration of the following drugs may cause hypersensitivity or skin rash: [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1209", "text": "A common misconception is that allopurinol is metabolized by its target,  xanthine oxidase , but this action is principally carried out by  aldehyde oxidase . [ 26 ]  The active  metabolite  of allopurinol is  oxipurinol , which is also an inhibitor of xanthine oxidase. Allopurinol is almost completely metabolized to oxipurinol within two hours of oral administration, whereas oxipurinol is slowly excreted by the kidneys over 18\u201330 hours. For this reason, oxipurinol is believed responsible for the majority of allopurinol's effect. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1210", "text": "Allopurinol is a purine analog; it is a structural  isomer  of  hypoxanthine  (a naturally occurring  purine  in the body) and is an  inhibitor  of the enzyme  xanthine oxidase . [ 5 ]  Xanthine (1H-Purine-2,6-dione) oxidase is responsible for the successive oxidation of hypoxanthine to  xanthine  and subsequently  uric acid , the product of human purine metabolism. [ 5 ]  In addition to blocking uric acid production, inhibition of xanthine oxidase causes an increase in hypoxanthine and xanthine. While xanthine cannot be converted to purine ribonucleotides, hypoxanthine can be salvaged to the purine  ribonucleotides   adenosine  and  guanosine monophosphates . Increased levels of these ribonucleotides may cause feedback inhibition of  amidophosphoribosyl transferase , the first and rate-limiting enzyme of purine biosynthesis. Allopurinol, therefore, decreases uric acid formation and may also inhibit purine synthesis. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1211", "text": "The HLA-B*5801 allele is a  genetic marker  for allopurinol-induced severe cutaneous adverse reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). [ 29 ] [ 30 ]  The frequency of the HLA-B*5801 allele varies between ethnicities: Han Chinese and Thai populations have HLA-B*5801  allele frequencies  of around 8%, as compared to European and Japanese populations, who have allele frequencies of around 1.0% and 0.5%, respectively. [ 31 ]  The increase in risk for developing allopurinol-induced SJS or TEN in individuals with the HLA-B*5801 allele (as compared to those who do not have this allele) is very high, ranging from a 40-fold to a 580-fold increase in risk, depending on ethnicity. [ 29 ] [ 30 ]  As of 2011 the FDA-approved drug label for allopurinol did not contain any information regarding the HLA-B*5801 allele, though FDA scientists did publish a study in 2011 which reported a strong, reproducible and consistent association between the allele and allopurinol-induced SJS and TEN. [ 32 ]  However, the American College of Rheumatology recommends screening for HLA-B*5801 in high-risk populations ( e.g.  Koreans with stage 3 or worse chronic kidney disease and those of Han Chinese and Thai descent), and prescribing patients who are positive for the allele an alternative drug. [ 33 ]  The Clinical Pharmacogenetics Implementation Consortium (CPIC) [ 34 ]  guidelines state that allopurinol is contraindicated in known carriers of the HLA-B*5801 allele. [ 35 ] [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1212", "text": "Allopurinol was first synthesized and reported in 1956 by Roland K. Robins (1926\u20131992), in a search for  antineoplastic agents . [ 5 ] [ 37 ]    Allopurinol inhibits the breakdown ( catabolism ) of the  thiopurine  drug  mercaptopurine , and was later tested by Wayne Rundles in collaboration with  Gertrude Elion 's lab at  Wellcome Research Laboratories  to see if it could improve treatment of  acute lymphoblastic leukemia  by enhancing the action of mercaptopurine. [ 5 ] [ 38 ]   However, no improvement in leukemia response was noted with mercaptopurine-allopurinol co-therapy, so that work turned to other compounds and the team then started testing allopurinol as a potential therapeutic for gout. [ 39 ]   Allopurinol was first marketed as a treatment for gout in 1966. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1213", "text": "Allopurinol is sold as an injection for intravenous use [ 4 ]  and as a tablet. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1214", "text": "Allopurinol has been marketed in the United States since 19 August 1966, when it was first approved by FDA under the trade name Zyloprim. [ 40 ]   Allopurinol was marketed at the time by  Burroughs Wellcome .  Allopurinol is a generic drug sold under a variety of brand names, including Allohexal, Allosig, Milurit, Alloril, Progout, \u00dcrikoliz, Zyloprim, Zyloric, Zyrik, and Aluron. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1215", "text": "Ampiroxicam  ( INN ) is a  non-steroidal anti-inflammatory drug  (NSAID). It is a  prodrug  of  piroxicam . [ 1 ]  It has been studied for potential  anticancer activity , but preliminary results did not show evidence of such activity. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1216", "text": "This  drug  article relating to the  musculoskeletal system  is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1217", "text": "This  analgesic -related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1218", "text": "Barbiturates [ a ]  are a class of  depressant drugs  that are chemically derived from  barbituric acid . [ 2 ]  They are effective when used  medically  as  anxiolytics ,  hypnotics , and  anticonvulsants , but have physical and psychological  addiction  potential as well as  overdose  potential among other possible adverse effects. They have been  used recreationally  for their anti-anxiety and sedative effects, and are thus  controlled  in most countries due to the risks associated with such use."}
{"_id": "WikiPedia_Dermatology$$$corpus_1219", "text": "Barbiturates have largely been replaced by  benzodiazepines  and  nonbenzodiazepines  (\"Z-drugs\") in routine medical practice, particularly in the treatment of  anxiety disorders  and  insomnia , because of the significantly lower risk of overdose, and the lack of an  antidote  for  barbiturate overdose . Despite this, barbiturates are still in use for various purposes: in  general anesthesia ,  epilepsy , treatment of acute  migraines  or  cluster headaches , acute  tension headaches ,  euthanasia ,  capital punishment , and  assisted suicide . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1220", "text": "Barbiturates, such as  phenobarbital , were long used as  anxiolytics  and  hypnotics . Intermediate-acting barbiturates reduce time to fall asleep, increase total sleep time, and reduce REM sleep time. Today they have been largely replaced by  benzodiazepines  for these purposes because the latter are less toxic in drug  overdose . [ 4 ] [ 5 ] [ 6 ]  However, barbiturates are still used as anticonvulsants (e.g.,  phenobarbital  and  primidone ) and general anesthetics (e.g.,  sodium thiopental )."}
{"_id": "WikiPedia_Dermatology$$$corpus_1221", "text": "Barbiturates in high doses are used for  medical aid in dying , and in combination with a  muscle relaxant  for  euthanasia  and for  capital punishment  by  lethal injection . [ 7 ] [ 8 ]  Barbiturates are frequently employed as euthanizing agents in small-animal  veterinary medicine ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1222", "text": "Sodium thiopental  is an ultra-short-acting barbiturate that is marketed under the name Sodium Pentothal. It is often mistaken for \" truth serum \", or  sodium amytal , an intermediate-acting barbiturate that is used for sedation and to treat insomnia, but was also used in so-called sodium amytal \"interviews\" where the person being questioned would incorrectly be thought to be more likely to provide the truth whilst under the influence of the drug. [ 9 ]   When dissolved in water, sodium amytal can be swallowed, or it can be administered by intravenous injection. The drug does not itself force people to tell the truth, but is thought to decrease inhibitions and slow creative thinking, making subjects more likely to be caught off guard when questioned, and increasing the possibility of the subject revealing information through emotional outbursts. Lying is somewhat more complex than telling the truth, especially under the influence of a sedative-hypnotic drug. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1223", "text": "The memory-impairing effects and cognitive impairments induced by sodium thiopental are thought to reduce a subject's ability to invent and remember lies. This practice is no longer considered legally admissible in court, owing to findings that subjects undergoing such interrogations may form false memories, putting the reliability of all information obtained through such methods into question. Nonetheless, it is still employed in certain circumstances by defense and law enforcement agencies as a \"humane\" alternative to torture interrogation when the subject is believed to have information critical to the security of the state or agency employing the tactic. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1224", "text": "In 1988, the synthesis and binding studies of an artificial receptor binding barbiturates by six complementary  hydrogen bonds  was published. [ 12 ]  Since this first article, different kind of receptors were designed, as well as different barbiturates and  cyanurates , not for their efficiencies as drugs but for applications in  supramolecular chemistry , in the conception of materials and molecular devices."}
{"_id": "WikiPedia_Dermatology$$$corpus_1225", "text": "The preferred IUPAC name of the base compound, barbituric acid, is  1,3-diazinane-2,4,6-trione. Different barbiturates have different substituents in the basic structure, mainly in position 5 on the ring. [ 13 ]  In modern chemistry the barbiturates are often presented by its Hirshfeld surface representations showing its intermolecular interactions  [1]   calculated with  CrystalExplorer  Program.\nSodium barbital and  barbital  have also been used as  pH buffers  for biological research, e.g., in immuno-electrophoresis or in fixative solutions. [ 14 ] [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1226", "text": "Barbiturates are classified based on the duration of action. Examples of each class include: [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1227", "text": "Indications  for the use of barbiturates include: [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1228", "text": "There are special risks to consider for older adults, and women who are pregnant. When a person ages, the body becomes less able to rid itself of barbiturates. As a result, people over the age of 65 are at higher risk of experiencing the harmful effects of barbiturates, including drug dependence and accidental overdose. [ 19 ]  When barbiturates are taken during pregnancy, the drug passes through the placenta to the fetus. After the baby is born, it may experience withdrawal symptoms and have trouble breathing. In addition, nursing mothers who take barbiturates may transmit the drug to their babies through breast milk. [ 20 ]  A rare adverse reaction to barbiturates is  Stevens\u2013Johnson syndrome , which primarily affects the mucous membranes."}
{"_id": "WikiPedia_Dermatology$$$corpus_1229", "text": "With regular use,  tolerance  to the effects of barbiturates develops. Research shows tolerance can develop with even one administration of a barbiturate. As with all GABAergic drugs, barbiturate withdrawal produces potentially fatal effects such as seizures, in a manner reminiscent of  delirium tremens  and  benzodiazepine withdrawal  although its more direct mechanism of GABA agonism makes barbiturate withdrawal even more severe than that of  alcohol  or benzodiazepines.  It is considered one of the most dangerous withdrawals of any known addictive substance. Similarly to benzodiazepines, the longer acting barbiturates produce a less severe withdrawal syndrome than short acting and ultra-short acting barbiturates. Withdrawal symptoms are dose-dependent with heavier users being more affected than lower-dose addicts."}
{"_id": "WikiPedia_Dermatology$$$corpus_1230", "text": "The pharmacological treatment of barbiturate withdrawal is an extended process often consisting of converting the patient to a long-acting benzodiazepine (i.e.  Valium ), followed by slowly tapering off the benzodiazepine. Mental cravings for barbiturates can last for months or years in some cases and counselling/support groups are highly encouraged by addiction specialists. Patients should never try to tackle the task of discontinuing barbiturates without consulting a doctor, owing to the high lethality and relatively sudden onset of the withdrawal. Attempting to quit \"cold turkey\" may result in neurological damage due to excitotoxicity, severe physical injuries received during convulsions, and even death resulting from arrhythmias during grande Mal seizures, paralleling death caused by delirium tremens. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1231", "text": "Some symptoms of an overdose typically include sluggishness, incoordination, difficulty in thinking, slowness of speech, faulty judgement, drowsiness, shallow breathing, staggering, and, in severe cases, coma or death. The lethal dosage of barbiturates varies greatly with tolerance and from one individual to another. The  lethal dose  is highly variable among different members of the class, with superpotent barbiturates such as pentobarbital being potentially fatal in considerably lower doses than the low-potency barbiturates such as butalbital. Even in inpatient settings, the development of tolerance is still a problem, as dangerous and unpleasant withdrawal symptoms can result when the drug is stopped after dependence has developed. Tolerance to the anxiolytic and sedative effects of barbiturates tends to develop faster than tolerance to their effects on smooth muscle, respiration, and heart rate, making them generally unsuitable for a long time psychiatric use. Tolerance to the anticonvulsant effects tends to correlate more with tolerance to physiological effects, however, meaning that they are still a viable option for long-term epilepsy treatment."}
{"_id": "WikiPedia_Dermatology$$$corpus_1232", "text": "Barbiturates in overdose with other CNS (central nervous system) depressants (e.g. alcohol, opiates, benzodiazepines) are even more dangerous owing to additive CNS and respiratory depressant effects. In the case of benzodiazepines, not only do they have additive effects, barbiturates also increase the binding affinity of the benzodiazepine binding site, leading to exaggerated benzodiazepine effects. (ex. If a benzodiazepine increases the frequency of channel opening by 300%, and a barbiturate increases the duration of their opening by 300%, then the combined effects of the drugs increases the channels' overall function by 900%, not 600%)."}
{"_id": "WikiPedia_Dermatology$$$corpus_1233", "text": "The longest-acting barbiturates have half-lives of a day or more, and subsequently result in  bioaccumulation  of the drug in the system. The therapeutic and recreational effects of long-acting barbiturates wear off significantly faster than the drug can be eliminated, allowing the drug to reach toxic concentrations in the blood following repeated administration (even when taken at the therapeutic or prescribed dose) despite the user feeling little or no effects from the plasma-bound concentrations of the drug. Users who consume alcohol or other sedatives after the drug's effects have worn off, but before it has cleared the system, may experience a greatly exaggerated effect from the other sedatives which can be incapacitating or even fatal."}
{"_id": "WikiPedia_Dermatology$$$corpus_1234", "text": "Barbiturates induce a number of hepatic  CYP  enzymes (most notably  CYP2C9 ,  CYP2C19 , and  CYP3A4 ), [ 22 ]  leading to exaggerated effects from many  prodrugs  and decreased effects from drugs which are metabolized by these enzymes to inactive metabolites. This can result in fatal overdoses from drugs such as  codeine ,  tramadol , and  carisoprodol , which become considerably more potent after being metabolized by CYP enzymes. Although all known members of the class possess relevant enzyme induction capabilities, the degree of induction overall as well as the impact on each specific enzyme span a broad range, with phenobarbital and secobarbital being the most potent enzyme inducers and butalbital and talbutal being among the weakest enzyme inducers in the class."}
{"_id": "WikiPedia_Dermatology$$$corpus_1235", "text": "People who are known to have killed themselves by barbiturate overdose include  Stefan Zweig ,  Charles Boyer ,  Ruan Lingyu ,  Dalida ,  Jeannine Deckers ,  Felix Hausdorff ,  Abbie Hoffman ,  Phyllis Hyman ,  Carole Landis ,  C. P. Ramanujam ,  George Sanders ,  Jean Seberg ,  Lupe V\u00e9lez  and the members of   Heaven's Gate  cult. Others who have died as a result of barbiturate overdose include  Pier Angeli ,  Brian Epstein ,  Judy Garland ,  Jimi Hendrix ,  Marilyn Monroe ,  Inger Stevens ,  Dinah Washington ,  Ellen Wilkinson , and  Alan Wilson ; in some cases these have been speculated to be suicides as well. Those who died of a combination of barbiturates and other drugs include  Rainer Werner Fassbinder ,  Dorothy Kilgallen ,  Malcolm Lowry ,  Edie Sedgwick  and  Kenneth Williams .  Dorothy Dandridge  died of either an overdose or an unrelated  embolism .  Ingeborg Bachmann  may have died of the consequences of barbiturate withdrawal (she was hospitalized with burns, the doctors treating her not being aware of her barbiturate addiction)."}
{"_id": "WikiPedia_Dermatology$$$corpus_1236", "text": "The use of Barbiturates is contraindicated in the following conditions:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1237", "text": "Barbiturates act as positive  allosteric modulators  and, at higher doses, as  agonists  of  GABA A  receptors . [ 24 ]   GABA  is the principal inhibitory  neurotransmitter  in the  mammalian   central nervous system  (CNS). Barbiturates bind to the GABA A  receptor at multiple homologous transmembrane pockets located at subunit interfaces, [ 25 ]  which are binding sites distinct from  GABA  itself and also distinct from the  benzodiazepine  binding site. Like benzodiazepines, barbiturates potentiate the effect of GABA at this receptor. In addition to this GABAergic effect, barbiturates also block  AMPA  and  kainate receptors , subtypes of  ionotropic glutamate receptor . Glutamate is the principal excitatory neurotransmitter in the mammalian CNS. Taken together, the findings that barbiturates potentiate inhibitory GABA A  receptors and inhibit excitatory AMPA receptors can explain the superior CNS-depressant effects of these agents to alternative GABA potentiating agents such as benzodiazepines and  quinazolinones . At higher concentration, they inhibit the  Ca 2+ -dependent release of neurotransmitters such as glutamate via an effect on  P / Q-type   voltage-dependent calcium channels . [ 26 ] \nBarbiturates produce their pharmacological effects by increasing the duration of chloride ion channel opening at the GABA A  receptor (pharmacodynamics: This increases the efficacy of GABA), whereas benzodiazepines increase the frequency of the chloride ion channel opening at the  GABA A  receptor (pharmacodynamics: This increases the potency of GABA). The direct gating or opening of the chloride ion channel is the reason for the increased toxicity of barbiturates compared to  benzodiazepines  in overdose. [ 27 ] [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1238", "text": "Further, barbiturates are relatively non-selective compounds that bind to an entire superfamily of ligand-gated ion channels, of which the GABA A  receptor channel is only one of several representatives. This  Cys-loop receptor  superfamily of ion channels includes the neuronal  nACh receptor  channel, the  5-HT 3  receptor  channel, and the  glycine receptor  channel. However, while GABA A  receptor currents are increased by barbiturates (and other general anesthetics), ligand-gated ion channels that are predominantly permeable for cationic ions are blocked by these compounds. For example, neuronal nAChR channels are blocked by clinically relevant anesthetic concentrations of both thiopental and pentobarbital. [ 29 ]  Such findings implicate (non-GABA-ergic) ligand-gated ion channels, e.g. the neuronal nAChR channel, in mediating some of the (side) effects of barbiturates. [ 30 ]  This is the mechanism responsible for the (mild to moderate) anesthetic effect of barbiturates in high doses when used in anesthetic concentration."}
{"_id": "WikiPedia_Dermatology$$$corpus_1239", "text": "Drug interactions with barbiturates are: [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1240", "text": "Caution is needed in people using: [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1241", "text": "Caution is also required in patients with:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1242", "text": "Barbituric acid  was first synthesized 27 November 1864, by  German  chemist  Adolf von Baeyer . This was done by  condensing   urea  with  diethyl malonate . There are several stories about how the substance got its name. The most likely story is that Baeyer and his colleagues went to celebrate their discovery in a  tavern  where the town's  artillery   garrison  were also celebrating the feast of  Saint Barbara \u00a0\u2013 the patron saint of artillerymen. An artillery officer is said to have christened the new substance by amalgamating  Barbara  with  urea . [ 31 ]  Another story holds that Baeyer synthesized the substance from the collected urine of a Munich waitress named Barbara. [ 32 ]  No substance of medical value was discovered, however, until 1903 when two German scientists working at  Bayer ,  Emil Fischer  and  Joseph von Mering , discovered that  barbital  was very effective in putting dogs to sleep. Barbital was then marketed by Bayer under the  trade name   Veronal . It is said that Mering proposed this name because the most peaceful place he knew was the  Italian  city of  Verona . [ 31 ]  In 1912, Bayer introduced another barbituric acid derivative,  phenobarbital , under the trade name Luminal, as a  sedative \u2013 hypnotic . [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1243", "text": "It was not until the 1950s that the behavioral disturbances and physical dependence potential of barbiturates became recognized. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1244", "text": "Since the 1970s, most barbiturates were replaced by  benzodiazepines . [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1245", "text": "Barbituric acid itself does not have any direct effect on the  central nervous system  and chemists have derived over 2,500 compounds from it that possess pharmacologically active qualities. The broad class of barbiturates is further broken down and classified according to speed of onset and duration of action. Ultrashort-acting barbiturates are commonly used for  anesthesia  because their extremely short duration of action allows for greater control. These properties allow doctors to rapidly put a patient \"under\" in emergency surgery situations. Doctors can also bring a patient out of anesthesia just as quickly, should complications arise during surgery. The middle two classes of barbiturates are often combined under the title \"short/intermediate-acting.\" These barbiturates are also employed for anesthetic purposes, and are also sometimes prescribed for  anxiety  or  insomnia . This is not a common practice anymore, however, owing to the dangers of long-term use of barbiturates; they have been replaced by the  benzodiazepines  and  Z-drug  such as zolpidem, zaleplon and eszopiclone for sleep. The final class of barbiturates are known as long-acting barbiturates (the most notable one being phenobarbital, which has a half-life of roughly 92 hours). This class of barbiturates is used almost exclusively as  anticonvulsants , although on rare occasions they are prescribed for daytime sedation. Barbiturates in this class are not used for insomnia, because, owing to their extremely long half-life, patients would awake with a residual \"hang-over\" effect and feel groggy."}
{"_id": "WikiPedia_Dermatology$$$corpus_1246", "text": "Barbiturates can in most cases be used either as the free acid or as salts of sodium, calcium, potassium, magnesium, lithium, etc.  Codeine - and  dionine -based salts of barbituric acid have been developed."}
{"_id": "WikiPedia_Dermatology$$$corpus_1247", "text": "During  World War II , military personnel in the Pacific region were given \"goofballs\" to improve their tolerance of the heat and humidity of daily working conditions. Goofballs reduced the demand on the respiratory system, as well as maintaining blood pressure. Many soldiers returned with addictions that required several months of rehabilitation before discharge. This led to growing dependency problems, often exacerbated by indifferent physicians prescribing high doses to unknowing patients through the 1950s and 1960s.  [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1248", "text": "In the late 1950s and 1960s, an increasing number of published reports of barbiturate  overdoses  and dependence problems led physicians to reduce their prescription, particularly for spurious requests. This eventually led to the scheduling of barbiturates as controlled drugs."}
{"_id": "WikiPedia_Dermatology$$$corpus_1249", "text": "In the Netherlands, the  Opium Law  classifies all barbiturates as  List II  drugs, with the exception of  secobarbital , which is on  List I ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1250", "text": "There is a small group of List II drugs for which physicians have to write the prescriptions according to the same, tougher guidelines as those for List I drugs (writing the prescription in full in letters, listing the patients name, and have to contain the name and initials, address, city and telephone number of the licensed prescriber issuing the prescriptions, as well as the name and initials, address and city of the person the prescription is issued to). Among that group of drugs are the barbiturates  amobarbital ,  butalbital ,  cyclobarbital , and  pentobarbital ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1251", "text": "In the United States, the  Controlled Substances Act  of 1970 classified most barbiturates as controlled substances\u2014and they remain so as of August\u00a02023 [update] .  Barbital ,  methylphenobarbital  (also known as  mephobarbital ), and  phenobarbital  are designated  schedule IV  drugs, and \"Any substance which contains any quantity of a derivative of barbituric acid, or any salt of a derivative of barbituric acid\" [ 36 ]  (all other barbiturates) were designated as being  schedule III . Under the original CSA, no barbiturates were placed in schedule I, II, or V; [ 37 ]  however, amobarbital, pentobarbital, and secobarbital are now schedule II controlled substances unless they are in a suppository dosage form. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1252", "text": "In 1971, the  Convention on Psychotropic Substances  was signed in  Vienna . Designed to regulate  amphetamines , barbiturates, and other synthetics, the 34th version of the  treaty , as of 25\u00a0January\u00a02014 [update] , regulates secobarbital as schedule II, amobarbital, butalbital, cyclobarbital, and pentobarbital as schedule III, and  allobarbital ,  barbital ,  butobarbital ,  mephobarbital ,  phenobarbital ,  butabarbital , and  vinylbital  as schedule IV on its \"Green List\". [ 39 ]  The combination medication  Fioricet , consisting of butalbital, caffeine, and  paracetamol  (acetaminophen), however, is specifically exempted from controlled substance status, while its sibling  Fiorinal , which contains aspirin instead of paracetamol and may contain  codeine  phosphate, remains a schedule III drug."}
{"_id": "WikiPedia_Dermatology$$$corpus_1253", "text": "Recreational users report that a barbiturate high gives them feelings of relaxed contentment and  euphoria . Physical and psychological dependence may also develop with repeated use. [ 40 ]  Chronic misuse of barbiturates is associated with significant morbidity. One study found that 11% of males and 23% of females with a  sedative - hypnotic  misuse die by suicide. [ 41 ]  Other effects of barbiturate  intoxication  include  drowsiness ,  lateral  and  vertical   nystagmus ,  slurred speech  and  ataxia , decreased anxiety, and loss of inhibitions. Barbiturates are also used to alleviate the adverse or withdrawal effects of illicit drug use, in a manner similar to long-acting  benzodiazepines  such as  diazepam  and  clonazepam . [ 42 ] [ 43 ]  Often polysubstance use occurs and barbiturates are consumed with or substituted by other available substances, most commonly alcohol."}
{"_id": "WikiPedia_Dermatology$$$corpus_1254", "text": "People who use substances tend to prefer short-acting and intermediate-acting barbiturates. [ 44 ]  The most commonly used are  amobarbital  (Amytal),  pentobarbital  (Nembutal), and  secobarbital  (Seconal). A combination of amobarbital and secobarbital (called  Tuinal ) is also highly used. Short-acting and intermediate-acting barbiturates are usually prescribed as sedatives and sleeping pills. These pills begin acting fifteen to forty minutes after they are swallowed, and their effects last from five to six hours."}
{"_id": "WikiPedia_Dermatology$$$corpus_1255", "text": "Slang terms for barbiturates include barbs, barbies, bluebirds, dolls, wallbangers, yellows, downers, goofballs, sleepers, 'reds & blues', and tooties. [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1256", "text": "(it lacks oxygen at #2 position of generic barbiturate structure)"}
{"_id": "WikiPedia_Dermatology$$$corpus_1257", "text": "(the oxygen at #2 position is replaced by a sulfur)"}
{"_id": "WikiPedia_Dermatology$$$corpus_1258", "text": "Thiopental  is a barbiturate with one of the C=O double bonds (with the carbon being labelled 2 in the adjacent diagram) replaced with a C=S double bond, R 1  being  CH 2 CH 3  (ethyl) and R3) being  CH(CH 3 )CH 2 CH 2 CH 3  ( sec -pentyl). Thiopental is no longer available in the United States. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1259", "text": "Bupropion , formerly called  amfebutamone , [ 16 ]  and sold under the brand name  Wellbutrin  among others, is an  atypical antidepressant  that is US FDA-approved to treat  major depressive disorder ,  seasonal affective disorder  and to support  smoking cessation . [ 17 ] [ 18 ]  It is also popular as an  add-on  medication in the cases of \"incomplete response\" to the first-line  selective serotonin reuptake inhibitor  (SSRI) antidepressant. [ 18 ] [ 19 ]  Bupropion has several features that distinguish it from other antidepressants: it does not usually cause sexual dysfunction, [ 18 ]  it is not associated with weight gain [ 18 ]  and  sleepiness , [ 20 ]  and it is more effective than SSRIs at improving symptoms of  hypersomnia  and fatigue. [ 21 ]  Bupropion, particularly the immediate-release formulation, carries a higher risk of seizure than many other antidepressants, hence caution is recommended in patients with a history of seizure disorder. [ 22 ]  The medication is taken  by mouth . [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1260", "text": "Common  adverse effects  of bupropion with the greatest difference from  placebo  are  dry mouth ,  nausea ,  constipation ,  insomnia ,  anxiety ,  tremor , and  excessive sweating . [ 10 ] [ 11 ]  Raised  blood pressure  is notable. [ 23 ]  Rare but serious side effects include  seizures , [ 10 ] [ 11 ]   liver toxicity , [ 24 ]   psychosis , [ 25 ]  and risk of  overdose . [ 26 ]  Bupropion use during  pregnancy  may be associated with increased likelihood of  congenital heart defects . [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1261", "text": "Bupropion acts as a  norepinephrine\u2013dopamine reuptake inhibitor  (NDRI) and a  nicotinic receptor antagonist . [ 2 ]  However, its effects on  dopamine  are weak and clinical significance is contentious. [ 28 ] [ 29 ] [ 30 ] [ 31 ] [ 32 ]  Chemically, bupropion is an  aminoketone  that belongs to the  class  of  substituted cathinones  and more generally that of  substituted amphetamines  and  substituted phenethylamines . [ 33 ] [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1262", "text": "Bupropion was invented by  Nariman Mehta , who worked at  Burroughs Wellcome , in 1969. [ 35 ]  It was first approved for medical use in the United States in 1985. [ 36 ]  Bupropion was originally called by the generic name amfebutamone, before being renamed in 2000. [ 16 ]  In 2022, it was the 21st most commonly prescribed medication in the United States, with more than 25 \u00a0 million prescriptions. [ 37 ] [ 38 ]  It is on the  World Health Organization's List of Essential Medicines . [ 39 ]  In 2022, the US  Food and Drug Administration  (FDA) approved the combination  dextromethorphan/bupropion  to serve as a rapid-acting  antidepressant  in patients with  major depressive disorder . [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1263", "text": "The evidence overall supports the  effectiveness  of bupropion over  placebo  for the treatment of depression. [ 41 ] [ 18 ] [ 42 ]  Some peer-reviewed studies suggest the  quality of evidence  is low. [ 42 ] [ 18 ]  Some  meta-analyses  report that bupropion has an at-most small  effect size  for depression. [ 43 ] [ 44 ] [ 42 ] [ 45 ]  One meta-analysis reported a large effect size. [ 18 ]  However, there were methodological limitations with this meta-analysis, including using a subset of only five trials for the effect size calculation, substantial  variability  in effect sizes between the selected trials\u2014which led the authors to state that their findings in this area should be interpreted with \"extreme caution\"\u2014and general lack of inclusion of  unpublished  trials in the meta-analysis. [ 18 ]  Unpublished trials are more likely to be negative in findings, [ 46 ] [ 47 ]  and other meta-analyses have included unpublished trials. [ 43 ] [ 44 ] [ 42 ] [ 45 ]  Evidence suggests that the effectiveness of bupropion for depression is similar to that of other antidepressants. [ 43 ] [ 44 ] [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1264", "text": "Over the autumn and winter months, bupropion prevents the development of depression in those who have recurring  seasonal affective disorder : 15% of participants on bupropion experienced a major depressive episode vs. 27% of those on placebo. [ 48 ]  Bupropion also improves depression in  bipolar disorder , with the efficacy and risk of an affective switch being similar to other antidepressants. [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1265", "text": "Bupropion has several features that distinguish it from other antidepressants: for instance, unlike the majority of antidepressants, it does not usually cause sexual dysfunction, and the occurrence of sexual side effects is not different from placebo. [ 18 ] [ 50 ]  Bupropion treatment is not associated with weight gain; on the contrary, the majority of studies observed significant weight loss in bupropion-treated participants. [ 18 ]  Bupropion treatment also is not associated with the  sleepiness  that may be produced by other antidepressants. [ 20 ]  Bupropion is more effective than  selective serotonin reuptake inhibitors  (SSRIs) at improving symptoms of  hypersomnia  and fatigue in depressed patients. [ 21 ]  Bupropion is effective in the treatment of anxious depression and, contrary to common belief, does not exacerbate anxiety in this context. [ 51 ] [ 52 ]  The effectiveness of bupropion for anxious depression is equivalent to that of SSRIs in the case of depression with low or moderate anxiety, whereas SSRIs show a modest effectiveness advantage in terms of response rates for depression with high anxiety. [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1266", "text": "The addition of bupropion to a prescribed SSRI is a common strategy when people do not respond to the SSRI, [ 19 ]  and it is supported by clinical trials; [ 18 ]  however, it appears to be inferior to the addition of atypical antipsychotic  aripiprazole . [ 53 ] [ further explanation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1267", "text": "Prescribed as an aid for smoking cessation, bupropion reduces the severity of  craving  for nicotine and  withdrawal  symptoms [ 54 ] [ 55 ] [ 56 ]  such as depressed\nmood, irritability, difficulty concentrating, and increased appetite. [ 57 ]  Initially, bupropion slows the weight gain that often occurs in the first weeks after quitting smoking. With time, however, this effect becomes negligible. [ 57 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1268", "text": "The bupropion treatment course lasts for seven to twelve weeks, with the patient halting the use of tobacco about ten days into the course. [ 57 ] [ 10 ]  After the course, the effectiveness of bupropion for maintaining abstinence from smoking declines over time, from 37% of tobacco abstinence at 3 months to 20% at one year. [ 58 ]  It is unclear whether extending bupropion treatment helps to prevent relapse of smoking. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1269", "text": "Overall, six months after the therapy, bupropion increases the likelihood of quitting smoking by approximately 1.6-fold as compared to placebo. In this respect, bupropion is as effective as  nicotine replacement therapy  but inferior to  varenicline . Combining bupropion and nicotine replacement therapy does not improve the quitting rate. [ 60 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1270", "text": "In children and adolescents, the use of bupropion for smoking cessation does not appear to offer any significant benefits. [ 61 ]  The evidence for its use to aid smoking cessation in pregnant women is insufficient. [ 62 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1271", "text": "In the United States, the treatment of  attention deficit hyperactivity disorder  (ADHD) is not an approved indication of bupropion, and it is not mentioned in the 2019 guideline on ADHD treatment from the  American Academy of Pediatrics . [ 63 ]  Systematic reviews of bupropion for the treatment of ADHD in both adults and children note that bupropion may be effective for ADHD but warn that this conclusion has to be interpreted with caution, because clinical trials were of low quality due to small sizes and risk of bias. [ 30 ] [ 64 ] [ 65 ] [ 66 ]  Similarly to  atomoxetine , bupropion has a delayed  onset of action  for ADHD, and several weeks of treatment are required for therapeutic effects. [ 30 ] [ 67 ]  This is in contrast to  stimulants , such as  amphetamine  and  methylphenidate , which have an immediate onset of effect in the condition. [ 67 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1272", "text": "Bupropion is less likely than other antidepressants to cause  sexual dysfunction . [ 68 ]  A range of studies indicate that bupropion not only produces fewer sexual side effects than other antidepressants but can actually help to alleviate sexual dysfunction [ 69 ]  including sexual dysfunction induced by  SSRI  antidepressants. [ 70 ]  There have also been small studies suggesting that bupropion or a bupropion/ trazodone  combination may improve some measures of sexual function in women who have  hypoactive sexual desire disorder  (HSDD) and are not depressed. [ 71 ]  According to an expert consensus recommendation from the International Society for the Study of Women's Sexual Health, bupropion can be considered as an off-label treatment for HSDD despite limited safety and efficacy data. [ 72 ]  Likewise, a 2022  systematic review  and  meta-analysis  of bupropion for sexual desire disorder in women reported that although data were limited, bupropion appeared to be dose-dependently effective for the condition. [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1273", "text": "Bupropion, when used for treating long-term weight gain over six to twelve months, results in an average weight loss of 2.7 kilograms (6.0\u00a0lb) over placebo. [ 74 ]  This is not much different from the weight loss produced by several other weight-loss medications such as  sibutramine  or  orlistat . [ 74 ]  The combination drug  naltrexone/bupropion  has been approved by the US  Food and Drug Administration  (FDA) for the treatment of obesity. [ 75 ] [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1274", "text": "Bupropion is not effective in the treatment of  cocaine dependence , [ 77 ]  but it is showing promise in reducing drug use in treating amphetamine-type stimulant use and cravings. [ 78 ] [ 79 ]  Based on studies indicating that bupropion lowers the level of the inflammatory mediator  TNF-alpha , there have been suggestions that it might be useful in treating  inflammatory bowel disease ,  psoriasis , and other autoimmune conditions, but very little clinical evidence is available. [ 80 ] [ 81 ] [ 82 ]  Bupropion is not effective in treating chronic low back pain. [ 83 ]  The drug may be useful in the treatment of  excessive daytime sleepiness  (EDS) and  narcolepsy . [ 84 ] [ 85 ] [ 86 ] [ 87 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1275", "text": "Bupropion has been used to treat  disorders of diminished motivation , like  apathy ,  abulia , and  akinetic mutism . [ 88 ] [ 89 ]  Accordingly, the drug has been found to increase  effort expenditure  and improve  motivational deficits  in  animal models . [ 88 ]  However, only limited benefits of bupropion in the treatment of apathy have been observed in  clinical trials  in various conditions. [ 88 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1276", "text": "Bupropion has been used in the treatment of  postural orthostatic tachycardia syndrome  (POTS). [ 90 ] [ 91 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1277", "text": "Bupropion is available as an  oral   tablet  in several different formulations. [ 10 ] [ 11 ]  It is mainly formulated as the  hydrochloride   salt [ 10 ] [ 11 ]  but also as the  hydrobromide  salt. [ 12 ]  In addition to single-drug formulations, bupropion is formulated in  combinations  including  naltrexone/bupropion  (Contrave) for obesity and  dextromethorphan/bupropion  (Auvelity) for depression. [ 92 ] [ 93 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1278", "text": "The US  Food and Drug Administration  (FDA) prescription label advises that bupropion should not be prescribed to individuals with  epilepsy  or other conditions that lower the  seizure threshold , such as  anorexia nervosa ,  bulimia nervosa , or  benzodiazepine  or  alcohol withdrawal . It should be avoided in individuals who are taking  monoamine oxidase inhibitors  (MAOIs). The label recommends that caution should be exercised when treating people with liver damage, severe  kidney disease , and severe  hypertension , and in children, adolescents, and young adults due to the increased risk of  suicidal ideation . [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1279", "text": "The common adverse effects of bupropion with the greatest difference from placebo are dry mouth, nausea, constipation, insomnia, anxiety, tremor, and excessive sweating. [ 10 ] [ 11 ]  Bupropion has the highest incidence of insomnia of all second-generation antidepressants, apart from  desvenlafaxine . [ 94 ]  It is also associated with about 20% increased risk of headache. [ 95 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1280", "text": "Bupropion raises blood pressure in some people. One study showed an average rise of 6\u00a0mm\u00a0Hg in systolic blood pressure in 10% of patients. [ 23 ]  The prescribing information notes that  hypertension , sometimes severe, is observed in some people taking bupropion, both with and without pre-existing hypertension. [ 10 ] [ 11 ]  The safety of bupropion in people with cardiovascular conditions and its general cardiovascular safety profile remains unclear due to the lack of data. [ 96 ] [ 97 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1281", "text": "Seizure  is a rare but serious adverse effect of bupropion. It is strongly dose-dependent: for the immediate release preparation, the seizure incidence is 0.4% at the dose 300\u2013450\u00a0mg per day; the incidence climbs almost ten-fold for the higher than recommended dose of 600\u00a0mg. [ 10 ] [ 11 ]  For comparison, the incidence of unprovoked seizure in the general population is 0.07\u20130.09%, and the risk of seizure for a variety of other antidepressants is generally 0\u20130.5% at the recommended doses. [ 98 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1282", "text": "Cases of  liver toxicity  leading to death or  liver transplantation  have been reported for bupropion. It is considered to be one of several antidepressants with a greater risk of hepatotoxicity. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1283", "text": "The prescribing information warns about bupropion triggering an angle-closure  glaucoma  attack. [ 10 ]  On the other hand, bupropion may decrease the risk of development of  open angle glaucoma . [ 99 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1284", "text": "Bupropion use by mothers in the first trimester of pregnancy is associated with a 23% increase in the odds of  congenital heart defects  in their children. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1285", "text": "Bupropion has rarely been associated with instances of  Stevens\u2013Johnson syndrome . [ 100 ] [ 101 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1286", "text": "Bupropion has not been associated with  QT prolongation  at therapeutic doses but has been associated with QT prolongation in  overdose . [ 102 ] [ 103 ] [ 104 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1287", "text": "The US  Food and Drug Administration  (FDA) requires all antidepressants, including bupropion, to carry a  boxed warning  stating that antidepressants may increase the risk of suicide in people younger than 25. This warning is based on a statistical analysis conducted by the FDA which found a 2-fold increase in  suicidal thought  and behavior in children and adolescents, and a 1.5-fold increase in the 18\u201324 age group. [ 105 ]  For this analysis the FDA combined the results of 295 trials of 11 antidepressants to obtain statistically significant results. Considered in isolation, bupropion was not statistically different from placebo. [ 105 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1288", "text": "Bupropion prescribed for smoking cessation results in a 25% increase in the risk of psychiatric side effects, in particular,  anxiety  (about 40% increase) and  insomnia  (about 80% increase). The evidence is insufficient to determine whether bupropion is associated with suicides or suicidal behavior. [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1289", "text": "In rare cases, bupropion-induced  psychosis  may develop. It is associated with higher doses of bupropion; many cases described are at higher than recommended doses. Concurrent antipsychotic medication appears to be protective. [ 25 ]  In most cases the psychotic symptoms are eliminated by reducing the dose, ceasing treatment or adding antipsychotic medication. [ 10 ] [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1290", "text": "Although studies are lacking, a handful of case reports suggest that abrupt discontinuation of bupropion may cause  antidepressant discontinuation syndrome . [ 106 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1291", "text": "Bupropion is considered moderately dangerous in overdose. [ 107 ] [ 108 ]  According to an analysis of  US National Poison Data System , adjusted for the number of prescriptions, bupropion and  venlafaxine  are the two new generation antidepressants (that is excluding  tricyclic antidepressants ) that result in the highest  mortality  and  morbidity . [ 26 ]  For significant overdoses, seizures have been reported in about a third of all cases; other serious effects include hallucinations, loss of consciousness, and  abnormal heart rhythms . When bupropion was one of several kinds of pills taken in an overdose, fever, muscle rigidity, muscle damage, hypertension or hypotension, stupor, coma, and respiratory failure have been reported. While most people recover, some people have died, having had multiple uncontrolled seizures and myocardial infarction. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1292", "text": "Since bupropion is metabolized to  hydroxybupropion  by the enzyme  CYP2B6 , drug interactions with CYP2B6 inhibitors are possible: this includes such medications as  paroxetine ,  sertraline ,  norfluoxetine  (active metabolite of  fluoxetine ),  diazepam ,  clopidogrel , and  orphenadrine . The expected result is an increase of bupropion and a decrease in hydroxybupropion blood concentration. The reverse effect (decrease of bupropion and increase of hydroxybupropion) can be expected with CYP2B6  inducers  such as  carbamazepine ,  clotrimazole ,  rifampicin ,  ritonavir ,  St John's wort , and  phenobarbital . [ 109 ]  Indeed, carbamazepine decreases exposure to bupropion by 90% and increases exposure to hydroxybupropion by 94%. [ 110 ]  Ritonavir,  lopinavir/ritonavir , and  efavirenz  have been shown to decrease levels of bupropion and/or its metabolites. [ 111 ]   Ticlopidine  and clopidogrel, both potent CYP2B6 inhibitors, have been found to considerably increase bupropion levels as well as decrease levels of its metabolite hydroxybupropion. [ 111 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1293", "text": "Bupropion and its metabolites are inhibitors of  CYP2D6 , with hydroxybupropion responsible for most of the inhibition. Additionally, bupropion and its metabolites may decrease the expression of CYP2D6 in the liver. The end effect is a significant slowing of the clearance of other drugs metabolized by this enzyme. [ 2 ]  For instance, bupropion has been found to increase  area-under-the-curve  of  desipramine , a CYP2D6 substrate, by 5-fold. [ 111 ]  Bupropion has also been found to increase levels of  atomoxetine  by 5.1-fold, while decreasing the exposure to its main metabolite by 1.5-fold. [ 112 ]  As another example, the ratio of  dextromethorphan  (a drug that is mainly metabolized by CYP2D6) to its major  metabolite   dextrorphan  increased approximately 35-fold when it was administered to people being treated with 300\u00a0mg/day bupropion. [ 109 ]  When people on bupropion are given  MDMA , about 30% increase of exposure to both drugs is observed, with enhanced mood but decreased  heart rate  effects of MDMA. [ 113 ] [ 114 ]  Interactions with other CYP2D6 substrates, such as  metoprolol ,  imipramine ,  nortriptyline , [ 114 ]   venlafaxine , [ 109 ]  and  nebivolol [ 2 ]  have also been reported. However, in a notable exception, bupropion does not seem to affect the concentrations of CYP2D6 substrates fluoxetine and paroxetine. [ 109 ] [ 115 ]  Bupropion prevents  norepinephrine  and  dopamine  release induced by  amphetamines  and has been found to reduce the subjective and  sympathomimetic  effects of  methamphetamine  in humans. [ 116 ] [ 117 ] [ 118 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1294", "text": "Bupropion lowers the  seizure  threshold, and therefore can potentially interact with other medications that also lower it, such as  antipsychotics ,  tricyclic antidepressants ,  theophylline , and systemic  corticosteroids . [ 10 ]  The prescribing information recommends minimizing the use of  alcohol , since in rare cases bupropion reduces alcohol tolerance. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1295", "text": "Caution should be observed when combining bupropion with a  monoamine oxidase inhibitor  (MAOI), as it may result in  hypertensive crisis . [ 119 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1296", "text": "The  mechanism of action  of bupropion in the treatment of depression and for other indications is unclear. [ 2 ]  However, it is thought to be related to the fact that bupropion is a  norepinephrine\u2013dopamine reuptake inhibitor  (NDRI) and  negative allosteric modulator  of several  nicotinic acetylcholine receptors . [ 2 ]  Bupropion does not act as a  norepinephrine\u2013dopamine releasing agent . [ 129 ]  Pharmacological actions of bupropion, to a substantial degree, are due to its active metabolites  hydroxybupropion ,  threo -hydrobupropion , and  erythro -hydrobupropion  that are present in the blood plasma at comparable or much higher levels. [ 2 ]  In fact, bupropion could accurately be conceptualized as a  prodrug  of these metabolites. [ 2 ]  Overall action of these metabolites, and particularly one enantiomer  S,S -hydroxybupropion , is also characterized by inhibition of norepinephrine and dopamine reuptake and nicotinic inhibition (see the chart on the right). [ 2 ]  Bupropion has no meaningful direct activity at a variety of  receptors , including  \u03b1-  and  \u03b2-adrenergic ,  dopamine ,  serotonin ,  histamine , and  muscarinic acetylcholine receptors . [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1297", "text": "The occupancy of  dopamine transporter  (DAT) by bupropion (300 \u00a0 mg/day) and its metabolites in the human brain as measured by several  positron emission tomography  (PET) studies is approximately 20%, with a mean occupancy range of about 14 to 26%. [ 130 ] [ 28 ] [ 29 ] [ 30 ]  For comparison, the NDRI  methylphenidate  at therapeutic doses is thought to occupy greater than 50% of DAT sites. [ 30 ]  In accordance with its low DAT occupancy, no measurable dopamine release in the human brain was detected with bupropion (one 150 \u00a0 mg dose) in a PET study. [ 130 ] [ 28 ] [ 29 ] [ 131 ]  Bupropion has also been shown to increase striatal  VMAT2 , though it is unknown if this effect is more pronounced than other DRIs. [ 132 ]  These findings raise questions about the role of  dopamine reuptake inhibition  in the pharmacology of bupropion, and suggest that other actions may be responsible for its therapeutic effects. [ 130 ] [ 28 ] [ 30 ] [ 29 ]  No data are available on occupancy of the  norepinephrine transporter  (NET) by bupropion and its metabolites. [ 130 ] [ 28 ]  However, due to the increased exposure of hydroxybupropion over bupropion itself, which has higher  affinity  for the NET than the DAT, [ 133 ]  bupropion's overall pharmacological profile in humans may end up making it effectively more of a  norepinephrine reuptake inhibitor  than a dopamine reuptake inhibitor. [ 31 ] [ 32 ]  Accordingly, the clinical effects of bupropion are more consistent with noradrenergic activity than with dopaminergic actions. [ 31 ] [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1298", "text": "Bupropion has been claimed to be a  sigma   \u03c3 1  receptor   agonist . [ 134 ] [ 135 ]  Its antidepressant-like effects in rodents depend on \u03c3 1  receptor activation. [ 134 ] [ 135 ] [ 136 ]  They are enhanced and inhibited by \u03c3 1  receptor agonists and antagonists, respectively. [ 134 ] [ 135 ] [ 136 ]  However, no data on the binding or functional effects of bupropion at the human sigma receptors seem to be available. [ 120 ] [ 121 ] [ 122 ]  In any case, bupropion has been reported to bind to rodent \u03c3 1  receptors with  IC 50 Tooltip half-maximal inhibitory concentration  values of 580 to 2,100 \u00a0 nM. [ 137 ]  In contrast to many other  phenethylamines  and  amphetamines , [ 138 ]  bupropion is not an  agonist  of the  trace amine-associated receptor 1  (TAAR1). [ 139 ] [ 140 ] [ 141 ] [ 142 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1299", "text": "Bupropion has been found to have a mixture of  anti-inflammatory  and  pro-inflammatory  activity through  modulation of the immune system . [ 143 ] [ 144 ] [ 145 ] [ 146 ] [ 147 ] [ 148 ] [ 149 ]  One such mechanism underlying these effects may be reduced levels of the pro-inflammatory  cytokine   tumor necrosis factor alpha  (TNF\u03b1). [ 143 ] [ 149 ] [ 150 ]  The catecholaminergic actions of bupropion may be involved in its immunomodulatory effects. [ 150 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1300", "text": "After oral administration, bupropion is rapidly and completely absorbed reaching the peak blood plasma concentration after 1.5 hours ( t max ). Sustained-release (SR) and extended-release (XL) formulations have been designed to slow down absorption resulting in t max  of 3 hours and 5 hours, respectively. [ 109 ]  Absolute  bioavailability  of bupropion is unknown but is presumed to be low, at 5\u201320%, due to the  first-pass metabolism . As for the relative bioavailability of the formulations, XL formulation has lower bioavailability (68%) compared to SR formulation and immediate release bupropion. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1301", "text": "Bupropion is metabolized in the body by a variety of pathways. The  oxidative  pathways are by  cytochrome P450  isoenzymes  CYP2B6  leading to  R,R - and  S,S -hydroxybupropion  and, to a lesser degree,  CYP2C19  leading to 4'-hydroxybupropion. The  reductive  pathways are by  11\u03b2-hydroxysteroid dehydrogenase type 1  in the liver and  AKR7A2 / AKR7A3  in the intestine leading to  threo -hydrobupropion  and by yet unknown enzyme leading to  erythro -hydrobupropion . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1302", "text": "The metabolism of bupropion is highly variable: the effective doses of bupropion received by persons who ingest the same amount of the drug may differ by as much as 5.5\u00a0times (with a  half-life  of 12\u201330\u00a0hours), while the effective doses of  hydroxybupropion  may differ by as much as 7.5\u00a0times (with a half-life of 15\u201325\u00a0hours). [ 10 ] [ 158 ] [ 159 ]  Based on this, some researchers have advocated monitoring of the blood level of bupropion and hydroxybupropion. [ 160 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1303", "text": "The metabolism of bupropion also seems to follow biphasic pharmacokinetics: the redistribution alpha phase with half-life of about 1 hour [ 161 ]  precedes the metabolism beta phase of about 12-30 hours. This might explain why abuse is unfeasible due to a short \"high\", as well as support the use of extended-release formulas to maintain a consistent concentration of bupropion."}
{"_id": "WikiPedia_Dermatology$$$corpus_1304", "text": "The metabolism of bupropion is highly species-dependent. [ 162 ] [ 163 ] [ 164 ]  As an example, oral bupropion results in hydroxybupropion levels that are 16-fold higher than those of bupropion itself in humans, whereas in rats, oral bupropion results in levels of bupropion that are 3.4-fold higher than those of hydroxybupropion. [ 162 ]  The species-dependent metabolism of bupropion is thought to be involved in species differences in its pharmacodynamic effects. [ 162 ] [ 163 ] [ 164 ]  For example, bupropion produces  psychostimulant -like and  reinforcing  effects in rodents, whereas oral bupropion at therapeutic doses seems to have much less or no potential for such effects in humans. [ 165 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1305", "text": "Bupropion is an  aminoketone  that belongs to the  class  of  substituted cathinones  and the more general class of  substituted phenethylamines . [ 33 ] [ 34 ]  It is also known structurally as 3-chloro- N - tert -butyl-\u03b2-keto-\u03b1-methylphenethylamine, 3-chloro- N - tert -butyl-\u03b2-ketoamphetamine, or 3-chloro- N - tert -butylcathinone. The clinically used bupropion is  racemic , which is a mixture of two  enantiomers :  S -bupropion and  R -bupropion. Although the  optical isomers  on bupropion can be separated, they rapidly  racemize  under physiological conditions. [ 2 ] [ 166 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1306", "text": "Bupropion is a  small-molecule   compound  with the  molecular formula  C 13 H 18 ClNO and a  molecular weight  of 239.74 \u00a0 g/mol. [ 167 ] [ 168 ]  It is a highly  lipophilic  compound, [ 2 ]  with an experimental  log P  of 3.6. [ 167 ] [ 168 ]  Pharmaceutically, bupropion is used mainly as the  hydrochloride   salt  but also to a lesser extent as the  hydrobromide  salt. [ 10 ] [ 11 ] [ 169 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1307", "text": "A number of  analogues  of bupropion exist, such as  hydroxybupropion ,  radafaxine , and  manifaxine , among others. [ 162 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1308", "text": "There have been reported cases of false-positive urine amphetamine tests in persons taking bupropion. [ 170 ] [ 171 ] [ 172 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1309", "text": "It is synthesized in two chemical steps starting from 3'-chloro- propiophenone . The alpha position adjacent to the ketone is first  brominated  followed by  nucleophilic displacement  of the resulting alpha-bromoketone with  t -butylamine  and treated with  hydrochloric acid  to give bupropion as the hydrochloride salt in 75\u201385% overall yield. [ 35 ] [ 173 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1310", "text": "Bupropion was invented by  Nariman Mehta  of Burroughs Wellcome (now  GlaxoSmithKline ) in 1969, and the US patent for it was granted in 1974. [ 35 ]  It was approved by the US  Food and Drug Administration  (FDA) as an antidepressant on 30 December 1985, and marketed under the name Wellbutrin. [ 36 ] [ 174 ]  However, a significant incidence of  seizures  at the originally recommended dosage (400\u2013600\u00a0mg/day) caused the withdrawal of the drug in 1986. Subsequently, the risk of seizures was found to be highly dose-dependent, and bupropion was re-introduced to the market in 1989 with a lower maximum recommended daily dose of 450\u00a0mg/day. [ 175 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1311", "text": "In 1996, the US  Food and Drug Administration  (FDA) approved a  sustained-release  formulation of alcohol-resistant bupropion called Wellbutrin SR, intended to be taken twice a day (as compared with three times a day for immediate-release Wellbutrin). [ 176 ]  In 2003, the FDA approved another sustained-release formulation called Wellbutrin XL, intended for once-daily dosing. [ 177 ]  Wellbutrin SR and XL are available in  generic  form in the United States and Canada. In 1997, bupropion was approved by the FDA for use as a smoking cessation aid under the name Zyban. [ 178 ] [ 176 ]  In 2006, Wellbutrin XL was similarly approved as a treatment for seasonal affective disorder. [ 179 ] [ 180 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1312", "text": "In October 2007, two providers of consumer information on nutritional products and supplements, ConsumerLab.com and The People's Pharmacy, released the results of comparative tests of different brands of bupropion. [ 181 ]  The People's Pharmacy received multiple reports of increased side effects and decreased efficacy of generic bupropion, which prompted it to ask ConsumerLab.com to test the products in question. The tests showed that \"one of a few generic versions of Wellbutrin XL 300\u00a0mg, sold as Budeprion XL 300\u00a0mg, didn't perform the same as the brand-name pill in the lab.\" [ 182 ]  The FDA investigated these complaints and concluded that Budeprion XL is equivalent to Wellbutrin XL in regard to bioavailability of bupropion and its main active metabolite hydroxybupropion. The FDA also said that coincidental natural mood variation is the most likely explanation for the apparent worsening of depression after the switch from Wellbutrin XL to Budeprion XL. [ 183 ]  On 3 October 2012, however, the FDA reversed this opinion, announcing that \"Budeprion XL 300\u00a0mg fails to demonstrate therapeutic equivalence to Wellbutrin XL 300\u00a0mg.\" [ 184 ]  The FDA did not test the bioequivalence of any of the other generic versions of Wellbutrin XL 300\u00a0mg, but requested that the four manufacturers submit data on this question to the FDA by March 2013. [ 184 ]  As of October\u00a02013 [update]  the FDA has made determinations on the formulations from some manufacturers not being bioequivalent. [ 184 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1313", "text": "In April 2008, the FDA approved a formulation of bupropion as a hydrobromide salt instead of a hydrochloride salt, to be sold under the name Aplenzin by  Sanofi-Aventis . [ 12 ] [ 185 ] [ 186 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1314", "text": "In 2009, the FDA issued a health advisory warning that the prescription of bupropion for smoking cessation has been associated with reports of unusual behavior changes, agitation, and hostility. Some people, according to the advisory, have become depressed or have had their depression worsen, have had thoughts about suicide or dying, or have attempted suicide. [ 187 ]  This advisory was based on a review of anti-smoking products that identified 75 reports of \"suicidal adverse events\" for bupropion over ten years. [ 188 ]  Based on the results of follow-up trials this warning was removed in 2016. [ 189 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1315", "text": "In 2012, the US Justice Department announced that GlaxoSmithKline had agreed to plead guilty and pay a $3 billion fine, in part for promoting the unapproved use of Wellbutrin for weight loss and sexual dysfunction. [ 190 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1316", "text": "In 2017, the  European Medicines Agency  (EMA) recommended suspending a number of nationally approved medicines due to misrepresentation of bioequivalence study data by Micro Therapeutic Research Labs in India. [ 191 ]  The products recommended for suspension included several 300\u00a0mg modified-release bupropion tablets. [ 192 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1317", "text": "Following EMA's call for an industry-wide review of medicines for the possible presence of nitrosamines, [ 193 ]  GlaxoSmithKline paused batch release and distribution of bupropion 150\u00a0mg tablets in November 2022. In July 2023, EMA raised the acceptable daily intake of nitrosamine impurities, leading GlaxoSmithKline to announce that distribution of bupropion 150\u00a0mg tablets would resume \"across the EU and Europe\" by the end of 2023. [ 194 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1318", "text": "While bupropion demonstrates some potential for misuse, this potential is less than of other commonly used stimulants, being limited by features of its pharmacology. [ 195 ]  Case reports describe the misuse of bupropion as producing a \"high\" similar to cocaine or amphetamine usage but with less intensity. Bupropion misuse is uncommon. [ 195 ]  There have been some anecdotal and case-study reports of bupropion abuse, but the bulk of evidence indicates that the subjective effects of bupropion when taken orally are markedly different from those of addictive stimulants such as cocaine or amphetamine. [ 196 ]  However, bupropion, by non-conventional routes of administration like injection or insufflation, has been reported to be misused in the United States and Canada, notably in prisons. [ 197 ] [ 198 ] [ 199 ] [ 200 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1319", "text": "In Russia bupropion is banned as a  narcotic drug , due to it being a derivative of  methcathinone . [ 201 ] \nIn Australia, France, and the UK, smoking cessation is the only licensed use of bupropion, and no generics are marketed. [ 202 ] [ 203 ] [ 204 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1320", "text": "Brand names include Wellbutrin, [ 10 ] [ 11 ]  Aplenzin, [ 12 ]  Budeprion, Buproban, buprapan, Forfivo, Voxra, Zyban, [ 8 ]  Bupron, Bupisure, Bupep, Smoquite, Elontril, Oribion and Buxon. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1321", "text": "Bupropion has been studied limitedly in the treatment of  social anxiety disorder . [ 205 ] [ 206 ] [ 207 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1322", "text": "Cantharidin  is an odorless, colorless fatty substance of the  terpenoid  class, which is secreted by many species of  blister beetles . [ a ]  Its main current use in pharmacology is treating  molluscum contagiosum  and  warts  topically. [ 2 ]  It is a burn agent and  poisonous  in large doses, and has been historically used as  aphrodisiacs  ( Spanish fly ). In its natural form, cantharidin is secreted by the male blister beetle, and given to the female as a copulatory gift during mating. Afterwards, the female beetle covers her eggs with it as a defense against predators."}
{"_id": "WikiPedia_Dermatology$$$corpus_1323", "text": "Poisoning from cantharidin is a significant veterinary concern, especially in horses, but it can also be poisonous to humans if taken internally (where the source is usually experimental self-exposure). Externally, cantharidin is a potent  vesicant  (blistering agent), exposure to which can cause severe  chemical burns . Properly dosed and applied, the same properties have also been used therapeutically, for instance, for treatment of skin conditions, such as  molluscum contagiosum  infection of the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_1324", "text": "Cantharidin is classified as an  extremely hazardous substance  in the  United States , and is subject to strict reporting requirements by facilities that produce, store, or use it in significant quantities. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1325", "text": "Cantharidin, from the Greek  kantharis , for beetle, [ 4 ]  is an odorless, colorless  natural product  with solubility in various organic solvents, [ specify ]  but only slight solubility in water. [ 5 ]  Its skeleton is  tricyclic , formally, a tricyclo-[5.2.1.0 2,6 ]decane skeleton. Its functionalities include a  carboxylic acid anhydride  (\u2212CO\u2212O\u2212CO\u2212) substructure in one of its rings, as well as a bridging  ether  in its  bicyclic  ring system."}
{"_id": "WikiPedia_Dermatology$$$corpus_1326", "text": "The complete mechanism of the  biosynthesis  of cantharidin is unknown. Its framework formally consists of two  isoprene  units. [ 6 ]  However,  feeding studies  indicate that the biosynthetic process is more complicated, and not a simple product of  geranyl pyrophosphate  or related ten-carbon parent structure, as the seeming  monoterpene  nature would suggest. Instead, there is a  farnesol  (15-carbon) precursor from which certain carbon segments are later excised. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1327", "text": "The level of cantharidin in blister beetles can be quite variable. Among blister beetles of the genus  Epicauta  in  Colorado ,  E. pennsylvanica  contains about 0.2\u00a0mg,  E. maculata  contains 0.7\u00a0mg, and  E. immaculata  contains 4.8\u00a0mg per beetle; males also contain higher levels than females. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1328", "text": "Males of  Berberomeloe majalis  have higher level of cantharidin per beetle: 64.22\u202f\u00b1\u202f51.28\u00a0mg/g (dry weight) and 9.10\u202f\u00b1\u202f12.64\u00a0mg/g (d. w.). Cantharidin content in  haemolymph  is also higher in males (80.9\u202f\u00b1\u202f106.5\u00a0\u03bcg/g) than in females (20.0\u202f\u00b1\u202f41.5\u00a0\u03bcg/g). [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1329", "text": "Preparations made from  blister beetles  (particularly \" Spanish fly \") have been used since ancient times as an  aphrodisiac , possibly because their physical effects were perceived to mimic those of sexual arousal, [ 10 ]  and because they can cause prolonged erection or  priapism  in men. [ 11 ]  These preparations were known as  cantharides , from the Greek word for \"beetle\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_1330", "text": "Examples of such use found in historical sources include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1331", "text": "Cantharidin was first isolated as a chemically pure substance in 1810 by  Pierre Robiquet , [ 23 ]  a French chemist then living in  Paris . Robiquet isolated cantharidin as the active ingredient in pharmacological preparations of  Lytta vesicatoria , a.k.a. \" Spanish fly \", a species of  blister beetle . This was one of the first historical instances of the identification and extraction of a simple active principle from a complex medicine."}
{"_id": "WikiPedia_Dermatology$$$corpus_1332", "text": "Robiquet found cantharidin to be an odorless and colorless solid at  room temperature . He demonstrated that it was the active principle responsible for the aggressively  blistering properties  of the coating of the eggs of the blister beetle, and additionally established that cantharidin had toxic properties comparable in degree to those of the most virulent poisons known in the 19th century, such as  strychnine . [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1333", "text": "Poisoning by  Epicauta  species from cantharidin is a significant veterinary concern, especially in horses; species infesting feedstocks depend on region\u2014e.g.,  Epicauta pennsylvanica  (black blister beetle) in the U.S. midwest; and  E. occidentalis, temexia, and vittata  species (striped blister beetles) in the U.S. southwest\u2014where the concentrations of the agent in each can vary substantially. [ 5 ]  Beetles feed on  weeds , and occasionally move into crop fields used to produce livestock feeds (e.g.,  alfalfa ), where they are found to cluster and find their way into  baled hay , e.g., a single flake (4\u20135 in. section [ 29 ] ) may have several hundred insects, or none at all. [ 5 ]  Horses are very sensitive to the cantharidin produced by beetle infestations: the  LD 50  for horses is roughly 1\u00a0mg/kg of the horse's body weight. Horses may be accidentally poisoned when fed bales of fodder with blister beetles in them. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1334", "text": "Great bustards , a strongly  polygynous  bird species, [ 31 ]  are not immune to the toxicity of cantharidin; they become intoxicated after ingesting blister beetles. However, cantharidin has activity also against parasites that infect them. [ 32 ] [ 33 ]  Great bustards may eat toxic  blister beetles  of the genus  Meloe  to increase the sexual arousal of males. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1335", "text": "As a blister agent, cantharidin has the potential to cause adverse effects when used medically; for this reason, it has been included in a list of \"problem drugs\" used by dermatologists and emergency personnel. [ 35 ]  However, this references unregulated sources of cantharidin. [ 36 ]  In July 2023, the US FDA approved a topical formulation of cantharidin (Ycanth) for the treatment of  molluscum contagiosum . [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1336", "text": "When  ingested  by humans, the  LD 50  is unknown, but fatal doses have been \nrecorded between 10 mg and 65 mg. [ 38 ]  The median lethal dose appears to be around 1 mg/kg [ 39 ]  but individuals have survived after consuming oral doses as high as 175 mg. [ 40 ]  Ingesting cantharidin can initially cause severe damage to the lining of the  gastrointestinal  and  urinary tracts , and may also cause permanent  renal  damage. Symptoms of cantharidin poisoning include  blood in the urine , abdominal pain, and (rarely)  prolonged erections . [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1337", "text": "The extreme toxicity of cantharidin makes any use as an aphrodisiac highly dangerous. [ 41 ] [ 42 ]   As a result, it is illegal to sell (or use) cantharidin or preparations containing it without a prescription in many countries. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1338", "text": "Topical cantharidin is absorbed by the lipid membranes of  epidermal cells , causing the release of  serine proteases ,  enzymes  that break the  peptide bonds  in proteins. This causes the disintegration of  desmosomal plaques , cellular structures involved in cell-to-cell adhesion, leading to detachment of the  tonofilaments  that hold cells together. The process leads to the loss of cellular connections ( acantholysis ), and ultimately results in blistering of the skin. Lesions heal without scarring. [ 43 ] [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1339", "text": "VP-102, an experimental drug-device combination that includes cantharidin delivered via a single-use applicator, is being studied for the treatment of  molluscum contagiosum ,  common warts , and  genital warts . [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1340", "text": "Cantharidin appears to have some effect in the topical treatment of  cutaneous leishmaniasis  in animal models. [ 46 ]  In addition to topical medical applications, cantharidin and its analogues may have activity against cancer cells. [ 47 ] [ 48 ] [ 49 ] \nLaboratory studies with cultured tumor cells suggest that this activity may be the result of  PP2A  inhibition. [ 50 ] [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1341", "text": "Carbamazepine , sold under the brand name  Tegretol  among others, is an  anticonvulsant medication  used in the treatment of  epilepsy  and  neuropathic pain . [ 4 ] [ 1 ]  It is used as an adjunctive treatment in  schizophrenia  along with other medications and as a  second-line  agent in  bipolar disorder . [ 6 ] [ 1 ]  Carbamazepine appears to work as well as  phenytoin  and  valproate  for focal and generalized seizures. [ 7 ]  It is not effective for  absence  or  myoclonic seizures . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1342", "text": "Carbamazepine was discovered in 1953 by Swiss chemist Walter Schindler. [ 8 ] [ 9 ]  It was first marketed in 1962. [ 10 ]  It is available as a  generic medication . [ 11 ]  It is on the  World Health Organization's List of Essential Medicines . [ 12 ]  In 2020, it was the 185th most commonly prescribed medication in the United States, with more than 2 \u00a0 million prescriptions. [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1343", "text": "Photoswitchable analogues of carbamazepine have been developed to control its pharmacological activity locally and on demand using light ( photopharmacology ), with the purpose of reducing the adverse systemic effects of the drug. [ 15 ]  One of these light-regulated compounds (carbadiazocine, based on a bridged  azobenzene  or  diazocine ) has been shown to produce analgesia with noninvasive illumination  in vivo  in a rat model of  neuropathic pain ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1344", "text": "Carbamazepine is typically used for the treatment of  seizure disorders  and  neuropathic pain . [ 1 ]  It is used  off-label  as a second-line treatment for bipolar disorder and in combination with an  antipsychotic  in some cases of  schizophrenia  when treatment with a conventional antipsychotic alone has failed. [ 1 ] [ 16 ]  However, evidence does not support its usage for schizophrenia. [ 17 ]  It is not effective for  absence seizures  or  myoclonic seizures . [ 1 ]  Although carbamazepine may have a similar effectiveness (as measured by people continuing to use a medication) and efficacy (as measured by the medicine reducing seizure recurrence and improving remission) when compared to  phenytoin  and  valproate , choice of medication should be evaluated on an individual basis as further research is needed to determine which medication is most helpful for people with newly-onset seizures. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1345", "text": "In the United States, carbamazepine is  indicated  for the treatment of  epilepsy  (including  partial seizures , generalized  tonic-clonic seizures  and  mixed seizures ), and  trigeminal neuralgia . [ 4 ] [ 18 ]  Carbamazepine is the only medication that is approved by the  Food and Drug Administration  for the treatment of trigeminal neuralgia. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1346", "text": "As of 2014, a  controlled release  formulation was available for which there is tentative evidence showing fewer side effects and unclear evidence with regard to whether there is a difference in efficacy. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1347", "text": "It has also been shown to improve symptoms of \"typewriter tinnitus\", a type of tinnitus caused by the neurovascular compression of the cochleovestibular nerve.  [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1348", "text": "In the US, the label for carbamazepine contains warnings concerning: [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1349", "text": "Common  adverse effects  may include drowsiness, dizziness, headaches and migraines,  ataxia , nausea, vomiting, and/or constipation.  Alcohol  use while taking carbamazepine may lead to enhanced depression of the  central nervous system . [ 5 ]   Less common side effects may include increased risk of seizures in people with  mixed seizure disorders , [ 25 ]   abnormal heart rhythms , blurry or  double vision . [ 5 ]   Also, rare case reports of an auditory side effect have been made, whereby patients perceive sounds about a  semitone  lower than previously; this unusual side effect is usually not noticed by most people, and disappears after the person stops taking carbamazepine. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1350", "text": "Serious skin reactions such as  Stevens\u2013Johnson syndrome  (SJS) or  toxic epidermal necrolysis  (TEN) due to carbamazepine therapy are more common in people with a particular  human leukocyte antigen  gene-variant ( allele ),  HLA-B*1502 . [ 5 ]   Odds ratios  for the development of SJS or TEN in people who carry the allele can be in the double, triple or even quadruple digits, depending on the population studied. [ 27 ] [ 28 ]   HLA-B*1502  occurs almost exclusively in people with ancestry across broad areas of Asia, but has a very low or absent frequency in European, Japanese, Korean and African populations. [ 5 ] [ 29 ]  However, the HLA-A*31:01 allele has been shown to be a strong predictor of both mild and severe adverse reactions, such as the  DRESS  form of severe cutaneous reactions, to carbamazepine among Japanese, Chinese, Korean, and Europeans. [ 28 ] [ 30 ]  It is suggested that carbamazepine acts as a potent antigen that binds to the antigen-presenting area of HLA-B*1502 alike, triggering an everlasting activation signal on immature CD8-T cells, thus resulting in widespread cytotoxic reactions like SJS/TEN. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1351", "text": "Carbamazepine has a potential for  drug interactions . [ 18 ]  Drugs that decrease breaking down of carbamazepine or otherwise increase its levels include  erythromycin , [ 32 ]   cimetidine ,  propoxyphene , and  calcium channel blockers . [ 18 ]  Grapefruit juice raises the  bioavailability  of carbamazepine by inhibiting the enzyme  CYP3A4  in the gut wall and in the liver. [ 5 ]  Lower levels of carbamazepine are seen when administered with  phenobarbital ,  phenytoin , or  primidone , which can result in breakthrough seizure activity. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1352", "text": "Valproic acid  and  valnoctamide  both inhibit  microsomal epoxide hydrolase  (mEH), the enzyme responsible for the breakdown of the  active metabolite  carbamazepine-10,11-epoxide into inactive metabolites. [ 34 ]  By inhibiting mEH, valproic acid and valnoctamide cause a build-up of the active metabolite, prolonging the effects of carbamazepine and delaying its excretion."}
{"_id": "WikiPedia_Dermatology$$$corpus_1353", "text": "Carbamazepine, as an inducer of  cytochrome P450  enzymes, may increase clearance of many drugs, decreasing their concentration in the blood to subtherapeutic levels and reducing their desired effects. [ 33 ]  Drugs that are more rapidly metabolized with carbamazepine include  warfarin ,  lamotrigine ,  phenytoin ,  theophylline ,  valproic acid , [ 18 ]  many  benzodiazepines , [ 35 ]  and  methadone . [ 36 ]  Carbamazepine also increases the metabolism of the hormones in  birth control pills  and can reduce their effectiveness, potentially leading to unexpected pregnancies. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1354", "text": "Carbamazepine is a  sodium channel blocker . [ 37 ]   It binds preferentially to  voltage-gated sodium channels  in their inactive conformation, which prevents repetitive and sustained firing of an  action potential .  Carbamazepine has effects on serotonin systems but the relevance to its antiseizure effects is uncertain. There is evidence that it is a  serotonin releasing agent  and possibly even a  serotonin reuptake inhibitor . [ 38 ] [ 39 ] [ 40 ]  It has been suggested that carbamazepine can also block  voltage-gated calcium channels , which will reduce neurotransmitter release. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1355", "text": "Carbamazepine is relatively slowly but practically completely absorbed after administration by mouth. Highest concentrations in the  blood plasma  are reached after 4 to 24 hours depending on the dosage form.  Slow release  tablets result in about 15% lower absorption and 25% lower peak plasma concentrations than ordinary tablets, as well as in less fluctuation of the concentration, but not in significantly lower  minimum concentrations . [ 42 ] [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1356", "text": "In the circulation, carbamazepine itself comprises 20 to 30% of total residues. The remainder is in the form of  metabolites ; 70 to 80% of residues is bound to  plasma proteins . Concentrations in breast milk are 25 to 60% of those in the blood plasma. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1357", "text": "Carbamazepine itself is not pharmacologically active. It is activated, mainly by CYP3A4, to carbamazepine-10,11- epoxide , which is solely responsible for the drug's anticonvulsant effects. The epoxide is then inactivated by microsomal epoxide hydrolase (mEH) to carbamazepine- trans -10,11- diol  and further to its  glucuronides . Other metabolites include various  hydroxyl  derivatives and carbamazepine- N -glucuronide. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1358", "text": "The  plasma half-life  is about 35 to 40 hours when carbamazepine is given as single dose, but it is a strong  inducer  of liver enzymes, and the plasma half-life shortens to about 12 to 17 hours when it is given repeatedly. The half-life can be further shortened to 9\u201310 hours by other enzyme inducers such as  phenytoin  or  phenobarbital . About 70% are excreted via the urine, almost exclusively in form of its metabolites, and 30% via the faeces. [ 42 ] [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1359", "text": "Carbamazepine was discovered by chemist Walter Schindler at J.R. Geigy AG (now part of  Novartis ) in  Basel ,  Switzerland , in 1953. [ 44 ] [ 45 ]   It was first marketed as a  drug to treat epilepsy in Switzerland in 1963 under the brand name Tegretol; its use for  trigeminal neuralgia  (formerly known as tic douloureux) was introduced at the same time. [ 44 ]  It has been used as an anticonvulsant and antiepileptic in the United Kingdom since 1965, and has been approved in the United States since 1968. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1360", "text": "Carbamazepine was studied for bipolar disorder throughout the 1970s. [ 46 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1361", "text": "Carbamazepine and its bio-transformation products have been detected in wastewater treatment plant  effluent [ 47 ] :\u200a224\u200a  and in streams receiving treated wastewater. [ 48 ]  Field and laboratory studies have been conducted to understand the accumulation of carbamazepine in food plants grown in soil treated with  sludge , which vary with respect to the concentrations of carbamazepine present in sludge and in the concentrations of sludge in the soil. Taking into account only studies that used concentrations commonly found in the environment, a 2014 review concluded that \"the accumulation of carbamazepine into plants grown in soil amended with biosolids poses a  de minimis  risk to human health according to the approach.\" [ 47 ] :\u200a227"}
{"_id": "WikiPedia_Dermatology$$$corpus_1362", "text": "Carbamazepine is available worldwide under many brand names including Tegretol. [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1363", "text": "Cefixime , sold under the brand name  Suprax  among others, is an  antibiotic  medication used to treat a number of  bacterial infections . [ 5 ]  These infections include  otitis media ,  strep throat ,  pneumonia ,  urinary tract infections ,  gonorrhea , and  Lyme disease . [ 5 ]  For gonorrhea typically only one dose is required. [ 6 ]  In the United States it is a second-line treatment to  ceftriaxone  for gonorrhea. [ 5 ]  It is taken by mouth. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1364", "text": "Common side effects include  diarrhea ,  abdominal pain , and  nausea . [ 5 ]  Serious side effects may include  allergic reactions  and  Clostridioides difficile  diarrhea . [ 5 ]  It is not recommended in people with a history of a severe  penicillin allergy . [ 6 ]  It appears to be relatively safe during  pregnancy . [ 7 ]  It is in the  third-generation cephalosporin  class of medications. [ 5 ]  It works by disrupting the bacteria's  cell wall  resulting in its death. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1365", "text": "Cefixime was patented in 1979 and approved for medical use in the United States in 1989. [ 5 ] [ 8 ]  It is on the  World Health Organization's List of Essential Medicines . [ 9 ]  It is available as a  generic medication  in the United States. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1366", "text": "Cefixime treats infections of the:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1367", "text": "It is also used to treat  typhoid fever . [ 13 ] [ 14 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1368", "text": "Cefixime is a broad spectrum cephalosporin antibiotic and is commonly used to treat bacterial infections of the ear, urinary tract, and upper respiratory tract. The following represents MIC susceptibility data for a few medically significant microorganisms: [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1369", "text": "The bactericidal action of Cefixime is due to the inhibition of cell wall synthesis. [ medical citation needed ]  It binds to one of the  penicillin binding proteins  (PBPs) which inhibits the final transpeptidation step of the peptidoglycan synthesis in the bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1370", "text": "Absorption \nOnly 40\u201350% is absorbed from the GI tract (oral  bioavailability ). Absorption may be slowed but not decreased when taken with food. Average peak concentration after administration of oral suspension is approximately 25\u201350% greater than the peak concentration following oral tablet or capsules administration. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1371", "text": "Distribution \nIt has high concentrations in  bile  and  urine . It can cross the placenta and its protein binding capacity is 65%. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1372", "text": "Cefixime is contraindicated in patients with known sensitivity or allergies to  cephalosporin  class of  antibiotics . [ 11 ] [ 16 ]  As Cefixime is a third generation cephalosporin, it is not contraindicated for patients with a true penicillin allergy."}
{"_id": "WikiPedia_Dermatology$$$corpus_1373", "text": "Adverse drug reactions include  diarrhea ,  dyspepsia ,  nausea  and vomiting. [ 5 ]  Hypersensitivity reactions like skin rashes,  urticaria  and  Stevens\u2013Johnson syndrome  have been reported. [ medical citation needed ]  There is no specific  antidote  for cefixime overdosage. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1374", "text": "It was sold under the trade name Suprax 125 in the United States until 2003, when it was taken off the market by drug manufacturer  Wyeth  after its  patent  expired. [ citation needed ]  Lupin started selling Suprax in the United States in 2007, [ 18 ]  and it is available in different formulations and strengths. [ 18 ] [ 19 ] [ 20 ] [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1375", "text": "Cefixime is marketed under many  brand names  worldwide; examples include Fixacef, Pancef, Caricef, Taxim o, Texit, Ofex, Ceftid, Cef-3, Denvar, 3-C, Cefim, Magnett, Oroken, Ofiken, Fix-A, and Zifi. [ 1 ] [ 22 ]  In India it is marketed as Zifi 200 and is commonly  counterfeited . [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1376", "text": "Ciprofloxacin  is a  fluoroquinolone   antibiotic  used to treat a number of  bacterial infections . [ 5 ]  This includes bone and  joint infections , intra-abdominal infections, certain types of  infectious diarrhea ,  respiratory tract infections , skin infections,  typhoid fever , and  urinary tract infections , among others. [ 5 ]  For some infections it is used in addition to other antibiotics. [ 5 ]  It can be taken by mouth, as eye drops, as ear drops, or intravenously. [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1377", "text": "Common side effects include nausea, vomiting, and diarrhea. [ 5 ]  Severe side effects include an increased risk of  tendon rupture ,  hallucinations , and nerve damage. [ 5 ]  In people with  myasthenia gravis , there is worsening muscle weakness. [ 5 ]  Rates of side effects appear to be higher than some groups of antibiotics such as  cephalosporins  but lower than others such as  clindamycin . [ 7 ]  Studies in other animals raise concerns regarding use in  pregnancy . [ 8 ]  No problems were identified, however, in the children of a small number of women who took the medication. [ 8 ]  It appears to be safe during  breastfeeding . [ 5 ]  It is a second-generation fluoroquinolone with a  broad spectrum of activity  that usually results in the  death of the bacteria . [ 5 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1378", "text": "Ciprofloxacin was patented in 1980 and introduced by Bayer in 1987. [ 11 ] [ 12 ]  It is on the  World Health Organization's List of Essential Medicines . [ 13 ] [ 14 ]  The World Health Organization classifies ciprofloxacin as critically important for human medicine. [ 15 ]  It is available as a  generic medication . [ 5 ] [ 16 ]  In 2022, it was the 181st most commonly prescribed medication in the United States, with more than 2 \u00a0 million prescriptions. [ 17 ] [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1379", "text": "Ciprofloxacin is used to treat a wide variety of infections, including  infections of bones and joints ,  endocarditis , bacterial  gastroenteritis ,  malignant otitis externa ,  bubonic plague ,  respiratory tract infections ,  cellulitis ,  urinary tract infections ,  prostatitis ,  anthrax , and  chancroid . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1380", "text": "Ciprofloxacin only treats bacterial infections; it does not treat viral infections such as the  common cold . For certain uses including acute sinusitis, lower respiratory tract infections and uncomplicated  gonorrhea , ciprofloxacin is not considered a first-line agent."}
{"_id": "WikiPedia_Dermatology$$$corpus_1381", "text": "Ciprofloxacin occupies an important role in treatment guidelines issued by major medical societies for the treatment of serious infections, especially those likely to be caused by Gram-negative bacteria, including  Pseudomonas aeruginosa . For example, ciprofloxacin in combination with  metronidazole  is one of several first-line antibiotic regimens recommended by the  Infectious Diseases Society of America  for the treatment of community-acquired abdominal infections in adults. [ 19 ]  It also features prominently in treatment guidelines for acute pyelonephritis, complicated or hospital-acquired urinary tract infection, acute or chronic prostatitis, [ 20 ]  certain types of endocarditis, [ 21 ]  certain skin infections, [ 22 ]  and prosthetic joint infections. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1382", "text": "In other cases, treatment guidelines are more restrictive, recommending in most cases that older, narrower-spectrum drugs be used as first-line therapy for less severe infections to minimize fluoroquinolone-resistance development. For example, the Infectious Diseases Society of America recommends the use of ciprofloxacin and other fluoroquinolones in urinary tract infections be reserved to cases of proven or expected resistance to narrower-spectrum drugs such as  nitrofurantoin  or  trimethoprim/sulfamethoxazole . [ 24 ]  The  European Association of Urology  recommends ciprofloxacin as an alternative regimen for the treatment of uncomplicated urinary tract infections, but cautions that the potential for \"adverse events have to be considered\". [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1383", "text": "Although approved by regulatory authorities for the treatment of respiratory infections, ciprofloxacin is not recommended for respiratory infections by most treatment guidelines due in part to its modest activity against the common respiratory pathogen  Streptococcus pneumoniae . [ 25 ] [ 26 ] [ 27 ]  \"Respiratory quinolones\" such as  levofloxacin , having greater activity against this pathogen, are recommended as first line agents for the treatment of community-acquired pneumonia in patients with important co-morbidities and in patients requiring hospitalization (Infectious Diseases Society of America 2007). Similarly, ciprofloxacin is not recommended as a first-line treatment for  acute sinusitis . [ 28 ] [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1384", "text": "Ciprofloxacin is approved for the treatment of gonorrhea in many countries, but this recommendation is widely regarded as obsolete due to resistance development. [ 30 ] [ 31 ] [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1385", "text": "An expert review of published data on experiences with ciprofloxacin use during pregnancy concluded therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk (quantity and quality of data=fair), but the data are insufficient to state no risk exists. [ 33 ]  Exposure to quinolones, including levofloxacin, during the first-trimester is not associated with an increased risk of stillbirths, premature births, birth defects, or low birth weight. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1386", "text": "Two small post-marketing epidemiology studies of mostly short-term, first-trimester exposure found that fluoroquinolones did not increase risk of major malformations, spontaneous abortions, premature birth, or low birth weight. [ 35 ] [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1387", "text": "Fluoroquinolones have been reported as present in a mother's milk and thus passed on to the nursing child. [ 37 ] [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1388", "text": "Oral and intravenous ciprofloxacin are approved by the FDA for use in children for only two indications due to the risk of permanent injury to the musculoskeletal system:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1389", "text": "Its spectrum of activity includes most strains of bacterial pathogens responsible for  community-acquired pneumonias ,  bronchitis ,  urinary tract infections , and gastroenteritis. [ 41 ]  Ciprofloxacin is particularly effective against  Gram-negative bacteria  (such as  Escherichia coli ,  Haemophilus influenzae ,  Klebsiella pneumoniae ,  Legionella pneumophila ,  Moraxella catarrhalis ,  Proteus mirabilis , and  Pseudomonas aeruginosa ), but is less effective against  Gram-positive bacteria  (such as methicillin-sensitive  Staphylococcus aureus ,  Streptococcus pneumoniae , and  Enterococcus faecalis ) than newer fluoroquinolones. [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1390", "text": "As a result of its widespread use to treat minor infections readily treatable with older, narrower-spectrum antibiotics, many bacteria have developed resistance to this drug, leaving it significantly less effective than it would have been otherwise. [ 43 ] [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1391", "text": "Resistance  to ciprofloxacin and other  fluoroquinolones  may evolve rapidly, even during a course of treatment. Numerous  pathogens , including  enterococci ,  Streptococcus pyogenes  , and  Klebsiella pneumoniae  (quinolone-resistant) now exhibit resistance. [ 45 ]  Widespread veterinary usage of fluoroquinolones, particularly in Europe, has been implicated. [ 46 ]  Meanwhile, some  Burkholderia cepacia ,  Clostridium innocuum , and  Enterococcus faecium  strains have developed resistance to ciprofloxacin to varying degrees. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1392", "text": "Fluoroquinolones had become the class of antibiotics most commonly prescribed to adults in 2002. [ 48 ]  Nearly half (42%) of those prescriptions in the US were for conditions not approved by the FDA, such as acute bronchitis, otitis media, and acute upper respiratory tract infection. [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1393", "text": "Contraindications include: [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1394", "text": "Ciprofloxacin is also considered to be contraindicated in children (except for the indications outlined above), in  pregnancy , to nursing mothers, and in people with  epilepsy  or other  seizure  disorders."}
{"_id": "WikiPedia_Dermatology$$$corpus_1395", "text": "Caution may be required in people with  Marfan syndrome  or  Ehlers-Danlos syndrome . [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1396", "text": "Adverse effects can involve the tendons, muscles, joints, nerves, and the central nervous system. [ 51 ] [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1397", "text": "Rates of adverse effects appear to be higher than with some groups of antibiotics such as  cephalosporins  but lower than with others such as  clindamycin . [ 7 ]  Compared to other antibiotics some studies find a higher rate of adverse effects [ 53 ] [ 54 ]  while others find no difference. [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1398", "text": "In clinical trials most of the adverse events were described as mild or moderate in severity, abated soon after the drug was discontinued, and required no treatment. [ 3 ]  Some adverse effects may be permanent. [ 51 ]  Ciprofloxacin was stopped because of an adverse event in 1% of people treated with the medication by mouth. The most frequently reported drug-related events, from trials of all formulations, all dosages, all drug-therapy durations, and for all indications, were nausea (2.5%), diarrhea (1.6%), abnormal liver function tests (1.3%), vomiting (1%), and rash (1%). Other adverse events occurred at rates of <1%. [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1399", "text": "Ciprofloxacin includes a  boxed warning  in the United States due to an increased risk of  tendinitis  and tendon rupture, especially in people who are older than 60 years, people who also use corticosteroids, and people with kidney, lung, or heart transplants. [ 57 ]  Tendon rupture can occur during therapy or even months after discontinuation of the medication. [ 58 ]  One study found that fluoroquinolone use was associated with a 1.9-fold increase in tendon problems. The risk increased to 3.2 in those over 60 years of age and to 6.2 in those over the age of 60 who were also taking corticosteroids. Among the 46,766 quinolone users in the study, 38 (0.08%) cases of Achilles tendon rupture were identified. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1400", "text": "The fluoroquinolones, including ciprofloxacin, are associated with an increased risk of cardiac toxicity, including  QT interval  prolongation,  torsades de pointes , ventricular arrhythmia, and  sudden death . [ 60 ] [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1401", "text": "Because Ciprofloxacin is lipophilic, it has the ability to cross the  blood\u2013brain barrier . [ 61 ]  The 2013 FDA label warns of nervous system effects. Ciprofloxacin, like other fluoroquinolones, is known to trigger seizures or lower the seizure threshold, and may cause other central nervous system adverse effects. Headache, dizziness, and insomnia have been reported as occurring fairly commonly in postapproval review articles, along with a much lower incidence of serious CNS adverse effects such as tremors, psychosis, anxiety, hallucinations, paranoia, and suicide attempts, especially at higher doses. [ 7 ]  Like other fluoroquinolones, it is also known to cause peripheral neuropathy that may be irreversible, such as weakness, burning pain, tingling or numbness. [ 62 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1402", "text": "Fluoroquinolones have already been reported for movement disorders. [ 6 ]  In this context, ciprofloxacin is especially associated with  myoclonus , which derives the term \"ciproclonus.\" [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1403", "text": "Ciprofloxacin is active in six of eight  in vitro  assays used as rapid screens for the detection of genotoxic effects, but is not active in  in vivo  assays of genotoxicity. [ 3 ]  Long-term carcinogenicity studies in rats and mice resulted in no carcinogenic or tumorigenic effects due to ciprofloxacin at daily oral dose levels up to 250 and 750\u00a0mg/kg to rats and mice, respectively (about 1.7 and 2.5 times the highest recommended therapeutic dose based upon mg/m 2 ). Results from photo co-carcinogenicity testing indicate ciprofloxacin does not reduce the time to appearance of UV-induced skin tumors as compared to vehicle control. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1404", "text": "The other black box warning is that ciprofloxacin should not be used in people with  myasthenia gravis  due to possible exacerbation of muscle weakness which may lead to breathing problems resulting in death or ventilator support. Fluoroquinolones are known to block neuromuscular transmission. [ 3 ]  There are concerns that fluoroquinolones including ciprofloxacin can affect cartilage in young children. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1405", "text": "Clostridioides difficile -associated diarrhea is a serious adverse effect of ciprofloxacin and other fluoroquinolones; it is unclear whether the risk is higher than with other broad-spectrum antibiotics. [ 63 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1406", "text": "A wide range of rare but potentially fatal adverse effects reported to the US FDA or the subject of case reports includes  aortic dissection , [ 64 ]   toxic epidermal necrolysis ,  Stevens\u2013Johnson syndrome , low blood pressure, allergic pneumonitis, bone marrow suppression, hepatitis or liver failure, and sensitivity to light. [ 3 ] [ 65 ]  The medication should be discontinued if a rash, jaundice, or other sign of hypersensitivity occurs. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1407", "text": "Children and the elderly are at a much greater risk of experiencing adverse reactions. [ 66 ] [ 67 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1408", "text": "Overdose of ciprofloxacin may result in reversible renal toxicity. Treatment of overdose includes emptying of the stomach by induced vomiting or  gastric lavage , as well as administration of antacids containing magnesium, aluminium, or calcium to reduce drug absorption. Renal function and urinary pH should be monitored. Important support includes adequate hydration and urine acidification if necessary to prevent crystalluria.  Hemodialysis  or  peritoneal dialysis  can only remove less than 10% of ciprofloxacin. [ 68 ]  Ciprofloxacin may be quantified in plasma or serum to monitor for drug accumulation in patients with hepatic dysfunction or to confirm a diagnosis of poisoning in acute overdose victims. [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1409", "text": "Ciprofloxacin interacts with certain foods and several other drugs leading to undesirable increases or decreases in the serum levels or distribution of one or both drugs."}
{"_id": "WikiPedia_Dermatology$$$corpus_1410", "text": "Ciprofloxacin should not be taken with antacids containing magnesium or aluminum, highly buffered drugs ( sevelamer ,  lanthanum carbonate ,  sucralfate ,  didanosine ), or with supplements containing calcium, iron, or zinc. It should be taken two hours before or six hours after these products. Magnesium or aluminum antacids turn ciprofloxacin into insoluble salts that are not readily absorbed by the intestinal tract, reducing peak serum concentrations by 90% or more, leading to therapeutic failure. Additionally, it should not be taken with dairy products or calcium-fortified juices alone, as peak serum concentration and the area under the serum concentration-time curve can be reduced up to 40%. However, ciprofloxacin may be taken with dairy products or calcium-fortified juices as part of a meal. [ 68 ] [ 70 ] [ 71 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1411", "text": "Ciprofloxacin inhibits the drug-metabolizing enzyme  CYP1A2  and thereby can reduce the clearance of drugs metabolized by that enzyme. CYP1A2 substrates that exhibit increased serum levels in ciprofloxacin-treated patients include  tizanidine ,  theophylline ,  caffeine ,  methylxanthines ,  clozapine ,  olanzapine , and  ropinirole . Co-administration of ciprofloxacin with the CYP1A2 substrate tizanidine (Zanaflex) is contraindicated due to a 583% increase in the peak serum concentrations of tizanidine when administered with ciprofloxacin as compared to administration of tizanidine alone. Use of ciprofloxacin is cautioned in patients on theophylline due to its narrow therapeutic index. The authors of one review recommended that patients being treated with ciprofloxacin reduce their caffeine intake. Evidence for significant interactions with several other CYP1A2 substrates such as  cyclosporine  is equivocal or conflicting. [ 71 ] [ 3 ] [ 72 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1412", "text": "The  Committee on Safety of Medicines  and the FDA warn that  central nervous system  adverse effects, including seizure risk, may be increased when  NSAIDs  are combined with quinolones. [ 3 ] [ 73 ]  The mechanism for this interaction may involve a  synergistic  increased antagonism of GABA neurotransmission. [ 74 ] [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1413", "text": "Altered serum levels of the antiepileptic drugs  phenytoin  and  carbamazepine  (increased and decreased) have been reported in patients receiving concomitant ciprofloxacin. [ 3 ] [ 76 ] [ 77 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1414", "text": "Ciprofloxacin is a potent inhibitor of  CYP1A2 ,  CYP2D6 , and  CYP3A4 . [ 78 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1415", "text": "Ciprofloxacin is a  broad-spectrum antibiotic  of the  fluoroquinolone  class. It is active against some  Gram-positive  and many  Gram-negative  bacteria. [ 79 ]  It functions by inhibiting a type II  topoisomerase  ( DNA gyrase ) and topoisomerase IV, [ 80 ] [ 81 ]  necessary to separate bacterial DNA, thereby inhibiting cell division. Bacterial DNA fragmentation will occur as a result of inhibition of the enzymes."}
{"_id": "WikiPedia_Dermatology$$$corpus_1416", "text": "Ciprofloxacin for systemic administration is available as immediate-release tablets, extended-release tablets, an oral suspension, and as a solution for intravenous administration. When administered over one hour as an intravenous infusion, [ 3 ]  ciprofloxacin rapidly distributes into the tissues, with levels in some tissues exceeding those in the serum. Penetration into the central nervous system is relatively modest, with cerebrospinal fluid levels normally less than 10% of peak serum concentrations. The serum half-life of ciprofloxacin is about 4\u20136 hours, with 50\u201370% of an administered dose being excreted in the urine as unmetabolized drug. An additional 10% is excreted in urine as metabolites. Urinary excretion is virtually complete 24 hours after administration. Dose adjustment is required in the elderly and in those with renal impairment. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1417", "text": "Ciprofloxacin is weakly bound to serum proteins (20\u201340%). It is an inhibitor of the drug-metabolizing enzyme  cytochrome P450 1A2 , which leads to the potential for clinically important drug interactions with drugs metabolized by that enzyme. [ 5 ]  Ciprofloxacin is about 70% available when administered orally. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1418", "text": "The extended release tablets [ 82 ]  allow once-daily administration by releasing the drug more slowly in the gastrointestinal tract. These tablets contain 35% of the administered dose in an immediate-release form and 65% in a slow-release matrix. Maximum serum concentrations are achieved between 1 and 4 hours after administration. Compared to the 250- and 500-mg immediate-release tablets, the 500-mg and 1000-mg XR tablets provide higher C max , but the 24\u2011hour AUCs are equivalent."}
{"_id": "WikiPedia_Dermatology$$$corpus_1419", "text": "Ciprofloxacin immediate-release tablets contain ciprofloxacin as the hydrochloride salt, and the XR tablets contain a mixture of the hydrochloride salt and the free base. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1420", "text": "Ciprofloxacin is 1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylic acid. Its empirical formula is C 17 H 18 FN 3 O 3  and its molecular weight is 331.4 g/mol. It is a faintly yellowish to light yellow crystalline substance. [ 68 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1421", "text": "Ciprofloxacin hydrochloride ( USP ) is the monohydrochloride monohydrate salt of ciprofloxacin. It is a faintly yellowish to light yellow crystalline substance with a molecular weight of 385.8 g/mol. Its empirical formula is C 17 H 18 FN 3 O 3 HCl\u2022H 2 O. [ 68 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1422", "text": "Ciprofloxacin is the most widely used of the second-generation quinolones. [ 83 ] [ 84 ]  In 2010, over 20 million prescriptions were written, making it the 35th-most-commonly prescribed generic drug and the 5th-most-commonly prescribed antibacterial in the US. [ 85 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1423", "text": "The first members of the quinolone antibacterial class were relatively low-potency drugs such as  nalidixic acid , used mainly in the treatment of urinary tract infections owing to their renal excretion and propensity to be concentrated in urine. [ 86 ]  In 1979, the publication of a patent [ 87 ]  filed by the pharmaceutical arm of Kyorin Seiyaku Kabushiki Kaisha disclosed the discovery of  norfloxacin , and the demonstration that certain structural modifications including the attachment of a fluorine atom to the quinolone ring leads to dramatically enhanced antibacterial potency. [ 88 ]  In the aftermath of this disclosure, several other pharmaceutical companies initiated research and development programs with the goal of discovering additional antibacterial agents of the fluoroquinolone class."}
{"_id": "WikiPedia_Dermatology$$$corpus_1424", "text": "The fluoroquinolone program at  Bayer  focused on examining the effects of very minor changes to the norfloxacin structure. [ 89 ] [ 90 ]  In 1983, the company published  in vitro  potency data for ciprofloxacin, a fluoroquinolone antibacterial having a chemical structure differing from that of norfloxacin by the presence of a single carbon atom. [ 91 ]  This small change led to a two- to 10-fold increase in potency against most strains of Gram-negative bacteria. Importantly, this structural change led to a four-fold improvement in activity against the important  Gram-negative  pathogen  Pseudomonas aeruginosa , making ciprofloxacin one of the most potent known drugs for the treatment of this intrinsically antibiotic-resistant pathogen. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1425", "text": "The oral tablet form of ciprofloxacin was approved in October 1987, [ 92 ]  just one year after the approval of norfloxacin. [ 93 ]  In 1991, the intravenous formulation was introduced. Ciprofloxacin sales reached a peak of about 2  billion  euros in 2001, before Bayer's patent expired in 2004, after which annual sales have averaged around \u20ac200 million. [ 94 ] [ 95 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1426", "text": "The name probably originates from the International Scientific Nomenclature: ci- (alteration of cycl-) + propyl + fluor- + ox- + az- + -mycin. [ 96 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1427", "text": "It is available as a generic medication and not very expensive. [ 5 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1428", "text": "In October 2001, the Prescription Access Litigation (PAL) project filed suit to dissolve an agreement between Bayer and three of its competitors which produced  generic versions of drugs  ( Barr Laboratories ,  Rugby Laboratories , and  Hoechst-Marion-Roussel ) that PAL claimed was blocking access to adequate supplies and cheaper, generic versions of ciprofloxacin. The plaintiffs charged that Bayer Corporation, a unit of Bayer AG, had unlawfully paid the three competing companies a total of $200 million to prevent cheaper, generic versions of ciprofloxacin from being brought to the market, as well as manipulating its price and supply. Numerous other consumer advocacy groups joined the lawsuit. On 15 October 2008, five years after Bayer's patent had expired, the United States District Court for the Eastern District of New York granted Bayer's and the other defendants' motion for summary judgment, holding that any anticompetitive effects caused by the settlement agreements between Bayer and its codefendants were within the exclusionary zone of the patent and thus could not be redressed by federal antitrust law, [ 97 ]  in effect upholding Bayer's agreement with its competitors."}
{"_id": "WikiPedia_Dermatology$$$corpus_1429", "text": "Ciprofloxacin for systemic administration is available as immediate-release tablets, as extended-release tablets, as an oral suspension, and as a solution for intravenous infusion. It is available for local administration as eye drops and ear drops. It is available in combination with  dexamethasone , with  celecoxib , with  hydrocortisone , and with  fluocinolone acetonide . [ 98 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1430", "text": "A class action was filed against Bayer AG on behalf of employees of the Brentwood Post Office in Washington, D.C., and workers at the U.S. Capitol, along with employees of American Media, Inc. in Florida and postal workers in general who alleged they developed serious adverse effects from taking ciprofloxacin in the aftermath of the  anthrax attacks in 2001 . The action alleged Bayer failed to warn class members of the potential side effects of the drug, thereby violating the Pennsylvania Unfair Trade Practices and Consumer Protection Laws. The class action was defeated and the litigation abandoned by the plaintiffs. [ 99 ]  A similar action was filed in 2003 in New Jersey by four New Jersey postal workers but was withdrawn for lack of grounds, as workers had been informed of the risks of ciprofloxacin when they were given the option of taking the drug. [ 100 ] [ 101 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1431", "text": "As resistance to ciprofloxacin has grown since its introduction, research has been conducted to discover and develop analogs that can be effective against resistant bacteria; some have been looked at in antiviral models as well. [ 102 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1432", "text": "A  dermatotoxin  or  dermatoxin  (from  derma , the  Greek  word for skin) is a  toxic  chemical that damages  skin ,  mucous membranes , or both, often leading to tissue  necrosis . Dermatoxins can be drugs, natural chemicals, or synthetic chemicals."}
{"_id": "WikiPedia_Dermatology$$$corpus_1433", "text": "The severity of the effects of a dermatoxic agent is strongly dependent on the dose, route of exposure, rate at which it spreads, and the health of the afflicted individual."}
{"_id": "WikiPedia_Dermatology$$$corpus_1434", "text": "It can produce  allergic contact dermatitis , changes that lead to  skin cancer ,  chemical burns ,  irritant dermatitis ,  photodermatitis ,  phototoxicity , changes to pigmentation, and  urticaria . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1435", "text": "This  toxicology -related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1436", "text": "Diclofenac , sold under the brand name  Voltaren  among others, is a  nonsteroidal anti-inflammatory drug  (NSAID) used to treat  pain  and  inflammatory diseases  such as  gout . [ 6 ] [ 9 ]  It can be taken  orally  (swallowed by mouth), inserted  rectally  as a  suppository , injected  intramuscularly , injected  intravenously ,  applied to the skin topically , or  through eye drops . [ 9 ] [ 12 ] [ 13 ]  Improvements in pain last up to eight hours. [ 9 ]  It is also available as the  fixed-dose combination   diclofenac/misoprostol  (Arthrotec) to help protect the stomach. [ 14 ] [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1437", "text": "Common side effects include  abdominal pain ,  gastrointestinal bleeding , nausea, dizziness, headache, and swelling. [ 9 ]  Serious side effects may include  heart disease ,  stroke ,  kidney problems , and  stomach ulceration . [ 15 ] [ 9 ]  Use is not recommended in the  third trimester of pregnancy . [ 9 ]  It is likely safe during  breastfeeding . [ 15 ]  Diclofenac is believed to work by decreasing the production of  prostaglandins , like other drugs in this class. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1438", "text": "In 2022, it was the 51st most commonly prescribed medication in the United States, with more than 12 \u00a0 million prescriptions. [ 17 ] [ 18 ]  It is available as its acid or in two salts, as either diclofenac sodium or potassium. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1439", "text": "Diclofenac is used to  treat   pain  related to  arthritis ,  dysmenorrhea ,  rheumatic diseases  and other  inflammatory disorders , [ 9 ]   kidney stones  and  gallstones . An additional indication is the treatment of acute  migraines . [ 7 ]  Diclofenac is used to treat mild to moderate postoperative or post-traumatic pain, in particular when inflammation is also present."}
{"_id": "WikiPedia_Dermatology$$$corpus_1440", "text": "Diclofenac ophthalmic is indicated for the treatment of postoperative inflammation in people who have undergone cataract extraction and for the temporary relief of pain and photophobia in people undergoing corneal refractive surgery. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1441", "text": "Diclofenac is also available in topical forms and is useful for  osteoarthritis  but not other types of long-term musculoskeletal pain. [ 20 ]  Diclofenac may also help with  actinic keratosis  and with acute pain caused by minor strains, sprains and  contusions . [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1442", "text": "In many countries, eye drops are sold to treat acute and chronic nonbacterial inflammation of the anterior part of the eyes (such as postoperative states). [ 22 ]  The eye drops have also been used to manage pain for  traumatic corneal abrasion . [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1443", "text": "Diclofenac is often used to treat chronic  pain associated with cancer , especially if inflammation is present. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1444", "text": "Diclofenac is contraindicated for pregnant women; for people with active stomach and/or duodenal  ulceration  or  gastrointestinal bleeding ; and for people undergoing  coronary artery bypass surgery . [ 9 ] [ 25 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1445", "text": "Diclofenac consumption has been associated with significantly increased vascular and coronary risk in a study including coxib, diclofenac,  ibuprofen  and  naproxen . [ 27 ]  Upper gastrointestinal complications were also reported. [ 27 ]   Major adverse cardiovascular events  were increased by about a third by diclofenac, chiefly due to an increase in major coronary events. [ 27 ]  Compared with placebo, of 1000 patients allocated to diclofenac for a year, three more had major vascular events, one of which was fatal. [ 27 ]  Vascular death is increased significantly by diclofenac. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1446", "text": "In October 2020, the US  Food and Drug Administration  (FDA) required the  prescription label  to be updated for all nonsteroidal anti-inflammatory medications to describe the risk of kidney problems in fetuses that result in low amniotic fluid. [ 28 ] [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1447", "text": "In 2013, a study found major vascular events were increased by about a third by diclofenac, chiefly due to an increase in major coronary events. [ 27 ]  Compared with placebo, of 1000 people allocated to diclofenac for a year, three more had major vascular events, one of which was fatal. [ 27 ]  Vascular death was increased by diclofenac (1\u00b765). [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1448", "text": "Following the identification of increased risks of heart attacks with the selective  COX-2 inhibitor   rofecoxib  in 2004, attention has focused on all the other members of the nonsteroidal anti-inflammatory drug group, including diclofenac. Research results are mixed, with a meta-analysis of papers and reports up to April 2006 suggesting a relative increased rate of heart disease of 1.63 compared to nonusers. [ 30 ]  Professor Peter Weissberg, medical director of the British Heart Foundation said, \"However, the increased risk is small, and many patients with chronic debilitating pain may well feel that this small risk is worth taking to relieve their symptoms\". Only  aspirin  was found not to increase the risk of heart disease; however, this is known to have a higher rate of gastric ulceration than diclofenac. As of January 2015, the MHRA announced that diclofenac would be reclassified as a prescription-only medicine (POM) due to the risk of cardiovascular adverse events. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1449", "text": "A subsequent large study of 74,838 Danish users of nonsteroidal anti-inflammatory drugs or  coxibs  found no additional cardiovascular risk from diclofenac use. [ 32 ]  A very large study of 1,028,437 Danish users of various nonsteroidal anti-inflammatory drugs or coxibs found the \"Use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with an increased risk of cardiovascular death ( odds ratio , 1.91; 95% confidence interval, 1.62 to 2.42; and odds ratio, 1.66; 95% confidence interval, 1.06 to 2.59, respectively), with a dose-dependent increase in risk.\" [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1450", "text": "Diclofenac is similar in COX-2 selectivity to  celecoxib . [ 34 ] [ contradictory ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1451", "text": "As with other nonsteroidal anti-inflammatory drugs, the primary  mechanism  responsible for its  anti-inflammatory ,  antipyretic  and  analgesic  action is thought to be inhibition of prostaglandin synthesis through  COX -inhibition."}
{"_id": "WikiPedia_Dermatology$$$corpus_1452", "text": "The main target in the inhibition of prostaglandin synthesis appears to be the transiently expressed prostaglandin-endoperoxide synthase-2 (PGES-2), also known as  cycloxygenase-2  (COX-2). That is, diclofenac is partially selective for COX-2. The reported selectivity for COX-2 varies from 1.5 to 30 depending on the source. [ 38 ] [ 39 ] [ 40 ] [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1453", "text": "The drug may be bacteriostatic via inhibiting bacterial DNA synthesis. [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1454", "text": "Diclofenac has a relatively high lipid solubility, making it one of the few nonsteroidal anti-inflammatory drugs that are able to enter the brain by crossing the  blood-brain barrier . [ 43 ]  As in the rest of the body, it is thought to exert its effect in the brain through inhibition of COX-2. [ 43 ]  In addition, it may have effects inside the spinal cord. [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1455", "text": "Diclofenac may be a unique member of the nonsteroidal anti-inflammatory drugs in other aspects. Some evidence indicates it inhibits the  lipoxygenase  pathways, [ 45 ] [ 46 ]  thus reducing the formation of  leukotrienes  (also pro-inflammatory  autacoids ). It also may inhibit  phospholipase A2 , which may be relevant to its mechanism of action. These additional actions may explain its high potency \u2013 it is the most potent NSAID on a broad basis. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1456", "text": "Marked differences exist among nonsteroidal anti-inflammatory drugs in their selective inhibition of the two subtypes of cyclooxygenase, COX-1, and COX-2. [ 48 ]  Drug developers have focused on selective COX-2 inhibition, particularly as a way to minimize the gastrointestinal side effects of nonsteroidal anti-inflammatory drugs. In practice, the use of some  COX-2 inhibitors  with their  adverse effects  has led to massive numbers of lawsuits alleging wrongful death by  heart attack , yet other significantly COX-selective nonsteroidal anti-inflammatory drugs, such as diclofenac, have been well tolerated by most of the population. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1457", "text": "Besides the COX-inhibition, several other molecular targets of diclofenac possibly contributing to its pain-relieving actions have recently been identified. These include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1458", "text": "The duration of action (i.e., duration of pain relief) of a single dose is longer (6 to 8\u00a0 h ) than the drug's 1.2\u20132\u00a0h half-life. This could be partly because it persists for over 11 hours in  synovial fluids . [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1459", "text": "Diclofenac was first synthesized by Alfred Sallmann and Rudolf Pfister in 1973. [ 54 ] [ 55 ]  The name \"diclofenac\" derives from its chemical name: 2-(2,6- dichlo ranilino)  phen yl ac etic acid. It was patented in Germany in 1978 by Ciba-Geigy (now  Novartis ). [ 56 ] [ 57 ]  It came into medical use in the United States in 1988. [ 9 ]   GlaxoSmithKline  purchased the rights in 2015. [ 54 ]  It is available as a  generic medication . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1460", "text": "Diclofenac formulations are available worldwide under many different brand names. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1461", "text": "Voltaren and Voltarol contain the sodium salt of diclofenac. In the United Kingdom, Voltarol can be supplied with either the sodium salt or the potassium salt, while Cataflam, sold in some other countries, is the potassium salt only. However, Voltarol Emulgel contains diclofenac diethylammonium 1.16%, being equivalent to 1% sodium salt. In 2016, Voltarol was one of the biggest selling branded over-the-counter medications sold in Great Britain, with sales of \u00a339.3 million. [ 58 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1462", "text": "In the United States, 1% diclofenac gel was approved by the FDA in 2007 as a prescription drug for the temporary relief of the pain of osteoarthritis of joints in the hands, knees, and feet. In 2020, the FDA approved the gel formulation for  nonprescription  use. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1463", "text": "In January 2015, diclofenac oral preparations were reclassified as prescription-only medicines in the UK. The topical preparations are available without a prescription. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1464", "text": "Use of diclofenac for animals is controversial due to toxicity when eaten by scavenging birds that eat dead animals; [ 60 ] [ 61 ]  the medication has been banned for veterinary use in several countries. [ 62 ] [ 63 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1465", "text": "Use of diclofenac in animals has been reported to have led to a sharp decline in the  vulture  population in the Indian subcontinent \u2013 a 95% decline by 2003 [ 64 ]  and a 99.9% decline by 2008. The mechanism is presumed to be  kidney failure ; [ 65 ]  however, toxicity may be due to direct inhibition of uric acid secretion in vultures. [ 66 ]  Vultures eat the carcasses of  livestock  that have been administered veterinary diclofenac, and are poisoned by the accumulated chemical, [ 67 ]  as vultures do not have a particular enzyme to break down diclofenac. At a meeting of the National Wildlife Board in March 2005, the Government of India announced it intended to phase out the veterinary use of diclofenac. [ 68 ]   Meloxicam  is a safer alternative to replace use of diclofenac. [ 69 ]  It is more expensive than diclofenac, but the cost is dropping [ when? ]  as more pharmaceutical companies are beginning to manufacture it. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1466", "text": "Steppe eagles  have the same vulnerability to diclofenac as Old World vultures and are therefore at a similar risk from its effects. [ 70 ]  Diclofenac has been shown also to harm freshwater fish species such as rainbow trout. [ 71 ] [ 72 ] [ 73 ] [ 74 ]  In contrast,  New World vultures , such as the  turkey vulture , can tolerate at least 100 times the level of diclofenac that is lethal to  Gyps  species. [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1467", "text": "\"The loss of tens of millions of vultures over the last decade has had major ecological consequences across the Indian subcontinent that pose a potential threat to human health. In many places, populations of  feral dogs  have increased sharply from the disappearance of  Gyps  vultures as the main scavenger of wild and domestic  ungulate  carcasses. Associated with the rise in dog numbers is an increased risk of  rabies \" [ 69 ]  and casualties of almost 50,000 people. [ 76 ]  The Government of India cites this as one of the major consequences of a vulture species extinction. [ 68 ]  A major shift in the transfer of corpse pathogens from vultures to feral dogs and rats could lead to a disease pandemic, causing millions of deaths in a crowded country like India, whereas vultures' digestive systems safely destroy many species of such pathogens. Vultures are long-lived and slow to breed. They start breeding only at the age of six and only 50% of their young survive. Even if the government ban is fully implemented, it will take many years to revive the vulture population. [ 77 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1468", "text": "The loss of vultures has had a social impact on the Indian  Zoroastrian   Parsi community , who traditionally use vultures to  dispose of human corpses  in  Towers of Silence , but are now compelled to seek alternative methods of disposal. [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1469", "text": "Despite the vulture crisis, diclofenac remains available in other countries including many in Europe. [ 78 ]  It was controversially approved for veterinary use in Spain in 2013 and continues to be available, despite Spain being home to around 90% of the European vulture population and an independent simulation showing that the drug could reduce the population of vultures by 1\u20138% annually.  Spain's medicine agency  presented simulations suggesting that the number of deaths would be quite small. [ 79 ] [ 80 ]  A paper published in 2021 identified the first authenticated death of a vulture from diclofenac in Spain, a  cinereous vulture . [ 61 ] [ 81 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1470", "text": "Diclofenac is on the European Union's watch list because it pollutes the  Baltic Sea . When the substance enters  freshwater , it has an environmental impact and is considered more difficult to remove in  wastewater treatment plants  than, for example,  ibuprofen . [ 82 ]  Harmful residues have been found in  blue mussels  and fish, among others, where it has been found to cause damage to internal organs such as the  gills , kidneys and liver. [ 83 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1471", "text": "Diclofenac is used for livestock; such use was responsible for the  Indian vulture crisis , during which in a few years 95% of the country's vulture population was killed, and in many countries, agricultural use is now forbidden. [ 60 ] [ 61 ] [ 62 ] [ 63 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1472", "text": "Diclofenac is approved as a veterinary medication in some countries [ 60 ] [ 61 ] [ 62 ] [ 63 ]  for the treatment of pets as well as in livestock. In some species of birds, diclofenac causes accumulation of  uric acid  crystals in internal organs\u2014especially the liver and kidneys\u2014resulting in  visceral gout , as well as cellular damage and  necrosis . [ 84 ]  In South Asia in the 2000s,  vulture populations were decimated  after feeding on carcasses of livestock that had been treated with diclofenac. [ 79 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1473", "text": "Droxicam  is a  non-steroidal anti-inflammatory drug  of the  oxicam  class. A  prodrug  of  piroxicam , it is used for the relief of  pain  and  inflammation  in  musculoskeletal disorders  such as  rheumatoid arthritis  and  osteoarthritis . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1474", "text": "When heated, phenyl pyridin-2-ylcarbamate (1) decomposes to 2-isocyanatopyridine (2) which reacts with the  heterocyclic compound  (3) to give droxicam. [ 2 ] [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1475", "text": "Ethosuximide , sold under the brand name  Zarontin  among others, is a medication used to treat  absence seizures . [ 4 ]  It may be used by itself or with other  antiseizure medications  such as  valproic acid . [ 4 ]  Ethosuximide is taken by mouth. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1476", "text": "Ethosuximide is usually well tolerated. [ 5 ]  Common side effects include loss of appetite, abdominal pain, diarrhea, and feeling tired. [ 4 ]  Serious side effects include  suicidal thoughts ,  low blood cell levels , and  lupus erythematosus . [ 4 ] [ 5 ]  It is unclear if it has adverse effects on the fetus during  pregnancy . [ 4 ]  Ethosuximide is in the  succinimide  family of medications. Its mechanism of action is thought to be due to antagonism of the postsynaptic T-type voltage-gated calcium channel. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1477", "text": "Ethosuximide was approved for medical use in the United States in 1960. [ 7 ]  It is on the  World Health Organization's List of Essential Medicines . [ 8 ]  Ethosuximide is available as a  generic medication . [ 4 ]  As of 2019 [update] , its availability was limited in many countries, with concerns about  price fixing  in the United States. [ 9 ] [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1478", "text": "Ethosuximide is approved for  absence seizures , [ 12 ]  and is considered the first choice medication for treating them, in part because it lacks the idiosyncratic  hepatotoxicity  of the alternative anti-absence drug,  valproic acid . [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1479", "text": "As with other anticonvulsants, ethosuximide carries a warning about use during pregnancy. Although a causal relationship with birth defects has not be established, the potential for harm to the baby is weighed against the known harm caused by a mother having even minor seizures. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1480", "text": "The following can occur with or without bone marrow loss:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1481", "text": "Valproates  can either decrease or increase the levels of ethosuximide; however, combinations of  valproates  and ethosuximide had a greater  protective index  than either drug alone. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1482", "text": "It may elevate serum  phenytoin  levels."}
{"_id": "WikiPedia_Dermatology$$$corpus_1483", "text": "The mechanism by which ethosuximide affects neuronal excitability includes block of  T-type calcium channels , and may include effects of the drug on other classes of ion channel. The primary finding that ethosuximide is a T-type calcium channel blocker gained widespread support, but initial attempts to replicate the finding were inconsistent. Subsequent experiments on recombinant T-type channels in cell lines demonstrated conclusively that ethosuximide blocks all T-type calcium channel isoforms. [ citation needed ]  Significant T-type calcium channel density occurs in dendrites of neurons, and recordings from reduced preparations that strip away this dendritic source of T-type calcium channels may have contributed to reports of ethosuximide ineffectiveness."}
{"_id": "WikiPedia_Dermatology$$$corpus_1484", "text": "In March 1989, Coulter, Huguenard and Prince showed that ethosuximide and  dimethadione , both effective anti-absence agents, reduced low-threshold  Ca 2+   currents  in  T-type calcium channels  in freshly removed  thalamic   neurons . [ 15 ]  In June of that same year, they also found the mechanism of this reduction to be  voltage -dependent, using acutely dissociated neurons of rats and guinea pigs; it was also noted that  valproic acid , which is also used in absence seizures, did not do that. [ 16 ]  The next year, they showed that anticonvulsant succinimides did this and that the  pro-convulsant  ones did not. [ 17 ]  The first part was supported by  Kostyuk  et al. in 1992, who reported a substantial reduction in current in  dorsal root   ganglia  at concentrations ranging from 7 \u03bcmol/L to 1\u00a0mmol/L. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1485", "text": "That same year, however, Herrington and Lingle found no such effect at concentrations of up to 2.5\u00a0mmol/L. [ 19 ]  The year after, a study conducted on human  neocortical  cells removed during surgery for intractable epilepsy, the first to use human tissue, found that ethosuximide had no effect on Ca 2+  currents at the concentrations typically needed for a therapeutic effect. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1486", "text": "In 1998, Slobodan M. Todorovic and Christopher J. Lingle of Washington University reported a 100% block of T-type current in dorsal root ganglia at 23.7 \u00b1 0.5\u00a0mmol/L, far higher than Kostyuk reported. [ 21 ]  That same year, Leresche et al. reported that ethosuximide had no effect on T-type currents, but did decrease noninactivating  Na +  current by 60% and the Ca 2+ -activated K +  currents by 39.1 \u00b1 6.4% in rat and cat thalamocortical cells. It was concluded that the decrease in Na +  current is responsible for the anti-absence properties. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1487", "text": "In the introduction of a paper published in 2001, Dr. Juan Carlos Gomora and colleagues at the  University of Virginia  in  Charlottesville  pointed out that past studies were often done in isolated neurons that had lost most of their T-type channels. [ 23 ]  Using cloned  \u03b1 1 G ,  \u03b1 1 H , and  \u03b1 1 I  T-type calcium channels, Gomora's team found that ethosuximide blocked the channels with an  IC 50  of 12 \u00b1 2\u00a0mmol/L and that of  N -desmethylmethsuximide (the active metabolite of  mesuximide ) is 1.95 \u00b1 0.19\u00a0mmol/L for \u03b1 1 G, 1.82 \u00b1 0.16\u00a0mmol/L for \u03b1 1 I, and 3.0 \u00b1 0.3\u00a0mmol/L for \u03b1 1 H. It was suggested that the blockade of open channels is facilitated by ethosuximide's physically plugging the channels when current flows inward."}
{"_id": "WikiPedia_Dermatology$$$corpus_1488", "text": "Ethosuximide is a chiral drug with a  stereocenter . Therapeutically, the  racemate , the 1: 1 mixture of (  S  ) and (  R  ) - isomers used. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1489", "text": "As of 2019 there were concerns in the United States that the price of ethosuximide was inflated by manufacturers. [ 11 ] [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1490", "text": "Availability of ethosuximide is limited in many countries. [ 9 ]  It was marketed under the trade names Emeside and Zarontin. However, both capsule preparations were discontinued from production, leaving only generic preparations available. Emeside capsules were discontinued by their manufacturer,  Laboratories for Applied Biology , in 2005. [ 26 ]  Similarly, Zarontin capsules were discontinued by  Pfizer  in 2007. [ 27 ]  Syrup preparations of both brands remained available."}
{"_id": "WikiPedia_Dermatology$$$corpus_1491", "text": "Etifoxine , sold under the trade name  Stresam  among others, is a  nonbenzodiazepine   anxiolytic  agent, primarily indicated for short-term management of  adjustment disorder , specifically instances of situational depression accompanied by  anxiety , such as stress-induced anxiety. [ 2 ] [ 6 ]  Administration is  by mouth . [ 7 ] \n Side effects  associated with etifoxine use include slight  drowsiness ,  headache ,  skin eruptions , and  allergic reactions . [ 2 ] [ 8 ] [ 9 ]  In rare cases, etifoxine has been linked to severe  skin  and  liver toxicity , as well as  menstrual bleeding between periods . [ 8 ] [ 1 ]  Unlike  benzodiazepines , etifoxine does not cause  sedation  or  lack of coordination . [ 10 ] [ 3 ]  Etifoxine acts as a  GABA A  receptor positive allosteric modulator  and as a  ligand  for  translocator proteins . [ 10 ]  Both mechanisms are conjectured to contribute to its anxiolytic properties. [ 10 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1492", "text": "Etifoxine was developed in the 1960s and was introduced for medical use in France in 1979. [ 11 ]  Its marketed in 53 countries worldwide, although it remains unavailable in the United States. [ 7 ] [ 11 ] [ 12 ]  Throughout the 2010s and early 2020s, the safety profile of etifoxine was scrutinized within France and the  European Union , prompted by reports of toxicity. [ 13 ] [ 8 ] [ 7 ]  The investigation revealed that instances of toxicity were infrequent, and etifoxine was allowed to remain on the market. [ 13 ] [ 8 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1493", "text": "Etifoxine has historically been used in the treatment of \" psychosomatic  manifestations of  anxiety \", for instance \" autonomic   dystonia , particularly with  cardiovascular  expression\". [ 7 ] [ 13 ] [ 8 ] [ 1 ]  Subsequently, the indication for etifoxine has been more formalized as treatment of  adjustment disorder  (situational depression) with anxiety (ADWA) (e.g.,  stress -related anxiety). [ 7 ] [ 14 ] [ 3 ]  Etifoxine has been found to reduce scores on the  Hamilton Anxiety Rating Scale  (HAM-A) in people with adjustment disorder with anxiety by approximately 50 to 75% after 4 \u00a0 weeks of treatment in  clinical trials  (e.g., AMETIS, ETILOR, ETIZAL, STRETI studies). [ 7 ]  The medication is similarly effective or more effective than  benzodiazepines  like  lorazepam ,  alprazolam , and  clonazepam  and more effective than  buspirone  for adjustment disorder with anxiety on the basis of directly comparative  randomized controlled trials . [ 14 ] [ 3 ] [ 15 ] [ 16 ] [ 17 ] [ 4 ]  However, in the AMETIS study, both etifoxine and lorazepam failed to show greater effectiveness over  placebo . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1494", "text": "The usual dosage of etifoxine (as the  hydrochloride   salt ) is 150 to 200 \u00a0 mg per day in divided doses of 50 to 100 \u00a0 mg two to three times per day (e.g., 50 \u00a0 mg\u201350 \u00a0 mg\u2013100 \u00a0 mg). [ 2 ] [ 7 ] [ 6 ] [ 18 ] [ 1 ] [ 19 ] [ 20 ]  It is taken for a few days to a few weeks, but no longer than 12 \u00a0 weeks. [ 2 ] [ 13 ] [ 7 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1495", "text": "Etifoxine is provided in the form of  oral   capsules  containing 50 \u00a0 mg etifoxine hydrochloride. [ 2 ] [ 1 ] [ 21 ] [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1496", "text": "Etifoxine is  contraindicated  in people with  circulatory shock , severe  liver impairment , severe  kidney impairment ,  myasthenia gravis ,  galactosemia  (due to  lactose  in the  drug formulation ), severe  respiratory failure , and  hypersensitivity  (allergy) to etifoxine. [ 2 ] [ 5 ]  The medication is not recommended in children or adolescents under the age of 18 [ 5 ]  and is not recommended during  pregnancy  and  breastfeeding  due to insufficient data. [ 2 ] [ 1 ]  Caution is warranted with regard to combining etifoxine and other  central depressants  such as  benzodiazepines ,  central   analgesics ,  antipsychotics ,  sedative   antihistamines , and  alcohol . [ 2 ] [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1497", "text": "Side effects  of etifoxine include slight  drowsiness  and  headache . [ 2 ] [ 9 ]  Rarely, etifoxine can cause benign  skin eruptions  or  rashes  and  allergic reactions  such as  hives  and  angioedema . [ 2 ] [ 8 ] [ 1 ]  Etifoxine shows less adverse effects of  anterograde amnesia ,  sedation , impaired psychomotor performance, and  withdrawal syndromes  than those of  benzodiazepines . [ 5 ]  No cases of  misuse  or  dependence  with etifoxine were identified in a French  pharmacovigilance survey , which is also in contrast to benzodiazepines. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1498", "text": "Etifoxine has been associated rarely with cases of severe  dermal toxicity  and  liver toxicity . [ 8 ] [ 23 ]  Skin and subcutaneous disorders are the most frequently reported, but these generally resolve after drug cessation. [ 3 ]  A 2012 review of etifoxine by the French National Pharmacovigilance Committee determined that etifoxine was safe and continued to provide a favorable alternative to benzodiazepine anxiolytics. The committee found (for a ten-year pharmacovigilance period) that safety concerns were rare or very rare and that the incidence of idiosyncratic hepatic (liver) problems were very rare. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1499", "text": "Unlike benzodiazepines, etifoxine may produce its anxiolytic effects through a dual mechanism, by directly binding to  GABA A  receptors  and (purportedly, exact binding site undetermined) to the mitochondrial  translocator protein  (TSPO). This results in stimulation of the  biosynthesis  of  endogenous   neurosteroids , for instance  allopregnanolone , a highly  potent  GABA A  receptor positive allosteric modulator. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1500", "text": "At GABA A  receptors etifoxine binds at the \u03b1+\u03b2\u2212 interface and preferentially potentiates \u03b1 2 \u03b2 3 \u03b3 2  and \u03b1 3 \u03b2 3 \u03b3 2  receptor types. [ 25 ]  This direct allosteric potentiation can only be observed at relatively high concentrations (starting at >1 \u00a0 mM) and is perhaps not physiologically relevant at normal human doses. [ 26 ]  This is different from benzodiazepines and etifoxine can be used alongside benzodiazepines to potentiate their effects without competing for binding sites; [ 27 ]  however, it also means that the direct effects of etifoxine are not reversed by the benzodiazepine antagonist  flumazenil . [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1501", "text": "Etifoxine is taken via  oral administration . [ 2 ] [ 5 ]  It is rapidly  absorbed  from the  gastrointestinal tract . [ 5 ]  It is well-absorbed, with a  bioavailability  of 90%. [ 2 ] [ 3 ]  The  time to peak levels  of etifoxine is 2 to 3 \u00a0 hours. [ 5 ]  The  plasma protein binding  of etifoxine is 88 to 95%. [ 4 ]  It does not bind to  blood cells . [ 2 ]  The drug is known to cross the  placental barrier . [ 2 ]  Etifoxine is  metabolized  in the  liver  into several  metabolites . [ 5 ]  One of these metabolites, diethyletifoxine, is  pharmacologically active . [ 5 ]  The  elimination half-life  of etifoxine is 6 \u00a0 hours and of diethyletifoxine is almost 20 \u00a0 hours. [ 5 ]  Etifoxine is  eliminated  in three phases. [ 2 ]  The drug is  excreted  mainly in  urine  in the form of metabolites. [ 5 ]  It is also excreted in  bile . [ 5 ]  Only small amounts are excreted unchanged. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1502", "text": "Etifoxine is a  nonbenzodiazepine \u2014that is, it is similarly a  GABA A  receptor positive allosteric modulator  but its  chemical structure  is distinct from that of  benzodiazepines . [ 3 ] [ 29 ]  Instead, it is a  benzoxazine   derivative . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1503", "text": "Etifoxine is used pharmaceutically as the  hydrochloride   salt . [ 30 ] [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1504", "text": "( S )-Etifoxine, the ( S )  enantiomer  of etifoxine, was under development by Anvyl Pharmaceuticals for the treatment of  neuropathic pain , but development was discontinued. [ 32 ]  A  deuterated  form of etifoxine with improved  pharmacokinetics  known as  deuterated etifoxine  (GRX-917) is under development by GABA Therapeutics for the treatment  anxiety  and  mood disorders . [ 33 ] [ 34 ] [ 24 ] [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1505", "text": "Etifoxine was developed by  Hoechst  in the 1960s. [ 11 ] [ 36 ]  It was introduced for medical use in  France  in 1979. [ 11 ]  Since at least 2000, etifoxine has been marketed by the French  pharmaceutical company  Biocodex. [ 31 ] [ 29 ] [ 37 ] [ 19 ]  Following reports of  post-marketing   toxicity , the  safety  of etifoxine was reassessed by the French government [ 13 ] [ 8 ]  and the  European Medicines Agency  (EMA). [ 38 ] [ 39 ]  In January 2022, the EMA \"finalized its review of Stresam and concluded that the medicine can continue to be used for the treatment of anxiety disorders, but it must not be used in patients who previously had severe skin reactions or severe liver problems after taking etifoxine.\" [ 38 ] [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1506", "text": "Etifoxine  is the  generic name  of the drug and its  INN Tooltip International Nonproprietary Name ,  BAN Tooltip British Approved Name , and  DCF Tooltip D\u00e9nomination Commune Fran\u00e7aise . [ 30 ] [ 31 ]  It is also known by the older and much-lesser-used synonym  etafenoxine [ 40 ]  and by its developmental code name  Hoe 36801 . [ 30 ] [ 31 ]  Etifoxine is marketed under the brand name  Stresam . [ 30 ] [ 31 ] [ 19 ]  It has also been marketed under the brand name  Strezam , specifically in Russia. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1507", "text": "Etifoxine has been marketed in 53 \u00a0 countries as of 2022. [ 7 ] [ 11 ]  Some of the countries in which etifoxine has been marketed include  Argentina ,  Bulgaria ,  Chile ,  France ,  Luxembourg ,  Malta ,  Romania ,  Russia ,  South Africa ,  Thailand , and  Ukraine . [ 19 ] [ 13 ] [ 7 ] [ 31 ]  Etifoxine is not approved for use by the  United States   Food and Drug Administration  (FDA) or the  European Medicines Agency  (EMA) of the  European Union , and hence is not marketed in these regions. [ 11 ] [ 7 ]  However, etifoxine is marketed in five European Union member states (France, Bulgaria, Luxembourg, Malta, Romania). [ 13 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1508", "text": "Ibuprofen  is a  nonsteroidal anti-inflammatory drug  (NSAID) that is used to relieve  pain ,  fever , and  inflammation . [ 8 ]  This includes  painful menstrual periods ,  migraines , and  rheumatoid arthritis . [ 8 ]  It may also be used to close a  patent ductus arteriosus  in a  premature baby . [ 9 ] [ 8 ]  It can be taken  orally  (by mouth) or  intravenously . [ 8 ]  It typically begins working within an hour. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1509", "text": "Common  side effects  include  heartburn ,  nausea ,  indigestion , and  abdominal pain . [ 8 ]  As with other NSAIDs, potential side effects include  gastrointestinal bleeding . [ 10 ]  Long-term use has been associated with  kidney failure , and rarely  liver failure , and it can exacerbate the condition of patients with  heart failure . [ 8 ]  At low doses, it does not appear to increase the risk of  heart attack ; however, at higher doses it may. [ 10 ]  Ibuprofen can also worsen  asthma . [ 10 ]  While its safety in early  pregnancy  is unclear, [ 8 ]  it appears to be harmful in later pregnancy, so it is not recommended during that period. [ 11 ]  Like other NSAIDs, it works by inhibiting the production of  prostaglandins  by decreasing the activity of the enzyme  cyclooxygenase  (COX). [ 8 ]  Ibuprofen is a weaker anti-inflammatory agent than other NSAIDs. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1510", "text": "Ibuprofen was discovered in 1961 by  Stewart Adams  and John Nicholson [ 12 ]  while working at  Boots UK Limited  and initially marketed as Brufen. [ 13 ]  It is available under a number of brand names including  Advil ,  Motrin , and  Nurofen . [ 8 ] [ 14 ]  Ibuprofen was first marketed in 1969 in the United Kingdom and in 1974 in the United States. [ 8 ] [ 13 ]  It is on the  World Health Organization's List of Essential Medicines . [ 15 ]  It is available as a  generic medication . [ 8 ]  In 2022, it was the 33rd most commonly prescribed medication in the United States, with more than 17 \u00a0 million prescriptions. [ 16 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1511", "text": "Ibuprofen is used primarily to treat  fever  (including postvaccination fever), mild to moderate  pain  (including pain relief after  surgery ),  painful menstruation ,  osteoarthritis , dental pain,  headaches , and  pain from kidney stones . About 60% of people respond to any NSAID; those who do not respond well to a particular one may respond to another. [ 18 ]  A Cochrane medical review of 51 trials of NSAIDs for the treatment of  lower back pain  found that \"NSAIDs are effective for short-term symptomatic relief in patients with acute low back pain\". [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1512", "text": "It is used for inflammatory diseases such as  juvenile idiopathic arthritis  and  rheumatoid arthritis . [ 20 ] [ 21 ]  It is also used for  pericarditis  and  patent ductus arteriosus . [ 9 ] [ 22 ] [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1513", "text": "In some countries, ibuprofen  lysine  (the lysine salt of ibuprofen, sometimes called \"ibuprofen lysinate\") is licensed for treatment of the same conditions as ibuprofen; the lysine salt is used because it is more water-soluble. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1514", "text": "In 2006, ibuprofen lysine was approved in the United States by the  Food and Drug Administration  (FDA) for closure of patent ductus arteriosus in premature infants weighing between 500 and 1,500\u00a0g (1 and 3\u00a0lb), who are no more than 32 weeks gestational age when usual medical management (such as fluid restriction, diuretics, and respiratory support) is not effective. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1515", "text": "Adverse effects include  nausea ,  heartburn ,  indigestion ,  diarrhea ,  constipation ,  gastrointestinal ulceration ,  headache ,  dizziness , rash, salt and fluid retention, and  high blood pressure . [ 8 ] [ 21 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1516", "text": "Infrequent adverse effects include esophageal ulceration,  heart failure ,  high blood levels of potassium ,  kidney impairment , confusion, and  bronchospasm . [ 21 ]  Ibuprofen can exacerbate asthma, sometimes fatally. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1517", "text": "Allergic reactions, including  anaphylaxis , may occur. [ 28 ]  Ibuprofen may be quantified in blood, plasma, or serum to demonstrate the presence of the drug in a person having experienced an anaphylactic reaction, confirm a diagnosis of poisoning in people who are hospitalized, or assist in a medicolegal death investigation. A  monograph  relating ibuprofen plasma concentration, time since ingestion, and risk of developing renal toxicity in people who have overdosed has been published. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1518", "text": "In October 2020, the U.S. FDA required the  drug label  to be updated for all NSAID medications to describe the risk of kidney problems in unborn babies that result in low amniotic fluid. [ 30 ] [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1519", "text": "Along with several other NSAIDs, chronic ibuprofen use is correlated with the risk of progression to  hypertension  in women, though less than for  paracetamol  (acetaminophen), [ 32 ]  and  myocardial infarction  (heart attack), [ 33 ]  particularly among those chronically using higher doses. On 9 July 2015, the U.S. FDA toughened warnings of increased  heart attack  and  stroke  risk associated with ibuprofen and related NSAIDs; the NSAID  aspirin  is not included in this warning. [ 34 ]  The  European Medicines Agency  (EMA) issued similar warnings in 2015. [ 35 ] [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1520", "text": "Along with other NSAIDs, ibuprofen has been associated with the onset of  bullous pemphigoid  or pemphigoid-like blistering. [ 37 ]  As with other NSAIDs, ibuprofen has been reported to be a  photosensitizing  agent, [ 38 ]  but it is considered a weak photosensitizing agent compared to other members of the  2-arylpropionic acid  class. Like other NSAIDs, ibuprofen is an extremely rare cause of the  autoimmune diseases   Stevens\u2013Johnson syndrome  (SJS) and  toxic epidermal necrolysis . [ 39 ] [ 40 ] [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1521", "text": "Drinking  alcohol  when taking ibuprofen may increase the risk of  stomach bleeding . [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1522", "text": "According to the FDA, \"ibuprofen can interfere with the  antiplatelet  effect of low-dose  aspirin , potentially rendering aspirin less effective when used for  cardioprotection  and  stroke  prevention\". Allowing sufficient time between doses of ibuprofen and immediate-release (IR) aspirin can avoid this problem. The recommended elapsed time between a dose of ibuprofen and a dose of aspirin depends on which is taken first. It would be 30\u00a0minutes or more for ibuprofen taken after IR aspirin, and 8\u00a0hours or more for ibuprofen taken before IR aspirin. However, this timing cannot be recommended for  enteric-coated  aspirin. If ibuprofen is taken only occasionally without the recommended timing, though, the reduction of the cardioprotection and stroke prevention of a daily aspirin regimen is minimal. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1523", "text": "Ibuprofen combined with  paracetamol  is considered generally safe in children for short-term usage. [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1524", "text": "Ibuprofen overdose has become common since it was licensed for  over-the-counter  (OTC) use. Many overdose experiences are reported in the  medical literature , although the frequency of life-threatening complications from ibuprofen overdose is low. [ 45 ]  Human responses in cases of overdose range from an absence of symptoms to a fatal outcome despite intensive-care treatment. Most symptoms are an excess of the pharmacological action of ibuprofen and include abdominal pain, nausea,  vomiting , drowsiness, dizziness, headache,  ear ringing , and  nystagmus . Rarely, more severe symptoms such as  gastrointestinal bleeding ,  seizures ,  metabolic acidosis ,  hyperkalemia ,  low blood pressure ,  slow heart rate ,  fast heart rate ,  atrial fibrillation ,  coma , liver dysfunction,  acute kidney failure ,  cyanosis ,  respiratory depression , and  cardiac arrest  have been reported. [ 46 ]  The severity of symptoms varies with the ingested dose and the time elapsed; however, individual sensitivity also plays an important role. Generally, the symptoms observed with an overdose of ibuprofen are similar to the symptoms caused by overdoses of other NSAIDs."}
{"_id": "WikiPedia_Dermatology$$$corpus_1525", "text": "The correlation between the severity of symptoms and measured ibuprofen plasma levels is weak. Toxic effects are unlikely at doses below 100 \u00a0 mg/kg, but can be severe above 400 \u00a0 mg/kg (around 150 tablets of 200 \u00a0 mg units for an average adult male); [ 47 ]  however, large doses do not indicate the clinical course is likely to be lethal. [ 48 ]  A precise  lethal dose  is difficult to determine, as it may vary with age, weight, and concomitant conditions of the person."}
{"_id": "WikiPedia_Dermatology$$$corpus_1526", "text": "Treatment to address an ibuprofen overdose is based on how the symptoms present. In cases presenting early, decontamination of the stomach is recommended. This is achieved using  activated charcoal ; charcoal absorbs the drug before it can enter the  bloodstream .  Gastric lavage  is now rarely used, but can be considered if the amount ingested is potentially life-threatening, and it can be performed within 60\u00a0minutes of ingestion. Purposeful vomiting is not recommended. [ 49 ]  Most ibuprofen ingestions produce only mild effects, and the management of overdose is straightforward. Standard measures to maintain normal urine output should be instituted and  kidney function  monitored. [ 47 ]  Since ibuprofen has acidic properties and is also excreted in the urine,  forced alkaline diuresis  is theoretically beneficial. However, because ibuprofen is highly protein-bound in the blood, the kidneys' excretion of the unchanged drug is minimal. Forced alkaline diuresis is, therefore, of limited benefit. [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1527", "text": "A Canadian study of pregnant women suggests that those taking any type or amount of NSAIDs (including ibuprofen,  diclofenac , and  naproxen ) were 2.4 times more likely to  miscarry  than those not taking the medications. [ 51 ]  However, an Israeli study found no increased risk of miscarriage in the group of mothers using NSAIDs. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1528", "text": "Ibuprofen works by inhibiting  cyclooxygenase  (COX) enzymes, which convert  arachidonic acid  to  prostaglandin H2  (PGH 2 ). PGH 2 , in turn, is converted by other enzymes into various  prostaglandins  (which mediate pain,  inflammation , and fever) and  thromboxane A2  (which stimulates  platelet  aggregation and promotes  blood clot  formation)."}
{"_id": "WikiPedia_Dermatology$$$corpus_1529", "text": "Like aspirin and  indomethacin , ibuprofen is a nonselective COX inhibitor, in that it inhibits two  isoforms  of cyclooxygenase,  COX-1  and  COX-2 . The  analgesic ,  antipyretic , and anti-inflammatory activity of NSAIDs appears to operate mainly through inhibition of COX-2, which decreases the synthesis of prostaglandins involved in mediating inflammation, pain, fever, and swelling. Antipyretic effects may be due to action on the hypothalamus, resulting in an increased peripheral blood flow, vasodilation, and subsequent heat dissipation. Inhibition of COX-1 instead would be responsible for unwanted effects on the gastrointestinal tract. [ 53 ]  However, the role of the individual COX isoforms in the analgesic, anti-inflammatory, and gastric damage effects of NSAIDs is uncertain, and different compounds cause different degrees of analgesia and gastric damage. [ 54 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1530", "text": "Ibuprofen is administered as a  racemic mixture . The  R -enantiomer undergoes extensive interconversion to the  S -enantiomer  in vivo . The  S -enantiomer is believed to be the more pharmacologically active enantiomer. [ 55 ]  The  R -enantiomer is converted through a series of three main enzymes. These enzymes include acyl-CoA-synthetase, which converts the  R -enantiomer to (\u2212)- R -ibuprofen I-CoA; 2-arylpropionyl-CoA epimerase, which converts (\u2212)- R -ibuprofen I-CoA to (+)- S -ibuprofen I-CoA; and hydrolase, which converts (+)- S -ibuprofen I-CoA to the  S -enantiomer. [ 41 ]  In addition to the conversion of ibuprofen to the  S -enantiomer, the body can metabolize ibuprofen to several other compounds, including numerous hydroxyl, carboxyl and glucuronyl metabolites. Virtually all of these have no pharmacological effects. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1531", "text": "Unlike most other NSAIDs, ibuprofen also acts as an inhibitor of  Rho kinase  and may be useful in recovery from spinal cord injury. [ 56 ] [ 57 ]  Another unusual activity is inhibition of the sweet taste receptor. [ 58 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1532", "text": "After oral administration, peak serum concentration is reached after 1\u20132\u00a0hours, and up to 99% of the drug is bound to plasma proteins. [ 59 ]  The majority of ibuprofen is metabolized and eliminated within 24\u00a0hours in the urine; however, 1% of the unchanged drug is removed through biliary excretion. [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1533", "text": "Ibuprofen is practically insoluble in water, but very soluble in most organic solvents like  ethanol  (66.18 \u00a0 g/100 \u00a0 mL at 40 \u00a0 \u00b0C for 90% EtOH),  methanol ,  acetone  and  dichloromethane . [ 60 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1534", "text": "The original synthesis of ibuprofen by the Boots Group started with the compound  isobutylbenzene . The synthesis took six steps. A modern, greener technique with fewer waste byproducts for the synthesis involves only three steps and was developed in the 1980s by the Celanese Chemical Company. [ 61 ] [ 62 ]  The synthesis is initiated with the acylation of isobutylbenzene using the recyclable Lewis acid catalyst hydrogen fluoride. [ 63 ] [ 64 ]  The following catalytic hydrogenation of isobutylacetophenone is performed with either Raney nickel or palladium on carbon to lead into the key-step, the  carbonylation  of 1-(4-isobutylphenyl)ethanol. This is achieved by a PdCl 2 (PPh 3 ) 2  catalyst, at around 50 bar of CO pressure, in the presence of HCl (10%). [ 65 ]  The reaction presumably proceeds through the intermediacy of the  styrene  derivative (acidic elimination of the alcohol) and (1-chloroethyl)benzene derivative (Markovnikow addition of HCl to the double bond). [ 66 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1535", "text": "Ibuprofen, like other 2-arylpropionate derivatives such as  ketoprofen ,  flurbiprofen  and  naproxen , contains a  stereocenter  in the \u03b1-position of the  propionate  moiety."}
{"_id": "WikiPedia_Dermatology$$$corpus_1536", "text": "The product sold in pharmacies is a  racemic mixture  of the  S  and  R -isomers. The  S  (dextrorotatory) isomer is the more biologically active; this isomer has been isolated and used medically (see  dexibuprofen  for details). [ 60 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1537", "text": "The  isomerase  enzyme,  alpha-methylacyl-CoA racemase , converts ( R )-ibuprofen into the ( S )- enantiomer . [ 67 ] [ 68 ] [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1538", "text": "(S)-ibuprofen, the  eutomer , harbors the desired therapeutic activity. The inactive (R)-enantiomer, the  distomer , undergoes a unidirectional  chiral inversion  to offer the active (S)-enantiomer. That is, when the ibuprofen is administered as a racemate the distomer is converted  in vivo  into the eutomer while the latter is unaffected. [ 70 ] [ 71 ] [ 72 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1539", "text": "Ibuprofen was derived from  propionic acid  by the  research  arm of  Boots Group  during the 1960s. [ 73 ]  The name is derived from the 3 functional groups: isobutyl (ibu) propionic acid (pro) phenyl (fen). [ 74 ]  Its discovery was the result of research during the 1950s and 1960s to find a safer alternative to  aspirin . [ 13 ] [ 75 ]  The molecule was discovered and synthesized by a team led by  Stewart Adams , with a patent application filed in 1961. [ 13 ]  Adams initially tested the drug as treatment for his  hangover . [ 76 ]  In 1985, Boots' worldwide patent for ibuprofen expired and generic products were launched. [ 77 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1540", "text": "The medication was launched as a treatment for  rheumatoid arthritis  in the United Kingdom in 1969, and in the United States in 1974. Later, in 1983 and 1984, it became the first NSAID (other than aspirin) to be available  over-the-counter  (OTC) in these two countries. [ 13 ] [ 75 ]  Boots was awarded the  Queen's Award for Technical Achievement  in 1985 for the development of the drug. [ 78 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1541", "text": "In November 2013, work on ibuprofen was recognized by the erection of a  Royal Society of Chemistry blue plaque  at Boots' Beeston Factory site in Nottingham, [ 79 ]  which reads:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1542", "text": "In recognition of the work during the 1980s by The Boots Company PLC on the development of ibuprofen which resulted in its move from prescription-only status to over-the-counter sale, therefore expanding its use to millions of people worldwide"}
{"_id": "WikiPedia_Dermatology$$$corpus_1543", "text": "and another at  BioCity Nottingham , the site of the original laboratory, [ 79 ]  which reads:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1544", "text": "In recognition of the pioneering research work, here on Pennyfoot Street, by Dr Stewart Adams and Dr John Nicholson in the Research Department of Boots which led to the discovery of ibuprofen used by millions worldwide for the relief of pain."}
{"_id": "WikiPedia_Dermatology$$$corpus_1545", "text": "Ibuprofen was made available by prescription in the United Kingdom in 1969 and in the United States in 1974. [ 80 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1546", "text": "Ibuprofen  is the  International nonproprietary name  (INN),  British Approved Name  (BAN),  Australian Approved Name  (AAN) and  United States Adopted Name  (USAN). In the United States, it has been sold under the brand-names Motrin and Advil since 1974 [ 81 ]  and 1984, [ 82 ]  respectively. Ibuprofen is commonly available in the United States up to the FDA's 1984 dose limit OTC, rarely used higher by prescription. [ 83 ] [ failed verification ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1547", "text": "In 2009, the first injectable formulation of ibuprofen was approved in the United States, under the brand name Caldolor. [ 84 ] [ 85 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1548", "text": "Ibuprofen can be taken  orally  (by mouth) (as a tablet, a capsule, or a suspension) and  intravenously . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1549", "text": "Ibuprofen is sometimes used for the treatment of acne because of its  anti-inflammatory  properties, and has been sold in Japan in topical form for  adult acne . [ 86 ] [ 87 ]  As with other NSAIDs, ibuprofen may be useful in the treatment of severe  orthostatic hypotension  (low blood pressure when standing up). [ 88 ]  NSAIDs are of unclear utility in the prevention and treatment of  Alzheimer's disease . [ 89 ] [ 90 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1550", "text": "Ibuprofen has been associated with a lower risk of  Parkinson's disease  and may delay or prevent it.  Aspirin , other NSAIDs, and  paracetamol  (acetaminophen) had no effect on the risk for Parkinson's. [ 91 ]  In March 2011, researchers at  Harvard Medical School  announced in  Neurology  that ibuprofen had a  neuroprotective  effect against the risk of developing  Parkinson's disease . [ 92 ] [ 93 ] [ 94 ]  People regularly consuming ibuprofen were reported to have a 38% lower risk of developing Parkinson's disease, but no such effect was found for other pain relievers, such as aspirin and paracetamol. Use of ibuprofen to lower the risk of Parkinson's disease in the general population would not be problem-free, given the possibility of adverse effects on the urinary and digestive systems. [ 95 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1551", "text": "Some  dietary supplements  might be dangerous to take along with ibuprofen and other NSAIDs, but as of 2016 [update] , more research needs to be conducted to be certain. These supplements include those that can  prevent platelet aggregation , including  ginkgo ,  garlic ,  ginger ,  bilberry ,  dong quai ,  feverfew ,  ginseng ,  turmeric ,  meadowsweet  ( Filipendula ulmaria ), and  willow  ( Salix  spp.); those that contain  coumarin , including  chamomile ,  horse chestnut ,  fenugreek  and  red clover ; and those that increase the risk of bleeding, like  tamarind . [ 96 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1552", "text": "Ibuprofen lysine is sold for rapid pain relief; [ 97 ]  given in the form of its lysine salt, absorption is much quicker (35 minutes for the salt compared to 90\u2013120 minutes for ibuprofen). However, a clinical trial with 351 participants in 2020, funded by Sanofi, found no significant difference between ibuprofen and ibuprofen lysine concerning the eventual onset of action or analgesic efficacy. [ 98 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1553", "text": "Isotretinoin , also known as  13- cis -retinoic acid  and sold under the brand name  Accutane  among others, is a medication used to treat skin diseases like  harlequin-type ichthyosis , and  lamellar ichthyosis , and severe cystic  acne  or moderate acne that is unresponsive to antibiotics. [ 6 ]  Isotretinoin is used off-label to treat  basal cell carcinoma  and  squamous cell carcinoma , although clinical evidence suggests it is not effective in this setting. [ 7 ]  It is a  retinoid , meaning it is related to  vitamin A , and is found in small quantities naturally in the body. Its  isomer ,  tretinoin , is also an acne drug."}
{"_id": "WikiPedia_Dermatology$$$corpus_1554", "text": "The most common adverse effects are dry lips ( cheilitis ), dry and fragile skin ( xeroderma ),  dry eyes [ 8 ]  and an  increased susceptibility to sunburn . Uncommon and rare side effects include muscle aches and pains ( myalgias ), and headaches. Some of those side effects can persist long after the discontinuation of the use of the drug. [ 8 ]  Isotretinoin may cause  liver failure , therefore the patient's  blood levels  should be regularly tested. [ 9 ]  It is known to cause  birth defects  due to in-utero exposure because of the molecule's close resemblance to  retinoic acid , a natural vitamin A derivative that controls normal embryonic development. It is associated with psychiatric side effects, most commonly depression but also, more rarely, psychosis and unusual behaviors. Other rare side effects include  hyperostosis  and premature  epiphyseal closure , which have been reported to be persistent."}
{"_id": "WikiPedia_Dermatology$$$corpus_1555", "text": "Isotretinoin was patented in 1969 and approved for medical use in 1982. [ 10 ]  In 2021, it was the 264th most commonly prescribed medication in the United States, with more than 1 \u00a0 million prescriptions. [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1556", "text": "Isotretinoin is used primarily for persistent cystic acne. [ 13 ] [ 14 ] [ 15 ] [ 16 ]   Many dermatologists also support its use for treatment of lesser degrees of acne that prove resistant to other treatments, or that produce scarring or psychological distress. [ 17 ]  Isotretinoin is not indicated for the treatment of prepubertal acne and is not recommended in children less than 12 years of age. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1557", "text": "It is also somewhat effective for  hidradenitis suppurativa  and some cases of severe  rosacea . [ 19 ]  It can also be used to help treat  harlequin ichthyosis ,  lamellar ichthyosis  and is used in  xeroderma pigmentosum  cases to relieve  keratoses . Isotretinoin has been used to treat the extremely rare condition  fibrodysplasia ossificans progressiva . It is also used for the treatment of  pediatric neuroblastoma  in Japan, but data for its efficacy is not conclusive and it has not been approved in other countries. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1558", "text": "Isotretinoin therapy has furthermore proven effective against  genital warts  in experimental use but is rarely used for this indication as there are more effective treatments. Isotretinoin may represent an efficacious and safe alternative systemic form of therapy for  recalcitrant condylomata acuminata  (RCA) of the cervix. In most countries, this therapy is currently unapproved and only used if other therapies fail. [ 21 ] [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1559", "text": "Isotretinoin is a  teratogen ; there is about a 20\u201335% risk for congenital defects in infants exposed to the drug  in utero , and about 30\u201360% of children exposed to isotretinoin prenatally have been reported to show neurocognitive impairment. [ 23 ]  Because of this risk, there are strict controls prescribing isotretinoin to women who have potential to become (or be) pregnant while taking isotretinoin and many are strongly advised to terminate their pregnancies because of the 20-60% risk. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1560", "text": "In the United States, since March 2006, the dispensing of isotretinoin is run through the  iPLEDGE program , under the direction of the  Food and Drug Administration . [ 24 ] [ 25 ]  Prescribers, pharmacists, and all people to whom the drug is prescribed need to register on the site and log information into it. Women with child-bearing potential must commit to using two forms of effective contraception simultaneously for the duration of isotretinoin therapy and for a month immediately preceding and a month immediately following therapy. Additionally, they must have two negative  pregnancy tests  30 days apart and have negative pregnancy tests before each prescription is written. [ 26 ] [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1561", "text": "In most countries, isotretinoin can only be prescribed by dermatologists or specialist physicians; some countries also allow limited prescriptions by general practitioners and family doctors. In the United Kingdom [ 28 ]  and Australia, [ 29 ] [ 30 ]  isotretinoin may be prescribed only by or under the supervision of a consultant  dermatologist . Because severe cystic acne has the potential to cause permanent scarring over a short period, restrictions on its more immediate availability have proved contentious. [ 31 ]  In New Zealand, isotretinoin can be prescribed by any doctor but subsidized only when prescribed by a vocationally-registered general practitioner, dermatologist or nurse practitioner. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1562", "text": "Increasingly higher dosages will result in higher toxicity, resembling  vitamin A toxicity . Adverse effects include: [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1563", "text": "Type of disorders"}
{"_id": "WikiPedia_Dermatology$$$corpus_1564", "text": "Very common  (\u2265 1/10)"}
{"_id": "WikiPedia_Dermatology$$$corpus_1565", "text": "Common (\u2265 1/100, < 1/10)"}
{"_id": "WikiPedia_Dermatology$$$corpus_1566", "text": "Rare (\u2265 1/ 10 000 ,< 1/1000)"}
{"_id": "WikiPedia_Dermatology$$$corpus_1567", "text": "Very rare (\u2264 1/ 10 000 )"}
{"_id": "WikiPedia_Dermatology$$$corpus_1568", "text": "and  mediastinal"}
{"_id": "WikiPedia_Dermatology$$$corpus_1569", "text": "subcutaneous tissues"}
{"_id": "WikiPedia_Dermatology$$$corpus_1570", "text": "connective tissue"}
{"_id": "WikiPedia_Dermatology$$$corpus_1571", "text": "and tendons)"}
{"_id": "WikiPedia_Dermatology$$$corpus_1572", "text": "The effects of isotretinoin may be permanent. This has been proposed to be due to induction of apoptosis in  sebaceous glands ,  meibomian glands ,  neuroblastoma  cells,  hypothalamic  cells,  hippocampus  cells,  Dalton's lymphoma  ascites cells,  B16F-10 melanoma cells ,  neuronal crest  cells,  stem cells  and others, [ 35 ]  that it changes  epigenetics [ 36 ]  and shortens  telomeres . [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1573", "text": "Isotretinoin may stop  long bone  growth in young people who are still growing. [ 16 ]  Premature  epiphyseal  closure can occur in people receiving recommended doses [ 38 ]  of Accutane. [ 39 ] [ 40 ] [ 41 ] [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1574", "text": "Isotretinoin is known to cause  meibomian gland  dysfunction which causes persistent  keratoconjunctivitis sicca  (dry eye). [ 43 ]   Problems with the meibomian and salivary glands are likely due to the  non-selective   apoptosis  of the cells of the  exocrine glands . [ 44 ]  Decreased  night vision  has been reported to persist in some people after discontinuation of isotretinoin therapy, [ 45 ] [ 46 ]  although most cases of decreased night vision appear to resolve after discontinuing the medication. [ 46 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1575", "text": "Isotretinoin is also associated with permanent sexual side effects, namely  erectile dysfunction  and reduced  libido . [ 47 ]  In October 2017, the UK  MHRA  issued a Drug Safety Update to physicians in response to reports of these problems. [ 48 ]  This was in response to an EU review, published in August 2017, which states that a plausible physiological explanation of these side effects \"may be a reduction in plasma testosterone\". [ 18 ]  The review also stated that \"the product information should be updated to include \u2018sexual dysfunction including erectile dysfunction and decreased libido\u2019 as an undesirable effect with an unknown frequency\". [ 49 ]  There have also been reports of  spermatogenesis  disorders, such as  oligospermia . 27 cases of sexual dysfunction report either negative  dechallenge  or positive dechallenge. [ clarification needed ] [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1576", "text": "The most common side effects are mucocutaneous: dry lips, skin, and nose. Other common mucocutaneous side effects are inflammation and chapping of the lips ( cheilitis ), redness of the skin ( erythema ), rashes, peeling, eczema ( dermatitis ), itching ( pruritus ) and nose bleeds ( epistaxis ). [ 50 ]  Absence of dryness of the lips is considered an indication of non-compliance with treatment (not taking the drug as advised), as it occurs in almost all people who take it. [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1577", "text": "Regular use of lip balm and moisturizer is recommended throughout treatment to reduce these problems. The dose may need to be decreased to reduce the severity of these side effects. [ 51 ]   The skin becomes more fragile\u2014especially to frictional forces\u2014and may not heal as quickly as normal. Wound healing is delayed. For this reason, elective surgery, waxing of hair, tattooing, tattoo removal, piercings, dermabrasion, exfoliation, etc., are not recommended. Treatment of acne scars is generally deferred until 12 months after completion of a course of isotretinoin."}
{"_id": "WikiPedia_Dermatology$$$corpus_1578", "text": "Isotretinoin is a  teratogen  highly likely to cause birth defects if taken by women during pregnancy or even a short time before conception. A few of the more common birth defects this drug can cause are hearing and visual impairment, missing or malformed earlobes, facial dysmorphism, and abnormalities in brain function. Isotretinoin is classified as  FDA   Pregnancy Category  X and  ADEC  Category X, and use is contraindicated in pregnancy. [ 19 ]  In the EU, isotretinoin (oral) is contraindicated in pregnancy and must not be taken by women able to have children unless the conditions of a pregnancy prevention program are met. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1579", "text": "The manufacturer recommends pregnancy be ruled out two weeks before commencement of isotretinoin, and women should use two simultaneous forms of effective contraception at least one month before commencement, during, and for at least one month following isotretinoin therapy. [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1580", "text": "In the US, around 2000 women became pregnant while taking the drug between 1982 and 2000, with most pregnancies ending in  abortion  or  miscarriage . About 160 babies with birth defects were born. After the FDA put the more strict iPLEDGE program in place for the companies marketing the drug in the US, in 2011, 155 pregnancies occurred (0.12%) among 129,544 women of childbearing potential taking isotretinoin. [ 54 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1581", "text": "People taking isotretinoin are not permitted to donate blood during and for at least one month after discontinuation of therapy due to its teratogenicity. [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1582", "text": "Rare psychological side effects may include depression, worsening of pre-existing depression, aggressive tendencies, irritable mood, and anxiety. Very rare effects include abnormal behaviour,  psychosis , suicidal ideation, suicide attempts, and  suicide . [ 15 ] [ 56 ] [ 57 ] [ 58 ]   In a total of 5577  adverse reactions  reported to the UK's  MHRA  up to 31 March 2017, the plurality (1207, or 22%) concerned psychiatric effects. [ 59 ]  There were 85 reports of suicidal ideation, 56 of suicide and 43 of suicide attempts. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1583", "text": "Isotretinoin decreases the brain metabolism in the orbitofrontal cortex by an average of 21%, a brain area known to mediate symptoms of depression. [ 60 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1584", "text": "The association between isotretinoin use and psychopathology has been controversial. Beginning in 1983, isolated case reports emerged suggesting mood change, particularly depression, occurring during or soon after isotretinoin use. [ 61 ]  Several studies have been conducted since then of the drug's effect on depression, psychosis, suicidal thoughts and other psychological effects. [ 61 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1585", "text": "Isotretinoin is the only non-psychiatric drug on the  FDA 's top 10 list of drugs associated with depression [ 57 ] [ 62 ]  and is also within the top 10 for suicide attempts. [ 63 ]  A  black box warning  for suicide, depression, and psychosis has been present on isotretinoin's packaging in the United States since 2005. [ 62 ]  In March 2018,  European Medicines Agency  issued a warning on a possible risk of neuropsychiatric disorders (such as depression, anxiety, and mood changes) following the use of oral retinoids, including isotretinoin, though the limitations of the available data did not allow them to establish whether this risk was due to the use of retinoids. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1586", "text": "A Swedish retrospective cohort study with 5756 patients showed a significantly increased risk of attempted suicides from 6 months after the treatment to around 2 years after the treatment. [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1587", "text": "In 2012, a systematic review covering all articles in the literature related to isotretinoin, depression, and suicide, as well as articles related to class effect, dose-response, and biological plausibility found that the literature reviewed was consistent with an association of isotretinoin administration and depression and with suicide in a subgroup of vulnerable individuals. [ 56 ]  Following this systematic review, in a 2014 review a group of Australian dermatologists and psychiatrists collaborated on a set of recommendations for safe prescribing of isotretinoin. [ 65 ]  However, whether isotretinoin use is causally associated with mental illness remains controversial. [ 65 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1588", "text": "Evidence for depression being causally associated with isotretinoin use includes 41 reports of positive  challenge/dechallenge/rechallenge  with isotretinoin, involving administering isotretinoin, withdrawing the drug, and then re-administering it. [ 56 ]  The majority of these cases had no psychiatric history. [ 56 ]  There is also a temporal relationship between the development of depression and initiation of isotretinoin treatment, with most cases developing after 1\u20132 months of treatment. [ 56 ]  Further, higher doses of isotretinoin increase the risk of developing depression, with 25% of people showing depression on a dose of 3\u00a0mg/kg/day as compared with 3\u20134% at normal doses. [ 56 ]  Studies have uncovered  several biological processes  which may credibly explain the affective changes induced by isotretinoin. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1589", "text": "Isotretinoin has also been linked to psychosis. [ 33 ]  Many of the side effects of isotretinoin mimic hypervitaminosis A, which has been associated with psychotic symptoms. [ 56 ]  The dopamine hypothesis of schizophrenia and psychosis suggests that an increase in dopaminergic stimulation or sensitivity in the limbic system causes psychotic symptoms. [ 66 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1590", "text": "It has been suggested that dysregulation of retinoid receptors by retinoids such as isotretinoin may cause schizophrenia. [ 67 ] [ 68 ]  The evidence for this is threefold: transcriptional activation of the  dopamine D2 receptor  \u2013 in addition to serotonin and  glutamate receptors  \u2013 is regulated by  retinoic acid ; [ 67 ]  schizophrenia and the retinoid  cascade  have been linked to the same  gene loci ; [ 67 ]  and retinoid dysfunction causes congenital anomalies identical to those observed in people with schizophrenia. [ 67 ]  Further, the expression of dopamine receptors has indeed been shown to be regulated by retinoic acid. [ 69 ] [ 70 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1591", "text": "Isotretinoin has a number of  muscoloskeletal  effects.  Myalgia  (muscular pain) and  arthralgia  (joint pain) are common side effects. [ 50 ]   Retinoids , such as high dose etretinate, are well known to cause bone changes, the most common type of which is  hyperostotic changes  (excessive bone growth), especially in growing children and adolescents. [ 50 ]  While excessive bone growth has been raised as a possible side effect of isotretinoin, a 2006 review found little evidence for this. [ 71 ]  Other problems include premature  epiphyseal closure  and  calcification  of tendons and ligaments. [ 50 ]  The bones of the spine and feet are most commonly affected. Risk factors for skeletal effects include older age, greater dosage, and longer course of treatment. Most bone changes cause no symptoms and may only be noticed using  X-ray imaging . [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1592", "text": "Isotretinoin may cause non-specific gastrointestinal symptoms including nausea, diarrhea, and abdominal pain. [ 50 ]  The drug is associated with  inflammatory bowel disease  (IBD)\u2014 ulcerative colitis , but not Crohn's disease. [ 72 ]   There are also reports of people developing  irritable bowel syndrome  (IBS) and worsening of existing IBS. [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1593", "text": "Isotretinoin and other retinoids are well known to affect the eyes.  Dry eyes  are very common during treatment and is caused by isotretinoin's apoptotic effect on the  meibomian glands . Some people develop contact lens intolerance as a result. [ 50 ]  In some people, these changes are long-lasting or irreversible and represent  Meibomian Gland Dysfunction  (MGD). [ 43 ]  Other common effects on the eyes include inflammation of the eyelid ( blepharitis ), red eye caused by  conjunctivitis  and irritation of the eye. More rare ocular side effects include blurred vision, decreased night vision (which may be permanent),  colour blindness , development of corneal opacities, inflammation of the cornea ( keratitis ), swelling of the optic disk ( papilloedema , associated with  IIH ),  photophobia  and other visual disturbances. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1594", "text": "Isotretinoin's exact  mechanism of action  is unknown, but several studies have shown that isotretinoin induces  apoptosis  (programmatic cell death) in various cells in the body. Cell death may be instigated in the  meibomian glands , [ 44 ] [ 74 ]   hypothalamic  cells, [ 75 ]   hippocampus  cells [ 76 ] [ 77 ]  and\u2014important for treatment of acne\u2014in  sebaceous gland  cells. [ 78 ] [ 79 ]  Isotretinoin has a low affinity for  retinoic acid receptors  (RAR) and  retinoid X receptors  (RXR), but may be converted intracellularly to metabolites that act as  agonists  of RAR and RXR  nuclear receptors . [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1595", "text": "One study suggests the drug amplifies production of  neutrophil gelatinase-associated lipocalin  (NGAL) in the skin, which has been shown to reduce  sebum  production by inducing apoptosis in sebaceous gland cells, while exhibiting an antimicrobial effect on  Cutibacterium acnes . [ 80 ] [ 81 ] [ 82 ]  The drug decreases the size and sebum output of the sebaceous glands. [ 83 ]  Isotretinoin is the only available acne drug that affects all four major pathogenic processes in acne, which distinguishes it from alternative treatments (such as antibiotics) and accounts for its efficacy in severe, nodulocystic cases. [ 84 ]  The effect of isotretinoin on sebum production can be temporary, [ 16 ]  or remission of the disease can be \"complete and prolonged.\" [ 83 ] [ 85 ] [ 86 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1596", "text": "Isotretinoin has been speculated to down-regulate the enzyme  telomerase  and  hTERT , inhibiting \" cellular immortalization  and  tumorigenesis .\" [ 87 ]  In a 2007 study, isotretinoin was proven to inhibit the action of the metalloprotease  MMP-9  ( gelatinase ) in  sebum  without any influence in the action of  TIMP1  and  TIMP2  (the tissue inhibitors of metalloproteases). [ 88 ] [ unreliable medical source? ]  It is already known that metalloproteases play an important role in the  pathogenesis  of acne. [ 89 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1597", "text": "A possible biological basis for the case reports of depression involves decreased metabolism in the  orbitofrontal cortex  (OFC) of the  frontal lobe . [ 56 ]  It has also been found that decreased OFC metabolism was correlated with headaches. [ 56 ]  People reporting headache as a side effect often report comorbid neuropsychiatric symptoms, especially depression; a statistically significant relationship between headache and depression has been established. [ 90 ]  It is suggested that people sensitive to isotretinoin-induced CNS effects may also be susceptible to other psychiatric side effects such as depression. [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1598", "text": "Studies in mice and rats have found that retinoids, including isotretinoin, bind to  dopaminergic receptors  in the central nervous system. [ 57 ] [ 91 ] [ 92 ]  Isotretinoin may affect dopaminergic  neurotransmission  by disrupting the structure of dopamine receptors and decreasing dopaminergic activity. [ 58 ]  The dopaminergic system is implicated in numerous psychological disorders, including depression. Isotretinoin is also thought to affect the  serotonergic  system \u2013 it increases expression of  5-HT 1A \u00a0receptors  in the pre-synaptic neuron, which inhibit serotonin secretion. [ 58 ]  Isotretinoin also, directly and indirectly, increases the translation of the  serotonin transporter protein  (SERT), leading to increased  reuptake  and consequently reduced synaptic availability of serotonin. [ 58 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1599", "text": "Inhibition of  hippocampal   neurogenesis  may also play a role in the development of isotretinoin-induced depression. [ 56 ]  A further effect of isotretinoin on the brain involves retinoic acid function in the  hypothalamus , the hormone regulatory centre of the brain and part of the  hypothalamus-pituitary-adrenal axis , a key part of the body's stress response. [ 56 ]  Other brain regions regulated by  retinoic acid  and potentially disrupted by isotretinoin include the  frontal cortex  and the  striatum . [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1600", "text": "Oral isotretinoin is best absorbed when taken with a high-fat meal because it has a high level of  lipophilicity . [ 93 ]  The efficacy of isotretinoin doubles when taken after a high-fat meal compared to when taken without food. [ 94 ]  Due to isotretinoin's molecular relationship to vitamin A, it should not be taken with vitamin A supplements due to the danger of toxicity through cumulative overdosing. [ 95 ]  Accutane also negatively interacts with tetracycline, another class of acne drug, and with micro-dosed ('mini-pill')  progesterone  preparations,  norethisterone / ethinylestradiol  ('OrthoNovum 7/7/7'),  St. John's Wort ,  phenytoin , and systemic  corticosteroids ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1601", "text": "Isotretinoin is primarily (99.9%) bound to plasma proteins, mostly  albumin . Three metabolites of isotretinoin are detectable in human plasma after oral administration: 4- oxo -isotretinoin, retinoid acid (tretinoin), and 4- oxo -retinoic acid (4- oxo -tretinoin). Isotretinoin also oxidizes, irreversibly, to 4- oxo -isotretinoin\u2014which forms its geometric isomer 4- oxo -tretinoin. After an orally administered 80\u00a0mg dose of liquid suspension  14 C-isotretinoin,  14 C-activity in blood declines with a half-life of 90 hours. [ 93 ]  The metabolites of isotretinoin and its conjugates are then excreted in the subject's  urine  and  faeces  in relatively equal amounts. [ 93 ]  After a single, 80\u00a0mg oral dose of Isotretinoin to 74 healthy adult subjects under fed conditions, the mean \u00b1SD  elimination half-life  (t 1/2 ) of isotretinoin and 4- oxo -isotretinoin were 21.0 \u00b1 8.2 hours and 24.0 \u00b1 5.3 hours, respectively. [ 93 ]  After both single and multiple doses, the observed accumulation ratios of isotretinoin ranged from 0.90 to 5.43 in people with cystic acne. [ 93 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1602", "text": "The compound 13-cis retinoic acid was first studied in the 1960s at Roche Laboratories in Switzerland by Werner Bollag as a treatment for skin cancer. Experiments completed in 1971 showed that the compound was likely to be ineffective for cancer but, surprisingly, that it could be useful to treat acne. However, they also showed that the compound was likely to cause birth defects, so in light of the events around  thalidomide , Roche abandoned the product. [ 96 ]  In 1979, an article was published reporting the drug's effectiveness as a treatment of cystic and conglobate acne on fourteen patients, thirteen of which experienced complete clearing of their disease. [ 83 ]  In clinical trials, subjects were carefully screened to avoid including women who were or might become pregnant. Roche's  New Drug Application  for isotretinoin for the treatment of acne included data showing that the drug caused birth defects in rabbits. [ medical citation needed ]  The FDA approved the application in 1982. [ 96 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1603", "text": "Scientists involved in the clinical trials published articles warning of birth defects at the same time the drug was launched in the US, but isotretinoin was taken up quickly and widely, both among dermatologists and general practitioners. Cases of birth defects showed up in the first year, leading the FDA to begin publishing case reports and to Roche sending warning letters to doctors and placing warning stickers on drug bottles, and including stronger warnings on the label. Lawsuits against Roche started to be filed. In 1983 the FDA's advisory committee was convened and recommended stronger measures, which the FDA took and were at that time unprecedented: warning blood banks not to accept blood from people taking the drug and adding a warning to the label advising women to start taking contraceptives a month before starting the drug. However, the use of the drug continued to grow, as did the number of babies born with birth defects. In 1985 the label was updated to include a  boxed warning . In early 1988 the FDA called for another advisory committee, and FDA employees prepared an internal memo estimating that around 1,000 babies had been born with birth defects due to isotretinoin, that up to around 1,000 miscarriages had been caused, and that between 5,000 and 7,000 women had had abortions due to isotretinoin. The memo was leaked to  The New York Times [ 97 ]  a few days before the meeting, leading to a storm of media attention. In the committee meeting, dermatologists and Roche each argued to keep the drug on the market but to increase education efforts; pediatricians and the  Centers for Disease Control and Prevention  (CDC) argued to withdraw the drug from the market. The committee recommended restricting physicians who could prescribe the drug and requiring a second opinion before it could be prescribed. The FDA, believing it did not have authority under the law to restrict who had the right to prescribe the drug, kept the drug on the market but took further unprecedented measures: it required Roche to make warnings yet more visible and graphic, provide doctors with  informed consent  forms to be used when prescribing the drug, and to conduct follow up studies to test whether the measures were reducing exposure of pregnant women to the drug. Roche implemented those measures, and offered to pay for contraception counseling and pregnancy testing for women prescribed the drug; the program was called the \"Pregnancy Prevention Program\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_1604", "text": "A CDC report published in 2000, [ 98 ]  showed problems with the Pregnancy Prevention Program and showed that the increase in prescriptions was from off-label use, and prompted Roche to revamp its program, renaming it the \"Targeted Pregnancy Prevention Program\" and adding label changes like requirements for two pregnancy tests, two kinds of contraception, and for doctors to provide pharmacists with prescriptions directly; providing additional educational materials, and providing free pregnancy tests. The FDA had another advisory meeting in late 2000 that again debated how to prevent pregnant women from being exposed to the drug; dermatologists testified about the remarkable efficacy of the drug, the psychological impact of acne, and demanded autonomy to prescribe the drug; others argued that the drug be withdrawn or much stricter measures be taken. In 2001 the FDA announced a new regulatory scheme called SMART (the System to Manage Accutane Related Teratogenicity) that required Roche to provide defined training materials to doctors, and for doctors to sign and return a letter to Roche acknowledging that they had reviewed the training materials, for Roche to then send stickers to doctors, which doctors would have to place on prescriptions they give people after they have confirmed a negative pregnancy test; prescriptions could only be written for 30 days and could not be renewed, thus requiring a new pregnancy test for each prescription. [ 99 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1605", "text": "In February 2002, Roche's patents for isotretinoin expired, and there are now many other companies selling cheaper generic versions of the drug. On 29 June 2009,  Roche Pharmaceuticals , the original creator and distributor of isotretinoin, officially discontinued both the manufacture and distribution of their  Accutane  brand in the  United States  due to what the company described as business reasons related to low market share (below 5%), coupled with the high cost of defending personal injury lawsuits brought by some people who took the drug. [ 100 ]  Roche USA continues to defend Accutane and claims to have treated over 13 \u00a0 million people since its introduction in 1982. F. Hoffmann-La Roche Ltd. apparently will continue to manufacture and distribute  Roaccutane  outside of the United States. [ 101 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1606", "text": "Among others, actor  James Marshall  sued Roche over allegedly Accutane-related disease that resulted in the removal of his  colon . [ 102 ]  The jury, however, decided that James Marshall had a pre-existing bowel disease. [ 103 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1607", "text": "Several trials over inflammatory bowel disease claims have been held in the United States, with many of them resulting in multimillion-dollar judgments against the makers of isotretinoin. [ 104 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1608", "text": "As of 2017, isotretinoin was marketed under many brand names worldwide: A-Cnotren, Absorica, Accuran, Accutane, Accutin, Acne Free, Acnecutan, Acnegen, Acnemin, Acneone, Acneral, Acnestar, Acnetane, Acnetin A, Acnetrait, Acnetrex, Acnogen, Acnotin, Acnotren, Acretin, Actaven, Acugen, Acutret, Acutrex, Ai Si Jie, Aisoskin, Aknal, Aknefug Iso, Aknenormin, Aknesil, Aknetrent, Amnesteem, Atlacne, Atretin, Axotret, Casius, Ciscutan, Claravis, Contracn\u00e9, Curacne, Curacn\u00e9, Curakne, Curatane, Cuticilin, Decutan, Dercutane, Effederm, Epuris, Eudyna, Farmacne, Flexresan, Flitrion, I-Ret, Inerta, Inflader, Inotrin, Isac, Isdiben, Isoacne, Isobest, Isocural, Isoderm, Isoface, IsoGalen, Isogeril, Isolve, Isoprotil, Isoriac, Isosupra, Isosupra Lidose, Isotane, Isotina, Isotinon, Isotren, Isotret, Isotretinoin, Isotretinoina, Isotretino\u00edna, Isotretinoine, Isotretino\u00efne, Isotr\u00e9tino\u00efne, Isotretinoinum, Isotrex, Isotrin, Isotroin, Izotek, Izotziaja, Lisacne, Locatret, Mayesta, Medinac, Myorisan, Neotrex, Netlook, Nimegen, Noitron, Noroseptan, Novacne, Oralne, Oraret, Oratane, Piplex, Policano, Procuta, Reducar, Retacnyl, Retin A, Roaccutan, Roaccutane, Roacnetan, Roacta, Roacutan, Rocne, Rocta, Sotret, Stiefotrex, Tai Er Si, Teweisi, Tretin, Tretinac, Tretinex, Tretiva, Tufacne, Zenatane, Zerocutan, Zonatian ME, and Zoretanin. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1609", "text": "The topical  combination drug   erythromycin/isotretinoin  combines the antibiotic  erythromycin  with isotretinoin and has been marketed under the brand names Isotrex Eritromicina, Isotrexin, and Munderm. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1610", "text": "Isoxicam  is a  nonsteroidal anti-inflammatory drug  (NSAID) that was taken or applied to reduce  inflammation  and as an  analgesic  reducing pain in certain conditions. The drug was introduced in 1983 by the  Warner-Lambert Company . Isoxicam is a chemical analog of  piroxicam  (Feldene) which has a pyridine ring in lieu of an isoxazole ring. In 1985 isoxicam was withdrawn from the French market, due to adverse effects, namely  toxic epidermal necrolysis  resulting in death. Although these serious side effects were observed only in France, the drug was withdrawn worldwide. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1611", "text": "Lamotrigine , sold under the brand name  Lamictal  among others, is a  medication  used to treat  epilepsy  and stabilize mood in  bipolar disorder . [ 5 ] [ 8 ]  For epilepsy, this includes  focal seizures ,  tonic-clonic seizures , and seizures in  Lennox-Gastaut syndrome . [ 8 ]  In bipolar disorder, lamotrigine has not been shown to reliably treat acute  depression  in any groups except for the severely depressed; but for patients with bipolar disorder who are not currently symptomatic, it appears to reduce the risk of future episodes of depression. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1612", "text": "Common side effects include  nausea ,  sleepiness ,  headache ,  vomiting ,  trouble with coordination , and  rash . [ 8 ]  Serious side effects include  excessive breakdown of red blood cells , increased risk of  suicide , severe skin reaction ( Stevens\u2013Johnson syndrome ), and  allergic reactions , which can be fatal. [ 8 ]  Lamotrigine is a  phenyltriazine , [ 5 ]  making it chemically different from other  anticonvulsants . [ 8 ]  Its mechanism of action is not clear, but it appears to inhibit release of excitatory neurotransmitters via  voltage-sensitive sodium channels  and  voltage-gated calcium channels  in neurons. [ 8 ] [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1613", "text": "Lamotrigine was first marketed in Ireland in 1991, [ 12 ]  and approved for use in the United States in 1994. [ 8 ] [ 13 ]  It is on the  World Health Organization's List of Essential Medicines . [ 14 ]  In 2022, it was the most commonly prescribed  mood stabilizer  and 58th most commonly prescribed medication in the United States, with more than 11 \u00a0 million prescriptions. [ 15 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1614", "text": "Lamotrigine is considered a first-line drug for primary generalized  tonic-clonic seizures  (includes simple partial, complex partial, and secondarily generalized seizures such as focal-onset tonic-clonic seizures). It is also used as an alternative or adjuvant medication for partial seizures, such as  absence seizure ,  myoclonic seizure , and  atonic seizures . [ 17 ] [ 18 ]  The evidence supporting the use of lamotrigine as an add-on therapy for drug-resistant generalized tonic-clonic seizures is not clear enough to inform clinical practice. [ 19 ]  Although low-certainty evidence suggests that it reduces generalized tonic-clonic seizures by 50% the level of uncertainty indicates that the actual findings could be significantly different. [ 19 ]  Evidence supporting the use of lamotrigine as an add-on therapy for  drug-resistant focal epilepsy  found that it is likely effective for reducing seizure frequency and is generally well tolerated. [ 20 ]  Lamotrigine has some side effects including a risk of dizziness, nausea, ataxia, or visual disturbances such as  diplopia . [ 20 ]  The long-term effects of lamotrigine have not been investigated. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1615", "text": "Lamotrigine is one of a small number of FDA-approved therapies for the form of  epilepsy  known as  Lennox\u2013Gastaut syndrome . [ 21 ]  It reduces the frequency of LGS seizures, and is one of two medications known to decrease the severity of drop attacks. [ 22 ]  Combination with  valproate  is common, but this increases the risk of lamotrigine-induced severe skin reaction  Stevens\u2013Johnson syndrome , and necessitates reduced dosing due to the interaction of these drugs. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1616", "text": "Lamotrigine is approved in the US for maintenance treatment of  bipolar I disorder  and  bipolar II disorder . [ 24 ]  While the anticonvulsants  carbamazepine  and  valproate  are predominantly  antimanics , lamotrigine has demonstrated efficacy only in preventing or reducing the risk of recurrent depressive episodes of bipolar disorder. The drug seems ineffective in the treatment of current rapid-cycling, acute mania, or acute depression in bipolar disorder. [ 25 ]  Lamotrigine has been shown to be as effective as  lithium , the standard treatment for bipolar disorder. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1617", "text": "Lamotrigine has not demonstrated clear efficacy in treating acute mood episodes, either mania or depression. It has not demonstrated effectiveness in treating acute mania, [ 27 ]  and there is controversy regarding the drug's effectiveness in treating acute bipolar depression. [ 28 ]  A paper written in 2008 by Nassir et al. reviewed evidence from trials that were unpublished and not referenced in the 2002 APA guidelines, and it concludes that lamotrigine has \"very limited, if any, efficacy in the treatment of acute bipolar depression\". [ 25 ]  A 2008 paper by Calabrese et al. examined much of the same data, and found that in five  placebo-controlled studies , lamotrigine did not significantly differ from placebo in the treatment of bipolar depression. [ 29 ]   However, in a meta-analysis of these studies conducted in 2008, Geddes, Calabrese, and Goodwin found that lamotrigine was effective in individuals with bipolar depression, with a  number needed to treat  (NNT) of 11, or 7 in severe depression. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1618", "text": "A 2013 review concluded that lamotrigine is recommended in bipolar maintenance when depression is prominent and that more research is needed regarding its role in the treatment of acute bipolar depression and unipolar depression. No information to recommend its use in other psychiatric disorders was found. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1619", "text": "Lamotrigine, as a monotherapy, is not substantially effective against  schizophrenia . However, various publications [ 32 ] [ 33 ]  and textbooks [ 34 ] [ 35 ]  have expressed that lamotrigine could be added to  clozapine  as augmentation therapy against partial or non-responding patients with schizophrenia. Patients had statistically significant improvements in positive, negative and affective symptoms. Lamotrigine does not have a statistically significant effect with  antipsychotics  other than  clozapine , such as:  olanzapine ,  risperidone ,  haloperidol ,  zuclopenthixol , etc. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1620", "text": "Off-label uses  include the treatment of  peripheral neuropathy ,  trigeminal neuralgia ,  cluster headaches ,  migraines ,  visual snow , and reducing  neuropathic pain , [ 37 ] [ 38 ] [ 39 ] [ 40 ]  although a systematic review conducted in 2013 concluded that well-designed clinical trials have shown no benefit for lamotrigine in  neuropathic pain . [ 41 ]  Off-label psychiatric usage includes the treatment of treatment-resistant  obsessive-compulsive disorder , [ 42 ]   depersonalization derealization disorder , [ 43 ]   hallucinogen persisting perception disorder , [ 44 ]   schizoaffective disorder , [ 45 ]  and  borderline personality disorder . [ 46 ]  It has not been shown to be useful in  post-traumatic stress disorder . [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1621", "text": "GlaxoSmithKline  investigated lamotrigine for the treatment of  ADHD  with inconclusive results. No detrimental effects on  cognitive function  were observed; however, the only statistical improvement in core ADHD symptoms was an improvement on a  Paced Auditory Serial Addition Test  that measures auditory processing speed and calculation ability. [ 48 ]  Another study reported that lamotrigine might be a safe and effective treatment option for adult ADHD  comorbid  with bipolar and recurrent depression. [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1622", "text": "Side effects such as rash, fever, and fatigue are very serious, as they may indicate incipient SJS, TEN, DRESS syndrome, or  aseptic meningitis . [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1623", "text": "Lamotrigine prescribing information has a  black box warning  about life-threatening skin reactions, including  Stevens\u2013Johnson syndrome  (SJS),  DRESS syndrome , and  toxic epidermal necrolysis  (TEN). [ 5 ]  The manufacturer states that nearly all cases appear in the first two to eight weeks of therapy. [ 5 ]  Patients should seek medical attention for any unexpected skin rash, as its presence is an indication of a possible serious or even deadly side effect of the drug. Not all rashes that occur while taking lamotrigine progress to SJS or TEN. Between 5 and 10% of patients will develop a rash, but only one in a thousand patients will develop a serious rash. Rash and other skin reactions are more common in children, so this medication is often reserved for adults. For patients whose lamotrigine has been stopped after the development of a rash, rechallenge with lamotrigine is also a viable option. Usually, rechallenge is done by reinstating lamotrigine at a smaller dose (5mg/day). However, it does not apply to very serious cases. [ 51 ]  The incidence of these eruptions increases in patients who are currently on, or recently discontinued a  valproate -type anticonvulsant drug, as these medications interact in such a way that the clearance of both is decreased and the effective dose of lamotrigine is increased. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1624", "text": "In 2018, the FDA required a new warning for the risk of  hemophagocytic lymphohistiocytosis . This serious reaction can occur between days to weeks after starting the treatment. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1625", "text": "Other side effects include  alopecia  (hair loss), loss of balance or coordination,  double vision ,  crossed eyes ,  pupil constriction ,  blurred vision ,  dizziness  and  lack of coordination ,  drowsiness ,  insomnia ,  anxiety , vivid dreams or  nightmares ,  dry mouth ,  mouth ulcers ,  memory  problems,  mood changes ,  itchiness ,  runny nose ,  cough ,  nausea ,  indigestion ,  abdominal pain ,  weight loss , missed or painful  menstrual periods , and  vaginitis . The side-effects profile varies for different patient populations. [ 50 ]  Overall adverse effects in treatment are similar between men, women, geriatric, pediatric, and racial groups. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1626", "text": "Lamotrigine has been associated with a decrease in white blood cell count ( leukopenia ). [ 53 ]  Lamotrigine does not prolong  QT/QTc  in TQT studies in healthy subjects. [ 54 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1627", "text": "In people taking antipsychotics, cases of lamotrigine-precipitated  neuroleptic malignant syndrome  have been reported. [ 55 ] [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1628", "text": "Women are more likely than men to have side effects. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1629", "text": "Some evidence shows interactions between lamotrigine and female hormones, which can be of particular concern for women on estrogen-containing  hormonal contraceptives .  Ethinylestradiol , an ingredient of such contraceptives, has been shown to decrease serum levels of lamotrigine. [ 57 ]  Women starting an estrogen-containing oral contraceptive may need to increase the dosage of lamotrigine to maintain its level of efficacy. Likewise, women may experience an increase in lamotrigine side effects upon discontinuation of birth control pills. This may include the \"pill-free\" week where lamotrigine serum levels have been shown to increase twofold. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1630", "text": "Many studies have found no association between lamotrigine exposure  in utero  and birth defects, while those that have found an association have found only slight associations with minor malformations such as  cleft palates . [ 58 ]  Review studies have found that overall rates of congenital malformations in infants exposed to lamotrigine  in utero  are relatively low (1\u20134%), which is similar to the rate of malformations in the general population. [ 59 ] [ 60 ]  It is known that lamotrigine is a weak inhibitor of human  dihydrofolate reductase  (DHFR) and other, more powerful, human DHFR inhibitors such as  methotrexate  are known to be  teratogenic . [ 58 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1631", "text": "Lamotrigine is expressed in  breast milk ; the manufacturer recommends carefully weighing the benefits and risks of taking lamotrigine while  breastfeeding . [ 61 ]  However, some studies suggest that lamotrigine is safe to use while breastfeeding. [ 62 ]   A frequently updated review of scientific literature rates lamotrigine as L3: moderately safe. [ 63 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1632", "text": "Lamotrigine binds to  melanin -containing tissues such as the iris of the eye or melanin-rich skin. The long-term consequences of this are unknown. [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1633", "text": "Lamotrigine is known to affect sleep. Studies with small numbers of patients (10\u201315) reported that lamotrigine increases the duration of  REM sleep , decreases the number of phase shifts, and decreases the duration of  slow-wave sleep , [ 65 ]  and that there was no effect on  vigilance , [ 66 ]  daytime somnolence and cognitive function. [ 67 ]  However, a retrospective study of 109 patients' medical records found that 6.7% of patients experienced an \"alerting effect\" resulting in intolerable  insomnia , for which the treatment had to be discontinued. [ 68 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1634", "text": "Lamotrigine can induce a type of seizure known as a  myoclonic jerk , which tends to happen soon after the use of the medication. [ 69 ]  When used in the treatment of myoclonic epilepsies such as  juvenile myoclonic epilepsy , lower doses (and lower plasma levels) are usually needed, as even moderate doses of this drug can induce seizures, including tonic-clonic seizures, which can develop into  status epilepticus , which is a medical emergency. It can also cause myoclonic status epilepticus. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1635", "text": "In overdose, lamotrigine can cause uncontrolled seizures in most people. Reported results in overdoses involving up to 15\u00a0g include increased seizures, coma, and death. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1636", "text": "Lamotrigine is a member of the  sodium channel blocking  class of antiepileptic drugs. [ 70 ]  This may suppress the release of  glutamate  and  aspartate , two dominant excitatory neurotransmitters in the central nervous system. [ 5 ]  It is generally accepted to be a member of the sodium channel blocking class of  antiepileptic drugs , [ 71 ]  but it could have additional actions, since it has a broader spectrum of action than other sodium channel antiepileptic drugs such as  phenytoin  and is effective in the treatment of the depressed phase of bipolar disorder, whereas other sodium channel-blocking antiepileptic drugs are not, possibly on account of its  sigma receptor  activity. In addition, lamotrigine shares few side effects with other, unrelated anticonvulsants known to inhibit sodium channels, which further emphasizes its unique properties. [ 72 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1637", "text": "It is a  triazine  derivate that inhibits  voltage-sensitive   sodium channels , leading to  stabilization of neuronal membranes . It also blocks L-, N-, and P-type  calcium channels  and weakly inhibits the serotonin  5-HT 3  receptor . [ 73 ]  These actions are thought to inhibit release of  glutamate  at cortical projections in the  ventral striatum   limbic areas , [ 74 ]  and its  neuroprotective  and antiglutamatergic effects have been pointed out as promising contributors to its mood stabilizing activity. [ 75 ]  Observations that lamotrigine reduced  GABA A  receptor -mediated neurotransmission in rat amygdala suggest that a  GABAergic  mechanism may also be involved. [ 76 ]  It appears that lamotrigine does not increase GABA blood levels in humans. [ 77 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1638", "text": "Lamotrigine does not have pronounced effects on any of the usual neurotransmitter receptors that anticonvulsants affect ( adrenergic ,  dopamine   D 1  and  D 2 ,  muscarinic ,  GABA ,  histaminergic   H 1 ,  serotonin   5-HT 2 , and  N-methyl-D-aspartate ). Inhibitory effects on  5-HT ,  norepinephrine , and dopamine transporters are weak. [ 78 ]  Lamotrigine is a weak inhibitor of  dihydrofolate reductase , [ 5 ]  but whether this effect is sufficient to contribute to a mechanism of action or increases risk to the fetus during pregnancy is not known. Early studies of lamotrigine's mechanism of action examined its effects on the release of endogenous amino acids from rat cerebral cortex slices  in vitro . As is the case for antiepileptic drugs that act on voltage-dependent sodium channels, lamotrigine thereby inhibits the release of  glutamate  and  aspartate , which is evoked by the sodium-channel activator  veratrine  and was less effective in the inhibition of  acetylcholine  or  GABA  release. At high concentrations, it did not affect spontaneous or  potassium -evoked amino acid release. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1639", "text": "These studies suggested that lamotrigine acts presynaptically on voltage-gated sodium channels to decrease glutamate release. Several electrophysiological studies have investigated the effects of lamotrigine on voltage-gated sodium channels. For example, lamotrigine blocked sustained repetitive firing in cultured mouse spinal cord neurons in a concentration-dependent manner, at concentrations that are therapeutically relevant in the treatment of human seizures. In cultured hippocampal neurons, lamotrigine reduced sodium currents in a voltage-dependent manner, and at depolarised potentials showed a small frequency-dependent inhibition. These and a variety of other results indicate that the antiepileptic effect of lamotrigine, like those of phenytoin and  carbamazepine , is at least in part due to use- and voltage-dependent modulation of fast voltage-dependent sodium currents. However, lamotrigine has a broader clinical spectrum of activity than phenytoin and carbamazepine and is recognized to be protective against generalized  absence epilepsy  and other generalized epilepsy syndromes, including primary generalized tonic-clonic seizures, juvenile myoclonic epilepsy, and Lennox-Gastaut syndrome."}
{"_id": "WikiPedia_Dermatology$$$corpus_1640", "text": "The basis for this broader spectrum of activity of lamotrigine is unknown but could relate to actions of the drug on  voltage-gated calcium channels . Lamotrigine blocks T-type  calcium channels  weakly, if at all. However, it does inhibit native and recombinant high voltage-gated calcium channels (N- and P/Q/R-types) at therapeutic concentrations. Whether this activity on calcium channels accounts for lamotrigine's broader clinical spectrum of activity in comparison with phenytoin and carbamazepine remains to be determined."}
{"_id": "WikiPedia_Dermatology$$$corpus_1641", "text": "It  antagonizes  these receptors with the following IC 50  values: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1642", "text": "The  pharmacokinetics  of lamotrigine follow  first-order kinetics , with a  half-life  of 29 hours and volume of distribution of 1.36 \u00a0 L/kg. [ 79 ]  Lamotrigine is rapidly and completely absorbed after oral administration. Its absolute  bioavailability  is 98% and its plasma  C max  occurs from 1.4 to 4.8 hours. Available data indicate that its bioavailability is not affected by food. Estimate of the mean apparent volume of distribution of lamotrigine following oral administration ranges from 0.9 to 1.3 \u00a0 L/kg. This is independent of dose and is similar to following single and multiple doses in both patients with epilepsy and in healthy volunteers. [ 80 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1643", "text": "Lamotrigine is inactivated by  glucuronidation  in the  liver . [ 81 ]  Lamotrigine is metabolized predominantly by  glucuronic acid   conjugation . Its major metabolite is an inactive 2-n-glucuronide conjugate. [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1644", "text": "Lamotrigine has fewer drug interactions than many  anticonvulsant  drugs, although pharmacokinetic interactions with  carbamazepine ,  phenytoin  and other hepatic enzyme-inducing medications may shorten  half-life . [ 83 ]  Dose adjustments should be made on clinical response, but monitoring may be of benefit in assessing compliance. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1645", "text": "The capacity of available tests to detect potentially adverse consequences of  melanin  binding is unknown. Clinical trials excluded subtle effects and optimal duration of treatment.  There are no specific recommendations for periodic ophthalmological monitoring. Lamotrigine binds to the eye and melanin-containing tissues which can accumulate over time and may cause toxicity. Prescribers should be aware of the possibility of long-term ophthalmologic effects and base treatment on clinical response.  Patient compliance should be periodically reassessed with lab and medical testing of liver and kidney function to monitor progress or side effects. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1646", "text": "The first synthesis of lamotrigine was disclosed in a patent file by the  Wellcome Foundation  in 1980. [ 84 ] [ 85 ] \n2,3-Dichlorobenzoyl chloride is treated with  cuprous cyanide  to form an  acyl cyanide . This is then reacted with the  nitrate  salt of  aminoguanidine  to give an intermediate which is cyclised to the diamino  triazine  of the drug product. [ 86 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1647", "text": "Lamotrigine is sold under the original brand name Lamictal [ 5 ]  and it is available in generic form under many brand names worldwide. [ 1 ] [ 89 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1648", "text": "In March 2021, the United States Food and Drug Administration (FDA) issued a warning regarding the potential for  cardiac arrhythmias  in people with pre-existing structural or conduction heart defects. [ 90 ] [ 91 ]  The warning provoked consternation and controversy within the professional community. [ 92 ]  An in-vitro study conducted in 2011 predicted Class IB antiarrhythmic activity at therapeutic concentrations of lamotrigine, due to its sodium channel-blocking activity. [ 93 ]  Thus, lamotrigine use in at-risk populations could prolong the QRS interval on the electrocardiogram, and increase the risk of arrhythmias and sudden death. No references to human studies or postmarket data in at-risk populations (i.e., people with structural heart disease) were cited to support the warning. A study in dogs is mentioned in the prescribing information brochure by the manufacturer. [ 90 ]  A rapid systematic review concluded that \"there is insufficient evidence to support or refute that lamotrigine is associated with sudden death or electrocardiogram changes...\" [ 94 ]  The FDA has recommended that further studies are conducted with lamotrigine and other sodium-channel blocking antiseizure medications. [ 91 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1649", "text": "In March 2023, an  FDA Adverse Event Reporting System  analysis demonstrated signals of  cardiac arrest , but not of  tachyarrhythmia  or  bradyarrhythmia  nor their clinical manifestation as fainting in lamotrigine. The study stratified the epileptic and psychiatric indications, explaining that the nature of the signal for cardiac arrest seems to be confounded by the psychiatric indication, which included 2.5 times more concomitant medications with cardiac adverse events, such as QT-prolonging drugs. Additionally, a 1.5-fold greater reports on  overdose  and  suicide attempts  was recorded in the psychiatric reports. Although lamotrigine blocks the cardiac sodium channels at therapeutically relevant concentrations, owing to its short-fast kinetics at the channel level, this blockage did not translate into a disproportional signal in this study. [ 95 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1650", "text": "Though lamotrigine has been used to treat seizures in infants, as of 2023, its effectiveness in this age group has been evaluated in only one study. Adverse effects were rarely severe enough for the medication to be discontinued in this age group, however, its effectiveness in reducing seizures was inconclusive. [ 96 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1651", "text": "Lornoxicam , also known as  chlortenoxicam , is a  nonsteroidal anti-inflammatory drug  (NSAID) of the  oxicam  class with  analgesic  (pain relieving),  anti-inflammatory  and  antipyretic  (fever reducing) properties. It is available in  oral  and  parenteral  formulations."}
{"_id": "WikiPedia_Dermatology$$$corpus_1652", "text": "It was patented in 1977 and approved for medical use in 1997. [ 1 ]  Brand names include  Xefo  and  Xefocam  among others."}
{"_id": "WikiPedia_Dermatology$$$corpus_1653", "text": "Lornoxicam is used for the treatment of various types of pain, especially resulting from inflammatory diseases of the joints,  osteoarthritis , surgery,  sciatica , and other inflammations. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1654", "text": "The drug is contraindicated in patients who must not take other NSAIDs, possible reasons including  salicylate sensitivity , gastrointestinal bleeding and  bleeding disorders , and severe impairment of heart, liver or kidney function. Lornoxicam is not recommended during pregnancy and breastfeeding and is contraindicated during the last third of pregnancy. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1655", "text": "Lornoxicam has side effects similar to other NSAIDs, most commonly mild ones like gastrointestinal disorders ( nausea  and  diarrhea ) and  headache . Severe but seldom side effects include bleeding,  bronchospasms  and the extremely rare  Stevens\u2013Johnson syndrome . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1656", "text": "Interactions with other drugs are typical of NSAIDs. Combination with  vitamin K antagonists  like  warfarin  increases the risk of bleeding. Combination with  ciclosporin  can lead to reduced kidney function, and to  acute kidney injury  in rare cases. Lornoxicam can also increase the adverse effects of  lithium ,  methotrexate  and  digoxin  and its derivatives. The effect of  diuretics ,  ACE inhibitors  and  angiotensin II receptor antagonists  can be reduced, but this is only relevant in patients with special risks like  heart failure . As with  piroxicam ,  cimetidine  can increase plasma levels but is unlikely to cause relevant interactions. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1657", "text": "Modafinil , sold under the brand name  Provigil  among others, is a  central nervous system  (CNS)  stimulant  and  eugeroic  ( wakefulness  promoter) medication used primarily to treat  narcolepsy , [ 3 ] [ 8 ] [ 15 ]  a  sleep disorder  characterized by  excessive daytime sleepiness  and sudden  sleep attacks . [ 16 ]  Modafinil is also approved for stimulating wakefulness in people with  sleep apnea  and  shift work sleep disorder . [ 3 ]  It is taken  by mouth . [ 3 ] [ 8 ]  Modafinil is not approved by the US  Food and Drug Administration  (FDA) for use in people under 17 years old. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1658", "text": "Common side effects of Modafinil include  anxiety ,  insomnia ,  dizziness , and  headache . Modafinil has potential for causing severe  allergic reactions ,  psychiatric  effects, [ 3 ]   hypersensitivity ,  adverse   interactions  with  prescription drugs , and misuse or  abuse . [ 3 ] [ 8 ] [ 15 ]  Modafinil may harm the  fetus  if taken during or two months prior to  pregnancy . [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1659", "text": "While modafinil is used as a  cognitive enhancer , or \"smart drug,\" among healthy individuals seeking improved focus and productivity, [ 18 ] [ 19 ]  its use outside medical supervision raises concerns regarding potential misuse or abuse. [ 3 ] [ 8 ] [ 20 ]  Research on the cognitive enhancement effects of modafinil in non-sleep deprived individuals has yielded mixed results, with some studies suggesting modest improvements in attention and executive functions, while others show no significant benefits or even a decline in cognitive functions at high doses. [ 21 ] [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1660", "text": "Modafinil, a  eugeroic  or  wakefulness-promoting drug , is primarily used for treating narcolepsy, a sleep disorder characterized by excessive daytime sleepiness and sudden sleep attacks. [ 16 ]  Being a  central nervous system  (CNS)  stimulant  itself, [ 23 ]  modafinil has lower addictive potential than classical stimulants such as  amphetamine ,  cocaine , or  methylphenidate , [ 13 ] [ 24 ] [ 25 ]  but still produces  psychoactive  and subjective effects typical of classical stimulants. [ 3 ] [ 8 ] [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1661", "text": "Narcolepsy causes a strong urge to sleep during the day and can include symptoms like  cataplexy  (sudden muscle weakness),  sleep paralysis  (inability to move or speak while falling asleep or waking up), and  hallucinations . Narcolepsy is linked to a lack of the brain chemical  hypocretin  ( orexin ), primarily produced in the  hypothalamus . [ 26 ] [ 27 ]  Modafinil is not a cure for narcolepsy, but it can help manage the symptoms. While modafinil is primarily used to treat excessive sleepiness, it may also help reduce the frequency and severity of cataplexy attacks in some people. Modafinil is approved for management of narcolepsy with or without cataplexy. However, it is not specifically approved for the treatment of cataplexy. [ 28 ] [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1662", "text": "Modafinil is also prescribed for  shift work sleep disorder . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1663", "text": "Modafinil performs moderately (but better than  armodafinil  or  solriamfetol ) [ 30 ]  as a drug to overcome  excessive daytime sleepiness  caused by  obstructive sleep apnea , [ 31 ]  though it is recommended that people with apnea use  continuous positive airway pressure  (CPAP) therapy, that is a sleep breathing apparatus to prevent apnea, before starting modafinil. [ 8 ] [ 22 ] [ 32 ]  When obstructive sleep apnea is comorbid with narcolepsy, modafinil is an effective drug to reduce the associated excessive daytime sleepiness. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1664", "text": "Modafinil's use varies by region. In the US, it is approved for adult narcolepsy, shift work sleep disorder, and obstructive sleep apnea, but not for children. [ 20 ]  In the UK and the EU, since 2014, it is approved solely for narcolepsy, including in children ( pediatric narcolepsy ), with its use for other conditions restricted by the European Medicines Agency. [ 28 ] [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1665", "text": "As of 2024, [update]  both the French and the American Academy of Sleep Medicine strongly recommend modafinil as the first-choice treatment for narcolepsy. [ 35 ]  In Europe, modafinil is considered one of the primary drugs recommended for treating narcolepsy according to the guidelines. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1666", "text": "The  National Institute for Health and Care Excellence  (NICE) in the UK, along with various non-governmental organizations focused on  multiple sclerosis  (MS), endorse the off-label use of modafinil to alleviate fatigue associated with MS. [ 20 ] [ 37 ] [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1667", "text": "MS-related fatigue is a common and often debilitating symptom experienced by people with multiple sclerosis. [ 39 ] [ 40 ] [ 41 ] [ 42 ]  It can significantly impact their daily functioning,  quality of life , and ability to perform everyday activities. When prescribed for MS-related fatigue management, modafinil works by promoting wakefulness and increasing  alertness  without causing drowsiness or disrupting nighttime sleep. People with multiple sclerosis often report increased energy levels, reduced feelings of tiredness, improved cognitive function, and an overall improvement in their quality of life when taking modafinil. [ 43 ]  While modafinil can provide relief from MS-related fatigue symptoms, [ 43 ]  it does not treat the underlying cause or cure MS itself. The primary goal of using modafinil in MS is symptom management and improving daily functioning. [ 41 ] [ 42 ] [ 44 ] [ 45 ]  The effects of modafinil on other aspects of MS-related fatigue, such as severity and cognitive function, are less clear. [ 45 ] [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1668", "text": "While modafinil has been shown to be effective in managing fatigue in people with MS, [ 43 ] [ 41 ]  optimal dosing and treatment schedules are not well established. [ 41 ] [ 42 ] [ 44 ] [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1669", "text": "Modafinil is occasionally prescribed  off-label  for individuals with attention deficit hyperactivity disorder (ADHD). [ 46 ] [ 47 ] [ 48 ]  It has not consistently shown efficacy in treating adult ADHD, [ 49 ]  especially when compared to other treatments such as  lisdexamfetamine . [ 50 ] [ 51 ]  In children, modafinil is efficient in treating ADHD symptoms. [ 52 ] [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1670", "text": "Given its approved status in the US to treat narcolepsy, physicians can also prescribe modafinil for off-label uses, such as treating ADHD in both children and adults. [ 54 ] [ 55 ] [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1671", "text": "The Canadian Network for Mood and Anxiety Treatments (CANMAT) suggests modafinil as a second-line choice for ADHD, after the first-line choices such as  bupropion  are exhausted. [ 57 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1672", "text": "Modafinil is used off-label as an  adjunctive treatment  (i.e., in combination therapy) for the acute depressive phase in bipolar disorder. [ 58 ] [ 59 ] [ 60 ] [ 61 ]  The depressive phase of  bipolar disorder  may feature excessive sleepiness and fatigue. Adjunctive treatment with modafinil can be used as an augmentation for the main treatment to increase its effect and is safe and effective, especially for people who do not respond well to standard antidepressants. [ 62 ] [ 63 ] [ 49 ]  Modafinil does not significantly increase the risk of mood switch to mania or suicide attempts in people with bipolar disorder. [ 64 ] [ 62 ]  Modafinil may also have cognitive benefits in people with bipolar disorder who are in a remission state. [ 65 ] [ 66 ] [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1673", "text": "Whereas modafinil and armodafinil are approved for narcolepsy, they have been repurposed as  adjunctive treatments  to alleviate symptoms of acute depressive phase in people with bipolar disorder. [ 67 ]  Drug repurposing in psychiatry is a strategy for discovering new uses for drugs that have already been approved or tested in clinical trials for other illnesses. As such, drug repurposing is a rapid, cost-effective, and reduced-risk strategy for the development of new treatment options for psychiatric disorders. [ 67 ]  2021  meta-analysis  concluded that add-on modafinil and armodafinil were more effective than placebo on response to treatment, clinical remission, and reduction in depressive symptoms, with only minor side effects, but the effect sizes are small and the quality of evidence is therefore low, limiting the clinical relevance of the evidence. [ 67 ] [ 68 ]  Very low rates of mood swing (a change in mood from one extreme to another) [ 64 ] [ 69 ]  have been observed with modafinil and armodafinil in depressive phase of bipolar disorder. [ 60 ] [ 70 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1674", "text": "Modafinil was used during the  Gulf War  by the  French Foreign Legion , [ citation needed ]  the  US Air Force , [ 71 ] [ 72 ]  and  US Marine [ 73 ]  infantry to enhance \"operational tempo\" (a term that denotes the speed and intensity at which military operations or activities are executed), aiming to optimize the overall performance and efficiency of the units. [ 72 ] [ 74 ] [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1675", "text": "Armed forces in various countries, including the United States, the United Kingdom, India, and France, have considered modafinil as an alternative to traditional  amphetamines  for managing sleep deprivation in combat or extended missions. [ 76 ]  The US military approved modafinil for specific Air Force missions, replacing amphetamines for fatigue management. [ 77 ]  The use of modafinil in military contexts without sleep deprivation is not recommended due to inconclusive evidence on its cognitive enhancement benefits and potential risks of adverse effects. [ 71 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1676", "text": "Modafinil is also available to astronauts aboard the International Space Station for the management of fatigue caused by circadian dyssynchrony in orbit. [ 78 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1677", "text": "Modafinil has been used non-medically as a \"smart drug\" [ 18 ] [ 19 ]  by various groups, including students, [ 79 ] [ 80 ] [ 81 ]  office workers,  transhumanists , [ 82 ] [ 83 ]  and professionals in various sectors. Its use is attributed by these individuals to its potential for enhancing attention, cognitive capabilities, and  alertness . [ 84 ] [ 85 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1678", "text": "The effectiveness of modafinil as a cognitive enhancer is still debated. Some studies suggest significant increases in cognitive abilities, while others indicate mild to nonexistent cognitive improvements. [ 86 ] [ 87 ] [ 58 ] [ 88 ]  In some cases, it has even been associated with impairments in certain cognitive functions. [ 21 ] [ 22 ] [ 89 ]  It has been shown that modafinil's positive impact on cognitive abilities is more noticeable on sleep-deprived individuals. [ 90 ]  Therefore, in people who are not sleep-deprived, the potential of modafinil as a cognitive enhancer may be limited. [ 91 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1679", "text": "Modafinil is generally well-tolerated but can have potential risks and side effects. Common adverse effects of modafinil, experienced by less than 10% of users, include  headaches ,  nausea , and  reduced appetite . [ 92 ] [ 93 ] [ 20 ]   Anxiety ,  insomnia ,  dizziness ,  diarrhea , and  rhinitis  are also reported in 5% to 10% of users. [ 20 ]  Psychiatric reactions have occurred in individuals with and without a preexisting psychiatric history. [ 94 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1680", "text": "No significant changes in body weight have been observed in clinical trials, although decreased appetite and weight loss have been noted in children and adolescents. [ 95 ]  Modafinil can cause a slight increase in  aminotransferase enzymes , indicative of liver function, but there is no evidence of serious liver damage when levels are within reference ranges. [ 96 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1681", "text": "Rare but serious adverse effects include severe skin rashes and allergy-related symptoms. Between December 1998 and January 2007, the FDA received reports of six cases of severe cutaneous adverse reactions, including  erythema multiforme ,  Stevens\u2013Johnson syndrome ,  toxic epidermal necrolysis , and  DRESS syndrome . The FDA has issued alerts regarding these risks and also noted reports of angioedema and multi-organ hypersensitivity reactions in  postmarketing surveillance . [ 97 ] [ 98 ]  In 2007, the FDA required Cephalon to modify the Provigil leaflet to include warnings about these serious conditions. The long-term safety and effectiveness of modafinil have not been conclusively established. [ 99 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1682", "text": "The FDA does not endorse modafinil for children's medical conditions due to an increased risk of rare but serious dermatological toxicity, manifested as  Stevens\u2013Johnson syndrome  which is a type of severe skin reaction. [ 100 ] [ 65 ] [ 101 ]  However, in Europe, modafinil may be prescribed for treating narcolepsy in children. [ 102 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1683", "text": "Modafinil is commercially available in  100\u00a0mg  and  200\u00a0mg  oral tablet forms. [ 8 ]  Additionally, it is offered as the ( R )- enantiomer , known as  armodafinil , and as a  prodrug  named  adrafinil . [ 103 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1684", "text": "Modafinil is contraindicated during pregnancy and 2 months before getting pregnant. [ 104 ]  Women who take modafinil should not become pregnant, and, additionally, should be aware that modafinil reduces effectiveness of hormonal contraceptives, increasing chances of getting pregnant. [ 8 ] [ 15 ] [ 105 ]  Modafinil therapy during pregnancy increases the risk of birth defects, [ 17 ] [ 106 ] [ 107 ] [ 104 ]  such as with  congenital torticollis ,  hypospadias , and  congenital heart defects . [ 106 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1685", "text": "Modafinil is contraindicated for individuals with known  hypersensitivity  to either modafinil or armodafinil. [ 8 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1686", "text": "Modafinil is also contraindicated in certain cardiac conditions, including uncontrolled moderate to severe  hypertension ,  arrhythmia ,  cor pulmonale , [ 108 ] [ 109 ]  and in cases with signs of CNS stimulant-induced  mitral valve prolapse  or  left ventricular hypertrophy . [ 110 ] [ 111 ]  The package insert in the United States cautions about using modafinil in people with a documented medical history of left ventricular hypertrophy or those diagnosed with mitral valve prolapse who have previously exhibited symptoms associated with the mitral valve prolapse syndrome while undergoing treatment involving central nervous system stimulants. [ 112 ]  The reasons why modafinil is contraindicated in certain cardiac conditions are because modafinil affects the autonomic nervous system and, in particular, exerts significant effects on autonomic cardiovascular regulation, leading in some people to notable increases in heart rate and blood pressure. These substantial changes in the autonomic system warrant careful consideration when prescribing modafinil to people with pre-existing cardiovascular conditions. [ 113 ]  The increase in heart rate and blood pressure can worsen the symptoms of such pre-existing conditions as hypertension, arrhythmia, and cor pulmonale. These changes in the autonomic system induced by modafinil can increase the risk of heart attack, stroke, and heart failure. Modafinil can stimulate the release of norepinephrine and epinephrine, hormones that activate the sympathetic nervous system. This can cause  vasoconstriction , which is the narrowing of blood vessels, and increase the heart's workload, which is not desired in people with pre-existing heart conditions. In particular, modafinil can worsen the consequences of mitral valve prolapse or left ventricular hypertrophy, which are structural abnormalities of the heart. These can affect the blood flow and oxygen delivery to the heart and other organs. [ 114 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1687", "text": "Modafinil is also contraindicated in people with congenital problems like  galactose  intolerance,  lactase deficiency , or  glucose-galactose malabsorption . [ 115 ] [ 108 ] [ 109 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1688", "text": "Extensive clinical research has not demonstrated  drug tolerance  as a common adverse effect, even with therapeutic use extending up to 40 weeks. [ 116 ] [ 117 ] [ 99 ]  Drug tolerance in this context is defined as a reduction in response, to wakefulness-promoting and  anti-fatigue  properties of modafinil. [ 116 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1689", "text": "While modafinil is generally found to be safe and significant adverse effects are rare, including in pediatric narcolepsy cases (sleep disorders in children), there is evidence that long-term usage can lead to tolerance in some individuals. [ 22 ]  This necessitates higher doses to maintain the same level of cognitive enhancement or relief from sleepiness. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1690", "text": "People with current or past substance addictions and those with a family history of addiction are particularly at risk for developing tolerance. [ 22 ] [ 102 ] [ 118 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1691", "text": "The mechanisms driving tolerance to modafinil, which may involve its impact on  dopamine  and  norepinephrine  levels in the brain, are not fully understood. [ 22 ] [ 102 ] [ 118 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1692", "text": "Repeated administration of modafinil for off-label use, such as increased  alertness  and cognitive-enhancing effects in sleep deprivation, can lead to drug tolerance, which means that the effectiveness of the drug may decrease over time. Still, modafinil therapy as a  eugeroic  agent to treat narcolepsy does not typically lead to drug tolerance, i.e., the effectiveness does not usually decrease on prolonged use, although individual responses may vary. [ 22 ] [ 102 ] [ 118 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1693", "text": "Despite being a  CNS stimulant , the addiction and  dependence  liabilities of modafinil are considered low. [ 8 ] [ 2 ] [ 25 ] [ 119 ]  The exact mechanisms of action of modafinil are not known, [ 120 ]  and it is believed that pharmacological profile of modafinil is different from that of the classical stimulants such as  cocaine  or  amphetamine . [ 13 ]  Although modafinil shares biochemical mechanisms with stimulant drugs, it is less likely to have  mood-elevating properties . [ 8 ]  The similarities in effects with  caffeine  are not clearly established. [ 13 ] [ 121 ]  Unlike other stimulants, modafinil does not induce a strong subjective  feeling of pleasure or reward , which is commonly associated with  euphoria , an intense feeling of well-being. [ 22 ]  Euphoria may be an indicator of a drug's potential to be abused. Substance abuse is a compulsive and excessive use of the substance despite adverse consequences. [ 122 ]  In comparison to classical stimulants, modafinil exhibits a low propensity for abuse, as it lacks significantly expressed pleasurable or euphoric effects. [ 22 ]  Albeit to a lower degree than classical stimulants, modafinil still can produce psychoactive, euphoric, and subjective effects typical for abused stimulants. [ 8 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1694", "text": "Modafinil was not observed to promote overuse or misuse, even in people who have a history of cocaine addiction. [ 123 ]  Despite the initial belief that modafinil carried no abuse potential, emerging evidence suggests that it works at the same neurobiological mechanisms as other addictive stimulants. Consequently, there exists a potential risk of modafinil abuse, necessitating prudent consideration and caution when prescribing or using this medication. [ 91 ]  Modafinil exhibits a lower response on the amphetamine scale of the addiction research center inventory, suggesting reduced propensity for abuse compared to amphetamine. [ 124 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1695", "text": "The US  Drug Enforcement Administration  has classified modafinil as a  Schedule IV controlled substance ; [ 2 ] [ 8 ]  the medicine is recognized for having valid medical uses with low addiction potential. [ 119 ] [ 54 ]  The  International Narcotics Control Board  does not classify it as a narcotic or a psychotropic substance. [ 125 ] [ 126 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1696", "text": "An  overdose  of modafinil can lead to a range of symptoms and complications. Psychiatric symptoms may include  psychosis ,  mania ,  hallucinations , and suicidal ideation, which can occur even in individuals without a history of mental illness and may persist after discontinuation of the drug. [ 127 ]  Neurological complications, such as seizures, tremors,  dystonia , and  dyskinesia , may arise from modafinil's interaction with various neurotransmitter systems. [ 127 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1697", "text": "Allergic reactions such as rash,  angioedema ,  anaphylaxis , and  Stevens\u2013Johnson syndrome  may rarely be triggered by an immunological response to modafinil or its metabolites. [ 128 ] [ 129 ]  Cardiovascular complications like hypertension,  tachycardia , chest pain, and  arrhythmias  may also be observed due to modafinil's sympathomimetic action. [ 127 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1698", "text": "In animal studies, the median lethal dose (LD 50 ) of modafinil varies among species and depends on the route of administration. In mice and rats, the LD 50  is approximately  1250\u00a0mg/kg  if administered via an injection, but the oral LD 50  for rats is  3400\u00a0mg/kg . [ 130 ] [ 131 ]  The LD 50  value for humans have not been established. Human clinical trials have involved total daily doses up to  1200\u00a0mg/d  for 7\u201321\u00a0days. Acute one-time total overdoses up to  4500\u00a0mg  have not been life-threatening but resulted in symptoms like  agitation ,  insomnia ,  tremor ,  palpitations , and  gastrointestinal disturbances . [ 8 ] [ 132 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1699", "text": "The management of modafinil overdose involves supportive care, monitoring of vital signs, and treatment of specific complications. In cases of recent consumption,  activated charcoal ,  gastric lavage , or  hemodialysis  may be used. [ 127 ]  There is no specific antidote for modafinil overdose. [ 132 ] [ 133 ] [ 134 ]  The main way to deal with modafinil overdose is supportive care, which includes sedating the patient and stabilizing their blood pressure, and muscle activity in case of manifestations such as agitation or tremor. [ 132 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1700", "text": "Some of the drugs that frequently interact with modafinil include  aripiprazole  (an antipsychotic),  amphetamine  (including its enantiomers and salts; stimulants),  aspirin ,  diphenhydramine  (an  antihistamine ), and others. [ 135 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1701", "text": "Modafinil is a weak to moderate  inducer  of  CYP3A4 [ 105 ] [ 136 ] [ 137 ]  and a weak inhibitor of  CYP2C19 , [ 11 ]  enzymes of the  cytochrome P450  group of enzymes. [ 20 ]  Modafinil also induces or inhibits other cytochrome P450 enzymes. [ 105 ]  One  in vitro  study predicts that modafinil may  induce  the cytochrome P450 enzymes  CYP1A2 , CYP3A4, and  CYP2B6 , as well as may inhibit  CYP2C9  and  CYP2C19 . [ 14 ]  However, other in-vitro studies find no significant inhibition of  CYP2C9 . [ 11 ] [ 138 ]  Modafinil may induce  P-glycoprotein , which may affect drugs transported by P-glycoprotein, such as  digoxin . [ 139 ] \nIt was clinically found that modafinil affects  pharmacodynamics  of drugs which are metabolized by CYP3A4 and other enzymes of the cytochrome P450 family so that interactions of modafinil with these drugs were observed in real people, rather than being predicted in a lab setting. [ 105 ] [ 136 ]  For instance, it was observed that induction of CYP3A4 by modafinil affects metabolism of the following  medications  and  endogenous  substances: [ 140 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1702", "text": "Hypertensive crises  have been reported when  armodafinil  (one of modafinil's  enantiomers ) has been taken with  monoamine oxidase inhibitors  (MAOIs) like  tranylcypromine . [ 145 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1703", "text": "The precise  mechanism of action  of modafinil for narcolepsy and other sleep disorders remains unclear. [ 3 ] [ 120 ] [ 151 ] [ 152 ]  Although modafinil may have interactions with neurotransmitter systems, its exact mode of action is not fully understood. [ 120 ] [ 153 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1704", "text": "From laboratory research, modafinil has little to no affinity for  serotonin  or  norepinephrine transporters  and does not directly interact with these systems. [ 20 ] [ 152 ]  However, studies have shown that elevated concentrations of norepinephrine and serotonin can occur as an indirect effect following modafinil administration due to increased extracellular dopamine activity. [ 152 ] [ 20 ]  Unlike traditional psychostimulant drugs, [ 23 ]  such as  cocaine  or  amphetamine , modafinil shows low potential for causing euphoria due to differences in how it interacts with dopamine transporters at a cellular level. [ 120 ] [ 152 ] [ 153 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1705", "text": "In addition to its influence on  dopaminergic pathways , modafinil may impact other neurotransmitter systems, such as  orexin  ( hypocretin ). [ 152 ]  Orexin neurons are involved in promoting wakefulness and regulating arousal states. Modafinil may increase signaling within hypothalamic orexin pathways, potentially contributing to its wake-promoting effects. [ 20 ] [ 152 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1706", "text": "C max  (peak levels) occurs approximately 2\u00a0to\u00a03\u00a0hours after modafinil administration. [ 11 ]  Food slows the absorption of modafinil but does not affect the total  area under the curve  (AUC).  In vitro  measurements indicate that 60% of modafinil is bound to  plasma proteins  at clinical concentrations of the drug. This percentage changes very little when the concentration of modafinil is varied. [ 154 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1707", "text": "Renal excretion of unchanged modafinil usually accounts for less than 10% of an oral dose. This means that when modafinil is taken by mouth, that is the only approved route of administration, less than 10% of the drug is eliminated from the body through the urine without being metabolized by the liver or other organs. The rest of the drug is either metabolized or excreted through other routes, such as feces or bile. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1708", "text": "The two major circulating  metabolites  of modafinil are  modafinil acid  (CRL-40467) and  modafinil sulfone  (CRL-41056). Both of these metabolites have been described as inactive, and neither appears to contribute to the wakefulness-promoting effects of modafinil. [ 65 ] [ 155 ]  However, modafinil sulfone does appear to possess  anticonvulsant  effects, a property that it shares with modafinil. [ 65 ] [ 156 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1709", "text": "Elimination half-life  is in the range of 10 to 12 hours, [ 11 ] [ 154 ]  subject to differences in sex, [ 105 ]  in cytochrome P450  genotypes , liver function and renal function. Modafinil is metabolized mainly in the liver, [ 11 ]  and its inactive metabolites are excreted in the urine. Urinary excretion of the unchanged drug is usually less than 10% but can range from 0% to as high as 18.7%, depending on the factors mentioned. [ 154 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1710", "text": "Modafinil exhibits sex-specific pharmacokinetic differences. [ 105 ]  It demonstrates higher  bioavailability  in women compared to men. The mean C max  is higher in women than in men,  5.2\u00a0 mg/L  vs.  4.2\u00a0 mg/L  (p\u2009<\u20090.05), following a single  200\u00a0mg  oral dose of modafinil. [ 105 ]  This difference persists even after adjusting for body weight ( 0.88\u00a0ml/min/kg  vs.  0.72\u00a0ml/min/kg ). [ 105 ]  The clearance of modafinil is 30% higher in men than in women, and plasma concentrations after a single dose are significantly higher in women than in men. These sex-specific pharmacokinetic differences may have implications for the efficacy and safety of modafinil. [ 105 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1711", "text": "Modafinil is a  racemic mixture  of two  enantiomers ,  armodafinil  (( R )-modafinil) and  esmodafinil  (( S )-modafinil). [ 157 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1712", "text": "Modafinil and/or its major metabolite, modafinil acid, may be quantified in plasma, serum, or urine to monitor dosage in those receiving the drug therapeutically, to confirm a diagnosis of poisoning in hospitalized patients, or to assist in the forensic investigation of a vehicular traffic violation. [ 158 ]  Instrumental techniques involving gas or liquid chromatography are usually employed for these purposes. [ 88 ] [ 159 ] [ 160 ]  In 2011, modafinil was not tested for by common  drug screens  (except for anti-doping screens) and is unlikely to cause false positives for other chemically unrelated drugs such as  substituted amphetamines . [ 149 ] [ 157 ] [ 161 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1713", "text": "Reagent testing  can screen for the presence of modafinil in samples. [ 162 ] [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1714", "text": "Many  derivatives  and  structural analogs  of modafinil have been synthesized. [ 24 ] [ 164 ] [ 165 ]  Examples include  adrafinil ,  CE-123 ,  fladrafinil  (CRL-40941; fluorafinil),  flmodafinil  (CRL-40940; bisfluoromodafinil, lauflumide),  RDS03-94 ,  JJC8-088 ,  modafiendz  and  modafinil sulfone  (CRL-41056). [ 166 ] [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1715", "text": "Modafinil was developed in France by  neurophysiology  professor  Michel Jouvet  and Lafon Laboratories. It is part of a series of benzhydryl sulfinyl compounds, including  adrafinil , initially used as a treatment for narcolepsy in France in 1986. [ 167 ]  Modafinil, the primary metabolite of  adrafinil , [ 168 ]  has been prescribed in France since 1994 under the name Modiodal, [ 167 ]  and in the United States since 1998 as Provigil. [ 8 ]  Unlike modafinil, adrafinil does not have FDA approval and was withdrawn from the French market in 2011. [ 169 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1716", "text": "The FDA approved modafinil in 1998 for  narcolepsy  treatment, and later for  shift work sleep disorder  and  obstructive sleep apnea  in 2003. [ 8 ] [ 170 ] [ 171 ]  It was approved in the UK in December 2002. In the United States, modafinil is marketed by  Cephalon , [ 172 ]  who acquired the rights from Lafon and purchased the company in 2001. [ 172 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1717", "text": "Cephalon introduced armodafinil, the ( R )-enantiomer of modafinil, in the United States in 2007. Generic versions of modafinil became available in the US in 2012 after extensive patent litigation. [ 173 ] [ 174 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1718", "text": "Modafinil is not approved for use by children in multiple jurisdictions. [ 1 ] [ 175 ] [ 7 ] [ 8 ] [ 176 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1719", "text": "In Australia, modafinil is considered to be a  Schedule 4   prescription-only medicine . This means that it is a drug with a perceived low potential for abuse and low risk of dependence; still, the use of Schedule 4 drugs in Australia is restricted to those who have a valid prescription from a medical practitioner; import from abroad is illegal. [ 177 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1720", "text": "In Canada, modafinil is not specifically included in the lists of controlled drugs and substances specified within the  Controlled Drugs and Substances Act . [ 178 ]  However, it is classified as a Schedule\u00a0F prescription drug. [ 179 ] [ 180 ] [ 181 ]  This means that modafinil can only be obtained legally with a valid prescription from a licensed health care practitioner in Canada, and the import of modafinil to Canada from other countries is subject to restrictions: importing prescription drugs without an import permit may result in the seizure of the drugs at the border, the refusal of entry of the drugs into Canada, or prosecution. [ 182 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1721", "text": "In mainland China, modafinil is strictly controlled like other stimulants such as amphetamines and  methylphenidate . It is classified as Class\u00a0I psychotropic drug. This classification means that modafinil is considered to have a high potential for abuse and dependence, and is therefore subject to strict regulation and control. As a result, modafinil is only available by prescription and cannot be purchased over the counter. In order to obtain a prescription for modafinil, a patient must have a valid medical reason for using the drug, such as  narcolepsy  or  obstructive sleep apnea . Additionally, the prescription must be written by a licensed physician and filled at a  licensed pharmacy . The use of modafinil for non-medical purposes, such as with the aim to improve cognitive performance or to stay awake for long periods of time, is strictly prohibited and can result in legal consequences. [ 183 ] [ 184 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1722", "text": "In Denmark, modafinil is a prescription drug but not listed as a controlled substance. According to the  Danish Medicines Agency , modafinil is approved for use in the treatment of narcolepsy, still, importing modafinil to Denmark is considered illegal without a valid prescription. [ 185 ] [ 186 ] [ 187 ] [ 188 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1723", "text": "In Finland, modafinil is a prescription drug but not listed as a  controlled substance . Finland is a member of the European Union, and it is illegal to import prescription medicine from outside the European Union unless the person has a valid prescription. [ 189 ] [ 190 ] [ 191 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1724", "text": "In the Republic of Moldova, modafinil is classified as a psychotropic drug (included in table III list 3 which is the list of psychotropic substances as defined by the  Government of Moldova ) [ 192 ]  and is available by prescription. [ 192 ]  Importation of modafinil may be considered illegal and subject to severe penalties, even if you have a prescription. [ 193 ]  For example, on June 29, 2017,  Moldovan postal officers  discovered 60 tablets of Modalert (200\u00a0mg modafinil tablets) in a parcel sent from India to a resident in  Chi\u0219in\u0103u , Moldova. The prohibited substance was detected during a routine scan and was seized as illegal. The authorities were notified of the incident and the recipient was charged with criminal penalties. [ 194 ] [ 195 ]  In the  Transnistria  region of Moldova, modafinil is completely prohibited, due to application of the legislation similar to that of Russia where modafinil is completely prohibited and is in the same list as narcotics. Possession or an attempt to bring modafinil to Transnistria potentially leads to imprisonment. [ 196 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1725", "text": "In Romania, modafinil is classified as a stimulant doping agent and is prohibited in sports competitions. [ 197 ]  In 2022, laws were passed making its importation or sale a felony, punishable by three to seven years in jail. [ 198 ]  Simple possession for personal use may result in a fine and confiscation. [ 198 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1726", "text": "In Sweden, modafinil is classified as a schedule\u00a0IV substance, which means that it is considered to have a low potential for abuse and a low risk of dependence. Still, possession is illegal without a prescription. [ 199 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1727", "text": "In the United Kingdom, it is not listed in  Misuse of Drugs Act , so possession is not illegal, but a prescription is required. [ 200 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1728", "text": "In Mexico, modafinil is not listed as a controlled substance, in the National Health Law, and can be purchased in pharmacies without prescription. [ 201 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1729", "text": "In Japan, modafinil is Schedule\u00a0I psychotropic drug. This means that it is considered to have a high potential for abuse and dependence, and is therefore subject to strict regulations. The use of Schedule I drugs in Japan is generally prohibited, except under certain circumstances, such as for medical purposes. It can only be prescribed by a doctor. It cannot be imported or exported without a permit. It cannot be used while driving or operating machinery. [ 202 ] [ 203 ]   Cephalon  licensed Alfresa Corporation to produce, and  Mitsubishi Tanabe Pharma  to sell modafinil products under the trade name Modiodal in Japan. [ 204 ]  There have been arrests of people who imported modafinil for personal use. [ 205 ] [ 206 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1730", "text": "In Russia, starting from May 18, 2012, modafinil is Schedule\u00a0II controlled substance. Being classified as a Schedule II controlled substance in Russia means that it is seen as a drug with a high potential for abuse and dependence. This classification imposes strict regulations on the production, distribution, and use of modafinil. Possession of a few modafinil pills can lead to three to ten years imprisonment. Modafinil is not approved for medical use in Russia and cannot be bought even in pharmacies. It also cannot be imported from abroad, even if you have a prescription issued outside Russia. [ 196 ] [ 207 ]  There are multiple cases of criminal proceedings initiated against Russian residents who tried to import modafinil by mail from abroad. [ 208 ] [ 209 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1731", "text": "In South Africa, modafinil is Schedule\u00a0V substance, which means that it is legal to use modafinil in South Africa, but only with a valid prescription from a licensed medical practitioner. [ 210 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1732", "text": "In the United States, modafinil is classified as a  schedule IV controlled substance [ 2 ]  under US federal law. [ 8 ] [ 211 ]  This means that the drug has a low potential for abuse and dependence compared to other controlled substances. However, it still requires a prescription from a  licensed healthcare provider  to obtain. [ 211 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1733", "text": "It is illegal to import modafinil to the United States without a  Drug Enforcement Administration  ( DEA )\u2013registered importer and a prescription. [ 212 ]  Individuals may legally bring modafinil into the US from a foreign country for personal use, limited to 50 dosage units, with a prescription and proper declaration at the border. [ 213 ]  Under the  Pure Food and Drug Act , marketing drugs for off-label uses is prohibited. [ 214 ]  Cephalon, the manufacturer of Provigil, faced legal issues for promoting off-label uses and paid significant fines in 2008. [ 215 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1734", "text": "Modafinil is sold under a variety of brand names worldwide, including Alertec, Alertex, Altasomil, Aspendos, Bravamax, Forcilin, Intensit, Karim, Mentix, Modafinilo, Modalert, Modanil, Modasomil, Modvigil, Modiodal, Modiwake, Movigil, Provigil, Resotyl, Stavigile, Vigia, Vigicer, Vigil, Vigimax, Waklert, and Zalux. [ 216 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1735", "text": "Originally developed in the 1970s by French neuroscientist Michel Jouvet and Lafon Laboratories, modafinil has been prescribed in France since 1994, [ 167 ] [ 36 ]  and was approved for medical use in the United States in 1998. [ 8 ] [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1736", "text": "Concerns have been raised about the growing use of modafinil as a \"smart drug\" or cognitive enhancer among healthy individuals who use it with the aim to improve concentration and memory. [ 217 ] [ 218 ]  In 2003, modafinil sales were skyrocketing, with some experts concerned that it had become a tempting pick-me-up for people looking for an extra edge in a productivity-obsessed society. [ 217 ]  The cost of modafinil varied depending on factors such as location and insurance coverage; [ 217 ] [ 218 ] [ 219 ]  still, in 2004, the price of modafinil in the US was around $120 or more per monthly supply. [ 217 ]  However, the availability of generic versions has increased since then and may have driven down prices. [ 217 ] [ 218 ] [ 219 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1737", "text": "In 2020, modafinil was the 302nd most commonly prescribed medication in the United States, with just over 1,000,000 prescriptions. [ 220 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1738", "text": "As of 2024, [update]  the global sales figures for modafinil are not known. Still, modafinil sold under the brand name Provigil accounted for over 40% of  Cephalon 's global turnover for several years, according to the information published in 2020. [ 221 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1739", "text": "Modafinil's patent history involves several key developments. The original patent,  U.S. patent 4,927,855 , was granted to Laboratoire L. Lafon in 1990, covering the chemical compound of modafinil. This patent expired in 2010. [ 222 ]  In 1994, Cephalon filed a patent for modafinil in the form of particles of a defined size, represented by  U.S. patent 5,618,845 , which expired in 2015. [ 223 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1740", "text": "Following the nearing expiration of marketing rights in 2002, generic manufacturers, including Mylan and Teva, applied for FDA approval to market a generic form of modafinil, leading to legal challenges by Cephalon regarding the particle size patent. [ 224 ]  The patent RE\u00a037,516 was declared invalid and unenforceable in 2011. [ 225 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1741", "text": "In addition, Cephalon entered agreements with several generic drug manufacturers to delay the sale of generic modafinil in the US. These agreements were subject to legal scrutiny and antitrust investigations, culminating in a ruling by the Court of Appeals in 2016, which found that the settlements did not violate antitrust laws. [ 226 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1742", "text": "The regulation of modafinil as a  doping agent  has been controversial in the sporting world, with high-profile cases attracting press coverage since several prominent American athletes tested positive for the substance. Some athletes who used modafinil protested that the drug was not on the prohibited list at the time of their offenses. [ 227 ]  However, the  World Anti-Doping Agency  (WADA) maintains that modafinil was related to already-banned substances. The Agency added modafinil to its list of prohibited substances on August 3, 2004, ten days before the start of the  2004 Summer Olympics . [ 161 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1743", "text": "Several athletes, such as sprinter  Kelli White  in 2003, [ 228 ]  cyclist  David Clinger [ 229 ]  and basketball player  Diana Taurasi [ 230 ]  in 2010, and rower Timothy Grant in 2015, [ 231 ]  were accused of using modafinil as a performance-enhancing  doping  agent. Taurasi and another player\u2014Monique Coker, tested at the same lab\u2014were later cleared. [ 232 ]  Kelli White, who tested positive after her 100m victory at the 2003 World Championships in Paris, was stripped of her gold medals. [ 233 ]  She claimed that she used modafinil to treat narcolepsy, but the  International Association of Athletics Federations  (IAAF) ruled that modafinil was a performance-enhancing drug. [ 233 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1744", "text": "The  BALCO  scandal brought to light an unsubstantiated (but widely published) account of Major League Baseball's all-time leading home-run hitter  Barry Bonds ' supplemental chemical regimen that included modafinil in addition to  anabolic steroids  and  human growth hormone . [ 234 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1745", "text": "The use of modafinil as a supposed cognitive enhancer may be considered as cheating, unnatural, or risky. [ 235 ]  The  University of Sussex  explained that it is a prescription drug and the decision should be made by the  doctor  on whether to prescribe modafinil to a student. [ 236 ]  As a matter of  bioethics , the US  President's Council on Bioethics  argued that excellence achieved through the use of drugs like modafinil is \"cheap\" as it obviates the need for hard work and study, and is not fully authentic because the excellence is partly attributable to the drug, not the individual. [ 237 ]  Alternately, people in environments like  Wall Street trading  may not view the use of modafinil as cheating, believing that if modafinil can give them an edge and they are aware of the risks involved, it should not be considered as cheating. [ 238 ]  Due to such varying views, modafinil users for narcolepsy may cope with stigma by hiding, denying, or justifying their use, or by seeking support from others who share their views or experiences. [ 239 ] [ 240 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1746", "text": "Modafinil has been studied in the treatment of  major depressive disorder . [ 241 ] [ 242 ] [ 243 ]  In a 2021  systematic review  and meta-analysis of  randomized controlled trials  of  psychostimulants  for depression, modafinil and other stimulants such as  methylphenidate  and amphetamines improved depression in traditional meta-analysis. [ 243 ]  However, when subjected to  network meta-analysis , modafinil and most other stimulants did not significantly improve depression, with only methylphenidate remaining effective. [ 243 ]  Modafinil and other stimulants likewise did not improve  quality of life  in the meta-analysis, although there was evidence for reduced fatigue and sleepiness with modafinil and other stimulants. [ 243 ]  While significant effectiveness of modafinil for depression has been reported by particular trials, [ 70 ] [ 242 ] [ 244 ]  reviews and meta-analyses note that the effectiveness of modafinil for depression is limited, the quality of available evidence is low, and the results are inconclusive. [ 243 ] [ 245 ] [ 246 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1747", "text": "Modafinil was considered for the treatment of ADHD because of its lower  abuse potential  than conventional psychostimulants [ 23 ]  like methylphenidate and amphetamines. [ 55 ] [ 247 ]  In 2008, an application to market modafinil for pediatric ADHD was submitted to the  Food and Drug Administration  in the US. [ 92 ] [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1748", "text": "However, evidence of modafinil for treatment of adult ADHD is mixed, and a 2016 systematic review of alternative drug therapies for adult ADHD did not recommend its use in this context. [ 51 ]  In a later large  phase\u00a03  clinical trial of modafinil for adult ADHD, modafinil was not effective in improving symptoms, there was also a high rate of side effects (86%) and discontinuation (47%). [ 248 ]  The poor  tolerability  of modafinil in this study was possibly due to the use of high doses ( 210\u2013510\u00a0mg/d ). [ 248 ]  Another reason for the denial of the approval was due to concerns about rare but serious dermatological toxicity in  Stevens\u2013Johnson syndrome . [ 92 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1749", "text": "The research on the use of modafinil for treating individuals with Autism Spectrum Disorder (ASD) who also exhibit ADHD symptoms is currently in its early stages with no results delivered. [ 249 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1750", "text": "Modafinil was studied for the treatment of  stimulant dependence , but the results are mixed and inconclusive. [ 24 ] [ 250 ]  Modafinil is not a  controlled substance  in some countries, unlike other medications, such as  bupropion , which is also used to treat  depression  and  nicotine dependence . [ 251 ]  The clinical trials that have tested modafinil as a treatment for stimulant abuse have failed to demonstrate its efficacy and the optimal dose and duration of modafinil treatment remain unclear, and modafinil is not a recommended treatment for stimulant abuse. [ 251 ]  2024 reviews found that modafinil was ineffective for treating individuals with  amphetamine-type stimulant use disorder [ 252 ]  or  methamphetamine use disorder [ 253 ]  from these dependencies. [ 253 ] [ 252 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1751", "text": "Modafinil and armodafinil were studied as a complement to  antipsychotic  medications in the treatment of  schizophrenia . They showed no effect on positive symptoms or cognitive performance. [ 254 ] [ 255 ]  A 2015  meta-analysis  found that modafinil and armodafinil may slightly reduce negative symptoms in people with acute schizophrenia, though they do not appear useful for people with the condition who are stable, with high negative symptom scores. [ 255 ]  Among medications demonstrated to be effective for reducing negative symptoms in combination with antipsychotics, modafinil, and armodafinil are among the smallest  effect sizes . [ 256 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1752", "text": "Modafinil is researched to determine whether it might improve abstinence in people with  cocaine addiction . [ 257 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1753", "text": "Modafinil has been found to reverse  tetrabenazine -induced  motivational deficits  in animals and hence can produce  pro-motivational  effects. [ 258 ] [ 259 ] [ 260 ]  Novel modafinil  analogs  with greater  potency , including  CE-123 ,  CE-158 ,  JJC8-088 ,  MK-26 , and  RDS03-94 , have also been developed and have shown pro-motivational effects in animals. [ 258 ] [ 261 ]  These agents are of potential interest in the treatment of  motivational disorders  in humans. [ 258 ] [ 261 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1754", "text": "A 2019 review conducted on the potential nootropic effects of modafinil in healthy, non-sleep-deprived individuals revealed the following: [ 262 ]  a) while studies using basic testing paradigms demonstrated that modafinil enhances  executive function , only half of these studies showed improvements in attention, learning, and memory, with a few studies even reporting impairments in divergent creative thinking; b) modafinil displayed small levels of enhancement in attention, executive functions, and learning abilities; c) no substantial side effects or mood changes were observed; d) the available evidence showed limited evidence for modafinil as a cognitive enhancer outside of its use for sleep-deprived populations."}
{"_id": "WikiPedia_Dermatology$$$corpus_1755", "text": "A 2020 review reported that modafinil has a modest effect on memory updating, but the effect is small and may not accurately reflect the perception that it is useful as a cognitive enhancer, as there is insufficient evidence to support such a claim. [ 263 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1756", "text": "General anesthesia  is required for many  surgeries , but may cause lingering fatigue, sedation, and/or drowsiness after surgery that lasts for hours to days. [ 264 ] [ 265 ]  In  outpatient surgery  the  sedation ,  fatigue , and occasional  dizziness  is problematic. [ 266 ] [ 267 ]  Modafinil was tested as a potential remedy to alleviate these symptoms. [ 54 ]  For example, it was expected that modafinil would help people recover quicker from general anesthesia after a short surgery, [ 92 ]  but the results were uncertain and the inconclusive studies could not reliably verify the expectation. [ 54 ]  The use of modafinil to relieve post-anesthesia sedation is investigational. [ 92 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1757", "text": "Caution should be exercised in people who have narcolepsy in  comorbidity  with  postural orthostatic tachycardia syndrome  (POTS). [ 268 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1758", "text": "Modafinil is being researched as a potential remedy for excessive daytime sleepiness in  myotonic dystrophy  (DM), an inherited condition characterized by progressive muscle loss, weakness, and  myotonia.  Myotonia is a condition where muscles cannot relax after they contract. [ 269 ]  Myotonic dystrophy has two main types: DM1 (Steinert disease) and DM2 (proximal myotonic myopathy). Both types can cause excessive daytime sleepiness. Studies suggest that modafinil may be a promising drug that can reduce both daytime sleepiness and myotonia itself, without significant cardiac conduction effects. These presumed property of modafinil is of particular interest for evntual treatment of pepole with myotonic dystrophy who often have underlying cardiac issues. [ 269 ]  Still, modafinil is not approved by the FDA for use in myotonic dystrophy, and the value and role of modafinil in DM remain the subject of debate. [ 269 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1759", "text": "Modafinil has been studied for its potential therapeutic effects in patients with  disorders of consciousness . [ 270 ]  Researchers are investigating whether modafinil can stimulate  neurotransmitters  such as  histamine ,  norepinephrine ,  serotonin ,  dopamine , and  orexin , and whether modafinil has potential  anti-oxidative effects . [ 270 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1760", "text": "Disorders of consciousness are states characterized by impaired arousal and awareness. [ 270 ]  These states include  coma ,  vegetative state / unresponsive wakefulness syndrome  (VS/UWS),  minimally conscious state  (MCS),  cognitive motor dissociation , and  covert cortical processing . [ 270 ]  Brain injuries can impair consciousness through  neuroanatomic lesions  involving the  bilateral cerebral hemispheres ,  rostral brainstem ,  diencephalon , or  basal forebrain . [ 270 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1761", "text": "Neuroimaging  studies have shown that modafinil increases  cerebral blood flow  in several brain regions, such as the  thalamus ,  locus coeruleus ,  limbic system , and  insular cortex ; [ 270 ]  still, observational reports on the use of modafinil in patients with disorders of consciousness have produced mixed results, indicating that its effectiveness may vary among individuals. [ 270 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1762", "text": "A possible link between  inflammatory processes  and depressive disorders [ 271 ]  has stimulated preliminary research on modafinil for its potential anti-inflammatory effects. [ 272 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1763", "text": "Mustard gas  or  sulfur mustard  are names commonly used for the  organosulfur   chemical compound   bis(2-chloroethyl) sulfide , which has the chemical structure S(CH 2 CH 2 Cl) 2 , as well as other  species . In the wider sense, compounds with the substituents  \u2212SCH 2 CH 2 X or \u2212N(CH 2 CH 2 X) 2  are known as  sulfur mustards  or  nitrogen mustards , respectively, where X = Cl or Br. Such compounds are potent  alkylating agents , making mustard gas acutely and severely toxic. [ 3 ]  Mustard gas is a  carcinogen . [ 3 ]  There is no preventative agent against mustard gas, with protection depending entirely on skin and airways protection, and no  antidote  exists for mustard poisoning. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1764", "text": "Also known as mustard agents, this family of compounds comprises infamous  cytotoxins  and  blister agents  with a long history of use as  chemical weapons . [ 4 ]  The name  mustard gas  is technically incorrect; the substances, when  dispersed , are often not gases but a fine mist of liquid droplets that can be readily absorbed through the skin and by inhalation. [ 3 ]  The skin can be affected by contact with either the liquid or vapor. The rate of penetration into skin is proportional to dose, temperature and humidity. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1765", "text": "Sulfur mustards are viscous liquids at room temperature and have an odor resembling  mustard plants ,  garlic , or  horseradish , hence the name. [ 3 ] [ 4 ]  When pure, they are colorless, but when used in impure forms, such as in warfare, they are usually  yellow-brown . Mustard gases form  blisters  on exposed skin and in the lungs, often resulting in prolonged illness ending in death. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1766", "text": "Sulfur mustard is a type of chemical warfare agent. [ 5 ]  As a chemical weapon, mustard gas was first used in  World War I , and has been used in several armed conflicts since then, including the  Iran\u2013Iraq War , resulting in more than 100,000 casualties. [ 6 ] [ 7 ]  Sulfur-based and  nitrogen-based  mustard agents are regulated under  Schedule 1  of the 1993  Chemical Weapons Convention , as substances with few uses other than in  chemical warfare . [ 4 ] [ 8 ]  Mustard agents can be deployed by means of  artillery shells ,  aerial bombs ,  rockets , or by spraying from aircraft."}
{"_id": "WikiPedia_Dermatology$$$corpus_1767", "text": "Mustard gases have powerful  blistering  effects on victims. They are also  carcinogenic  and  mutagenic   alkylating agents . [ 3 ]  Their high  lipophilicity  accelerates their absorption into the body. [ 2 ]  Because mustard agents often do not elicit immediate symptoms, contaminated areas may appear normal. [ 4 ]  Within 24 hours of exposure, victims experience intense  itching  and skin irritation. If this irritation goes untreated, blisters filled with  pus  can form wherever the agent contacted the skin. [ 4 ]  As  chemical burns , these are severely debilitating. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1768", "text": "If the victim's eyes were exposed, then they become sore, starting with  conjunctivitis  (also known as pink eye), after which the eyelids swell, resulting in temporary blindness. Extreme ocular exposure to mustard gas vapors may result in  corneal ulceration , anterior chamber scarring, and  neovascularization . [ 9 ] [ 10 ] [ 11 ] [ 12 ]  In these severe and infrequent cases,  corneal transplantation  has been used as a treatment. [ 13 ]   Miosis , when the pupil constricts more than usual, may also occur, which may be the result of the cholinomimetic activity of mustard. [ 14 ]  If inhaled in high concentrations, mustard agents cause bleeding and blistering within the  respiratory system , damaging  mucous membranes  and causing  pulmonary edema . [ 4 ]  Depending on the level of contamination, mustard agent burns can vary between  first  and  second degree burns . They can also be as severe, disfiguring, and dangerous as  third degree burns . Some 80% of sulfur mustard in contact with the skin evaporates, while 10% stays in the skin and 10% is absorbed and circulated in the blood. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1769", "text": "The carcinogenic and mutagenic effects of exposure to mustard gas increase the risk of developing  cancer  later in life. [ 3 ]  In a study of patients 25 years after wartime exposure to chemical weaponry, c-DNA microarray profiling indicated that 122 genes were significantly mutated in the lungs and airways of mustard gas victims. Those genes all correspond to functions commonly affected by mustard gas exposure, including  apoptosis , inflammation, and stress responses. [ 15 ]  The long-term ocular complications include burning, tearing, itching,  photophobia ,  presbyopia , pain, and foreign-body sensations. [ 4 ] [ 16 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1770", "text": "In a rinse-wipe-rinse sequence, skin is decontaminated of mustard gas by washing with liquid soap and water, or an absorbent powder. [ 4 ]  The eyes should be thoroughly rinsed using saline or clean water. A topical analgesic is used to relieve skin pain during decontamination. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1771", "text": "The blistering effects of mustard gas can be neutralized by decontamination solutions such as \"DS2\" (2%  NaOH , 70%  diethylenetriamine , 28%  2-methoxyethanol ). [ medical citation needed ]  For skin lesions, topical treatments, such as  calamine lotion , steroids, and oral  antihistamines  are used to relieve itching. [ 4 ]  Larger blisters are irrigated repeatedly with saline or soapy water, then treated with an antibiotic and petroleum gauze. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1772", "text": "Mustard agent burns do not heal quickly and (as with other types of burns) present a risk of  sepsis  caused by  pathogens  such as  Staphylococcus aureus  and  Pseudomonas aeruginosa . The mechanisms behind mustard gas's effect on endothelial cells are still being studied, but recent studies have shown that high levels of exposure can induce high rates of both  necrosis  and  apoptosis . In vitro tests have shown that at low concentrations of mustard gas, where apoptosis is the predominant result of exposure, pretreatment with 50 mM  N-acetyl-L-cysteine  (NAC) was able to decrease the rate of apoptosis. NAC protects  actin  filaments from reorganization by mustard gas, demonstrating that actin filaments play a large role in the severe burns observed in victims. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1773", "text": "A British nurse treating soldiers with mustard agent burns during  World War I  commented: [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1774", "text": "They cannot be bandaged or touched. We cover them with a tent of propped-up sheets. Gas burns must be agonizing because usually the other cases do not complain, even with the worst wounds, but gas cases are invariably beyond endurance and they cannot help crying out."}
{"_id": "WikiPedia_Dermatology$$$corpus_1775", "text": "Sulfur mustards readily eliminate  chloride  ions by intramolecular  nucleophilic substitution  to form cyclic  sulfonium  ions. These very reactive intermediates tend to permanently  alkylate   nucleotides  in  DNA  strands, which can prevent cellular division, leading to  programmed cell death . [ 2 ]  Alternatively, if cell death is not immediate, the damaged DNA can lead to the development of cancer. [ 2 ]   Oxidative stress  would be another pathology involved in mustard gas toxicity."}
{"_id": "WikiPedia_Dermatology$$$corpus_1776", "text": "In the wider sense, compounds with the structural element BC 2 H 4 X, where X is any  leaving group  and B is a  Lewis base , are known as  mustards . [ citation needed ]  Such compounds can form cyclic  \"onium\" ions  (sulfonium,  ammonium , etc.) that are good  alkylating agents . Other such compounds are bis(2-haloethyl)ethers ( oxygen mustards ), the (2-haloethyl)amines ( nitrogen mustards ), and  sesquimustard , which has two \u03b1-chloroethyl thioether groups (ClC 2 H 4 S\u2212) connected by an ethylene bridge (\u2212C 2 H 4 \u2212). [ citation needed ]  These compounds have a similar ability to alkylate DNA, but their physical properties vary."}
{"_id": "WikiPedia_Dermatology$$$corpus_1777", "text": "In its history, various types and mixtures of mustard gas have been employed. These include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1778", "text": "Mustard gases were possibly developed as early as 1822 by  C\u00e9sar-Mansu\u00e8te Despretz  (1798\u20131863). [ 23 ]  Despretz described the reaction of  sulfur dichloride  and  ethylene  but never made mention of any irritating properties of the reaction product. In 1854, another French chemist, Alfred Riche (1829\u20131908), repeated this procedure, also without describing any adverse physiological properties. In 1860, the British scientist  Frederick Guthrie  synthesized and characterized the mustard agent compound and noted its irritating properties, especially in tasting. [ 24 ]  Also in 1860, chemist  Albert Niemann , known as a pioneer in  cocaine  chemistry, repeated the reaction, and recorded blister-forming properties. In 1886,  Viktor Meyer  published a paper describing a synthesis that produced good yields. He combined  2-chloroethanol  with  aqueous   potassium sulfide , and then treated the resulting  thiodiglycol  with  phosphorus trichloride . The purity of this compound was much higher and consequently the adverse health effects upon exposure were much more severe. These symptoms presented themselves in his assistant, and in order to rule out the possibility that his assistant was suffering from a mental illness (psychosomatic symptoms), Meyer had this compound tested on laboratory  rabbits , most of which died. In 1913, the English chemist  Hans Thacher Clarke  (known for the  Eschweiler-Clarke reaction ) replaced the phosphorus trichloride with  hydrochloric acid  in Meyer's formulation while working with  Emil Fischer  in  Berlin . Clarke was hospitalized for two months for burns after one of his flasks broke. According to Meyer, Fischer's report on this accident to the  German Chemical Society  sent the  German Empire  on the road to chemical weapons. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1779", "text": "Mustard gas can have the effect of turning a patient's skin different colors, including shades of red, orange, pink, and in unusual cases, blue. The  German Empire  during  World War I  relied on the Meyer-Clarke method because  2-chloroethanol  was readily available from the German dye industry of that time."}
{"_id": "WikiPedia_Dermatology$$$corpus_1780", "text": "Mustard gas was first  used in World War I  by the German army against British and Canadian soldiers near  Ypres , Belgium, on July 12, 1917, [ 26 ]  and later also against the  French Second Army .  Yperite  is \"a name used by the French, because the compound was first used at Ypres.\" [ 27 ]  The Allies did not use mustard gas until November 1917 at  Cambrai , France, after the armies had captured a stockpile of German mustard shells. It took the British more than a year to develop their own mustard agent weapon, with production of the chemicals centred on  Avonmouth Docks  (the only option available to the British was the Despretz\u2013Niemann\u2013Guthrie process). [ 28 ] [ 29 ]  This was used first in September 1918 during the breaking of the  Hindenburg Line ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1781", "text": "Mustard gas was originally assigned the name LOST, after the scientists Wilhelm Lommel and  Wilhelm Steinkopf , who developed a method of large-scale production for the  Imperial German Army  in 1916. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1782", "text": "Mustard gas was dispersed as an  aerosol  in a mixture with other chemicals, giving it a yellow-brown color. Mustard agent has also been dispersed in such munitions as  aerial bombs ,  land mines ,  mortar rounds ,  artillery shells , and  rockets . [ 1 ]  Exposure to mustard agent was lethal in about 1% of cases. Its effectiveness was as an  incapacitating agent . The early countermeasures against mustard agent were relatively ineffective, since a soldier wearing a  gas mask  was not protected against absorbing it through his skin and being blistered. A common countermeasure was using a urine-soaked mask or facecloth to prevent or reduce injury, a readily available remedy attested by soldiers in documentaries (e.g.  They Shall Not Grow Old  in 2018) and others (such as forward aid nurses) interviewed between 1947 and 1981 by the British Broadcasting Corporation for various World War One history programs; however, the effectiveness of this measure is unclear."}
{"_id": "WikiPedia_Dermatology$$$corpus_1783", "text": "Mustard gas can remain in the ground for weeks, and it continues to cause ill effects. If mustard agent contaminates one's clothing and equipment while cold, then other people with whom they share an enclosed space could become poisoned as contaminated items warm up enough material to become an airborne toxic agent. An example of this was depicted in a British and Canadian documentary about life in the trenches, particularly once the \"sousterrain\" (subways and berthing areas underground) were completed in Belgium and France. Towards the end of World War I, mustard agent was used in high concentrations as an  area-denial weapon  that forced troops to abandon heavily contaminated areas."}
{"_id": "WikiPedia_Dermatology$$$corpus_1784", "text": "Since World War I, mustard gas has been used in several wars and other conflicts, usually against people who cannot retaliate in kind: [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1785", "text": "The use of toxic gases or other chemicals, including mustard gas, during warfare is known as  chemical warfare , and this kind of warfare was prohibited by the  Geneva Protocol of 1925 , and also by the later  Chemical Weapons Convention of 1993 . The latter agreement also prohibits the development, production, stockpiling, and sale of such weapons."}
{"_id": "WikiPedia_Dermatology$$$corpus_1786", "text": "In September 2012, a US official stated that the rebel militant group  ISIS  was manufacturing and using mustard gas in Syria and Iraq, which was allegedly confirmed by the group's head of chemical weapons development, Sleiman Daoud al-Afari, who has since been captured. [ 47 ] [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1787", "text": "As early as 1919 it was known that mustard agent was a suppressor of  hematopoiesis . [ 49 ]  In addition, autopsies performed on 75 soldiers who had died of mustard agent during  World War I  were done by researchers from the  University of Pennsylvania  who reported decreased counts of  white blood cells . [ 39 ]  This led the American Office of Scientific Research and Development (OSRD) to finance the biology and chemistry departments at  Yale University  to conduct research on the use of chemical warfare during World War II. [ 39 ] [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1788", "text": "As a part of this effort, the group investigated  nitrogen mustard  as a therapy for  Hodgkin's lymphoma  and other types of  lymphoma  and  leukemia , and this compound was tried out on its first human patient in December 1942. The results of this study were not published until 1946, when they were declassified. [ 50 ]  In a parallel track, after the  air raid on Bari  in December 1943, the doctors of the U.S. Army noted that white blood cell counts were reduced in their patients. Some years after World War II was over, the incident in Bari and the work of the Yale University group with nitrogen mustard converged, and this prompted a search for other similar  chemical compounds . Due to its use in previous studies, the nitrogen mustard called \"HN2\" became the first cancer  chemotherapy  drug,  chlormethine  (also known as mechlorethamine, mustine) to be used. Chlormethine and other mustard gas molecules are still used to this day as an chemotherapy agent albeit they have largely been replaced with more safe chemotherapy drugs like  cisplatin  and  carboplatin . [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1789", "text": "In the United States, storage and incineration of mustard gas and other chemical weapons were carried out by the U.S. Army Chemical Materials Agency. [ 52 ]  Disposal projects at the two remaining American chemical weapons sites were carried out near  Richmond, Kentucky , and  Pueblo, Colorado ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1790", "text": "New detection techniques are being developed in order to detect the presence of mustard gas and its metabolites. The technology is portable and detects small quantities of the hazardous waste and its oxidized products, which are notorious for harming unsuspecting civilians. The  immunochromatographic  assay would eliminate the need for expensive, time-consuming lab tests and enable easy-to-read tests to protect civilians from sulfur-mustard dumping sites. [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1791", "text": "In 1946, 10,000 drums of mustard gas (2,800 tonnes) stored at the production facility of Stormont Chemicals in  Cornwall, Ontario , Canada, were loaded onto 187 boxcars for the 900 miles (1,400\u00a0km) journey to be buried at sea on board a 400 foot (120\u00a0m) long barge 40 miles (64\u00a0km) south of  Sable Island , southeast of  Halifax , at a depth of 600 fathoms (1,100\u00a0m). The dump location is 42 degrees, 50 minutes north by 60 degrees, 12 minutes west. [ 54 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1792", "text": "A large British stockpile of old mustard agent that had been made and stored since World War I at  M. S. Factory, Valley  near  Rhydymwyn  in  Flintshire , Wales, was destroyed in 1958. [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1793", "text": "Most of the mustard gas found in Germany after  World War II  was dumped into the  Baltic Sea . Between 1966 and 2002, fishermen have found about 700 chemical weapons in the region of  Bornholm , most of which contain mustard gas. One of the more frequently dumped weapons was \"Spr\u00fchb\u00fcchse 37\" (Spr\u00fcB\u00fc37, Spray Can 37, 1937 being the year of its fielding with the German Army). These weapons contain mustard gas mixed with a  thickener , which gives it a tar-like viscosity. When the content of the Spr\u00fcB\u00fc37 comes in contact with water, only the mustard gas in the outer layers of the lumps of viscous mustard  hydrolyzes , leaving behind amber-colored residues that still contain most of the active mustard gas. On mechanically breaking these lumps (e.g., with the drag board of a fishing net or by the human hand) the enclosed mustard gas is still as active as it had been at the time the weapon was dumped. These lumps, when washed ashore, can be mistaken for amber, which can lead to severe health problems.  Artillery shells  containing mustard gas and other toxic ammunition from World War I (as well as conventional explosives) can still be found in France and Belgium. These were formerly disposed of by explosion undersea, but since the current environmental regulations prohibit this, the  French government  is building an automated factory to dispose of the accumulation of chemical shells."}
{"_id": "WikiPedia_Dermatology$$$corpus_1794", "text": "In 1972, the  U.S. Congress  banned the practice of disposing of chemical weapons into the ocean by the United States. 29,000 tons of nerve and mustard agents had already been dumped into the ocean off the United States by the  U.S. Army . According to a report created in 1998 by William Brankowitz, a deputy project manager in the  U.S. Army Chemical Materials Agency , the army created at least 26 chemical weapons dumping sites in the ocean offshore from at least 11 states on both the  East Coast  and the  West Coast  (in  Operation CHASE ,  Operation Geranium , etc.). In addition, due to poor recordkeeping, about one-half of the sites have only their rough locations known. [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1795", "text": "In June 1997, India declared its stock of chemical weapons of 1,044 tonnes (1,151 short tons) of mustard gas. [ 57 ] [ 58 ]  By the end of 2006, India had destroyed more than 75 percent of its chemical weapons/material stockpile and was granted extension for destroying the remaining stocks by April 2009 and was expected to achieve 100 percent destruction within that time frame. [ 57 ]  India informed the United Nations in May 2009 that it had destroyed its stockpile of chemical weapons in compliance with the international Chemical Weapons Convention. With this India has become the third country after South Korea and Albania to do so. [ 59 ] [ 60 ]  This was cross-checked by inspectors of the United Nations."}
{"_id": "WikiPedia_Dermatology$$$corpus_1796", "text": "Producing or stockpiling mustard gas is prohibited by the  Chemical Weapons Convention . When the convention entered force in 1997, the parties declared worldwide stockpiles of 17,440 tonnes of mustard gas. As of December 2015, 86% of these stockpiles had been destroyed. [ 61 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1797", "text": "A significant portion of the United States' mustard agent  stockpile  was stored at the Edgewood Area of  Aberdeen Proving Ground  in  Maryland . Approximately 1,621 tons of mustard agents were stored in one-ton containers on the base under heavy guard. A chemical neutralization plant was built on the proving ground and neutralized the last of this stockpile in February 2005. This stockpile had priority because of the potential for quick reduction of risk to the community. The nearest schools were fitted with overpressurization machinery to protect the students and faculty in the event of a catastrophic explosion and fire at the site. These projects, as well as planning, equipment, and training assistance, were provided to the surrounding community as a part of the Chemical Stockpile Emergency Preparedness Program (CSEPP), a joint program of the Army and the  Federal Emergency Management Agency  (FEMA). [ 62 ]  Unexploded shells containing mustard gases and other chemical agents are still present in several test ranges in proximity to schools in the Edgewood area, but the smaller amounts of poison gas (4 to 14 pounds (1.8 to 6.4\u00a0kg)) present considerably lower risks. These remnants are being detected and excavated systematically for disposal. The U.S. Army Chemical Materials Agency oversaw disposal of several other chemical weapons stockpiles located across the United States in compliance with international chemical weapons treaties. These include the complete incineration of the chemical weapons stockpiled in  Alabama ,  Arkansas ,  Indiana , and  Oregon . Earlier, this agency had also completed destruction of the chemical weapons stockpile located on  Johnston Atoll  located south of  Hawaii  in the  Pacific Ocean . [ 63 ]  The largest mustard agent stockpile, at approximately 6,200  short tons , was stored at the  Deseret Chemical Depot  in northern  Utah . The incineration of this stockpile began in 2006. In May 2011, the last of the mustard agents in the stockpile were incinerated at the Deseret Chemical Depot, and the last artillery shells containing mustard gas were incinerated in January 2012."}
{"_id": "WikiPedia_Dermatology$$$corpus_1798", "text": "In 2008, many empty  aerial bombs  that contained mustard gas were found in an excavation at the  Marrangaroo Army Base  just west of Sydney, Australia. [ 64 ] [ 65 ]  In 2009, a mining survey near  Chinchilla, Queensland , uncovered 144 105-millimeter  howitzer  shells, some containing \"Mustard H\", that had been buried by the U.S. Army during World War II. [ 65 ] [ 66 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1799", "text": "In 2014, a collection of 200 bombs was found near the  Flemish  villages of  Passendale  and  Moorslede . The majority of the bombs were filled with mustard agents. The bombs were left over from the German army and were meant to be used in the  Battle of Passchendaele  in World War I. It was the largest collection of chemical weapons ever found in Belgium. [ 67 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1800", "text": "A large amount of chemical weapons, including mustard gas, was found in a neighborhood of  Washington, D.C.  The cleanup was completed in 2021. [ 68 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1801", "text": "In 2002, an archaeologist at the Presidio Trust archaeology lab in San Francisco was exposed to mustard gas, which had been dug up at the  Presidio of San Francisco , a former military base. [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1802", "text": "In 2010, a clamming boat pulled up some old  artillery  shells of World War I from the  Atlantic Ocean  south of  Long Island, New York . Multiple fishermen suffered from blistering and respiratory irritation severe enough to require hospitalization. [ 70 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1803", "text": "From 1943 to 1944, mustard agent experiments were performed on Australian service volunteers in tropical  Queensland, Australia , by  Royal Australian Engineers ,  British Army  and American experimenters, resulting in some severe injuries. One test site, the  Brook Islands National Park , was chosen to simulate Pacific islands held by the  Imperial Japanese Army . [ 71 ] [ 72 ]  These experiments were the subject of the documentary film  Keen as Mustard . [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1804", "text": "The United States tested sulfur mustards and other chemical agents including  nitrogen mustards  and  lewisite  on up to 60,000 servicemen during and after WWII. The experiments were classified secret and as with  Agent Orange [ broken anchor ] , claims for medical care and compensation were routinely denied, even after the WWII-era tests were declassified in 1993. The  Department of Veterans Affairs  stated that it would contact 4,000 surviving test subjects but failed to do so, eventually only contacting 600. Skin cancer, severe eczema, leukemia, and chronic breathing problems plagued the test subjects, some of whom were as young as 19 at the time of the tests, until their deaths, but even those who had previously filed claims with the VA went without compensation. [ 74 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1805", "text": "African American servicemen  were tested alongside white men in separate trials to determine whether their skin color would afford them a degree of immunity to the agents, and  Nisei  servicemen, some of whom had joined after their release from  Japanese American Internment Camps  were tested to determine susceptibility of  Japanese military personnel  to these agents. These tests also included  Puerto Rican  subjects. [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1806", "text": "Concentrations of thiodiglycol in urine have been used to confirm a diagnosis of chemical poisoning in hospitalized victims. The presence in urine of 1,1'-sulfonylbismethylthioethane (SBMTE), a conjugation product with glutathione, is considered a more specific marker, since this metabolite is not found in specimens from unexposed persons. In one case, intact mustard gas was detected in postmortem fluids and tissues of a man who died one week post-exposure. [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1807", "text": "Notes"}
{"_id": "WikiPedia_Dermatology$$$corpus_1808", "text": "Nevirapine  ( NVP ), sold under the brand name  Viramune  among others, is a medication used to treat and prevent  HIV/AIDS , specifically  HIV-1 . [ 5 ]  It is generally recommended for use with other  antiretroviral medications . [ 5 ]  It may be used to prevent  mother to child spread during birth  but is not recommended following other exposures. [ 5 ]  It is taken by mouth. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1809", "text": "Common side effects include rash, headache, nausea, feeling tired, and  liver problems . [ 5 ]  The liver problems and skin rash may be severe and should be checked for during the first few months of treatment. [ 5 ] [ 6 ]  It appears to be safe for use during  pregnancy . [ 5 ]  It is a non-nucleoside  reverse transcriptase inhibitor  (NNRTI) and works by blocking the function of  reverse transcriptase . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1810", "text": "Nevirapine was approved for medical use in the United States in 1996. [ 5 ]  It is on the  World Health Organization's List of Essential Medicines . [ 7 ]  It is available as a  generic medication . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1811", "text": "Nevirapine is used in people six years of age and older infected with HIV-1 as part of combination antiretroviral treatment (ART or cART). Monotherapy with nevirapine is not indicated due to rapid emergence of resistance. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1812", "text": "Nevirapine in triple combination therapy has been shown to suppress  viral load  effectively when used as initial antiretroviral therapy ( i.e. , in antiretroviral-naive patients). [ 8 ]  Some clinical trials have demonstrated comparable HIV suppression with nevirapine-based regimens to that achieved with regimens based on a  protease inhibitor  (PI) [ 9 ] [ 10 ]  or  efavirenz . [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1813", "text": "This drug is generally only to be considered for use if the CD4 cell count is very low. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1814", "text": "Although concerns have been raised about nevirapine-based regimens in those starting therapy with high viral load or low CD4 count, some analyses suggest that nevirapine may be effective in this group of people. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1815", "text": "Nevirapine may also form a useful component of salvage regimens after virological failure, usually in combination with one or more PIs as well as  nucleotide reverse transcriptase inhibitor  (NRTIs), especially in those who have not previously taken an NNRTI."}
{"_id": "WikiPedia_Dermatology$$$corpus_1816", "text": "Dosing in children is based on  body surface area  (BSA), [ 3 ]  however, weight-based dosing algorithms have been released. These guidelines include dosing algorithms for as young as newborn babies. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1817", "text": "Although a single dose of nevirapine given to both mother and child reduced the rate of HIV transmission by almost 50% compared with a very short course of  zidovudine  (AZT) prophylaxis, in a clinical trial in  Uganda ., [ 13 ]  that trial was found in an Associated Press investigation to be riddled with \"sloppy recordkeeping\" and possibly fraud. [ 14 ]  A subsequent study in  Thailand  showed that prophylaxis with single-dose nevirapine in addition to zidovudine is more effective than zidovudine alone. [ 15 ]  These and other trials have led the  World Health Organization  to endorse the use of single-dose nevirapine prophylaxis in many developing world settings as a cost-effective way of reducing mother-to-child transmission. However, in the United States the Ugandan study was deemed flawed  [ 16 ]  and as of 2006 the FDA has not approved of such nevirapine prophylaxis. [ 17 ]  However, supporters of HIVNET 012 experiment argued that the flaws in this experiment were largely due to bureaucratic incompetence, while the findings regarding the safety and efficacy of single-dose nevirapine from this study were scientifically solid and too important to discard. [ 18 ]  Moreover, it was argued that holding African researchers who operated under resource-poor situations to the same moral and procedural standards to their Western counterparts was unrealistic, and would further marginalize African researchers' role in the science community and impede the progress of African science. [ 19 ]  Another clinical trial,  Using Nevirapine to Prevent Mother-to-Child HIV Transmission During Breastfeeding , was completed in September 2013. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1818", "text": "A major concern with this approach is that NNRTI resistance mutations are commonly observed in both mothers and infants after single-dose nevirapine, [ 21 ]  and may compromise the response to future NNRTI-containing regimens. [ 22 ]  A short course of maternal  Lamivudine/zidovudine  is recommended by the U.S. Public Health Service Task Force to reduce this risk. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1819", "text": "Nevirapine is contraindicated for non-occupational post-exposure-prophylaxis including for pregnant and nonpregnant women due to severe liver toxicity. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1820", "text": "The most common adverse effect of nevirapine is the development of mild or moderate rash (13%). [ 25 ] [ 26 ]  Severe or life-threatening skin reactions have been observed in 1.5% of patients, including  Stevens\u2013Johnson syndrome ,  toxic epidermal necrolysis  and  hypersensitivity . [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1821", "text": "Nevirapine may cause severe or life-threatening liver toxicity, usually emerging in the first six weeks of treatment. [ 25 ] [ 27 ]  In 2000, the U.S.  Food and Drug Administration  issued a  black box warning  on nevirapine, warning that it could cause life-threatening liver toxicity and skin reactions. [ 4 ]  Unacceptably high risk of serious liver symptoms in certain patient groups (women with CD4 count >250 and men >400) [ 11 ] [ 28 ]  has led the U.S. DHHS to recommend the restriction of nevirapine use to those at lower risk, unless the benefit to the patient clearly outweighs the risk; [ 27 ]  although in the 2NN study which found these CD4 limits, the effect was seen only in patients recruited from Thailand. More recent studies on the use of Nevirapine in people with higher CD4 cell counts have come to the following conclusion: Treatment-experienced patients who start NVP-based combination therapy with low pre\u2013ART and high current CD4 cell counts and an undetectable VL have a similar likelihood for discontinuing NVP therapy because of hypersensitivity reactions (HSRs), compared with treatment-naive patients with low CD4 cell counts. This suggests that NVP-based combination therapy may be safely initiated in such patients. However, in similar patients with a detectable VL, it is prudent to continue to adhere to current CD4 cell count thresholds. [ 29 ]  The U.S. Public Health Service Task Force advocates caution in the use of nevirapine in pregnancy due to toxicity issues, which may be exacerbated during pregnancy. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1822", "text": "Cases of  immune reconstitution syndrome  and  fat redistribution  have also been observed with this drug. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1823", "text": "The U.S. Food and Drug Administration recommends stopping nevirapine if a person experiences: [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1824", "text": "Additionally, the U.S.  FDA  recommends close monitoring during the first 6 weeks of therapy for the above symptoms as there is high risk during this time. Continued monitoring is recommended for up to the first 18 weeks of treatment. If a patient experiences hepatitis plus rash or other systemic symptoms, or severe hypersensitivity or skin rash, nevirapine should not be restarted. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1825", "text": "Nevirapine is a substrate for liver  CYP3A  and  CYP2B6  enzymes. Concomitant administration of drugs that are inhibitors of these enzymes may increase serum nevirapine levels significantly. Some examples of these drugs include  ritonavir ,  fosamprenavir , and  fluconazole . On the other hand, drugs that are  inducers  of these enzymes such as  rifampicin  may lower serum nevirapine levels. [ 30 ] [18]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1826", "text": "In addition, concomitant use of   St. John's wort   (Hypericum perforatum , which has been shown to induce  CYP3A4  and  CYP1A2 [ 31 ] ) or St. John's wort containing products may significantly lower nevirapine levels. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1827", "text": "Nevirapine is an inducer of  cytochrome P450  isoenzymes  CYP3A4  and  CYP2B6 . It may reduce levels of several co-administered drugs including the antiretrovirals  efavirenz ,  indinavir ,  lopinavir ,  nelfinavir  and  saquinavir , as well as  clarithromycin ,  ketoconazole , forms of  hormonal contraception , and  methadone . [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1828", "text": "Nevirapine falls in the non-nucleoside reverse transcriptase inhibitor (NNRTI) class of antiretrovirals. [ 32 ]   Both nucleoside and non-nucleoside RTIs inhibit the same target, the  reverse transcriptase  enzyme, an essential viral enzyme which transcribes viral RNA into DNA. Unlike  nucleoside  RTIs, which bind at the polymerase active site, NNRTIs bind to a hydrophobic pocket in the subdomain of p66 which is about 10 angstrom away from the active site (known as the NNRTI pocket). Therefore, this NNRTI-binding pocket will inhibit reverse transcription in a way that is distinct to the NRTIs. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1829", "text": "Nevirapine is not effective against HIV-2, as the pocket of the HIV-2 reverse transcriptase has a different structure, which confers intrinsic resistance to the NNRTI class. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1830", "text": "Resistance to nevirapine develops rapidly if viral replication is not completely suppressed. [ 8 ]  The most common mutations observed after nevirapine treatment are Y181C and K103N, which are also observed with other NNRTIs. [ 25 ] [ 35 ]  As all NNRTIs bind within the same pocket, viral strains which are resistant to nevirapine are usually also resistant to the other NNRTIs,  efavirenz  and  delavirdine . However, second generation NNRTIs like  rilpivirine  and  etravirine  are effective in treatment for HIV strains resistant to nevirapine and other first generation drugs in that same class."}
{"_id": "WikiPedia_Dermatology$$$corpus_1831", "text": "Nevirapine was discovered by Karl D. Hargrave and colleagues at Boehringer Ingelheim Pharmaceuticals, Inc., one of the  Boehringer Ingelheim  group of companies. It is covered by  U.S. Patent 5,366,972   Archived  2018-09-20 at the  Wayback Machine  and corresponding foreign patents.  Nevirapine was the first NNRTI approved by the  U.S. Food and Drug Administration  (FDA). It was approved June 21, 1996 for adults and September 11, 1998, for children. It was also approved in Europe in 1997."}
{"_id": "WikiPedia_Dermatology$$$corpus_1832", "text": "Former U.S. President  George W. Bush 's  PEPFAR funding  of $500 million to help combat the African AIDS epidemic included nevirapine, among other medications and programs."}
{"_id": "WikiPedia_Dermatology$$$corpus_1833", "text": "In South Africa, the  Treatment Action Campaign  successfully sued the government over its failure to make nevirapine widely available. In  Minister of Health v Treatment Action Campaign  the  Constitutional Court of South Africa  ordered the government to immediately \"remove the restrictions that prevent Nevirapine from being made available for the purpose of reducing the risk of mother-to-child transmission of HIV at public hospitals and clinics that are not research and training sites [and] permit and facilitate the use of Nevirapine for the purpose of reducing the risk of mother-to-child transmission of HIV and to make it available for this purpose at hospitals and clinics when in the judgement of the attending medical practitioner acting in consultation with the medical superintendent of the facility concerned this is medically indicated, which shall if necessary include that the mother concerned has been appropriately tested and counselled.\" [ 36 ] [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1834", "text": "Non-steroidal anti-inflammatory drugs [ 1 ] [ 3 ]  ( NSAID ) [ 1 ]  are members of a  therapeutic   drug class  which  reduces pain , [ 4 ]   decreases inflammation ,  decreases fever , [ 1 ]  and  prevents blood clots . Side effects depend on the specific drug, its dose and duration of use, but largely include an increased risk of  gastrointestinal ulcers and bleeds ,  heart attack , and  kidney disease . [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1835", "text": "The term  non-steroidal , common from around 1960, distinguishes these drugs from  corticosteroids , another class of  anti-inflammatory  drugs, [ 7 ]  which during the 1950s had acquired a bad reputation due to overuse and side-effect problems after their introduction in 1948. [ 8 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1836", "text": "NSAIDs work by inhibiting the activity of  cyclooxygenase   enzymes  (the  COX-1  and  COX-2   isoenzymes ). In cells, these enzymes are involved in the synthesis of key biological mediators, namely  prostaglandins , which are involved in  inflammation , and  thromboxanes , which are involved in  blood clotting ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1837", "text": "There are two general types of NSAIDs available: non-selective and  COX-2 selective . [ 11 ]  Most NSAIDs are non-selective, and inhibit the activity of both COX-1 and COX-2. These NSAIDs, while reducing inflammation, also inhibit platelet aggregation and increase the risk of  gastrointestinal ulcers  and bleeds. [ 11 ]  COX-2 selective inhibitors have fewer gastrointestinal side effects, but promote  thrombosis , and some of these agents substantially increase the risk of  heart attack . As a result, certain COX-2 selective inhibitors\u2014such as  rofecoxib \u2014are no longer used due to the high risk of undiagnosed  vascular disease . [ 11 ]  These differential effects are due to the different roles and tissue localisations of each COX isoenzyme. [ 11 ]  By inhibiting physiological COX activity, NSAIDs may cause deleterious effects on kidney function, [ 12 ]  and, perhaps as a result of water and sodium retention and decreases in renal blood flow, may lead to heart problems. [ 13 ]  In addition, NSAIDs can blunt the production of  erythropoietin , resulting in anaemia, since haemoglobin needs this hormone to be produced."}
{"_id": "WikiPedia_Dermatology$$$corpus_1838", "text": "The most prominent NSAIDs are  aspirin ,  ibuprofen , and  naproxen ; all available  over the counter  (OTC) in most countries. [ 14 ]   Paracetamol  (acetaminophen) is generally not considered an NSAID because it has only minor anti-inflammatory activity. Paracetamol treats pain mainly by blocking COX-2 and inhibiting  endocannabinoid  reuptake almost exclusively within the brain, and only minimally in the rest of the body. [ 15 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1839", "text": "NSAIDs are often suggested for the treatment of acute or chronic conditions where  pain  and inflammation are present. NSAIDs are generally used for the symptomatic relief of the following conditions: [ 17 ] [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1840", "text": "The effectiveness of NSAIDs for treating non-cancer chronic pain and cancer-related pain in children and adolescents is not clear. [ 27 ] [ 28 ]  There have not been sufficient numbers of high-quality randomised controlled trials conducted. [ 27 ] [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1841", "text": "Differences in anti-inflammatory activity between the various individual NSAIDs are small, but there is considerable variation among individual patients in therapeutic response and tolerance to these drugs. About 60% of patients will respond to any NSAID; of the others, those who do not respond to one may well respond to another. Pain relief starts soon after taking the first dose, and a full analgesic effect should normally be obtained within a week, whereas an anti-inflammatory effect may not be achieved (or may not be clinically assessable) for up to three weeks. If appropriate responses are not obtained within these times, another NSAID should be tried. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1842", "text": "Pain following  surgery  can be significant, and many people require strong pain medications such as opioids. There is some low-certainty evidence that starting NSAID painkiller medications in adults early, before surgery, may help reduce post-operative pain, and also reduce the dose or quantity of opioid medications required after surgery. [ 29 ]  Any increase risk of surgical bleeding, bleeding in the gastrointestinal system, myocardial infarctions, or injury to the kidneys has not been well studied. [ 29 ]  When used in combination with paracetamol, the analgesic effect on post-operative pain may be improved. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1843", "text": "Aspirin , the only NSAID able to irreversibly inhibit  COX-1 , is also indicated for  antithrombosis  through  inhibition of platelet aggregation . This is useful for the management of arterial  thrombosis , and prevention of adverse cardiovascular events like heart attacks. Aspirin inhibits platelet aggregation by inhibiting the action of  thromboxane A 2 . [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1844", "text": "NSAIDs are useful in the management of post-operative  dental pain  following invasive dental procedures such as  dental extraction . When not contra-indicated, they are favoured over the use of  paracetamol  alone due to the anti-inflammatory effect they provide. [ 32 ]  There is weak evidence suggesting that taking pre-operative analgesia can reduce the length of post operative pain associated with placing orthodontic spacers under local anaesthetic. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1845", "text": "Based on  observational studies  and  randomized controlled trials , NSAID use is not effective for the treatment or prevention of  Alzheimer's disease . [ 34 ] [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1846", "text": "NSAIDs may be used with caution by people with the following conditions:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1847", "text": "NSAIDs should usually be avoided by people with the following conditions:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1848", "text": "The widespread use of NSAIDs has meant that the adverse effects of these drugs have become increasingly common. Use of NSAIDs increases risk of a range of  gastrointestinal  (GI) problems, kidney disease and adverse cardiovascular events. [ 40 ] [ 41 ]  As commonly used for post-operative pain, there is evidence of increased risk of kidney complications. [ 42 ]  Their use following gastrointestinal surgery remains controversial, given mixed evidence of increased risk of leakage from any bowel  anastomosis  created. [ 43 ] [ 44 ] [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1849", "text": "An estimated 10\u201320% of people taking NSAIDs experience  indigestion . In the 1990s, high doses of prescription NSAIDs were associated with serious upper gastrointestinal adverse events, including bleeding. [ 46 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1850", "text": "NSAIDs, like all medications, may interact with other medications. For example, concurrent use of NSAIDs and  quinolone antibiotics  may increase the risk of quinolones' adverse  central nervous system  effects, including seizure. [ 47 ] [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1851", "text": "There is an argument over the benefits and risks of NSAIDs for treating chronic musculoskeletal pain. Each drug has a benefit-risk profile and balancing the risk of no treatment with the competing potential risks of various therapies should be considered. [ 49 ]  For people over the age of 65 years old, the balance between the benefits of pain-relief medications such as NSAIDS and the potential for adverse effects has not been well determined. [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1852", "text": "There is some evidence suggesting that, for some people, use of NSAIDs (or other anti-inflammatories) may contribute to the initiation of chronic pain. [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1853", "text": "Side effects are dose-dependent, and in many cases severe enough to pose the risk of ulcer perforation, upper gastrointestinal bleeding, and death, limiting the use of NSAID therapy. An estimated 10\u201320% of NSAID patient's experience  dyspepsia , and NSAID-associated upper gastrointestinal adverse events are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States, and represent 43% of drug-related emergency visits. Many of these events are avoidable; a review of physician visits and prescriptions estimated that unnecessary prescriptions for NSAIDs were written in 42% of visits. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1854", "text": "Aspirin should not be taken by people who have  salicylate intolerance [ 53 ] [ 54 ]  or a more generalized  drug intolerance  to NSAIDs, and caution should be exercised in those with  asthma  or  NSAID -precipitated  bronchospasm . Owing to its effect on the stomach lining, manufacturers recommend people with  peptic ulcers , mild  diabetes , or  gastritis  seek medical advice before using aspirin. [ 55 ] [ 56 ]  Use of aspirin during  dengue fever  is not recommended owing to increased bleeding tendency. [ 57 ]  People with  kidney disease ,  hyperuricemia , or  gout  should not take aspirin because it inhibits the kidneys' ability to excrete  uric acid , and thus may exacerbate these conditions."}
{"_id": "WikiPedia_Dermatology$$$corpus_1855", "text": "If a  COX-2 inhibitor  is taken, a traditional NSAID (prescription or over-the-counter) should not be taken at the same time. [ 58 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1856", "text": "Rofecoxib  (Vioxx) was shown to produce significantly fewer gastrointestinal adverse drug reactions ( ADRs ) compared with naproxen. [ 59 ]  The study, the VIGOR trial, raised the issue of the cardiovascular safety of the coxibs (COX-2 inhibitors). A statistically significant increase in the incidence of  myocardial infarctions  was observed in patients on rofecoxib. Further data, from the APPROVe trial, showed a statistically significant relative risk of cardiovascular events of 1.97 versus placebo [ 60 ] \u2014which caused a worldwide withdrawal of rofecoxib in October 2004. [ 61 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1857", "text": "Use of methotrexate together with NSAIDs in  rheumatoid arthritis  is safe, if adequate monitoring is done. [ 62 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1858", "text": "NSAIDs, aside from aspirin, increase the risk of  myocardial infarction  and  stroke . [ 63 ] [ 64 ]  This occurs at least within a week of use. [ 5 ]  They are not recommended in those who have had a previous heart attack as they increase the risk of death or recurrent MI. [ 65 ]  Evidence indicates that  naproxen  may be the least harmful out of these. [ 64 ] [ 66 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1859", "text": "NSAIDs aside from (low-dose) aspirin are associated with a doubled risk of  heart failure  in people without a history of cardiac disease. [ 66 ]  In people with such a history, use of NSAIDs (aside from low-dose aspirin) was associated with a more than 10-fold increase in heart failure. [ 67 ]  If this link is proven causal, researchers estimate that NSAIDs would be responsible for up to 20 percent of hospital admissions for congestive heart failure. In people with heart failure, NSAIDs increase mortality risk ( hazard ratio ) by approximately 1.2\u20131.3 for naproxen and ibuprofen, 1.7 for rofecoxib and celecoxib, and 2.1 for diclofenac. [ 68 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1860", "text": "On 9 July 2015, the  Food and Drug Administration  (FDA) toughened warnings of increased  heart attack  and  stroke  risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs)  other than  aspirin . [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1861", "text": "A 2005 Finnish survey study found an association between long term (over three months) use of NSAIDs and  erectile dysfunction . [ 70 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1862", "text": "A 2011 publication [ 71 ]  in  The Journal of Urology  received widespread publicity. [ 72 ]  According to the study, men who used NSAIDs regularly were at significantly increased risk of erectile dysfunction. A link between NSAID use and erectile dysfunction still existed after controlling for several conditions. However, the study was observational and not controlled, with low original participation rate, potential participation bias, and other uncontrolled factors. The authors warned against drawing any conclusion regarding cause. [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1863", "text": "The main  adverse drug reactions  (ADRs) associated with NSAID use relate to direct and indirect irritation of the  gastrointestinal (GI) tract . NSAIDs cause a dual assault on the GI tract: the acidic molecules directly irritate the  gastric mucosa , and inhibition of COX-1 and COX-2 reduces the levels of protective  prostaglandins . [ 40 ]  Inhibition of prostaglandin synthesis in the GI tract causes increased gastric acid secretion, diminished bicarbonate secretion, diminished mucus secretion and diminished trophic effects on the epithelial mucosa. [ 74 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1864", "text": "Common gastrointestinal side effects include: [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1865", "text": "Clinical NSAID ulcers are related to the systemic effects of NSAID administration. Such damage occurs irrespective of the route of administration of the NSAID (e.g., oral, rectal, or parenteral) and can occur even in people who have  achlorhydria . [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1866", "text": "Ulceration risk increases with therapy duration, and with higher doses. To minimize GI side effects, it is prudent to use the lowest effective dose for the shortest period of time\u2014a practice that studies show is often not followed. Over 50% of patients who take NSAIDs have sustained some mucosal damage to their small intestine. [ 77 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1867", "text": "The risk and rate of gastric adverse effects is different depending on the type of NSAID medication a person is taking.  Indomethacin ,  ketoprofen , and  piroxicam  use appear to lead to the highest rate of gastric adverse effects, while  ibuprofen  (lower doses) and  diclofenac  appear to have lower rates. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1868", "text": "Certain NSAIDs, such as aspirin, have been marketed in  enteric-coated  formulations that manufacturers claim reduce the incidence of gastrointestinal ADRs. Similarly, some believe that rectal formulations may reduce gastrointestinal ADRs. However, consistent with the systemic mechanism of such ADRs, and in clinical practice, these formulations have not demonstrated a reduced risk of GI ulceration. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1869", "text": "Numerous \"gastro-protective\" drugs have been developed with the goal of preventing gastrointestinal toxicity in people who need to take NSAIDs on a regular basis. [ 40 ]  Gastric adverse effects may be reduced by taking medications that suppress acid production such as  proton pump inhibitors  (e.g.:  omeprazole  and  esomeprazole ), or by treatment with a drug that mimics  prostaglandin  in order to restore the lining of the GI tract (e.g.: a prostaglandin analog  misoprostol ). [ 40 ]  Diarrhea is a common side effect of misoprostol; however, higher doses of misoprostol have been shown to reduce the risk of a person having a complication related to a gastric ulcer while taking NSAIDs. [ 40 ]  While these techniques may be effective, they are expensive for maintenance therapy. [ 78 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1870", "text": "Hydrogen sulfide  NSAID hybrids prevent the gastric ulceration/bleeding associated with taking the NSAIDs alone. Hydrogen sulfide is known to have a protective effect on the cardiovascular and gastrointestinal system. [ 79 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1871", "text": "NSAIDs should be used with caution in individuals with  inflammatory bowel disease  (e.g.,  Crohn's disease  or  ulcerative colitis ) due to their tendency to cause gastric bleeding and form ulceration in the gastric lining. [ 80 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1872", "text": "NSAIDs are also associated with a fairly high incidence of adverse drug reactions ( ADRs ) on the kidney and over time can lead to  chronic kidney disease . The mechanism of these kidney ADRs is due to changes in kidney blood flow. Prostaglandins normally dilate the  afferent arterioles  of the  glomeruli . This helps maintain normal glomerular perfusion and  glomerular filtration rate  (GFR), an indicator of  kidney function . This is particularly important in kidney failure where the kidney is trying to maintain renal perfusion pressure by elevated angiotensin II levels. At these elevated levels, angiotensin II also constricts the afferent arteriole into the glomerulus in addition to the efferent arteriole it normally constricts. Since NSAIDs block this prostaglandin-mediated effect of afferent arteriole dilation, particularly in kidney failure, NSAIDs cause unopposed constriction of the afferent arteriole and decreased RPF (renal perfusion flow) and GFR. [ 81 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1873", "text": "Common ADRs associated with altered kidney function include: [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1874", "text": "These agents may also cause kidney impairment, especially in combination with other nephrotoxic agents. Kidney failure is especially a risk if the patient is also concomitantly taking an  ACE inhibitor  (which removes angiotensin II's vasoconstriction of the efferent arteriole) and a  diuretic  (which drops plasma volume, and thereby RPF)\u2014the so-called \"triple whammy\" effect. [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1875", "text": "In rarer instances NSAIDs may also cause more severe kidney conditions: [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1876", "text": "NSAIDs in combination with excessive use of  phenacetin  or  paracetamol  (acetaminophen) may lead to  analgesic nephropathy . [ 83 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1877", "text": "Photosensitivity  is a commonly overlooked adverse effect of many of the NSAIDs. [ 84 ]  The 2-arylpropionic acids are the most likely to produce photosensitivity reactions, but other NSAIDs have also been implicated including  piroxicam ,  diclofenac , and  benzydamine . [ 85 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1878", "text": "Benoxaprofen , since withdrawn due to its  liver toxicity , was the most photoactive NSAID observed. The mechanism of photosensitivity, responsible for the high photoactivity of the 2-arylpropionic acids, is the ready  decarboxylation  of the  carboxylic acid   moiety . The specific absorbance characteristics of the different  chromophoric  2-aryl substituents, affects the decarboxylation mechanism. [ 86 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1879", "text": "While NSAIDs as a class are not direct  teratogens , use of NSAIDs in late pregnancy can cause premature closure of the fetal  ductus arteriosus  and kidney ADRs in the fetus. [ 87 ]  Thus, NSAIDs are not recommended during the third trimester of pregnancy because of the increased risk of premature constriction of the ductus arteriosus. [ 87 ]  Additionally, they are linked with  premature birth [ 88 ]  and  miscarriage . [ 89 ]  Aspirin, however, is used together with  heparin  in pregnant women with  antiphospholipid syndrome . [ 90 ]  Additionally,  indomethacin  can be used in pregnancy to treat  polyhydramnios  by reducing fetal urine production via inhibiting fetal renal blood flow. [ 91 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1880", "text": "In contrast,  paracetamol  (acetaminophen) is regarded as being safe and well tolerated during pregnancy, but Leffers et al. released a study in 2010, indicating that there may be associated male infertility in the unborn. [ 92 ] [ 93 ]  Doses should be taken as prescribed, due to risk of liver toxicity with overdoses. [ 94 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1881", "text": "In France, the country's health agency contraindicates the use of NSAIDs, including aspirin, after the sixth month of pregnancy. [ 95 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1882", "text": "In October 2020, the U.S.  Food and Drug Administration  (FDA) required the  drug label  to be updated for all nonsteroidal anti-inflammatory medications, to describe the risk of kidney problems in unborn babies which can then lead to low amniotic fluid levels, as a result of the use of NSAIDs. [ 96 ] [ 97 ]  They are recommending avoiding the use of NSAIDs by pregnant women at 20 weeks or later in pregnancy. [ 96 ] [ 97 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1883", "text": "A variety of allergic or allergic-like  NSAID hypersensitivity reactions  follow the ingestion of NSAIDs. These hypersensitivity reactions differ from the other adverse reactions listed here which are toxicity reactions, i.e. unwanted reactions that result from the pharmacological action of a drug, are dose-related, and can occur in any treated individual; hypersensitivity reactions are idiosyncratic reactions to a drug. [ 98 ]  Some NSAID hypersensitivity reactions are truly allergic in origin:  1)  repetitive  IgE -mediated  urticarial  skin eruptions,  angioedema , and  anaphylaxis  following immediately to hours after ingesting one structural type of NSAID but not after ingesting structurally unrelated NSAIDs; and  2)  Comparatively mild to moderately severe  T cell -mediated delayed onset (usually more than 24 hour), skin reactions such as  maculopapular rash ,  fixed drug eruptions ,  photosensitivity reactions , delayed  urticaria , and  contact dermatitis ; or  3)  far more severe and potentially life-threatening t-cell-mediated delayed systemic reactions such as the  DRESS syndrome ,  acute generalized exanthematous pustulosis , the  Stevens\u2013Johnson syndrome , and  toxic epidermal necrolysis . Other NSAID hypersensitivity reactions are allergy-like symptoms but do not involve true allergic mechanisms; rather, they appear due to the ability of NSAIDs to alter the metabolism of arachidonic acid in favor of forming metabolites that promote allergic symptoms. Affected individuals may be abnormally sensitive to these provocative metabolites or overproduce them and typically are susceptible to a wide range of structurally dissimilar NSAIDs, particularly those that inhibit COX1. Symptoms, which develop immediately to hours after ingesting any of various NSAIDs that inhibit COX-1, are:  1)  exacerbations of asthmatic and rhinitis (see  aspirin-exacerbated respiratory disease ) symptoms in individuals with a history of  asthma  or  rhinitis  and  2)  exacerbation or first-time development of  wheals  or  angioedema  in individuals with or without a history of chronic  urticarial  lesions or angioedema. [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1884", "text": "It has been hypothesized that NSAIDs may delay healing from  bone  and  soft-tissue injuries  by inhibiting inflammation. [ 99 ]  On the other hand, it has also been hypothesized that NSAIDs might speed recovery from soft tissue injuries by preventing inflammatory processes from damaging adjacent, non-injured muscles. [ 100 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1885", "text": "There is moderate evidence that they delay bone healing. [ 101 ]  Their overall effect on soft-tissue healing is unclear. [ 100 ] [ 99 ] [ 102 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1886", "text": "Long-term use of NSAID analgesics and paracetamol is associated with an increased risk of hearing loss. [ 103 ] [ 104 ] [ 105 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1887", "text": "The use of NSAIDs for analgesia following gastrointestinal surgery remains controversial, given mixed evidence of an increased risk of leakage from any bowel  anastomosis  created. This risk may vary according to the class of NSAID prescribed. [ 43 ] [ 44 ] [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1888", "text": "Common adverse drug reactions (ADR), other than listed above, include: raised liver  enzymes ,  headache ,  dizziness . [ 17 ]  Uncommon ADRs include an  abnormally high level of potassium in the blood , confusion,  spasm of the airways , and rash. [ 17 ]  Ibuprofen may also rarely cause  irritable bowel syndrome  symptoms. NSAIDs are also implicated in some cases of  Stevens\u2013Johnson syndrome . [ 106 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1889", "text": "Most NSAIDs penetrate poorly into the  central nervous system  (CNS). However, the COX enzymes are expressed constitutively in some areas of the CNS, meaning that even limited penetration may cause adverse effects such as somnolence and dizziness. [ 107 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1890", "text": "NSAIDs may increase the risk of bleeding in patients with  Dengue fever [ 108 ]  For this reason, NSAIDs are only available with a prescription in India. [ 109 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1891", "text": "In very rare cases, ibuprofen can cause  aseptic meningitis . [ 110 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1892", "text": "As with other drugs,  allergies  to NSAIDs might exist. While many allergies are specific to one NSAID, up to 1 in 5 people may have unpredictable cross-reactive allergic responses to other NSAIDs as well. [ 111 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1893", "text": "Although small doses generally have little to no effect on the immune system, large doses of NSAIDs significantly suppress the production of immune cells. [ 112 ]  As NSAIDs affect prostaglandins, they affect the production of most fast growing cells. [ 112 ]  This includes immune cells. [ 112 ]  Unlike  corticosteroids , they do not directly suppress the immune system and so their effect on the immune system is not immediately obvious. [ 112 ]  They suppress the production of new immune cells, but leave existing immune cells functional. [ 112 ]  Large doses slowly reduce the immune response as the immune cells are renewed at a much lower rate. [ 112 ]  Causing a gradual reduction of the immune system, much slower and less noticeable than the immediate effect of Corticosteroids. [ 112 ]  The effect significantly increases with dosage, in a nearly exponential rate. [ 112 ]  Doubling of dose reduced cells by nearly four times. [ 112 ]  Increasing dose by five times reduced cell counts to only a few percent of normal levels. [ 112 ]  This is likely why the effect was not immediately obvious in low dose trials, as the effect is not apparent until much higher dosages are tested. [ 112 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1894", "text": "NSAIDs reduce kidney blood flow and thereby decrease the efficacy of  diuretics , and inhibit the elimination of  lithium  and  methotrexate . [ 113 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1895", "text": "NSAIDs cause  decreased ability to form blood clots , which can increase the risk of bleeding when combined with other drugs that also decrease blood clotting, such as  warfarin . [ 113 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1896", "text": "NSAIDs may aggravate  hypertension  (high blood pressure) and thereby antagonize the effect of  antihypertensives , [ 113 ]  such as  ACE inhibitors . [ 114 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1897", "text": "NSAIDs may interfere and reduce effectiveness of  SSRI  antidepressants through inhibiting  TNF\u03b1  and  IFN\u03b3 , both of which are cytokine derivatives. [ 115 ] [ 116 ]  NSAIDs, when used in combination with SSRIs, increase the risk of adverse gastrointestinal effects. [ 117 ]  NSAIDs, when used in combination with SSRIs, increase the risk of internal bleeding and brain hemorrhages. [ 118 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1898", "text": "Various widely used NSAIDs enhance  endocannabinoid  signaling by blocking the anandamide-degrading membrane enzyme  fatty acid amide hydrolase  ( FAAH ). [ 119 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1899", "text": "NSAIDs may reduce the effectiveness of  antibiotics . An  in-vitro  study on cultured  bacteria  found that adding NSAIDs to antibiotics reduced their effectiveness by around 20%. [ 120 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1900", "text": "The concomitant use of NSAIDs with  alcohol  and/or  tobacco  products significantly increases the already elevated risk of  peptic ulcers  during NSAID therapy. [ 121 ] [ better\u00a0source\u00a0needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1901", "text": "Most NSAIDs act as nonselective inhibitors of the  cyclooxygenase  (COX)  enzymes , inhibiting both the cyclooxygenase-1 ( COX-1 ) and cyclooxygenase-2 ( COX-2 )  isoenzymes . This inhibition is competitively  reversible  (albeit at varying degrees of reversibility), as opposed to the mechanism of  aspirin , which is irreversible inhibition. [ 122 ]  COX catalyzes the formation of  prostaglandins  and  thromboxane  from  arachidonic acid  (itself derived from the cellular  phospholipid  bilayer by  phospholipase A 2 ). Prostaglandins act (among other things) as messenger molecules in the process of  inflammation . This  mechanism of action  was elucidated in 1970 by  John Vane  (1927\u20132004), who received a  Nobel Prize  for his work (see  Mechanism of action of aspirin ). [ 123 ] [ 124 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1902", "text": "COX-1 is a constitutively expressed enzyme with a \"house-keeping\" role in regulating many normal physiological processes. One of these is in the  stomach  lining, where prostaglandins serve a protective role, preventing the stomach  mucosa  from being eroded by its own acid. COX-2 is an enzyme facultatively expressed in inflammation, and it is inhibition of COX-2 that produces the desirable effects of NSAIDs. [ 125 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1903", "text": "When nonselective COX-1/COX-2 inhibitors (such as aspirin, ibuprofen, and naproxen) lower stomach prostaglandin levels,  ulcers  of the stomach or  duodenum  and internal  bleeding  can result. [ 126 ]  The discovery of COX-2 led to research to the development of selective COX-2 inhibiting drugs that do not cause gastric problems characteristic of older NSAIDs. [ 127 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1904", "text": "NSAIDs have been studied in various assays to understand how they affect each of these enzymes. While the assays reveal differences, unfortunately, different assays provide differing ratios. [ 128 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1905", "text": "Paracetamol  (acetaminophen) is not considered an NSAID because it has little anti-inflammatory activity. It treats pain mainly by blocking COX-2 mostly in the central nervous system, but not much in the rest of the body. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1906", "text": "However, many aspects of the mechanism of action of NSAIDs remain unexplained, and for this reason, further COX pathways are hypothesized. The  COX-3  pathway was believed to fill some of this gap but recent findings make it appear unlikely that it plays any significant role in humans and alternative explanation models are proposed. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1907", "text": "NSAIDs interact with the  endocannabinoid system  and its  endocannabinoids , as COX2 have been shown to utilize endocannabinoids as substrates, and may have a key role in both the  therapeutic effects  and  adverse effects  of NSAIDs, as well as in NSAID-induced  placebo  responses. [ 129 ] [ 130 ] [ 131 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1908", "text": "NSAIDs are also used in the acute pain caused by  gout  because they inhibit  urate  crystal  phagocytosis  besides inhibition of prostaglandin synthase. [ 132 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1909", "text": "NSAIDs have  antipyretic  activity and can be used to treat fever. [ 133 ] [ 134 ]  Fever is caused by elevated levels of  prostaglandin E2  (PGE2), which alters the firing rate of neurons within the  hypothalamus  that control thermoregulation. [ 133 ] [ 135 ]  Antipyretics work by inhibiting the enzyme COX, which causes the general inhibition of  prostanoid  biosynthesis (PGE2) within the hypothalamus. [ 133 ] [ 134 ]  PGE2 signals to the hypothalamus to increase the body's thermal setpoint. [ 134 ] [ 136 ]   Ibuprofen  has been shown more effective as an  antipyretic  than  paracetamol  (acetaminophen). [ 135 ] [ 137 ] \n Arachidonic acid  is the precursor substrate for cyclooxygenase leading to the production of prostaglandins F, D, and E. [ 138 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1910", "text": "NSAIDs can be classified based on their chemical structure or mechanism of action. Older NSAIDs were known long before their mechanism of action was elucidated and were for this reason classified by chemical structure or origin. Newer substances are more often classified by mechanism of action. [ 139 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1911", "text": "The following NSAIDs are derived from  fenamic acid , which is a derivative of  anthranilic acid , [ 143 ] :\u200a235\u200a  which in turn is a nitrogen  isostere  of  salicylic acid , which is the  active metabolite  of  aspirin . [ 143 ] :\u200a235\u200a [ 144 ] :\u200a17"}
{"_id": "WikiPedia_Dermatology$$$corpus_1912", "text": "Most NSAIDs are  chiral  molecules;  diclofenac  and the  oxicams  are exceptions. However, the majority are prepared as  racemic mixtures . Typically, only a single  enantiomer  is pharmacologically active. For some drugs (typically profens), an  isomerase   enzyme   in vivo  converts the inactive enantiomer into the active form, although its activity varies widely in individuals. This phenomenon is likely responsible for the poor correlation between NSAID efficacy and plasma concentration observed in older studies when specific analysis of the active enantiomer was not performed. [ 151 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1913", "text": "Ibuprofen  and  ketoprofen  are now available in single-enantiomer preparations (dexibuprofen and dexketoprofen), which purport to offer quicker onset and an improved side-effect profile.  Naproxen  has always been marketed as the single active enantiomer. [ 152 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1914", "text": "NSAIDs within a group tend to have similar characteristics and tolerability. There is little difference in clinical efficacy among the NSAIDs when used at equivalent doses. [ 153 ]  Rather, differences among compounds usually relate to dosing regimens (related to the compound's  elimination half-life ), route of administration, and tolerability profile. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1915", "text": "Regarding adverse effects, selective  COX-2 inhibitors  have lower risk of gastrointestinal bleeding. [ 153 ]  With the exception of  naproxen , nonselective NSAIDs increase the risk of having a heart attack. [ 153 ]  Some data also supports that the partially selective  nabumetone  is less likely to cause gastrointestinal events. [ 153 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1916", "text": "A consumer report noted that  ibuprofen , naproxen, and  salsalate  are less expensive than other NSAIDs, and essentially as effective and safe when used appropriately to treat osteoarthritis and pain. [ 154 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1917", "text": "Most nonsteroidal anti-inflammatory drugs are weak acids, [ 155 ]  with a pKa of 3\u20135. They are absorbed well from the  stomach  and intestinal mucosa. They are highly protein-bound in plasma (typically >95%), usually to  albumin , so that their  volume of distribution  typically approximates to plasma volume. Most NSAIDs are metabolized in the  liver  by  oxidation  and conjugation to inactive metabolites that typically are excreted in the  urine , though some drugs are partially excreted in  bile . Metabolism may be abnormal in certain disease states, and accumulation may occur even with normal dosage. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1918", "text": "Ibuprofen and diclofenac have short half-lives (2\u20133 hours). Some NSAIDs (typically oxicams) have very long half-lives (e.g., 20\u201360 hours). [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1919", "text": "It is widely believed that naturally occurring salicin in  willow  trees and other plants was used by the ancients as a form of analgesic or anti-inflammatory drug, [ 156 ]  but this story, although compelling, is not entirely true. [ 157 ] [ 158 ]  Hippocrates does not mention willow at all. [ 159 ]   Dioscorides 's  De materia medica  was arguably the most influential herbal from Roman to Medieval times but, if he mentions willow at all (there is doubt about the identity of 'Itea'), then he used the ashes, steeped in vinegar, as a treatment for corns, [ 160 ]  which corresponds well with modern uses of  salicylic acid ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1920", "text": "Willow bark (from trees of the  Salix  genus) was widely known to be used as a medicine by multiple First Nations communities. [ 161 ]  The bark would be chewed or steeped in water for its pain relieving and antipyretic effects. The effects are a result of the bark's salicin content. Meadowsweet, another plant to contain salicin, has strong roots in British folk medicine for the same maladies. Willow bark was first reported in Western science by Edward Stone in 1763 as a treatment for  ague  (fever) according to the pseudoscientific  doctrine of signatures . [ 162 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1921", "text": "In the body, salicin is turned into salicylic acid, which produces the antipyretic and analgesic effects that the plants are known for."}
{"_id": "WikiPedia_Dermatology$$$corpus_1922", "text": "Salicin was first isolated by  Johann Andreas Buchner  in 1827. By 1829, French chemist Henri Leroux had improved the extraction process to obtain about 30g of purified salicin from 1.5 \u00a0 kg of willow bark. [ 163 ]  By  hydrolysis , salicin releases  glucose  and  salicyl alcohol  which can be converted into  salicylic acid , both  in vivo  and through chemical methods. [ 164 ]  In 1869,  Hermann Kolbe  synthesised salicylic acid, although it was too acidic for the  gastric mucosa . [ 164 ]  The reaction used to synthesise  aromatic  acid from a  phenol  in the presence of CO 2  is known as the  Kolbe-Schmitt reaction . [ 165 ] [ 166 ] [ 167 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1923", "text": "By 1897, the German chemist  Felix Hoffmann  and the  Bayer  company prompted a new age of pharmacology by converting salicylic acid into acetylsalicylic acid\u2014named  aspirin  by  Heinrich Dreser . Other NSAIDs like  ibuprofen  were developed from the 1950s forward. [ 163 ] \nIn 2001, NSAIDs accounted for 70,000,000 prescriptions and 30 \u00a0 billion  over-the-counter  doses sold annually in the  United States . [ 46 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1924", "text": "Research supports the use of NSAIDs for the control of pain associated with veterinary procedures such as dehorning and castration of calves. [ citation needed ]  The best effect is obtained by combining a short-term local anesthetic such as  lidocaine  with an NSAID acting as a longer term analgesic. [ citation needed ]  However, as different species have varying reactions to different medications in the NSAID family, little of the existing research data can be extrapolated to animal species other than those specifically studied, and the relevant government agency in one area sometimes prohibits uses approved in other jurisdictions. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1925", "text": "In the United States,  meloxicam  is approved for use only in canines, whereas (due to concerns about liver damage) it carries warnings against its use in cats [ 168 ] [ 169 ]  except for one-time use during surgery. [ 170 ]  In spite of these warnings, meloxicam is frequently prescribed \"off-label\" for non-canine animals including cats and livestock species. [ 171 ]  In other countries, for example  The European Union  (EU), there is a label claim for use in cats. [ 172 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1926", "text": "Nystatin , sold under the brand name  Mycostatin  among others, is an  antifungal medication . [ 1 ]  It is used to treat  Candida  infections of the skin including  diaper rash ,  thrush ,  esophageal candidiasis , and  vaginal yeast infections . [ 1 ]  It may also be used to prevent candidiasis in those who are at high risk. [ 1 ]  Nystatin may be used by mouth, in the vagina, or applied to the skin. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1927", "text": "Common side effects when applied to the skin include burning, itching, and a rash. [ 1 ]  Common side effects when taken by mouth include vomiting and diarrhea. [ 1 ]  During  pregnancy  use in the vagina is safe while other formulations have not been studied in this group. [ 1 ]  It works by disrupting the  cell membrane  of the fungal cells. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1928", "text": "Nystatin was discovered in 1950 by  Rachel Fuller Brown  and  Elizabeth Lee Hazen . [ 2 ]  It was the first polyene macrolide antifungal. [ 3 ]  It is on the  World Health Organization's List of Essential Medicines . [ 4 ]  It is available as a  generic medication . [ 1 ]  It is made from the bacterium  Streptomyces noursei . [ 2 ]  In 2022, it was the 236th most commonly prescribed medication in the United States, with more than 1 \u00a0 million prescriptions. [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1929", "text": "Skin ,  vaginal ,  mouth , and  esophageal   Candida  infections usually respond well to treatment with nystatin. Infections of nails or  hyperkeratinized  skin do not respond well. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1930", "text": "When given parenterally, its activity is reduced due to presence of plasma. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1931", "text": "Oral nystatin is often used as a preventive treatment in people who are at risk for fungal infections, such as  AIDS  patients with a low CD4 +  count and people receiving  chemotherapy . It has been investigated for use in patients after liver transplantation, but  fluconazole  was found to be much more effective for preventing colonization, invasive infection, and death. [ 9 ]  It is effective in treating oral candidiasis in elderly people who wear dentures. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1932", "text": "It is also used in very low birth-weight (less than 1500 g or 3\u00a0lb 5oz o) infants to prevent invasive fungal infections, although fluconazole is the preferred treatment. It has been found to reduce the rate of invasive fungal infections and also reduce deaths when used in these babies. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1933", "text": "Liposomal nystatin is not commercially available, but investigational use has shown greater  in vitro  activity than colloidal formulations of  amphotericin B , and demonstrated effectiveness against some amphotericin B-resistant forms of fungi. [ 12 ]  It offers an intriguing possibility for difficult-to-treat systemic infections, such as invasive aspergillosis, or infections that demonstrate resistance to amphotericin B.  Cryptococcus  is also sensitive to nystatin. Additionally, liposomal nystatin appears to cause fewer cases of and less severe nephrotoxicity than observed with amphotericin B. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1934", "text": "Bitter taste and nausea are more common than most other adverse effects. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1935", "text": "The oral suspension form produces a number of adverse effects including but not limited to: [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1936", "text": "Both the oral suspension and the topical form can cause:"}
{"_id": "WikiPedia_Dermatology$$$corpus_1937", "text": "Too high of a dosage can potentially lead to additional side effects such as: [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1938", "text": "Like  amphotericin B  and  natamycin , nystatin is an  ionophore . [ 17 ]  It binds to  ergosterol , a major component of the fungal  cell membrane . When present in sufficient concentrations, it forms pores in the membrane that lead to  K +  leakage, acidification, and death of the fungus. [ 18 ]  Ergosterol is a  sterol  unique to fungi, so the drug does not have such catastrophic effects on animals or plants. However, many of the systemic/toxic effects of nystatin in humans are attributable to its binding to mammalian sterols, namely  cholesterol . This is the effect that accounts for the  nephrotoxicity  observed when high serum levels of nystatin are achieved. [ 16 ]  Despite the molecular similarities and differences of ergosterol and cholesterol, there is currently no consensus as to why nystatin has a higher binding affinity for ergosterol because it remains unclear how the nystatin pores are formed. [ 16 ]  Researchers have concluded thus far that nystatin pores are formed from 4-12 nystatin molecules, with an unknown number of the necessary sterol interactions. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1939", "text": "Nystatin also impacts cell membrane potential and transport by  lipid peroxidation . [ 20 ]   Conjugated  double bonds in nystatin's structure steal  electron density  from ergosterol in fungal cell membranes. Lipid peroxidation alters the  hydrophilicity  of the interior of  channels  in the membrane, which is necessary to transport ions and  polar  molecules. Disruption of  membrane transport  from nystatin results in rapid cell death. Lipid peroxidation by nystatin also contributes significantly to  K +  leakage due to structural modifications of the membrane. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1940", "text": "Nystatin A 1  (often called nystatin) is biosynthesized by a bacterial strain,  Streptomyces noursei . [ 22 ]  The structure of this active compound is characterized as a polyene macrolide with a deoxysugar  D - mycosamine , an  aminoglycoside . [ 22 ]  The genomic sequence of nystatin reveals the presence of the polyketide loading module (nysA), six polyketide syntheses modules (nysB, nysC, nysI, nysJ, and nysK) and two thioesterase modules (nysK and nysE). [ 22 ]  It is evident that the biosynthesis of the macrolide functionality follows the  polyketide synthase  I pathway. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1941", "text": "Following the biosynthesis of the macrolide, the compound undergoes post-synthetic modifications, which are aided by the following enzymes: GDP-mannose dehydratase (nysIII), P450 monooxygenase (nysL and nysN), aminotransferase (nysDII), and glycosyltransferase (nysDI). [ 22 ]  The biosynthetic pathway is thought to proceed as shown to yield nystatin."}
{"_id": "WikiPedia_Dermatology$$$corpus_1942", "text": "The melting point of nystatin is 44 - 46\u00a0\u00b0C. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1943", "text": "Like many other antifungals and antibiotics, nystatin has  bacterial  origin. It was isolated from  Streptomyces noursei  in 1950 by  Elizabeth Lee Hazen  and  Rachel Fuller Brown , who were doing research for the Division of Laboratories and Research of the New York State Department of Health. Hazen found a promising micro-organism in the soil of a friend's dairy farm. She named it  Streptomyces noursei , after Jessie Nourse, the wife of the farm's owner. [ 25 ]  Hazen and Brown named nystatin after the  New York  State Health Department in 1954. [ 26 ]  The two discoverers patented the drug, and then donated the $13 million in profits to a foundation to fund similar research. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1944", "text": "It is also used in cellular biology as an inhibitor of the  lipid raft - caveolae   endocytosis pathway  on mammalian cells, at concentrations around 3\u00a0\u03bcg/ml. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1945", "text": "In certain cases, a nystatin derivative has been used to prevent the spread of mold on objects such as works of art. For example, it was applied to wood panel paintings damaged as a result of  the Arno River Flood of 1966 in Florence, Italy . [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1946", "text": "Nystatin is also used as a tool by scientists performing  \"perforated\" patch-clamp  electrophysiological recordings of cells. When loaded in the recording pipette, it allows for measurement of electrical currents without washing out the intracellular contents, because it forms pores in the cell membrane that are permeable to only  monovalent   ions , [ 29 ]  preferably cations such as sodium, potassium, lithium, and cesium. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1947", "text": "Another electrophysiological measurement that can be made is fusion event duration in a nystatin-ergosterol based system. Fusions are measured while the voltage is held constant, and is characterized by a spike in the current that then returns to the baseline current as the nystatin channels close. When present in smaller concentrations, nystatin momentarily forms pores that allows a vesicle fusion to occur more easily; that fusion then interrupts the pore stability and the nystatin and ergosterol disperse from each other. [ 31 ]  Conversely, researchers have found that the half-life of these nystatin pores increase with an increased dosage level of nystatin to the membrane systems. This indicates a lower energy of both the lipid membrane and the ionophores when there is a higher concentration of nystatin. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1948", "text": "Due to its  toxicity  profile when high levels in the serum are obtained, no injectable formulations of nystatin are on the US market. However, injectable formulations have been investigated in the past. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1949", "text": "Oseltamivir , sold under the brand name  Tamiflu  among others, is an  antiviral medication  used to treat and prevent  influenza A  and  influenza B , viruses that cause  the flu . [ 5 ]  Many medical organizations recommend it in people who have complications or are at high risk of complications within 48 hours of first symptoms of infection. [ 6 ]  They recommend it to prevent infection in those at high risk, but not the general population. [ 6 ]  The  Centers for Disease Control and Prevention  (CDC) recommends that clinicians use their discretion to treat those at lower risk who present within 48 hours of first symptoms of infection. [ 6 ] [ 7 ] [ 8 ]  It is taken by mouth, either as a pill or liquid. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1950", "text": "Recommendations regarding oseltamivir are controversial as are criticisms of the recommendations. [ 6 ] [ 9 ] [ 10 ] [ 11 ]  A 2014  Cochrane Review  concluded that oseltamivir does not reduce hospitalizations, and that there is no evidence of reduction in complications of influenza. [ 11 ]  Two  meta-analyses  have concluded that benefits in those who are otherwise healthy do not outweigh its risks. [ 12 ] [ 13 ]  They also found little evidence regarding whether treatment changes the risk of hospitalization or death in high risk populations. [ 12 ] [ 13 ]  However, another meta-analysis found that oseltamivir was effective for prevention of influenza at the individual and household levels. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1951", "text": "Common side effects include  vomiting ,  diarrhea , headache, and trouble sleeping. [ 5 ]  Other side effects may include  psychiatric symptoms  and  seizures . [ 5 ] [ 15 ] [ 16 ]  In the United States it is recommended for influenza infection during pregnancy. [ 1 ]  It has been taken by a small number of pregnant women without signs of problems. [ 1 ]  Dose adjustment may be needed in those with kidney problems. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1952", "text": "Oseltamivir was approved for medical use in the US in 1999. [ 5 ]  It was the first  neuraminidase inhibitor  available by mouth. [ 17 ]  It is on the  World Health Organization's List of Essential Medicines  but was downgraded to \"complementary\" status in 2017. [ 18 ] [ 19 ] [ 20 ]  A  generic version  was approved in the US in 2016. [ 21 ] [ 22 ]  In 2022, it was the 205th most commonly prescribed medication in the United States, with more than 1 \u00a0 million prescriptions. [ 23 ] [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1953", "text": "Oseltamivir is used for the prevention and treatment of  influenza  caused by influenza A and B viruses. [ 5 ] [ 25 ]  It is on the  World Health Organization's List of Essential Medicines . [ 20 ]  The WHO supports its use for severe illness due to confirmed or suspected influenza virus infection in critically ill people who have been hospitalized. [ 20 ]  Oseltamivir's risk-benefit ratio is controversial. [ 10 ] [ 11 ]  In 2017, it was moved from the core to the complementary list based on its lower cost-effectiveness. [ 26 ]  The Expert Committee did not recommend the deletion of oseltamivir from the EML and EMLc, recognizing that it is the only medicine included on the Model Lists for critically ill patients with influenza and for influenza pandemic preparedness. [ 18 ]  However, the Committee noted that, since the inclusion of oseltamivir on the Model List in 2009, new evidence in seasonal and pandemic influenza has lowered earlier estimates of the magnitude of effect of oseltamivir on relevant clinical outcomes. [ 18 ]  The Committee recommended that the listing of oseltamivir be amended, moving the medicine from the core to the Complementary List, and that its use be restricted to severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalized patients. [ 18 ]  The Expert Committee noted that WHO guidelines for pharmacological management of pandemic and seasonal influenza would be updated in 2017: unless new information is provided to support the use of oseltamivir in seasonal and pandemic outbreaks, the next Expert Committee might consider oseltamivir for deletion. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1954", "text": "The US  Centers for Disease Control and Prevention  (CDC),  European Centre for Disease Prevention and Control  (ECDC),  Public Health England  and the  American Academy of Pediatrics  (AAP) recommend the use of oseltamivir for people who have complications or are at high risk for complications. [ 6 ] [ 7 ] [ 27 ] [ 28 ] [ 29 ]  This includes those who are hospitalized, young children, those over the age of 65, people with other significant health problems, those who are pregnant, and  Indigenous peoples of the Americas  among others. [ 27 ]  The  Infectious Disease Society of America  takes the same position as the CDC. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1955", "text": "A systematic review of  systematic reviews  in  PLoS One  did not find evidence for benefits in people who are at risk, noting that \"the trials were not designed or powered to give results regarding serious complications, hospitalization and mortality\", [ 12 ]  as did a 2014 Cochrane Review. [ 30 ]  The Cochrane Review further recommended: \"On the basis of the findings of this review, clinicians and healthcare policy-makers should urgently revise current recommendations for use of the neuraminidase inhibitors (NIs) for individuals with influenza.\" [ 30 ]  That is not utilizing NIs for prevention or treatment \"Based on these findings there appears to be no evidence for patients, clinicians or policy-makers to use these drugs to prevent serious outcomes, both in annual influenza and pandemic influenza outbreaks.\" [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1956", "text": "The CDC, ECDC, Public Health England, Infectious Disease Society of America, the AAP, and  Roche  (the originator) reject the conclusions of the Cochrane Review, arguing in part that the analysis inappropriately forms conclusions about outcomes in people who are seriously ill based on results obtained primarily in healthy populations, and that the analysis inappropriately included results from people not infected with influenza. [ 6 ] [ 7 ] [ 9 ] [ 28 ] [ 29 ]  The EMA did not change its labeling of the drug in response to the Cochrane study. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1957", "text": "A 2014 review recommended that all people admitted to intensive care units during influenza outbreaks with a diagnosis of  community-acquired pneumonia  receive oseltamivir until the absence of influenza infection is established by  polymerase chain reaction  (PCR) testing. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1958", "text": "A 2015 systematic review and meta-analysis found oseltamivir effective at treating the symptoms of influenza, reducing the length of hospitalization, and reducing the risk of  otitis media . The same review found that oseltamivir did not significantly increase the risk of adverse events. [ 33 ]  A 2016 systematic review found that oseltamivir slightly reduced the time it takes for the symptoms of influenza to be alleviated, and that it also increased the risk of \"nausea, vomiting, [and] psychiatric events in adults and vomiting in children.\" [ 34 ]  The decrease in duration of sickness was about 18 hours. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1959", "text": "In those who are otherwise healthy the CDC states that antivirals may be considered within the first 48 hours. [ 27 ]  A German clinical practice guideline recommends against its use. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1960", "text": "Two 2013  meta-analyses  have concluded that benefits in those who are otherwise healthy do not outweigh its risks. [ 12 ] [ 13 ]  When the analysis was restricted to people with confirmed infection, the same 2014 Cochrane Review (see above) found unclear evidence of change in the risk of complications such as  pneumonia , [ 30 ]  while three other reviews found a decreased risk. [ 13 ] [ 37 ] [ 38 ]  Together, published studies suggest that oseltamivir reduces the duration of symptoms by 0.5\u20131.0 day. [ 39 ]  Any benefit of treatment must be balanced against side effects, which include psychiatric symptoms and increased rates of vomiting. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1961", "text": "The 2014  Cochrane Collaboration  review concluded that oseltamivir did not affect the need for hospitalizations, and that there is no proof of reduction of complications of influenza (such as pneumonia) because of a lack of diagnostic definitions, or reduction of the spread of the virus. There was also evidence that suggested that oseltamivir prevented some people from producing sufficient numbers of their own antibodies to fight infection. The authors recommended that guidance should be revised to take account of the evidence of small benefit and increased risk of harms. [ 30 ] [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1962", "text": "The US  Centers for Disease Control and Prevention  (CDC), the  European Centre for Disease Prevention and Control  (ECDC), the  Public Health England  (PHE), the  Infectious Disease Society of America  (IDSA), the  American Academy of Pediatrics  (AAP), and Roche (the originator) rejected the recommendations of the 2014 Cochrane Review to urgently change treatment guidelines and drug labels. [ 6 ] [ 7 ] [ 9 ] [ 28 ] [ 29 ] [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1963", "text": "As of 2017 [update] , the CDC does not recommend to use oseltamivir generally for prevention due to concerns that widespread use will encourage resistance development. [ 27 ]  They recommend that it be considered in those at high risk, who have been exposed to influenza within 48 hours and have not received or only recently been vaccinated. [ 27 ]  They recommended it during outbreaks in  long term care facilities  and in those who are significantly immunosuppressed. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1964", "text": "As of 2011 [update] , reviews concluded that when oseltamivir is used preventatively it decreases the risk of exposed people developing symptomatic disease. [ 30 ] [ 41 ]  A systematic review of systematic reviews found low to moderate evidence that it decreases the risk of getting symptomatic influenza by 1 to 12% (a relative decrease of 64 to 92%). [ 12 ]  It recommended against its use in healthy, low-risk persons due to cost, the risk of resistance development, and side effects and concluded it might be useful for prevention in unvaccinated  high risk persons. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1965", "text": "Common  adverse drug reactions  (ADRs) associated with oseltamivir therapy (occurring in over 1\u00a0percent of people) include nausea and vomiting. In adults, oseltamivir increased the risk of nausea for which the  number needed to harm  was 28 and for vomiting was 22. So, for every 22 adult people on oseltamivir one experienced vomiting. In the treatment of children, oseltamivir also induced vomiting. The number needed to harm was 19. So, for every 19 children on oseltamivir one experienced vomiting. In prevention there were more headaches, kidney, and psychiatric events. Oseltamivir's effect on the heart is unclear: it may reduce cardiac symptoms, but may also induce serious arrhythmias. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1966", "text": "Postmarketing reports include  liver inflammation  and elevated liver enzymes, rash, allergic reactions including  anaphylaxis ,  toxic epidermal necrolysis ,  abnormal heart rhythms , seizure, confusion, aggravation of diabetes, and  haemorrhagic   colitis  and  Stevens\u2013Johnson syndrome . [ 42 ] [ 43 ]  Neuropsychiatric symptoms and body pain, followed by skin problems, were identified as the side effects most significantly reducing patient satisfaction on a drug review platform. [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1967", "text": "The US and EU package inserts for oseltamivir contain a warning of psychiatric effects observed in post-marketing surveillance. [ 45 ] [ 46 ]  The frequency of these appears to be low and a causative role for oseltamivir has not been established. [ 46 ] [ 47 ]  The 2014 Cochrane Review found a dose-response effect on psychiatric events. In trials of prevention in adults one person was harmed for every 94 treated. [ 30 ]  Neither of the two most cited published treatment trials of oseltamivir reported any drug-attributable serious adverse events. [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1968", "text": "It is  pregnancy category  B in Australia, meaning that it has been taken by a small number of women without signs of problems and in animal studies it looks safe. [ 48 ]  Dose adjustment may be needed in those with kidney problems. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1969", "text": "Oseltamivir is a  neuraminidase inhibitor , a  competitive inhibitor  of influenza's  neuraminidase  enzyme. The enzyme cleaves the  sialic acid  which is found on  glycoproteins  on the surface of human cells that helps new virions to exit the cell, preventing new viral particles from being released. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1970", "text": "The vast majority of mutations conferring resistance are single  amino acid  residue substitutions (His274Tyr in N1) in the  neuraminidase  enzyme. [ 49 ]  A 2011 meta-analysis of 15 studies found a pooled incidence rate for oseltamivir resistance of 2.6%. Subgroup analyses detected higher rates among influenza A patients, especially the H1N1 subtype. It was found that a substantial number of patients might become oseltamivir-resistant as a result of oseltamivir use, and that oseltamivir resistance might be significantly associated with pneumonia. [ 49 ]  In severely immunocompromised patients there were reports of prolonged shedding of oseltamivir- (or  zanamivir )-resistant virus, even after oseltamivir treatment was stopped. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1971", "text": "As of December\u00a015, 2010 [update] , the  World Health Organization  (WHO) reported 314 samples of the prevalent  2009 pandemic H1N1 flu  tested worldwide showed resistance to oseltamivir. [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1972", "text": "The CDC found sporadic oseltamivir-resistant 2009 H1N1 virus infections had been identified, including with rare episodes of limited transmission, but the public health impact had been limited. Those sporadic cases of resistance were found in immunosuppressed patients during oseltamivir treatment and persons who developed illness while receiving oseltamivir chemoprophylaxis. [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1973", "text": "During 2011, a new influenza A(H1N1)2009 variant with mildly reduced oseltamivir (and zanamivir) sensitivity was detected in more than 10% of community specimens in Singapore and more than 30% of samples from northern Australia. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1974", "text": "While there is concern that antiviral resistance may develop in people with haematologic malignancies due to their inability to reduce viral loads and several surveillance studies found oseltamivir-resistant pH1N1 after administration of oseltamivir in those people, as of November 2013 [update] , widespread transmission of oseltamivir-resistant pH1N1 has not occurred. [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1975", "text": "During the 2007\u201308 flu season, the US CDC found 10.9% of H1N1 samples (n=1,020) to be resistant. [ 54 ]  In the 2008\u201309 season, the proportion of resistant H1N1 increased to 99.4%, while no other seasonal strains (H3N2, B) showed resistance. [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1976", "text": "From 2009 to 2014, oseltamivir resistance was very low in seasonal flu. In the 2010\u201311 flu season, 99.1% of H1N1, 99.8% of H3N, and 100% of Influenza B remained oseltamivir susceptible in the US. [ 56 ]  In January 2012, the US and European CDCs reported all seasonal flu samples tested since October 2011 to be oseltamivir susceptible. [ 57 ] [ 58 ]  In the 2013\u201314 season only 1% of 2009 H1N1 viruses showed oseltamivir resistance. No other influenza viruses were resistant to oseltamivir. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1977", "text": "Three studies have found resistance in 0%, 3.3%, and 18% of subjects. [ 49 ]  In the study with the 18% resistance rate, the subjects were children, many of whom had not been previously exposed to influenza virus and therefore had a weakened immune response; the results suggest that higher and earlier dosing may be necessary in such populations. [ 60 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1978", "text": "In 2007, Japanese investigators detected neuraminidase-resistant influenza B virus strains in individuals not treated with these drugs. The prevalence was 1.7%. [ 61 ]  According to the CDC, As of 2019 [update] , transmission of oseltamivir-resistant influenza B virus strains\u2014from persons treated with the drug\u2014is rare. [ 62 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1979", "text": "As of 2013 [update] , H274Y and N294S mutations that confer resistance to oseltamivir have been identified in a few H5N1 isolates from infected patients treated with oseltamivir, and have emerged spontaneously in Egypt. [ 63 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1980", "text": "As of 2013 [update] , two of 14 adults infected with A(H7N9) and treated with oseltamivir developed oseltamivir-resistant virus with the Arg292Lys mutation. [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1981", "text": "Its oral bioavailability is over 80% and is extensively metabolised to its active form upon first-pass through the liver. [ 4 ]  It has a  volume of distribution  of 23\u201326 litres. [ 4 ]  Its  half-life  is about 1\u20133 hours and its active carboxylate metabolite has a half-life of 6\u201310 hours. [ 4 ]  More than 90% of the oral dose is eliminated in the urine as the active metabolite. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1982", "text": "Oseltamivir was discovered by scientists at  Gilead Sciences  using  shikimic acid  as a starting point for  synthesis ; shikimic acid was originally available only as an extract of  Chinese star anise ; but by 2006, 30% of the supply was manufactured  recombinantly  in  E. coli. [ 65 ] [ 66 ]  Gilead exclusively licensed their relevant patents to  Roche  in 1996. [ 67 ]  The drug has not been patent-protected in Thailand, the Philippines, Indonesia, and several other countries. [ 67 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1983", "text": "In 1999, the FDA approved oseltamivir phosphate for the treatment of influenza in adults [ 68 ]  based on two double-blind, randomized, placebo-controlled clinical trials. [ 69 ]  In June 2002, the  European Medicines Agency  (EMA) approved oseltamivir phosphate for prophylaxis and treatment of influenza. In 2003, a pooled analysis of ten randomised clinical trials concluded that oseltamivir reduced the risk of lower respiratory tract infections resulting in antibiotic use and hospital admissions in adults. [ 70 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1984", "text": "Oseltamivir (as Tamiflu) was widely used during the H5N1 avian influenza  epidemic  in Southeast Asia in 2005. [ medical citation needed ]  In response to the epidemic, various governments \u2013 including those of the United Kingdom, Canada, Israel, United States, and Australia \u2013 stockpiled quantities of oseltamivir in preparation for a possible  pandemic [ 71 ]  and there were worldwide shortages of the drug, driven by the high demand for stockpiling. [ 65 ]  In November 2005, US President  George W. Bush  requested that Congress fund US$1\u00a0billion for the production and stockpile of oseltamivir, after Congress had already approved $1.8\u00a0billion for military use of the drug. Defense Secretary Donald Rumsfeld, who was a past chairman of Gilead Sciences, recused himself from all government decisions regarding the drug. [ 72 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1985", "text": "In 2006, a Cochrane Review (since withdrawn) raised controversy by concluding that oseltamivir should not be used during routine seasonal influenza because of its low effectiveness. [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1986", "text": "In December 2008, the Indian drug company  Cipla  won a case in India's court system allowing it to manufacture a cheaper generic version of Tamiflu, called Antiflu. In May 2009, Cipla won approval from the World Health Organization (WHO) certifying that its drug Antiflu was as effective as Tamiflu, and Antiflu is included in the WHO list of prequalified medicinal products. [ 74 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1987", "text": "In 2009, a new A/H1N1 influenza virus was discovered to be spreading in North America. In June 2009, the WHO declared the A/H1N1 influenza a pandemic. [ 75 ]  The  National Institute for Health and Care Excellence  (NICE), the CDC, the WHO, and the ECDC maintained their recommendation to use oseltamivir. [ 8 ] [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1988", "text": "From 2010 to 2012, Cochrane requested Roche's full clinical study reports of their trials, which they did not provide. [ 77 ]  In 2011, a  freedom of information request  to the European Medicines Agency (EMA) provided Cochrane with reports from 16 Roche oseltamivir trials. In 2012, the Cochrane team published an interim review based on those reports. In 2013, Roche released 74 full clinical study reports of oseltamivir trials after GSK released the data on  zanamivir  studies. [ 78 ]  In 2014, Cochrane published an updated review based solely on full clinical study reports and regulatory documents. [ 30 ] [ 77 ]  In 2016, Roche's oseltamivir patents began to expire. [ 67 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1989", "text": "There have been [ when? ]  reports of oseltamivir reducing disease severity and hospitalization time in  canine parvovirus  infection. [ 79 ]  The drug may limit the ability of the virus to invade the  crypt  cells of the  small intestine  and decrease gastrointestinal  bacterial  colonization and toxin production. [ 80 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1990", "text": "Oseltamivir has been deemed ineffective at treating  COVID-19 , consistent with the  SARS-CoV-2 virus  lacking influenza's neuraminidase enzyme. [ 81 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1991", "text": "Oxicam  is a class of  non-steroidal anti-inflammatory drugs  (NSAIDs), [ 2 ]  meaning that they have  anti-inflammatory ,  analgesic , and antipyretic therapeutic effects.  Oxicams bind closely to  plasma proteins . [ 1 ]   Most oxicams are unselective inhibitors of the  cyclooxygenase  (COX) enzymes.  The exception is  meloxicam  with a slight (10:1) preference for  COX-2 , which, however, is only clinically relevant at low doses. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1992", "text": "The most popular drug of the oxicam class is  piroxicam . [ 1 ]   Other examples include:  ampiroxicam ,  droxicam ,  pivoxicam ,  tenoxicam ,  lornoxicam , [ 1 ]  and  meloxicam ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1993", "text": "Isoxicam  has been suspended as a result of fatal skin reactions. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1994", "text": "The physico-chemical characteristics of these molecules vary greatly depending upon the environment. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1995", "text": "In contrast to most other NSAIDs, oxicams are not  carboxylic acids .  They are  tautomeric , and can exist as a number of tautomers ( keto-enol tautomerism ), here exemplified by piroxicam: [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1996", "text": "The oxicams are associated with drug-related  erythema multiforme  (EM),  Stevens\u2013Johnson syndrome , and  toxic epidermal necrolysis  (TEN).  This association is one of the reasons oxicams are not regularly prescribed."}
{"_id": "WikiPedia_Dermatology$$$corpus_1997", "text": "Paracetamol , [ a ]  or  acetaminophen , [ b ]  is a non-opioid  analgesic  and  antipyretic  agent used to treat  fever  and mild to moderate  pain . [ 13 ] [ 14 ] [ 15 ]  It is a widely available  over-the-counter drug  sold under various brand names, including  Tylenol  and  Panadol ."}
{"_id": "WikiPedia_Dermatology$$$corpus_1998", "text": "Paracetamol relieves pain in both acute mild  migraine  and episodic  tension headache . [ 16 ] [ 17 ]  At a standard dose, paracetamol slightly reduces fever; [ 14 ] [ 18 ] [ 19 ]  it is inferior to  ibuprofen  in that respect, [ 20 ]  and the benefits of its use for fever are unclear, particularly in the context of fever of viral origins. [ 14 ] [ 21 ] [ 22 ]   The  aspirin/paracetamol/caffeine  combination also helps with both conditions where the pain is mild and is recommended as a  first-line treatment  for them. [ 23 ] [ 24 ]  Paracetamol is effective for post- surgical  pain, but it is inferior to ibuprofen. [ 25 ]  The  paracetamol/ibuprofen  combination provides further increase in potency and is superior to either drug alone. [ 25 ] [ 26 ]  The pain relief paracetamol provides in  osteoarthritis  is small and clinically insignificant. [ 15 ] [ 27 ] [ 28 ]  The evidence in its favor for the use in low back pain,  cancer pain , and  neuropathic pain  is insufficient. [ 15 ] [ 27 ] [ 29 ] [ 30 ] [ 31 ] [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_1999", "text": "In the short term, paracetamol is safe and effective when used as directed. [ 33 ]  Short term adverse effects are uncommon and similar to ibuprofen, [ 34 ]  but paracetamol is typically safer than  nonsteroidal anti-inflammatory drugs  (NSAIDs) for long-term use. [ 35 ]  Paracetamol is also often used in patients who cannot tolerate NSAIDs like ibuprofen. [ 36 ] [ 37 ]  Chronic consumption of paracetamol may result in a drop in  hemoglobin  level, indicating possible  gastrointestinal bleeding , [ 38 ]  and  abnormal liver function tests . The recommended maximum daily dose for an adult is three to four grams. [ 27 ] [ 39 ]  Higher doses may lead to toxicity, including  liver failure . [ 40 ]   Paracetamol poisoning  is the foremost cause of  acute liver failure  in the  Western world , and accounts for most drug overdoses in the United States, the United Kingdom, Australia, and New Zealand. [ 41 ] [ 42 ] [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2000", "text": "Paracetamol was first made in 1878 by  Harmon Northrop Morse  or possibly in 1852 by  Charles Fr\u00e9d\u00e9ric Gerhardt . [ 44 ] [ 45 ] [ 46 ]  It is the most commonly used medication for pain and fever in both the United States and Europe. [ 47 ]  It is on the  World Health Organization's List of Essential Medicines . [ 48 ]  Paracetamol is available as a  generic medication , with brand names including  Tylenol  and  Panadol  among  others . [ 49 ]  In 2022, it was the 114th most commonly prescribed medication in the United States, with more than 5 \u00a0 million prescriptions. [ 50 ] [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2001", "text": "Paracetamol is used for reducing fever. [ 13 ]  However, there has been a lack of research on its  antipyretic  properties, particularly in adults, and thus its benefits are unclear. [ 14 ]  As a result, it has been described as  over-prescribed  for this application. [ 14 ]  In addition, low-quality  clinical data  indicates that when used for the  common cold , paracetamol may relieve a  stuffed  or  runny  nose, but not other cold symptoms such as  sore throat ,  malaise ,  sneezing , or  cough . [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2002", "text": "For people in  critical care , paracetamol decreases body temperature by only 0.2\u20130.3 \u00a0 \u00b0C more than control interventions and has no effect on their  mortality . [ 18 ]  It did not change the outcome in febrile patients with stroke. [ 53 ]  The results are contradictory for paracetamol use in sepsis: higher mortality, lower mortality, and no change in mortality were all reported. [ 18 ]  Paracetamol offered no benefit in the treatment of  dengue fever  and was accompanied by a higher rate of liver enzyme elevation: a sign of potential liver damage. [ 54 ]  Overall, there is no support for a routine administration of antipyretic drugs, including paracetamol, to hospitalized patients with fever and infection. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2003", "text": "The efficacy of paracetamol in children with fever is unclear. [ 55 ]  Paracetamol should not be used solely to reduce body temperature; however, it may be considered for children with fever who appear distressed. [ 56 ]  It does not prevent  febrile seizures . [ 56 ] [ 57 ]  It appears that 0.2 \u00a0 \u00b0C decrease of the body temperature in children after a standard dose of paracetamol is of questionable value, particularly in emergencies. [ 14 ]  Based on this, some physicians advocate using higher doses that may decrease the temperature by as much as 0.7 \u00a0 \u00b0C. [ 19 ]  Meta-analyses showed that paracetamol is less effective than ibuprofen in children (marginally less effective, according to another analysis [ 58 ] ), including children younger than 2 years old, [ 59 ]  with equivalent safety. [ 20 ]   Exacerbation  of asthma occurs with similar frequency for both medications. [ 60 ]  Giving paracetamol and ibuprofen together at the same time to children under 5 is not recommended; however, doses may be alternated if required. [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2004", "text": "Paracetamol is used for the relief of mild to moderate pain such as headache, muscle aches, minor arthritis pain, toothache as well as pain caused by cold, flu, sprains, and  dysmenorrhea . [ 61 ]  It is recommended, in particular, for acute mild to moderate pain, since the evidence for the treatment of chronic pain is insufficient. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2005", "text": "The benefits of paracetamol in musculoskeletal conditions, such as osteoarthritis and backache, are uncertain. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2006", "text": "It appears to provide only small and not clinically important benefits in  osteoarthritis . [ 15 ] [ 27 ]   American College of Rheumatology  and  Arthritis Foundation  guideline for the management of osteoarthritis notes that the  effect size  in  clinical trials  of paracetamol has been very small, which suggests that for most individuals it is ineffective. [ 28 ]  The guideline conditionally recommends paracetamol for short-term and episodic use to those who do not tolerate nonsteroidal anti-inflammatory drugs. For people taking it regularly, monitoring for liver toxicity is required. [ 28 ]  Essentially the same recommendation was issued by  EULAR  for hand osteoarthritis. [ 62 ]  Similarly, the ESCEO algorithm for the treatment of knee osteoarthritis recommends limiting the use of paracetamol to short-term rescue analgesia only. [ 63 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2007", "text": "Paracetamol is ineffective for acute low back pain. [ 15 ] [ 29 ]  No randomized clinical trials evaluated its use for chronic or  radicular  back pain, and the evidence in favor of paracetamol is lacking. [ 30 ] [ 27 ] [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2008", "text": "Paracetamol is effective for acute migraine: [ 16 ]  39\u00a0% of people experience pain relief at one hour compared with 20\u00a0% in the control group. [ 64 ]  The aspirin/paracetamol/caffeine combination also \"has strong evidence of effectiveness and can be used as a  first-line treatment  for migraine\". [ 23 ]  Paracetamol on its own only slightly alleviates episodic  tension headache  in those who have them frequently. [ 17 ]  However, the aspirin/paracetamol/caffeine combination is superior to both paracetamol alone and placebo and offers meaningful relief of tension headache: two hours after administering the medication, 29\u00a0% of those who took the combination were pain-free as compared with 21\u00a0% on paracetamol and 18\u00a0% on placebo. [ 65 ]  The German, Austrian, and Swiss headache societies and the German Society of Neurology recommend this combination as a \"highlighted\" one for self-medication of tension headache, with paracetamol/caffeine combination being a \"remedy of first choice\", and paracetamol a \"remedy of second choice\". [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2009", "text": "Pain after a dental surgery provides a reliable model for the action of analgesics on other kinds of acute pain. [ 66 ]  For the relief of such pain, paracetamol is inferior to ibuprofen. [ 25 ]  Full therapeutic doses of nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen,  naproxen  or  diclofenac  are clearly more efficacious than the paracetamol/codeine combination which is frequently prescribed for dental pain. [ 67 ]  The combinations of paracetamol and NSAIDs ibuprofen or diclofenac are promising, possibly offering better pain control than either paracetamol or the NSAID alone. [ 25 ] [ 26 ] [ 68 ] [ 69 ]  Additionally, the paracetamol/ibuprofen combination may be superior to paracetamol/codeine and ibuprofen/codeine combinations. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2010", "text": "A meta-analysis of general post-surgical pain, which included dental and other surgery, showed the paracetamol/codeine combination to be more effective than paracetamol alone: it provided significant pain relief to as much as 53\u00a0% of the participants, while the placebo helped only 7\u00a0%. [ 70 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2011", "text": "Paracetamol fails to relieve procedural pain in  newborn babies . [ 71 ] [ 72 ]  For  perineal  pain  postpartum  paracetamol appears to be less effective than  nonsteroidal anti-inflammatory drugs  (NSAIDs). [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2012", "text": "The studies to support or refute the use of paracetamol for cancer pain and neuropathic pain are lacking. [ 31 ] [ 32 ]  There is limited evidence in favor of the use of the intravenous form of paracetamol for acute pain control in the emergency department. [ 74 ]  The combination of paracetamol with caffeine is superior to paracetamol alone for the treatment of acute pain. [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2013", "text": "Paracetamol helps ductal closure in  patent ductus arteriosus . It is as effective for this purpose as ibuprofen or  indomethacin , but results in less frequent gastrointestinal bleeding than ibuprofen. [ 76 ]  Its use for extremely low birth weight and gestational age infants however requires further study. [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2014", "text": "Gastrointestinal adverse effects such as nausea and  abdominal pain  are extremely uncommon, and their frequency is nothing \nlike that of ibuprofen. [ 37 ]  Increase in risk-taking behavior is possible. [ 77 ]  According to the U.S.  Food and Drug Administration  (FDA), the drug may cause rare and possibly fatal skin reactions such as  Stevens\u2013Johnson syndrome  and  toxic epidermal necrolysis , [ 78 ]   Rechallenge  tests and an analysis of American but not French  pharmacovigilance  databases indicated a risk of these reactions. [ 78 ] [ 79 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2015", "text": "In clinical trials for  osteoarthritis , the number of participants reporting adverse effects was similar for those on paracetamol and on placebo. However, the abnormal liver function tests (meaning there was some inflammation or damage to the liver) were almost four times more likely in those on paracetamol, although the clinical importance of this effect is uncertain. [ 80 ]  After 13 weeks of paracetamol therapy for knee pain, a drop in hemoglobin level indicating  gastrointestinal bleeding  was observed in 20\u00a0% of participants, this rate being similar to the ibuprofen group. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2016", "text": "Due to the absence of  controlled studies , most of the information about the long-term safety of paracetamol comes from  observational studies . [ 37 ]  These indicate a consistent pattern of increased  mortality  as well as  cardiovascular  ( stroke ,  myocardial infarction ), gastrointestinal ( ulcers ,  bleeding ) and  renal  adverse effects with increased dose of paracetamol. [ 38 ] [ 37 ] [ 81 ]  Use of paracetamol is associated with 1.9 times higher risk of peptic ulcer. [ 37 ]  Those who take it regularly at a higher dose (more than 2\u20133 \u00a0 g daily) are at much higher risk (3.6\u20133.7 times) of gastrointestinal bleeding and other bleeding events. [ 82 ]  Meta-analyses suggest that paracetamol may increase the risk of  kidney impairment  by 23\u00a0% [ 83 ]  and kidney cancer by 28\u00a0%. [ 81 ]  Paracetamol slightly but significantly increases  blood pressure  and heart rate. [ 37 ]  A 2022 double-blind, placebo-controlled, crossover study has provided evidence that daily, high-dose use (4 g per day) of paracetamol increases systolic BP. [ 84 ] [ non-primary source needed ]   A review of available research has suggested that increase in systolic blood pressure and increased risk of gastrointestinal bleeding associated with chronic paracetamol use shows a degree of dose dependence. [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2017", "text": "The association between paracetamol use and  asthma  in children has been a matter of controversy. [ 85 ]  However, the most recent research suggests that there is no association, [ 86 ]  and that the frequency of asthma exacerbations in children after paracetamol is the same as after another frequently used pain killer, ibuprofen. [ 60 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2018", "text": "In recommended doses, the  side effects  of paracetamol are mild to non-existent. [ 87 ]  In contrast to aspirin, it is not a  blood thinner  (and thus may be used in patients where bleeding is a concern), and it does not cause gastric irritation. [ 88 ]  Compared to Ibuprofen\u2014which can have adverse effects that include diarrhea, vomiting, and abdominal pain\u2014paracetamol is well tolerated with fewer side effects. [ 89 ]  Prolonged daily use may cause kidney or liver damage. [ 88 ] [ 90 ]  Paracetamol is metabolized by the liver and is  hepatotoxic ; side effects may be more likely in  chronic alcoholics  or patients with liver damage. [ 87 ] [ 91 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2019", "text": "Until 2010 paracetamol was believed safe in pregnancy however, in a study published in October 2010 it has been linked to  infertility  in the adult life of the unborn. [ 92 ]  Like NSAIDs and unlike opioid analgesics, paracetamol has not been found to cause euphoria or alter mood. One recent research study showed evidence that paracetamol can ease psychological pain, but more studies are needed to draw a stronger conclusion. [ 93 ]  Unlike aspirin, it is safe for children, as paracetamol is not associated with a risk of  Reye's syndrome  in children with viral illnesses. [ 94 ]  Chronic users of paracetamol may have a higher risk of developing  blood cancer . [ 95 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2020", "text": "Paracetamol safety in pregnancy has been under increased scrutiny. There appears to be no link between paracetamol use in the first trimester and adverse pregnancy outcomes or  birth defects . However, indications exist of a possible increase in the risk of asthma and developmental and reproductive disorders in the offspring of women with prolonged use of paracetamol during pregnancy. [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2021", "text": "Paracetamol use by the mother during pregnancy is associated with an increased risk of childhood  asthma , [ 96 ] [ 97 ]  but so are the maternal infections for which paracetamol may be used, and separating these influences is difficult. [ 82 ]  Paracetamol, in a small-scale meta-analysis was also associated with a 20\u201330\u00a0% increase in  autism spectrum disorder ,  attention deficit hyperactivity disorder , and  conduct disorder , with the association being lower in a meta-analysis where a larger demographic was used, but it is unclear whether this is a causal relationship and whether there was potential bias in the findings. [ 82 ] [ 98 ] [ 99 ]  There is also an argument that the large number, consistency, and robust designs of the studies provide strong evidence in favor of paracetamol causing the increased risk of these neurodevelopmental disorders. [ 100 ] [ 101 ]  In animal experiments, paracetamol disrupts fetal  testosterone  production, and several epidemiological studies linked  cryptorchidism  with mother's paracetamol use for more than two weeks in the second trimester. On the other hand, several studies did not find any association. [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2022", "text": "The consensus recommendation appears to be to avoid prolonged use of paracetamol in pregnancy and use it only when necessary, at the lowest effective dosage, and for the shortest time. [ 82 ] [ 102 ] [ 103 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2023", "text": "In pregnancy, paracetamol and  metoclopramide  are deemed safe as are NSAIDs until the  third trimester . [ 104 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2024", "text": "Overdose  of paracetamol is caused by taking more than the recommended maximum daily dose of paracetamol for healthy adults (three or four grams), [ 39 ]  and can cause potentially fatal  liver damage . [ 105 ] [ 106 ]  A single dose should not exceed 1000\u00a0mg, doses should be taken no sooner than four hours apart, and no more than four doses (4000\u00a0mg) in 24 hours. [ 39 ]  While a majority of adult overdoses are linked to suicide attempts, many cases are accidental, often due to the use of more than one paracetamol-containing product over an extended period. [ 107 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2025", "text": "Paracetamol toxicity  has become the foremost cause of acute liver failure in the United States by 2003, [ 43 ]  and as of 2005 [update] , paracetamol accounted for most drug overdoses in the United States, the United Kingdom, Australia, and New Zealand. [ 108 ]  As of 2004, paracetamol overdose resulted in more calls to  poison control centers  in the U.S. than overdose of any other pharmacological substance. [ 109 ]  According to the FDA, in the United States, \"56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths per year [were] related to acetaminophen-associated overdoses during the 1990s. Within these estimates, unintentional acetaminophen overdose accounted for nearly 25\u00a0% of the emergency department visits, 10\u00a0% of the hospitalizations, and 25\u00a0% of the deaths.\" [ 110 ] [ needs update ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2026", "text": "Overdoses are frequently related to high-dose  recreational use  of prescription  opioids , as these opioids are most often combined with paracetamol. [ 111 ]  The overdose risk may be heightened by frequent consumption of alcohol. [ 112 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2027", "text": "Untreated paracetamol overdose results in a lengthy, painful illness. Signs and symptoms of paracetamol toxicity may initially be absent or  non-specific symptoms . The first symptoms of overdose usually begin several hours after ingestion, with  nausea ,  vomiting , sweating, and pain as acute liver failure starts. [ 113 ]  People who take overdoses of paracetamol do not fall asleep or lose consciousness, although most people who attempt suicide with paracetamol wrongly believe that they will be rendered unconscious by the drug. [ 114 ] [ 115 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2028", "text": "Treatment is aimed at removing the paracetamol from the body and replenishing  glutathione . [ 115 ]   Activated charcoal  can be used to decrease absorption of paracetamol if the person comes to the hospital soon after the overdose. While the antidote,  acetylcysteine  (also called  N -acetylcysteine or NAC), acts as a precursor for glutathione, helping the body regenerate enough to prevent or at least decrease the possible damage to the liver; a  liver transplant  is often required if damage to the liver becomes severe. [ 41 ] [ 116 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2029", "text": "NAC was usually given following a treatment  nomogram  (one for people with risk factors, and one for those without), but the use of the nomogram is no longer recommended as evidence to support the use of risk factors was poor and inconsistent, and many of the risk factors are imprecise and difficult to determine with sufficient certainty in clinical practice. [ 117 ] [ 118 ]  Toxicity of paracetamol is due to its  quinone metabolite   NAPQI  and NAC also helps in neutralizing it. [ 115 ]   Kidney failure  is also a possible side effect. [ 112 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2030", "text": "Prokinetic agents  such as  metoclopramide  accelerate gastric emptying, shorten time (t max ) to paracetamol  peak blood plasma concentration  (C max ), and increase C max . Medications slowing gastric emptying such as  propantheline  and  morphine  lengthen t max  and decrease C max . [ 119 ] [ 120 ]  The interaction with morphine may result in patients failing to achieve the therapeutic concentration of paracetamol; the clinical significance of interactions with metoclopramide and propantheline is unclear. [ 120 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2031", "text": "There have been suspicions that  cytochrome inducers  may enhance the toxic pathway of paracetamol metabolism to  NAPQI  (see  Paracetamol#Pharmacokinetics ). By and large, these suspicions have not been confirmed. [ 120 ]  Out of the inducers studied, the evidence of potentially increased liver toxicity in paracetamol overdose exists for  phenobarbital ,  primidone ,  isoniazid , and possibly  St John's wort . [ 121 ]  On the other hand, the anti-tuberculosis drug  isoniazid  cuts the formation of NAPQI by 70%. [ 120 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2032", "text": "Ranitidine  increased paracetamol  area under the curve  (AUC) 1.6-fold. AUC increases are also observed with  nizatidine  and  cisapride . The effect is explained by these drugs inhibiting  glucuronidation  of paracetamol. [ 120 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2033", "text": "Paracetamol raises plasma concentrations of  ethinylestradiol  by 22\u00a0% by inhibiting its sulfation. [ 120 ]  Paracetamol increases  INR  during  warfarin  therapy and should be limited to no more than 2 g per week. [ 122 ] [ 123 ] [ 124 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2034", "text": "Paracetamol appears to exert its effects through two mechanisms: the inhibition of  cyclooxygenase  (COX) and actions of its metabolite  N-arachidonoylphenolamine  (AM404). [ 125 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2035", "text": "Supporting the first mechanism, pharmacologically and in its side effects, paracetamol is close to classical nonsteroidal anti-inflammatory drugs (NSAIDs) that act by inhibiting  COX-1  and  COX-2  enzymes and especially similar to selective  COX-2 inhibitors . [ 126 ]  Paracetamol inhibits  prostaglandin  synthesis by reducing the active form of COX-1 and COX-2 enzymes. This occurs only when the concentration of  arachidonic acid  and  peroxides  is low. Under these conditions, COX-2 is the predominant form of cyclooxygenase, which explains the apparent COX-2 selectivity of paracetamol. Under the conditions of inflammation, the concentration of peroxides is high, which counteracts the reducing effect of paracetamol. Accordingly, the anti-inflammatory action of paracetamol is slight. [ 125 ] [ 126 ]  The anti-inflammatory action of paracetamol (via COX inhibition) has also been found to primarily target the  central nervous system  and not peripheral areas of the body, explaining the lack of side effects associated with conventional NSAIDs such as gastric bleeding."}
{"_id": "WikiPedia_Dermatology$$$corpus_2036", "text": "The second mechanism centers on the paracetamol metabolite  AM404 . This metabolite has been detected in the brains of animals and  cerebrospinal fluid  of humans taking paracetamol. [ 125 ] [ 127 ]  It is formed in the brain from another paracetamol metabolite  4-aminophenol  by action of  fatty acid amide hydrolase . [ 125 ]  AM404 is a weak agonist of cannabinoid receptors  CB1  and  CB2 , an inhibitor of  endocannabinoid transporter , and a potent activator of  TRPV1  receptor. [ 125 ]  This and other research indicate that the  endocannabinoid system  and TRPV1 may play an important role in the analgesic effect of paracetamol. [ 125 ] [ 128 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2037", "text": "In 2018, Suemaru  et al . found that, in mice, paracetamol exerts an anticonvulsant effect by activation of the  TRPV1  receptors [ 129 ]  and a decrease in neuronal excitability by  hyperpolarization  of neurons. [ 130 ]  The exact mechanism of the anticonvulsant effect of acetaminophen is not clear. According to Suemaru  et al ., acetaminophen and its active metabolite  AM404  show a dose-dependent anticonvulsant activity against pentylenetetrazol-induced seizures in mice. [ 129 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2038", "text": "After being taken by mouth, paracetamol is rapidly absorbed from the  small intestine , while absorption from the stomach is negligible. Thus, the rate of absorption depends on stomach emptying. Food slows the stomach's emptying and absorption, but the total amount absorbed stays the same. [ 131 ]  In the same subjects, the peak plasma concentration of paracetamol was reached after 20 minutes when fasting versus 90 minutes when fed. High carbohydrate (but not high protein or high fat) food decreases paracetamol peak plasma concentration by four times. Even in the fasting state, the rate of absorption of paracetamol is variable and depends on the formulation, with maximum plasma concentration being reached after 20 minutes to 1.5 hours. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2039", "text": "Paracetamol's  bioavailability  is dose-dependent: it increases from 63\u00a0% for 500 \u00a0 mg dose to 89\u00a0% for 1000 \u00a0 mg dose. [ 6 ]  Its plasma terminal elimination half-life is 1.9\u20132.5 hours, [ 6 ]  and  volume of distribution  is roughly 50 \u00a0 L. [ 132 ]  Protein binding is negligible, except under the conditions of overdose, when it may reach 15\u201321\u00a0%. [ 6 ]  The concentration in serum after a typical dose of paracetamol usually peaks below 30 \u00a0 \u03bcg/mL (200 \u00a0 \u03bcmol/L). [ 133 ]  After 4 hours, the concentration is usually less than 10 \u00a0 \u03bcg/mL (66 \u00a0 \u03bcmol/L). [ 133 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2040", "text": "Paracetamol is  metabolized  primarily in the liver, mainly by  glucuronidation  and  sulfation , and the products are then eliminated in the urine (see the Scheme on the right). Only 2\u20135\u00a0% of the drug is excreted unchanged in the urine. [ 6 ]  Glucuronidation by  UGT1A1  and  UGT1A6  accounts for 50\u201370\u00a0% of the drug metabolism. Additional 25\u201335\u00a0% of paracetamol is converted to sulfate by sulfation enzymes  SULT1A1 ,  SULT1A3 , and  SULT1E1 . [ 134 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2041", "text": "A minor metabolic pathway (5\u201315\u00a0%) of oxidation by  cytochrome P450  enzymes, mainly by  CYP2E1 , forms a toxic metabolite known as  NAPQI  ( N -acetyl- p -benzoquinone imine). [ 134 ]  NAPQI is responsible for the liver toxicity of paracetamol. At usual doses of paracetamol, NAPQI is quickly detoxified by conjugation with  glutathione . The non-toxic conjugate APAP-GSH is taken up in the bile and further degraded to mercapturic and cysteine conjugates that are excreted in the urine. In overdose, glutathione is depleted by a large amount of formed NAPQI, and NAPQI binds to  mitochondria  proteins of the liver cells causing  oxidative stress  and toxicity. [ 134 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2042", "text": "Yet another minor but important direction of metabolism is deacetylation of 1\u20132\u00a0% of paracetamol to form  p -aminophenol .  p -Aminophenol is then converted in the brain by  fatty acid amide hydrolase  into  AM404 , a compound that may be partially responsible for the analgesic action of paracetamol. [ 132 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2043", "text": "The classical methods for the production of paracetamol involve the  acetylation  of  4-aminophenol  with  acetic anhydride  as the last step. They differ in how 4-aminophenol is prepared. In one method,  nitration  of  phenol  with  nitric acid  affords  4-nitrophenol , which is reduced to 4-aminophenol by  hydrogenation  over  Raney nickel . In another method,  nitrobenzene  is reduced  electrolytically  giving 4-aminophenol directly. Additionally, 4-nitrophenol can be selectively reduced by  Tin(II) Chloride  in  absolute ethanol  or  ethyl acetate  to produce a 91\u00a0% yield of 4-aminophenol. [ 135 ] [ 136 ] [ 137 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2044", "text": "An alternative industrial synthesis developed at  Celanese  involves firstly direct acylation of phenol with acetic anhydride in the presence of  hydrogen fluoride  to a ketone, then the conversion of the ketone with  hydroxylamine  to a  ketoxime , and finally the acid-catalyzed  Beckmann rearrangement  of the cetoxime to the para-acetylaminophenol product. [ 135 ] [ 138 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2045", "text": "4 -Aminophenol may be obtained by the amide  hydrolysis  of paracetamol. This reaction is also used to determine paracetamol in urine samples: After hydrolysis with hydrochloric acid,  4 -aminophenol reacts in ammonia solution with a phenol derivate, e.g. salicylic acid, to form an  indophenol  dye under oxidization by air. [ 139 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2046", "text": "Acetanilide  was the first  aniline  derivative serendipitously found to possess analgesic as well as antipyretic properties, and was quickly introduced into medical practice under the name of  Antifebrin  by Cahn & Hepp in 1886. [ 140 ]  But its unacceptable toxic effects\u2014the most alarming being  cyanosis  due to  methemoglobinemia , an increase of hemoglobin in its ferric [Fe 3+ ] state, called  methemoglobin , which cannot bind oxygen, and thus decreases overall carriage of oxygen to tissue\u2014prompted the search for less toxic aniline derivatives. [ 141 ]  Some reports state that Cahn & Hepp or a French chemist called Charles Gerhardt first synthesized paracetamol in 1852. [ 45 ] [ 46 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2047", "text": "Harmon Northrop Morse  synthesized paracetamol at  Johns Hopkins University  via the reduction of  p -nitrophenol  with  tin  in glacial  acetic acid  in 1877, [ 142 ] [ 143 ]  but it was not until 1887 that clinical pharmacologist  Joseph von Mering  tried paracetamol on humans. [ 141 ]  In 1893, von Mering published a paper reporting on the clinical results of paracetamol with  phenacetin , another aniline derivative. [ 144 ]  Von Mering claimed that, unlike phenacetin, paracetamol had a slight tendency to produce  methemoglobinemia . Paracetamol was then quickly discarded in favor of phenacetin. The sales of phenacetin established  Bayer  as a leading pharmaceutical company. [ 145 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2048", "text": "Von Mering's claims remained essentially unchallenged for half a century until two teams of researchers from the United States analyzed the metabolism of acetanilide and phenacetin. [ 145 ]  In 1947,  David Lester  and Leon Greenberg found strong evidence that paracetamol was a major metabolite of acetanilide in human blood, and in a subsequent study they reported that large doses of paracetamol given to albino rats did not cause methemoglobinemia. [ 146 ]  In 1948,  Bernard Brodie ,  Julius Axelrod  and Frederick Flinn confirmed that paracetamol was the major metabolite of acetanilide in humans, and established that it was just as efficacious an analgesic as its precursor. [ 147 ] [ 148 ] [ 149 ]  They also suggested that methemoglobinemia is produced in humans mainly by another metabolite,  phenylhydroxylamine . A follow-up paper by Brodie and Axelrod in 1949 established that phenacetin was also metabolized to paracetamol. [ 150 ]  This led to a \"rediscovery\" of paracetamol. [ 141 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2049", "text": "Paracetamol was first marketed in the United States in 1950 under the name Trigesic, a combination of paracetamol, aspirin, and caffeine. [ 143 ]  Reports in 1951 of three users stricken with the blood disease  agranulocytosis  led to its removal from the marketplace, and it took several years until it became clear that the disease was unconnected. [ 143 ]  The following year, 1952, paracetamol returned to the U.S. market as a prescription drug. [ 151 ]  In the United Kingdom, marketing of paracetamol began in 1956 by  Sterling-Winthrop Co.  as Panadol, available only by prescription, and promoted as preferable to aspirin since it was safe for children and people with ulcers. [ 152 ] [ 153 ]  In 1963, paracetamol was added to the  British Pharmacopoeia , and has gained popularity since then as an analgesic agent with few side-effects and little interaction with other pharmaceutical agents. [ 152 ] [ 143 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2050", "text": "Concerns about paracetamol's safety delayed its widespread acceptance until the 1970s, but in the 1980s paracetamol sales exceeded those of aspirin in many countries, including the United Kingdom. This was accompanied by the commercial demise of phenacetin, blamed as the cause of  analgesic nephropathy  and hematological toxicity. [ 141 ]  Available in the U.S. without a prescription since 1955 [ 151 ]  (1960, according to another source [ 154 ] ), paracetamol has become a common household drug. [ 155 ]  In 1988, Sterling Winthrop was acquired by  Eastman Kodak  which sold the over the counter drug rights to  SmithKline Beecham  in 1994. [ 156 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2051", "text": "In June 2009, an FDA advisory committee recommended that new restrictions be placed on paracetamol use in the United States to help protect people from the potential toxic effects. The maximum single adult dosage would be decreased from 1000 \u00a0 mg to 650 \u00a0 mg, while combinations of paracetamol and other products would be prohibited. Committee members were particularly concerned by the fact that the then-present maximum dosages of paracetamol had been shown to produce alterations in liver function. [ 157 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2052", "text": "In January 2011, the FDA asked manufacturers of prescription combination products containing paracetamol to limit its amount to no more than 325 \u00a0 mg per tablet or capsule and began requiring manufacturers to update the labels of all prescription combination paracetamol products to warn of the potential risk of severe liver damage. [ 158 ] [ 159 ] [ 160 ] [ 161 ] [ 162 ]  Manufacturers had three years to limit the amount of paracetamol in their prescription drug products to 325 \u00a0 mg per dosage unit. [ 159 ] [ 161 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2053", "text": "In November 2011, the  Medicines and Healthcare products Regulatory Agency  revised UK dosing of liquid paracetamol for children. [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2054", "text": "In September 2013, \"Use Only as Directed\", an episode of the radio program  This American Life [ 164 ]  highlighted deaths from paracetamol overdose. This report was followed by two reports by  ProPublica  alleging that the \"FDA has long been aware of studies showing the risks of acetaminophen. So has the maker of Tylenol, McNeil Consumer Healthcare, a division of Johnson & Johnson\" [ 165 ]  and \"McNeil, the maker of Tylenol, ... has repeatedly opposed safety warnings, dosage restrictions and other measures meant to safeguard users of the drug.\" [ 166 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2055", "text": "Paracetamol  is the  Australian Approved Name [ 167 ]  and  British Approved Name [ 168 ]  as well as the  international nonproprietary name  used by the WHO and in many other countries;  acetaminophen  is the  United States Adopted Name [ 168 ]  and  Japanese Accepted Name  and also the name generally used in Canada, [ 168 ]  Venezuela, Colombia, and Iran. [ 168 ] [ 169 ]  Both  paracetamol  and  acetaminophen  are contractions of chemical names for the compound. The word \"paracetamol\" is a shortened form of para-acetylaminophenol, [ 170 ]  and was coined by Frederick Stearns & Co in 1956, [ 171 ]  while the word \"acetaminophen\" is a shortened form of N-acetyl-p-aminophenol (APAP), which was coined and first marketed by McNeil Laboratories in 1955. [ 172 ]  The initialism  APAP  is used by dispensing pharmacists in the United States. [ 173 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2056", "text": "Paracetamol is available in oral, suppository, and  intravenous  forms. [ 174 ]  Intravenous paracetamol is sold under the brand name Ofirmev in the United States. [ 175 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2057", "text": "In some formulations, paracetamol is combined with the  opiate   codeine , sometimes referred to as  co-codamol  ( BAN ) and Panadeine in Australia. In the U.S., this combination is available only by prescription. [ 176 ]  As of 1 February 2018, medications containing codeine also became prescription-only in Australia. [ 177 ]  Paracetamol is also combined with other opioids such as  dihydrocodeine , [ 178 ]  referred to as  co-dydramol  ( British Approved Name  (BAN)),  oxycodone [ 179 ]  or  hydrocodone . [ 180 ]  Another very commonly used analgesic combination includes paracetamol in combination with  propoxyphene napsylate . [ 181 ]  A combination of paracetamol, codeine, and the  doxylamine succinate  is also available. [ 182 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2058", "text": "Paracetamol is sometimes combined with  phenylephrine hydrochloride . [ 183 ]  Sometimes a third active ingredient, such as  ascorbic acid , [ 183 ] [ 184 ]   caffeine , [ 185 ] [ 186 ]   chlorpheniramine maleate , [ 187 ]  or  guaifenesin [ 188 ] [ 189 ] [ 190 ]  is added to this combination."}
{"_id": "WikiPedia_Dermatology$$$corpus_2059", "text": "Claims that paracetamol is an effective analgesic medication to treat symptoms of  COVID-19  were found to be unsubstantiated. [ 191 ] [ 192 ] [ 193 ] [ 194 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2060", "text": "Paracetamol is extremely toxic to cats, which lack the necessary  UGT1A6  enzyme to detoxify it. Initial symptoms include vomiting, salivation, and discoloration of the tongue and gums. Unlike an overdose in humans, liver damage is rarely the cause of death; instead,  methemoglobin  formation and the production of  Heinz bodies  in red blood cells inhibit oxygen transport by the blood, causing  asphyxiation  ( methemoglobinemia  and  hemolytic anemia ). [ 195 ]  Treatment of the toxicosis with  acetylcysteine  is recommended. [ 196 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2061", "text": "Paracetamol has been reported to be as effective as aspirin in the treatment of musculoskeletal pain in dogs. [ 197 ]  A paracetamol\u2013codeine product (brand name Pardale-V) [ 198 ]  licensed for use in dogs is available for purchase under supervision of a vet, pharmacist or other qualified person. [ 198 ]  It should be administered to dogs only on veterinary advice and with extreme caution. [ 198 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2062", "text": "The main effect of toxicity in dogs is liver damage, and GI ulceration has been reported. [ 196 ] [ 199 ] [ 200 ] [ 201 ]  Acetylcysteine treatment is efficacious in dogs when administered within two hours of paracetamol ingestion. [ 196 ] [ 197 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2063", "text": "Paracetamol is lethal to snakes [ 202 ]  and has been suggested as a chemical control program for the invasive  brown tree snake  ( Boiga irregularis ) in  Guam . [ 203 ] [ 204 ]  Doses of 80 \u00a0 mg are inserted into dead mice that are scattered by helicopter [ 205 ]  as lethal bait to be consumed by the snakes."}
{"_id": "WikiPedia_Dermatology$$$corpus_2064", "text": "Phenytoin  ( PHT ), sold under the brand name  Dilantin  among others, [ 1 ]  is an  anti-seizure medication . [ 3 ]  It is useful for the prevention of  tonic-clonic seizures  (also known as grand mal seizures) and  focal seizures , but not  absence seizures . [ 3 ]  The intravenous form,  fosphenytoin , is used for  status epilepticus  that does not improve with  benzodiazepines . [ 3 ]   It may also be used for certain  heart arrhythmias  or  neuropathic pain . [ 3 ]  It can be taken  intravenously  or by mouth. [ 3 ]  The intravenous form generally begins working within 30 minutes and is effective for roughly 24 hours. [ 4 ]  Blood levels can be measured to determine the proper dose. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2065", "text": "Common side effects include nausea, stomach pain, loss of appetite, poor coordination,  increased hair growth , and  enlargement of the gums . [ 3 ]  Potentially serious side effects include  sleepiness ,  self harm , liver problems,  bone marrow suppression ,  low blood pressure ,  toxic epidermal necrolysis [ 3 ] , and atrophy of the  cerebellum . [ 6 ] [ 7 ] [ 8 ]  There is evidence that use during pregnancy results in abnormalities in the baby. [ 3 ]   It appears to be safe to use when  breastfeeding . [ 3 ]   Alcohol  may interfere with the medication's effects. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2066", "text": "Phenytoin was first made in 1908 by the German chemist  Heinrich Biltz  and found useful for seizures in 1936. [ 9 ] [ 10 ]  It is on the  World Health Organization's List of Essential Medicines . [ 11 ]  Phenytoin is available as a  generic medication . [ 12 ]   In 2020, it was the 260th most commonly prescribed medication in the United States, with more than 1 \u00a0 million prescriptions. [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2067", "text": "Though phenytoin has been used to treat seizures in infants, as of 2023, its effectiveness in this age group has been evaluated in only one study. Due to the lack of a comparison group, the evidence is inconclusive. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2068", "text": "Common side effects include nausea, stomach pain, loss of appetite, poor coordination,  increased hair growth , and  enlargement of the gums . Potentially serious side effects include  sleepiness ,  self harm , liver problems,  bone marrow suppression ,  low blood pressure , and  toxic epidermal necrolysis . There is evidence that use during pregnancy results in abnormalities in the baby. Its use appears to be safe during  breastfeeding .  Alcohol  may interfere with the medication's effects. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2069", "text": "Severe  low blood pressure  and abnormal heart rhythms can be seen with rapid infusion of IV phenytoin. IV infusion should not exceed 50\u00a0mg/min in adults or 1\u20133\u00a0mg/kg/min (or 50\u00a0mg/min, whichever is slower) in children. Heart monitoring should occur during and after IV infusion. Due to these risks, oral phenytoin should be used if possible. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2070", "text": "At therapeutic doses, phenytoin may produce  nystagmus  on lateral gaze. At toxic doses, patients experience vertical nystagmus,  double vision ,  sedation , slurred speech, cerebellar  ataxia , and  tremor . [ 22 ]  If phenytoin is stopped abruptly, this may result in increased seizure frequency, including  status epilepticus . [ 21 ] [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2071", "text": "Phenytoin may accumulate in the  cerebral cortex  over long periods of time which can cause  atrophy  of the  cerebellum . The degree of atrophy is related to the duration of phenytoin treatment and is not related to dosage of the medication. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2072", "text": "Phenytoin is known to be a causal factor in the development of  peripheral neuropathy . [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2073", "text": "Folate is present in food in a polyglutamate form, which is then converted into monoglutamates by  intestinal conjugase  to be absorbed by the jejunum. Phenytoin acts by inhibiting this enzyme, thereby causing  folate deficiency , and thus  megaloblastic anemia . [ 25 ] \nOther side effects may include:  agranulocytosis , [ 26 ]   aplastic anemia , [ 27 ]   decreased white blood cell count , [ 28 ]  and  a low platelet count . [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2074", "text": "Phenytoin is a known  teratogen , since children exposed to phenytoin are at a higher risk of  birth defects  than children born to women without epilepsy and to women with untreated epilepsy. [ 30 ] [ 31 ]  The birth defects, which occur in approximately 6% of exposed children, include  neural tube defects ,  heart defects  and  craniofacial abnormalities , including broad nasal bridge, cleft lip and palate, and  smaller than normal head . [ 31 ] [ 32 ]  The effect on IQ cannot be determined as no study involves phenytoin as monotherapy, however poorer language abilities and  delayed motor development  may have been associated with maternal use of phenytoin during pregnancy. [ 30 ]  This syndrome resembles the well-described  fetal alcohol syndrome . [ 33 ]  and has been referred to as \" fetal hydantoin syndrome \". Some recommend avoiding polytherapy and maintaining the minimal dose possible during pregnancy, but acknowledge that current data fails to demonstrate a dose effect on the risk of birth defects. [ 30 ] [ 31 ]  Data now being collected by the Epilepsy and Antiepileptic Drug Pregnancy Registry may one day answer this question definitively."}
{"_id": "WikiPedia_Dermatology$$$corpus_2075", "text": "There is no good evidence to suggest that phenytoin is a human  carcinogen . [ 34 ] [ 35 ]  However, lymph node abnormalities have been observed, including malignancies. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2076", "text": "Phenytoin has been associated with drug-induced  gingival enlargement  (overgrowth of the gums), probably due to above-mentioned folate deficiency; indeed, evidence from a  randomized controlled trial  suggests that folic acid supplementation can prevent gingival enlargement in children who take phenytoin. [ 37 ]  Plasma concentrations needed to induce gingival lesions have not been clearly defined.  Effects consist of the following: bleeding upon probing, increased gingival  exudate , pronounced gingival inflammatory response to plaque levels, associated in some instances with bone loss but without tooth detachment."}
{"_id": "WikiPedia_Dermatology$$$corpus_2077", "text": "Hypertrichosis ,  Stevens\u2013Johnson syndrome ,  purple glove syndrome , rash,  exfoliative dermatitis ,  itching ,  excessive hairiness , and coarsening of facial features can be seen in those taking phenytoin."}
{"_id": "WikiPedia_Dermatology$$$corpus_2078", "text": "Phenytoin therapy has been linked to the life-threatening skin reactions  Stevens\u2013Johnson syndrome  (SJS) and  toxic epidermal necrolysis  (TEN). These conditions are significantly more common in patients with a particular  HLA-B   allele ,  HLA-B*1502 . [ 38 ]  This allele occurs almost exclusively in patients with ancestry across broad areas of Asia, including South Asian Indians."}
{"_id": "WikiPedia_Dermatology$$$corpus_2079", "text": "Phenytoin is primarily metabolized to its inactive form by the enzyme  CYP2C9 . Variations within the CYP2C9 gene that result in decreased enzymatic activity have been associated with increased phenytoin concentrations, as well as reports of drug toxicities due to these increased concentrations. [ 39 ]  The  U.S. Food and Drug Administration  (FDA) notes on the phenytoin drug label that since strong evidence exists linking HLA-B*1502 with the risk of developing SJS or TEN in patients taking  carbamazepine , consideration should be given to avoiding phenytoin as an alternative to carbamazepine in patients carrying this allele. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2080", "text": "Phenytoin has been known to cause drug-induced  lupus . [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2081", "text": "Phenytoin is also associated with induction of reversible  IgA deficiency . [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2082", "text": "Phenytoin may increase risk of suicidal thoughts or behavior. People on phenytoin should be monitored for any changes in mood, the development or worsening depression, and/or any thoughts or behavior of suicide. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2083", "text": "Chronic phenytoin use has been associated with decreased bone density and increased bone fractures. Phenytoin induces metabolizing enzymes in the liver. This leads to increased metabolism of  vitamin D , thus decreased vitamin D levels.  Vitamin D deficiency , as well as  low calcium  and  phosphate  in the blood cause decreased bone mineral density. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2084", "text": "Phenytoin is an inducer of the  CYP3A4  and  CYP2C9  families of the  P450  enzyme responsible for the liver's degradation of various drugs. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2085", "text": "A 1981 study by the  National Institutes of Health  showed that  antacids  administered concomitantly with phenytoin \"altered not only the extent of absorption but also appeared to alter the rate of absorption.  Antacids administered in a peptic ulcer regimen may decrease the AUC of a single dose of phenytoin. Patients should be cautioned against concomitant use of antacids and phenytoin.\" [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2086", "text": "Warfarin  and  trimethoprim  increase serum phenytoin levels and prolong the serum half-life of phenytoin by inhibiting its metabolism. Consider using other options if possible. [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2087", "text": "In general, phenytoin can interact with the following drugs: [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2088", "text": "Phenytoin is believed to protect against seizures by causing voltage-dependent block of  voltage gated sodium channels . [ 46 ]  This blocks sustained high frequency repetitive firing of  action potentials . This is accomplished by reducing the amplitude of sodium-dependent action potentials through enhancing steady-state inactivation. Sodium channels exist in three main conformations: the resting state, the open state, and the inactive state."}
{"_id": "WikiPedia_Dermatology$$$corpus_2089", "text": "Phenytoin binds preferentially to the inactive form of the sodium channel. Because it takes time for the bound drug to dissassociate from the inactive channel, there is a time-dependent block of the channel. Since the fraction of inactive channels is increased by membrane  depolarization  as well as by repetitive firing, the binding to the inactive state by phenytoin sodium can produce voltage-dependent, use-dependent and time-dependent block of sodium-dependent action potentials. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2090", "text": "The primary site of action appears to be the  motor cortex  where spread of seizure activity is inhibited. [ 48 ]  Possibly by promoting sodium efflux from neurons, phenytoin tends to stabilize the threshold against hyperexcitability caused by excessive stimulation or environmental changes capable of reducing membrane sodium gradient. This includes the reduction of  post-tetanic potentiation  at synapses which prevents cortical seizure foci from detonating adjacent cortical areas. Phenytoin reduces the maximal activity of brain stem centers responsible for the tonic phase of generalized tonic-clonic seizures. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2091", "text": "Phenytoin elimination kinetics show mixed-order, non-linear elimination behaviour at therapeutic concentrations. Where phenytoin is at low concentration it is cleared by  first order kinetics , and at high concentrations by  zero order kinetics . A small increase in dose may lead to a large increase in drug concentration as elimination becomes saturated. The time to reach steady state is often longer than 2 weeks. [ 49 ] [ 50 ] [ 51 ] [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2092", "text": "Phenytoin (diphenylhydantoin) was first synthesized by German chemist  Heinrich Biltz  in 1908. [ 53 ] \nBiltz sold his discovery to Parke-Davis, which did not find an immediate use for it. In 1938, other physicians, including  H. Houston Merritt  and  Tracy Putnam , discovered phenytoin's usefulness for controlling seizures, without the sedative effects associated with  phenobarbital . [ 54 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2093", "text": "According to  Goodman and Gilman's Pharmacological Basis of Therapeutics :"}
{"_id": "WikiPedia_Dermatology$$$corpus_2094", "text": "In contrast to the earlier accidental discovery of the antiseizure properties of  potassium bromide  and phenobarbital, phenytoin was the product of a search among nonsedative structural relatives of phenobarbital for agents capable of suppressing electroshock convulsions in laboratory animals. [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2095", "text": "It was approved by the FDA in 1953 for use in seizures. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2096", "text": "Jack Dreyfus , founder of the  Dreyfus Fund , became a major proponent of phenytoin as a means to control nervousness and  depression  when he received a prescription for Dilantin in 1966. He has claimed to have supplied large amounts of the drug to  Richard Nixon  throughout the late 1960s and early 1970s, although this is disputed by former White House aides [ 56 ]  and Presidential historians. [ 57 ] \nDreyfus' experience with phenytoin is outlined in his book,  A Remarkable Medicine Has Been Overlooked . [ 58 ]  Despite more than $70\u00a0million in personal financing, his push to see phenytoin evaluated for alternative uses has had little lasting effect on the medical community.  This was partially because  Parke-Davis  was reluctant to invest in a drug nearing the end of its patent life, and partially due to mixed results from various studies. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2097", "text": "In 2008, the drug was put on the FDA's Potential Signals of Serious Risks List to be further evaluated for approval. The list identifies medications with which the FDA has identified potential safety issues, but has not yet identified a causal relationship between the drug and the listed risk. To address this concern, the Warnings and Precautions section of the labeling for Dilantin injection was updated to include additional information about  Purple glove syndrome  in November 2011. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2098", "text": "Phenytoin is available as a generic medication. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2099", "text": "Since September 2012, the marketing licence in the UK has been held by Flynn Pharma Ltd, of Dublin,  Ireland , and the product, although identical, has been called Phenytoin Sodium  xx mg Flynn Hard Capsules. (The  xx mg in the name refers to the strength\u2014for example \"Phenytoin sodium 25\u00a0mg Flynn Hard Capsules\"). [ 60 ]   The capsules are still made by  Pfizer 's Goedecke subsidiary's plant in  Freiburg , Germany, and they still have Epanutin printed on them. [ 61 ]  After Pfizer's sale of the UK marketing licence to Flynn Pharma, the price of a 28-pack of 25\u00a0mg phenytoin sodium capsules marked Epanutin rose from 66p (about $0.88) to  \u00a315.74  (about $25.06). Capsules of other strengths also went up in price by the same factor\u20142,384%, [ 62 ]  costing the UK's  National Health Service  an extra  \u00a343 million  (about $68.44\u00a0million) a year. [ 63 ]   The companies were referred to the  Competition and Markets Authority  (CMA) who found that they had exploited their dominant position in the market to charge \"excessive and unfair\" prices. [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2100", "text": "The CMA imposed a record  \u00a384.2 million  fine on the manufacturer Pfizer, and a  \u00a35.2 million  fine on the distributor Flynn Pharma and ordered the companies to reduce their prices. [ 65 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2101", "text": "Phenytoin is marketed under many brand names worldwide. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2102", "text": "In the US, Dilantin is marketed by  Viatris  after Upjohn was spun off from Pfizer. [ 66 ] [ 67 ] [ 68 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2103", "text": "Tentative evidence suggests that topical phenytoin is useful in wound healing in people with chronic skin wounds. [ 69 ] [ 70 ]  A meta-analysis also supported the use of phenytoin in managing various ulcers. [ 71 ]  Phenytoin is incorporated into compounded medications to optimize wound treatment, often in combination with  misoprostol . [ 72 ] [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2104", "text": "Some clinical trials have explored whether phenytoin can be used as  neuroprotector  in  multiple sclerosis . [ 74 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2105", "text": "Piroxicam  is a  nonsteroidal anti-inflammatory drug  (NSAID) of the  oxicam  class used to relieve the symptoms of painful inflammatory conditions like  arthritis . [ 4 ] [ 5 ]  Piroxicam works by preventing the production of endogenous  prostaglandins  which are involved in the mediation of pain, stiffness, tenderness and swelling. [ 4 ]  The medicine is available as  capsules ,  tablets  and, in some countries, as a prescription-free  gel  0.5%. [ 6 ]  It is also available in a  betadex  formulation, which allows a more rapid absorption of piroxicam from the digestive tract. [ 4 ]  Piroxicam is one of the few NSAIDs that can be given  parenteral  routes. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2106", "text": "It was patented in 1968 by  Pfizer  and approved for medical use in 1979. [ 7 ]  It became generic in 1992, [ 8 ]  and is marketed worldwide under many brand names. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2107", "text": "It is used in the treatment of certain inflammatory conditions like  rheumatoid  and  osteoarthritis , primary  dysmenorrhoea , and postoperative pain; it acts as an  analgesic , especially where there is an  inflammatory  component. [ 4 ]  The  European Medicines Agency  issued a review of its use in 2007 and recommended that its use be limited to the treatment of chronic inflammatory conditions, as it is only in these circumstances that its risk-benefit ratio proves to be favourable. [ 6 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2108", "text": "As with other NSAIDs the principal side effects include: digestive complaints like  nausea , discomfort,  diarrhoea  and bleeds or ulceration of the  stomach , as well as  headache , dizziness, nervousness,  depression , drowsiness,  insomnia , vertigo, hearing disturbances (such as  tinnitus ),  high blood pressure ,  oedema , light sensitivity, skin reactions (including, albeit rarely,  Stevens\u2013Johnson syndrome  and  toxic epidermal necrolysis ) and rarely,  kidney failure ,  pancreatitis ,  liver  damage, visual disturbances, pulmonary  eosinophilia  and  fibrosing alveolitis . [ 6 ]  Compared to other NSAIDs it is more prone to causing gastrointestinal disturbances and serious skin reactions. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2109", "text": "In October 2020, the U.S.  Food and Drug Administration  (FDA) required the  drug label  to be updated for all nonsteroidal anti-inflammatory medications to describe the risk of kidney problems in unborn babies that result in low amniotic fluid. [ 10 ] [ 11 ]  They recommend avoiding NSAIDs in pregnant women at 20 weeks or later in pregnancy. [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2110", "text": "Piroxicam is an NSAID and, as such, is a non-selective  COX   inhibitor  possessing both analgesic and  antipyretic  properties. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2111", "text": "Piroxicam exists as  alkenol   tautomer  in organic solvents and as  zwitterionic  form in water. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2112", "text": "The project that produced piroxicam began in 1962 at  Pfizer ; the first clinical trial results were reported in 1977, and the product launched in 1980 under the brand name \"Feldene\". [ 8 ] [ 13 ]    Major patents expired in 1992 [ 8 ]  and the drug is marketed worldwide under many brandnames. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2113", "text": "Psoralen  (also called  psoralene ) is the parent compound in a family of naturally occurring organic compounds known as the linear  furanocoumarins . It is structurally related to  coumarin  by the addition of a fused  furan  ring, and may be considered as a derivative of  umbelliferone . Psoralen occurs naturally in the seeds of  Psoralea corylifolia , as well as in the  common fig ,  celery ,  parsley ,  West Indian satinwood , and in all  citrus fruits . It is widely used in  PUVA  (psoralen +  UVA ) treatment for  psoriasis ,  eczema ,   vitiligo , and  cutaneous T-cell lymphoma ; these applications are typically through the use of medications such as  Methoxsalen .  Many furanocoumarins are extremely toxic to fish, and some are deposited in streams in  Indonesia  to catch fish. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2114", "text": "Psoralen is a  mutagen , and is used for this purpose in molecular biology research. Psoralen  intercalates  into DNA and on exposure to ultraviolet (UVA) radiation can form  monoadducts  and  covalent interstrand cross-links  (ICL) with thymines, preferentially at 5'-TpA sites in the genome, inducing  apoptosis . Psoralen plus UVA (PUVA) therapy can be used to treat hyperproliferative skin disorders like  psoriasis  and certain kinds of  skin cancer . [ 2 ]  Unfortunately, PUVA treatment itself leads to a higher risk of skin cancer. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2115", "text": "An important use of psoralen is in PUVA treatment for skin problems such as  psoriasis  and, to a lesser extent, eczema and  vitiligo . This takes advantage of the high  UV  absorbance of psoralen. The psoralen is applied first to sensitise the skin, then UVA light is applied to address the condition. Psoralens are also used in  photopheresis , where they are mixed with the extracted leukocytes before UV radiation is applied."}
{"_id": "WikiPedia_Dermatology$$$corpus_2116", "text": "Despite the  photocarcinogenic  properties of psoralen, [ 4 ] [ 5 ]  it was used as a  tanning activator  in sunscreens until 1996. [ 6 ]  Psoralens are used in tanning accelerators, because psoralen increases the skin's sensitivity to light.  Some patients have had severe skin loss after sunbathing with psoralen-containing tanning activators. [ 7 ]  Patients with lighter skin colour suffer four times as much from the melanoma-generating properties of psoralens than those with darker skin. [ 6 ]  Psoralens short term side effects include nausea, vomiting, erythrema, pruritus, xerosis, skin pain due to phototoxic damage of dermal nerve and may cause cutaneous and genital skin malignancies. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2117", "text": "An additional use for optimized psoralens is for the inactivation of pathogens in blood products. The synthetic amino-psoralen, amotosalen HCl, has been developed for the inactivation of infectious pathogens (bacteria, viruses, protozoa) in platelet and plasma blood components prepared for transfusion support of patients. Prior to clinical use, amotosalen-treated platelets have been tested and found to be non-carcinogenic when using the established p53  knockout mouse  model. [ 9 ]   The technology is currently in routine use in certain European blood centers and has been recently approved in the US. [ 10 ] [ 11 ] [ 12 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2118", "text": "Psoralen  intercalates  into the DNA double helix where it is ideally positioned to form one or more  adducts  with adjacent pyrimidine bases, preferentially thymine, upon excitation by an ultraviolet photon."}
{"_id": "WikiPedia_Dermatology$$$corpus_2119", "text": "Several physicochemical methods have been employed to derive binding constants for psoralen-DNA interactions. Classically, two chambers of psoralen and buffered DNA solution are partitioned by a  semi-permeable membrane ; the affinity of the psoralen for DNA is directly related to the concentration of the psoralen in the DNA chamber after equilibrium. Water solubility is important for two reasons:  pharmacokinetics  relating to drug solubility in blood and necessitating the use of organic solvents (e.g.  DMSO ). Psoralens can also be activated by irradiation with long wavelength UV light. While  UVA  range light is the clinical standard, research that  UVB  is more efficient at forming photoadducts suggests that its use may lead to higher efficacy and lower treatment times. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2120", "text": "The photochemically reactive sites in psoralens are the alkene-like carbon-carbon double bonds in the furan ring (the five-member ring) and the pyrone ring (the six-member ring). When appropriately intercalated adjacent to a pyrimidine base, a four-center photocycloaddition reaction can lead to the formation of either of two cyclobutyl-type monoadducts. Ordinarily, furan-side monoadducts form in a higher proportion. The furan monoadduct can absorb a second UVA photon leading to a second four-center photocycloaddition at the pyrone end of the molecule and hence the formation of a diadduct or cross-link. Pyrone monoadducts do not absorb in the UVA range and hence cannot form cross-links with further UVA irradiation. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2121", "text": "Another important feature of this class of compounds is their ability to generate  singlet oxygen , although this process is in direct competition with adduct formation and may be an alternate pathway for the dissipation of excited state energy."}
{"_id": "WikiPedia_Dermatology$$$corpus_2122", "text": "Research on psoralen has historically focused on interactions with DNA and RNA (in particular, ICL formation). Psoralen, however, has also been shown to block signaling of the  ErbB2 receptor  which is overexpressed in certain aggressive types of breast cancer. [ 16 ]  A synthetic derivative of  bergapten , 5-(4-phenoxybutoxy)psoralen, shows promise as an immunosuppressant by inhibiting a specific  potassium channel . Its structure prevents intercalation into DNA, and it only very weakly produces singlet oxygen, majorly reducing unwanted toxicity and mutagenicity  in vivo . This has implications for the treatment of various autoimmune diseases (e.g.  multiple sclerosis ,  type-1 diabetes , and  rheumatoid arthritis ). [ 17 ]  While cell-surface modification and ion channel blocking are two newly discovered mechanisms of action, much research remains to be done."}
{"_id": "WikiPedia_Dermatology$$$corpus_2123", "text": "Most furanocoumarins can be regarded as derivatives of either psoralen or  angelicin . Psoralen and its derivatives are often referred to as the  linear furanocoumarins , so called since they exhibit a linear chemical structure. Important linear furanocoumarins include xanthotoxin (also called  methoxsalen ),  bergapten ,  imperatorin , and  nodakenetin ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2124", "text": "The structure of psoralen was originally deduced by identifying the products of its degradation reactions. It exhibits the normal reactions of the  lactone  of coumarin, such as ring opening by  alkali  to give a  coumarinic acid  or  coumaric acid  derivative.  Potassium permanganate  causes oxidation of the furan ring, while other methods of oxidation produce furan-2,3-carboxylic acid."}
{"_id": "WikiPedia_Dermatology$$$corpus_2125", "text": "Psoralen is difficult to synthesize because  umbelliferone  undergoes  substitution  at the 8-position rather than at the desired 6 position.  Benzofuran  reacts preferentially in the  furan  ring rather than in the  benzene  ring. However, the 7-hydroxy derivative of 2,3-dihydrobenzofuran (also called coumaran) does undergo substitution at the desired 6-position allowing the following synthesis of the coumarin system via a  Gattermann\u2013Koch reaction  followed by a  Perkin condensation  using  acetic anhydride . The synthesis is then completed by  dehydrogenation  of the five-membered ring to produce the furan ring."}
{"_id": "WikiPedia_Dermatology$$$corpus_2126", "text": "Psoralen originates from  coumarins  in the  shikimate  pathway; its biosynthesis is shown in the figure below. The aromatic ring in 6 is activated at positions ortho to the hydroxyl group, and is alkylated by 5, an  alkylating agent . The dimethylallyl group in 7 then undergoes cyclization with the phenol group to give 8. This transformation is catalysed by a cytochrome P-450-dependent monooxygenase17 (psoralen 5-monooxygenase), and cofactors ( NADPH ) and molecular oxygen. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2127", "text": "A biosynthetic pathway in which psoralen is formed is shown in the figure below. A second  P-450 -dependent  monooxygenase  enzyme ( psoralen synthase ) then cleaves off 10 (in the form of 11) from 8 to give 1. This pathway does not involve any hydroxylated intermediate, and cleavage is postulated to be initiated by a  radical reaction . [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2128", "text": "Ficus carica  (fig) is probably the most abundant source of psoralens. They are also found in small quantities in   Ammi visnaga  (bisnaga),  Pastinaca sativa  (parsnip),  Petroselinum crispum  ( parsley ),  Levisticum officinale  (lovage),  Foeniculum vulgare  (fruit, i.e., fennel seeds),  Daucus carota  (carrot),  Psoralea corylifolia  (babchi),  Apium graveolens  (celery),  bergamot oil  ( bergapten ,  bergamottin ). [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2129", "text": "PUVA treatment  produces both  DNA interstrand crosslinks  (ICLs) and monoadducts. The ICLs introduced by psoralen are highly  genotoxic  to actively replicating cells.  The covalent linkage impedes  replication fork  progression. Thus unlinking the ICL is required before replication can resume.  The initial steps in repair ordinarily involve incisions in one parental strand on both sides of the crosslink. [ 20 ]   Subsequently, repair of the lesion can occur by an accurate or an inaccurate process."}
{"_id": "WikiPedia_Dermatology$$$corpus_2130", "text": "The accurate process for repairing crosslinks is  homologous recombinational  repair (HRR). This involves replacing the damaged information using the intact information from another  homologous chromosome  in the same cell.   Escherichia coli  cells deficient in HRR are highly sensitive to PUVA compared to wild-type cells. [ 21 ]   HRR appears to be efficient.  In  E. coli , even though one or two unrepaired crosslinks are sufficient to inactivate a cell, a wild-type cell can repair and therefore recover from 53 to 71 psoralen crosslinks. [ 21 ]   In the yeast  Saccharomyces cerevisiae  HRR is a major pathway for accurately removing psoralen-crosslinks. [ 22 ]   In wild-type yeast, the recombination events associated with crosslink removal by HRR are predominantly non-crossover  gene conversion  events.  Psoralen crosslinks in virus DNA also appear to be removed by a recombinational repair process as occurs in SV40 virus infected cells, [ 23 ]  and in herpes simplex virus infected cells. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2131", "text": "One inaccurate process for repairing psoralen crosslinks appears to employ a  DNA polymerase  to fill in the gap formed in the strand with the two incisions.  This process is inaccurate because the complementary un-incised strand still retains a portion of the crosslink and thus cannot serve as an adequate template for accurate repair synthesis.  Inaccurate repair synthesis can cause  mutation .  Psoralen monoadducts in the template DNA strand may also cause inaccurate replication bypass ( translesion synthesis ) that can lead to mutation.  In  phage T4 , the increase in mutation observed after PUVA treatment was found to reflect translesion synthesis by wild-type DNA polymerase, likely due to imperfect proof reading capability."}
{"_id": "WikiPedia_Dermatology$$$corpus_2132", "text": "Psoralens can reversibly crosslink nucleic acids double helices, and therefore have been used extensively for the analysis of interactions and structures for both DNA and RNA. [ 25 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2133", "text": "Sterigmatocystin  is a polyketide  mycotoxin  produced by certain species of  Aspergillus . The toxin is naturally found in some  cheeses ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2134", "text": "Sterigmatocystin is a toxic metabolite structurally closely related to the  aflatoxins  as it is the penultimate precursor of aflatoxins B1 and G1. [ 1 ]  It contains a  xanthone  nucleus attached to a  bifuran  structure. Sterigmatocystin is mainly produced by the fungi  Aspergillus nidulans  and  A. versicolor ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2135", "text": "It has been reported in mouldy grain, green coffee beans and cheese although information on its occurrence in foods is limited. It appears to occur much less frequently than the aflatoxins, although analytical methods for its determination have not been as sensitive, and so it is possible that small concentrations in food commodities may not always have been detected. Although it is a potent liver carcinogen similar to  aflatoxin B1 , current knowledge suggests that it is nowhere near as widespread in its occurrence. If this is the true situation it would be justified to consider sterigmatocystin as no more than a risk to consumers in special or unusual circumstances. A number of closely related compounds such as o-methyl sterigmatocystin are known, and some may also occur naturally."}
{"_id": "WikiPedia_Dermatology$$$corpus_2136", "text": "Sterigmatocystin forms pale yellow needles and that are readily soluble in  methanol ,  ethanol ,  acetonitrile ,  benzene , and  chloroform . Sterigmatocystin reacts with a hot solution of potassium hydroxide and ethanol and is easily methylated by  methyl iodide . Treatment with ethanol in acid produces dihydroethoxysterigmatocystin. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2137", "text": "The toxic effects of sterigmatocystin are much the same as those of  aflatoxin B1 . It is thus considered as a potent  carcinogen ,  mutagen , and  teratogen . It is less acutely toxic to rodents and monkeys but appears to be slightly more toxic to  zebra fish . The LD50 in mice is in excess of 800\u00a0mg/kg. The 10-day LD50 in Wistar rats is 166\u00a0mg/kg in males, 120\u00a0mg/kg in females, and 60\u201365\u00a0mg/kg for ip. administration in males. The ip. 10-day LD50 for vervet monkeys is 32\u00a0mg/kg. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2138", "text": "Chronic symptoms include induction of hepatomas in rats, pulmonary tumours in mice, renal lesions and alterations in the liver and kidneys of African Green monkeys. Rats fed 5\u201310\u00a0mg/kg of sterigmatocystin for two years showed a 90% incidence of liver tumours. It has been suggested that sterigmatocystin is about 1/10 as potent a carcinogen as aflatoxin B1. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2139", "text": "Toxic effects of sterigmatocystin-fed laboratory animals have included kidney and liver damage and diarrhoea. Skin and hepatic tumours are induced in rats by dermal application. Cattle exhibiting bloody diarrhoea, loss of milk production and in some cases death were found to have ingested feed containing Aspergillus versicolor and high levels of sterigmatocystin of about 8\u00a0mg/kg. The acute toxicity, carcinogenicity, and metabolism of sterigmatocystin has been compared with those for aflatoxin and several other hepatotoxic mycotoxins. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2140", "text": "The  IARC-classification  of sterigmatocystin is group 2B, which means it is carcinogenic in other species and is possibly  carcinogenic  to humans, but that a definitive link between human exposure and cancer has not been proven."}
{"_id": "WikiPedia_Dermatology$$$corpus_2141", "text": "Because sterigmatocystin (ST) is an intermediate of the aflatoxin biosynthesis pathway and is produced by the  BSL-1  organism  Aspergillus nidulans , it serves as a model for studying regulation of the aflatoxin  biosynthetic gene cluster  (BGC). Sterigmatocystin was shown to be produced only in the absence of glucose ( carbon catabolite repression ) but independent of CreA [ 2 ]  when glucose is used as sole carbon source. Instead, it was shown to be dependent on a regulator of  G 0  which transmits the glucose signal to downstream targets. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2142", "text": "The occurrence of sterigmatocystin in raw materials and foods has not been reported often. The instances reported have usually been on mouldy, or poor quality materials such as wheat, maize, animal feed, hard cheese, pecan nuts and green coffee beans. While this lack of information may be due to deficiencies in the analytical methods, where surveys of good quality products have been carried out with reliable methodology, sterigmatocystin has rarely if ever been found. However, further assurance is required before sterigmatocystin can finally be dismissed as a risk because A. versicolor has been isolated frequently from cereals, grain products, fruits and marmalade, dried meat products and grapefruit juice. Relatively high levels of sterigmatocystin have been formed in bread, cured ham and salami after inoculation with A. versicolor. More than in food, sterigmatocystin is frequently found in water-damaged buildings. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2143", "text": "Methods for extraction of sterigmatocystin have been commonly based on a mixture of  acetonitrile  and 4% aqueous  potassium chloride . Methods for detection using TLC are not very sensitive having a limit of detection in the range 20-50 microgrammes/kg. TLC plates must be sprayed with  aluminium chloride  and heated. Analytical methods for the determination of sterigmatocystin have been reported using  HPLC  but again these are not very sensitive because of lack of UV absorbance or  fluorescence , although a post column reaction with aluminium chloride has been used to increase sensitivity. Methods using HPLC linked with atmospheric pressure  ionisation mass spectrometric  detection have been developed for foods such as cheese, bread and corn products. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2144", "text": "There appear to be no reports about the stability of sterigmatocystin, other than in solution, where it is similar to the aflatoxins. There is one report that phosphine gas significantly depresses the formation of sterigmatocystin when cereals are inoculated with A. versicolor. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2145", "text": "No country has legislation for sterigmatocystin. Natural occurrence appears to be infrequent although only a limited number of surveys have been carried out. Soon after it was recognised as a highly toxic compound, the  California Department of Health Services  used TD50 values from the Cancer Potency Database to produce 'no significant risk' intake levels for humans. The level resulting was 8 microgrammes/kg body weight/day for a 70\u00a0kg adult [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2146", "text": "Sulfonamide  is a  functional group  (a part of a  molecule ) that is the basis of several groups of  drugs , which are called  sulphonamides ,  sulfa drugs  or  sulpha drugs . The original antibacterial sulfonamides  are synthetic  antimicrobial  agents that contain the  sulfonamide  group. Some sulfonamides are also devoid of antibacterial activity, e.g., the  anticonvulsant   sultiame . The  sulfonylureas  and  thiazide diuretics  are newer drug groups based upon the antibacterial sulfonamides. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2147", "text": "Allergies  to sulfonamides are common. The overall incidence of  adverse drug reactions  to sulfa antibiotics is approximately 3%, close to  penicillin ; [ 3 ]  hence medications containing sulfonamides are prescribed carefully."}
{"_id": "WikiPedia_Dermatology$$$corpus_2148", "text": "Sulfonamide drugs were the first broadly effective antibacterials to be used systemically, and paved the way for the antibiotic revolution in medicine."}
{"_id": "WikiPedia_Dermatology$$$corpus_2149", "text": "In bacteria, antibacterial sulfonamides act as  competitive inhibitors  of the enzyme  dihydropteroate synthase  (DHPS), an enzyme involved in  folate synthesis . Sulfonamides are therefore bacteriostatic and inhibit growth and multiplication of bacteria, but do not kill them. Humans, in contrast to bacteria, acquire  folate  (vitamin B 9 ) through the diet. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2150", "text": "Sulfonamides are used to treat allergies and coughs, as well as having antifungal and antimalarial functions. The moiety is also present in other medications that are not antimicrobials, including  thiazide   diuretics  (including  hydrochlorothiazide ,  metolazone , and  indapamide , among others), loop diuretics (including  furosemide ,  bumetanide , and  torsemide ),  acetazolamide ,  sulfonylureas  (including  glipizide ,  glyburide , among others), and some  COX-2 inhibitors  (e.g.,  celecoxib )."}
{"_id": "WikiPedia_Dermatology$$$corpus_2151", "text": "Sulfasalazine , in addition to its use as an antibiotic, is also used in the treatment of  inflammatory bowel disease . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2152", "text": "Sulfonamide drugs were the first broadly effective antibacterials to be used systemically, and paved the way for the antibiotic revolution in medicine. The first sulfonamide, trade-named  Prontosil , was a  prodrug . Experiments with Prontosil began in 1932 in the laboratories of  Bayer  AG, at that time a component of the huge German chemical trust  IG Farben . The Bayer team believed that  coal-tar dyes  which are able to bind preferentially to bacteria and parasites might be used to attack harmful organisms in the body. After years of fruitless trial-and-error work on hundreds of dyes, a team led by physician/researcher  Gerhard Domagk [ 6 ]  (working under the general direction of IG Farben executive  Heinrich H\u00f6rlein ) finally found one that worked: a red dye synthesized by Bayer chemist  Josef Klarer  that had remarkable effects on stopping some bacterial infections in mice. [ 7 ]  The first official communication about the breakthrough discovery was not published until 1935, more than two years after the drug was patented by Klarer and his research partner Fritz Mietzsch. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2153", "text": "Prontosil, as Bayer named the new drug, was the first medicine ever discovered that could effectively treat a range of bacterial infections inside the body. It had a strong protective action against infections caused by  streptococci , including blood infections,  childbed fever , and  erysipelas , and a lesser effect on infections caused by other cocci. However, it had no effect at all in the test tube, exerting its antibacterial action only in live animals. Later, it was discovered by  Daniel Bovet , [ 8 ]  Federico Nitti, and  Jacques  and  Th\u00e9r\u00e8se Tr\u00e9fou\u00ebl , a French research team led by  Ernest Fourneau  at the  Pasteur Institute , that the drug was metabolized into two parts inside the body, releasing from the inactive dye portion a smaller, colorless, active compound called  sulfanilamide . [ 9 ]  The discovery helped establish the concept of \"bioactivation\" and dashed the German corporation's dreams of enormous profit; the active molecule sulfanilamide (or sulfa) had first been synthesized in 1906 and was widely used in the dye-making industry; its patent had since expired and the drug was available to anyone. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2154", "text": "The result was a sulfa craze. [ 11 ]  For several years in the late 1930s, hundreds of manufacturers produced myriad forms of sulfa. This and the lack of testing requirements led to the  elixir sulfanilamide  disaster in the fall of 1937, during which at least 100 people were poisoned with  diethylene glycol . This led to the passage of the  Federal Food, Drug, and Cosmetic Act  in 1938 in the United States, giving authority to the U.S.  Food and Drug Administration  (FDA) to oversee the safety of food, drugs, medical devices, and cosmetics. As the first and only effective broad-spectrum antibiotic available in the years before  penicillin , heavy use of sulfa drugs continued into the early years of  World War II . [ 12 ]  They are credited with saving the lives of tens of thousands of patients, including  Franklin Delano Roosevelt Jr.  (son of US President  Franklin Delano Roosevelt ) and  Winston Churchill . [ 13 ] [ 14 ]  Sulfa had a central role in preventing wound infections during the war. American soldiers were issued a  first-aid kit  containing sulfa pills and powder and were told to sprinkle it on any open wound. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2155", "text": "The sulfanilamide compound is more active in the  protonated  form. The drug has very low solubility and sometimes can crystallize in the kidneys, due to its first pK a  of around 10. [ clarification needed ]  This is a very painful experience, so patients are told to take the medication with copious amounts of water. Newer analogous compounds prevent this complication because they have a lower pK a , around 5\u20136, [ citation needed ]  making them more likely to remain in a soluble form."}
{"_id": "WikiPedia_Dermatology$$$corpus_2156", "text": "Many thousands of molecules containing the sulfanilamide structure have been created since its discovery (by one account, over 5,400 permutations by 1945), yielding improved formulations with greater effectiveness and less toxicity. Sulfa drugs are still widely used for conditions such as acne and urinary tract infections, and are receiving renewed interest for the treatment of infections caused by bacteria resistant to other antibiotics. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2157", "text": "Sulfonamides are prepared by the reaction of a  sulfonyl chloride  with ammonia or an amine. Certain sulfonamides (sulfadiazine or  sulfamethoxazole ) are sometimes mixed with the drug  trimethoprim , which acts against  dihydrofolate reductase . As of 2013 [update] , the  Republic of Ireland  is the largest exporter worldwide of sulfonamides, accounting for approximately 32% of total exports. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2158", "text": "Sulfonamides have the potential to cause a variety of  adverse effects , including urinary tract disorders,  haemopoietic  disorders,  porphyria  and hypersensitivity reactions. When used in large doses, they may cause a strong allergic reaction. The most serious of these are classified as  severe cutaneous adverse reactions  (i.e. SCARs) and include the  Stevens\u2013Johnson syndrome ,  toxic epidermal necrolysis  (also known as Lyell syndrome), the  DRESS syndrome , and a not quite as serious SCARs reaction,  acute generalized exanthematous pustulosis . Any one of these SCARs may be triggered by certain sulfonamides. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2159", "text": "Approximately 3% of the general population have adverse reactions when treated with sulfonamide antimicrobials. Of note is the observation that patients with HIV have a much higher prevalence, at about 60%. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2160", "text": "Hypersensitivity reactions are less common in nonantibiotic sulfonamides, and, though controversial, the available evidence suggests those with hypersensitivity to sulfonamide antibiotics do not have an increased risk of hypersensitivity reaction to the nonantibiotic agents. [ 18 ]  A key component to the allergic response to sulfonamide antibiotics is the arylamine group at N4, found in sulfamethoxazole, sulfasalazine, sulfadiazine, and the anti-retrovirals amprenavir and fosamprenavir. Other sulfonamide drugs do not contain this arylamine group; available evidence suggests that patients who are allergic to arylamine sulfonamides do not cross-react to sulfonamides that lack the arylamine group, and may therefore safely take non-arylamine sulfonamides. [ 19 ]  It has therefore been argued that the terms \"sulfonamide allergy\" or \"sulfa allergy\" are misleading and should be replaced by a reference to a specific drug (e.g., \" cotrimoxazole  allergy\"). [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2161", "text": "Two regions of the sulfonamide antibiotic chemical structure are implicated in the hypersensitivity reactions associated with the class."}
{"_id": "WikiPedia_Dermatology$$$corpus_2162", "text": "The nonantibiotic sulfonamides lack both of these structures. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2163", "text": "The most common manifestations of a hypersensitivity reaction to sulfa drugs are  rash  and  hives . However, there are several life-threatening manifestations of hypersensitivity to sulfa drugs, including  Stevens\u2013Johnson syndrome ,  toxic epidermal necrolysis ,  agranulocytosis ,  hemolytic anemia ,  thrombocytopenia , fulminant hepatic necrosis, and  acute pancreatitis , among others. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2164", "text": "T-2 mycotoxin  is a  trichothecene   mycotoxin .  It is a naturally occurring  mold  byproduct of  Fusarium  spp.  fungus  which is toxic to humans and other animals. The clinical condition it causes is  alimentary toxic aleukia  and a host of symptoms related to organs as diverse as the skin, airway, and stomach. Ingestion may come from consumption of moldy whole  grains . T-2 can be  absorbed  through human skin. [ 2 ]  Although no significant systemic effects are expected after dermal contact in normal  agricultural  or residential environments, local skin effects can not be excluded. Hence, skin contact with T-2 should be limited."}
{"_id": "WikiPedia_Dermatology$$$corpus_2165", "text": "Alimentary toxic aleukia (ATA), a disease which is caused by trichothecenes like T-2 mycotoxin, killed many thousands of USSR citizens in the  Orenburg District  in the 1940s. It was reported that the mortality rate was 10% of the entire population in that area. During the 1970s it was proposed that the consumption of  contaminated  food was the cause of this mass poisoning. Because of World War II, harvesting of grains was delayed and food was scarce in Russia. This resulted in the consumption of grain that was contaminated with  Fusarium  molds, which produce T-2 mycotoxin. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2166", "text": "In 1981, the  United States Secretary of State   Alexander Haig  and his successor  George P. Shultz  accused the Soviet Union of using T-2 mycotoxin as a chemical weapon known as \" yellow rain \" in Laos (1975\u201381), Kampuchea (1979\u201381), and  Afghanistan  (1979\u201381), where it allegedly caused thousands of casualties. [ 4 ]  Although several US chemical weapons experts claim to have identified \"yellow rain\" samples from Laos as trichothecenes, other experts believe that this exposure was due to naturally occurring T-2 mycotoxin in contaminated foods. [ 5 ]  Another alternative theory was developed by Harvard biologist  Matthew Meselson , who proposed that the \"yellow rain\" found in Southeast Asia originated from the excrement of jungle bees. [ 6 ]  The first indication for this theory came from finding high levels of  pollen  in the collected samples, giving the substance its yellow color. It was also found that jungle bees in this area fly collectively in great numbers, at altitudes too high to be easily seen, producing showers of feces that could have been mistaken for sprays from aircraft. [ 7 ]  Further testing later determined that the oily liquid was, in fact, the pollen-filled feces of jungle bees. [ 6 ]  A similar case in China was brought to light, and in this instance the cause of the phenomenon had also been bee excrement. [ 8 ]  Despite this conclusive analysis, the United States has not withdrawn its allegations and declares that the issue has not been fully resolved."}
{"_id": "WikiPedia_Dermatology$$$corpus_2167", "text": "T-2 mycotoxin is also thought to be a cause of  Gulf War syndrome . US troops suffered from mycotoxicosis-like symptoms after an Iraqi missile detonated in a US military camp in Saudi Arabia during  Operation Desert Storm  in the Persian Gulf War, in 1991. It has been shown that Iraq researched trichothecene mycotoxins, among other substances, and thus was capable of its possession and employment in  chemical warfare . Nevertheless, much of the key information from these incidents remains classified, leaving these matters still unresolved. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2168", "text": "This compound has a tetracyclic  sesquiterpenoid  12,13-epoxytrichothene ring system, which relates it to the trichothecenes. [ 10 ]  These compounds are generally very stable and are not degraded during storage/milling and cooking/processing of food. They do not degrade at high temperatures either. This compound has an epoxide ring, and several acetyl and hydroxyl groups on its side chains. These features are mainly responsible for the biological activity of the compound and make it highly toxic. T-2 mycotoxin is able to inhibit  DNA  and  RNA synthesis   in vivo  and  in vitro [ 11 ]  and can induce  apoptosis . [ 12 ]  However, in vivo the compound rapidly metabolizes to HT-2 mycotoxin (a major  metabolite ). [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2169", "text": "The  toxicity  of T-2 toxin is due to its 12,13-epoxy ring. [ 14 ]   Epoxides  are in general toxic compounds; these react with  nucleophiles  and then undergo further  enzymatic reactions . The  reactivity  of epoxides can lead to reactions with endogenous compounds and cellular constituents like DNA bases and proteins. [ 15 ]                          \nThese reactions could be the reason for the noticed actions and effects of T-2 mycotoxin. The toxic compound influences the  metabolism  of  membrane   phospholipids , leads to an increase of liver lipid  peroxidases  and has an inhibiting effect on DNA and RNA synthesis. In addition it can bind to an integral part of the 60s ribosomal subunit,  peptidyltransferase , thereby inhibiting  protein synthesis .\nThese effects are thought to be the explanation for T-2 toxin inducing apoptosis (cell death) in different tissues as the  immune system , the gastrointestinal tissue and also fetal tissue. With regard to apoptosis there has been noticed that the level of the pro-apoptotic factor Bas (Bcl-2-associated X protein) was increased and the level of Bcl-xl, an anti-apoptotic factor, was decreased in human chrondocytes ( cartilage  cells).  When exposed to T-2 mycotoxin. Furthermore, the level of Fas, an apoptosis-related cell-surface antigen and p53, a protein regulating the cell cycle, were increased."}
{"_id": "WikiPedia_Dermatology$$$corpus_2170", "text": "T-2 mycotoxin is produced naturally by Fusarium fungi of which the most important species are:  F. sporotrichioides ,  F. langsethiae ,  F. acuminatum  and  F. poae .  These fungi are found in grains such as  barley ,  wheat  and  oats . The production of this compound for research and commercial purposes is generally accomplished by cultivating some strain of T-2 mycotoxin producing fungi on  agar plates . On these agar plates the fungi appear powdery and can yield substantial amounts of T-2 mycotoxin. For the isolation of the compound  high pressure liquid chromatography  is commonly used (HPLC). [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2171", "text": "In the  Fusarium  species,  biosynthesis  of the T-2 mycotoxin often starts with trichodiene, and many of the species share a common route of  oxidizations  and  cyclizations . As an example, from the  F. sporotrichioides  species, the important oxidation steps that occur start from trichodiene and goes to isotrichodiol. From there, the eleventh carbon atom is oxidized to form isotrichotriol. The ninth carbon is then oxidized, and trichotriol is formed, which then cyclizes to make isotrichodermol. After that, the fifteenth carbon is oxidized to form didecalonectrin, which leads to the fourth carbon being oxidized, and diacetoxyscirpenol is formed. The second to last step is the oxidation of the eighth carbon to make neosolaniol, which then undergoes slight modification to create the T-2 toxin. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2172", "text": "Humans and animals are generally exposed to T-2 mycotoxins through food. Certain grains can contain the toxin which makes it a threat to human health and an economic burden. [ 18 ]  Unlike most biological toxins T-2 mycotoxin can be absorbed through intact skin. The compound can be delivered via food, water, droplets,  aerosols  and smoke from various dispersal systems. This makes it a potential  biological weapon , however large amounts of the compound are required for a  lethal dose . T-2 mycotoxin has an  LD 50  of approximately 1 milligram per kilogram of body weight."}
{"_id": "WikiPedia_Dermatology$$$corpus_2173", "text": "The  EFSA  estimates that the mean exposure of T-2 in the EU lies between 12 and 43\u00a0ng/kg bw/day. [ 19 ]  This range is below the TDI of 100\u00a0ng/ kg body weight for the sum of HT-2 and T-2 toxins which is used by the EFSA."}
{"_id": "WikiPedia_Dermatology$$$corpus_2174", "text": "T-2 mycotoxin is distributed uniformly throughout the body without preference to a specific organ or site. In rodents,  plasma  concentration levels peak around roughly thirty minutes after exposure, and in one study, the  half-life  of the T-2 toxin was seen to be less than twenty minutes. In a different study involving pigs, the distribution after four hours of IV injection was seen to be 15\u201324% in the GI tract and 4.7\u20135.2% in various other tissues. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2175", "text": "Once absorbed and distributed to various tissues, the T-2 mycotoxin goes through various metabolic reactions before it gets excreted. In vivo studies showed that the most occurring reactions are  ester   hydrolysis  and  hydroxylation  of the isovaleryl group. Deepoxidation and  glucuronide  conjugation do also occur. Ht-2 is the main metabolite. For the hydroxylation, the cytochrome p450 enzyme complex is suggested to be involved. T-2 triol and T-2 tetraol are most likely to be formed via  acetylcholine esterases . Some of the metabolic reactions of the mycotoxin are performed by the  microflora  in the gut.  The formed metabolites in these reactions are species- and pH-dependent. The ester cleavages are however performed by the mammal itself and not by the microflora. In  red blood cells  T-2 mycotoxin is metabolized to neosolaniol, and, in  white blood cells , to HT-2 via hydrolysis catalyzed by carboxylesterases."}
{"_id": "WikiPedia_Dermatology$$$corpus_2176", "text": "Following absorption, distribution, and metabolism, T-2 mycotoxin is excreted fairly quickly, where 80\u201390% of it is excreted within 48 hours. [ 20 ]  The main methods of excretion seem to be from the urine and feces, [ 21 ]  where excretion through  bile  contributes heavily to the feces route of excretion. [ 14 ]  There is also very little of the parent T-2 mycotoxin in the excretions, meaning most of the initial compound is metabolized beforehand. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2177", "text": "T-2 is highly toxic when inhaled.  Acute toxic symptoms include vomiting, diarrhea, skin irritation, itching, rash, blisters, bleeding and  dyspnea . [ citation needed ]  If the individual is exposed to T-2 over a longer period alimentary toxic aleukia (ATA) develops."}
{"_id": "WikiPedia_Dermatology$$$corpus_2178", "text": "At first the patient experiences a burning sensation in the mouth, throat and stomach. After a few days the person will suffer from an acute  gastroenteritis  that will last for 3 to 9 days. Within 9 weeks the  bone marrow  will slowly degenerate. Also the skin starts bleeding and the total number of  leukocytes  decreases. Problems with the nervous system can occur."}
{"_id": "WikiPedia_Dermatology$$$corpus_2179", "text": "In the end the following symptoms might occur: a high fever,  petechial haemorrhage ,  necrosis  of muscles and skin, bacterial infections of the necrotic tissue,  enlarged lymph nodes . There is the possibility of  asphyxiation  because of  laryngeal   oedema  and  stenosis  of the  glottis . The lack of oxygen is then the cause of death.  Otherwise the patient will die of  bronchial pneumonia  and lung bleeding. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2180", "text": "T-2 mycotoxin is also toxic to animals. The compound is known for having lethal and sub-lethal effects on farm animals. It is often found in contaminated cereal grains that are fed to these animals. [ 23 ]  Most of the toxic effects are shared between humans and animals. After exposing  zebra fish  embryos to a concentration of 20\u00a0\u03bcmol/L or higher  malformation  and  mortality rates  increased. The malformations included tail deformities,  cardiovascular  defects and changes in behavior in early stages of life. This is the result of an increase in the amount of epoxides, which causes cell apoptosis. [ 24 ]  Other studies have shown that T-2-toxin causes lipid peroxidation in rats after feeding it to them. As the effect of T-2 toxin, elevated reactive oxygen species (ROS) levels were observed in several mammalian species. However, in spite of the general harmful effects caused by the toxin, in a study carried out in different chicken derived hepatic cell culture models, no alterations were found in the redox status of the cells. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2181", "text": "The compound also seems to reduce the fertility of ewes and heifers. Research has shown that a high dose of T-2 delays the  ovulation  due to a delayed  follicle  maturation. This possibly retards the following  luteinisation , which makes it impossible for female animals to conceive."}
{"_id": "WikiPedia_Dermatology$$$corpus_2182", "text": "T-2 also has an effect on the fertility of bulls. In 1998 it was discovered that moldy hay influenced the quality of semen of bulls. Analysis of the moldy hay showed that T-2 was present. The compound decreased  sperm motility  and testosterone levels and increased the frequency of morphological abnormalities in the sperm cells."}
{"_id": "WikiPedia_Dermatology$$$corpus_2183", "text": "The liver is another target for the mycotoxin. It is one of the first organs where the compound passes through after ingestion. Here it causes a reduced expression of  CYP1A  proteins in rabbits, pigs and rats.  CYP3A  activity decreases in pigs too. These enzymes help metabolize drugs that pass through the liver. Decrease in the activity could lead to an increase of unmetabolized drugs in the plasma. This can have a dangerous effect on an animal's health. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2184", "text": "All of the mentioned effects happen when T-2 is ingested in high doses. Animals are able to metabolize the compound with enzymes from the CYP3A family, just like humans."}
{"_id": "WikiPedia_Dermatology$$$corpus_2185", "text": "At the moment, there is no specific therapy for T-2 mycotoxin poisonings. [ 21 ]  Exposure of the mycotoxin is typically followed by standardized treatment for toxic compounds in order to reduce the effect of the toxin. This includes using  activated charcoal , which has a high binding capacity of 0.48\u00a0mg of T-2 mycotoxin to 1\u00a0mg of charcoal. [ 21 ]  For dermal contact, soap and water is used to reduce the dermal effects. [ 21 ]  As a kind of  prophylaxis ,  antioxidants  are believed to have properties that may provide benefits. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2186", "text": "There are currently no applications, aside from war, for T-2 mycotoxins; however, there are some plausible therapeutic uses. Due to their abilities, research shows possible uses for the mycotoxin as growth promoters,  antibiotics ,  antivirals , as an  antileukemic , and as an  antimalarial . [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2187", "text": "Tenoxicam , sold under the brand name  Mobiflex  among others, is a  nonsteroidal anti-inflammatory drug  (NSAID). It is used to relieve  inflammation ,  swelling , stiffness, and pain associated with  rheumatoid arthritis ,  osteoarthritis ,  ankylosing spondylitis  (a type of arthritis involving the  spine ),  tendinitis  (inflammation of a tendon),  bursitis  (inflammation of a  bursa , a  fluid -filled sac located around joints and near the bones), and  periarthritis  of the shoulders or hips (inflammation of tissues surrounding these joints). [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2188", "text": "Tenoxicam belongs to the class of NSAIDs known as  oxicams ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2189", "text": "It was patented in 1974 by  Roche  and approved for medical use in 1987. [ 2 ]  It is available as a  prescription-only drug  in the  United Kingdom  and other countries, but not in the  US .  Outside the United Kingdom, tenoxicam is also marketed under brand names including Tilatil, Tilcitin, and Alganex. [ 1 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2190", "text": "The drug is contraindicated for patients who are seniors who have been given  anesthesia  or  surgery ; are at risk of increased bleeding or kidney failure; have an active inflammatory disease involving the stomach or intestine (like  ulcerative colitis ); have an active stomach or  intestinal ulcer ; have had an acute asthmatic attack, hives, rhinitis (inflammation of the inner lining of the nasal passage), or other allergic reactions caused by  aspirin  or other nonsteroidal anti-inflammatory drugs (for example  diclofenac ,  ibuprofen ,  indomethacin ,  naproxen ). [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2191", "text": "Common side effects that have been observed with tenoxicam include peptic ulceration, dyspepsia, nausea, constipation, abdominal pain, diarrhea, rash, headache, edema, renal failure, and vertigo. [ 6 ] [ 5 ] [ 7 ]   In rare cases, tenoxicam and other NSAIDs can contribute to thrombotic events, Stevens-Johnson Syndrome, and toxic epidermal necrolysis. [ 8 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2192", "text": "It is not recommended that women who are trying to conceive, who are pregnant, or who are breastfeeding take tenoxicam. Tenoxicam can be taken in the first and second trimester when necessary, but it is a contraindication in the third trimester.  Some studies have looked at whether or not NSAIDs are able to enter the breast milk and the first few studies have found evidence that NSAIDs can be found in breast milk.  Therefore, it is not recommended that women take tenoxicam while breastfeeding. [ 6 ] [ 5 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2193", "text": "Taking tenoxicam with other drugs can increase the chance of side effects or alter the therapeutic effect of tenoxicam or the other drug, depending on the combination.  Drug types the tenoxicam may interact with include: other analgesic NSAIDs,  salicylates  such as aspirin,  antacids , anticoagulants,  cardiac glycosides ,  ciclosporin ,  quinolone antibiotics ,  lithium therapy , diuretics and anti-hypertensives,  methotrexate , oral anti-diabetics,  colestyramine ,  dextromethorphan ,  mifepristone , corticosteroids, anti-platelet agents and  selective serotonin reuptake inhibitors  (SSRIs),  tacrolimus ,  zidovudine , and gold/ penicillamine . [ 6 ] [ 5 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2194", "text": "Like all NSAIDs, the exact mechanism of action of tenoxicam is unknown. [ dubious  \u2013  discuss ]  Involved in the mechanism of action is inhibition of  cyclooxygenase  (COX-1 and COX-2) which leads to the potential adverse effect of increased bleeding. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2195", "text": "Tenoxicam is sold in the form of 20\u00a0mg tablets with the price of treatment ranging from US$1.29\u20132.73 per tablet. [ 11 ]   Recommended dosing calls for tenoxicam to be taken once daily with food.  One week is the typical length for treatment, but the treatment length may be extended. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2196", "text": "In 2008, the reported sales level for Tilcotil (tenoxicam) was 70 million SEK (approximately US$10.5 million). [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2197", "text": "The first members of the oxicam family of NSAIDs were brought to market in France in 1982. [ 13 ]   Shortly thereafter, tenoxicam went to phase III clinical trials for approval as use as an analgesic began in the 1980s.  The general consensus from clinical studies is that tenoxicam has about equal analgesic effect as other NSAIDs and does not elicit any important side effects.  More recent clinical trials for tenoxicam are examining the use of tenoxicam independently and in combination with other drugs for more specialized analgesic purposes in surgical operations such as third molar extraction and labor pains. [ 14 ] [ 15 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2198", "text": "Tetracycline , sold under various brand names, is an  antibiotic  in the  tetracyclines  family of medications, used to treat a number of  infections , [ 3 ]  including  acne ,  cholera ,  brucellosis ,  plague ,  malaria , and  syphilis . [ 3 ]  It is available in oral and topical formulations. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2199", "text": "Common side effects include vomiting,  diarrhea , rash, and loss of appetite. [ 3 ]  Other side effects include poor  tooth  development if used by children less than eight years of age,  kidney problems , and  sunburning  easily. [ 3 ]  Use during  pregnancy  may harm the baby. [ 3 ]  It works by inhibiting protein synthesis in bacteria. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2200", "text": "Tetracycline was patented in 1953 [ 6 ]  and was approved for prescription use in 1954. [ 7 ] [ 8 ]  It is on the  World Health Organization's List of Essential Medicines . [ 9 ]  Tetracycline is available as a  generic medication . [ 3 ]   Tetracycline was originally made from bacteria of the genus  Streptomyces . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2201", "text": "Tetracyclines have a broad spectrum of antibiotic action. Originally, they possessed some level of bacteriostatic activity against almost all medically relevant  aerobic  and  anaerobic  bacterial genera, both  Gram-positive  and  Gram-negative , with a few exceptions, such as  Pseudomonas aeruginosa  and  Proteus  spp. , which display intrinsic resistance. However, acquired (as opposed to inherent) resistance has proliferated in many  pathogenic organisms  and greatly eroded the formerly vast versatility of this group of antibiotics. Resistance amongst  Staphylococcus  spp. ,  Streptococcus  spp. ,  Neisseria gonorrhoeae , anaerobes, members of the  Enterobacteriaceae , and several other previously sensitive organisms is now quite common. Tetracyclines remain especially useful in the management of infections by certain obligately intracellular bacterial pathogens such as  Chlamydia ,  Mycoplasma , and  Rickettsia . They are also of value in  spirochaetal  infections, such as  syphilis , and  Lyme disease . Certain rare or exotic infections, including  anthrax ,  plague , and  brucellosis , are also susceptible to tetracyclines. Tetracycline tablets were used in the plague outbreak in India in 1994. [ 10 ]   Tetracycline is first-line therapy for  Rocky Mountain spotted fever  ( Rickettsia ),  Lyme disease  ( B. burgdorferi ),  Q fever  ( Coxiella ),  psittacosis ,  Mycoplasma pneumoniae , and nasal carriage of  meningococci . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2202", "text": "It is also one of a group of antibiotics which together may be used to treat  peptic ulcers  caused by bacterial infections. The mechanism of action for the antibacterial effect of tetracyclines relies on disrupting protein translation in bacteria, thereby damaging the ability of microbes to grow and repair; however, protein translation is also disrupted in eukaryotic  mitochondria  leading to effects that may  confound  experimental results. [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2203", "text": "The following list presents  MIC  susceptibility data for some medically significant microorganisms:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2204", "text": "The tetracyclines also have activity against certain  eukaryotic  parasites, including those responsible for diseases such as  dysentery  caused by an  amoeba ,  malaria  (a  plasmodium ), and  balantidiasis  (a  ciliate ). [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2205", "text": "Since tetracycline is absorbed into bone, it is used as a marker of bone growth for  biopsies  in humans. Tetracycline labeling is used to determine the amount of bone growth within a certain period of time, usually a period around 21 days. Tetracycline is incorporated into mineralizing bone and can be detected by its  fluorescence . [ 14 ]  In \"double tetracycline labeling\", a second dose is given 11\u201314 days after the first dose, and the amount of bone formed during that interval can be calculated by measuring the distance between the two fluorescent labels. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2206", "text": "Tetracycline is also used as a biomarker in  wildlife  to detect consumption of medicine- or  vaccine -containing baits. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2207", "text": "Use of  tetracycline antibiotics  can: [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2208", "text": "Caution should be exercised in long-term use when breastfeeding. Short-term use is safe;  bioavailability  in milk is low to nil. [ 23 ]  According to the U.S.  Food and Drug Administration  (FDA),  cases of  Stevens\u2013Johnson syndrome ,  toxic epidermal necrolysis , and  erythema multiforme  associated with  doxycycline  use have been reported, but a causative role has not been established. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2209", "text": "Tetracycline inhibits protein synthesis by blocking the attachment of charged  tRNA  at the  P site  peptide chain. Tetracycline blocks the A-site so that a hydrogen bond is not formed between the amino acids. Tetracycline binds to the 30S and 50S subunit of microbial ribosomes. [ 3 ]  Thus, it prevents the formation of a peptide chain. [ 25 ]  The action is usually not inhibitory and irreversible even with the withdrawal of the drug. Mammalian cells are not vulnerable to the effect of Tetracycline as these cells contain no 30S ribosomal subunits so do not accumulate the drug. [ 26 ]  This accounts for the relatively small off-site effect of tetracycline on human cells. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2210", "text": "Bacteria usually acquire resistance to tetracycline from  horizontal transfer  of a  gene  that either encodes an  efflux pump  or a ribosomal protection protein. Efflux pumps actively eject tetracycline from the cell, preventing the build up of an inhibitory concentration of tetracycline in the  cytoplasm . [ 28 ]   Ribosomal protection proteins interact with the ribosome and dislodge tetracycline from the ribosome, allowing for translation to continue. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2211", "text": "The tetracyclines, a large family of antibiotics, were discovered by  Benjamin Minge Duggar  in 1948 as natural products, and first prescribed in 1948. [ 30 ]  Benjamin Duggar, working under  Yellapragada Subbarow  at  Lederle Laboratories , discovered the first tetracycline antibiotic,  chlortetracycline  (Aureomycin), in 1945. [ 31 ]  The structure of Aureomycin was elucidated in 1952 and published in 1954 by the Pfizer-Woodward group. [ 32 ]  After the discovery of the structure, researchers at  Pfizer  began chemically modifying aureomycin by treating it with hydrogen in the presence of a  palladized carbon catalyst . This  chemical  reaction replaced a chlorine moiety with a hydrogen, creating a compound named tetracycline via  hydrogenolysis . [ 33 ]  Tetracycline displayed higher potency, better solubility, and more favorable pharmacology than the other antibiotics in its class, leading to its FDA approval in 1954. The new compound was one of the first commercially successful semi-synthetic antibiotics that was used, and laid the foundation for the development of Sancycline,  Minocycline , and later the  Glycylcyclines . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2212", "text": "Tetracycline has a high affinity for calcium and is incorporated into bones during the active mineralization of  hydroxyapatite . When incorporated into bones, tetracycline can be identified using ultraviolet light. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2213", "text": "There is evidence that early inhabitants of Northeastern Africa consumed tetracycline antibiotics.  Nubian  mummies from between 350 and 550 A.D. were found to exhibit patterns of fluorescence identical with that of modern tetracycline labelled bone. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2214", "text": "It is conjectured that the beer brewed by the Nubians was the source of the tetracycline found in these bones. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2215", "text": "According to data from EvaluatePharma and published in the  Boston Globe , in the USA the price of tetracycline rose from $0.06 per 250- mg  pill in 2013 to $4.06 a pill in 2015. [ 37 ]  The  Globe  described the \"big price hikes of some generic drugs\" as a \"relatively new phenomenon\" which has left most pharmacists \"grappling\" with large upswings\" in the \"costs of generics, with 'overnight' price changes sometimes exceeding 1,000%.\" [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2216", "text": "It is marketed under the brand names Sumycin, Tetracyn, and Panmycin, among others. Actisite is a thread-like fiber formulation used in dental applications. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2217", "text": "It is also used to produce several semisynthetic derivatives, which together are known as the  tetracycline antibiotics . The term \"tetracycline\" is also used to denote the four-ring system of this compound; \"tetracyclines\" are related substances that contain the same four-ring system. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2218", "text": "Due to the drug's association with fighting infections, it serves as the main \"commodity\" in the science fiction series  Aftermath , with the search for tetracycline becoming a major preoccupation in later episodes. [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2219", "text": "Tetracycline is also represented in  Bohemia Interactive 's survival sandbox,  DayZ . In the game, players may find the antibiotic to treat the common cold, influenza, cholera and infected wounds, but does not portray any side effects associated with tetracycline."}
{"_id": "WikiPedia_Dermatology$$$corpus_2220", "text": "In  genetic engineering , tetracycline is used in  transcriptional activation . It has been used as an engineered \"control switch\" in  chronic myelogenous leukemia  models in mice. Engineers were able to develop a retrovirus that induced a particular type of leukemia in mice, and could then \"switch\" the cancer on and off through tetracycline administration. This could be used to grow the cancer in mice and then halt it at a particular stage to allow for further experimentation or study. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2221", "text": "A technique being developed for the control of the  mosquito  species  Aedes aegypti  (the infection  vector  for  yellow fever ,  dengue fever ,  Zika fever , and several other diseases) uses a strain that is  genetically modified  to require tetracycline to develop beyond the larval stage. Modified males raised in a laboratory develop normally as they are supplied with this chemical and can be released into the wild. Their subsequent offspring inherit this trait, but find no tetracycline in their environments, so never develop into adults. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2222", "text": "Urushiol   / \u028a \u02c8 r u\u02d0 \u0283 i . \u0252 l /  is an oily mixture of  organic compounds  with  allergenic  properties found in  plants  of the  family   Anacardiaceae , especially  Toxicodendron   spp.  (e.g.,  poison oak ,  Chinese lacquer tree ,  poison ivy ,  poison sumac ),  Comocladia spp.  (maidenplums) ,  Metopium spp . (poisonwood) , and also in parts of the  mango tree  and the fruit of the  cashew  tree. [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2223", "text": "In most individuals, urushiol causes an allergic  skin  rash on contact, [ 7 ]  known as  urushiol-induced contact dermatitis ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2224", "text": "The name urushiol is derived from the  Japanese  word for the lacquer tree,  Toxicodendron vernicifluum  ( \u6f06 ,  urushi ) . [ 8 ]  The  oxidation  and polymerization of urushiol in the tree's sap in the presence of moisture allows it to form a hard  lacquer , which is used to produce traditional Chinese, Korean, and Japanese  lacquerware ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2225", "text": "Although urushiol-containing  lacquers  and their skin-irritating properties were well known in East Asia for several millennia beforehand, its first recorded Western texts were in 1624 by  John Smith  where he initially likened poison ivy to  English ivy . [ 9 ]  He did not classify it as a poison at first due to the speed with which its rash disappeared and Smith hypothesized that there may actually be medicinal uses for the plant. [ 9 ]  In the 18th and 19th centuries, many experiments were done in this area to determine whether or not this theory was true. Because medicine was dominated by plant-based treatments at the time, physicians were hopeful that the strong effect this chemical produced on the body could be effective in some way."}
{"_id": "WikiPedia_Dermatology$$$corpus_2226", "text": "Andr\u00e9-Ignace-Joseph Dufresnoy was one of the first to come up with a medicinal use for this chemical in 1780 when he boiled poison ivy to produce an infusion for internal use. [ 9 ]  This led to a distilled extract of poison ivy which he prescribed to many people suffering from skin problems and even paralysis. He claimed this treatment to have yielded several positive results. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2227", "text": "For many years, poison ivy was thought to fall into the  Rhus  genus; however, in the 1900s, it was reclassified into a more appropriate genus,  Toxicodendron , meaning  poison tree . [ 9 ]  There were many documented cases of irritations and allergic reactions from the plant, and its prevalence in medicinal use quickly dwindled. After this new categorization, scientists began attempts to determine what it was that rendered plants of this genus noxious, starting with a hypothesis of a volatile oil present in the plants. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2228", "text": "While this proved incorrect, Rikou Majima from Japan was able to determine that the chemical urushiol was the irritant. Further, he determined that the substance was a type of alkyl catechol, and due to its structure it was able to penetrate the skin and survive on surfaces for months to years. [ 9 ]  Urushiol's ability to polymerise into a hard glossy coating is the chemical basis for traditional lacquerware in many Asian countries. [ 10 ]  After urushiol comes in contact with oxygen, under certain conditions it becomes a black lacquer and has been named  urushi lacquer . [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2229", "text": "Urushiol in its pure form is a pale-yellow  liquid  with a  density  of about 0.968 g/mL and a  boiling point  of 200\u00a0\u00b0C (392\u00a0\u00b0F).  It is soluble in  diethyl ether ,  acetone ,  ethanol ,  carbon tetrachloride , and  benzene . [ 12 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2230", "text": "Urushiol is a mixture of several closely related  organic compounds . Each consists of a  catechol  substituted in the 3 position with a  hydrocarbon  chain that has 15 or 17 carbon atoms. The hydrocarbon group may be  saturated  or unsaturated. The exact composition of the mixture varies, depending on the plant source. Whereas  western poison oak  urushiol contains chiefly catechols with C 17  side-chains, [ 14 ]  poison ivy and poison sumac contain mostly catechols with C 15  sidechains."}
{"_id": "WikiPedia_Dermatology$$$corpus_2231", "text": "The likelihood and severity of allergic reaction to urushiol is dependent on the degree of  unsaturation  of the  hydrocarbon  chain. Less than half of the general population experience a reaction with the saturated urushiol alone, but over 90% do so with urushiol that contains at least two  degrees of unsaturation  (double bonds). Longer side chains tend to produce a stronger reaction. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2232", "text": "Urushiol is an  oleoresin  contained within the sap of  poison ivy  and related plants, and after injury to the plant, or late in the fall, the sap leaks to the surface of the plant, where under certain temperature and humidity conditions the urushiol becomes a blackish  lacquer  after being in contact with  oxygen . [ 15 ] [ 16 ] [ 11 ]  Urushi lacquer is very stable. It is able to withstand disturbances from alkali, acid, and alcohol, while also being able to resist temperatures of over 300\u00a0\u00b0C. However, the lacquer can be degraded by UV rays from the sun and other sources. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2233", "text": "Within the United States, urushiol-containing plants are widely distributed. Poison ivy can be found in all states except California, Alaska, and Hawaii. Poison oak can be found on the west coast or in some states in the southeast, while poison sumac can be found only in the eastern half of the country. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2234", "text": "These plants all have distinguishing features that will help in identification. Poison ivy always grows with groups of three glossy, pointed leaflets on leaves that alternate along the branch (in contrast to similar looking leaves of boxelder which has opposite leaves). Poison oak has a similar appearance, but with larger and more rounded lobes, with a light, velvety  pubescence  and grow in groups of 3, 5, or 7. Poison sumac grows in groups of 7 to 13 leaflets, always an odd number. The leaflets are ovate-lanceolate and glossy. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2235", "text": "Before the urushiol has been absorbed by the skin, it can be removed with a washcloth using soap and water. Substantial amounts of urushiol may be absorbed within minutes. Once urushiol has penetrated the skin, attempting to remove it with water is ineffective. [ 15 ]  After being absorbed by the skin, it is recognized by the  immune system 's  dendritic cells , otherwise called  Langerhans cells . These cells then migrate to the  lymph nodes , where they present the urushiol to  T-lymphocytes  and thus recruit them to the skin, and the T-lymphocytes cause pathology through the production of  cytokines  and  cytotoxic  damage to the skin. [ 19 ]  This causes the painful rash, blisters, and itching."}
{"_id": "WikiPedia_Dermatology$$$corpus_2236", "text": "Once this response starts, only a few treatments, such as  cortisone  or  prednisone , are effective. [ 9 ]  Medications that can reduce the irritation include  antihistamines  ( diphenhydramine  (Benadryl) or  cetirizine  (Zyrtec)). Other treatments include applying cold water or  calamine lotion  to soothe the pain and stop the itching. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2237", "text": "Research conducted on urushiol by  Mahmoud ElSohly  led to the development of  PDC-APB , a candidate for a vaccine against skin irritation from  poison ivy . [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2238", "text": "To cause an  allergic dermatitis  reaction, the urushiol is first oxidized to create two double-bonded oxygens on the chemical. It then reacts with a protein  nucleophile  to trigger a reaction within the skin.  Dermatitis  is mediated by an  acquired immune response . Urushiol is too small to directly activate an immune response. Instead, it attaches to certain proteins of the skin, where it acts as a  hapten , leading to a  type IV hypersensitivity  reaction. [ 21 ] [ self-published source? ] [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2239", "text": "Hydrocortisone , the active ingredient in cortisone, works to alleviate this condition by stopping the release of chemicals that cause the dermatitis reaction. [ 23 ]  Hydrocortisone itself does not react with urushiol in any way."}
{"_id": "WikiPedia_Dermatology$$$corpus_2240", "text": "Valdecoxib  is a  nonsteroidal anti-inflammatory drug  (NSAID) used in the treatment of  osteoarthritis ,  rheumatoid arthritis , and painful  menstruation  and menstrual symptoms. It is a selective  cyclooxygenase-2 inhibitor . It was patented in 1995. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2241", "text": "Valdecoxib was manufactured and marketed under the brand name  Bextra  by  G. D. Searle & Company  as an anti-inflammatory arthritis drug. [ 3 ]  It was approved by the United States  Food and Drug Administration  (FDA) on November 20, 2001, to treat arthritis and menstrual cramps, [ 4 ] [ 5 ]  and was available by prescription in tablet form until 2005 when the FDA requested that Pfizer withdraw Bextra from the American market. [ 6 ]  The FDA cited \"potential increased risk for serious cardiovascular (CV) adverse events,\" an \"increased risk of serious skin reactions\" and the \"fact that Bextra has not been shown to offer any unique advantages over the other available NSAIDs.\" [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2242", "text": "In 2009, Bextra was at the center of the \"largest health-care fraud settlement and the largest criminal fine of any kind ever.\" [ 4 ] [ 7 ]  Pfizer paid a $2.3 billion civil and criminal fine.  Pharmacia & Upjohn , a Pfizer subsidiary, violated the United States  Food, Drug and Cosmetic Act  for misbranding Bextra \"with the intent to defraud or mislead.\" [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2243", "text": "A water-soluble and injectable  prodrug  of valdecoxib,  parecoxib , is marketed in the  European Union  under the tradename Dynastat."}
{"_id": "WikiPedia_Dermatology$$$corpus_2244", "text": "In the United States, the FDA approved valdecoxib for the treatment of  osteoarthritis , adult  rheumatoid arthritis , and primary  dysmenorrhea . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2245", "text": "Valdecoxib was also used  off-label  for controlling acute pain and various types of surgical pain. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2246", "text": "On April 7, 2005, Pfizer withdrew Bextra from the U.S. market on recommendation by the FDA, citing an increased risk of  heart attack  and  stroke  and also the risk of a serious, sometimes fatal, skin reaction. This was a result of recent attention to prescription NSAIDs, such as  Merck's   Vioxx . Other reported side effects were  angina  and  Stevens\u2013Johnson syndrome ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2247", "text": "Pfizer first acknowledged cardiovascular risks associated with Bextra in October 2004. The  American Heart Association  soon after was presented with a report indicating patients using Bextra while recovering from heart surgery were 2.19 times more likely to suffer a stroke or heart attack than those taking  placebos ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2248", "text": "In a large study published in  The Journal of the American Medical Association  in 2006, valdecoxib appeared less adverse for renal (kidney) disease and heart arrhythmia compared to Vioxx, but elevated renal risks were slightly suggested. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2249", "text": "On September 2, 2009, the  United States Department of Justice  fined Pfizer $2.3 billion after one of its  subsidiaries , Pharmacia & Upjohn Company, pleaded guilty to marketing four drugs, including Bextra, \"with the intent to defraud or mislead.\" [ 10 ]  Pharmacia & Upjohn admitted to criminal conduct in the promotion of Bextra, and agreed to pay the largest criminal fine ever imposed in the United States for any matter, $1.195 billion. [ 11 ]  A former Pfizer district sales manager was  indicted  and sentenced to home confinement for destroying documents regarding the illegal promotion of Bextra. [ 12 ] [ 13 ]  In addition, a regional manager pleaded guilty to distribution of a misbranded product, and was fined $75,000 and 24 months on probation. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2250", "text": "The remaining $1 billion of the fine were paid to resolve allegations under the civil  False Claims Act  case and is the largest civil fraud settlement against a pharmaceutical company. Six whistleblowers were awarded more than $102 million for their role in the investigation. [ 15 ]  Former Pfizer sales representative John Kopchinski acted as a  qui tam  relator and filed a complaint in 2004 outlining the illegal conduct in the marketing of Bextra. [ 16 ]  Kopchinski was awarded $51.5 million for his role in the case because the improper marketing of Bextra was the largest piece of the settlement at $1.8 billion. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2251", "text": "Several HPLC-UV methods [ 18 ]  have been reported for valdecoxib estimation in biological samples like human urine. [ 19 ] [ 20 ]  Valdecoxib has analytical methods for bioequivalence studies, [ 21 ] [ 22 ]  metabolite determination, [ 23 ] [ 24 ] [ 19 ]  estimation of formulation, [ 25 ]  and an HPTLC method for simultaneous estimation in tablet dosage form. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2252", "text": "This is a list of  allergies , which includes the  allergen , potential reactions, and a brief description of the cause where applicable."}
{"_id": "WikiPedia_Dermatology$$$corpus_2253", "text": "Many substances can cause an allergic reaction when in contact with the human  integumentary system ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2254", "text": "Many  skin conditions  require a  skin biopsy  for confirmation of the diagnosis.  With several of these conditions there are features within the cells contained in the skin biopsy specimen that have elements in their cytoplasm or nucleus that have a characteristic appearance unique to the condition.  These elements are termed  inclusion bodies ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2255", "text": "There are many different  keratin  proteins normally expressed in the human  integumentary system ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2256", "text": "Acropustulosis  refers to  acrodermatitis  with  pustular  involvement."}
{"_id": "WikiPedia_Dermatology$$$corpus_2257", "text": "Types include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2258", "text": "Albinism  is a  congenital condition  characterized in humans by the partial or complete absence of  pigment  in the skin, hair and eyes. Albinism is associated with a number of vision defects, such as  photophobia ,  nystagmus , and  amblyopia . Lack of skin pigmentation makes for more susceptibility to sunburn and skin cancers. In rare cases such as  Ch\u00e9diak\u2013Higashi syndrome , albinism may be associated with deficiencies in the transportation of melanin granules. This also affects essential granules present in immune cells, leading to increased susceptibility to infection. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2259", "text": "Albinism results from inheritance of  recessive gene   alleles  and is known to affect all  vertebrates , including  humans . It is due to absence or defect of  tyrosinase , a copper-containing enzyme involved in the production of  melanin . Unlike humans, other animals have multiple  pigments  and for these,  albinism  is considered to be a hereditary condition characterised by the absence of melanin in particular, in the eyes, skin, hair, scales, feathers or cuticle. [ 4 ]  While an organism with complete absence of melanin is called an albino, an organism with only a diminished amount of melanin is described as  leucistic  or albinoid. [ 5 ]  The term is from the  Latin   albus , \"white\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_2260", "text": "There are two principal types of albinism:  oculocutaneous , affecting the eyes, skin and hair, and  ocular  affecting the eyes only."}
{"_id": "WikiPedia_Dermatology$$$corpus_2261", "text": "There are different types of oculocutaneous albinism depending on which gene has undergone mutation. With some there is no pigment at all. The other end of the spectrum of albinism is \"a form of albinism called rufous oculocutaneous albinism, which usually affects dark-skinned people\". [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2262", "text": "According to the  National Organization for Albinism and Hypopigmentation , \"With ocular albinism, the color of the iris of the eye may vary from blue to green or even brown, and sometimes darkens with age. However, when an optometrist or ophthalmologist examines the eye by shining a light from the side of the eye, the light shines back through the iris since very little pigment is present.\" [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2263", "text": "Because individuals with albinism have skin that entirely lacks the dark pigment melanin, which helps protect the skin from the sun's  ultraviolet   radiation , their skin can  burn  more easily from overexposure. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2264", "text": "The human eye normally produces enough pigment to color the  iris  blue, green or brown and lend opacity to the eye. In photographs, those with albinism are more likely to demonstrate \"red eye\", due to the red of the  retina  being visible through the iris. Lack of pigment in the eyes also results in problems with vision, both related and unrelated to  photosensitivity . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2265", "text": "Those with albinism are generally as healthy as the rest of the population (but see related disorders below), with growth and development occurring as normal, and albinism by itself does not cause mortality, [ 10 ]  although the lack of pigment blocking  ultraviolet   radiation  increases the risk of melanomas (skin cancers) and other problems. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2266", "text": "Development of the optical system is highly dependent on the presence of melanin. For this reason, the reduction or absence of this pigment in people with albinism may lead to:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2267", "text": "Eye conditions common in albinism include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2268", "text": "The improper development of the  retinal pigment epithelium  (RPE), which in normal eyes absorbs most of the reflected sunlight, further increases glare due to light scattering within the eye. [ 13 ]  The resulting sensitivity (photophobia) generally leads to discomfort in bright light, but this can be reduced by the use of sunglasses or brimmed hats. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2269", "text": "Oculocutaneous albinism  is generally the result of the  biological inheritance  of  genetically recessive   alleles  ( genes ) passed from both parents of an individual such as  OCA1  and  OCA2 .  A mutation in the human TRP-1 gene may result in the deregulation of melanocyte tyrosinase enzymes, a change that is hypothesized to promote brown versus black melanin synthesis, resulting in a third oculocutaneous albinism (OCA) genotype, \"OCA3\". [ 15 ]  Some rare forms are inherited from only one parent. There are other  genetic mutations  which are proven to be associated with albinism. All alterations, however, lead to changes in melanin production in the body. [ 10 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2270", "text": "The chance of offspring with albinism resulting from the pairing of an organism with albinism and one without albinism is low. However, because organisms (including humans) can be carriers of genes for albinism without exhibiting any traits, albinistic offspring can be produced by two non-albinistic parents. Albinism usually occurs with equal frequency in both sexes. [ 10 ]  An exception to this is  ocular albinism , which it is passed on to offspring through X-linked inheritance. Thus, ocular albinism occurs more frequently in males as they have a single X and Y  chromosome , unlike females, whose genetics are characterized by two X\u00a0chromosomes. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2271", "text": "There are two different forms of albinism: a partial lack of the melanin is known as hypomelanism, or hypomelanosis, and the total absence of melanin is known as  amelanism  or amelanosis. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2272", "text": "The enzyme defect responsible for OCA1-type albinism is tyrosine 3-monooxygenase (tyrosinase), which synthesizes melanin from the amino acid  tyrosine .\n [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2273", "text": "It is suggested that the early genus  Homo  (humans in the broader sense) started to evolve in East Africa around 3 million years ago. [ 20 ]  The dramatic  phenotypic  change from the ape-like  Australopithecus  to early  Homo  is hypothesized to have involved the extreme loss of body hair \u2013 except for areas most exposed to UV radiation, such as the head \u2013 to allow for more efficient  thermoregulation  in the early hunter-gatherers. The skin that would have been exposed upon general body hair loss in these early proto-humans would have most likely been non-pigmented, reflecting the pale skin underlying the hair of our chimpanzee relatives. A positive advantage would have been conferred to early hominids inhabiting the African continent that were capable of producing darker skin \u2013 those who first expressed the  eumelanin -producing  MC1R   allele  \u2013 which protected them from harmful epithelium-damaging ultraviolet rays. Over time, the advantage conferred to those with darker skin may have led to the prevalence of darker skin on the continent. The positive advantage, however, would have had to be strong enough so as to produce a significantly higher reproductive fitness in those who produced more melanin. The cause of a selective pressure strong enough to cause this shift is an area of much debate. Some hypotheses include the existence of significantly lower reproductive fitness in people with less melanin due to lethal skin cancer, lethal kidney disease due to excess  vitamin D  formation in the skin of people with less melanin, or simply natural selection due to mate preference and sexual selection. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2274", "text": "When comparing the prevalence of albinism in Africa to its prevalence in other parts of the world, such as Europe and the United States, the potential evolutionary effects of skin cancer as a selective force due to its effect on these populations may not be insignificant. [ 20 ]  It would follow, then, that there would be stronger selective forces acting on albino individuals in Africa than on albinos in Europe and the US. [ 21 ]  In two separate studies in Nigeria, very few people with albinism appear to survive to old age. One study found that 89% of people diagnosed with albinism are between 0 and 30 years of age, while the other found that 77% of albinos were under the age of 20. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2275", "text": "However, it has also been theorized that albinism may have been able to spread in some Native American communities, because albino males were culturally revered and assumed as having divine origins. The very high incidence of albinism among the Hopi tribe has been frequently attributed to the privileged status of albino males in Hopi society, who were not required to perform physical work outdoors, shielding them from the harmful effects of UV radiation. This privileged status of albino males in Hopi society allowed them to reproduce with large numbers of non-albino women, spreading the genes that are associated with albinism. [ 22 ] [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2276", "text": "Genetic testing  can confirm albinism and what variety it is, but offers no medical benefits, except in the case of non-OCA disorders. Such disorders cause other medical problems in conjunction with albinism, and may be treatable. Genetic tests are currently available for parents who want to find out if they are carriers of ty-neg albinism. Diagnosis of albinism involves carefully examining a person's eyes, skin and hairs. Genealogical analysis can also help."}
{"_id": "WikiPedia_Dermatology$$$corpus_2277", "text": "Albinism can also be a feature of several syndromes: [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2278", "text": "Since there is no cure for albinism, it is managed through lifestyle adjustments. People with albinism need to take care not to get sunburnt and should have regular healthy skin checks by a dermatologist. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2279", "text": "For the most part, treatment of the eye conditions consists of visual rehabilitation. Surgery is possible on the  extra-ocular muscles  to decrease  strabismus . [ 8 ]   Nystagmus -damping surgery can also be performed, to reduce the \"shaking\" of the eyes back and forth. [ 25 ]  The effectiveness of all these procedures varies greatly and depends on individual circumstances. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2280", "text": "Glasses  (often with tinted lenses), low vision aids,  large-print  materials, and bright angled reading lights can help individuals with albinism. Some people with albinism do well using  bifocals  (with a strong reading lens), prescription reading glasses, hand-held devices such as  magnifiers  or  monoculars  or wearable devices like  eSight \nand  Brainport . [ 14 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2281", "text": "The condition may lead to abnormal development of the  optic nerve  and sunlight may damage the  retina  of the eye as the  iris  cannot filter out excess light due to a lack of pigmentation.  Photophobia  may be ameliorated by the use of sunglasses which filter out ultraviolet light. [ 27 ]  Some use  bioptics , glasses which have small telescopes mounted on, in, or behind their regular lenses, so that they can look through either the regular lens or the telescope. Newer designs of bioptics use smaller light-weight lenses. Some US states allow the use of bioptic telescopes for driving motor vehicles. [ citation needed ]  (See also  NOAH  bulletin \"Low Vision Aids\".)"}
{"_id": "WikiPedia_Dermatology$$$corpus_2282", "text": "There are a number of national support groups across the globe which come under the umbrella of the World Albinism Alliance. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2283", "text": "Albinism affects people of all ethnic backgrounds; its frequency worldwide is estimated to be approximately one in 17,000. Prevalence of the different forms of albinism varies considerably by population, and is highest overall in people of  sub-Saharan  African descent. [ 29 ]  Today, the prevalence of albinism in  sub-Saharan Africa  is around 1 in 5,000, while in Europe and the US it is around 1 in 20,000 of the European derived population. [ 30 ] [ 20 ]  Rates as high as 1 in 1,000 have been reported for some populations in Zimbabwe and other parts of  Southern Africa . [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2284", "text": "Certain ethnic groups and populations in isolated areas exhibit heightened susceptibility to albinism, presumably due to genetic factors. These include notably the  Native American   Kuna ,  Zuni  and  Hopi  nations (respectively of  Panama ,  New Mexico  and  Arizona );  Japan , in which one particular form of albinism is unusually common (OCA 4); [ 31 ]  and  Ukerewe Island , the population of which shows a very high incidence of albinism. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2285", "text": "In some  Native American  and  South Pacific  cultures, people with albinism have been traditionally revered, because they were considered heavenly beings associated with the  sky . [ 34 ] [ 35 ]  Among various indigenous tribes in  South America , albinos were able to live luxurious lives due to their divine status. [ 36 ]  This special status was applied mainly to male albinos. [ 37 ]  It has been theorized that the very high level of albinism among some Native American tribes can be attributed to sexual privileges given to male albinos, which allowed them to reproduce with large numbers of non-albino women in their tribes, leading to the spread of genes that are associated with albinism. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2286", "text": "Humans with albinism often face social and cultural challenges (even threats), as the condition is often a source of ridicule, discrimination, or even fear and violence. It is especially socially stigmatised in many African societies. A study conducted in Nigeria on albino children stated that \"they experienced alienation, avoided social interactions and were less emotionally stable. Furthermore, affected individuals were less likely to complete schooling, find employment, and find partners\". [ 38 ]  Many cultures around the world have developed beliefs regarding people with albinism. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2287", "text": "In African countries such as  Tanzania [ 39 ]  and  Burundi , [ 40 ] [ 41 ]  there has been an unprecedented rise in  witchcraft -related killings of people with albinism in recent years, because their body parts are used in potions sold by  witch doctors . [ 42 ]  Numerous authenticated incidents have occurred in Africa during the 21st century. [ 43 ] [ 44 ] [ 45 ] [ 46 ]  For example, in Tanzania, in September 2009, three men were convicted of killing a 14-year-old albino boy and severing his legs in order to sell them for witchcraft purposes. [ 47 ]   Again in Tanzania and Burundi in 2010, the murder and dismemberment of a kidnapped albino child was reported from the courts, [ 40 ]  as part of a continuing problem.  The US-based  National Geographic Society  estimated that in Tanzania a complete set of albino body parts is worth  US$ 75,000. [ 48 ] [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2288", "text": "Another harmful and false belief is that sex with an albinistic woman will cure a man of  HIV . This has led, for example in  Zimbabwe , to rapes (and subsequent HIV infection). [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2289", "text": "Famous people with albinism include historical figures such as  Oxford  don  William Archibald Spooner ; actor-comedian  Victor Varnado ; musicians such as  Johnny  and  Edgar Winter ,  Salif Keita ,  Winston \"Yellowman\" Foster ,  Brother Ali ,  Sivuca ,  Hermeto Pascoal ,  Willie \"Piano Red\" Perryman ,  Kalash Criminel ; actor-rapper  Krondon , and fashion models  Connie Chiu , Ryan \"La Burnt\" Byrne and  Shaun Ross .   Emperor Seinei  of Japan is thought to have albinism because he was said to have been born with white hair. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2290", "text": "International Albinism Awareness Day  was established after a motion was accepted on 18 December 2014 by the  United Nations General Assembly , proclaiming that 13 June would be known as International Albinism Awareness Day as of 2015. [ 51 ]   This was followed by a mandate created by the  United Nations Human Rights Council  that appointed  Ms. Ikponwosa Ero , who is from Nigeria, as the first Independent Expert on the enjoyment of human rights by persons with albinism. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2291", "text": "Amelanism  (also known as  amelanosis ) is a pigmentation abnormality characterized by the lack of  pigments  called  melanins , commonly associated with a  genetic  loss of  tyrosinase  function. Amelanism can affect  fish ,  amphibians ,  reptiles ,  birds , and  mammals  including humans.  The appearance of an amelanistic animal depends on the remaining non-melanin pigments.  The opposite of amelanism is  melanism , a higher percentage of melanin. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2292", "text": "A similar condition,  albinism , is a hereditary condition characterised in animals by the absence of pigment in the eyes, skin, hair, scales, feathers or cuticle. [ 1 ]  This results in an all white animal, usually with pink or red eyes."}
{"_id": "WikiPedia_Dermatology$$$corpus_2293", "text": "Melanin  is a compound found in  plants ,  animals , and  protists , and is derived from the  amino acid   tyrosine . Melanin is a  photoprotectant , absorbing the  DNA-damaging   ultraviolet  radiation of the sun.  Vertebrates  have melanin in their  skin  and  hair ,  feathers , or  scales . They also have two layers of pigmented tissue in the eye: the  stroma , at the front of the  iris , and the  iris pigment epithelium , a thin but critical layer of pigmented cells at the back of the iris. Melanin is also present in the  inner ear , and is important for the early development of the  auditory system . [ 2 ]  Melanin is also found in parts of the  brain  and  adrenal gland . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2294", "text": "Melanins are produced in  organelles  called  melanosomes . The production of melanins is called  melanogenesis . Melanosomes are found in specialized pigment cells called  melanocytes , but may also be engulfed by other cells, which are then called melanophages. Hair acquires pigment from melanocytes in the root bulb, which deposit melanosomes into the growing hair structure. A critical step in the production of melanins is the  catalysis  of  tyrosine  by an  enzyme  called  tyrosinase , producing dopaquinone. Dopaquinone may become eumelanin, or phaeomelanin. Eumelanin, meaning  true black , is a dense  compound  that absorbs most wavelengths of light, and appears black or brown as a result. Phaeomelanin, meaning  rufous-black , is characterized by the presence of  sulfur -containing  cysteine , and it appears reddish to yellowish as a result. Melanosomes containing eumelanin are eumelanosomes, while those containing phaeomelanin are phaeomelanosomes.  Melanocyte-stimulating hormone  (MSH) binds to the  Melanocortin 1 receptor  (MC1R) and commits melanocytes to the production of eumelanin. In the absence of this signal, melanocytes produce phaeomelanin. Another chemical,  Agouti signalling peptide  (ASP), can attach itself to MC1R and interfere with MSH/MC1R signalling. In many mammals, variation in the level of ASP switches melanocytes between eumelanin and phaeomelanin production, resulting in coloured patterns."}
{"_id": "WikiPedia_Dermatology$$$corpus_2295", "text": "Melanocytes, and the parallel  melanophores  found in fishes, amphibians, and reptiles, are derived from a strip of tissue in the  embryo  called the  neural crest .  Stem cells  in the neural crest give rise to the cells of the  autonomic nervous system , supportive elements of the skeleton such as  chondrocytes , cells of the  endocrine system , and melanocytes. This strip of tissue is found along the dorsal midline of the  embryo , and  multipotent  cells migrate down along the sides of the embryo, or through  germ layers , to their ultimate destinations. Melanocyte stem cells are called melanoblasts. Conditions associated with abnormalities in the migration of melanoblasts are known collectively as  piebaldism . Pigment cells of the  iris pigment epithelium  have a separate embryological origin. [ 3 ]  Piebaldism and amelanism are distinct conditions."}
{"_id": "WikiPedia_Dermatology$$$corpus_2296", "text": "The only pigments that mammals produce are melanins. For a mammal to be unable to chemically manufacture melanin renders it completely pigmentless. This condition is more commonly called  albinism . Amelanistic mammals have white hair, pink skin, and eyes that have a pink, red, or violet appearance. Reddish eyes are due to the lack of pigment in the  iris pigment epithelium . When the  stroma  is unpigmented but the iris pigment epithelium is not, mammalian eyes appear blue. Melanin in the pigment epithelium is critical for visual acuity and contrast. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2297", "text": "Loss of melanogenesis function is linked to the  gene  that encodes  tyrosinase . Certain  alleles  of this gene,  TYR , at the  Color  locus, cause  oculocutaneous albinism type 1  in humans and the familiar red-eyed albino conditions in  mice  and other mammals."}
{"_id": "WikiPedia_Dermatology$$$corpus_2298", "text": "Other vertebrates, such as fishes, amphibians, reptiles and birds, produce a variety of non-melanin  pigments . Disruption of melanin production does not affect the production of these pigments. Non-melanin pigments in other vertebrates are produced by cells called  chromatophores . Within this categorization, xanthophores are cells that contain primarily yellowish pteridines, while erythrophores contain primarily orangish  carotenoids . Some species also possess iridophores or leucophores, which do not contain true pigments, but light-reflective structures that give iridescence. An extremely uncommon type of chromatophore, the cyanophore, produces a very vivid blue pigment. [ 5 ]  Amelanism in fishes, amphibians, reptiles and birds has the same  genetic   etiology  as in mammals: loss of  tyrosinase  function. However, due to the presence of other pigments, other amelanistic vertebrates are seldom white and red-eyed like amelanistic mammals."}
{"_id": "WikiPedia_Dermatology$$$corpus_2299", "text": "Melanocytes depend on the  Melanocortin 1 receptor  (MC1R) to signal the production of eumelanin. Loss of melanocortin 1 receptor function or high activity of the MC1R-antagonist,  Agouti signalling peptide , can cause the widespread absence of eumelanin. Loss of MC1R function, a recessive trait, has been observed in many species. In humans, various  mutations  of the  MC1R  gene result in  red hair ,  blond hair , fair skin, and susceptibility to sundamaged skin and  melanoma . [ 6 ]  Aeumelanic hair coats, associated with mutations of the  MC1R  gene, have also been identified in mice, [ 7 ]  cattle, [ 8 ]  dogs, [ 9 ]  and horses. [ 10 ]  These coat colors are called \"yellow\" in mice and dogs, \"red\" in cattle and  chestnut  in horses. The loss of eumelanin in the coat is, in these species, harmless. The distinction between aeumelanism and hyperphaeomelanism \u2013 over abundance of phaeomelanin \u2013 is semantic."}
{"_id": "WikiPedia_Dermatology$$$corpus_2300", "text": "Aphaeomelanism is the abnormal absence of phaeomelanin from the  integumentary system  and/or eyes. [ 11 ]  Phaeomelanin is produced by melanocytes in the absence of melanocortin 1 receptor. This absence is mediated by agouti signalling protein, which antagonizes melanocortin 1 receptor. Loss of function of agouti signalling protein can permit unmediated eumelanin production, producing a uniformly black-to-brown coat color. This condition can be observed in dogs, [ 12 ]  cats, [ 13 ]  and horses. [ 14 ]  The appearance of mammals with recessive agouti mutations is typically dense black. As with aeumelanism, the difference between lack of phaeomelanin and abundance of eumelanin is one of words. Some agouti alleles in mice are associated with health defects, but this is not the case in dogs, cats, or horses."}
{"_id": "WikiPedia_Dermatology$$$corpus_2301", "text": "Atrophoderma  refers to conditions involving thinning of skin. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2302", "text": "Atypia  (from  Greek ,  a  +  typos , without type; a condition of being irregular or nonstandard) [ 1 ]  is a  histopathologic  term for a structural abnormality in a  cell , i.e. it is used to describe atypical cells."}
{"_id": "WikiPedia_Dermatology$$$corpus_2303", "text": "Atypia can be caused by infection or irritation. If, for example it were diagnosed in a  Pap smear  in the  uterus  it is more likely to be precancerous."}
{"_id": "WikiPedia_Dermatology$$$corpus_2304", "text": "The related concept of  dysplasia  refers to an abnormality of development, [ 2 ]  and includes abnormalities on larger,  histopathologic  scales."}
{"_id": "WikiPedia_Dermatology$$$corpus_2305", "text": "Features that constitute atypia have different definitions for different diseases, but often include the following  nucleus  abnormalities: [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2306", "text": "In  Barrett's esophagus , features that are classified as atypia but not as  dysplasia  are mainly: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2307", "text": "It may or may not be a  precancerous  indication associated with later  malignancy , but the level of appropriate concern is highly dependent on the context with which it is diagnosed."}
{"_id": "WikiPedia_Dermatology$$$corpus_2308", "text": "For example, already differentiated, specialised cells such as epithelia displaying \"cellular atypia\" are far less likely to become problematic (cancerous/malignant) than are  myeloid progenitor cells  of the immune system. The 'further back' in an already specialised, differentiated cell's lineage, the more problematic cellular atypia is likely to be. This is due to the conferring of such atypia to progeny-cells further down the lineage of that cell type."}
{"_id": "WikiPedia_Dermatology$$$corpus_2309", "text": "In  medicine ,  Breslow's depth  was used as a  prognostic factor  in  melanoma  of the  skin . It is a description of how deeply tumor cells have invaded. Currently, the standard Breslow's depth has been replaced by the AJCC depth, in the  AJCC staging system of melanoma . Originally, Breslow's depth was divided into 5 stages. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2310", "text": "Depth of invasion was first reported as a prognostic factor in melanoma by the  pathologist  Alexander Breslow, M.D. at George Washington University in 1970. [ 1 ]  In recognition of his contribution, the depth of invasion of melanoma is referred to by the  eponym   Breslow's depth ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2311", "text": "Subsequent studies confirmed and refined the role of depth of invasion in the prognosis of malignant melanoma. [ 2 ] [ 3 ]  Currently, Breslow's depth is included in the  AJCC   staging  guidelines for melanoma as a major prognostic factor."}
{"_id": "WikiPedia_Dermatology$$$corpus_2312", "text": "Tumor depth is most accurately measured by evaluating the entire tumor via an  excisional biopsy . Determination from specimens obtained using other  biopsy  techniques, such as a wedge or punch biopsy, are less accurate. Tumor depth cannot be calculated from a shave biopsy that only contains a portion of the tumor because it leads to an underestimation of its thickness."}
{"_id": "WikiPedia_Dermatology$$$corpus_2313", "text": "Breslow's depth is determined by using an  ocular micrometer  at a  right angle  to the skin to directly measure the depth to which  tumor cells  have invaded the  skin . Breslow's depth is measured from the  granular layer  of the  epidermis  down to the deepest point of invasion (sometimes involving detached nests of cells)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2314", "text": "Tumor depth is one of the cornerstones of the current  AJCC   TNM staging  of malignant melanoma. A large study validated the importance of tumor depth (but not Breslow's original description) as one of the three most important prognostic factors in melanoma (the others being T stage and ulceration). [ 4 ]  Breslow's depth also accurately predicted the risk for  lymph node   metastasis , with deeper tumors being more likely to involve the nodes. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2315", "text": "The above studies showed that depth was a continuous variable correlating with prognosis. However, for staging purposes, the most recent AJCC guidelines use cutoffs of 1\u00a0mm, 2\u00a0mm, and 4\u00a0mm to divide patients into stages."}
{"_id": "WikiPedia_Dermatology$$$corpus_2316", "text": "Survival figures from British Association of Dermatologist Guidelines, 2002"}
{"_id": "WikiPedia_Dermatology$$$corpus_2317", "text": "Clark's level  is a related  staging system , used in conjunction with Breslow's depth, which describes the level of anatomical invasion of the melanoma in the skin. [ 6 ]  Clark's level was the primary factor in earlier AJCC staging schemas for melanoma.  [ citation needed ]  However, with further study, it has been shown that Clark's level has a lower predictive value, is less reproducible, and is more operator-dependent as compared with Breslow's depth.  [ citation needed ]  Thus, in the current (2010) AJCC staging system, Clark's level has prognostic significance only in patients with very thin (Breslow depth <1\u00a0mm) melanomas. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2318", "text": "Five anatomical levels are recognized, and higher levels have worsening prognostic implications. These levels are:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2319", "text": "A  bruise , also known as a  contusion , is a type of  hematoma  of  tissue , [ 3 ]  the most common cause being  capillaries  damaged by  trauma , causing localized bleeding that  extravasates  into the surrounding  interstitial  tissues. Most bruises occur close enough to the epidermis such that the bleeding causes a visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by  immune system  action. Bruises which do not  blanch  under pressure can involve capillaries at the level of skin,  subcutaneous tissue , muscle, or bone. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2320", "text": "Bruises are not to be confused with other similar-looking  lesions . Such lesions include  petechia  (less than 3\u00a0mm (0.12\u00a0in), resulting from numerous and diverse etiologies such as adverse reactions from medications such as warfarin, straining, asphyxiation,  platelet  disorders and diseases such as  cytomegalovirus ); [ 6 ]  and  purpura  (3\u201310\u00a0mm (0.12\u20130.39\u00a0in)), classified as palpable purpura or non-palpable purpura and indicating various pathologic conditions such as  thrombocytopenia . [ 7 ]  Additionally, although many  terminology  schemas treat an  ecchymosis  (plural, ecchymoses) (over 1\u00a0cm (0.39\u00a0in)) as synonymous with a bruise, [ 1 ]  in some other schemas, an ecchymosis is differentiated by its remoteness from the source and cause of bleeding, with blood dissecting through tissue planes and settling in an area remote from the site of trauma or even nontraumatic pathology, such as in  periorbital  ecchymosis (\" raccoon eyes \"), arising from a  basilar skull fracture  or from a  neuroblastoma . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2321", "text": "As a type of hematoma, a bruise is always caused by internal bleeding into the interstitial tissues which does not break through the skin, usually initiated by  blunt trauma , which causes damage through  physical compression  and  deceleration  forces. Trauma sufficient to cause bruising can occur from a wide variety of situations including accidents, falls, and surgeries. Disease states such as insufficient or malfunctioning  platelets , other  coagulation  deficiencies, or vascular disorders, such as venous blockage associated with severe  allergies [ 9 ]  can lead to the formation of purpura which is not to be confused with trauma-related bruising/contusion. [ 10 ]  If the trauma is sufficient to break the skin and allow blood to escape the interstitial tissues, the injury is not a bruise but bleeding, a different variety of hemorrhage. Such injuries may be accompanied by bruising elsewhere. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2322", "text": "Bruises often induce pain immediately after the trauma that results in their formation, but small bruises are not normally dangerous alone. Sometimes bruises can be serious, leading to other more life-threatening forms of hematoma, such as when associated with serious injuries, including  fractures  and more severe  internal bleeding .  The likelihood and severity of bruising depends on many factors, including type and healthiness of affected tissues. Minor bruises may be easily recognized in people with light skin color by characteristic blue or purple appearance (idiomatically described as \"black and blue\") in the days following the injury."}
{"_id": "WikiPedia_Dermatology$$$corpus_2323", "text": "Hematomas can be subdivided by size. By definition, ecchymoses are 1 centimetres in size or larger, and are therefore larger than  petechiae  (less than 3 millimetres in diameter) [ 12 ]  or  purpura  (3 to 10 millimetres in diameter). [ 13 ]  Ecchymoses also have a more diffuse border than other purpura. [ 14 ]  A broader definition of ecchymosis is the escape of blood into the tissues from ruptured blood vessels. [ 15 ] [ 16 ]  The term also applies to the subcutaneous discoloration resulting from seepage of blood within the injured tissue."}
{"_id": "WikiPedia_Dermatology$$$corpus_2324", "text": "Bruise colors vary from red, blue, or almost black, depending on the severity of broken capillaries or blood vessels within the bruise site. Broken  venules  or  arterioles  often result in a deep blue or dark red bruise, respectively. Darker colored bruises may result from a more severe bleeding from both blood vessels. Older bruises may appear yellow, green or brown. [ 11 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2325", "text": "There are many causes of subcutaneous hematomas including ecchymoses.  Coagulopathies  such as  hemophilia A  may cause ecchymosis formation in children. [ 18 ]  The medication  betamethasone  can have the adverse effect of causing ecchymosis. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2326", "text": "The presence of bruises may be seen in patients with  platelet  or  coagulation  disorders, or those who are being treated with an  anticoagulant . Unexplained bruising may be a warning sign of  child abuse ,  domestic abuse , or serious medical problems such as  leukemia  or  meningoccocal  infection. Unexplained bruising can also indicate internal bleeding or certain types of cancer. Long-term glucocorticoid therapy can cause easy bruising. Bruising present around the  navel  (belly button) with severe abdominal pain suggests acute  pancreatitis . Connective tissue disorders such as  Ehlers\u2013Danlos syndrome  may cause relatively easy or spontaneous bruising depending on the severity. Spontaneous bruising or bruising with minimal trauma in the absence of other explanations and together with other minor or major criteria suggestive of vascular Ehlers\u2013Danlos Syndrome (vEDS) suggests  genetic testing  for the condition. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2327", "text": "During an  autopsy , bruises accompanying  abrasions  indicate the abrasions occurred while the individual was alive, as opposed to damage incurred post mortem."}
{"_id": "WikiPedia_Dermatology$$$corpus_2328", "text": "Bruise shapes may correspond directly to the instrument of injury or be modified by additional factors. Bruises often become more prominent as time lapses, resulting in additional size and swelling, and may grow to a large size over the course of the hours after the injury that caused the bruise was inflicted."}
{"_id": "WikiPedia_Dermatology$$$corpus_2329", "text": "Bruises can be scored on a scale from 0\u20135 to categorize the severity and danger of the injury."}
{"_id": "WikiPedia_Dermatology$$$corpus_2330", "text": "The harm score is determined by the extent and severity of the injuries to the organs and tissues causing the bruising, in turn depending on multiple factors.  For example, a  contracted  muscle will bruise more severely, as will tissues crushed against underlying bone.   Capillaries  vary in strength, stiffness and toughness, which can also vary by age and medical conditions."}
{"_id": "WikiPedia_Dermatology$$$corpus_2331", "text": "Low levels of damaging forces produce small bruises and generally cause the individual to feel minor pain straight away. Repeated impacts worsen bruises, increasing the harm level. Normally, light bruises heal nearly completely within two weeks, although duration is affected by variation in severity and individual healing processes; [ 22 ]  generally, more severe or deeper bruises take somewhat longer."}
{"_id": "WikiPedia_Dermatology$$$corpus_2332", "text": "Severe bruising (harm score 2\u20133) may be dangerous or cause serious complications.  Further bleeding and excess fluid may accumulate causing a hard, fluctuating lump or swelling hematoma.  This has the potential to cause  compartment syndrome  in which the swelling cuts off blood flow to the tissues.  The trauma that induced the bruise may also have caused other severe and potentially fatal harm to internal  organs .  For example, impacts to the head can cause  traumatic brain injury : bleeding, bruising and massive swelling of the brain with the potential to cause  concussion ,  coma  and death.  Treatment for brain bruising may involve emergency surgery to relieve the pressure on the brain."}
{"_id": "WikiPedia_Dermatology$$$corpus_2333", "text": "Damage that causes bruising can also cause bones to be  broken ,  tendons  or muscles to be  strained ,  ligaments  to be  sprained , or other tissue to be damaged.  The symptoms and signs of these injuries may initially appear to be those of simple bruising. Abdominal bruising or severe injuries that cause difficulty in moving a limb or the feeling of liquid under the skin may indicate life-threatening injury and require the attention of a physician."}
{"_id": "WikiPedia_Dermatology$$$corpus_2334", "text": "Increased distress to tissue causes  capillaries  to break under the skin, allowing blood to escape and build up. As time progresses, blood seeps into the surrounding tissues, causing the bruise to darken and spread.  Nerve  endings within the affected tissue detect the increased pressure, which, depending on severity and location, may be perceived as pain or pressure or be  asymptomatic . The damaged capillary  endothelium  releases  endothelin , a  hormone  that causes  narrowing of the blood vessel  to minimize bleeding. As the endothelium is destroyed, the underlying  von Willebrand factor  is exposed and initiates  coagulation , which creates a temporary  clot  to plug the wound and eventually leads to restoration of normal tissue."}
{"_id": "WikiPedia_Dermatology$$$corpus_2335", "text": "During this time, larger bruises may change color due to the breakdown of  hemoglobin  from within escaped  red blood cells  in the extracellular space. The striking colors of a bruise are caused by the  phagocytosis  and sequential degradation of hemoglobin to  biliverdin  to  bilirubin  to  hemosiderin , with hemoglobin itself producing a red-blue color, biliverdin producing a green color, bilirubin producing a yellow color, and hemosiderin producing a golden-brown color. [ 11 ]  As these products are cleared from the area, the bruise disappears. Often the underlying tissue damage has been repaired long before this process is complete."}
{"_id": "WikiPedia_Dermatology$$$corpus_2336", "text": "Treatment for light bruises is minimal and may include  RICE  ( rest ,  ice ,  compression , and  elevation ),  painkillers  (particularly  NSAIDs ) and, later in recovery, light stretching exercises. Particularly, immediate application of ice while elevating the area may reduce or completely prevent swelling by restricting blood flow to the area and preventing internal bleeding. Rest and preventing re-injury is essential for rapid recovery."}
{"_id": "WikiPedia_Dermatology$$$corpus_2337", "text": "Very gently massaging the area and applying heat may encourage blood flow and relieve pain according to the  Gate control theory  of pain, although causing additional pain may indicate the massage is exacerbating the injury. [ 23 ]  As for most injuries, these techniques should not be applied until at least three days following the initial damage to ensure all internal bleeding has stopped, because although increasing blood flow will allow more healing factors into the area and encourage drainage, if the injury is still bleeding this will allow more blood to seep out of the wound and cause the bruise to become worse."}
{"_id": "WikiPedia_Dermatology$$$corpus_2338", "text": "Folk medicine , including ancient medicine of Egyptians, Greeks, Celts, Turks, Slavs, Maya, Aztecs and Chinese, has used bruising as a treatment for some health problems. The methods vary widely and include cupping, scraping, and slapping.  Fire cupping  uses suction which causes bruising in patients. Scraping ( gua sha ) uses a small hand device with a rounded edge to gently scrape the scalp or the skin. Another ancient device that creates mild bruising is a  strigil , used by Greeks and Romans in the bath. Archaeologically there is no precedent for scraping tools before Greek archaeological evidence, not Chinese or Egyptian. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2339", "text": "The word  ecchymosis  ( / \u02cc \u025b k \u026a \u02c8 m o\u028a s \u026a s / ; plural  ecchymoses ,  / \u02cc \u025b k \u026a \u02c8 m o\u028a s i\u02d0 s / ), comes to English from  Neo-Latin , based on  Greek   \u1f10\u03ba\u03c7\u03cd\u03bc\u03c9\u03c3\u03b9\u03c2 ,  ekchym\u014dsis , from  \u1f10\u03ba\u03c7\u03c5\u03bc\u03bf\u1fe6\u03c3\u03b8\u03b1\u03b9 ,  ekchymousthai , 'to extravasate blood', from  \u1f10\u03ba- ,  ek-  (elided to  \u1f10- ,  e- ) and  \u03c7\u03c5\u03bc\u03cc\u03c2 ,  chymos , 'juice'. [ 25 ]  Compare  enchyma , \"tissue infused with organic juice\"; elaboration from chyme, the formative juice of tissues."}
{"_id": "WikiPedia_Dermatology$$$corpus_2340", "text": "Clark's level  is a  staging system , which describes the level of anatomical invasion of the  melanoma  in the skin. It was developed by  Wallace H. Clark Jr.  at  Harvard University  and  Massachusetts General Hospital  in the 1960s."}
{"_id": "WikiPedia_Dermatology$$$corpus_2341", "text": "Five anatomical levels are recognized, and higher levels have worsening prognostic implications.  These levels are: [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2342", "text": "In the  United States , the current staging system adopted by the  American Joint Committee on Cancer  (AJCC) no longer considers Clark's level, because it is less prognostic and more subjective than other alternatives. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2343", "text": "However, it is a mandatory component for melanoma pathology in  Sweden . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2344", "text": "A  comedo  (plural  comedones ) is a clogged  hair follicle  (pore) in the skin. [ 2 ]   Keratin  (skin debris) combines with oil to block the follicle. [ 3 ]  A comedo can be open ( blackhead ) or closed by skin ( whitehead ) and occur with or without  acne . [ 3 ]  The word  comedo  comes from  Latin   comedere  'to eat up' and was historically used to describe parasitic worms; in modern medical terminology, it is used to suggest the worm-like appearance of the expressed material. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2345", "text": "The chronic inflammatory condition that usually includes comedones, inflamed papules, and pustules ( pimples ) is called acne. [ 3 ] [ 4 ]  Infection causes inflammation and the development of  pus . [ 2 ]  Whether a skin condition classifies as acne depends on the number of comedones and infection. [ 4 ]  Comedones should not be confused with  sebaceous filaments ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2346", "text": "Comedo-type  ductal carcinoma  in situ  (DCIS) is not related to the skin conditions discussed here. DCIS is a noninvasive form of breast cancer, but comedo-type DCIS may be more aggressive, so may be more likely to become invasive. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2347", "text": "Oil production in the  sebaceous glands  increases during puberty, causing comedones and  acne  to be common in adolescents. [ 3 ] [ 4 ]  Acne is also found premenstrually and in women with  polycystic ovarian syndrome . [ 3 ]  Smoking may worsen acne. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2348", "text": "Oxidation  rather than poor hygiene or dirt causes blackheads to be black. [ 2 ]  Washing or scrubbing the skin too much could make it worse, by irritating the skin. [ 2 ]  Touching and picking at comedones might cause irritation and spread infection. [ 2 ]  What effect shaving has on the development of comedones or acne is unclear. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2349", "text": "Some skin products might increase comedones by blocking pores, [ 2 ]  and greasy hair products (such as  pomades ) can worsen acne. [ 3 ]  Skin products that claim to not clog pores may be labeled  noncomedogenic  or nonacnegenic. [ 6 ]  Make-up and skin products that are oil-free and water-based may be less likely to cause acne. [ 6 ]  Whether dietary factors or sun exposure make comedones better, worse, or neither is unknown. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2350", "text": "A hair that does not emerge normally, an  ingrown hair , can also block the pore and cause a bulge or lead to infection (causing inflammation and  pus ). [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2351", "text": "Genes may play a role in the chances of developing acne. [ 3 ]  Comedones may be more common in some ethnic groups. [ 3 ] [ 7 ]  People of  Latino  and recent African descent may experience more inflammation in comedones, more comedonal acne, and earlier onset of inflammation. [ 3 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2352", "text": "Comedones are associated with the  pilosebaceous unit , which includes a  hair follicle  and  sebaceous gland . These units are mostly on the face, neck, upper chest, shoulders, and back. [ 3 ]  Excess keratin combined with  sebum  can plug the opening of the follicle. [ 3 ] [ 8 ]  This small plug is called a microcomedo. [ 8 ]   Androgens  increase sebum (oil) production. [ 3 ]  If sebum continues to build up behind the plug, it can enlarge and form a visible comedo. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2353", "text": "A comedo may be open to the air (\"blackhead\") or closed by skin (\"whitehead\"). [ 2 ]  Being open to the air causes oxidation of the melanin pigment, which turns it black. [ 9 ] [ 2 ]   Cutibacterium acnes  is the suspected infectious agent in acne. [ 3 ]  It can proliferate in sebum and cause inflamed  pustules  (pimples) characteristic of acne. [ 3 ]   Nodules  are inflamed, painful, deep bumps under the skin. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2354", "text": "Comedones that are 1\u00a0mm or larger are called macrocomedones. [ 10 ]  They are closed comedones and are more frequent on the face than neck. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2355", "text": "Solar comedones (sometimes called senile comedones) are related to many years of exposure to the sun, usually on the cheeks, not to acne-related pathophysiology. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2356", "text": "Using nonoily cleansers and mild soap may not cause as much irritation to the skin as regular soap. [ 13 ] [ 14 ]  Blackheads can be removed across an area with commercially available  pore-cleansing strips  (which can still damage the skin by leaving the pores wide open and ripping excess skin) or the more aggressive  cyanoacrylate  method used by dermatologists. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2357", "text": "Squeezing blackheads and whiteheads can remove them, but  can also damage the skin. [ 2 ]  Doing so increases the risk of causing or transmitting infection and scarring, as well as potentially pushing any infection deeper into the skin. [ 2 ]  Comedo extractors are used with careful hygiene in beauty salons and by dermatologists, usually after using steam or warm water. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2358", "text": "Complementary medicine  options for acne in general have not been shown to be effective in trials. [ 3 ]  These include aloe vera,  pyridoxine  (vitamin B 6 ), fruit-derived acids,  kampo  (Japanese herbal medicine),  ayurvedic  herbal treatments, and acupuncture. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2359", "text": "Some  acne treatments  target infection specifically, but some treatments are aimed at the formation of comedones, as well. [ 16 ]  Others remove the dead layers of the skin and may help clear blocked pores. [ 2 ] [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2360", "text": "Dermatologists  can often extract open comedones with minimal skin trauma, but closed comedones are more difficult. [ 3 ]  Laser treatment for acne might reduce comedones, [ 17 ]  but dermabrasion and laser therapy have also been known to cause scarring. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2361", "text": "Macrocomedones (1\u00a0mm or larger) can be removed by a dermatologist using surgical instruments or cauterized with a device that uses light. [ 10 ] [ 11 ]  The acne drug  isotretinoin  can cause severe flare-ups of macrocomedones, so dermatologists recommend removal before starting the drug and during treatment. [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2362", "text": "Some research suggests that the common acne medications  retinoids  and  azelaic acid  are beneficial and do not cause increased pigmentation of the skin. [ 18 ]  If using a retinoid, sunscreen is recommended."}
{"_id": "WikiPedia_Dermatology$$$corpus_2363", "text": "Favre\u2013Racouchot syndrome  occurs in sun-damaged skin and includes open and closed comedones. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2364", "text": "Nevus comedonicus  or comedo nevus is a benign  hamartoma  (birthmark) of the  pilosebaceous unit  around the oil-producing gland in the skin. [ 20 ]  It has widened open hair follicles with dark keratin plugs that resemble comedones, but they are not actually comedones. [ 20 ] [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2365", "text": "Dowling\u2013Degos disease  is a genetic pigment disorder that includes comedo-like  lesions  and scars. [ 22 ] [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2366", "text": "Familial dyskeratotic comedones are a rare  autosomal-dominant  genetic condition, with keratotic (tough) papules and comedo-like lesions. [ 24 ] [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2367", "text": "A  cyst   / s \u026a s t /  is a closed  sac , having a distinct envelope and  division  compared with the nearby  tissue . Hence, it is a cluster of  cells  that have grouped together to form a sac (like the manner in which water molecules group together to form a bubble); however, the distinguishing aspect of a cyst is that the cells forming the \"shell\" of such a sac are distinctly abnormal (in both appearance and behaviour) when compared with all surrounding cells for that given location. A cyst may contain air, fluids, or semi-solid material. A collection of  pus  is called an  abscess , not a cyst. Once formed, a cyst may resolve on its own. When a cyst fails to resolve, it may need to be removed  surgically , but that would depend upon its type and location."}
{"_id": "WikiPedia_Dermatology$$$corpus_2368", "text": "Cancer -related cysts are formed as a defense mechanism for the body following the development of  mutations  that lead to an uncontrolled  cellular division . Once that mutation has occurred, the affected cells divide incessantly and become cancerous, forming a  tumor . The body encapsulates those cells to try to prevent them from continuing their division and contain the tumor, which becomes known as a cyst. That said, the cancerous cells still may mutate further and gain the ability to form their own  blood vessels , from which they receive nourishment before being contained. Once that happens, the capsule becomes useless, and the tumor may advance from  benign  to cancerous."}
{"_id": "WikiPedia_Dermatology$$$corpus_2369", "text": "Some cysts are  neoplastic , and thus are called  cystic tumors . Many types of cysts are not neoplastic, they are  dysplastic  or  metaplastic .  Pseudocysts  are similar to cysts in that they have a sac filled with fluid, but lack an  epithelial  lining."}
{"_id": "WikiPedia_Dermatology$$$corpus_2370", "text": "A  pseudocyst  is very similar to a cyst, but is a collection of cells without a distinct membrane ( epithelial  or  endothelial  cells)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2371", "text": "A  syrinx  in the  spinal cord  or  brainstem  is sometimes inaccurately referred to as a \"cyst\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_2372", "text": "Treatment ranges from simple  enucleation  of the cyst to  curettage  to  resection . There are cysts\u2014e.g.,  buccal bifurcation cyst \u2014that resolve on their own, in which just close observation may be employed, unless it is  infected  and  symptomatic . [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2373", "text": "Despite being described in 1938 as \"the  microscopic  appearance of cysts in the pancreas\", [ 16 ]   cystic fibrosis  is an example of a  genetic disorder  whose name is related to fibrosis of the  cystic duct  (which serves the  gallbladder ) and does not involve cysts. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2374", "text": "This is just one example of how the Greek root  cyst- , which simply means a fluid-filled sac, also is found in medical terms that relate to the  urinary bladder  and the  gallbladder , neither of which involve cysts."}
{"_id": "WikiPedia_Dermatology$$$corpus_2375", "text": "The Dermatology life Quality Index (DLQI)  is a ten-question questionnaire used to measure the impact of  skin disease  on the quality of life of an affected person.  It is designed for people aged 16 years and above."}
{"_id": "WikiPedia_Dermatology$$$corpus_2376", "text": "The DLQI was created by Andrew Y Finlay and Gul Karim Khan from 1990 to 1994 at the Department of Dermatology,  University of Wales College of Medicine  (now Cardiff University), Cardiff, UK. [ 1 ]  120 patients with a variety of skin diseases completed a questionnaire that asked them to write down all of the ways that their skin disease affected their lives. 49 different ways were identified, and these were used as the basis of the questions of the DLQI. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2377", "text": "The DLQI was first presented at the  British Association of Dermatologists  annual meeting in July 1993 [ 3 ]  and described in an article published in 1994 in  Clinical and Experimental Dermatology . [ 4 ]  This article has become one of the most frequently cited articles in clinical dermatology. [ 5 ]  The DLQI is the most frequently used method for evaluating quality of life for patients with different skin conditions. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2378", "text": "There are 10 questions, covering the following topics: symptoms, embarrassment, shopping and home care, clothes, social and leisure, sport, work or study, close relationships, sex, treatment.  Each question refers to the impact of the skin disease on the patient\u2019s life over the previous week. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2379", "text": "The DLQI has been translated into over 140 languages. The full translations are available at the Cardiff University Department of Dermatology website. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2380", "text": "Each question is scored from 0 to 3, giving a possible score range from 0 (meaning no impact of skin disease on quality of life) to 30 (meaning maximum impact on quality of life)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2381", "text": "A series of validated \u201cband descriptors\u201d were described in 2005 to give meaning to the scores of the DLQI. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2382", "text": "These bands are as follows: 0-1 = No effect on patient\u2019s life, 2-5 = Small effect, 6-10 = Moderate effect, 11-20 = Very large effect, 21-30 = Extremely large effect."}
{"_id": "WikiPedia_Dermatology$$$corpus_2383", "text": "The Minimal Clinically Important Difference (MCID) is the score difference that is the minimum meaningful difference for a patient. Although previously considered to be 5, [ 10 ]  the DLQI MCID for inflammatory skin diseases should be considered to be a score difference of 4. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2384", "text": "DLQI scores can be converted to EQ-5D utility values. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2385", "text": "The DLQI can provide clinicians with more accurate insight into the impairment of quality of life experienced by individual patients. This may lead to more appropriate clinical decisions. [ 13 ]   The DLQI can also be used when required by national guidelines, for example in the management of  psoriasis [ 14 ]  or hand eczema. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2386", "text": "The DLQI is recommended for use in national treatment guidelines, and to assist management decisions, [ 16 ]  in many countries, including: Australia, [ 17 ]  Canada, [ 18 ]  Bulgaria, [ 19 ]  Croatia, [ 19 ]  Czech Republic, [ 19 ]  England and Wales, [ 20 ]  Europe, [ 21 ]  Germany, [ 22 ]  Hungary, [ 19 ]  Italy, [ 23 ]  Japan,  [ 24 ]  Norway, [ 25 ]  Poland, [ 19 ]  Romania, [ 19 ]  Saudi Arabia, [ 26 ]  Scotland, [ 27 ]  Singapore, [ 28 ]  South Africa, [ 29 ]  Spain, [ 30 ]  Sweden, [ 31 ]   Switzerland, [ 32 ]  Taiwan, [ 33 ]  Turkey [ 34 ]  and  Venezuela. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2387", "text": "The DLQI has been used as a patient reported outcome measure in many published clinical research studies. [ 36 ]   For example, it has been used to assess novel drugs, [ 37 ]  models of clinical care, in audit of clinical services and in assessment of teledermatology. [ 36 ]  The DLQI is the most widely used quality of life outcome measure in randomised controlled trials of therapies for psoriasis. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2388", "text": "The Rule of Tens is a concept to aid clinicians in making the diagnosis of \u201csevere psoriasis\u201d. [ 39 ]  It states that a patient is considered to have \u201csevere psoriasis\u201d if their  body surface area  affected is >10%, or if their Psoriasis Area and Severity Index (PASI) score is >10, or if the DLQI score is >10. [ 39 ]  The Rule of Tens has influenced national guidelines concerning the criteria to be fulfilled before starting a patient on  biological therapy . [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2389", "text": "The DLQI is  copyrighted  but the originators allow it to be used for routine clinical purposes without seeking permission and without charge. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2390", "text": "The DLQI has been validated for use on tablets such as the iPad. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2391", "text": "Several systematic reviews have been carried out documenting the use of the DLQI."}
{"_id": "WikiPedia_Dermatology$$$corpus_2392", "text": "The DLQI has been used as an outcome measure in 454 randomised controlled trials, involving 69 diseases and 43 countries. [ 41 ]   In 24 randomised control trials the DLQI was used as a primary outcome measure. [ 42 ]  The DLQI has been used as a benchmark in the validation of 101 quality of life instruments. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2393", "text": "A systematic review of 207 studies has described aspects of the validation of the DLQI. [ 44 ]   The 207 articles included 58,828 patients from >49 different countries and 41 diseases met the inclusion criteria. The DLQI demonstrated strong test\u2013retest reliability; 43 studies confirmed good internal consistency, Twelve studies used anchors to assess change responsiveness with effect sizes from small to large, giving confidence that the DLQI responds appropriately to change. Forty-two studies tested known-groups validity, providing confidence in construct and use of the DLQI over many parameters, including disease severity, anxiety, depression, stigma, scarring, well-being, sexual function, disease location and duration."}
{"_id": "WikiPedia_Dermatology$$$corpus_2394", "text": "A  dermatomycosis  is a  skin disease  caused by a  fungus . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2395", "text": "The most frequent form is  dermatophytosis  (ringworm, tinea). \nAnother example is cutaneous  candidiasis . These fungal infections impair superficial layers of the skin, hair and nails."}
{"_id": "WikiPedia_Dermatology$$$corpus_2396", "text": "Dermatoscopy , also known as  dermoscopy [ 1 ]  or  epiluminescence microscopy , is the examination of  skin lesions  with a  dermatoscope . It is a tool similar to a camera to allow for inspection of skin lesions unobstructed by skin surface reflections. The  dermatoscope  consists of a magnifier, a light source (polarized or non-polarized), a transparent plate and sometimes a liquid medium between the instrument and the  skin . The dermatoscope is often handheld, although there are stationary cameras allowing the capture of whole body images in a single shot. When the images or video clips are digitally captured or processed, the instrument can be referred to as a  digital epiluminescence dermatoscope . The image is then analyzed automatically and given a score indicating how dangerous it is. This technique is useful to  dermatologists  and skin cancer practitioners in distinguishing benign from  malignant  (cancerous) lesions, especially in the diagnosis of  melanoma ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2397", "text": "There are two main types of dermatoscopes, hand held portable and stationary mounted type."}
{"_id": "WikiPedia_Dermatology$$$corpus_2398", "text": "A hand held dermatoscope is composed of a transilluminating light source and a magnifying optic (usually a 10-fold magnification). There are three main modes of dermatoscopy: [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2399", "text": "Polarized light allows for visualization of deeper skin structures, while non-polarized light provide information about the superficial skin. Most modern dermatoscopes allow the physician to toggle between the two modes, which provide complementary information. Others may also allow the doctor to have different zoom levels and color overlay."}
{"_id": "WikiPedia_Dermatology$$$corpus_2400", "text": "A stationary type allows a full body image to be captured in one snap. It is then transferred into image analysis algorithms that generates a three dimensional model of the person. Lesions on the person are marked and analyzed using  Artificial intelligence ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2401", "text": "With doctors who are experts in dermatoscopy, the diagnostic accuracy for melanoma is significantly better than those who do not have any specialized training. [ 3 ] \nThus, there is considerable improvement in the   sensitivity  (detection of melanomas) as well as  specificity   (percentage of non-melanomas correctly diagnosed as benign), compared with naked eye examination. The accuracy by dermatoscopy was increased up to 20% in the case of sensitivity and up to 10% in the case of specificity, compared with naked eye examination. [ 4 ] [ 5 ]   By using dermatoscopy the specificity is thereby increased, reducing the frequency of unnecessary surgical excisions of benign lesions. [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2402", "text": "Artificial intelligence is used to automatically distinguish benign from malignant ( cancerous ) lesions. [ 25 ]  Modern software technology allows the usage of databases to aid in this process. [ 26 ] [ 27 ]  Patients will consent their lesion pictures to be stored in a database which acts as an archive and allow artificial intelligence programs to compare newly taken ones. The program then compares key features of a new image with known features of benign and malignant lesions. Oftentimes a score is given to a specific lesion, indicating how dangerous and likely it is to be a malignant lesion. It is then flagged for further examination through a  dermatologist . This speeds up the diagnosis process."}
{"_id": "WikiPedia_Dermatology$$$corpus_2403", "text": "One limit is that since not many patients get their lesions documented, the sample size is minuscule compared to what an AI needs."}
{"_id": "WikiPedia_Dermatology$$$corpus_2404", "text": "Proposed solutions include generating synthetic images of skin lesions to improve the algorithm. Then, the AI needs to differentiate whether the sample came from the synthetic samples or from real data sets. It needs to minimize the probability that it will predict its outputs as fake while also maximizing its probability to correctly distinguish between real and fake samples. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2405", "text": "Skin surface microscopy started in 1663 by Johan Christophorous Kolhaus and was improved with the addition of immersion oil in 1878 by  Ernst Abbe . [ 29 ]  The German dermatologist,  Johann Saphier , added a built-in light source to the instrument.  Leon Goldman  was the first dermatologist to coin the term \"dermascopy\" and to use the dermatoscope to evaluate pigmented cutaneous lesions."}
{"_id": "WikiPedia_Dermatology$$$corpus_2406", "text": "In 1989 dermatologists from the  Ludwigs-Maximilian-University of Munich  developed a new device for dermoscopy. A team of physicians led by  Professor Otto Braun-Falco  in collaboration with the medical device manufacturer  HEINE Optotechnik  developed a dermatoscope, which was hand-held and illuminated by a halogen lamp. It also featured an achromatic lens with a 10-fold magnification. To reduce light reflection the lesion was covered with immersion oil. This dermatoscope helped to diagnose pigmented skin lesions more quickly and easily. The approach was confirmed by Wilhelm Stolz et al. from the Department of Dermatology and Allergology of the University of Munich and published in the \"Lancet\"(1989). [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2407", "text": "At the  Medical University of Vienna  a dermatoscope based on cross-polarization was  invented and patented , a methodology further used in digital dermatoscopes such as the  MoleMax  device or by  FotoFinder . Following, in 2001, a California medical device manufacturer, 3Gen, introduced the first polarized handheld dermatoscope, the DermLite. Polarized illumination, coupled with a cross-polarised viewer, reduces (polarised) skin surface reflection, thus allowing visualisation of skin structures (the light from which is depolarised) without using an immersion fluid. Examination of several lesions is thus more convenient because physicians no longer have to stop and apply immersion oil, alcohol, or water to the skin before examining each lesion. With the marketing of polarised dermatoscopes, dermatoscopy increased in popularity among physicians worldwide. Although images produced by polarised light dermatoscopes are slightly different from those produced by a traditional skin contact glass dermatoscope, they have certain advantages, such as vascular patterns not being potentially missed through compression of the skin by a glass contact plate. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2408", "text": "Due to the fairly standardised imaging, and limited amount of diagnoses compared to clinical dermatology, dermatoscopic images became one center of interest for automated medical image analysis. While in the past decades computer vision algorithms and hardware-based method were used [ 32 ] [ 33 ]  large standardized public image collections such as HAM10000 [ 34 ]  enabled application of convolutional neural networks. \nThe latter approach has now shown experimental evidence of human-level accuracy in larger/international, [ 35 ] [ 36 ] [ 37 ] \n [ 38 ]  and smaller/local trials, [ 39 ] [ 40 ] [ 41 ]  but this application is not without dispute. [ 42 ] [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2409", "text": "Full-body capture"}
{"_id": "WikiPedia_Dermatology$$$corpus_2410", "text": "Desquamation , or  peeling skin , is the shedding of dead cells from the outermost layer of  skin . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2411", "text": "The term is from  Latin    desquamare \u00a0'to scrape the  scales  off a  fish '."}
{"_id": "WikiPedia_Dermatology$$$corpus_2412", "text": "Keratinocytes  are the predominant cells of the  epidermis , the outermost layer of the skin. Living keratinocytes reside in the basal, spinous, or granular layers of the epidermis. The outermost layer of the epidermis is called the  stratum corneum  and it is composed of terminally differentiated keratinocytes, the  corneocytes . In the absence of disease, desquamation occurs when corneocytes are individually shed unnoticeably from the surface of the skin. [ 2 ]  Typically the time it takes for a corneocyte to be formed and then shed is about 14 weeks but this time can vary depending on the anatomical location that the skin is covering. For example, desquamation occurs more slowly at acral (palm and sole) surfaces and more rapidly where the skin is thin, such as the eyelids. Normal desquamation can be visualized by immersing skin in warm or hot water. This induces the outermost layer of corneocytes to shed, such as is the case after a hot shower or bath. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2413", "text": "Corneocytes are held together by corneodesmosomes. In order for desquamation to occur these corneodesmosome connections must be degraded. [ 2 ]  Keratinocytes residing in the stratum granulosum produce corneodesmosome-degrading kallikrein family members, especially  KLK1 ,  KLK5 , and  KLK7 . [ 3 ]  Kallikreins are serine proteases. They are packaged within lamellar bodies and released into the intercellular space between the keratinocytes as they transition into becoming corneocytes. [ 2 ]  To prevent premature desquamation, granular layer keratinocytes also produce kallikrein-inhibitory proteins. [ 3 ]  At acral surfaces, desquamation occurs more slowly because granular layer keratinocytes downregulate expression of KLK1 and KLK7 and upregulate expression of protease inhibitors, including the KLK5-specific  SPINK9  and the cysteine protease inhibitors CSTA and CST3. [ 3 ]  Slowing the process of corneocyte desquamation allows acral (palm and sole) skin to form a thick protective stratum corneum. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2414", "text": "Scale forms on the skin surface in various disease settings, and is the result of abnormal desquamation. In pathologic desquamation, such as that seen in X-linked ichthyosis, the stratum corneum becomes thicker (hyperkeratosis), imparting a \"dry\" or scaly appearance to the skin, and instead of detaching as single cells, corneocytes are shed in clusters, which forms visible scales. [ 2 ]  Desquamation of the  epidermis  may result from disease or  injury  of the skin. For example, once the  rash  of  measles  fades, there is desquamation. Skin peeling typically follows healing of a first degree  burn  or  sunburn .  Toxic shock syndrome , a potentially fatal  immune system  reaction to a  bacterial infection  such as  Staphylococcus aureus , [ 4 ]  can cause severe desquamation; so can  mercury poisoning . Other serious skin diseases involving extreme desquamation include  Stevens\u2013Johnson syndrome  and  toxic epidermal necrolysis  (TEN). [ 5 ]  Radiation can cause dry or  moist desquamation . [ 6 ]  Desquamation is also abnormal in patients with immune-mediated skin diseases such as psoriasis and atopic dermatitis. [ 3 ]  Abnormal desquamation often results in scale formation on the skin's surface. [ 3 ]   Lipid composition alterations in scale have been used to construct diagnostic models for human skin disease. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2415", "text": "Certain eye tissues, including the  conjunctiva  and  cornea , may undergo pathological desquamation in diseases such as  dry eye syndrome . [ 7 ]  The anatomy of the  human eye  makes desquamation of the  lens  impossible. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2416", "text": "Dyskeratosis  is abnormal  keratinization  occurring prematurely within individual cells or groups of cells below the  stratum granulosum . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2417", "text": "Dyskeratosis congenita is  congenital  disease characterized by  reticular  skin pigmentation, nail degeneration, and  leukoplakia  on the  mucous membranes  associated with short  telomeres . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2418", "text": "Erythema  ( Ancient Greek :  \u1f10\u03c1\u03cd\u03b8\u03b7\u03bc\u03b1 , from  Greek    erythros \u00a0'red') is redness of the skin or  mucous membranes , caused by  hyperemia  (increased blood flow) in superficial  capillaries . [ 1 ]  It occurs with any skin injury, infection, or  inflammation . Examples of erythema not associated with pathology include  nervous blushes . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2419", "text": "It can be caused by  infection ,  massage , electrical treatment,  acne  medication,  allergies , exercise, solar radiation ( sunburn ),  photosensitization , [ 3 ]   acute radiation syndrome ,  mercury toxicity ,  blister agents , [ 4 ]   niacin  administration, [ 5 ]  or waxing and tweezing of the hairs\u2014any of which can cause the affected capillaries to dilate, resulting in redness. Erythema is a common side effect of  radiotherapy  treatment due to patient exposure to  ionizing radiation ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2420", "text": "Erythema disappears on finger pressure ( blanching ), whereas  purpura  or bleeding in the skin and  pigmentation  do not. There is no temperature elevation, unless it is associated with the dilation of arteries in the deeper layer of the skin. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2421", "text": "Erythrism  or  erythrochroism  refers to an unusual reddish pigmentation of an animal's  hair ,  skin ,  feathers , or  eggshells . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2422", "text": "Causes of erythrism include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2423", "text": "Erythrism in  katydids  has been occasionally observed. The coloring might be a camouflage that helps some members of the species survive on red plants. [ 4 ]  There is also consensus that the erythristic mutation is actually a dominant trait among katydid species, albeit a disadvantageous one, due to the overwhelmingly green coloration of most foliage. Hence, most pink or otherwise vividly colored katydids do not survive to adulthood, and this observation explains their rarity. [ 5 ]  Erythrism in  leopards  is rare, but one study [ 6 ]  reported that two of twenty-eight leopards seen in  camera traps  in a South African nature reserve were erythristic, and the authors found records of five other \"strawberry\" leopards from the region. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2424", "text": "An  exanthem  is a widespread  rash  occurring on the outside of the body and usually occurring in  children . [ 1 ]  It is usually caused by a virus, [ 2 ]  but an exanthem can be caused by  bacteria , [ 3 ]   toxins ,  drugs , other  microorganisms , or as the result from  autoimmune disease . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2425", "text": "The term exanthem is from the  Greek   \u1f10\u03be\u03ac\u03bd\u03b8\u03b7\u03bc\u03b1 ,  ex\u00e1nth\u0113ma , 'a breaking out'. [ 4 ]  It can be contrasted with  enanthems  which occur inside the body, such as on mucous membranes."}
{"_id": "WikiPedia_Dermatology$$$corpus_2426", "text": "In 1905, the Russian-French physician L\u00e9on Cheinisse (1871\u20131924), proposed a numbered classification of the six most common childhood exanthems. [ 5 ] [ 6 ] [ 7 ] [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2427", "text": "Of these six \"classical\" infectious childhood exanthems, [ 10 ]  four are viral. Numbers were provided in 1905. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2428", "text": "The four viral exanthems have much in common, and are often studied together as a class. They are:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2429", "text": "Scarlet fever , or \"second disease\", is associated with the bacterium  Streptococcus pyogenes .  Fourth disease , also known as \"Dukes' disease\" is a condition whose existence is not widely accepted today. It was described in 1900 and is postulated to be related to the bacterium  Staphylococcus aureus . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2430", "text": "In 1979 and 2001 a possible \"seventh disease\" was postulated following reports of a condition in Japan also referred to as acute febrile infantile  mucocutaneous lymph node syndrome  (MCLS). [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2431", "text": "Many other common viruses apart from the ones mentioned above can also produce an exanthem as part of their presentation, though they are not considered part of the classic numbered list:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2432", "text": "The  Ferriman\u2013Gallwey score  is a method of evaluating and quantifying  hirsutism  in women.  The method was originally published in 1961 by D. Ferriman and J.D. Gallwey in the  Journal of Clinical Endocrinology . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2433", "text": "The original method used 11 body areas to assess hair growth, but was decreased to 9 body areas in the modified method:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2434", "text": "In the modified method, hair growth is rated from 0 (no growth of  terminal hair ) to 4 (extensive hair growth) in each of the nine locations.  A patient's score may therefore range from a minimum score of 0 to a maximum score of 36. With each ethnic group, the amount of hair expected for that ethnicity should be considered. For example, in  Caucasian  women, a score of 8 or higher is regarded as indicative of  androgen  excess."}
{"_id": "WikiPedia_Dermatology$$$corpus_2435", "text": "The method was further modified in 2001 to include a total of 19 locations, with the 10 extra locations being:  sideburns ,  neck ,  buttocks ,  inguinal  area,  perianal  area,  forearm ,  leg ,  foot ,  toes  and  fingers .  Each area has its own specified definition of the four-point scale. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2436", "text": "In  medicine , a  finger tip unit  ( FTU ) is defined as the amount of  ointment ,  cream  or other semi-solid  dosage form  expressed from a tube with a 5\u00a0mm diameter nozzle, applied from the distal skin-crease to the tip of the  index finger  of an adult. [ 1 ] [ 2 ]    The \"distal skin-crease\" is the skin crease over the joint nearest the end of the finger.  One FTU is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together, i.e. a \"handprint\".  Two FTUs are approximately equivalent to 1\u00a0g of topical  steroid ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2437", "text": "One handprint is 0.8% (i.e. approximately 1%) of the total body surface area, [ 3 ]  and one FTU covers approximately two handprints. As two FTUs are approximately equivalent to 1g of topical application, the \"Rule of Hand\" states that \"4 hand areas = 2\u00a0FTU = 1\u00a0g\". [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2438", "text": "In the original study in the UK, [ 1 ]  one FTU weighed 0.49\u00a0g in men and 0.43\u00a0g in women.  The area covered by one FTU was 312\u00a0cm 2  in men and 257\u00a0cm 2  in women. [ 2 ]  Very similar results were found in a Mexico study. [ 5 ]  The weight of an FTU has been recalculated in Japan, relating to the use of 5\u00a0g tubes of ointment with a much smaller nozzle diameter. [ 6 ]   The weight of ointment is less if the nozzle diameter is smaller than the standard 5\u00a0mm."}
{"_id": "WikiPedia_Dermatology$$$corpus_2439", "text": "When a topical drug was used as a foam, the weight of an FTU was 52.5\u00a0\u03bcg: the area covered by one foam FTU was less than that of an FTU of cream. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2440", "text": "The FTU is particularly useful when counseling patients with regards to the amount of topical steroid cream they should be applying in order to minimize the side-effects which are associated with their use. The FTU can also be used in children. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2441", "text": "The FTU concept has been used as a central part of an education programme for parents of children with atopic eczema. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2442", "text": "The use of the FTU has been advocated to reduce the variation in usage of topical steroids  [ 10 ]  and to encourage adherence to therapy. [ 11 ]   The FTU can also be used to guide the use of topical sunscreens. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2443", "text": "Dermatology Working Groups in the UK  [ 13 ]  and in Poland  [ 14 ]  have recommended that guidance for use of topical corticosteroids in patient information leaflets should include clear FTU instructions, preferably with images of a FTU and a chart to show the number of units required for specific areas of the body.  USA guidelines of care  [ 15 ]  for the management of psoriasis with topical therapies include guidance of amount to be used based on the FTU."}
{"_id": "WikiPedia_Dermatology$$$corpus_2444", "text": "European Guidelines for the treatment of atopic eczema recommend that application amount of topical anti-inflammatory therapy should follow the FTU rule. [ 16 ]    In the USA it has been recommended that the FTU should be used as part of the treatment plan and communication with patients and caregivers of children with atopic eczema. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2445", "text": "The FTU has been used to standardize the amount of cream being applied in clinical research studies in the UK, [ 18 ]  Belgium, [ 19 ]  Turkey, [ 20 ]  India, [ 21 ]  Iran, [ 22 ]  Pakistan, [ 23 ]  Malaysia, [ 24 ]  and the USA. [ 25 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2446", "text": "The  Fitzpatrick scale  (also  Fitzpatrick skin typing test ; or  Fitzpatrick phototyping scale ) is a numerical classification schema for  human skin color . It was developed in 1975 by American dermatologist  Thomas B. Fitzpatrick  as a way to estimate the response of different types of skin to  ultraviolet  (UV) light. [ 2 ]  It was initially developed on the basis of skin color to measure the correct dose of  UVA  for  PUVA therapy , and when the initial testing based only on hair and eye color resulted in too high UVA doses for some, it was altered to be based on the patient's reports of how their skin responds to the sun; it was also extended to a wider range of skin types. [ 3 ] [ 4 ] [ 5 ]  The Fitzpatrick scale remains a recognized tool for dermatological research into human skin pigmentation."}
{"_id": "WikiPedia_Dermatology$$$corpus_2447", "text": "The following table shows the six categories of the Fitzpatrick scale in relation to the 36 categories of the older  von Luschan scale : [ 6 ] [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2448", "text": "The Fitzpatrick scale is also the basis of skin color in  emoji , with five modifiers according to the Fitzpatrick scale (types  I  and  II  merged)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2449", "text": "The Fitzpatrick scale has been criticized for its  Eurocentric bias  and insufficient representation of global skin color diversity. [ 9 ]  The scale originally was developed for classifying \" white skin \" in response to  solar radiation , [ 2 ]  and initially included only four categories focused on white skin, with \"brown\" and \"black\" skin types (V and VI) added as an afterthought. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2450", "text": "The scale's methodology, relying on self-reporting of skin color,  sunburn , and  sun tanning  response, fails to capture the broad spectrum of skin reflectance. Studies demonstrate that European populations have the narrowest skin color variation, whereas groups categorized as 'brown' or 'black' exhibit a much wider range. [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2451", "text": "The efficacy of the Fitzpatrick scale even among white-skinned individuals has been argued to be questionable, [ 9 ]  since studies such as that on a Dutch student population [ 12 ]  have found it inadequate for categorizing, challenging its appropriateness for investigating the relationship between sunburn tendency and tanning ability. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2452", "text": "The Fitzpatrick scale's Eurocentric orientation and its limitations in accurately representing global skin color diversity, along with similar biases in classifying other phenotypic traits, have been argued to require more inclusive and scientifically valid categorizations in dermatological and genetic research. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2453", "text": "A  fungating lesion  is a  skin lesion  that  fungates , that is, becomes like a  fungus  in its appearance or growth rate. It is marked by  ulcerations  (breaks on the skin or surface of an organ) and  necrosis  (death of living tissue) and usually presents a foul odor. This kind of lesion may occur in many types of  cancer , including  breast cancer ,  melanoma , and  squamous cell carcinoma , and especially in advanced disease. The characteristic malodorous smell is caused by  dimethyl trisulfide . [ 1 ]  It is usually not a  fungal infection  but rather a  neoplastic growth  with necrosing portions."}
{"_id": "WikiPedia_Dermatology$$$corpus_2454", "text": "There is a weak evidence that  6%  miltefosine  solution applied topically on superficial fungating breast lesions of less than 1 cm in size, on patients who received previous radiotherapy, surgery, hormonal therapy or chemotherapy for their breast cancer, may slow the disease progression. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2455", "text": "This article incorporates  public domain material  from  Dictionary of Cancer Terms .  U.S. National Cancer Institute ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2456", "text": "This  oncology  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2457", "text": "Glabrousness  (from the  Latin   glaber  meaning \"bald\", \"hairless\", \"shaved\", \"smooth\") is the technical term for a lack of  hair ,  down ,  setae ,  trichomes  or other such covering. A glabrous surface may be a natural characteristic of all or part of a plant or animal, or be due to loss because of a physical condition, such as  alopecia universalis  in humans, which causes hair to fall out or not regrow."}
{"_id": "WikiPedia_Dermatology$$$corpus_2458", "text": "Glabrousness or otherwise, of leaves, stems, and fruit is a feature commonly mentioned in plant  keys ; in  botany  and  mycology , a  glabrous   morphological  feature is one that is smooth and may be glossy. It has no bristles or hair-like structures such as  trichomes . In anything like the zoological sense, no plants or fungi have hair or wool, although some structures may resemble such materials."}
{"_id": "WikiPedia_Dermatology$$$corpus_2459", "text": "The term \"glabrous\" strictly applies only to features that lack  trichomes  at all times. When an organ bears trichomes at first, but loses them with age, the term used is  glabrescent ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2460", "text": "In the model plant  Arabidopsis thaliana , trichome formation is initiated by the GLABROUS1 protein.  Knockouts  of the corresponding gene lead to glabrous plants. This  phenotype  has already been used in  gene editing  experiments and might be of interest as a visual marker for plant research to improve gene editing methods such as  CRISPR/Cas9. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2461", "text": "In varying degrees most  mammals  have some  skin  areas without natural hair. In  humans , glabrous skin is found on the  ventral  portion of the  fingers ,  palms ,  soles of feet  and  lips , which are all parts of the body most closely associated with interacting with the world around us, [ 3 ]   as are the  labia minora  and  glans penis . [ 4 ]  There are four main types of  mechanoreceptors  in the glabrous skin of humans:  Pacinian corpuscles ,  Meissner's corpuscles ,  Merkel's discs , and  Ruffini corpuscles ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2462", "text": "The  Naked mole-rat  ( Heterocephalus glaber ) has evolved skin lacking in general, pelagic hair covering, yet has retained long, very sparsely scattered tactile hairs over its body. [ 3 ]  Glabrousness is a trait that may be associated with  neoteny . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2463", "text": "Within  entomology , the term glabrous is used to refer to those parts of an insect's body with are lacking in setae (bristles) or  scales . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2464", "text": "A  hydrocarbon keratosis , also known as  pitch keratosis ,  tar keratosis , and  tar wart , is a  precancerous   keratotic   skin lesion  that occurs in people who have been occupationally exposed to  polycyclic aromatic hydrocarbons . [ 1 ] :\u200a728"}
{"_id": "WikiPedia_Dermatology$$$corpus_2465", "text": "Hydropic swelling  is intracellular  edema  of  keratinocytes , often seen with  viral infections . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2466", "text": "Hyperkeratinization  ( American English  or hyperkeratinisation in  British ) is a  disorder  of the cells lining the inside of a  hair follicle . It is the normal function of these cells to detach or slough off ( desquamate ) from the skin lining at normal intervals. The dead cells are then forced out of the follicle (primarily by the growing hair). However, in hyperkeratinization, this process is interrupted and a number of these dead skin cells do not leave the follicle because of an excess of  keratin , a natural protein found in the skin.  This excess of keratin, which is influenced by genetics, results in an increased adherence/bonding of dead skin cells together.  This cohesion of cells will block or \"cap\" the hair follicle (leading to  keratosis pilaris ) or clog the  sebaceous /oil duct (leading to  acne ).  Pathogens may also play a role in causing, perpetuating, or simply taking advantage of this phenomenon, such as virulent sub-strains of  Cutibacterium acnes  and irregular migration of  Staphylococcus epidermidis  from the outer surface of the skin into the follicle, where  commensal  strains of  C. acnes  exclusively habitate. It itches mildly at times, and strongly at others. Very often it cannot be felt at all. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2467", "text": "Hyperkeratosis  is thickening of the  stratum corneum  (the outermost layer of the  epidermis , or  skin ), often associated with the presence of an abnormal quantity of  keratin , [ 1 ]  and is usually accompanied by an increase in the granular layer. As the corneum layer normally varies greatly in thickness in different sites, some experience is needed to assess minor degrees of hyperkeratosis."}
{"_id": "WikiPedia_Dermatology$$$corpus_2468", "text": "It can be caused by  vitamin A deficiency  or chronic exposure to  arsenic ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2469", "text": "Hyperkeratosis can also be caused by  B-Raf  inhibitor drugs such as  Vemurafenib  and  Dabrafenib . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2470", "text": "It can be treated with  urea-containing creams , which dissolve the  intercellular matrix  of the cells of the stratum corneum, promoting  desquamation  of scaly skin, eventually resulting in softening of hyperkeratotic areas. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2471", "text": "Follicular hyperkeratosis, also known as  keratosis pilaris  (KP), is a skin condition characterized by excessive development of  keratin  in  hair follicles , resulting in rough, cone-shaped, elevated  papules . The openings are often closed with a white plug of encrusted  sebum . When called  phrynoderma,  the condition is associated with nutritional deficiency or malnourishment."}
{"_id": "WikiPedia_Dermatology$$$corpus_2472", "text": "This condition has been shown in several small-scale studies to respond well to supplementation with vitamins and fats rich in  essential fatty acids .  Deficiencies  of  vitamin E , [ 4 ]   vitamin A , and  B-complex vitamins  have been implicated in causing the condition. [ 5 ]  Follicular hyperkeratosis is also a symptom in inherited collagen-related diseases of  Ehlers-Danlos syndromes  and  Bethlem myopathy ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2473", "text": "The term hyperkeratosis is often used in connection with lesions of the  mucous membranes , such as  leukoplakia . Because of the differences between mucous membranes and the skin (e.g., keratinizing mucosa does not have a  stratum lucidum  and non keratinizing mucosa does not have this layer or normally a  stratum corneum  or a  stratum granulosum ), sometimes specialized texts give slightly different definitions of hyperkeratosis in the context of mucosae. Examples are \"an excessive formation of keratin (e.g., as seen in leukoplakia)\" [ 12 ]  and \"an increase in the thickness of the keratin layer of the epithelium, or the presence of such a layer in a site where none would normally be expected.\" [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2474", "text": "The word  hyperkeratosis  ( / \u02cc h a\u026a p \u0259r \u02cc k \u025br \u0259 \u02c8 t o\u028a s \u026a s / ) is based on the  Ancient Greek morphemes   hyper-  +  kerato-  +  -osis , meaning 'the condition of too much keratin'."}
{"_id": "WikiPedia_Dermatology$$$corpus_2475", "text": "Nasodigitic hyperkeratosis in dogs may be idiopathic, secondary to an underlying disease, or due to congenital abnormalities in the normal anatomy of the nose and fingertips."}
{"_id": "WikiPedia_Dermatology$$$corpus_2476", "text": "In the case of congenital anatomical abnormalities, contact between the affected area and rubbing surfaces is impaired. It is roughly the same with finger pads \u2014 in animals with an anatomical abnormality, part of the pad is not in contact with rubbing surfaces and excessive keratin deposition is formed. The idiopathic form of nasodigitic hyperkeratosis in dogs develops from unknown causes and is more common in older animals (senile form). [ 14 ] [ 15 ]  Of all dog breeds, Labradors, Golden Retrievers, Cocker Spaniels, Irish Terriers, Bordeaux Dogs are the most prone to hyperkeratosis. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2477", "text": "Since the deposition of excess keratin cannot be stopped, therapy is aimed at softening and removing it. For moderate to severe cases, the affected areas should be hydrated (moisturised) with warm water or compresses for 5-10 minutes. Softening preparations are then applied once a day until the excess keratin is removed."}
{"_id": "WikiPedia_Dermatology$$$corpus_2478", "text": "In dogs with severe hyperkeratosis and a significant excess of keratin, it is removed with scissors or a blade. After proper instructions, pet owners are able to perform this procedure at home, and it may be the only method of correction. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2479", "text": "Hyperpigmentation  is the darkening of an area of  skin  or  nails  caused by increased  melanin ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2480", "text": "Hyperpigmentation can be caused by sun damage,  inflammation , or other skin injuries, including those related to  acne vulgaris . [ 1 ] [ 2 ] [ 3 ] :\u200a854\u200a  People with darker skin tones are more prone to hyperpigmentation, especially with excess sun exposure. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2481", "text": "Many forms of hyperpigmentation are caused by an excess production of melanin. [ 4 ]  Hyperpigmentation can be diffuse or focal, affecting such areas as the face and the back of the hands. Melanin is produced by  melanocytes  at the lower layer of the  epidermis . Melanin is a class of pigment responsible for producing color in the body in places such as the eyes, skin, and hair. The process of melanin synthesis (melanogenesis) starts with the oxidation of  l -tyrosine to  l-dopa  by the enzyme  tyrosine hydroxylase , then to  l -dopaquinone  and  dopachrome , which forms melanin. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2482", "text": "As the body ages, melanocyte distribution becomes less diffuse and its regulation less controlled by the body. UV light stimulates melanocyte activity, and where concentration of the cells is greater, hyperpigmentation occurs. Another form of hyperpigmentation is post-inflammatory hyperpigmentation. These are dark and discoloured spots that appear on the skin following acne that has healed. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2483", "text": "Hyperpigmentation is associated with a number of diseases or conditions, including the following:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2484", "text": "Hyperpigmentation can sometimes be induced by  dermatological   laser  procedures."}
{"_id": "WikiPedia_Dermatology$$$corpus_2485", "text": "There are a wide range of depigmenting treatments used for hyperpigmentation conditions, and responses to most are variable. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2486", "text": "Most often treatment of hyperpigmentation caused by melanin overproduction (such as melasma, acne scarring, liver spots) includes the use of topical depigmenting agents, which vary in their efficacy and safety, as well as in prescription rules. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2487", "text": "Many topical treatments disrupt the synthesis of melanin by inhibiting the enzyme  tyrosine hydroxylase . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2488", "text": "Several are prescription only in the US, especially in high doses, such as  hydroquinone ,  azelaic acid , [ 13 ]  and  kojic acid . [ 14 ]  Some are available without prescription, such as  niacinamide , [ 15 ] [ 16 ]   l - ascorbic acid , [ citation needed ]  retinoids such as  tretinoin , [ 17 ]  or  cysteamine hydrochloride . [ 18 ] [ 19 ]  Hydroquinone was the most commonly prescribed hyperpigmentation treatment before the long-term safety concerns were raised, [ 20 ]  and the use of it became more regulated in several countries and discouraged in general by  WHO . [ 21 ]  For the US, only 2% is at present sold over-the-counter, and 4% needs prescription. In the EU hydroquinone was banned from cosmetic applications. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2489", "text": "Oral medication with  procyanidin  plus vitamins A, C, and E also shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated. [ 23 ]  Other treatments that do not involve topical agents are also available, including fraction lasers [ 24 ]  and dermabrasion. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2490", "text": "Laser toning using  YAG  lasers [ 25 ]  and  intense pulsed light  have been used to treat hyperpigmentation such as melasma and post-inflammatory hyperpigmentation. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2491", "text": "Hypopigmentation  is characterized specifically as an area of  skin  becoming lighter than the baseline skin color, but not completely devoid of  pigment . This is not to be confused with  depigmentation , which is characterized as the absence of all pigment. [ 1 ]   It is caused by  melanocyte  or  melanin  depletion, or a decrease in the  amino acid   tyrosine , which is used by melanocytes to make melanin. [ 2 ]  Some common genetic causes include mutations in the  tyrosinase  gene or  OCA2  gene. [ 3 ] [ 4 ]   As melanin pigments tend to be in the skin, eye, and hair, these are the commonly affected areas in those with hypopigmentation. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2492", "text": "Hypopigmentation is common and approximately one in twenty have at least one hypopigmented macule. Hypopigmentation can be upsetting to some, especially those with darker skin whose hypopigmentation marks are seen more visibly. Most causes of hypopigmentation are not serious and can be easily treated. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2493", "text": "It is seen in:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2494", "text": "Areas of lighter pigmentation can be indications of hypopigmentation. Biopsies and genetic information are also used to diagnose."}
{"_id": "WikiPedia_Dermatology$$$corpus_2495", "text": "Often, hypopigmentation can be brought on by laser treatments; however, the hypopigmentation can be treated with other lasers or light sources. [ 6 ]   Micropigmentation  can also be used to obtain a more normal appearance of the hypopigmentated skin. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2496", "text": "Treatment for hypopigmentation depends on the initial cause of the discoloration. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2497", "text": "Can also use oral medications, such as oral imidazoles or triazoles."}
{"_id": "WikiPedia_Dermatology$$$corpus_2498", "text": "Patients can also have transplants if they are stable or a depigmentation with topical MBEH if the patient has widespread discoloration."}
{"_id": "WikiPedia_Dermatology$$$corpus_2499", "text": "Intertrigo , commonly called \u201cskin fold dermatitis\u201d, refers to a type of  inflammatory   rash  ( dermatitis ) of the superficial skin that occurs within a person's body folds. [ 1 ]  These areas are more susceptible to irritation and subsequent infection due to factors that promote skin breakdown such as moisture, friction, and exposure to bodily secretions and excreta such as  sweat ,  urine , or  feces . [ 1 ]  Areas of the body which are more likely to be affected by intertrigo include the  inframammary fold ,  intergluteal cleft ,  armpits , and spaces between the fingers or toes. Skin affected by intertrigo is more prone to infection than intact skin. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2500", "text": "The term \"intertrigo\" commonly refers to a secondary infection with  bacteria  (such as  Corynebacterium minutissimum ),  fungi  (such as  Candida albicans ), or  viruses . A frequent manifestation is  candidal intertrigo ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2501", "text": "Intertrigo occurs more often in warm and humid conditions. Generally, intertrigo is more common in people with a weakened immune system including children, the elderly, and  immunocompromised  people. [ 1 ]  The condition is also more common in people who experience  urinary incontinence  and decreased ability to move. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2502", "text": "Bacterial intertrigo can be caused by  Streptococci  and  Corynebacterium minutissimum . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2503", "text": "Intertrigo can be diagnosed clinically by a medical professional after taking a thorough history and performing a detailed physical examination. Many other skin conditions can mimic intertrigo's appearance including  erythrasma ,  inverse psoriasis ,  scabies ,  pyoderma ,  atopic dermatitis ,  candidiasis ,  seborrheic dermatitis , and  fungal infections of the superficial skin  like  Tinea versicolor  or  Tinea corporis . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2504", "text": "Greases, oils, and barrier ointments  [ 3 ]  may help by protecting skin from moisture and from friction. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2505", "text": "Intertrigo is also a known symptom of  vitamin B6  deficiency. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2506", "text": "Kamino bodies  are eosinophilic globoids. [ 1 ]  Kamino bodies are commonly observed microscopically with the condition  spitz nevi , [ 2 ]   a  benign   melanocytic nevus , a type of  skin  lesion, affecting the  epidermis  and  dermis . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2507", "text": "This article related to  pathology  is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2508", "text": "Keratosis  (from  kerat-  +  -osis ) [ 1 ]  is a growth of  keratin  on the skin or on  mucous membranes  stemming from  keratinocytes , the prominent cell type in the  epidermis . More specifically, it can refer to:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2509", "text": "Leucism  ( / \u02c8 l u\u02d0 s \u026a z \u0259m ,   - k \u026a z -/ ) [ 2 ] [ 3 ] [ 4 ]  is a wide variety of conditions that result in partial loss of  pigmentation  in an  animal \u2014causing white, pale, or patchy coloration of the skin, hair, feathers, scales, or cuticles, but not the eyes. [ 4 ]  It is occasionally spelled  leukism . Some genetic conditions that result in a \"leucistic\" appearance include  piebaldism ,  Waardenburg syndrome ,  vitiligo ,  Ch\u00e9diak\u2013Higashi syndrome , flavism,  isabellinism ,  xanthochromism ,  axanthism ,  amelanism , and  melanophilin  mutations. Pale patches of skin, feathers, or fur (often referred to as \" depigmentation \") can also result from injury. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2510", "text": "Leucism  is often used to describe the  phenotype  that results from defects in  pigment cell  differentiation and/or migration from the  neural crest  to skin, hair, or feathers during  development . This results in either the entire surface (if all pigment cells fail to develop) or patches of body surface (if only a subset are defective) having a lack of cells that can make  pigment ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2511", "text": "Since all pigment cell-types differentiate from the same  multipotent  precursor cell-type, leucism can cause the reduction in all types of pigment. This is in contrast to  albinism , for which leucism is often mistaken. Albinism results in the reduction of  melanin  production only, though the  melanocyte  (or  melanophore ) is still present. Thus in species that have other pigment cell-types, for example  xanthophores , albinos are not entirely white, but instead display a pale yellow color."}
{"_id": "WikiPedia_Dermatology$$$corpus_2512", "text": "More common than a complete absence of pigment cells is localized or incomplete  hypopigmentation , resulting in irregular patches of white on an animal that otherwise has normal coloring and patterning. This partial leucism is known as a \"pied\" or \" piebald \" effect; and the ratio of white to normal-colured skin can vary considerably not only between generations, but between different offspring from the same parents, and even between members of the same litter. This is notable in  horses ,  cows ,  cats ,  dogs , the urban  crow [ 7 ]  and the  ball python [ 8 ]  but is also found in many other species."}
{"_id": "WikiPedia_Dermatology$$$corpus_2513", "text": "Due to the lack of melanin production in both the  retinal  pigmented epithelium (RPE) and  iris , those affected by  albinism  sometimes have pink pupil due to the underlying blood vessels showing through. However, this is not always the case and many albino animals do not have pink pupils. [ 9 ]  The common belief that all albinos have pink pupils results in many albinos being incorrectly labeled as 'leucistic'. The neural crest disorders that cause leucism do not result in pink pupils and therefore most leucistic animals have normally colored eyes. This is because the melanocytes of the RPE do not derive from the  neural crest . Instead, an out-pouching of the  neural tube  generates the  optic cup  that, in turn, forms the  retina . As these cells are from an independent developmental origin, they are typically unaffected by the genetic cause of leucism."}
{"_id": "WikiPedia_Dermatology$$$corpus_2514", "text": "Genes  that, when  mutated , can cause leucism include  c-kit , [ 11 ]   mitf [ 12 ]  and  EDNRB . [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2515", "text": "The terms  leucistic  and  leucism  are derived from the stem  leuc-  +  -ism , from Latin  leuco-  in turn derived from  Greek   leukos  meaning  white ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2516", "text": "A  lichenoid eruption  is a  skin disease  characterized by damage and  infiltration  between the  epidermis  and  dermis . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2517", "text": "Examples include  lichen planus ,  lichen sclerosus  and  lichen nitidus . It can also be associated with abrasion or drug use. [ 2 ]  It has been observed in conjunction with the use of  proton pump inhibitors , and might be a sign and/or symptom of  lupus  such as  subacute cutaneous lupus erythematous , according to the  case reports  and reviews. [ 3 ] [ 4 ] [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2518", "text": "The term \"lichenoid\" derives from a resemblance to a  lichen ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2519", "text": "A  maculopapular rash  is a type of  rash  characterized by a flat, red area on the skin that is covered with small confluent bumps. It may only appear red in lighter-skinned people. The term \"maculopapular\" is a compound:  macules  are small, flat discolored spots on the surface of the skin; and  papules  are small, raised bumps. It is also described as  erythematous , or red."}
{"_id": "WikiPedia_Dermatology$$$corpus_2520", "text": "This type of rash is common in several diseases and medical conditions, including  scarlet fever ,  measles ,  Ebola virus disease ,  rubella ,  HIV , secondary  syphilis  (Congenital syphilis, which is asymptomatic, the newborn may present this type of rash),  erythrovirus  ( parvovirus B19 ),  chikungunya  (alphavirus),  zika ,  smallpox  (which has been eradicated),  varicella  (when vaccinated persons exhibit symptoms from the modified form),  heat rash , and sometimes in  Dengue fever . It is also a common manifestation of a skin reaction to the antibiotic  amoxicillin  or  chemotherapy  drugs. [ 1 ]   Cutaneous infiltration of  leukemic  cells may also have this appearance. Maculopapular rash is seen in  graft-versus-host disease  (GVHD) developed after a hematopoietic stem cell transplant (bone marrow transplant), which can be seen within one week or several weeks after the transplant. In the case of GVHD, the maculopapular lesions may progress to a condition similar to  toxic epidermal necrolysis . [ 2 ]  In addition, this is the type of rash that some patients presenting with  Ebola virus  hemorrhagic (EBO-Z) fever will reveal but can be hard to see on dark skin people. [ 3 ]  It is also seen in patients with  Marburg hemorrhagic fever , a  filovirus  not unlike Ebola."}
{"_id": "WikiPedia_Dermatology$$$corpus_2521", "text": "This type of rash can be as a result of large doses of  niacin  or no-flush niacin (2000 \u2013 2500\u00a0mg), [ citation needed ]  used for the management of low HDL cholesterol. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2522", "text": "This type of rash can also be a symptom of  Sea bather's eruption . This stinging, pruritic, maculopapular rash affects swimmers in some Atlantic locales (e.g., Florida, Caribbean, Long Island). It is caused by hypersensitivity to stings from the larvae of the sea anemone (e.g.,  Edwardsiella lineate ) or the thimble jellyfish ( Linuche unguiculata ). The rash appears where the bathing suit contacts the skin. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2523", "text": "This type of rash can also be a symptom of acute arsenic intoxication, appearing 2 weeks later. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2524", "text": "A  malar rash  (from  Latin    mala \u00a0'jaw, cheek-bone'), also called  butterfly rash , [ 1 ]  is a  medical sign  consisting of a characteristic form of facial  rash . It is often seen in  lupus erythematosus . More rarely, it is also seen in other diseases, such as  pellagra ,  dermatomyositis , and  Bloom syndrome ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2525", "text": "There are many conditions which can cause rashes with a similar appearance to a malar rash. A malar rash is present in approximately 46\u201365% of people with lupus."}
{"_id": "WikiPedia_Dermatology$$$corpus_2526", "text": "A malar rash of lupus is red or purplish and mildly scaly. It has the characteristic shape of a butterfly, and involves the bridge of the nose. Notably, the rash spares the  nasolabial folds  of the face, which contributes to its characteristic appearance. It is usually macular with sharp edges, and not itchy. The rash can be transient or progressive with involvement of other parts of the facial skin. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2527", "text": "While some literature has described the slapped-cheek rash of  fifth disease  as a malar rash, it differs slightly in that the nose is typically spared. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2528", "text": "There are many conditions which can cause rashes with a similar appearance to a malar rash. [ 1 ]  These include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2529", "text": "Lupus causes up to 96% of all cases of malar rash. [ 3 ]  Where lupus is suspected, further  medical tests  and a detailed history and examination are necessary to  differentiate  it from other conditions. [ citation needed ]  These tests may include a test for the presence of  anti-nuclear antibody  in the blood as a  screening  test, which is not specific for lupus erythematosus. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2530", "text": "A malar rash is present in approximately 46\u201365% of people with lupus, [ 7 ] [ 8 ]  with an average of 57% of lupus patients having it across all populations. [ 3 ]  This percentage varies between different populations. [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2531", "text": "A malar rash is often known more  colloquially  as a butterfly rash due to its distinctive appearance. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2532", "text": "The  Malpighian layer  ( stratum mucosum  or  stratum malpighii ) of the  epidermis  is generally defined as both the  stratum basale  (basal layer) and the thicker  stratum spinosum  (spinous layer/prickle cell layer) immediately above it as a single unit, [ 1 ] [ 2 ]  although it is occasionally defined as the stratum basale specifically, [ 3 ]  or the stratum spinosum specifically. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2533", "text": "It is named after the Italian biologist and physician  Marcello Malpighi ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2534", "text": "Basal cell carcinoma  originates from the basal layer of the stratum malpighii."}
{"_id": "WikiPedia_Dermatology$$$corpus_2535", "text": "This layer is where almost all of the  mitotic  activity in the  epidermis  occurs. The activity of these cells is increased by IL-1 ( interleukin-1 ) and  epidermal growth factor . The activity is decreased by  transforming growth factor beta . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2536", "text": "Melanism  is the  congenital  excess of  melanin  in an organism resulting in dark  pigment ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2537", "text": "Pseudomelanism, also called abundism, is another variant of pigmentation, identifiable by dark spots or enlarged stripes, which cover a large part of the body of the animal, making it appear melanistic. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2538", "text": "The morbid deposition of black matter, often of a malignant character causing pigmented  tumors , is called  melanosis . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2539", "text": "Melanism related to the process of  adaptation  is called adaptive. Most commonly, dark individuals become  fitter  to survive and reproduce in their environment as they are better camouflaged. This makes some species less conspicuous to predators, while others, such as  leopards , use it as a foraging advantage during night hunting. [ 4 ]  Typically, adaptive melanism is  heritable : A  dominant   allele , which is entirely or nearly entirely expressed in the  phenotype , is responsible for the excessive amount of melanin. By contrast, adaptive melanism associated with Batesian mimicry in  Zelandoperla fenestrata   stoneflies  is controlled by a  recessive allele  at the ebony locus. [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2540", "text": "Adaptive melanism has been shown to occur in a variety of animals, including mammals such as  squirrels , many  cats  and  canids , and  coral snakes . Adaptive melanism can lead to the creation of  morphs , a notable example being the  peppered moth , whose evolutionary history in the  United Kingdom  is offered as a classic instructional tool for teaching the principles of  natural selection . [ 7 ]  A more replicated example of human-induced shifts in  melanism  has arisen from repeated selection against melanic  Zelandoperla fenestrata  stonefly phenotypes following widespread  deforestation in New Zealand . [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2541", "text": "Industrial melanism is an  evolutionary  effect in insects such as the peppered moth,  Biston betularia  in areas subject to  industrial pollution . Darker pigmented individuals are favored by  natural selection , apparently because they are better  camouflaged  against polluted backgrounds. When pollution was later reduced, lighter forms regained the advantage and melanism became less frequent. [ 8 ] [ 9 ] [ 10 ] [ 11 ] [ 12 ] [ 13 ]  Other explanations have been proposed, such as that the melanin pigment enhances function of immune defences, [ 14 ]  or a thermal advantage from the darker coloration. [ 15 ] [ 16 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2542", "text": "Melanistic coat coloration occurs as a common  polymorphism  in 11 of 37  felid  species and reaches high population frequency in some cases but never achieves complete  fixation . The  black panther , a melanistic  leopard , is common in the  equatorial rainforest  of  Malaya  and the  tropical rainforest  on the slopes of some African mountains, such as  Mount Kenya . The  serval  also has melanistic forms in certain areas of  East Africa . In the  jaguarundi , coloration varies from dark brown and gray to light reddish. Melanic forms of  jaguar  are common in certain parts of  South America . [ 18 ]  In 1938 and 1940, two melanistic  bobcats  were trapped alive in sub-tropical  Florida . [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2543", "text": "In 2003, the  dominant  mode of inheritance of melanism in jaguars was confirmed by performing  phenotype -transmission analysis in a 116-individual captive  pedigree . Melanistic animals were found to carry at least one copy of a mutant  MC1R  sequence  allele , bearing a 15- base pair  inframe deletion. Ten unrelated melanistic jaguars were either  homozygous  or  heterozygous  for this allele. A 24-base pair deletion causes the incompletely dominant allele for melanism in the jaguarundi. Sequencing of the  agouti signalling peptide  in the  agouti gene  coding region revealed a 2-base pair deletion in black  domestic cats . These variants were absent in melanistic individuals of  Geoffroy's cat ,  oncilla ,  pampas cat  and  Asian golden cat , suggesting that melanism arose independently at least four times in the cat family. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2544", "text": "Melanism in leopards is inherited as a  Mendelian ,  monogenic   recessive trait  relative to the spotted form. Pairings of black animals have a significantly smaller litter size than other possible pairings. [ 21 ]  Between January 1996 and March 2009,  Indochinese leopards  were photographed at 16 sites in the  Malay Peninsula  in a sampling effort of more than 1000 trap nights. Of 445 photographs of melanistic leopards, 410 were taken south of the  Kra Isthmus , where the non-melanistic morph was never photographed. These data suggest the near fixation of the dark allele in the region. The expected time to fixation of this recessive allele due to  genetic drift  alone ranged from about 1,100 years to about 100,000 years. [ 22 ] \nMelanism in leopards has been hypothesized to be causally associated with a selective advantage for ambush. [ 23 ]  Other theories are that genes for melanism in felines may provide resistance to viral infections, or a high-altitude adaptation, since black fur absorbs more light for warmth. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2545", "text": "The chicken breeds  Silkie  and  Ayam Cemani  commonly exhibit this trait.  Ayam Cemani  is an uncommon and relatively modern breed of chicken from Indonesia. They have a dominant gene that causes hyperpigmentation (Fibromelanosis), making the chicken entirely black; including feathers, beak, and internal organs."}
{"_id": "WikiPedia_Dermatology$$$corpus_2546", "text": "Melanism in feral  rock doves  are actually quite common,to some extent, especially if the area is abundant with the species. The amount of pigmentation is varied, from a slight darker pigmentation in the pigeon\u2019s wings, to being almost completely black."}
{"_id": "WikiPedia_Dermatology$$$corpus_2547", "text": "In April 2015, an extremely rare black  flamingo  was spotted on the Mediterranean island of  Cyprus . [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2548", "text": "The  alpine salamander ,  Salamandra atra , has one subspecies ( S. atra atra ) that is completely black. [ 26 ]  The pigment comes from a specific cell called a melanophore, which produce the compound melanin. [ 27 ] [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2549", "text": "There are four other subspecies of this salamander, [ 29 ]  and they have varying levels of melanin pigmentation. [ 28 ] [ 30 ] [ 31 ]  The subspecies have yellow spots in different concentrations or proportions. The  pigment-producing cells  that contribute to the yellow spots of some sub-species are called xanthophores. [ 30 ]  It appears that the fully-black phenotypes do not ever develop these xanthophores. [ 31 ]  Alpine salamanders produce a toxin from their skin, and both fully melanistic, black salamanders and spotted individuals produce the compound. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2550", "text": "Studies done that traced DNA histories have suggested that the original alpine salamander phenotype was black with some yellow spots, meaning that the fully black color evolved over time and was thus selected for over many generations. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2551", "text": "Melanism, meaning a mutation that results in completely dark skin, does not exist in humans. In humans, the amount of melanin is determined by three dominant alleles (AABBCC), and different ethnicities have varying amounts. [ 33 ]  Melanin is the primary determinant of the degree of skin pigmentation and protects the body from harmful  ultraviolet radiation . The same ultraviolet radiation is essential for the synthesis of  vitamin D  in skin, so lighter colored skin \u2013 less melanin \u2013 is an adaptation related to the prehistoric movement of humans away from equatorial regions, as there is less exposure to sunlight at higher latitudes. People from parts of Africa,  South Asia ,  Southeast Asia , Australia,  Papua New Guinea ,  Fiji ,  Vanuatu ,  New Caledonia , and the  Solomon Islands  may have very dark skin, but this is not melanism."}
{"_id": "WikiPedia_Dermatology$$$corpus_2552", "text": "This rare  genetic disorder  is characterized by the development of  macules  with  hyperpigmentation  on the lips and  oral mucosa  ( melanosis ), as well as benign polyps in the gastrointestinal tract. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2553", "text": "The term  melanism  has been used on  Usenet ,  internet forums  and  blogs  to mean an  African-American   social movement  holding that dark-skinned humans are the original people from which those of other  skin color  originate. The term  melanism  has been used in this context as early as the mid-1990s [ 35 ]  and was promoted by some  Afrocentrists , such as  Frances Cress Welsing ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2554", "text": "Melanosis  is a form of  hyperpigmentation  associated with increased  melanin . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2555", "text": "It can also refer to:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2556", "text": "The term  morbilliform  refers to a  rash  that looks like  measles . [ 1 ] [ 2 ]  The rash consists of  macular   lesions  that are red and usually 2\u201310\u00a0mm in diameter but may be confluent in places. [ 3 ]  A morbilliform rash is a rose-red flat ( macular ) or slightly elevated ( maculopapular ) eruption, showing circular or elliptical lesions varying in diameter from 1 to 3\u00a0mm, with healthy-looking skin intervening. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2557", "text": "Patients with measles will have the rash but there are other syndromes and infections that will display the same symptom such as patients with  Kawasaki disease , [ 4 ]   meningococcal   petechiae  or  Waterhouse-Friderichsen syndrome , [ 4 ]   Dengue ,  Roseola , congenital syphilis, [ 5 ]   rubella , [ 4 ]   Echovirus 9 , [ 4 ]  drug hypersensitivity reactions (in particular with certain classes of  antiretroviral drugs , such as  abacavir  and  nevirapine , and also the antiepileptic drug  phenytoin ), or other conditions may also have a morbilliform rash. It has also been mentioned as a possible manifestation of onset or recovery from  COVID-19 . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2558", "text": "One cause of morbilliform rash is an allergic reaction to transfused blood/blood components. In such a case, the skin lesions would develop within a few hours (Approx. 4hours) of transfusion along with pruritus. The condition may even present with other symptoms, such as conjunctival oedema, oedema in the lips and tongue, and even localised angioedema. On rare occasions, the condition may even escalate to anaphylactic shock where pulmonary restrictions are seen. The associated cause for this is a reaction against an allergen that is seldom identified during testing. Transfusing products with anti-IgA antibodies to IgA-deficient patients has also been a suspected cause for such reactions. Management usually relates to the stoppage of transfusion for around 30minutes, until given antihistamines take effect. Transfusion may even be continued after, if no further progression is seen."}
{"_id": "WikiPedia_Dermatology$$$corpus_2559", "text": "Nevi and melanomas  are a group of neoplasia."}
{"_id": "WikiPedia_Dermatology$$$corpus_2560", "text": "Although a  nevus  and a  melanoma  are often treated as independent entities, there is evidence that a nevus can be a precursor for a melanoma. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2561", "text": "Common mutations have been identified in nevi and melanomas. [ 2 ] [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2562", "text": "Nevus  ( pl. :  nevi ) is a nonspecific medical term for a visible, circumscribed,  chronic   lesion  of the  skin  or  mucosa . [ 1 ]  The term originates from  n\u00e6vus , which is Latin for \" birthmark \"; however, a nevus can be either congenital (present at birth) or acquired. Common terms, including  mole ,  birthmark , and  beauty mark , are used to describe nevi, but these terms do not distinguish specific types of nevi from one another."}
{"_id": "WikiPedia_Dermatology$$$corpus_2563", "text": "The term  nevus  is applied to a number of conditions caused by  neoplasias  and  hyperplasias  of  melanocytes , [ 2 ]  as well as a number of pigmentation disorders, both hypermelanotic (containing increased  melanin , the pigment responsible for skin color) and hypomelanotic (containing decreased melanin). [ 3 ]  Suspicious skin moles which are multi-colored or pink may be a finding in  skin cancer . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2564", "text": "Additional types of nevi do not involve disorders of pigmentation or melanocytes. These additional nevi represent hamartomatous proliferations of the epithelium, [ 8 ]  connective tissue, [ 9 ]  and vascular malformations. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2565", "text": "These nevi represent excess growth of specific cells types found in the skin, including those that make up oil and sweat glands. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2566", "text": "Connective tissue nevi  represent abnormalities of  collagen  in the dermis, the deep layer of the skin. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2567", "text": "These nevi represent excess growth of blood vessels, including capillaries. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2568", "text": "An  intramucosal nevus  is a nevus within the  mucosa  as found in for example the mouth and genital areas. In the mouth, they are found most frequently on the hard palate. They are typically light brown and dome-shaped. [ 12 ]  Intramucosal nevi account for 64% of all reported case of oral nevi. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2569", "text": "Nevi are typically diagnosed clinically with the naked eye or using  dermatoscopy . More advanced imaging tests are available for distinguishing melanocytic nevi from melanoma, including computerized dermoscopy and image analysis. [ 14 ]  The management of nevi depends on the type of nevus and the degree of diagnostic uncertainty. Some nevi are known to be benign, and may simply be monitored over time. Others may warrant more thorough examination and  biopsy  for histopathological examination (looking at a sample of skin under a microscope to detect unique cellular features). For example, a clinician may want to determine whether a pigmented nevus is a type of melanocytic nevus, dysplastic nevus, or melanoma as some of these skin lesions pose a risk for malignancy. The ABCDE criteria (asymmetry, border irregularity, color variegation, diameter > 6\u00a0mm, and evolution) are often used to distinguish nevi from melanomas in adults, while modified criteria (amelanosis, bleeding or bumps, uniform color, small diameter or de novo, and evolution) can be used when evaluating suspicious lesions in children. [ 15 ]   In addition to histopathological examination, some lesions may also warrant additional tests to aid in diagnosis, including special stains,  immunohistochemistry , and electron microscopy. [ 16 ]  Typically, the nevi that exist since childhood are harmless."}
{"_id": "WikiPedia_Dermatology$$$corpus_2570", "text": "Hypermelanotic nevi must be differentiated from other types of pigmented skin lesions, including: [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2571", "text": "The management of a nevus depends on the specific diagnosis, however, the options for treatment generally include the following modalities:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2572", "text": "The decision to observe or treat a nevus may depend on a number of factors, including cosmetic concerns, irritative symptoms (e.g., pruritus), ulceration, infection, and concern for potential malignancy. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2573", "text": "The term nevus is included in the names of multiple dermatologic syndromes:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2574", "text": "Orthokeratosis  is  hyperkeratosis  without  parakeratosis . No nucleus is seen in the cells. There is also formation of an anuclear keratin layer, [ 1 ]  as in the normal epidermis."}
{"_id": "WikiPedia_Dermatology$$$corpus_2575", "text": "Pagetoid  is a term used in dermatology to refer to \"upward spreading\" of abnormal cells in the epidermis (ie from bottom to top). It is uncommon and a possible indication of a precancerous or cancerous condition. Cells display pagetoid growth when they invade the upper epidermis from below.  Squamous cell carcinoma ,  melanoma   in situ , Pagetoid  Bowen's disease , ocular sebaceous carcinoma, and other  carcinomas  can all display pagetoid growth."}
{"_id": "WikiPedia_Dermatology$$$corpus_2576", "text": "The term  pagetoid  (i.e., 'Paget-like') is derived from the  extramammary Paget's disease , wherein the large tumour cells are arranged singly or in small clusters within the epidermis and its appendages. These cells are distinguished by a clear halo from the surrounding epithelial cells and a finely granular cytoplasm. [ 1 ]  This proliferation of cells in the epidermis is responsible for the \"buckshot scatter\" pattern. [ 2 ]  This is a typical feature of superficial spreading type of  melanoma ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2577", "text": "Pallor  is a pale color of the  skin  that can be caused by illness, emotional shock or stress, stimulant use, or  anemia , and is the result of a reduced amount of  oxyhaemoglobin  and may also be visible as pallor of the  conjunctivae of the eyes  on physical examination."}
{"_id": "WikiPedia_Dermatology$$$corpus_2578", "text": "Pallor is more evident on the  face  and  palms . It can develop suddenly or gradually, depending on the cause. It is not usually clinically significant unless it is accompanied by a general pallor (pale  lips ,  tongue , palms,  mouth  and other regions with  mucous membranes ). It is distinguished from similar presentations such as  hypopigmentation  (lack or loss of skin  pigment ) or simply a fair complexion."}
{"_id": "WikiPedia_Dermatology$$$corpus_2579", "text": "Papillomatosis  is skin surface elevation caused by  hyperplasia  and enlargement of  contiguous   dermal papillae . [ 1 ]  These papillary projections of the epidermis form an undulating surface under microscopic examination."}
{"_id": "WikiPedia_Dermatology$$$corpus_2580", "text": "A  papule  is a small, well-defined bump in the  skin . [ 2 ]  It may have a rounded, pointed or flat top, and may have a  dip . [ 2 ]  It can appear with a  stalk , be thread-like or look  warty . [ 3 ]  It can be soft or firm and its surface may be rough or smooth. [ 2 ]  Some have  crusts  or  scales . [ 2 ]  A papule can be flesh colored, yellow, white, brown, red, blue or purplish. [ 4 ]  There may be just one or many, and they may occur irregularly in different parts of the body or appear in clusters. [ 2 ]  It does not contain fluid but may progress to a  pustule  or  vesicle . [ 2 ]  A papule is smaller than a  nodule ; it can be as tiny as a pinhead and is typically less than 1\u00a0cm in width, according to some sources, [ 2 ] [ 3 ]  and 0.5\u00a0cm according to others. [ 4 ]  When merged together, it appears as a plaque. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2581", "text": "A papule's colour might indicate its cause, such as white in  milia , red in  eczema ,  yellowish  in  xanthoma  and black in  melanoma . [ 2 ]  They may open when scratched and become infected and crusty. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2582", "text": "A papule is a small, well-defined bump in the  skin . [ 2 ]  It is smaller than a  nodule ; it can be as tiny as a pinhead and is typically less than 1\u00a0cm in width, according to some sources, [ 2 ] [ 3 ]  and 0.5\u00a0cm according to others. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2583", "text": "A papule may have a rounded, pointed or flat top, and may have a dip. [ 2 ]   It can be polygonal but is never rectangular or square. [ 6 ]  It can appear with a  stalk , be thread-like or look  warty . [ 3 ]  Ulceration, oozing, bleeding or thin blood vessels may be present in a papule. [ 6 ]  It can be soft or firm and its surface may be rough or smooth. [ 2 ]  Some have  crusts  or  scales . [ 2 ]  A papule can be flesh colored, yellow, white, brown, black, blue or purplish, or varying shades of red. [ 4 ] [ 6 ]  The intensity of redness might indicate how long the papule has been present. [ 6 ]  There may be just one or many, and they may occur irregularly in different parts of the body or appear in clusters. [ 2 ]  It may progress to a pustule or vesicle. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2584", "text": "Angiofibromas  are papules, types of which include the usually solitary  fibrous papule of the nose  and  periungual angiofibroma , and multiple in  pearly penile papules , and the  facial angiofibromas  as may be seen in  tuberous sclerosis . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2585", "text": "Papules with scale on the palms and soles may occur in  secondary syphilis ,  psoriasis ,  eczema ,  tinea manuum ,  mycosis fungoides . [ 6 ]  In  lichen planus  papules may be itchy, flat-topped, polygonal, purplish with white streaks, and can be solitary, or occur in clusters or in a line. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2586", "text": "A  papulopustular  condition is a condition composed of both  papule  and  pustules . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2587", "text": "Examples of papulopustular conditions include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2588", "text": "A  papulosquamous disorder  is a condition which presents with both  papules  and  scales , [ 1 ]  or both scaly papules and  plaques . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2589", "text": "Examples include  psoriasis ,  lichen planus , [ 3 ]  and  pityriasis rosea . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2590", "text": "Parakeratosis  is a mode of  keratinization  characterized by the retention of nuclei in the  stratum corneum . [ 1 ]  In  mucous membranes , parakeratosis is normal. [ 2 ]   In the skin, this process leads to the abnormal replacement of  annular   squames  with  nucleated  cells. Parakeratosis is associated with the thinning or loss of the  granular layer  and is usually seen in diseases of increased cell turnover, whether  inflammatory  or  neoplastic . Parakeratosis is seen in the plaques of  psoriasis  and in  dandruff ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2591", "text": "Granular parakeratosis (originally termed axillary granular parakeratosis) is an  idiopathic , benign, nondisabling cutaneous disease that manifests with  intertriginous   erythematous , brown or red, scaly or keratotic  papules  and  plaques . It presents in all age groups and has no established clinical associations. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2592", "text": "Paraneoplastic keratoderma  is a cutaneous condition characterized by a hornlike skin texture associated with an internal malignancy. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2593", "text": "Pathergy  is a skin condition in which a minor trauma such as a bump or bruise leads to the development of skin lesions or ulcers that may be resistant to healing.  Pathergy can also lead to ulcerations at the site of surgical incisions. Pathergy is seen with both  Beh\u00e7et's disease  and  pyoderma gangrenosum . [ 1 ]   A highly similar phenomenon known as the  Koebner phenomenon  occurs in  autoimmune diseases  such as  psoriasis  and  systemic lupus erythematosus , among others."}
{"_id": "WikiPedia_Dermatology$$$corpus_2594", "text": "Doctors looking toward a diagnosis of Beh\u00e7et's disease may attempt to induce a pathergy reaction with a test known as a \"skin prick test\". [ 2 ]  The inflammation and ulceration that occurs as a result of pathergy in pyoderma gangrenosum often responds to systemic steroid therapy."}
{"_id": "WikiPedia_Dermatology$$$corpus_2595", "text": "The pathergy reaction is a unique feature of Beh\u00e7et's disease and, according to the International Study Group for Behcet's Disease, is among the major criteria required for the diagnosis. Different positive pathergy reaction rates in BD have been reported worldwide. When BD-positive groups are studied for pathergy reaction, the pathergy-positive and pathergy-negative BD groups showed a similar male: female ratio, age at disease onset, and mean disease duration. They also exhibited similar  HLA-B51  levels and a similar frequency of oral ulcerations in close family members. The mucocutaneous manifestations, systemic disease expression, and severity score were similar in patients with and without the pathergy reaction. The presence of a positive pathergy reaction is not associated with an increased risk for specific mucocutaneous or systemic manifestations of the disease, and probably does not predict a more severe disease course. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2596", "text": "It is also important to note that, while a positive pathergy reaction helps to confirm a specific Beh\u00e7et's disease diagnosis, a negative reaction does not invalidate a BD diagnosis, because the disease process has to be active at the time of the skin prick test to produce a pathergy reaction. Differences in positive/negative pathergy and severity of the reaction depend on disease activity, ethnicity, type of needle used for the prick test, among other factors. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2597", "text": "Pathergy test is done both orally and cutaneous."}
{"_id": "WikiPedia_Dermatology$$$corpus_2598", "text": "Orally, the lower lip is the site of testing. Appearance of any ulcer or papule indicates a positive pathergy reaction."}
{"_id": "WikiPedia_Dermatology$$$corpus_2599", "text": "Cutaneous sites are the flexor forearm."}
{"_id": "WikiPedia_Dermatology$$$corpus_2600", "text": "Physical urticaria  is a distinct subgroup of  urticaria  (hives) that are induced by an exogenous physical stimulus rather than occurring spontaneously. [ 1 ]  There are seven subcategories that are recognized as independent diseases. [ 2 ] [ 3 ]  Physical urticaria is known to be painful, itchy and physically unappealing; it can recur for months to years. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2601", "text": "Urticaria are characterized by dermal  edema  (wheal, swollen) and  erythema  (flare, red), [ 2 ]  also known as hives. [ 5 ]  Hive lesions typically last less than 24 hours and are usually  itchy  (pruritic). [ 2 ]  Hives can appear anywhere on the body and they may change shape, move around, disappear and reappear over short periods of time. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2602", "text": "Acute urticaria (short-term): can develop suddenly and will last less than six weeks. [ 6 ]  About one in six people will have acute hives at one point in their life. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2603", "text": "Chronic urticaria (long-term): can develop suddenly and will persist more than six weeks. [ 6 ]  This type of urticaria is uncommon [ 6 ]  and occurs in only 0.1% of the population. [ 7 ]  20% of people with chronic urticaria report still having problems 10 years after its onset. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2604", "text": "The cause of physical urticaria is unknown but it has been suggested to be an  autoimmune  disease, suggesting that antibodies, which are produced by the immune system to protect humans from foreign microbes, are binding to body tissue and damaging it. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2605", "text": "In some cases physical urticaria can be a symptom of an underlying health issue such as: [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2606", "text": "There are seven sub-categories of physical urticaria:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2607", "text": "Antihistamine  agents are the typically prescribed drug for the treatment of physical urticaria. [ 2 ]  They block the effect of histamine, a compound produced by the body which forms a part of the local immune response consequently causing inflammation. [ 6 ]  Some research has suggested that the use of antihistamines and  antagonists  in synergy are better for the treatment of physical urticarias. [ 11 ] [ 12 ] [ better\u00a0source\u00a0needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2608", "text": "The cascade of events that link the autoantibody-antigen reaction with the production and release of histamine is not well characterized. Therefore, the focus of treatment for physical urticaria has been on characterizing the effectiveness of antihistamines rather than analysis of receptor binding or the pathomechanisms. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2609", "text": "A  pimple  or  zit  is a kind of  comedo  that results from excess  sebum  and dead skin cells getting trapped in the pores of the skin. In its aggravated state, it may evolve into a  pustule  or  papule . [ 1 ]  Pimples can be treated by  acne  medications,  antibiotics , and  anti-inflammatories  prescribed by a physician, or various  over the counter  remedies purchased at a pharmacy."}
{"_id": "WikiPedia_Dermatology$$$corpus_2610", "text": "Sebaceous glands  inside the pore of the skin produce  sebum . When the outer layers of skin shed (a natural and continuous process, normally), dead skin and oily sebum left behind may bond together and form a blockage of the  sebaceous gland  at the base of the skin. This is most common when the skin becomes thicker at  puberty . [ 2 ]  The sebaceous gland continues to produce sebum, which builds up behind the blockage, allowing  bacteria  to grow in the area, including the species  Staphylococcus aureus  and  Cutibacterium acnes , which causes inflammation and infection. Other causes of pimples include family history,  stress , fluctuations in  hormone  levels, hair and skincare products, medication  side effects , and un-diagnosed or underlying medical conditions. [ 3 ]  Pimples can be part of the presentation of  rosacea . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2611", "text": "The American Academy of Dermatology recommends that adults with acne use products labeled as \"non-comedogenic\", \"non-acnegenic\", \"oil-free\" or \"won\u2019t clog pores\", as they are \"least likely\" to cause skin irritation or acne. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2612", "text": "Common  over-the-counter medications  for pimples are  benzoyl peroxide ,  salicylic acid ,  adapalene , and antibacterial agents such as  triclosan . These topical medications, which can be found in many creams and gels used to treat acne (acne vulgaris), induce skin to slough off more easily, helping to remove bacteria faster. Before application, the face should be washed with warm water or a topical cleanser and then dried."}
{"_id": "WikiPedia_Dermatology$$$corpus_2613", "text": "A regimen of keeping the affected skin area clean, plus the regular application of these topical medications is usually enough to keep acne under control, if not at bay altogether. The most common product is a topical treatment of benzoyl peroxide, which has minimal risk apart from minor skin irritation that may present similar as a mild allergy. [ 6 ]  Recently,  nicotinamide  (vitamin B 3 ), applied topically, has been shown to be more effective in treatment of pimples than  antibiotics  such as  clindamycin . [ 7 ]  Nicotinamide is not an antibiotic and has no  side effects  typically associated with antibiotics. It has the added advantage of reducing skin  hyperpigmentation  which results in pimple scars. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2614", "text": "Severe acne usually indicates the necessity of prescription medication to treat the pimples. Prescription medications used to treat acne and pimples include  isotretinoin , which is a  retinoid , anti-seborrheic medications, anti-androgen medications, hormonal treatments,  alpha hydroxy acid ,  azelaic acid , and  keratolytic  soaps. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2615", "text": "Historically,  antibiotics  such as  tetracyclines  and  erythromycin  were prescribed. While they were more effective than topical applications of benzoyl peroxide, the bacteria eventually grew resistant to the antibiotics and the treatments became less and less effective. Also, antibiotics had more side effects than topical applications, such as stomach cramps and severe discoloration of teeth. Common antibiotics prescribed as of 2001 by dermatologists included  doxycycline  and minocycline. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2616", "text": "Isotretinoin  is used primarily for severe cystic acne and acne that has not responded to other treatments. [ 11 ] [ 12 ] [ 13 ] [ 14 ]  Many dermatologists also support its use for treatment of lesser degrees of acne that prove resistant to other treatments, or that produce physical or psychological scarring. [ 15 ]  It is  teratogenic , and requires strict prevention of pregnancy during its use."}
{"_id": "WikiPedia_Dermatology$$$corpus_2617", "text": "Expression, the manual bursting of pimples which have evolved into  whiteheads  with one's fingers (colloquially, \"popping\"), can allow bacteria to be introduced into the open wound this creates. This can result in infection and permanent scarring. Thus expression is generally recommended against by  dermatologists  and  estheticians  in favour of allowing pimples to run through their natural lifespans. [ 16 ] [ 17 ] [ 18 ] [ 19 ] [ 20 ]  Some dermatologists offer incision and drainage services to sterilely drain the pimple. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2618", "text": "Pityriasis  commonly refers to flaking (or scaling) [ 1 ]  of the  skin . The word comes from the Greek \u03c0\u03af\u03c4\u03c5\u03c1\u03bf\u03bd ' bran '."}
{"_id": "WikiPedia_Dermatology$$$corpus_2619", "text": "Poliosis circumscripta , commonly referred to as a \"white  forelock \", is a condition characterized by localized patches of white hair due to a reduction or absence of  melanin  in hair follicles. Although traditionally associated with the scalp, poliosis can affect any hairy area on the body, including eyebrows, eyelashes, and beards. Microscopically, poliosis is marked by the lack of melanin or  melanocytes  in the  hair bulbs , though  epidermal  melanocytes typically remain unaffected unless associated with conditions like  vitiligo . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2620", "text": "Poliosis can be congenital and often occurs in the context of various genetic syndromes. These disorders are typically linked to other systemic manifestations."}
{"_id": "WikiPedia_Dermatology$$$corpus_2621", "text": "In addition to genetic factors, poliosis can develop due to various inflammatory, autoimmune, or  neoplastic  conditions, or as a side effect of medication."}
{"_id": "WikiPedia_Dermatology$$$corpus_2622", "text": "Several genetic and acquired disorders can mimic poliosis, and they should be considered during diagnosis:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2623", "text": "Poliosis occurs in several genetic syndromes such as  piebaldism ,  Waardenburg syndrome ,  neurofibromatosis type I , and  tuberous sclerosis . [ 16 ]  It can also occur in conditions such as  vitiligo ,  Vogt\u2013Koyanagi\u2013Harada disease ,  alopecia areata , and  sarcoidosis , and in association with  neoplasms  and some medications. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2624", "text": "Psoriasis Area and Severity Index  ( PASI ) is the most widely used tool for the measurement of severity of  psoriasis . PASI combines the assessment of the severity of  lesions  and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease). [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2625", "text": "The body is divided into four sections ( head  (H) (10% of a person's  skin );  arms  (A) (20%);  trunk  (T) (30%);  legs  (L) (40%)). Each of these areas is scored by itself, and then the four scores are combined into the final PASI. For each section, the percent of area of skin involved, is estimated and then transformed into a grade from 0 to 6:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2626", "text": "Within each area, the severity is estimated by three clinical signs:  erythema  (redness),  induration  (thickness) and  desquamation  (scaling). Severity parameters are measured on a scale of 0 to 4, from none to maximum."}
{"_id": "WikiPedia_Dermatology$$$corpus_2627", "text": "The sum of all three severity parameters is then calculated for each section of skin, multiplied by the area score for that area and multiplied by weight of respective section (0.1 for head, 0.2 for arms, 0.3 for body and 0.4 for legs)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2628", "text": "PASI is widely used in clinical trials of therapies to treat psoriasis. Although absolute PASI score is often used to define entry into a trial, it is response to treatment that is important to measure efficacy and outcomes. This is usually presented as a percentage response rate; e.g., PASI 50, PASI 75, PASI 90, PASI 100."}
{"_id": "WikiPedia_Dermatology$$$corpus_2629", "text": "PASI 75, for example, represents the percentage (or number) of patients who have achieved a 75% or more reduction in their PASI score from baseline. PASI 100 indicates patients who have achieved a complete resolution of all disease. By definition a patient who has achieved PASI 75 has also achieved PASI 50. There is a gradual tendency, as therapies become more effective to report higher efficacy rates in clinical trials - but aiming high may not be without risk of over-treating some patients. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2630", "text": "Psoriatic  area  assessment and  severity  assessments were found to be non-reproducible. Several automated procedure for more reproducible measurement of psoriatic area were developed, but were not suitable for large-scale  trials .  A method where the advantage of accurate computerized measurement of the area on the digital photograph was combined with physician's proficiency in determination of the edge of psoriatic lesion was published. [ 3 ]  The patients were examined and photographed before and after the therapy with calcipotriol ointment or placebo. The psoriatic area was manually outlined on the patient's photographs by physician and the area was automatically measured by a computer. For comparison, the physicians also made standard psoriatic area assessment.  Computer-aided measurement of psoriatic lesion area was found to improve the power of the clinical trial, compared to the standard approach.  The physician's estimations of the psoriatic lesion area tend to overestimate. The adapted PASI index, where the psoriatic area was not converted into an area grade, but was maintained as a continuous variable, also improved the power of the clinical trial.  The modified PASI which involves computer-aided area measurement as a continuous variable is named  Computer aided  psoriasis  continuous  area and severity score cPcASI."}
{"_id": "WikiPedia_Dermatology$$$corpus_2631", "text": "PASI can be too unwieldy to use outside of trials, which has led to attempts to simplify the index (SPASI) for clinical use. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2632", "text": "While higher PASI scores indicate more severe psoriasis, it is difficult for patients or doctors to describe the clinical severity for any specific PASI number.  Attempts have been made to address this problem by providing descriptions of psoriasis severity in evaluation systems, including the Psoriasis Global Assessment (PGA) and the Lattice-System Physician's Global Assessment (LS-PGA); a study compared and validated PASI, PGA, and LS-PGA. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2633", "text": "Purpura  ( / \u02c8 p \u025c\u02d0r p j\u028a\u0259r \u0259 / [ 1 ] ) is a condition of  red or purple discolored spots on the  skin  that do not  blanch  on applying pressure. The spots are caused by  bleeding  underneath the skin secondary to platelet disorders, vascular disorders, coagulation disorders, or other causes. [ 2 ]  They measure 3\u201310\u00a0mm, [ 3 ]  whereas  petechiae  measure less than 3\u00a0mm, and  ecchymoses  greater than 1\u00a0cm. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2634", "text": "Purpura is common with  typhus  and can be present with  meningitis  caused by meningococci or  septicaemia .  In particular, meningococcus ( Neisseria meningitidis ), a  Gram-negative  diplococcus organism, releases endotoxin when it  lyses .  Endotoxin activates the Hageman factor (clotting factor XII), which causes  disseminated intravascular coagulation  (DIC).  The DIC is what appears as a rash on the affected individual."}
{"_id": "WikiPedia_Dermatology$$$corpus_2635", "text": "Purpura are a common and nonspecific medical sign; however, the underlying mechanism commonly involves one of:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2636", "text": "Cases of  psychogenic  purpura are also described in the medical literature, [ 6 ]  some claimed to be due to \"autoerythrocyte sensitization\". Other studies [ 7 ]  suggest the local (cutaneous) activity of  tissue plasminogen activator  can be increased in psychogenic purpura, leading to substantial amounts of localized plasmin activity, rapid degradation of fibrin clots, and resultant bleeding. Petechial rash is also characteristic of a  rickettsial  infection."}
{"_id": "WikiPedia_Dermatology$$$corpus_2637", "text": "The word  purpura  ( / \u02c8 p \u025c\u02d0r p \u025c\u02d0r \u0259 / ) comes from Latin  purpura , \" purple \", which came from ancient Greek \u03c0\u03bf\u03c1\u03c6\u03cd\u03c1\u03b1.  Purpura  is a  mass noun  naming the condition or state, not the name of an individual spot (thus there is no * purpurum , * purpura  or * purpura , * purpurae  count declension)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2638", "text": "Pyoderma  means any  skin disease  that is  pyogenic  (has pus). These include superficial bacterial infections such as  impetigo ,  impetigo contagiosa ,  ecthyma ,  folliculitis ,  Bockhart's impetigo ,  furuncle ,  carbuncle ,  tropical ulcer , etc. [ 1 ] [ 2 ]   Autoimmune  conditions include  pyoderma gangrenosum . Pyoderma affects more than 111 million children worldwide, making it one of the three most common skin disorders in children along with  scabies  and  tinea . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2639", "text": "A  rash  is a change of the  skin  that affects its color, appearance, or texture."}
{"_id": "WikiPedia_Dermatology$$$corpus_2640", "text": "A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color,  itch , become warm, bumpy,  chapped , dry, cracked or  blistered , swell, and may be painful.\nThe causes, and therefore treatments for rashes, vary widely. Diagnosis must take into account such things as the appearance of the rash, other symptoms, what the patient may have been exposed to, occupation, and occurrence in family members. The diagnosis may confirm any number of conditions.\nThe presence of a rash may aid diagnosis; associated signs and symptoms are diagnostic of certain diseases. For example, the rash in  measles  is an  erythematous ,  morbilliform ,  maculopapular rash  that begins a few days after the fever starts. It classically starts at the head, and spreads downwards."}
{"_id": "WikiPedia_Dermatology$$$corpus_2641", "text": "Common causes of rashes include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2642", "text": "Uncommon causes:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2643", "text": "The causes of a rash are numerous, which may make the evaluation of a rash extremely difficult. An accurate evaluation by a provider may only be made in the context of a thorough history, i.e. medications the patient is taking, the patient's occupation, where the patient has been and complete physical examination. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2644", "text": "Points typically noted in the examination include: [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2645", "text": "A  patch test  may be ordered, for diagnostic purposes. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2646", "text": "Treatment differs according to which rash a patient has been diagnosed with. Common rashes can be easily remedied using steroid topical creams (such as  hydrocortisone ) or non-steroidal treatments. Many of the medications are available over the counter in the United States. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2647", "text": "The problem with steroid topical creams i.e. hydrocortisone; is their inability to penetrate the skin through absorption and therefore not be effective in clearing up the affected area, thus rendering the hydrocortisone almost completely ineffective in all except the most mild of cases. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2648", "text": "The  SCORAD  (\"SCORing Atopic Dermatitis\") index is a clinical tool for assessing the extent of the disease, disease intensity, and subjective symptoms of  atopic dermatitis . [ 1 ]  It gives approximate weights of 60% to intensity and 20% each to extent and subjective symptoms. These are used to calculate a maximum total score of 103, however, the scores for each category can be used individually if clinically appropriate. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2649", "text": "The SCORAD index was developed by the European Task Force on Atopic Dermatitis in 1993. [ 3 ]  The index was the most widely used disease-severity scale for atopic dermatitis between its development and 2010. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2650", "text": "To calculate the SCORAD index, the extent of disease is determined using the  rule of nines  to estimate percentage of the affected body surface area. The maximum value for the extent of the disease is 100%."}
{"_id": "WikiPedia_Dermatology$$$corpus_2651", "text": "Disease intensity is then calculated based on six characteristics:  erythema ,  edema , oozing/crusts, excoriations,  lichenification , and dryness. Each characteristic is given a score between 0 and 3, where 0 is absent and 3 is severe. The scores for each characteristic are added together for a total intensity score of up to 18."}
{"_id": "WikiPedia_Dermatology$$$corpus_2652", "text": "Subjective symptoms including sleep loss and  pruritus  are measured using a 10\u00a0cm  visual analogue scale  with a total maximum score of 20."}
{"_id": "WikiPedia_Dermatology$$$corpus_2653", "text": "The SCORAD index is then calculated with the following formula:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2654", "text": "The  SCORTEN scale  (SCORe of Toxic Epidermal Necrosis) is a severity-of-illness scale with which the severity of certain  bullous  conditions can be systematically determined. It was originally developed for  toxic epidermal necrolysis , [ 1 ]  but can be used with burn victims, sufferers of  Stevens\u2013Johnson syndrome , cutaneous drug reactions, or exfoliative wounds. [ citation needed ]  These conditions have in common that they compromise the integrity of the skin and/or mucous membranes."}
{"_id": "WikiPedia_Dermatology$$$corpus_2655", "text": "In the SCORTEN Scale 7 independent risk factors for high mortality are systematically scored, so as to determine the  mortality rate  for that particular patient."}
{"_id": "WikiPedia_Dermatology$$$corpus_2656", "text": "The more risk factors present, the higher the SCORTEN score, and the higher the mortality rate, as shown in the following table."}
{"_id": "WikiPedia_Dermatology$$$corpus_2657", "text": "A  skin fissure  is a  cutaneous condition  in which there is a linear-like cleavage of  skin , sometimes defined as extending into the  dermis . [ 1 ]  It is smaller than a skin  laceration ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2658", "text": "A skin area on which there are many skin fissures is called  cracked skin , and is most commonly a result of  skin dryness .  Ichthyosis  is a  genetic disorder  where there is often severe skin cracking."}
{"_id": "WikiPedia_Dermatology$$$corpus_2659", "text": "Spongiosis  is mainly intercellular [ 1 ]   edema  (abnormal accumulation of fluid) in the  epidermis , [ 2 ]  and is characteristic of eczematous  dermatitis , manifested clinically by intraepidermal  vesicles  (fluid-containing spaces), \"juicy\"  papules , and/or  lichenification . [ 3 ]  It is a severe case of eczema that affects the epidermis, dermis or subcutaneous skin tissues. [ 4 ]  The three types of spongiotic dermatitis are acute, subacute and chronic. [ 4 ]  A dermatologist can diagnose acute spongiotic dermatitis by examining the skin during an office visit, but a biopsy is needed for an accurate diagnosis of the type. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2660", "text": "It can be caused by several internal or external factors, such as food, an insect bite, stress, medication or cosmetics. The treatment varies depending on the type and severity; it is normally treated with topical corticosteroid cream. [ medical citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2661", "text": "Telangiectasias  (from   tel- \u00a0'end'   angi- \u00a0' blood vessel ' and    ectasia \u00a0'the expansion of a hollow or tubular organ'), also known as  spider veins , are small  dilated  blood vessels [ 1 ]  that can occur near the surface of the skin or  mucous membranes , measuring between 0.5 and 1 millimeter in diameter. [ 2 ]  These dilated blood vessels can develop anywhere on the body, but are commonly seen on the face around the nose, cheeks and chin. Dilated blood vessels can also develop on the legs, although when they occur on the legs, they often have underlying  venous reflux  or \"hidden varicose veins\" (see  Venous hypertension  section below). When found on the legs, they are found specifically on the upper thigh, below the  knee joint  and around the ankles."}
{"_id": "WikiPedia_Dermatology$$$corpus_2662", "text": "Many patients with spider veins seek the assistance of physicians who specialize in vein care or peripheral vascular disease. These physicians are called  vascular surgeons  or  phlebologists . More recently,  interventional radiologists  have started treating venous problems."}
{"_id": "WikiPedia_Dermatology$$$corpus_2663", "text": "Some telangiectasias are due to developmental abnormalities that can closely mimic the behaviour of  benign   vascular neoplasms . They may be composed of abnormal aggregations of  arterioles ,  capillaries  or  venules . Because telangiectasias are vascular lesions, they  blanch  when tested with  diascopy ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2664", "text": "Telangiectasias, aside from presenting in many other conditions, are one of the features of the acronymically named  CREST syndrome , a form of  systemic scleroderma . The syndrome recognises the significantly co-presenting symptoms of  calcinosis ,  Raynaud's phenomenon ,  esophageal dysmotility ,  sclerodactyly  and telangiectasia."}
{"_id": "WikiPedia_Dermatology$$$corpus_2665", "text": "The causes of telangiectasia can be divided into  congenital  and acquired factors."}
{"_id": "WikiPedia_Dermatology$$$corpus_2666", "text": "Goldman states that \"numerous inherited or congenital conditions display cutaneous telangiectasia\". [ 2 ]  These include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2667", "text": "In the past, it was believed that leg varicose veins or telangiectasia were caused by high venous pressure or \"venous hypertension\". However it is now understood that venous reflux disease is usually the cause of these problems. [ 4 ] [ full citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2668", "text": "Telangiectasia in the legs is often related to the presence of venous reflux within underlying  varicose veins . Flow abnormalities in smaller veins known as  reticular veins  or  feeder veins  under the skin can also cause spider veins to form, thereby making a recurrence of spider veins in the treated area less likely."}
{"_id": "WikiPedia_Dermatology$$$corpus_2669", "text": "Factors that predispose to the development of  varicose  and telangiectatic leg veins include"}
{"_id": "WikiPedia_Dermatology$$$corpus_2670", "text": "Acquired telangiectasia, not related to other venous abnormalities, for example on the face and trunk, can be caused by factors such as"}
{"_id": "WikiPedia_Dermatology$$$corpus_2671", "text": "Before any treatment of leg telangiectasia is considered, it is essential to have  duplex ultrasonography , the test that has replaced Doppler ultrasound. The reason for this is that there is a clear association between leg telangiectasia and underlying venous reflux. [ 12 ]  Research has shown that 88\u201389% of women with telangiectasia have refluxing reticular veins close, [ 13 ]  and 15% have incompetent  perforator veins  nearby. [ 14 ]  As such, it is essential to both find and treat underlying venous reflux before considering any treatment at all."}
{"_id": "WikiPedia_Dermatology$$$corpus_2672", "text": "Sclerotherapy  is the \"gold standard\" and is preferred over laser for eliminating telangiectasiae and smaller varicose leg veins. [ 15 ]  A sclerosant medication is injected into the diseased vein so it hardens and eventually shrinks away. Recent evidence with foam sclerotherapy shows that the foam containing the irritating sclerosant quickly appears in the patient's heart and lungs, and then in some cases travels through a patent foramen ovale to the brain. [ 16 ]  This has led to concerns about the safety of sclerotherapy for telangiectasias."}
{"_id": "WikiPedia_Dermatology$$$corpus_2673", "text": "In some cases  stroke  and  transient ischemic attacks  have occurred after sclerotherapy. [ 17 ]   Varicose veins  and reticular veins are often treated before treating telangiectasia, although treatment of these larger veins in advance of sclerotherapy for telangiectasia may not guarantee better results. [ 18 ] [ 19 ] [ 20 ]  Varicose veins can be treated with foam sclerotherapy,  endovenous laser treatment ,  radiofrequency ablation , or open surgery.  The biggest risk, however, seems to occur with sclerotherapy, especially in terms of  systemic risk  of  DVT ,  pulmonary embolism , and stroke. [ citation needed ] \nOther issues which arise with the use of sclerotherapy to treat spider veins are staining, shadowing, telangiectatic matting, and ulceration.  In addition, incompleteness of therapy is common, requiring multiple treatment sessions. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2674", "text": "Telangiectasias on the face are often treated with a laser. Laser therapy uses a light beam that is pulsed onto the veins in order to seal them off, causing them to dissolve. These light-based treatments require adequate heating of the veins.  These treatments can result in the destruction of  sweat glands , and the risk increases with the number of treatments. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2675", "text": "The  triple response of Lewis  is a cutaneous response that occurs from firm stroking of the  skin . This produces an initial  red  line, followed by a flare around that line, and then finally a  wheal ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2676", "text": "The triple response consists of three aspects:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2677", "text": "The red spot emerges within 15  seconds . [ 4 ]  Flare can take up to 45 seconds to begin. [ 4 ]  Wheal can take up to 3  minutes  to begin. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2678", "text": "The triple response is caused by firm stroking of the skin with a pointed object. [ 5 ]   but some time at caused by capillary vasodilation. [ citation needed ]  \nThe triple response of Lewis is particularly sensitive in people with  dermatographia urticaria . [ 4 ] [ 5 ]  Some form of dermatographia is present in around 5% of the population. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2679", "text": "The triple response of Lewis is due to the release of  histamine .  Histamine , or 2-(imidazol-4-yl)ethanamine, is a dibasic  vasoactive   amine  that is located in most body tissues but is highly concentrated in the lungs, skin, and gastrointestinal tract. Histamine is a  small molecule , stored in granules of  mast cells  and  basophils . Mast cells and basophils are the effector cells involved in the immediate hypersensitivity response. Found in tissues throughout the body, they are particularly associated with blood vessels and nerves, and are in proximity to surfaces that border the external environment."}
{"_id": "WikiPedia_Dermatology$$$corpus_2680", "text": "The underlying  pathophysiology  of  frostbite  is a combination of freezing, vascular insufficiency (constriction and occlusion) and damage due to inflammatory mediators. As extremities cool, the \u2018hunting response of Lewis\u2019 (alternating vasoconstriction and vasodilation) occurs, ending with vasoconstriction. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2681", "text": "An  ulcer  is a sore on the  skin  or a  mucous membrane , accompanied by the disintegration of tissue. Ulcers can result in complete loss of the  epidermis  and often portions of the  dermis  and even  subcutaneous fat . Ulcers are most common on the skin of the  lower extremities  and in the  gastrointestinal tract . An ulcer that appears on the skin is often visible as an inflamed tissue with an area of reddened skin. A skin ulcer is often visible in the event of exposure to heat or cold, irritation, or a problem with  blood circulation ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2682", "text": "They can also be caused due to a lack of mobility, which causes prolonged pressure on the tissues. This stress in the blood circulation is transformed to a skin ulcer, commonly known as  bedsores or decubitus ulcers . [ 1 ]  Ulcers often become  infected , and  pus  forms."}
{"_id": "WikiPedia_Dermatology$$$corpus_2683", "text": "Skin ulcers appear as open craters, often round, with layers of skin that have eroded. The skin around the ulcer may be red, swollen, and tender. Patients may feel pain on the skin around the ulcer, and fluid may ooze from the ulcer. In some cases, ulcers can  bleed  and, rarely, patients experience  fever . Ulcers sometimes seem not to heal; healing, if it does occur, tends to be slow. Ulcers that heal within 12 weeks are usually classified as  acute , and longer-lasting ones as  chronic . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2684", "text": "Ulcers develop in stages. In stage 1 the skin is red with soft underlying  tissue . In the second stage the redness of the skin becomes more pronounced, swelling appears, and there may be some  blisters  and loss of outer skin layers. During the next stage, the skin may become  necrotic  down through the deep layers of skin, and the  fat  beneath the skin may become exposed and visible. In stage 4, deeper necrosis usually occurs, the fat underneath the skin is completely exposed, and the  muscle  may also become exposed. In the last two stages the sore may cause a deeper loss of fat and necrosis of the muscle; in severe cases it can extend down to  bone  level, destruction of the bone may begin, and there may be  sepsis  of  joints ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2685", "text": "Chronic ulcers may be  painful . Most patients complain of constant pain at night and during the day. Chronic ulcer symptoms usually include increasing pain, friable granulation tissue, foul odour, and wound breakdown instead of healing. [ 3 ]  Symptoms tend to worsen once the wound has become infected."}
{"_id": "WikiPedia_Dermatology$$$corpus_2686", "text": "Venous skin ulcers  that may appear on the lower leg, above the  calf  or on the lower  ankle  usually cause achy and swollen legs. If these ulcers become infected they may develop an unpleasant odour, increased tenderness and redness. Before the ulcer establishes definitively, there may be a dark red or purple skin over the affected area as well as a thickening, drying, and itchy skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_2687", "text": "Although skin ulcers do not seem of great concern at a first glance, they are worrying conditions especially in people with  diabetes , as they are at risk of developing diabetic  neuropathy ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2688", "text": "Ulcers may also appear on the  cheeks ,  soft palate , the  tongue , and on the inside of the lower  lip . These ulcers usually last from 7 to 14 days and can be painful. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2689", "text": "Different types of discharges from ulcer are: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2690", "text": "The wounds from which ulcers arise can be caused by a wide variety of factors, but the main cause is impaired blood circulation. Especially,  chronic wounds  and ulcers are caused by poor circulation, either through cardiovascular issues or external pressure from a  bed  or a  wheelchair . [ 3 ]  A very common and dangerous type of skin ulcer is caused by what are called pressure-sensitive sores, more commonly called bed sores, which are frequent in people who are bedridden or who use wheelchairs for long periods. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2691", "text": "Other causes producing skin ulcers include  bacterial  and  viral infections ,  fungal infections   [ 6 ]  and  cancers . Blood disorders and chronic wounds can result in skin ulcers as well. [ 7 ]  Venous leg ulcers due to impaired circulation or a blood flow disorder are more common in the  elderly ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2692", "text": "Rare causes of skin ulcers include pyoderma gangraenosum, lesions caused by Crohn's disease or ulcerative colitis, granulomatosis with polyangiitis, morbus Beh\u00e7et and infections that are usually seen in those who are immunocompromised, for example ecthyma gangraenosum. It is important to consider such causes if the skin ulcerations don't show improvement with antibiotic treatments and when other systemic symptoms are present. It is advised not to use surgical procedures on ulcerations caused by Beh\u00e7et or pyoderma gangraenosum since those diseases usually exhibit  pathergy ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2693", "text": "Wagner's grading of ulcer follows: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2694", "text": "Some of the investigations done for ulcer are: [ 5 ] :\u200a19"}
{"_id": "WikiPedia_Dermatology$$$corpus_2695", "text": "Skin ulcers may take a very long time to heal. Treatment is typically to avoid the ulcer getting infected, remove any excess discharge, maintain a moist wound environment, control the  edema , and ease pain caused by  nerve  and tissue damage."}
{"_id": "WikiPedia_Dermatology$$$corpus_2696", "text": "Topical antibiotics  are normally used to prevent the ulcer getting infected, and the wound or ulcer is usually kept clear of dead tissue through surgical  debridement ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2697", "text": "Commonly, as a part of the treatment, patients are advised to change their lifestyle if possible and to change their  diet . Improving the  circulation  is important in treating skin ulcers, and patients are consequently usually recommended to  exercise , stop  smoking , and lose weight."}
{"_id": "WikiPedia_Dermatology$$$corpus_2698", "text": "In recent years, advances have been made in accelerating healing of  chronic wounds  and ulcers. Chronic wounds produce fewer growth  hormones  than necessary for healing tissue, and healing may be accelerated by replacing or stimulating growth factors while controlling the formation of other substances that work against them. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2699", "text": "Leg ulcers can be prevented by using  compression stockings  to prevent blood pooling and back flow. It is likely that a person who has had a skin ulcer will have it again; use of compression stockings every day for at least five years after the skin ulcer has healed may help to prevent recurrence."}
{"_id": "WikiPedia_Dermatology$$$corpus_2700", "text": "There is limited evidence that  negative-pressure wound therapy  may be effective in reducing the time to healing of leg ulcers. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2701", "text": "Ulerythema  means \"scar plus redness,\" and refers to several different cutaneous conditions, including  atrophoderma vermiculatum  and  keratosis pilaris atrophicans faciei . [ 1 ] :\u200a1511"}
{"_id": "WikiPedia_Dermatology$$$corpus_2702", "text": "This  Genodermatoses  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2703", "text": "Vacuolar interface dermatitis  ( VAC , also known as  liquefaction degeneration ,  vacuolar alteration  or  hydropic degeneration ) is a  dermatitis  with  vacuolization  at the  dermoepidermal junction , with lymphocytic inflammation at the epidermis and dermis. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2704", "text": "An interface dermatitis with  vacuolar  alteration, not otherwise specified, may be caused by viral  exanthems ,  phototoxic dermatitis , acute  radiation dermatitis ,  erythema dyschromicum perstans ,  lupus erythematosus  and  dermatomyositis . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2705", "text": "The  vermilion border  (sometimes spelled  vermillion border ), also called margin or zone, is the normally sharp demarcation between the  lip  and the adjacent normal  skin . It represents the change in the  epidermis  from highly  keratinized  external skin to less keratinized internal skin. It has no  sebaceous glands ,  sweat glands , or  facial hair . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2706", "text": "It has a prominence on the face, creating a focus for  cosmetics  (it is where  lipstick  is sometimes applied) and is also a location for several skin diseases. Its functional properties, however, remain unknown. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2707", "text": "The lips are composed wholly of soft tissue. The skin of the face is thicker than the skin overlying the lips where blood vessels are closer to the surface. As a consequence, the margin of the lips shows a transition between the thicker and thinner skin, represented by the vermilion border. It therefore has the appearance of a sharp line between the coloured edge of the lip and adjoining skin. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2708", "text": "It has been described as a pale, white rolled border and also as being a red line. [ 1 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2709", "text": "This fine line of pale skin accentuates the colour difference between the  vermilion  and normal skin. Along the upper lip, two adjacent elevations of the vermilion border form the  Cupid's bow . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2710", "text": "The vermilion border represents the change in the epidermis from highly  keratinized  external skin to less keratinized internal skin. It has no  sebaceous glands ,  sweat glands , or  facial hair . [ 2 ] [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2711", "text": "There are two reasons that the border appears red in some people:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2712", "text": "The  vermilion border  is important in  dentistry  and  oral pathology  as a marker to detect  disease , such as in  actinic cheilitis . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2713", "text": "A  vermilionectomy  (sometimes spelled  vermillionectomy ) is the surgical removal of the vermilion border. It is sometimes performed to treat  carcinoma  of the lip. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2714", "text": "Close attention is given when repairing any injury to the vermilion border. Even 1\u00a0mm of vermilion misalignment could be noticeable. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2715", "text": "Xanthosis  is a yellowish discoloration of degenerating  tissues , especially seen in malignant  neoplasms . It can be differentiated clinically from  jaundice  as the  sclerae  are colored yellow in jaundice, but are not discolored in xanthosis. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2716", "text": "Xanthosis, or yellows, is a mid 20th century term for  strawberry mild yellow-edge virus , a disease in strawberries, cause by the  strawberry aphid . The disease is prevalent throughout the Americas. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2717", "text": "Xanthosis is a brown pigmentation of  skeletal  and  heart muscles  of cattle. The condition is particularly seen in older animals, and in some wasting diseases. [ 3 ]  Prevalent in  Ayrshire cattle  and their crosses. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2718", "text": "It was the championship word used in the 1995  Scripps National Spelling Bee , and was also featured in the film  Akeelah and the Bee . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2719", "text": "Xeroderma ,  xerosis  or  xerosis cutis , or simply  dry skin , is a  skin condition  characterized by excessively dry  skin . [ 2 ]  The term derives from  Greek     \u03be\u03b7\u03c1\u03cc\u03c2  (xeros) \u00a0'dry' and    \u03b4\u03ad\u03c1\u03bc\u03b1  (derma) \u00a0'skin'."}
{"_id": "WikiPedia_Dermatology$$$corpus_2720", "text": "In most cases, dry skin can safely be treated with  moisturizers  (also called emollients). Xeroderma occurs most commonly on the  scalp , lower  legs ,  arms , hands,  knuckles , the sides of the  abdomen , and  thighs . Symptoms most associated with xeroderma are such  skin conditions  as scaling (the visible peeling of the outer skin layer),  itching , and  skin fissures  (cracked skin). [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2721", "text": "Xeroderma is a very common condition. It happens more often in the winter when the cold air outside and the hot air inside create a low  relative humidity . This causes the skin to lose moisture and it may crack and peel.  Bathing  or  hand washing  too frequently, especially if one is using harsh  soaps , can contribute to xeroderma. Xeroderma can be caused by a deficiency of  vitamin A ,  vitamin D ,  zinc ,  systemic illness , severe  sunburn , or some  medication . [ 4 ]  Xeroderma can be caused by  choline inhibitors .  Detergents  such as  washing powder  and  dishwashing liquid  can cause xeroderma. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2722", "text": "Today, many creams and lotions, commonly based on vegetable oils/butters, petroleum oils/jellies, and  lanolin  are widely available. As a preventive measure, such products may be rubbed onto the affected area as needed (often every other day) to prevent dry skin. The skin is then patted dry to prevent the removal of natural lipids from the skin. Taking a shower or washing hands with special moisturizing soaps or body washes can protect the skin from drying out further."}
{"_id": "WikiPedia_Dermatology$$$corpus_2723", "text": "Repeated application (typically over a few days) of  emollients  or skin lotions/creams to the affected area will likely result in quick alleviation of xeroderma. In particular, the application of highly occlusive barriers to moisture, such as  petrolatum , vegetable oils/butters, and  mineral oil  have been shown to provide excellent results.  Many individuals find specific commercial skin creams and lotions (often comprising oils, butters, and or waxes emulsified in water) quite effective (although individual preferences and results vary among the wide array of commercially available creams). [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2724", "text": "Lanolin , a natural mixture of lipids derived from sheep's wool, helps replace natural lipids in human skin and has been used since ancient times (and in modern medicine) as among the most powerful treatments for xeroderma. Some people may, however, have allergies to lanolin, producing the opposite of the desired effect. [ 7 ]  Also, pure lanolin is a thick waxy substance which, for many individuals, proves difficult and inconvenient for general use on dry skin (especially over large areas of the body).  As a result, many formulated lanolin products, having a softer consistency than pure lanolin, are available. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2725", "text": "Many skin creams include common allergens such as fragrances,  parabens , and lanolin. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2726", "text": "Xerostomia , also known as  dry mouth , is a subjective complaint of dryness in the  mouth , which may be associated with a change in the composition of  saliva , or reduced salivary flow, or  have no identifiable cause . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2727", "text": "This symptom is very common and is often seen as a  side effect  of many types of medication. It is more common in older people (mostly because this group tend to take several medications) and in people who  breathe through their mouths .  Dehydration ,  radiotherapy  involving the  salivary glands ,  chemotherapy  and several diseases can cause reduced salivation (hyposalivation), or a change in saliva consistency and hence a complaint of xerostomia. Sometimes there is no identifiable cause, and there may sometimes be a  psychogenic  reason for the complaint. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2728", "text": "Xerostomia is the subjective sensation of dry mouth, which is often (but not always) associated with hypofunction of the salivary glands. [ 3 ]  The term is derived from the Greek words \u03be\u03b7\u03c1\u03cc\u03c2 ( xeros ) meaning \"dry\" and \u03c3\u03c4\u03cc\u03bc\u03b1 ( stoma ) meaning \"mouth\". [ 4 ] [ 5 ]  A drug or substance that increases the rate of salivary flow is termed a  sialogogue ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2729", "text": "Hyposalivation  is a clinical diagnosis that is made based on the history and examination, [ 1 ]  but reduced salivary flow rates have been given objective definitions. Salivary gland hypofunction has been defined as any objectively demonstrable reduction in whole and/or individual gland flow rates. [ 6 ]  An unstimulated whole saliva flow rate in a normal person is 0.3\u20130.4 ml per minute, [ 7 ]  and below 0.1 ml per minute is significantly abnormal. A stimulated saliva flow rate less than 0.5 ml per gland in 5\u00a0minutes or less than 1 ml per gland in 10\u00a0minutes is decreased. [ 1 ]  The term subjective xerostomia is sometimes used to describe the symptom in the absence of any clinical evidence of dryness. [ 8 ]  Xerostomia may also result from a change in composition of saliva (from serous to mucous). [ 6 ]   Salivary gland dysfunction  is an  umbrella term  for the presence of xerostomia, salivary gland hyposalivation, [ 6 ]  and  hypersalivation . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2730", "text": "Hyposalivation may give the following signs and symptoms:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2731", "text": "However, sometimes the clinical findings do not correlate with the symptoms experienced. [ 9 ]  For example, a person with signs of hyposalivation may not complain of xerostomia. Conversely a person who reports experiencing xerostomia may not show signs of reduced salivary secretions (subjective xerostomia). [ 8 ]  In the latter scenario, there are often other oral symptoms suggestive of  oral dysesthesia  (\"burning mouth syndrome\"). [ 3 ]  Some symptoms outside the mouth may occur together with xerostomia."}
{"_id": "WikiPedia_Dermatology$$$corpus_2732", "text": "These include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2733", "text": "There may also be other systemic signs and symptoms if there is an underlying cause such as  Sj\u00f6gren's syndrome , [ 1 ]  for example, joint pain due to associated  rheumatoid arthritis ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2734", "text": "The differential of hyposalivation significantly overlaps with that of xerostomia. A reduction in saliva production to about 50% of the normal unstimulated level will usually result in the sensation of dry mouth. [ 8 ]  Altered saliva composition may also be responsible for xerostomia. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2735", "text": "Salivary flow rate is decreased during sleep, which may lead to a transient sensation of dry mouth upon waking. This disappears with eating or drinking or with oral hygiene. When associated with halitosis, this is sometimes termed \"morning breath\". Dry mouth is also a common sensation during periods of anxiety, probably owing to enhanced  sympathetic  drive. [ 11 ]  During periods of stress, our body responds in a \u2018fight or flight\u2019 state that will interfere with the saliva flow in the mouth. [ 12 ]  Dehydration is known to cause hyposalivation, [ 1 ]  the result of the body trying to conserve fluid. Physiologic age-related changes in salivary gland tissues may lead to a modest reduction in salivary output and partially explain the increased prevalence of xerostomia in older people. [ 1 ]  However,  polypharmacy  is thought to be the major cause in this group, with no significant decreases in salivary flow rate being likely to occur through aging alone. [ 9 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2736", "text": "Aside from physiological causes of xerostomia,  iatrogenic  effects of medications are the most common cause. [ 1 ]  A medication which is known to cause xerostomia may be termed  xerogenic . [ 3 ]  Over 400 medications are associated with xerostomia. [ 8 ]  Although drug induced xerostomia is commonly reversible, the conditions for which these medications are prescribed are frequently chronic. [ 8 ]  The likelihood of xerostomia increases in relation to the total number of medications taken, whether the individual medications are xerogenic or not. [ 9 ]  The sensation of dryness usually starts shortly after starting the offending medication or after increasing the dose. [ 1 ]   Anticholinergic ,  sympathomimetic , or  diuretic  drugs are usually responsible. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2737", "text": "Xerostomia may be caused by autoimmune conditions which damage saliva-producing cells. [ 8 ]  Sj\u00f6gren's syndrome is one such disease, and it is associated with symptoms including fatigue,  myalgia  and  arthralgia . [ 8 ]  The disease is characterised by inflammatory changes in the moisture-producing glands throughout the body, leading to reduced secretions from glands that produce saliva, tears and other secretions throughout the body. [ 8 ]  Primary Sj\u00f6gren's syndrome is the combination of dry eyes and xerostomia. Secondary Sj\u00f6gren's syndrome is identical to primary form but with the addition of a combination of other connective tissue disorders such as  systemic lupus erythematosus  or  rheumatoid arthritis . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2738", "text": "Xerostomia may be the only symptom of celiac disease, especially in adults, who often have no obvious digestive symptoms. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2739", "text": "Radiation therapy for  cancers of the head and neck  (including  brachytherapy  for  thyroid cancers ) where the salivary glands are close to or within the field irradiated is another major cause of xerostomia. [ 8 ]  A radiation dose of 52 Gy is sufficient to cause severe salivary dysfunction. Radiotherapy for oral cancers usually involves up to 70 Gy of radiation, often given along with chemotherapy which may also have a damaging effect on saliva production. [ 8 ]  This side effect is a result of radiation damage of the parasympathetic nerves. Formation of salivary gland ducts depends on the secretion of a  neuropeptide  from the parasympathetic nerves, while development of the end buds of the salivary gland depends on  acetylcholine  from the parasympathetic nerves. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2740", "text": "\"Sicca\" simply means dryness. Sicca syndrome is not a specific condition, and there are varying definitions, but the term can describe oral and eye dryness that is not caused by autoimmune diseases (e.g., Sj\u00f6gren syndrome)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2741", "text": "Oral dryness may also be caused by mouth breathing, [ 3 ]  usually caused by partial obstruction of the  upper respiratory tract . Examples include  hemorrhage ,  vomiting ,  diarrhea , and  fever . [ 1 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2742", "text": "Alcohol may be involved in the cause of salivary gland disease, liver disease, or dehydration. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2743", "text": "Smoking is another possible cause. [ 9 ]  Other recreational drugs such as  methamphetamine , [ 16 ]   cannabis , [ 17 ]   hallucinogens , [ 18 ]  or  heroin , [ 19 ]  may be implicated."}
{"_id": "WikiPedia_Dermatology$$$corpus_2744", "text": "Hormonal disorders, such as poorly controlled diabetes, chronic graft versus host disease or low fluid intake in people undergoing  hemodialysis  for renal impairment may also result in xerostomia, due to dehydration. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2745", "text": "Nerve damage can be a cause of oral dryness. An injury to the face or surgery can cause nerve damage to the head and neck area which can effect the nerves that are associated with the salivary flow. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2746", "text": "Xerostomia may be a consequence of infection with hepatitis C virus (HCV) and a rare cause of salivary gland dysfunction may be  sarcoidosis . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2747", "text": "Infection with Human Immunodeficiency Virus/Acquired immunodeficiency Syndrome (AIDS) can cause a related salivary gland disease known as Diffuse Infiltrative Lymphocytosis Syndrome (DILS). [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2748", "text": "Similar to taste dysfunction, xerostomia is one of the most prevalent and persistent oral symptoms associated with COVID-19. Despite a close association with COVID-19, xerostomia, dry mouth and hyposalivation tend to be overlooked in COVID-19 patients and survivors, unlike ageusia, dysgeusia and hypogeusia. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2749", "text": "A diagnosis of hyposalivation is based predominantly on the clinical signs and symptoms. [ 1 ]  The  Challacombe scale  maybe used to classify the extent of dryness. [ 22 ] [ 23 ]  The rate of the salivary flow in an individual's mouth can also be measured. [ 24 ]  There is little correlation between symptoms and objective tests of salivary flow, [ 25 ]  such as  sialometry . This test is simple and noninvasive, and involves measurement of all the saliva a patient can produce during a certain time, achieved by dribbling into a container. Sialometery can yield measures of stimulated salivary flow or unstimulated salivary flow. Stimulated salivary flow rate is calculated using a stimulant such as 10%  citric acid  dropped onto the tongue, and collection of all the saliva that flows from one of the  parotid papillae  over five or ten minutes. Unstimulated whole saliva flow rate more closely correlates with symptoms of xerostomia than stimulated salivary flow rate. [ 1 ]   Sialography  involves introduction of  radio-opaque  dye such as  iodine  into the duct of a salivary gland. [ 1 ]  It may show blockage of a duct due to a calculus. Salivary  scintiscanning  using  technetium  is rarely used. Other medical imaging that may be involved in the investigation include  chest x-ray  (to exclude sarcoidosis),  ultrasonography  and  magnetic resonance imaging  (to exclude Sj\u00f6gren's syndrome or neoplasia). [ 1 ]  A minor salivary gland  biopsy , usually taken from the lip, [ 26 ]  may be carried out if there is a suspicion of  organic disease  of the salivary glands. [ 1 ]   Blood tests  and  urinalysis  may be involved to exclude a number of possible causes. [ 1 ]  To investigate xerophthalmia, the Schirmer test of lacrimal flow may be indicated. [ 1 ]   Slit-lamp examination  may also be carried out. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2750", "text": "The successful treatment of xerostomia is difficult to achieve and often unsatisfactory. [ 9 ]  This involves finding any correctable cause and removing it if possible, but in many cases it is not possible to correct the xerostomia itself, and treatment is  symptomatic , and also focuses on  preventing tooth decay through improving  oral hygiene . Where the symptom is caused by hyposalivation secondary to underlying chronic disease, xerostomia can be considered permanent or even progressive. [ 8 ]  The management of salivary gland dysfunction may involve the use of saliva substitutes and/or saliva stimulants:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2751", "text": "Saliva substitutes can improve xerostomia, but tend not to improve the other problems associated with salivary gland dysfunction. [ citation needed ]  Parasympathomimetic drugs (saliva stimulants) such as pilocarpine may improve xerostomia symptoms and other problems associated with salivary gland dysfunction, but the evidence for treatment of radiation-induced xerostomia is limited. [ 27 ]  Both stimulants and substitutes relieve symptoms to some extent. [ 28 ]   Salivary stimulants are probably only useful in people with some remaining detectable salivary function. [ 3 ]  A systematic review compromising of 36  randomised controlled trials  for the treatment of dry mouth found that there was no strong evidence to suggest that a specific  topical  therapy is effective. [ 8 ]  This review also states that topical therapies can be expected to provide only short-term effects, which are reversible. [ 8 ]  The review reported limited evidence that oxygenated glycerol triester spray was more effective than electrolyte sprays. [ 8 ]  Sugar free  chewing gum  increases saliva production but there is no strong evidence that it improves symptoms. [ 8 ]   Plus, there is no clear evidence to suggest whether chewing gum is more or less effective as a treatment. [ 8 ]  There is a suggestion that intraoral devices and integrated mouthcare systems may be effective in reducing symptoms, but there was a lack of strong evidence. [ 8 ]  A systematic review of the management of radiotherapy-induced xerostomia with parasympathomimetic drugs found that there was limited evidence to support the use of pilocarpine in the treatment of radiation-induced salivary gland dysfunction. [ 6 ]  It was suggested that, barring any  contraindications , a trial of the drug be offered in the above group (at a dose of five mg three times per day to minimize side effects). [ 6 ]  Improvements can take up to twelve weeks. [ 6 ]  However, pilocarpine is not always successful in improving xerostomia symptoms. [ 6 ]  The review also concluded that there was little evidence to support the use of other parasympathomimetics in this group. [ 6 ]  Another systematic review showed, that there is some low-quality evidence to suggest that amifostine prevents the feeling of dry mouth or reduce the risk of moderate to severe xerostomia in people receiving radiotherapy to the head and neck (with or without chemotherapy) in the short- (end of radiotherapy) to medium-term (three months postradiotherapy). But, it is less clear whether or not this effect is sustained to 12 months postradiotherapy. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2752", "text": "A 2013 review looking at non-pharmacological interventions reported a lack of evidence to support the effects of electrostimulation devices, or acupuncture, on symptoms of dry mouth. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2753", "text": "Xerostomia is a very common symptom. A conservative estimate of prevalence is about 20% in the general population, with increased prevalences in females (up to 30%) and the elderly (up to 50%). [ 8 ]  Estimates of the prevalence of persistent dry mouth vary between 10 and 50%. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2754", "text": "Xerostomia has been used as a test to detect lies, which relied on emotional inhibition of salivary secretions to indicate possible incrimination. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2755", "text": "ATC code D   Dermatologicals  is a section of the  Anatomical Therapeutic Chemical Classification System , a system of alphanumeric codes developed by the  World Health Organization  (WHO) for the classification of  drugs  and other medical products. [ 1 ] [ 2 ] [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2756", "text": "Codes for  veterinary  use ( ATCvet codes ) can be created by placing the letter Q in front of the human ATC code: for example,  QD . [ 5 ]  ATCvet codes without corresponding human ATC codes are cited with the leading Q in the following list. National issues of the ATC classification may include additional codes not present in this list, which follows the WHO version."}
{"_id": "WikiPedia_Dermatology$$$corpus_2757", "text": "Aluminium triacetate , formally named  aluminium acetate , [ 2 ]  is a  chemical compound  with composition  Al(CH 3 CO 2 ) 3 .  Under  standard conditions  it appears as a white,  water -soluble solid [ 1 ]  that decomposes on heating at around 200\u00a0\u00b0C. [ 3 ]   The triacetate  hydrolyses  to a mixture of basic hydroxide /  acetate   salts , [ 4 ]  and multiple species co-exist in  chemical equilibrium , particularly in aqueous solutions of the acetate ion; the name aluminium acetate is commonly used for this mixed system."}
{"_id": "WikiPedia_Dermatology$$$corpus_2758", "text": "It has therapeutic applications for its anti-itching,  astringent , and  antiseptic  properties, [ 5 ]  and, as an  over-the-counter preparation  like  Burow's solution , [ 6 ]  it is used to treat  ear infections . [ 7 ] [ 8 ]  Burow's solution preparations have been diluted and modified with  amino acids  to make them more  palatable  for use as  gargles  for conditions like  aphthous ulcers  of the mouth. [ 9 ]   In  veterinary medicine , aluminium triacetate's astringency property is used for treating  Mortellaro disease  in hoofed animals such as cattle. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2759", "text": "Aluminium triacetate is used as a  mordant  agent with dyes like  alizarin , [ 11 ]  both alone and in combination. Together with  aluminium diacetate [ 12 ]  or with  aluminium sulfacetate [ 13 ]  it is used with  cotton , other  cellulose  fibres, [ 14 ]  and  silk . [ 13 ]   It has also been combined with  ferrous acetate  to produce different colours. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2760", "text": "According to the  formal rules for naming inorganic compounds , the name for  Al(CH 3 CO 2 ) 3  is aluminium acetate, [ 2 ]  though more formal names like aluminium(III) acetate and aluminium ethanoate are acceptable. [ 4 ]   The use of the \"tri\" multiplying prefix in the name aluminium triacetate, while not technically required, is regularly used to avoid potential confusion with related compounds with  hydroxo ligands .  Basic  aluminium diacetate , formally hydroxyaluminium diacetate ( CAS RN  142-03-0), [ 1 ]  has composition  HOAl(CH 3 CO 2 ) 2  with one hydroxo ligand in place of an acetate ligand, and dibasic  aluminium monoacetate , formally dihydroxyaluminium acetate (CAS RN 7360-44-3), has composition  (HO) 2 AlCH 3 CO 2  with only one acetate ligand.  These three compounds are distinct in the solid phase but are usually treated as a group and described collectively as aluminium acetate in solution, due to the triacetate  hydrolyzing  to a mixture which includes the other two forms. [ 4 ]   The abbreviation as AlAc, along with variants like  AlAc 2+  and  AlAc + 2 , are sometimes used in the discipline of  geochemistry , [ 16 ]  though these are inconsistent with standard practice in mainstream  chemistry . [a]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2761", "text": "The formula  Al(CH 3 CO 2 ) 3  indicates the presence of aluminium centres in the +3  oxidation state  and  acetate  groups in a ratio of 1:3. Images used to represent this substance, such as those shown at left, represent two highly oversimplified approximations of the solid-state structure: the first is as a purely  ionic   salt  with a single aluminium(III)  cation  (Al 3+ ) surrounded by and associated  electrostatically  with three acetate anions ( CH 3 CO \u2212 2 ), but this should not be taken to convey information about the  crystal structure . For example, sodium chloride (NaCl) has a cation-to-anion  stoichiometry  of 1:1, but it has a  cubic structure  with each ion surrounded  octahedrally  by six ions of the opposite charge. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2762", "text": "The other image is a  molecular  form with the three acetate groups  covalently bonded  to the metal centre in a  trigonal planar  geometry and  intermolecular interactions  holding the molecules together with each other in the crystal structure.  It is highly likely that the solid state structure is more complicated and includes both covalent and ionic characteristics and it is possible that multiple aluminium centres and / or  bridging acetate  groups might be present \u2013 both of these have been reported in aluminium acetate  solution [ 18 ]  and  aluminium chloride  is known to exist as a  Al 2 Cl 6   dimer . [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2763", "text": "NMR  investigations of the aqueous aluminium(III) / acetate system show the presence of aluminium as a hexaaqua  complex ,  [Al(H 2 O) 6 ] 3+ , [ 20 ]  as well as mononuclear species with different substitutions. In addition, the investigations demonstrate that a significant solution-phase species is an  Al 13   tridecamer , [ 21 ]  a  moiety  reported in conflicting mechanisms of hydrolysis and  polymerisation  aluminium solutions. [ 22 ]   Other trivalent metal cations are known to form polynuclear species:  iron(III) acetate , for example, forms a trinuclear structure [ 23 ]  with a triply-bridged oxo centre [ 24 ]  with the cation  [Fe 3 ( \u03bc 3 \u2013O)(OAc) 6 (H 2 O) 3 ] + . [ 25 ]   The compound  chromium acetate hydroxide , Cr 3 (OH) 2 (OAc) 7 , has also been described as isostructural. [ 26 ]   Analogous  ruthenium(III), vanadium(III), rhodium(III), and iridium(III) compounds with trinuclear structures are known. [ 27 ]   Copper(II) acetate  and  chromium(II) acetate  both have dinuclear dihydrate structures, M 2 (OAc) 4 (H 2 O) 2 , [ 28 ]  as does  rhodium(II) acetate ; [ 29 ]  each shows significant metal-metal bonding interactions. [ 28 ] [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2764", "text": "According to the  CRC Handbook of Inorganic Compounds,  aluminium triacetate is a white, water-soluble solid and is usually prepared from  aluminium chloride  or directly from  aluminium  by heating in an  acetic acid  solution with  acetic anhydride . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2765", "text": "Theoretically all of the aluminium / acetate / hydroxide  salts  can be prepared from  aluminium hydroxide  or  sodium aluminate  and acetic acid, but formation of the triacetate only occurs in the absence of water. [ 4 ]     In solutions, the diacetate is the major product formed, and is also produced when aluminium chloride is treated with a  sodium acetate  solution in basic conditions. [ 30 ]   The equations for these processes are:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2766", "text": "An improved process using a combination of  aluminium chloride  and sodium aluminate with sodium acetate prepared  in situ  has been  patented : [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2767", "text": "The  mordants  aluminium triacetate and  aluminium sulfacetate  can be prepared from  aluminium sulfate , the product formed being determined by the amount of  lead(II) acetate  used: [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2768", "text": "On heating, aluminium triacetate decomposes above 200\u00a0\u00b0C in a process similar to that of  aluminium formate . [ 3 ]   The process begins with loss of acetic anhydride ( Ac 2 O ) between 120 and 140\u00a0\u00b0C [ 1 ]  to form the a mixture of the basic oxide acetates such as  Al 2 O(CH 3 CO 2 ) 4  and  Al 3 O(CH 3 CO 2 ) 7 , [ 30 ]  which are ultimately transformed to  Al 2 O 3  ( alumina ), first as an  amorphous   anhydrous  solid and then through other solid  phases  (\u03b3-, \u03b4-, and \u03b8-  crystal forms ) to ultimately become  polymorphic  \u03b1- Al 2 O 3 : [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2769", "text": "Aluminium triacetate hydrolyses to produce both the mono- and di-basic hydroxide acetates in solution or by  hygroscopy : [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2770", "text": "According to the  National Cancer Institute , the aluminium acetates are used  topically  in humans as  antiseptic agents , which also cause  body tissues to shrink . [ 5 ]   Its astringency property is also used for treating  Mortellaro disease  in hoofed animals such as cattle. [ 10 ]   Aluminium acetate promotes healing of  infected skin  and also assists with  inflammation ,  itching , and stinging. [ 5 ]   The  Food and Drug Administration  has approved it for use for \"temporary relief of minor skin irritations due to ... ' poison ivy ,' 'poison oak,' ' poison sumac ,' 'insect bites,' ' athlete's foot ,' or 'rashes caused by soaps, detergents, cosmetics, or jewelry.'\" [ 32 ]   For these applications,  over-the-counter preparations  such as  Burow's solution  are typically used, [ 6 ]  while diluted forms are used as  gargles  for conditions like  aphthous ulcers  of the mouth, including with  amino acid  additives to improve  palatability  and  taste . [ 9 ]   The most common use of Burow's solution is in treating  ear infections [ 7 ] [ 8 ]  including  otomycosis , though it is generally not as effective as  clotrimazole  in these fungal infections. [ 33 ]   Topical astringent powder Domeboro contains  aluminium sulfate tetradecahydrate ,  [Al(H 2 O) 6 ] 2 (SO 4 ) 3 \u20222H 2 O , and  calcium acetate monohydrate ,  Ca(CH 3 CO 2 ) 2 \u2022H 2 O , and forms an aluminium acetate solution similar to Burow's solution when dissolved. [ 34 ]   Domeboro solutions in warm water can be used in cases of  ingrown toenails , [ 35 ]  to reduce irritation and contain any infection which might be present."}
{"_id": "WikiPedia_Dermatology$$$corpus_2771", "text": "A mordant is a substance used to set  dyes  on fabrics or tissue sections by forming a  coordination complex  with the dye, which subsequently attaches to the fabric or tissue. [ 37 ]   A mordant often contains a  polyvalent  metal ion, commonly aluminium or iron, [ 38 ]  as is the case with mixtures of aluminium triacetate with aluminium sulfacetate [ 13 ]  or with basic aluminium diacetate. [ 12 ]   Aluminium triacetate mordants have been used with  cotton , other  cellulose -based fibres, [ 14 ]  and  silk . [ 13 ]   They have also been combined with  ferrous acetate  to produce different colours. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2772", "text": "In the case of the dye  alizarin  (1,2-dihydroxy anthraquinone ,  H 2 Az ), mordanting was hypothesised to involve the formation of a dianion of alizarin. This would form a five-coordinate aluminium complex,  CaAl(OH)Az 2 , [ 39 ]  which can take up water to form a hydrate with a six-coordinate aluminium-centred dianion,  Ca[Al(H 2 O)(OH)Az 2 ]\u20222H 2 O . [ 40 ]   The proposal was based on  infrared spectroscopic  data, and was subsequently challenged by work suggesting a structure with two bridging hydroxyl ligands connecting a dinuclear core,  Az 2 Al(\u03bc-OH) 2 AlAz 4\u2212 2 , with two alizarin  moieties  each  chelating  to each aluminium centre. [ 36 ]  The structure was proposed by Soubayrol  et al.  based on  27 Al NMR spectroscopy and  electrospray ionisation   mass spectrometry  evidence. [ 41 ]   They reported that the degree of hydration was dependent on the identity of the counter-ion, with the sodium salt being a stable tetrahydrate with a monohydrate being formed from  potassium hydroxide . These were distinguishable based on their  chemical shifts , suggesting the waters are associating with the aluminium centres or the alizarin moieties, and not behaving as is typical for  waters of crystallisation . [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2773", "text": "A related structure with calcium ions was reported in 1994, and in it the alizarins chelate to the calcium ions to form AzCaAz bridges between the aluminium centres (which are also bridged by hydroxo groups) and the aluminium centres subsequently bind to the deprotonated  phenol  residues of the dye; [ 11 ]  in the Soubayrol model, each alizarin is associated with a single aluminium cation. [ 41 ]   As with the structure of aluminium acetate itself, the forms it takes in applications has not been resolved."}
{"_id": "WikiPedia_Dermatology$$$corpus_2774", "text": "a   This \"Ac\" is not referring to the element  actinium .  Used in this way, the convention in  organic chemistry  is for Ac to refer to the  acetyl  group, the  radical  form of which is  CH 3 CO , [ 42 ]  and OAc or AcO would be used for the  acetate  radical,  CH 3 CO 2 , [ 43 ]  sometimes also called \"acetoxy.\"  The acetate ion would then be AcO \u2212 ,  CH 3 CO \u2212 2 , and acetic acid would be AcOH or HOAc.  Under this convention, aluminium triacetate would be Al(OAc) 3 .  Publications in  geochemistry , however, are using Ac to refer to acetate rather than acetyl and thus  AlAc + 2  in geochemistry would be written under more usual chemistry conventions as  [Al(OAc) 2 ] +  or  [Al(CH 3 CO 2 ) 2 ] + ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2775", "text": "Araroba powder , also known as  Bahia powder  and  Goa powder , is a drug occurring in the form of a yellowish-brown powder, varying considerably in tint, from the  Portuguese  colony of  Goa , where it appears to have been introduced about the year 1852. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2776", "text": "The tree which yields it is the  Andira araroba  of the  family   Fabaceae . It is abundant in certain forests in the province of  Bahia  in Brazil as well as imported into India, preferring as a rule low and humid spots. The tree ranges from 80 to 100\u00a0ft. high and has large  imparipinnate , or feather shaped, leaves, the leaflets of which are oblong, about 12 in. long and 1 in. broad, and somewhat truncate at the apex. The flowers are  papilionaceous , of a purple color and arranged in  panicles . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2777", "text": "The Goa powder or araroba is contained in the trunk, filling crevices in the  heartwood . It is a morbid product in the tree, and yields to hot chloroform 50% of a substance known officially as  chrysarobin . It occurs as a  microcrystalline , odorless, tasteless powder, very slightly soluble in either water or alcohol; it also occurs in  rhubarb  root. This complex mixture contains pure chrysarobin, di-chrysarobin, and di-chrysarobin methylether. Chrysarobin is a  methyl trioxyanthracene  and exists as a  glucoside  in the plant, but is gradually  oxidized  to  chrysophanic acid  (a dioxy-methyl  anthraquinone ) and  glucose . This strikes a blood-red color in  alkaline  solutions, and may therefore cause much alarm if administered to a patient whose urine is alkaline. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2778", "text": "Dithranol  and  chrysophanic acid  are therapeutic substances in araroba powder that are responsible for success in treatment of  psoriasis  and chronic  eczema . [ 3 ]  It has been used as a treatment of  ringworm . Generally, when used for skin conditions, the powder is mixed into a zinc or petrolatum  ointment ,  paste , or  cream  base to contain it to the treatment area. [ 4 ]  The  British Pharmacopoeia  lists an ointment containing one part of chrysarobin and 24 parts of  benzoated   lard . [ 1 ]  The drug is a weak  antiparasitic ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2779", "text": "Araroba powder stains skin, hair, and clothing a deep yellow or brown, a coloration which may be removed by caustic alkali in weak solution. [ 1 ]  Both internally and externally the drug is a powerful irritant. Reported  adverse effects  include inflammation of the  eyes ,  gastrointestinal tract , and  kidneys .  Contact allergy  has also been reported. [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2780", "text": "The  mechanism of action  of araroba powder is not yet confirmed, but is believed to effect  cell turnover .  Anti-inflammatory  properties are also present by  neutrophil  and  monocyte  function inhibition. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2781", "text": "Becaplermin , sold under the brand name  Regranex , is a  cicatrizant , available as a  topical gel .  Regranex is a human  platelet-derived growth factor  indicated along with good wound care for the treatment of lower extremity diabetic neuropathic ulcers. [ 1 ]  It is also known as \"platelet-derived growth factor BB\". [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2782", "text": "Becaplermin is used for the treatment of  diabetic   foot ulcers . [ 2 ]  Studies of becaplermin showed that when used with good wound care, complete healing significantly increased and the ulcers healed on average 6 weeks faster. [ 3 ]  Pharmacoeconomic studies reinforce the cost effectiveness of becaplermin as an adjunct to good wound care. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2783", "text": "The amount of becaplermin to be applied will vary depending upon the size of the ulcer area. Becaplermin should be stored in the refrigerator. [ 1 ]  Analysis of healing human wounds showed that PDGF-BB induces fibroblast proliferation and differentiation and was found to increase healing in patients with decreased healing capacity, such as people living with diabetes. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2784", "text": "Becaplermin must not be used at the site of a  skin cancer . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2785", "text": "The most common side effects in clinical studies were  erythematous rashes . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2786", "text": "A  boxed warning  has been added to the US FDA prescription label to describe an increase rate of death from  cancer  when three or more tubes are used. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2787", "text": "Birch triterpenes , sold under the brand name  Filsuvez , is an extract of  birch bark  used as a  topical medication  for the treatment of  epidermolysis bullosa . [ 1 ] [ 3 ]  The active ingredients are  triterpenes  extracted from the outer bark of  silver birch  ( Betula pendula ) and  downy birch  ( Betula pubescens ). [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2788", "text": "The most common side effects include wound complications such as skin reactions at the application site, infections, pruritus (itching), and  hypersensitivity . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2789", "text": "Birch triterpenes was approved for medical use in the European Union in June 2022, [ 3 ]  and in the United States in December 2023. [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2790", "text": "Epidermolysis bullosa is an inherited disease of the skin that makes the skin very fragile and causes severe blistering and scarring. [ 3 ]  Birch triterpenes is used in two types of epidermolysis bullosa,  dystrophic epidermolysis bullosa  and  junctional epidermolysis bullosa , to treat partial-thickness skin wounds. [ 3 ]  These are wounds where the upper layers of the skin have been damaged. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2791", "text": "Birch triterpenes is  indicated  for the treatment of partial thickness wounds associated with dystrophic and junctional epidermolysis bullosa in people aged six months of age and older. [ 1 ] [ 3 ]  The US  Food and Drug Administration  (FDA) considers it to be a  first-in-class medication . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2792", "text": "The most common side effects include wound complications. [ 3 ]  Other common side effects include skin reactions at the application site, wound infections, pruritus (itching), and hypersensitivity (allergic) reactions. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2793", "text": "The active substance of birch triterpenes is birch bark extract (as dry extract, refined) from  Betula pendula  Roth/ Betula pubescens  Ehrh. (equivalent to 0.5\u20111.0 g birch bark), including 84\u201195 mg triterpenes calculated as the sum of  betulin ,  betulinic acid ,  erythrodiol ,  lupeol , and  oleanolic acid . [ 3 ]  The mechanism of action of birch triterpenes in the treatment of wounds associated with epidermolysis bullosa is unknown. [ 1 ]  It is thought to work by modulating inflammatory mediators and stimulating keratinocyte differentiation and migration, thereby promoting wound healing and closure. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2794", "text": "The pharmacodynamics of birch triterpenes are unknown. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2795", "text": "The US FDA approved birch triterpenes based on evidence from a clinical trial (NCT03068780 [ 1 ] [ 8 ] ) of 223 participants with dystrophic and junctional epidermolysis bullosa. [ 6 ]  The efficacy and safety of birch triterpenes for the treatment of partial-thickness wounds associated with inherited epidermolysis bullosa was evaluated in a randomized, double-blind, placebo-controlled trial in participants aged six months of age and older with dystrophic epidermolysis bullosa and junctional epidermolysis bullosa. [ 6 ]  The primary endpoint was the proportion of subjects with first complete closure of the target wound by day 45 of the 90-day double-blind phase of the study, based on clinical assessment by the investigator. [ 6 ]  The trial was conducted at 49 sites in 26 countries including Argentina, Australia, Austria, Belgium, Brazil, Chile, Colombia, Croatia, the Czech Republic, Denmark, France, Germany, Greece, Hong Kong, Hungary, Ireland, Israel, Italy, Romania, Russia, Serbia, Singapore, Spain, Switzerland, the United Kingdom, and the United States. [ 6 ]  There were 14 participants enrolled in the United States and 209 participants were enrolled outside the United States. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2796", "text": "In April 2022, the  Committee for Medicinal Products for Human Use  (CHMP) of the  European Medicines Agency  (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Filsuvez, intended for the treatment of  epidermolysis bullosa . [ 9 ]  The applicant for this medicinal product is Amryt Pharmaceuticals DAC. [ 9 ]  Birch triterpenes was approved for medical use in the European Union in June 2022, [ 3 ] [ 10 ]  and in the United States in December 2023. [ 5 ] [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2797", "text": "Burow's solution  is an  aqueous solution  of  aluminium triacetate . It is available in the U.S. as an  over-the-counter drug  for  topical administration , with brand names including Domeboro (Moberg Pharma), Domeboro Otic (ear drops), Star-Otic, and Borofair. [ 1 ] \nThe preparation has  astringent  and  antibacterial  properties and may be used to treat a number of skin conditions, including  insect bites and stings ,  rashes  caused by  poison ivy  and  poison sumac ,  swelling ,  allergies , and  bruises . However, its main use is for treatment of  otitis  (ear infection), including  otomycosis  (fungal ear infection). [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2798", "text": "The creator of Burow's solution was  Karl August Burow  (1809-1874), a military surgeon and anatomist. Burow was also the inventor of some plastic surgery and wound healing techniques which are still in wide use today. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2799", "text": "Burow's solution may be used to treat various forms of ear infections, known as  otitis . [ 4 ] [ 5 ]  As a drug it is inexpensive and  non-ototoxic . In cases of  otomycosis  it is less effective than  clotrimazole  but remains an effective treatment. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2800", "text": "Most versions of Burow's solution can be used as a soak or compress. As an FDA approved astringent it is used for the relief of skin irritations due to  poison ivy ,  poison oak , and  poison sumac , and rashes from allergic reactions to soaps, detergents, cosmetics and jewelry. [ 7 ]  This is due to the combination of two active ingredients found in this version of Burow's solution, i.e.  aluminum sulfate tetradecahydrate  and  calcium acetate monohydrate . [ 8 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2801", "text": "The solution is used by some to reduce inflammation and potential infection from conditions such as  ingrown nails , in a warm water soak. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2802", "text": "Cosmetic psychopharmacology , a term coined in 1990 by the psychiatrist  Peter D. Kramer  and popularized in his 1993 book  Listening to Prozac , refers to the use of drugs to move persons from a normal psychological state to another normal state that is more desired or better socially rewarded \u2014 e.g., from  melancholy  towards assertiveness and confidence or from slower to quicker cognition."}
{"_id": "WikiPedia_Dermatology$$$corpus_2803", "text": "The comparison is with surgery, in which the same intervention can be therapeutic (as in reparative work on burn victims) or cosmetic (as in  rhinoplasty  for the enhancement of beauty in conventional terms). In general, cosmetic psychopharmacology refers to the use of psychoactive medications by normal, healthy individuals for the purpose of enhancement rather than the treatment of a formal pathology. Kramer reported that with the antidepressant  Prozac , occasional patients seemed \"better than well,\" and he discussed the ethical dilemmas that might result if similar medications were offered to individuals not afflicted with psychiatric disorders. Following these case reports, much controversy arose over the veracity and ethics of the cosmetic use of actual  antidepressants  and other similar medications. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2804", "text": "Opponents of cosmetic pharmacology believe that such drug usage is unethical and that the concept of cosmetic pharmacology is a manifestation of naive consumerism. Proponents, such as philosopher  Arthur Caplan , state that it is an individual's (rather than the government's or physician's) right to determine whether to use a drug for cosmetic purposes. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2805", "text": "Anjan Chatterjee, a neurologist at the  University of Pennsylvania , has argued that western medicine stands on the brink of a neuro-enhancement revolution in which people will be able to improve their memory and attention through pharmacological means.  [ 3 ]   Jacob M. Appel , a  Brown University  ethicist, has raised concerns about the possibility of employers mandating such enhancements for their workers. [ 4 ]   [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2806", "text": "Crilanomer  is a  cicatrizant ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2807", "text": "This  dermatologic   drug  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2808", "text": "Crocodile oil  is extracted from the fatty tissues of crocodiles.  Crocodile fat  is a product of commercial farming, evident in Thailand. Historically, for centuries crocodile oil has been used by traditional practitioners across the globe, including  Chinese traditional medicine , Southeast Asia, Ancient Egypt.  Crocodile oil has been used since the nineteenth century for different purposes in different cultures. [ 1 ]   Due to the oil's components, its richness in monounsaturated and  polyunsaturated fats , it is sold as ointment for treatment of skin conditions, skin structure enhancement, collagen deposition, and medicine for illnesses. [ 2 ]  In recent times, the use of crocodile oil has invited criticism from the use of crocodile oil as there is an increased demand for cruelty-free and vegan-friendly beauty products in consumers of today's society."}
{"_id": "WikiPedia_Dermatology$$$corpus_2809", "text": "Crocodile oil was used by traditional practitioners for centuries in treatment of ailments, skin conditions, and illnesses such as cancer. [ 3 ]  In  Ancient Egyptian medicine , crocodile oil was used in a liniment to stimulate the growth of hair, to treat bald patches also called  alopecia  as well as prevent grey hair growth. [ 4 ]  Crocodile oil was recognised by the Ancient Egyptians to treat burns when combined with other components such as Egyptian goat fat and lion fat. [ 4 ]  Crocodile oil was also used by the Egyptians to help with trembling in limbs when smeared with other components including honey and olive oil. [ 4 ]  The Papyrus Ebers mentions  Egyptians medicine  recommends the creation of a  vaginal contraceptive  solution composed of crocodile oil,  gum acacia  or honey, and  natron . [ 4 ]  The Historical Table of the Materia Media reports crocodile oil use in  Egyptian Medicine  in creating the ointment with combination of \"slime of the nile\", frictions of crocodile fat in rheumatism, salt, alum, platters. [ 5 ]  In Africa, crocodile oil is used for ailments such as skin rashes and to promote wound healing. There is also evidence of crocodile oil being used traditionally in South Africa. [ 6 ]  South Africans consult traditional healers, who still play a role in healthcare in rural areas.  Crocodile fat  is mixed with the ground bark of  Cryptocarya latifolia  and used by the  Zulu people  to treat chest ailments. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2810", "text": "Crocodile oil was also used by  Indian Ayurveda medicine  in the nineteenth century for treatment of burns. [ 7 ]   Crocodile oil use in India is recorded in other journals, specifically, the oil is prepared by the Sanif tribe of the Punjab, who eat crocodile fat. [ 8 ]  They [ who? ]  state crocodile oil contains larger amounts of \"solidifiable fat\" than any fish oil. [ 8 ]  The journal also mentions the oil to be procurable in abundance in Agra. [ 8 ]  Similarly, a journal published by Royal Society of Arts in 1879 discussed the commercial value of crocodile oil as well as how the oil was used in the nineteenth century specifically in Agra, India. [ 1 ]  A Western researcher [ who? ] [ when? ]  determined that crocodile oil contained a larger proportion of solid fat either cod liver or fish oils. They softened the quality of various animal oils on leather and found leather treated with crocodile oil remained stiffer compared to other natural oils. Melted fat of crocodile or crocodile oil was also recorded to be used for \"gastric obstructions\". [ 9 ]   Nature , in 1886, refers to the use of crocodile oil in Germany for leather dressing, prepared in Punjab and solidified at 33 degrees. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2811", "text": "Chinese traditional medicine as well as Southeast Asian traditional medicine uses crocodile oil and products as ointments for burns and scalds. [ 11 ]  A study tested burn wound-healing efficacy of crocodile oil through a Chinese herbal medicine called crocodile oil burn ointment, consisting of crocodile oil, natural mineral and extraction of other herbal medicines by employing second-degree burns in rats and found crocodile oil enhances burn wound healing capabilities. [ 12 ]  Chinese traditional medicine uses the oil of crocodiles for other conditions such as  bronchitis , allergy, skin problems,  high blood pressure , and cancer. [ 13 ]  Crocodile oil is also prescribed to treat burns, skin ulcers and cancer, coughs, and  asthma  in Madagascar. [ 13 ] [ 14 ]  There is also evidence of crocodile oil being used traditionally in South Africa for skin condition treatments for eczema and rashes and for promoting wound healing. [ 3 ]  Crocodile oil is used in Mexico for treatment of illnesses such as asthma,  emphysema , and  influenza . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2812", "text": "The following tables provides information about the composition of the  fatty acids  in crocodile oil, a more recent and detailed table can be found in Ngernjan  et al. : [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2813", "text": "The table below compares acid in crocodile oil and human skin oil:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2814", "text": "According to Venter, the composition of  fatty acids  in crocodile oil compared those found in human skin oil indicated that the  palmitoleic acid  (6%),  oleic acid  (39%), and  linoleic acid  (20%) in crocodile oil showed higher percentage than in  human skin  oil. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2815", "text": "Crocodile oil was also used by traditional practitioners to treat skin conditions including  microbial  infections and  inflammatory  conditions. A research by the State Key Laboratory of Marine Environmental Science in China describes the burn wound healing capabilities in crocodile oil indicated by decrease in wound closure time and scar formation in rats. [ 12 ]   The fatty acid profile of crocodile oil indicates that the oil consists mainly of fatty acids that possess antimicrobial and anti-inflammatory properties. [ 3 ]   A research provides scientific evidence of the antimicrobial and anti-inflammatory properties of crocodile oil, compared the use of crocodile oil by traditional healers. [ 12 ]   Their research focused on the study of burn ointment (COBO), topical Chinese herbal medicine (CHM) a compound made from natural mineral, crocodile oil, and extraction of five herbal medicines. [ clarification needed ] [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2816", "text": "The fatty acid profile of crocodile oil indicates that the oil consists mainly of fatty acids that possess antimicrobial and  anti-inflammatory  properties (Kabara  et al. , 1972, Maroon and Bost, 2006).  This study provides novel scientific evidence of antimicrobial and anti-inflammatory properties of crocodile oil, justifying its use by traditional healers.  It highlighted the effects these properties may have when applied as oil or ointment on human skin. A clinical study tested the positive claims of crocodile oil in treatment of ageing skin in comparison to  placebo  lotion. [ 2 ]  They found crocodile oil had \"good stability over 6 months period\", both lotions showed an increase in skin hydration. [ 2 ]   Venter's research showed no improvement in skin scaliness and elasticity. [ 2 ]  Treatment of  ageing skin  has become very popular over the last decade. Ageing skin is characterised by wrinkles, sagging skin and decreased  laxity . As a result, crocodile oil is used for skin repair to assist in skin quality and appearance as well as skin conditions. According to Croc City, crocodile oil and crocodile oil containing products currently on the market, are used for treatment of  dermatitis , scrapes,  acne ,  razor bumps ,  bed sores ,  haemorrhoids , inflammation of  arthritic  conditions, treatment of discolouration, pigmentation of skin-like brown spots, freckles,  menopausal  darkening, treatment of dry, flaky, itchy and ageing skin,  nappy rash , athlete's foot,  jock-itch  and irritation of head skin. [ 16 ]   Crocodile oil lotion is proven to be a safe product to use on skin. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2817", "text": "With the increase in commercial alligator farming in countries including Thailand, the United States, Australia, South Africa, and  South East Asia , crocodile fat and oil became a commercial product that can be used in a number of ways such as medicine, skin care products, and as a feedstock for  biodiesel . Natural oils are extensively used in cosmetics and as treatment for a growing number of conditions. According to Vermaak, the natural products industry is a multibillion-dollar industry and has grew enormously in the years up to 2011. [ 17 ]  Crocodile oil as an oil mainly containing fatty acids contribute to beneficial properties in cosmetics and personal care products. More specifically, crocodile oil is also used in the tanning industry. [ 18 ]  The oil can range from about $US4 for a tube of crocodile lip balm to about $US104 for a large [ vague ]  jar of pure crocodile oil balm. [ 19 ]  Businesses consider the capability to convert crocodile fat to a marketable oil. They can capitalise on \"first-mover advantage\" due to crocodile oil benefits. Golden 8 Skincare is an Australian company, using crocodile oil as the main ingredient of its product. [ 20 ]  The company's description of the product include \"Packed full of Omegas 3,6 7 and 9 to help in the healing of skin conditions due to its Natural Moisturising Factor (NMF) Crocodile Oil helps prevents dermal irritation and regenerates the skin whilst providing the skin its daily dose of Omegas to produce clear, glowing, healthy skin.\" [ 20 ]  Crocodile oil lotions and other products derived from crocodile fat can be seen sold online for personal use."}
{"_id": "WikiPedia_Dermatology$$$corpus_2818", "text": "Critics of  Crocodile farming  mentions the use of crocodile oil as a contribution to the diminishing numbers of various crocodile species. [ 21 ]  Many species of crocodile are endangered such as the  Siamese crocodile , [ 22 ]  which is farmed in Thailand. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2819", "text": "According to the  Convention on International Trade in Endangered Species of Wild Fauna and Flora  (CITES), products made from endangered species can be legally traded after certification. [ 23 ]   CITES lists the Nile crocodile under Appendix II which means species are not threatened with extinction, but the collection, processing, domestic trading, and exporting of all crocodile products must be controlled.  Over catching of this animal has led to the decline of this species in wild populations. Efforts are made to preserve the existing habitat of this species. [ 18 ]  Crocodiles have been bred in farms since the early twentieth century, where Thai crocodile farming industry is currently the largest in the world. [ 23 ]   Breeding this animal under captivity is a developing industry in some parts of the world. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2820", "text": "Delgocitinib , sold under the brand name  Corectim  among others, is a  medication  used for the treatment of autoimmune disorders and hypersensitivity, including inflammatory skin conditions. [ 3 ]   Delgocitinib  was  developed  by  Japan Tobacco  and approved in Japan for the treatment of  atopic dermatitis . [ 3 ]   In the United States, delgocitinib is in  Phase III clinical trials  and the  Food and Drug Administration  has granted delgocitinib  fast track  designation for  topical  treatment of adults with moderate to severe chronic hand  eczema . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2821", "text": "Delgocitinib works by  blocking activation  of the  JAK-STAT signaling pathway  which contributes to the pathogenesis of chronic inflammatory skin diseases. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2822", "text": "In July 2024, the  Committee for Medicinal Products for Human Use  of the  European Medicines Agency  adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product \nAnzupgo, intended for the treatment of chronic hand eczema. [ 1 ] [ 6 ]  The applicant for this medicinal product is LEO Pharma A/S. [ 1 ]  Anzupgo was approved for medical use in the European Union in September 2024. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2823", "text": "Dextranomer  (trade name  Debrisan ,  Exudex [ 1 ] ) is a  cicatrizant  used in dressings for wound healing, [ 2 ]  and in pharmaceutical products to treat  fecal incontinence . [ 3 ]   It consists of  dextran  polymer chains cross-linked into a three-dimensional network. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2824", "text": "Solesta is the marketed brand name of a system of injections of dextranomer in stabilized  sodium hyaluronate  for use in fecal incontinence (FI). [ 5 ]   This preparation is a biocompatible gel, for use as a  perianal injectable bulking agent . The system is intended to be injected in the submucosal layer of the proximal  anal canal  (i.e. above the level of the  dentate line )."}
{"_id": "WikiPedia_Dermatology$$$corpus_2825", "text": "Diphenylcyclopropenone  ( diphencyprone ) is a  topically administered  experimental drug intended for treating  alopecia areata  and  alopecia totalis . [ 1 ]  Topical immunotherapy using diphenylcyclopropenone may also be an effective treatment option for recalcitrant warts. [ 2 ]   It is not approved by either the  Food and Drug Administration  or the  European Medicines Agency . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2826", "text": "Diphenylcyclopropenone triggers an immune response that is thought to oppose the action of the autoreactive cells that otherwise cause hair loss. [ 4 ]  One hypothesis is that in response to DPCP treatment, the body will attempt to downregulate inflammation through a variety of pathways, resulting in a downregulation of the autoimmune response at the hair follicle. This autoinflammatory reaction would otherwise destroy body's hair follicles. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2827", "text": "A study of 41 alopecia areata patients showed significant hair regrowth in 40% at 6 months, being sustained in two thirds of these after a 12-month-follow up-period. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2828", "text": "In a 2002 study for the treatment of warts, the responders consisted of 135 individuals (87.7%) that had complete clearance of warts. Reported adverse effects were local and included with pruritus (itching) (15.6%), with blistering (7.1%), and with eczematous reactions (eczema)(14.2%). The majority of the patients tolerated the treatment very well. One patient developed local impetigo (minor infection). Patients had an average of 5 treatments over a 6-month period. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2829", "text": "The chemical properties of diphenylcyclopropenone are dominated by the strong  polarization  of the  carbonyl  group, which gives a partial positive charge with  aromatic stabilization  on the cyclopropene ( cyclopropenium ) ring and a partial negative charge on oxygen.  The steric hindrance and partial charge on the cyclopropenium inhibit further  electrophilic aromatic substitution  there, but the phenyl rings are reactive.  The cyclopropenium acts as a  meta  director . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2830", "text": "Electrophilic  Lewis acids  stabilize the charge separation, forming diphenylcyclopropenium ether or ester salts.  Such compounds are extremely reactive electrophiles. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2831", "text": "Conversely, the oxygen is quite nucleophilic.   Lux-Flood acids  can abstract the oxygen: thus activated  isocyanates  effect imines;  phosphorus sulfides  or activated  thioic acids  effect the  thione , [ 6 ]  and a wide variety of electrophilic chlorinators, including  oxalyl chloride ,  thionyl chloride , and  phosphorus pentachloride , effect 3,3\u2011dichloro-1,2\u2011diphenyl\u00adcyclopropene.  The latter sees primary application as an electrophilical chlorinator itself, [ 7 ]  and catalyzes the action of the aforementioned chlorinators. [ 6 ]   However, 3,3\u2011dichloro-1,2\u2011diphenyl\u00adcyclopropene also ligates  palladium  for  cross-coupling reactions , [ 7 ]  and reacts with  trichloroacetate  to give  diphenylcyclobutenedione  upon aqueous  workup . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2832", "text": "In other respects, the carbonyl is a typical  electrophile ,  adding Grignard reagents ,  Knoevenagel enols , and  enamines .  The central ring is highly strained, and the presence of most  transition metals  or heating to 160\u00a0\u00b0C induces  decarbonylation , although heating just below the decarbonylation temperature (150\u00a0\u00b0C) irreversibly  forms a [3+2] dimer  instead.  Soft nucleophiles that typically  add in conjugate  typically open the ring instead, as do na\u00efve attempts at reduction.  However, careful  hydroboration  can  reduce away the carbonyl . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2833", "text": "Dixanthogen disulfides  are a class of  organosulfur compounds  with the formula  (ROC(S)S) 2 .  Usually yellow solids, they are the product of the oxidation of  xanthate  salts. [ 1 ]     A common derivative is  diethyl dixanthogen disulfide . Diisopropyl dixanthogen disulfide is commercially available. They are structurally related to  thiuram disulfides ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2834", "text": "Diethyl dixanthogen disulfide is a component for  froth flotations  used, inter alia, for the separation of sulfide minerals like  pyrrhotite . Diisopropyl dixanthogen disulfide is a  reagent  in the synthesis of sulfur  heterocycles . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2835", "text": "Dialkoxy dixanthogen disulfides undergo desulfurization by cyanide to give bis(alkoxythiocarbonyl)sulfides: [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2836", "text": "Dixanthogens are also  ectoparasiticides ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2837", "text": "This  antiinfective   drug  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2838", "text": "Enoxolone  ( INN ,  BAN ; also known as  glycyrrhetinic acid  or  glycyrrhetic acid ) is a pentacyclic  triterpenoid  derivative of the  beta-amyrin  type obtained from the  hydrolysis  of  glycyrrhizic acid , which was obtained from the herb  liquorice ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2839", "text": "The substance has a sweet taste, so it is used in  flavoring  to mask the bitter taste of drugs like  aloe  and  quinine . It may have some anti-inflammatory activities. [ 1 ]  One of its metabolites is responsible for the blood pressure-increasing effect of liquorice. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2840", "text": "In Turkey, enoxolone is used in a \"Anzibel\" lozenge in combination with  benzocaine  (a local anesthetic) and  chlorhexidine  hydrochloride (an antibacterial). [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2841", "text": "It is found in an over-the-counter \"Arthrodont\" toothpaste. Evidence for the ingredient's usefulness for plaque and gingivitis is lacking. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2842", "text": "In Japan, enoxolone is found in the \" Salonpas \" pain-relief menthol patch. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2843", "text": "It is also used in the Singaporean \"Vetic\" cream. [ 3 ]  In the United States, it is found in PruClair, a \"precription medical device\" indicated for generic  dermatoses . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2844", "text": "Enoxolone is effective in the treatment of  peptic ulcer  and also has  expectorant  (antitussive) properties. [ 1 ]   It has some additional pharmacological properties with possible antiviral, antifungal, antiprotozoal, and antibacterial activities. [ 6 ] [ 7 ] [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2845", "text": "Glycyrrhetinic acid inhibits the  enzymes  ( 15-hydroxyprostaglandin dehydrogenase  and delta-13-prostaglandin) that metabolize the  prostaglandins  PGE-2 and PGF-2\u03b1 to their respective, inactive 15-keto-13,14-dihydro  metabolites . This increases prostaglandins in the digestive system. Prostaglandins inhibit gastric secretion, stimulate  pancreatic  secretion and mucous secretion in the  intestines , and markedly increase intestinal motility. They also cause cell proliferation in the  stomach . The effect on  gastric acid  secretion, and promotion of mucous secretion and cell proliferation shows why licorice has potential in treating peptic ulcers. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2846", "text": "Licorice should not be taken during pregnancy, because PGF-2\u03b1 stimulates activity of the uterus during pregnancy and can cause abortion. [ citation needed ] \nds\nThe structure of glycyrrhetinic acid is similar to that of  cortisone . Both molecules are flat and similar at positions 3 and 11. This might be the basis for licorice's  anti-inflammatory  action. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2847", "text": "3-\u03b2- D -(Monoglucuronyl)-18-\u03b2-glycyrrhetinic acid, a metabolite of glycyrrhetinic acid, inhibits the conversion of 'active'  cortisol  to 'inactive'  cortisone  in the  kidneys . [ 11 ]  This occurs via inhibition of the enzyme  11-\u03b2-hydroxysteroid dehydrogenase . [ citation needed ]  As a result, cortisol levels become high within the collecting duct of the kidney. Cortisol has intrinsic mineralocorticoid properties (that is, it acts like  aldosterone  and increases  sodium  reabsorption) that work on ENaC channels in the collecting duct.  [ citation needed ]   Hypertension  develops due to this mechanism of sodium retention. People often have high blood pressure with a low  renin  and low  aldosterone  blood level. [ citation needed ]  The increased amounts of cortisol binds to the unprotected, nonspecific mineralocorticoid receptors and induce sodium and fluid retention,  hypokalaemia , high blood pressure, and inhibition of the renin-angiotensin-aldosterone system. Therefore, licorice should not be given to patients with a known history of hypertension in doses sufficient to inhibit 11-\u03b2-hydroxysteroid dehydrogenase. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2848", "text": "In glycyrrhetinic acid, the  functional group  ( R ) is a  hydroxyl  group. Research in 2005 demonstrated that with a proper functional group a very effective glycyrrhetinic  artificial sweetener  can be obtained. [ 12 ]  When  R  is an  anionic  NHCO(CH 2 )CO 2 K  side chain , the sweetening effect is found to be 1200 times that of  sugar  (human sensory panel data). A shorter or longer  spacer  reduces the sweetening effect. One explanation is that the  taste bud  cell  receptor  has 1.3  nanometers  (13  angstroms ) available for docking with the sweetener molecule. In addition, the sweetener molecule requires three  proton  donor positions, of which two reside at the extremities, to be able to interact efficiently with the receptor cavity."}
{"_id": "WikiPedia_Dermatology$$$corpus_2849", "text": "A synthetic analog,  carbenoxolone , was developed in Britain.  [ citation needed ]  Both glycyrrhetinic acid and carbenoxolone have a modulatory effect on neural signaling through  gap junction  channels."}
{"_id": "WikiPedia_Dermatology$$$corpus_2850", "text": "Acetoxolone , the  acetyl  derivative of glycyrrhetinic acid, is a drug used in the treatment of  peptic ulcer  and  gastroesophageal reflux disease ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2851", "text": "EpiCeram  ( EpiCeram Skin Barrier Emulsion ) is a topical non-steroidal  skin cream .\nBased on the research of Peter M. Elias, [ 1 ]  it is made up of  ceramides , free  fatty acids , and  cholesterol , and is designed to treat  atopic dermatitis , [ 2 ]  a type of  eczema . [ 3 ] [ medical citation needed ]   Ceragenix  obtained marketing clearance from the  U.S. Food and Drug Administration  in April 2006. [ 4 ]  This prescription medical device [ 5 ] [ failed verification ]  works as a  moisturizer  and barrier cream. In the US, it requires prescription and was launched in October 2008 by Promius Pharma. [ 1 ]  EpiCeram was acquired by PuraCap Pharmaceutical LLC in 2010."}
{"_id": "WikiPedia_Dermatology$$$corpus_2852", "text": "EpiCeram obtained  Health Canada  medical device license in September 2009 and was launched by  Pediapharm  in November of the same year. It is sold under  prescription ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2853", "text": "Ethyl lauroyl arginate  ( LAE ) is a  food preservative ,  antimicrobial  compound, and drug more commonly known as  E243 . [ 1 ] [ 2 ] [ 3 ] [ 4 ]  It is used to treat  dermatological  disorders [ 2 ]  and is often provided in the form of its  hydrochloride  salt. LAE is an  amino acid -based  surfactant  with broad-spectrum antimicrobial activity, high biodegradability and low toxicity. Due to these features, LAE is a preservative used in food and cosmetic formulations."}
{"_id": "WikiPedia_Dermatology$$$corpus_2854", "text": "The first synthesis of ethyl lauroyl arginate hydrochloride and its antimicrobial properties were reported in 1976. In the earlies 1980s, LAMIRSA together with Consejo Superior de Investigaciones Cient\u00edficas (CSIC, Barcelona) began to investigate a new approach to the control of pathogens in food through the application of cationic surfactants based on natural building blocks that inhibit the proliferation of a huge variety of microorganisms, including Gram-positive and Gram-negative bacteria, moulds and yeasts. In 1995 LAMIRSA together with CSIC patented a new process to synthesize LAE. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2855", "text": "LAE is a white solid, soluble in deionized water up to 247 g/kg at 20\u00a0\u00b0C with a melting point from 57\u00a0\u00b0C to 58\u00a0\u00b0C. Its partition coefficient between olive oil and water is 0.07; it allows LAE to be located in the water fraction, which is more susceptible to microbial contamination. [ 5 ]  This property gives LAE an advantage over other preservatives with a different chemical structure intended for the same applications."}
{"_id": "WikiPedia_Dermatology$$$corpus_2856", "text": "LAE shows chemical stability at a pH range between 3 and 7 [ 6 ] [ 7 ]  and maintains its antimicrobial activity in this interval."}
{"_id": "WikiPedia_Dermatology$$$corpus_2857", "text": "Its low toxicity and remarkable antimicrobial features make LAE a product with a wide application within the food and cosmetic preservation fields. The use of LAE means a great technological innovation toward manufacturing products with better preservation qualities. In this connection, MIRENAT is a range of formulated products based on LAE intended for the food industry. At the same time, AMINAT is a range of formulated products based on LAE intended for the cosmetic industry."}
{"_id": "WikiPedia_Dermatology$$$corpus_2858", "text": "MIRENAT range of products reduces the risk of food spoilage as it diminishes the presence of pathogens such as  Listeria monocytogenes ,  Salmonella spp.,  and  Escherichia coli . MIRENAT also prolongs the shelf life of food products because of its broad spectrum of activity against all types of microorganisms. Furthermore, it does not modify the organoleptic properties of the treated products."}
{"_id": "WikiPedia_Dermatology$$$corpus_2859", "text": "The antimicrobial activity of LAE solutions applied in food has been widely studied. For instance, Luchansky  et al.  studied the preservation of commercially prepared ham using LAE solutions. [ 8 ]  Initially, hams were surface inoculated with a five-strain cocktail of  Listeria monocytogenes  (7 log 10  CFU/ ham), added to shrink-wrap bags that already contained LAE, vacuum-sealed, and stored at 4\u00a0\u00b0C for 24 h. In samples treated with 2, 4, 6, and 8 mL of 5% Mirenat-N ( i.e.,  0.5% of LAE), pathogen levels decreased dramatically by 5.1, 5.4, and 5.5 log 10  CFU/ham. In addition, samples treated with 8 mL of 5% Mirenat-N for 28 days of refrigerated storage still showed pathogen levels below the limit of detection ( i.e.,  1.48 log10). Similar assays were also conducted using an initial inoculum of 3 log 10  CFU/ham. Here, samples treated with 2, 4, 6, and 8 mL of 5% Mirenat-N and stored at 4\u00a0\u00b0C for 24 h showed pathogen levels below the detection limit for all volumes assayed. Furthermore, samples treated with 6 and 8 mL of 5% Mirenat-N for 28 days of refrigerated storage still showed pathogen levels below the detection limit."}
{"_id": "WikiPedia_Dermatology$$$corpus_2860", "text": "Soni  et al.  also studied the reduction of  Listeria monocytogenes  in cold-smoked salmon by LAE. [ 9 ]  The authors reported that treatment of cold-smoked salmon containing 3.5 log 10  CFU/cm 2   Listeria monocytogenes  with LAE (200 ppm) showed strong listericidal action. Thus, treatment with 200 ppm LAE at 4\u00a0\u00b0C yielded 2.7 and 5.5 log 10  CFU mL \u22121  reduction after 1 h and 4 h incubation, respectively. After 24 h incubation at 4\u00a0\u00b0C, no  Listeria monocytogenes  survival was recovered. At 30\u00a0\u00b0C,  Listeria monocytogenes  reductions were 3.8, 7.0, and 8.0 log 10  CFU mL \u22121  after 1 h, 4 h, and 24 h incubation treatment, respectively."}
{"_id": "WikiPedia_Dermatology$$$corpus_2861", "text": "AMINAT range of products are preservatives for personal care products such as cosmetic creams, lotions, body milks, hair conditioners, and sunscreen formulas or can be used as an active ingredient in soaps, anti-dandruff shampoos, deodorants, and oral care products. AMINAT combines a high antimicrobial efficacy with innocuousness, non-sensitizing, and non-skin irritating features. It also provides smoothness to skin and hair because of its cationic nature."}
{"_id": "WikiPedia_Dermatology$$$corpus_2862", "text": "AMINAT is an environmentally acceptable cosmetic ingredient with the certifications Ecocert, Cosmos, and Natrue."}
{"_id": "WikiPedia_Dermatology$$$corpus_2863", "text": "Vedeqsa scientists evaluated the activity of LAE in anti-dandruff applications. [ 10 ]  The authors performed suspension tests to compare the antimicrobial activity  in vitro  of several formulations against  Malassezia furfur , yeast involved in the proliferation of dandruff. The results demonstrated that the action of the shampoo containing LAE was comparable to the shampoo containing the active zinc pyrithione and slightly superior to that of the shampoo containing the active piroctone olamine.  In vivo  assays were also performed. Thus, a dermatologist evaluated the dandruff severity of twenty volunteers before and after a four-week treatment. Shampoo containing LAE showed comparable or superior performance to the classic anti-dandruff active agents, with a better toxicological and eco-toxicological profile. The authors also evaluated the activity of LAE in anti-acne applications. Here, suspension tests were performed to compare the antimicrobial activity  in vitro  of several dermo-purifying gels against  Propionibacterium acnes , a Gram-positive bacterium involved in acne formation. Results revealed that gels containing LAE had a quicker killing effect than gels containing other active ingredients such as salicylic acid or \u03b4-gluconolactone. The  in vivo  activity of gel containing LAE was assayed in eleven volunteers with greasy and acne-prone skin for 28 days by applying 1 mL of the gel. The results showed a significant reduction in the number of pimples for each volunteer during the treatment. Furthermore, a 13.5% decrease in the average amount of sebum measured on volunteers showed a sebolytic effect of the gel containing LAE as an active."}
{"_id": "WikiPedia_Dermatology$$$corpus_2864", "text": "LAE has potential in treating  gingivitis , and the more advanced  periodontitis . In a study comparing ethyl lauroyl arginate in 0.147% mouthwash to  chlorhexidine  0.12% as an adjunctive therapy in the non-surgical treatment of periodontitis, the results showed there were no treatment-related adverse events. Total bacterial count and the specific pathogens were reduced at 4 weeks and 3 months by both mouthwashes with no statistical differences between them at neither periods of time. It was concluded that 0.147% LAE-containing mouthwash could be an alternative to the use of 0.12% chlorhexidine in the non-surgical therapy of periodontitis considering the similar clinical effects, more stable microbiological improvement and absence of adverse effects. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2865", "text": "It is sold as the main active ingredient in  Listerine  Advanced Defence Gum Treatment [ 12 ]  and as one of the active ingredients in GUM Activital Mouthwash. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2866", "text": "Researchers from the Systems Immunity University Research Institute, Division of Infection & Immunity, School of Medicine in Cardiff, UK were studying the virucidal properties of several mouthwashes against SARS-CoV-2. The study, first published in November 2020, noted that mouthwashes containing LAE eradicated the virus completely, giving >5-log10 reduction in viral titres, surpassing the level required for  EN14476 ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2867", "text": "\"Two  CPC -containing mouthwashes (Dentyl Dual Action and Dentyl Fresh Protect) and a mouthwash containing 23% v/v ethanol/LAE (Listerine\u00ae Advanced DGT) eradicated the virus completely, giving >5-log10 reduction in viral titers and thus met EN14476 as a virucide.\" [ 14 ]  \"Aqueous solutions of LAE below (3.3 mM) and above (9.9 mM) the critical micelle concentration (cmc, 4.9 mM), completely eradicated SARS-CoV2, mirroring the potent antiviral activity of Listerine\u00ae Advanced DGT, which contains 3.3 mM LAE (Fig. 5B). This was seen with or without 23% ethanol inclusion, indicating that LAE is responsible for the antiviral activity of this product. To determine the potential effect of charge on molecular interactions with the viral lipid membrane, in addition to CPC and LAE (cationic surfactants), the effect of the anionic surfactant dodecylbenzensulfonate was tested and found to completely eradicate infectivity (Fig. 5B).\" [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2868", "text": "The authors noted several studies on the impact of surfactant-based oral and nasal rinsing: \"Furthermore, a recent small study [ 15 ]  suggested that oral rinsing could shorten hospital stay, whereas another study suggested that oral and nasal rinsing could reduce both disease and symptoms in health care professionals. Recently, World Health Organization included a recommendation that  PVP-I  could be used to reduce the risk of clinical transmission in dentistry. [ 16 ] \""}
{"_id": "WikiPedia_Dermatology$$$corpus_2869", "text": "Due to its basic guanidine group, LAE is a cationic surfactant. The target of cationic surfactants is the bacterial cytoplasmic membrane, which carries a negative charge often stabilized by the presence of divalent cations such as Mg 2+ and Ca 2+ . Initially, the cationic surfactant crosses the cell wall ( i.e.,  external cell envelopes) of bacteria. Then, the antimicrobial agent displays a high binding affinity for the outermost surface of the cytoplasmic membrane ( i.e.,  inner cell envelope). \u00a0Later, the cationic surfactant's alkyl chain penetrates into the membrane's hydrophobic core. This leads to a progressive leakage of cytoplasmic material, perturbating their metabolic processes, and the normal bacterial cycle is inhibited. Thus, cationic surfactants are considered a \"membrane-active agent\". [ 17 ] [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2870", "text": "Dra. Manresa  et al.  investigated the effects caused by LAE in  Salmonella typhymurium  and  Staphylococcus aureus . LAE caused disturbance in membrane potential and structural changes and loss of cell viability. However, no disruption of cells was detected. [ 20 ]  Similar effects were also observed on two food-related bacteria such as  Yersina enterolitica  and  Lactobacillus plantarum . Here, flow cytometry, transmission electron microscopy, and potassium leakage assays demonstrated that LAE targets the cytoplasmic membrane causing loss of membrane potential and potassium ions. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2871", "text": "The following tables [ clarification needed ]  show the minimum inhibitory concentrations of LAE against different types of microorganisms, primarily pathogens, giving insight into LAE's broad spectrum antimicrobial activity and great effectiveness. Dr. Manresa evaluated the antimicrobial activity of LAE in the Faculty of Pharmacy of the University of Barcelona. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2872", "text": "Further information concerning the antimicrobial properties of LAE is available at  [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2873", "text": "On 1 September 2005, the United States Food and Drug Administration issued the No Objection Letter that LAE is Generally Recognized as Safe for use as an antimicrobial in several food categories at levels up to 200 ppm. Besides, the USDA (United States Department of Agriculture) approved its use in meat and poultry products. LAMIRSA submitted both petitions."}
{"_id": "WikiPedia_Dermatology$$$corpus_2874", "text": "In July 2006 and ratified in July 2012, the Health Secretary of Mexico (Secretar\u00eda de Salud) published in its Official Journal that lauric arginate is an allowed substance to be used as a food additive for human consumption."}
{"_id": "WikiPedia_Dermatology$$$corpus_2875", "text": "The EFSA (European Food Safety Authority) evaluated this new additive with a favorable opinion in April 2007 and, in July 2013, assigned it the number E-243. In May 2014, Regulation 506/2014 was published, authorizing a maximum dosage level of 160 ppm for its use in cooked meat products."}
{"_id": "WikiPedia_Dermatology$$$corpus_2876", "text": "In August 2014, Health Canada amended the food legislation to include LAE as a preservative in various foods at a maximum dosage level of 200 ppm."}
{"_id": "WikiPedia_Dermatology$$$corpus_2877", "text": "The Joint FAO/WHO Expert Committee on Food Additives (JECFA) evaluated LAE at its 69th meeting in June 2008. JECFA, a body dependent on WHO (World Health Organization), established an acceptable daily intake of 4\u00a0mg/Kg bw for the active material. Codex Alimentarius approved LAE use in several food matrixes up to 200 ppm in July 2011."}
{"_id": "WikiPedia_Dermatology$$$corpus_2878", "text": "In March 2015, LAE was included in the IPA database (Inventory of Substances used as Processing Aids) of the CCFA (Codex Committee on Food Additives) as a processing aid in meat products, poultry, and game."}
{"_id": "WikiPedia_Dermatology$$$corpus_2879", "text": "In March 2016, the CCFA issued a positive evaluation of LAE use in several food categories of meat and poultry. In July 2016, the Codex Alimentarius Commission included these approvals at the 39th meeting."}
{"_id": "WikiPedia_Dermatology$$$corpus_2880", "text": "During the 50th session of the CCFA in March 2018, the proposed uses in food categories of fishery products were accepted. It is expected to be approved by Codex Alimentarius Commission at its 41st meeting scheduled for July 2018."}
{"_id": "WikiPedia_Dermatology$$$corpus_2881", "text": "Other countries where the use of lauric arginate is also approved are Colombia (October 2009), Australia and New Zealand (April 2010), Vietnam (November 2012), Chile (August 2013), Israel (November 2014), Turkey (November 2013) and United Arab Emirates (April 2015), India (2011)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2882", "text": "Most recently, the Food Safety and Standards Authority of India (FSSAI) included in 2018 similar uses and food categories previously recognized by CODEX in 2011. Finally, a request for the use of LAE as a processing aid antimicrobial treatment on raw meat was made to the Government of Canada (Health Canada), resulting in a Letter Of No Objection (LONO) issued in December 2022."}
{"_id": "WikiPedia_Dermatology$$$corpus_2883", "text": "In addition to food applications, LAE has exceptional properties to be used as a cosmetic preservative/active ingredient for a wide range of cosmetic products."}
{"_id": "WikiPedia_Dermatology$$$corpus_2884", "text": "As a cosmetic preservative, LAE was approved in the EU in 2009 according to the Cosmetic Directive to be used up to 0.4% for cosmetic products (except for lips, oral, and spray products) and up to 0.15% in mouthwashes (not children < 10 years). As an active cosmetic ingredient, it was also approved to be used up to 0.8% in soaps, anti-dandruff shampoos, and deodorants (not in spray)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2885", "text": "In the same way as EU approval for cosmetic applications, LAE is also confirmed to be used in the US, Mexico, Canada, Australia, New Zealand, South Korea, and Japan, with similar applications and reference doses."}
{"_id": "WikiPedia_Dermatology$$$corpus_2886", "text": "In conjunction with its remarkable antimicrobial features, the low toxicity makes LAE a product with a wide application within the food and cosmetics preservation fields. The addition of LAE means a great technological innovation toward manufacturing products with better preservation qualities."}
{"_id": "WikiPedia_Dermatology$$$corpus_2887", "text": "To many customers, the claim, \"no preservative added\", often has the false connotation of improved quality. However, proper use of food preservatives can benefit the safety and quality of food."}
{"_id": "WikiPedia_Dermatology$$$corpus_2888", "text": "A series of toxicological experiments carried out by Huntingdon Life Science, Ltd. [ 24 ]  confirmed the safety of LAE tests, included the metabolism of LAE in animals and humans, mutagenic, acute, subchronic, chronic, reproductive, and developmental toxicity. The results of these studies have been published in the prestigious scientific journal  Food Chemical Toxicology . [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2889", "text": "Rats were administered an oral dose of  14 C-LAE (arginine portion of LAE uniformly radio-labeled) to assess the absorption, distribution, metabolism, and excretion (ADME) of LAE."}
{"_id": "WikiPedia_Dermatology$$$corpus_2890", "text": "Once  14 C -LAE was administered to rats, the biotransformation of LAE was followed through the absorption and excretion rates. [ 26 ]  The excretion rates were determined through the analysis of urine, faeces, and air exhalation, the routes of radioactivity elimination from the body. The following figure (Figure 1) summarises the excretion of radioactivity and the percentage retained in the carcass:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2891", "text": "The results in Figure 1 show that approximately 50% of the  14 C -LAE administered was absorbed and remained in the carcass of rats, including the liver and gastrointestinal tract."}
{"_id": "WikiPedia_Dermatology$$$corpus_2892", "text": "The next task was to identify and quantify the specific radioactive compounds present in the rats' plasma and define the toxicokinetics based on an  in vivo  study of metabolism. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2893", "text": "Figure 2 reports the percentage of radioactive compounds present in samples of plasma extracted over 4.5 hours after administering  14 C-LAE to rats. LAE is rapidly metabolised to  N \u03b1 -lauroyl-L-arginine (LAS) and then to arginine, which is more slowly metabolised to ornithine. Ornithine is transformed into endogenous products via the urea and citric acid cycles."}
{"_id": "WikiPedia_Dermatology$$$corpus_2894", "text": "The metabolism experiments' results help to establish a biotransformation mechanism for LAE after ingestion. Figure 3 is the proposed pathway of LAE degradation by which it is rapidly hydrolyzed either by loss of the lauroyl side chain to form arginine ethyl ester and/or cleavage of the ethyl ester to form  N \u03b1 -lauroyl-L-arginine (LAS)."}
{"_id": "WikiPedia_Dermatology$$$corpus_2895", "text": "Further hydrolysis of either intermediate results in the generation of arginine, which is then further hydrolyzed to ornithine and urea. Ornithine can be incorporated into the organisms via the urea and citric acid cycles until final degradation to CO 2 . This metabolic pathway (Figure 4) and the supporting data were presented to the ISSX International Congress in Munich in 2001. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2896", "text": "The cream containing the  drug  combination  fluocinolone acetonide/hydroquinone/tretinoin  (trade name  Tri-Luma ) is used for the treatment of  melasma  (dark skin patches).It is marketed by  Galderma . [ 1 ] [ 2 ]  In China, this generic drug with the same ingredients is sold under the trade name \"Fumeida \u00ae  \uff08\u5b5a\u7f8e\u8fbe \u00ae \u4e73\u818f\uff09\" [ 3 ]   [ 4 ] and exclusively manufactured and marketed by  Zhejiang Fonow Medicine Co., Ltd. \uff08\u6d59\u6c5f\u5b5a\u8bfa\u836f\u4e1a\u80a1\u4efd\u6709\u9650\u516c\u53f8\uff09 [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2897", "text": "Fluocinolone acetonide (0.01%)/Hydroquinone (4%)/ Tretinoin (0.05%) Cream is indicated for the short-term (up to 8 weeks) treatment of moderate to severe melasma of the face in the presence of measures for sun avoidance, including the use of sunscreens.  [ 6 ]  Tri-Luma is the only FDA-approved drug containing hydroquinone, [ 7 ]  a prescription product approved for the short-term treatment of dark spots associated with moderate-to-severe melasma of the face. FA+HQ+RA  is effective in patients of all races/ethnicities and Fitzpatrick skin types. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2898", "text": "Some patients may have very severe allergic reactions to Tri-Luma Cream  due to the sulfites contained in the product. In some cases, these allergic reactions may result in severe asthma attacks, which can be life threatening.\nWhile you use Tri-Luma Cream, your skin may develop mild-to-moderate redness, peeling, burning, dryness, or itching."}
{"_id": "WikiPedia_Dermatology$$$corpus_2899", "text": "Tri-Luma Cream contains a corticosteroid medicine as one of its active components.  The following side effects have been reported with application of corticosteroid medicines to the skin: itching, irritation, dryness, infection of the hair follicle, acne, changes in skin color, inflammation around the mouth, allergic skin reaction, skin infection, skin thinning, stretch marks and sweat problems.\nIn addition, Tri-Luma Cream contains a corticosteroid that may produce reversible effects on the adrenal gland called hypothalamic-pituitary-adrenal (HPA) axis suppression, so tell your doctor if you have any condition that may affect your adrenal function, such as Addison\u2019s disease.\nSome patients using Tri-Luma Cream develop dark spots on their skin, tingling, increased skin sensitivity, rash, acne, skin redness caused by a condition called rosacea, skin bumps, blisters, or tiny red lines or blood vessels showing through the skin. Tri-Luma Cream may also cause a gradual blue-black darkening of your skin. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2900", "text": "The most common side effects \uff1a [ 10 ] \n\u2022 redness \n\u2022 dryness \n\u2022 peeling \n\u2022 itching \n\u2022 burning  \n\u2022 acne"}
{"_id": "WikiPedia_Dermatology$$$corpus_2901", "text": "Hydroquinone \nSeveral hypotheses exist to explain the action of hydroquinone in skin lightening.It may interrupt one or more steps in thetyrosine-tyrosinase pathway of melanin synthesis,thus inhibit-ing the conversion of tyrosine to melanin.It compromises the formation of melanosomes and destroys the membranous structures of melanocytes,which results in their degradation.It has also been shown that hydroquinone affects fundamental aspects of cellular metabolism and that melanocytes are partic-ularly vulnerable.Hydroquinone may be oxidized by tyrosi-nase to form toxic compounds.Even low concentrations can cause decreases in DNA and RNA synthesis in melanotic cells. \n Tretinoin \nTretinoin (retinoic acid)causes dispersion of pigment granules in keratinocytes,interferes with pigment transfer,and acceler-ates epidermal transfer,thus causing pigment to be lost more rapidly.Tretinoin also accelerates epidermal turnover,shorten-ing the \"transit time\"from the basal layer and accelerating pig-ment loss.Retinoic acid reduces epidermal melanin,possibly by decreasing the rate of transfer of melanosomes to ker-atinocytes,secondary to an increase in epidermal proliferation and tyrosinase inhibition and a resultant reduction in melano-genesis. \n Corticosteroid \nCorticosteroids have anti-metabolic effects on many cell sys-tems.They are cytotoxic or cytostatic for the epidermis anddecrease epidermal turnover. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2902", "text": "Kligman formula consisting of 0.1% tretinoin, 5.0% hydroquinone, 0.1% dexamethasone, and hydrophilic ointment. [ 12 ]  The dermatologist gold-standard formula for treating hyperpigmentation is the Kligman formula, a prescription named after its inventor, dermatologist Dr. Albert Kilgman. It was originally formulated in 1975 and has remained the most effective topical treatment formula for fading dark spots ever since.  [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2903", "text": "Ingenol mebutate , sold under the brand name  Picato , is a substance that is found in the sap of the plant  Euphorbia peplus , [ 1 ]  commonly known as petty spurge, and is an inducer of  apoptosis . This compound was isolated first from this plant in 2000. [ 2 ]  A gel formulation of the drug has been approved by the U.S.  Food and Drug Administration  (FDA) [ 3 ]  and by the  European Medicines Agency  (EMA) [ 4 ]  for the topical treatment of  actinic keratosis . Two different strengths of the gel have been approved for use on either the face and scalp (0.015%) or the trunk and extremities (0.05%), respectively. [ 5 ]  In 2020 the drug was withdrawn from the market in the EU. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2904", "text": "Irritation of the application site is very common. The various types of irritation include redness, scaling, crusting, pain, severe itching, and sometimes infection. Additional possible side effects include eye irritation, such as  periorbital edema  (3% of patients in studies), headaches (2%) and  nasopharyngitis  (running nose, 2%). [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2905", "text": "Allergic reactions,  shingles , changes in pigmentation at application site, chemical conjunctivitis, and corneal burns may also occur. [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2906", "text": "The  European Medicines Agency  recommended suspending the marketing authorisation of ingenol mebutate due to concerns regarding increased incidence of skin cancer in patients treated with topical ingenol mebutate compared to  vehicle  or  imiquimod . Physicians were advised to refrain from prescribing ingenol and to use different treatment options. [ 10 ]  Subsequently, the marketing authorization holder requested withdrawal of the manufacturing authorization for commercial reasons. The withdrawal was granted and therefore, ingenol mebutate is no longer registered in the EU. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2907", "text": "As ingenol mebutate is not effectively absorbed through the skin and into the bloodstream, interactions with oral drugs are unlikely. [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2908", "text": "The substance is an  ester  of the  diterpene  ingenol and  angelic acid .  A 3-step semisynthesis of ingenol mebutate starting from ingenol was described by a chemical research group in Denmark in 2012. [ 13 ]  A 14-step synthesis of (+)-ingenol from  (+)-3-carene , which is a relatively inexpensive constituent of  turpentine , was published in July 2013. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2909", "text": "The mechanism by which ingenol mebutate causes cell death is still not fully understood.  One study on squamous cell carcinoma, the precursor of which is actinic keratosis, cultures found that the PKC/MEK/ERK signaling pathway is involved in causing cell death after treatment with ingenol mebutate.  In addition, the interleukin decoy receptors IL1R2 and IL13RA2 were induced, resulting in a reduction in the long-term viability of the cells, which could help prevent recurrence. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2910", "text": "Results from four multicenter, randomized, double-blind studies have shown that ingenol mebutate gel applied topically, for 2 to the trunk or 3 days to the face or scalp, is effective for field treatment of actinic keratoses. [ 16 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2911", "text": "A twelve-month follow-up study was performed on actinic keratosis patients who had been treated with ingenol mebutate, 108 of which had been treated for face or scalp and 71 for trunk or extremities and the study found that of those treated for the face or scalp 46.1% had sustained clearance, and of those treated for the trunk 44.0% had sustained clearance for the period of the study. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2912", "text": "Ingenol mebutate has also been found to be useful for reactivating latent  HIV  virus in cells taken from individuals who have tested negative for signs of the disease following extended courses of anti-retroviral drugs, raising the possibility that this drug may be used to expose the last traces of virus, and thus potentially provide a permanent cure for HIV infection. Research is ongoing to determine whether the effects observed  in vitro  are also seen in animal models, with a view to eventual human trials for this application. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2913", "text": "A placebo-controlled study on hairless mice found that 0.1% ingenol mebutate gel was able to remove two-week-old tattoos consistently.  It was observed that the microspheres within the skin containing the dye would exude into the scab intact and slough off as the skin healed about 20 days after treatment began. This mechanism appears to be independent of ink color, unlike laser tattoo removal, which is less effective for certain colors. There are no reports of human trials having been conducted. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2914", "text": "Health Canada assessed twelve studies published in scientific and medical literature in order to determine the link between the use of ingenol mebutate and skin cancer. Health Canada's review found that six of the twelve studies had evidence of skin cancer with the use of ingenol mebutate. The European Medicines Agency (EMA) has also reviewed this safety issue. In April 2020, it concluded that ingenol mebutate may increase the risk of skin cancer and that its risks outweigh its benefits. On 11 February 2020, the manufacturer voluntarily withdrew the product from the European Union market. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2915", "text": "Jasminum officinale , known as the  common jasmine  or simply  jasmine , is a species of  flowering plant  in the olive  family  Oleaceae. It is native to the Caucasus and parts of Asia, also widely naturalized."}
{"_id": "WikiPedia_Dermatology$$$corpus_2916", "text": "It is also known as  summer jasmine , [ 1 ]   poet's jasmine , [ 2 ]   white jasmine , [ 2 ]   true jasmine  or  jessamine , [ 2 ]  and is particularly valued by gardeners throughout the  temperate  world for the intense fragrance of its flowers in summer. It is also the  National flower  of  Pakistan ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2917", "text": "Jasminum officinale  is a vigorous, twining  deciduous   climber  with sharply pointed  pinnate  leaves and clusters of starry, pure white flowers in summer, which are the source of its heady scent. [ 3 ]  The leaf has 5 to 9 leaflets. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2918", "text": "The Latin  specific epithet   officinale  means \"useful\". [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2919", "text": "It is found in the Caucasus, northern Iran, Afghanistan, Pakistan, the Himalayas, Tajikistan, India, Nepal and western China ( Guizhou ,  Sichuan ,  Xizang  (Tibet),  Yunnan ). The species is also widely cultivated in many places, and is reportedly naturalized in Spain, France, Italy, Portugal, Romania, Croatia, Bosnia and Herzegovina, Montenegro, Serbia, Algeria, Florida and the West Indies. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2920", "text": "J. officinale  has been found to contain alkaloids, coumarins, flavonoids, tannins, terpenoids, glycosides, emodine,  leucoanthocyanins , steroids, anthocyanins, phlobatinins,  essential oil  and saponins. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2921", "text": "Jasminum officinale  is so ancient in cultivation that its country of origin, though somewhere in  Central Asia , is not certain. [ 7 ]  H.L. Li,  The Garden Flowers of China , [ 8 ]   notes that in the third century CE, jasmines identifiable as  J. officinale  and  J. sambac  were recorded among \"foreign\" plants in Chinese texts, and that in ninth-century Chinese texts  J. officinale  was said to come from  Byzantium . Its Chinese name,  Yeh-hsi-ming  is a version of the Persian and Arabic name. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2922", "text": "Its entry into European gardens was most likely through the Arab-Norman culture of Sicily, but, as the garden historian John Harvey has said, \"surprisingly little is known, historically or archaeologically, of the cultural life of pre-Norman Sicily\". [ 10 ]  In the mid-14th century the  Florentine  author  Boccaccio  in his  Decameron  describes a  walled garden  in which \"the sides of the alleys were all, as it were, walled in with roses white and red and jasmine; insomuch that there was no part of the garden but one might walk there not merely in the morning but at high noon in grateful shade.\" [ 11 ]  Jasmine water also features in the story of Salabaetto in the  Decameron . [ 12 ]   Jasminum officinale , \"of the household office\" where perfumes were distilled, was so thoroughly naturalized that  Linnaeus  thought it was native to Switzerland. [ 13 ]  As a garden plant in London it features in  William Turner 's  Names of Herbes , 1548."}
{"_id": "WikiPedia_Dermatology$$$corpus_2923", "text": "Double forms, here as among many flowers, were treasured in the 16th and 17th centuries."}
{"_id": "WikiPedia_Dermatology$$$corpus_2924", "text": "Numerous  cultivars  have been developed for garden use, often with  variegated  foliage. The cultivar 'Argenteovariegatum', [ 14 ]  with cream-white  variegation  on the leaves, has gained the  Royal Horticultural Society 's  Award of Garden Merit . [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2925", "text": "The  essential oil  of  Jasminum officinale  is used in  aromatherapy . Jasmine  absolute  has a heavy, sweet scent valued by perfumers. The flowers release their perfume at dusk, so flowers are picked at night and a tiny amount of oil is obtained from each blossom by solvent extraction. The result is an expensive oil which can be used in low concentrations. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2926", "text": "Jasmine is \" generally recognized as safe \" (GRAS) as a food ingredient by the U.S.  Food and Drug Administration . [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2927", "text": "It is unknown whether jasmine consumption affects breastmilk, as the safety and efficacy of jasmine in nursing mothers or infants has not been adequately studied. [ 16 ]  Drinking small amounts of jasmine tea likely are not harmful during nursing. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2928", "text": "Allergic reactions  to jasmine may occur. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2929", "text": "Maxacalcitol  (trade name  Oxarol ) is a  vitamin D 3  analog and  vitamin D receptor  activator (VDRA). [ 1 ]  As a pharmaceutical drug, it is used as an injection to treat  secondary hyperparathyroidism  resulting from  hemodialysis  and as a topical ointment for  psoriasis . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2930", "text": "It was approved for use in Japan in 2010 [ 3 ]  and in Taiwan in 2018. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2931", "text": "Mederma  is a topical product used to improve  scar  appearance. It is a  gel  based on an  onion  extract. Mederma is product of HRA Pharma, a division of  Perrigo . A Mederma  marketing claim  is that the product can can make scars \"softer, smoother, and less noticeable\". [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2932", "text": "The Mederma brand was owned by  Merz Pharma  for over 20 years until its 2019 sale to HRA Pharma. [ 2 ]  Perrigo then acquired HRA Pharma as a  subsidiary  in 2021. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2933", "text": "A 1999 pilot trial found an onion extract gel less effective than the petrolatum. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2934", "text": "A 2002 study published in  Plastic and Reconstructive Surgery  examined the effectiveness of Mederma on hypertrophic scars on rabbit ears. It found no significant reduction in the size, height, or inflammation of scars. The only improvement was dermal  collagen  organization when compared to scars that were not treated with Mederma, thus suggesting that it may have a positive effect on the formation of raised scars. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2935", "text": "A 2006  clinical trial  found no statistically significant change in  hypertrophic  scar appearance from products of this type compared to the standard petrolatum emollient. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2936", "text": "According to a 2011  Los Angeles Times  article, \"there were just two randomized comparison trials of Mederma, with a combined total of 38 participants. Neither trial found that Mederma improved the appearance of scars more than petroleum jelly\". [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2937", "text": "Allantoin [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2938", "text": "Water (purified), PEG 200, alcohol,  xanthan gum ,  allium cepa  (onion) bulb extract, lecithin,  methylparaben ,  sorbic acid , panthenol, sodium hyaluronate, fragrance [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2939", "text": "PDC-APB , or  3-pentadecyl-1,2-phenylene bis(4-(4-aminophenyl)butanoate) , [ 1 ]  is a  drug candidate  under evaluation to determine if it might protect against  contact dermatitis  caused by  urishiol  from  poison ivy ,  poison oak , and  poison sumac . [ 2 ] [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2940", "text": "The compound is one of a class of compounds developed through  University of Mississippi  research [ 5 ]  by  Mahmoud ElSohly ,  Waseem Gul , and  Mohammad Khalid Ashfaq . [ 1 ]  Work on the compound is ongoing under  Hapten Sciences , [ 6 ]  who licensed the university's research in 2010. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2941", "text": "The compound has been evaluated in two  Phase I clinical trials , and a third Phase I  randomized controlled trial , with a secondary objective of evaluating the effect of treatment on urishiol sensitivity, is due to be completed in December 2022. [ 7 ] [ needs update ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2942", "text": "Pyrilutamide  (developmental code name  KX-826 ) is a  nonsteroidal antiandrogen  (NSAA) \u2013 specifically, a  selective  high- affinity   silent   antagonist  of the  androgen receptor  (AR) \u2013 which is under development by Suzhou Kintor Pharmaceuticals, inc., a subsidiary of Kintor Pharmaceutical Limited, for the potential treatment of  androgenic alopecia  (androgen-dependent scalp hair loss) [ 2 ] [ 3 ] [ 4 ]  As of September 2022, it is in  phase 3   clinical trials  for androgenic alopecia and  phase 2  trials for acne. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2943", "text": "Pyrilutamide has undergone several clinical trials for the treatment of androgenic alopecia (AGA) in both males and females. [ 5 ]  The primary endpoint for most trials was the change from baseline in non- vellus  target area hair count (TAHC) compared to placebo after 24 weeks of treatment. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2944", "text": "A phase II trial in China enrolled 120 male patients, randomized into four groups: KX-826 0.25% BID (twice daily), KX-826 0.5% QD (once daily), KX-826 0.5% BID, and placebo. After 24 weeks, the 0.5% BID group showed significant improvement: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2945", "text": "A phase II trial for female AGA in China included 160 patients in five groups: KX-826 0.25% QD, 0.25% BID, 0.5% QD, 0.5% BID, and placebo. After 24 weeks: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2946", "text": "A phase II trial in the U.S. enrolled 123 male patients, divided into KX-826 0.25% QD, 0.5% QD, 0.5% BID, and placebo groups. Results after 24 weeks showed: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2947", "text": "A phase III trial for male AGA in China enrolled 740 patients, randomized into KX-826 0.5% BID and placebo groups. Results announced on November 27, 2023, showed: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2948", "text": "In addition to its ongoing clinical development, Pyrilutamide has been introduced to the market as a cosmetic anti-hair loss product under the brand name Koshine. This approach allows it to be made available to consumers without the need for full regulatory approval as a medical treatment. Its classification as a cosmetic reflects a strategic decision to facilitate earlier access while formal medical approval is still pending. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2949", "text": "Pyrilutamide is generally well-tolerated. The most common adverse event is  contact dermatitis . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2950", "text": "Across all trials, KX-826 demonstrated a favorable safety profile: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2951", "text": "Pyrilutamide binds to the androgen receptor with a very high affinity with an  IC 50  of 0.28 nM. [ 4 ]  Reference drug  bicalutamide  had an IC 50  of 3.1 nM. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2952", "text": "A  rubefacient  is a substance for  topical  application that produces redness of the  skin , e.g. by causing  dilation  of the  capillaries  and an increase in  blood circulation . It has sometimes been used to relieve acute or chronic pain, but there is limited evidence as to its efficacy, [ 1 ] [ 2 ]  and as of 2014 the best evidence does not support using gels and creams containing rubefacients for this purpose. [ 1 ] [ better\u00a0source\u00a0needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2953", "text": "Common medicinal rubefacients include: [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2954", "text": "Common herbal rubefacients include: [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2955", "text": "Sofpironium bromide , sold under the brand name  Ecclock  among others, is a  medication  used to treat  hyperhidrosis  (excessive sweating). [ 1 ]  Sofpironium bromide is an  anticholinergic  agent that is applied to the skin. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2956", "text": "It was approved in Japan in 2020, for the treatment of  primary axillary hyperhidrosis . [ 2 ]  It was approved for medical use in the United States in June 2024. [ 1 ] [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2957", "text": "Sofpironium bromide is  indicated  for the treatment of primary axillary hyperhidrosis. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2958", "text": "The pharmacodynamics of sofpironium bromide are unknown. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2959", "text": "It was approved for medical use in Japan in November 2020, [ 5 ]  and in the United States in June 2024. [ 1 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2960", "text": "Sofpironium bromide is the  international nonproprietary name . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2961", "text": "It is sold under the brand name Ecclock in Japan and under the brand name Sofdra in the US."}
{"_id": "WikiPedia_Dermatology$$$corpus_2962", "text": "Tea tree oil , also known as  melaleuca oil , is an  essential oil  with a fresh,  camphoraceous   odour  and a colour that ranges from pale yellow to nearly colourless and clear. [ 1 ] [ 2 ]  It is derived from the  leaves  of the tea tree,  Melaleuca alternifolia , native to southeast  Queensland  and the northeast coast of  New South Wales , Australia. The oil comprises many constituent chemicals, and its composition changes if it is exposed to air and  oxidises . Commercial use of tea tree oil began in the 1920s, pioneered by the entrepreneur  Arthur Penfold ."}
{"_id": "WikiPedia_Dermatology$$$corpus_2963", "text": "There is little evidence for the effectiveness of tea tree oil in treating  mite-infected   crusting of eyelids , [ 3 ]  although some claims of efficacy exist. [ 4 ] [ 5 ]  In  traditional medicine , it may be applied  topically  in low concentrations for skin diseases, although there is little evidence for efficacy. [ 2 ] [ 6 ] [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2964", "text": "Tea tree oil is neither a  patented  product nor an  approved drug  in the United States, although it has been used in  skin care products [ 2 ] [ 8 ]  and is approved as a complementary medicine for  aromatherapy  in Australia. [ 9 ]  It is  poisonous  if consumed by mouth and is unsafe for children. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2965", "text": "Although tea tree oil is claimed to be useful for treating  dandruff ,  acne ,  lice ,  herpes ,  insect bites ,  scabies , and skin  fungal  or  bacterial  infections, [ 8 ] [ 11 ]  insufficient evidence exists to support any of these claims due to the limited quality of research. [ 2 ] [ 7 ] [ 12 ]  A 2015  Cochrane  review of acne complementary therapies found a single low-quality trial showing benefit on skin lesions compared to  placebo . [ 13 ]  Tea tree oil was also used during  World War II  to treat skin lesions of munitions factory workers. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2966", "text": "According to the  Committee on Herbal Medicinal Products  (CHMP) of the  European Medicines Agency , traditional usage suggests that tea tree oil is a possible treatment for \"small, superficial wounds, insect bites, and small boils\" and that it may reduce itching in minor cases of athlete's foot. The CHMP states that tea tree oil products should not be used on people under 12 years of age. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2967", "text": "Tea tree oil is not recommended for treating  nail fungus  because it is yet to be proven effective, [ 15 ]  It is not recommended for treating head lice in children because its effectiveness and safety have not been established and it could cause skin irritation or  allergic reactions . [ 16 ] [ 17 ]  As of 2020 [update] , there is uncertainty regarding the effectiveness of 5-50% tea tree oil as an effective treatment for  demodex  mite infestations, although products claiming efficacy exist. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2968", "text": "Tea tree oil is highly toxic when ingested orally. [ 2 ] [ 7 ] [ 19 ] [ 12 ]  It may cause drowsiness, confusion, hallucinations, coma, unsteadiness, weakness, vomiting, diarrhoea, nausea, blood-cell abnormalities, and severe rashes. It should be kept away from pets and children. [ 12 ]  It should not be used in or around the mouth. [ 2 ] [ 7 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2969", "text": "Application of tea tree oil to the skin can cause an allergic reaction in some, [ 2 ]  the potential for which increases as the oil ages and its chemical composition changes. [ 20 ]  Adverse effects include skin irritation, allergic contact dermatitis, systemic  contact dermatitis ,  linear immunoglobulin A disease ,  erythema multiforme -like reactions, and systemic  hypersensitivity  reactions. [ 11 ] [ 21 ]  Allergic reactions may be due to the various oxidation products that are formed by exposure of the oil to light and air. [ 21 ] [ 22 ]  Consequently, oxidised tea tree oil should not be used. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2970", "text": "In Australia, tea tree oil is one of the many  essential oils  causing poisoning, mostly of children. From 2014 to 2018, 749 cases were reported in New South Wales, accounting for 17% of essential oil poisoning incidents. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2971", "text": "Tea tree oil potentially poses a risk for causing  abnormal breast enlargement  in men [ 25 ] [ 26 ]  and prepubertal children. [ 27 ] [ 28 ]  A 2018 study by the  National Institute of Environmental Health Sciences  found four of the constituent chemicals ( eucalyptol ,  4-terpineol ,  dipentene , and  alpha-terpineol ) are  endocrine disruptors , raising concerns of potential  environmental health  impacts from the oil. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2972", "text": "In dogs and cats, death [ 30 ] [ 31 ]  or transient signs of toxicity (lasting two to three days), such as lethargy, weakness, incoordination, and muscle tremors, have been reported after external application at high doses. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2973", "text": "As a test of  toxicity  by oral intake, the  median lethal dose  (LD 50 ) in rats is 1.9\u20132.4\u00a0ml/kg. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2974", "text": "Tea tree oil is defined by the International Standard  ISO  4730 (\"Oil of  Melaleuca ,  terpinen-4-ol  type\"), containing terpinen-4-ol, \u03b3- terpinene , and \u03b1-terpinene as about 70% to 90% of whole oil, while  p -cymene , terpinolene, \u03b1-terpineol, and  \u03b1-pinene  collectively account for some 15% of the oil (table). [ 1 ] [ 6 ] [ 8 ]  The oil has been described as colourless to pale yellow [ 1 ] [ 2 ]  having a fresh,  camphor -like smell. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2975", "text": "Tea tree oil products contain various  phytochemicals , among which  terpinen-4-ol  is the major component. [ 1 ] [ 2 ] [ 6 ]  Adverse reactions diminish with lower  eucalyptol  content. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2976", "text": "The name \"tea tree\" is used for several plants, mostly from  Australia  and  New Zealand , from the family  Myrtaceae  related to the  myrtle . The use of the name probably originated from  Captain James Cook 's description of one of these shrubs that he used to make an  infusion  to drink in place of  tea . [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2977", "text": "The commercial tea tree oil industry originated in the 1920s when Australian chemist  Arthur Penfold  investigated the business potential of a number of native extracted oils; he reported that tea tree oil had promise, as it exhibited  antiseptic  properties. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2978", "text": "Tea tree oil was first  extracted  from  Melaleuca alternifolia  in Australia, and this species remains the most important commercially. In the 1970s and 1980s, commercial plantations began to produce large quantities of tea tree oil from  M. alternifolia . Many of these plantations are located in New South Wales. [ 33 ]  Since the 1970s and 80s, the industry has expanded to include several other species for their extracted oil:  Melaleuca armillaris  and  Melaleuca styphelioides  in Tunisia and Egypt;  Melaleuca leucadendra  in Egypt, Malaysia, and Vietnam;  Melaleuca acuminata  in Tunisia;  Melaleuca ericifolia  in Egypt; and  Melaleuca quinquenervia  in the United States (considered an invasive species in Florida [ 36 ] )."}
{"_id": "WikiPedia_Dermatology$$$corpus_2979", "text": "Similar oils can also be produced by water distillation from  Melaleuca linariifolia  and  Melaleuca dissitiflora . [ 37 ]  Whereas the availability and  nonproprietary  nature of tea tree oil would make it\u00a0\u2013 if proved effective\u00a0\u2013 particularly well-suited to a disease such as scabies that affects poor people disproportionately, those same characteristics diminish corporate interest in its development and validation. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2980", "text": "Tralokinumab  sold under the brand names  Adtralza  (EU/UK) and  Adbry  (US) among others, is a  human monoclonal antibody  used for the treatment of  atopic dermatitis . [ 3 ] [ 5 ]  Tralokinumab targets the cytokine  interleukin 13 . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2981", "text": "The most common side effects include upper respiratory tract infections (colds and other infections of the nose and throat), reactions at the injection site, and redness and discomfort in the eye. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2982", "text": "Tralokinumab was approved for medical use in the European Union and in the United Kingdom in June 2021. [ 3 ] [ 5 ] [ 9 ]  It was approved for medical use in the United States in December 2021. [ 7 ] [ 10 ] [ 4 ]  The U.S.  Food and Drug Administration  (FDA) considers it to be a  first-in-class medication . [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2983", "text": "Tralokinumab is  indicated  for the treatment of moderate-to-severe atopic dermatitis in adults who are candidates for systemic therapy. [ 5 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2984", "text": "In the United States, tralokinumab is indicated for the treatment of moderate-to-severe atopic dermatitis in adults whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. [ 4 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2985", "text": "Tralokinumab was discovered by  Cambridge Antibody Technology  scientists [ 12 ] [ 13 ] [ 14 ]  using protein optimization based on  Ribosome Display . [ 15 ]  They used the extensive data sets from ribosome display to patent protect CAT-354 in a world-first of sequence-activity-relationship claims. [ 14 ]  In 2004, clinical development of CAT-354 was initiated with this first study completing in 2005. [ 16 ]  On 21 July 2011,  MedImmune  LLC initiated a Phase IIb, randomized, double-blind study to evaluate the efficacy of tralokinumab in adults with asthma. [ 17 ] [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2986", "text": "In 2016, MedImmune and AstraZeneca started developing tralokinumab for asthma (Phase III) and atopic dermatitis (Phase IIb) while clinical development for moderate-to-severe  ulcerative colitis  and idiopathic pulmonary fibrosis (IPF) have been discontinued. [ 16 ]  In July of that year AstraZeneca licensed tralokinumab to  Leo Pharma  for skin diseases. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2987", "text": "A phase IIb study of tralokinumab found that treatment was associated with early and sustained improvements in atopic dermatitis symptoms and tralokinumab had an acceptable safety and tolerability profile, thereby providing evidence for targeting IL-13 in patients with atopic dermatitis. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2988", "text": "In June 2017,  Leo Pharma  started phase III clinical trials with tralokinumab in atopic dermatitis. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2989", "text": "In April 2021, the  Committee for Medicinal Products for Human Use  of the  European Medicines Agency  adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Adtralza, intended for the treatment of moderate\u2011to\u2011severe atopic dermatitis. [ 23 ]  The applicant for this medicinal product is LEO Pharma A/S. [ 23 ]  Tralokinumab was approved for medical use in the European Union in June 2021. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2990", "text": "Tralokinumab is the  international nonproprietary name  (INN) [ 24 ]  and the  United States Adopted Name  (USAN). [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2991", "text": "Immune activation :  Dostarlimab \n Other:   Ibalizumab"}
{"_id": "WikiPedia_Dermatology$$$corpus_2992", "text": "Urea , also known as  carbamide-containing cream , [ clarification needed ]  is used as a medication and applied to the skin to treat dryness and itching such as may occur in  psoriasis ,  dermatitis , or  ichthyosis . [ 1 ] [ 2 ] [ 3 ]  It may also be used to soften  nails . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2993", "text": "In adults side  effects are generally few. [ 4 ]  It may occasionally cause skin irritation. [ 1 ]  Urea works in part by loosening dried skin. [ 5 ]  Preparations generally contain 5 to 50%  urea . [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2994", "text": "Urea  containing creams have been used since the 1940s. [ 6 ]  It is on the  World Health Organization's List of Essential Medicines . [ 7 ]  It is available  over the counter . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2995", "text": "Urea cream is indicated for  debridement  and promotion of normal healing of skin areas with  hyperkeratosis , particularly where healing is inhibited by local  skin infection , skin  necrosis , fibrinous or itching debris or  eschar . [ 5 ]  Specific condition with hyperkeratosis where urea cream is useful include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2996", "text": "Common side effects of urea cream are:"}
{"_id": "WikiPedia_Dermatology$$$corpus_2997", "text": "In severe cases, there can be an  allergic reaction  with symptoms such as  skin rash ,  urticaria ,  difficulty breathing  and swelling of the mouth, face, lips, or tongue. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2998", "text": "Urea in low doses is a  humectant  while at high doses (above 20%) it causes breakdown of protein in the skin. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_2999", "text": "Urea dissolves the  intercellular matrix  of the cells of the  stratum corneum , promoting  desquamation  of  scaly skin , eventually resulting in softening of  hyperkeratotic  areas. [ 5 ]  In  nails , urea causes softening and eventually debridement of the nail plate. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3000", "text": "Dermatology  is the branch of  medicine  dealing with the  skin . [ 1 ] [ 2 ]  It is a speciality with both medical and surgical aspects. [ 3 ] [ 4 ] [ 5 ]  A  dermatologist  is a specialist medical doctor who manages diseases related to skin, hair, nails, and some cosmetic problems. [ 2 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3001", "text": "Attested in English in 1819, the word \"dermatology\" derives from the  Greek  \u03b4\u03ad\u03c1\u03bc\u03b1\u03c4\u03bf\u03c2 ( dermatos ), genitive of \u03b4\u03ad\u03c1\u03bc\u03b1 ( derma ), \"skin\" [ 7 ]  (itself from \u03b4\u03ad\u03c1\u03c9  dero , \"to flay\" [ 8 ] ) and -\u03bb\u03bf\u03b3\u03af\u03b1  -logia . Neo-Latin  dermatologia  was coined in 1630, an anatomical term with various French and German uses attested from the 1730s. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3002", "text": "In 1708, the first great school of dermatology became a reality at the famous  H\u00f4pital Saint-Louis  in Paris, and the first textbooks (Willan's, 1798\u20131808) and atlases ( Alibert's , 1806\u20131816) appeared in print around the same time. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3003", "text": "After earning a medical degree ( M.D.  or  D.O. ), the length of training in the United States for a general dermatologist to be eligible for board certification by the  American Academy of Dermatology ,  American Board of Dermatology , or  American Osteopathic Board of Dermatology  is four years. [ 11 ]  This training consists of an initial medical, transitional, surgical, or pediatric intern year followed by a three-year dermatology residency. [ 2 ] [ 12 ] [ 13 ]  Following this training, one- or two-year post-residency fellowships are available in  immunodermatology ,  phototherapy ,  laser medicine ,  Mohs micrographic surgery ,  cosmetic surgery ,  dermatopathology , or pediatric dermatology. While these dermatology fellowships offer additional subspecialty training, many dermatologists proficiently provide these services without subspecialty fellowship training. For the past several years, dermatology residency positions in the United States have been one of the most competitive to obtain. [ 14 ] [ 15 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3004", "text": "According to the American Academy of Dermatology, dermatologists are trained to diagnose and manage over 3,000 distinct skin, hair, and nail conditions across patients spanning various age groups. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3005", "text": "The United States has been experiencing a national shortage of dermatologists for more than a decade. A study published by the  Journal of the American Medical Association  reported fewer than 3.4 dermatologists for every 100,000 people. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3006", "text": "In the UK, a dermatologist is a medically qualified practitioner who has gone on to specialize in medicine and then subspecialize in dermatology. This involves:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3007", "text": "Upon successful completion of the four-year training period, the doctor becomes an accredited dermatologist and is able to apply for a consultant hospital post as a consultant dermatologist. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3008", "text": "Dermatologists have been leaders in the field of cosmetic surgery. [ 20 ]  Some dermatologists complete fellowships in surgical dermatology. Many are trained in their residency on the use of  botulinum toxin , fillers, and laser surgery. Some dermatologists perform cosmetic procedures including  liposuction ,  blepharoplasty , and  face lifts . [ 21 ] [ 22 ]  Most dermatologists limit their cosmetic practice to minimally invasive procedures. Despite an absence of formal guidelines from the  American Board of Dermatology , many cosmetic fellowships are offered in both surgery and laser medicine. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3009", "text": "A dermatopathologist is a  pathologist  or dermatologist who specializes in the  pathology  of the skin. [ 24 ]  This field is shared by dermatologists and pathologists. Usually, a dermatologist or pathologist completes one year of dermatopathology fellowship and according to market projections, it is estimated to expand at a compound annual growth rate (CAGR) of 11.4% from 2022 to 2030. This usually includes six months of general pathology and six months of dermatopathology. [ 25 ]  Alumni of both specialties can qualify as dermatopathologists. At the completion of a standard residency in dermatology, many dermatologists are also competent at dermatopathology. Some dermatopathologists qualify to sit for their examinations by completing a residency in dermatology and one in pathology. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3010", "text": "Trichology specializes in diseases, which manifest with hair loss, hair abnormalities,  hypertrichosis  and scalp changes.  Trichoscopy  is a medical diagnostic method that is used by dermatologists with a special interest in trichology. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3011", "text": "This field specializes in the treatment of immune-mediated skin diseases such as  lupus ,  bullous pemphigoid ,  pemphigus vulgaris , and other immune-mediated skin disorders. [ 27 ]  Specialists in this field often run their own immunopathology labs. [ citation needed ]  Immunodermatology testing is essential for the correct diagnosis and treatment of many diseases affecting epithelial organs including skin, mucous membranes, gastrointestinal and respiratory tracts. The various diseases often overlap in clinical and histological presentation and, although the diseases themselves are not common, may present with features of common skin disorders such as urticaria, eczema and chronic itch. Therefore, the diagnosis of an immunodermatological disease is often delayed. Tests are performed on blood and tissues that are sent to various laboratories from medical facilities and referring physicians across the United States. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3012", "text": "The dermatologic subspecialty called Mohs surgery focuses on the excision of skin cancers using a technique that allows intraoperative assessment of most of the peripheral and deep tumor margins. Developed in the 1930s by  Frederic E. Mohs , the procedure is defined as a type of  CCPDMA  processing. Physicians trained in this technique must be comfortable with both pathology and surgery, and dermatologists receive extensive training in both during their residency. Physicians who perform Mohs surgery can receive training in this specialized technique during their dermatology residency, but many seek additional training either through formal preceptorships to become fellows of the American Society for Mohs Surgery [ 29 ]  or through one-year Mohs surgery fellowship training programs administered by the American College of Mohs Surgery. [ 30 ]  In 2020, the American Board of Dermatology (ABD) received approval from the American Board of Medical Specialties (ABMS) to establish a board-certification exam in the subspecialty of Micrographic Dermatologic Surgery (Mohs Surgery). The exam was first offered in October 2021 to any US board-certified dermatologist who practices Mohs surgery, regardless of whether they received their training in dermatology residency or as part of a fellowship. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3013", "text": "This technique requires the integration of the same doctor in two different capacities - surgeon and pathologist. In case either of the two responsibilities is assigned to another doctor or qualified health-care professional, it is not considered to be Mohs surgery. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3014", "text": "Physicians can qualify for this specialization by completing both a pediatric residency and a dermatology residency. Or they might elect to complete a post-residency fellowship. [ 32 ]  This field encompasses the complex diseases of the  neonates , hereditary skin diseases or  genodermatoses , and the many difficulties of working with the  pediatric  population. [ 33 ]  Another area pediatric dermatologists may focus on is treating acne. Acne is formed when follicles under the skin become clogged. This can be caused by sebum, an oil that keeps the skin moist, or dead skin cells clogging the pores. This is very common in teens and young adults, and can be treated by prescription from a dermatologist.  [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3015", "text": "Teledermatology is a form of dermatological practice in which telecommunication technologies are used to exchange medical information and treatment through audio, visual, and data communication, including photos of dermatologic conditions, between dermatologists and nondermatologists who are evaluating patients, along with dermatologists directly with patients via distance. [ 35 ] [ 36 ] [ 37 ]  In India, during the severe coronavirus situations, some dermatologists have initiated online consultation with their patients using some of popular apps, such as Practo, Apollo Pharmacy, Skin Beauty Pal, Lybrate, etc. This subspecialty deals with options to view skin conditions over a large distance to provide  knowledge exchange , [ 38 ]  to establish second-opinion services for experts, [ 39 ]  or to use this for follow-up of individuals with chronic skin conditions. [ 40 ] [ 41 ]  Teledermatology can reduce wait times by allowing dermatologists to treat minor conditions online while serious conditions requiring immediate care are given priority for appointments. [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3016", "text": "Dermatoepidemiology is the study of skin disease at the population level. [ 43 ]  One of its aspects is the determination of the global burden of skin diseases. [ 44 ] [ 45 ] \nFrom 1990 to 2013, skin disease constituted about 2% of total global disease disability  [ 46 ]  as measured in disability-adjusted life-years. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3017", "text": "Comparative dermatology is a branch of dermatology that examines skin disorders across species, focusing on similarities and differences between humans and animals, such as dogs. This interdisciplinary approach is crucial for enhancing our understanding of dermatological conditions and developing more effective treatment and prevention strategies."}
{"_id": "WikiPedia_Dermatology$$$corpus_3018", "text": "Skin disorders are common in dogs, significantly affecting their quality of life and often requiring veterinary intervention. While some breeds are genetically predisposed to specific skin issues, there remains a notable gap in research comparing these canine conditions to similar human skin disorders. Addressing this gap can yield insights into the shared mechanisms underlying these diseases. For instance, atopic dermatitis. [ 48 ]  It is a common, itchy, and often difficult-to-treat condition. The Merck Veterinary Manual highlights various congenital and inherited skin disorders in dogs that are influenced by these factors, emphasizing the need for comparative research to improve disease management across species. [ 49 ]  By comparing the disease in animals and humans, researchers can gain insights into its progression and variability in response to treatments."}
{"_id": "WikiPedia_Dermatology$$$corpus_3019", "text": "Furthermore, research into the genetic underpinnings of skin disorders has demonstrated that certain genetic mutations in dogs are associated with inherited skin diseases, which may serve as models for understanding similar human conditions. [ 50 ]  Environmental factors, such as allergens and pollutants, also play a significant role in skin health. Studies published in journals focusing on inflammatory skin conditions in humans and veterinary research reveal how these environmental influences intersect with genetic predispositions, offering a comparative framework for further study. [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3020", "text": "Treatment strategies for skin disorders also differ between veterinary and human medicine. Veterinary treatments often prioritize symptomatic relief and prevention, while human dermatological care may involve a broader range of targeted pharmaceutical options. Comparative analysis of these treatment methodologies could lead to the development of new therapies beneficial to both fields, as discussed in microbiological research into skin health. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3021", "text": "By emphasizing the comparative aspects of dermatology, researchers can contribute to a deeper understanding of skin health across species. This field underscores the importance of genetic research, environmental studies, and treatment innovations, as evidenced by ongoing research in dermatological and veterinary science."}
{"_id": "WikiPedia_Dermatology$$$corpus_3022", "text": "Therapies provided by dermatologists include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3023", "text": "Most dermatologic pharmacology can be categorized based on the  Anatomical Therapeutic Chemical (ATC) classification system , specifically the  ATC code D ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3024", "text": "Acres of Skin: Human Experiments at Holmesburg Prison  is a 1998 book by  Allen Hornblum . The book documents clinical non-therapeutic  medical experiments on prison inmates  at  Holmesburg Prison  in Philadelphia from 1951 to 1974, conducted under the direction of  dermatologist   Albert Kligman . [ 1 ]  The title of the book is a reference to Kligman's reaction on seeing hundreds of prisoners when he entered the prison: \"All I saw before me were acres of skin\"; \"It was like a farmer seeing a fertile field for the first time\". [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3025", "text": "The book discusses issues surrounding the inadequate consent procedures of the 1950s and 1960s when using prisoners.  Prisoners, attracted by the compensation, were angry when two of the experiment's participants testified before Congress. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3026", "text": "The publication of  Acres of Skin  in 1998 attracted considerable international media interest. [ 2 ]  The book has been reviewed in several journals including the  International Journal of Dermatology , [ 4 ]   Social History of Medicine [ 5 ]  and  Canadian Journal of History . [ 1 ] [ 6 ] [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3027", "text": "Actinic keratosis  ( AK ), sometimes called  solar keratosis  or  senile keratosis , [ 1 ] [ 2 ]  is a  pre-cancerous [ 3 ]  area of thick, scaly, or crusty skin. [ 4 ] [ 5 ]  Actinic keratosis is a disorder ( -osis ) of  epidermal   keratinocytes  that is induced by  ultraviolet (UV)  light exposure ( actin- ). [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3028", "text": "These growths are more common in  fair-skinned  people and those who are frequently in the  sun . [ 7 ]  They are believed to form when  skin  gets damaged by UV radiation from the sun or indoor  tanning beds , usually over the course of decades. Given their pre-cancerous nature, if left untreated, they may turn into a type of skin cancer called  squamous cell carcinoma . [ 5 ]  Untreated lesions have up to a 20% risk of progression to squamous cell carcinoma, [ 8 ]  so treatment by a  dermatologist  is recommended."}
{"_id": "WikiPedia_Dermatology$$$corpus_3029", "text": "Actinic keratoses characteristically appear as thick, scaly, or crusty areas that often feel dry or rough. Size commonly ranges between 2 and 6  millimeters , but they can grow to be several centimeters in diameter.  AKs are often felt before they are seen, and the texture is sometimes compared to  sandpaper . [ 9 ]  They may be dark, light, tan, pink, red, a combination of all these, or have the same color as the surrounding skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_3030", "text": "Given the causal relationship between sun exposure and AK growth, they often appear on a background of sun-damaged skin and in areas that are commonly sun-exposed, such as the face, ears, neck, scalp, chest, backs of hands, forearms, or lips.  Because sun exposure is rarely limited to a small area, most people who have an AK have more than one. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3031", "text": "If clinical examination findings are not typical of AK and the possibility of in situ or invasive  squamous cell carcinoma (SCC)  cannot be excluded based on clinical examination alone, a  biopsy  or  excision  can be considered for definitive diagnosis by  histologic  examination of the lesional tissue. [ 11 ]  Multiple treatment options for AK are available.  Photodynamic therapy  (PDT) is one option for the treatment of numerous AK lesions in a region of the skin, termed field cancerization. [ 12 ]  It involves the application of a photosensitizer to the skin followed by illumination with a strong light source. Topical creams, such as  5-fluorouracil  or  imiquimod , may require daily application to affected skin areas over a typical time course of weeks. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3032", "text": "Cryotherapy  is frequently used for few and well-defined lesions, [ 14 ]  but undesired skin lightening, or hypopigmentation, may occur at the treatment site. [ 15 ]  By following up with a dermatologist, AKs can be treated before they progress to skin cancer. If cancer does develop from an AK lesion, it can be caught early with close monitoring, at a time when treatment is likely to have a high cure rate."}
{"_id": "WikiPedia_Dermatology$$$corpus_3033", "text": "Actinic keratoses (AKs) most commonly present as a white, scaly  plaque  of variable thickness with surrounding redness; they have a sandpaper-like texture when felt with a gloved hand. Skin nearby the lesion often shows evidence of solar damage characterized by pigmentary alterations, being yellow or pale in color with areas of hyperpigmentation; deep wrinkles, coarse texture,  purpura  and  ecchymoses ,  dry skin , and scattered  telangiectasias  are also characteristic. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3034", "text": "Photoaging leads to an accumulation of  oncogenic  changes, resulting in a proliferation of mutated  keratinocytes  that can manifest as AKs or other neoplastic growths. [ 17 ]  With years of sun damage, it is possible to develop multiple AKs in a single area on the skin.  This condition is termed field cancerization."}
{"_id": "WikiPedia_Dermatology$$$corpus_3035", "text": "The lesions are usually asymptomatic, but can be tender, itch, bleed, or produce a stinging or burning sensation. [ 18 ]  AKs are typically graded in accordance with their clinical presentation: Grade I (easily visible, slightly palpable), Grade II (easily visible, palpable), and Grade III (frankly visible and hyperkeratotic). [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3036", "text": "Actinic keratoses can have various clinical presentations, often characterized as follows:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3037", "text": "The presence of  ulceration ,  nodularity , or  bleeding  should raise concern for malignancy. [ 23 ]  Specifically, clinical findings suggesting an increased risk of progression to  squamous cell carcinoma  can be recognized as\u00a0\"IDRBEU\": I (induration/inflammation), D (diameter > 1\u00a0cm), R (rapid enlargement), B (bleeding), E (erythema), and U (ulceration). [ 24 ]  AKs are usually diagnosed clinically, but because they are difficult to clinically differentiate from squamous cell carcinoma, any concerning features warrant biopsy for diagnostic confirmation. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3038", "text": "The most important cause of AK formation is solar radiation, through a variety of mechanisms.  Mutation of the  p53  tumor suppressor gene, induced by UV radiation, has been identified as a crucial step in AK formation. [ 26 ]  This  tumor suppressor gene , located on  chromosome 17p 132, allows for  cell cycle  arrest when DNA or RNA is damaged.  Dysregulation  of the p53 pathway can thus result in unchecked replication of dysplastic keratinocytes, thereby serving as a source of  neoplastic  growth and the development of AK, as well as possible progression from AK to skin cancer. [ 27 ]  Other  molecular markers  that have been associated with the development of AK include the expression of p16 ink4 , p14, the  CD95  ligand,  TNF -related apoptosis-inducing ligand ( TRAIL ) and TRAIL receptors, and  loss of heterozygosity . [ 28 ] [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3039", "text": "Evidence also suggests that the  human papillomavirus  (HPV) plays a role in the development of AKs. The HPV virus has been detected in AKs, with measurable HPV viral loads (one HPV-DNA copy per less than 50 cells) measured in 40% of AKs. [ 29 ]  Similar to UV radiation, higher levels of HPV found in AKs reflect enhanced viral DNA replication.  This is suspected to be related to the abnormal keratinocyte proliferation and differentiation in AKs, which facilitate an environment for HPV replication. This in turn may further stimulate the abnormal proliferation that contributes to the development of AKs and carcinogenesis."}
{"_id": "WikiPedia_Dermatology$$$corpus_3040", "text": "It is thought that  ultraviolet (UV) radiation  induces mutations in the keratinocytes of the epidermis, promoting the survival and proliferation of these atypical cells. Both  UV-A  and  UV-B  radiation have been implicated as causes of AKs.  UV-A radiation (wavelength 320\u2013400\u00a0nm) reaches more deeply into the skin and can lead to the generation of  reactive oxygen species , which in turn can damage cell membranes, signaling proteins, and nucleic acids.   UV-B  radiation (wavelength 290\u2013320\u00a0nm) causes  thymidine   dimer  formation in DNA and RNA, leading to significant cellular mutations. [ 30 ]   In particular, mutations in the p53 tumor suppressor gene have been found in 30\u201350% of AK lesion skin samples. [ 26 ] [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3041", "text": "UV radiation has also been shown to cause elevated inflammatory markers such as  arachidonic acid , as well as other molecules associated with inflammation. [ 27 ]   Eventually, over time these changes lead to the formation of AKs.  Several predictors for increased AK risk from UV radiation have been identified:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3042", "text": "Melanin  is a pigment in the epidermis that functions to protect keratinocytes from the damage caused by UV radiation; it is found in higher concentrations in the epidermis of darker-skinned individuals, affording them protection against the development of AKs."}
{"_id": "WikiPedia_Dermatology$$$corpus_3043", "text": "Fair-skinned individuals have a significantly increased risk of developing AKs when compared to olive-skinned individuals ( odds ratios  of 14.1 and 6.5, respectively), [ 33 ]  and AKs are uncommon in dark-skinned people of African descent. [ 31 ]  Other phenotypic features seen in fair-skinned individuals that are associated with an increased propensity to develop AKs include: [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3044", "text": "Physicians usually diagnose actinic keratosis by doing a thorough physical examination, through a combination of visual observation and touch. However a  biopsy  may be necessary when the keratosis is large in diameter, thick, or bleeding, in order to make sure that the lesion is not a  skin cancer . Actinic keratosis may progress to invasive  squamous cell carcinoma  (SCC) but both diseases can present similarly upon physical exam and can be difficult to distinguish clinically. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3045", "text": "Histological  examination of the lesion from a  biopsy  or excision may be necessary to definitively distinguish AK from  in situ  or invasive  SCC . [ 6 ]  In addition to SCCs, AKs can be mistaken for other  cutaneous  lesions including  seborrheic keratoses ,  basal cell carcinoma ,  lichenoid keratosis ,  porokeratosis ,  viral warts ,  erosive pustular dermatosis of the scalp ,  pemphigus foliaceus , inflammatory dermatoses like  psoriasis , or  melanoma . [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3046", "text": "A lesion  biopsy  is performed if the diagnosis remains uncertain after a clinical physical exam, or if there is suspicion that the AK might have progressed to squamous cell carcinoma. The most common tissue sampling techniques include shave or punch biopsy. When only a portion of the lesion can be removed due to its size or location, the biopsy should sample tissue from the thickest area of the lesion, as SCCs are most likely to be detected in that area."}
{"_id": "WikiPedia_Dermatology$$$corpus_3047", "text": "If a  shave biopsy  is performed, it should extend through to the level of the  dermis  in order to provide sufficient tissue for diagnosis; ideally, it would extend to the mid-reticular dermis.  Punch biopsy  usually extends to the  subcutaneous fat  when the entire length of the punch blade is utilized."}
{"_id": "WikiPedia_Dermatology$$$corpus_3048", "text": "On histologic examination, actinic keratoses usually show a collection of atypical keratinocytes with hyperpigmented or pleomorphic nuclei, extending to the  basal layer  of the  epidermis . A \"flag sign\" is often described, referring to alternating areas of  orthokeratosis  and  parakeratosis .  Epidermal thickening  and surrounding areas of  sun-damaged skin  are often seen. [ 39 ]  The normal ordered maturation of the  keratinocytes  is disordered to varying degrees: there may be widening of the intracellular spaces, cytologic atypia such as abnormally large nuclei, and a mild  chronic inflammatory  infiltrate. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3049", "text": "Specific findings depend on the clinical variant and particular lesion characteristics. The seven major histopathologic variants are all characterized by atypical keratinocytic proliferation beginning in the basal layer and confined to the epidermis; they include: [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3050", "text": "Dermoscopy  is a noninvasive technique utilizing a handheld magnifying device coupled with a transilluminating lift. It is often used in the evaluation of cutaneous lesions but lacks the definitive diagnostic ability of biopsy-based tissue diagnosis. Histopathologic exam remains the gold standard."}
{"_id": "WikiPedia_Dermatology$$$corpus_3051", "text": "Polarized contact dermoscopy of AKs occasionally reveals a \"rosette sign,\" described as four white points arranged in a clover pattern, often localized to within a follicular opening. [ 41 ]  It is hypothesized that the \"rosette sign\" corresponds histologically to the changes of orthokeratosis and parakeratosis known as the \"flag sign.\" [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3052", "text": "Ultraviolet radiation is believed to contribute to the development of actinic keratoses by inducing mutations in epidermal keratinocytes, leading to proliferation of atypical cells. [ 44 ]  Therefore, preventive measures for AKs are targeted at limiting exposure to solar radiation, including:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3053", "text": "Recent research implicating human papillomavirus (HPV) in the development of AKs suggests that HPV prevention might in turn help prevent development of AKs, as UV-induced mutations and oncogenic transformation are likely facilitated in cases of active HPV infection. [ 29 ]   A key component of HPV prevention includes  vaccination , and the CDC currently recommends routine vaccination in all children at age 11 or 12. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3054", "text": "There are some data that in individuals with a history of non-melanoma skin cancer, a low-fat diet can serve as a preventative measure against future actinic keratoses. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3055", "text": "There are a variety of treatment options for AK depending on the patient and the clinical characteristics of the lesion.  AKs show a wide range of features, which guide decision-making in choosing treatment. As there are multiple effective treatments, patient preference and lifestyle are also factors that physicians consider when determining the management plan for actinic keratosis. [ 48 ]  Regular follow-up is advisable after any treatment to make sure no new lesions have developed and that old ones are not progressing. Adding topical treatment after a procedure may improve outcomes. [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3056", "text": "Topical medications are often recommended for areas where multiple or ill-defined AKs are present, as the medication can easily be used to treat a relatively large area. [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3057", "text": "Topical  fluorouracil  (5-FU) destroys AKs by blocking  methylation  of  thymidylate synthetase , thereby interrupting DNA and RNA synthesis. [ 50 ]  This in turn prevents the proliferation of dysplastic cells in AK. Topical 5-FU is the most utilized treatment for AK, and often results in effective removal of the lesion. [ 51 ]  Overall, there is a 50% efficacy rate resulting in 100% clearance of AKs treated with topical 5-FU. [ 52 ] [ 53 ]  5-FU may be up to 90% effective in treating non-hyperkeratotic lesions. [ 54 ]  While topical 5-FU is a widely used and cost-effective treatment for AKs and is generally well tolerated, its potential side-effects can include: pain, crusting, redness, and local swelling. [ 55 ]  These adverse effects can be mitigated or minimized by reducing the frequency of application or taking breaks between uses. [ 55 ]  The most commonly used application regimen consists of applying a layer of topical cream to the lesion twice a day after washing; duration of treatment is typically 2\u20134 weeks to thinner skin like the cheeks and up to 8 weeks for the arms; treatment of up to 8 weeks has demonstrated a higher cure rate. [ 56 ] [ 57 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3058", "text": "Imiquimod  is a topical immune-enhancing agent licensed for the treatment of genital warts. [ 25 ]  Imiquimod stimulates the  immune system  through the release and up-regulation of  cytokines . [ 56 ]  Treatment with Imiquimod cream applied 2\u20133 times per week for 12 to 16 weeks was found to result in complete resolution of AKs in 50% of people, compared to 5% of controls. [ 58 ]  The Imiquimod 3.75% cream has been validated in a treatment regimen consisting of daily application to entire face and scalp for two 2-week treatment cycles, with a complete clearance rate of 36%. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3059", "text": "While the clearance rate observed with the Imiquimod 3.75% cream was lower than that observed with the 5% cream (36 and 50 percent, respectively), there are lower reported rates of adverse reactions with the 3.75% cream: 19% of individuals using Imiquimod 3.75% cream reported adverse reactions including local erythema, scabbing, and flaking at the application site, while nearly a third of individuals using the 5% cream reported the same types of reactions with Imiquimod treatment. [ 58 ] [ 59 ]  However, it is ultimately difficult to compare the efficacy of the different strength creams directly, as current study data varies in methodology (e.g. duration and frequency of treatment, and amount of skin surface area covered)."}
{"_id": "WikiPedia_Dermatology$$$corpus_3060", "text": "Ingenol mebutate  is a newer treatment for AK used in Europe and the United States. It works in two ways, first by disrupting cell membranes and mitochondria resulting cell death, and then by inducing antibody-dependent cellular cytotoxicity to eliminate remaining tumor cells. [ 60 ]  A 3-day treatment course with the 0.015% gel is recommended for the scalp and face, while a 2-day treatment course with the 0.05% gel is recommended for the trunk and extremities. [ 61 ]  Treatment with the 0.015% gel was found to completely clear 57% of AK, while the 0.05% gel had a 34% clearance rate. [ 62 ]  Advantages of ingenol mebutate treatment include the short duration of therapy and a low recurrence rate. [ 63 ]  Local skin reactions including pain, itching and redness can be expected during treatment with ingenol mebutate. This treatment was derived from the petty spurge,  Euphorbia peplus  which has been used as a traditional remedy for keratosis."}
{"_id": "WikiPedia_Dermatology$$$corpus_3061", "text": "Topical  diclofenac sodium  gel is a nonsteroidal anti-inflammatory drug that is thought to work in the treatment of AK through its inhibition of the arachidonic acid pathway, thereby limiting the production of prostaglandins which are thought to be involved in the development of UVB-induced skin cancers. [ 40 ]  Recommended duration of therapy is 60 to 90 days with twice daily application. Treatment of facial AK with diclofenac gel led to complete lesion resolution in 40% of cases. [ 64 ]  Common side effects include dryness, itching, redness, and rash at the site of application. [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3062", "text": "Topical  retinoids  have been studied in the treatment of AK with modest results, and the American Academy of Dermatology does not currently recommend this as first-line therapy. [ 65 ]  Treatment with  adapalene  gel daily for 4 weeks, and then twice daily thereafter for a total of nine months led to a significant but modest reduction in the number AKs compared to placebo; it demonstrated the additional advantage of improving the appearance of photodamaged skin. [ 66 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3063", "text": "Topical  tretinoin  is ineffective as treatment for reducing the number of AKs. [ 25 ]  For secondary prevention of AK, systemic, low-dose  acitretin  was found to be safe, well tolerated and moderately effective in chemoprophylaxis for skin cancers in kidney transplant patients. [ 67 ]   Acitretin is a viable treatment option for organ transplant patients according to expert opinion. [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3064", "text": "Tirbanibulin  (Klisyri) was approved for medical use in the United States in December 2020, for the treatment of actinic keratosis on the face or scalp. [ 68 ] [ 69 ] [ 70 ] [ 71 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3065", "text": "Liquid nitrogen  (\u2212195.8\u00a0\u00b0C) is the most commonly used destructive therapy for the treatment of AK in the United States. [ 72 ]  It is a well-tolerated office procedure that does not require anesthesia. [ 73 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3066", "text": "Cryotherapy is particularly indicated for cases where there are fewer than 15 thin, well-demarcated lesions. [ 72 ]  Caution is encouraged for thicker, more hyperkeratotic lesions, as dysplastic cells may evade treatment. [ 57 ]   Treatment with both cryotherapy and field treatment can be considered for these more advanced lesions. [ 57 ]   Cryotherapy is generally performed using an open-spray technique, wherein the AK is sprayed for several seconds. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3067", "text": "The process can be repeated multiple times in one office visit, as tolerated. Cure rates from 67 to 99 percent have been reported, [ 74 ] [ 15 ]  depending on freeze time and lesion characteristics. Disadvantages include discomfort during and after the procedure; blistering, scarring and redness; hypo- or hyperpigmentation; and destruction of healthy tissue. [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3068", "text": "AKs are one of the most common dermatologic lesions for which  photodynamic therapy , including topical  methyl aminolevulinate  (MAL) or  5-aminolevulinic acid  (5-ALA), is indicated. [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3069", "text": "Treatment begins with preparation of the lesion, which includes scraping away scales and crusts using a dermal curette. A thick layer of topical MAL or 5-ALA cream is applied to the lesion and a small area surrounding the lesion, which is then covered with an occlusive dressing and left for a period of time. During this time the photosensitizer accumulates in the target cells within the AK lesion. The dressings are then removed and the lesion is treated with light at a specified wavelength."}
{"_id": "WikiPedia_Dermatology$$$corpus_3070", "text": "Multiple treatment regimens using different photosensitizers, incubation times, light sources, and pretreatment regimens have been studied and suggest that longer incubation times lead to higher rates of lesion clearance. [ 77 ]  Photodynamic therapy is gaining in popularity. It has been found to have a 14% higher likelihood of achieving complete lesion clearance at 3 months compared to cryotherapy, [ 78 ]  and seems to result in superior cosmetic outcomes when compared to cryotherapy or 5-FU treatment. [ 79 ]  Photodynamic therapy can be particularly effective in treating areas with multiple AK lesions. [ 80 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3071", "text": "Laser therapy  using  carbon dioxide  (CO 2 ) or erbium:yttrium aluminum garnet ( Er:YAG ) lasers is a treatment approach being utilized with increased frequency, and sometimes in conjunction with computer scanning technology. [ 83 ]  Laser therapy has not been extensively studied, but current evidence suggests it may be effective in cases involving multiple AKs refractive to medical therapy, or AKs located in cosmetically sensitive locations such as the face. [ 84 ]   The CO 2  laser has been recommended for extensive actinic cheilitis that has not responded to 5-FU. [ 57 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3072", "text": "A  chemical peel  is a topically applied agent that wounds the outermost layer of the skin, promoting organized repair, exfoliation, and eventually the development of smooth and rejuvenated skin. Multiple therapies have been studied. A medium-depth peel may effectively treat multiple non-hyperkeratotic AKs. [ 85 ]  It can be achieved with 35% to 50%  trichloroacetic acid  (TCA) alone or at 35% in combination with  Jessner's solution  in a once-daily application for a minimum of 3 weeks; 70%  glycolic acid  (\u03b1-hydroxy acid); or solid CO 2 . [ 86 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3073", "text": "When compared to treatment with 5-FU, chemical peels have demonstrated similar efficacy and increased ease of use with similar morbidity. [ 87 ]  Chemical peels must be performed in a controlled clinic environment and are recommended only for individuals who are able to comply with follow-up precautions, including avoidance of sun exposure. Furthermore, they should be avoided in individuals with a history of  HSV  infection or  keloids , and in those who are  immunosuppressed  or who are taking  photosensitizing  medications."}
{"_id": "WikiPedia_Dermatology$$$corpus_3074", "text": "Untreated AKs follow one of three paths: they can either persist as AKs, regress, or progress to invasive skin cancer, as AK lesions are considered to be on the same continuum with  squamous cell carcinoma  (SCC). [ 17 ]  AK lesions that regress also have the potential to recur."}
{"_id": "WikiPedia_Dermatology$$$corpus_3075", "text": "Given the aforementioned differering clinical outcomes, it is difficult to predict the clinical course of any given actinic keratosis.  AK lesions may also come and go\u2014in a cycle of appearing on the skin, remaining for months, and then disappearing. Often they will reappear in a few weeks or months, particularly after unprotected sun exposure. Left untreated, there is a chance that the lesion will advance to become invasive.  Although it is difficult to predict whether an AK will advance to become squamous cell carcinoma, it has been noted that squamous cell carcinomas originate in lesions formerly diagnosed as AKs with frequencies reported between 65 and 97%. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3076", "text": "Actinic keratosis is very common, with an estimated 14% of dermatology visits related to AKs. [ 91 ]  It is seen more often in fair-skinned individuals, [ 33 ]  and rates vary with geographical location and age. [ 92 ]  Other factors such as exposure to ultraviolet (UV) radiation, [ 93 ]  certain  phenotypic  features, and immunosuppression can also contribute to the development of AKs."}
{"_id": "WikiPedia_Dermatology$$$corpus_3077", "text": "Men are more likely to develop AK than women, and the risk of developing AK lesions increases with age. These findings have been observed in multiple studies, with numbers from one study suggesting that approximately 5% of women ages 20\u201329 develop AK compared to 68% of women ages 60\u201369, and 10% of men ages 20\u201329 develop AK compared to 79% of men ages 60\u201369. [ 94 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3078", "text": "Geography seems to play a role in the sense that individuals living in locations where they are exposed to more UV radiation throughout their lifetime have a significantly higher risk of developing AK. Much of the literature on AK comes from Australia, where the prevalence of AK is estimated at 40\u201350% in adults over 40, [ 94 ]  as compared to the United States and Europe, where prevalence is estimated at under 11\u201338% in adults. [ 37 ] [ 93 ]  One study found that those who immigrated to Australia after age 20 had fewer AKs than native Australians in all age groups. [ 95 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3079", "text": "Diagnostically, researchers are investigating the role of novel biomarkers to assist in determining which AKs are more likely to develop into cutaneous or metastatic SCC. Upregulation of  matrix metalloproteinases  (MMP) is seen in many different types of cancers, and the expression and production of MMP-7 in particular has been found to be elevated in SCC specifically. [ 96 ]  The role of  serin peptidase inhibitors  (Serpins) is also being investigated. SerpinA1 was found to be elevated in the keratinocytes of SCC cell lines, and SerpinA1 upregulation was correlated with SCC tumor progression  in vivo . [ 96 ]  Further investigation into specific biomarkers could help providers better assess prognosis and determine best treatment approaches for particular lesions."}
{"_id": "WikiPedia_Dermatology$$$corpus_3080", "text": "In terms of treatment, a number of medications are being studied. Resiquimod is a TLR 7/8 agonist that works similarly to imiquimod, but is 10 to 100 times more potent; when used to treat AK lesions, complete response rates have range from 40 to 74%. [ 97 ]   Afamelanotide  is a drug that induces the production of melanin by  melanocytes  to act as a protective factor against UVB radiation. [ 98 ]  It is being studied to determine its efficacy in preventing AKs in organ transplant patients who are on immunosuppressive therapy.  Epidermal growth factor receptor  (EGFR) inhibitors such as  gefitinib , and anti-EGFR antibodies such as  cetuximab  are used in the treatment of various types of cancers, and are currently being investigated for potential use in the treatment and prevention of AKs. [ 99 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3081", "text": "The  arrector pili muscles , also known as  hair erector muscles , [ 1 ]  are small muscles attached to  hair follicles  in  mammals . Contraction of these muscles causes the hairs to stand on end, [ 2 ]  known colloquially as  goose bumps  (piloerection). [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3082", "text": "Each arrector pili is composed of a bundle of  smooth muscle  fibres which attach to several follicles (a follicular unit). [ 4 ]  Each is innervated by the sympathetic division of the  autonomic nervous system . [ 4 ]  The muscle attaches to the follicular stem cell niche in the follicular bulge, [ 3 ] [ 4 ] [ 5 ]  splitting at their deep end to encircle the follicle. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3083", "text": "The contraction of the muscle is involuntary. Stresses such as  cold ,  fear  etc. may stimulate the  sympathetic nervous system , and thus cause muscle contraction. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3084", "text": "Contraction of arrector pili muscles have a principal function in the majority of mammals of providing thermal insulation. [ 4 ]  Air becomes trapped between the erect hairs, helping the animal retain heat."}
{"_id": "WikiPedia_Dermatology$$$corpus_3085", "text": "Many animals experience contraction of the arrector pili muscle in response to a perceived threat. This helps the animal seem more larger and more intimidating as a result. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3086", "text": "Pressure exerted by the muscle may cause  sebum  to be forced along the hair follicle towards the surface, protecting the hair. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3087", "text": "Arrector pili muscles also stabilise the base of the  hair follicle . [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3088", "text": "Skin conditions such as  leprosy  can damage arrector pili muscles, preventing their contraction. [ 9 ]  Inducing contraction of the arrector pili muscles via an  \u03b11-adrenergic receptor  agonist has been shown to reduce hair shedding as a result of  traction alopecia [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3089", "text": "The term \"arrector pili\" comes from Latin. It translates to \"hair erector\". [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3090", "text": "Derm101  was an online and mobile resource for physicians and healthcare professionals to learn the diagnosis and treatment of dermatologic diseases. [ 1 ]  The resource includes online textbooks, interactive quizzes, peer-reviewed open access dermatology journals, a dermatologic surgery video library, case studies, thousands of clinical photographs and photomicrographs of skin diseases, and mobile applications."}
{"_id": "WikiPedia_Dermatology$$$corpus_3091", "text": "Dr.  A. Bernard Ackerman  (1936\u20132008), a prominent figure in  dermatology  and  dermatopathology , and Andy Zwick, his nephew and collaborator, founded Derm101 in 2002. [ 2 ] [ 3 ]  The concept for Derm101 was envisioned and proposed to Dr. Ackerman by Zwick in 1999, while he was a senior at  Harvard , and they went on to develop Derm101 together. Derm101 debuted in February 2002 at the annual meeting of the  American Academy of Dermatology  in New Orleans."}
{"_id": "WikiPedia_Dermatology$$$corpus_3092", "text": "In February 2016, Nestl\u00e9 announced its creation of Nestl\u00e9 Skin Health, a conglomerate of skin health-related companies, of which Derm101 was a part of. [ 4 ]  In 2019, Nestl\u00e9 Skin Health was acquired by a private equity firm EQT, a unit of the Abu Dhabi Investment Authority and PSP Investments, and rebranded as Galderma. [ 5 ] [ 6 ]  Shortly after the sale was finalized, Galderma made the decision to decommission Derm101 which occurred on December 31, 2019."}
{"_id": "WikiPedia_Dermatology$$$corpus_3093", "text": "\u2022 Derm101.com ( http://www.derm101.com )"}
{"_id": "WikiPedia_Dermatology$$$corpus_3094", "text": "Dr. Pimple Popper  is an American  reality television  series airing on  TLC . The series, starring  dermatologist  and Internet celebrity  Dr. Sandra Lee , follows her as she treats patients with unusual cases of facial and skin disorders at her clinic Skin Physicians & Surgeons in the  Inland Empire  city of  Upland, California . The show started with an hour-long special on January 3, 2018 before the first season aired on July 11, 2018. [ 1 ] [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3095", "text": "Initially airing at 10:00\u00a0p.m.  Eastern Time  on Wednesdays,  Dr. Pimple Popper  became the top-rated cable program in its time slot among women between ages 25\u201354. On August 14, the day before the final episode for Season 1 aired, TLC announced it had renewed the series for a second season, with new episodes set to air in January 2019. [ 4 ]  Another hour-long special was aired on December 13, 2018, before the second season began on January 3, 2019 with its episodes moved to 9 p.m. Eastern Time on Thursdays. Beginning part-way through the fifth season, new episodes became available on the  Discovery+  streaming service, before returning to TLC for the sixth season. A spin-off series titled  Dr. Pimple Popper: Before the Pop  premiered on September 3, 2020. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3096", "text": "The ninth and final season premiered on April 5, 2023. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3097", "text": "On August 5, 2020, it was announced that a spin-off series titled  Dr. Pimple Popper: Before the Pop  would premiere on September 3, 2020. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3098", "text": "Dr. Pimple Popper: This Is Zit  is an online series available on TLC's website and  Facebook . Each three- to six-minute episode focuses on a particular procedure done by Dr. Lee. [ 97 ] [ 98 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3099", "text": "The first season of  Dr. Pimple Popper  has a  Rotten Tomatoes  rating of 78%. [ 99 ]  Kristen Baldwin of  Entertainment Weekly  gave the pilot episode a \"B\" rating, commenting that \" Pimple Popper  delivers that blast of feel-good warmth you want from a makeover show, as the patients offer tearful post-procedural testimonials about how Dr. Lee changed their life for the better.\" [ 100 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3100", "text": "Excess skin  is an effect of surplus skin and fat after expansion during  pregnancy  or  adipositas  and following a massive and considerable  weight loss . Further reasons can be aging effects, genetic disorders or an intentional expansion for skin reconstruction. Due to the elastic nature of the skin, there is generally some improvement over time. Excessive loose skin can be permanent to a degree but surgical treatment is an option."}
{"_id": "WikiPedia_Dermatology$$$corpus_3101", "text": "Methods to remove excess skin by surgery include  abdominoplasty ,  breast reduction  and  brachioplasty ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3102", "text": "In 1994,  60 Minutes  covered the mystery of Tomm Tennent, a young man \"born hugely wrinkled by an excess of skin\". Per  60 Minutes , Tennent was then the only person in the world with this congenital condition. [ 1 ]  He was born in 1992 with a great excess of skin, which hung about him in many wrinkles. As he grew towards adulthood, he \"grew into\" his skin, as into an oversize garment, and the wrinkles flattened out. His condition is compared to  Shar Pei  dog puppies, which have this condition also; the boy and Shar Pei puppies in their skins both have 10 times the normal level of  hyaluronic acid . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3103", "text": "In March 2015, Kaitlyn Smith shared her experience after losing 208 pounds (\"half her size\"), [ 3 ]  having once weighed more than 400 lbs."}
{"_id": "WikiPedia_Dermatology$$$corpus_3104", "text": "In September 2020,  Biggest Loser  trainer Erica Lugo underwent a 360 tummy tuck. Having quickly lost over 160 lbs, Lugo was left with 8.5 lbs of excess skin.  People  covered the pre- and post- op experience. Lugo told  People  the decision to get surgery was not easy, but that she had a \"new body\" and was \"floored\" at the postoperative results. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3105", "text": "TLC Skin Tight is a TV show with each episode following \u201ctwo people who have lost massive amounts of weight and are about to undergo a full body transformation through skin removal surgery.\u201d [ 6 ]  \u201cIt\u2019s not unusual, says the show, for there to be \u201cup to 50 pounds\u201d of sagging skin following massive weight loss. Skin Tight ran for three seasons and 33 episodes, with the first episode airing 6 January 2016, and the last 20 May 2018. [ 7 ] [ non-primary source needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3106", "text": "First Derm  is a US-based online  dermatology  and tele-health website providing answers to skin conditions. Users send in cases to  board certified   dermatologists  via an  iOS ,  Android  or  Web app ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3107", "text": "First Derm was founded in 2014 by Dr. Alexander B\u00f6rve to support dermatologists in treating patients online. Dr. B\u00f6rve studied at the  Sahlgrenska Academy  based in The  University of Gothenburg , where he was a researcher in  mobile health  and tele-dermatology. [ 1 ]  The research conducted was one of the first of its time, based on using mobile devices as a tool to answer questions and queries for dermatologists. The research included a pilot study of the effectiveness of a mobile health service in Sweden, [ 2 ]  the use of MMS and  SMS  in teledermatology, [ 3 ]  and the use of  teledermoscopy  as a tool to refer possible skin cancer patients to a dermatologist. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3108", "text": "Over 300,000 cases have been checked from over 160 countries and the service is available in seven languages."}
{"_id": "WikiPedia_Dermatology$$$corpus_3109", "text": "The purpose of First Derm is to provide immediate solutions to skin care concerns without diagnosing the patient. This allows the patient to speed up the referral process and receive surgery or treatment more quickly than the traditional route."}
{"_id": "WikiPedia_Dermatology$$$corpus_3110", "text": "The tool is also used by national health services such as  NHSx  who employ the tool as a triage solution for doctors. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3111", "text": "The  hair follicle  is an  organ  found in  mammalian   skin . [ 1 ]  It resides in the  dermal  layer of the skin and is made up of 20 different  cell types , each with distinct functions. The hair follicle regulates  hair growth  via a complex interaction between  hormones ,  neuropeptides , and  immune cells . [ 1 ]  This complex interaction induces the hair follicle to produce different types of  hair  as seen on different parts of the body. For example,  terminal hairs  grow on the  scalp  and  lanugo hairs  are seen covering the bodies of  fetuses  in the  uterus  and in some  newborn babies . [ 1 ]  The process of  hair growth  occurs in distinct sequential stages:  anagen  is the active growth phase,  catagen  is the regression of the hair follicle phase,  telogen  is the resting stage,  exogen  is the active shedding of hair phase and  kenogen  is the phase between the empty hair follicle and the growth of new hair. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3112", "text": "The function of hair in humans has long been a subject of interest and continues to be an important topic in society, developmental biology and medicine. Of all mammals, humans have the longest growth phase of scalp hair compared to hair growth on other parts of the body. [ 1 ]  For centuries, humans have ascribed esthetics to scalp hair styling and dressing and it is often used to communicate social or cultural norms in societies. In addition to its role in defining human appearance, scalp hair also provides protection from  UV sun rays  and is an insulator against extremes of hot and cold temperatures. [ 1 ]  Differences in the shape of the scalp hair follicle determine the observed ethnic differences in scalp hair appearance, length and texture."}
{"_id": "WikiPedia_Dermatology$$$corpus_3113", "text": "There are many human diseases in which abnormalities in hair appearance, texture or growth are early signs of local disease of the hair follicle or systemic illness. Well known diseases of the hair follicle include  alopecia [ 2 ]  or hair loss,  hirsutism  or excess hair growth and  lupus erythematosus . [ 3 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3114", "text": "The position and distribution of hair follicles varies over the body. For example, the skin of the palms and soles does not have hair follicles whereas skin of the scalp, forearms, legs and genitalia has abundant hair follicles. [ 1 ]  There are many structures that make up the hair follicle. Anatomically, the triad of hair follicle, sebaceous gland and arrector pili muscle make up the  pilosebaceous unit . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3115", "text": "A hair follicle consists of\u00a0:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3116", "text": "Other structures associated with the hair follicle include the cup in which the follicle grows known as the infundibulum, [ 8 ]  the  arrector pili  muscles, the  sebaceous glands , and the  apocrine   sweat glands .  Hair follicle receptors  sense the position of the hair."}
{"_id": "WikiPedia_Dermatology$$$corpus_3117", "text": "Attached to the follicle is a tiny bundle of  muscle fiber  called the  arrector pili .  This muscle is responsible for causing the follicle lissis to become more perpendicular to the surface of the skin, and causing the follicle to protrude slightly above the surrounding skin (piloerection) and a  pore  encased with skin oil. This process results in  goose bumps  (or goose flesh)."}
{"_id": "WikiPedia_Dermatology$$$corpus_3118", "text": "Also attached to the follicle is a  sebaceous gland , which produces the oily or waxy substance  sebum . The higher the  density  of the hair, the more sebaceous glands that are found."}
{"_id": "WikiPedia_Dermatology$$$corpus_3119", "text": "There are ethnic differences in several different hair characteristics. The differences in appearance and texture of hair are due to many factors: the position of the hair bulb relative to the hair follicle, size and shape of the dermal papilla, and the curvature of the hair follicle. [ 1 ]  The scalp hair follicle in people of European descent is elliptical in shape and, therefore, produces straight or wavy hair, whereas the scalp hair follicle of people of African descent is more curvy, resulting in the growth of tightly curled hair. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3120", "text": "(micrometers)"}
{"_id": "WikiPedia_Dermatology$$$corpus_3121", "text": "In utero, the epithelium and underlying  mesenchyme  interact to form hair follicles. [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3122", "text": "A key aspect of hair loss with age is the aging of the hair follicle.  Ordinarily, hair follicle renewal is maintained by the stem cells associated with each follicle.  Aging of the hair follicle appears to be primed by a sustained cellular response to the DNA damage that accumulates in renewing stem cells during aging. [ 13 ]   This damage response involves the proteolysis of type XVII collagen by neutrophil elastase in response to the DNA damage in the hair follicle stem cells.  Proteolysis of collagen leads to elimination of the damaged cells and then to terminal hair follicle miniaturization."}
{"_id": "WikiPedia_Dermatology$$$corpus_3123", "text": "Hair grows in cycles of various phases: [ 14 ]   anagen  is the growth phase;  catagen  is the involuting or regressing phase; and  telogen , the resting or quiescent phase (names derived using the Greek prefixes ana-, kata-, and telos- meaning up, down, and end respectively).  Each phase has several morphologically and histologically distinguishable sub-phases.  Prior to the start of cycling is a phase of  follicular morphogenesis  (formation of the follicle).  There is also a shedding phase, or  exogen , that is independent of anagen and telogen in which one or several hairs that might arise from a single follicle exits.  Normally up to 85% of the hair follicles are in anagen phase, while 10\u201314% are in telogen and 1\u20132% in catagen. The cycle's length varies on different parts of the body. For  eyebrows , the cycle is completed in around 4 months, while it takes the  scalp  3\u20134 years to finish; this is the reason eyebrow hair have a much shorter length limit compared to hair on the head. Growth cycles are controlled by a chemical signal like  epidermal growth factor .  DLX3  is a crucial regulator of hair follicle differentiation and cycling. [ 15 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3124", "text": "Anagen is the active growth phase of hair follicles [ 17 ]  during which the root of the hair is dividing rapidly, adding to the hair shaft. During this phase the hair grows about 1\u00a0cm every 28 days. A hair pulled out in this phase will typically have the  root sheath  attached to it which appears as a clear gel coating the first few mm of the hair from its base; this may be misidentified as the follicle, the root or the sebaceous gland by non-health care professionals. Scalp hair stays in this active phase of growth for 2\u20137 years; this period is genetically determined. At the end of the anagen phase an unknown signal causes the follicle to go into the catagen phase."}
{"_id": "WikiPedia_Dermatology$$$corpus_3125", "text": "The catagen phase is a short transition stage that occurs at the end of the anagen phase. [ 18 ]  It signals the end of the active growth of a hair. This phase lasts for about 2\u20133 weeks while the hair converts to a club hair, which is formed during the catagen phase when the part of the hair follicle in contact with the lower portion of the hair becomes attached to the hair shaft. A bulb of keratin attaches to the bottom tip of the hair and keeps it in place while a new hair begins to grow below it. A hair pulled out in this phase will have the bulb of keratin attached to it which appears as a small white ball on the end of the hair. This process cuts the hair off from its blood supply and from the cells that produce new hair. When a club hair is completely formed, about a 2-week process, the hair follicle enters the telogen phase."}
{"_id": "WikiPedia_Dermatology$$$corpus_3126", "text": "The telogen phase is the resting phase of the hair follicle, about three months. [ 19 ]  When the body is subjected to extreme stress, as much as 70 percent of hair can prematurely enter the telogen phase and begin to fall, causing a noticeable loss of hair. This condition is called  telogen effluvium . [ 20 ]  The club hair is the final product of a hair follicle in the telogen stage, and is a dead, fully keratinized hair. [ 11 ]   Fifty to one-hundred club hairs are shed daily from a normal scalp. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3127", "text": "There are many human diseases in which abnormalities in hair appearance, texture or growth are early signs of local disease of the hair follicle or systemic illness. Well known diseases of the hair follicle include  alopecia  or hair loss,  hirsutism  or excess hair growth, and  lupus erythematosus . [ 3 ]  Therefore, understanding the function of the normal hair follicle is fundamental to diagnosing and treating many dermatologic and systemic diseases with hair abnormalities. [ 3 ]  Studies of Witka et al. 2020 has shown the role of  microbiome  in the biology, immunology and diseases of scalp hair follicle. Studies further shown that change in hair follicle microbiome result into scalp disease like;  Seborrheic dermatitis  of the scalp and  dandruff ,  Folliculitis decalvans ,  Androgenetic alopecia ,  Scalp psoriasis  and  Alopecia areata . [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3128", "text": "Hair follicles form the basis of the two primary methods of  hair transplantation  in  hair restoration ,  Follicular Unit Transplantation  (FUT) and  follicular unit extraction  (FUE). In each of these methods, naturally occurring groupings of one to four hairs, called follicular units, are extracted from the hair restoration patient and then surgically implanted in the balding area of the patient's scalp, known as the recipient area. These follicles are extracted from donor areas of the scalp, or other parts of the body, which are typically resistant to the miniaturization effects of the hormone  DHT . It is this miniaturization of the hair shaft that is the primary predictive indicator of  androgenetic alopecia , [ 22 ]  commonly referred to as male pattern baldness or male hair loss. When these  DHT -resistant follicles are transplanted to the recipient area, they continue to grow hair in the normal hair cycle, thus providing the hair restoration patient with permanent, naturally-growing hair."}
{"_id": "WikiPedia_Dermatology$$$corpus_3129", "text": "While hair transplantation dates back to the 1950s, [ 23 ]  and plucked human hair follicle cell culture in vitro to the early 1980s, [ 24 ]  it was not until 1995 when hair transplantation using individual follicular units was introduced into medical literature. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3130", "text": "Hair removal  is the deliberate removal of  body hair  or head  hair . This process is also known as  epilation  or  depilation ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3131", "text": "Hair is a common feature of the human body, exhibiting considerable variation in thickness and length across different populations. Hair becomes more visible during and after  puberty . Additionally, men typically exhibit thicker and more conspicuous body hair than women. [ 1 ] \nBoth males and females have visible body hair on the  head ,  eyebrows ,  eyelashes ,  armpits ,  genital area ,  arms , and  legs . Males and some females may also have thicker hair growth on their  face ,  abdomen ,  back ,  buttocks ,  anus ,  areola ,  chest ,  nostrils , and  ears . Hair does not generally grow on the  lips , back of the ear, the underside of the  hands  or  feet , or on certain areas of the  genitalia ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3132", "text": "Hair removal may be practiced for cultural,  aesthetic ,  hygienic , sexual, medical, or religious reasons. Forms of hair removal have been practiced in almost all human cultures since at least the  Neolithic  era. The methods used to remove hair have varied in different times and regions."}
{"_id": "WikiPedia_Dermatology$$$corpus_3133", "text": "The term \"depilation\" is derived from the  Medieval Latin  \"depilatio,\" which in turn is derived from the  Latin  \"depilare,\" a word formed from the prefix \"de-\" and the root \"pilus,\" meaning \"hair.\""}
{"_id": "WikiPedia_Dermatology$$$corpus_3134", "text": "For centuries, hair removal has long shaped  gender roles , served to signify  social status  and defined notions of femininity and the ideal \" body image \". [ 2 ] [ 3 ]  In early periods, the condition of being hairless was mostly done as a way to keep the body clean, using flint, seashells, beeswax and various other depilatory utensils and exfoliator substances, some highly questionable and highly caustic. [ 3 ] [ 4 ]   Ancient Rome  also associated hair removal with status: a person with smooth skin was associated with purity and superiority. Removing body hair was done by both men and women [ 2 ] [ 3 ] [ 5 ] [ 6 ] \nPsilothrum or psilotrum ( Ancient Greek :  \u03c8\u03af\u03bb\u03c9\u03b8\u03c1\u03bf\u03bd ) and dropax (Ancient Greek:  \u03b4\u03c1\u1ff6\u03c0\u03b1\u03be ) were depilatories in ancient Greece and Rome. [ 7 ] [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3135", "text": "In  Ancient Egypt , besides being a fashion statement for affluent Egyptians of all genders, [ 3 ] [ 10 ]  hair removal served as a treatment for  louse infestation , which was a prevalent issue in the region. [ 11 ]  Very often, they would replace the removed head hair with a  Nubian wig , which was seen as easier to maintain and also fashionable. [ 11 ]  Ancient Egyptian priests also shaved or depilated all over daily, so as to present a \"pure\" body before the images of the gods. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3136", "text": "In ancient times, one highly abrasive depilatory paste consisted of an admixture of  slaked lime , water, wood-ash and yellow  orpiment  ( arsenic trisulfide ); In rural India and Iran, where this mixture is called  vajibt , it is still commonly used to remove  pubic hair . [ 3 ] [ 4 ] [ 12 ]  In other cultures, oil extracted from unripe olives (which had not reached one-third of their natural stage of ripeness) was used to remove body hair. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3137", "text": "During the  medieval period ,  Catholic  women were expected to let their hair grow long as a display of femininity, whilst keeping the hair concealed by wearing a  wimple  headdress in public places. [ 2 ]  The face was the only area where hair growth was considered unsightly; 14th-century ladies would also pick off hair from their foreheads to recede the hairline and give their face a more oval form. From the mid-16th century, it is said when Queen  Elizabeth I  came to power, she made  eyebrow  removal fashionable. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3138", "text": "By the 18th century, body hair removal was still considered a non-necessity by European and American women. But in 1760, when the first safety  straight razor  appeared for men to safely shave their beard and not inadvertently cut themselves, some women allegedly used this safety razor too. [ 2 ]  It was invented in Paris by the French master cutler  Jean-Jacques Perret \u00a0[ fr ] , author of  La pogonotomie, ou L'art d'apprendre \u00e0 se raser soi-m\u00eame  ( Pogonotomy , or The Art of Learning to Shave). [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3139", "text": "It was not until the late 19th century that women in Europe and America started to make hair removal a component of their  personal care  regime. According to  Rebecca Herzig , the modern-day notion of body hair being unwomanly can be traced back to  Charles Darwin 's book first published in 1871 \"The Descent of Man and Selection in Relation to Sex\". Darwin's theory of natural selection associated body hair with \"primitive ancestry and an atavistic return to earlier less developed forms\", writes Herzig, a professor of gender and sexuality studies at Bates College in Maine. [ 2 ]  Darwin also suggests having less body hair was an indication of being more evolved and sexually attractive. [ 2 ]  As Darwin's ideas polarized, other 19th century medical and scientific experts started to link hairiness to \"sexual inversion, disease pathology, lunacy, and criminal violence\". Those connotations were mostly applied to women's and not men's body hair. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3140", "text": "By the early 20th century, the upper- and middle-class  white America  increasingly saw smooth skin as a marker of femininity, and female body hair as repulsive, with hair removal giving \"a way to separate oneself from cruder people, lower class and immigrant\". [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3141", "text": "Harper's Bazaar , in 1915, was the first women's fashion magazine to run a campaign devoted to the removal of  underarm hair  as \"a necessity\". Shortly after,  Gillette  launched the first safety razor marketed specifically for women\u2014the \"Milady D\u00e9collet\u00e9 Gillette\", one that solves \"...an embarrassing personal problem\" and keeps the underarm \"...white and smooth\". [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3142", "text": "Body hair characteristics such as thickness and length vary across human populations, some people have less pronounced  body hair  and others have more conspicuous body hair characteristics."}
{"_id": "WikiPedia_Dermatology$$$corpus_3143", "text": "Each  culture  of human  society  developed  social norms  relating to the presence or absence of body hair, which has changed from one time to another. Different standards of  human physical appearance  and  physical attractiveness  can apply to females and males. People whose hair falls outside a culture's aesthetic  body image  standards may experience real or perceived  social acceptance  problems, psychological distress and  social pressure . For example, for women in several societies, exposure in public of body hair other than head hair, eyelashes and eyebrows is generally considered to be  unaesthetic , unattractive and  embarrassing . [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3144", "text": "With the increased popularity in many countries of women wearing  fashion  clothing,  sportswear  and  swimsuits  during the 20th century and the consequential exposure of parts of the body on which hair is commonly found, there has emerged a popularization for women to remove visible  body hair , such as on legs, underarms and elsewhere, or the consequences of  hirsutism  and  hypertrichosis . [ 2 ] [ 15 ]  In most of the  Western world , for example, the vast majority of women regularly shave their legs and armpits, while roughly half also shave hair that may become exposed around their  bikini  pelvic area (often termed the \"bikini line\"). [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3145", "text": "In Western and Asian cultures, in contrast to most Middle Eastern cultures, a majority of men are accustomed to shaving their facial hair, so only a minority of men reveal a  beard , even though fast-growing facial hair must be shaved daily to achieve a  clean-shaven  or beardless appearance. Some men shave because they cannot genetically grow a \"full\" beard (generally defined as an even density from cheeks to neck), their beard color is genetically different from their scalp hair color, or because their facial hair grows in many directions, making a  groomed  or contoured appearance difficult to achieve. Some men shave because their beard growth is excessive, unpleasant, or coarse, causing skin irritation. Some men grow a beard or  moustache  from time to time to change their appearance or visual style."}
{"_id": "WikiPedia_Dermatology$$$corpus_3146", "text": "Some men  tonsure  or  head shave , either as a religious practice, a fashion statement, or because they find a shaved head preferable to the appearance of  male pattern baldness , or in order to attain enhanced cooling of the skull \u2013 particularly for people suffering from  hyperhidrosis . A much smaller number of Western women also shave their heads, often as a fashion or political statement."}
{"_id": "WikiPedia_Dermatology$$$corpus_3147", "text": "Some women also shave their heads for cultural or social reasons. In India, tradition required widows in some sections of the society to shave their heads as part of being  ostracized  (see  Women in Hinduism \u00a7\u00a0Widowhood and remarriage ). The outlawed custom is still infrequently encountered mostly in rural areas. Society at large and the government are working to end the practice of ostracizing widows. [ 16 ]  In addition, it continues to be common practice for men to shave their heads prior to embarking on a pilgrimage."}
{"_id": "WikiPedia_Dermatology$$$corpus_3148", "text": "The  unibrow  is considered a sign of beauty and attractiveness for women in  Oman  and for both genders in  Tajikistan , often emphasized with  kohl . [ 2 ]  In Middle Eastern societies, regular trimming or removal of female and male  underarm hair  and pubic hair has been considered proper personal  hygiene , necessitated by local customs, for many centuries. [ 3 ] [ 17 ] [ 18 ]  Young girls and unmarried women, however, are expected to retain their body hair until shortly before marriage, when the whole body is depilated from the neck down. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3149", "text": "In China, body hair has long been regarded as normal, and even today women are confronted with far less  social pressure  to remove body hair. [ 2 ]  The same attitude exists in other countries in Asia. While hair removal has become routine for many of the continent's younger women, trimming or removing pubic hair, for instance, is not as common or popular as in the  Western world , [ 2 ]  where both women and men may trim or remove all their pubic hair for  aesthetic  or  sexual reasons . This custom can be motivated by reasons of potentially increased personal cleanliness or hygiene, heightened sensitivity during  sexual activity , or the desire to take on a more exposed appearance or visual appeal, or to boost  self-esteem  when affected by excessive hair. In Korea, pubic hair has long been considered a sign of fertility and sexual health, and it has been reported in the mid-2010s that some Korean women were undergoing pubic hair transplants, to add extra hair, [ 2 ]  especially when affected by the condition of pubic atrichosis (or  hypotrichosis ), which is thought to affect a small percentage of Korean women. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3150", "text": "Unwanted or excessive hair is often removed in preparatory situations by both sexes, in order to avoid any perceived  social stigma  or prejudice. For example, unwanted or excessive hair may be removed in preparation for an intimate encounter, or before visiting a public beach or swimming pool."}
{"_id": "WikiPedia_Dermatology$$$corpus_3151", "text": "Though traditionally in Western culture women remove body hair and men do not, some women choose not to remove hair from their bodies, either as a non-necessity or as an act of rejection against  social stigma , while some men remove or trim their body hair, a practice that is referred to in modern society as being a part of \"manscaping\" (a  portmanteau expression  for  male-specific grooming )."}
{"_id": "WikiPedia_Dermatology$$$corpus_3152", "text": "The term \" glabrousness \" also has been applied to human fashions, wherein some participate in culturally motivated hair removal by depilation (surface removal by  shaving ,  dissolving ), or  epilation  (removal of the entire hair, such as  waxing  or  plucking )."}
{"_id": "WikiPedia_Dermatology$$$corpus_3153", "text": "Although the appearance of secondary hair on parts of the human body commonly occurs during  puberty , and therefore, is often seen as a symbol of adulthood, removal of this and other hair may become fashionable in some cultures and subcultures. In many modern  Western cultures , men are encouraged to shave their beards, and women are encouraged to remove hair growth in various areas. Commonly depilated areas for women are the underarms, legs, and pubic hair. Some individuals depilate the forearms. In recent years, bodily depilation in men has increased in popularity among some subcultures of Western males. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3154", "text": "For men, the practice of depilating the pubic area is common, especially for aesthetic reasons. Most men will use a razor to shave this area, however, as best practice, it is recommended to use a body trimmer to shorten the length of the hair before shaving it off completely."}
{"_id": "WikiPedia_Dermatology$$$corpus_3155", "text": "In ancient Egypt, depilation was commonly practiced, with  pumice  and  razors  used to shave. [ 20 ] [ 21 ]  In both  Ancient Greece  and  Ancient Rome , the removal of body and pubic hair may have been practiced among both men and women. It is represented in some artistic depictions of male and female nudity,  [ citation needed ]  examples of which may be seen in  red figure pottery  and sculptures like the  Kouros  of Ancient Greece in which both men and women were depicted without body or pubic hair. Emperor  Augustus  was said, by Suetonius, to have applied \"hot nutshells\" on his legs as a form of depilation. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3156", "text": "In the  clothes free movement , the term \"smoothie\" refers to an individual who has removed their body hair. In the past, such practices were frowned upon and in some cases,  forbidden: violators could face exclusion from the club. Enthusiasts grouped together and formed societies of their own that catered to that fashion, and smoothies became a major percentage at some nudist venues. [ 23 ]  The first Smoothie club (TSC) was founded by a British couple in 1991. [ 24 ]  A Dutch branch was founded in 1993 [ 25 ]  in order to give the idea of a hairless body greater publicity in the  Netherlands . Being a Smoothie is described by its supporters as exceptionally comfortable and liberating. The Smoothy-Club is also a branch of the World of the Nudest Nudist (WNN) and organizes nudist ship cruises and regular nudist events."}
{"_id": "WikiPedia_Dermatology$$$corpus_3157", "text": "Head-shaving ( tonsure ) is a part of some  Buddhist ,  Christian ,  Muslim ,  Jain  and  Hindu  traditions. [ 26 ]  Buddhist and Christian  monks  generally undergo some form of tonsure during their induction into monastic life. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3158", "text": "Within  Amish  society, tradition ordains men to stop shaving a part of their facial hair upon marriage and grow a  Shenandoah  style beard which serves the significance of wearing a  wedding ring ,  moustaches  are rejected as they are regarded as martial (traditionally associated with the  military ). [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3159", "text": "In  Judaism  (see  Shaving in Judaism ), there is no obligation for women to remove body hair or facial hair, unless they wish to do so. However, in preparation for a woman's immersion in a  ritual bath  after concluding her days of purification (following her menstrual cycle), the custom of Jewish women is to shave off their pubic hair. [ 28 ]  During a  mourning  ritual, Jewish men are restricted in the  Torah  and  Halakha  to using scissors and prohibited from using a razor blade to shave their beards or sideburns, [ 29 ]  and, by custom, neither men nor women may cut or shave their hair during the  shiva  period. [ 30 ] [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3160", "text": "The  Bah\u00e1\u02bc\u00ed Faith  recommends against complete and long-term head-shaving outside of medical purposes. It is not currently practiced as a law, contingent upon a future decision by the  Universal House of Justice , its highest governing body.  Sikhs  take an even stronger stance, opposing all forms of hair removal. One of the \" Five Ks \" of Sikhism is  Kesh , meaning \"hair\". [ 32 ]  Baptized Sikhs are specifically instructed to have unshorn Kesh (the hair on their head and beards for men) as a major tenet of the Sikh faith. To Sikhs, the maintenance and management of long hair is a manifestation of one's piety. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3161", "text": "The majority of Muslims believe that adult removal of pubic and axillary hair, as a hygienic measure, is religiously beneficial. Under Muslim law ( Sharia ), it is recommended to keep the beard. [ citation needed ]  A Muslim may trim or cut hair on the head. In the 9th century, the use of  chemical depilatories  for women was introduced by  Ziryab  in  Al-Andalus . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3162", "text": "The body hair of surgical patients is often removed beforehand on the skin surrounding  surgical sites . Shaving was the primary form of hair removal until reports in 1983 showed that it may lead to an increased risk of infection.  [ 33 ]   Clippers  are now the recommended pre-surgical hair removal method. [ 34 ] [ 35 ]  A 2021  systematic review  brought together evidence on different techniques for hair removal before surgery. This involved 25 studies with a total of 8919 participants. Using a razor probably increases the chance of developing a surgical site infection compared to using clippers or hair removal cream or not removing hair before surgery. [ 36 ]  Removing hair on the day of surgery rather than the day before may also slightly reduce the number of infections. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3163", "text": "Some people with  trichiasis  find it medically necessary to remove ingrown eyelashes. [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3164", "text": "The shaving of hair has sometimes been used in attempts to eradicate  lice  or to minimize  body odor  due to the accumulation of odor-causing  micro-organisms  in hair. In extreme situations, people may need to remove all body hair to prevent or combat infestation by  lice ,  fleas  and other parasites. Such a practice was used, for example, in  Ancient Egypt . [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3165", "text": "It has been suggested that an increasing percentage of humans  removing  their pubic hair has led to reduced  crab louse  populations in some parts of the world. [ 39 ] [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3166", "text": "A  buzz cut  or completely shaven haircut is common in military organizations where, among other reasons, it is considered to promote uniformity and neatness. [ 41 ] [ 42 ]  Most militaries have  occupational safety and health  policies that govern the hair length and hairstyles permitted; [ 41 ]  in the field and living in close-quarter environments where bathing and sanitation can be difficult, soldiers can be susceptible to parasite infestation such as  head lice , that are more easily propagated with long and unkempt hair. [ 43 ]  It also requires less maintenance in the field and in adverse weather it dries more quickly. Short hair is also less likely to cause severe burns from flash flame exposure (as a result of  flash fires  from  explosions ) which can easily set hair alight. [ 41 ]  Short hair can also minimize interference with safety equipment and fittings attached to the head, such as  combat helmets  and  NBC suits . [ 41 ]  Militaries may also require men to maintain clean-shaven faces as facial hair can prevent an air-tight seal between the face and  military gas masks  or other  respiratory  equipment, such as a  pilot's oxygen mask , or  full-face diving mask . [ 41 ]  The process of testing whether a mask adequately fits the face is known as a \" respirator fit test \"."}
{"_id": "WikiPedia_Dermatology$$$corpus_3167", "text": "In many militaries, head-shaving (known as the  induction cut ) is mandatory for men when beginning their  recruit training . However, even after the initial recruitment phase, when head-shaving is no longer required, many soldiers maintain a completely or partially shaven hairstyle (such as a \" high and tight \", \" flattop \" or \" buzz cut \") for personal convenience or neatness. Head-shaving is not required and is often not permitted for women in military service, although they must have their hair cut or tied to regulation length. [ 42 ]  For example, the shortest hair a female soldier can have in the U.S. Army is 1/4 inch from the scalp. [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3168", "text": "It is a common practice for professional  footballers (soccer players)  and  road cyclists  to remove leg hair for a number of reasons. In the case of a crash or tackle, the absence of the leg hair means the injuries (usually  road rash  or scarring) can be cleaned up more efficiently, and treatment is not impeded. Professional cyclists, as well as professional footballers, also receive regular leg  massages , and the absence of hair reduces the friction and increases their comfort and effectiveness. [ citation needed ]  Football players are also required to wear shin guards, and in case of a skin rash, the affected area can be treated more efficiently."}
{"_id": "WikiPedia_Dermatology$$$corpus_3169", "text": "It is also common for  competitive swimmers  to shave the hair off their legs, arms, and torsos (and even their whole bodies from the neckline down), to reduce drag and provide a heightened \"feel\" for the water by removing the exterior layer of skin along with the body hair. [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3170", "text": "In some situations, people's hair is shaved as a punishment or a form of humiliation. After World War II, head-shaving was a common punishment in France, the Netherlands, and Norway for women who had collaborated with the Nazis during the occupation, and, in particular, for women who had sexual relations with an occupying soldier. [ 46 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3171", "text": "In the United States, during the  Vietnam War , conservative students would sometimes attack student radicals or \"hippies\" by shaving beards or cutting long hair. One notorious incident occurred at  Stanford University , when unruly fraternity members grabbed  Resistance  founder (and student-body president)  David Harris , cut off his long hair, and shaved his beard."}
{"_id": "WikiPedia_Dermatology$$$corpus_3172", "text": "During European  witch-hunts  of the  Medieval  and  Early Modern periods , alleged  witches  were stripped naked and their entire body shaved to discover the so-called  witches' marks . The discovery of witches' marks was then used as evidence in trials. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3173", "text": "Inmates have their heads shaved upon entry at certain prisons. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3174", "text": "\"Depilation\", or temporary removal of hair to the level of the skin, lasts several hours to several days and can be achieved by"}
{"_id": "WikiPedia_Dermatology$$$corpus_3175", "text": "\"Epilation\", or removal of the entire hair from the root, lasts several days to several weeks and may be achieved by"}
{"_id": "WikiPedia_Dermatology$$$corpus_3176", "text": "Electrology  has been practiced in the United States since 1875. [ 56 ]  It is approved by the  FDA . This technique permanently destroys germ cells [ citation needed ]  responsible for hair growth by way of the insertion of a fine probe into the hair follicle and the application of a current adjusted to each hair type and treatment area. [ citation needed ]  Electrology is the only permanent hair removal method recognized by the FDA. [ 57 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3177", "text": "A 2006 review article in the journal \"Lasers in Medical Science\" compared intense pulsed light (IPL) and both alexandrite and diode lasers. The review found no statistical difference in effectiveness, but a higher incidence of side effects with diode laser-based treatment. Hair reduction after 6 months was reported as 68.75% for alexandrite lasers, 71.71% for diode lasers, and 66.96% for IPL. Side effects were reported as 9.5% for alexandrite lasers, 28.9% for diode lasers, and 15.3% for IPL. All side effects were found to be temporary and even  pigmentation  changes returned to normal within 6 months. [ 58 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3178", "text": "A 2006 meta-analysis of randomized controlled trials found that alexandrite and diode lasers caused 50% hair reduction for up to 6 months, while there was no evidence of hair reduction from intense pulsed light, neodymium-YAG or ruby lasers. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3179", "text": "Many methods have been proposed or sold over the years without published clinical proof they can work as claimed."}
{"_id": "WikiPedia_Dermatology$$$corpus_3180", "text": "There are several disadvantages to many of these hair removal methods."}
{"_id": "WikiPedia_Dermatology$$$corpus_3181", "text": "Hair removal can cause issues: skin inflammation, minor burns, lesions, scarring, ingrown hairs, bumps, and infected hair follicles ( folliculitis )."}
{"_id": "WikiPedia_Dermatology$$$corpus_3182", "text": "Some removal methods are not permanent, can cause medical problems and permanent damage, or have very high costs. Some of these methods are still in the testing phase and have not been clinically proven."}
{"_id": "WikiPedia_Dermatology$$$corpus_3183", "text": "One issue that can be considered an advantage or a disadvantage depending upon an individual's viewpoint, is that removing hair has the effect of removing information about the individual's hair growth patterns due to  genetic  predisposition, illness,  androgen  levels (such as from pubertal hormonal imbalances or drug side effects), and/or  gender  status."}
{"_id": "WikiPedia_Dermatology$$$corpus_3184", "text": "In the hair follicle, stem cells reside in a discrete microenvironment called the bulge, located at the base of the part of the follicle that is established during morphogenesis but does not degenerate during the hair cycle. The bulge contains multipotent stem cells that can be recruited during wound healing to help repair the epidermis. [ 61 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3185", "text": "[ 62 ] == References =="}
{"_id": "WikiPedia_Dermatology$$$corpus_3186", "text": "Hematidrosis , also called  hematohidrosis ,  haematidrosis ,  hemidrosis  and  blood sweat , is a very rare condition in which a human  sweats   blood . [ 1 ]  The term is from  Ancient Greek   ha\u00eema / ha\u00edmatos  ( \u03b1\u1f37\u03bc\u03b1 / \u03b1\u1f35\u03bc\u03b1\u03c4\u03bf\u03c2 ), meaning blood, and  h\u012bdr\u1e53s  ( \u1f31\u03b4\u03c1\u03ce\u03c2 ), meaning sweat."}
{"_id": "WikiPedia_Dermatology$$$corpus_3187", "text": "Blood usually oozes from the forehead, nails,  umbilicus , and other skin surfaces. In addition, oozing from  mucocutaneous  surfaces causing  nosebleeds , blood-stained tears, and vicarious menstruation are common. [ 2 ]  The episodes may be preceded by intense  headache  and abdominal pain and are usually self-limiting. In some conditions, the secreted fluid is more dilute and appears to be blood-tinged, while others may have darker, bright red secretions resembling blood. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3188", "text": "While the extent of blood loss generally is minimal, hematidrosis also results in the skin becoming extremely tender and fragile."}
{"_id": "WikiPedia_Dermatology$$$corpus_3189", "text": "Hematidrosis is a condition in which  capillary  blood vessels that feed the  sweat glands  rupture, causing them to exude blood, occurring under conditions of extreme physical or emotional  stress . [ 4 ]  Severe mental  anxiety  activates the  sympathetic nervous system  to invoke the  fight-or-flight response  to such a degree as to cause hemorrhage of the vessels supplying the sweat glands. [ 5 ]  It has been suggested that acute fear and extreme stress can cause hematidrosis. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3190", "text": "Investigations such as  platelet  count, platelet aggregation test,  coagulation  profile, and  skin biopsy  reveal no abnormalities, and direct light microscopy of fluid demonstrates presence of normal  red blood cells . Investigations also fail to show any  vasculitis  or skin appendages (i.e.  sweat glands ,  sebaceous glands  and  hair follicles ) abnormalities. [ 3 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3191", "text": "A 2015 case study investigated hematidrosis with a patient who has  epilepsy . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3192", "text": "Effects on the body include weakness and mild-to-moderate dehydration from the severe anxiety and both blood and sweat loss. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3193", "text": "The condition is very rare, but there are reports in the medical literature of successful treatment with  beta blockers  ( propranolol  10\u00a0mg), [ 10 ] [ 11 ]  with significant reduction in the frequency of spontaneous blood oozing. The successful use of beta blockers supports the theory that the condition is induced by stress and anxiety. However, this etiology is not yet fully established, as the high prevalence of stress and anxiety in the modern era has not changed the incidence of this extremely rare disease, suggesting that other co-abnormalities also play a key role. [ 7 ]   Atropine  sulfate  transdermal patches  have also been used successfully. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3194", "text": "Favorable results with psychiatric counselling to reduce stress highlight the relationship between psychogenic causes and hematohidrosis. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3195", "text": "Dermatological research notes the presence of hematidrosis in people awaiting execution. [ 5 ]  It has also been proposed as a possible explanation for Jesus'  agony in the garden  of  Gethsemane  ( Luke 22:44 ), [ 12 ]  and for claims associated with  stigmata . [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3196", "text": "Leonardo da Vinci  described a soldier who sweated blood before battle. The phenomenon has also been observed in individuals in fear for their lives; a case occurred during the  London Blitz , and a case of fear of a storm while sailing, etc. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3197", "text": "Henle's layer  is the third and the outermost layer of the  inner root sheath  of the  hair  follicle, consisting of a single layer of  cubical cells  with clear flattened nuclei. It is named after  German   physician ,  pathologist  and  anatomist   Friedrich Gustav Jakob Henle . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3198", "text": "This article incorporates text in the  public domain  from  page 1068  of\u00a0the 20th edition of   Gray's Anatomy   (1918)"}
{"_id": "WikiPedia_Dermatology$$$corpus_3199", "text": "The  history of dermatology  concerns the development of the practice of researching, defining and treating skin diseases, from  ancient times  to the  present . The field has its origin in the earliest forms of medicine, later becoming a distinct field with its own specialised practitioners and researchers."}
{"_id": "WikiPedia_Dermatology$$$corpus_3200", "text": "Readily visible alterations of the  skin  surface have been recognised since the dawn of history. Among the first to take an interest in skin diseases were the  Mesopotamian peoples , who sought to understand the reasons for these problems, often resorting to explanations rooted in  religion ,  astrology  and  divination , and were the first to observe and define various dermatopathies. Skin conditions were considered a sign of divine punishment, the actions of demons and spirits, or as the result of black magic. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3201", "text": "One of the most influential sources of understanding views on skin conditions in Mesopotamia comes from the  Babylonian  chief scholar  Esagil-kin-aplim , who wrote a diagnostic manual called  Sakikk\u016b . One passage describes a complex skin condition which is associated with a sexual encounter. Another work,  Alandimm\u00fb , observes the human physical appearance, with a section dedicated to dermal marks, such as  moles , and  spots . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3202", "text": "While matching the descriptions of diseases in the few surviving  cuneiform  medical texts to specific ailments is challenging, it appears likely that Babylonians and  Assyrians  were the first to define and describe warts, pustules and scabies in writing. [ 3 ]  It is also possible to draw some conclusions about their attitude to skin conditions. Doctors of the era clearly sought to define disease according to certain criteria, using observations such as such as heat, smell, breath and bodily fluids, to help draw a  diagnostic  conclusion. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3203", "text": "Among the oldest preserved medical documents relevant to skin diseases are the  ancient Egyptian   Smith Papyrus  and  Ebers Papyrus  dating to  c. \u20091600 BCE  and  c. \u20091550 BCE  respectively, though it is likely their contents were copied and passed down with their ultimate origins being much older  folk remedies . [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3204", "text": "These scrolls describe various diseases, including skin complaints such as  ulcers ,  burn wounds ,  rashes , and  tumours , as well as medical techniques on how to recognise and treat the diseases. Many of the treatments involved  magical incantations , the application of  herbs , or formulations of ingredients for medicines or ointments, as well as surgical procedures, such as  skin grafts . [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3205", "text": "Ancient Egyptians believed in a form of proto- humorism , that skin diseases were a symptom of health problems inside the body, caused by a blockage in the flow of bodily fluids. This turned the fluids into pain-making substances that could cause diseases anywhere in the body. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3206", "text": "While many of the procedures do not resemble those prescribed by modern medicine, the papyri are notable for their evidence of an early system of thorough inquiry into skin diseases, recommending a systematic examination, diagnosis and treatment, something that would later be more formalised by  Greek schools of medicine . [ 4 ] [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3207", "text": "Ancient Greek physicians adopted many treatments of the Egyptians, with the likes of  Homer  and  Diodorus  attesting to their respect of Egyptian medicine, though they rejected the use of incantations as a method of treatment. [ 8 ]  However, Greek and Roman medicine did not see the skin as an organ in itself, but rather a mere covering for the body. Similarly to the Egyptians, they viewed skin diseases as merely a representation of a humoral imbalance. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3208", "text": "Greek medicine, with its focus on the harmony between external beauty and internal goodness, laid the foundation for dermatological practices, emphasizing a healthy diet and physical activity.  Empedocles of Agrigento  made early inroads into understanding skin diseases and the concept of  cutaneous respiration , suggesting the skin's role in  gas exchange similar to the lungs . [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3209", "text": "Hippocrates  described skin diseases and proposed the first classification of skin diseases with two categories: diseases of the skin itself (idiopathic) and diseases due to an imbalance of  humors  that a merely manifested on the skin (exanthematic). [ 11 ] [ 12 ]  Around a century later, his work would be compiled into the  Corpus Hippocraticum , which described the anatomy and physiological processes of the skin, including  sweating  and  glandular secretion . [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3210", "text": "Rome, while indebted to Greek medical knowledge, also absorbed insights from  Etruscan  magical medicine, which revered water's regenerative powers and utilized plants for their  antiseptic  properties. Key Roman figures in dermatology include  Aulus Cornelius Celsus  and  Claudius Galen . Celsus, in his  De Medicina , detailed various skin conditions with precise terminology, covering diseases like  ulcers  and  leprosy . Galen expanded on dermatological diseases, especially those affecting the genitals, and explored the causes of hair color and the notion of  sexually transmitted diseases ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3211", "text": "Much of early Greek and Roman medicinal research was preserved only as  Arabic-language  copies, stored in  Byzantine  libraries. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3212", "text": "Arab and Persian dermatologists made a significant contribution to the science during the Middle Ages, with clinicians of the  Islamic Golden Age  such as  Rhazes ,  Haly Abbas  and  Avicinna  providing descriptions of diseases, including  leprosy ,  vitiligo  and  smallpox . Avicinna wrote separate chapters in his  Canon of Medicine  on skin diseases, hair diseases and skin colour diseases. [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3213", "text": "In Europe, the Middle Ages saw the broader dissemination of ancient and foreign texts. Organised medicine was mostly the preserve of the  Catholic Church , which used such texts to inform its medical practice. [ 12 ]  For example, the  Benedictine  monk  Constantine the African  assembled a vast collection of medical works, which he translated into Latin and used to inform his teaching at the Abbey of  Monte Cassino , a major centre of learning in the 11th century. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3214", "text": "The arrival of Constantine in Italy in 1077 coincided with the rise in notoriety of the  Salerno Medical School , which had been founded in the 9th century, but was now increasingly influential.  Trota of Salerno  introduced new practices for treating the skin inspired by eastern societies [ 16 ]  and  Rogerius  first used the term  lupus  to describe the  malar rash ,  [ citation needed ]  with both physicians associated with the medical school. Rogerius in particular became renowned for his writing on the pathology and surgical treatment of diseases of the head, neck, trunk and extremities. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3215", "text": "The Middle Ages in Europe saw a marked rise in infectious skin diseases, such as leprosy and  plague , and the figures of  surgeons  and  barbers  (who, at the time, offered surgical interventions) emerging alongside physicians in the treatment of dermatological symptoms. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3216", "text": "The Renaissance period saw significant advancements in medical research. The previously taboo practice of postmortem dissection gradually became seen as necessary for the advancement of medicine. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3217", "text": "A major development in the formalisation of the study of skin came from  Andreas Vesalius , who first analysed and described the skin's substance, its layers, pores, fat and nerves. [ 9 ]  During his first public  anatomical dissection  in 1540, Vesalius showed and explained to the witnesses the difference between the 'inner skin' ( hypodermis ) and the 'outer skin' ( epidermis ) and their respective properties, [ 19 ]  and wrote about the subject in his seminal work on anatomy,  De Humani Corporis Fabrica Libri Septem  (\"On the fabric of the human body in seven books\")."}
{"_id": "WikiPedia_Dermatology$$$corpus_3218", "text": "In 1572,  Geronimo Mercuriali  completed  De morbis cutaneis  (\"On the diseases of the skin\"), which sought to compile all medical knowledge on skin diseases and was the first scientific work to be dedicated entirely to dermatology. Unlike Vesalius, much of his writing relied on ancient sources of dubious veracity, and did not attempt to test those assumptions with original research. [ 18 ]  While Mercuriali was a generalist physician, he went on to write many texts focused on skin diseases, as well as  De Decoration Liber  (\"Book on Adornment\") about the use of cosmetics, such as to hide blemishes."}
{"_id": "WikiPedia_Dermatology$$$corpus_3219", "text": "There are many physicians which could be described as 'the first' dermatologist, such as English surgeon  Daniel Turner . He wrote a treatise of skin diseases in 1714 called De Morbis Cutaneis, A Treatise of Diseases Incident to the Skin in Two Parts. Despite its Latin title and unusually for medical texts at the time, Turner wrote the book in English, and it was soon translated into French and German. He combined ancient descriptions of diseases and their treatments with references to research by contemporaries such as  William Cowper , though Turner mostly recounts various cases that he encountered and how he treated them. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3220", "text": "Turner's writing did not yet approach the scientific standard of modern medicine. He blamed humours for discolourations in the skin, and wrote on how pregnant women could inflict marks and deformities on their unborn children due to the \"strong imagination or disappointed longings of the mother\". [ 20 ]  This last theory was a particular point of criticism used against Turner, with  Thomas Bateman  referring to him as \"credulous\". [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3221", "text": "In 1799,  Francesco Bianchi  wrote the book  Dermatologia  which is the first comprehensive textbook of modern dermatology written for the students of medicine. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3222", "text": "The development of optics allowed medical researchers to look at diseased skin in more detail."}
{"_id": "WikiPedia_Dermatology$$$corpus_3223", "text": "In 1801 the first great school of  dermatology  became a reality at the famous  H\u00f4pital Saint-Louis  in Paris, while the first textbooks (Willan's, 1798\u20131808) and atlases ( Alibert's , 1806\u20131814) appeared in print during the same period of time. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3224", "text": "By the mid-19th century, dermatology had become a widely recognised field. [ 23 ]  Publications such as  Gustav Simon 's  Die Hautkrankheiten durch anatomische Untersuchungen erl\u00e4utert  (Skin Diseases Illustrated by Anatomical Investigations) [ 24 ]  and  Ferdinand von Hebra 's  Atlas der Hautkrankheiten  (Atlas of Skin Diseases) [ 25 ]  sought to illustrate a wide range of dermatological conditions and allow physicians to recognise symptoms in their patients. Hospitals such as  Berlin's Charit\u00e9  had established dedicated dermatological departments, which led to significant advances in the description of conditions and their potential treatments."}
{"_id": "WikiPedia_Dermatology$$$corpus_3225", "text": "Hypnodermatology  is an informal label for the use of  hypnosis  in treating the skin conditions that fall between conventional medical  dermatology  and the mental health disciplines."}
{"_id": "WikiPedia_Dermatology$$$corpus_3226", "text": "The use of hypnosis to provide relief for some skin conditions is based on observations that the severity of the disease may correlate with emotional issues. In addition,  hypnotherapy  has been used to suggest improvement on dermatological symptoms, such as chronic  psoriasis , [ 1 ]  eczema, [ 2 ]  ichthyosis, warts [ 3 ]  and  alopecia areata . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3227", "text": "Philip D. Shenefelt, a research  dermatologist  at the  University of South Florida School of Medicine , has identified two dozen dermatologic conditions that have shown response to hypnosis in the literature, with varying degrees of evidence. These include successful results in controlled trials on  verruca vulgaris ,  psoriasis , and  atopic dermatitis . [ 5 ] [ 6 ]  A 2005 review in the Mayo Clinic Proceedings stated that, \"A review of the use of hypnosis in dermatology supports its value for many skin conditions not believed to be under conscious control\". [ 7 ]  The most comprehensively studied skin conditions in relation to hypnotherapy are psoriasis and warts. [ 3 ]  Hypnosis may have positive effects on dermatological conditions in both adults and children. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3228", "text": "Hypnotherapy may contribute towards reducing itching and discomfort brought on by the presence of warts and improves and possibly decreasing lesions. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3229", "text": "This article about  alternative medicine  is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3230", "text": "Immunodermatology  studies  skin  as an organ of  immunity  in health and disease. Several areas have special attention, such as photo-immunology (effects of  UV  light on skin defense),  inflammatory  diseases such as  Hidradenitis suppurativa ,  allergic  contact  dermatitis  and  atopic eczema , presumably  autoimmune  skin diseases such as  vitiligo  and  psoriasis , and finally the  immunology  of  microbial  skin diseases such as  retrovirus  infections and  leprosy . New therapies in development for the  immunomodulation  of common immunological skin diseases include  biologicals  aimed at neutralizing  TNF-alfa  and  chemokine receptor  inhibitors. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3231", "text": "There are multiple universities currently do Immunodermatology:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3232", "text": "Metal allergies inflame the skin after it has been in contact with metal. They are a form of  allergic contact dermatitis . They are becoming more common, as of 2021 [update] , except in areas with regulatory countermeasures."}
{"_id": "WikiPedia_Dermatology$$$corpus_3233", "text": "People may become sensitized to certain metals by skin contact, usually by wearing or holding consumer products (including non-metal products, like textiles and leather treated with metals), or sometimes after exposure at work. Contact with damaged skin makes sensitization more likely. Medical implants may also cause allergic reactions. Diagnosis is by  patch test , a method which does not work as well for metals as it does for some other allergens."}
{"_id": "WikiPedia_Dermatology$$$corpus_3234", "text": "Prevention and treatment consists of avoiding the metal allergen; there is no other treatment, as of 2021 [update] . It can be difficult to identify and avoid the allergen, because many metals are common in the environment, and some are biologically necessary to humans. Regulations have successfully reduced the rates of some metal allergies in Europe, but are not widespread. The social and economic costs of metal allergies are high."}
{"_id": "WikiPedia_Dermatology$$$corpus_3235", "text": "Metal allergies are  type IV allergies ; the metals are  haptens . The toxicity of some allergenic metals may contribute to the development of allergies. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3236", "text": "Nickel allergy  and allergies to  mercury  and  chromium  have long been recognised;  gold ,  palladium , and  cobalt  have gotten attention more recently. [ 2 ] [ 3 ]  There is often cross-sensitization, where a person allergic to one metal may become allergic to another, but monosensitization, reacting to just one metal, is also possible. [ 4 ]  For instance, many people allergic to nickel are often also allergic to cobalt (a similar element often found in the same places as nickel) and palladium. But it is also possible to only be allergic to one of these metals. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3237", "text": "Nickel is one of the most common contact allergens. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3238", "text": "Most cases of metal allergy are caused by consumer products containing metal; exposure at work can also cause metal allergies. [ 3 ]  The largest human exposure to metals is ingestion; while food or drink containing metals can cause an allergic reaction in people who already have an allergy, it's not clear if it can cause a new allergy, as of 2021 [update] . Some metal allergens are nutritionally necessary to humans. Airborne metals have been linked to higher rates of sensitization. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3239", "text": "It can be difficult to figure out what allergen a person with contact dermatitis is reacting to, especially if the allergic reaction is systemic, rather than just occurring where the allergen entered the body. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3240", "text": "Consumer products that have induced allergies include jewellery (both cheap and expensive, brand-name jewellery may release metal allergens [ 8 ] ), buttons, clothing fasteners (such as zippers, [ 1 ]  buckles, and hooks), dental restorations, mobile phones, and leather [ 3 ]  (from the  tanning  process). Metal hair fasteners may also leach allergens. [ 8 ]  The increase in consumer products, including consumer electronics, that use  metal nanomaterials , mainly silicon, titanium, zinc and aluminum, increases exposure. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3241", "text": "Tattoo inks  contaminated with metal allergens have been known to cause severe reactions, sometimes years later, when the original ink is not available for testing. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3242", "text": "Implants and prosthetics, including dental repairs, are also an exposure; dental work is the main way in which the general population is sensitized to palladium, and dental workers may get occupational palladium allergies, though cross-sensitization may also be a common way in which people develop an allergy to this fairly rare metal. Medications containing metals could also potentially cause sensitization. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3243", "text": "Exposure on damaged skin, such as chapped hands or a piercing, increases the risk of sensitization from a low-level exposure to the allergen. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3244", "text": "Diagnosis is by  patch testing , a method first used in 1895. Patches containing potential allergens are stuck on the skin, and the skin is monitored for inflammation. For metal allergens, patch test reproducibility is low, and the extent to which they predict implant failures is debated. If the person being tested has a rash already, it may be difficult to do a patch test. Patch testing may also worsen the allergy. it is also difficult to distinguish co-sensitivity from cross-sensitivity using a patch test. [ clarification needed ] [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3245", "text": "In-vitro  tests, where a  blood sample  is examined for metal-sensitive T cells, are in development, but not widely used, partly due to cost. Many non-allergic people also have metal-specific T cells, and in some cases they seem to have more than some allergic individuals, which makes the test less useful. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3246", "text": "Metal allergies are rapidly becoming more common. Nickel is the most common contact allergen worldwide (of people with contact dermatitis, 11.4% in Europe, 8.8\u201325.7% in China, and 17.5% in North America are allergic to nickel). [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3247", "text": "Nickel allergy, and contact allergies more generally, can develop when people are any age, but they are most likely to develop in early adulthood. This may be due to patterns in exposure or changes in the immune system with age, or both. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3248", "text": "Preventing and treating contact allergies largely involves avoiding the allergen, which may be difficult when it is a common metal. There are no other treatments for metal allergies, as of 2021 [update] . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3249", "text": "In the  Netherlands , regulations that limit the release of nickel from consumer products, introduced in the 1990s, [ 1 ]  worked. Dutch women are now significantly less likely to develop nickel allergies. [ clarification needed ] [ 3 ]  Sweden followed in 1994, and later [ when? ]  regulations were made Europe-wide. These limits cover objects inserted into piercings (0.2 \u03bcg/cm\u00b2/week) and those in direct or prolonged contact with the skin (0.5 \u03bcg/cm 2 ). They also set target values for nickel in ambient air; (20 ng/mg 3 ) increases in nickel concentrations in ambient air, even when absolute levels are quite low, have been linked to increased rates of sensitization in human populations. Nickel allergy rates in Europe have decreased, though it is still the most common contact allergy. [ 1 ]  Regulation is generally inadequate, given the amount of the social and economic harm caused by metal allergies. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3250", "text": "Regulation encouraged use of metals other than nickel, and that caused more cases of allergies to other metals. Nickel remains the most common, but cobalt is the second most common allergy, and in 2020 the EU introduced a temporary generic concentration limit (GCL) of 0.1% on cobalt. Limits on nickel and cobalt in textiles (130mg/kg nickel, 110 mg/kg cobalt) and leather (70mg/kg nickel, 60 mg/kg cobalt), were proposed in 2020 by France and Sweden. There is no allergen regulation of pallidium in Europe as of October 2021 [update] . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3251", "text": "MoleMax  was the first digital epiluminescence microscopy ( dermatoscopy ) system developed in cooperation with medical faculty Department of Dermatology [ 1 ]  of the  Medical University of Vienna . It is currently owned and distributed by DermaMedicalSystems. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3252", "text": "In 1997, MoleMax was presented to international experts at the Melanoma World Congress and the following Dermatology World Congress in  Sydney  and generated great public interest. Since then, over 2000 MoleMax systems are in use in over 50 countries. \nToday, MoleMax is worldwide accepted clinical standard in digital  epiluminescence microscopy ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3253", "text": "Thanks to the worldwide patented [ 3 ]   light polarisation  technique for cameras with skin contact, these camera systems do not require any immersion fluid for the epiluminescence microscopic analysis."}
{"_id": "WikiPedia_Dermatology$$$corpus_3254", "text": "The MoleMax system was part of multiple scientific works such as measurements of the growth rate of pigmented  skin lesions \n [ 4 ] [ 5 ]  \nand verification of follow-up imaging. [ 6 ]  \nImages made by this system also ended up in large public image databases such as HAM10000. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3255", "text": "Polymorphous light eruption  ( PLE )  presents with  itchy   red   small bumps  on sun-exposed skin, particularly face, neck, forearms and legs. [ 1 ]  It generally appears 30 minutes to a few hours after sun exposure and may last between one and 14 days. [ 3 ]   The bumps may become  small blisters  or plaques and may appear bloody, [ 3 ] often healing with minimal scarring. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3256", "text": "It is a non-life-threatening and potentially distressing [ 4 ]  skin condition that is triggered by  sunlight  and artificial  UV exposure [ 5 ]  in a genetically susceptible person, [ 6 ]  particularly in  temperate climates  during the spring and early summer. [ 2 ]  Due to its many  clinical appearances , it is named polymorphic or polymorphous and the terms are used interchangeably. [ 7 ]  The resulting itch can cause significant suffering. [ 4 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3257", "text": "PLE is also defined as an idiopathic primary  photodermatosis , [ 9 ]  in which the  photosensitizer  is unknown. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3258", "text": "Treatments include prevention with sun avoidance and supervised light therapy, and symptom control with topical steroids. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3259", "text": "Typically, the first episode develops in the spring following the first exposure to intense sun. [ 10 ]  Further episodes of the irritable rash occur several hours to days following subsequent sun exposure. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3260", "text": "PLE appears on areas of the skin newly exposed to sunlight such as the visible part of the neckline, backs of hands, arms and legs, and feet, but less commonly the face. [ 2 ] [ 6 ]  At these areas, there may be feelings of burning [ 9 ]  and severe itching. Smooth red-topped small  papules  which merge into plaques, small fluid-filled blisters (papulovesicles) [ 2 ]  and less commonly target-shaped lesions which look like  erythema multiforme  may be visible. [ 5 ]  In addition, it may occur in other parts of the body in some people treated for inflammatory skin diseases with  phototherapy . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3261", "text": "The rash is usually quite symmetrical and characteristic for each individual, appearing similar with each recurrence, but can look dissimilar in different people. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3262", "text": "Fever, fatigue and headaches have been previously associated with the eruption, but are rare. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3263", "text": "The rash may persist for many days to a couple of weeks, [ 5 ]  resolving spontaneously without scarring as long as further sunlight exposure is avoided. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3264", "text": "Recurring yearly, the eruption can sometimes last longer than a few days if persistent and repeated sun exposure occurs. [ 2 ]  However, the \"hardening\" effect, with respite during the later summer, frequently occurs with gradual exposure of sunlight, [ 5 ]  eventually leading to significant improvement. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3265", "text": "The cause of PLE is not yet understood, but several factors may be involved. [ 6 ]  It is thought to be due to a  type IV delayed-type hypersensitivity  to an allergen produced in the body following sunlight exposure, [ 12 ]  in a genetically susceptible person. [ 10 ]  It is also thought that skin microbiome or microbial elements could be involved in pathogenesis of the disease  [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3266", "text": "PLE can be provoked by UVA or UVB (chief cause of sunburn) rays, meaning it can be triggered even by sunlight through glass. UV-A is a major constituent of sunlight, can pass through glass, is relatively resistant to sunscreen and can cause light eruption without sunburn. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3267", "text": "Artificial UV light sources from tanning units and phototherapy treatment units can also trigger PLE. About three-quarters of patients acquire PLE after UV-A exposure only, one-tenth after UV-B exposure only, and the rest after a combination of UV-A and UV-B exposure. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3268", "text": "People vary in the amount of sun exposure needed to trigger the rash. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3269", "text": "Oxidative stress  and the modification of the  redox  status of the skin has been implicated in the expression of PLE. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3270", "text": "It has been suggested that an undefined endogenous or exogenous photo-allergen may trigger a delayed immune reaction resulting in PLE. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3271", "text": "Half of patients have a family history of PLE, [ 6 ]  demonstrating a clear genetic influence. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3272", "text": "The preponderance in women with a decline in severity following menopause has been thought to be associated with oestrogen effects, [ 6 ]  A natural fall in oestrogens may account for the tendency to remit after the menopause. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3273", "text": "The diagnosis of PLE is typically made by assessing the history and clinical observations. Any investigations are usually to exclude other conditions, particularly  lupus  and  porphyria . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3274", "text": "Blood tests are usually normal. However, positive  antinuclear antibody  and  extractable nuclear antigen  (anti-Ro/La) in low titre may be found, even in the absence of other criteria to suggest a diagnosis of lupus erythematosus. If clinical findings suggest a possibility of porphyria, urinary and red cell porphyrin screening may be performed and are negative in PLE. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3275", "text": "Photoprovocation tests are usually not required but may be undertaken by specialised centres in winter. [ 2 ]  When a decision to undertake this is made, a small area of the frequently affected skin is exposed to varying doses of UVA and minimal erythema dose (MED) (amount of UV radiation that will produce minimal redness of skin within a few hours following exposure) [ 2 ] [ 17 ]  of broadband UVB for three consecutive days. An examination of the skin to detect the rash is made, however, up to 40% have  false negative  responses. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3276", "text": "Depending on the clinical signs,  histology  of a  skin biopsy  may vary. There may be oedema in the  epidermis  with a dense superficial and deep lymphocytic infiltrate [ 10 ]  without vasculitis. Recently appearing lesions may show  neutrophils .  Spongiosis  and vesicle formation may also be present.  Direct immunofluorescence  testing is negative. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3277", "text": "The photosensitivity connected with lupus erythematosus is the main condition that may appear like PLE. However, the rash of lupus is inclined to be more persistent. [ 2 ]  PLE does not increase the risk of lupus. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3278", "text": "Other similar appearing conditions are  solar urticaria , which has a shorter duration, the eczema-like condition, photosensitive dermatitis, [ 2 ]  and photosensitivity drug reaction. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3279", "text": "Prickly heat, which is caused by warm weather or heat is not the same as PLE. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3280", "text": "Photosensitivity is also found in some of the  porphyrias . Nearly all cases of  porphyria cutanea tarda [ 18 ]  exhibit blister formation on the skin within 2\u20134 days of light exposure.  Variegate porphyria [ 19 ]  and  hereditary coproporphyria [ 20 ]  can also exhibit symptoms of light-induced blisters. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3281", "text": "Sunlight has been documented to trigger numerous skin conditions and the confusing terminology and categorisation previously has made the correct diagnosis and subsequent treatment difficult. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3282", "text": "Variants of PLE have been described: [ 21 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3283", "text": "Management entails regulating triggers whilst simultaneously inducing \"hardening\"; that is, steadily increasing exposure to sunlight, [ 2 ]  as light sensitivity is reduced with repeated sun exposure [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3284", "text": "Covering up with densely woven clothing has also been shown to help, in addition to applying a broad-spectrum, water-resistant semi-opaque sun protection factor (SPF) 50+  sunblock cream  before sun exposure and then every two hours thereafter confers some protection. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3285", "text": "The application of  topical corticosteroids  may lessen the redness and itch, [ 2 ]  and for preventing predictable holiday flare-ups, short courses of oral corticosteroids are sometimes considered. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3286", "text": "Another treatment option is a supervised course of low dose phototherapy, usually undertaken in winter. [ 2 ]  If resistant, the administration of  hydroxychloroquine  in early spring is sometimes considered. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3287", "text": "As sun exposure is avoided,  vitamin D  levels may fall and hence supplements are sometimes advised. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3288", "text": "Generally, PLE resolves without treatment; also, PLE irritations generally leave no scar. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3289", "text": "There may be a possible link with autoimmune thyroid disease. [ 9 ]  Some progression to autoimmune disease has been observed. [ 23 ]  However, another study of people with elevated titres of antinuclear antibodies with PLE found no progression to lupus erythematosus after an 8-year follow-up. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3290", "text": "In the United States, whilst one-quarter of people being investigated for a photosensitivity disorder were diagnosed with PLE, the prevalence in the general population is 10 to 15% and may even be as high as 40% as suggested in one study of more than 2000 people. [ 5 ] [ 6 ]  It is also particularly more prevalent in Central Europe and Scandinavia. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3291", "text": "PLE is more common in young adults and has a female preponderance [ 5 ]  with a ratio of 2:1 female-to-male. In Germany the female to male ratio has been cited as 9:1. [ 4 ]  It can, however, occur in all age groups and all skin types. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3292", "text": "Those experiencing sun exposure all year round seldom acquire PLE eruption. [ 15 ]  Hence, it is less common near the equator. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3293", "text": "The cases of this condition are most common between the spring and autumn months in the  northern hemisphere  and at higher altitudes. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3294", "text": "Reports of psychological distress have been made in more than 40% of peoples with PLE. [ 16 ]  This includes emotional distress, anxiety and depression [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3295", "text": "Thomas Bateman , following on from findings of his predecessor,  Robert Willan , [ 24 ]  first recorded a description of PLE in the nineteenth century, defining it as  eczema solare  with recurrent non scarring eczematous lesions triggered by sun exposure. [ 25 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3296", "text": "Danish physician  Carl Rasch  first described the  eczema-like polymorphic light eruption  in 1900, following his interest in the effect of  sunlight  on the  skin . He has since been credited with coining the term \"polymorphic light eruption\". [ 27 ] [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3297", "text": "Psychodermatology  is the treatment of  skin  disorders using  psychological  and  psychiatric  techniques by addressing the interaction between mind and skin. Though historically there has not been strong scientific support for its practice, there is increasing evidence that behavioral treatments may be effective in the management of chronic skin disorders. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3298", "text": "The practice of psychodermatology is based on the complex interplay between neurological, immunological, cutaneous and endocrine systems, known alternatively as the NICE network, NICS, and by other similar acronyms. The interaction between nervous system, skin, and immunity has been explained by release of mediators from network. In the course of several inflammatory skin diseases and psychiatric conditions, the neuroendocrine-immune-cutaneous network is destabilized."}
{"_id": "WikiPedia_Dermatology$$$corpus_3299", "text": "The disorders that proponents classify as psychodermatologic fall into three general categories: psychophysiologic disorders, primary psychiatric disorders and secondary psychiatric disorders. [ 2 ]  Proponents frequently claim treatment for  psoriasis ,  eczema ,  hives , genital and oral  herpes ,  acne ,  warts , skin  allergies ,  pain , burning sensations, and hair loss. Psychodermatological treatment techniques include  psychotherapy ,  meditation , relaxation,  hypnosis ,  acupuncture ,  yoga ,  tai chi , and  anti-anxiety drugs . [ 3 ] [ 4 ] [ 5 ] [ 6 ]  Additionally, cosmetics companies may offer products utilizing terms such as \"psychodermatology\" or \"neurocosmetics\" in their marketing, [ 7 ]  though these terms are not regulated."}
{"_id": "WikiPedia_Dermatology$$$corpus_3300", "text": "Psychophysiologic disorders are conditions that are precipitated by or worsened by experiencing stressful emotions. [ 8 ]  These conditions are not always related to stress and in many cases respond to medication but stress can be a contributing factor in some cases. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3301", "text": "In a 2013 paper published in the  Clinics in Dermatology , the official journal of the International Academy of Cosmetic Dermatology, the facts and controversies of this topic were examined with the conclusion: [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3302", "text": "Harriet Hall  notes that the specialty may not be needed at all because medicine already takes a holistic approach to treating a patient. [ 11 ]  A 2007 review of the literature generated from 1951 to 2004 finds that most dermatologists and psychologists recommend a synthesis of treatment rather than seeing another specialist. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3303", "text": "Association for Psychoneurocutaneous Medicine of North America (APMNA)"}
{"_id": "WikiPedia_Dermatology$$$corpus_3304", "text": "The  Quality of Life Index for Atopic Dermatitis  (QoLIAD) is a disease specific  patient reported outcome  which measures the impact that  atopic dermatitis  (AD) has on a given patient's  quality of life . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3305", "text": "It is a 25-item  questionnaire  for patients over the age of 16 [ 2 ]  with a maximum score of 25 and is restricted to yes or no answers. [ 3 ]  Higher scores on the QoLIAD indicate a greater negative influence that the disease has on quality of life. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3306", "text": "The QoLIAD was developed in 2004 and funded by  Novartis Pharma AG , Switzerland. It was produced in several countries and the content was derived from 65 qualitative interviews with patients in the UK, Italy and Netherlands. The initial version of the measure was produced in UK English and it was then translated for the Netherlands, Italy, Germany, France and the US. A Spanish version was then later developed. Further tests were implemented to validate the measure and it was administered to 300 patients in each country to finalize the instrument. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3307", "text": "The institutions involved in the development of the QoLIAD are: Galen Research (United Kingdom),  Erasmus University  (The Netherlands),  University of Greifswald  (Germany),  University of Verona  (Italy), C.H.U Bichat (France), 3D Health Research (Spain) and Novartis Pharmaceuticals Corporation (USA). [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3308", "text": "The QoLIAD has been translated into seven languages other than UK English. [ 6 ]  They include German, Spanish and Japanese."}
{"_id": "WikiPedia_Dermatology$$$corpus_3309", "text": "The QoLIAD has also been utilized to assess the effectiveness of new treatments of atopic dermatitis. This includes studies looking into educational intervention, [ 4 ] [ 7 ]  topical  corticosteroids [ 8 ]  and  pimecrolimus . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3310", "text": "Rete pegs  (also known as  rete processes  or  rete ridges ) are the  epithelial  extensions that project into the underlying connective tissue in both  skin  and  mucous membranes ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3311", "text": "In the epithelium of the mouth, the  attached gingiva  exhibit rete pegs, while the  sulcular [ 2 ]  and  junctional epithelia  do not. [ 3 ]   Scar tissue  lacks rete pegs and scars tend to shear off more easily than normal tissue as a result. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3312", "text": "Also known as  papillae , they are downward thickenings of the  epidermis  between the  dermal papillae ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3313", "text": "Rook's Textbook of Dermatology  is a leading textbook of  dermatology  published by Wiley. The ninth edition was published in 2016."}
{"_id": "WikiPedia_Dermatology$$$corpus_3314", "text": "The first edition of  Rook's  was published in two volumes by  Blackwell Scientific Publications  in Oxford in 1968. It was jointly edited by  Arthur Rook ,  Darrell Wilkinson  and  John Ebling . [ 1 ]  Rook was the editor of the  British Journal of Dermatology  from 1968 to 1974 [ 2 ]  a dermatologist at  Addenbrooke's Hospital , Cambridge, and a medical historian. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3315", "text": "An online version was introduced for the eighth edition in 2010. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3316", "text": "The ninth edition in four volumes was published by Wiley in 2016. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3317", "text": "This article about a  medical book  is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3318", "text": "Summer penile syndrome  (also known as 'Lions Mane Penis') [ 1 ]  is a seasonal pediatric medical condition characterized by redness, swelling ( edema ), and itching ( pruritus ) of the penile skin. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3319", "text": "Summer penile syndrome is usually caused by  chigger  bites on the penis, or, more rarely by exposure of the genital region to plants like poison ivy, sumac, and oak. [ 2 ] [ 3 ]  The majority of cases occur in the summer months, with the clothing associated with warmer weather making penis-arachnid and penis-plant contact more likely. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3320", "text": "First line treatments for Summer penile syndrome include oral  antihistamines  and  cold compresses . In extreme cases where the sufferer is in severe pain or is unable to pass urine, systemic  corticosteroids  are considered. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3321", "text": "This  pediatrics  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3322", "text": "Surgical treatments of ingrown toenails  include a number of different options. If conservative treatment of a minor  ingrown toenail  does not succeed or if the ingrown toenail is severe, surgical management by a podiatrist is recommended. [ 1 ]  The initial surgical approach is typically a partial avulsion of the  nail plate  known as a  wedge resection  or a complete removal of the toenail. [ 1 ]  If the ingrown toenail recurs despite this treatment, destruction of the germinal matrix with  phenol  is recommended. [ 1 ]  As an alternative, one may use 10% sodium hydroxide which is less toxic [ 2 ]  or trichloroacetic acid which may give faster healing time. [ 3 ]   Antibiotics  are not needed if surgery is performed."}
{"_id": "WikiPedia_Dermatology$$$corpus_3323", "text": "The physician will perform an  onychectomy  in which the nail along the edge that is growing into the skin is cut away ( ablated ) and the offending piece of nail is pulled out. Any infection is surgically drained. This process is referred to as a \"wedge resection\" or simple surgical  ablation  and is not permanent (i.e., the nail will re-grow from the matrix). The entire procedure may be performed in a physician's office in approximately thirty to forty-five minutes depending on the extent of the problem. The patient is allowed to go home the same day and the recovery time is anywhere from two weeks to two months barring any complications such as infection. As a follow-up, a physician may prescribe an  oral  or  topical  antibiotic or a special soak to be used for about a week after the surgery. Some use \"lateral onychoplasty,\" or \"wedge resection,\" as the method of choice for ingrown toenails. A wide wedge resection, with a total cleaning (removal) of nail matrix, has a nearly 100% success rate. [ citation needed ]   Some physicians will not perform a complete nail avulsion (removal) except under extreme circumstances.  In most cases, these physicians will remove both sides of a toenail (even if one side is not currently ingrown) and coat the nail matrix on both sides with a chemical or acid (usually phenol) to prevent re-growth.  This leaves most of the nail intact, but ensures that the problem of ingrowth will not recur. There are possible disadvantages if the nail matrix is not coated with the applicable chemical or acid (phenol) and is allowed to re-grow; this method is prone to failure. Also, the underlying condition can still become symptomatic if the nail grows back within a year: the nail matrix could be growing a nail that is too curved, thick, wide or otherwise irregular to allow normal growth. Furthermore, the flesh can become injured by concussion, tight socks, quick twisting motions while walking, or simply  because the nail is growing incorrectly (likely too wide). This hypersensitivity to continued injury can mean chronic ingrowth; the solution is nearly always edge avulsion by the more effective procedure of phenolisation."}
{"_id": "WikiPedia_Dermatology$$$corpus_3324", "text": "In case of recurrence after complete removal, and if the patient never felt any pain before inflammation occurred, the condition is more likely to be  onychia  which is often confused for an ingrown or ingrowing nail ( onychocryptosis ). Complete removal of the whole nail is a simple procedure.  Anaesthetic  is injected and the nail is removed quickly by pulling it outward from the toe. The patient can function normally right after the procedure and most of the discomfort goes away in a few days. The entire procedure can be performed in approximately 20 minutes and is less complex than the wedge resection. The nail often grows back, however, and in most cases it can cause more problems by becoming ingrown again. It can get injured by concussion and in some cases grows back too thick, too wide or deformed. This procedure can result in chronic ingrown nails causing more pain. Accordingly, in some cases as determined by a doctor, the nail matrix is coated with a chemical (usually  phenol ) so none of the nail will ever grow back. This is known as a permanent or full nail  avulsion , or full matrixectomy, phenolisation, or full phenol avulsion. As can be seen in the images below, the nail-less toe does not look like a normal toe.  Fake nails  or  nail varnish  can still be applied to the area to provide a normal appearance. In a few cases phenolisation is not successful and has to be repeated. Podiatrists routinely warn patients of this possibility of regrowth. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3325", "text": "The Vandenbos procedure was first described by Vandenbos and Bowers in 1959 in the US Armed Forces Medical Journal. [ 5 ]  They reported on 55 patients, all without recurrences. Since 1988 Dr. Henry Chapeskie has performed this procedure on over 2,700 patients who had no recurrences. Unlike other procedures, the Vandenbos procedure does  not  touch the nail. In this procedure, the affected toe is anesthetized with a digital block and a tourniquet is applied. An incision is made proximally from the base of the nail about 5\u00a0mm (leaving the nail bed intact) then extended toward the side of the toe/toenail in an elliptical sweep to end up under the tip of the nail about 3\u20134\u00a0mm in from the edge. It is important that all the skin at the edge of the nail be removed. The excision must be adequate leaving a soft tissue deficiency measuring 1.5 \u00d7 3\u00a0cm. A portion of the lateral aspect of the distal phalanx is occasionally exposed without fear of infection. Antibiotics are not necessary as the wound is left open to close by secondary intention. Postoperative management involves soaking of the toe in warm water 3 times/day for 15\u201320 minutes. The wound is healed in 4\u20136 weeks. No cases of  osteomyelitis  have been reported. After healing, the nail fold skin remains low and tight at the side of the nail. The rationale is that the nail itself is usually healthy, but overgrown by skin; when walking, the bilateral nail folds are pressed upwards, which is why narrowing the nail causes excessive recurrences, contrary to narrowing the nail fold. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3326", "text": "In difficult or recurrent cases of  onychocryptosis  (ingrown toenail) the patient's symptoms persist necessitating a permanent operative solution. The \"avulsion procedure\" is simple but the surgeon must be skilled enough to accomplish total destruction, and removal of, the nail matrix. Another disadvantage is the long healing and recovery time(> 2 months). In these cases, the best method is the Syme procedure, that means total nail matrix removal + skin flap transfer + phalanx partial osteotomy + stitching. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3327", "text": "Following injection of a local anaesthetic at the base of the toenail and perhaps application of a tourniquet, the surgeon will remove ( ablate ) the edge of the nail growing into the flesh and destroy the matrix area with  phenol  to permanently and selectively ablate the matrix that is producing the ingrown portion of the nail (i.e., the nail margin).  This is known as a partial matrixectomy, phenolisation, phenol  avulsion  or partial nail avulsion with matrix phenolisation. Also, any infection is surgically drained. After this procedure, other suggestions on aftercare will be made, such as salt water bathing of the toe. The purpose of the procedure is to prevent re-growth where the matrix was cauterized. After the procedure, the nail is slightly narrower (usually one millimeter or so) and is barely noticeable a year later. The surgery is advantageous because it can be performed in the doctor's office under local anesthesia and recovery time is minimal. There is no visible scar on the surgery site and a nominal chance of recurrence. However, if the phenol is improperly or inadequately applied, the nail matrix can regenerate from its partial cauterization and grow a new nail. This will result in a recurrence of the ingrown nail in approximately 4\u20136 months as the skin that the original ingrown nail grew under would also recover from the procedure. The recovery of the skin on either side of the nail is standard in this type of procedure. Many patients who have a minor recurrence of the ingrown nail often have the procedure performed again. However, in cases of severe recurrence, a podiatrist can perform the procedure again or resort to a more involved, permanent solution such as removal of the entire nail or the Vandenbos Procedure."}
{"_id": "WikiPedia_Dermatology$$$corpus_3328", "text": "Teledermatology  is a subspecialty in the medical field of  dermatology  and probably one of the most common applications of  telemedicine  and  e-health . [ 1 ]  In teledermatology, telecommunication technologies are used to exchange medical information (concerning skin conditions and  tumours  of the skin) over a distance using audio, visual, and data communication. Applications comprise health care management such as diagnoses, consultation, and treatment as well as (continuous) education. [ 2 ] [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3329", "text": "The dermatologists Perednia and Brown were the first to coin the term \"teledermatology\" in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3330", "text": "Teledermatology (as telemedicine) is practised on the basis of two concepts:  Store and forward  (SAF)  and  real time/live interactive teledermatology . Hybrid modes also exist (combining SAF and real time applications)."}
{"_id": "WikiPedia_Dermatology$$$corpus_3331", "text": "The SAF method is most commonly used in teledermatology: It involves sending (forwarding) digital images associated with (anonymous) medical information to the data storage unit of a consulted specialist. It can be as easy as sending an email with a digital image of a lesion to seek advice for a skin condition. Advantages of this method are that it does not demand the presence of both parties at the same time and does not usually require expensive equipment."}
{"_id": "WikiPedia_Dermatology$$$corpus_3332", "text": "In real-time/ live interactive teledermatology applications, provider and individuals usually interact via live  videoconferencing . It may also involve  remote surgery  and the use of telerobotic microscopes in dermatopathology. This mode generally requires more sophisticated and costly technology than used in the SAF mode. Both participants must be available at the same time."}
{"_id": "WikiPedia_Dermatology$$$corpus_3333", "text": "There is insufficient evidence to support teledermatology in diagnosing and triaging patients for specialist care. Therefore, more studies are needed to determine its effectiveness. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3334", "text": "Direct consultation  involves an individual with a skin condition contacting a dermatologist via telecommunication to request diagnosis and treatment. In this field, mobile applications of teledermatology gain importance."}
{"_id": "WikiPedia_Dermatology$$$corpus_3335", "text": "Telediagnosis  in the absence of personal contact with health care workers to the individual is complex. It requires active participation of the individual and without appropriate guidance may lead to improper management. However, as a  triage  tool, leading the individual directly to the appropriate specialist for his/her disease, could be very valuable in the near future."}
{"_id": "WikiPedia_Dermatology$$$corpus_3336", "text": "Specialist referral  is a major area of application in teledermatology A general practitioner (or other medical professional) that sees the individual consults a specialist/ specialised centre via telecommunication to get a second opinion. The specialist then helps the GP in rendering a diagnosis, providing management options et cetera. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3337", "text": "Home telehealth/telehomecare  involves an individual with a chronic condition being examined and managed remotely at home. An important field of interest of telehomecare in dermatology is the follow-up treatment of individuals with skin conditions requiring regular follow-up such as  crural ulcers  or  psoriasis  management. Crural ulcers are a common skin condition that needs follow up visits up to twice a week demanding significant time commitments by the individuals in addition to causing a financial burden on the health care system. [ 8 ]  Psoriasis is experienced by 3.2% of adults in the United States, and emerging research on teledermatology treatment of this condition suggests increased access to specialty care with positive patient satisfaction, outcomes, and cost savings. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3338", "text": "Medical education/continuous education  are a major advantage of telemedicine/e-health. Numerous universities offer online courses, computer-based training and Web applications in this field principally aimed at medical students. Specialist training courses via internet are also available, particularly in  dermoscopy . [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3339", "text": "General medical/health information  may be accessed by non-professionals, such as individuals affected by a skin condition, and their relatives, through the internet. They are also able to join peer support groups with others affected by the same condition. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3340", "text": "In teledermoscopy, digital dermoscopic  lesion  images (with or without clinical images) are transmitted electronically to a specialist for examination. This can be done on the web-based telediagnostic network Campus Medicus."}
{"_id": "WikiPedia_Dermatology$$$corpus_3341", "text": "Dermoscopy  (dermatoscopy, epiluminescence microscopy) is the technical field of using an epiluminescence  microscope  for viewing skin lesions in magnification in-vivo. It is particularly useful in the early detection of malignant skin lesions (i.e., melanoma). Digital dermoscopic images can be taken with a  digital camera  attached to a dermatoscope or special video cameras suited for dermoscopy, e.g. the  Fotofinder . Since dermoscopy is based on examination of a two-dimensional image it is very well suited for digital imaging and teledermatology."}
{"_id": "WikiPedia_Dermatology$$$corpus_3342", "text": "Teledermatopathology is the transmission of dermatopathologic images either in real-time with the aid of a robotic microscope or using a store-and-forward system (transmission as a single file). In the latter method (SAF) a rather new development is the introduction of virtual slide systems (VSS). [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3343", "text": "Virtual slides are made by digitally scanning an entire glass slide at a high  resolution  and then sending the images to a storage system. These can be then assessed on a computer screen similar to conventional microscopy, allowing the  pathologist  to maneuver around the image and view every part of the slide at any magnification."}
{"_id": "WikiPedia_Dermatology$$$corpus_3344", "text": "This is the transmission of crucial medical data and dermoscopic as well as clinical images to a pathologist who renders the conventional histopathologic diagnosis."}
{"_id": "WikiPedia_Dermatology$$$corpus_3345", "text": "In the everyday clinical setting, skin  biopsies  are taken by the physician directly responsible for the individual and are assessed by a dermatopathologist. This pathologist has most likely never seen the clinical aspect of the lesion and might not have any information about the person. These limitations can be overcome by teledermoscopically aided dermatopathology whereby a patient history and clinical data may increase the sensitivity of  diagnosis . [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3346", "text": "Additionally it has been shown that provision of such data may improve the level of diagnostic confidence held by the assessing dermatopathologists."}
{"_id": "WikiPedia_Dermatology$$$corpus_3347", "text": "Mobile telemedicine is a system in which at least one participant (the person seeking advice or the doctor, for instance) uses wireless or mobile equipment [ 14 ]  (i.e. mobile phones, handheld devices), in contrast to conventional stationary  telemedicine  platforms. Travellers who develop skin lesions as well as doctors who are on the move in hospital/non-hospital area can benefit from this new development in teledermatology. To facilitate access to medical advice and enable individuals to play a more active role in managing their own health status, mobile teledermatology seems to be especially suited for patient filtering or  triage . (i.e. referral based on the severity and character of their skin condition). Another possible practical application is for follow-up of individuals with chronic skin conditions. [ 15 ]  However, currently available studies show a high rate of missed skin cancers including melanoma, and there is not enough robust data to recommend this method of diagnosis. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3348", "text": "Not all cases are suitable for teledermatology. The type of cases suited for teledermatology is a topic, which requires more studies. Some studies have observed that eczema and follicular lesions were diagnosed with relatively more certainty, while in some other studies it was seen that diagnoses were made with more certainty in cases like viral warts, herpes zoster, acne vulgaris, irritant dermatitis, vitiligo, and superficial bacterial and fungal infections. Unlike in western studies where pigmented lesions suspicious of melanomas are one of the most referred cases for teledermatology (with or without teledermatoscopy), Asian studies have fewer cases referred based on the suspicion of melanoma. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3349", "text": "24% of the population in England and Wales seek medical advice for a skin condition, and approximately 6% of patients presenting with a skin problem are referred for specialist advice each year. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3350", "text": "The Department of Health encourages the use of digital technology in key areas to support delivery of the quality, innovation, productivity, and prevention (QIPP). This includes the introduction of digital or online services to deliver greater convenience for patients and to free up face-to-face clinical time for individuals who really need it. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3351", "text": "Brazil has had a high influx of white-skinned European immigrants from Portugal, Spain, Italy, Austria, Germany, Poland, Russia, etc., for many centuries. High  ultraviolet  content of  solar  exposure of skin leads to a high  prevalence  of lesions, especially skin cancer, with almost 200,000 diagnosed cases per year (30% of call cancer cases in the country). [ 20 ]  Teledermatology and teledermoscopy services both at the level of public and private medicine have been implemented since 2005 in almost all states, particularly in Southern states where prevalence is higher. The Ministry of Health and the state's Health Secretaries have funded several initiatives within the framework of the Brazilian Primary Care Telehealth Program, such as in the state of  Santa Catarina , where all municipalities have access to a teledermatology diagnosis and triage system headed by the  Federal University of Santa Catarina [ 21 ]  In the private sector, several initiatives have also taken place, such as a joint effort by the  Albert Einstein Israelite Hospital  of S\u00e3o Paulo's Telemedicine Center and the Municipal Health Secretary to provide teledermatology services to public health units, and was very useful to reduce queues, prioritize and expedite care for the more urgent cases of cancer care. [ 22 ]  In addition, several private telemedicine services and  startups  experienced growth during the  COVID-19   pandemic  in the country."}
{"_id": "WikiPedia_Dermatology$$$corpus_3352", "text": "Teledermatology and teledermoscopy currently exist in different forms in Australia. They assist with combatting the high  skin cancer  rates and allows rural patients to access specialist advice without having to travel. However,  store-and-forward  teledermatology or teledermoscopy are not currently funded under the Australian national health scheme called  Medicare . Research has been done into the economic impact of funding teledermoscopy in the Australian setting, finding that it would cost around $2 for every day that diagnosis or treatment was expedited. [ 23 ]  Australian dermatologists have been reported as reflecting on teledermoscopy by saying \"that it is valuable, [and] advanced dermatology service\" but given the option \"they would prefer face-to-face consultation with patients where possible to allow for a full body examination\". [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3353", "text": "Systematic review of economic evidence"}
{"_id": "WikiPedia_Dermatology$$$corpus_3354", "text": "Roland Tomb   is a Lebanese-French author,  bioethicist  and  dermatologist  born in 1958 in  Beirut , Lebanon. He held office as the Dean of the Faculty of Medicine at Beirut's  Saint Joseph University  from 2011 to 2023. He is the chairperson of the Department of Bioethics at this same university, and is an active member of  UNESCO's  committees concerned with bioethics."}
{"_id": "WikiPedia_Dermatology$$$corpus_3355", "text": "Tomb attended high school in Lebanon the Jesuit institution  Coll\u00e8ge Notre-Dame de Jamhour , graduating in 1976. [ 1 ]  He pursued his medical studies in Paris, at the Faculty of Medicine Pierre et Marie Curie (part of  Sorbonne University ), [ 2 ]   and then obtain his M.D. in 1989 from  Louis Pasteur University  (today part of the  University of Strasbourg ). The subject of his thesis, supervised by Pr Edouard Grosshans, was the rediscovery of formerly described skin diseases. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3356", "text": "When practicing medicine in Strasbourg, where he became assistant clinical director, also taught and conducted research, directed the allergology clinic for 8 years, and also obtained a DEA (Degree of Profound studies) in pharmacology and pharmacochemistry. [ 4 ]   Tomb relocated to Lebanon in 1993. He started directing the dermatology department at the  Hotel-Dieu de France  Hospital in Beirut, and was named professor. [ 4 ]  In 2011, Tomb was elected Dean of Saint Joseph University's Faculty of Medicine . [ 5 ]  He was reelected twice to this position for four-year mandates, in 2015 and in 2019. [ 6 ] [ 7 ]  During his tenure as dean, Tomb signed numerous conventions and agreements with French, Swiss and Belgian universities and research centers, concerning academic collaboration and student exchanges. He notably initiated the construction of a simulation center and a new high-tech medical school . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3357", "text": "Tomb is a member and former president of the Lebanese Society of Dermatologists, [ 9 ]  a member of the Soci\u00e9t\u00e9 Fran\u00e7aise de Dermatologie, [ 4 ]  and the vice-president of the Association des Dermatologistes Francophones. [ 10 ] [ 2 ]  He is also a board member of the Lebanese Order of Physicians. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3358", "text": "Tomb is the author or co-author of more than 300 articles in medical journals internationally. [ 11 ]  In addition, he has authored or contributed to the following collective medical works:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3359", "text": "At Saint Joseph University's Faculty of Medicine, Tomb created a diploma in medical ethics and was named Chair of bioethics. He was also the president of the ethics committee of the Hotel-Dieu de France hospital in Beirut, and the president of the ethics committee of the Lebanese Order of physicians. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3360", "text": "In 2009, Tomb obtained a Doctorat d'\u00c9tat (Ph.D.) in Life Sciences with a focus on philosophy and bioethics from  Aix-Marseilles . The thesis, supervised by Pr Pierre Le Coz, tackled the bioethical stakes of male circumcision. [ 18 ]  In 2022, he published a book,  Histoire de la Circoncision,  based on his thesis's findings, which has been reviewed internationally. [ 19 ] [ 20 ] [ 21 ] [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3361", "text": "In 2014, he was named rapporteur at UNESCO's intergovernmental bioethics committee. [ 23 ]  In 2016, he was named a member of  UNESCO's   International Bioethics Committee  (IGBC), [ 24 ]  of which he became one of the vice-chairpeople in 2018. [ 25 ] [ 26 ]  In addition, he was a member of the Lebanese National Consultative Committee of Bioethics from 2010 to 2018. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3362", "text": "Tomb is a member of the Board of Advisors of the Alexis and Anne-Marie Habib Foundation that provides financial educational support for Lebanese youth. [ 28 ]  He has had minor roles in two films,  Beyrouth Hotel  (2011) and  In the Battlefields  (2004), both by French-Lebanese filmmaker  Danielle Arbid . [ 29 ]  He has studied ancient Oriental languages at the Institut catholique de Paris and the Facult\u00e9 de th\u00e9ologie protestante de Strasbourg. [ 4 ]  He also contributed to several history books, among them:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3363", "text": "On 19 May 2014, Tomb was made Officer of the Lebanese Order of the Cedar. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3364", "text": "Verrucous lupus erythematosus   presents with non- pruritic  papulonodular lesions on the arms and hands, resembling  keratoacanthoma  or hypertrophic  lichen planus . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3365", "text": "Skin care  or  skincare  is a range of practices that support  skin  integrity, enhance its appearance, and relieve skin conditions. They can include nutrition, avoidance of excessive sun exposure, and appropriate use of emollients. Practices that enhance appearance include the use of  cosmetics ,  botulinum ,  exfoliation ,  fillers ,  laser resurfacing ,  microdermabrasion , peels,  retinol  therapy, [ 1 ]  and ultrasonic skin treatment. [ 2 ]  Skin care is a routine daily procedure in many settings, such as skin that is either too dry or too moist, and prevention of  dermatitis  and prevention of skin injuries. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3366", "text": "Skin care is a part of the treatment of  wound healing ,  radiation therapy  and some medications."}
{"_id": "WikiPedia_Dermatology$$$corpus_3367", "text": "Skin care is at the interface of  cosmetics [ 4 ]  and  dermatology . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3368", "text": "The US  Federal Food, Drug, and Cosmetic Act  defines cosmetics as products intended to cleanse or beautify (for instance, shampoos and lipstick). A separate category exists for medications, which are intended to diagnose, cure, mitigate, treat, or prevent disease, or to affect the structure or function of the body (for instance, sunscreens and acne creams), although some products, such as moisturizing sunscreens and anti-dandruff shampoos, are regulated within both categories. [ 4 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3369", "text": "Skin care differs from  dermatology  by its inclusion of non-physician professionals, such as  estheticians  and wound care nursing staff. [ 1 ] [ 7 ]  Skin care includes modifications of individual behavior and of environmental and working conditions. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3370", "text": "Guidelines for neonatal skin care have been developed. Nevertheless, the pediatric and dermatological communities have not reached a consensus on best cleansing practices, as good  quality scientific evidence  is scarce. [ 8 ]  Immersion in water seems superior to washing alone, and use of synthetic  detergents  or mild liquid baby cleansers seems comparable or superior to water alone. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3371", "text": "Dermatologists normally recommend that children wash their skin with a mild cleanser, use moisturizing lotion as needed, and wear sunscreen every day. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3372", "text": "Adolescents may be influenced by  social media marketing  to buy expensive skin care products, which are often not appropriate for their age (e.g.,  \"anti-ageing\" serums , which are for middle-aged and elderly people). [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3373", "text": "Skin ageing is associated with increased skin vulnerability, [ 10 ]  and the texture and colour of the skin can change over time. Although wrinkles occur naturally due to ageing, smoking can intensify the appearance of wrinkles. Sunspots, dryness,  wrinkles , and  melanomas  can occur from  UV  exposure over time, whether it be through the  sun  or through  tanning beds . Exposure to UV can make skin less elastic. Skin problems including  pruritus  are common in the elderly but are often inadequately addressed. [ 11 ]  A literature review of studies assessing the maintenance of skin integrity in the elderly found most studies to have low  levels of evidence , but the review concluded that skin-cleansing with synthetic  detergents  or  amphoteric   surfactants  induced less skin dryness than using soap and water. [ 10 ]   Moisturizers  with  humectants  helped with skin dryness and skin barrier occlusive reduced skin injuries. [ 10 ]  When taking baths or showers, using warm water rather than hot water can aid with dryness."}
{"_id": "WikiPedia_Dermatology$$$corpus_3374", "text": "There is limited evidence that moisturizing soap bar; combinations of water soak, oil soak, and lotion are effective in maintaining the skin integrity of elderly people when compared to standard care. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3375", "text": "A  systematic review  examined the benefits and clinical efficacy of routine skin care activities, such as  washing , bathing, and applying  lotions , in acute and long-term care adult settings. The study led to a proposed 2-step program targeting adults with intact or preclinically damaged skin. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3376", "text": "Sun protection is an important aspect of skin care. Though the sun is beneficial in order for the human body to get its daily dose of vitamin D, unprotected excessive sunlight can cause extreme damage to the skin.  Ultraviolet  (UVA and UVB) radiation in the sun's rays can cause sunburn in varying degrees, early ageing and an increased risk of skin cancer. [ 14 ]  UV exposure can cause patches of uneven skin tone and dry out the skin. It can reduce skin's elasticity and encourage sagging and wrinkle formation."}
{"_id": "WikiPedia_Dermatology$$$corpus_3377", "text": "Sunscreen  can protect the skin from sun damage; sunscreen should be applied at least 20 minutes before exposure and should be re-applied every four hours. Sunscreen should be applied to all areas of the skin that will be exposed to sunlight, and at least a tablespoon (25\u00a0ml) should be applied to each limb, the face, chest, and back, to ensure thorough coverage. Many tinted moisturizers, foundations and primers now contain some form of SPF."}
{"_id": "WikiPedia_Dermatology$$$corpus_3378", "text": "Sunscreens may come in the form of creams, gels or lotions; their  SPF  number indicates their effectiveness in protecting the skin from the sun's radiation. There are sunscreens available to suit every skin type; in particular, those with oily skin should choose non-comedogenic sunscreens; those with dry skins should choose sunscreens with moisturizers to help keep skin hydrated, and those with sensitive skin should choose unscented, hypoallergenic sunscreen and spot-test in an inconspicuous place (such as the inside of the elbow or behind the ear) to ensure that it does not irritate the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_3379", "text": "According to the American Academy of Dermatology, between 40 and 50 million Americans develop acne each year. [ 15 ]  Although many associate acne with adolescence, acne can occur at any age, with its causes including heredity, hormones, menstruation, food, and emotional stress. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3380", "text": "Those with inflammatory acne should exfoliate with caution as the procedure may make conditions worse and consult a dermatologist before treatment. [ 15 ]  Some anti-acne creams contain drying agents such as  benzoyl peroxide  (in concentrations of 2.5 - 10% ). [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3381", "text": "Pressure sores are injuries to the skin and underlying tissue as a result of prolonged pressure on the skin. A known example of a pressure sore is a bedsore called a pressure ulcer."}
{"_id": "WikiPedia_Dermatology$$$corpus_3382", "text": "When cleaning the stoma area, plain warm water should be use and dry wipe to gently clean around the stoma. Pat gently and make sure not to rub the area. Put all used wipes in a disposable bag and wash your hands after."}
{"_id": "WikiPedia_Dermatology$$$corpus_3383", "text": "Wound healing is a complex and fragile process in which the skin repairs itself after injury. It is susceptible to interruption or failure that creates non-healing chronic wounds. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3384", "text": "Radiation induces skin reactions in the treated area, particularly in the  axilla , head and neck,  perineum  and skin fold regions. [ 18 ]  Formulations with moisturising, anti-inflammatory, anti-microbial and wound healing properties are often used, but no preferred approach or individual product has been identified as best practice. [ 18 ] [ 19 ]  Soft silicone dressings that act as barriers to friction may be helpful. [ 18 ]  In breast cancer,  calendula  cream may reduce the severity of radiation effects on the dark spot corrector. [ 19 ] [ 20 ]   Deodorant  use after completing radiation treatment has been controversial but is now recommended for practice. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3385", "text": "Epidermal growth factor receptor  (EGFR) inhibitors are medications used in cancer treatment. These medications commonly cause skin and nail problems, including rashes, dry skin and  paronychia . [ 21 ]  Preventive intensive moisturizing with emollient ointments several times, avoidance of water-based creams and water soaks (although in certain circumstances white vinegar or potassium permanganate soaks may help), protection the skin from excessive exposure to sunshine, and soap substitutes which are less dehydrating for the skin than normal soaps, as well as shampoos that reduce the risk of scalp folliculitis, are recommended. Treatment measures with topical antibiotic medication can be helpful. [ 21 ] [ 22 ] [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3386", "text": "Cosmeceuticals  are topically applied, combination products that bring together  cosmetics  and \"biologically active ingredients\". Products which are similar in perceived benefits but ingested orally are known as  nutricosmetics . According to the United States Food and Drug Administration ( FDA ), the Food, Drug, and Cosmetic Act \"does not recognize any such category as \"cosmeceuticals.\" A product can be a drug, a cosmetic, or a combination of both, but the term \"cosmeceutical\" has no meaning under the law\". Drugs are subject to an intensive review and approval process by FDA. Cosmetics, and these related products, although regulated, are not approved by FDA prior to sale."}
{"_id": "WikiPedia_Dermatology$$$corpus_3387", "text": "Elaborate skin care routines are promoted on social media platforms such as  TikTok . [ 9 ]   This has led to children and teens using harsh and inappropriate products, such as  anti-aging products , which provide no benefit to young skin and may be harmful. [ 9 ]   It has also encouraged children and teens to wear  sunscreen  every day. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3388", "text": "Skin care procedures include use of botulinum; [ 24 ]  exfoliation; fillers;  laser medicine  in cosmetic resurfacing,  hair removal ,  vitiligo ,  port-wine stain  and  tattoo removal ;  photodynamic therapy ; microdermabrasion; peels; retinol therapy. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3389", "text": "Ingredients of cosmetic products  are listed following  International Nomenclature of Cosmetic Ingredients (INCI) . \nThese INCI names often differ greatly from systematic  chemical nomenclature  or from more common  trivial names ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3390", "text": "The below tables are sorted as follows:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3391", "text": "Aburatorigami  ( \u3042\u3076\u3089\u3068\u308a\u7d19 ,  lit. \u2009 ' oil removal paper ' )  is a traditional Japanese facial oil  blotting paper .  Aburatorigami  absorbs excess oil, thereby eliminating shine from the face.\n Aburatorigami  has traditionally been used by  kabuki  actors and  geisha  when wearing  oshiroi  (traditional white makeup), to keep makeup looking fresh throughout performances."}
{"_id": "WikiPedia_Dermatology$$$corpus_3392", "text": "In modern times it has been growing in popularity for everyday use amongst women and men for its various skincare and makeup benefits. [ 1 ]   Aburatorigami  also works well to keep the balance of water and oil in the skin and prevents skin problems. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3393", "text": "Traditional  aburatorigami  is made from only the finest grade of the blotting paper  abaca  leaf, rather than  pulp  or  rice paper . Although sometimes known as  Manila hemp ,  Cebu hemp , or  Davao hemp , the abaca plant is not related to true  hemp . [ 3 ]  The  Philippine Bureau of Fiber and Inspection Service  defines a total of 15 grades of abaca, the highest of which are derived from the leaf sheaths located closest to the center of the abaca stem. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3394", "text": "Aburatorigami  is essentially a by-product of the gold-leaf production process, effectively using material that might otherwise be thrown away. [ 5 ]  After  aburatorigami  is used, it can be  composted  and degraded naturally back into the earth. No oil-based chemicals are used in its production. As a result,  aburatorigami  has relatively low  environmental impact . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3395", "text": "Aburatorigami  was discovered for its oil-absorbing qualities several hundred years ago but was effectively present as a by-product of the  gold leaf  making process over a thousand years ago in  Kyoto . Originally called  hakuuchi-gami , gold leaf artisans in  Kanazawa  used this specialty paper to protect the gold during the vigorous goldbeating technique. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3396", "text": "During the  Heian period  (794\u20131192 CE), the demand was extremely high, as gold was used in decorating temples and in providing the  emperor  and the nobility with high-quality furnishings and crafts. Thus, much  hakuuchi-gami  was taken to Kyoto as wrapping for delicate gold leaf. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3397", "text": "During the  Edo period  (1603\u20131867), its popularity spread as its notability for absorbing oil and refreshing the complexion grew. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3398", "text": "During the  Edo period ,  Minamiza , the first  kabuki  theater of Japan, was built in Kyoto in 1610. The kabuki actors, like  geisha , were especially grateful to have a product that would help keep their thick makeup on while absorbing excess oil and sweat, for their performances in non-air-conditioned theaters. [ 2 ]  As a result, the culture of  aburatorigami  began to flourish in Kyoto. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3399", "text": "Aburatorigami  were given to geisha in Kyoto as a small present by the gold artisans who would linger around the  teahouses , the exclusive establishments also known as  ochaya . Geisha wore thick white foundation with limited time to touch up their makeup during performances. Geisha would also use  aburatorigami  to prepare and set their makeup, as they would commonly entertain for hours. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3400", "text": "Ahava Dead Sea Laboratories, Limited  ( Hebrew :  \u05d0\u05d4\u05d1\u05d4 ,  Love ) is an Israeli  cosmetics  company with headquarters in  Lod [ 1 ]  that manufactures  skin care  products made of mud and mineral-based compounds from the  Dead Sea .  The company has flagship stores in Israel, Germany, Hungary, South Korea, the Philippines and Singapore. [ 2 ]  As of 2015 [update] , Ahava income was more than US$150 million a year. [ 3 ]  In 2015, the Chinese conglomerate  Fosun International  agreed to purchase a controlling share of the company, which has been valuated to ca. NIS 300 million ($77 million USD). [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3401", "text": "Ahava products have been the target of the  Boycott, Divestment and Sanctions  movement because it operates in an  Israeli settlement  in the  West Bank . [ 5 ] [ 6 ] [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3402", "text": "The company's administrative headquarters are currently located in  Holon , while the main manufacturing plant and showroom are in  Mitzpe Shalem , [ a 1 ]  an  Israeli settlement  and  kibbutz  located on the Dead Sea in the  West Bank . [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3403", "text": "Ziva Gilad, a  spa  technician, came up with the idea of marketing  Dead Sea  mud after watching women tourists scooping up the mud to take home. [ 11 ]  Ahava was founded in 1988 as a single stand selling bottles of body scrub to tourists, generating $1 million that year. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3404", "text": "As of 2010, Ahava is the only cosmetics company licensed by the Israeli government that is legally permitted to mine raw materials at the Dead Sea. [ 11 ]  On the Jordanian side of the Dead Sea, there are approximately fifty small companies producing cosmetics, but only 15 have a global presence. Israel has imported raw materials for its Dead Sea mud cosmetics from Jordan since 1994. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3405", "text": "In 2009, Ahava took on new shareholder  Shamrock Holdings , the investment company owned by  Disney Family , which purchased 20% of Ahava Dead Sea Laboratories from its existing shareholders. [ 13 ] [ 14 ]  The company has 200 employees, 180 of them in Israel. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3406", "text": "In 2009, the company reported sales of nearly $150 million a year. In the United States, the largest overseas market for Ahava products, the company signed distribution deals with  Lord & Taylor ,  Nordstrom  and the beauty-supply chain  Ulta . [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3407", "text": "In 2011, Elana Drell Szyfer, former Senior Vice President of Global Marketing for  Estee Lauder , was appointed general manager of Ahava North America. [ 15 ]  In 2013, Szyfer left to work for  Kenneth Cole Productions . [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3408", "text": "As of 2011, Ahava's shareholders included Hamashbir Holdings, Gaon Holdings,  Kibbutz Ein Gedi ,  Kibbutz Mitzpe Shalem  and  Kibbutz Kalya . Of these kibbutzim, \n Mitzpe Shalem  and  Kalya  are located north of the Green Line, in the West Bank. [ 17 ]  As of 2015, Ahava is controlled by Gaon Holdings, the Livnat family and Shamrock Holdings who together own 53% of the company; Kibbutz Mitzpeh Shalem holds 35%, Kibbutz Kalia 5.8%, and a group of local kibbutzim another 6.7%. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3409", "text": "In 2015, the Chinese conglomerate  Fosun International  agreed to purchase a controlling share of the company, which as a whole has been valuated to ca. NIS 300 million (USD 77 million). [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3410", "text": "In March 2016, under its new ownership, it was reported that Ahava is moving its factory at Kibbutz Mitzpe Shalem to the Tamar Regional Council in order to avoid the EU directives against trade with companies operating in illegal settlements and pressure from the international BDS movement. [ 18 ]  However, the statement released by Ahava mentions only the opening of an additional facility at Ein Gedi, not to the closure of the existing plan at Ein Gedi. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3411", "text": "Ahava product lines include a basic product for all skin types; other products for dry, sensitive skin and for men\u2019s skin; and anti-aging products for face and body. [ 20 ]  Product lines include hand cream, foot cream, facial cleanser, body milk, facial nourishing cream, facial moisturizer, moisturizing shower cream and body cream. [ 21 ]  Some products claim to use citrus and citrus products as a source of vitamins and minerals. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3412", "text": "Dead Sea mud, alone or in combination with other ingredients, is believed to have benefits for deep cleansing and stimulation of the skin. Minerals extracted from Dead Sea water such as calcium, magnesium and potassium, are said to improve the metabolism, stimulate circulation and aid in the natural repair of cells. [ 22 ]   In 2009, Ahava Dermud range of skincare products was shown to have protective,  anti-oxidant  and  anti-inflammatory  properties that antagonize biological effects of  UVB radiation  on skin, reducing skin photodamage, photoaging, oxidative stress and  inflammation  in skin pathologies. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3413", "text": "Therapy with mud packs for conditions such as osteoarthritis is relatively expensive and requires the assistance of a therapist and a treatment room. In the wake of these limitations, Ahava developed mud compresses used in the home which are heated in a microwave\noven or a pot of hot water and placed over painful joints. A clinical research by the  Ben Gurion University of the Negev , supported in part by a grant from \"Ahava\" concluded that the group treated with natural mud compresses had a reduction of 20% or more in Knee  Osteoarthritis  pain scores at treatment completion, at one month, and at three months, compared to the control group. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3414", "text": "Embracing the trend toward more natural ingredients in cosmetics, Ahava purifies its own water and, according to the company, employs minimally invasive techniques to harvest mud and minerals. Ingredients are not tested on animals and Ahava products are packaged in recyclable containers. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3415", "text": "Ahava is one of several Israeli cosmetics companies researching  nanotechnology  applications. The company has established an R&D program to research  nanoemulsion  and nanosuspension with mud  nanoparticles . [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3416", "text": "Ahava operates its own laboratory for cell and organ culture. It is the coordinator of SkinTreat (FP-7) and a partner in nanoReTox (FP-7) founded by Cellage, a European research consortium the specializes in skin cellular Ageing (FP-5). [ 25 ]  Ahava developed a laboratory model for in-vitro NP screening that is employed for studying inflammatory processes using UV- irradiated human skin organ cultures. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3417", "text": "There is a controversy about whether Ahava is in breach of international law, due to the location of the factory on the West Bank section of the Dead Sea shore. According to a 2012 report by  Who Profits? , Ahava extracts mud from the occupied portion of the Dead Sea shore. Ahava is the only company that has an Israeli permit to extract mud for commercial purposes. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3418", "text": "Ahava's factory itself is located in the occupied West Bank, triggering global protests. [ 27 ]  Ahava is licensed to extract mud from the West Bank section of the Dead Sea coast. [ 28 ]  According to human rights organization  B'Tselem , several Israeli commercial ventures in the West Bank, including Ahava, breach the  Hague Convention  on the Law and Customs of War on Land, which prohibits exploitation of resources in occupied territory. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3419", "text": "Ahava's position is that the facility in Mitzpe Shalem is legal and that there is no recognized right of any people's other than Israel to the West Bank and that the mud is excavated from the Israeli part of the Dead Sea. [ 30 ] [ 31 ]  Ahava's CEO has threatened legal action against boycotters. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3420", "text": "Boycott campaigns have been organized by organizations such as  Code Pink , which says that Ahava's products come from \"stolen Palestinian natural resources in the occupied territory of the Palestinian West Bank\", and are produced in Mitzpe Shalem. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3421", "text": "In 2012, the British  Natural History Museum  was denounced in a letter signed by a group of 21 prominent academics and cultural figures for participating in a joint European Union-funded research programme with Ahava. The signatories said that \"[Ahava-DSL] extracts, processes and exports Palestinian resources to generate profits that fund an illegal settlement. Israel's settlement project has been held... to break international law. Organisations which aid and abet this process may well themselves be found to be in violation.\" The museum said Ahava-DSL was chosen from a list approved by the European Commission and they \"would not participate in any academic or educational boycotts that could restrict academic freedom\". [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3422", "text": "As part of the  economic agreement  between Israel and the  European Union , Israel cannot label products made in the West Bank as \"made in Israel\"; products made in the West Bank are subject to higher tariffs compared to products made in Israel. [ 33 ]  In November 2009, Dutch MP Van Bommel (Socialist Party) asked Dutch FM Verhagen (CDA) whether or not Ahava products that were marketed at the time in the Netherlands originated from the Palestinian Territories. If so, Ahava would not be entitled to a tax-exemption at Dutch customs. [ 34 ]  Verhagen promised to launch an investigation through the Dutch customs authority. [ 35 ]  In February 2010, the state-secretary of Economic Affairs Heemskerk responded to Van Bommel through a letter to the Dutch Parliament, saying records for the years 2007\u20132009 indicated that Dutch customs had not given tax-exemption to Ahava products. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3423", "text": "Ahava's store in a fashionable street of London's West End closed in September 2011 after constant protests by anti-Israeli activists. Owners of the surrounding stores complained to the landlord  Shaftesbury plc  that the repeated protests were affecting their business. A pro-Israeli group also held fortnightly counter-demonstrations, which attracted renewed controversy when members of the far-right  English Defence League  turned up, unasked, and joined in the demonstrations in support of Ahava. [ 36 ] [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3424", "text": "In January 2011, Managing Director for the retail chain  John Lewis , Andy Street, stated that it had stopped stocking Ahava products: [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3425", "text": "As a socially responsible retailer, John Lewis takes very seriously the treatment of workers and their working conditions. We expect all our suppliers not only to obey the law, but also to respect the rights, interests, and well-being of their employees, their communities, and the environment."}
{"_id": "WikiPedia_Dermatology$$$corpus_3426", "text": "In September, 2011, South African Industry Minister Rob Davies agreed in principle that goods manufactured in the occupied territories should not be labelled as a product of Israel since that is misleading. Davies said: \"We're persuaded it's in the interest of South African consumers to know whether their products are coming from Israel or from the occupied territories.\" [ 6 ]  The new South African rules will ensure that such products, such as Ahava, are labeled \"product of illegal settlement in the Occupied Palestinian Territories\" before they can be sold in South Africa. [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3427", "text": "Prior to this, South African activists had submitted an affidavit to the South African Police Service accusing retailer, Wellness Warehouse, and local Ahava importer, SDV Pharmaceuticals, of violating South African trade law by selling Ahava products carrying false labels of origin. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3428", "text": "In May 2012, South Africa\u2019s Minister of Trade and Industry announced new labelling rules for Israeli settlement goods; [ 7 ]  Ahava was mentioned by name as a company whose goods were fraudulently labeled as \u201cProduct of Israel\u201d when their place of origin is the occupied Palestinian Territories."}
{"_id": "WikiPedia_Dermatology$$$corpus_3429", "text": "Anti-aging creams  are predominantly  moisturizer -based  skin care  products marketed with unproven claims of making the consumer look younger by reducing, masking or preventing signs of skin  aging .  Anti-aging supplements  are ingestible products promoted to diminish the effects of aging, including  vitamin supplements , powders, and teas. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3430", "text": "In the United States, anti-aging products are commonly marketed with false  health claims , and are deemed to be among various scams on consumers. [ 3 ] [ 4 ]  Since 2007, the US  Food and Drug Administration  (FDA) has issued dozens of  warning letters  to manufacturers of skin care products with false marketing \u2013 including supposed anti-aging effects \u2013 about the benefits of such products, which are not authorized to be marketed as  drugs  that would require FDA approval to be safe and effective for treating the aging process. [ 4 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3431", "text": "Social media marketing  has been effective at getting children and teenagers to buy anti-aging skin care products. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3432", "text": "Traditionally, anti-aging creams have been marketed towards women, but products specifically targeting men are common in the 21st century. [ 6 ]  Marketing of anti-aging products has been criticized as reinforcing  ageism , particularly against women. [ 7 ]  Anti-aging promotions specifically reinforce the belief that older people should look like middle-aged people, and that old age comes with a loss of gender identity. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3433", "text": "Aqueous Cream BP , also known as  sorbolene , is a light,  hydrocarbon -based  emulsion , which is officially registered in the  British Pharmacopoeia  and categorised by the  British National Formulary  as a  non-proprietary emollient preparation . [ 1 ]  It is used as a topical, external medicine,  emollient  moisturiser, and general-purpose substitute for toiletries such as soap, shower gel,  shaving cream , and  lip salve ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3434", "text": "The common ingredients are:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3435", "text": "British researchers found evidence that using the cream to moisturize areas affected by  eczema  may actually aggravate the condition. [ 2 ]  They suggested this was due to skin-thinning effects of a detergent  sodium lauryl sulfate . The National Eczema Society recommends alternatives such as white soft paraffin wax or other types of emollient without such a high content of sodium lauryl sulfate. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3436", "text": "Baby oil  is an inert  oil  used to keep  skin  soft and supple, named for its use on babies and also often used on adults for skincare and massage."}
{"_id": "WikiPedia_Dermatology$$$corpus_3437", "text": "The  skin  of an infant, especially a  premature  one, is sensitive, thin, and fragile. The skin's neutral  pH  on the surface significantly reduces the protection against excessive  bacterial  growth. The  epidermis  and  dermis  are thinner than those of adults and the  epidermal barrier  is not yet fully developed. Consequences can for example be dry skin,  infections ,  peeling , blister formation and poor  thermoregulation . The application of different  oils  to the skin of the newborn is routinely practiced in many countries. In general, these oils are used for cleansing, to maintain the skin's moisture and to protect its surface. Additionally, baby oil is used for the  massage  of newborns and as additive in  lotions  and  creams . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3438", "text": "Some baby oils are based on  mineral oil ; others are based on  vegetable oils ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3439", "text": "Typical components of baby oils are the highly purified  mineral oil  products, such as  liquid paraffin  (INCI name: paraffinum liquidum) and  petroleum jelly  (INCI name: petrolatum). These compounds are odorless and tasteless, dermatologically tested and approved, not allergenic, and  hydrophobic ; they contain no  pesticides  or  herbicides .  Preservatives  and  antioxidants  are not necessary, because, unlike vegetable oils, paraffins cannot become rancid. [ 3 ]  Nevertheless, the use of mineral oil in cosmetics is being criticized. Natural-cosmetic companies claim that mineral oil causes skin occlusion. Conventional cosmetic manufacturers and dermatologists and cosmetic chemists argue against that, and studies have shown no statistical difference between paraffin oil and vegetable oils in skin penetration and skin occlusion. [ 4 ] [ 5 ]  On the contrary, petrolatum-based preparations have been shown to be effective to the skin barrier function, even in premature infants. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3440", "text": "Vegetable oils are produced by plants with the highest concentration being present in  seeds  and  fruits . About 95% of each vegetable oil is primarily composed of  triglycerides .  Coconut oil  and  palm oil  contain mainly  saturated fatty acids , while other oils largely contain  unsaturated fatty acids , for example  oleic acid  and  linoleic acid . Accompanying substances in vegetable oils are, inter alia,  phospholipids ,  glycolipids ,  sulfolipids ,  squalene ,  carotenoids ,  vitamin E ,  polyphenols  and triterpene  alcohols . [ 7 ]  To avoid rancidity, preservatives or antioxidants are added to baby oils based on vegetable oils. [ 3 ]  On cosmetic products, these oils are listed according to the  International Nomenclature of Cosmetic Ingredients  (INCI), e.g.: [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3441", "text": "Vegetable oils are not to be confused with  essential oils , both being sourced from plants. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3442", "text": "Baby oils are largely used as skin care products and their principal use remains as skin moisturizers. In particular, baby oils find application in the treatment of various skin diseases like  atopic dermatitis ,  xerosis ,  psoriasis  and other  eczematous  conditions. [ 7 ]  Another area of use is the oil massage of the newborn which has been a tradition in India and other Asian countries since time immemorial. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3443", "text": "In addition to its principal usage, liquid paraffin-based baby oil is commonly used in the automotive maintenance industry as a fuel for  diagnostic smoke test machines , which generate smoke used to detect leaks in engine induction systems, brake system, manifolds, gaskets and similar sealed systems. When heated to approximately 300\u00b0C in a low oxygen environment, liquid paraffin creates a thick and visible smoke which is injected into the sealed system. Leaks in a system can easily be found by observing the place at which smoke escapes."}
{"_id": "WikiPedia_Dermatology$$$corpus_3444", "text": "Baby powder  is an  astringent   powder  used for preventing  diaper rash  and for  cosmetic  uses.  It may be composed of  talc  (in which case it is also called  talcum powder ),  corn starch  or  potato starch . [ 1 ]  It may contain additional ingredients such as  fragrances . Baby powder can also be used as a  dry shampoo ,  cleaning agent  (to remove grease stains), and  air freshener . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3445", "text": "Talcum powder, if inhaled, may cause  aspiration pneumonia  and  granuloma . [ 3 ]  Severe cases may lead to chronic respiratory problems and death. [ 4 ] [ 5 ]  The particles in corn starch powder are larger and less likely to be inhaled. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3446", "text": "Some studies have found a statistical relationship between talcum powder applied to the  perineal  area by female babies and the incidence of  ovarian cancer , but there is not a consensus about  causality . [ 7 ] [ 8 ]  In 2016, more than 1,000 women in the United States  sued   Johnson & Johnson  for covering up the possible  cancer  risk associated with its baby powder. [ 9 ]  In 1975, an official at the US federal  Food and Drug Administration  stated that \"No mother was going to powder her baby with 1% of a known  carcinogen  irregardless [sic] of the large safety factor\" as a comment on the testing methodology that J&J backed. [ 10 ]  The company stopped selling talc-based baby powder in the United States and Canada in 2020 [ 11 ]  and has said it will stop all talc sales worldwide by 2023, switching to a  corn starch -based formula. However, Johnson & Johnson says that its talc-based baby powder does not contain asbestos and is safe to use. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3447", "text": "This  material -related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3448", "text": "A  barrier cream  is a  topical formulation  used in industrial applications and as a cosmetic to place a physical barrier between the skin and contaminants that may irritate the skin ( contact dermatitis  or  occupational dermatitis ). [ 1 ]  There are many other terms for creams designed to protect skin from harmful substances, including skin protective creams, pre-work creams, antisolvent gels, protective ointments, [ 2 ]  and  shielding lotions . [ 3 ]  Three classes of barrier creams are used: water repellent creams, water-soluble creams, and creams designed for special applications. [ 4 ]  Barrier creams may contain substances such as  zinc oxide ,  talc  or  kaolin  to layer over the skin. [ 5 ]  For hand care they are designed to protect against the harm from detergents and other irritants. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3449", "text": "The efficacy of barrier creams is controversial. [ 5 ]  They have not been demonstrated to be useful in preventing  hand eczema . [ 7 ]  A 2018  Cochrane review  concluded that the use of moisturizers alone or in combination with barrier creams may result in important protective effects for the prevention of  Occupational Irritant Hand Dermatitis  (OIHD). [ 1 ]  They are a poor substitute for protective clothing for workers. [ 8 ]  Gloves provide a greater protection than barrier creams. [ 9 ]  However they are reasonably effective for the protection of the face against some airborne substances. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3450", "text": "Some evidence suggests that improper use of barrier cream could cause a harmful rather than a beneficial effect. [ 6 ]  Skin that has been moisturized by barrier cream may be more susceptible to irritation by  sodium lauryl sulfate , which can permeate hydrated skin more easily because of its  hydrophilia . [ 5 ]  Barrier creams that contain  petroleum jelly  or certain oils may cause rubber or latex gloves to deteriorate. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3451", "text": "For hand care they are designed to protect against the harm from detergents and other irritants. [ 6 ]  To help prevent the spread of  pathogens , health care providers are required to wash their hands frequently. [ 10 ]  Frequent hand washing can result in chronic damage termed  irritant contact dermatitis  which includes dryness, irritation, itching, and more seriously, cracking and bleeding. [ 10 ]  Irritant contact dermatitis is very common among nurses, ranging from 25% to 55%, with as many as 85% relating a history of having skin problems. [ 10 ]  The  World Health Organization  has considered the use of barrier creams and has found their efficacy to be \"equivocal\" and too expensive to be considered in health-care settings where resources are limited. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3452", "text": "The  Centers for Disease Control and Prevention  found \"Two recent randomized, controlled trials that evaluated the skin condition of caregivers demonstrated that barrier creams did not yield better results than did the control lotion or vehicle used. As a result, whether barrier creams are effective in preventing irritant contact dermatitis among health-care workers remains unknown.\" [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3453", "text": "The Great Ormond Street Hospital Manual of Children's Nursing Practices 2012 book found that \"disposable nappies are effective in drawing fluid away from the skin and can be changed less frequently in the absence of stools, making regular application of barrier creams unnecessary in most children.\" [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3454", "text": "Barrier creams have been used in industry to protect workers' skin from the contaminants encountered in occupations such as nurses, hairdressers, employees in the food processing industry, cleaners, metal workers, printers, bricklayers etc. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3455", "text": "A 2018  Cochrane review  concluded that the use of moisturizers alone or in combination with barrier creams may result in important protective effects for the prevention of  Occupational Irritant Hand Dermatitis  (OIHD) [ 1 ]   Barrier creams can be applied before exposure to potential irritants, [ 13 ]  but are not typically used as the main protection against hazardous substances. [ 14 ]  They are a poor substitute for protective clothing for workers; [ 8 ]  in particular, gloves provide greater protection. [ 9 ]  However barrier creams are reasonably effective for protection of the face against some airborne substances. [ 8 ]  Active barrier creams containing silicone, tartaric acid, glycerin, and other ingredients are said to be beneficial for some chromate-sensitive construction workers. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3456", "text": "The efficacy of barrier creams is controversial. [ 5 ]  They have not been demonstrated to be useful in preventing  hand eczema . [ 7 ]  According to the  National Safety Council , \"shielding lotions can keep the skin from drying out\". [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3457", "text": "A 2002 review found \"some reports indicate that inappropriate BC (barrier cream) application might induce a deleterious rather than a beneficial effect.\" [ 6 ]  Skin that has been moisturized by barrier cream may be more susceptible to irritation by  sodium lauryl sulfate , which can permeate hydrated skin more easily due to its  hydrophilia . [ 5 ]  When handling hazardous molecules such as  sodium hydroxide , ingredients in barrier cream could react and induce  skin irritation . [ 5 ]  Barrier creams that contain  petroleum jelly  or certain oils may cause  rubber  or  latex gloves  to deteriorate. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3458", "text": "The mechanism of barrier cream varies by product. [ 5 ]  Three categories of barrier creams are used: water repellent creams, water-soluble creams, and creams designed for special applications. [ 4 ]   Moisturizing  barrier cream acts as a lubricating film on the skin to prevent depletion of water ( transepidermal water loss ) in the skin's outermost layer, the  stratum corneum . [ 5 ]  This may have a protective effect against  irritant contact dermatitis  and  allergic contact dermatitis , which often result from such depletion. [ 5 ]  These barrier creams can be classed as occlusives (which prevent loss through a  hydrophobic  effect),  humectants  (which absorb water from the  dermis  and environment due to  hygroscopy ), or hydrating agents (which both moisturize the skin and maintain its water content). [ 5 ]  Barrier creams may contain substances such as  zinc oxide ,  talc  or  kaolin  to layer over the skin. [ 5 ]  Other barrier creams are intended to protect the skin from some external agents, though they are not sufficient to provide a complete barrier. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3459", "text": "Bath salts  are water-soluble, pulverized  minerals  that are added to water to be used for  bathing . It is said that these salts improve cleaning, enhance the enjoyment of bathing, and serve as a vehicle for cosmetic agents. [ 1 ]  Bath salts have been developed which mimic the properties of natural mineral baths or  hot springs . [ 2 ]  Some bath salts contain  glycerine  so the product will act as an  emollient ,  humectant , or  lubricant . Fragrances and colors are often added to bath salts; the fragrances are used to increase the users' enjoyment of the bathing experience."}
{"_id": "WikiPedia_Dermatology$$$corpus_3460", "text": "Substances often labeled as bath salts include  magnesium sulfate  (Epsom salts),  sodium chloride  (table salt),  sodium bicarbonate  (baking soda),  sodium hexametaphosphate  (Calgon, amorphous/glassy sodium metaphosphate),  sodium sesquicarbonate ,  sodium citrate  and formerly  borax .  Glycerin , or liquid glycerin, is another common ingredient in bath salts."}
{"_id": "WikiPedia_Dermatology$$$corpus_3461", "text": "Fragrances and colors are often added to bath salts; in fact, one purpose of salts is as a vehicle or  diluent  to extend fragrances which are otherwise too potent for convenient use. Other common additives to bath salts are oils (agglomerating the salts to form amorphous granules, the product being called \"bath beads\" or \"bath oil beads\"), foaming agents, and effervescent agents. Bath salts may be packaged for sale in boxes or bags. Their appearance is often considered attractive or appealing, and they may be sold in transparent containers, showing off, for example, the needlelike appearance of  sodium sesquicarbonate  crystals."}
{"_id": "WikiPedia_Dermatology$$$corpus_3462", "text": "Some bath salts act as  water softeners  and change the way  soap  rinses."}
{"_id": "WikiPedia_Dermatology$$$corpus_3463", "text": "High concentrations of salts increase the  density  of the water and increase  buoyancy , which makes the body feel lighter in the bath. Very high concentrations of salts in water are used in many  isolation tank  therapies. Isolation tanks are special baths with enclosures which block out all light. Researchers have also studied their use in treating  arthritis . [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3464", "text": "Bath fizzies are material products designed to effervesce in bathwater.  They come in the form of amorphous grains of homogeneous mixture, packaged in a box, jar, or envelope; single-use envelopes of mixed powders; and solid boluses of homogeneous or inhomogeneous mixture called  bath bombs . Bath fizzies are a form of bath salts in that the products of their use include a salt solution in addition to the carbon dioxide bubbles which are their definitive feature.  Their ingredients must include one or more acid(s) and one or more water-soluble bicarbonate, sesquicarbonate, and/or carbonate.  In addition they commonly include coloring, fragrance, and/or other water-soluble, water-dispersible, and/or volatile ingredients for esthetic, cosmetic, or skin soothing purposes.  This principle of effervescing while releasing other ingredients is the same that has been used by  tableted products for children to produce their own carbonated beverages ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3465", "text": "Even though bath additives containing emollient are sometimes suggested for the treatment  atopic dermatitis , their use does not provide any benefits for the symptoms. [ 5 ] [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3466", "text": "A number of powdered  recreational   designer drugs  are now named \"bath salts\", referring to an incident where illegal drugs were distributed in packages disguised as bath salts, often in shops selling  drug paraphernalia  such as  head shops . [ 8 ] [ 9 ] [ 10 ] [ 11 ] [ 12 ]  The white powder, granules, or  crystals  often resemble true bath salts such as  Epsom salts . The drugs' packaging often states \"not for human consumption\" in an effort to evade  drug prohibition laws . [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3467", "text": "BB cream  is a marketing term that stands for  blemish balm ,  blemish base ,  beblesh balm , and in Western markets,  beauty balm , beauty blend... Products marketed as BB creams are generally designed to serve as a  foundation ,  moisturizer , and  sunscreen  all at once."}
{"_id": "WikiPedia_Dermatology$$$corpus_3468", "text": "The marketing term \" CC cream \" was invented later and sometimes stands for Color Correction cream. Products marketed as CC creams claim to serve the same function as BB creams, with greater emphasis on homogenizing skin color. [ 2 ]  Differences between BB creams and CC creams vary from brand to brand."}
{"_id": "WikiPedia_Dermatology$$$corpus_3469", "text": "What became BB cream was originally formulated in the 1960s in Germany by dermatologist Dr. Christine Schrammek to protect her patients' skin after facial peels and surgery. It was popularized by beauty trends in South Korea and later spread across the globe.  [ 1 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3470", "text": "BB creams come in a variety of different formulations. [ 1 ]  Because Korean companies focused initially on the Korean and East Asian markets, they are offered in a limited number of hues. Instead of offering multiple shades for different  skin colors , most formulae are designed to oxidize to match the user's skin tone. [ 4 ]  The skin-whitening properties of the cream as sold in the Asian market are an important element in its popularity. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3471", "text": "The cream is promoted as a multi-tasker and all-in-one treatment, but Korean women mostly use it as an alternative to foundation, particularly those with Western formulations that tend to be too heavy for their tastes. The coverage is often mineral-based, and is intended to both cover and treat blemishes such as acne, sun spots, and age spots. Some brands claim anti-wrinkle, anti-inflammatory, and soothing effects for their products. Several contain  hyaluronic acid  and  vitamin C ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3472", "text": "BB creams make up 13 percent of the cosmetics market in South Korea. Some Korean brands also offer BB creams for men. [ 6 ]  Notable Korean brands include  Etude House ,  HIDEHERE ,  Missha ,  Nature Republic ,  Skin Food ,  Sulhwasoo ,  The Face Shop ,  SKIN79 ,  Innisfree ,  Banila Co.  and CLIO."}
{"_id": "WikiPedia_Dermatology$$$corpus_3473", "text": "Western cosmetics companies began to launch BB creams in the Western market in 2012, though some of these creams have been criticized for lacking the skin-caring functions that BB creams normally have, and for being no more than tinted moisturizer. [ citation needed ]  Early arrivals included  Boscia ,  Clinique ,  Dior ,  Est\u00e9e Lauder ,  Garnier ,  Marcelle ,  Maybelline ,  Revlon  and  Smashbox . [ 7 ]   Lab Series  makes a BB cream for men. [ 8 ]  Certain BB creams have been tailored for Western markets: Est\u00e9e Lauder, for example, has not included the whitening properties in their formulation for North America. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3474", "text": "BB creams advertised as  cruelty-free  include Smashbox (owned by  Est\u00e9e Lauder ) and  The Body Shop  (owned by  Natura & Co ). [ 10 ]  The definition of \"cruelty-free\" varies. The Body Shop BB cream is certified by the Leaping Bunny Program, which means, according to the certification process, that no new animal testing has been used in any phase of product development by the company, its laboratories, or the suppliers of its ingredients. [ 11 ]  As of May 2013,  Amore Pacific , which has as its subsidiaries  Etude House  and  Laneige , has ended animal testing on all ingredients and cosmetics. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3475", "text": "Products certified as cruelty-free may still contain  animal products  and may not be suitable for  vegans . Vegan BB creams include the Superdrug own brand BB cream, [ 13 ]  BB cream souffles from Haut Cosmetics, 100% Pure Cosmetics, Multi-Mineral BB Cream from Pacifica, [ 14 ]  and the Evenly Radiant BB Cr\u00e8me from Dermae. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3476", "text": "Beauty.AI  is a mobile  beauty pageant  for humans and a contest for  programmers  developing algorithms for evaluating human appearance. The  mobile app  and  website  created by Youth Laboratories that uses  artificial intelligence  technology to evaluate people's external appearance through certain algorithms, such as symmetry, facial blemishes, wrinkles, estimated age and age appearance, and comparisons to actors and models. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3477", "text": "The Beauty.AI 2.0 contest caused great concern over important ethical issues with  deep neural networks  such as age, race and gender bias and lead to the creation of the Diversity.AI think tank dedicated to developing new methods for uncovering and managing bias in artificially intelligent systems. [ 3 ] [ 4 ] [ 5 ]  Beauty.AI was also an attempt to find approaches on how machines can perceive  human face  through evaluating particular features, commonly associated with health and beauty."}
{"_id": "WikiPedia_Dermatology$$$corpus_3478", "text": "The Beauty.AI app was created by Youth Laboratories, a company based out of Russia and Hong Kong that focuses on facial skin analytics. [ 6 ] [ 7 ]  The bioinformation company Insilico Medicine assists in the Beauty.AI app by testing its deep learning techniques to the app. [ 7 ]  One goal of the app is to reduce the need for human and animal testing as well as improving people's overall health. [ 7 ]  Its first contest was started in December 2016, and the results were announced in August 2016. [ 8 ]  More than 60,000 people submitted entries into the contest. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3479", "text": "The  mobile app  uses  artificial intelligence  technology to inspect photographs for certain facial features in order to both determine a person's beauty through artificial means by multiple robots. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3480", "text": "Part of the Beauty.AI app's purpose is to collect visual and  anecdotal data  to improve its creator's Youth Laboratories skin analyst skills. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3481", "text": "There were a total of 44 individuals from different age groups and genders judged as the most attractive, with 37  white entrants , six  Asian entrants , and one  dark-skinned entrant . [ 6 ]  The app has received criticism from  social justice advocates  and computer science professionals."}
{"_id": "WikiPedia_Dermatology$$$corpus_3482", "text": "However,  Alex Zhavoronkov , PhD, chief science officer of Youth Laboratories and chief technology officer Konstantin Kiselev, both for Youth Laboratories, noted that a lack of data may have contributed to these results. [ 6 ]  Also, Kiselev added that another issue was that approximately 75% of entrants were white Europeans, whereas only 7% and 1% were from India and Africa, respectively. [ 6 ]  Kiselev stated that they would work on doing more and better outreach to these areas to improve in this area. [ 6 ]  Despite this, it was said by Dr. Zhavoronkov that the AI would discard photos of dark-skinned people if the lighting is too poor. [ 6 ]  Dr. Zhavoronkov vowed to weed out the issues for the next beauty pageant and to try to avoid a similar controversy in the future. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3483", "text": "Borak  or  burak [ 1 ]  is a cosmetic  face powder  or paste that is applied on the face for protection from the sun. It is traditionally used by the  Sama-Bajau  people of the  Philippines ,  Malaysia , and  Indonesia ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3484", "text": "Borak is most commonly used by Sama-Bajau women to protect the face and exposed skin areas from the harsh tropical sun at sea. [ 2 ]  Ingredients can include  talcum  powder,  rice flour ,  turmeric , and other ingredients. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3485", "text": "When dry, borak is in  powder  form. The powder is first soaked in water to form a paste before being applied on the face. [ 3 ]  The paste can be a yellowish color or sometimes white."}
{"_id": "WikiPedia_Dermatology$$$corpus_3486", "text": "In  Myanmar ,  thanaka , a yellow-white cosmetic paste made of ground tree bark, is traditionally used for sun protection. In  Madagascar , a paste of wood called  masonjoany  is worn for decoration as well as for sun protection. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3487", "text": "C-beauty , or  Chinese beauty  is an umbrella term encompassing contemporary beauty products, practises, and ideals originating from  China . [ 1 ] [ 2 ]  China has the second largest beauty market in the world, after the United States. [ 3 ]  Common C-beauty products include  cosmetics ,  skin care ,  hair care ,  perfumes , and  nail art . [ 4 ] [ 5 ] [ 6 ] [ 7 ]  C-beauty often incorporates influences from  traditional Chinese medicine  and  Chinese art . [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3488", "text": "Chinese beauty products are known for their elaborate packaging, rapid innovation, and cost-effectiveness due to the high expectations of Chinese consumers. [ 10 ] [ 11 ]  As the Chinese market is intensely competitive, some C-beauty brands have multiple product lines in the works simultaneously. They may take only three to six months to conceptualize, launch, and manufacture a product line. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3489", "text": "Pechoin , founded in 1931, is China's oldest skin care brand. [ 13 ]  Lip muds are a cosmetic product invented by Chinese brand INTO YOU, and later adopted by several other Chinese brands. [ 11 ] [ 14 ]  C-beauty content creators are credited for popularizing the skincare routine of Vitamin C and Vitamin A serums at different times of day via the \"Morning C, Night A\" slogan. [ 15 ] [ 16 ] [ 17 ]  C-beauty products that are heavily influenced by  Chinese culture  may be characterized as being part of a broader social movement known as \"gu\u00f3ch\u00e1o\" (\u56fd\u6f6e) or \"China chic\", which celebrates traditional Chinese culture. [ 18 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3490", "text": "K-beauty  became popular in China in 2012 and South Korea surpassed the United States and Japan in 2015 to become the second largest exporter of cosmetics to China after France. However, the popularity of K-beauty declined sharply starting from 2018 due to a combination of unappealing packaging, low efficacy, unreasonable prices, and an over-reliance on the popularity of the  Korean Wave  rather than focusing on the quality of the products themselves to maintain consumer interest. This provided the opportunity for domestic C-beauty brands to grow their market share as they offered a more diverse range of higher quality products at more affordable prices compared to K-beauty. [ 19 ] [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3491", "text": "The intense competition of the Chinese beauty market has caused Chinese companies to expand into overseas markets. [ 21 ]  Skincare brand Herborist was the earliest to expand, opening its first European flagship store in  Paris  in 2015. [ 22 ]  In 2016, Chinese cosmetics brand Kailijumei's color-changing, flower lipsticks became a viral sensation overseas. [ 23 ] [ 24 ] [ 25 ]  One of the most internationally successful C-beauty brands is Flower Knows. [ 26 ] [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3492", "text": "Within a five-year span, from 2017 to 2022, the C-beauty industry doubled its market share. In 2022, C-beauty brands surpassed international competitors in sales within China. [ 28 ]  China exported US$4.85 billion worth of cosmetics in 2021. [ 29 ]  In 2023, the C-beauty market value was worth US$67.18 billion. [ 30 ]  In the early 2020s, Chinese makeup styles and cosmetics became popular in  Japan . [ 31 ] [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3493", "text": "In 2021, the practice of  gua sha  facial massage and jade rollers became viral in the West through  TikTok . [ 33 ] [ 34 ]  Although this faced criticisms of  cultural appropriation  as most brands selling Chinese facial tools in the West were not of Chinese origin and Western influencers were promoting gua sha massage methods with no basis in  traditional Chinese medicine . [ 35 ] [ 36 ] [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3494", "text": "A broad range of Chinese makeup styles and techniques have been labelled \"Douyin makeup\" in the West, named after the Chinese version for  TikTok . [ 38 ] [ 39 ]  However, the majority of these makeup trends have nothing to do with Douyin, and people in China do not use the term \"Douyin makeup\" themselves. Chinese people simply refer to the makeup styles collectively as \"Chinese makeup\" or by the specific names of the styles. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3495", "text": "Since 2014, cosmetics manufactured and sold in China do not require animal testing if reliable safety assessment reports are provided, although it continued to require animal testing for imported products from other countries. This law was amended in 2021, when foreign companies were allowed to export cosmetics to China without animal testing. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3496", "text": "Calamine , also known as  calamine lotion , is a medication made from powdered  calamine mineral  that is used to treat mild  itchiness . [ 2 ] [ 3 ]  Conditions treated include  sunburn , insect bites,  poison ivy ,  poison oak , and other mild skin conditions. [ 4 ] [ 5 ]  It may also help dry out secretions resulting from skin irritation. [ 1 ]  It is applied on the skin as a  cream  or  lotion . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3497", "text": "Side effects may include skin irritation. [ 4 ]  It is considered to be safe in  pregnancy . [ 4 ]  Calamine is a combination of  zinc oxide  and 0.5%   ferric oxide  (Fe 2 O 3 ). [ 6 ]  The lotion is produced with additional ingredients such as  phenol  and  calcium hydroxide . [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3498", "text": "The use of calamine lotion dates back as far as 1500 BC. [ 8 ]  It is on the  World Health Organization's List of Essential Medicines . [ 9 ]  Calamine is available  over-the-counter  as a  generic medication . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3499", "text": "Calamine is used to treat  itchiness . [ 2 ]  This includes  sunburn , insect bite, or other mild skin conditions. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3500", "text": "The  FDA  recommends applying some topical over-the-counter skin products, such as calamine, to absorb the weeping of the skin caused by poisonous plants such as  poison ivy ,  poison oak , and  poison sumac . For relieving the pain or itching caused by these plants, the FDA document recommends a cold water compress and topical  corticosteroids . [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3501", "text": "A  callus shaver  (also called a  credo knife ) is a tool for the medical and cosmetic removal of a  callus , mainly on the feet (see also  pedicure ), or hands. Technically speaking, its function is the abrasive treatment of  hyperkeratotic  skin lesions."}
{"_id": "WikiPedia_Dermatology$$$corpus_3502", "text": "The callus shaver consists of a handle, which is usually arched, and a blade made of ceramic or metal. Because the shaver is very sharp, injuries can result from careless use. [ 1 ]  For this reason the shaver is illegal to be used by  beauty salons  in some places in the United States. [ 2 ] [ 3 ] [ 4 ]  A  cellulitis  infection is possible if the skin is cut, especially if the shaver is shared with others and not properly sterilized. In very severe cases,  amputation  or death can result. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3503", "text": "Treatment with a callus shaver should involve the user in a longer-term care plan. Calluses are usually several skin layers deep, which means that treatment must be repeated several times on the affected area (usually the feet) if it is to remain callus free. However, there should be a period of a few days between the individual treatments, otherwise skin irritations and/or an even thicker callus may occur. [ 3 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3504", "text": "The callus shaver should not be confused with a  foot file  (foot rasp), which is used during the after-treatment of working with a callus shaver."}
{"_id": "WikiPedia_Dermatology$$$corpus_3505", "text": "The callus shaver and other instruments date back to the instruments mentioned by the Frenchman Nicolas-Laurent LaForest in his 1782 book \"L'art de soigner les pieds\". [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3506", "text": "Calmurid  was the name of a skin cream manufactured by Galderma (now discontinued due to safety reasons). Calmurid Cream contained the active ingredients  lactic acid  and  urea , [ 1 ]  whereas  Calmurid HC  contained an additional ingredient, the mild  corticosteroid   hydrocortisone ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3507", "text": "Owing to lactic acid's  keratolytic  properties (to break down hard skin cells) and urea's hydrating properties, Calmurid was used primarily in the treatment of dry, scaly skin.  Ichthyosis  and general  dermatitis  in the absence of  inflammation  are some of its indications."}
{"_id": "WikiPedia_Dermatology$$$corpus_3508", "text": "When the extra steroid component is added (as in Calmurid HC), it was used to treat dry, scaly skin that is accompanied by inflammation of the skin. This may include various forms of  eczema . The presence of a corticosteroid, however, means that the cream needed to be used sparingly and only for the shortest time period due to possible side effects that could occur due to systemic absorption of the steroid."}
{"_id": "WikiPedia_Dermatology$$$corpus_3509", "text": "Composition: Urea 100\u00a0mg/g and lactic acid 50\u00a0mg/g in an emulsified base containing betaine monohydrate,  glyceryl monostearate , diethanolamine cetylphosphate complex, hard fat, cholesterol, sodium chloride, purified water."}
{"_id": "WikiPedia_Dermatology$$$corpus_3510", "text": "This  pharmacology -related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3511", "text": "Capitol School of Hairstyling & Esthetics  (Capitol School of Hair Design) is a nationally accredited  cosmetology  and  esthetics  school located in  Omaha, Nebraska . It was founded in 1923. [ 1 ]    \nCapitol School of Hairstyling & Esthetics is a member of the  Omaha Chamber of Commerce  and accredited by the  Better Business Bureau  of  Nebraska . The school is approved by the Nebraska State Board of Education, accredited by the National Accrediting Commission of Cosmetology Arts and Sciences (NACCAS), and licensed by the Nebraska State Board of Cosmetology. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3512", "text": "Eric Hahn won the title \"World's Tallest Mohawk\" from  Guinness Book of World Records  on November 14, 2008, at Capitol School. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3513", "text": "Lyal McCaig, the owner and Director of Education for Capitol, was named \"Legend of Hair\" by  Omaha Magazine  shortly before he died in 2007. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3514", "text": "Caudalie  is a French skincare company that is specialized in  vinotherapy . It is known for its skincare products crafted from the harnessed extracts of grapes and grapevines. On the family estate, the discovery of a hot spring 1,500 feet underground inspired the creation of the first Vinotherapy Spa."}
{"_id": "WikiPedia_Dermatology$$$corpus_3515", "text": "Caudalie takes its name from the unit of measurement, the Caudalie, pronounced ko-da-li, used in  oenology , the study of wine."}
{"_id": "WikiPedia_Dermatology$$$corpus_3516", "text": "In 1993, during the harvest at  Ch\u00e2teau Smith Haut Lafitte , Mathilde Thomas and her husband Bertrand Thomas met Professor Joseph Vercauteren, a  polyphenols  specialist from the Pharmacy University in  Bordeaux  and his research team. Mr. Vercauteren shared one of his discoveries with them - that PCOs (procyanidolic oligomers) extracted from grape-seeds, are more effective than  vitamin E  against free radicals. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3517", "text": "In 1995, Mathilde and Bertrand Thomas launched Caudalie by developing three products containing stabilized grape-seed polyphenols with anti-aging properties. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3518", "text": "In 1996, Caudalie signed a research agreement with the Bordeaux Pharmacy Faculty and created a team of researchers, leading to the development of two further patents, Resveratrol [ 3 ]  and Viniferine. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3519", "text": "In September 1999, Mathilde and Bertrand Thomas created their first Vinoth\u00e9rapie Spa [ 5 ]  in the grounds of Ch\u00e2teau Smith Haut Lafitte. This spa combines water from a natural hot water spring with extracts from grapes and the grapevine."}
{"_id": "WikiPedia_Dermatology$$$corpus_3520", "text": "Early in 2013, Caudalie opened its first boutique in Brazil. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3521", "text": "In 2015, Caudalie filed a new patent following the discovery of combining vine stalk Resveratrol [ 7 ]  with  hyaluronic acid . This also marked the launch of a new anti-ageing range, Resveratrol[Lift]."}
{"_id": "WikiPedia_Dermatology$$$corpus_3522", "text": "In 2017, Caudalie opened its New York flagship boutique 'La Maison Caudalie' [ 8 ]  in the  Meatpacking District , NYC."}
{"_id": "WikiPedia_Dermatology$$$corpus_3523", "text": "In 2018, Caudalie opened its Natural Formulation Laboratory as well as a new site in Gidy, near Orleans, France."}
{"_id": "WikiPedia_Dermatology$$$corpus_3524", "text": "In 2018, Caudalie launched Vinopure, a new range designed specifically for oily, blemish-prone skin types. The range was awarded a  Marie Claire  Prix d'excellence de la Beaut\u00e9 in 2019. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3525", "text": "In 2019, Caudalie launched a new line of eco-friendly sun care products in support of Coral Guardian, a company which plants corals in Indonesia. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3526", "text": "Caudalie is an independent and family-owned business. In 2018, Mathilde Thomas was presented with a French Legion of Honor award by Prime Minister,  Edouard Philippe , for her entrepreneurial achievements and commitment to creating products which are both eco-friendly and effective.  [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3527", "text": "Caudalie has its own Natural Formulation Laboratory situated in  Gidy ,  France  and works in partnership with Harvard Medical School and anti-ageing guru, Dr David Sinclair, to develop patents to combat skin ageing. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3528", "text": "Caudalie also follows a strict ingredients charter named its \u201ccosm-ethics\u201d charter, [ 13 ]  which bans the use of phthalates, phenoxyethanol, mineral oils, parabens, Sodium Laureth Sulfate, synthetic coloring agents as well as ingredients of animal origin in its product formulas."}
{"_id": "WikiPedia_Dermatology$$$corpus_3529", "text": "Since 2012, Caudalie has been a member of the \" 1% for the Planet \" [ 14 ]  network and thus contributes 1% of its worldwide turnover to organizations committed to protecting the environment."}
{"_id": "WikiPedia_Dermatology$$$corpus_3530", "text": "Caudalie also supports various associations such as the WWF,  Surfrider , Nordesta, Pur Project, NFF, Coeur de Floret and is committed to planting 8 million trees by 2021."}
{"_id": "WikiPedia_Dermatology$$$corpus_3531", "text": "Caudalie offers products for face, body and hair. The brand typically uses natural, active ingredients while using the nutrients of grapevines and grapes."}
{"_id": "WikiPedia_Dermatology$$$corpus_3532", "text": "Caudalie's products are sold in over 27 countries [ 15 ]  worldwide:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3533", "text": "The brand also has 8 Vinotherapie Spas as well as more than 36 Boutique-SPAs around the world."}
{"_id": "WikiPedia_Dermatology$$$corpus_3534", "text": "CC cream  is a marketing term coined in the wake of the marketing term  Blemish Balm  cream or  Beauty Balm .   \"CC cream\" is used by some brands to mean Color Control cream, or Color Correcting cream, and some brands claim to reduce the appearance of skin redness or sallowness or to improve uneven skin tone. BB creams and CC creams are both tinted  moisturizers  containing  sun protection . There is no scientific definition for either term, nor is there quantifiable basis for difference between BB creams and CC creams: differences between the two vary from brand to brand.  BB (Blemish Balm) cream  was originally formulated in  Germany  and has, in recent years, gained popularity in  Asia , especially  South Korea , and is also gaining popularity in  Europe  and  North America ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3535", "text": "Coverage can vary greatly among the different brands, [ 1 ]  and differences are more often than not minimal when compared to BB creams. [ 2 ]  Some users apply them as  primers  rather than as a replacement for  foundation . Most cosmetics companies offer both BB- and CC-creams without any particular market leader in 2016."}
{"_id": "WikiPedia_Dermatology$$$corpus_3536", "text": "This  product  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3537", "text": "A  Certified Organic Sunscreen [ 1 ] , also known as  Petrochemical-Free Sunscreen , is a third party certified [ 2 ]   sunscreen  product consisting of certified and approved organic ingredients, with typically  zinc oxide  acting as the photo-protector. An organic sunscreen is verified and approved by a certifier to international or national organic standards, such as NSF/ANSI 305 and  USDA  organic, which define production and labelling requirements for personal care products containing organic ingredients. [ 3 ] [ 4 ]  These standards are complemented by existing sunscreen regulatory bodies such as the FDA that regulate the efficacy of the sunscreen, safety and permitted ingredients. Generally speaking, sunscreen has photo-protective properties that reduce the risk of skin cancer and ageing with relation to the  SPF  value and proper application. [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3538", "text": "Certified organic sunscreen is part of a broader trend towards certified organic cosmetics [ 7 ]  and certified natural cosmetics. [ 8 ]  Especially in the sunscreen market, developers have been 'pushed' [ 3 ]  towards alternatives to petrochemical UV filters due to their lack of safety data [ 9 ]  and their detrimental ecological effects, [ 3 ]  which has resulted in various petrochemical UV filters being banned in different countries and ecological areas. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3539", "text": "Organisations that manage standards and certifiers generally provide allowances for natural ingredients, such as water, as well as minerals such zinc oxide and titanium dioxide towards their organic calculation [ 11 ] [ 12 ]  as they have photo-protective properties and a well regarded safety profile. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3540", "text": "Certified Organic refers to the processing and production of a personal care product without the use of synthetic pesticides, herbicides, petrochemicals, aromatic hydrocarbons and other contaminants or practices. [ 13 ] [ 1 ]  Petrochemical suppliers may promote their ingredients as organic compounds; however, it is essential not to confuse this with the term \"organic\" or \"certified organic\". In this context, \"organic compounds\" simply means that the substances are derived from petroleum sources. Marketing products under organic is protected by consumer commissions such as the  Australian Competition & Consumer Commission  and other national bodies. [ 1 ] [ 14 ] [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3541", "text": "Created by Non-For Profit Organization  NSF , it is a standard designed for products intended for external use on any part of the body. [ 16 ]  This specific standard allows using the \"contains organic ingredients\" label for products containing at least 70% organic ingredients. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3542", "text": "Source: [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3543", "text": "Due to the fact that the FDA does not define or regulate the term \u201corganic\u201d in personal care products, the United States Department of Agriculture (USDA) has taken responsibility. The USDA has been regulating organic cosmetics and personal care products since 2001, under the National Organic Program. [ 18 ]  Unlike personal care products, sunscreen is regulated by the FDA as an OTC drug and thus has a GRASE monograph, so it is possible that the FDA may expand its role in regulating organic sunscreen in the future. Currently, only zinc oxide and titanium dioxide have been determined by the FDA to be generally recognised as safe and effective (GRASE). [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3544", "text": "The ISO 16128 is a guideline defined by the  International Organization for Standardization  which establishes how to numerically determine the degree of natural and organic origin of a product based on the single ingredients which compose its formulation. The ISO is an independent, non-governmental international organisation with a membership of 169 national standards bodies. [ 19 ]  The ISO:16128 standard aims to contribute to the UN's Sustainable Development Goals 3 and 12 [ 20 ] [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3545", "text": "The  Cosmos  Natural and Organic standard was established in 2002, and is the first voluntary standard harmonized at the European level. [ 3 ]  COSMOS standard prohibits petrochemical UV filters in cosmetic product. The standards permit the utilization of minerals such as zinc oxide and titanium dioxide, contingent upon their acquisition via meticulously defined industrial processes, owing to their lack of agricultural origins. [ 3 ]  It does not calculate natural minerals, such as zinc oxide, towards the organic percentage of a product,  as the standard was heavily adapted off of existing organic agricultural standards. [ clarification needed ] [ 22 ] [ 2 ] [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3546", "text": "Natrue  was created in 2007. The first Natrue labelled product launched in 2009. There are now over 7,000 Natrue certified products. [ 24 ]  The standard is for natural and organic cosmetics."}
{"_id": "WikiPedia_Dermatology$$$corpus_3547", "text": "Certified organic sunscreens or products must comply with certifiers 'green list' of ingredients that are considered safe and represent their organic standard. [ 25 ]  Ingredients that are not permitted generally include: silicones,  parabens ,  microplastics , synthetic fragrances, synthetic colorants, petrochemicals and certain preservatives such as  phenoxyethanol . [ 25 ] [ 26 ]  As well as contaminants such as  heavy metals ,  pesticides , aromatic hydrocarbons,  dioxins , PCBs, radiation, [ 27 ]  mycotoxins, nitrates, nitrosamines. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3548", "text": "Major organic certifiers prohibit animal testing for the product to carry their label [ 28 ]  and European certifiers generally require the ingredients to be non-GMO. [ 25 ] [ 26 ]  Organic certifiers do not allow the use of synthetic pesticides or chemical fertilisers in the production of certified organic ingredients. [ 13 ]  Cross contamination [ 29 ]  has been citied as a major cause of benzene contamination in sunscreens, and organic production practices typically prohibit this practice by requiring organic only production facilities. [ 30 ]   Reported [ 31 ]  cases of benzene contamination [ 32 ]  have resulted in sunscreen recalls [ 33 ]  initiated by regulators such as the TGA [ 34 ]  and FDA or voluntarily by the brand. [ 35 ]  Other reasons why the contamination likely occurred was the degradation of benzene-based (hydrocarbon) ingredients, [ 36 ]  such as petrochemical UV filters [ 37 ]  or from supply chain neglect. [ 38 ]  Most notably Valisure, an independent Connecticut based laboratory, found benzene contamination in products such as sunscreen, deodorant, and hand sanitiser resulting in over 25 million products being recalled in the US since 2019. [ 39 ] [ clarification needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3549", "text": "Certified organic and natural UV protectors Titanium Dioxide and Zinc Oxide, \"TiO2 and ZnO[,] represent the only effective alternatives to ultraviolet (UV) filters of petrochemical origin regarding photoprotection, and they contribute significantly to the safety of consumers who use them.\" [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3550", "text": "Certified Organic Sunscreen bans the use of all petrochemicals active ingredients that are generally regarded as harmful to the environment such as  Avobenzone ,  Oxybenzone ,  Octinoxate . [ 40 ]  Avobenzone, for example, is one of the most frequently used UV filters on the market and  [ 41 ] [ 42 ]  has been shown to cause damage to marine ecosystems such as coral reefs and harm marine life. [ 43 ] [ 41 ] [ 10 ] [ 44 ] [ 45 ]  Avobenzone has also been shown to absorb into the bloodstream after application in an FDA funded study. [ 46 ]   Oxybenzone  and  Octinoxate  were also both banned in Hawaii over studies showing toxicity towards marine life. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3551", "text": "A  chemical peel  is a treatment used to improve and smooth the texture of the  skin . The skin on the face is most commonly treated, but peels can also be performed on the body.  Chemical peels are intended to remove the outermost layers of the skin. To accomplish this task, the chosen peel solution induces a controlled injury to the skin, which causes the skin to peel. This process leads to smoother skin can improve fine lines, acne scars, and pigment. Medium depth peels must be performed by a medical provider (MD, NP, RN, or AP Esthetician in certain states)."}
{"_id": "WikiPedia_Dermatology$$$corpus_3552", "text": "There are several types of chemical peels. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3553", "text": "Alpha hydroxy acids  (AHAs) are naturally occurring  carboxylic acids  such as  glycolic acid , a natural constituent of sugar cane juice, and  lactic acid , found in sour milk and tomato juice as well as being produced  endogenously  during normal  metabolism  and  exercise . [ 2 ]  This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids can also be mixed with facial washes, serums or creams in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture."}
{"_id": "WikiPedia_Dermatology$$$corpus_3554", "text": "There are five usual fruit acids:  citric acid ,  glycolic acid ,  lactic acid ,  malic acid  and  tartaric acid . Many other alpha hydroxy acids exist and are used."}
{"_id": "WikiPedia_Dermatology$$$corpus_3555", "text": "AHA peels are not indicated for treating wrinkles. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3556", "text": "AHA peels may cause stinging,  skin redness , mild skin irritation, and  dryness ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3557", "text": "Higher pH levels and lower percentages of hydroxy acids are commonly used as home peels. These will not work as quickly as an in-office procedure, but can be economical for many people."}
{"_id": "WikiPedia_Dermatology$$$corpus_3558", "text": "Salicylic acid  is a beta hydroxy acid. It is antibacterial (mostly bacteriostatic, except in high concentrations when it is more frequently bactericidal) and anti-inflammatory which helps treat acne.. Salicylic acid also has the ability to reduce the spots and bumps associated with acne. [ 5 ]  It is becoming common for  beta hydroxy acid  (BHA) peels to be used instead of the stronger alpha hydroxy acid (AHA) peels due to BHA's being oil soluble. [ 6 ]  Studies show that BHA peels control sebum excretion, acne as well as remove dead skin cells to a certain extent better than AHAs [ citation needed ]  due to AHAs only working on the surface of the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_3559", "text": "Retinoic acid  is a  retinoid . This type of facial peel is also performed in the office of a plastic surgeon, oral and maxillofacial surgeon, or a provider in a  medical spa  setting. This is a deeper peel than the beta hydroxy acid peel and is used to treat scars, wrinkles, and pigment."}
{"_id": "WikiPedia_Dermatology$$$corpus_3560", "text": "It is usually performed in conjunction with a  Jessner ; which is performed right before, in order to open up the skin, so the retinoic acid can penetrate deeper into the skin. The client leaves with the chemical peel solution on their face. The peeling process takes place on the third day. More dramatic changes to the skin require multiple peels over time. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3561", "text": "A  phenol - croton oil  is a type of chemical peel. [ 7 ]  The term \"phenol-croton oil peel\" has replaced the vague term \"phenol peel\" in medical literature. It was originally used on a clandestine basis by early Hollywood stars in the 1920s and was incorporated into mainstream practice in the 1960s by Thomas Baker and Howard Gordon. [ 8 ]  The active ingredient is  croton oil , which causes an intense caustic exfoliating reaction in the skin. [ 9 ] [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3562", "text": "Resurfacing and restoring skin with chemical peel was introduced in the second half of the 19th century by the Austrian dermatologist  Ferdinand Ritter von Hebra  (1816\u20131880), founder of the Vienna School of Dermatology. He used exfoliative agents, like phenol, croton oil, nitric acid in various caustic combinations for treating freckles and skin irregularities. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3563", "text": "The deeper the peel, the more complications that can arise. [ 1 ]  Professional strength chemical peels are typically administered by certified dermatologists or licensed estheticians. Professional peels and lower-concentration DIY home peel kits can pose health risks, including injury and scarring of the skin.  Possible complications include photosensitivity, prolonged  erythema , pigmentary changes,  milia , skin atrophy, and textural changes. [ 1 ]  Many individuals report professional chemical peels leave a minor yellowish tinge on their skin due to the retinol elements in the peel. This is expected to last 2\u20133 hours maximum. Varying mild to moderate redness after the procedure is expected."}
{"_id": "WikiPedia_Dermatology$$$corpus_3564", "text": "Light chemical peels like AHA and  BHA are usually done in medical offices or Med Spas.  There is minimal  discomfort  so usually no  anesthetic  is given because the patient feels only a slight stinging when the  solution  is applied. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3565", "text": "Medium peels such as  trichloroacetic acid  (TCA) are also performed in the doctor's office or in an  ambulatory surgery center  as an outpatient procedure and can cause more discomfort. Frequently, the combination of a  tranquilizer  such as  diazepam  and an oral analgesic is administered. TCA peels often do not require anesthesia even if the solution itself has - at the contrary of phenol - no numbing effect on the skin. [ clarification needed ]  The  patient  usually feels a warm or burning sensation. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3566", "text": "Phenol  used to be a deep chemical peel. Early phenol peel solutions were very painful and most practitioners would perform it under either  general anesthesia , administered by an anesthesiologist or nurse anesthetist. Today it is more correctly referred to as a  croton oil  peel, since that has proven to be the active ingredient responsible for most of its effects. [ citation needed ]  Recent formulations allow more variation in the depth of treatment, and allow its use under  sedation  either orally or intravenously, usually in conjunction with local anesthetic injections."}
{"_id": "WikiPedia_Dermatology$$$corpus_3567", "text": "Clarisonic , or Pacific Bioscience Laboratories, Inc., was a company based in  Redmond, Washington  that produced the Clarisonic line of skin care devices. The company was sold to  L'Oreal  in 2011. [ 1 ]  In 2018, Clarisonic devices made up 14% of the skin care device market. In July 2020, L'Or\u00e9al announced it would discontinue the Clarisonic brand and products, choosing instead to focus on other core business offerings. It is speculated that the actual cause was increasing competition from cheaper alternatives as the skin care device market grew. [ 2 ]  As of September 30, 2020, the business and brand were discontinued."}
{"_id": "WikiPedia_Dermatology$$$corpus_3568", "text": "During its peak days, Clarisonic products were available to spa owners, physicians and consumers, and the brand was available in over 50 countries. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3569", "text": "Clarisonic was founded by David Giuliani, Robb Akridge, Steve Meginniss, Ward Harris, and Ken Pilcher in 2000. Giuliani, Clarisonic's CEO, is the former co-founder and CEO of Optiva, which developed the  Sonicare  line of toothbrushes. Giuliani sold Optiva to  Philips  Oral Healthcare in 2000. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3570", "text": "Akridge was a scientist at Optiva Corporation before co-founding Clarisonic. He holds a bachelor's degree from University of Texas, a Master of Science degree in biology from  Texas State University\u2013San Marcos  and a doctorate in microbiology from  Texas A&M University ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3571", "text": "Ken Pilcher is the lead inventor of Clarisonic's skin care systems. In the past, he has developed avionics for the  NASA   Space Shuttle , as well as medical electronics."}
{"_id": "WikiPedia_Dermatology$$$corpus_3572", "text": "Clarisonic was backed by angel groups including  Keiretsu Forum  who provided the seed capital for the company"}
{"_id": "WikiPedia_Dermatology$$$corpus_3573", "text": "2012"}
{"_id": "WikiPedia_Dermatology$$$corpus_3574", "text": "The term  cleanser  refers to a product that cleans or removes dirt or other substances. A cleanser could be a  detergent , and there are many types of cleansers that are produced with a specific objective or focus. For instance, a  degreaser  or  carburetor  cleanser used in automotive mechanics for cleaning certain engine and car parts."}
{"_id": "WikiPedia_Dermatology$$$corpus_3575", "text": "Other varieties include the ones used in  cosmetology ,  dermatology  or general  skin care . In this case, a cleanser is a  facial  care product that is used to remove  make-up , skin care product residue, microbes, dead  skin cells , oils, sweat, dirt and other types of daily pollutants from the face. These washing aids help prevent filth-accumulation, infections, clogged pores, irritation and cosmetic issues like dullness from dead skin buildup & excessive skin shine from sebum buildup. This can also aid in preventing or treating certain skin conditions; such as  acne . Cleansing is the first step in a skin care regimen and can be used in addition of a  toner  and  moisturizer , following cleansing or using makeup remover cotton and makeup remover."}
{"_id": "WikiPedia_Dermatology$$$corpus_3576", "text": "Sometimes \"double cleansing\" before moving on to any other skincare product is encouraged to ensure the full  dissolution & removal of residues that might be more resistant to cleansing, such as; waterproof makeup, water-resistant  sunscreen , the excess  sebum  of oily skin-type individuals and air pollution particles. Double cleansing usually involves applying a  lipid-soluble  cleanser (e.g. cleansing balm, cleansing oil, micellar cleansing water) to dry skin and massaging it around the face for a length of time, then the area may or may not be splashed with water. Any type of aqueous cleanser is then emulsified with water and used as the main cleanser that removes the first cleanser and further cleans the skin. Then the face is finally thoroughly rinsed with water until no filth or product residue remains."}
{"_id": "WikiPedia_Dermatology$$$corpus_3577", "text": "Using a cleanser designated for the facial skin to remove dirt is considered to be a better alternative to bar  soap  or another form of skin cleanser not specifically formulated for the face for the following reasons:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3578", "text": "Facial cleansers include the following:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3579", "text": "Cleansers that have active ingredients are more suitable for oily skins to prevent breakouts. [ citation needed ]  But they may overdry and irritate dry skin, this may make the skin appear and feel worse. Dehydrated skin may require a creamy lotion-type cleanser. These are normally too gentle to be effective on oily or even normal skin, but dry skin requires much less cleansing power. It may be a good idea to select a cleanser that is alcohol-free for use on dry, sensitive, or dehydrated skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_3580", "text": "Some cleansers may incorporate fragrance or essential oils. However, for some people, these cleansers may irritate the skin and often provoke allergic responses. People with such sensitivity should find cleansers that are pH-balanced cosmetic balanced, contain fewer irritants, suit many variating skin types, and do not make the skin feel dehydrated directly after cleansing. Tight, uncomfortable skin is often dehydrated and may appear shiny after cleansing, even when no sebum is present. This is due to the taughtening and 'stripping' effect some cleaners can have on the skin. One should discontinue use of a cleanser that upsets the balance of the skin; cleansers should work with the skin not against it. Finding the right cleanser can involve some trial-and-error."}
{"_id": "WikiPedia_Dermatology$$$corpus_3581", "text": "Clindamycin/benzoyl peroxide , sold under the brand name  Benzaclin  among others, is a topical gel used for the treatment of  acne . [ 7 ]  It is a  fixed-dose combination  of  clindamycin , as the phosphate, an  antibiotic ; and  benzoyl peroxide , an  antiseptic . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3582", "text": "Common side effects include peeling, itching, and dryness of the skin where the gel was applied. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3583", "text": "Clindamycin/benzoyl peroxide was approved for medical use in the United States in December 2000. [ 12 ] [ 13 ] [ 14 ]  It is available as a generic medication. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3584", "text": "The gel is used on the skin to treat light to medium  acne vulgaris  in people 12 years and older. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3585", "text": "There is an average 52% decrease in inflammatory acne lesions by week 12. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3586", "text": "The combination is less effective than benzoyl peroxide/ salicylic acid  after short-term treatment of two to four weeks, but the two treatments showed similar effectiveness after ten to twelve weeks. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3587", "text": "Studies on whether or not the use of clindamycin/benzoyl peroxide gels is  teratogenic  or has adverse effects on nursing infants have not been performed. While oral clindamycin passes into breast milk, no such data are available for clindamycin in gel form. Limited data regarding topical clindamycin and benzoyl peroxide have shown no safety problems. [ 16 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3588", "text": "The gel is not recommended for those who are allergic to clindamycin, benzoyl peroxide, any components of the formulation, or  lincomycin . [ 16 ] [ 19 ]  Individuals previously diagnosed with  regional enteritis ,  ulcerative colitis , or antibiotic-associated colitis are also recommended not to use it. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3589", "text": "Common side effects are peeling, itching, redness, dryness, burning, and  dermatitis . Benzoyl peroxide bleaches hair, clothes, towels, bedclothing, and the like. Prolonged exposure to natural or artificial sun light ( UV rays ) is not recommended because the gel may cause  photosensitivity . [ 16 ] [ 19 ]  Irritation due to benzoyl peroxide can be reduced by avoiding harsh facial cleansers and wearing  sunscreen  prior to sun exposure. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3590", "text": "Clinical studies have shown systemic absorption of clindamycin through topical application, in some cases leading to diarrhea, bloody diarrhea, and  colitis . Reports of  anaphylaxis  were also seen. However, the sources of these reports were personal accounts without controls and of an unknown population, thus it is difficult to attribute their cause to the clindamycin/benzoyl peroxide gel. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3591", "text": "No formal interaction studies have been done. Combination with topical products containing alcohol or  astringents , as well as  skin peelings , may increase the irritant effect of clindamycin/benzoyl peroxide. Topical  erythromycin  may antagonise the effect of clindamycin, although this has only be demonstrated in  in vitro  studies. Topical  tretinoin  and other  retinoids  may be inactivated by benzoyl peroxide or increase its irritant effect. [ 16 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3592", "text": "Clindamycin phosphate is a water-soluble  ester  of the semi-synthetic antibiotic clindamycin, which is synthesized from lincomycin. Like the  macrolide  antibiotics, it acts as a  bacteriostatic  agent by interfering with the  50S  subunit of the  ribosome  of  Cutibacterium acnes , inhibiting bacterial protein synthesis and preventing bacteria from replicating. [ 16 ] [ 21 ]   C. acnes  plays a role in the development of acne. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3593", "text": "Benzoyl peroxide also kills  C. acnes , but by releasing free radical oxygen species, thus oxidizing bacterial proteins. Also, it dries out the area by reducing  sebum  production, prevents  clogged pores , and is a  keratolytic  agent. [ 16 ]  Since benzoyl peroxide is an oxidizer, not an antibiotic, it is not subject to  C. acnes  resistance unlike clindamycin. [ 18 ] [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3594", "text": "Both ingredients have been shown to reduce the number of acne lesions with statistical significance. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3595", "text": "Clindamycin phosphate is an inactive  prodrug . It is quickly activated to clindamycin by  hydrolysis . After four weeks of application during a study, 0.043% of the used clindamycin dose were found in the blood. Benzoyl peroxide is only absorbed through the skin after reduction to  benzoic acid , which is subsequently metabolized to  hippuric acid  and eliminated via the kidneys. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3596", "text": "The combination is sold under various brand names including Acanya, [ 8 ]  Benzaclin, [ 7 ]  Duac, [ 10 ]  and Onexton. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3597", "text": "Dow Pharmaceuticals filed the patent for Onexton, and the  United States Patent and Trademark Office  issued the patent on 16 October 2012. On 24 November 2014, the US  Food and Drug Administration  (FDA) approved the  new drug application  (NDA) No. 050819 for Onexton, with Dow Pharmaceutical as the holder. [ 24 ]  The patent is set to expire on 5 August 2029. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3598", "text": "On 12 January 2016, [ 26 ]   Dow Pharmaceutical Sciences  and Valeant Pharmaceuticals North America LLC filed a lawsuit against  Taro  USA and Taro Industries, an Israel-based corporation. The lawsuit was filed for infringement upon their Onexton patent, by Taro attempting to submit an  abbreviated new drug application  (ANDA) to the  Food and Drug Administration  (FDA) for its generic 3.75% benzoyl peroxide and 1.2% clindamycin phosphate  topical gel . The court concluded that Taro was guilty of attempting to submit an ANDA patent request before the Onexton patent expired. [ 24 ]  Perrigo settled its patent litigation with Valeant and Dow. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3599", "text": "Collagen induction therapy  ( CIT ), also known as  microneedling ,  dermarolling , or  skin needling , is a  cosmetic  procedure that involves repeatedly puncturing the  skin  with tiny, sterile needles (microneedling the skin). CIT should be separated from other contexts in which microneedling devices are used on the skin (e.g.,  transdermal  drug delivery,  vaccination )."}
{"_id": "WikiPedia_Dermatology$$$corpus_3600", "text": "It is a technique for which research is ongoing, but has been used for a number of skin problems including scarring and  acne . [ 1 ]  Some studies have also shown that when combined with  minoxidil  treatment, microneedling is able to treat hair loss more effectively than minoxidil treatment alone. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3601", "text": "Platelet-rich plasma  (PRP) can be combined with collagen induction therapy treatment in a form of  dermatologic   autologous blood therapy . PRP is derived from the patient's own blood and may contain  growth factors  that increase collagen production. [ 3 ]  It can be applied topically to the entire treatment area during and after collagen induction therapy treatments or injected intradermally to scars. Efficacy of the combined treatments remains in question pending scientific studies. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3602", "text": "More serious safety concerns have been cited for these treatments, popularly known as  vampire facials , when performed in non-medical settings by people untrained in  infection control . [ 6 ] [ 7 ]  The New Mexico Department of Health issued a statement that at least one such business offering vampire facials \"could potentially spread blood-borne infections such as  HIV ,  hepatitis B  and  hepatitis C  to clients\". [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3603", "text": "In April 2024, the CDC announced that three women who had been patients at the Albuquerque, New Mexico, VIP Spa had been diagnosed with HIV after getting \"vampire facials\" there. Another almost 200 former clients and their sexual partners were also tested but were found to not have HIV. No mention was made of any testing for other possible blood-borne infections. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3604", "text": "A  concealer  or  color corrector  is a type of  cosmetic  that is used to mask imperfections on the skin. These imperfections can include dark circles under the eyes, blemishes, and hyperpigmentation. Concealer is similar to, and can be used in conjunction with  foundation , a lighter cosmetic that is used to even out the  skin tone . Both concealer and foundation are typically used to make skin appear smoother and more uniform in color. These two types of cosmetics differ in that concealers tend to be more heavily  pigmented , though concealer and foundation are both available in a wide range of colors and  opacities ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3605", "text": "To use a concealer, an individual typically applies a small amount of product to the area of the skin that they want to cover. The concealer is then blended into the surrounding skin using a brush, sponge, or the fingertips to create a seamless finish. Concealers can be applied before or after foundation, depending on the desired effect. Applying concealer before foundation can help to create a more even canvas for the foundation, while applying concealer after foundation can help to touch up any areas that still require coverage."}
{"_id": "WikiPedia_Dermatology$$$corpus_3606", "text": "Concealers comes in different forms such as liquid, cream, stick, pencil, and powder. The first commercially available concealer was  Max Factor 's  Erace , launched in 1954. [ 1 ]  Camouflage makeup is a much heavier pigmented form of concealer. It is used to cover serious skin discolorations such as birthmarks, scars and  vitiligo ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3607", "text": "Concealer is available in a variety of shades. When picking a concealer, people tend to choose one or two shades lighter than their skin tone to better hide their blemishes and dark circles under the eye; once blended out and then set with a powder, it will be smooth and resemble more youthful skin. Some colors are intended to look like a natural skin tone, while others are meant to cancel out the color of a particular type of blemish. Concealers with yellow undertones are used to hide dark circles. Green and blue can counteract red patches on the skin, such as those caused by pimples, broken veins, or  rosacea . A purple-tinted concealer can make sallow (yellowish) complexions look brighter."}
{"_id": "WikiPedia_Dermatology$$$corpus_3608", "text": "Each type of concealer is unique and has qualities that are better suited for different skin types."}
{"_id": "WikiPedia_Dermatology$$$corpus_3609", "text": "These are some common ingredients found in all concealer products: [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3610", "text": "Cosmetics  are composed of mixtures of  chemical compounds  derived from either  natural sources  or synthetically created ones. [ 1 ]  Cosmetics have various purposes, including  personal  and  skin care . They can also be used to conceal blemishes and enhance natural features (such as the  eyebrows  and  eyelashes ). Makeup can also add colour to a person's face, enhance a person's features or change the appearance of the face entirely to resemble a different person, creature, or object. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3611", "text": "People have used cosmetics for thousands of years for skin care and appearance enhancement. Visible cosmetics for women and men have gone in and out of fashion over the centuries."}
{"_id": "WikiPedia_Dermatology$$$corpus_3612", "text": "Some early forms of cosmetics used harmful ingredients such as lead that caused serious health problems and sometimes resulted in death. Modern commercial cosmetics are generally tested for safety but may contain controversial ingredients, such as  per- and polyfluoroalkyl substances  (PFAS),  formaldehyde releasers , and ingredients that cause allergic reactions."}
{"_id": "WikiPedia_Dermatology$$$corpus_3613", "text": "The European Union and regulatory agencies around the world have stringent regulations for cosmetics. In the United States, cosmetic products and ingredients do not require FDA approval. Some countries have banned using animals for cosmetic testing."}
{"_id": "WikiPedia_Dermatology$$$corpus_3614", "text": "The word  cosmetics  is derived from the  Greek   \u03ba\u03bf\u03c3\u03bc\u03b7\u03c4\u03b9\u03ba\u1f74 \u03c4\u03ad\u03c7\u03bd\u03b7  ( kosmetik\u0113 tekhn\u0113 ), meaning \"technique of dress and ornament,\"  from  \u03ba\u03bf\u03c3\u03bc\u03b7\u03c4\u03b9\u03ba\u03cc\u03c2  ( kosm\u0113tikos ), \"skilled in ordering or arranging,\" [ 3 ]  and from  \u03ba\u03cc\u03c3\u03bc\u03bf\u03c2  ( kosmos ), meaning \"order\" and \"ornament.\". [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3615", "text": "Though the legal definition of cosmetics in most countries is broader, in some  Western countries , [ which? ]  cosmetics are commonly taken to mean only makeup products, such as  lipstick ,  mascara ,  eye shadow ,  foundation ,  blush ,  highlighter ,  bronzer ,  fake eyelashes ,  eyeliner ,  concealer ,  lip gloss , and several other product types. [ clarification needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3616", "text": "In the United States, the  Food and Drug Administration  (FDA), which regulates cosmetics, [ 5 ]  defines cosmetics as products \"intended to be applied to the human body for cleansing, beautifying, promoting attractiveness, or altering the appearance without affecting the body's structure or functions.\" This broad definition includes any material intended for use as an  ingredient  in a cosmetic product, with the FDA specifically excluding pure  soap  from this category. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3617", "text": "Cosmetics designed for  skin care   may be used to cleanse,  exfoliate  and protect the skin, as well as replenish it, using  body lotions ,  cleansers ,  toners , serums,  moisturizers , eye creams,  retinol , and balms. Cosmetics designed for more general  personal care , such as  shampoo , soap, and  body wash , can be used to clean the body."}
{"_id": "WikiPedia_Dermatology$$$corpus_3618", "text": "Cosmetics designed to enhance one's appearance (makeup) can be used to conceal blemishes, enhance one's natural features, or add color to a person's face. In some cases, more extreme forms of makeup are used for performances,  fashion shows , and people in  costume  and can change the appearance of the face entirely to resemble a different person, creature, or object. Techniques for changing appearance include  contouring , which aims to give shape to an area of the face."}
{"_id": "WikiPedia_Dermatology$$$corpus_3619", "text": "Cosmetics can also be designed to add  fragrance  to the body."}
{"_id": "WikiPedia_Dermatology$$$corpus_3620", "text": "Products used for  haircare , such as permanent waves,  hair colors , and  hairsprays , are classified as cosmetic products as well. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3621", "text": "Cosmetics have been in use for thousands of years, with  ancient Egyptians  and  Sumerians  using them. In Europe, the use of cosmetics continued into the  Middle Ages \u2014where the face was whitened and the cheeks rouged\u2014 [ 8 ]  though attitudes towards cosmetics varied throughout time, with the use of cosmetics being openly frowned upon at many points in Western history. [ 9 ]  Regardless of the changes in social attitudes towards cosmetics, many occasionally achieved ideals of appearance through cosmetics."}
{"_id": "WikiPedia_Dermatology$$$corpus_3622", "text": "According to one source, early major developments in cosmetics include: [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3623", "text": "Historically, the absence of regulation of the manufacture and use of cosmetics, as well as the absence of scientific knowledge regarding the effects of various compounds on the human body for much of this time period, led to a number of negative  effects  upon those who used cosmetics, including  deformities , blindness, and, in some cases, death.  Although harmless products were used, such as berries, and  beetroot , many cosmetic products available at this time were still chemically dubious and even poisonous. Examples of the prevalent usage of harmful cosmetics include the use of  ceruse  (white lead) throughout a number of different cultures, such as during the  Renaissance  in the West, and blindness caused by the mascara  Lash Lure  during the early 20th century. During the 19th century, there were numerous incidents of  lead poisoning  due to the fashion for red and white lead makeup and powder, leading to swelling and inflammation of the eyes, weakened tooth enamel, and blackened skin, with heavy use known to lead to death. [ 10 ]  Usage of white lead was not confined only to the West, with the white Japanese face makeup known as  oshiroi  also produced using white lead. In the second part of the 19th century, scientific advances in the production of makeup lead to the creation of makeup free of hazardous substances such as  lead . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3624", "text": "Throughout the late 19th and early 20th centuries, changes in the prevailing attitudes towards cosmetics led to a wider expansion of the cosmetics industry. In 1882, English actress and socialite  Lillie Langtry  became the poster girl for  Pears  of London, making her the first celebrity to endorse a commercial product. [ 11 ]  She allowed her name to be used on face powders and skin products. [ 12 ]  During the 1910s, the market in the US was developed by figures such as  Elizabeth Arden ,  Helena Rubinstein , and  Max Factor . These firms were joined by  Revlon  just before  World War II  and  Est\u00e9e Lauder  just after. By the middle of the 20th century, cosmetics were in widespread use by women in nearly all  industrial societies  around the world, with the cosmetics industry becoming a multibillion-dollar enterprise by the beginning of the 21st century. [ 13 ]  The wider acceptance of the use of cosmetics led some to see makeup as a tool used in the oppression and subjection of women to unfair societal standards. In 1968, at the feminist  Miss America protest , protesters symbolically threw a number of feminine products into a \"Freedom Trash Can\", [ 14 ]  with cosmetics among the items the protesters called \"instruments of female torture\" [ 15 ]  and accoutrements of what they perceived to be enforced  femininity ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3625", "text": "As of 2016 [update] , the world's largest cosmetics company is  L'Or\u00e9al , founded by  Eug\u00e8ne Schueller  in 1909 as the French Harmless Hair Colouring Company (now owned by  Liliane Bettencourt  26% and  Nestl\u00e9  28%; the remaining 46% is traded publicly)."}
{"_id": "WikiPedia_Dermatology$$$corpus_3626", "text": "Although modern makeup has been traditionally used mainly by women, men also use makeup to enhance their own facial features or cover blemishes and dark circles. The negative stigma of men wearing makeup in countries such as the United States has weakened over the years, with the number of men using makeup increasing in the 21st century. [ 16 ]  Cosmetics brands have increasingly targeted men in the sale of cosmetics, with some products targeted  specifically at men . [ 17 ] [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3627", "text": "Lead has been used as a makeup product since the 18th century. It is said to be lethal to women who apply it daily to achieve a pale complexion representing nobility, as tanner skin represents the working class. Lead can be detrimental to people's health and cause death if mixed with  vinegar  which it allows lead to be absorbed through the skin. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3628", "text": "Though there are a large number of different cosmetics used for a variety of different purposes, all cosmetics are typically intended to be applied externally. These products can be applied to the face (on the skin, lips, eyebrows, and eyes), to the body (on the skin, particularly the hands and nails), and to the hair. These products may be intended for use as skincare, personal care, or to alter the appearance, with the subset of cosmetics known as makeup primarily referring to products containing colour pigments intended for the purpose of altering the wearer's appearance; some manufacturers will distinguish only between \"decorative\" cosmetics intended to alter the appearance and \"care\" cosmetics designed for skincare and personal care."}
{"_id": "WikiPedia_Dermatology$$$corpus_3629", "text": "Most cosmetics are also distinguished by the area of the body intended for application, with cosmetics designed to be used on the face and eye area usually applied with a brush, a makeup sponge, or the fingertips. Cosmetics can also be described by the physical composition of the product. Cosmetics can be liquid or cream  emulsions , powders (pressed or loose), dispersions, or  anhydrous  creams or sticks."}
{"_id": "WikiPedia_Dermatology$$$corpus_3630", "text": "Cleansing is a standard step in skin care routines. Skin cleansing includes some or all of these steps or cosmetics:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3631", "text": "Hair care  is a category of cosmetics devoted to products which are used to improve the appearance of hair. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3632", "text": "Perfumes  or fragrances, are liquids that can be sprayed or applied to produce a long-lasting smell. [ 30 ]  They are created by mixing different compounds together. There are different groups of perfumes which are categorised according to their concentration. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3633", "text": "The difference between  Eau de parfum  and  Eau de toilette  is more about the perfume oil concentration.  Eau de parfum  has a higher concentration of perfume than  Eau de toilette ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3634", "text": "Various tools are used to apply cosmetics."}
{"_id": "WikiPedia_Dermatology$$$corpus_3635", "text": "In addition to brushes, a  makeup sponge  is a popular applicator. Makeup sponges can be used to apply foundation, blend concealer, and apply powder or highlighter."}
{"_id": "WikiPedia_Dermatology$$$corpus_3636", "text": "Loofahs ,  microfiber  cloths, natural sponges, or brushes may be used to exfoliate skin simply by rubbing them over the face in a circular motion. Gels, creams, or lotions may contain an acid to encourage dead skin cells to loosen, and an abrasive such as  microbeads , sea salt and sugar, ground nut shells, rice bran, or ground apricot kernels to scrub the dead cells off the skin. Salt and sugar scrubs tend to be the harshest, while scrubs containing beads or rice bran are typically very gentle."}
{"_id": "WikiPedia_Dermatology$$$corpus_3637", "text": "A variety of  organic compounds  and  inorganic compounds  comprise typical cosmetics. Typical organic compounds are modified natural oils and fats as well as a variety of petrochemically derived agents. Inorganic compounds are processed minerals such as  iron oxides ,  talc , and  zinc oxide . The oxides of zinc and iron are classified as  pigments , i.e., colorants that have no solubility in solvents. Cosmetic companies have become more transparent in the ingredients of their products because consumers are interested in the formula of their products. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3638", "text": "Handmade and  certified organic  products are becoming more mainstream due to consumer concerns that certain chemicals in some  skincare  products may be harmful if absorbed through the skin. The  FDA , which regulates the US cosmetic industry, says \"FDA has not defined the term \u201cnatural\u201d and has not established a regulatory definition for this term in cosmetic labeling.\" [ 33 ]   It goes on to warn consumers, \"choosing ingredients from sources you consider \u201corganic\u201d or \u201cnatural\u201d is no guarantee that they are safe.\""}
{"_id": "WikiPedia_Dermatology$$$corpus_3639", "text": "The term \"mineral makeup\" applies to a category of face makeup, including foundation, eye shadow, blush, and bronzer, made with loose, dry mineral powders. These powders are often mixed with oil-water  emulsions . Lipsticks, liquid foundations, and other liquid cosmetics, as well as compressed makeups such as eye shadow and blush in compacts, are often called mineral makeup if they have the same primary ingredients as dry mineral makeups. Liquid makeups must contain preservatives, and compressed makeups must contain binders, which dry mineral makeups do not. Mineral makeup usually does not contain synthetic fragrances, preservatives, parabens, mineral oil, or chemical dyes. For this reason, dermatologists may consider mineral makeup to be gentler on the skin than makeup that contains those ingredients. [ 34 ]  Some minerals are nacreous or pearlescent, giving the skin a shining or sparking appearance. One example is  bismuth oxychloride . [ 1 ]  There are various mineral-based makeup brands, including: Bare Minerals,  Tarte ,  Bobbi Brown , and  Stila ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3640", "text": "The term  cosmetic packaging  is used for  primary packaging  and secondary packaging of cosmetic products. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3641", "text": "Primary packaging, also called cosmetic containers, houses the cosmetic product. It is in direct contact with the cosmetic product. Secondary packaging is the outer wrapping of one or several cosmetic container(s). An important difference between primary and secondary packaging is that any information that is necessary to clarify the safety of the product must appear on the primary package. Otherwise, much of the required information can appear on just the secondary packaging. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3642", "text": "Cosmetic packaging is standardized by  ISO 22715 , set by the  International Organization for Standardization [ 36 ]  and regulated by national or regional regulations such as those issued by the  EU  or the  FDA . Marketers and manufacturers of cosmetic products must be compliant to these regulations to be able to market their cosmetic products in the corresponding  areas of jurisdiction . [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3643", "text": "The manufacture of cosmetics is dominated by a small number of  multinational corporations  that originated in the early 20th century, but the distribution and sales of cosmetics are spread among a wide range of businesses. The world's largest cosmetic companies are  L'Or\u00e9al ,  Procter & Gamble ,  Unilever ,  Shiseido , and  Est\u00e9e Lauder . [ 38 ]  In 2005, the market volume of the cosmetics industry in the US, Europe, and Japan was about EUR 70 Billion/a year. [ 1 ]  In Germany, the cosmetic industry generated \u20ac12.6 billion of  retail  sales in 2008, [ 39 ]  which makes the German cosmetic industry the third largest in the world, after Japan and the United States. German  exports  of cosmetics reached \u20ac5.8 billion in 2008, whereas imports of cosmetics totaled \u20ac3 billion. [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3644", "text": "The worldwide cosmetics and perfume industry currently generates an estimated annual turnover of US$170 billion (according to Eurostaf, May 2007). Europe is the leading market, representing approximately \u20ac63 billion, while sales in France reached \u20ac6.5 billion in 2006, according to FIPAR (F\u00e9d\u00e9ration des Industries de la Parfumerie \u2013 the French federation for the perfume industry). [ 40 ] [ unreliable source? ]  France is another country in which the cosmetic industry plays an important role, both nationally and internationally. According to data from 2008, the cosmetic industry has grown constantly in France for 40 consecutive years. In 2006, this industrial sector reached a record level of \u20ac6.5 billion. Famous cosmetic brands produced in France include Vichy,  Yves Saint Laurent ,  Yves Rocher , and many others."}
{"_id": "WikiPedia_Dermatology$$$corpus_3645", "text": "The Italian cosmetic industry is also an important player in the European cosmetic market. Although not as large as in other  European countries , the cosmetic industry in Italy was estimated to reach \u20ac9 billion in 2007. [ citation needed ]  The Italian cosmetic industry is dominated by  hair  and body products and not makeup as in many other European countries. In Italy, hair and body products make up approximately 30% of the cosmetic market. Makeup and facial care are the most common cosmetic products exported to the United States."}
{"_id": "WikiPedia_Dermatology$$$corpus_3646", "text": "According to Euromonitor International, the market for cosmetics in  China  is expected to be $7.4 billion in 2021 up from $4.3 billion in 2016. The increase is due to  social media  and the changing attitudes of people in the 18-to-30-year age bracket. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3647", "text": "Due to the popularity of cosmetics, especially fragrances, many designers who are not necessarily involved in the cosmetic industry came up with perfumes bearing their names. Moreover, some actors and  singers  (such as  Celine Dion ) have their own perfume line. Designer perfumes are, like any other designer products, the most expensive in the industry as the consumer pays for the product and the brand. Famous Italian fragrances are produced by  Giorgio Armani ,  Dolce & Gabbana , and others."}
{"_id": "WikiPedia_Dermatology$$$corpus_3648", "text": "Procter & Gamble , which sells  CoverGirl  and  Dolce & Gabbana  makeup, funded a study [ 42 ]  concluding that makeup makes women seem more competent. [ 43 ]  Due to the source of funding, the quality of this  Boston University  study is questioned."}
{"_id": "WikiPedia_Dermatology$$$corpus_3649", "text": "Cosmetics products may be retailed in  beauty stores ,  department stores  and  hypermarkets ,  drugstores ,  variety stores ,  grocery stores , beauty supply stores, and many other formats, and in similar types of online stores or the online presence of these types of physical stores."}
{"_id": "WikiPedia_Dermatology$$$corpus_3650", "text": "Cosmetic companies have changed their traditional methods of marketing by using social media influencers and brand ambassadors to market their products. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3651", "text": "During the 20th century, the popularity of cosmetics increased rapidly. [ 44 ]  Cosmetics are used by girls at increasingly young ages, especially in the United States. Because of the fast-decreasing age of makeup users, many companies, from drugstore brands like Rimmel to higher-end products like Estee Lauder, cater to this expanding market by introducing flavored lipsticks and glosses, cosmetics packaged in glittery and sparkly packaging, and marketing and advertising using young  models . [ 45 ]  The social consequences of younger and younger cosmetics use have had much attention in the media over the last few years."}
{"_id": "WikiPedia_Dermatology$$$corpus_3652", "text": "Criticism  of cosmetics has come from a wide variety of sources including some  feminists , [ 46 ]   religious groups ,  animal rights activists ,  authors , and public interest groups. It has also faced criticism from men, some of whom describe it as a form of deception or  fakeup . [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3653", "text": "The new generation has been more accepting of males wearing makeup, and having a \"soft pretty boy\" look in South Korea has become more widespread in recent years, particularly among younger generations. This trend is known as \"K-beauty,\" and it has been popularized by K-pop idols, actors, and social media influencers. Many of these idols have become beauty icons and have allowed many men to access beauty products and to feel comfortable using them. While there may still be some societal pressure to conform to traditional gender norms, there is also a growing acceptance of individual expression and breaking free from traditional gender roles. [ 48 ] [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3654", "text": "\"The  Sephora Kids  are the generation alpha (the cohort born roughly between 2010 and 2025) and is growing up in a very different environment compared to previous generations, and several factors contribute to their heightened interest in skincare and makeup. [ 50 ]  Platforms like TikTok have also popularized short, fun videos about skincare and makeup tips, making beauty routines seem exciting and achievable. Social media platforms have made it easier for celebrities and influencers to become role models for Gen Alpha, and as a result, many celebrities and influencers actively promote skincare routines or collaborate with beauty brands, making skincare and makeup more aspirational Alpha is also inspired by the \"clean beauty\" movement and inclusive beauty brands that champion self-expression, allowing them to feel more confident in exploring skincare and makeup.\" [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3655", "text": "In 2023 and 2024, many people posting on social media have reported seeing girls, ranging from 10 to 12 in age in popular cosmetic stores, such as the likes of Boots and Sephora. [ 50 ]  This is most commonly reported in western countries, specifically America, Australia and the United Kingdom. This has garnered attention because it bring awareness to the growing need for make-up for younger girls and women, many criticize this claiming it's connected to western beauty standards which in recent years have become an increasingly controversial topic in many medias revolving around politics and women's rights. [ 52 ]  It's also a hot topic in medical spaces such as dermatology, due to the increase of young girls using anti-aging cream, despite only being around 11 years old. [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3656", "text": "In the United States, \"Under the law, cosmetic products and ingredients do not need FDA premarket approval.\" [ 56 ]  The EU and other regulatory agencies around the world have more stringent regulations. [ 57 ]  The FDA does not have to approve or review cosmetics, or what goes in them, before they are sold to consumers. The FDA only regulates some colors that can be used in the cosmetics and hair dyes. The cosmetic companies do not have to report any injuries from the products; they also only have voluntary recalls of products. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3657", "text": "There has been a marketing trend towards the sale of cosmetics lacking controversial ingredients, especially those derived from  petroleum ,  sodium lauryl sulfate  (SLS), and  parabens . [ 58 ]   Per- and polyfluoroalkyl substances  (PFAS) are a class of about 9,000 synthetic  organofluorine  compounds that have multiple highly toxic  fluorine  atoms attached to an  alkyl chain . PFAS are used by major  cosmetics industry  companies in a wide range of cosmetics, including such products as  lipstick ,  eye liner ,  mascara ,   foundation ,  concealer ,  lip balm ,   blush ,  nail polish . A 2021 study tested 231  personal care products  and found organic fluorine, a hallmark of PFAS, in more than half of the samples. Substantial levels of fluorine were identified in tested brands of products as follows: 82% of the brands of waterproof mascara, 63% of the brands of foundations, and 62% of liquid lipstick. PFAS compounds are readily absorbed through  human skin  and through  tear ducts , and such products on  lips  are often unwittingly ingested. Manufacturers often fail to label their products as containing PFAS, which makes it difficult for cosmetics consumers to avoid products containing PFAS. [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3658", "text": "Formaldehyde  is no longer used in cosmetics but has been replaced by  formaldehyde releasers . Formaldehyde is dangerous to human health, especially when inhaled. [ 60 ] [ 61 ] [ 62 ]  In 2011, the US  National Toxicology Program  described formaldehyde as \" known to be a human carcinogen \". [ 63 ] [ 64 ] [ 65 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3659", "text": "The danger of formaldehyde is a major reason for the development of formaldehyde releasers which release formaldehyde slowly at lower levels. [ 66 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3660", "text": "Numerous reports have raised concern over the safety of a few  surfactants , including  2-butoxyethanol . In some individuals, SLS may cause a number of skin problems, including  dermatitis . Additionally, some individuals have had an emergence of vitiligo after using cosmetics containing the ingredient rhododendrol. [ 67 ] [ 68 ] [ 69 ] [ 70 ] [ 71 ] [ 72 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3661", "text": "Parabens  can cause skin irritation and  contact dermatitis  in individuals with paraben  allergies , a small percentage of the general population. [ 73 ]  Animal experiments have shown that parabens have a weak  estrogenic  activity, acting as  xenoestrogens . [ 74 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3662", "text": "Perfumes  are widely used in consumer products. Studies concluded from  patch testing  show  fragrances  contain some ingredients which may cause  allergic reactions . [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3663", "text": "Balsam of Peru  was the main recommended marker for perfume allergy before 1977, which is still advised. The presence of Balsam of Peru in a cosmetic will be denoted by the  INCI  term  Myroxylon pereirae . [ 76 ] [ 77 ]  In some instances, Balsam of Peru is listed on the ingredient label of a product by one of its  various names , but it may not be required to be listed by its name by mandatory labeling conventions (in fragrances, for example, it may simply be covered by an ingredient listing of \"fragrance\"). [ 77 ] [ 78 ] [ 79 ] [ 80 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3664", "text": "Some cosmetics companies have made  pseudo-scientific  claims about their products which are misleading or unsupported by scientific evidence. [ 81 ] [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3665", "text": "As of 2019, an estimated 50\u2013100 million animals are tested each year in locations such as the United States and China. [ 83 ]  Such tests have involved general toxicity, eye and skin irritants,  phototoxicity  (toxicity triggered by  ultraviolet  light), and  mutagenicity . [ 84 ] [ 85 ]  Due to ethical concerns around animal testing, some nations have legislated against animal testing for cosmetics. An updated list can be found on the Humane Societies website. [ 86 ]  According to the Humane Society of the United States, there are nearly 50 non-animal tests that have been validated for use, and are potentially more efficacious. [ 87 ]  In the United States, mice, rats, rabbits, and cats are the most used animals for testing. [ 88 ]  In 2018, California banned the sale of animal-tested cosmetics. [ 89 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3666", "text": "Cosmetics testing is banned in the Netherlands, India, Norway, Israel, New Zealand, Belgium, and the UK. In 2002, the European Union agreed to phase in a near-total ban on the sale of animal-tested cosmetics throughout the EU from 2009 and to ban all cosmetics-related animal testing. [ 90 ]  In December 2009, the European Parliament and Council passed  EC Regulation 1223/2009 on cosmetics , a bill to regulate the cosmetic industry in the EU. [ 91 ]  EC Regulation 1223/2009 took effect on July 11, 2013. [ 91 ]  In March 2013, the EU banned the import and sale of cosmetics containing ingredients tested on animals. [ 92 ]  China required animal testing on cosmetic products until 2014, when they waived animal testing requirements for domestically produced products. [ 93 ]  In 2019, China approved nine non-animal testing methods, and in 2020 laws making animal testing compulsory were lifted. [ 94 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3667", "text": "In June 2017, legislation was proposed in Australia to end animal testing in the cosmetics industry. [ 95 ]  In March 2019, the Australian Senate passed a bill that banned the use of data from animal testing in the cosmetic industry since July 1, 2020. [ 96 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3668", "text": "In the European Union, the manufacture, labelling, and supply of cosmetics and personal care products are regulated by  Regulation EC 1223/2009 . [ 91 ]  It applies to all the countries of the EU as well as Iceland, Norway, and Switzerland. This regulation applies to single-person companies making or importing just one product as well as to large multinationals. Manufacturers and importers of cosmetic products must comply with the applicable regulations in order to sell their products in the EU. In this industry, it is common fall back on a suitably qualified person, such as an independent third party inspection and testing company, to verify the cosmetics' compliance with the requirements of applicable cosmetic regulations and other relevant legislation, including  REACH ,  GMP ,  hazardous substances , etc. [ 97 ] [ 98 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3669", "text": "In the European Union, the circulation of cosmetic products and their safety have been the subject of legislation since 1976. One of the newest improvements to the regulation concerning the cosmetic industry is the ban on  animal testing . Testing cosmetic products on animals has been illegal in the European Union since September 2004, and testing the separate ingredients of such products on animals is also prohibited by law, since March 2009 for some endpoints and full since 2013. [ 99 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3670", "text": "Cosmetic regulations in Europe are often updated to follow the trends of innovations and new technologies while ensuring  product safety . For instance, all annexes of Regulation 1223/2009 were aimed at addressing potential risks to human  health .\nUnder the EU cosmetic regulation, manufacturers, retailers, and importers of cosmetics in Europe will be designated as \"responsible persons.\". [ 91 ]  This new status implies that the responsible person has the  legal liability  to ensure that the cosmetics and  brands  they manufacture or sell comply with the current cosmetic regulations and norms. The responsible person is also responsible for the documents contained in the Product Information File (PIF), a list of product information including data such as Cosmetic Product Safety Report, product description,  GMP statement , or product function."}
{"_id": "WikiPedia_Dermatology$$$corpus_3671", "text": "In 1938, the U.S. passed the  Food, Drug, and Cosmetic Act  authorizing the  Food and Drug Administration  (FDA) to oversee safety via legislation in the cosmetic industry and its aspects in the United States. [ 100 ] [ 101 ]  The FDA joined with 13 other federal agencies in forming the Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) in 1997, which is an attempt to ban animal testing and find other methods to test cosmetic products. [ 102 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3672", "text": "The current law on cosmetics in the U.S. does not require cosmetic products and ingredients to have  FDA  approval before going on the market, except from color additives. [ 103 ]  The Cosmetic Safety Enhancement Act was introduced in December 2019 by Representative  Frank Pallone . [ 104 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3673", "text": "ANVISA (Ag\u00eancia Nacional de Vigil\u00e2ncia Sanit\u00e1ria,  Brazilian Health Surveillance Agency ) is the regulatory body responsible for cosmetic legislation and  directives  in the country. The rules apply to manufacturers, importers, and retailers of cosmetics in Brazil, and most of them have been harmonized so they can apply to the entire  Mercosur ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3674", "text": "The current legislation restricts the use of certain substances, such as pyrogallol,  formaldehyde , or paraformaldehyde, and bans the use of others, such as lead  acetate  in cosmetic products. All restricted and forbidden substances and products are listed in the regulation RDC 16/11 and RDC 162, 09/11/01."}
{"_id": "WikiPedia_Dermatology$$$corpus_3675", "text": "More recently, a new cosmetic  Technical Regulation  (RDC 15/2013) was set up to establish a list of authorized and restricted substances for cosmetic use, used in products such as  hair dyes , nail hardeners, or used as product preservatives."}
{"_id": "WikiPedia_Dermatology$$$corpus_3676", "text": "Most Brazilian regulations are optimized, harmonized, or adapted in order to be applicable and extended to the entire Mercosur  economic zone ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3677", "text": "The  International Organization for Standardization  (ISO) published new guidelines on the safe manufacturing of cosmetic products under a Good Manufacturing Practices (GMP) regime. Regulators in several countries and regions have adopted this standard, ISO 22716:2007, effectively replacing existing guidance and standards. \nISO 22716 provides a comprehensive approach for a quality management system for those engaged in the manufacturing, packaging, testing, storage, and transportation of cosmetic end products. The standard deals with all aspects of the supply chain, from the early delivery of raw materials and components until the shipment of the final product to the consumer."}
{"_id": "WikiPedia_Dermatology$$$corpus_3678", "text": "The standard is based on other quality management systems, ensuring smooth integration with such systems as ISO 9001 or the British Retail Consortium (BRC) standard for consumer products. Therefore, it combines the benefits of GMP, linking cosmetic product safety with overall business improvement tools that enable organisations to meet global consumer demand for cosmetic product safety certification. [ 105 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3679", "text": "In July 2012, since microbial contamination is one of the greatest concerns regarding the quality of cosmetic products, the ISO introduced a new standard for evaluating the antimicrobial protection of a cosmetic product by preservation efficacy testing and microbiological risk assessment."}
{"_id": "WikiPedia_Dermatology$$$corpus_3680", "text": "Cucumber juice  is the  juice  derived from  cucumbers  produced by squeezing or pressing it. [ 1 ]  Cucumbers are 98% water. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3681", "text": "Cucumber juice is used in beverages such as  cocktails  like the  Bloody Mary , [ 3 ]  dishes such as  cucumber soup , [ 4 ]  and in dips and salad dressings, such as  green goddess dressing . [ 5 ]  Cucumber juice has significant amounts of  potassium [ 1 ]  and is high in vitamin A. [ 6 ]  It also contains  sterol [ 7 ]  and significant amounts of  silicon . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3682", "text": "Cucumber juice is used as an ingredient in cosmetics, soaps, shampoos, and lotions, [ 11 ] [ 12 ]  and in  eau de toilette  and perfumes. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3683", "text": "It was used in Russian  traditional medicine  to aid in the treatment of respiratory tract inflammation and to reduce lingering cough. [ 14 ]  In other traditions it was used to soothe  heartburn  and reduce acid in the stomach. [ 15 ]  For skin, it has been used to soothe burns and rashes. [ 15 ] [ 14 ] [ 16 ]  Cucumber juice has been described as a repellent against  wood lice  and  fish-moths . [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3684", "text": "Dead Sea salt  refers to  salt  and other mineral deposits extracted or taken from the  Dead Sea .  The composition of this material differs significantly from oceanic salt."}
{"_id": "WikiPedia_Dermatology$$$corpus_3685", "text": "Dead Sea salt was used by the peoples of  Ancient Egypt [ 1 ]  and it has been utilized in various unguents, skin creams, and soaps since then. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3686", "text": "The Dead Sea's mineral composition varies with season, rainfall, depth of deposit, and ambient temperature. Most oceanic salt is approximately 85 wt.%  sodium chloride  (the same salt as table salt) while Dead Sea salt is only 30.5 wt.% of this, with the remainder composed of other dried minerals and salts. The concentrations of the major  ions  present in the Dead Sea water are given in the following table: [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3687", "text": "The chemical composition of the crystallized Dead Sea salts does not necessarily correspond to the results presented in this table because of composition changes due to the process of  fractional crystallization ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3688", "text": "The main detritic minerals present in the Dead Sea mud were carried by runoff streams flowing into the Dead Sea. They constituted large mud deposits intermixed with salt layers during the  Holocene  era. Their elemental composition expressed as equivalent oxides (except for Cl \u2013  and Br \u2013 ) is given here below: [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3689", "text": "Except for chloride and bromide, the results of the elemental composition of the Dead Sea mud given here above are presented as equivalent oxides for the sake of convenience. [ 3 ]  To illustrate this chemical convention, the neutral  sodium sulfate  (Na 2 SO 4 ) is reported here as basic  sodium oxide  (Na 2 O) and acidic  sulfur trioxide  (SO 3 ), neither of which can naturally occur under these free forms in this mud. However, one will note that the elemental composition given here above is incomplete as a major component is lacking in this table:  carbon dioxide  (CO 2 ) accounting for the significant  carbonate  fraction present in this mud."}
{"_id": "WikiPedia_Dermatology$$$corpus_3690", "text": "Dead Sea salts have been claimed to treat the following conditions:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3691", "text": "Rheumatologic conditions  can be treated in the  balneotherapy  of  rheumatoid arthritis ,  psoriatic arthritis , and  osteoarthritis . The minerals are absorbed while soaking, stimulating blood circulation. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3692", "text": "Skin disorders such as  acne  and  psoriasis  may be relieved by regularly soaking the affected area in water with added Dead Sea salt. The  National Psoriasis Foundation  recommends Dead Sea and Dead Sea salts as effective treatments for  psoriasis . [ 5 ] [ 6 ]  High concentration of  magnesium  in Dead Sea salt may be helpful in improving skin hydration and reducing inflammation, [ 7 ]  although  Epsom salt  is a much less expensive salt that also contains high amounts of magnesium and therefore may be equally as useful for this purpose."}
{"_id": "WikiPedia_Dermatology$$$corpus_3693", "text": "The high concentration of  bromide  and  magnesium  in the Dead Sea salt may help relieve  allergic reactions  of the skin by reducing inflammation. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3694", "text": "Dead Sea salt may reduce the depth of skin wrinkling, a form of  skin ageing . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3695", "text": "A  destination spa  or  health resort  is a  resort  centered on a  spa , such as a  mineral spa . Historically, many such spas were developed at the location of natural  hot springs  or  mineral springs . In the era before modern  biochemistry  and  pharmacotherapy , \"taking the waters\" was often believed to have great medicinal powers. Even without such mystic powers, the  stress relief  and  health education  of spas also often has some degree of positive effect on  health . Destination spas offer  day spa  facilities, but what sets them apart is that they also offer hotel facilities so that people can stay multiple nights."}
{"_id": "WikiPedia_Dermatology$$$corpus_3696", "text": "Typically, over a seven-day stay, they provide a comprehensive program that includes spa services, physical fitness activities, wellness education, healthy cuisine, and special interest programming."}
{"_id": "WikiPedia_Dermatology$$$corpus_3697", "text": "A special subgroup are the medical spas who offer treatments that are paid back by the national health insurance program."}
{"_id": "WikiPedia_Dermatology$$$corpus_3698", "text": "Some destination spas offer an all-inclusive program that includes facilitated fitness classes, healthy cuisine, educational classes and seminars, as well as similar to a  beauty salon  or a  day spa . Guests reside and participate in the program at a destination spa instead of just visiting for a treatment or pure vacation. Some destination spas are in tropical locations or in  spa towns ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3699", "text": "Destination spas have been in use for a considerable time, and some are no longer used but are rather  preserved as elements of earlier history; for example,  Gilroy Yamato Hot Springs  in  California  is such a historically used spa whose peak patronage occurred in the late 19th and early 20th century."}
{"_id": "WikiPedia_Dermatology$$$corpus_3700", "text": "Resort spas are generally located in  resorts , and offer similar services via rooms with services, meals, body treatments, and fitness a la carte."}
{"_id": "WikiPedia_Dermatology$$$corpus_3701", "text": "Typical medical services offered at destination spas include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3702", "text": "Medical Spas - provide treatments and revalidation therapies paid back by the national health insurance, have to comply to the ISO 21426:2018 on tourism and related service requirements for medical spas [ 1 ]  and have a medical doctor on site who supervises all the treatments."}
{"_id": "WikiPedia_Dermatology$$$corpus_3703", "text": "In 21 of the 27  EU countries  they are very known and they have often state contracts with the ministry of health to provide a certain minimum yearly capacity of treatment places for patients. Another example are the contracts with for example the national public transport operators to help recuperate lung capacity or change unhealthy lifestyle and food consumption behavior. In the latter case, reimbursement by the public health care is only done after people stayed the minimum prescribed 14 to 18 days, the time necessary to provoke behavioral changes and take the healthier lifestyle choices and practices back home. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3704", "text": "It is common for elderly people to take every year a one-week treatment in medical public spas, which offer treatments for patients with syndrome diseases such as  fibromyalgia ,  multiple sclerosis ,  rheumatism , and  arthritis ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3705", "text": "Treatment is also offered in  Ministry of Ayush  hospital revalidation centers, in the Middle Eastern Hammam steam bath facilities, as well as Asian or \"Traditional Chinese Hot Spring\" centers, and Japanese  shinrin-yoku  centres."}
{"_id": "WikiPedia_Dermatology$$$corpus_3706", "text": "Since the  COVID-19 pandemic , medical spas have received additional attention for the treatment of  post-COVID  patients, especially the subgroup with symptoms indicating destroyed neural cells and neural networks in the brain, to undergo specific ergo-therapies during 2\u20133 weeks to give their body and brain the time to regrow these neural networks. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3707", "text": "Diprobase  is an  emollient , specifically targeted at  eczema  and  dermatitis . It is an occlusive emollient, meaning that it restores the layer of  oil  on the surface of the  skin  to slow water loss. [ 1 ]  This gives its tendency to make the applied area sticky."}
{"_id": "WikiPedia_Dermatology$$$corpus_3708", "text": "Diprobase contains no 'active ingredients'. It is made from a combination of  liquid paraffin ,  white soft paraffin , and water, as well as  cetomacrogol  and  cetostearyl alcohol  as  emulsifying agents ,  chlorocresol  as an  antimicrobial preservative ,  phosphoric acid ,  sodium dihydrogen phosphate , and  sodium hydroxide ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3709", "text": "Dry skin results from lack of water in the outer layer of skin cells (the  stratum corneum ). When this layer becomes  dehydrated , it loses its flexibility and becomes cracked, scaly, and sometimes itchy. The stratum corneum contains natural water-holding substances that retain water seeping up from the deeper layers of the skin, and water is also normally retained in the stratum corneum by a surface film of natural oil ( sebum ) and broken-down skin cells, which slow down  evaporation  of water from the skin surface.  Diprobase works by increasing that layer of oil."}
{"_id": "WikiPedia_Dermatology$$$corpus_3710", "text": "Diprobase is a British brand of the American pharmaceutical company  Schering-Plough . Its trademark stems from the now older range of  corticosteroids  the company still manufactures; Diprosone and Diprosalic. The Dipro being suggestive of  betamethasone dipropionate .  Diprobase was originally conceived from the emollient vehicle these products had, Diprobase is purely an emollient which has no steroid component."}
{"_id": "WikiPedia_Dermatology$$$corpus_3711", "text": "EC Regulation 1223/2009 on cosmetics  sets binding requirements for  cosmetic products  that have been made available on the market within the  European Union . Manufacturers of products that fall under the category or cosmetics are required to abide by this regulation as they prepare their initial release of products and while continuing to sell said products within the Member States of the EU. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3712", "text": "EC Regulation  1223/2009 [ 2 ]  was created by the  European Parliament  and  Council  with the intent of establishing  standards  for  cosmetic products  that are available on the market.  Compliance  to these standards helps protect the functioning of the internet market, but most importantly, it provides a high-level of protection for the safety and health of  EU citizens . [ 1 ]  The Regulation was set into force on July 11, 2013. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3713", "text": "In its quest to protect the  health  and  safety  of EU citizens, EC Regulation 1223/2009 regulates a multitude of aspects related to the  manufacturing  and  labeling  of products that are considered to fall into the category of cosmetics. [ 1 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3714", "text": "Before a cosmetic product can be released on the market, proof must be provided that it is safe for human health during the course of its intended use or what is considered to be reasonable foreseeable conditions of its use. Article 3 of EC Regulation 1223/2009 builds upon  Directive  87/357/EEC guidelines regarding the safety of the product in reference to its instructions for use, its disposal and most importantly, its labeling. A safety assessment must be performed and a cosmetic product safety report provided to demonstrate compliance with Article 3. Guidelines for the report are found in the Regulations Annex I."}
{"_id": "WikiPedia_Dermatology$$$corpus_3715", "text": "Under Article 4 of the Regulation, a representative of the manufacturer must be named as the \u201cresponsible person\u201d for dealing with compliance with EC 1223/2009. This responsible person is responsible for ensuring that the manufacturer remains in compliance before and after bringing their cosmetic product to market."}
{"_id": "WikiPedia_Dermatology$$$corpus_3716", "text": "In the event the cosmetic product does not meet the requirements of compliance under the Regulation, the responsible person must address those issues. If the manufacturer becomes aware that the cosmetic product presents a threat to human health, the responsible person must notify the competent authorities within each Member State where the product is available. The notification would include details of the risks of using the product, non-compliance issues and what corrective actions will be performed. Corrective actions may include withdrawing the product from the market or initiating product recalls. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3717", "text": "Another responsibility of the responsible person is that they must maintain a product information file for each cosmetic product that is put on the market by his or her company under Article 11 of EC 1223/2009. This file must remain accessible to the relevant competent authority and / or government for at least 10 years after the last batch of the product was placed on the market. The product information file at minimum must contain information and data regarding the description of the cosmetic product, safety reports regarding the product, and evidence that the product performs according to manufacturer claims. Additionally, data about any  product testing on animals  that may have been performed by the manufacturer, agents of the manufacturer or suppliers must be included in the information file. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3718", "text": "Under Article 12 of EC 1223/2009 requires that cosmetic products must be sampled and analyzed in a reliable and reproducible manner. If local Community legislation, as what might be found in a Directive is non-existent, the assumption will be that the manufacturer will rely on methods of harmonized standards that have been published in the  Official Journal of the European Union . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3719", "text": "The appointed responsible person must supply information to the EU Commission according to the guidelines provided under Article 13 of the Regulation before their cosmetic product can be placed on the market. This information includes the name and category of the product, contact information for the responsible person, the product\u2019s country of origin, and Member State(s) where the product where be sold. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3720", "text": "Before placing cosmetic products on the market, the manufacturer must comply with container and packaging labeling guidelines under EC 1223/2009. To comply with the Regulation all required information must be presented in a legible and indelible manner."}
{"_id": "WikiPedia_Dermatology$$$corpus_3721", "text": "Information to be included shall include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3722", "text": "The date itself or details of where it appears on the packaging shall be preceded by the symbol shown in point 3 of Annex VII or the words: \u2018best used before the end of\u2019.\nThe date of minimum durability shall be clearly expressed and shall consist of either the month and year or the day, month and year, in that order.\nIf necessary, this information shall be supplemented by an indication of the conditions which must be satisfied to guarantee the stated durability.\nIndication of the date of minimum durability shall not be mandatory for cosmetic products with a minimum durability of more than 30 months. For such products, there shall be an indication of the period of time after opening for which the product is safe and can be used without any harm to the consumer. This information shall be indicated, except where the concept of durability after opening is not relevant, by the symbol shown in point 2 of Annex VII followed by the period (in months and/or years) (Regulation 1223/2009 EU; Chapter VI, Art 19)"}
{"_id": "WikiPedia_Dermatology$$$corpus_3723", "text": "Exceptions are made for individual labeling for smaller items that allow for product information to appear as a notice on or nearby the container where the cosmetic product is displayed for sale.\nThe function, amount, precautions, and warnings must be translated into the language of the destination country.  A full translation of all label elements is requested by Austria, Bulgaria, France, Poland, Portugal and Slovakia."}
{"_id": "WikiPedia_Dermatology$$$corpus_3724", "text": "On 26 July 2023, the EU Commission published Commission Regulation (EU) 2023/1545, which amends the cosmetic regulation 1223/2009 and added extra ingredients to the list of declarable allergens  [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3725", "text": "Certain product ingredients are prohibited under Chapter IV of EC 1223/2009 based on their threat to human health. The Annexes are lists of chemical substances that are either banned or restricted for use in specific product types or to certain limits in the final product.  These are as follows:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3726", "text": "Annex II List of substances prohibited in cosmetic products"}
{"_id": "WikiPedia_Dermatology$$$corpus_3727", "text": "Annex III List of substances which cosmetics should not contain except subject to the restrictions laid down"}
{"_id": "WikiPedia_Dermatology$$$corpus_3728", "text": "Annex IV List of  colorants  allowed in cosmetic products"}
{"_id": "WikiPedia_Dermatology$$$corpus_3729", "text": "Annex V List of  preservatives  allowed in cosmetic products"}
{"_id": "WikiPedia_Dermatology$$$corpus_3730", "text": "Annex VI List of  UV filter  allowed in cosmetic products"}
{"_id": "WikiPedia_Dermatology$$$corpus_3731", "text": "Chapter V addresses the prohibition of  animal testing  with the final formulation of cosmetic products, before being placed on the market and when testing methods are other than the alternative methods that have been validated and adopted by the EU Community. [ 2 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3732", "text": "As a regulation, EC No 1233/2009 supersedes previous Directives that applied to cosmetic manufacturers throughout the European Union. As of 30 November 2009, all  Member States  are required to adhere to the guidelines for compliance to this regulation. Regulations carry more legal weight than Directives, which generally provide guidance in good practices that should be followed by individual Member States."}
{"_id": "WikiPedia_Dermatology$$$corpus_3733", "text": "In the event of non-compliance, the relevant competent authority will inform the competent authority of the responsible person\u2019s Member State. When there are grounds for concern or certainty exists that the cosmetic product presents a serious risk to human health, the authority will take steps toward instituting appropriate provisional measures to withdraw, recall or restrict the availability of the non-complying product. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3734", "text": "Egg oil  ( CAS No.  8001\u201317\u20130,  INCI : egg oil), also known as  egg yolk  oil or ovum oil, is derived from the  yolk  of  chicken  eggs consisting mainly of  triglycerides  with traces of  lecithin ,  cholesterol ,  biotin ,  xanthophylls   lutein  and  zeaxanthin , and immunoglobulins.  It is free of egg proteins [ 1 ]  and hence may be used safely by people who are allergic to eggs, for topical applications such as hair and skin care. The product has several historical references in  Unani  (Greek) medicine for  hair care .  Traditional Chinese medicine  uses egg oil for burns,  eczema ,  dermatitis ,  mouth ulcers ,  skin ulcers , chapped nipples,  tinea capitis ,  ringworm ,  nasal vestibulitis ,  frostbite , and  hemorrhoids . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3735", "text": "In  alchemy , the oil was traditionally extracted from the yolk by a fairly simple process, [ 3 ] [ failed verification ]  by which fifty eggs yielded approximately five ounces of oil. [ 4 ]  Modern methods of production include  liquid\u2013liquid extraction [ 5 ]  using common solvents such as  hexane , [ 6 ]   petroleum ether ,  chloroform , and  ethanol . Unlike traditional egg oil produced by heat, solvent extracted product also contains  immunoglobulins , [ 7 ]  which are destroyed at higher temperatures. There are only a few commercial producers globally."}
{"_id": "WikiPedia_Dermatology$$$corpus_3736", "text": "The  fatty acid  composition of egg oil is rich in long-chain  polyunsaturated fatty acids  (LCPUFA) such as  omega-3 fatty acids  (including  docosahexaenoic acid ) and  omega-6 fatty acids  (including  arachidonic acid ), and closely resembles the fatty acid profile of  human milk , [ 8 ]  as well as the  lipid profile  of human skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_3737", "text": "Egg yolk has been used in traditional cosmetics since the eleventh century in Jewish, Greek, Arab, and Latin cultures. [ 9 ]  Several popular modern cosmetic brands contain egg oil."}
{"_id": "WikiPedia_Dermatology$$$corpus_3738", "text": "Egg oil is widely used in India for hair care. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3739", "text": "Egg oil can be used as an excipient/carrier in a variety of cosmetic preparations such as creams, ointments, sun-screen products, or lotions where it acts as an emollient, moisturizer, anti-oxidant, penetration enhancer, occlusive skin conditioner, and anti-bacterial agent. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3740", "text": "For treatment of  scabies  in Spain, oil of egg yolk was used along with oil of castor and roses [ 11 ]  in ancient  Andalusia ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3741", "text": "Egg oil was traditionally used in treating  wounds  and injuries. [ 12 ]  In the 16th century,  Ambroise Par\u00e9  used a solution of egg yolk, oil of roses, and  turpentine  for war wounds, an old method that the Romans had discovered 1000 years before him. He published his first book  The method of curing wounds caused by  arquebus  and firearms  in 1545."}
{"_id": "WikiPedia_Dermatology$$$corpus_3742", "text": "Egg oil is a potential source of  polyunsaturated fatty acids  such as  docosahexaenoic acid  and  arachidonic acid  for infant nutrition [ 13 ]  or combined with fish oil for infant formula production. [ 14 ]  It is also a source of  vitamin D . [ 15 ] [ unreliable source? ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3743", "text": "Cosmetic electrotherapy  is a range of  beauty treatments  that uses low  electric currents  passed through the  skin  to produce several therapeutic effects [ 2 ] [ unreliable source? ]  such as  muscle toning  in the body [ 3 ] [ unreliable source? ] :\u200a226\u200a  and micro-lifting of the face. [ 4 ]  It is based on  electrotherapy , which has been researched and accepted in the field of rehabilitation, [ 5 ]  though the \"scientific and medical communities have tended to sideline or dismiss the use of electrotherapy for healthy muscles\". [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3744", "text": "The use of electricity in cosmetics goes back to the end of the 19th century, [ 7 ] [ 8 ]  almost a hundred years after  Luigi Galvani  discovered that electricity can make the muscle in a frog's leg twitch [ 9 ]  (see  galvanism ). Subsequent research in  electrophysiology  has been carried out by people such as  Robert O. Becker , Dr Bj\u00f6rn Nordenstr\u00f6m, [ 10 ]  a former chair of the Nobel Selection Committee for Medicine, and Dr Thomas Wing, [ 11 ] [ 12 ]  who invented some of the first micro-current devices."}
{"_id": "WikiPedia_Dermatology$$$corpus_3745", "text": "There are four main types of treatment, that differ in the type of current they use (see  Comparison table, below ), including:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3746", "text": "Galvanic treatment in the beauty industry has been described since at least the 1970s [ 15 ]  and earlier. [ 13 ]  Sometimes called  galvanism , the treatment aims to improve the skin in two ways: (1) cleansing: a process called  desincrustation , and (2) nourishing the skin condition, through an electro-chemical process [ 16 ]   called  iontophoresis [ 17 ]   (also called ionisation). [ 18 ]  This is achieved by the application of a small, constant,  direct current . [ 19 ]  The treatment works on the principle that charged  ions  in the  skin  are either attracted or repelled from the  electrodes , resulting in certain chemical effects. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3747", "text": "Galvanic treatment are often used on the face (facial galvanic treatment) and on the body to treat cellulite (galvanic cellulite treatments). [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3748", "text": "Faradic treatment has also been described in the beauty industry since the 1970s [ 15 ]  and earlier. [ 13 ]  The treatment tones the muscles by repeatedly contracting them with the electric current, resulting in their firming and toning, and an increase in muscular metabolism aims to remove waste products more readily. [ 23 ]  Faradic treatments are generally used on the face and body, and work by contracting muscles with a short pulse of interrupted direct current. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3749", "text": "The treatment is also called  neuromuscular electrical stimulation  (NMES), [ 25 ]  and some of the manufactures who produce the equipment use their own terms, for example,  Slendertone  calls it electronic muscle stimulation, [ 26 ]  or the treatment is called after the name of the manufacturer, such as Ultratone or Slim Master. [ 3 ] :\u200a264"}
{"_id": "WikiPedia_Dermatology$$$corpus_3750", "text": "Microcurrent treatments ( MENS ) have been around since the 1970s in medical applications and are distinguished by their use of  micro-ampere  currents (i.e. millionths of an amp) which are hardly perceptible, but mimic the body's own  bio-electric currents . [ 3 ] :\u200a272\u200a  The treatment is designed to soften wrinkles and rejuvenate skin, including skin damaged by  sunburn ,  acne ,  stretch marks ,  cellulite  and  scarring . [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3751", "text": "This increased ATP also energizes the facial muscles, similar to how exercise energizes the muscles of our bodies. Unlike anywhere else on the body, the facial muscles are directly connected to the skin, so the result of energizing the muscle is often an improved, lifted appearance. [ 27 ]  When used on the face, the treatment has become known as a \"non-surgical facelift\" [ 28 ]  and \"facial lifting\". [ 3 ] :\u200a273"}
{"_id": "WikiPedia_Dermatology$$$corpus_3752", "text": "Microcurrent treatment works by passing a very small direct current through muscle tissue to stimulate the  Golgi tendon organ . [ 29 ]  It encourages production of ATP (Adenosine triphosphate) which leads to the creation and stimulation of structural proteins like elastin and collagen."}
{"_id": "WikiPedia_Dermatology$$$corpus_3753", "text": "Different microcurrent characteristics, particular the frequency and shape of the changing voltage (waveform), have different effects on the tissue. [ 3 ] :\u200a273\u200a [ unreliable source? ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3754", "text": "Microcurrent devices have been in the beauty industry for over a decade, the most known being the CACI device. Modern professional and personal use microcurrent devices combine waves of multiple shape and vary in frequencies used."}
{"_id": "WikiPedia_Dermatology$$$corpus_3755", "text": "Since microcurrent treatment uses a low-grade electrical current, there has been health concerns over safety of its use. People with pacemakers or any kind of heart condition should avoid it. Moreover, pregnant women are advised against it as well. It is always recommended to individually consult with doctor or aesthetician before using microcurrent. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3756", "text": "High-frequency treatment uses low-current  high-frequency alternating currents , delivered via a glass electrode. [ 31 ]  Glass electrodes are often filled with either Neon gas which produces pink, orange, or red light or they are filled with  Argon  or rarefied gas which produces violet light. Because of the color of light that is produced when electricity is passed through the gas, they are inaccurately called  ultraviolet  or  infra-red , however no UV rays or infra-red rays are produced, just visible light.  High frequency does current convert some of the  oxygen  in the  air  surrounding the electrodes into  ozone , the treatment has a  germicidal  action, and is also drying and warming. [ 32 ]  Consequently, the treatment is used to aid healing and also to help  desquamation  (the skin's natural exfoliation) and stimulate  sweat  and  sebaceous glands . [ 31 ]   Sparking  may occur when the electrode is close to the skin and then pulled away repeatedly. Some electrodes may contain a metal coil that produces a mechanical vibration, as well as sparking energy that can be felt indirectly when held in one person's hand while another person uses their hands directly on the skin. Because the effect may be pleasurable, similar devices are used in  erotic electrostimulation ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3757", "text": "The characteristics of the treatment current include: (a) whether it is ( direct  or  alternating ), (b) current frequency,  (c) size of the current (all very small), and (d) the duration and shape of any pulses."}
{"_id": "WikiPedia_Dermatology$$$corpus_3758", "text": "The origins of the terms \"galvanic\" and \"Faradism\" are described in the medical journal,  The Lancet , in 1851. A note reads:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3759", "text": "It is noted that:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3760", "text": "In  cosmetology ,  exfoliation  is the removal of the surface skin cells and built-up dirt from the skin's surface. The term comes from the  Latin  word  exfoliare  ('to strip off leaves'). [ 1 ]  This is a regular practice within the cosmetic industry, both for its outcome of promoting skin regeneration as well as providing a deep cleanse of the skin barrier. Being used in  facials , this process can be achieved by mechanical or chemical means, such as  microdermabrasion  or  chemical peels . [ 2 ]  Exfoliants are advertised as treatments that enhance beauty and promote a youthful and healthy appearance. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3761", "text": "Exfoliation was first practiced among the ancient Egyptians. [ 4 ] [ 5 ]  This was also used in  Asia , specifically in  China , during the  Qing Dynasty  (1644\u20131944)."}
{"_id": "WikiPedia_Dermatology$$$corpus_3762", "text": "Mechanical exfoliation methods involve physically scrubbing the skin with an  abrasive  material. [ 6 ]  These types of exfoliants include  microfiber  cloths, adhesive exfoliation sheets,  microbead  facial scrubs, cr\u00eape paper, crushed  apricot kernel  or  almond  shells,  sugar  or  salt crystals ,  pumice , and abrasive materials such as  sponges ,  loofahs ,  brushes , and fingernails. [ 3 ] [ 7 ]  A variety of facial scrubs are available in  over-the-counter products  for application by the user. People with  dry skin  should avoid exfoliants which have a significant portion of  pumice , or crushed volcanic rock. Pumice is known as a material to exfoliate the skin of the feet. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3763", "text": "Loofahs are shower accessories that are commonly used for a dual purpose of cleaning and exfoliating the skin. Loofahs are named for the tropical and subtropical gourd within the cucumber family called  luffa  that is used as material to make the shower sponges. As the  luffa plant  matures, its fibers dry out, allowing the shell left over to be used as the spongy material for the exfoliation tool after their seeds are removed and the gourd is sliced and shaped. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3764", "text": "Loofahs offer benefits beyond exfoliation: they effectively spread soap around the body to cleanse and they stimulate blood circulation during use.\u00a0Because loofahs are porous, they are more susceptible to harboring bacteria and fungal organisms that could be harmful and cause infections. [ 10 ]  Proper care for the loofah includes rinsing and drying the loofah after each use and soaking the loofah in a diluted solution of bleach to clean it weekly. [ 10 ]  It is also recommended to replace a loofah every 3 to 4 weeks. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3765", "text": "Exfoliation nets are shower accessories used for exfoliation and lathering that are composed of nylon material in the form of knotted mesh nets. [ 11 ]  Exfoliation nets are native to Ghana, but they are a familiar shower accessory in numerous countries in West Africa. [ 11 ]  The shape and material allow exfoliation nets to dry quicker than typical sponges, so there is less accumulation of bacteria in the accessory. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3766", "text": "Proper care for exfoliation nets includes leaving the net to hang dry between uses and cleaning it using a washing machine or hand-wash method weekly. [ 11 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3767", "text": "Microbead scrubs are cosmetic products that contain small plastic spheres that act as exfoliating components when scrubbed against skin. [ 13 ]  The plastic beads act as alternatives for natural, eco-friendly exfoliating agents such as  pumice ,  oatmeal , and walnut husks. [ 13 ]  Microbeads are commonly composed of the material  polyethylene terephthalate , but can also be made with other plastic materials. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3768", "text": "When scrubbed against the skin, the beads polish the skin by removing the dead skin cells from the top layer of the skin. [ 14 ]  The steps involved to use a micro-bead scrub include softening the skin using lukewarm water, gently scrubbing the product against the skin in circular motions, and rinsing the product off the skin. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3769", "text": "Due to the significant environmental impact and harm caused to marine ecosystems, microplastic beads have been banned by many countries. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3770", "text": "Pumice, an  igneous rock  that is composed of solidified lava that rapidly cools with gas bubbles being trapped inside of it, is commonly used as an exfoliating material. [ 16 ]  Pumice is a decently abrasive material, making it useful as an exfoliating agent. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3771", "text": "Pumice stone can be effectively used as an exfoliation tool on calluses or corns, often found on feet, to remove the dead skin cells. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3772", "text": "To effectively use a pumice stone as an exfoliation tool, soaking the affected area in warm water until the skin begins to soften is a recommended first step. [ 8 ]  The pumice stone then must be wet before rubbing against the affected area with moderate pressure for about 2 to 3 minutes. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3773", "text": "The exfoliating process of dermaplaning requires a single blade razor resembling a scalpel called a  dermatome . [ 17 ]  The dermatome is gently dragged across the skin on the face to remove the top layer of dead skin cells and peach fuzz. [ 18 ]  This process helps the skin to absorb products better and boost the production of  collagen , which improves the texture and tightness of the skin. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3774", "text": "A common misconception is that the  vellus hair  (known as peach fuzz) that is removed via dermaplaning will grow back thicker and darker, giving the appearance of a beard. This has been denied by dermaplaning specialists, who state that the removal of the dead skin and peach fuzz does not impact growth, color, or texture of facial hair. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3775", "text": "The procedure is recommended to be performed by an  aesthetician . [ 17 ]  In most cases, the blade must be used on clean, dry skin and covers the forehead, cheeks, chin, nose, and neck. However, dermaplaning can also be performed on skin that has oil applied to it. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3776", "text": "Some methods of  hair removal  also mechanically exfoliate the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_3777", "text": "Waxing  functions as an exfoliant, plucking the hair out of the skin. While it can be performed every two to eight weeks, waxing is not carried out as frequently as many exfoliants. Thus, it does not fully substitute for an exfoliation regimen."}
{"_id": "WikiPedia_Dermatology$$$corpus_3778", "text": "Wet shaving  also has exfoliating properties. Gliding a shaving brush vigorously across the face removes dead skin cells and cleanses the skin simultaneously. After applying the lather with a brush, the use of a razor removes dead skin because the razor is dragged closely across the skin. Manual razors exfoliate more effectively than electric razors."}
{"_id": "WikiPedia_Dermatology$$$corpus_3779", "text": "Methods of chemical exfoliation for aesthetic enhancement of the skin have dated back to the time of the Ancient Egyptians, who used a combination of animal oils, alabaster, salt, and sour milk as an exfoliant to improve skin quality. [ 20 ]  Various other chemical exfoliation techniques were developed in multiple other civilizations, such as Greek, Roman, Turkish, Indian, and Hungarian peoples. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3780", "text": "Chemical exfoliation to lessen the appearance of freckles with phenol peeling was a method developed by  Tilbury Fox  in 1871, and from there the use of phenol peeling increased in popularity. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3781", "text": "Chemical exfoliation methods, also known as chemical peeling, utilizes chemical substances in order to remove dead skin cells from the face. These types of exfoliants contain  alpha-hydroxy acids  ( glycolic acid ,  lactic acid ,  mandelic acid ,  malic acid ,  tartaric acid , and  citric acid ),  beta hydroxy acids  ( salicylic acid ), polyhydroxy acids ( lactobionic acid ,  gluconolactone , and  galactose ) or enzymes ( trypsin  or  collagenase ). [ 21 ] [ 22 ] [ 23 ] [ 24 ]  These chemicals weaken cell adhesion, allowing them to ease away. Out of these, only alpha-hydroxyl acids (AHAs) and beta hydroxyl acids (BHAs) are available on the market for daily use. While AHAs are applied to clear the outer layer of the skin, BHAs penetrate and clean it from within. These scrubs may be applied in high concentrations by medical professionals, or provided in lower concentrations via over-the-counter products. This type of exfoliation is recommended for people treating  acne . In Continental European beauty spa treatments, wine-producing grapes are considered to have exfoliating properties and are used in the practice of  vinotherapy ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3782", "text": "Though primarily intended for  hair removal ,  chemical depilatory , such as  Nair  and shaving powder, also function as a chemical exfoliant. Such products contain  calcium hydroxide  and/or  thioglycolic acid . They are applied more frequently than waxing (once a week) since they only partially destroy the hair below the skin, rather than pulling up the entire root as waxing does. Using them weekly can substitute for a weekly exfoliant regime. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3783", "text": "Technological advances in the cosmetics industry have led to innovative exfoliation techniques, such as laser resurfacing."}
{"_id": "WikiPedia_Dermatology$$$corpus_3784", "text": "Most commonly used for facial rejuvenation, this exfoliation process utilizes a laser to treat flaws on the skin surface. This method of exfoliation is most effective for treating wrinkles and discoloration.  Carbon dioxide lasers , erbium lasers, and combinations of these are examples of the types of  ablative lasers  that are used in the resurfacing process. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3785", "text": "The top outer layer of the skin is removed by the laser, which simultaneously heats the layer of skin lying beneath it. This process encourages collagen growth, which will improve the texture and tightness of the skin. The top layer of the skin will continue to heal and grow back to reveal a smoother and tighter appearance. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3786", "text": "Fractional  versions of ablative lasers have also recently been developed. These are designed to leave minimal amounts of untreated tissue on the skin to provide quicker healing time and less side effects. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3787", "text": "Ablative laser resurfacing has multiple risks associated with the exfoliation process. These risks include: redness, swelling, itching, pain, acne, infection, skin discoloration, and scarring. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3788", "text": "To have ablative laser resurfacing performed, one must consult with a doctor to review suitability of the procedure. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3789", "text": "Dermabrasion  is used to reduce the appearance of flaws on facial skin, such as facial lines, wrinkles, scars, and discoloration. In this exfoliation process, a rapidly rotating device is used to remove the outermost layer of facial skin. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3790", "text": "Dermabrasion requires  anesthetics  to numb the skin before the procedure. Depending on the extent of the treatment, further numbing medication might be provided to limit the amount of pain felt from the treatment. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3791", "text": "There are multiple risks associating with dermabrasion. These risks include: redness, swelling, acne, enlarged pores, skin discoloration, infection, scarring, or rashes. In most cases, skin that is treated with dermabrasion will be sensitive with splotches of redness and discoloration for weeks following the procedure. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3792", "text": "According to dermatologists, chemical or manual exfoliation is not medically necessary, as dead skin cells already exfoliate naturally, [ 27 ]  and excessive artificial exfoliation can break the skin's barrier against  microorganisms  and lead to infection, [ 27 ]  as well as tightness and sensitivity in the skin. [ 27 ]  Artificial exfoliation can exacerbate dry, flaky skin, which needs moisturization for repair, [ 27 ]  and can result in some initial redness to the skin. Near the end of chemical peels, the skin frosts, with colors varying from a bright white to grey on the skin surface. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3793", "text": "Microbead  particles used in mechanical exfoliation are too small (less than 1\u00a0mm) to be caught by  sewage works , so large amounts of microbeads are released into the environment, which damage marine  ecosystems . [ 28 ]  Consequently, in June 2014,  Illinois  became the first American state to ban the use of microbeads, and cosmetics manufacturers such as  L'Oreal ,  Johnson & Johnson , and  Colgate  agreed to use more natural ingredients. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3794", "text": "Face powder  is a  cosmetic product  applied to the face to serve different functions, typically to beautify the face. Originating from  ancient Egypt , [ citation needed ]  face powder has had different social uses across cultures and in modern times, it is typically used to set makeup, brighten the skin and contour the face. Face powders generally come in two main types. One of which is loose powder, which is used to assist with oily skin in absorbing excess moisture and mattifying the face to reduce shininess. The other is pressed powder which conceals blemishes and maximises coverage. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3795", "text": "The use of face powder has contributed to beauty standards throughout history. In  ancient Europe  and  Asia , a whitened face with a smooth complexion signalled a woman of high status. [ 2 ]  The prevalence of this trend was carried throughout the  Crusades  and  Medieval era.  During this time, women used harmful ingredients as face powder including  bleaches , lead and  lye . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3796", "text": "Archaeological remains and chemical analyses indicate the use of face powder dating back from between 2000 and 1200\u00a0BC, and include lead fibres, a common cosmetic ingredient used in ancient Egypt. [ 4 ]   Kohl  jars used to store  eyeliner  as well as stone containers holding face powder were discovered in graves as this promised the ancient Egyptians eternal beauty in the afterlife. [ 4 ]  Men and women used an early form of  rouge  powdered blush for their cheeks which was made from red ochre. [ 5 ]  Greek queen  Cleopatra  heavily influenced the  ancient Egyptian  beauty standard with a distinctive make-up style, inspiring the ancient Egyptians to paint their eyes with green and blue powders. [ 6 ]  Face powder was also considered to have medicinal purposes to protect people from illness. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3797", "text": "Ancient Egyptian beauty trends travelled across the Mediterranean and influenced cosmetic practices in Greece. Using similar ingredients,  ancient Greeks  used  cinnabar  as a powdered  rouge  for the face as well as brightening their  complexion  with  white lead . [ 5 ]  While the desire for a white complexion represented social ideas about race superiority, skin tone also enforced gender as in ancient times, women were paler than men, due to having less haemoglobin. [ 5 ]  A sign of belonging to the upper class was white, unblemished skin free from sun-exposure, as it was the life of wealthy women that involved staying indoors. Traces of the skin-lightening face powder made from white lead have been uncovered from the graves of wealthy ancient Greek women. [ 7 ]  The city of  Athens  was nearby the  Laurion mines , from which the Greeks extracted vast amounts of silver and obtained a great deal of their wealth through trade. White lead was found in the mines as a by-product of the silver, [ 8 ]  from which ancient Greeks produced face powder. The use of face powder also appears in the work of ancient Greek writers. Writer and historian  Xenophon  writes of women who \"rubbed in white lead to the face to appear whiter\". [ 9 ]  In his book  Oeconominicus , Ancient Greek poet  Eubulus  in his play  Stephanopolides  compares lower class and upper-class women, declaring that poor women \"are not plastered over with white lead\". [ 10 ]  While it was known the white lead was poisonous, the ancient Greeks were not deterred from applying the face powder to fulfil their beauty standards. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3798", "text": "The ancient Roman use of face powder was centred around the Roman ideal of  femininity  and beauty standards, expressing signs of social and health status. [ 12 ]  The pale complexion was desired by Roman women and is frequently expressed in the poetry of ancient Roman poet  Ovid . [ 2 ]  Small glass jars and  brushes  from archaeological remains suggest the storage and use of face powder. [ 13 ]  Ancient Roman poets  Juvenal  and  Martial  mention a mistress named \"Chione\" in their works, which literally translates to \"snowy\" or \"cold\", [ 12 ]  referring to the desired fair complexion of ancient Roman women. Skin whitening as well as sun-blocking were practiced by applying face powder in the form of  cerussa , which was a mix of white lead shavings and vinegar. [ 12 ]  Roman women wished to conceal blemishes and freckles, as well as smoothing the skin using this powder.  Chalk  was also used to whiten the skin, as well as powdered ash and saffron on the eyes. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3799", "text": "Ancient Chinese women desired whitened skin for beauty as their use of face powder dates back to the  Spring and Autumn period  from 770 to 476\u00a0BC. [ 14 ]  An early form of face powder was prepared by grinding fine rice which was applied to the face. [ 15 ]  In addition,  pearls  were crushed to create  pearl powder  that improved facial appearance and was also used as a medicine to treat eye diseases,  acne  and  tuberculosis . [ citation needed ]  Chinese empress  Wu Zetian  used pearl powder to maintain radiant skin. [ 16 ]  Lead was also a common ingredient used for face powder and remained popular for its skin-whitening properties. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3800", "text": "At a time of prevalent disease, beauty in the  Middle Ages  was characterised by having clear, bright skin that signalled fertility and good health. [ 17 ]  Lead based powders were continually used throughout the 16th century by the noble class as  Queen Elizabeth I  was known to use face powder to conceal her smallpox scars. [ 6 ]  The leading cause of her death was blood poisoning, primarily due to her cosmetic practices of using makeup containing toxic materials, including the lead-based face powder. [ 18 ]  During the  Victorian era , noticeable make-up became less popular as women desired to look naturally beautiful and hence, powders derived from  zinc oxides  were used to maintain ivory coloured skin. [ 19 ]  With the outbreak of  smallpox  in 1760, fewer women used face powder due to how it aggravated the skin and revealed facial scarring. [ 19 ]  Works of art from the  Renaissance  reinforced the idealised image of beauty and influenced the use of face powder. The social uses of face powder to maintain whitened, unblemished skin is visible in Renaissance art pieces including  The Birth of Venus  by  Sandro Botticelli . [ 20 ]   Shakespeare's  works comment on femininity and the culture of cosmetic use at the time, specifically with his references to silver, indicative of the desired glistening complexion achieved with the use of pearl face powder. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3801", "text": "During the  Edwardian era , makeup for women was used to enhance natural beauty and many young women applied light face powder on a daily basis. [ citation needed ]  Influenced by traditional beauty standards, women preferred pale, whitened and powdered skin throughout the early 1900s. However, in the 1920s,  Hollywood  became the main inspiration for beauty in America and powdering the face shifted from an  upper-class  practice to that of the social-class as the powdered face look became associated with prostitutes and movie stars. [ 22 ]  Due to growing popularity, the end of the decade saw a rise of cosmetic brands with over 1300 brands of face powder, which eventuated in a 52-million-dollar industry. [ citation needed ]  Early makeup developers including  Elizabeth Arden  and  Helena Rubinstein  produced skin care products and powders that attracted an international market. [ 23 ]  Cosmetics for women of colour during this time were also in production, with the first face powder for African-American women created by  Anthony Overton  in 1898, called the High-Brown Face Powder. [ 24 ]  Overton made multiple darker tones of face powder with product names including \"nut-brown\", \"olive-tone\", \"brunette\" and \"soft-pink\", [ 25 ]  and by 1920, his sales earned him a Dun and Bradstreet Credit rating of one million dollars. [ 26 ]  Other  African-American  entrepreneurs also marketed cosmetics despite discrimination during the  Jim Crow era , including  Annie Turnbo Malone  who sold face powder in darker shades which developed into a multi-million dollar business. [ 27 ]  Businesswoman  Madam C. J. Walker   retailed face powders  for African American women in  drugstores  despite the controversy caused as skin bleaching for fairer skin was a popular beauty trend at the time. [ 28 ]  Hungarian-American businessman Morton Neumann established his own cosmetic company in 1926,  Valmor Products Co. , and marketed darker-toned face powders for  black women  which retailed for 60 cents each. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3802", "text": "In the 1930s, face powder remained a staple cosmetic product and its increased demand raised health concerns about lead based powders that were still in use. [ 23 ]  As a result, the Food, Drugs and Cosmetics Act was passed in 1938 to regulate the ingredients used in cosmetics and ensure they were safe for use. [ 23 ]  Due to  World War Two  rationing in the 1940s, cosmetics were not as widely available, yet a powdered, beautified face remained the desired beauty trend. [ 29 ]  In 1942, the American War Production Board sought to conserve materials by placing restrictions on the production of certain cosmetics. [ 29 ]  Face powder was found to be a heavily used product by women and remained in production during wartime as cosmetics were considered essential products for women's self-expression and autonomy. [ 29 ]  The interwar period in Germany in 1935 also saw that cosmetics were on demand, accounting for 48% of magazine advertising with face powder being a staple item. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3803", "text": "Following the Second World War, rationing in America had ceased and the cosmetic industry flourished. [ 31 ]  With the popularity of female Hollywood stars including  Marilyn Monroe  and  Audrey Hepburn , American television culture influenced the 1950s beauty trend of clear, beautified skin. [ 31 ]   Max Factor , the leading cosmetic brand at the time, introduced the Cr\u00e8me Puff, the first ever multipurpose face powder that offered an all-in-one base, setting and finishing powder. [ 32 ]  The  1970s  that saw a widespread inclusion of diversity with new cosmetic brands offering face powder with darker shades. [ 33 ]  By 1977, cosmetics for black women became a $1.5\u00a0billion industry, with darker shades of powders, foundation and lipsticks available in stores around the US. [ 33 ]  By the  1990s , face powder became a staple cosmetic product for not only concealing blemishes but setting makeup in place. [ 34 ]  The Australian Government's National Industrial Chemicals Notification and Assessment Scheme was established in 1990 to ensure that industrial chemicals used in face powders and other cosmetics are safe for citizens to use. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3804", "text": "The changing conceptions of  masculinity  during the  2000s  led to evolving beauty trends that saw cosmetic products sold to men including facial scrubs, face powders and eye shadow. [ 36 ]  The use of face makeup has expanded to include males who desire an enhanced look, using face powder to achieve a chiselled complexion. [ 37 ]  As cosmetics in contemporary society are diverse in shade range options, modern face powder enhances natural skin tones and most brands cater for all skin types. 21st century cosmetic trends are heavily influenced by beauty icons and the face powder application technique known as  \u2018baking\u2019  has been popularised by socialite  Kim Kardashian West . [ 38 ]   Baking  involves patting translucent face powder under the eyes, the 'T' zone, beneath the cheek bones, along the jawline and on the sides of the nose, allowing it to sit for a few minutes while the foundation is absorbed by the skin's body heat, then brushing it off. [ 39 ]  This technique creates a pore-less and creaseless look that is a desired make-up beauty standard in modern times."}
{"_id": "WikiPedia_Dermatology$$$corpus_3805", "text": "Modern face powders are currently available in different types to serve multiple functions. The six main types of face powder include loose powder, pressed powder, mineral powder, translucent powder, HD powder and finishing powder."}
{"_id": "WikiPedia_Dermatology$$$corpus_3806", "text": "Loose powder can be  translucent  or coloured and is generally packaged in a jar. [ 40 ]  It has a fine consistency with small particles and is used to give light coverage to the skin for a smooth, silky texture. [ 40 ]  Coloured loose powders work to minimise redness by colour-correcting. [ 41 ]  Loose powder is also used to set make-up, meaning it locks in the  foundation  and  concealer  underneath to smoothen out the complexion and limit cracks and lines in the skin. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3807", "text": "Pressed powder is available in different shades and is sold in a  compound container . It is compressed to provide a travel-friendly product for on-the-go touch-ups. [ 42 ]  Pressed powders give coverage to the face, concealing blemishes and discolouration, therefore can be used as a light coverage foundation. [ 43 ]  The particles in pressed powder are larger than those in loose powder and can give off a thick, clotted appearance when overused. [ 41 ]  Pressed powder can also be used for setting makeup."}
{"_id": "WikiPedia_Dermatology$$$corpus_3808", "text": "Mineral powder comes in a loose powder form consisting of  vitamins  and minerals. It contains a mix of  iron ,  zinc  and  titanium dioxides , as well as  talc , providing health benefits to the skin including anti-inflammatory qualities. [ 44 ]  Mineral powders also limit the clogging of pores and are usually fragrance and preservative free. [ 44 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3809", "text": "Translucent  powder is available in both pressed and loose forms. Its use is to mattify the skin to reduce oiliness and shine. [ 42 ]  It can be used for the  'baking'  application technique, by brightening up certain areas of the face, offering a long-lasting wear. [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3810", "text": "High definition powder is mainly used for people featuring in  high-definition film  and  video  to prevent camera flashback, which is the white patches of powdered areas that are highlighted by a camera flash. [ citation needed ]  Available in both pressed and loose forms, HD powder can reduce skin shininess, soften out the skin and mattify it. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3811", "text": "Finishing powder is mainly used to minimise fine lines and pores. It can even out the skin texture and blur out imperfections, used as a final product to complete makeup. [ 45 ]  It is available in both pressed and loose forms."}
{"_id": "WikiPedia_Dermatology$$$corpus_3812", "text": "Toxic and harmful chemicals are rare in face powders today. [ 46 ]  Modern powders contain ingredients that can conceal blemishes and smoothen out the skin due to their absorbency. [ 47 ]  The most common ingredients used to make face powder include the following."}
{"_id": "WikiPedia_Dermatology$$$corpus_3813", "text": "A  facial  is a family of skin care treatments for the  face , including steam,  exfoliation  (physical and chemical),  extraction , creams, lotions,  facial masks ,  peels , and  massage . They are normally performed in  beauty salons , but are also a common  spa treatment . They are used for general skin health as well as for specific skin conditions. Types of facials include European facial, [ 1 ]  LED  light therapy facials , hydrafacials and mini-facials."}
{"_id": "WikiPedia_Dermatology$$$corpus_3814", "text": "There are different kinds of masks (e.g., clay,  cactus ,  cucumber ) for different purposes: deep-cleansing, by penetrating the  pores ; healing  acne scars  or hyper-pigmentation; brightening, for a gradual illumination of the skin tone. Facial masks also help with anti-aging, acne,  crows feet , under  eye bags , sagging lids, dark circles, puffiness, [ 2 ]  and more. Some masks are designed to dry or solidify on the face, almost like  plaster ; others just remain wet. The green face mask is very essential and benefited."}
{"_id": "WikiPedia_Dermatology$$$corpus_3815", "text": "Masks are removed by either rinsing the face with water, wiping off with a damp cloth, or peeling off of the face. Duration for wearing a mask varies with the type of mask, and manufacturer's usage instructions. The time can range from a few minutes to overnight. Those with  sensitive skin  are advised to first test out the mask on a small portion of the skin, in order to check for any irritations. Some facial masks are not suited to frequent use. A  glycolic  mask should not be used more frequently than once a month to avoid the risk of burning the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_3816", "text": "Masks can be found anywhere from  drugstores  to department stores and can vary in consistency and form. Setting masks include:  clay , which is a thicker consistency, and will draw out impurities (and sometimes, natural oils, too) from the  pores ; a cream, which stays damp to hydrate the skin; sheet-style, in which a paper mask is dampened with liquid to tone and moisturize the skin; and lastly, a hybrid/clay and cream form that includes small beads for removing dead surface skin cells. Non-setting facial masks include warm oil and  paraffin wax  masks. These different forms are made to suit different skin types (e.g., oily or dry), and different skincare goals or needs (e.g., moisturizing, cleansing, exfoliating).  Clay  and mud masks suit oily and some \"combination\" skin types, [ 3 ]  while cream-based masks tend to suit dry and sensitive skin types. There are also peel-off masks which are used to remove thin layers of dead skin cells and dirt. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3817", "text": "A  facial mask  is a creamy or thick pasted mask applied to the face for cleansing or skin-smoothing purposes. Facial masks often contain  minerals ,  vitamins , and  fruit extracts , such as  cactus  and  cucumber . A  sheet mask  is a piece of paper,  cellulose  or fabric used to apply a facial mask."}
{"_id": "WikiPedia_Dermatology$$$corpus_3818", "text": "The first facial mask was invented in  Ohio, United States , during the 19th century by Madame Rowley. It was called the \"Toilet Mask\" or the first \"face glove\", and was advertised as able to 'bleach, purify and preserve the complexion' of the skin. It was patented in 1875. There are different kinds of masks for different purposes; some are deep cleansing for cleaning the pores. The perceived effect of a facial mask treatment can be revitalizing, rejuvenating or refreshing. Although widely believed to provide tighter pores, increased skin clarity, and a reduction in facial skin wrinkles, masks have not been shown to be any more effective at accomplishing these things than a standard moisturizing lotion. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3819", "text": "Some masks are washed off with tepid water, others are peeled off by hand. Duration for wearing a mask depends on type of mask, but can be three minutes to 30 minutes, and sometimes the whole night."}
{"_id": "WikiPedia_Dermatology$$$corpus_3820", "text": "Honey  is a very popular mask because it smooths skin, and cleans pores. A popular  home remedy [ 2 ]  includes a slice of  cucumber  on the eyes. [ 3 ]  Some also use pickle juice. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3821", "text": "Facial masks should be selected according to  skin type .  Clay  and  mud masks  suit  oily skin ; cream-based masks work best on  dry skin  types. Masks should be used only on cleansed skin for the best results. Firming masks should not be applied on the eye area because they can cause  itching . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3822", "text": "Fraxel Laser Treatment  is a line of lasers developed by Reliant Technologies in 2004. It was developed from a US patent licensed from the Wellman Center for Photomedicine.  R. Rox Anderson  was the inventor. Fraxel lasers cause fractional  photothermolysis  for skin resurfacing."}
{"_id": "WikiPedia_Dermatology$$$corpus_3823", "text": "Complications observed in a study of 961 fractional laser treatments included  acne  and  herpes  outbreaks. [ 1 ]  There have also been anecdotal negative accounts of bad scarring and  hyperpigmentation  following the use of Fraxel lasers. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3824", "text": "Fraxel laser is used primarily to rejuvenate skin. It is used to treat hyperpigmentation, dark spots, and superficial signs of aging such as fine lines and wrinkles, as well as acne scarring. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3825", "text": "Several variations of Fraxel lasers exist, each with distinct characteristics. These systems are distinguished by their laser types and the depth of tissue ablation they achieve. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3826", "text": "Galderma SA  is a Swiss pharmaceutical company specializing in  dermatological  treatments and  skin care  products. Formerly a subsidiary of  L'Or\u00e9al  and  Nestl\u00e9 , it has been held by a consortium of private institutional investors since 2019."}
{"_id": "WikiPedia_Dermatology$$$corpus_3827", "text": "Galderma was formed in 1981 as a joint venture between  Nestl\u00e9  and  L'Or\u00e9al , then it became a subsidiary of Nestl\u00e9. [ 2 ]  Since 2019, it belongs to an investment fund. The company, headed by president and CEO  Flemming \u00d8rnskov  (ex-Shire), has 33 sites in 100 countries [ 3 ]  with a worldwide network of distributors and employs more than 4,600 people. The headquarters is based in  Zug , Switzerland."}
{"_id": "WikiPedia_Dermatology$$$corpus_3828", "text": "The origins of Galderma date back to 1961 and the founding of the Owen dermatology company in  Dallas , Texas, USA by M. Owen. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3829", "text": "In 1979, Hans Schaefer founded the International Center for Dermatological Research (CIRD) in  Sophia Antipolis , with the support of the CEO of  L'Or\u00e9al ,  Fran\u00e7ois Dalle , who wanted to diversify his cosmetic research into the drug sector. At the same time,  Nestl\u00e9 , which also had ambitions in dermatology bought the Owen laboratory."}
{"_id": "WikiPedia_Dermatology$$$corpus_3830", "text": "L'Or\u00e9al and Nestl\u00e9 joined forces to create Galderma in 1981 (CIRD became Galderma R&D). It was a joint venture between the two companies. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3831", "text": "Galderma expanded by specializing in the research, development and commercialization of products for  dermatology  (skin care) patients. It reached a significant size, with 38 subsidiaries present in 100 countries in the 2010s. [ 3 ]  It diversified into aesthetic medicine products with the  botulinum toxin  Azzalure, a field in which it strengthened in 2010 with the acquisition of the Swedish medical-device company Q-Med. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3832", "text": "In 2014, Nestl\u00e9 bought back all the shares from L'Or\u00e9al, thus creating a new unit of Nestl\u00e9 group called Nestle Skin Health. The transaction had a value of \u20ac3.1\u00a0billion (US$4.23\u00a0billion) and was paid for by Nestl\u00e9 with 21.2\u00a0million L'Or\u00e9al shares. [ 7 ]  L'Or\u00e9al paid \u20ac3.4\u00a0billion (US$4.63\u00a0billion) for the remaining 27.3\u00a0million shares. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3833", "text": "In 2019, Nestl\u00e9 sold Galderma for $10.2\u00a0billion [ 8 ] [ 9 ]  to a  consortium  comprising the EQT VIII fund, Luxinva (a wholly owned subsidiary of  Abu Dhabi Investment Authority ), PSP Investments and other institutional investors. Since then, it has been the largest independent dermatology company in the world. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3834", "text": "In November 2021, Galderma bought California-based Alastin, a firm specialising in specialist skincare products, for an undisclosed price. [ 4 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3835", "text": "In June 2022, Galderma announced positive results in two Phase III trials for liquid botulinum toxin A, showing RelabotulinumtoxinA was well tolerated. This result primes the company to apply for approval in the US and other global markets. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3836", "text": "Also in June 2022, Galderma announced positive data from Phase III trial, showing efficacy and safety of nemolizumab in patients with  prurigo nodularis . Nemolizumab is a monoclonal antibody that blocks the signaling of IL-31, a neuroimmune cytokine involved in the pathogenesis of prurigo nodularis. [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3837", "text": "On 6 March 2023 Galderma announced its intention to list on the  Swiss stock exchange . [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3838", "text": "The  IPO  took place \u00a0on March 22, 2024, and was one of the biggest in Europe in 2 years, and the largest in Switzerland since 2017. [ 16 ] [ 17 ]  The price of the stock went up to 62,68  Swiss francs , up from the price of the IPO at 53 francs per share. [ 18 ]   Bloomberg  reports that including debt, Galderma's total market value should come out in the range of $18.69 billion to $19.72 billion. [ 19 ]  The company plans to repay debt with offering proceeds. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3839", "text": "Galderma provides a range of over-the-counter and prescription dermatological products for skin care, aesthetics and treatment of conditions including  acne ,  rosacea ,  psoriasis  and other steroid-responsive  dermatoses  (SRD),  onychomycosis  (fungal nail infections), pigmentary disorders,  skin cancer  and  skin aging . Galderma's activities are divided into three business units: aesthetics, consumer care and prescription medicine. Galderma's products are sold in more than 100 countries. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3840", "text": "In 2007, Galderma and  Ipsen  signed a licensing agreement for the distribution of the  botulinum toxin  Dysport, known as Azzalure in the  European Union . More than 40 million treatments have been performed in the United States and the European Union. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3841", "text": "The main brands are  Restylane , Azzalure, Dysport, Alluzience, Sculptra and Relfydess (relabotulinumtoxinA), which received a positive decision for use in Australia [ 21 ]  and in the European Union in July 2024. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3842", "text": "Galderma's products are available over-the-counter to consumers. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3843", "text": "The main consumer care brands are Cetaphil, with its range of  skin care  products for all ages; Benzac and Differin OTC for mild-to-moderate acne; and Loceryl, used to treat fungal nail infections, and Alastin. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3844", "text": "Disease areas are  atopic dermatitis , dermato- oncology  and  psoriasis . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3845", "text": "The main brands are  Aklief ,  Benzac ,  Cetaphil ,  Epiduo , Epiduo Forte,  Twyneo , Epsolay, Loceryl, Differin, Soolantra, Mirvaso, Oracea, Metvix and Nemluvio which received US  Food and drug Administration  approval for adult patients living with  prurigo nodularis  in August 2024 [ 23 ]  and for patients with  atopic dermatitis  in December 2024. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3846", "text": "The company invests substantially in  research and development  and sources new treatments from its own activities and from its partnerships with others. [ citation needed ]  It divides its  research and development  departments between six sites:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3847", "text": "Galderma has manufacturing facilities at the following locations: [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3848", "text": "Gelatin  or  gelatine  (from  Latin     gelatus \u00a0'stiff, frozen') is a translucent, colorless, flavorless food ingredient, commonly derived from  collagen  taken from animal body parts. It is brittle when dry and rubbery when moist. It may also be referred to as  hydrolyzed  collagen, collagen  hydrolysate , gelatine hydrolysate, hydrolyzed gelatine, and collagen  peptides  after it has undergone hydrolysis. It is commonly used as a  gelling agent  in food, beverages,  medications , drug or vitamin  capsules ,  photographic films ,  papers , and  cosmetics ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3849", "text": "Substances containing gelatin or functioning in a similar way are called  gelatinous substances . Gelatin is an irreversibly  hydrolyzed  form of collagen, wherein the hydrolysis reduces  protein  fibrils into smaller  peptides ; depending on the physical and chemical methods of denaturation, the molecular weight of the peptides falls within a broad range. Gelatin is present in  gelatin desserts , most  gummy candy  and  marshmallows ,  ice creams ,  dips , and  yogurts . [ 1 ]  Gelatin for cooking comes as powder, granules, and sheets. Instant types can be added to the food as they are; others must soak in water beforehand."}
{"_id": "WikiPedia_Dermatology$$$corpus_3850", "text": "Gelatin is a collection of peptides and  proteins  produced by partial  hydrolysis  of collagen extracted from the skin, bones, and  connective tissues  of animals such as domesticated cattle, chicken, pigs, and fish. During hydrolysis, some of the bonds between and within component proteins are broken. Its chemical composition is, in many aspects, closely similar to that of its parent collagen. [ 2 ]  Photographic and pharmaceutical grades of gelatin generally are sourced from cattle bones and pig skin. Gelatin is classified as a  hydrogel ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3851", "text": "Gelatin is nearly tasteless and odorless with a colorless or slightly yellow appearance. [ 3 ] [ 4 ]  It is transparent and brittle, and it can come as sheets, flakes, or as a powder. [ 3 ]   Polar solvents  like hot water, glycerol, and acetic acid can dissolve gelatin, but it is insoluble in organic solvents like alcohol. [ 3 ]  Gelatin absorbs 5\u201310 times its weight in water to form a gel. [ 3 ]  The gel formed by gelatin can be melted by reheating, and it has an increasing viscosity under stress ( thixotropic ). [ 3 ]  The upper melting point of gelatin is below  human body temperature , a factor that is important for  mouthfeel  of foods produced with gelatin. [ 5 ]  The  viscosity  of the gelatin-water mixture is greatest when the gelatin concentration is high and the mixture is kept cool at about 4\u00a0\u00b0C (39\u00a0\u00b0F). Commercial gelatin will have a gel strength of around 90 to 300 grams Bloom using the  Bloom  test of gel strength. [ 6 ]  Gelatin's strength (but not viscosity) declines if it is subjected to temperatures above 100\u00a0\u00b0C (212\u00a0\u00b0F), or if it is held at temperatures near 100\u00a0\u00b0C for an extended period of time. [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3852", "text": "Gelatins have diverse melting points and gelation temperatures, depending on the source. For example, gelatin derived from fish has a lower melting and gelation point than gelatin derived from beef or pork. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3853", "text": "When dry, gelatin consists of 98\u201399% protein, but it is not a nutritionally complete protein since it is missing  tryptophan  and is deficient in  isoleucine ,  threonine , and  methionine . [ 10 ] [ page\u00a0needed ]  The  amino acid  content of hydrolyzed collagen is the same as collagen. Hydrolyzed collagen contains 19 amino acids, predominantly  glycine  (Gly) 26\u201334%,  proline  (Pro) 10\u201318%, and  hydroxyproline  (Hyp) 7\u201315%, which together represent around 50% of the total amino acid content. [ 11 ]  Glycine is responsible for close packing of the chains. Presence of proline restricts the conformation. This is important for gelation properties of gelatin. [ 12 ]  Other amino acids that contribute highly include:  alanine  (Ala) 8\u201311%;  arginine  (Arg) 8\u20139%;  aspartic acid  (Asp) 6\u20137%; and  glutamic acid  (Glu) 10\u201312%. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3854", "text": "In 2011, the  European Food Safety Authority  Panel on Dietetic Products, Nutrition and Allergies concluded that \"a  cause and effect relationship  has not been established between the consumption of collagen hydrolysate and maintenance of joints\". [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3855", "text": "Hydrolyzed collagen has been investigated as a type of wound dressing aimed at correcting imbalances in the wound microenvironment and the treatment of refractory wounds (chronic wounds that do not respond to normal treatment), as well as deep second-degree burn wounds. [ 14 ] [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3856", "text": "Hydrolyzed collagen, like gelatin, is made from animal  by-products  from the  meat industry  or sometimes animal carcasses removed and cleared by  knackers , including skin, bones, and connective tissue."}
{"_id": "WikiPedia_Dermatology$$$corpus_3857", "text": "In 1997, the U.S.  Food and Drug Administration  (FDA), with support from the TSE ( transmissible spongiform encephalopathy ) Advisory Committee, began monitoring the potential risk of transmitting animal diseases, especially  bovine spongiform encephalopathy  (BSE), commonly known as  mad cow disease . [ 16 ]  An FDA study from that year stated: \"... steps such as heat, alkaline treatment, and filtration could be effective in reducing the level of contaminating TSE agents; however, scientific evidence is insufficient at this time to demonstrate that these treatments would effectively remove the BSE infectious agent if present in the source material.\" [ 17 ]  On 18 March 2016, the FDA finalized three previously issued interim final rules designed to further reduce the potential risk of BSE in human food. [ 18 ]  The final rule clarified that \"gelatin is not considered a prohibited cattle material if it is manufactured using the customary industry processes specified.\" [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3858", "text": "The Scientific Steering Committee (SSC) of the  European Union  in 2003 stated that the risk associated with bovine bone gelatin is very low or zero. [ 20 ] [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3859", "text": "In 2006, the  European Food Safety Authority  stated that the SSC opinion was confirmed, that the BSE risk of bone-derived gelatin was small, and that it recommended removal of the 2003 request to exclude the skull, brain, and  vertebrae  of bovine origin older than 12 months from the material used in gelatin manufacturing. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3860", "text": "In 2019, the worldwide demand of gelatin was about 620,000  tonnes  (1.4 \u00d7 10 ^ 9 \u00a0lb). [ 23 ]  On a commercial scale, gelatin is made from  by-products  of the  meat  and  leather  industries.\nMost gelatin is derived from pork skins, pork and cattle bones, or split cattle hides. [ 24 ]  Gelatin made from fish by-products avoids some of the religious objections to gelatin consumption. [ 5 ]  The raw materials are prepared by different curing, acid, and alkali processes that are employed to extract the dried collagen hydrolysate. These processes may take several weeks, and differences in such processes have great effects on the properties of the final gelatin products."}
{"_id": "WikiPedia_Dermatology$$$corpus_3861", "text": "Gelatin also can be prepared at home. Boiling certain cartilaginous cuts of meat or bones results in gelatin being dissolved into the water. Depending on the concentration, the resulting stock (when cooled) will form a jelly or gel naturally. This process is used for  aspic ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3862", "text": "While many processes exist whereby collagen may be converted to gelatin, they all have several factors in common. The intermolecular and intramolecular bonds that stabilize insoluble collagen must be broken, and also, the hydrogen bonds that stabilize the collagen  helix  must be broken. [ 2 ]  The manufacturing processes of gelatin consists of several main stages:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3863", "text": "If the raw material used in the production of the gelatin is derived from  bones , dilute  acid  solutions are used to remove  calcium  and other salts. Hot water or several solvents may be used to reduce the fat content, which should not exceed 1% before the main extraction step. If the raw material consists of  hides  and skin, then size reduction, washing, hair removal, and degreasing are necessary to prepare the materials for the hydrolysis step."}
{"_id": "WikiPedia_Dermatology$$$corpus_3864", "text": "After preparation of the raw material, i.e., removing some of the impurities such as fat and salts, partially purified collagen is converted into gelatin through hydrolysis. Collagen hydrolysis is performed by one of three different methods:  acid -,  alkali -, and  enzymatic hydrolysis . Acid treatment is especially suitable for less fully  cross-linked  materials such as pig skin collagen and normally requires 10 to 48 hours. Alkali treatment is suitable for more complex collagen such as that found in  bovine  hides and requires more time, normally several weeks. The purpose of the alkali treatment is to destroy certain chemical crosslinks still present in collagen. Within the gelatin industry, the gelatin obtained from acid-treated raw material has been called type-A gelatin and the gelatin obtained from alkali-treated raw material is referred to as type-B gelatin. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3865", "text": "Advances are occurring to optimize the yield of gelatin using enzymatic hydrolysis of collagen. The treatment time is shorter than that required for alkali treatment, and results in almost complete conversion to the pure product. The physical properties of the final gelatin product are considered better. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3866", "text": "Extraction is performed with either water or acid solutions at appropriate temperatures. All industrial processes are based on neutral or acid pH values because although alkali treatments speed up conversion, they also promote degradation processes. Acidic extraction conditions are extensively used in the industry, but the degree of acid varies with different processes. This extraction step is a multistage process, and the extraction temperature usually is increased in later extraction steps, which ensures minimum thermal degradation of the extracted gelatin."}
{"_id": "WikiPedia_Dermatology$$$corpus_3867", "text": "This process includes several steps such as filtration, evaporation, drying, grinding, and sifting. These operations are concentration-dependent and also dependent on the particular gelatin used. Gelatin degradation should be avoided and minimized, so the lowest temperature possible is used for the recovery process. Most recoveries are rapid, with all of the processes being done in several stages to avoid extensive deterioration of the peptide structure. A deteriorated peptide structure would result in a low gel strength, which is not generally desired."}
{"_id": "WikiPedia_Dermatology$$$corpus_3868", "text": "The 10th-century  Kitab al-Tabikh  includes a recipe for a fish aspic, made by boiling fish heads. [ 27 ] [ page\u00a0needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3869", "text": "A recipe for jelled meat broth is found in  Le Viandier , written in or around 1375. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3870", "text": "In 15th century Britain, cattle hooves were boiled to produce a gel. [ 29 ]  By the late 17th century, the French inventor  Denis Papin  had discovered another method of gelatin extraction via boiling of bones. [ 30 ]  An English patent for gelatin production was granted in 1754. [ 29 ]  In 1812, the chemist  Jean-Pierre-Joseph d'Arcet \u00a0[ fr ]  further experimented with the use of  hydrochloric acid  to extract gelatin from bones, and later with steam extraction, which was much more efficient. The French government viewed gelatin as a potential source of cheap, accessible protein for the poor, particularly in Paris. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3871", "text": "Food applications in France and the United States during the 19th century appear to have established the versatility of gelatin, including the origin of its popularity in the US as  Jell-O . [ 32 ]  In the mid-19th century, the American industrialist and inventor,  Peter Cooper , registered a patent for a gelatin dessert powder he called \"Portable Gelatin\", which only needed the addition of water. In the late 19th century, Charles and  Rose Knox  set up the Charles B. Knox Gelatin Company in New York, which promoted and popularized the use of gelatin. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3872", "text": "Probably best known as a  gelling agent  in  cooking , different types and grades of gelatin are used in a wide range of food and nonfood products. Common examples of foods that contain gelatin are  gelatin desserts ,  trifles ,  aspic ,  marshmallows ,  candy corn , and confections such as  Peeps ,  gummy bears ,  fruit snacks , and  jelly babies . [ 34 ]  Gelatin may be used as a  stabilizer , thickener, or texturizer in foods such as yogurt,  cream cheese , and  margarine ; it is used, as well, in fat-reduced foods to simulate the  mouthfeel  of fat and to create volume. It also is used in the production of several types of Chinese soup dumplings, specifically Shanghainese soup dumplings, or  xiaolongbao , as well as  Shengjian mantou , a type of fried and steamed dumpling. The fillings of both are made by combining ground pork with gelatin cubes, and in the process of cooking, the gelatin melts, creating a soupy interior with a characteristic gelatinous stickiness."}
{"_id": "WikiPedia_Dermatology$$$corpus_3873", "text": "Gelatin is used for the clarification of juices, such as apple juice, and of vinegar. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3874", "text": "Isinglass  is obtained from the swim bladders of fish. It is used as a fining agent for wine and beer. [ 36 ]  Besides  hartshorn  jelly, from deer antlers (hence the name \"hartshorn\"), isinglass was one of the oldest sources of gelatin."}
{"_id": "WikiPedia_Dermatology$$$corpus_3875", "text": "In cosmetics, hydrolyzed collagen may be found in topical creams, acting as a product texture conditioner, and moisturizer. Collagen implants or dermal fillers are also used to address the appearance of wrinkles, contour deficiencies, and acne scars, among others. The U.S. Food and Drug Administration has approved its use, and identifies cow (bovine) and human cells as the sources of these fillers. According to the FDA, the desired effects can last for 3\u20134 months, which is relatively the most short-lived compared to other materials used for the same purpose. [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3876", "text": "The consumption of gelatin from particular animals may be forbidden by religious rules or cultural taboos."}
{"_id": "WikiPedia_Dermatology$$$corpus_3877", "text": "Islamic  halal  and Jewish  kosher  customs generally require gelatin from sources other than pigs, such as cattle that have been slaughtered according to religious regulations (halal or kosher), or fish (that Jews and Muslims are allowed to consume). [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3878", "text": "On the other hand, some  Islamic  jurists have argued that the chemical treatment \"purifies\" the gelatin enough to always be halal, an argument most common in the field of medicine. [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3879", "text": "It has similarly been argued that gelatin in medicine is permissible in Judaism, as it is not used as food. [ 46 ]  According to  The  Jewish  Dietary Laws , the book of kosher guidelines published by the  Rabbinical Assembly , the organization of  Conservative Jewish  rabbis, all gelatin is kosher and  pareve  because the chemical transformation undergone in the manufacturing process renders it a different physical and chemical substance. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3880", "text": "Buddhist ,  Hindu , and  Jain  customs may require gelatin alternatives from sources other than animals, as many Hindus, almost all Jains and some Buddhists are vegetarian. [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3881", "text": "Media related to  Gelatin  at Wikimedia Commons"}
{"_id": "WikiPedia_Dermatology$$$corpus_3882", "text": "Hand sanitizer  (also known as  hand antiseptic ,  hand disinfectant ,  hand rub , or  handrub ) is a liquid, gel, or foam used to kill  viruses ,  bacteria , and other  microorganisms  on the hands. [ 3 ] [ 4 ]  It can also come in the form of a cream, spray, or wipe. [ 5 ]  While  hand washing  with soap and water is generally preferred, [ 6 ]  hand sanitizer is a convenient alternative in settings where soap and water are unavailable. However, it is less effective against certain pathogens like  norovirus  and  Clostridioides difficile  and cannot physically remove harmful chemicals. [ 6 ]  Improper use, such as wiping off sanitizer before it dries, can also reduce its effectiveness, and some sanitizers with low alcohol concentrations are less effective. [ 6 ]  Additionally, frequent use of hand sanitizer may disrupt the skin's microbiome and cause dermatitis. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3883", "text": "Alcohol -based hand sanitizers, which contain at least 60% alcohol ( ethanol  or isopropyl alcohol), are recommended by the United States  Centers for Disease Control and Prevention  (CDC) when soap and water are not available. [ 8 ]  In healthcare settings, these sanitizers are often preferred over hand washing with soap and water because they are more effective at reducing bacteria and are better tolerated by the skin. [ 9 ] [ 10 ]  However, hand washing should still be performed if contamination is visible or after using the toilet. [ 11 ]  Non-alcohol-based hand sanitizers, which may contain  benzalkonium chloride  or  triclosan , are less effective and generally not recommended, [ 9 ]  though they are not flammable. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3884", "text": "The formulation of alcohol-based hand sanitizers typically includes a combination of isopropyl alcohol, ethanol, or  n -propanol, with alcohol concentrations ranging from 60% to 95% being the most effective. [ 4 ]  These sanitizers are flammable [ 9 ]  and work against a wide variety of microorganisms, but not spores. [ 4 ]  To prevent skin dryness, compounds such as glycerol may be added, and some formulations include fragrances, though these are discouraged due to the risk of allergic reactions. [ 12 ]  Non-alcohol-based versions are less effective and should be used with caution. [ 13 ] [ 14 ] [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3885", "text": "The use of alcohol as an antiseptic dates back to at least 1363, with evidence supporting its use emerging in the late 1800s. [ 16 ]  Alcohol-based hand sanitizers became commonly used in Europe by the 1980s [ 17 ]  and have since been included on the  World Health Organization's List of Essential Medicines . [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3886", "text": "Alcohol-based hand sanitizers may not be effective if the hands are greasy or visibly soiled. In hospitals, the hands of healthcare workers are often contaminated with pathogens, but rarely soiled or greasy."}
{"_id": "WikiPedia_Dermatology$$$corpus_3887", "text": "Some commercially available hand sanitizers (and online recipes for homemade rubs) have alcohol concentrations that are too low. [ 20 ]  This makes them less effective at killing germs. [ 6 ]  Poorer people in developed countries [ 20 ]  and people in developing countries may find it harder to get a hand sanitizer with an effective alcohol concentration. [ 21 ]  Fraudulent labelling of alcohol concentrations has been a problem in Guyana. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3888", "text": "The current evidence that the effectiveness of school hand hygiene interventions is of poor quality. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3889", "text": "In a 2020 Cochrane review comparing rinse-free hand washing to conventional soap and water techniques and the subsequent impact on school absenteeism found a small but beneficial effect on rinse-free hand washing on illness related absenteeism. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3890", "text": "Hand sanitizers were first introduced in 1966 in medical settings such as hospitals and healthcare facilities. The product was popularized in the early 1990s. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3891", "text": "Alcohol-based hand sanitizer is more convenient compared to  hand washing  with soap and water in most situations in the healthcare setting. [ 9 ]  Among healthcare workers, it is generally more effective for hand  antisepsis , and better tolerated than soap and water. [ 4 ]  Hand washing should still be carried out if contamination can be seen or following the use of the  toilet . [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3892", "text": "Hand sanitizer that contains at least 60% alcohol or contains a \"persistent antiseptic\" should be used. [ 26 ] [ 27 ]  Alcohol rubs kill many different kinds of bacteria, including  antibiotic resistant  bacteria and  TB  bacteria. They also kill many kinds of viruses, including the  flu virus , the common  cold virus ,  coronaviruses , and  HIV . [ 28 ] [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3893", "text": "90% alcohol rubs are more effective against  viruses  than most other forms of hand washing. [ 30 ]  Isopropyl alcohol will kill 99.99% or more of all non-spore forming bacteria in less than 30 seconds, both in the laboratory and on human skin. [ 26 ] [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3894", "text": "In too low quantities (0.3 ml) or concentrations (below 60%), the alcohol in hand sanitizers may not have the 10\u201315 seconds exposure time required to denature proteins and  lyse  cells. [ 4 ]  In environments with high lipids or protein waste (such as food processing), the use of alcohol hand rubs alone may not be sufficient to ensure proper hand hygiene. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3895", "text": "For health care settings, like hospitals and clinics, optimum alcohol concentration to kill bacteria is 70% to 95%. [ 32 ] [ 33 ]  Products with alcohol concentrations as low as 40% are available in American stores, according to researchers at  East Tennessee State University . [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3896", "text": "Alcohol rub sanitizers kill most bacteria, and fungi, and stop some viruses.  Alcohol rub sanitizers containing at least 70% alcohol (mainly  ethyl alcohol ) kill 99.9% of the bacteria on hands 30 seconds after application and 99.99% to 99.999% [ note 1 ]  in one minute. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3897", "text": "For health care, optimal disinfection requires attention to all exposed surfaces such as around the fingernails, between the fingers, on the back of the thumb, and around the wrist.  Hand alcohol should be thoroughly rubbed into the hands and on the lower  forearm  for a duration of at least 30 seconds and then allowed to air dry. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3898", "text": "Use of alcohol-based hand gels dries skin less, leaving more moisture in the  epidermis , than hand washing with antiseptic/antimicrobial  soap  and  water . [ 36 ] [ 37 ] [ 38 ] [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3899", "text": "Hand sanitizers containing a minimum of 60 to 95% alcohol are efficient germ killers. Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria ( MRSA  and  VRE ),  tuberculosis , and some viruses (including  HIV ,  herpes ,  RSV ,  rhinovirus ,  vaccinia ,  influenza , [ 40 ]  and  hepatitis ) and  fungi . Alcohol rub sanitizers containing 70% alcohol kill 99.97% (3.5  log reduction , similar to 35  decibel  reduction) of the bacteria on hands 30 seconds after application and 99.99% to 99.999% (4 to 5 log reduction) of the bacteria on hands 1 minute after application. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3900", "text": "There are certain situations during which  hand washing  with soap and water are preferred over hand sanitizer, these include: eliminating bacterial spores of  Clostridioides difficile , parasites such as  Cryptosporidium , and certain viruses like  norovirus  depending on the concentration of alcohol in the sanitizer (95% alcohol was seen to be most effective in eliminating most viruses). [ 41 ]  In addition, if hands are contaminated with fluids or other visible contaminates, hand washing is preferred as well as after using the toilet and if discomfort develops from the residue of alcohol sanitizer use. [ 42 ]   Furthermore, CDC states hand sanitizers are not effective in removing chemicals such as pesticides. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3901", "text": "Alcohol gel can catch fire, producing a translucent blue flame.  This is due to the  flammable  alcohol in the gel.  Some hand sanitizer gels may not produce this effect due to a high concentration of water or moisturizing agents. There have been some rare instances where alcohol has been implicated in starting fires in the operating room, including a case where alcohol used as an antiseptic pooled under the surgical drapes in an operating room and caused a fire when a cautery instrument was used. Alcohol gel was not implicated. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3902", "text": "To minimize the risk of fire, alcohol rub users are instructed to rub their hands until dry, which indicates that the flammable alcohol has evaporated. [ 44 ]  Igniting alcohol hand rub while using it is rare, but the need for this is underlined by one case of a health care worker using hand rub, removing a polyester isolation gown, and then touching a metal door while her hands were still wet; static electricity produced an audible spark and ignited the hand gel. [ 4 ] :\u200a13\u200a  Hand sanitizer should be stored in temperatures below 105\u00a0\u00b0F and should not be left in a car during hot weather due to risk of flammability. [ 45 ]  Fire departments suggest refills for the alcohol-based hand sanitizers can be stored with cleaning supplies away from heat sources or open flames. [ 46 ] [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3903", "text": "Researchers have not thoroughly studied the implications of hand sanitizer use for the body and the microbiome. [ 7 ]  Studies of healthcare workers have correlated high rates of hand eczema with hand sanitizer use. [ 48 ] [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3904", "text": "The alcohol in hand sanitizer strips the skin of the outer layer of oil, which may have negative effects on barrier function of the skin. A study also shows that disinfecting hands with an antimicrobial detergent results in a greater barrier disruption of skin compared to alcohol solutions, suggesting an increased loss of skin lipids. [ 50 ] [ 51 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3905", "text": "Frequent use of alcohol-based hand sanitizers can cause  dry skin  unless  emollients  and/or skin moisturizers are added to the formula. The drying effect of alcohol can be reduced or eliminated by adding  glycerin  and/or other emollients to the formula. [ 52 ]  In  clinical trials , alcohol-based hand sanitizers containing emollients caused substantially less skin  irritation  and dryness than soaps or antimicrobial detergents.  Allergic contact dermatitis , contact  urticaria  syndrome or  hypersensitivity  to alcohol or additives present in alcohol hand rubs rarely occur. [ 31 ]  The lower tendency to induce  irritant contact dermatitis  became an attraction as compared to soap and water hand washing."}
{"_id": "WikiPedia_Dermatology$$$corpus_3906", "text": "In the United States, the  U.S. Food and Drug Administration  (FDA) controls antimicrobial handsoaps and sanitizers as  over-the-counter drugs  (OTC) because they are intended for topical anti-microbial use to prevent disease in humans. [ 53 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3907", "text": "The FDA requires strict labeling which informs consumers on proper use of this OTC drug and dangers to avoid, including warning adults not to ingest, not to use in the eyes, to keep out of the reach of children, and to allow use by children only under adult supervision. [ 54 ]  According to the  American Association of Poison Control Centers , there were nearly 12,000 cases of hand sanitizer ingestion in 2006. [ 55 ]  If ingested, alcohol-based hand sanitizers can cause  alcohol poisoning  in small children. [ 56 ]  However, the U.S.  Centers for Disease Control  recommends using hand sanitizer with children to promote good hygiene, under supervision, and furthermore recommends parents pack hand sanitizer for their children when traveling, to avoid their contracting disease from dirty hands. [ 57 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3908", "text": "Denaturants are an ingredient added to hand sanitizers, such as Purell, that is used to stop the liquid gel from being digested. This chemical adds a taste to the gel that makes it less enticing to consume. It is especially helpful in keeping younger children away because of the different smells and colors of hand sanitizers that tend to attract children. [ 58 ] [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3909", "text": "People with  alcoholism  may attempt to consume hand sanitizer in desperation when traditional alcoholic beverages are unavailable, or personal access to them is restricted by force or law. There have been reported incidents of people  drinking the gel  in prisons and hospitals to become intoxicated. As a result, access to sanitizing liquids and gels is controlled and restricted in some facilities. [ 60 ] [ 61 ] [ 62 ]  For example, over a period of several weeks during the  COVID-19 pandemic in New Mexico , seven people in that U.S. state who were alcoholic were severely injured by drinking sanitizer: three died, three were in critical condition, and one was left permanently blind. [ 63 ] [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3910", "text": "In 2021, a dozen children were hospitalized in the state of Maharashtra, India, after they were mistakenly orally administered hand sanitizer instead of a polio vaccine. [ 65 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3911", "text": "On 30 April 2015, the FDA announced that they were requesting more scientific data based on the safety of hand sanitizer. Emerging science suggests that for at least some health care antiseptic active ingredients, systemic exposure (full body exposure as shown by detection of antiseptic ingredients in the blood or urine) is higher than previously thought, and existing data raise potential concerns about the effects of repeated daily human exposure to some antiseptic active ingredients. This would include hand antiseptic products containing alcohol and  triclosan . [ 66 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3912", "text": "Hands must be disinfected before any surgical procedure by hand washing with mild soap and then hand-rubbing with a sanitizer. Surgical disinfection requires a larger dose of the hand-rub and a longer rubbing time than is ordinarily used.  It is usually done in two applications according to specific hand-rubbing techniques, EN1499 (hygienic handwash), and German standard DIN EN 1500 (hygienic hand disinfection) to ensure that antiseptic is applied everywhere on the surface of the hand. [ 67 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3913", "text": "Some hand sanitizer products use agents other than alcohol to kill microorganisms, such as  povidone-iodine ,  benzalkonium chloride  or  triclosan . [ 4 ]  The World Health Organization (WHO) and the CDC recommends \"persistent\" antiseptics for hand sanitizers. [ 68 ]  Persistent activity is defined as the prolonged or extended antimicrobial activity that prevents or inhibits the proliferation or survival of microorganisms after application of the product. This activity may be demonstrated by sampling a site several minutes or hours after application and demonstrating bacterial antimicrobial effectiveness when compared with a baseline level. This property also has been referred to as \"residual activity.\" Both substantive and nonsubstantive active ingredients can show a persistent effect if they substantially lower the number of bacteria during the wash period."}
{"_id": "WikiPedia_Dermatology$$$corpus_3914", "text": "Laboratory studies have shown lingering benzalkonium chloride may be associated with  antibiotic  resistance in  MRSA . [ 69 ] [ 70 ]  Tolerance to alcohol sanitizers may develop in fecal bacteria. [ 71 ] [ 72 ]  Where alcohol sanitizers utilize 62%, or higher, alcohol by weight, only 0.1 to 0.13% of benzalkonium chloride by weight provides equivalent antimicrobial effectiveness."}
{"_id": "WikiPedia_Dermatology$$$corpus_3915", "text": "Triclosan has been shown to accumulate in  biosolids  in the environment, one of the top seven organic contaminants in waste water according to the  National Toxicology Program [ 73 ]  Triclosan leads to various problems with natural biological systems, [ 74 ]  and triclosan, when combined with chlorine e.g. from tap water, produces  dioxins , a probable  carcinogen  in humans. [ 75 ]  However, 90\u201398% of triclosan in waste water biodegrades by both photolytic or natural biological processes or is removed due to  sorption  in waste water treatment plants. Numerous studies show that only very small traces are detectable in the effluent water that reaches rivers. [ 76 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3916", "text": "A series of studies show that  photodegradation  of triclosan produced  2,4-dichlorophenol  and 2,8-dichlorodibenzo-p-dioxin (2,8-DCDD). The 2,4-dichlorophenol itself is known to be biodegradable as well as photodegradable. [ 77 ]  For DCDD, one of the non-toxic compounds of the dioxin family, [ 78 ]  a conversion rate of 1% has been reported and estimated half-lives suggest that it is photolabile as well. [ 79 ]  The formation-decay kinetics of DCDD are also reported by Sanchez-Prado et al. (2006) who claim \"transformation of triclosan to toxic dioxins has never been shown and is highly unlikely.\" [ 80 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3917", "text": "Alcohol-free hand sanitizers may be effective immediately while on the skin, but the solutions themselves can become contaminated because alcohol is an in-solution preservative and without it, the alcohol-free solution itself is susceptible to contamination. However, even alcohol-containing hand sanitizers can become contaminated if the alcohol content is not properly controlled or the sanitizer is grossly contaminated with microorganisms during manufacture. In June 2009, alcohol-free Clarcon Antimicrobial Hand Sanitizer was pulled from the US market by the FDA, which found the product contained gross contamination of extremely high levels of various bacteria, including those which can \"cause opportunistic infections of the skin and underlying tissues and could result in medical or surgical attention as well as permanent damage\".  Gross contamination of any hand sanitizer by bacteria during manufacture will result in the failure of the effectiveness of that sanitizer and possible infection of the treatment site with the contaminating organisms. [ 81 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3918", "text": "Alcohol-based hand rubs are extensively used in the hospital environment as an alternative to antiseptic soaps. Hand-rubs in the hospital environment have two applications: hygienic hand rubbing and surgical hand disinfection. Alcohol based hand rubs provide a better skin tolerance as compared to antiseptic soap. [ 39 ] \nHand rubs also prove to have more effective microbiological properties as compared to antiseptic soaps."}
{"_id": "WikiPedia_Dermatology$$$corpus_3919", "text": "The same ingredients used in over-the-counter hand-rubs are also used in hospital hand-rubs: alcohols such as  ethanol  and  isopropanol , sometimes combined with  quaternary ammonium cations  (quats) such as  benzalkonium chloride .  Quats are added at levels up to 200 parts per million to increase antimicrobial effectiveness. Although allergy to alcohol-only rubs is rare, fragrances, preservatives and quats can cause contact allergies. [ 82 ]   These other ingredients do not evaporate like alcohol and accumulate leaving a \"sticky\" residue until they are removed with soap and water."}
{"_id": "WikiPedia_Dermatology$$$corpus_3920", "text": "The most common brands of alcohol hand rubs include Aniosgel, Avant, Sterillium, Desderman and Allsept S. All hospital hand rubs must conform to certain regulations like EN 12054 for hygienic treatment and surgical disinfection by hand-rubbing. Products with a claim of \"99.99% reduction\" or 4- log reduction  are ineffective in hospital environment, since the reduction must be more than \"99.99%\". [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3921", "text": "The hand sanitizer dosing systems for hospitals are designed to deliver a measured amount of the product for staff.  They are dosing pumps screwed onto a bottle or are specially designed dispensers with refill bottles. Dispensers for surgical hand disinfection are usually equipped with elbow controlled mechanism or infrared sensors to avoid any contact with the pump."}
{"_id": "WikiPedia_Dermatology$$$corpus_3922", "text": "Consumer alcohol-based hand sanitizers, and  health care  \"hand alcohol\" or \"alcohol hand antiseptic agents\" exist in liquid, foam, and easy-flowing gel formulations. Products with 60% to 95%  alcohol by volume  are effective antiseptics. Lower or higher concentrations are less effective; most products contain between 60% and 80% alcohol. [ 83 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3923", "text": "In addition to alcohol ( ethanol ,  isopropanol  or  n-Propanol ), hand sanitizers also contain the following: [ 83 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3924", "text": "The  World Health Organization  has published the following formulations to guide to the production of large quantities of hand sanitizer from chemicals available in developing countries, where commercial hand sanitizer may not be available: [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3925", "text": "In 2010 the  World Health Organization  produced a guide for manufacturing hand sanitizer, which received renewed interest in 2020 because of shortages of hand sanitizer in the wake of the  COVID-19 pandemic . [ 2 ]   Dozens of liquor and perfume manufacturers switched their manufacturing facilities from their normal product to hand sanitizer. [ 84 ]  In order to keep up with the demand, local  distilleries  started using their alcohol to make hand sanitizer. [ 85 ]  Distilleries producing hand sanitizer originally existed in a legal grey area in the United States, until the  Alcohol and Tobacco Tax and Trade Bureau  declared that distilleries could produce their sanitizer without authorization. [ 86 ] [ 87 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3926", "text": "In the beginnings of the pandemic, because of hand sanitizer shortages due to  panic buying , people resorted to using 60% to 99% concentrations of isopropyl or ethyl alcohol for hand sanitization, typically mixing them with  glycerol  or soothing  moisturizers  or liquid contain  aloe vera  to counteract  irritations  with options of adding drops of  lemon  or  lime  juice or  essential oils  for scents, and thus making  DIY  hand sanitizers. [ 88 ]  However, there are cautions against making them, such as a wrong measurement or ingredient may resulting in an insufficient amount of alcohol to kill the coronavirus, thus rendering the mixture  ineffective or even poisonous . [ 89 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3927", "text": "Additionally, some commercial products are dangerous, either due to poor oversight and process control, or fraudulent motive. In June 2020, the FDA issued an advisory against use of hand sanitizer products manufacture by Eskbiochem SA de CV in Mexico due to excessive levels of  methanol  \u2013 up to 81% in one product. Methanol can be absorbed through the skin, is toxic in modest amounts, and in substantial exposure can result in \"nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the nervous system or death\". [ 90 ]  Products suspected of manufacture by Eskbiochem SA with excessive methanol have been reported as far away as  British Columbia , Canada. [ 91 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3928", "text": "In August 2020, the FDA expanded the list of dangerous hand sanitizers. [ 92 ] [ 93 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3929", "text": "Hinokitiol  ( \u03b2-thujaplicin ) is a natural  monoterpenoid  found in the wood of trees in the family  Cupressaceae . It is a  tropolone  derivative and one of the  thujaplicins . [ 3 ]  Hinokitiol is used in oral and skin care products, [ 4 ] [ 5 ]  and is a  food additive  used in  Japan . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3930", "text": "Hinokitiol was discovered by a Japanese chemist  Tetsuo Nozoe  in 1936. It was isolated from the  essential oil  component of the  heartwood  of  Taiwanese hinoki , from which the compound ultimately adopted its name. [ 7 ]  Hinokitiol is the first non- benzenoid  aromatic compound identified. [ 8 ]  The compound has a heptagonal molecular structure and was first synthesized by  Ralph Raphael  in 1951. [ 9 ]  Due to its iron-chelating activity, hinokitiol has been called an \"Iron Man molecule\" in the scientific media, which is ironic because Tetsuo is translated into English as \"Iron Man\". [ 10 ]  Taiwanese hinoki is native to  East Asian  countries, particularly to  Japan  and  Taiwan . [ 11 ]  Hinokitiol has also been found in other trees of the  Cupressaceae  family, including  Thuja plicata  Donn ex D. Don  which is common in the  Pacific Northwest ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3931", "text": "Woods that are rich in hinokitiol were used by people of ancient  Japan  for creating long-standing buildings, such as the  Konjiki-d\u014d , a japanese national treasure, one of the buildings of  Ch\u016bson-ji  complex, a temple in  Iwate Prefecture . It kept it from harm against  insects ,  wood-rotting fungi , and  molds  for a long time of about 840 years. Additionally, there are some old famous Buddhist temples and  Shinto shrines  using trees, later known to contain hinokitiol. [ 12 ]  Beginning in the 2000s, the biological properties of hinokitiol have become of research interest, focusing on its biological properties. [ 10 ]  And the resistance of  cypress  trees to  wood decay  was the leading reason prompting to study their chemical content and to find the substances responsible for those properties. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3932", "text": "Hinokitiol has been found in the heartwood of the conifer trees of the  Cupressaceae  family, including  Chamaecyparis obtusa  (Hinoki cypress),  Thuja plicata  (Western red cedar),  Thujopsis dolabrata  var.  hondai  (Hinoki asunaro),  Juniperus cedrus  (Canary Islands juniper),  Cedrus atlantica  (Atlas cedar),  Cupressus lusitanica  (Mexican white cedar),  Chamaecyparis lawsoniana  (Port Orford cedar),  Chamaecyparis taiwanensis  (Taiwan cypress),  Chamaecyparis thyoides  (Atlantic white cedar),  Cupressus arizonica  (Arizona cypress),  Cupressus macnabiana  (MacNab cypress),  Cupressus macrocarpa  (Monterey cypress),  Juniperus chinensis  (Chinese juniper),  Juniperus communis  (Common juniper),  Juniperus californica  (California juniper),  Juniperus occidentalis  (Western juniper),  Juniperus oxycedrus  (Cade),  Juniperus sabina  (Savin juniper),  Calocedrus decurrens  (California incense-cedar),  Calocedrus formosana  (Taiwan incense-cedar),  Platycladus orientalis  (Chinese thuja),  Thuja occidentalis  (Northern white-cedar),  Thuja standishii  (Japanese thuja),  Tetraclinis articulata  (Sandarac). [ 14 ] [ 15 ] [ 16 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3933", "text": "Its concentration in the trees are 0.1-0.2% in  Chamaecyparis taiwanensis  (2 mg of hinokitiol per 1 g of dry sawdust), 0.04% in  Juniperus cedrus  and  Thujopsis dolabrata  var.  hondai  (0.4 mg of hinokitiol per 1 g of dry sawdust), and 0.02% in  Chamaecyparis obtusa  (0.2 mg of hinokitiol per 1 g of dry sawdust). [ 7 ] [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3934", "text": "There are three naturally found  thujaplicins : \u03b1-thujaplicin, \u03b2-thujaplicin (hinokitiol) and \u03b3-thujaplicin. Hinokitiol is the most common isomer and it appears to be the only isomer that exerts all biological activities attributed to thujaplicins. [ 19 ] [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3935", "text": "There are different pathways to synthesize thujaplicins. Hinokitiol, as other thujaplicins, can be synthesized by  cycloaddition  of isopropyl cyclopentadiene  and dichloro ketene,  1,3-dipolar cycloaddition  of 5-isopropyl-1-methyl-3-oxidopyridinium,  ring expansion  of 2-isopropylcyclohexanone, regiocontrolled  hydroxylation  of oxyallyl  (4+3) cycloadducts ,  regioselectively  from ( R )-(+)- limonene , and from troponeirontricarbonyl complex. [ 21 ] [ 22 ]  Hinokitiol can also be isolated through  plant cell suspension cultures , [ 23 ] [ 24 ]  or readily extracted from the wood with chemical  solvents  and  ultrasonication . [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3936", "text": "(1) Synthesis of hinokitiol from troponeirontricarbonyl complex:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3937", "text": "(2) Synthesis of hinokitiol by electro-reductive alkylation of substituted cycloheptatrienes:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3938", "text": "(3) Synthesis of hinokitiol through ring expansion of 2-isopropylcyclohexanone:"}
{"_id": "WikiPedia_Dermatology$$$corpus_3939", "text": "(4) Synthesis of hinokitiol through oxyallyl cation [4+3] cyclization (Noyori's synthesis):"}
{"_id": "WikiPedia_Dermatology$$$corpus_3940", "text": "Hinokitiol is a  tropolone  derivative containing an unsaturated seven-membered carbon ring. It is a  monoterpenoid  \u2013  cyclohepta-2,4,6-trien-1-one  substituted by a  hydroxy group  at position 2 and an  isopropyl group  at position 4. [ 26 ] [ 27 ] [ 28 ]  It is a  enol  and a cyclic  ketone . It derives from a hydride of a  cyclohepta-1,3,5-triene . Thujaplicins are soluble in organic solvents and aqueous buffers. [ 2 ]  Hinokitiol provides acetone on vigorous oxidation and gives the saturated monocyclic diol upon catalytic hydrogenation. [ 7 ]  It is stable to alkali and acids, forming salts or remaining unchanged, but does not convert to catechol derivatives.\nHinokitiol, as other thujaplicins and tropolones, reversibly binds metal ions. It forms complex salts with metal ions."}
{"_id": "WikiPedia_Dermatology$$$corpus_3941", "text": "Hinokitiol, as other  tropolones , reversibly binds metal ions (i.e.  Zn 2+ ,  Fe 2+ ,  Cu 2+ ,  Co 2+ ,  Mn 2+ ,  Ag 2+ ) and form complex  salts . It is considered as a broad-spectrum  metallophore , and an efficient  iron - chelating agent . [ 17 ]  The iron complex with hinokitiol with the formula (C 10 H 11 O 2 ) 3 Fe is called hinokitin.  Hinoki  oil is rich in hinokitin which has an appearance of dark red crystals. [ 7 ]  The complexes made of iron and tropolones display high thermodynamic stability and has shown to have a stronger binding constant than the transferrin-iron complex. [ 29 ]  It is believed that metal-binding activity may be the principal mechanism of action underlying the most part of its biological activities, especially binding iron, zinc, and copper ions. [ 20 ]  By binding different metal ions and serving as an  ionophore , it accelerates the intracellular uptake of those ions and increases their intracellular levels, thus influencing on different biological activities. It is shown that a synergistic effect in some biological activities and settings may occur when ionophores are combined with the ions they bind. [ 30 ]  As an ionophore, its molecule has an hydrophilic center and a hydrophobic part. The hydrophobic part interacts with biological membranes. The hydrophilic center binds metal ions and form ionophore-ion complexes."}
{"_id": "WikiPedia_Dermatology$$$corpus_3942", "text": "Hinokitiol and other  thujaplicins  have been mainly investigated in  in-vitro  studies and animal models for their possible biological properties, such as antimicrobial, antifungal, antiviral, antiproliferative, anti-inflammatory, antiplasmodial effects. [ 10 ] [ 17 ] [ 20 ]  However, no evidence exists from clinical studies to support these findings. It has also shown to have insecticidal, pesticidal and antibrowning effects. The vast majority of these properties are thought to be due to the metal ion-binding activity. Hinokitiol appeared to exert all  in-vitro  activities attributed to thujaplicins. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3943", "text": "Hinokitiol has been shown to possess inhibitory effects on  Chlamydia trachomatis  and may be clinically useful as a topical drug. [ 31 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3944", "text": "The safety of hinokitiol has been tested in rats and no carcinogenic effect to rats was found. [ 32 ]  In 2006, hinokitiol was categorized under the Domestic substances list (DSL) in Canada as non-persistent, non-bioaccumulative and non-toxic to aquatic organisms. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3945", "text": "Hinokitiol is used in a range of consumer products intended for skin care, such as  soaps ,  skin lotions ,  eyelid cleanser ,  shampoos  and  hair tonics ; [ 4 ] [ 34 ] [ 35 ]  for oral care, such as  toothpastes ,  breath sprays . [ 4 ] [ 5 ] [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3946", "text": "In April 2020, Advance Nanotek, an Australian producer of zinc oxide, filed a joint patent application with AstiVita Limited, for an anti-viral composition that included oral care products. [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3947", "text": "Hinokitiol is found to have  insecticidal  and  pesticidal  activities against crop-damaging  termites  ( Reticulitermes speratus ,  Coptotermes formosanus ) and beetles ( Lasioderma serricorne ,  Callosobruchus chinensis ). [ 15 ] [ 38 ] [ 17 ]  It has also shown to act against certain mites ( Dermatophagoides farinae ,  Tyrophagus putrescentiae ) and mosquito larvae ( Aedes aegypti ,  Culex pipiens ). Hinokitiol is supplemented in commercial tick and  insect repellents . [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3948", "text": "In experimental studies hinokitiol has been shown to act against  Botrytis cinerea , a necrotrophic fungus causing gray mold in many plant species and known to damage  horticultural   crops . Thus it has been suggested to be used for  post-harvest   waxing  to prevent  post-harvest decay . [ 17 ] [ 39 ]  Hinokitiol is a registered  food additive  in Japan. [ 6 ]  Hinokitiol appears to suppress  food browning  through inhibiting  browning enzymes , particularly tyrosinase and other  polyphenol oxidases  by chelating  copper  ions. [ 17 ]  This effect has been shown on different vegetables, fruits, mushrooms, flowers, plants, other agricultural products and seafood. [ 40 ]  Due to the latter effects, hinokitiol is used in  food packaging  as a  shelf-life  extending agent. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3949", "text": "Hinokitiol is one of the chemical compounds isolated from trees, known as  extractives , responsible for natural durability of certain trees. Hinokitiol is found in the  heartwood  of naturally durable trees belonging to the  Cupressaceae  family. [ 13 ] [ 42 ]  These compounds give the wood natural resistance to  decay  and insect attacks due to their fungicidal, insecticidal and pesticidal activities. Thereby, hinokitiol, as some other natural extractives, is suggested to be used as a  wood preservative  for  timber  treatment. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3950", "text": "Researchers screening a library of small biomolecules for signs of iron transport found that hinokitiol restored cell functionality. Further work by the team suggested a mechanism by which hinokitiol restores or reduces cell iron. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3951", "text": "Different  in-vitro  studies have investigated the effects of hinokitiol on various tumor  cell lines ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3952", "text": "Indoor tanning lotions  accelerate the  tanning process , by promoting the production of  melanin . [ 1 ]  Increasing blood flow to the skin is a proposed mechanism, which may in turn stimulate production of melanin by melanocytes. [ 2 ]  Historically, indoor tanning lotions have contained no  sunscreen  and offer no protection from the sun. However, many tanning lotions currently contain sunscreen.  Unlike sunless tanning lotions, these are designed for use with an ultraviolet source such as a  tanning bed  or booth."}
{"_id": "WikiPedia_Dermatology$$$corpus_3953", "text": "Some of the active ingredients found in common tanning lotions include melanin and  L-Tyrosine . [ 3 ]   Other commonly found ingredients include  tea oil ,  copper  (in many different chemical compounds),  green tea  extract and many other natural  oils .  Indoor tanning lotions are usually designed to only use ingredients that will not cause damage or build up on acrylic surfaces.  This is because all tanning beds use 100% acrylic in their protective shields. This is one reason people should not use outdoor tanning lotion in a tanning bed, as some common ingredients such as  mineral oil  (common ingredient in cosmetics, including some  baby oil  brands) will damage the surface of the acrylics. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3954", "text": "Tingle  is a standard description for indoor tanning lotions that contain ingredients that increase blood flow at the skin level, or cause a \"tingling\" sensation."}
{"_id": "WikiPedia_Dermatology$$$corpus_3955", "text": "Some lotions have a bronzing effect to them. There are three different types of bronzers; cosmetic, natural and DHA. DHA (dihydroxyacetone) is a higher level of bronzer that stays on the skin for about 4\u20135 days depending on how much one exfoliates. Natural bronzers that are made from plant extracts, and stay on the skin for about 3\u20134 days, also exist. Cosmetic bronzers stain the skin the most, they stay on the skin for about 1\u20133 days and can be easily washed off in the shower. [ 5 ]  These bronzers work with the skin to provide a darker cosmetic color. They take approximately 4\u20136 hours to develop full color.  Having a base tan before using a bronzer produces a more natural looking color. Natural bronzers use natural ingredients, such as caramel, riboflavin, etc. These ingredients provide a slight instant boost of color, but will wash off in the shower."}
{"_id": "WikiPedia_Dermatology$$$corpus_3956", "text": "Higher quality natural bronzer lotions will have certain organic ingredients/natural or exotic extracts that aid in the process of tanning (melanin production/oxidization)."}
{"_id": "WikiPedia_Dermatology$$$corpus_3957", "text": "One of the primary purposes for using indoor tanning lotions is to moisturize the skin.  This is because tanning (indoors or out) can dehydrate the skin so additional moisturization is needed to compensate and leave the skin looking smooth and healthy.  One of the most popular moisturizing elements in tanning lotions is  hempseed oil , although other oils are also common.  The primary moisturizing ingredients in tanning lotions are essentially the same as in regular hand lotions, although they tend to have less  alcohol  in them."}
{"_id": "WikiPedia_Dermatology$$$corpus_3958", "text": "Most indoor tanning lotions do not offer protection from the sun (have no  SPF ) and are not intended for outdoor use. However, many tanning lotions now contain SPF."}
{"_id": "WikiPedia_Dermatology$$$corpus_3959", "text": "The  Italy towel , ( Korean : \uc774\ud0dc\ub9ac \ud0c0\uc62c) also known as the  Korean exfoliating mitt  or  Korean exfoliating towel  (depending on the shape), [ 1 ]  is a mass-produced bath product used to scrub and peel the outermost layer of skin; it was invented in  Busan  by Kim Won-jo (CEO of Hanil Textile) in 1967. Since then, the Italy towel has become a household item in Korean homes and a staple item in  Korean saunas . The Italy towel is also used in other areas of Asia such as  Thailand , the north of  China , Central Asia and  Japan ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3960", "text": "The Korean exfoliating mitt was named the Italy towel because the  viscose  fabric used to make it was imported from  Italy  at the time. [ 2 ] [ 3 ] [ 4 ]  Different colors represent different strengths, with green being the standard. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3961", "text": "According to a 2017 poll held by the  Korean Intellectual Property Office , the Italy towel was ranked as one of the top ten inventions made within the country. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3962", "text": "There are different types of Italy towels, with most towels typically made of two squares that are sewn together and fit snugly over the hand. [ 6 ]   The towels are made of various coarse materials such as viscose  rayon ,  sisal  hemp, and  nylon . [ 7 ]  The color of the Italy towel represents the item's strength, with pink and blue representing the softest and most coarse respectively. Green is used to designate the standard coarseness and is the most common type used. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3963", "text": "The coarse surface of the Italy towels is meant to help users exfoliate skin more effectively by using a scrubbing motion over the body. [ 6 ]   Vogue  writer Monica Kim has recommended that the towels be used after several minutes of soaking or exposing the skin in water to soften the skin and to use a soothing soap. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3964", "text": "Korean scrub staff, or  ttaemiri , recommend to only use the Italy towel once a week to avoid skin damage. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3965", "text": "This  health -related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3966", "text": "K-beauty  ( Korean :\u00a0 \ucf00\uc774\ubdf0\ud2f0 ;  RR :\u00a0 Keibyuti ) is an umbrella term for   skincare  products that are derived from  South Korea . [ 1 ] [ 2 ] [ 3 ] [ 4 ]  The fad gained popularity worldwide, especially in  East Asia , [ 5 ] [ 6 ]   Southeast Asia , [ 7 ] [ 8 ] [ 9 ]   South Asia , [ 10 ] [ 11 ] [ 12 ]  and the  Western world , [ 13 ] [ 14 ] [ 15 ] [ 16 ]  and focuses on  health ,  hydration , and an emphasis on brightening effects. [ 17 ] [ 18 ] [ 19 ] [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3967", "text": "Although the focus for these beauty products are on skin aesthetics such as health, hydration, and luminous textured skin, glowing \"glass skin\" is favored by South Koreans. Rather than having layers of foundation, it is preferred to have a lengthy skincare regimen with a focus on toning and clarifying. Various natural ingredients are utilized in the creation of these products in addition to the numerous steps involved in a skincare routine. The skincare and cosmetics industry continues to lead the way in terms of economic gain, as displayed by the growth and expansion of Korean skincare domestically and internationally. [ 21 ]  The history of Korean skincare has influenced the standards for the ideal beauty and skincare routine which have become engrained into Korean norms over time. [ 22 ]  The result of which has led to several controversies and movements against harmful and rigid beauty standards set upon the Korean people. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3968", "text": "The  Asia-Pacific  holds the largest market share in the K-beauty industry as of December 2020, with Asian countries/regions being some of the largest consumers of K-beauty products. [ 23 ]  There is also a growing market for K-beauty products in Western countries such as the  United Kingdom . [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3969", "text": "In recent years, Korean skincare and cosmetic products have become a worldwide phenomenon, revolutionizing the global beauty industry with innovative products and aesthetic trends. Korean beauty first emerged in the West in 2011 with the launch of the BB cream, marketed as a multi-tasking skincare product that serves as a foundation, moisturizer and sunscreen. [ 25 ]  Korean skin care products are available and can be found in department stores, pharmacies, and special beauty retailers. United States-based retailers have reported business growth since introducing Korean beauty products."}
{"_id": "WikiPedia_Dermatology$$$corpus_3970", "text": "Beauty products consumers are paying more attention to the ingredients of the skin care products before investing and purchasing the items. Products that say natural and organic have more appeal to consumers. Recently, natural ingredients beauty products have clinical research studies began evaluating their therapeutic potential and biological cutaneous effects. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3971", "text": "Korean beauty standards  in the 21st century prize a youthful look and the appearance of moisture on the skin, which results in a preference for cremes over powders. K-beauty products are also more often designed for export, as a result of South Korea's history of  import substitution industrialization . [ 27 ]  K-Beauty products are presented using sophisticated ingredients and appealing packaging. Products use ingredients ranging from more natural sources such as green tea leaves, orchid, soybean [ 28 ]  to  snail slime ,  morphing  masks,  bee venom  (an  anti-inflammatory  \"faux-tox\" alleged to relax facial muscles),  moisturizing   starfish  extract, and pig collagen. [ 29 ] [ 30 ] [ 31 ]  The regimen involves a series of steps including  cleansing  rituals (with oil and water based products), sheet masks, essences,  serums ,  moisturizers , cushion compacts, fermented products, and SPF 35 sunscreen. At night, the sunscreen is replaced by a \"night cream\". [ 1 ] [ 32 ]  Each regimen is addressed differently depending on complexion factors including  hormonal  fluctuations and lifestyle choices. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3972", "text": "The ultra-elaborated K-Beauty skincare regimen consisted of an average of 10 steps. It normally starts with a dual cleaning ritual, series of sheet masks, essences lotions, serums, and rich moisturizers, and then ends with an SPF sunscreen, except at night when the sunscreen is swapped for a thick sleep cream. [ 1 ]  The facial skincare products are successful, due to the abundant development of new skin products and that two-thirds (68%) of all launches of skincare products were products from South Korea. [ 34 ] [ 35 ]  Although men are increasingly participating in the market, the focus is still on women.  YouTubers  offer tutorials on how to apply cosmetics and skincare products. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3973", "text": "South Korea is the leader of the global beauty industry, it continues to advance; analysts expect K-Beauty to generate immense growth and expansion of Korean skincare brands to bring in high revenue. [ 21 ]  This continues to be the projection for the upcoming years. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3974", "text": "South Korea is also known for being the center for many skin care brand's research and development as well as a manufacturing and production hub. [ 36 ]  The majority of Koreans are found to be well-educated and informed about skin care and health, so many of the products developed by Korea are thoroughly regulated. [ 37 ]  An additional factor for its success includes the influence of popular culture, such as the  Hallyu Wave , where celebrities promote makeup brands and help to promote them domestically and internationally. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3975", "text": "K-Beauty is associated with the  Korean Wave ; for example, the South Korean cosmetics company  Amorepacific  sponsored  My Love from the Star , a 2014  K-drama  whose constant marketing of Amorepacific products resulted in an increase in skincare and lipstick sales of up to 75 and 400 percent. The combination of increased international  tourism in South Korea  combined with K-Beauty products' presence in  duty-free shops  has also worked to increase sales of  cosmetics in Korea . [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3976", "text": "In the past, Koreans were known to create and utilize several skincare and makeup products. Additionally, the superficial appearance was thought to be linked to one's inner health and care. [ 40 ]  Many were made from natural ingredients around them such as oils, plants, or natural powders. These natural cosmetics at the time added fragrance to the product which was often thought to reduce stress and fatigue, as stated in the  Gyuhap Chongseo  or Women's Encyclopedia. [ 40 ]  The origins of Korean beauty developed during the time of the  Three Kingdoms  where beauty culture became more prevalent. [ 41 ] [ 42 ]  A special emphasis was placed upon the  Goryeo  era as it was known to be the pinnacle for Korean beauty standards. [ 41 ]  In the Joseon dynasty, the idea of beauty stems from fair-looking skin and cherry lips to accentuates the elegancy of their status. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3977", "text": "Throughout each of the Three Kingdom eras, women and elites were often informed of what beauty products were acceptable via the  Gyuhap Chongseo . [ 40 ]  The Three Kingdoms included from oldest to recent:  Silla ,  Goguryeo , and  Baekje  (BC 37~668). [ 41 ]  Much of the information and knowledge of skincare and beauty from the Silla era was carried onto the Goguryeo era where further advancements were implemented. [ 41 ]  The Gyuhap Chongseo detailed the proper ways to do one's makeup. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3978", "text": "The Goguryeo era was thought to be excessive by Joseon standards. During the  Joseon  dynasty,  Confucianism  dictated what was acceptable in terms of beauty with a focus on the inner self. [ 44 ]  Korean beauty often flowed from the lower-class to the elites as many elites mirrored the female entertainers, known as  gisaeng . [ 40 ]  Beauty accessories and containers were then invented and sold. Trade and imports from other countries, like  Russia  and  China , then became more frequent. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3979", "text": "This is evidence of South Koreans' strong interest in physical wellbeing and attractiveness, which are considered to be linked both to body wellness. [ 45 ]  South Korea has become a destination for cosmetic tourism thanks to the popularity of K-beauty and the high quality of the country's doctors and healthcare system. [ 22 ]  The standards in South Korea have created the \"Escape the Corset\" movement to cast off what a minority believe are the country's rigid beauty standards.  This movement was created by a small group of women that wanted to put a stop to existing beauty standards, as well as their long-accepted attitude towards plastic surgery and cosmetic. This movement was inspired by the #MeToo Movement. [ 22 ]  The Korean wave has led to new  beauty standards  among young people in South Korea. Facial beauty products are particularly popular in South Korea. [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3980", "text": "In common with most of the rest of the world, the value that South Koreans have placed on physical attractiveness can influence some young person's self-esteem and interpersonal and romantic relationships, for those who believe that they are not up to these standards. [ 40 ]  Social aesthetic preferences for women wearing makeup and having a small 'heart-shaped' face is strong. In South Korea, in the past pressure for conformity against people who left the mainstream path used to be relatively intense as compared to fellow advanced, democratized countries. [ 22 ] \nIn 2014 it was recorded that 980,000 cosmetic surgery procedures were done in that year, albeit only around 50 percent of them involved South Korean nationals. Thanks to the popularity of kbeauty and the quality of South Korean doctors and its healthcare system, many foreigners fly to South Korea for surgery, especially from China, Japan, the United States and Southeast Asia. \n [ 46 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3981", "text": "Because of the hallyu Korean wave, the nation has seen Korean celebrities as models of physical attractiveness. Also, South Korea's growing cosmetic surgery industry has highlighted the attention its citizens and foreigners alike put on achieving defined standards of beauty. In the last decade, exposing nude torso has become requisite for male talents. [ 47 ]  The fast emergence of good physical physique derives from new strategies among Korea's media industries in shaping consumer desires by foregrounding male sexuality. [ 47 ]  For the women, not only is their body important but also their faces and skins. In this respect, South Korea is similar to the United States, Europe, Japan, China and Southeast Asia."}
{"_id": "WikiPedia_Dermatology$$$corpus_3982", "text": "The global natural skincare product market in 2022 was estimated at US$17.78 billion billion, and is expected to reach US$19.73 billion in 2023. \n [ 48 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3983", "text": "Natural skincare is often associated with clean beauty, which refers to cosmetic products that favor natural ingredients yet often incorporate synthetics that have been deemed safe for people and the planet. Although they go hand in hand, to be specific, natural can be clean, but clean is not always natural. \n [ 49 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3984", "text": "Clean beauty at large encompasses conscious, cruelty-free, vegan, and sustainable packaging, and it is significantly connected to wellness. \n [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3985", "text": "A  kabuki brush , sometimes called  mushroom brush , [ citation needed ]  is a  makeup brush  with dense  bristles  and a short  handle . [ 1 ]  The brush head is usually rounded, though it can also be flat. Traditionally, the bristles are made of natural materials like animal hair, such as from  horses  or  goats , but most modern brushes have synthetic bristles."}
{"_id": "WikiPedia_Dermatology$$$corpus_3986", "text": "The brush is named after  kabuki , a traditional type of Japanese drama theater, in which actors wear heavy makeup painted in dramatic styles ( kumadori ) to emphasize the nature of the characters. Actors use the kabuki brush to apply the white rice powder uniformly on their face."}
{"_id": "WikiPedia_Dermatology$$$corpus_3987", "text": "Usually, a kabuki brush is used to apply loose powdered make-up, such as  foundation ,  face powder , or blush, on large surfaces of the face. Because of its design, the brush blends powdered makeup evenly on the skin and creates natural-looking coverage."}
{"_id": "WikiPedia_Dermatology$$$corpus_3988", "text": "Keratolytic  ( / \u02cc k \u025br \u0259 t o\u028a \u02c8 l \u026a t \u026a k / [ 1 ] [ 2 ] ) therapy is a type of medical treatment to remove  warts ,  calluses  and other lesions in which the  epidermis  produces excess skin. In this therapy,  acidic  topical medicines, such as  Whitfield's ointment  or  Jessner's solution , are applied to the lesion in order to thin the  skin  on and around it. This therapy causes the outer layer of the skin to loosen and shed. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3989", "text": "Keratolytics can also be used to soften  keratin , a major component of the skin.  This serves to improve the skin's moisture binding capacity, which is beneficial in the treatment of dry skin. Such agents (keratolytics) include  alkalis  (by  swelling  and  hydrolysis  of skin),  salicylic acid ,  urea ,  lactic acid ,  allantoin ,  glycolic acid , and  trichloroacetic acid . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3990", "text": "While  cytostatic  agents such as  zinc pyrithione  are first line, keratolytics ( salicylic acid  and  sulfur ) can also be used in the treatment of  dandruff  and  seborrheic dermatitis . [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3991", "text": "Sulfur and salicylic acid can also be used to effectively treat  acne  and  cradle cap  in some patients.  Resorcinol  is another keratolytic that is usually combined with sulfur. [ 4 ]   Urea  acts as a keratolytic due to its  hygroscopic  property."}
{"_id": "WikiPedia_Dermatology$$$corpus_3992", "text": "Lip balm  or  lip salve  is a  wax -like substance applied to the lips to moisturize and relieve  chapped  or dry lips,  angular cheilitis ,  stomatitis , or  cold sores . Lip balm often contains   beeswax  or  carnauba wax ,  camphor ,  cetyl alcohol ,  lanolin ,  paraffin , and  petrolatum , among other ingredients. Some varieties contain dyes, flavor, fragrance,  phenol ,  salicylic acid , and  sunscreen ."}
{"_id": "WikiPedia_Dermatology$$$corpus_3993", "text": "The primary purpose of lip balm is to provide an occlusive layer on the lip surface to seal moisture in lips and protect them from external exposure. Dry air, cold temperatures, and wind all have a drying effect on skin by drawing moisture away from the body. Lips are particularly vulnerable because the skin is so thin, and thus they are often the first to present signs of dryness. Occlusive materials like waxes and  petroleum jelly  prevent moisture loss and maintain lip comfort while flavorings, colorants, sunscreens, and various medicaments can provide additional, specific benefits. Lip balms are produced from bee wax and natural candelilla and carnauba waxes. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3994", "text": "Lip balm can be applied by a finger to the lips, or in a  lipstick -style tube from which it can be applied directly."}
{"_id": "WikiPedia_Dermatology$$$corpus_3995", "text": "In 2022, the global lip balm market was valued at US$732.76 mln. The market is predicted to grow at a rate of 9.28% within the next five years and is likely to reach US$1247.74 mln by 2027. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3996", "text": "Production for lip balms includes the following stages: [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3997", "text": "Since 40 BC, the Egyptians made treatment for lip care, which was made with a mixture of beeswax, olive oil, and animal fat. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3998", "text": "In the 1800s,  Lydia Maria Child  recommended earwax as a treatment for cracked lips in her highly-popular book,  The American Frugal Housewife .  Child observed that, \"Those who are troubled with cracked lips have found this earwax remedy successful when others have failed. It is one of those sorts of cures, which are very likely to be laughed at; but I know of its having produced very beneficial results.\" [ 5 ]  The invention of the lip balm was first formally invented in the 1880s by physician  Charles Brown Fleet [ 6 ]  though its origins may be traced to  earwax . [ 7 ]  Fleet later named his lip balm product \" ChapStick \". [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_3999", "text": "In 1872, chemist  Robert Chesebrough  discovered and sampled a new petroleum jelly, initially describing it as a \"natural, waxy ingredient, rich in minerals from deep within the earth\" which could be used as a solution for skin repair. He then distributed his product under the name \"Wonder Jelly\" before shortly changing it to \"Vaseline\". [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4000", "text": "In the early 1880s, Charles Brown Fleet created ChapStick. [ 8 ]  However, due to the lack of sales, Fleet sold his formula and rights to ChapStick to John Morton in 1912 for $5, who saw the marketing potential in the brand. [ 4 ]  After making the purchase, Morton commissioned Frank Wright, Jr. to create a design for the logo of ChapStick for $15 in 1936. [ 4 ]  In 1972, ChapStick tubes concealing hidden microphones were used during the  Watergate scandal . [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4001", "text": "In 1937, Alfred Woelbing created  Carmex  to treat cold sores in Milwaukee, though the occurrence of  World War 2  would slow the production and sales due to the lack of  lanolin . In 1980, Carmex underwent a product change by converting its packaging into squeezable tubes. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4002", "text": "In 1973,  Bonne Bell  created the first flavored lip balm and marketed the company as Lip Smackers. The company would later collaborate on various different-flavored lip balms including  Dr. Pepper  in 1975,  The Wrigley Company  in 2004, and  The Coca-Cola Company  in 2006. Bonne Bell also collaborated with  Disney  to produce lip balms with various princess characters in 2010. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4003", "text": "In 1991, Burt Shavitz and Roxanne Quimby created their first beeswax based lip balm solution through their company,  Burt's Bees . [ 13 ]  In 2020, it was reported that Burt's Bees had used 50 percent of recycled material to package various products and that 100 percent of the products were recyclable. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4004", "text": "In 2011,  Evolution of Smooth  (or commonly known as EOS) created a spherical-shaped lip balm as well as describing its 95% organic ingredients. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4005", "text": "With the gradual legalization of cannabis in the United States, some companies have produced lip balms containing doses of  THC  or  CBD  oil. The lip balms were infused with a low dosage of THC in order to prevent the occurrence of any psychoactive or related effect.  [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4006", "text": "According to a report, professor Brad Rohu states that it is natural for the lips to feel dry. [ 15 ]  The exposure to environments with cold, dry, or windy weather can directly cause the chapping of the lips as well as behaviors such as lip licking or  mouth breathing . [ 16 ]  These factors may directly contribute to an increased amount of lip balm usage. According to dermatologist Amy Derick, those who have expressed dependencies on lip balm have developed a desire of how the lips feel after application. She also mentions that the variety of lip balm flavor may also directly cause lip balm dependency as a person may want to lick their lips to taste the flavor, which may consequentially remove the lip balm coating from the lips. This may also leave saliva on the lips which can dry up and make the lips feel even more dry than they initially were. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4007", "text": "Some physicians have suggested that certain types of lip balm can be addictive or contain ingredients that actually cause drying, [ 18 ]  though, it has been debated by many professionals. Lip balm manufacturers sometimes state in their FAQs that there is nothing addictive in their products or that all ingredients are listed and approved by the  FDA .  Snopes  found the claim that there are substances in  Carmex  that are irritants necessitating reapplication, such as ground glass, to be false. [ 19 ]  However, some experts such as dermatologist Dr. Cynthia Bailey state that some ingredients in lip balm directly causes sensitive lip skin which may lead to addiction. [ 20 ]  Dermatology professor Marcia Driscoll also adds onto this argument by stating that aroma ingredients found in flavored or scented lip balms have the potential to irritate skin. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4008", "text": "The human lips have an inadequate capability of holding moisture as well as an imperfect lip barrier function. [ 22 ]  The  Journal of the American Academy of Dermatology  performed a study in order to determine whether consistent use of lip balm would enhance the overall quality of the lips. The study used 32 female participants within the ages of 20 to 40 years and the participants had mild to moderate dried lips without any history of health-related complications. The participants underwent a procedure in which no lip treatment was provided on the first 3 days, then 2 weeks of consistent lip balm usage, and then a period of no treatment for 3 days. The study determined the quality of the lips based on the physical details and appearance throughout the study. The study showed a direct improvement of the physical details of the lips except for lip cracking during the second week of treatment and after the period of no treatment. The study also showed that hydration of the lips lasted for approximately 8 hours after usage and the lip balm improved the lip barrier function despite discontinued usage. The study concluded that lip balms assist the hydration of the lips which consequentially improves the lip barrier function and the quality. [ 23 ]  This study was completely funded by  Burt's Bees , a lip balm company."}
{"_id": "WikiPedia_Dermatology$$$corpus_4009", "text": "In 2015, German consumer watchdog  Stiftung Warentest  analyzed cosmetics containing mineral oils. After developing a new detection method they found high concentrations of Mineral Oil Aromatic Hydrocarbons (MOAH) and even polyaromatics in products containing mineral oils with Vaseline products containing the most MOAH of all tested cosmetics (up to 9%). [ 24 ]  The  European Food Safety Authority  sees MOAH and polyaromatics as possibly carcinogenic. [ 24 ]  Based on the results, Stiftung Warentest warns not to use Vaseline or any product that is based on mineral oils for lip care."}
{"_id": "WikiPedia_Dermatology$$$corpus_4010", "text": "In 2019, a research report conducted by the  Statista Research Department  concluded that ChapStick was the leading lip balm brand in the United States with an approximate unit sale of 55.8 million. Carmex was the second leading brand with approximately 35.2 million units sold and Burt's Bees being the third leading brand with approximately 32.3 million units sold. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4011", "text": "Beezin' is a trend dating back to 2013 in which a person applies  Burt's Bees  brand lip balm onto the eyelids. [ 26 ]  The practice is done in order to feel a sensation of being high or drunk, and even to increase the desired effects of alcohol and other substances. [ 27 ]  In 2022, Beezin' became a viral trend on the social media platform  TikTok . [ 28 ]  Some ingredients, including peppermint oil, are known to be eye irritants which can cause an unintentional inflammatory response which may require treatment and may also cause dermatitis on the eyelids. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4012", "text": "Liquid bandage  is a topical skin treatment for minor wounds which binds to the  skin  to form a protective  polymeric  layer that keeps dirt and germs out and moisture in. [ 1 ]  It can be directly applied to the wound after removing debris."}
{"_id": "WikiPedia_Dermatology$$$corpus_4013", "text": "For the fast-acting, reactive adhesive that is used to mend deep cuts or surgery wounds, see  cyanoacrylates  (specifically  2-Octyl cyanoacrylate )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4014", "text": "Liquid bandage is typically a  polymer  dissolved in a solvent (commonly water or an alcohol), sometimes with an added  antiseptic  and  local anesthetic , although the alcohol in some brands may serve the same purpose. [ 1 ]  These products protect the wound by forming a thin film of polymer when the carrier evaporates. [ 1 ]  Polymers used may include  polyvinylpyrrolidone  (water based), ethyl cellulose,  pyroxylin / nitrocellulose  or poly(methylacrylate-isobutene-monoisopropylmaleate) (alcohol based), and  acrylate  or  siloxane  polymers ( hexamethyldisiloxane  or  isooctane  solvent based). [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4015", "text": "In addition to their use in replacing conventional  bandages  in minor cuts  and scrapes, they have found use in surgical and veterinary offices. [ 1 ]  Liquid bandages are increasingly finding use in the field of combat, where they can be used to rapidly stanch a wound until proper medical attention can be obtained. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4016", "text": "Liquid bandages are suitable for clean cuts that close easily and shallow small wounds, as it will help both sides of the wound to bond and produce a  suture -like effect. Due to the drying of liquid wound dressing, it will form a nonelastic film on the wound and cannot absorb  tissue fluid . If the wound area is too large, it will actually hinder wound shrinkage and healing."}
{"_id": "WikiPedia_Dermatology$$$corpus_4017", "text": "It's not recommended for use on large wounds, abrasion patches, ulcers,  suppuration , burns, sensitive skin areas around the eyes,  mucosa , and patients with  favism ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4018", "text": "Lotion  is a low- viscosity  topical preparation intended for application to the  skin . By contrast,  creams  and  gels  have higher viscosity, typically due to lower water content. [ 1 ] [ 2 ]   Lotions are applied to external skin with bare hands, a brush, a clean cloth, or  cotton wool ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4019", "text": "While a lotion may be used as a medicine delivery system, many lotions, especially  hand lotions  and  body lotions  and lotion for  allergies  are meant instead to simply smooth, moisturize, soften and, sometimes, perfume the skin. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4020", "text": "Some skincare products, such as  sunscreen  and  moisturizer , may be available in multiple formats, such as lotions, gels, creams, or sprays."}
{"_id": "WikiPedia_Dermatology$$$corpus_4021", "text": "Dermatologists can prescribe lotions to treat or prevent skin diseases. [ 1 ]  It is not unusual for the same drug ingredient to be formulated into a lotion,  cream  and  ointment . Creams are the most convenient of the three but inappropriate for application to regions of hairy skin such as the scalp, while a lotion is less viscous and may be readily applied to these areas (many medicated  shampoos  are in fact lotions). Historically, lotions also had an advantage in that they may be spread thinly compared to a cream or ointment and may economically cover a large area of skin, but product research has steadily eroded this distinction.  Non-comedogenic  lotions are recommended for use on acne prone skin. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4022", "text": "Lotions can be used for the delivery to the skin of medications such as:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4023", "text": "Since health care workers must wash their hands frequently to prevent disease transmission, hospital-grade lotion is recommended to prevent skin  dermatitis  caused by frequent exposure to cleaning agents in the soap. [ 5 ]  A 2006 study found that application of hospital-grade lotion after hand washing significantly reduced skin roughness and dryness. [ 6 ] [ failed verification ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4024", "text": "Care must be taken not to use consumer lotions in a hospital environment, as the  perfumes  and  allergens  may be a danger to those who are immunodeficient or with allergies. [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4025", "text": "Most cosmetic lotions are  moisturizing lotions , although other forms, such as  tanning lotion , also exist."}
{"_id": "WikiPedia_Dermatology$$$corpus_4026", "text": "Cosmetic lotions may be marketed as anti-aging lotions, which can also be classified as a cosmetic in many cases, and may contain fragrances. The  Food and Drug Administration  voiced concern about lotions not classified as drugs that advertise anti-aging or anti-wrinkle properties. [ 7 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4027", "text": "Most lotions are oil-in-water  emulsions  using a substance such as  cetearyl alcohol  to keep the emulsion together, but water-in-oil lotions are also formulated. The key components of a skin care lotion, cream or gel emulsion (that is mixtures of oil and water) are the  aqueous  and oily phases, an  emulsifier  to prevent separation of these two phases, and, if used, the  drug  substance or substances. Various other ingredients such as  fragrances ,  glycerol ,  petroleum jelly ,  dyes ,  preservatives ,  proteins  and stabilizing agents are commonly added to lotions."}
{"_id": "WikiPedia_Dermatology$$$corpus_4028", "text": "Manufacturing lotions and creams can be completed in two cycles:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4029", "text": "A typical oil-in-water manufacturing process may be:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4030", "text": "Depending on their composition, lotions can be comedogenic, meaning that they can result in the increased formation of  comedones  (clogged hair follicles). [ 10 ]  People who are prone to  acne  or forming comedones often prefer lotions that are designed to be non-comedogenic (not causing outbreaks). [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4031", "text": "All topical products, including lotions, can result in the  percutaneous (through the skin) absorption  of their ingredients. Though this has some use as a route of drug administration, it more commonly results in unintended  side effects . For example, medicated lotions such as  diprolene  are often used with the intention of exerting only  local effects , but absorption of the drug through the skin can occur to a small degree, resulting in systemic side effects such as  hyperglycemia  and  glycosuria . [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4032", "text": "Absorption through the skin is increased when lotions are applied and then covered with an  occlusive  layer, when they are applied to large areas of the body, or when they are applied to damaged or broken skin. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4033", "text": "Lotions containing some aromas or food additives may trigger an immune reaction or even cause users to develop new allergies. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4034", "text": "There is currently no regulation over use of the term \"hypoallergenic\", and even pediatric skin products with the label were found to still contain allergens. [ 13 ]  Those with  eczema  are especially vulnerable to an allergic reaction with lotion, as their compromised skin barrier allows preservatives to bind with and activate immune cells. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4035", "text": "The  American Academy of Allergy, Asthma, and Immunology  released a warning in 2014 that natural lotion containing ingredients commonly found in food (such as goats milk, cow's milk, coconut milk, or oil) may introduce new allergies, and an allergic reaction when those foods are later consumed. [ 12 ]  A 2021 study found that \"frequent skin moisturization in early life might promote the development of food allergy, most likely through transcutaneous sensitization\". [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4036", "text": "A  makeup brush  is a tool with  bristles , used for the application of  makeup  or  face painting . The bristles may be made out of natural or synthetic materials, while the handle is usually made out of plastic or wood. When cosmetics are applied using the appropriate brush, they blend better onto the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_4037", "text": "There is a large variety of shapes and sizes of makeup brushes, depending on the face area where makeup will be applied, the cosmetic product and the wanted result. For example, the shape of the brush tip can be chiseled, straight, angular, round, flat or tapered."}
{"_id": "WikiPedia_Dermatology$$$corpus_4038", "text": "Makeup application can alter due to the materials used to create a brush. The bristles of a makeup brush can either be synthetic or natural. In the application of the makeup, the brush itself is important because it can determine how the product is applied: depending on the makeup brush type and its bristles, it could either densely pack or loosely apply the makeup product."}
{"_id": "WikiPedia_Dermatology$$$corpus_4039", "text": "Synthetic bristles are the most common material used in makeup brushes. These brushes are widely found in drugstores and makeup-specific stores. The bristles are made out of plastic,  nylon , or other synthetic fibers, and may be dyed. [ 9 ]  Synthetic bristles are often used with liquid and cream products, as they tend to blend out products more easily and will not absorb product as much as a natural bristle brush. [ 10 ]  Synthetic brushes are cruelty-free. Synthetic brushes usually last longer than natural haired bristles as they do not degrade and are not as fragile."}
{"_id": "WikiPedia_Dermatology$$$corpus_4040", "text": "The natural bristles are often dark in color, not super soft, sheds, hold pigments better and difficult to wash. As the natural bristles are very porous they pick up more pigments and distributes them evenly. The natural bristled brushes best applies powder products and it is best to avoid liquid or cream products as they will drink up most of the products. Although natural bristles are more preferred in the cosmetic industry, the bristles themselves can cause allergic reactions to the animal hair. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4041", "text": "Natural bristles may more easily control the product when blending out or even packing on a product, because they have hair cuticles."}
{"_id": "WikiPedia_Dermatology$$$corpus_4042", "text": "Masonjoany  ( Malagasy pronunciation:   [masund\u0361zuan\u02b2] ) (or  msindanu  or  msindzano  in  Comoros  and  Mayotte ) [ a ]  is a  cosmetic  paste and  sunscreen  made of ground wood. It is worn as a protective and decorative mask by women and girls in  Madagascar ,  Comoros , and  Mayotte . In Madagascar, the paste has yellow and white forms, with yellow masonjoany being derived from the wood of the tab\u00e0ky or Madagascar sandalwood ( Coptosperma  madagascarensis ), and white masonjoany deriving from the wood of the aviavy or fihamy tree ( Ficus  grevei ). [ 2 ]  In Comoros, the most commonly used tree for msindzano is  Indian sandalwood  ( Santalum album ), producing a \"canary yellow\" paste. [ 3 ] [ 4 ]  The wood is ground against a surface of ceramic, stone, or  coral  skeleton, and combined with water and oil to make the paste. [ 5 ] [ 6 ]  The practice in Madagascar originates from  cultural exchange  in  Nosy Be  between  Malagasy  natives and  Indian  merchants, who first arrived to the island in the 11th century CE. [ 7 ] [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4043", "text": "Masonjoany is both protective and decorative: women wear it as  sunscreen  and  insect repellent , and sometimes paint it in natural and abstract designs with a mix of contrasting white and yellow pastes. Common motifs in decorative masonjoany include flowers, stars, and leaves. [ 7 ]  Other benefits associated with masonjoany in Madagascar include anti-aging, eliminating skin impurities, and cleansing the skin. Other benefits ascribed in Comoros include the  lightening of skin  as well as treatment of medical ailments like  eczema ,  acne , and  allergies . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4044", "text": "Masonjoany in Madagascar is also worn for  religious rituals  and beauty pageants. Molecular biologist Gianfranco Rasuelo reported that a Malagasy woman he had met on the street had told him that yellow masonjoany was spread on the faces of widows in mourning, but noted that this information is apocryphal. [ 5 ]  The paste is typical of Madagascar's  Northwestern coastal region , particularly by  Sakalava  and  Vezo  women in the provinces of  Nosy Be ,  Antsiranana , and  Toliara \u2014though it has spread throughout the island and can now be found adorning women's faces as far as the  Central Highlands . [ 5 ]  Sakalava women wear yellow masonjoany when performing the  Kahoitry  ritual dance. [ 10 ]  The mask is ubiquitous throughout Mayotte, and is common, though waning in popularity, in Comoros. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4045", "text": "A  moisturizer , or  emollient , [ 1 ]  is a  cosmetic preparation  used for protecting, moisturizing, and lubricating the  skin . These functions are normally performed by  sebum  produced by healthy skin. [ 2 ]  The word \"emollient\" is derived from the Latin verb  mollire , to soften. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4046", "text": "In the human body, water constantly evaporates from the deeper layers of the skin through an effect known as  transepidermal water loss . By regulating its water content, human skin naturally maintains a dry, easily shed surface as a  barrier  against pathogens, dirt, or damage, while protecting itself from drying out and becoming brittle and rigid. The ability to retain moisture depends on the  lipid bilayer  between the  dead skin cells . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4047", "text": "Moisturizers modify the rate of water loss, with active ingredients of moisturizers falling into one of two categories: occlusives and  humectants . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4048", "text": "Occlusives  form a hydrophobic coating on the surface of the skin, keeping moisture from escaping. The more occlusive the formulation, the greater the effect.  Ointments  are more occlusive than  aqueous creams , which are more occlusive than  lotion . [ 5 ]  Water loss through the skin is normally about 4\u20138 g/(m 2 \u22c5h). A layer of  petrolatum  applied to normal skin can reduce that loss by 50\u201375% for several hours. [ 4 ]  Oils naturally produced by the human body moisturize through this same mechanism. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4049", "text": "Humectants  are hydrophilic and absorb water. They absorb water from humid air (when >70% humidity) to moisturize the skin. More commonly, however, they draw out water from the dermis into the epidermis, making deeper skin dryer. [ 6 ]  When used in practical applications, humectants are combined with occlusives. [ 7 ]  Moisturizers commonly contain water, which acts as a temporary hydration agent. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4050", "text": "There are many different types of moisturizers.  Petrolatum  is one of the most effective moisturizers, although it can be unpopular due to its oily consistency. [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4051", "text": "Other popular moisturizers are  cetyl alcohol ,  cetearyl alcohol ,  cocoa butter ,  isopropyl myristate ,  isopropyl palmitate ,  lanolin ,  liquid paraffin ,  polyethylene glycols ,  shea butter ,  silicone oils ,  stearic acid ,  stearyl alcohol  and  castor oil , and other oils."}
{"_id": "WikiPedia_Dermatology$$$corpus_4052", "text": "Moisturizers may also be available as  lotions ,  creams ,  ointments ,  bath oils , or  soap substitutes ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4053", "text": "Mineral oils and waxes are not prone to  oxidation  or  rancidity . [ 11 ]  For this reason, they have essentially replaced  vegetable oils  in emollients and topical medication."}
{"_id": "WikiPedia_Dermatology$$$corpus_4054", "text": "Moisturizer cosmetics may additionally contain  antioxidants ,  ceramides ,  emulsifiers ,  fragrances ,  penetration enhancers ,  preservatives , and  solvents . Some products are marketed as having anti-wrinkle and skin enhancement effects. Many plant and animal extracts have been claimed to impart skin benefits, but such claims are presented with little scientific evidence."}
{"_id": "WikiPedia_Dermatology$$$corpus_4055", "text": "Moisturizers are used for the treatment of certain skin diseases, such as  psoriasis ,  ichthyosis vulgaris ,  xerosis , and  pruritus  in  atopic dermatitis . More often, they are bases or vehicles for  topical medication , such as in  Whitfield's ointment . They are often combined with humectants, such as  salicylic acid  and  urea . [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4056", "text": "Moisturizers are also widely used in  sunscreens ,  antiperspirants ,  skin cleansers ,  shaving creams ,  aftershaves , and  hair tonics ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4057", "text": "Moisturizers are used in  disposable diapers  to prevent dry skin and  diaper dermatitis ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4058", "text": "Moisturizers show some beneficial effects in treating  atopic dermatitis  (eczema). Using moisturizers helps to improve skin comfort and may reduce disease flares. [ 13 ] [ 14 ]  They can be used as leave-on treatments, bath additives, or  soap substitutes . There are many different moisturizer products, but the majority of leave-on treatments (from least to most greasy) are one of the following: lotions, creams, gels, or ointments. As none of the different types of moisturizers are more effective than the others, people with atopic dermatitis need to choose one or more products according to their age, affected body site, climate/season, and personal preference. [ 15 ] [ 14 ]  However using moisturizers daily in infants during the first year of life does not help to prevent the development of atopic dermatitis, and might even increase the risk of skin infections. [ 16 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4059", "text": "Persistent moisturization to the skin via water contact may contribute to an allergic reaction or contact dermatitis. [ citation needed ]  This could allow foreign objects to penetrate the skin. [ ambiguous ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4060", "text": "Changes in the skin's normal ecological environment\u2013either atop or within the skin\u2013can also allow for the overgrowth of pathogens. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4061", "text": "Aromas or food additives in moisturizers may trigger an immune reaction, including development of an allergy. [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4062", "text": "There is currently no regulation over use of the term \"hypoallergenic\". In fact, some pediatric skin products marketed as hypoallergenic contained allergens. [ 20 ] [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4063", "text": "Those with  eczema  are especially vulnerable to allergic reaction with lotions and creams, as their compromised skin barrier allows preservatives to bind with and activate immune cells. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4064", "text": "The  American Academy of Allergy, Asthma, and Immunology  released a warning in 2014 that natural lotion containing ingredients commonly found in food (such as goats milk, cow's milk, coconut milk, or oil) may introduce new allergies, potentially causing an allergic reaction upon later consuming such foods. [ 18 ]  A paper published in 2021 noted that frequent skin moisturization in early life might promote the development of food allergy, even when skin conditions such as eczema are taken into account. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4065", "text": "Paraffin-based skincare products and contaminated clothing can pose a serious fire hazard. [ 23 ]  Between 2010 and 2018, paraffin was linked to 50 fire incidents (49 of which were fatal) in the U.K. [ 24 ]  A West Yorkshire Fire and Rescue Service study found that clothing contaminated with cream containing only 21% paraffin, when set alight, was fully engulfed in flame in 3 seconds. [ 23 ]  The  Medicines and Healthcare products Regulatory Agency  (MHRA) released a warning in 2008 about the flammability of paraffin-based products. [ 25 ]  MHRA recommends that regular paraffin users change their sheets regularly, refrain from smoking and/or bringing open flames near paraffin-coated people or objects. [ 26 ]  MHRA also recommends that skin creams containing any paraffin have a flammability warning on the packaging. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4066", "text": "Natural skin care  uses topical creams and lotions made of ingredients available in nature. [ 1 ]  Much of the recent literature reviews plant-derived ingredients, which may include  herbs ,  roots ,  flowers  and  essential oils , [ 2 ] [ 3 ] [ 4 ]  but natural substances in skin care products include animal-derived products such as  beeswax , and minerals. These substances may be combined with various carrier agents,  preservatives ,  surfactants ,  humectants  and  emulsifiers . [ 5 ] :\u200a5\u20138"}
{"_id": "WikiPedia_Dermatology$$$corpus_4067", "text": "There are no legal definitions in the U.S. for advertising terms \"natural\" or \"organic\" when applied to personal care products. [ 6 ]  Consumers often express a preference for skin products with organic and natural ingredients. [ 1 ]   The personal skin care market based on natural products has shown strong growth. [ 7 ]  Clinical and laboratory studies have identified activities in many natural ingredients that have potential beneficial activities for personal skin care, [ 2 ] [ 3 ]  but there is a shortage of convincing evidence for natural product efficacy in medical problems. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4068", "text": "Some natural products and therapies may be harmful, either to the skin or systemically. [ 4 ] [ 8 ] [ 9 ]  People prone to allergies should pay careful attention to what they use on their skin. Dermatologists may feel that there is enough scientific evidence to assist in the selection or avoidance of particular natural ingredients. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4069", "text": "Many countries require that the ingredient composition of skin care products is listed on the product, using the  International Nomenclature of Cosmetic Ingredients  (INCI) conventions. [ 5 ] :\u200a4\u200a  Ingredients are listed in the order of their percentage within the product; natural ingredients are listed in Latin and synthetic ingredients are listed by technical name. [ 5 ] :\u200a4\u200a  \"The U.S. government has documented more than 10,500 ingredients in cosmetic products, but only a small percentage of those chemicals have been tested for safety. Of those that have been tested, some have been identified as carcinogens (causes cancer), teratogens (causes birth defects), and reproductive toxicants (damages the ability to reproduce).\" [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4070", "text": "The FDA surveyed 1,687 consumers ages 14 and older in 1994 about their use of cosmetics. [ 11 ]  Nearly half of these consumers felt that a product claiming to be \"natural\" should contain all natural ingredients. [ 11 ]  However, although the United States Department of Agriculture (USDA) has designated within its certain requirements within its specific area of regulation for organic products, [ 1 ]  the U.S.  Food and Drug Administration  (FDA) does not recognize a definition for natural products. [ 1 ]  Accordingly, there are no legal definitions in the U.S. for the advertising terms \"natural\" or \"organic\" in personal care products. [ 6 ]  The FDA prohibits certain ingredients in cosmetics. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4071", "text": "Some organic products which are designated organic may be intensely modified, sometimes considerably more so than conventional products. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4072", "text": "Plant extracts and herbs have been used by many cultures as cosmetics and perfumes since ancient times. [ 2 ] [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4073", "text": "Research is scientifically assessing natural products, selected based on experience in the ancient era. [ 15 ] [ 16 ]  Validated use of these materials and products awaits further assessment. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4074", "text": "Consumers often express a preference for skin products with organic and natural ingredients. [ 1 ]  The skin care market based on natural products has shown strong growth. [ 7 ]  Clinical and laboratory studies have identified activities in many natural ingredients that have potential beneficial activities for the skin. [ 2 ] [ 3 ]  Dermatologists may feel that there is enough scientific evidence to assist in the selection of particular natural ingredients. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4075", "text": "Consumers expected products to perform as advertised. [ 11 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4076", "text": "Voluntary discontinuation of precursor substances that release small quantities of formaldehyde, which is a carcinogen, as well as reducing levels of the potentially carcinogenic impurity 1,4-dioxane. [ 6 ]  Polycyclic musk fragrance ingredients, which have raised concerns as persistent and bioaccumulative endocrine disruptors, are being discontinued. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4077", "text": "There are significant reservations about complementary and alternative medicine (CAM) [ 18 ] [ 19 ]  including a \"shortage of evidence supporting the efficacy and safety of CAM\" for skin problems. [ 8 ]  However, patients express a desire to utilize natural ingredients as treatment. [ 1 ]  A literature search found a growing prevalence of CAM use for skin conditions. [ 8 ]  A number of textbooks address CAM perspectives of skin care. [ 20 ] [ 21 ]  The purpose of this section is to review botanical compounds in skin care; a broader review the history and theory behind other CAM modalities such as psychocutaneous therapies, acupuncture and homeopathy can be found in recent reviews. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4078", "text": "The plant monographs with dermatological relevance of the former German Commission E have recently been reviewed. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4079", "text": "According to Baumann, \"Botanical compounds for which dermatologic and cosmetic applications have emerged include: olive oil, chamomile,   colloidal oatmeal , oat kernel extract,  feverfew ,  acai berry ,  coffee berry ,  curcumin , green tea, pomegranate,  licorice ,  paper mulberry ,  arbutin , and soy. [ 3 ]  \"Many of these botanical sources offer biologically active components that require further in vitro and in vivo investigation\". [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4080", "text": "A review of 35 plant  families  found that a \"variety of phytomolecules, derived in particular from polyphenols, triterpenes and sterols classes, demonstrated a promising activity.\" [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4081", "text": "Colloidal oatmeal may be beneficial in psoriasis. Aloe vera may help in atopic dermatitis. In both these conditions, the benefit may arise from anti-inflammatory properties. \"For combating acne and rosacea, green tea, niacinamide and feverfew are considered efficacious. For  hyperpigmentation  and antioxidative capabilities, licorice, green tea, arbutin, soy, acai berry, turmeric and pomegranate are among those plants and compounds found to be most beneficial. Additional research is needed to determine to confirm and elucidate the benefits of these ingredients in the prevention and management of skin disease.\" [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4082", "text": "An assessment of clinical trials on green tea preparations and their uses in dermatology found some evidence for potential benefits. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4083", "text": "Ayurvedic  skincare is derived from medicinal practices that began over 5,000-years ago in India. [ 24 ]  Ayurvedic medicine and healing practices are based on Indian philosophical, psychological, conventional, and medicinal understandings. \nMost of the ayurvedic skincare products contain the following herbs\u2014aloe vera, almond, avocado, carrot, castor, clay, cocoa, coconut oil, cornmeal, cucumber, cutch tree, emu oil, ginkgo biloba, ginseng, grape seed oil, ground almond and walnut shell, horse chestnut, witch hazel, and honey. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4084", "text": "Ayurvedic approaches have been used in  molluscum contagiosum , [ 25 ]   lymphatic filariasis ,  vitiligo  and  lichen planus . [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4085", "text": "Phyllanthus emblica  (amla, Indian gooseberry) has been used in ayurvedic medicine. [ 26 ]  Standardized extracts of Phyllanthus emblica have a long-lasting and broad-spectrum antioxidant activity. [ 27 ]  This may be suitable for use in  Anti-aging cream , sunscreen and general purpose skin care products. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4086", "text": "Natural skin care ingredients include  jojoba ,  safflower oil ,  rose hip seed oil ,  shea butter ,  beeswax ,  witch hazel ,  aloe vera ,  tea tree oil , coconut oil, and chamomile."}
{"_id": "WikiPedia_Dermatology$$$corpus_4087", "text": "Dermatological research suggests that the bioactive ingredients used in cosmeceuticals have benefits beyond the traditional moisturizer (e.g., Chen et al., 2005; [ 36 ]  Zettersten, Ghadially, Feingold, Crumrine, & Elias, 1997). [ 37 ]  However, despite reports of benefits from some cosmeceutical products, there are no formal requirements to prove that these products live up to their claims."}
{"_id": "WikiPedia_Dermatology$$$corpus_4088", "text": "Biocompatible and environmentally friendly natural compounds have the potential to provide materials with photoresistant and thermoresistant properties. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4089", "text": "Dehydroabietic acid (DAA), a naturally occurring  diterpene  resin acid, \"has lifespan extension effects in  Caenorhabditis elegans , prevents lipofuscin accumulation, and prevents  collagen  secretion in human dermal fibroblasts. We found that these anti-aging effects are primarily mediated by  SIRT1  activation.\" DAA may activate SIRT1 enzymatic activity, which may have a preventive effect against the aging process. [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4090", "text": "Validated use of these materials and products awaits further assessment. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4091", "text": "Cosmeceuticals  are topically applied, combination products that bring together  cosmetics  and \"biologically active ingredients\". Products which are similar in perceived benefits but ingested orally are known as  nutricosmetics . According to the  United States Food and Drug Administration  (FDA), the  Food, Drug, and Cosmetic Act  \"does not recognize any such category as \"cosmeceuticals\". A product can be a drug, a cosmetic, or a combination of both, but the term \" cosmeceutical \" has no meaning under the law\". Drugs are subject to an intensive review and approval process by FDA. Cosmetics, and these related products, although regulated, are not approved by FDA prior to sale. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4092", "text": "Some alternative and natural products and therapies may be harmful, either to the skin or systemically. [ 4 ] [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4093", "text": "The FDA recommends understanding the ingredient label and says \"There is no list of ingredients that can be guaranteed not to cause allergic reactions, so consumers who are prone to allergies should pay careful attention to what they use on their skin\", further warning that \"[t]here is no basis in fact or scientific legitimacy to the notion that products containing natural ingredients are good for the skin\". Food preservatives are commonly used to preserve the safety and efficacy in these products. Alternative remedies may increase the prevalence of  eczema . [ 9 ]  Bhuchar recommends that \"ingestible substances including most homeopathic, Ayurvedic, and traditional Chinese medicine herbal formulations that are not US FDA regulated should be viewed with caution as they may cause severe adverse effects\" such as  arsenic poisoning  and  liver failure .\" [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4094", "text": "Given the shortage of evidence for natural skin care efficacy, if applied it may often need to be used in combination with conventional treatment, rather than independently. [ 8 ]  In fact, a recent 2022 study found that nearly all skin products that have the label \"natural\" actually contained ingredients that triggered contact dermatitis. The study looked at nearly 1,700 products.  [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4095", "text": "According to Bhuchar, there is a consensus in the literature that dermatologists need more information about CAM. [ 8 ]  Wu advises that \"dermatologists should be aware of what patients may be using and be able to advise them about the efficacy of these ingredients or the potential for adverse effects\". [ 41 ]  Many patients fail to inform their physicians about their use of herbal ingredients. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4096", "text": "Officine Universelle Buly 1803  is a French company formed in 2014 by  Ramdane Touhami  and Victoire de Taillac-Touhami. Entrepreneur Jean-Vincent Bully sold perfume products in the early 19th century on  rue Saint-Honore  in  Paris . This brand would then be reinvigorated by Touhami. It is headquartered in Paris, France, and has had more than 25 stores around the globe and counting, the brand sells perfumes, scented candles, soaps, plant oils, and other beauty products for body, [ 1 ]  face and hair, as well as accessories."}
{"_id": "WikiPedia_Dermatology$$$corpus_4097", "text": "At the beginning of the 19th century, a distiller, perfumer and cosmetician, Claude Bully, invented a vinaigre de toilette, [ 2 ]  a vinegar-based fragrance designed to fight body odours, cure disease, and nourish the skin, which later influenced the perfume industry and popular beauty care sector."}
{"_id": "WikiPedia_Dermatology$$$corpus_4098", "text": "His son, Jean-Vincent Bully, [ 3 ]  sought validation from doctors and scientists, bringing further recognition to the brand, and the vinegar based product was granted two patents in 1809, and a second for a revised product in 1814. Bully showcased products at the 1823, 1827, and 1849  World's Fairs , and at the 1851  Great Exhibition  in London. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4099", "text": "Bully lost his shop due to a riot during a period of revolution, and then had to sell his business \"for a trifling sum\", [ 5 ]  after which the perfumer died in poverty."}
{"_id": "WikiPedia_Dermatology$$$corpus_4100", "text": "The protagonist Cesar in the 1837 novel  C\u00e9sar Birotteau  by  Balzac , was influenced by Jean Bully, reflected his fame during the 19th century."}
{"_id": "WikiPedia_Dermatology$$$corpus_4101", "text": "In the summer of 1937,  Le Figaro  mentioned in its Beauty section: \"Don't forget to buy a bottle of \u2026 Bully vinegar, the object of world renowned for nearly a century.\""}
{"_id": "WikiPedia_Dermatology$$$corpus_4102", "text": "The product \"Vinagre Aromatico Tipo de Bully\" with the same formula concocted by Bully continued to exist in  Latin America  due to international licensing; the work of the Bully family had endured long after the end of Jean Bully's company, although outside the borders of France."}
{"_id": "WikiPedia_Dermatology$$$corpus_4103", "text": "Reinvigorated by Ramdane Touhami and Victoire de Taillac-Touhami, the brand was revived as 'Officine Universelle Buly', or 'Buly 1803' in 2014. [ 6 ] [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4104", "text": "The first Buly shop was established in 2014, [ 9 ]  at 6  rue Bonaparte  in Paris, [ 10 ]  and has seen a fast expansion around the world ever since. As of March 2021, Buly 1803 has 25 shops globally, in cities such as Paris, [ 11 ]   Hong Kong , [ 12 ]   New York , [ 13 ]   San Francisco ,  London ,  Tokyo , [ 14 ] [ 15 ]   Kyoto ,  Osaka ,  Seoul  and  Taipei ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4105", "text": "Officine Universelle Buly was acquired by the multi-national  LVMH  in October 2021. [ 16 ]  The company is managed by the duo Ramdane Touhami, the manager, and Victoire de Taillac-Touhami, the head of communication and the spokesperson. The brand now operates in 7 countries in the world and is rapidly expanding."}
{"_id": "WikiPedia_Dermatology$$$corpus_4106", "text": "Officine Universelle Buly carries a wide range of beauty products for body, face, hair and home, [ 17 ]  with more than 800 variants amassed from around the world. Most of them bear a traditional French name [ 18 ]  honoring its commitment to old beauty recipes but combined with innovative cosmetic techniques, such as eau triple, the brand\u2019s water-based perfume, containing 0 alcohol. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4107", "text": "2019 has seen an unprecedented collaboration between the  Louvre  museum and Officine Universelle Buly, [ 20 ] [ 21 ] [ 22 ] [ 23 ] [ 24 ] [ 25 ] [ 26 ]  with eight perfumers each selecting eight art pieces as an inspiration for eight new fragrances, [ 27 ]  namely:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4108", "text": "Some of the scents are also available in candles, postcards, as well as soap sheets. [ 30 ] [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4109", "text": "The  oil cleansing method , often abbreviated as  OCM , is a system for cleaning the human body. It is sometimes used for treating acne. [ 1 ]  Sometimes, oils can be mixed; one example is 50%  extra virgin olive oil  and 50%  castor oil . [ 2 ]  This mixture can be optimized based on  skin type  and personal preference."}
{"_id": "WikiPedia_Dermatology$$$corpus_4110", "text": "In accordance with skin type variations,  castor oil  may be too harsh in some skin-care regimens and is sometimes used in a 1:9 ratio. However, overly oily skin can make use of a larger proportion of castor oil. [ 2 ] [ 3 ]  Other oils that are commonly used are  jojoba oil ,  sweet almond oil ,  coconut oil ,  argan oil ,  rosehip oil ,  sunflower oil ,  safflower  oil, and  grapeseed oil . [ 3 ]  Furthermore, some sources say that the oil cleansing method is not viable for sensitive skin. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4111", "text": "The modern OCM method claims to be derived from ancient bathing practices. It differs from these practices in its focus solely on oil, and the ancients would also use water. Modern soap was not produced industrially until the 19th century. In the ancient world people would use olive oil as part of their bathing. They may have combined the oil with ash, and we know they used a scraping implement called a  strigil ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4112", "text": "In the Roman  baths , a man would bathe in this way before taking a  Caldarium  or 'hot bath'.   Pliny the Elder  himself mentions ancient bathing practices. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4113", "text": "In this beauty treatment, the oil is rubbed into skin for approximately two minutes. Next, a warm, damp  microfiber  wash cloth is used to wipe off the excess oil. [ 2 ]  Applied sparingly, oil may be used to moisturize the skin after the cleansing oil has been removed from the face. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4114", "text": "Otjize  is a mixture of  butterfat  and  ochre  pigment used by the  Himba people  of  Namibia  to protect themselves from the harsh desert climate. The paste is often perfumed with the aromatic resin of  Commiphora multijuga  ( omuzumba ). [ 1 ] [ 2 ]  The Himba apply otjize to their skin and hair, which is long and plaited into intricate designs. [ 3 ] [ 4 ] [ 5 ]  Himba women start designing their hair from puberty using the red clay as well as adding on the hair of goats for stylistic purposes. [ 3 ]  Other documented uses of otjize include  initiation ceremonies , the burial of human corpses, and as a mosquito repellent. [ 5 ]  The use of otjize by both men and women has been documented, with the decline in use by men beginning in the 1960s and attributed to \"the presence of the  South African Defence Force  in the region and the subsequent employment of many men as trackers and soldiers\". [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4115", "text": "Otjize is also used for hygienic purposes due to  water scarcity . Over time, otjize flakes off, removing dirt and dead skin.  Wood ash  is used to wash the hair. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4116", "text": "In  Nnedi Okorafor 's  Hugo Award \u2013winning novella  Binti  (2015), the protagonist's use of otjize represents an \"animist spirituality [that] radically decenters human exceptionality while simultaneously imbricating people thoroughly with their material world\". [ 6 ]  For scholar S. R. Toliver, Binti's success in creating otjize on a planet away from her home planet \"symbolizes a metaphorical rebirth of the Himba culture in a new land\" and \"is a lasting remnant of home and healing in a land that was initially defined by surveillance and control\". [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4117", "text": "In 2022 a team of South African and French scientists published a study of otjize's physical properties, concluding that \"such a red ochre exhibits an exceptional  UV  filtration and a significant  IR  reflectivity substantiating its effectiveness as an effective UV-blocking and solar heat IR reflector in support of the low  skin cancer  rate within the Namibian Himba community\". [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4118", "text": "Pearl powder  ( Chinese :  \u73cd\u73e0\u7c89 ;  pinyin :  zh\u0113nzh\u016b f\u011bn ) is a preparation of crushed  pearls  used in  China  and elsewhere for  skin care  and in  traditional Chinese medicine ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4119", "text": "Pearl powder is made from  freshwater pearls  or saltwater pearls below jewellery grade. These are sterilised in boiling water [ 1 ]  and then milled into a fine powder using stainless steel grinding discs or by milling with small  porcelain  balls in moist conditions. [ 2 ]  The powder is sold as such or mixed into creams. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4120", "text": "Pearl powder is widely believed to help improve the appearance of the skin, and is used as a cosmetic by royal families in Asia. [ 3 ]  It is also used as a treatment for  acne . Some studies have claimed that pearl powder can stimulate the skin's  fibroblasts , help regenerate  collagen , and accelerate healing of certain skin conditions, wounds, and burns. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4121", "text": "Pearl powder contains a number of  amino acids , over 30 trace minerals, [ 4 ]  and a high concentration of  calcium . [ 3 ]   In Chinese medicine, it is used as an  anti-inflammatory  and  detoxification  agent, and as a  relaxant . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4122", "text": "The calcium content is considered beneficial for calcium deficient persons with issues such as  osteoporosis . A typical dose is 1 gram of pearl powder taken by mouth, traditionally mixed into water or tea, twice weekly. Excessive doses may cause calcium toxicity. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4123", "text": "The powder is also used to treat stomach and intestinal conditions such as  indigestion  and chronic  constipation . It is claimed to minimize pain from sores and ulcers, and to help reduce the sores and ulcers themselves. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4124", "text": "The use in China of pearl powder, both as medicine and as cosmetic, dates back at least to 320 AD. Pearl powder was an ingredient in traditional Chinese medicine (TCM), in the treatment of eye diseases,  tuberculosis  and to prevent heart attacks. The empress  Wu Ze Tian  (625 AD \u2013 705 AD) used pearl powder internally and on her skin. The medical book  Bencao Gangmu  of the  Ming dynasty  claimed that pearl can stimulate new skin growth and healing, release toxins, and remove sun damage and age spots. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4125", "text": "Pearl powder was also used in  Ayurvedic medicine  in the  Indian subcontinent . Narahari, a physician of  Kashmir , wrote in about 1240 that the pearl was an antidote to poisons, cured conditions of the eyes,  consumption  and \"morbid disturbances\", and increased general strength and health. [ 6 ]  Powdered pearl was also an ingredient of love potions. [ 7 ]  An Indian pharmacological work published in 1903 listed the powder as a tonic, stimulant and aphrodisiac. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4126", "text": "In the  Philippines  from pre-colonial times, selected youths called  binukot   are special type of princes and princesses that were kept in seclusion and hidden from the sun in order to have fair and white skin. The  binukot  were fed crushed pearl powders to enhance the fairness and luminosity of their skin. Crushed pearl powder was also applied to their face and body to make their skin more pale and firm. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4127", "text": "In medieval Europe, pearl powder was widely perceived to have therapeutic qualities. It was used in an attempt to treat the insanity of  Charles VI of France  (1368\u20131422), and the fever of which  Lorenzo de Medici  died in 1492. [ 9 ]  Seventeenth-century German and English works claimed its effectiveness in a wide range of physical and mental conditions. [ 10 ]   Francis Bacon  (1561\u20131626) recommended it as a means of prolonging life. [ 9 ]   Pearl powder was also used as a skin whitener by women in Europe during the nineteenth century; [ 4 ] [ 11 ]  one work, however, deprecated it as imparting a \"pale, sickly hue\", as well as being injurious to the skin and general health. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4128", "text": "Periorbital puffiness , also known as  puffy eyes , or  swelling around the eyes , is the appearance of swelling in the tissues around the  eyes , called the  orbits . It is almost exclusively caused by fluid buildup around the eyes, or  periorbital  edema . Minor puffiness usually detectable below the eyes only is often called  eye bags . Such transient puffiness is distinct from the age related and gradual increase in the size of the fat pad lying below the lower eyelids (suborbicularis oculi fat \u2013 \"SOOF\") which can also be colloquially referred to as  eye bags . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4129", "text": "While some degree of puffiness may be normal for a given individual, factors such as age and fatigue may make the swelling more prominent. The periorbital tissues are most noticeably swollen immediately after waking, perhaps due to the gravitational redistribution of fluid in the horizontal position."}
{"_id": "WikiPedia_Dermatology$$$corpus_4130", "text": "Eye puffiness may also be caused by:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4131", "text": "Puffy eyes are usually only a temporary  cosmetic  worry, but occasionally, individuals become concerned about the cosmetic effect of periorbital swelling and seek  surgical  correction. Severe and persistent puffiness may be a sign of other serious medical conditions."}
{"_id": "WikiPedia_Dermatology$$$corpus_4132", "text": "For someone predisposed to eye puffiness, changes to diet and  lifestyle  (under the supervision of a  physician ) may be required to reduce the possibility of swelling."}
{"_id": "WikiPedia_Dermatology$$$corpus_4133", "text": "A cold compress near the eye can act as a short-term remedy as cold temperature constricts  blood vessels , preventing the flow of fluid into tissues and diminishing puffiness in the process. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4134", "text": "Live Yeast Cell Derivative (LYCD) may be effective. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4135", "text": "Elevating the head while sleeping can prevent the gravitational redistribution of fluid that is associated with eye swelling. Eating  foods  rich in vitamins, especially  A ,  C  and  E , helps to reduce eye puffiness and to maintain clear, moist skin. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4136", "text": "Phisoderm  is a skin  detergent  which assists persons who are allergic to soap and  Phisohex , a detergent [ 1 ]  and sudsless cleanser [ 2 ]  which prevents the spread of infections.\nIn the 1950s, both Phisoderm and Phisohex were manufactured by Winthrop Laboratories. Earlier, the product  was made by  Fairchild Brothers & Foster . Phisoderm was developed by B. Thurber Guild (1886\u20131958), a physician and pharmaceutical manufacturer. Guild practiced medicine in  Boston, Massachusetts , and was a specialist in  allergies . [ 1 ]  The brand is currently owned by  Mentholatum ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4137", "text": "Both Phisoderm and Phisohex were removed by drugstores and retail outlet stores when the  Food and Drug Administration  halted the production and distribution of products containing more than 1% of  hexachlorophene , in September 1972. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4138", "text": "Phisoderm continued to be produced by Winthrop Laboratories, a division of  Sterling Drug , in 1980. An  over-the-counter drug , its advertising was carried out by Warren Muller Dulubowsky. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4139", "text": "By April 1989, Sterling Drug was owned by  Eastman Kodak . Three Sterling brands, Haley's M-O, Philips' Milk of Magnesia, and Phisoderm, were being advertised by  N.W. Ayer . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4140", "text": "In 1991, the Phisoderm account was picked up by Ammirati & Puris of  New York City . [ 5 ]  When  Bayer  bought Sterling in 1994,  Chattem  acquired the Phisoderm brand."}
{"_id": "WikiPedia_Dermatology$$$corpus_4141", "text": "In 2005, it was sold to The Mentholatum Company."}
{"_id": "WikiPedia_Dermatology$$$corpus_4142", "text": "In the current formulation, as of 2023, the anti-acne active ingredient [ 6 ]  is 2%  salicylic acid ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4143", "text": "Pumice  (   / \u02c8 p \u028c m \u026a s / ), called  pumicite  in its powdered or dust form, is a  volcanic rock  that consists of extremely  vesicular  rough-textured  volcanic glass , which may or may not contain crystals. It is typically light-colored.  Scoria  is another vesicular volcanic rock that differs from pumice in having larger vesicles, thicker vesicle walls, and being dark colored and denser. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4144", "text": "Pumice is created when super-heated, highly pressurized rock is rapidly ejected from a  volcano . The unusual foamy configuration of pumice happens because of simultaneous rapid cooling and rapid depressurization. The depressurization creates bubbles by lowering the  solubility  of gases (including  water  and  CO 2 ) that are dissolved in the lava, causing the gases to rapidly  exsolve  (like the bubbles of CO 2  that appear when a carbonated drink is opened). The simultaneous cooling and depressurization freeze the bubbles in a  matrix .  Eruptions under water are rapidly cooled and the  large volume of pumice created  can be a shipping hazard for cargo ships. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4145", "text": "Pumice is composed of highly  microvesicular  glass  pyroclastic  with very thin, translucent bubble walls of  extrusive   igneous rock . It is commonly [ 4 ]  but not exclusively of  silicic  or  felsic  to intermediate in composition (e.g.,  rhyolitic ,  dacitic ,  andesite ,  pantellerite ,  phonolite ,  trachyte ), but  basaltic  and other compositions are known. Pumice is commonly pale in color, ranging from white, cream, blue or grey, to green-brown or black. It forms when  volcanic gases  exsolving from viscous  magma  form bubbles that remain within the viscous magma as it cools to glass. Pumice is a common product of explosive eruptions ( plinian  and  ignimbrite -forming) and commonly forms zones in upper parts of silicic  lavas . Pumice has a  porosity  of 64\u201385% by volume and it floats on water, possibly for years, until it eventually becomes waterlogged and sinks. [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4146", "text": "Scoria  differs from pumice in being denser. With larger vesicles and thicker vesicle walls, scoria sinks rapidly. The difference is the result of the lower viscosity of the magma that forms scoria. When larger amounts of gas are present, the result is a finer-grained variety of pumice known as  pumicite . Pumicite consists of particles less than 4\u00a0mm (0.16\u00a0in) in size. [ 7 ]  Pumice is considered a  volcanic glass  because it has no  crystal  structure. Pumice varies in density according to the thickness of the solid material between the bubbles; many samples float in water. After the explosion of  Krakatoa ,  rafts of pumice  drifted through the Indian Ocean for up to 20 years, with tree trunks floating among them. [ 8 ]  In fact, pumice rafts disperse and support several marine species. [ 9 ]  In 1979, 1984 and 2006, underwater volcanic eruptions near  Tonga  created large pumice rafts that floated hundreds of kilometres to  Fiji . [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4147", "text": "There are two main forms of vesicles. Most pumice contains tubular microvesicles that can impart a silky or fibrous fabric. The elongation of the microvesicles occurs due to  ductile  elongation in the volcanic conduit or, in the case of pumiceous lavas, during flow. The other form of vesicles are subspherical to spherical and result from high  vapor pressure  during an eruption. [ 11 ]   Reticulite  is a type of basaltic pumice formed in very high lava fountains. It has an extremely low density and is composed of a network of volcanic glass formed when the vesicles have almost completely coalesced. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4148", "text": "Pumice is an igneous rock with a foamy appearance. The name is derived from the Latin word  pumex  (meaning \"pumice\") [ 13 ]  which is related to the Latin word  spuma  meaning \"foam\". [ 14 ]  In former times, pumice was called \"Spuma Maris\", meaning \"froth of the sea\" in Latin because the frothy material was thought to be hardened sea foam. Around 80 B.C., it was called \"lapis spongiae\" in Latin for its vesicular properties. Many Greek scholars decided there were different sources of pumice, one of which was in the sea coral category. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4149", "text": "Pumice can be found all around the globe deriving from continental volcanic occurrences and submarine volcanic occurrences. Floating stones can also be distributed by ocean currents. [ 16 ]  As described earlier pumice is produced by the eruption of explosive volcanoes under certain conditions, therefore, natural sources occur in volcanically active regions. Pumice is mined and transported from these regions. In 2011, Italy and Turkey led pumice mining production at 4 and 3 million tons respectively; other large producers at or exceeding a million tonnes were Greece, Iran, Chile, and Syria. Total world pumice production in 2011 was estimated at 17 million tonnes. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4150", "text": "There are large reserves of pumice in Asian countries including Afghanistan, Indonesia, Japan, Syria, Iran, and eastern Russia. Considerable amounts of pumice can be found at the  Kamchatka Peninsula  on the eastern flank of Russia. This area contains 19 active volcanoes and it lies in close proximity with the  Pacific volcanic belt . Asia is also the site of the second-most dangerous volcanic eruption in the 20th century,  Mount Pinatubo , which  erupted on June 12, 1991  in the  Philippines . Ash and pumice  lapilli  were distributed over a mile around the volcano. These ejections filled trenches that once reached 660 feet deep. So much magma was displaced from the vent that the volcano became a depression on the surface of the Earth. [ 18 ]  Another well-known volcano that produces pumice is  Krakatoa . An eruption in 1883 ejected so much pumice that kilometers of sea were covered in floating pumice and in some areas rose 1.5 meters above sea level. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4151", "text": "Europe is the largest producer of pumice with deposits in Italy, Turkey, Greece, Hungary, Iceland, and Germany. Italy is the largest producer of pumice because of its numerous eruptive volcanoes. On the  Aeolian Islands  of Italy, the island of  Lipari  is entirely made up of volcanic rock, including pumice. Large amounts of igneous rock on Lipari are due to the numerous extended periods of volcanic activity from the Late  Pleistocene  ( Tyrrhenian ) to the Holocene. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4152", "text": "Pumice can be found all across North America including on the  Caribbean Islands . In the United States, pumice is mined in  Nevada ,  Oregon ,  Idaho ,  Arizona ,  California ,  New Mexico  and  Kansas . U.S. production of pumice and pumicite in 2011 was estimated at 380,000 tonnes, valued at $7.7 million with approximately 46% coming from Nevada and Oregon. [ 17 ]  Idaho is also known as a large producer of pumice because of the quality and brightness of the rock found in local reserves. [ 21 ]  One of the most famous volcanoes was  Mount Mazama  that erupted 7,700 years ago in Oregon and deposited 300 feet of pumice and ash around the vent. The large amount of magma that was erupted caused the structure to collapse, forming a caldera now known as  Crater Lake . [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4153", "text": "Chile  is one of the leading producers of pumice in the world. [ 22 ]  The  Puyehue-Cord\u00f3n Caulle  are two coalesced volcanoes in the  Andes  mountains that ejected ash and pumice across Chile and  Argentina . A recent eruption in 2011 wreaked havoc on the region by covering all surfaces and lakes in ash and pumice. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4154", "text": "Kenya ,  Ethiopia  and  Tanzania  have some deposits of pumice.  [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4155", "text": "The  Havre Seamount  volcano produced the largest-known deep ocean volcanic eruption on Earth. The volcano  erupted in July 2012  but remained unnoticed until enormous pieces of pumice were seen to be floating on the Pacific Ocean. Blankets of rock reached a thickness of 5 meters. [ 24 ]  Most of this floating pumice is deposited on the northwest coast of  New Zealand  and the  Polynesia  islands."}
{"_id": "WikiPedia_Dermatology$$$corpus_4156", "text": "The  mining  of pumice is an environmentally friendly process compared with other mining methods because the igneous rock is deposited on the surface of the earth in loose aggregate form. The material is mined by open-pit methods. Soils are removed by machinery in order to obtain more pure quality pumice. Scalping screens are used to filter impure surficial pumice of organic soils and unwanted rocks. Blasting is not necessary because the material is unconsolidated, therefore only simple machinery is used such as bulldozers and power shovels. Different sizes of pumice are needed for specific uses therefore crushers are used to achieve desired grades ranging from lump, coarse, intermediate, fine, and extra fine. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4157", "text": "Pumice is a very lightweight, porous and abrasive material and it has been used for centuries in the construction and beauty industry as well as in early medicine. It is also used as an  abrasive , especially in  polishes , pencil  erasers , and the production of  stone-washed   jeans . Pumice was also used in the early book-making industry to prepare parchment paper and leather bindings. [ 26 ]  There is high demand for pumice, particularly for water filtration, chemical spill containment, cement manufacturing, [ 27 ]  horticulture and increasingly for the pet industry. The mining of pumice in environmentally sensitive areas has been under more scrutiny after such an operation was stopped in the U.S. state of Oregon, at Rock Mesa in the southern part of the  Three Sisters Wilderness . [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4158", "text": "Pumice has been used in the medicinal industry for more than 2000 years. Ancient Chinese medicine used ground pumice along with ground  mica  and fossilized bones added to teas to calm the spirit. This tea was used to treat dizziness, nausea, insomnia, and anxiety disorders. Ingestion of these pulverized rocks was believed to be able to soften nodules and was later used with other herbal ingredients to treat gallbladder cancer and urinary difficulties. In Western medicine, beginning in the early 18th century, pumice ground into a sugar consistency mixed with other ingredients was used to attempt to treat ulcers mostly on the skin and cornea. Concoctions such as these were also used to help wounds scar in a supposedly healthier manner. In approximately 1680 it was noted by an English naturalist that pumice powder was used to promote sneezing. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4159", "text": "Pumice has been used as a material in personal care for thousands of years. It is an abrasive material that can be used in powdered form or as a stone to remove unwanted hair or skin. In ancient  Egypt , it was common to remove all hair on the body to control  lice  and as a form of ritual purification, using creams, razors, and pumice stones. [ 30 ]  Pumice in powdered form was an ingredient in toothpastes in ancient Rome. [ 31 ]  Nail care was very important in ancient China; nails were kept groomed with pumice stones, and pumice stones were also used to remove calluses."}
{"_id": "WikiPedia_Dermatology$$$corpus_4160", "text": "It was discovered in a Roman poem that pumice was used to remove dead skin as far back as 100 BC, and likely before then. [ 32 ]  It has been used throughout many eras since then, including the  Victorian Era . Today, many of these techniques are still used; pumice is widely used as a skin  exfoliant . Even though hair removal techniques have evolved over the centuries, abrasive material like pumice stones is also still used. \"Pumice stones\" are often used in beauty salons during the  pedicure  process to remove dry and excess skin from the bottom of the foot as well as  calluses ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4161", "text": "Finely ground pumice has been added to some  toothpastes  as a polish, similar to Roman use, and easily removes  dental plaque  build-up.  Such toothpaste is too abrasive for daily use. Pumice is also added to heavy-duty hand cleaners (such as  lava soap ) as a mild abrasive. Some brands of  chinchilla   dust bath  are formulated with powdered pumice. Old beauty techniques using pumice are still employed today but newer substitutes are easier to obtain."}
{"_id": "WikiPedia_Dermatology$$$corpus_4162", "text": "Pumice stone, sometimes attached to a handle, [ 33 ]  is an effective scrubbing tool for removal of limescale, rust, hard water rings, and other stains on porcelain fixtures in households (e.g., bathrooms). It is a quick method compared to alternatives like chemicals or  vinegar  and  baking soda  or  borax ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4163", "text": "Good soil requires sufficient water and nutrient loading as well as little compaction to allow easy exchange of gases. The roots of plants require continuous transportation of  carbon dioxide  and  oxygen  to and from the surface. Pumice improves the quality of soil because of its porous properties; water and gases can be transported easily through the pores and nutrients can be stored in the microscopic holes. Pumice rock fragments are inorganic therefore no decomposition and little compaction occur."}
{"_id": "WikiPedia_Dermatology$$$corpus_4164", "text": "Another benefit of this inorganic rock is that it does not attract or host  fungi  or  insects . As drainage is very important in horticulture, with the presence of pumice  tillage  is much easier. Pumice usage also creates ideal conditions for growing plants like  cacti  and  succulents  as it increases the water retention in sandy soils and reduces the density of  clayey  soils to allow more transportation of gases and water. The addition of pumice to soil improves and increases vegetative cover as the roots of plants make slopes more stable therefore it helps reduce  erosion . It is often used on roadsides and ditches and commonly used in turf and golf courses to maintain grass cover and flatness that can degrade due to large amounts of traffic and compaction. Chemically pumice is  pH  neutral, neither  acidic  nor  alkaline . [ 34 ]  In 2011, 16% of pumice mined in the United States was used for horticultural purposes. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4165", "text": "Pumice contributes to soil fertility in areas where it is naturally present in the soil due to volcanic activity. For example, in the  Jemez Mountains  of New Mexico, the  Ancestral Puebloans  settled on \"pumice patches\" of the  El Cajete Pumice  which likely retained a greater amount of moisture and was ideal for farming. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4166", "text": "Pumice is widely used to make lightweight  concrete  and  insulative  low-density  cinder blocks . The air-filled vesicles in this porous rock serve as a good insulator. [ 18 ]  A fine-grained version of pumice called  pozzolan  is used as an additive in cement and is mixed with  lime  to form a light-weight, smooth, plaster-like concrete. This form of concrete was used as far back as  Roman  times. Roman engineers utilized it to build the huge dome of the  Pantheon  with increasing amounts of pumice added to concrete for higher elevations of the structure. It was also commonly used as a construction material for many  aqueducts ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4167", "text": "One of the main uses of pumice currently in the United States is manufacturing concrete. This rock has been used in concrete mixtures for thousands of years and continues to be used in producing concrete, especially in regions close to where this volcanic material is deposited. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4168", "text": "New studies prove a broader application of pumice powder in the concrete industry. Pumice can act as a cementitious material in concrete and researchers have shown that concrete made with up to 50% pumice powder can significantly improve durability yet reduce greenhouse gas emissions and fossil fuel consumption. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4169", "text": "Radio-frequency skin tightening  is an aesthetic technique that uses  radio frequency  (RF) energy to heat skin with the purpose of stimulating cutaneous  collagen , elastin and  hyaluronic acid  production in order to reduce the appearance of fine lines and loose skin. [ 1 ] [ 2 ]  The technique induces tissue remodeling [ 3 ]  and production of new collagen and  elastin . [ 4 ] [ 5 ]  The process provides an alternative to  facelift [ 6 ]  and other cosmetic surgeries."}
{"_id": "WikiPedia_Dermatology$$$corpus_4170", "text": "By manipulating skin cooling during treatment, RF can also be used for heating and reduction of fat. Currently, the most common uses of RF-based devices are to noninvasively manage and treat skin tightening of lax skin (including sagging jowls, abdomen, thighs, and arms), as well as  wrinkle  reduction,  cellulite  improvement, and body contouring. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4171", "text": "Several companies manufacture RF devices, including D-Finitive Thermage by Solta Medical, Evo by Beco Medical V-Form by Viora, Venus Freeze Plus, Venus Legacy by  Venus Concept , VelaShape by  Syneron , Exilis by BTL, and 3DEEP by Endymed. Microneedle radiofrequency is the latest form of delivery and devices include Profound by Candela lasers, Fractora, Intensif, Thermia Ablative RF Fractional by Melorin Group and Genius by Lutronic. Alternative techniques include  Laser Resurfacing  and certain Ultrasound alternatives.  Novel non-invasive versions of radiofrequency delivery include tripolar devices such as Tripolar by Lumenis and Triactive by DEKA. Devices have different penetration depths depending on the number of electrodes (monopolar, bipolar, or unipolar). [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4172", "text": "The ideal target temperature in the dermis for inducing dermal remodeling and wrinkle and laxity reduction was shown to be 67 \u00b0C. By delivering radiofrequency power until this target temperature is attained, clinical outcomes are optimized. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4173", "text": "Microneedle radiofrequency has also been  FDA -approved for cellulite reduction using vertically penetrating needles that target the subnormal plane. [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4174", "text": "Due to  radiation  of high-energy radio frequency, several patients have reported pain requiring sedation during the procedure. The process also requires extreme care in its execution. Improper application may result in dents on the skin surface due to uneven healing responses on the skin. Many effects including  fat necrosis  and atrophic scarring have also been reported, although several new techniques have overcome this obstacle. With the application of a vacuum at the point of application, the burning and crusting was reportedly reduced. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4175", "text": "Helena Rubinstein  (born  Chaja Rubinstein ; December 25, 1872 \u2013 April 1, 1965) [ 2 ]  was a Polish and American businesswoman, art collector, and philanthropist. A  cosmetics  entrepreneur, she was the founder and  eponym  of Helena Rubinstein Incorporated cosmetics company, which made her one of the world's richest women. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4176", "text": "Rubinstein was the eldest of eight daughters [ 4 ]  born to  Polish Jews , \"Augusta\" Gitte (Gitel) Shaindel Rubinstein n\u00e9e Silberfeld and Naftoli Hertz \"Horace\" Rubinstein. Her father was a shopkeeper in  Krak\u00f3w ,  Lesser Poland , which was then occupied by  Austria-Hungary  following the  partitions of Poland  in the late 18th century. The  existentialist  philosopher  Martin Buber  was her cousin. She was also the cousin of  Ruth Rappaport 's mother. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4177", "text": "After refusing an arranged marriage, Rubinstein emigrated from Poland to Australia in 1896, with no money and little command of the English language. [ 6 ]  Her stylish clothes and milky complexion did not pass unnoticed among the town's ladies, however, and she soon found enthusiastic buyers for the jars of beauty cream in her luggage. She spotted a market where she began to make her own. A key ingredient of the cream,  lanolin , was readily at hand."}
{"_id": "WikiPedia_Dermatology$$$corpus_4178", "text": "Coleraine , in the  Western Victoria region , where her uncle was a shopkeeper, might have been an \"awful place\" [ This quote needs a citation ]  but was home to some 75 million [ citation needed ]  sheep that secreted abundant quantities of lanolin. These sheep were the wealth of the nation and the Western District's vast mobs of  merinos  produced the finest wool in the land. To disguise the lanolin's pungent odour, Rubinstein experimented with  lavender ,  pine  bark, and  water lilies ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4179", "text": "Rubinstein had a falling out with her uncle, but after a stint as a bush governess began waitressing at the Winter Garden tearooms in  Melbourne . There, she found an admirer willing to stump up the funds to launch her Cr\u00e8me Valaze, supposedly including herbs imported \"from the  Carpathian Mountains \". [ This quote needs a citation ]  It cost ten  pence  and sold for six  shillings  (72 pence). Known to her customers only as Helena, Rubinstein could soon afford to open a salon in fashionable  Collins Street , selling glamour as a science to customers whose skin was \"diagnosed\" and a suitable treatment \"prescribed\". [ This quote needs a citation ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4180", "text": "Sydney was next, and within five years, Australian operations were profitable enough to finance a Salon de Beaut\u00e9 Valaze in London. As such, Rubinstein formed one of the world's first cosmetic companies. Her business enterprise proved immensely successful and later in life, she used her enormous wealth to support charitable institutions in the fields of education, art, and health."}
{"_id": "WikiPedia_Dermatology$$$corpus_4181", "text": "Rubinstein rapidly expanded her operation. In 1908, her sister Ceska assumed the Melbourne shop's operation, and with $100,000, Rubinstein moved to London and began what was to become an international enterprise. (Women at this time could not obtain bank loans, so the money was her own.)"}
{"_id": "WikiPedia_Dermatology$$$corpus_4182", "text": "In 1908, she married the Polish-born American journalist Edward William Titus in London.  They had two sons, Roy Valentine Titus (London, December 12, 1909 \u2013 New York, June 18, 1989) and Horace Titus (London, April 23, 1912 \u2013 New York, May 18, 1958).  They eventually moved to Paris where she opened a salon in 1912.  Her husband helped with writing the  publicity  and set up a small publishing house, published  Lady Chatterley's Lover [ citation needed ]  and hired  Samuel Putnam  to translate famous model  Alice Prin 's (Kiki de Montparnasse) memoirs,  Kiki's Memoirs ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4183", "text": "Rubinstein threw lavish dinner parties and became known for apocryphal quips, such as when an intoxicated French ambassador expressed vitriol toward  Edith Sitwell  and her brother  Sacheverell :  Vos anc\u00eatres ont br\u00fbl\u00e9 Jeanne d'Arc!  Rubinstein, who knew little French, asked a guest what the ambassador had said. \"He said, 'Your ancestors burned  Joan of Arc . ' \"  Rubinstein replied, \"Well, someone had to do it.\" [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4184", "text": "At another  f\u00eate ,  Marcel Proust  asked her what makeup a duchess might wear. She summarily dismissed him because \"he smelt of mothballs\". Rubinstein recollected later, \"How was I to know he was going to be famous?\" [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4185", "text": "At the outbreak of  World War I , she and Titus moved to New York City, where she opened a cosmetics salon in 1915, the forerunner of a chain throughout the country. Rubinstein opened up the boundless American market, and she skilfully used it, despite serious competitors. This was the beginning of her vicious rivalry with another notable woman of the cosmetics industry,  Elizabeth Arden . Both Rubinstein and Arden, who died within 18 months of each other, were social climbers. They were both keenly aware of effective marketing and luxurious packaging, the attraction of beauticians in neat uniforms, the value of celebrity endorsements, the perceived  value of overpricing  and the promotion of the  pseudoscience  of skincare. The rivalry with Arden lasted all her life. Rubinstein said of her rival, \"With her packaging and my product, we could have ruled the world.\" [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4186", "text": "From 1917, Rubinstein took on the manufacturing and wholesale distribution of her products. The \"Day of Beauty\" in the various salons became a great success. The purported portrait of Rubinstein in her advertising was of a middle-age mannequin with a  Gentile  appearance. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4187", "text": "In 1928, she sold the American business to  Lehman Brothers  for $7.3 million, ($127 million in 2022). After the onset of the  Great Depression , she bought back the nearly worthless stock for less than $1 million and eventually increased the value of the company to $100 million, establishing salons and outlets in almost a dozen US cities. This saga, and Rubinstein's early business career, has been the subject of a recent  Harvard Business School  case. [ 10 ]  Her subsequent spa at 715  Fifth Avenue  included a restaurant, a gymnasium and rugs by painter  Joan Mir\u00f3 . She commissioned artist  Salvador Dal\u00ed  to design a powder compact as well a portrait of herself in 1943, titled  Princess Arthchild Gourielle-Helena Rubinstein . [ 11 ]  Other artists who painted her portrait [ 12 ]  were  Graham Sutherland  in 1957 for the Helena Rubinstein Foundation, now in the  National Portrait Gallery of Australia , [ 13 ]   Marie Laurencin  in 1934 (now in the  National Portrait Gallery (United States) , [ 14 ]   Raoul Dufy  (1930), [ 15 ]   Roberto Montenegro  (1941). [ 16 ]  After Rubinstein's last visit to Australia,  William Dobell  painted a series of eight portraits in 1957. [ 17 ] [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4188", "text": "After her divorce, in 1938 Helena readily married Prince Artchil Gourielli-Tchkonia (sometimes spelled Courielli-Tchkonia; born in  Georgia , February 18, 1895, died in New York City, November 21, 1955), whose somewhat clouded matrilinear claim to  Georgian nobility  stemmed from him having been born a member of the untitled noble Tchkonia family of  Guria , enticing the ambitious young man to appropriate the genuine title of his grandmother, born Princess  Gourielli . [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4189", "text": "Gourielli-Tchkonia was 23 years younger than Rubinstein. Eager for a regal title, Rubinstein pursued the handsome man avidly and named a male cosmetics line after her youthful prized catch. Some have claimed that the marriage was a marketing ploy, including Rubinstein's being able to pass herself off as Helena Princess Gourielli. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4190", "text": "Rubinstein took a packed lunch to work and was frugal in many matters, but bought top-fashion clothing and valuable fine art and furniture. She founded the Helena Rubinstein Pavilion of Contemporary Art at the  Tel Aviv Museum of Art  and in 1957 she established the Helena Rubinstein Travelling Art Scholarship in Australia. [ 17 ]  In 1953, she established the philanthropic Helena Rubinstein Foundation to provide funds to organizations specializing in health, medical research and rehabilitation. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4191", "text": "In 1959, Rubinstein represented the US cosmetics industry at the  American National Exhibition  in Moscow."}
{"_id": "WikiPedia_Dermatology$$$corpus_4192", "text": "Called \"Madame\" by her employees, she eschewed idle chatter, continued to be active in the corporation throughout her life, even from her sick bed, and staffed the company with her relatives. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4193", "text": "Rubinstein died April 1, 1965, of natural causes and was buried in  Mount Olivet Cemetery  in  Queens . [ 22 ]  Some of her estate, including African and fine art,  Lucite  furniture, and Victorian furniture upholstered in purple, was auctioned in 1966 at the  Parke-Bernet  Galleries in New York City."}
{"_id": "WikiPedia_Dermatology$$$corpus_4194", "text": "One of Rubinstein's numerous sayings was: \"There are no ugly women, only lazy ones.\" [ 23 ]  A scholarly study of her exclusive beauty salons and how they blurred and influenced the conceptual boundaries at the time among fashion, art galleries, the domestic interior and versions of modernism is explored by Marie J. Clifford. [ 24 ]  A feature-length  documentary film ,  The Powder & the Glory  (2009) by Ann Carol Grossman and Arnie Reisman, details the rivalry between Rubinstein and  Elizabeth Arden . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4195", "text": "In her book  Ugly Beauty ,  Ruth Brandon  described her methodology:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4196", "text": "She knew how to advertise\u2014using 'fear copy with a bit of blah-blah'\u2014 and introduced the concept of 'problem' skin types. She also pioneered the use of pseudo-science in marketing, donning a lab coat in many advertisements, despite the fact that her only training had been a two-month tour of European skin-care facilities. She knew how to manipulate consumers' status anxiety, as well: If a product faltered initially, she would hike the price to raise the perceived value. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4197", "text": "In 1973, the company Helena Rubinstein, Inc. was sold to  Colgate-Palmolive .  By the 1980's the brand had faded from the US market. [ 26 ]  In 1984 it was acquired by  L'Or\u00e9al . [ 27 ] [ 28 ]  The L'Oreal takeover was to cause a good deal of scandal as company founder,  Eug\u00e8ne Schueller , had been an enthusiastic collaborator during the war, and in its aftermath, L'Oreal became notorious for employing ex-Nazis on the run.  Jacques Corr\u00e8ze , who engineered the takeover, was one of these: he had been active in expropriating Jewish property in Paris. [ 29 ]  The brand was re-launched in the US market in 1999 but it was unprofitable despite its having a renaissance in Asia, Europe, and South America. The US operation was closed down in 2003. [ 30 ]   Since 2011, L'Or\u00e9al has been repositioning the brand as an ultra-premium skin care franchise. As of 2023, high-end Helena Rubinstein products remain unavailable in the US but are sold in international markets. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4198", "text": "The  L'Or\u00e9al-UNESCO Awards for Women in Science  are also known as the Helena Rubinstein Women in Science Awards."}
{"_id": "WikiPedia_Dermatology$$$corpus_4199", "text": "The Helena Rubinstein Foundation, which had been established in 1953, operated through 2011, ultimately distributing nearly $130 million over the course of six decades, primarily to education, arts, and community-based organizations in New York City. [ 21 ]  The foundation was a longtime supporter of children's programming for New York City's  PBS  affiliate  WNET ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4200", "text": "The Manhattan  Jewish Museum  hosted the exhibition \"Helena Rubinstein: Beauty Is Power\", the first museum show devoted to Rubinstein, from October 31, 2014, until March 22, 2015. [ 31 ] [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4201", "text": "A one-off Rubinstein Mural Prize was awarded in 1958 to  Erica McGilchrist  for her work in the Women's College,  University of Melbourne , and a Helena Rubinstein Scholarship was awarded to  Frank Hodgkinson  in 1958 and  Charles Blackman  1960."}
{"_id": "WikiPedia_Dermatology$$$corpus_4202", "text": "The  Helena Rubinstein Portrait Prize  was an annual prize of \u00a3300 for portraiture by an Australian artist, and was mostly staged at the  Claude Hotchin  Gallery in Western Australia. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4203", "text": "Based on Woodhead's book, [ 34 ]  the 2016 musical  War Paint  dramatizes her rivalry with competitor  Elizabeth Arden . After a run Chicago's  Goodman Theatre , the show opened on  Broadway  at the  Nederlander Theatre  on April 6, 2017, starring  Patti LuPone  as Rubinstein and  Christine Ebersole  as Arden. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4204", "text": "The comedy  Lip Service  by the Australian dramatist  John Misto  chronicles the life and career of Rubinstein and her rivalry with Elizabeth Arden and  Revlon [ clarification needed ] .  Lip Service  premiered April 26, 2017, at the  Park Theatre  in London, under the title  Madame Rubinstein , before opening at Sydney's  Ensemble Theatre  in August of the same year.  Miriam Margolyes  starred as Rubinstein. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4205", "text": "Sources"}
{"_id": "WikiPedia_Dermatology$$$corpus_4206", "text": "Shea butter  ( / \u0283 i\u02d0 /   SHEE ,  / \u02c8 \u0283 i\u02d0 \u0259 /   SHEE -\u0259 , or  / \u0283 e\u026a /   SHAY ;  Bambara :  \u07db\u07cc\u07ee\u07d5\u07ce\u07df\u07ce ,  romanized:\u00a0 s\u00ectulu [ 1 ] ) is a fat ( triglyceride ; mainly  oleic acid  and  stearic acid ) extracted from the nut of the African shea tree ( Vitellaria paradoxa ). [ 2 ]  It is ivory in color when raw and commonly dyed yellow with  borututu  root or  palm oil . It is widely used in cosmetics as a moisturizer or lotion. It is edible and is used in food preparation in some African countries. [ 3 ]  It is occasionally mixed with other oils as a substitute for cocoa butter, although the taste is noticeably different. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4207", "text": "The English word \"shea\" comes from  s\u01d0 , the tree's name in  Bambara . [ 6 ]  It is known by many local names, such as  kpakahili  in the  Dagbani language ,  taama  in the  Wali language ,  nkuto  in  Twi ,  ka\u0257e  or  ka\u0257anya  in  Hausa ,  \u00f2kw\u00f9m\u00e1  in the  Igbo language ,  \u00f2r\u00ed  in the  Yoruba language , and  karit\u00e9  in the  Wolof language  of  Senegal . [ 7 ]  It is also known as Moo-yaa in the  Acholi  language. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4208", "text": "The common name is  sh\u00edsu   \u07db\u07ed\u07cc\u07ed\u07db\u07ce  (lit. \"shea tree\") in the Bambara language of Mali. This is the origin of the English word, one pronunciation of which rhymes with \"tea\"  / \u0283 i\u02d0 / , although the pronunciation  / \u0283 e\u026a /  (rhyming with \"day\") is common, and is listed second in major dictionaries. The tree is called  ghariti  in the Wolof language of Senegal, which is the origin of the French name of the tree and the butter,  karit\u00e9 ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4209", "text": "The shea tree grows naturally in the wild in the dry  savannah  belt of West Africa from Senegal in the west to  Sudan  in the east, and onto the foothills of the Ethiopian highlands. It occurs in 21 countries across the African continent, namely  Benin ,  Burkina Faso ,  Cameroon ,  Central African Republic ,  Chad ,  Ethiopia ,  Eritrea ,  Ghana ,  Guinea Bissau ,  Ivory Coast ,  Mali ,  Niger ,  Nigeria ,  Senegal ,  Sierra Leone ,  South Sudan ,  Sudan ,  Togo ,  Uganda ,  Democratic Republic of the Congo ,  Kenya  and  Guinea ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4210", "text": "A  testa  found at the site of the medieval village of Saouga is evidence of shea butter production by the 14th century. [ 9 ]  The butter was being imported into Britain by 1846. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4211", "text": "Shea butter is composed of five principal fatty acids:  palmitic ,  stearic ,  oleic ,  linoleic , and  arachidic  (see Table below). About 85 to 90% of the fatty acid composition is stearic and oleic acids. The relative proportion of these two fatty acids affects shea butter consistency. The stearic acid gives it a solid consistency, while the oleic acid influences how soft or hard the shea butter is, depending on ambient temperature."}
{"_id": "WikiPedia_Dermatology$$$corpus_4212", "text": "The proportions of stearic and oleic acids in the shea kernels and butter differ across the distribution range of the species. Ugandan shea butter has consistently high oleic acid content, and is liquid at warm ambient temperatures. It fractionizes into liquid and solid phases, and is the source of liquid shea oil. The fatty acid proportion of West African shea butter is much more variable than Ugandan shea butter, with an oleic content of 37 to 55%. Variability can be high even locally, and a tree that produces hard butter can grow with one that produces soft butter."}
{"_id": "WikiPedia_Dermatology$$$corpus_4213", "text": "Nuts are gathered from a wide area for local production, so shea butter consistency is determined by the average fatty acid profile of the population. Within West Africa, shea butter from the Mossi Plateau region of  Burkina Faso  has a higher average stearic acid content, and so is usually harder than shea butter from other West African regions. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4214", "text": "A 2014 review characterized and quantified phenolic compounds in shea butter, identifying 10 phenolic compounds, eight of which are  catechins . [ 12 ]  This study also found that the overall concentration and relative percentages of different phenolic content in shea kernels varied from region to region. [ 12 ]  The authors hypothesized that the overall concentration of phenols in shea kernels is linked to the level of environmental stress that the trees endure. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4215", "text": "Shea butter is mainly used in the cosmetics industry for skin- and hair-related products (lip gloss, lip stick, skin moisturizer creams and emulsions, and hair conditioners for dry and brittle hair). [ citation needed ]  It is also used by soap makers and massage oil manufacturers, typically in small amounts, because it has plenty of  unsaponifiables , and higher amounts result in a softer soap that has less cleaning ability. Some artisan soap makers use shea butter in amounts to 25% \u2013 with the European Union regulating the maximum use around 28%, but it is rarely the case in commercially produced soap due to its high cost compared to oils like palm oil or olive oil."}
{"_id": "WikiPedia_Dermatology$$$corpus_4216", "text": "In some African countries such as  Benin , shea butter is used for cooking oil, [ 13 ]  as a waterproofing wax, for hairdressing, for candle-making, and as an ingredient in medicinal ointments. It is used by makers of traditional African  percussion instruments  to increase the durability of wood (such as carved  djembe  shells), dried  calabash  gourds, and leather tuning straps. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4217", "text": "The  United States Agency for International Development  and other companies have suggested a classification system for shea butter, separating it into five grades:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4218", "text": "Commercial grades are A, B, and C. The color of raw (grade A) butter ranges from cream (like whipped butter) to grayish yellow. It has a nutty aroma which is removed in the other grades. Grade C is pure white. While the level of vitamin content can be affected by refining, up to 95% of vitamin content can be removed from refined grades (i.e., grade C) of shea butter while reducing contamination levels to undetectable levels."}
{"_id": "WikiPedia_Dermatology$$$corpus_4219", "text": "Skin disinfection  is a process that involves the application of a  disinfectant  to reduce levels of  microorganisms  on the skin. [ 1 ]  Disinfecting the skin of the patient and the hands of the healthcare providers are an important part of  surgery . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4220", "text": "Skin disinfection may be accomplished with a number of solutions including  providone-iodine ,  chlorhexidine ,  alcohol  based solutions, and  cetrimide . [ 2 ]  There is strong evidence that  chlorhexidine  and  denatured alcohol  use to clean skin prior to surgery is better than any other commercially available antiseptic, such as povidone-iodine with alcohol. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4221", "text": "Its importance in health care was determined by  Semmelweis  in the 1840s. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4222", "text": "Soap  is a  salt  of a  fatty acid  (sometimes other carboxylic acids) used for cleaning and lubricating products as well as other applications. [ 1 ]  In a domestic setting, soaps, specifically \"toilet soaps\", are  surfactants  usually used for  washing ,  bathing , and other types of  housekeeping . In industrial settings, soaps are used as  thickeners , components of some  lubricants ,  emulsifiers , and  catalysts ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4223", "text": "Soaps are often produced by mixing fats and oils with a  base . [ 2 ]  Humans have used soap for millennia; evidence exists for the production of soap-like materials in ancient  Babylon  around 2800 BC."}
{"_id": "WikiPedia_Dermatology$$$corpus_4224", "text": "In a domestic setting, \"soap\" usually refers to what is technically called a toilet soap, used for household and personal cleaning. Toilet soaps are salts of fatty acids with the general formula ( RCO 2 \u2212 )M + , where M is  Na  (sodium) or  K  (potassium). [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4225", "text": "When used for cleaning, soap  solubilizes  particles and grime, which can then be separated from the article being cleaned. The insoluble oil/fat \"dirt\" become associated inside  micelles , tiny spheres formed from soap molecules with polar  hydrophilic  (water-attracting) groups on the outside and encasing a  lipophilic  (fat-attracting) pocket, which shields the oil/fat molecules from the water, making them soluble. Anything that is soluble will be washed away with the water. In  hand washing , as a surfactant, when lathered with a little water, soap kills  microorganisms  by disorganizing their membrane  lipid bilayer  and  denaturing  their  proteins . [ citation needed ]  It also  emulsifies  oils, enabling them to be carried away by running water. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4226", "text": "When used in  hard water , soap does not lather well but forms  soap scum  (related to  metallic soaps , see below). [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4227", "text": "So-called  metallic soaps  are key components of most lubricating  greases  and thickeners. [ 3 ]  A commercially important example is  lithium stearate . Greases are usually  emulsions  of  calcium soap  or  lithium soap  and  mineral oil . Many other metallic soaps are also useful, including those of  aluminium ,  sodium , and mixtures thereof. Such soaps are also used as thickeners to increase the  viscosity  of oils. In ancient times, lubricating greases were made by the addition of  lime  to  olive oil , which would produce calcium soaps. [ 6 ]  Metal soaps are also included in modern artists'  oil paints  formulations as a  rheology  modifier. [ 7 ]  Metal soaps can be prepared by neutralizing fatty acids with metal oxides:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4228", "text": "A cation from an  organic base  such as  ammonium  can be used instead of a metal; ammonium  nonanoate  is an ammonium-based soap that is used as an herbicide. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4229", "text": "Another class of non-toilet soaps are  resin soaps , which are produced in the  paper industry  by the action of tree rosin with alkaline reagents used to separate cellulose from raw wood.  A major component of such soaps is the sodium salt of  abietic acid .  Resin soaps are used as emulsifiers. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4230", "text": "The production of toilet soaps usually entails  saponification  of  triglycerides , which are vegetable or animal oils and fats. An alkaline solution (often  lye  or  sodium hydroxide ) induces saponification whereby the triglyceride fats first  hydrolyze  into salts of fatty acids.  Glycerol  (glycerin) is liberated. The glycerin is sometimes left in the soap product as a softening agent, although it is sometimes separated. [ 10 ] [ 11 ]  Handmade soap can differ from industrially made soap in that an excess of fat or coconut oil beyond that needed to consume the  alkali  is used (in a cold-pour process, this excess fat is called \"superfatting\"), and the glycerol left in acts as a moisturizing agent. However, the glycerine also makes the soap softer. The addition of glycerol and processing of this soap produces  glycerin soap . Superfatted soap is more skin-friendly than one without extra fat, although it can leave a \"greasy\" feel. Sometimes, an  emollient  is added, such as  jojoba  oil or  shea butter . [ 12 ]   Sand  or  pumice  may be added to produce a  scouring  soap. The scouring agents serve to remove dead cells from the skin surface being cleaned. This process is called  exfoliation ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4231", "text": "To make  antibacterial  soap, compounds such as  triclosan  or  triclocarban  can be added. There is some concern that use of antibacterial soaps and other products might encourage  antimicrobial resistance  in microorganisms. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4232", "text": "The type of alkali metal used determines the kind of soap product.  Sodium  soaps, prepared from  sodium hydroxide , are firm, whereas  potassium  soaps, derived from  potassium hydroxide , are softer or often liquid. Historically, potassium hydroxide was extracted from the ashes of  bracken  or other plants. Lithium soaps also tend to be hard. These are used exclusively in  greases ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4233", "text": "For making toilet soaps,  triglycerides  (oils and fats) are derived from coconut, olive, or palm oils, as well as  tallow . [ 14 ]  Triglyceride is the chemical name for the  triesters  of fatty acids and  glycerin . Tallow,  i.e.,   rendered  fat, is the most available triglyceride from animals. Each species offers quite different fatty acid content, resulting in soaps of distinct feel. The seed oils give softer but milder soaps. Soap made from pure  olive oil , sometimes called  Castile soap  or  Marseille soap , is reputed for its particular mildness. The term \"Castile\" is also sometimes applied to soaps from a mixture of oils with a high percentage of olive oil."}
{"_id": "WikiPedia_Dermatology$$$corpus_4234", "text": "Proto-soaps, which mixed fat and alkali and were used for cleansing, are mentioned in  Sumerian ,  Babylonian  and  Egyptian  texts. [ 15 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4235", "text": "The earliest recorded evidence of the production of soap-like materials dates back to around 2800\u00a0BC in ancient Babylon. [ 17 ]  A formula for making a soap-like substance was written on a Sumerian clay tablet around 2500 BC. This was produced by heating a mixture of oil and  wood ash , the earliest recorded chemical reaction, and used for washing  woolen  clothing. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4236", "text": "The  Ebers papyrus  (Egypt, 1550\u00a0BC) indicates the ancient Egyptians used a soap-like product as a medicine and created this by combining animal fats or vegetable oils with a  soda ash  substance called  trona . [ 18 ]  Egyptian documents mention a similar substance was used in the preparation of  wool  for weaving. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4237", "text": "In the reign of  Nabonidus  (556\u2013539\u00a0BC), a recipe for a soap-like substance consisted of  uhulu  [ashes],  cypress  [oil] and sesame [seed oil] \"for washing the stones for the servant girls\". [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4238", "text": "True soaps, which we might recognise as soaps today, were different to proto-soaps. They foamed, were made deliberately, and could be produced in a hard or soft form because of an understanding of lye sources. [ 16 ]  It is uncertain as to who was the first to invent true soap. [ 15 ] [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4239", "text": "Knowledge of how to produce true soap emerged at some point between early mentions of proto-soaps and the first century AD. [ 15 ] [ 16 ]  Alkali was used to clean textiles such as wool for thousands of years [ 21 ]  but soap only forms when there is enough fat, and experiments show that washing wool does not create visible quantities of soap. [ 15 ]  Experiments by Sally Pointer show that the repeated laundering of materials used in  perfume -making lead to noticeable amounts of soap forming. This fits with other evidence from  Mesopotamian  culture. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4240", "text": "Pliny the Elder, whose writings chronicle life in the first century AD, describes soap as \"an invention of the Gauls\". [ 22 ]  The word  sapo , Latin for soap, has  connected to a mythical Mount Sapo, a hill near the River Tiber where animals were sacrificed. [ 23 ]  But in all likelihood, the word was borrowed from an early Germanic language and is  cognate  with Latin  sebum , \" tallow \". It first appears in  Pliny the Elder 's account, [ 24 ]   Historia Naturalis , which discusses the manufacture of soap from tallow and ashes. There he mentions its use in the treatment of  scrofulous sores , as well as among the  Gauls  as a dye to redden hair which the men in  Germania  were more likely to use than women. [ 25 ] [ 26 ]  The Romans avoided washing with harsh soaps before encountering the milder soaps used by the Gauls around 58\u00a0BC. [ 27 ]   Aretaeus of Cappadocia , writing in the 2nd century AD, observes among \"Celts, which are men called Gauls, those alkaline substances that are made into balls [...] called  soap \". [ 28 ]  The Romans' preferred method of cleaning the body was to massage oil into the skin and then scrape away both the oil and any dirt with a  strigil . [ 29 ]  The standard design is a curved blade with a handle, all of which is made of metal. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4241", "text": "The 2nd-century AD physician  Galen  describes soap-making using lye and prescribes washing to carry away impurities from the body and clothes. The use of soap for personal cleanliness became increasingly common in this period. According to Galen, the best soaps were Germanic, and soaps from Gaul were second best.  Zosimos of Panopolis ,  circa  300\u00a0AD, describes soap and soapmaking. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4242", "text": "In the Southern  Levant , the ashes from  barilla plants , such as species of  Salsola , saltwort ( Seidlitzia rosmarinus ) and  Anabasis , were used to make  potash . [ 32 ] [ 33 ]  Traditionally, olive oil was used instead of animal lard throughout the Levant, which was boiled in a copper cauldron for several days. [ 34 ]  As the boiling progresses, alkali ashes and smaller quantities of  quicklime  are added and constantly stirred. [ 34 ]  In the case of lard, it required constant stirring while kept lukewarm until it began to trace. Once it began to thicken, the brew was poured into a mold and left to cool and harden for two weeks. After hardening, it was cut into smaller cakes. Aromatic herbs were often added to the rendered soap to impart their fragrance, such as  yarrow  leaves,  lavender ,  germander , etc."}
{"_id": "WikiPedia_Dermatology$$$corpus_4243", "text": "A detergent similar to soap was manufactured in ancient China from the seeds of  Gleditsia sinensis . [ 35 ]  Another traditional detergent is a mixture of pig pancreas and plant ash called  zhuyizi  ( simplified Chinese :  \u732a\u80f0\u5b50 ;  traditional Chinese :  \u8c6c\u80f0\u5b50 ;  pinyin :  zh\u016by\u00edz\u01d0 ). Soap made of animal fat did not appear in China until the modern era. [ 36 ]  Soap-like detergents were not as popular as ointments and creams. [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4244", "text": "Hard toilet soap with a pleasant smell was produced in the  Middle East  during the  Islamic Golden Age , when soap-making became an established industry. Recipes for soap-making are described by  Muhammad ibn Zakariya al-Razi  (c. 865\u2013925), who also gave a recipe for producing  glycerine  from  olive oil . In the Middle East, soap was produced from the interaction of  fatty oils  and  fats  with  alkali . In  Syria , soap was produced using olive oil together with alkali and  lime . Soap was exported from Syria to other parts of the  Muslim world  and to Europe. [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4245", "text": "A 12th-century document describes the process of soap production. [ 38 ]  It mentions the key ingredient,  alkali , which later became crucial to modern chemistry, derived from  al-qaly  or \"ashes\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_4246", "text": "By the 13th century, the manufacture of soap in the Middle East had become a major cottage industry, with sources in  Nablus ,  Fes ,  Damascus , and  Aleppo . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4247", "text": "Soapmakers in  Naples  were members of a  guild  in the late sixth century (then under the control of the  Eastern Roman Empire ), [ 39 ]  and in the eighth century, soap-making was well known in Italy and Spain. [ 40 ]  The  Carolingian   capitulary   De Villis , dating to around 800, representing the royal will of  Charlemagne , mentions soap as being one of the products the stewards of royal estates are to tally. The lands of  Medieval Spain  were a leading soapmaker by 800, and soapmaking began in the  Kingdom of England  about 1200. [ 41 ]  Soapmaking is mentioned both as \"women's work\" and as the produce of \"good workmen\" alongside other necessities, such as the produce of carpenters, blacksmiths, and bakers. [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4248", "text": "In Europe, soap in the 9th century was produced from animal fats and had an unpleasant smell. This changed when olive oil began to be used in soap formulas instead, after which much of Europe's soap production moved to the Mediterranean olive-growing regions. [ 43 ]  Hard toilet soap was introduced to Europe by Arabs and gradually spread as a luxury item. It was often perfumed. [ 37 ] [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4249", "text": "By the 15th century, the manufacture of soap in  Christendom  often took place on an industrial scale, with sources in  Antwerp ,  Castile ,  Marseille ,  Naples  and  Venice . [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4250", "text": "In France, by the second half of the 16th century, the semi-industrialized professional manufacture of soap was concentrated in a few centers of  Provence \u2014 Toulon ,  Hy\u00e8res , and  Marseille \u2014which supplied the rest of France. [ 44 ]  In Marseilles, by 1525, production was concentrated in at least two factories, and soap production at Marseille tended to eclipse the other Proven\u00e7al centers. [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4251", "text": "English manufacture tended to concentrate in London. [ 46 ]  The demand for high-quality hard soap was significant enough during the Tudor period that barrels of ashes were imported for the manufacture of soap. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4252", "text": "Finer soaps were later produced in Europe from the 17th century, using vegetable oils (such as  olive oil ) as opposed to animal fats. Many of these soaps are still produced, both industrially and by small-scale artisans.  Castile soap  is a popular example of the vegetable-only soaps derived from the oldest \"white soap\" of Italy. In 1634 Charles I granted the newly formed Society of Soapmakers a monopoly in soap production who produced certificates from 'foure Countesses, and five Viscountesses, and divers other Ladies and Gentlewomen of great credite and quality, besides common Laundresses and others', testifying that 'the New White Soap washeth whiter and sweeter than the Old Soap'. [ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4253", "text": "During the  Restoration era  (February 1665 \u2013 August 1714) a soap tax was introduced in England, which meant that until the mid-1800s, soap was a luxury, used regularly only by the well-to-do. The soap manufacturing process was closely supervised by revenue officials who made sure that soapmakers' equipment was kept under lock and key when not being supervised. Moreover, soap could not be produced by small makers because of a law that stipulated that soap boilers must manufacture a minimum quantity of one imperial ton at each boiling, which placed the process beyond the reach of the average person. The soap trade was boosted and deregulated when the tax was repealed in 1853. [ 48 ] [ 49 ] [ 50 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4254", "text": "Industrially manufactured  bar soaps  became available in the late 18th century, as advertising campaigns in Europe and America promoted popular awareness of the relationship between cleanliness and health. [ 51 ]  In modern times, the use of soap has become commonplace in industrialized nations due to a better understanding of the role of  hygiene  in reducing the population size of  pathogenic   microorganisms . [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4255", "text": "Until the  Industrial Revolution , soapmaking was conducted on a small scale and the product was rough. In 1780,  James Keir  established a chemical works at  Tipton , for the manufacture of alkali from the sulfates of  potash  and soda, to which he afterwards added a soap manufactory. The method of extraction proceeded on a discovery of Keir's. In 1790,  Nicolas Leblanc  discovered how to make alkali from  common salt . [ 27 ]   Andrew Pears  started making a high-quality, transparent soap,  Pears soap , in 1807 in London. [ 53 ]  His son-in-law,  Thomas J. Barratt , became the brand manager (the first of its kind) for Pears in 1865. [ 54 ]  In 1882, Barratt recruited English actress and socialite  Lillie Langtry  to become the poster-girl for Pears soap, making her the first celebrity to endorse a commercial product. [ 55 ] [ 56 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4256", "text": "William Gossage  produced low-priced, good-quality soap from the 1850s.  Robert Spear Hudson  began manufacturing a soap powder in 1837, initially by grinding the soap with a  mortar and pestle . American manufacturer  Benjamin T. Babbitt  introduced marketing innovations that included the sale of bar soap and distribution of  product samples .  William Hesketh Lever  and his brother,  James , bought a small soap works in  Warrington  in 1886 and founded what is still one of the largest soap businesses, formerly called Lever Brothers and now called  Unilever . These soap businesses were among the first to employ large-scale  advertising  campaigns."}
{"_id": "WikiPedia_Dermatology$$$corpus_4257", "text": "Liquid soap was invented in the nineteenth century; in 1865, William Sheppard patented a liquid version of soap. [ 57 ]  In 1898, B.J. Johnson developed a soap derived from palm and olive oils; his company, the  B.J. Johnson Soap Company , introduced \" Palmolive \" brand soap that same year. [ 58 ]  This new brand of soap became popular rapidly, and to such a degree that B.J. Johnson Soap Company changed its name to  Palmolive . [ 59 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4258", "text": "In the early 1900s, other companies began to develop their own liquid soaps. Such products as  Pine-Sol  and  Tide  appeared on the market, making the process of cleaning things other than skin, such as clothing, floors, and bathrooms, much easier."}
{"_id": "WikiPedia_Dermatology$$$corpus_4259", "text": "Liquid soap also works better for more traditional or non-machine washing methods, such as using a  washboard . [ 60 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4260", "text": "A  soap substitute  is a natural or synthetic cleaning product used in place of  soap  or other  detergents , typically to reduce environmental impact or health harms or provide other benefits."}
{"_id": "WikiPedia_Dermatology$$$corpus_4261", "text": "Traditionally, soap has been made from animal or plant derived fats and has been used by humans for cleaning purposes for several thousand years. [ 1 ]  Soap is not harmful to human health but, like any natural or unnatural surfactant, it does have the potential to cause environmental harm by forming a surface film that impedes the diffusion of oxygen into the water if it is added to an aquatic environment faster than it can biodegrade. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4262", "text": "Many washing agents today, from laundry and dish detergents to body wash and shampoos, are technically not soap, but synthetic detergents. [ 3 ]  They also often contain compounds that have been found to be harmful to human and wildlife health as well as to the environment. [ 2 ] [ 4 ] [ 5 ]  In this context, \u201cSoap Substitutes\u201d refers to cleansing products that significantly reduce or eliminate some or all of the components that have the potential to cause human or environmental harm. Throughout the last 100 years many changes have been made to the formulas of cleansing agents for these purposes, but the process of developing effective substitute detergent formulations that are completely harmless to humans and the environment is ongoing."}
{"_id": "WikiPedia_Dermatology$$$corpus_4263", "text": "This article outlines some of the problems and concerns about synthetic surfactant based cleaning products since their popularization in the early 20th century as well as how these issues have been addressed, both technologically and legislatively."}
{"_id": "WikiPedia_Dermatology$$$corpus_4264", "text": "Petroleum derived synthetic detergents became popular in the United States during World War 2 due to shortages of animal and plant derived fats and because they worked better when cleaning with hard water (water with a high concentration of dissolved minerals) than traditional soap. [ 6 ]  By the 1950s synthetic detergents were more commonly used than traditional soap in the United States. [ 7 ]  Many of the first synthetic detergents were made from compounds that contained branched carbon chains, which persist in the environment for far longer than their linear counterparts. [ 6 ]  Consequently, this led to the buildup of these foamy surfactants in water treatment plants as well as the formation of large flotillas of foam in waterways. [ 6 ]  Public pressure led the US and Europe to ban the use of alkyl benzene sulphonate (ABS) and other branched chain surfactants in 1965. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4265", "text": "This sparked great interest in the development of synthetic detergents that biodegrade into environmentally friendly byproducts. Such interest has led to the development of the linear carbon chain compounds commonly used today, such as sodium lauryl sulfate and sodium laureth sulfate/ sodium lauryl ether sulfate (SLS/SLES). [ 6 ]  While these surfactants are still derived from petroleum, a nonrenewable resource, and have been shown to cause mild to moderate irritation of skin, they biodegrade significantly faster, and this has led to a drastic reduction in surfactant pollution of waterways. [ 6 ] [ 8 ]  While the environmental friendliness of the biodegradation byproducts of the surfactants most commonly used today varies, the United States Environmental Protection Agency (EPA) monitors and regulates claims made by companies about the environmental friendliness and potential toxicity of the biodegradation byproducts of their cleansing products. [ 6 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4266", "text": "There have been continued efforts to develop surfactants that are milder to humans and pose less risk to the environment.\u00a0 An emerging substitute for synthetic petroleum derived surfactants such as SDS are Alkyl polyglycosides (APGs). [ 10 ] [ 11 ]  They are derived from plant based substances such as palm oil or wheat and exposure of APGs to skin and eyes is considerably safer than their petroleum derived counterparts. [ 10 ] [ 11 ]  Studies have shown APG use, even in large quantities, pose no measurable environmental risk, while others report that more research is needed to confirm the true environmental impact of APGs. [ 11 ]  Although the use of APG surfactants currently have some disadvantages, such as the relatively high cost of production and uncertainties about the potential environmental impact of large scale use, further research into the development of APG surfactants shows a promising path to the creation of a naturally derived, non-toxic and environmentally friendly substitute for petroleum derived surfactants that is inexpensive, equally effective, and mass producible. [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4267", "text": "Another environmental issue with synthetic detergents is the addition of phosphates to these cleaning products. Phosphates are added to detergent as tripolyphosphate or as sodium/potassium phosphate. [ 2 ] [ 6 ]  Phosphates interact with other ions in solution, like Calcium and Magnesium, to improve the washing ability of the detergent, especially when washing with hard water. [ 2 ]  Phosphates have also been shown to aid in killing germs when used in washing. [ 6 ]  However ,  most wastewater treatment processes generally remove only a small fraction of the phosphate in the water, and subsequently large quantities are released into waterways. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4268", "text": "When large quantities of phosphates accumulate in waterways, it causes a bloom in algae and a subsequent lack of oxygen in the water, which severely damages the aquatic ecosystem. This process is called \u201ceutrophication\u201d. [ 2 ] [ 6 ]  In 1959 detergents contained 7-12% phosphate by weight, by 1969 this increased to 15-17% by weight. [ 6 ] \u00a0 It is believed that during its peak use in the 1970s, half of all phosphates released by human activity was from detergents. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4269", "text": "Newfound knowledge of eutrophication from scientific research in the 1940s and 1950s along with the occurrence of massive algal blooms during the 1960s-1970s in waterways like Lake Erie led to significant public concern about the increasing pollution in lakes and rivers. [ 6 ]  People believed phosphates from detergents to be a major cause. [ 6 ]  This led to a demand for methods of removal of phosphate from wastewater during the treatment. [ 6 ]  The first processes designed to remove phosphates from municipal wastewater (for environmental purposes) were implemented in the 1960s. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4270", "text": "During this time, two main processes were used; phosphates were removed from the wastewater by either chemical precipitation or through biological mechanisms. [ 13 ]  Further investment and research into phosphate removal methods led to the development of the modern multiphase biological reactor for removal of phosphorus-containing compounds. [ 14 ] [ 15 ]  Despite the technological advances made in phosphate removal processes, most were designed for use in large water treatment facilities that have advanced monitoring capabilities and expert operating technicians on site. [ 15 ]  As of 1999, only 7% of municipal wastewater treatment facilities in the United States have the tertiary treatment processes needed to remove greater than 20% of the phosphate from affluent wastewater. [ 15 ]  Even today, there remains a lack of technologies for phosphate removal in the smaller water treatment facilities found in non-urban areas. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4271", "text": "By the early 1970s there was also significant public pressure on the United States government to ban phosphates in detergent cleansing products and congressional hearings on the topic were held. [ 17 ]  Detergent manufacturers explored the use of other compounds as a potential substitute for phosphates such as nitrile-tri-acetic acid (NTA), gluconic acid, citric acid, and polyelectrolytes. [ 17 ]  Ultimately, effective detergent formulations using citric acid and polyelectrolytes were developed and in some cases even sold; but they were not a comparable substitute to phosphate containing detergent formulations, either economically or in cleaning ability. [ 17 ] [ 18 ]  \u00a0While these hearings did not result in any direct regulation of the phosphate content of detergent by the federal government, they were part of the many hearings that led to the  Clean Water Act  of 1972. [ 17 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4272", "text": "Major soap manufactures resisted an outright ban on phosphates, and in 1970 voluntarily agreed to lower phosphate concentrations in detergents to 8.7%. [ 6 ] \u00a0 Although the US federal government has made no legislation banning phosphates in laundry detergent, between 1971 and 1990, most US states independently banned or strictly limited it. [ 15 ] \u00a0 In 1994, the Soap and Detergent Association (today known as the American Cleaning Institute (ACI)), a coalition representing most major detergent manufactures, voluntarily agreed to ban phosphates in consumer laundry detergents. [ 15 ]  Notably, this ban did not include dish detergents. [ 15 ]  Procter and Gamble, a detergent industry giant and ACI member, did not remove phosphates from all of their brands of laundry detergent (Tide, Ariel, Ace, and Bounty) until 2016. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4273", "text": "By 2010, many US states and municipalities also enacted regulations on the use of phosphates in dishwashing detergent. [ 21 ]  At that time, The American Cleaning Institute announced a voluntary ban on the use of phosphates in all dish detergents. [ 22 ]  Despite this, Procter & Gamble\u2019s sustainability reports only report the complete removal of phosphates from its Fairy and Dreft brand dish detergent; and these changes were not enacted until 2017. [ 23 ] [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4274", "text": "The European Union took a different path than the United States. They banned the use of phosphates in consumer laundry and dish detergents in 2014 and 2017 respectively. [ 25 ]  Like the regulations enacted by many US states, these laws did not apply to the use of phosphates in commercial products. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4275", "text": "Although there are a number of exceptions to the laws and bans that allow phosphate use in detergent products [ 21 ]  and it is not entirely clear of the degree in which detergent manufacturers complied with their voluntary bans, there has been a significant reduction in phosphate use in detergent products. [ 15 ]  Today, formulations with zeolites, polycarboxylates, citric acid, and sodium bicarbonate are among the most effective and popular substitutes for phosphates in detergent cleaning products. [ 26 ] \u00a0 This, along with improved water treatment processes, has greatly contributed to a significant reduction in the amount of phosphate from detergent in waterways. These efforts have resulted in an overall reduction of the phosphate concentration in US waterways and some of the ecosystems most effected by eutrophication, such as Lake Erie, to show drastic improvement. [ 15 ] [ 27 ] [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4276", "text": "There are also opponents to eliminating phosphates in detergent. [ 6 ] [ 29 ] [ 30 ]  There are widespread claims that no effective substitute for phosphate has been developed, as many people report that when washing with phosphate free dish detergents, the dishes are left with a white film or spots on them. [ 30 ]  Opponents to bans of phosphate in dish detergents argue that efforts should be focused on developing an effective method of removal during the treatment process, not banning the product itself; which is both useful and unrivaled by any substitute. Additionally, there are arguments that phosphate is not the primary cause of eutrophication in coastal waters, and therefore phosphorus should not be regulated in these regions. This argument is based upon reports that the nitrogen content of coastal waters is limited (nitrogen is required for algal growth), therefore, reduction in phosphate use would have little effect on the amount of algae that can grow in these coastal areas. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4277", "text": "There have been more recent efforts to increase the  environmental sustainability  of laundry and dish detergents via the addition of enzymes that break down dirt and grease. Adding enzymes significantly reduces the amount of detergent needed to wash, and subsequently reduces the amount of surfactant being put into waterways. [ 1 ]  Enzymes that have been designed to work at lower temperatures can also significantly reduce the amount of energy needed to wash clothes. [ 1 ] [ 31 ]  For example, when using a top-load washer, switching from using \u201chot/warm\u201d or \u201cwarm/warm\u201d cycle to a \u201ccold/cold\u201d cycle uses 15 times and 11.6 times less energy, respectively. This technology has already been implemented by companies like Tide, in its Cold Water Clean Laundry Detergent. [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4278", "text": "Automatic dishwashing detergent is poisonous if swallowed. [ 33 ]   Formaldehyde, while not intentionally added, has also been found in some detergent cleansing products. [ 34 ]  Per the Centers for Disease Control and Prevention (CDC), exposure to formaldehyde at low levels from inhalation increases one\u2019s risk of cancer and the EPA classifies formaldehyde as a B1 probable carcinogen. [ 35 ] [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4279", "text": "There has also been recent concern about potential environmental and health risks associated with an antimicrobial agent called Triclosan. [ 37 ]  Triclosan is found in so many consumer products that it is believed that 75% of all Americans have been exposed to it. [ 38 ]  While research on the health and environmental risks of Triclosan are far from complete, studies have shown it is dermally absorbed and retained in the body and it has also been shown to disrupt biological processes. [ 38 ]  Investigations of the chemical properties of Triclosan have revealed it has the potential to accumulate and persist in the environment. [ 37 ]  In 2016, the FDA banned the marketing of Triclosan, along with several other antimicrobial agents, in antibacterial detergent products because \u201cmanufactures did not demonstrate that the ingredients are both safe for long-term daily use and more effective than plain soap and water in preventing illness and the spread of certain infections\u201d. [ 39 ]  In the US, Triclosan is still used in toothpaste, mouthwash, hand sanitizer, and surgical soaps. [ 38 ]  In 2017, the European Union banned Triclosan from all personal hygiene products. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4280", "text": "Even though the fragrances in scented cleaning products have been shown to release volatile and potentially harmful compounds into the air, fragrance ingredients are not required to be listed by manufactures. [ 41 ] [ 42 ]  Artificial fragrances can cause sensitivity, allergies, and rashes and some of these chemicals are known carcinogens and endocrine disruptors. [ 43 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4281", "text": "There are still many compounds that are potentially damaging to human and environmental health found in many detergent cleaning products; and just because a product is labeled as \u201cgreen\u201d does not mean it is safe. [ 44 ]  If people are concerned about being exposed to harmful compounds through detergent products, it is best to do their own research on how to decide which product is best for them using a reliable source, such as the EPA\u2019s \u201cSafer Choice\u201d program, which provides consumers with safety information of products like dish, laundry, and hand detergents. [ 44 ] [ 45 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4282", "text": "There are many small companies that offer soaps claimed to be made the traditional way (from all natural fats and contain no harmful additives, such as Rocky Mountain Soap Co. and Dr. Squatch Soap Co). There are also companies that claim to sell all natural and additive free laundry soaps, but many of these soaps still contain an additive called borax, which has been shown to cause irritation to skin, eyes, and lungs as well as reproductive and kidney damage if swallowed or inhaled."}
{"_id": "WikiPedia_Dermatology$$$corpus_4283", "text": "Additionally, one can ensure their soap is all natural and contains no potentially harmful additives by making their own soap at home. There are many resources for instructions on making soap at home, and the only required ingredients are plant or animal fat, water, and lye (sodium hydroxide). It is also noteworthy that there are many homemade products that are highly efficient at cleaning, such as hot water, vinegar, baking soda, lemon juice, salt, coffee powder, ascorbic acid, and grapefruit extract. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4284", "text": "[ 47 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4285", "text": "Sunscreen , also known as  sunblock , [ a ]   sun lotion  or  sun cream , is a  photoprotective  topical product for the  skin  that helps protect against  sunburn  and prevent  skin cancer . Sunscreens come as  lotions , sprays, gels, foams (such as an expanded foam lotion or whipped lotion [ 4 ] ), sticks, powders and other topical products. Sunscreens are common supplements to clothing, particularly  sunglasses ,  sunhats  and special  sun protective clothing , and other forms of photoprotection (such as  umbrellas )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4286", "text": "Sunscreens may be classified according to the type of  active ingredient(s)  present in the formulation ( inorganic compounds  or  organic molecules ) as:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4287", "text": "Medical organizations such as the  American Cancer Society  recommend the use of sunscreen because it aids in the prevention of  squamous cell carcinomas . [ 12 ]  The routine use of sunscreens may also reduce the risk of  melanoma . [ 13 ]  To effectively protect against all the potential damages of UV light, the use of broad-spectrum sunscreens (covering both  UVA  and  UVB  radiation) has been recommended. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4288", "text": "As of 2021, only zinc oxide and titanium dioxide are generally recognized as safe and effective ( GRASE ) by the U.S. Food and Drug Administration (FDA) [ 14 ]  since there is currently insufficient data to support recognizing petrochemical UV filters as safe."}
{"_id": "WikiPedia_Dermatology$$$corpus_4289", "text": "Early civilizations used a variety of plant products to help protect the skin from sun damage. For example,  ancient Greeks  used olive oil for this purpose, and  ancient Egyptians  used extracts of rice, jasmine, and lupine plants whose products are still used in skin care today. [ 15 ]  Zinc oxide paste has also been popular for skin protection for thousands of years. [ 16 ]  Among the nomadic sea-going  Sama-Bajau people  of the  Philippines ,  Malaysia , and  Indonesia , a common type of sun protection is a paste called  borak  or  burak , which was made from water weeds, rice and spices. It is used most commonly by women to protect the face and exposed skin areas from the harsh tropical sun at sea. [ 17 ]  In  Myanmar ,  thanaka , a yellow-white cosmetic paste made of ground bark, is traditionally used for sun protection. In  Madagascar , a ground wood paste called  masonjoany  has been worn for sun protection, as well as decoration and insect repellent, since the 18th century, and is ubiquitous in the Northwest coastal regions of the island to this day. [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4290", "text": "The first ultraviolet B filters were produced in 1928. [ 20 ]  Followed by the first sunscreen, invented in Australia by chemist H.A. Milton Blake, in 1932 [ 21 ]  formulating with the UV filter 'salol' (Phenyl salicylate) at a concentration of 10%. [ 22 ]  Its protection was verified by the  University of Adelaide . [ 23 ] [ 24 ]  In 1936,  L'Oreal  released its first sunscreen product, formulated by French chemist  Eug\u00e8ne Schueller . [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4291", "text": "The US military was an early adopter of sunscreen. In 1944, as the hazards of sun overexposure became apparent to soldiers stationed in the Pacific tropics at the height of  World War II , [ 25 ] [ 21 ] [ 26 ] [ 27 ]  Benjamin Green, an airman and later a  pharmacist  produced Red Vet Pet (for red veterinary petrolatum) for the US military. Sales boomed when  Coppertone  improved and commercialized the substance under the  Coppertone girl  and  Bain de Soleil  branding in the early 1950s. In 1946,  Austrian  chemist Franz Greiter introduced a product, called  Gletscher Cr\u00e8me  (Glacier Cream), subsequently became the basis for the company Piz Buin, named in honor of  the mountain  where Greiter allegedly received the sunburn. [ 28 ] [ 29 ] [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4292", "text": "In 1974, Greiter adapted earlier calculations from Friedrich Ellinger and Rudolf Schulze and introduced the \"sun protection factor\" (SPF), which has become the global standard for measuring UVB protection. [ 25 ] [ 31 ]  It has been estimated that  Gletscher Cr\u00e8me  had an SPF of 2."}
{"_id": "WikiPedia_Dermatology$$$corpus_4293", "text": "Water-resistant sunscreens were introduced in 1977, [ 21 ]  and recent development efforts have focused on overcoming later concerns by making sunscreen protection both longer-lasting and broader-spectrum (protection from both UVA & UVB rays), more environmentally friendly, [ 32 ]  more appealing to use [ 25 ]  and addressing the safety concerns of petrochemical sunscreens, i.e. FDA studies showing their systematic absorption into the bloodstream. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4294", "text": "Sunscreen use can help prevent  melanoma [ 34 ] [ 35 ] [ 36 ]  and  squamous cell carcinoma , two types of  skin cancer . [ 37 ]  There is little evidence that it is effective in preventing  basal cell carcinoma . [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4295", "text": "A 2013 study concluded that the diligent, everyday application of sunscreen could slow or temporarily prevent the development of wrinkles and sagging skin. [ 39 ]  The study involved 900  white  people in Australia and required some of them to apply a broad-spectrum sunscreen every day for four and a half years. It found that people who did so had noticeably more resilient and smoother skin than those assigned to continue their usual practices. [ 39 ]  A study on 32 subjects showed that daily use of sunscreen (SPF 30) reversed  photoaging  of the skin within 12 weeks and the amelioration continued until the end of the investigation period of one year. [ 40 ]  Sunscreen is inherently anti-ageing as the sun is the number one cause of premature ageing; it therefore may slow or temporarily prevent the development of wrinkles, dark spots, and sagging skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_4296", "text": "Minimizing UV damage is especially important for children and fair-skinned individuals and those who have  sun sensitivity  for medical reasons. [ 41 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4297", "text": "In February 2019, the US  Food and Drug Administration  (FDA) started classifying already approved UV filter molecules into three categories: those which are  generally recognized as safe and effective  (GRASE), those which are non-GRASE due to safety issues, and those requiring further evaluation. [ 42 ]  As of 2021, only zinc oxide and titanium dioxide are recognized as GRASE. [ 43 ]  Two previously approved UV filters, para-aminobenzoic acid (PABA) and trolamine salicylate, were banned in 2021 due to safety concerns. The remaining FDA approved active ingredients were put in the third category as their manufacturers have yet to produce sufficient safety data \u2014 despite the fact that some of the chemicals have sold in sunscreen products for more than 40 years. [ 7 ]  Some researchers argue that the risk of sun-induced skin cancer outweighs concerns about toxicity and mutagenicity, [ 44 ] [ 45 ]  although environmentalists say this ignores \"ample safer alternatives available on the market containing the active ingredient minerals zinc oxide or titanium dioxide\", which are also safer for the environment. [ 46 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4298", "text": "Regulators can investigate and ban UV filters over safety concerns (such as  PABA ), which can result in withdrawal of products from the consumer market. [ 25 ] [ 47 ]  Regulators, such as the TGA and the FDA, have also been concerned with recent reports of contamination in sunscreen products with known possible human carcinogens such as  benzene  and  benzophenone . [ 48 ]  Independent laboratory testing carried out by Valisure found benzene contamination in 27% of the sunscreens they tested, with some batches having up to triple the FDA's conditionally restricted limit of 2 parts per million (ppm). [ 49 ]  This resulted in a voluntary recall by some major sunscreen brands that were implicated in the testing, as such, regulators also help publicise and coordinate these voluntary recalls. [ 50 ]  VOC's (Volatile Organic Compounds) such as benzene, are particularly harmful in sunscreen formulations as many active and inactive ingredients can increase permeation across the skin. [ 51 ]  Butane, which is used as a propellant in spray sunscreens, has been found to have benzene impurities from the refinement process. [ 52 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4299", "text": "Recent research by the FDA on six common petrochemical UV filters ( avobenzone ,  oxybenzone ,  octocrylene ,  homosalate ,  octisalate , and  octinoxate ) found that they could be detected on the skin, in blood, in breast milk and in urine samples weeks after a single use. [ 53 ] [ 54 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4300", "text": "There is a risk of an allergic reaction to sunscreen for some individuals, as \"Typical allergic contact dermatitis may occur in individuals allergic to any of the ingredients that are found in sunscreen products or cosmetic preparations that have a sunscreen component. The rash can occur anywhere on the body where the substance has been applied and sometimes may spread to unexpected sites.\" [ 55 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4301", "text": "There are some concerns about potential  vitamin D deficiency  arising from prolonged use of sunscreen. [ 56 ] [ 57 ]  The typical use of sunscreen does not usually result in vitamin D deficiency; however, extensive usage may. [ 58 ]  Sunscreen prevents ultraviolet light from reaching the skin, and even moderate protection can substantially reduce vitamin D synthesis. [ 59 ] [ 60 ]  However, adequate amounts of vitamin D can be obtained via diet or supplements. [ 61 ]  Vitamin D overdose is impossible from UV exposure due to an equilibrium the skin reaches in which vitamin D degrades as quickly as it is created. [ 62 ] [ 63 ] [ 64 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4302", "text": "High-SPF sunscreens filter out most UVB radiation, which triggers vitamin D production in the skin. However, clinical studies show that regular sunscreen use does not lead to vitamin D deficiency. Even high-SPF sunscreens allow a small amount of UVB to reach the skin, sufficient for vitamin D synthesis. Additionally, brief, unprotected  sun exposure  can produce ample vitamin D, but this exposure also risks significant DNA damage and skin cancer. To avoid these risks, vitamin D can be obtained safely through  diet  and supplements. Foods like  fatty fish , fortified milk, and orange juice, along with supplements, provide necessary vitamin D without harmful sun exposure.\n [ 65 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4303", "text": "Studies have shown that sunscreen with a high UVA protection factor enabled significantly higher vitamin D synthesis than a low UVA protection factor sunscreen, likely because it allows more UVB transmission. [ 66 ] [ 67 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4304", "text": "The sun protection factor (SPF rating, introduced in 1974) is a measure of the fraction of sunburn-producing UV rays that reach the skin. For example, \"SPF 15\" means that  1 \u2044 15  of the burning radiation will reach the skin, assuming sunscreen is applied evenly at a thick  dosage  of 2 milligrams per square centimeter [ 68 ]  (mg/cm 2 ). It is important to note that sunscreens with higher SPF do not last or remain effective on the skin any longer than lower SPF and must be continually reapplied as directed, usually every two hours. [ 69 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4305", "text": "The SPF is an imperfect measure of skin damage because invisible damage and skin malignant melanomas are also caused by  ultraviolet A  (UVA, wavelengths 315\u2013400 or 320\u2013400  nm ), which does not primarily cause reddening or pain. Conventional sunscreen blocks very little UVA radiation relative to the nominal SPF; broad-spectrum sunscreens are designed to protect against both UVB and UVA. [ 70 ] [ 71 ] [ 72 ]  According to a 2004 study, UVA also causes  DNA damage  to cells deep within the skin, increasing the risk of  malignant melanomas . [ 73 ]  Even some products labeled \"broad-spectrum UVA/UVB protection\" have not always provided good protection against UVA rays. [ 74 ]   Titanium dioxide  probably gives good protection but does not completely cover the UVA spectrum, with early 2000s research suggesting that zinc oxide is superior to titanium dioxide at wavelengths 340\u2013380\u00a0nm. [ 75 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4306", "text": "Owing to consumer confusion over the real degree and duration of protection offered, labelling restrictions are enforced in several countries. In the  EU , sunscreen labels can only go up to SPF 50+ (initially listed as 30 but soon revised to 50). [ 76 ]   Australia 's  Therapeutic Goods Administration  increased the upper limit to 50+ in 2012. [ 77 ] [ 78 ]  In its 2007 and 2011 draft rules, the US  Food and Drug Administration  (FDA) proposed a maximum SPF label of 50, to limit unrealistic claims. [ 79 ] [ 3 ] [ 80 ]  (As of August 2019, the FDA has not adopted the SPF 50 limit. [ 81 ] ) Others have proposed restricting the active ingredients to an SPF of no more than 50, due to lack of evidence that higher dosages provide more meaningful protection, [ 82 ]  despite a common misconception that protection directly scales with SPF; doubling when SPF is doubled. [ 83 ] [ 84 ]  Different sunscreen ingredients have different effectiveness against UVA and UVB. [ 85 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4307", "text": "The SPF can be measured by applying sunscreen to the skin of a volunteer and measuring how long it takes before sunburn occurs when exposed to an artificial sunlight source. In the US, such an  in vivo  test is required by the FDA. It can also be measured  in vitro  with the help of a specially designed  spectrometer . In this case, the actual  transmittance  of the sunscreen is measured, along with the degradation of the product due to being exposed to sunlight. In this case, the transmittance of the sunscreen must be measured over all wavelengths in sunlight's UVB\u2013UVA range (290\u2013400\u00a0nm), along with a table of how effective various wavelengths are in causing sunburn (the  erythemal action spectrum ) and the standard intensity  spectrum  of sunlight (see the figure). Such  in vitro  measurements agree very well with  in vivo  measurements. [ attribution needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4308", "text": "Numerous methods have been devised for evaluation of UVA and UVB protection. The most-reliable spectrophotochemical methods eliminate the subjective nature of grading  erythema . [ 86 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4309", "text": "The ultraviolet protection factor (UPF) is a similar scale developed for rating fabrics for  sun protective clothing . According to recent testing by  Consumer Reports , UPF ~30+ is typical for protective fabrics, while UPF ~20 is typical for standard summer fabrics. [ 87 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4310", "text": "Mathematically, the SPF (or the UPF) is calculated from measured data as: [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4311", "text": "S \n P \n F \n \n = \n \n \n \n \u222b \n A \n ( \n \u03bb \n ) \n E \n ( \n \u03bb \n ) \n d \n \u03bb \n \n \n \u222b \n A \n ( \n \u03bb \n ) \n E \n ( \n \u03bb \n ) \n \n / \n \n \n M \n P \n F \n \n ( \n \u03bb \n ) \n \n d \n \u03bb \n \n \n \n , \n \n \n {\\displaystyle \\mathrm {SPF} ={\\frac {\\int A(\\lambda )E(\\lambda )d\\lambda }{\\int A(\\lambda )E(\\lambda )/\\mathrm {MPF} (\\lambda )\\,d\\lambda }},}"}
{"_id": "WikiPedia_Dermatology$$$corpus_4312", "text": "where  \n \n \n \n E \n ( \n \u03bb \n ) \n \n \n {\\displaystyle E(\\lambda )} \n \n  is the  solar irradiance  spectrum,  \n \n \n \n A \n ( \n \u03bb \n ) \n \n \n {\\displaystyle A(\\lambda )} \n \n  the erythemal action spectrum, and  \n \n \n \n \n M \n P \n F \n \n ( \n \u03bb \n ) \n \n \n {\\displaystyle \\mathrm {MPF} (\\lambda )} \n \n  the monochromatic protection factor, all functions of the wavelength  \n \n \n \n \u03bb \n \n \n {\\displaystyle \\lambda } \n \n . The MPF is roughly the inverse of the transmittance at a given wavelength. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4313", "text": "The combined SPF of two layers of sunscreen may be lower than the square of the single-layer SPF. [ 88 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4314", "text": "The persistent pigment darkening (PPD) method is a method of measuring UVA protection, similar to the SPF method of measuring sunburn protection. Originally developed in Japan, it is the preferred method used by manufacturers such as  L'Or\u00e9al ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4315", "text": "Instead of measuring  erythema , the PPD method uses UVA radiation to cause a persistent darkening or tanning of the skin. Theoretically, a sunscreen with a PPD rating of 10 should allow a person 10 times as much UVA exposure as would be without protection. The PPD method is an  in vivo  test like SPF. In addition, the European Cosmetic and Perfumery Association ( Colipa ) has introduced a method that, it is claimed, can measure this  in vitro  and provide parity with the PPD method. [ 89 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4316", "text": "As part of revised guidelines for sunscreens in the EU, there is a requirement to provide the consumer with a minimum level of UVA protection in relation to the SPF. This should be a UVA protection factor of at least 1/3 of the SPF to carry the UVA seal. [ 90 ]  The 1/3 threshold derives from the European Commission recommendation 2006/647/EC. [ 91 ]  This Commission recommendation specifies that the UVA protection factor should be measured using the PPD method as modified by the French health agency  AFSSAPS (now ANSM)  \"or an equivalent degree of protection obtained with any in vitro method\". [ 92 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4317", "text": "A set of final US FDA rules effective from summer 2012 defines the phrase \"broad spectrum\" as providing UVA protection proportional to the UVB protection, using a standardized testing method. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4318", "text": "In the UK and Ireland, the  Boots  star rating system is a proprietary  in vitro  method used to describe the ratio of UVA to UVB protection offered by sunscreen creams and sprays. Based on original work by Brian Diffey at  Newcastle University , the Boots Company in Nottingham, UK, developed a method that has been widely adopted by companies marketing these products in the UK."}
{"_id": "WikiPedia_Dermatology$$$corpus_4319", "text": "One-star products provide the lowest ratio of UVA protection, five-star products the highest. The method was revised in light of the Colipa UVA PF test and the revised EU recommendations regarding UVA PF. The method still uses a  spectrophotometer  to measure absorption of UVA versus UVB; the difference stems from a requirement to pre-irradiate samples (where this was not previously required) to give a better indication of UVA protection and photostability when the product is used. With the current methodology, the lowest rating is three stars, the highest being five stars."}
{"_id": "WikiPedia_Dermatology$$$corpus_4320", "text": "In August 2007, the FDA put out for consultation the proposal that a version of this protocol be used to inform users of American product of the protection that it gives against UVA; [ 79 ]  but this was not adopted, for fear it would be too confusing. [ 82 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4321", "text": "Asian brands, particularly Japanese ones, tend to use The Protection Grade of UVA (PA) system to measure the UVA protection that a sunscreen provides. The PA system is based on the PPD reaction and is now widely adopted on the labels of sunscreens. According to the Japan Cosmetic Industry Association, PA+ corresponds to a UVA protection factor between two and four, PA++ between four and eight, and PA+++ more than eight. This system was revised in 2013 to include PA++++ which corresponds to a PPD rating of sixteen or above."}
{"_id": "WikiPedia_Dermatology$$$corpus_4322", "text": "Some sunscreens include an  expiration date \u2014a date indicating when they may become less effective. [ 93 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4323", "text": "Sunscreen formulations contain UV absorbing compounds (the active ingredients) dissolved or dispersed in a mixture of other ingredients, such as water, oils, moisturizers, and antioxidants. The UV filters can be either:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4324", "text": "The organic compounds used as UV filter are often  aromatic  molecules  conjugated  with  carbonyl  groups. This general structure allows the molecule to absorb high-energy ultraviolet rays and release the energy as lower-energy rays, thereby preventing the skin-damaging ultraviolet rays from reaching the skin. So, upon exposure to UV light, most of the ingredients (with the notable exception of  avobenzone ) do not undergo significant chemical change, allowing these ingredients to retain the UV-absorbing potency without significant  photodegradation . [ 97 ]  A chemical stabilizer is included in some sunscreens containing avobenzone to slow its breakdown. The stability of avobenzone can also be improved by  bemotrizinol , [ 98 ]   octocrylene [ 99 ]  and various other photostabilisers. Most organic compounds in sunscreens slowly degrade and become less effective over the course of several years even if stored properly, resulting in the  expiration dates  calculated for the product. [ 100 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4325", "text": "Sunscreening agents are used in some hair care products such as shampoos, conditioners and styling agents to protect against protein degradation and color loss. Currently,  benzophenone-4  and  ethylhexyl methoxycinnamate  are the two sunscreens most commonly used in hair products. The common sunscreens used on skin are rarely used for hair products due to their texture and weight effects."}
{"_id": "WikiPedia_Dermatology$$$corpus_4326", "text": "UV filters need usually to be approved by local agencies (such as the FDA in the United States) to be used in sunscreen formulations. As of 2023, 29 compounds are approved in the European Union and 17 in the USA. [ 95 ]  No UV filters have been approved by the FDA for use in cosmetics since 1999."}
{"_id": "WikiPedia_Dermatology$$$corpus_4327", "text": "The following are the FDA allowable active ingredients in sunscreens:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4328", "text": "(Not currently supported in EU and may be delisted)"}
{"_id": "WikiPedia_Dermatology$$$corpus_4329", "text": "Zinc oxide was approved as a UV filter by the EU in 2016. [ 113 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4330", "text": "Other ingredients approved within the EU [ 114 ]  and other parts of the world, [ 115 ]  that have not been included in the current FDA Monograph:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4331", "text": "*  Time and Extent Application (TEA), Proposed Rule on FDA approval originally expected 2009, now expected 2015. [ needs update ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4332", "text": "Many of the ingredients awaiting approval by the FDA are relatively new, and developed to absorb UVA. [ 118 ]  The 2014  Sunscreen Innovation Act  was passed to accelerate the FDA approval process. [ 119 ] [ 120 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4333", "text": "It is known that SPF is affected by not only the choice of active ingredients and the percentage of active ingredients but also the formulation of the vehicle/base. Final SPF is also impacted by the distribution of active ingredients in the sunscreen, how evenly the sunscreen applies on the skin, how well it dries down on the skin and the pH value of the product among other factors. Changing any inactive ingredient may potentially alter a sunscreen's SPF. [ 121 ] [ 122 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4334", "text": "When combined with UV filters, added  antioxidants  can work synergistically to affect the overall SPF value positively. Furthermore, adding antioxidants to sunscreen can amplify its ability to reduce markers of extrinsic photoaging, grant better protection from  UV induced pigment formation , mitigate skin  lipid peroxidation , improve the photostability of the active ingredients, neutralize reactive oxygen species formed by irradiated photocatalysts  (e.g., uncoated TiO\u2082)  and aid in DNA repair post-UVB damage, thus enhancing the efficiency and safety of sunscreens. [ 123 ] [ 124 ] [ 125 ] [ 126 ]  Compared with sunscreen alone, it has been shown that the addition of antioxidants has the potential to suppress  ROS  formation by an additional 1.7-fold for SPF 4 sunscreens and 2.4-fold for SPF 15-to-SPF 50 sunscreens, but the efficacy depends on how well the sunscreen in question has been formulated. [ 127 ]  Sometimes  osmolytes  are also incorporated into commercially available sunscreens in addition to antioxidants since they also aid in protecting the skin from the detrimental effects of UVR. [ 128 ]  Examples include the osmolyte taurine, which has demonstrated the ability to protects against UVB-radiation induced immunosuppression [ 129 ]  and the osmolyte ectoine, which aids in counteracting cellular accelerated aging & UVA-radiation induced premature photoaging. [ 130 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4335", "text": "Other inactive ingredients can also assist in photostabilizing unstable UV filters.  Cyclodextrins  have demonstrated the ability to reduce photodecomposition, protect antioxidants and limit skin penetration past the  uppermost skin layers , allowing them to longer maintain the protection factor of sunscreens with UV filters that are highly unstable and/or easily permeate to the lower layers of the skin. [ 131 ] [ 132 ] [ 124 ]  Similarly,  film-forming polymers  like polyester-8 and polycryleneS1 have the ability to protect the efficacy of older petrochemical UV filters by preventing them from destabilizing due to extended light exposure. These kinds of ingredients also increase the water resistance of sunscreen formulations. [ 133 ] [ 134 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4336", "text": "In the 2010s and 2020s, there has been increasing interest in sunscreens that protect the wearer from the sun's  high-energy visible light  and  infrared light  as well as ultraviolet light. This is due to newer research revealing  blue & violet visible light  and certain wavelengths of infrared light  (e.g.,  NIR, IR-A )  work synergistically with UV light in contributing to oxidative stress, free radical generation, dermal cellular damage, suppressed skin healing, decreased immunity, erythema, inflammation, dryness, and several aesthetic concerns, such as: wrinkle formation, loss of skin elasticity and dyspigmentation. [ 135 ] [ 136 ] [ 137 ] [ 138 ] [ 139 ] [ 140 ] [ 141 ]  Increasingly, a number of commercial sunscreens are being produced that have manufacturer claims regarding skin protection from blue light, infrared light and even air pollution. [ 141 ]  However, as of 2021 there are no regulatory guidelines or mandatory testing protocols that govern these claims. [ 127 ]  Historically, the American FDA has only recognized protection from sunburn  (via UVB protection)  and protection from skin cancer  (via SPF 15+ with some UVA protection)  as drug/medicinal sunscreen claims, so they do not have regulatory authority over sunscreen claims regarding protecting the skin from damage from these other environmental stressors. [ 142 ]  Since sunscreen claims not related to protection from ultraviolet light are treated as  cosmeceutical  claims rather than drug/medicinal claims, the innovative technologies and additive ingredients used to allegedly reduce the damage from these other environmental stressors may vary widely from brand to brand."}
{"_id": "WikiPedia_Dermatology$$$corpus_4337", "text": "Some studies show that mineral sunscreens primarily made with substantially large particles  (i.e., neither nano nor micronized)  may help protect from visible and infrared light to some degree, [ 141 ] [ 127 ] [ 143 ]  but these sunscreens are often unacceptable to consumers due to leaving an obligatory opaque white cast on the skin. Further research has shown that sunscreens with added  iron oxide pigments  and/or pigmentary titanium dioxide can provide the wearer with a substantial amount of HEVL protection. [ 127 ] [ 144 ] [ 145 ] [ 146 ]  Cosmetic chemists have found that other  cosmetic-grade  pigments can be functional filler ingredients.  Mica  was discovered to have significant synergistic effects with UVR filters when formulated in sunscreens, in that it can notably increase the formula's ability to protect the wearer from HEVL. [ 139 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4338", "text": "There is a growing amount of research demonstrating that adding various vitamer antioxidants  (eg;  retinol ,  alpha tocopherol, gamma tocopherol ,  tocopheryl acetate ,  ascorbic acid ,  ascorbyl tetraisopalmitate, ascorbyl palmitate, sodium ascorbyl phosphate ,  ubiquinone )  and/or a mixture of certain botanical antioxidants  (eg;  epigallocatechin-3-gallate ,  b-carotene ,  vitis vinifera ,  silymarin ,  spirulina extract ,  chamomile extract  and possibly others)  to sunscreens efficaciously aids in reducing damage from the free radicals produced by exposure to solar ultraviolet radiation, visible light, near infrared radiation and infrared-a radiation. [ 123 ] [ 147 ] [ 137 ] [ 127 ] [ 148 ] [ 125 ] [ 128 ]  Since sunscreen's active ingredients work preventatively by creating a shielding film on the skin that absorbs, scatters, and reflects light before it can reach the skin, UV filters have been deemed an ideal \u201cfirst line of defense\u201d against sun damage when exposure can't be avoided. Antioxidants have been deemed a good \u201csecond line of defense\u201d since they work responsively by decreasing the overall burden of free radicals that do reach the skin. [ 139 ]  The degree of the free radical protection from the entire solar spectral range that a sunscreen can offer has been termed the \"radical protection factor\" (RPF) by some researchers."}
{"_id": "WikiPedia_Dermatology$$$corpus_4339", "text": "SPF 30 or above must be used to effectively prevent UV rays from damaging skin cells. This is the amount that is recommended to prevent against skin cancer. Sunscreen must also be applied thoroughly and re-applied during the day, especially after being in the water. Special attention should be paid to areas like the ears and nose, which are common spots of skin cancer. Dermatologists may be able to advise about what sunscreen is best to use for specific skin types. [ 149 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4340", "text": "The dose used in FDA sunscreen testing is 2\u00a0mg/cm 2  of exposed skin. [ 97 ]  If one assumes an \"average\" adult build of height 5\u00a0ft 4\u00a0in (163\u00a0cm) and weight 150\u00a0lb (68\u00a0kg) with a 32-inch (82-cm) waist, that adult wearing a bathing suit covering the groin area should apply approximately 30\u00a0g (or 30\u00a0ml, approximately 1\u00a0oz) evenly to the uncovered body area. This can be more easily thought of as a \"golf ball\" size amount of product per body, or at least six teaspoonfuls. Larger or smaller individuals should scale these quantities accordingly. [ 150 ]  Considering only the face, this translates to about 1/4 to 1/3 of a teaspoon for the average adult face."}
{"_id": "WikiPedia_Dermatology$$$corpus_4341", "text": "Some studies have shown that people commonly apply only 1/4 to 1/2 of the amount recommended for achieving the rated sun protection factor (SPF), and in consequence the effective SPF should be downgraded to a 4th root or a square root of the advertised value, respectively. [ 88 ]  A later study found a significant exponential relation between SPF and the amount of sunscreen applied, and the results are closer to linearity than expected by theory. [ 151 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4342", "text": "Claims that substances in pill form can act as sunscreen are false and disallowed in the United States. [ 152 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4343", "text": "On 1 January 2020,  Palau  banned the manufacturing and selling of sun cream products containing any of the following ingredients:  benzophenone-3 ,  octyl methoxycinnamate ,  octocrylene ,  4-methyl-benzylidene camphor ,  triclosan ,  methylparaben ,  ethylparaben ,  butylparaben ,  benzyl paraben , and  phenoxyethanol . [ 153 ]  The decision was taken to protect the local coral reef and sea life. [ 154 ]  Those compounds are known or suspected to be harmful to coral or other sea life. [ 154 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4344", "text": "Sunscreen labeling standards have been evolving in the United States since the FDA first adopted the SPF calculation in 1978. [ 155 ]  The FDA issued a comprehensive set of rules in June 2011, taking effect in 2012\u20132013, designed to help consumers identify and select suitable sunscreen products offering protection from sunburn, early skin aging, and skin cancer. [ 156 ] [ 157 ] [ 158 ]  However, unlike other countries, the United States classifies sunscreen as an over-the-counter drug rather than a cosmetic product. As FDA approval of a new drug is typically far slower than for a cosmetic, the result is fewer ingredients available for sunscreen formulations in the US compared with many other countries. [ 159 ] [ 160 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4345", "text": "In 2019, the FDA proposed tighter regulations on sun protection and general safety, including the requirement that sunscreen products with SPF greater than 15 must be broad spectrum, and imposing a prohibition on products with SPF greater than 60. [ 161 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4346", "text": "In 2021, the FDA introduced an additional administrative order regarding the safety classification of cosmetic UV filters, to categorize a given ingredient as either:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4347", "text": "To be considered a GRASE active ingredient, the FDA requires it to have undergone both non-clinical animal studies as well as human clinical studies. The animal studies evaluate the potential for inducing carcinogenesis, genetic or reproductive harm, and any toxic effects of the ingredient once absorbed and distributed in the body. The human trials expand upon the animal trials, providing additional information on safety in the pediatric population, protection against UVA and UVB, and the potential for skin reactions after application. Two previously approved UV filters, para-aminobenzoic acid (PABA) and trolamine salicylate, were reclassified as  not GRASE  due to safety concerns and have consequently been removed from the market. [ 95 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4348", "text": "Europe"}
{"_id": "WikiPedia_Dermatology$$$corpus_4349", "text": "In Europe, sunscreens are considered a cosmetic product rather than an over-the-counter drug. These products are regulated by the Cosmetic Regulation (EC) No 1223/2009, which was created in July 2013. [ 162 ]  The recommendations for formulating sunscreen products are guided by the Scientific Community on Consumer Safety (SCCS). [ 163 ]  The regulation of cosmetic products in Europe requires the producer to follow six domains when formulating their product:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4350", "text": "I. Cosmetic safety report must be conducted by a qualified personnel"}
{"_id": "WikiPedia_Dermatology$$$corpus_4351", "text": "II. The product must not contain substances banned for cosmetic products"}
{"_id": "WikiPedia_Dermatology$$$corpus_4352", "text": "III. The product must not contain substances restricted for cosmetic products"}
{"_id": "WikiPedia_Dermatology$$$corpus_4353", "text": "IV. The product must adhere to the approved list of colourants for cosmetic products."}
{"_id": "WikiPedia_Dermatology$$$corpus_4354", "text": "V. The product must adhere to the approved list of preservatives for cosmetic products."}
{"_id": "WikiPedia_Dermatology$$$corpus_4355", "text": "VI. The product must contain UV filters approved in Europe. [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4356", "text": "According to the EC, sunscreens at a minimum must exhibit:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4357", "text": "Canada"}
{"_id": "WikiPedia_Dermatology$$$corpus_4358", "text": "Regulation of sunscreen is dependent on the ingredient used; It is then classified and follows the regulations for either natural health products or drug product. Companies must complete a product licensing application prior to introducing their sunscreen on the market. [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4359", "text": "ASEAN (Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, Vietnam)"}
{"_id": "WikiPedia_Dermatology$$$corpus_4360", "text": "The regulation of sunscreen for ASEAN countries closely follows European regulations. However, products are regulated by the ASEAN scientific community rather than the SCCS. Additionally, there are minor differences in the allowed phrasing printed on sunscreen packages. [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4361", "text": "Japan"}
{"_id": "WikiPedia_Dermatology$$$corpus_4362", "text": "Sunscreen is considered a cosmetic product, and is regulated under the Japan Cosmetic Industry Association (JCIA). Products are regulated mostly for the type of UV filter and SPF. SPF may range from 2 to 50. [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4363", "text": "China"}
{"_id": "WikiPedia_Dermatology$$$corpus_4364", "text": "Sunscreen is regulated as cosmetic product under the State Food and Drug Administration (SFDA). The list of approved filters is the same as it is in Europe. However, sunscreen in China requires safety testing in animal studies prior to approval. [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4365", "text": "Australia"}
{"_id": "WikiPedia_Dermatology$$$corpus_4366", "text": "Sunscreens are divided into therapeutic and cosmetic sunscreens. Therapeutic sunscreens are classified into primary sunscreens (SPF \u2265 4) and secondary sunscreens (SPF < 4).  Therapeutic sunscreens are regulated by the Therapeutic Goods Administration (TGA). Cosmetic sunscreens are products that contain a sunscreen ingredient, but do not protect from the sun. These products are regulated by the National Industrial Chemicals Notification and Assessment Scheme (NICNAS). [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4367", "text": "New Zealand"}
{"_id": "WikiPedia_Dermatology$$$corpus_4368", "text": "Sunscreen is classified as a cosmetic product, and closely follows EU regulations. However, New Zealand has a more extensive list of approved UV filters than Europe. [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4369", "text": "Mercosur"}
{"_id": "WikiPedia_Dermatology$$$corpus_4370", "text": "Mercosur  is an international group consisting of Argentina, Brazil, Paraguay, and Uruguay. Regulation of sunscreen as a cosmetic product began in 2012, and is similar in structure to the European regulations. Sunscreens must meet specific standards including water resistance, sun protection factor, and a UVA/UVB ratio of 1/3. The list of approved sunscreen ingredients is greater than in Europe or the US. [ 163 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4371", "text": "Some sunscreen active ingredients have been shown to cause toxicity towards marine life and coral, resulting in bans in different states, countries and ecological areas. [ 164 ] [ 165 ]  Coral reefs, comprising organisms in delicate ecological balances, are vulnerable to even minor environmental disturbances. Factors like temperature changes, invasive species, pollution, and detrimental fishing practices have previously been highlighted as threats to coral health. [ 166 ] [ 167 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4372", "text": "In 2018, Hawaii passed legislation that prohibits the sale of sunscreens containing  oxybenzone  and  octinoxate . In sufficient concentrations, oxybenzone and octinoxate can damage coral DNA, induce deformities in coral  larvae , [ 165 ]  heighten the risk of viral infections, and make corals more vulnerable to bleaching. Such threats are even more concerning given that coral ecosystems are already compromised by climate change, pollution, and other environmental stressors. While there is ongoing debate regarding the real-world concentrations of these chemicals versus laboratory settings, [ 168 ] [ 169 ] [ 170 ] [ 171 ]  an assessment in Kahaluu Bay in Hawaii showed oxybenzone concentrations to be 262 times higher than what the U.S. Environmental Protection Agency designates as high-risk. Another study in Hanauma Bay found levels of the chemical ranging from 30 ng/L to 27,880 ng/L, noting that concentrations beyond 63 ng/L could induce toxicity in corals. [ 172 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4373", "text": "Echoing Hawaii's initiative, other regions including Key West, Florida, [ 173 ]  the U.S. Virgin Islands, [ 174 ]  Bonaire, and Palau [ 175 ]  have also instituted bans on sunscreens containing oxybenzone and octinoxate."}
{"_id": "WikiPedia_Dermatology$$$corpus_4374", "text": "The environmental implications of sunscreen usage on marine ecosystems are multi-faceted and vary in severity. In a 2015 study, titanium dioxide nanoparticles, when introduced to water and subjected to ultraviolet light, were shown to amplify the production of hydrogen peroxide, a compound known to damage phytoplankton. [ 176 ]  In 2002, research indicated that sunscreens might escalate virus abundance in seawater, compromising the marine environment in a manner akin to other pollutants. [ 177 ]  Further probing the matter, a 2008 investigation examining a variety of sunscreen brands, protective factors, and concentrations revealed unanimous bleaching effects on hard corals. Alarmingly, the degree of bleaching magnified with increasing sunscreen quantities. When assessing individual compounds prevalent in sunscreens, substances such as butylparaben, ethylhexylmethoxycinnamate, benzophenone-3, and 4-methylbenzylidene camphor induced complete coral bleaching at even minimal concentrations. [ 178 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4375", "text": "A 2020 study from the journal  Current Dermatology Report  summarized the situation as the US FDA currently approving only zinc oxide (ZnO) and titanium dioxide (TiO 2 ) as safe ultraviolet filters, and for those concerned with coral bleaching, they should use non-nano ZnO or TiO 2  since they have the most consistent safety data. [ 179 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4376", "text": "New products are in development such as sunscreens based on  bioadhesive  nanoparticles. These function by encapsulating commercially used UV filters, while being not only adherent to the skin but also non-penetrant. This strategy inhibits primary UV-induced damage as well as secondary free radicals. [ 180 ]  UV filters based on  sinapate   esters  are also under study. [ 181 ]  Sunscreens with natural and sustainable connotations are increasingly being developed, as a result of increased environmental concern. [ 182 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4377", "text": "T-Beauty , or Taiwanese Beauty, refers to beauty products and routines associated with  Taiwan ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4378", "text": "According to  NBC  \"Taiwanese beauty movement focuses on a simple, holistic approach to skin care by using high-quality, natural ingredients and techniques rooted in traditional Chinese medicine.\" [ 1 ]  It is also influenced by Taiwan's warm climate with a resulting emphasis on hydrating and lightweight products. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4379", "text": "In general it includes four steps: cleanse, tone, moisturize and sheet mask. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4380", "text": "The Taiwanese cosmetics industry got its start doing contract manufacturing for Japanese firms like  Shiseido  and the  Kao Corporation . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4381", "text": "In the 2000s Taiwanese companies began exporting products under their own name. [ 1 ]  Early successful brands included My Beauty Diary, Annie's Way, and Maskingdom. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4382", "text": "Taiwan banned cosmetic testing on animals in 2016. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4383", "text": "In 2017 Taiwan exported $730 million worth of cosmetics. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4384", "text": "The Taiwan Beauty Alliance is an industry organizing group. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4385", "text": "Thanaka  ( Burmese :  \u101e\u1014\u1015\u103a\u1001\u102b\u1038 ;  MLCTS :  sa.nap hka: ;  pronounced   [\u03b8\u0259n\u0259k\u02b0\u00e1] ) is a paste made from ground bark. It is a distinctive feature of the culture of  Myanmar , seen commonly applied to the face and sometimes the arms of women and girls, and is used to a lesser extent also by men and boys. [ 1 ] [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4386", "text": "Thanaka has been used by Burmese people since the mid-11th century. In a Bagan Pagoda, there is a Bagan era wall painting of a Bagan woman wearing thanaka. The earliest literary reference to thanakha is in a 14th-century poem written by  King Razadarit 's  Mon-speaking  consort. During King Bayinnaung, Alungpaya and Bodawpaya's military campaign in Thailand, thanakha was first introduced to Thai people. [ 4 ]  Mentions of thanaka also exist in the 15th-century literary works of Burmese monk-poet  Shin Ra\u1e6d\u1e6dhas\u0101ra  (1486\u20131529). [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4387", "text": "The wood of several trees may be used to produce thanaka cream; these trees grow abundantly in central Myanmar. They include principally  Murraya  spp. (thanaka) [ 2 ]  but also  Limonia acidissima  ( theethee  or wood apple). [ 5 ]  The two most popular are  Shwebo  thanaka  from  Sagaing Region  and  Shinmadaung thanaka  from  Magway Region . A more recent contender sold as a paste is  Taunggyi   Maukme thanaka  from southern  Shan State . Thanaka trees are  perennials , and a tree must be at least 35 years old before it is considered mature enough to yield good-quality cuttings. Thanaka in its natural state is sold as small logs individually or in bundles, but nowadays also available as a paste or in powder form."}
{"_id": "WikiPedia_Dermatology$$$corpus_4388", "text": "Thanaka cream is made by grinding the bark, wood, or roots [ 2 ]  of a thanaka tree with a small amount of water [ 5 ]  on a circular slate slab called  kyauk pyin , [ 6 ]  which has a channel around the rim for the water to drain into."}
{"_id": "WikiPedia_Dermatology$$$corpus_4389", "text": "Thanaka cream has been used by Burmese men, women, and children (especially women as make-up) for over 2,000 years. [ 6 ]  It has a fragrant scent somewhat similar to  sandalwood . [ 2 ] [ 7 ]  The creamy paste is applied to the face in attractive designs, the most common form being a circular patch on each cheek, nose, sometimes made stripey with the fingers known as  thanaka b\u00e8 gya , or patterned in the shape of a leaf, often also highlighting the bridge of the nose with it at the same time. [ 6 ]  It may be applied from head to toe ( thanaka chi zoun gaung zoun ). Apart from cosmetic beauty, thanaka also gives a cooling sensation and provides protection from  sunburn . [ 1 ]  It is believed to help remove acne and promote smooth skin. [ 6 ]  It is also an anti-fungal. [ 2 ]   Marmesin  has been proposed to be the principle UV blocking agent. [ 8 ]  A study was conducted in 2010 by the  Chulalongkorn University  in  Bangkok  and the  University of London . Thanaka bark is antioxidant, anti-inflammatory and absorbs UV rays. The research additionally revealed that Thanaka inhibits  tyrosinase , the enzyme that triggers melanin synthesis and impacts pores and skin discolouration. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4390", "text": "Thujaplicin  ( isopropyl  cycloheptatrienolone) is any of three  isomeric   tropolone -related  natural products  that have been isolated from the  softwoods  of the trees of  Cupressaceae  family. [ 1 ]  These compounds are known for their antibacterial,  antifungal , and  antioxidant  properties. [ 2 ] [ 3 ]  They were the first natural tropolones to be made synthetically. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4391", "text": "Thujaplicins were discovered in the mid-1930s and purified from the  heartwood  of  Thuja plicata  Donn ex D. Don , commonly called as Western red cedar tree. [ 5 ]  These compounds were also identified in the constituents of  Chamaecyparis obtusa , another species from the  Cupressaceae  family.  C. obtusa  is native to East Asian countries including  Japan  and  Taiwan , and is also known as  Taiwan hinoki , from which the \u03b2-thujaplicin was first isolated in 1936 and received its name,  hinokitiol . Thujaplicins were the first natural  tropolones  to be made synthetically, by  Ralph Raphael  and colleagues, and the \u03b2-thujaplicin was the first non-benzenoid aromatic compound identified, by  Tetsuo Nozoe  and colleagues. [ 4 ] [ 5 ]  The resistance of the heartwood of the tree to  decay  was the main reason prompting to investigate its content and identify the compounds responsible for antimicrobial properties. [ 4 ]  \u03b2-thujaplicin gained more scientific interest beginning in the 2000s. [ 6 ]  Later, iron-binding activity of \u03b2-thujaplicin was discovered and the molecule has been ironically nicknamed as \u201cIron Man molecule\u201d, [ 7 ]  because the first name of  Tetsuo Nozoe  can be translated into English as \u201cIron Man\u201d. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4392", "text": "Tjujaplicins are found in the heartwood of the conifer trees belonging to the  Cupressaceae  family, including  Chamaecyparis obtusa  (Hinoki cypress),  Thuja plicata  (Western red cedar),  Thujopsis dolabrata  var.  hondai  (Hinoki asunaro),  Juniperus cedrus  (Canary Islands juniper),  Cedrus atlantica  (Atlas cedar),  Cupressus lusitanica  (Mexican white cedar),  Chamaecyparis lawsoniana  (Port Orford cedar),  Chamaecyparis taiwanensis  (Taiwan cypress),  Chamaecyparis thyoides  (Atlantic white cedar),  Cupressus arizonica  (Arizona cypress),  Cupressus macnabiana  (MacNab cypress),  Cupressus macrocarpa  (Monterey cypress),  Juniperus chinensis  (Chinese juniper),  Juniperus communis  (Common juniper),  Juniperus californica  (California juniper),  Juniperus occidentalis  (Western juniper),  Juniperus oxycedrus  (Cade),  Juniperus sabina  (Savin juniper),  Calocedrus decurrens  (California incense-cedar),  Calocedrus formosana  (Taiwan incense-cedar),  Platycladus orientalis  (Chinese thuja),  Thuja occidentalis  (Northern white-cedar),  Thuja standishii  (Japanese thuja),  Tetraclinis articulata  (Sandarac). [ 8 ] [ 9 ] [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4393", "text": "Thujaplicins can be produced in  plant cell suspension cultures , [ 12 ] [ 13 ]  or can be extracted from wood using  solvents  and  ultrasonication . [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4394", "text": "Thujaplicins can be synthesized by  cycloaddition  of isopropyl cyclopentadiene  and dichloroketene,  1,3-dipolar cycloaddition  of 5-isopropyl-1-methyl-3-oxidopyridinium,  ring expansion  of 2-isopropylcyclohexanone, regiocontrolled  hydroxylation  of oxyallyl  (4+3) cycloadducts , from ( R )-(+)- limonene   regioselectively  by several steps, and from troponeirontricarbonyl complex by few steps. [ 15 ] [ 16 ]  The synthesis pathway of \u03b2-thujaplicin from troponeirontricarbonyl complex is found below:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4395", "text": "The synthesis pathway of \u03b2-thujaplicin by electro-reductive alkylation of substituted cycloheptatrienes is shown below:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4396", "text": "The synthesis pathway of \u03b2-thujaplicin through ring expansion of 2-isopropylcyclohexanone is shown below:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4397", "text": "The synthesis pathway of \u03b2-thujaplicin through oxyallyl cation [4+3] cyclization (Noyori's synthesis) is shown below:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4398", "text": "Thujaplicins belong to tropolones containing an unsaturated seven-membered carbon ring. Thujaplicins are  monoterpenoids  that are  cyclohepta-2,4,6-trien-1-one  substituted by a  hydroxy group  at position 2 and an  isopropyl group  at positions 3, 4 or 5. [ 17 ]  These compounds are  enols  and cyclic  ketones . They derive from a hydride of a  cyclohepta-1,3,5-triene . Thujaplicins are soluble in organic solvents and aqueous  buffers . Hinokitiol is soluble in  ethanol ,  dimethyl sulfoxide ,  dimethylformamide  with a solubility of 20, 30 and 12.5\u00a0mg/ml, respectively. [ 18 ]  \u03b2-thujaplicin provides acetone on vigorous oxidation and gives the saturated monocyclic diol upon catalytic hydrogenation. [ 19 ]  It is stable to alkali and acids, forming salts or remaining unchanged, but does not convert to catechol derivatives. The complexes made of iron and tropolones display high thermodynamic stability and has shown to have a stronger binding constant than the transferrin-iron complex. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4399", "text": "There are three  isomers  of thujaplicin, with the  isopropyl group  positioned progressively further from the two oxygen atoms around the ring: \u03b1-thujaplicin, \u03b2-thujaplicin, and \u03b3-thujaplicin. [ 4 ]   \u03b2-Thujaplicin, also called  hinokitiol , is the most common in nature. [ 21 ]  Each exists in two  tautomeric  forms, swapping the  hydroxyl  hydrogen to the other oxygen, meaning the two oxygen  substituents  do not have distinct \"carbonyl\" vs \"hydroxyl\" identities. The extent of this exchange is that the  tropolone  ring is  aromatic  with an overall cationic nature, and the oxygen\u2013hydrogen\u2013oxygen region has an anionic nature. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4400", "text": "Thujaplicins are shown to act against  Reticulitermes speratus  (Japanese termites),  Coptotermes formosanus  (super termites),  Dermatophagoides farinae  (dust mites),  Tyrophagus putrescentiae  (mould mites),  Callosobruchus chinensis  (adzuki bean weevil),  Lasioderma serricorne  (cigarette beetle). [ 9 ] [ 22 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4401", "text": "Hinokitiol has also shown some larvicidal activities against  Aedes aegypti  (yellow fever mosquito) and  Culex pipiens  (common house mosquito), and anti-plasmodial activities against  Plasmodium falciparum  and  Plasmodium berghei . [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4402", "text": "Thujaplicins, as other tropolones, demonstrate  chelating  activity, acting as an  ionophore  by binding different metal ions. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4403", "text": "Tropolone  and thujaplicins exhibit potent suppressive activity on  enzymatic browning  due to inhibition of  polyphenol oxidase  and  tyrosinase . This have been shown in experiments on different vegetables, fruits, mushrooms, plants and other agricultural products. [ 11 ]  Prevention of darkening has also been elicited on  seafood  products. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4404", "text": "Owing to their antibacterial activities against various microbes colonizing and affecting the skin, thujaplicins, including also  thujaplicinol , are used in skin care and hair growth products, [ 25 ]  and are especially popular in Eastern Asia. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4405", "text": "Hinokitiol is used in various oral care products, including  toothpastes  and oral sprays. [ 25 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4406", "text": "Due to its antifungal activity against  Malassezia pachydermatis , it is used in eardrop formulations for  external otitis  in dogs. [ 27 ] [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4407", "text": "Considering their antifungal activity against many plant-pathogenic  fungi , and  pesticidal  and  insecticidal  properties, the role of thujaplicins in agriculture is evolving, including their use in the management of different plant diseases and for controlling the  postharvest decay . [ 9 ] [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4408", "text": "Thujaplicins are used as food additives in Japan. [ 30 ]  Due to its suppressive activity on  food browning  and the inhibitory activity against bacteria and fungi causing  food spoilage  (such as  Clostridium perfringens ,  Alternaria alternata ,  Aspergillus niger ,  Botrytis cinerea ,  Fusobacterium  species,  Monilinia fructicola  and  Rhizopus stolonifer ), hinokitiol is also used in  food packaging  as a  shelf-life  extending agent. [ 31 ] [ 32 ] [ 33 ]   Thujaplicinol , a tropolone, is also used in Japan as a food additive in small amount."}
{"_id": "WikiPedia_Dermatology$$$corpus_4409", "text": "In  cosmetics ,  skin toner  or simply  toner  refers to a water-based  lotion ,  tonic , or wash designed to cleanse the skin and prepare it for other skincare products, such as  moisturizers  and serums. [ 1 ]  Typically used on the face, toners remove any remaining impurities after cleansing, balance the skin\u2019s pH, and hydrate the skin. [ 2 ]  They also serve to protect and refresh the skin, [ 3 ]  often containing ingredients that can soothe, moisturize, exfoliate, or target specific skin concerns like oil control or pore minimization. [ 4 ]  Toners are typically categorized by their function and intensity into types such as skin bracers, tonics, acid toners, and astringents."}
{"_id": "WikiPedia_Dermatology$$$corpus_4410", "text": "Toners can be applied to the skin in different ways:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4411", "text": "The use of toners in skincare emerged in the early 20th century as a response to the limitations of harsh,  alkaline , soap-based facial cleansers. [ 5 ]  These early cleansers, while effective in removing dirt and oil, were often harsh on the skin. They could disrupt the skin's natural pH balance, leaving behind a scum or residue that made the skin feel dry and irritated. [ 6 ]  Toners were developed as a solution aimed at restoring the skin's natural acidity. Initially, they were primarily formulated with  astringent  ingredients, such as alcohol and witch hazel. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4412", "text": "In the late 1960s, toners became more popular as the 'cleanse, tone, moisturize' routine emerged as the first skincare regimen to undergo  clinical testing . [ 7 ]  Over time, it became clear that alcohol-based  astringents , while effective in treating oily skin, [ 8 ]  were too harsh for many skin types and caused excess drying and irritation. As a result, skincare brands began formulating gentler toners focused on soothing and hydrating the skin. [ 6 ]  Ingredients like herbal extracts, floral waters, and  aloe vera  were introduced, allowing toners to balance the skin without stripping it of moisture. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4413", "text": "Today, toners are diverse and cater to a wide range of skincare needs, including hydration,  exfoliation , and  antioxidant  protection. In recent years, the clean beauty movement has influenced the formulation of toners, leading to a focus on organic and natural ingredients that avoid synthetic chemicals known to irritate sensitive skin. [ 10 ]  Current beauty trends centered around skincare have increased awareness and demand for toner, contributing to an increasing market size and sales volume for skin toner globally. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4414", "text": "These are the mildest form of toners; [ 12 ]  they contain water and a  humectant  such as  glycerin , and little if any  alcohol  (0\u201310%).  Humectants help to keep the moisture in the upper layers of the  epidermis  by preventing it from  evaporating .  A popular example of this is  rosewater ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4415", "text": "These toners are the gentlest to the skin, and are most suitable for use on dry, dehydrated, sensitive and normal skins.  It may give a burning sensation to  sensitive skin ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4416", "text": "These are slightly stronger and contain a small quantity of alcohol (up to 20%), water and a  humectant  ingredient.   Orange flower water  is an example of a skin tonic.  Skin tonics are suitable for use on normal, combination, and oily skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_4417", "text": "These are a strong form of toner that typically contains  alpha hydroxy acid  and or  beta hydroxy acid . Acid toners are formulated with the intent of chemically exfoliating the skin. [ 13 ]  Glycolic, lactic, and mandelic acids are the most commonly used  alpha hydroxy acids , best suited to exfoliate the surface of the skin. Salicylic acid is the most commonly used  beta hydroxy acid  best for exfoliating into the deeper layers of the skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_4418", "text": "These are the strongest form of toner and contain a high proportion of alcohol (20\u201360%), antiseptic ingredients, water, and a humectant ingredient.  These can be irritating and damaging to the skin as they can remove excess protective lipids as well as denature proteins in the skin when a high percentage of alcohol is used."}
{"_id": "WikiPedia_Dermatology$$$corpus_4419", "text": "Common ingredients found in toners include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4420", "text": "Different toners are formulated with a variety of active ingredients tailored to address specific skin concerns, resulting in varying outcomes. Users can select toners based on their individual skincare needs and preferences. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4421", "text": "Uguisu no fun  ( \u9daf\u306e\u7cde , literally meaning \"nightingale faeces\" in  Japanese ) , also called the \"Geisha Facial\", [ 1 ]  refers to the  excrement  ( fun ) produced by a particular  nightingale , the  Japanese bush warbler  ( uguisu ). [ 1 ]  The droppings have been used in  facials  throughout  Japanese history . [ 1 ]  Recently, the product has appeared in the  Western world . [ 1 ]  The facial is said to whiten the skin and balance  skin tone , [ clarification needed ]  as well as treat skin affected by  hyperpigmentation . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4422", "text": "The use of nightingale excrement dates back to the  Heian period  (794\u20131185) when it was introduced to the  Japanese  by the  Korean people . [ 1 ] [ 3 ]  Koreans used the  guano  to remove  dye  from fabric, allowing them to make intricate designs on clothing. [ 1 ] [ 3 ]  The Japanese used the bird droppings to remove stains from  silk  garments such as  kimono . [ 4 ] [ 5 ]  During the  Edo period  (1603\u20131868), the Japanese expanded its use by using it as a beauty treatment. [ 3 ]   Geisha  and  kabuki  actors used white makeup known as  oshiroi  that contained  zinc  and  lead , which likely caused many issues such as skin diseases. [ 1 ] [ 6 ]   Uguisu no fun  was used to thoroughly remove this makeup and to whiten the skin. [ 1 ] [ 4 ]   Buddhist monks  also used the droppings to polish and clean their bald scalps. [ 1 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4423", "text": "The first modern written mention of the use of  uguisu no fun  is in a book entitled  Shunkin-sho  ( Portrait of Lady Shunkin ), published in 1933 by  Jun'ichir\u014d Tanizaki , set in Japan's  Meiji period  (1868\u20131912)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4424", "text": "Currently, Hyakusuke is the last shop in  Tokyo  to sell government-approved  uguisu no fun . [ 7 ]  This 200 year-old cosmetic shop carries the powder along with other cosmetic products. [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4425", "text": "The modern-day revival of  uguisu no fun  in Japan [ clarification needed ]  may be attributed to a respect for ancestral traditions as well as to the innovative  culture of Japan . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4426", "text": "Uguisu no fun  is harvested in nightingale  farms  in Japan. [ 1 ]  Though wild nightingales eat  insects  and  berries , the diet of the caged birds consists of  organic   seeds . [ 1 ] [ 9 ]  Some nightingales feed on  caterpillars  that eat from  plum  trees. [ 5 ]  The guano is scraped from the cages, and an  ultraviolet  light is often used to kill the  bacteria  to sanitize it. [ 1 ] [ 9 ]  The droppings are then usually dried with a dehydrator. [ 1 ]  Some are sun-dried for over two weeks while simultaneously being  UV sterilized . Next, it is ground into a fine white powder, and it is sold in this form. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4427", "text": "Rice bran  is sometimes added to the guano for the purpose of  exfoliation . [ 1 ]  The powder is mixed with water, yielding a paste, before being massaged into the skin for a few minutes and then being rinsed off. [ 1 ]  The facial is usually rather odorless and sanitized. [ 1 ] [ 5 ]  The added rice bran can also neutralize the slight  musky  odor. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4428", "text": "In one  New York   spa  that offers the application of  ugisu no fun , the process takes about one hour and costs $180. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4429", "text": "The way the facial works is not entirely clear. [ 4 ]  The guano from the nightingale has a high concentration of  urea  and  guanine . [ 1 ]  Because birds excrete a fecal and urine waste from a single opening, called the  cloaca , the fecal-urine combination gives the droppings a high concentration of urea. [ 1 ] [ 4 ]  Urea is sometimes found in cosmetics because it locks moisture into the skin. [ 1 ] [ 4 ]  The guanine may produce shimmery,  iridescent  effects on the skin. [ 1 ] [ 6 ]  It is claimed that because of the short  intestine  of the nightingale, the droppings have  protein , a fat-degrading  enzyme , and a whitening enzyme that acts on  fat  and  scurf  to whiten skin and even out blemishes."}
{"_id": "WikiPedia_Dermatology$$$corpus_4430", "text": "Numerous sources comment that \"the  amino acid  guanine\" gives  uguisu no fun  its cosmetic properties, though guanine is a  nucleotide  base, not an amino acid. [ 1 ] [ 3 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4431", "text": "Victoria Beckham , who has long suffered with  acne , has used  uguisu no fun  to improve her skin. It was reported that Beckham admired the clarity of the skin of Japanese women and subsequently learned about the droppings. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4432", "text": "In the novel  Memoirs of a Geisha , the character Chiyo repays Hatsumomo's cruelty by mixing pigeon droppings with her face cream that contained  unguent  of nightingale droppings. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4433", "text": "In the 2012 movie  Mirror Mirror , based on the fairytale  Snow White , the evil queen, played by  Julia Roberts , undergoes extreme beauty treatments in order to woo a prince. The treatment begins with an application of bird droppings to her face."}
{"_id": "WikiPedia_Dermatology$$$corpus_4434", "text": "Vinotherapy , also written \"Vinotherapie\", describes a beauty therapy process where the residue of  wine making  (the pips and pulp) are rubbed into the skin. The pulp is claimed to have  exfoliating  qualities and to help reduce the signs of ageing."}
{"_id": "WikiPedia_Dermatology$$$corpus_4435", "text": "The concept of vinotherapy was expanded by Mathilde and Bertrand Thomas. The French couple learned about the impact of grape seeds from the leading expert on grape and grapevine polyphenols Dr. Vercauteren. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4436", "text": "In 1995, Mathilde and Bertrand launched a line of Vinoth\u00e9rapie skincare products made from grape derived ingredients:  Caudalie ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4437", "text": "Vinotherapie makes use of the grape and the vine extracts to provide skincare treatments, with claimed anti-ageing action. Caudal\u00ede was the first to stabilized and patent the extraction of Grape Seed  Polyphenols  (OPC), and use them in dermocosmetics."}
{"_id": "WikiPedia_Dermatology$$$corpus_4438", "text": "There is a \"Vinoth\u00e9rapie\" spa hotel at  La Rioja  in Spain. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4439", "text": "This  wine -related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4440", "text": "The  American Journal of Clinical Dermatology  (Am J Clin Dermatol) is a bimonthly  peer-reviewed   medical journal  published by  Springer Nature . The  American Journal of Clinical Dermatology  promotes evidence-based therapy and effective patient management within the discipline of dermatology by publishing critical and comprehensive review articles and clinically focussed original research articles covering all aspects of the management of dermatological conditions. The  editor-in-chief  is Kathy Fraser."}
{"_id": "WikiPedia_Dermatology$$$corpus_4441", "text": "The journal is included in  Index Medicus  ( MEDLINE ) [ 1 ]  and  EMBASE. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4442", "text": "According to the  Journal Citation Reports , [ 3 ]  the journal has a 2023 impact factor of 8.6."}
{"_id": "WikiPedia_Dermatology$$$corpus_4443", "text": "Annales des Maladies de la Peau et de la Syphilis  was a French  medical journal  established in 1843 by  Pierre Cazenave . In 1844 it published the first account of  pemphigus foliaceus , written by Cazenave. Most issues were his works and its contents reflect a summary of his career in general."}
{"_id": "WikiPedia_Dermatology$$$corpus_4444", "text": "The journal's final years saw papers describing several experiments on syphilis, including one where Cazenave claimed to have inoculated himself with the disease. Contributions also came from  William Wallace ,  Philippe Ricord , and  Vidal de Cassis ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4445", "text": "The journal ceased publication in 1852."}
{"_id": "WikiPedia_Dermatology$$$corpus_4446", "text": "Annales des Maladies de la Peau et de la Syphilis  was established in 1843 by the French  dermatologist   Pierre Louis Alph\u00e9e Cazenave , who had trained under  Jean-Louis Marie Alibert  at the  H\u00f4pital Saint-Louis . [ 1 ]  It focussed on skin diseases and  syphilis . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4447", "text": "The second dermatological journal, it was released five years after  Syphilidologie ; both combined the specialties of  dermatology  and  venereology . [ 2 ] [ 3 ]  At the time, Cazenave was  professor  of medicine at the  H\u00f4pital Saint-Louis , where he used his observations to publish in the journal. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4448", "text": "Cazenave wrote most of the text himself and its contents reflect a summary of his career in general. [ 1 ]  Sometimes he used a different name as authorship. [ 5 ]  He published the first account of  pemphigus foliaceus  in the journal in 1844. [ 1 ]  In it he also wrote on  lupus erythematosus . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4449", "text": "The early 1850s saw the appearance of several reports on \"syphilization\". [ 7 ]  In his article titled \"Observations. Syphilide tuberculeuse. Ecthyma syphilitique. P\u00e9riostoses. Inoculation avec succ\u00e8s du sympt\u00f4me secondaire,\" (1850-1851) Cazenave claimed to have inoculated himself with syphilis. [ 7 ]  It received little attention unlike the experiments of  Johann von Waller  in \"Du caract\u00e8re contagieux de la syphilis secondaire,\" (1850-1851), which gave the account of infecting several children using pus from presumed cases of secondary syphilis. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4450", "text": "In a later issue, the 1830s experiments by Dublin's  William Wallace  and  Lourcine's   Henri Bouley  appeared in an article titled \"De la contagion, par voie d'inoculation artificielle, des accidents cons\u00e9cutifs de la syphilis\". [ 7 ]  A detailed account of how Bouley re-infected a woman with syphilis appeared in the November 1851 issue. [ 8 ] [ 9 ] [ a ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4451", "text": "The journal ceased publication in 1852. [ 2 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4452", "text": "Archives of Dermatological Research , published by  Springer Science+Business Media , is a  peer-reviewed   medical journal  that focuses on  skin disease . It was established as the  Archiv f\u00fcr Dermatologie und Syphilis  in 1869 by  Heinrich Auspitz  and  Philipp Josef Pick . Springer acquired the journal in 1921 and renamed it the  Archiv f\u00fcr klinische und experimentelle Dermatologie und Syphilis . In the 1950s it followed the general trend to drop its link to  sexually transmitted infections  in its title. It became the  Archiv f\u00fcr Dermatologische Forschung  in 1971 before obtaining its current name in 1975."}
{"_id": "WikiPedia_Dermatology$$$corpus_4453", "text": "Other past editors have included  Albert Neisser ,  Josef Jadassohn ,  Erich Hoffmann , and  Enno Christophers . Its current  editor-in-chief  is  Murad Alam  ( Northwestern University )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4454", "text": "The  Archives of Dermatological Research  is a dermatological journal, published by  Springer Science+Business Media . [ 1 ] [ 2 ]  The editor-in-chief is Murad Alam (Northwestern University). [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4455", "text": "In mid-19th century German-speaking parts of Europe, the specialties of  venereology  and  dermatology  were beginning to be associated with each other, particularly as  syphilis  presented with signs and symptoms in skin. [ 3 ] [ a ]  As a result, in 1869, the Austrian dermatologists  Heinrich Auspitz  and  Philipp Josef Pick  established the  Archiv f\u00fcr Dermatologie und Syphilis . [ 3 ] [ 5 ]  A significant amount of work involved syphilis so it was included in the title. [ 6 ]  It was published in German, in Prague. [ 7 ] [ 8 ]  In 1874 it changed to being published four times a year under the name  Vierteljahresschrift fur Dermatologie und Syphilis , and returned to its original name in 1889. [ 9 ]  Auspitz and Pick both co-edited the journal until Auspitz's death in 1886, after which Pick carried on with it. [ 10 ]  Other early co-editors included  Albert Neisser . [ 11 ]  The Japanese dermatologist  Keizo Dohi  published his first paper in the journal in German. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4456", "text": "Springer-Verlag  took over the journal's publishing in 1921, when it became the  Archiv f\u00fcr klinische und experimentelle Dermatologie und Syphilis . [ 13 ]  For the next 52 years it was an official publication for the  Deutsche Dermatologische Gesellschaft . [ 14 ]  Issues were suspended in 1944 after Volume 185. [ 15 ]  Its publication recommenced in 1948 with Volume 186, its editors then being Erich Hoffmann, Georg Alexander Rost, and Fritz Hussels. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4457", "text": "By the mid-1950s, following the widespread availability of  penicillin  to treat syphilis, the disease appeared to be under control and considered by dermatologists to no longer be a concern. [ 9 ]  Subsequently, dermatologists found a way of separating themselves from  sexually transmitted infections  and the unpopular specialty of venereology. [ 9 ]  In 1955, links to sexually transmitted infection including syphilis were dropped from the titles of several journals including the  Archiv f\u00fcr klinische und experimentelle Dermatologie und Syphilis , which was renamed  Archiv f\u00fcr klinische und experimentelle Dermatologie . [ 9 ] [ 14 ]  In the same year the  American Medical Association (AMA) Archives of Dermatology and Syphilology  also dropped syphilis and became  AMA Archives of Dermatology , and the  Indian Journal of Dermatology and Venereology  removed venerology from its title to form the  Indian Journal of Dermatology . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4458", "text": "Between 1970 and 1975 the journal was renamed the  Archiv f\u00fcr Dermatologische Forschung . [ 13 ]   Enno Christophers  became its editor in 1971 and continued in that post when in 1975 the journal became the  Archives of Dermatological Research . [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4459", "text": "Former editors include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4460", "text": "The journal is abstracted and indexed in:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4461", "text": "According to the  Journal Citation Reports , the journal has a 2022  impact factor  of 3.0. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4462", "text": "The  British Journal of Dermatology  is a monthly  peer-reviewed   medical journal  that covers the field of  dermatology . It is published by  Wiley-Blackwell  on behalf of the  British Association of Dermatologists . The journal was established in 1888 and the  editor-in-chief  is John Ingram. According to the  Journal Citation Reports , the journal has a 2020  impact factor  of 9.3., [ 1 ]  ranked third within the dermatology subject category."}
{"_id": "WikiPedia_Dermatology$$$corpus_4463", "text": "The journal was founded in 1888 as the  British Journal of Dermatology , published by Blackwell\u2019s. [ 2 ]  It was edited from 1896 to 1904 by  Sir James Galloway . [ 3 ]  In 1917, the words \"and syphilis\" were added to the title, and dropped in 1950. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4464", "text": "Clinical and Experimental Dermatology  is a  peer-reviewed   medical journal  provide relevant and educational material for practising clinicians and dermatological researchers. The journal is published by  Wiley . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4465", "text": "The journal is abstracted and indexed in: [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4466", "text": "According to the  Journal Citation Reports , the journal has a 2020  impact factor  of 3.470. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4467", "text": "Clinics in Dermatology  is a  medical journal  published for the  International Academy of Cosmetic Dermatology  by  Elsevier , addressing clinical treatment and care of  skin disorders . According to the  Journal Citation Reports , the journal has a 2014  impact factor  of 2.470. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4468", "text": "Dermatologic Clinics  is a  peer-reviewed   medical journal  published quarterly for the Dermatologic Clinics of North America by  Elsevier . It has been published since 1983."}
{"_id": "WikiPedia_Dermatology$$$corpus_4469", "text": "According to the  Journal Citation Reports , the journal has a 2017  impact factor  of 3.214. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4470", "text": "Dermatologic Surgery  is a monthly peer-reviewed journal that deals with the subject matter of dermatology. The journal is published by  American Society for Dermatologic Surgery ,  Lippincott ,  Williams & Wilkins \nAccording to the  Journal Citation Reports , the journal has a 2022  impact factor  of 2.4."}
{"_id": "WikiPedia_Dermatology$$$corpus_4471", "text": "This article about a  surgery   journal  is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4472", "text": "Dermatology  is a  peer-reviewed   medical journal  published by  Karger Publishers . It was established in 1893 as the  Dermatologische Zeitschrift  and was renamed  Dermatologica  in 1939. It obtained its current name in 1993. The founding  editor-in-chief  was  Oskar Lassar . Other notable editors were  Wilhelm Lutz   (1939\u20131958) and  Rudolf Schuppli  (1959\u20131985). It was the official journal of the  Schweizerische Gesellschaft f\u00fcr Dermatologie und Venere  and the  Belgian Society for Dermatology and Syphiligraphy . According to the  Journal Citation Reports , the journal has a 2019  impact factor  of 3.695. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4473", "text": "The  Dermatology Online Journal  is a monthly  open-access   peer-reviewed   medical journal  that was established in 1995 by Arthur Huntley (Department of Dermatology,  University of California, Davis ). [ 1 ]  It is published by the  California Digital Library  and covers all aspects of general  dermatology . The current  editor-in-chief  is Barbara Burrall (University of California Davis)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4474", "text": "Besides medical information, the journal provides medical perspectives on non-medical topics [ 2 ]  and the  Dermatology Online Journal  published the first dermatology training program ranking. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4475", "text": "The journal is indexed in  PubMed , [ 5 ]   MEDLINE , [ 5 ]  and  Scopus . [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4476", "text": "Dr Mark Duffill"}
{"_id": "WikiPedia_Dermatology$$$corpus_4477", "text": "DermNet  is a worldwide clinical resource website about  dermatology  and skin conditions. [ 1 ]  Its co-founder and former editor-in-chief is dermatologist and Adjunct Associate Professor  Amanda Oakley . [ 2 ]  The website was launched in 1996 under the umbrella of the  New Zealand Dermatological Society , and as of 2017, around 2 million people access the website monthly. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4478", "text": "The purpose of DermNet is to provide authoritative information about skin diseases, conditions and treatments for dermatologists, students and medical researchers. The website has been praised for articles on little represented conditions, such as hyperhidrosis. [ 4 ]  As of November 2017, there are 2,300 pages and a library of 25,000 dermatology and dermatopathology images on the website. [ 5 ]  Pages and images are contributed and reviewed by health professionals from countries including the United States, the  United Kingdom ,  Australia , Canada, and New Zealand. [ 6 ]  The website also provides online medical courses for the continuing education of dermatologists."}
{"_id": "WikiPedia_Dermatology$$$corpus_4479", "text": "In 2017, DermNet released its first book,  Dermatology Made Easy . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4480", "text": "DermNet also provides an interactive tool, DermDiag, which allows users to assess their own skin conditions. The tool allows the user to input increasingly specific levels of information regarding their condition, starting from location of ailment, up to number of blemishes, and provides the user with potential diagnoses. The provided diagnoses are ranked from COMMON to RARE, and images of each potential diagnosis are provided to the user, along with clinical features of each condition. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4481", "text": "DermNet won the 2017 New Zealand Ministry of Health Clinician's Challenge Award for the development of a skin disease image recognition tool. [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4482", "text": "In 2017, Oakley won the Lifetime Achievement Award at the New Zealand Charity Technology Awards for her tenure as creator and editor-in-chief of the website. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4483", "text": "In 2018, Oakley was awarded the New Zealand Order of Merit for services to dermatology as part of the Queen's Birthday Honours List. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4484", "text": "Expert Review of Dermatology  was a bimonthly  peer-reviewed   medical journal  covering all aspects of  dermatology . [ citation needed ]  It was established in 2001 and ceased publication in 2013. It was published by  Informa  and abstracted and indexed in  Scopus . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4485", "text": "The  Indian Journal of Dermatology  is a bimonthly  peer-reviewed   open-access   medical journal  published on behalf of the  Indian Association of Dermatologists, Venereologists and Leprologists , West Bengal Branch. The journal covers clinical and experimental  dermatology , cutaneous biology, dermatological therapeutics, cosmetic dermatology,  dermatopathology , and dermatosurgery. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4486", "text": "It was established in 1955. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4487", "text": "The  Indian Journal of Dermatology, Venereology and Leprology  is a  peer-reviewed   open-access   medical journal  published by  Scientific Scholar   on behalf of the  Indian Association of Dermatologists, Venereologists and Leprologists . The journal covers clinical and experimental  dermatology , cutaneous biology, dermatological therapeutics, cosmetic dermatology,  dermatopathology , dermatosurgery, pediatric dermatology, photodermatology, and  HIV  medicine."}
{"_id": "WikiPedia_Dermatology$$$corpus_4488", "text": "The journal is indexed in Abstracts on Hygiene and Communicable Diseases, Bioline International,  CAB Abstracts ,  CINAHL ,  EBSCO ,  Excerpta Medica / EMBASE , Expanded Academic ASAP, Global Health, Health & Wellness Research Center, Health Reference Center Academic, IndMed,  MEDLINE / Index Medicus ,  SafetyLit ,  Science Citation Index Expanded ,  Scopus , SIIC databases, Tropical Diseases Bulletin, and  Ulrich's Periodicals Directory ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4489", "text": "The  International Journal of Dermatology  is a  peer-reviewed  monthly journal covering all aspects of  dermatology . According to the  Journal Citation Reports , the journal has a 2022  impact factor  of 3.6. [ 1 ]  The journal is indexed in  Current Contents ,  Index Medicus , and the  Science Citation Index . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4490", "text": "JAMA Dermatology  is a monthly  peer-reviewed   medical journal  published by the  American Medical Association . [ 1 ]  It covers the effectiveness of  diagnosis  and treatment in medical and surgical  dermatology ,  pediatric  and  geriatric  dermatology, and  oncologic  and  aesthetic  dermatologic  surgery ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4491", "text": "The journal was established in the  Archives of Dermatology and Syphilology  (1920\u20131950), continuing as the  A.M.A. Archives of Dermatology and Syphilology  (1950\u20131954), then  A.M.A. Archives of Dermatology  (1955\u20131960), then  Archives of Dermatology  (1960\u20132012), obtaining its current name in January 2013. According to  Journal Citation Reports , the journal has a 2021  impact factor  of 11.816, ranking it 2nd out of 69 journals in the category \"Dermatology\". [ 2 ]  The  editor-in-chief  is Kanade Shinkai ( University of California, San Francisco )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4492", "text": "The journal is abstracted and indexed in  Index Medicus / MEDLINE / PubMed . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4493", "text": "The  Journal of Cosmetic Dermatology  is a quarterly  peer-reviewed   medical journal  published by  Wiley-Blackwell . It is the official journal of the  International Academy of Cosmetic Dermatology  and covers all aspects of cosmetic  dermatology . The  editor-in-chief  is Zoe Diana Draelos. The journal was established in 2002. According to the  Journal Citation Reports , the journal has a 2014  impact factor  of 0.876. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4494", "text": "The  Journal of Cutaneous and Aesthetic Surgery  is a triannual  peer-reviewed   open-access   medical journal  published by  Medknow Publications  on behalf of the  Association of Cutaneous Surgeons of India . It covers research on  skin surgery  and  aesthetic surgery . The  editor-in-chief  is  Imran Majid ( Shri Maharaja Hari Singh Hospital ), who succeeded Niti Khunger ( Vardhman Mahavir Medical College )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4495", "text": "The journal is abstracted and indexed in  EBSCO databases ,  Expanded Academic ASAP , and  Scopus . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4496", "text": "The  Journal of Cutaneous Medicine and Surgery  (abbreviated  JCMS ) is a bimonthly  peer-reviewed   medical journal  covering  dermatology . It was established in 1996 and is published by  SAGE Publications  in collaboration with the Canadian Dermatology Association, of which it is the official journal. [ 1 ]  The  editor-in-chief  is Kirk Barber ( University of Calgary ). According to the  Journal Citation Reports , the journal has a 2020  impact factor  of 2.092, ranking it 46th out of 69 journals in the category \"Dermatology\". [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4497", "text": "Journal of Dermatological Science  is a  medical journal  that covers the entire scope of dermatology, from molecular studies to clinical investigations. The journal is published by  Elsevier . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4498", "text": "According to the  Journal Citation Reports , the journal has a 2021  impact factor  of 5.408. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4499", "text": "The  Journal of Dermatological Treatment  is a bimonthly  peer-reviewed   medical journal  that covers all aspects of the treatment of  skin disease , including the use of topical and systematically administered drugs and other forms of therapy. It is published by  Informa Healthcare  and the  editors-in-chief  are Peter van de Kerkhof ( Radboud University Nijmegen ) and Steven R. Feldman ( Wake Forest University School of Medicine ). The journal is available online and in paper format."}
{"_id": "WikiPedia_Dermatology$$$corpus_4500", "text": "The journal was established in June 1989 in Cardiff, UK, by the co-founding editors, Ronald Marks and Andrew Y Finlay, [ 1 ]  published jointly by Martin Dunitz Ltd and The Macmillan Press Ltd. The journal was edited by Marks and Finlay until the September 1997 issue of Volume 8. From the December 1997 issue the editorship passed to  Chris Griffiths  and Jean-Paul Ortonne. [ 2 ]  In January 2004 Richard Groves and Steven R Feldman became editors.  From 2008 the editors have been Steven R Feldman and Peter van de Kerkhof."}
{"_id": "WikiPedia_Dermatology$$$corpus_4501", "text": "The journal was published four times each year from its foundation in 1989 until 2003. From 2004 six issues have been published each year."}
{"_id": "WikiPedia_Dermatology$$$corpus_4502", "text": "The  Journal of Dermatology  is a  peer-reviewed   medical journal  covering  dermatology  published by the  Japanese Dermatological Association  (\u65e5\u672c\u76ae\u819a\u79d1\u5b66\u4f1a  Nihon Hifuka Gakkai ) and the  Asian Dermatological Association . Its 2014  impact factor  is 2.252. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4503", "text": "The  Journal of Drugs in Dermatology  is a monthly  peer-reviewed   medical journal  of  dermatology  published by Sanovaworks. The journal was established in 2002 by  Mohs surgeon   Perry Robins , founder of the  Skin Cancer Foundation . It is the flagship publication of Sanovaworks, publisher of  Derm-in-Review  and  Next Steps , as well as the sponsor of  JDD Podcasts  and two annual medical specialty conferences, Skin of Color Update (SOCU), and the ODAC Dermatology Aesthetic and Surgical (ODAC) conferences."}
{"_id": "WikiPedia_Dermatology$$$corpus_4504", "text": "The following persons have been co- editor-in-chief  of the journal:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4505", "text": "The journal is  abstracted and indexed  in the following  bibliographic databases : [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4506", "text": "The journal was accepted into the  Science Citation Index [ 5 ]  in 2003 and received an  impact factor  in 2004. [ 6 ]  According to the  Journal Citation Reports , the journal has a 2019  impact factor  of 1.464. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4507", "text": "The  Journal of Investigative Dermatology  is a  peer-reviewed   medical journal  covering  dermatology . It has been published by  Elsevier  since 2016 and the  editor-in-chief  is Erwin Tschachler ( University of Vienna ). [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4508", "text": "In 1972, it absorbed the journal  Advances in Biology of Skin , also known as the  Proceedings of the Brown University Symposium on the Biology of Skin ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4509", "text": "According to the  Journal Citation Reports , the journal has a 2023  impact factor  of 5.7. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4510", "text": "The  Journal of the American Academy of Dermatology , sometimes abbreviated  JAAD , is a monthly  peer-reviewed   medical journal  covering  dermatology . It was established in 1979 and is published by  Elsevier  on behalf of the  American Academy of Dermatology , of which it is the official journal. [ 1 ]  The  editor-in-chief  is Dirk Elston ( Medical University of South Carolina ). According to the  Journal Citation Reports , the journal has a 2017  impact factor  of 6.898. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4511", "text": "JAAD has a companion journal focusing on  case reports  called  JAAD Case Reports . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4512", "text": "The  Journal of the European Academy of Dermatology and Venereology  is the official journal of the European Academy of Dermatology and Venereology. The journal is  peer-reviewed  monthly that publishes articles of general and practical interest in the field of  dermatology  and  venereology  on clinical and basic science topics, as well as research with practical implications. According to the  Journal Citation Reports , the journal has a 2022  impact factor  of 9.2. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4513", "text": "The  Journal of Tissue Viability  is a quarterly  peer-reviewed   medical journal  covering all aspects of the occurrence and treatment of  wounds ,  ulcers , and  pressure sores . It is published by  Elsevier ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4514", "text": "The journal was established in 1991 with P Shakespeare as its founding  editor-in-chief . It is the official publication of the  Tissue Viability Society  and its current editor-in-chief is Dan Bader ( University of Southampton )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4515", "text": "According to the  Journal Citation Reports , the journal has a 2017  impact factor  of 1.925. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4516", "text": "Pediatric Dermatology  is a  peer-reviewed   medical journal  provide relevant and educational material for practising clinicians and dermatological researchers, focused on hemangiomas, atopic dermatitis, neonatal medicine etc. The journal is published by  Wiley . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4517", "text": "According to the  Journal Citation Reports , the journal has a 2020  impact factor  of 1.997. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4518", "text": "Photodermatology, Photoimmunology and Photomedicine  is a  peer-reviewed   scientific journal  published bimonthly by  Wiley-Blackwell  which focusses, as its title implies, on photodermatology, photoimmunology and  photomedicine . Warwick L. Morison is  editor-in-chief . It is the official journal of the  Photomedicine Society , the  British Photodermatology Group , and the  European Society for Photodermatology ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4519", "text": "Photodermatology, Photoimmunology and Photomedicine  has been published since 1985. [ 1 ]  The founding editors were Christer Jans\u00e9n and G\u00f6ren Wennersten, [ 2 ]  other past editors in chief have been Henry Wan-Peng Lim. [ 3 ]  and Paul R. Bergstresser. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4520", "text": "In 2008 the European Society for Photodermatology voted to make  Photodermatology, Photoimmunology and Photomedicine  its official journal. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4521", "text": "Photodermatology, Photoimmunology and Photomedicine  is abstracted and indexed in  Academic Search ,  Biological Abstracts ,  BIOSIS Previews ,  Current Contents /Clinical Medicine,  CSA Biological Sciences Database , Immunological Abstracts,  EMBASE ,  Journal Citation Reports ,  MEDLINE / PubMed , Research Alert, and the  Science Citation Index . According to the  Journal Citation Reports , the journal has a 2014  impact factor  of 1.259, ranking it 40th out of 63 journals in the category \"Dermatology\". [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4522", "text": "Skin Pharmacology and Physiology  is a  peer-reviewed   medical journal  and an official journal of the Society for Dermopharmacy / Gesellschaft f\u00fcr Dermopharmazie e.V. (GD). [ 1 ]  It was established in 1988 under the title  Skin Pharmacology , renamed to  Skin Pharmacology and Applied Skin Physiology  in 1998, and obtained its current title in 2003. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4523", "text": "According to the  Journal Citation Reports , the journal has a 2014  impact factor  of 2.366. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4524", "text": "This article about a  pharmacology   journal  is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4525", "text": "Syphilidologie  was a medical journal first created in 1838 in Leipzig by  Friedrich Jacob Behrend . [ 1 ] [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4526", "text": "This is a  list of dermatologists  who have made notable contributions to the field of  dermatology ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4527", "text": "Carl Heinrich Auspitz  (2 September 1835 in  Nikolsburg ,  Moravia  \u2013 22 May 1886 in  Vienna ) was a  Jewish [ 1 ]   Austrian   dermatologist . He was the husband of pianist  Auguste Auspitz-K\u00f3lar  (1843\u20131878). [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4528", "text": "He was a member of the famous Moravian-Austrian  Auspitz Family \u00a0[ de ] . Heinrich was a son of Jewish surgeon  Moritz \u00a0[ de ]  (1803, Nikolsburg \u2013 1880). His younger brother  Leopold \u00a0[ de ]  (1838, Nikolsburg \u2013 1907) was an Imperial & Royal  Generalmajor  and writer. In 1840, Moritz was given a job at a Jewish hospital in Vienna, and allowed better education to his sons."}
{"_id": "WikiPedia_Dermatology$$$corpus_4529", "text": "Trained at the  University of Vienna , he specialized in dermatology and  syphilis . He was part of the so-called  Vienna School of Dermatology , and studied and worked with several eminent physicians of the time;  Ernst Wilhelm (Ritter von) Br\u00fccke  (1819, Berlin \u2013 1892),  Karel  (Carl)  Freiherr von Rokytansk\u00fd  (1804, Bohemia \u2013 1878),  Josef \u0160koda  (1805, Bohemia \u20131881),  Johann Ritter von Oppolzer  (1808, Bohemia \u2013 1871), and  Ferdinand Ritter von Hebra  (1816, Moravia \u20131880)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4530", "text": "In 1863 he became a  privat-docent  of dermatology and syphilis, and during the following year began work in the  histological  institute of  Carl Wedl . [ 2 ]  In 1872 he was named director of the general policlinic, and from 1875 onward, was an associate professor at the  university ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4531", "text": "A pioneer in  tissue   pathology , he described the pinpoint  bleeding  on removal of a  psoriasis  scale that bears his name: \" Auspitz's sign \". [ 3 ]  In 1885 he published an article involving  mycosis fungoides  titled \" Ein Fall von Granuloma fungoides (Mycosis fungoides Alibert) \". [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4532", "text": "Together with  Philipp Josef Pick  (1834-1910), he founded first German-language magazine for dermatology, the \" Archiv f\u00fcr Dermatologie und Syphilis \" (1869). In 1882 he became a member of the  German Academy of Sciences Leopoldina . In May 1886 he died from a heart condition, and was interred in the  Wiener Zentralfriedhof . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4533", "text": "Since 2005, the \"Heinrich Auspitz Preis\" has been awarded by the  Wyeth and Pfizer Corporation Austria  in order to promote scientific research in the field of dermatology. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4534", "text": "Bernard Wolff Beffie  (18 May 1872 \u2013 2 July 1943) was a Dutch  dermatologist  and  chess  player,  unofficial Dutch Chess Championship  winner (1906)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4535", "text": "Beffie was a son of Isaac Wolff, who had the name Beffie added to his family name in 1877. The parental family consisted of ten children: seven boys and three girls. Bernard Wolff Beffie was born in Amsterdam on 18 May 1872. He was married to Dirkje Johanna Kuiper, who died in 1938. The couple had no children and lived at Amsterdam. Beffie studied medicine in his hometown, where he took his medical exam on 26 February 1900. He specialized in  dermatology  and  sexually transmitted infection ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4536", "text": "Beffie was also a member of the United Amsterdam Chess Society. In 1906, in  Arnhem  he won the  unofficial Dutch Chess Championship . During the raid on 20 June 1943, he fell into the hands of the  SD . On 2 July 1943 he was murdered in the Sobibor extermination camp. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4537", "text": "This biographical article relating to a Dutch chess figure is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4538", "text": "Iwan Bloch  (8 April 1872 \u2013 21 November 1922), also known as  Ivan Bloch , was a German  dermatologist , and  psychiatrist ,  psychoanalyst  born in  Delmenhorst ,  Grand Ducal Oldenburg ,  Germany , and often called the first  sexologist ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4539", "text": "Together with  Magnus Hirschfeld  and  Albert Eulenburg , Bloch is known for having proposed the new concept of a science of sexuality ( Sexualwissenschaft ) or  sexology . In 1906 he wrote in German the book  Das Sexualleben unserer Zeit in seinen Beziehungen zur modernen Kultur  which was translated as  The Sexual Life of our Time in its Relations to Modern Civilization , a complete encyclopedia of the sexual sciences in their relation to modern civilization. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4540", "text": "He is also known for having discovered the  Marquis de Sade 's manuscript of  The 120 Days of Sodom , which had been believed to be lost, and published it under the pseudonym  Eugen D\u00fchren  in 1904. He had previously published  Marquis de Sade: his life and works.  In 1899 under the same  pseudonym , which he used later for the publishing of more works about Sade and R\u00e9tif de la Bretonne."}
{"_id": "WikiPedia_Dermatology$$$corpus_4541", "text": "Bloch came from a  Jewish  family. His father Louis Bloch (1846\u20131892) was a cattle dealer from Bassum who had a total of five children with his wife Rosa Lisette Rosette, n\u00e9e Meyer (1845\u20131921). [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4542", "text": "According to  Sigmund Freud , Bloch's studies were instrumental in the development of the anthropological approach to the theory of sexuality. Before Bloch, homosexuality was analyzed using a pathological approach. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4543", "text": "Iwan Bloch began the publication of his  Handbuch der gesamten Sexualwissenschaft in Einzeldarstellungen  ( Handbook of Sexology in its Entirety Presented in Separate Studies ) in 1912. Three volumes appeared until the project was aborted because of Bloch's untimely death at age 50, in 1922."}
{"_id": "WikiPedia_Dermatology$$$corpus_4544", "text": "(Band 1, Band 2, Band 3: Louis Marcus, Berlin, 1912\u201325):"}
{"_id": "WikiPedia_Dermatology$$$corpus_4545", "text": "He had published earlier:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4546", "text": "Were published after his death:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4547", "text": "Fredric Sheldon Brandt  (June 26, 1949\u00a0\u2013 April 5, 2015) was an American physician, researcher, lecturer, author, and radio host specializing in cosmetic  dermatology . Among the first to use  botulinum toxin  (\"botox\") and fillers, [ 1 ]  Brandt was noted for his role in the FDA approval of numerous fillers and botulinum toxins for cosmetic use in the United States."}
{"_id": "WikiPedia_Dermatology$$$corpus_4548", "text": "Brandt, who hosted a radio show called  Ask Dr. Brandt  on SiriusXM radio and whose celebrity patients included   Madonna , was called the \"Baron of Botox\" by  W  magazine [ 2 ]  and \"King of Collagen\" for using more botox and collagen than any other dermatologist in the world. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4549", "text": "Brandt was born into a Jewish family [ 4 ] [ 5 ] [ 6 ] [ 7 ]  in  Newark, New Jersey , where his parents, Irving and Esther Brandt, owned a candy shop. [ 2 ]  He graduated from  Rutgers University  in 1971. [ 8 ]  Brandt then obtained his medical degree from  Hahnemann Medical College  and completed an internal medicine residency at  New York University , followed by a dermatology residency at the  University of Miami . He set up a practice in Miami in 1982, and subsequently opened up a practice in New York City in 1998. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4550", "text": "Brandt's Dermatology Research Institute was located in his dermatology office in Miami, Florida. Along with his associates, Brandt performed clinical research on FDA-approved protocols for new fillers, forms of botulinum toxins, lasers, and cosmetic ingredients. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4551", "text": "Brandt was the author of two books about the skin aging process and retention of youthful appearance."}
{"_id": "WikiPedia_Dermatology$$$corpus_4552", "text": "Brandt died from suicide on April 5, 2015, in his home in  Coconut Grove, Florida , aged 65. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4553", "text": "Abraham Buschke  (27 September 1868 \u2013 25 February 1943) was a  Jewish   German   dermatologist  who was a native of  Nakel  in the  Province of Posen . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4554", "text": "In 1891 he received his doctorate in  Berlin , and afterwards was a  surgical  assistant in  Greifswald . Later he worked at dermatological clinics in  Breslau  under  Albert Neisser  (1855\u20131916) and in Berlin with  Edmund Lesser  (1852\u20131918). In 1906 he became head of dermatology at  Rudolf Virchow Hospital  in  Wedding ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4555", "text": "In 1943 he died in the Nazi concentration camp at  Theresienstadt ,  Bohemia . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4556", "text": "Abraham Buschke specialized in research of  venereal disease . In 1926 with  Martin Gumpert  (1897\u20131955) he published a treatise on  syphilis  in children titled  Geschlechtskrankheiten bei Kindern  (Venereal Diseases in Children). His name is associated with several eponymous dermatological disorders, including:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4557", "text": "In 1894 with  pathologist   Otto Busse  (1867\u20131922) Buschke described an infectious disease caused by the  fungus   Cryptococcus neoformans . This condition is sometimes referred to as Busse\u2013Buschke disease."}
{"_id": "WikiPedia_Dermatology$$$corpus_4558", "text": "Benno Chajes  (14 November 1880 \u2013 3 October 1938) was a German physician, professor for  Social medicine  and politician. He was a member of the  Prussian parliament  representing the  Social Democratic Party of Germany ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4559", "text": "Chajes was born in  Danzig ,  West Prussia ,  German Empire  (Gda\u0144sk, Poland) to Wolf Chajes (1845\u20131901) and Emma n\u00e9e Braff (1846\u20131932), he passed his  Abitur  in Danzig and studied medicine at the  University of Berlin  and the  University of Freiburg . He received his doctorate in 1903 in  Freiburg  and started to practice as an assistant doctor in 1903 at the  Charit\u00e9  in  Berlin . From 1904 to 1907 he worked for  Alfred Blaschko  and in 1907 at the  H\u00f4pital Saint-Louis  in  Paris . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4560", "text": "He returned to Berlin in 1908 to work at Hans Goldschmidt's clinic and started his private practice specialising in  dermatology ,  sexual diseases  and  urology  in 1911 in  Berlin Sch\u00f6neberg . From 1906 to 1921 he worked as public assistant doctor in Sch\u00f6neberg, from 1915 to 1933 he was the physician of the  Deutsches Theater (Berlin) . Chajes joined the Association of socialist physicians ( Verein sozialistischer \u00c4rzte ) in 1913 and became its deputy chairman in 1924. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4561", "text": "In  World War I  he served as a military physician from 1915 to 1918 and was awarded the  Iron Cross  second class. During the  German Revolution  he was a member of the  workers' and soldiers council  in  Frankfurt (Oder) , he is described either as chairman of the central department of the soldiers' councils in the  Province of Brandenburg [ 1 ]  or in the  Regierungsbezirk Frankfurt (Oder) . [ 2 ]  Chajes was a delegate at the national congress of councils. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4562", "text": "In 1919 he started to lecture at the  Technical University Charlottenburg  on industrial hygiene. In 1922 he became a member of the Committee for industrial hygiene at the  International Labour Office  in  Geneva . He was elected a member of the Prussian Parliament in 1928 and became his fraction's expert in public health services. [ 3 ]  He followed  Alfred Grotjahn  at the University of Berlin and headed the Institute for social hygiene at the University of Berlin from 1931 on. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4563", "text": "Being Jewish, Chajes lost his positions according to the  Law for the Restoration of the Professional Civil Service   after the  Nazi seizure of power  in 1933. He emigrated via  Switzerland  and  Turkey  to  Mandate Palestine , where he arrived in autumn 1933. In 1934 he started to practice as a physician in  Tel Aviv . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4564", "text": "Chajes was engaged in constituting  healthcare in Israel , he co-founded the  Assuta Medical Center  and the Shiloah Insurance company, today part of the  Harel Group . [ 5 ]  In 1935 Chajes became the chairman of the Committee for industrial and social hygiene of the  Histadrut  Union. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4565", "text": "He died in 1938 while on vacation in  Ascona ,  Switzerland . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4566", "text": "Chajes was married to K\u00e4te Schattner (1882\u20131925), step-daughter of  Eduard Bernstein , and in a second marriage to Flora Rosenbund (1898\u20131942). [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4567", "text": "Salomon Ehrmann  (December 19, 1854 - October 24, 1926) was a Jewish-Austrian  dermatologist  and  histologist  born in the village of  Ostrovec , today part of the  Czech Republic . He was an important member of the so-called  Vienna School of Dermatology , a group founded by  Ferdinand von Hebra  (1816\u20131888)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4568", "text": "Ehrmann was a pupil of  histopathologist   Carl Wedl  (1815\u20131891) at the  University of Vienna . He later became director of the dermatological department at  Vienna General Hospital . He specialized in the field of  syphilology , and is remembered for his research involving the parasite  Spirochaetae pallida  (the causative agent of syphilis), and its spread throughout the human body."}
{"_id": "WikiPedia_Dermatology$$$corpus_4569", "text": "In 1895 he described  acne keloidalis , which he referred to as  folliculitis  nuchae sclerotisans . Among his written works was a comparative diagnostic atlas of skin diseases called  Vergleichend-diagnostischer Atlas der Hautkrankheiten und der Syphilide . Other published works by Ehrmann include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4570", "text": "This biographical article related to medicine in Austria is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4571", "text": "Irwin Mark Freedberg  ( c. \u20091933 ,  Brookline, Massachusetts  \u2013 July 17, 2005, New York City) was an American  dermatologist. [ 1 ]   He taught dermatology at Harvard Medical School, was director of the department of dermatology at  Johns Hopkins University , was the first chief of dermatology at  Beth Israel Hospital , and was the George Miller MacKee Professor and chairman of the Ronald O. Perelman Department of  Dermatology  at the  New York University Medical Center .  He studied the  protein   keratin  (the main component of hair, nails, and skin) and  keratinocytes  (the most common cells in the  epidermis )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4572", "text": "He received his undergraduate degree from  Dartmouth College  and earned his medical degree at  Harvard Medical School  in 1956, and performed his dermatology residency at the  Massachusetts General Hospital  from 1959 to 1962. [ 2 ]  He then taught at Harvard from 1962 to 1977, eventually as a professor of dermatology. [ 3 ]  He moved to Johns Hopkins University, where he was director of the department of dermatology until 1981. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4573", "text": "He was the first chief of dermatology at  Beth Israel Hospital . [ 4 ]  Subsequently, he was the George Miller MacKee Professor and chairman of the Ronald O. Perelman Department of  Dermatology  at the  New York University Medical Center , New York, from 1981 through 2005. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4574", "text": "Freedberg studied the  protein   keratin  (the main component of hair, nails, and skin) and  keratinocytes  (the most common cells in the  epidermis ). [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4575", "text": "He was the former editor in chief of  The Journal of Investigative Dermatology . [ 3 ]  He also was a co-editor for a number of editions of  Fitzpatrick's Dermatology in General Medicine ;  Freedberg; et\u00a0al., eds. (2003).  Fitzpatrick's Dermatology in General Medicine  (6th\u00a0ed.). McGraw-Hill.  ISBN \u00a0 0-07-138067-1 . [ 3 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4576", "text": "In 1995, he was elected to the  National Academy of Sciences ' Institute of Medicine. [ 3 ]  Freedberg was named president of the American Dermatologic Association in 1997. [ 3 ]  He was a former president of the Association of Professors of Dermatology and of the  American Board of Dermatology . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4577", "text": "He died from a  brain tumor  at the age of 74 in New York City on July 17, 2005. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4578", "text": "This biographical article related to a physician in the United States is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4579", "text": "Wilhelm Siegmund Frei  (5 September 1885 \u2013 27 January 1943) was a German  dermatologist  best known for his contributions to  Durand-Nicolas-Favre disease , a  sexually transmitted disease  found mainly in tropical and subtropical climates. He is also known for the  Frei Test , [ 1 ]  which was developed in 1925 for the detection of  lymphogranuloma venereum  (LGV). [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4580", "text": "Wilhelm Siegmund Frei was born in  Neustadt ,  Upper Silesia . His father, Emil Frei, was a  mining  firm director, from Neustadt. His mother was Frederika Ring, who came from  Austria . Wilhelm had two sisters, Gerta Frei (1887 \u2014 presumably killed by Nazis) and Josephina Frei (1888)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4581", "text": "Wilhelm studied medicine in  Freiburg , Germany, and went on to get his  doctorate  in  G\u00f6ttingen  in 1913. He met  Magda Frankfurter  (1885\u20131973) when they were both studying medicine in Freiburg and was married on 12 January 1912. They had their first child Marianne, later that year on 7 November 1912, and their second child Fritz was born on 12 December 1915."}
{"_id": "WikiPedia_Dermatology$$$corpus_4582", "text": "Due to the rise of the  Nazis  and bad times looming ahead in Germany, he immigrated to New York with his family [ 3 ]  and went to work at the  Montefiore Hospital  in the  Bronx  from 1937 until he fell ill and died on 27 January 1943, leaving behind his wife and three children at the age of 58."}
{"_id": "WikiPedia_Dermatology$$$corpus_4583", "text": "Walter Freudenthal  (6 May 1893 \u2013 27 March 1952) was a German-Jewish dermatologist who gave the earliest clear  histopathological  description of keratoma senile ( actinic keratosis ) in 1926 in  Breslau . In 1933, he moved to London to escape the Nazi regime and worked as a dermatopathologist at  University College Hospital  (UCH) in London where he coined the term  keratoacanthoma  in the 1940s."}
{"_id": "WikiPedia_Dermatology$$$corpus_4584", "text": "He worked with dermatologist  Geoffrey Dowling  on the connection between  dermatomyositis  and  scleroderma  and was later appointed to the first readership in dermatological histology by London University."}
{"_id": "WikiPedia_Dermatology$$$corpus_4585", "text": "In addition to lecturing, demonstrating specimens at the  Royal Society of Medicine  and postgraduate training, Freudenthal wrote many papers on his histopathological findings, and chapters in dermatology textbooks."}
{"_id": "WikiPedia_Dermatology$$$corpus_4586", "text": "Walter Freudenthal was born on 6 May 1893 [ 1 ]  in Breslau (later  Wroclaw , Poland) in the  Silesia  region of Germany, into a Jewish family of physicians. [ 2 ]  In 1913 he began to study medicine in Geneva, but this was interrupted by the  First World War . [ 2 ]  Returning to Breslau in 1919, he resumed his medical education [ 2 ]  and completed it at the clinic of the  Friedrich-Wilhelms University  (now the University of Wroc\u0142aw), graduating in 1920. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4587", "text": "While working in the histopathology laboratory and being in charge of the male ward in the outpatient clinic, he became a university lecturer and then full professor. He became concerned that existing skin treatments were inadequate and started to work with a pharmacist to educate himself on the chemical content of various ointments and creams. At the same time, he lectured on  sexually transmitted diseases , dermatohistopathology and related topics. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4588", "text": "He was particularly influenced by Breslau's chair of dermatology  Josef Jadassohn , [ 3 ]  and was his assistant from 1920 to 1933 at the Breslau University. [ 2 ]  He also worked alongside other well-known names in the field of dermatology, such as  W. N. Goldsmith ,  Max Jessner  and  Rudolph L. Mayer . After receiving his  MD  in 1922, he became a  privatdozent  in 1929. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4589", "text": "His most significant works were written at Breslau. [ 3 ]  He examined 14 biopsy specimens of lesions taken from the skin of either the back of the hands or the upper face from 13 people aged between 34 and 76. He gave the earliest histopathological definition of these lesions, which he called keratoma senile ( actinic keratosis ), and distinguished them from verruca senilis ( seborrheic keratosis ). [ 4 ] [ 5 ]  The description appeared in the  Archiv f\u00fcr Dermatologie und Syphilis  in 1926 and was regarded by his colleagues as important. [ 3 ] [ 5 ]  He also proposed that keratoma senile might be caused by sunlight. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4590", "text": "Like many other Jewish physicians at his university, the Nazi takeover in 1933 resulted in the withdrawal of his permission to lecture, and in due course he moved to England. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4591", "text": "On arrival in London he was asked to recertify in order to practice medicine. He opted against this and instead, with the help of  Sir Archibald Gray , [ 3 ]  who had already recruited Freudenthal's old friend from Breslau W. N. Goldsmith, [ 6 ]  took up studies in dermatohistopathology at University College Hospital (UCH) in London. It was in this field that he was eventually appointed to the teaching faculty. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4592", "text": "During the Second World War, he assisted in the outpatient department of UCH, and after the war he became active in postgraduate training of home and international dermatologists. [ 2 ]  In 1945 he was elected to the first readership in dermatological histology at UCH. [ 3 ]  He also wrote about numerous other skin conditions including   amyloidosis ,  glomus tumour , mucin in  granuloma annulare [ 2 ]  and  Kaposi\u2019s sarcoma . [ 7 ]  Encouragement and collaboration with dermatologist Geoffrey Dowling led to an interest in the relationship between  dermatomyositis  and  scleroderma . [ 8 ]  He regularly attended the meetings of the dermatology section of the Royal Society of Medicine and demonstrated his specimens on the screen. His comments were reported in their  Proceedings . [ 2 ] [ 3 ]  In addition, he noted significant  acanthosis  in a lesion he was studying and coined the term \"keratoacanthoma\" [ 9 ] [ 10 ]  which was adopted by dermatologist  Arthur Rook  and pathologist  Ian Whimster  in 1950. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4593", "text": "Freudenthal suffered from constant headaches [ 2 ]  and heart disease in the final five years of life and, following a morning's work in the laboratory, died in London on 27 May 1952 at the age of 58. [ 3 ]  His wife survived him. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4594", "text": "The poet Ruth Hoffmann, [ 12 ]  who was also a friend of Freudenthal, devoted a significant section of her book to him.  Meine Freunde aus Davids Geschlecht (My friends from David\u2019s lineage)  was published in 1947 in Berlin and contained a description of him, which was quoted by a colleague:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4595", "text": "A man with thinning, blackish hair, an unmistakable, nimble, bird-like gait, who would disappear as fast as he had approached. He would depart with a short farewell, which would not last longer than the usual good-bye on the main station of Breslau after a weekend trip, even when it involved foreign travel, the ocean, years, and war. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4596", "text": "Numerous textbooks and articles by other dermatologists refer to him as Freudenthal of Wroclaw. [ 9 ] [ 10 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4597", "text": "David Gruby  (20 August 1810 \u2013 14 November 1898) was a Hungarian  physician  born in the village of Kis-K\u00e9r (now  Ba\u010dko Dobro Polje , Serbia) to a  Jewish  farmer. [ 1 ]  He received his doctorate in  Vienna  and performed scientific research in Paris."}
{"_id": "WikiPedia_Dermatology$$$corpus_4598", "text": "Gruby is remembered as a pioneer in the fields of  microbiology  and  medical mycology . Most of his important work was done during the 1840s, when he reported that human disease could be caused by fungi. [ 2 ]  In 1841 he described the fungus associated with  favus , a discovery that was independent of  Johann Lukas Sch\u00f6nlein 's (1793\u20131864) findings. Later, the fungal  parasite  was called  Achorion  schoenleinii  in Sch\u00f6nlein's honor."}
{"_id": "WikiPedia_Dermatology$$$corpus_4599", "text": "In 1842 he described a microscopic  cryptogam  ( Trichophyton ectothrix ) that is associated with a  dermatological  disease known as  sycosis barbae . Gruby also discovered  Candida (Monilia) albicans , the cause of  candidiasis , and in 1843 he described a fungus ( Microsporum audouinii ) that is the cause of a type of  ringworm . This fungus was named after  naturalist   Jean Victor Audouin  (1797\u20131842)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4600", "text": "Gruby also discovered a parasite in the blood of frogs he called  Trypanosoma  sanguinis . During the early years of  anaesthesia , he performed important experiments with  chloroform  and  ether  on animals."}
{"_id": "WikiPedia_Dermatology$$$corpus_4601", "text": "Martin Gumpert  (13 November 1897 \u2013 18 April 1955) was a German-born physician, dermatologist, medical historian, and author. Born in Berlin to a family of doctors, Gumpert pursued a medical career, specializing in dermatology and medical history. His early life was marked by service as a medical orderly during World War I and academic pursuits in Berlin and Heidelberg, culminating in a dissertation on syphilis in 1923. A left-wing social activist and trade unionist, Gumpert also engaged in expressionist poetry and literature."}
{"_id": "WikiPedia_Dermatology$$$corpus_4602", "text": "Gumpert was born on 13 November 1897 in Berlin to his parents Ely, a doctor, and Elise. [ 1 ]  In 1923 he married Charlotte Blaschko, also a doctor, who died of tuberculosis in 1933. [ 2 ]  The couple had a daughter, Nina, who was born in around 1927. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4603", "text": "Gumpert trained as a doctor in Berlin and Heidelberg, working as a medical orderly during the First World War. [ 1 ]  His 1923 dissertation was on the history of  syphilis , and he went on to write texts on pediatrics and developmental deformity. He studied in Paris in 1928. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4604", "text": "Gumpert was a left-wing social activist and trade unionist and published expressionist poetry. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4605", "text": "In 1933 Gumpert was forced out of his medical position by the Nazi rise to power. [ 1 ]  Over the next few years he wrote several texts of literature and the history of science and  medicine. He was further excluded from the association of German writers, the   Reichsverband deutscher Schriftsteller  as a Jew in 1935 and emigrated to the United States in 1936."}
{"_id": "WikiPedia_Dermatology$$$corpus_4606", "text": "Gumpert opened a dermatology practice in New York in 1936 and became a US citizen in 1942. [ 3 ]  During these years Gumpert became a friend of the siblings  Erika  and  Klaus Mann [ 4 ]  and in 1949 visited their father  Thomas Mann  in Germany. Thomas Mann used Gumpert's medical knowledge on the course of syphilis in writing his novel  Doktor Faustus. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4607", "text": "From 1952 Gumpert edited the gerontology journal  Lifetime Living   and worked as a  geriatrician  at the  Jewish Memorial Hospital , New York. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4608", "text": "Gumpert continued to write about the exile experience in poems and literary publications. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4609", "text": "Gumpert died on 18 April 1955. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4610", "text": "Salim Haim  (1919\u20131983) was a  dermatologist . In 1965 he described for the first time a case of  Haim\u2013Munk syndrome . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4611", "text": "This biographical article related to medicine in Iraq is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4612", "text": "Ludwig Halberst\u00e4dter  (9 December 1876, in  Beuthen ,  Oberschlesien  \u2013 20 August 1949) was a German-Jewish  radiologist ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4613", "text": "In 1901 he obtained his medical doctorate from the  University of Breslau , and following graduation became an assistant to  surgeon   Carl Garr\u00e9  (1857\u20131928) at the  University of K\u00f6nigsberg . Afterwards he returned to  Breslau  as an assistant to  dermatologist   Albert Neisser  (1855\u20131916), under whose direction he participated on a medical research mission to  Java  (1907)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4614", "text": "In 1922 he obtained his habilitation for dermatology and  radiation therapy  in  Berlin . Here he became director of the radiation department at the  Instituts f\u00fcr Krebsforschung  (Institute for Cancer Research),  Berlin-Dahlem . In this capacity he used  thorium  as a treatment for  cancer . [ 1 ]  In 1933 he emigrated from Nazi Germany to  Palestine , where he became director of radiation therapy at the  Hadassah Hospital  in  Jerusalem . He died in  New York City  on August 20, 1949."}
{"_id": "WikiPedia_Dermatology$$$corpus_4615", "text": "In 1905 he introduced radiation for  ablation  of the  ovaries . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4616", "text": "Hans Haustein  (August 27, 1894 \u2013 November 12, 1933) was a Jewish medical doctor and scientist in the  Weimar Republic ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4617", "text": "Haustein was born and died in Berlin."}
{"_id": "WikiPedia_Dermatology$$$corpus_4618", "text": "Hans Haustein studied medicine in  Freiburg im Breisgau  and Berlin from 1913 to 1918. In 1920, he completed a  Doctorate  in Berlin. Afterwards, he received his  medical licence  and became a  medical assistant . His teachers in the fields of  dermatology  and  venereology  were  Abraham Buschke , at Rudolf Virchow Hospital, as well as  Georg Arndt , at the dermatology clinic of the  Charit\u00e9 \u2013 Berlin University of Medicine ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4619", "text": "In 1924, soon after Haustein was made a  consultant  in  skin diseases  and  sexually transmitted diseases , he opened a  surgery  on  Kurf\u00fcrstendamm . This afforded him an affluent clientele of high  social status . He gained a reputation as a fashionable doctor, who also treated  prostitutes  and supplied them with  pessaries  for  birth control . As a  consultant , he was both a colleague and a rival of  Gottfried Benn , who practised on Belle-Alliance-Street, today  Mehringdamm ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4620", "text": "He lived in a large house on 4 Bregenzer Street in Berlin-Wilmersdorf, which was a centre for high society. In these rooms, he hosted lavish parties at which writers, composers, painters and patrons gathered. At the time of the  Weimar Republic , a large proportion of  Wilmersdorf 's population was Jewish. Numerous Jewish artists and writers lived in this district. Haustein, who was known for his intellectual and erotic permissiveness, was regarded as a lounge lizard. He was in a relationship with a model called Sonja, who he is said to have been sexually dependent on. Among his closest friends were the writer  Lion Feuchtwanger , the composer  Fred Raymond  and the painter  Christian Schad , who painted a portrait of him in the style of  magical realism  in 1928. Haustein's lover Sonja can also be seen as a shadow on the wall in this painting."}
{"_id": "WikiPedia_Dermatology$$$corpus_4621", "text": "Haustein was also an academic and was considered one of the leading experts in combating venereal diseases. From 1916 on, he published over 70 works, including, his seminal works such as  Venereal Diseases inclusive of Prostitution  and  The Early History of Syphilis . From 1921 until 1923, he worked for the magazine  Social Hygiene, Welfare and the Hospital System . From 1932 he led the historical section of the Department of Genetics at the Kaiser-Wilhelm Institute for Brain Research in  Buch, Berlin ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4622", "text": "When the  National Socialists   Machtergreifung  in 1933, Haustein suddenly lost his upper-class status and faced discrimination and persecution. His medical license was revoked and he had to endure house searches and interrogations. On 7 July 1933, he was arrested along with other Jewish and politically unpopular doctors and was severely maltreated in a provisional  concentration camp . After these experiences, Haustein had no illusions over his fate as a Jew. When the  Gestapo  attempted to arrest him on 12 November 1933, he killed himself with  cyanide ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4623", "text": "As early as April 22, 1933, the Nazi regime revoked the medical license of Jewish and politically left wing doctors, applying the new  regulations of medical admission , thereby taking away their means of existence. While communist and socialist doctors had absolutely no right to object, their Jewish colleagues, who had already had a practice during World War I or had fought on the front line, could keep practicing for the time being. However, the Nazi regime restricted the opportunity increasingly in the subsequent years and eventually prohibited all of the Jewish doctors from exercising their profession from September 30, 1938 onwards by means of the fourth act of  the law of the citizens of the Third Reich  in Nazi Germany. Only a few of them were given permission \u2013 as so-called  treaters of sick people  \u2013 to take exclusively care of Jewish patients. The Nazi regime thought this gradual procedure was necessary because in Berlin in 1933 2000 out of 3600 health service doctors were Jewish according to the National Social categorisation and medical care had to be ensured."}
{"_id": "WikiPedia_Dermatology$$$corpus_4624", "text": "Most doctors were presumably accepting of the procedure towards their Jewish colleagues and also profited from this. All of a sudden, the opportunity to take over a practice presented itself to young doctors in particular. This behaviour on the part of many doctors made it much more difficult to confront the past after the Second World War. It wasn't until recently that the role of the  medical profession  and  Associations of Statutory Health Insurance Physicians  in the era of  National Socialism  began to be examined. An example of this is the medical historian Rebecca Schwoch's 2009 investigation into the history of the  Associations of SHI Physicians  in Berlin titled \u2018Jewish Doctors in Berlin and their Fate in National Socialism\u2019.\nThe long-lasting research work was financed by the donations of the  National Association of Statutory Health Insurance Physicians ,  German Medical Association  and the  German Medical Journal . In the subsequent period, the  Association of Statutory Health Insurance Physicians  in  Bavaria  began an academic study of the fate of Jewish doctors in  Nazi Germany [ 1 ]  und die  \u00c4rztekammer Niedersachsen  ver\u00f6ffentlichte eine Brosch\u00fcre zum Gedenken an j\u00fcdische Kollegen. [ 2 ]  and the  Medical Association  of  Lower Saxony  published a booklet in commemoration of their Jewish colleagues. In 2018, the Scientific Services of the  German Bundestag  released a short documentary about the exclusion, disenfranchisement and  persecution of Jewish  doctors under  National Socialism  for the members of the  German Bundestag . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4625", "text": "Karl Herxheimer  ( German pronunciation:   [ka\u0281l   \u02c8h\u025b\u0281ks\u02ccha\u026am\u0250] ; 26 June 1861 \u2013 6 December 1942) was a German-Jewish  dermatologist  who was a native of  Wiesbaden ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4626", "text": "He studied medicine at the universities of  Freiburg ,  Strasbourg  and  W\u00fcrzburg , receiving his doctorate in 1885 with a thesis on cerebral syphilis. Following graduation he worked as an assistant to  Karl Weigert  at the  Institute of Pathology  in  Frankfurt am Main , and to  Albert Neisser  at the university skin clinic in  Breslau . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4627", "text": "He later worked with his older brother, Salomon Herxheimer (1841\u20131899) in Frankfurt, where in 1894, he became director of the municipal dermatology clinic. Along with  Paul Ehrlich , he was instrumental in founding the  University of Frankfurt . In 1914 he became a professor for skin and venereal diseases at the new university. In August 1942, at the age of 81, he was taken to the  Theresienstadt concentration camp , where he died a few months later. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4628", "text": "Herxheimer is credited with providing an early description of  acrodermatitis chronica atrophicans  (Taylor's disease), which is a dermatological disorder associated with the later stages of  Lyme disease . This condition is sometimes referred to as \"Pick\u2013Herxheimer disease\", named along with co-discoverer  Philipp Josef Pick  (1834\u20131910). [ 3 ] [ 4 ]  With Austrian dermatologist  Adolf Jarisch  (1850\u20131902), the  Jarisch-Herxheimer reaction  (\"herxing\") is named, which is an inflammatory reaction to  Salvarsan ,  antibiotics  or  mercury , when using these agents to treat  syphilis . [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4629", "text": "The clinical pharmacologist  Andrew Herxheimer  was his great nephew. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4630", "text": "Joseph (Josef) Jadassohn  (10 September 1863 in  Liegnitz  \u2013 24 March 1936 in  Zurich ) was a  German   dermatologist ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4631", "text": "He was an assistant to  Albert Neisser  at the Allerheiligen Hospital in  Breslau  until 1892, the director of the university skin clinic in  Bern  (1896\u20131917), and later a professor of dermatology at  Breslau University  (1917\u20131932)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4632", "text": "Jadassohn was among the first to take an  immunological  approach in research of dermatological disorders, and contributed to the understanding of the  immunopathology  of  tuberculosis  and  trichophytosis . He was a pioneer in the field of  allergology , and is credited for introducing  patch testing  for diagnosis of  contact dermatitis . [ 1 ]  In 1901 he described a rare childhood dermatological disorder known as  granulosis rubra nasi ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4633", "text": "Two dermatological disorders that are named after him are: \"Jadassohn's disease I\" (a skin disorder originating at the  elbow ) and \"Jadassohn's disease II\" (a natal skin disorder affecting the face and scalp). Together with his assistants, Walter D\u00f6ssekker (1868\u20131962), Max Ti\u00e8che (1878\u20131938), and  Felix Lewandowsky  (1879\u20131921), he shares the following eponymous medical conditions:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4634", "text": "Jadassohn published a revision of  Edmund Lesser \u2019s  Lehrbuch der Haut- und Geschlechtskrankheiten  (14th edition, 1927\u201330), and from 1927 published the multi-volume  Handbuch f\u00fcr Haut- und Geschlechtskrankheiten . Other noted written works of his include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4635", "text": "Max Jessner  (2 November 1887 \u2013 27 August 1978) [ citation needed ]  was a German dermatologist and university professor. In 1928 he travelled to  Buriat-Mongolia  on an expedition to study  syphilis  and the effects of the anti-syphilitic drug  Salvarsan . After escaping Nazi occupied Europe in the mid-1930s, he settled in New York. Jessner is remembered for the development of the chemical peel known as  Jessner's solution  and the description of  Jessner-Kanof disease ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4636", "text": "Max Jessner was born on 2 November 1887 in  Stolp  (now S\u0142upsk in  Poland ), the son of the dermatologist and lecturer at the University of K\u00f6nigsberg  Samuel Jessner  (1859\u20131929). [ 1 ]  He studied medicine at the universities of Munich and K\u00f6nigsberg. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4637", "text": "Jessner did his dermatological training at clinics in Breslau (now  Wroclaw ) under  Albert Neisser . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4638", "text": "He became assistant to  Joseph Jadassohn  at the University Department of Dermatology in Bern from 1912 to 1914. [ 2 ]  Following the interruption of the First World War, in which he also fought, [ 3 ]  he followed Jadassohn to the  University of Breslau  in 1917. [ 2 ]  After his  habilitation  there in 1922, he was appointed associate professor in 1926. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4639", "text": "In April 1928, [ 5 ] \nJessner travelled to  Buriat-Mongolia  as part of the  Soviet-German Syphilis Expedition , an expedition to study  syphilis  and the effects of the anti-syphilitic drug  Salvarsan . The mission involved eight Soviet and eight German researchers. [ 2 ] [ 5 ] [ 6 ]   For post-revolutionary Russia, the expedition marked an opportunity to use science to solidify political relations and improve communication. For the Germans, it was an opening to the east. [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4640", "text": "In 1931, he was appointed to Josef Jadassohn's chair. [ 4 ]  In either 1934 [ 4 ]  or 1935, [ 2 ]  he was forced to resign, along with  Hans Biberstein , because of his Jewish descent. [ 3 ] [ 2 ] [ 8 ]  His successor was  Heinrich Gottron  who was favoured by the  National Socialist  regime. [ 4 ]  Biberstein later became professor of dermatology at New York University [ 4 ]  like many other dermatologists who escaped Nazi-occupied Europe by travelling to North America. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4641", "text": "Jessner first emigrated to Switzerland in 1935, [ 4 ]  then in 1941 to New York, [ 10 ]  where he was reunited with Biberstein. [ 11 ]  At first, he found work at the New York Postgraduate Medical School and later, he was appointed to the teaching staff of New York University School of Medicine's Skin and Cancer Unit. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4642", "text": "Also known as the Coombe's formula, [ 12 ]  Jessner developed it to form  Jessner's solution , [ 13 ]  a liquid peeling treatment for hyperkeratotic epidermal lesions, containing  salicyclic acid ,  resorcinol , and  lactic acid  in 95%  ethanol , and works by breaking intracellular bridges between  keratinocytes . He reduced the concentration of resorcinol due to its associated  allergic contact dermatitis ,  irritant contact dermatitis  and skin discolouration. Modified Jessner's solutions, replacing resorcinol with  TCA  are available. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4643", "text": "In New York, he was assisted, like many others, by  Marion Sulzberger  at the New York Skin and Cancer Unit. [ 15 ]  It was here that in 1953, with Kanof, he became renowned for the description of  Jessner-Kanof disease , a lymphocytic infiltrate of the skin where the lesions were asymptomatic, presenting as red spots or plaques with spontaneous recurrences. [ 2 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4644", "text": "After retiring, Jessner moved back to Switzerland, where he died on 27 June 1978. [ citation needed ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4645", "text": "Samuel Jessner  (5 January 1859 - 7 December 1929) was a German dermatologist known for his work on the skin and hair symptoms of patients with  syphilis . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4646", "text": "Jessner was born in Dorbian (now Darb\u0117nai),  Russian Empire , and studied medicine at the  University of K\u00f6nigsberg . After completing his doctorate, he habilitated there as well. He dealt mainly with skin and venereal diseases. He was chairman of the K\u00f6nigsberg branch of the free-religious Deutschen Gesellschaft f\u00fcr ethische Kultur (German Society for Ethical Culture). His sons were the dermatologist  Max Jessner [ 2 ]  and the theater director and director  Fritz Jessner ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4647", "text": "This article about a German person in the field of medicine is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4648", "text": "Ricky Kanee Schachter ,  FRCP(C) ,  CM  (December 23, 1918 \u2013 July 1, 2007) was a  dermatologist  who practiced in the  Toronto  area, and was invested as a Member of the  Order of Canada  in 1998, as \"a researcher, teacher, administrator and healer, whose work in the areas of skin cancer and psoriasis has improved the lives of her patients, and inspired fellow researchers across Canada.\" [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4649", "text": "Schachter grew up in  Melville ,  Saskatchewan , at a time when women were not generally accepted as professionals in Canada. [ 5 ]  When she decided to go to university at the age of 16, to become a doctor, even her father, an educated Russian immigrant and community leader, said to her that she would \"be taking up a space for a man.\" [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4650", "text": "In 1940, she received a Bachelor of Arts degree from the University of Saskatchewan. [ 3 ]  Dr. Schachter then graduated from the  University of Toronto \u2019s Faculty of Medicine in 1943, and pursued post-graduate training in dermatology at  Columbia University  in New York from 1944 to 1945. [ 3 ]  She began working at the  Women's College Hospital , in  Toronto  in 1946 and became a Fellow of the Royal College, in Canada, in 1950. She was appointed associate professor at the  University of Toronto's Faculty of Medicine  in 1961. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4651", "text": "Her husband, Benjamin Schachter, was a Torontonian biochemist, working at the  University of Toronto , who, from 1934 to 1939, conducted research on female sex hormones. He isolated and identified conjugated  oestrone  sulphate ( Premarin ). [ 8 ]  Her late brother,  Sol Kanee , also received the  Order of Canada  for his work with the  Bank of Canada  and the  Canadian Jewish Congress . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4652", "text": "She began working at  Women's College Hospital , in Toronto in 1946 where she was appointed the head of the Division of Dermatology. [ 3 ]  Schachter became a Fellow of the Royal College of Physicians and Surgeons, in Canada, in 1950. [ 3 ]  In 1976 she established the Psoriasis Education and Research Centre (PERC) at Women's College Hospital and became its first director. [ 3 ]  This centre was the first of its kind in Canada to specialize in treatment, education and research on psoriasis. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4653", "text": "Dr. Schachter retired from her position at Women's College Hospital on June 30, 1985. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4654", "text": "A chair in dermatology was established to honour her, and in 1985, the Dr. Ricky Kanee Schachter Dermatology Fund was established in recognition of her commitment to patient care. In July 1991, the Dr. Ricky Kanee Schachter Dermatology Centre opened its doors [ 10 ]  at  Women's College Hospital  to treat a variety of skin conditions, through several out-patient clinics:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4655", "text": "In addition to being at the forefront of her field, and a pioneer in the treatment of  psoriasis  on an out-patient basis, [ 11 ]  Schachter worked for the promotion of women's rights, Jews' rights, and for gender equality in the medical profession. [ 12 ]  She was a devoted teacher and healer, and received numerous recognitions of her work. With her appointment in 1978 as the president of the  Canadian Dermatological Association \u2014the first female in Canada to lead specialists in her field. She was also the first woman to win the Canadian Dermatology Foundation's Practitioner of the Year award, in 2005, [ 11 ]  and received an honorary  Doctor of Laws , by  Queen's University , in 2006. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4656", "text": "During her time at Women's College Hospital, Schachter was also the president of the medical staff and Medical Advisory Committee from 1958 to 1959. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4657", "text": "Moritz Kaposi  ( Hungarian :  Kaposi M\u00f3r ,  pronounced   [\u02c8k\u0252po\u0283i   \u02c8mo\u02d0r] ; 23 October 1837 \u2013 6 March 1902) was a  physician  and  dermatologist  from the  Austro-Hungarian Empire  who discovered the skin tumor that received his name ( Kaposi's sarcoma )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4658", "text": "Born in  Kaposv\u00e1r ,  Hungary ,  Austrian Empire , to a  Jewish  family, originally his surname was Kohn; but, with his conversion to the  Catholic  faith, he changed it to Kaposi in 1871, in reference to his town of birth. One purported reason behind this is that he wanted to marry a daughter of current dermatology chairman,  Ferdinand Ritter von Hebra , and advance in the society, which he could not have done being of Jewish faith. This seems unlikely because he married Martha Hebra and converted to Catholicism several years prior to changing his name, by which time he was already well established in the Vienna University faculty and a close associate of her father, Ferdinand. A more plausible explanation is based on his own comments to colleagues that he changed his name to avoid confusion with five other similarly named physicians on the Vienna faculty. Rumors about the sincerity of both his marriage and his concerns about his Jewish ancestry may have arisen through professional jealousy ( William Dubreuilh  (1857\u20131935), first professor and chairman of dermatology in Bordeaux: \"On disait de Kaposi qu'il avait pris la fille de Hebra, sa maison, sa chaire et sa client\u00e8le, laissant le reste \u00e0 son beau-fr\u00e8re Hans Hebra.\" (\"It was said of Kaposi that he had taken the daughter of Hebra, his home, his chair and his clientele, leaving the rest to his brother-in-law, Hans Hebra.\") [ This quote needs a citation ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4659", "text": "In 1855, Kaposi began to study  medicine  at the  University of Vienna  and attained a  doctorate  in 1861.  In his dissertation, titled  Dermatologie und Syphilis  (1866) he made an important contribution to the field.  Kaposi was appointed as professor at the University of Vienna in 1875, and in 1881 he became a member of the board of the  Vienna General Hospital  and director of its clinic of  skin diseases ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4660", "text": "Together with his mentor, Ferdinand Ritter von Hebra, he authored the book  Lehrbuch der Hautkrankheiten  (Textbook of Skin Diseases) in 1878.  Kaposi's main work, however, was   Pathologie und Therapie der Hautkrankheiten in Vorlesungen f\u00fcr praktische \u00c4rzte und Studierende  (Pathology and Therapy of the Skin Diseases in Lectures for Practical Physicians and Students), published in 1880, which became one of the most significant books in the history of  dermatology , being translated to several languages.  He is credited with the description of  xeroderma pigmentosum , a rare genetic disorder now known to be caused by defects in  nucleotide excision repair  (\"Ueber Xeroderma pigmentosum. Medizinische Jahrb\u00fccher, Wien, 1882: 619\u2013633\").  Among other diseases, Kaposi was the first to study  lichen scrofulosorum  and  lupus erythematosus . In all, he published over 150 books and papers.  He is widely credited with advancing the use of  pathologic examination  in the diagnosis of dermatologic diseases."}
{"_id": "WikiPedia_Dermatology$$$corpus_4661", "text": "He died on 6 March 1902 in  Vienna ,  Austria-Hungary ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4662", "text": "His name entered into the  history of medicine  in 1872, when he described for the first time  Kaposi's sarcoma , a  cancer  of the  skin , which he had discovered in five elderly male patients and which he initially named \"idiopathic multiple pigmented sarcoma\".  More than a century later, the appearance of this disease in young gay men in  New York City ,  San Francisco  and other coastal cities in the  United States  was one of the first indications that a new disease, now called  AIDS , had appeared.  Kaposi's sarcoma is a tumor that is caused by a virus,  Kaposi's sarcoma-associated herpesvirus  or KSHV, discovered in 1993.  Kaposi's sarcoma is now the most commonly reported cancer in parts of sub-Saharan Africa."}
{"_id": "WikiPedia_Dermatology$$$corpus_4663", "text": "According to J. D. Oriel, \"in his lifetime, Moritz Kaposi was acknowledged as one of the great masters of the  Vienna School of Dermatology , a superb clinician and renowned teacher\". [ 1 ]  While his mentor, Ferdinand von Hebra, is considered the \"father of German dermatology\", [ 2 ]  Kaposi was one of the first to establish dermatology on its anatomical  pathology  scientific basis. He became the chairman of the  Vienna School of Dermatology , after Hebra's death in 1880."}
{"_id": "WikiPedia_Dermatology$$$corpus_4664", "text": "Arnold William Klein  (February 27, 1945 \u2013 October 22, 2015) was an American  dermatologist . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4665", "text": "In the infancy of the  AIDS  epidemic, Klein became one of the first doctors in Los Angeles to diagnose a case of  Kaposi's sarcoma  in a young patient. [ 3 ]  He also worked closely with American pop musician  Michael Jackson , diagnosing him with  discoid lupus erythematosus  and  vitiligo  and supplying him with over 200 shots of  pethidine , aiding his addiction, starting in the mid-1980s."}
{"_id": "WikiPedia_Dermatology$$$corpus_4666", "text": "Klein was born on February 27, 1945, in  Mt. Clemens, Michigan , the son of a Jewish Orthodox rabbi. He was raised in Michigan and  North Miami, Florida , graduating with hall of fame pitcher  Steve Carlton  from  North Miami High School  in 1963. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4667", "text": "In 1967, Klein earned his  bachelor's degree  in biology from the  University of Pennsylvania . He attended the  University of Pennsylvania School of Medicine , earning his  Doctor of Medicine  degree in 1971. He completed an internship at  Cedars-Sinai Medical Center  in Los Angeles and his residency in dermatology at the University of Pennsylvania and the  University of California at Los Angeles  (UCLA). In 1975, he served as Chief Resident in Dermatology at UCLA. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4668", "text": "Klein was an unpaid, volunteer professor of Medicine and Dermatology at the UCLA David Geffen School of Medicine. [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4669", "text": "Klein was an outspoken critic of the misuse of  prescription drugs , toxins, and certain synthetic dermal fillers, including  ArteFill . [ 7 ] [ 8 ]  He was responsible for the FDA giving Allergan's  Botox  a black box warning. [ 9 ]  Klein was named a consultant to the FDA. [ 10 ]  He died on October 22, 2015, at the age of 70 at the  Eisenhower Medical Center  in Rancho Mirage, California. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4670", "text": "Klein served as the dermatologist for  Michael Jackson . Following Jackson's death, Klein claimed to be a  sperm donor , but stated that he did not believe he was the biological father of Jackson's children. [ 12 ]  However, Klein had multiple health problems such as  multiple sclerosis , which would've prevented him from donating sperm as sperm donors are not allowed to donate if they have genetic disorders or other medical concerns. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4671", "text": "In August 1985, Klein joined the board of the  National AIDS Research Foundation  (NARF). A month later, the Foundation merged with the  AIDS Medical Association  and are now known as  amfAR . [ 14 ] \nAs of 2012 [update] , Klein was also a member of the Advisory Board of the AIDS Services Foundation Orange County, now known as Radiant Health Centers. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4672", "text": "Over the next two decades, they additionally established the  Elizabeth Taylor AIDS Foundation  and  Art for AIDS  in  Orange County . [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4673", "text": "In 2007, Klein founded  The Elizabeth Taylor Endowment  for the  UCLA CARE Center , a facility that focuses on advancing HIV/AIDS research and treatment. [ 16 ]  In the November 2008 issue of  L'Uomo Vogue , in an article related to AIDS in Africa, it was reported that Klein and the organizations which he founded have raised in excess of $274 million for HIV research and care. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4674", "text": "Klein served as a trustee to various boards of directors, some of which included the Jennifer Jones-Simon Foundation and The  Hereditary Disease Foundation . [ 18 ]  Klein, alongside his friend  Frank Gehry , helped the foundation to raise funds and awareness for inherited diseases. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4675", "text": "Klein also co-founded the Rose Tarlow-Arnold W. Klein Breast Cancer Foundation at UCLA which provides breast cancer treatment for individuals who are unable to afford it. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4676", "text": "He received numerous awards and honors including Who's Who in the World, Best Doctors in America, Men of Achievement, AIDS Services Foundation of Orange County, Award of Merit, Los Angeles Magazine, The Best of L.A., Los Angeles Business Journal, 10 Masters of Medicine in Los Angeles, Haney Scholar, University of Pennsylvania, Inaugural Visiting Professor in Cosmetic Dermatology, Harvard School of Medicine, Inaugural Visiting Professor in Cosmetic Dermatology, University of Vermont, Measey Scholar, University of Pennsylvania, Philadelphia Foundation Fellow, Public Health Service Post \u2013 Doctoral Fellow, and Top Doctors of America. [ 19 ] \nIn 2004, Klein was given a chair in his name at the UCLA Division of Dermatology. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4677", "text": "Klein died on October 22, 2015, at  Eisenhower Medical Center  in  Rancho Mirage, California . [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4678", "text": "Edmund Klein  (22 October 1922 \u2013 23 July 1999) was an Austrian-born American dermatologist."}
{"_id": "WikiPedia_Dermatology$$$corpus_4679", "text": "He was born in  Vienna ,  Austria , to David Klein, a  cantor , and Helen Bibelman Klein. [ 1 ]  Jewish, he escaped from Austria in 1938, during the  Anschluss . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4680", "text": "He was a research professor at the  University at Buffalo  and served as chief of dermatology at  Roswell Park Comprehensive Cancer Center . Klein developed a topical treatment for  skin cancer  with  5-fluorouracil , developed one of the first effective treatments for  Kaposi's sarcoma , and was amongst the first to clinically explore the use of  lymphocytes  to help cancer patients, earning him the nickname \"the Father of Immunotherapy.\" He won the 1972  Lasker Award . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4681", "text": "Klein developed a technique that allowed the separation of whole human blood into its component parts of  plasma ,  platelets ,  white blood cells , and  red blood cells , greatly increasing the efficiency of the entire transfusion process; now three people could benefit from a single donor instead of one, with red blood cells used for anemic individuals, platelets for cancer patients, and plasma for those with decreased blood volume. Klein's results were published in both the  New England Journal of Medicine  and the  Journal of Pediatrics  and earned him the first prize for originality of research from the International Society for Hematology in 1956. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4682", "text": "Albert Montgomery Kligman  (March 17, 1916 \u2013 February 9, 2010) [ 1 ]  was an American  dermatologist  who co-invented  Retin-A , the acne medication, with  James Fulton  in 1969. [ 2 ]  Kligman performed human experiments on inmates at  Holmesburg Prison  in Philadelphia, which led to a well-documented scandal years later. The experiments intentionally exposed humans to pathogens and  dioxin , and later became a  textbook example  of unethical experimenting on humans. He and others involved were sued for alleged injuries, but the lawsuit was dismissed due to the  statute of limitations  expiring. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4683", "text": "Albert Montgomery Kligman was born in Philadelphia on March 17, 1916, the son of Jewish immigrants. His father, born in Ukraine, was a newspaper distributor; his mother, born in England, was a sales clerk. As a child, he was a  Boy Scout , developing a love of plants on scouting trips to the countryside. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4684", "text": "With financial support from  Simon Greenberg , a major rabbi of the time, he attended  Pennsylvania State University , earning a bachelor's degree in 1939. He was captain of the gymnastics team. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4685", "text": "He went on to receive a Ph.D. in  botany  from the  University of Pennsylvania  in 1942, specializing in the study of fungi. He continued at the University of Pennsylvania, enrolling in  its medical school , earning his  M.D.  in 1947. He chose dermatology as his specialty in order to apply his expertise in fungi."}
{"_id": "WikiPedia_Dermatology$$$corpus_4686", "text": "Upon graduation, he joined the dermatology faculty as an associate, also signing on at the  Hospital of the University of Pennsylvania . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4687", "text": "Kligman was a prolific scholar and was known for bringing scientific rigor to a field that, at the time, was lacking it. Kligman wrote numerous papers on run-of-the-mill dermatological conditions such as  athlete's foot  and  dandruff . He also worked at the intersection of cosmetics and medicine.  [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4688", "text": "The identification of the use of  tretinoin  along Dr.  James E. Fulton  and Dr. Gerd Plewig as a treatment for  acne  and wrinkles was perhaps their best-known contribution to dermatology. Sold as  Retin-A , this innovation earned Kligman significant royalties. He was a generous supporter of the department of dermatology at the University of Pennsylvania and donated over $4 million by 1998. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4689", "text": "Kligman is best known for having conducted human experiments on prisoners at  Holmesburg Prison  in Philadelphia. Stemming from early testing of treatments for  ringworm , his work there started with an effort to control athlete's foot at the invitation of prison officials. He found the environment fraught with possibilities, and undertook dozens of experiments there for pharmaceutical companies and government agencies. Between 1951 and 1974, Kligman exposed approximately seventy-five prisoners at Holmesburg to high doses of  dioxin , [ failed verification ]  the contaminant responsible for  Agent Orange 's toxicity to humans.  Dow Chemical  paid Kligman $10,000 [ failed verification ]  to conduct these dioxin experiments. Prisoners were awarded for participation, their primary source of income, in 1959 acquiring in total $73,000 by volunteering to test pills and creams. Little effort was taken to assure the safety of the test subjects, some of whom were intentionally exposed to pathogens causing infections, including  herpes ,  staphylococcus , and athlete's foot. Moreover, Kligman's payment of subjects had other unintended consequences: the economic power gained by subjects was used by some of them to \"coerce sexual favors from other inmates\". [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4690", "text": "Kligman's prisoner testing for the government was not limited to dermatology, extending even to the testing of  psychoactive drugs  for the  Department of Defense . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4691", "text": "While Kligman maintained that the testing was consistent with scientific and ethical norms of the era, nearly 300 subjects tested while in prison sued him, the University of Pennsylvania, and  Johnson & Johnson . The lawsuit was brought because of violations of the  Nuremberg Code . Though the suit was dismissed under the  statute of limitations , the public reaction to the testing program contributed to the enactment of federal regulations restricting medical studies in prisons. [ 1 ]  Later commentators, including Senator  Ted Kennedy , remarked how, in spite of the sets of ethical principles laid out in the 1947 Nuremberg Code and (much later) the  Declaration of Helsinki , the poorer members of society typically bore the brunt of unethical biomedical research; Kligman's research at Holmesburg prison has become a textbook example of such unethical experimenting, [ 6 ] [ 8 ] [ 9 ] [ 10 ] [ 11 ]  and has been denounced as equivalent to \"the barbarity and sadism of Auschwitz and Dachau.\" [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4692", "text": "Beyond the controversies relating to the testing on prisoners, Kligman was found to have discrepancies in the data underlying his experiments. This led to his research being barred by the  Food and Drug Administration  for a period. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4693", "text": "Kligman was married three times. He divorced from his first wife and became a widower from his second. He died of a heart attack in February, 2010, at age 93. He was survived by his third wife. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4694", "text": "https://www.inquirer.com/politics/philadelphia/philadelphia-apology-holmesburg-prison-experiment-albert-kligman-20221006.html"}
{"_id": "WikiPedia_Dermatology$$$corpus_4695", "text": "Oskar Lassar  (11 January 1849 \u2013 21 December 1907) was a German  dermatologist  who was a native of  Hamburg ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4696", "text": "After earning his medical doctorate in 1872, he worked briefly as a hospital assistant at the  Berlin   Charit\u00e9 . He later started a private hospital for  dermatology  and  syphilis  in Berlin. His clinic was known for being technologically advanced, and it was the first to have a Finsen  ultraviolet light therapy  device and  X-ray machine . [ 1 ]  In 1902 he became a professor at the  University of Berlin ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4697", "text": "Lassar is remembered for the creation of public  bath houses  for low-income individuals in Germany and  Austria . These bath houses were constructed in the interest of public  hygiene , at a time when poorer people didn't have private baths or showers. In Germany, the bath-houses were called  Volksbad , and in Austria-  Tr\u00f6pferlbad . In 1899, Lassar was founder of the German Society for Volksb\u00e4dern. One of his slogans was \"a weekly bath for every German.\" [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4698", "text": "He was very social, and he invited physicians who made referrals to his clinic to a  champagne breakfast  twice a year. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4699", "text": "Lassar was among the first physicians in  Europe  to employ  X-ray  technology for therapeutic purposes. Also, he developed a  zinc  paste for treatment of  eczema , an  ointment  that is still used today and known as \"Lassar's paste\". [ 2 ]  In addition, Lassar was the first to assemble a collection of  moulage  (model injuries for training purposes) in Germany."}
{"_id": "WikiPedia_Dermatology$$$corpus_4700", "text": "He was founder of the dermatology journal  Dermatologische Zeitschrift  and was its editor from 1893 until his death in 1907."}
{"_id": "WikiPedia_Dermatology$$$corpus_4701", "text": "Ern\u0151 L\u00e1szl\u00f3  (11 July 1897 \u2013 March 1973) was a Hungarian-born American  dermatologist  and  cosmetics  businessman who founded The Ern\u0151 L\u00e1szl\u00f3 Institute."}
{"_id": "WikiPedia_Dermatology$$$corpus_4702", "text": "L\u00e1szl\u00f3 was born in the Kingdom of Hungary and raised in  Budapest . [ 1 ]  He studied skin  pathology  and skin disease at the  Royal Hungarian University of Medical Sciences  in Budapest, and completed his clinical studies in Berlin, Germany, under Max Joseph."}
{"_id": "WikiPedia_Dermatology$$$corpus_4703", "text": "In 1927, L\u00e1szl\u00f3 opened his first institute in Budapest with his brother, William Laszlo, the dr. Med. L\u00e1szl\u00f3 Institute for Scientific Cosmetology. [ 2 ]  He achieved fame when he created a special  foundation cream  for  Princess St\u00e9phanie of Belgium  who lost her self-confidence due to an acute case of acne. His reputation was further solidified after he treated actress Frida Gombaszoegi's facial scars after being shot in the face by a man she rejected. [ 3 ]  Soon, women from all ranks of society wanted to see L\u00e1szl\u00f3 for skin and make-up advice."}
{"_id": "WikiPedia_Dermatology$$$corpus_4704", "text": "In 1939, at the onset of World War II, L\u00e1szl\u00f3 moved to New York. On 3 November 1939, the  New York Herald Tribune  reported that the Ern\u0151 L\u00e1szl\u00f3 Institute, specializing in beauty treatments and cosmetics, had leased a floor in a building on 677  Fifth Avenue , Manhattan. L\u00e1szl\u00f3's poor command of the English language threatened his institute, for despite the efforts of a language coach he could not pass the  American Medical Association's   accreditation examinations. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4705", "text": "The Ern\u0151 L\u00e1szl\u00f3 Institute was aimed at the rich, famous and powerful. One needed to be recommended to gain admittance. Among his clients were the  Duchess of Windsor ,  Doris Duke ,  Marjorie Merriweather Post ,  Greta Garbo ,  Lillian Gish ,  Grace Kelly ,  Ava Gardner ,  Cecil Beaton ,  Katharine Hepburn ,  Paulette Goddard ,  Audrey Hepburn ,  Marilyn Monroe , and  Jacqueline Kennedy Onassis . [ 1 ] [ 2 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4706", "text": "In the early 1940s,  Helena Rubinstein  approached L\u00e1szl\u00f3 and offered to buy his business, but he declined. In 1945, L\u00e1szl\u00f3 became a United States citizen. In 1966, L\u00e1szl\u00f3 entered the retail marketplace, with partner  Chesebrough-Ponds , which later bought the Ern\u0151 L\u00e1szl\u00f3 Institute."}
{"_id": "WikiPedia_Dermatology$$$corpus_4707", "text": "L\u00e1szl\u00f3 married actress  Ir\u00e9n Gombasz\u00f6gi \u00a0[ hu ] , whom he met while treating her sister, fellow actress  Frida Gombasz\u00f6gi \u00a0[ hu ] . His wife died of  leukemia  in 1967. Three years later, in 1970, he married Sibille Schulz in a ceremony near  Lugano , Switzerland."}
{"_id": "WikiPedia_Dermatology$$$corpus_4708", "text": "L\u00e1szl\u00f3 died of  heart failure  in March 1973. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4709", "text": "In 1995, the company L\u00e1szl\u00f3 founded was bought by Mana Products from  Elizabeth Arden . Mana Products' founder, Nikos Mouyiaris, had once worked for Ern\u0151 L\u00e1szl\u00f3 as a chemist. The company was purchased in 2002 by Cradle Holdings Inc., a division of corporate finance group Fox Paine.  In February 2011, the  RBS  Special Opportunities Fund, managed by RBS Equity Finance, backed Charles Denton in the acquisition of Ern\u0151 L\u00e1szl\u00f3."}
{"_id": "WikiPedia_Dermatology$$$corpus_4710", "text": "Aaron Bunsen Lerner  (September 21, 1920 \u2013 February 3, 2007) [ 1 ]  was an American physician, researcher and professor who is known for the discovery of  melatonin . He was the first chair of the Department of Dermatology at  Yale University ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4711", "text": "Born in 1920 in  Minneapolis , Lerner received his medical degree and a PhD in chemistry from the  University of Minnesota  in 1945. After teaching at the universities of Michigan and Oregon, he joined the  Yale University School of Medicine  as an associate professor of medicine in 1955. [ 2 ]  The following year he became director of the  dermatology  section within the Department of  Internal Medicine , and when the Department of Dermatology was established in 1971 he was appointed its first chair. [ 3 ]  When Professor Lerner retired in 1991, he was named a Professor Emeritus of Dermatology. [ 4 ] [ 5 ] [ 2 ]  He was in 1973 elected to membership in the  National Academy of Sciences  (Medical physiology and metabolism)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4712", "text": "Lerner is perhaps best known for leading the team of researchers who isolated and named, in 1958, the hormone  melatonin . He was an expert in the metabolic basis of  inherited diseases , particularly  vitiligo  for which he, in the 1980s, developed a skin transplantation therapy. Lerner also isolated the compound  melanocyte-stimulating hormone  (MSH). [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4713", "text": "Lerner was married to Marguerite Rush Lerner,, an author of children's books and a book about admission to medical school ( Medical School: The Interview and the Applicant ). Their two sons are both dermatologists. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4714", "text": "Edmund Lesser  (12 May 1852 \u2013 7 June 1918) was a German  dermatologist  who was a native of  Neisse ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4715", "text": "He studied medicine at the universities of  Berlin ,  Bonn  and  Strasbourg , earning his medical doctorate in 1876. Later he became an assistant to  Oskar Simon  (1845\u20131892) at the dermatological clinic in  Breslau , and in 1882 received his  habilitation  at the  University of Leipzig . In 1892 he was an associate professor at the  University of Bonn , and several years later was appointed chief physician of the  syphilitic  department at the Berlin- Charit\u00e9  (1896). The following year he became head of the dermatological and syphilitic dispensary at the University of Berlin."}
{"_id": "WikiPedia_Dermatology$$$corpus_4716", "text": "Lesser was a leading authority in the field of  syphilis  research. He was the author of  Lehrbuch der Haut- und Geschlechtskrankheiten f\u00fcr Studirende und \u00c4rzte  (Textbook of skin and  venereal diseases  for students and physicians), a publication that ran for numerous editions. With  zoologist   Richard Hertwig  (1850\u20131937), he was co-author of  \u00dcber Rhizopoden und denselben nahestehende Organismen . Other publications by Lesser include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4717", "text": "Felix Lewandowsky  (1 October 1879,  Hamburg  \u2013 31 October 1921,  Basel ) was a German  dermatologist ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4718", "text": "In 1902, he earned his doctorate at the  University of Strassburg . From 1903 to 1907, he worked at the dermatological clinic in  Bern , where he served as an assistant to  Josef Jadassohn  (1863\u20131936). Afterwards, he returned to his hometown of Hamburg, where he worked in dermatologist  Eduard Arning \u2019s department at St. Georg's Hospital. In 1917, he was appointed director of the dermatological clinic at  Basel . While at Basel, he was the author of works on  leprosy . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4719", "text": "Lewandowsky specialized in the study of  tuberculosis  and pediatric skin diseases, and published an important work in 1916 on tuberculosis of the skin titled  Die Tuberkulose der Haut . With Jadassohn, he described an ectodermal  dysplasia  now known as  Jadassohn\u2013Lewandowsky syndrome . Just prior to his death, he described  epidermodysplasia verruciformis , a rare skin disorder sometimes known as \"Lewandowsky\u2013Lutz dysplasia\" (named along with dermatologist Wilhelm Lutz 1888\u20131958). [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4720", "text": "He died on 31 October 1921 in Basel."}
{"_id": "WikiPedia_Dermatology$$$corpus_4721", "text": "Georg Richard Lewin  (19 April 1820 \u2013 1 November 1896) was a German  dermatologist , known for his research into  syphilis  and various skin diseases."}
{"_id": "WikiPedia_Dermatology$$$corpus_4722", "text": "Lewin was born in  Sondershausen  in the principality of  Schwarzburg-Sondershausen  (modern-day  Thuringia ), attending  Gymnasium  there and later in  Magdeburg  and  M\u00fchlhausen . He completed his  Abitur  in 1841. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4723", "text": "He was further educated at the universities of  Halle  and Berlin, graduating as  doctor of medicine  in 1845. After a postgraduate course at the universities of  Vienna ,  W\u00fcrzburg , and  Paris  he settled in Berlin, where he practised as a specialist first in  otology , and later in dermatology and  syphilis . In 1862 Lewin was admitted to the medical faculty of his alma mater as  privat-docent  in otology."}
{"_id": "WikiPedia_Dermatology$$$corpus_4724", "text": "In 1865 he became chief physician in the Syphilis and Skin Diseases Department at the  Charit\u00e9 hospital  in Berlin, replacing  Felix von B\u00e4rensprung . [ 1 ]  In 1868 he was appointed associate professor for  laryngology  and dermatology at the  Friedrich Wilhelm University . [ 2 ]  The following year published his influential research on the treatment of syphilis using  subcutaneous injections  of  mercuric chloride . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4725", "text": "In 1880 Lewin became a member of the imperial department of health, and in 1884 received the title of \"Geheimer Medicinalrat.\" In the same year, through the influence of  Otto von Bismarck , Lewin's clinic was divided into two departments, Lewin retaining the class in syphilis, while  Ernst Schweninger , Bismarck's physician, was appointed chief physician for dermatology. This action of the government aroused much indignation in the medical faculties of most of the universities of Germany, and much public sympathy was expressed for Lewin."}
{"_id": "WikiPedia_Dermatology$$$corpus_4726", "text": "He was an industrious writer, and contributed many essays to the medical journals:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4727", "text": "Pagel,  Biog. Lex. ; \nMeyers  Konversations-Lexikon"}
{"_id": "WikiPedia_Dermatology$$$corpus_4728", "text": "Max Marcuse  (April 14, 1877,  Berlin \u00a0\u2013 June 24, 1963,  Tel Aviv ) was a German  dermatologist  and  sexologist . [ 1 ] [ 2 ] [ 3 ] [ 4 ]   He became an editor for  Magnus Hirschfeld \u2019s  Journal of Sexology  in 1919 and continued editing the journal until 1932. Marcuse immigrated to  Palestine  in 1933, following the  Nazi  rise to power. Several of Marcuse's unpublished writings are being preserved at the  Kinsey Institute ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4729", "text": "Emil Meirowsky  (March 9, 1876, in Guttstadt, Germany \u2013 January 22, 1960, in  Nashville ) was a German dermatologist."}
{"_id": "WikiPedia_Dermatology$$$corpus_4730", "text": "Meirowsky studied at the universities of Berlin and K\u00f6nigsberg, where he received his doctorate in 1901. He interned at the Berlin Polyclinic with Oscar Werler, in  Breslau  with  Albert Neisser , with  Paul Gerson Unna  and in Paris. From 1908 the family lived in Cologne-Lindenthal. He opened a practice with his own laboratory. [ 1 ]  In 1919 he received the title of professor. In 1920 he received his habilitation at the  University of Cologne , which appointed him associate professor a year later. He was chairman of the Cologne Medical Association and a member of the German Democratic Party."}
{"_id": "WikiPedia_Dermatology$$$corpus_4731", "text": "When the  Nazis  came to power in 1933, Meirowsky was persecuted because of his Jewish heritage. On November 24, 1933, his teaching license at the University of Cologne was revoked, in February 1936 his academic titles were revoked, and in 1938 he was forced to give up his practice. In 1939 he emigrated to England with his wife Clara and their 29-year-old son Arnold. From 1942 he worked at the Royal Surrey Hospital in Guilford. In 1946 he received an offer to return to teaching at Cologne University. After the war, when the Meirowsky couple learned that their daughter Lisamaria had been murdered in the  Holocaust , the family decided never to return to Germany. [ 2 ]  On May 2, 1947, Emil Meirowsky emigrated to the United States with his wife and son. There he taught at Indiana University Medical School until 1953."}
{"_id": "WikiPedia_Dermatology$$$corpus_4732", "text": "Meirowsky researched the origins of  melanin . In 1906 he proved (in Unna's laboratory) that the epidermis can produce melanin. The  Meirowsky phenomenon  (1909), the tanning of the skin by high temperatures, is named after him. He also researched the life cycle of the syphilis pathogen and the etiology of moles and congenital malformations of the skin. Meirowsky also discovered the viral etiology of  psoriasis . [ 3 ] [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4733", "text": "His daughter  Lisamaria Meirowsky  was also a doctor and was murdered in the  Auschwitz-Birkenau  concentration camp. [ 6 ]  His youngest son Arnold became a renowned neurosurgeon in the United States, and his oldest son,  Werner Leopold  (1907-1994), emigrated to England. Werner helped his parents escape the Nazi persecution and  took the name William Merrow. In England,  he worked in business and built the successful  multilingual recruitment company: Merrow Language Recruitment, he also worked as an actor after World War II. His daughter, Emil's granddaughter, is the actress  Jane Merrow . Emil's brother was the entrepreneur and art collector  Max Meirowsky . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4734", "text": "In March 2015, a commemorative stumbling stone was laid in front of his last residence in  Cologne-Lindenthal , F\u00fcrst-P\u00fcckler-Strasse 42, in his memory as part of the art and memorial project by Cologne artist  Gunter Demnig ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4735", "text": "Alan Menter  (born 30 October 1941, in  Doncaster ) is an English-born  dermatologist , and former flyhalf  rugby union  player for the  Springboks . [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4736", "text": "Menter played his first international game on the South African tour of France in 1968. The Springboks won both games.  He captained both the Universities of Witwatersrand and Pretoria in South Africa through his University career (1961\u201370) as well as playing for Guys' Hospital Rugby team and the Harlequins during his Fellowship years in London from 1971 to 1973. He also represented the South African Universities Cricket team against New Zealand in 1961."}
{"_id": "WikiPedia_Dermatology$$$corpus_4737", "text": "Menter attended  Parktown Boys' High School , followed by medical school at the  University of Witwatersrand , South Africa in 1968. [ 3 ]  He completed his  dermatology  residency at Pretoria General Hospital at the  University of Pretoria .  Menter is Jewish. He has resided in Dallas, USA since 1975 [ 2 ] [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4738", "text": "Menter is a dermatologist, Chairman of the Division of Dermatology and Director of the Dermatology Residency program for Baylor University Medical Center, Clinical Professor of Dermatology at the University of Texas Southwestern Medical School, and Principal Faculty at Texas A&M College of Medicine, all in Dallas."}
{"_id": "WikiPedia_Dermatology$$$corpus_4739", "text": "After obtaining his medical degree from the University of Witwatersrand in Johannesburg, South Africa, Menter completed his residency in dermatology at the  University of Pretoria  in South Africa and fellowships at  Guy's Hospital  in London and St. John's Hospital for Diseases of the Skin in London, as well as the University of Texas Southwestern Medical School. Menter is board-certified in dermatology. In August 2004, he founded the International Psoriasis Council, an international organization dedicated to raising international consciousness and understanding of psoriasis as a serious immune-mediated disease. He served as its initial President until December 2010"}
{"_id": "WikiPedia_Dermatology$$$corpus_4740", "text": "He is also a member of the  American Academy of Dermatology , American Dermatological Association, American Society for Laser Medicine and Surgery, American Society of Dermatologic Surgery,  British Association of Dermatologists , and The  Society for Investigative Dermatology . He is past President of the Texas Dermatology Society (1995\u201396) and has been an honorary member of Solapso (Latin America Society for Psoriasis) since 2009. He has authored or co-authored more than 255 scientific journal articles, four books and multiple book chapters. [2]  Professor Menter was honored at the 2015 American Academy of Dermatology meeting by the Dermatology Foundation with the Clark W. Finnerud Award, intended to honor a dermatologist whose contributions as a clinical educator are exemplary. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4741", "text": "Herman Musaph  ( Dutch :  Heijman Musaph ) (7 January 1915 \u2013 18 November 1992) was a Dutch  Holocaust survivor ,  psychiatrist , dermatologist and  sexologist . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4742", "text": "Musaph was born in  Amsterdam . He studied medicine at the  University of Amsterdam . In 1977 Musaph became Professor of Medicine at the  University of Utrecht . He wrote various works on  dermatology ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4743", "text": "Musaph founded the  Dutch Society for Sexual Reform  and he wrote the \"Handbook of Sexology\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_4744", "text": "He was the winner of the  Magnus Hirschfeld Medal  in 1990. The  Herman Musaph Foundation for Psychodermatology  is named in his honor."}
{"_id": "WikiPedia_Dermatology$$$corpus_4745", "text": "Herman was married to  Rosetta Andriesse  and had no children."}
{"_id": "WikiPedia_Dermatology$$$corpus_4746", "text": "This biographical article about a Dutch academic is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4747", "text": "This article about a psychiatrist is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4748", "text": "Albert Ludwig Sigesmund Neisser  (22 January 1855,  Schweidnitz  \u2013 30 July 1916,  Breslau ) was a German  physician  who discovered the causative agent ( pathogen ) of  gonorrhea , a strain of  bacteria  that was named in his honour ( Neisseria gonorrhoeae )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4749", "text": "Neisser was born in the  Silesian  town of Schweidnitz (now \u015awidnica, in Poland), the son of a well-known  Jewish  physician, Moritz Neisser. After he completed the elementary school in  M\u00fcnsterberg , Neisser enrolled in the St. Maria Magdalena School in  Breslau  (now Wroc\u0142aw, in Poland). In this school, he was a contemporary of another great name in the history of medicine,  Paul Ehrlich . He obtained the  Abitur  in 1872."}
{"_id": "WikiPedia_Dermatology$$$corpus_4750", "text": "Neisser began to study  medicine  at the  University of Breslau , but later moved to  Erlangen , completing his studies in 1877. Initially Neisser wanted to be an  internist , but did not find a suitable place. He found work, however as an assistant of the dermatologist  Oskar Simon  (1845\u20131892), concentrating on  sexually transmitted diseases  and  leprosy . During the following two years he studied and obtained experimental evidence about the pathogen for gonorrhea,  Neisseria gonorrhoeae ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4751", "text": "Neisser was also the co-discoverer of the causative agent of leprosy. In 1879 the Norwegian physician  Gerhard Armauer Hansen  gave to young Neisser (who had visited him in Norway to examine some 100 leprosy patients) some tissue samples of his patients. Neisser successfully stained the bacteria and announced his findings in 1880, claiming to have discovered the pathogenesis of leprosy. There was some conflict between Neisser and Hansen, because Hansen had failed to culture the organism and demonstrate unequivocally its link to leprosy, although he had observed the bacterium since 1872."}
{"_id": "WikiPedia_Dermatology$$$corpus_4752", "text": "In 1882 Neisser was appointed  professor extraordinarius  by the University at the age of 29, and worked as a  dermatologist  in the university hospital of Breslau. Later he was promoted to the head of the hospital. In the following year he married Toni Neisser, n\u00e9e Kauffmann."}
{"_id": "WikiPedia_Dermatology$$$corpus_4753", "text": "In 1898 Albert Neisser published clinical trials on serum therapy in patients with syphilis. He injected cell free serum from patients with syphilis into patients who were admitted for other medical conditions. Most of these patients were prostitutes, who were neither informed about the experiment nor asked for their consent. When some of them contracted syphilis Neisser argued that the women did not contract syphilis as a result of his serum injections but contracted the disease because they worked as prostitutes. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4754", "text": "In 1905 and 1906 Neisser travelled to  Java , in order to study the possible transmission of  syphilis  from  apes  to humans. He later cooperated with  August Paul von Wassermann  (1866\u20131925) to develop the famous diagnostic test for detecting  Treponema pallidum  infections, and also in the testing of the first chemotherapeutic agent for syphilis,  Salvarsan , which was discovered by his former school fellow  Paul Ehrlich  in 1910. In 1907, Neisser was promoted to  professor ordinarius  of dermatology and sexually transmitted diseases at Breslau."}
{"_id": "WikiPedia_Dermatology$$$corpus_4755", "text": "As a scientific leader, Neisser was also very active. In the field of  public health , he promoted vigorously  preventive  and educational measures to the public, and the better sanitary control of  prostitutes , in order to combat venereal diseases. He was one of the founder of the  Deutsche Gesellschaft zur Bek\u00e4mpfung der Geschlechtskrankheiten  (German Society for the Fight Against Venereal Diseases) in 1902, and of the Deutsche Dermatologische Gesellschaft (German Dermatological Society) in 1888."}
{"_id": "WikiPedia_Dermatology$$$corpus_4756", "text": "Neisser died of  sepsis  on 30 July 1916, at the age of 61 years, in  Breslau ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4757", "text": "The Albert Neisser Lectureship has been awarded since 2005 by the Department of Dermatology at the  University of Wroc\u0142aw  to dermatologists who have made significant clinical and research contributions to the field. Past awardees include:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4758", "text": "Brigadier   Kenneth Ocen Obwot , is a  Ugandan   physician ,  military officer  and medical administrator in  the  Uganda People's Defence Forces  (UPDF). He serves as the Deputy Director of Medical Services in the UPDF. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4759", "text": "He was born in the  Acholi sub-region  of the  Northern Region  of Uganda circa 1954. After attending local elementary and secondary schools, he was admitted to  Makerere University , Uganda's oldest and largest public university in 1974. He entered  Makerere University School of Medicine , graduating with a  Bachelor of Medicine  and Bachelor of Surgery  degree, in 1979. In 1990, he obtained a  Master  of Medicine  in  Internal Medicine , also from Makerere University. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4760", "text": "In 1996, he was admitted to the  Cardiff University School of Medicine  (at that time  University of Wales College of Medicine ), where he graduated with a  Diploma in Dermatology . The following year he obtained a  Master of Science  degree in  Dermatology . Later, in 2000, he successfully studied for a  Postgraduate Diploma in Health Management , from the same university. He specialized in  dermatology  (skin diseases). [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4761", "text": "Dr Ocen Obwot, when on military duty, is based at  Bombo Military Hospital , in  Luweero District . [ 4 ] [ 5 ]  In February 2019, as part of a promotions exercise that involved 2,031 UPDF men and women, Dr. Kenneth Ocen Obwot was promoted from the rank of  colonel  to that of  brigadier general . [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4762", "text": "Berta Ottenstein  (born 27. March 1891 in  Nuremberg , died 17. June 1956 near  Concord (Massachusetts) ) was a German dermatologist who was the first woman to obtain her habilitation at the  University of Freiburg im Breisgau  and the first woman in Germany to habilitate in  dermatology . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4763", "text": "Ottenstein, the youngest of six children born into a Nuremberg merchant family, studied at the University of Erlangen, where she received her doctorate in chemistry in 1914. After a position at the Kaiser Wilhelm Institute for Biochemistry in Berlin-Dahlem (1927), she moved to the University of Freiburg in 1928, where she received an assistant post. [ 2 ]  As early as 1930, her superior, hospital director Georg Alexander Rost, expressed his intention to propose her for habilitation in the foreseeable future. The habilitation was approved by the Senate on 3 June 1931 and confirmed by the responsible Ministry in Karlsruhe on 11 June. Three weeks earlier, Ottenstein had already been awarded the degree at the medical faculty, so that she could take up a position as a private lecturer in the winter semester of 1931/32. The title of her habilitation thesis was \"Untersuchungen \u00fcber den Gehalt der Haut und des Blutes an diastatischem Ferment und dessen biochemische Bedeutung bei Hautkrankheiten\" (Studies on the content of diastatic ferment in the skin and blood and its biochemical significance in skin diseases)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4764", "text": "Ottenstein's contract with the University of Freiburg was extended for the last time in 1932, but even before it expired in autumn 1934 she was \"granted leave\" by the National Socialists because of her Jewish ancestry. Together with many other lecturers she had to leave the university on April 12, 1933. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4765", "text": "1933-35 she held an assistant position at the dermatological clinic of Budapest before she changed to the University of Istanbul in 1935, where she worked as lecturer and head of the dermatological clinic until 1945. She then emigrated to the US, where she received a position as research fellow at Harvard University and worked at the New England Medical Center in Boston."}
{"_id": "WikiPedia_Dermatology$$$corpus_4766", "text": "In 1951 Ottenstein was awarded an extraordinary professorship by the University of Freiburg and she received American citizenship. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4767", "text": "The University of Freiburg's Women's Promotion Prize has been called the Bertha Ottenstein Prize since 2005. [ 4 ]  According to the university's website, the prize is awarded for outstanding scientific achievements in the field of women's and gender studies, teaching concepts and seminar forms, training and further education programmes that integrate the aspect of gender equality in a cross-sectional way and stimulate gender-oriented processes of awareness building, networking, event or exhibition organisation on gender issues, above-average commitment to the implementation of Faculty Equality Plans and/or the Central Equality Plan, recruitment and staff development measures that are likely to increase the proportion of women at the individual skill levels at which they are under-represented, and innovative measures to improve the living, studying and working conditions of student and employed parents at the university. In Freiburg, a street in the Br\u00fchl-Beurbarung district on the former freight station site was named after Berta Ottenstein."}
{"_id": "WikiPedia_Dermatology$$$corpus_4768", "text": "Thelma Phillip-Browne  (born in  Newtown, Basseterre , St Kitts) is the  Ambassador to the United States from Saint Kitts and Nevis . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4769", "text": "Phillip-Browne attended Girls High School and Basseterre High School before graduating with a medical degree from the  University of the West Indies  (UWI) in 1978. She attended  Johns Hopkins Bloomberg School of Public Health  and earned a Diploma in Dermatological Science from the  Cardiff University School of Medicine . She obtained a Master of Theological Studies (MTS) degree from  Anderson University  in 2011. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4770", "text": "Besides working as a dermatologist in private practice, she was Director of Primary Health Care and later Chief Medical Officer of the Federation of St Kitts and Nevis. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4771", "text": "Phillip-Browne has served as a lay preacher and member of the Women of the Church of God. She has two daughters and one son, and has two granddaughters. She has seven siblings. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4772", "text": "This Saint Kitts and Nevis biographical article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4773", "text": "This diplomat-related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4774", "text": "Philipp Josef Pick  (14 October 1834,  Neustadt an der Mettau  - 3 June 1910,  Prague ) was a  dermatologist  from the Austro-Hungarian Empire."}
{"_id": "WikiPedia_Dermatology$$$corpus_4775", "text": "He studied medicine at the  University of Vienna  as a pupil of  Josef Hyrtl  and  Carl von Rokitansky . He obtained his doctorate in 1860 and served as an assistant to  Joseph \u0160koda ,  Carl Ludwig Sigmund  and  Ferdinand Ritter von Hebra  in Vienna. [ 1 ]  In 1867 he received his  habilitation  at the  University of Prague , becoming an associate professor six years later. From 1896 to 1906 he was a full professor of dermatology at the University of Prague. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4776", "text": "He was the first to describe the bacterial infection  Trichomycosis palmellina , [ 1 ]  and independent of  Heinrich K\u00f6bner  (and shortly afterwards), he discovered  Trichophyton tonsurans  in  eczema marginatum . [ 2 ]  He also made contributions in his research of  molluscum contagiosum , melanosis lenticularis progressiva,  urticaria pigmentosa ,  erythromelia  and  acne frontalis . [ 1 ]  With German dermatologist  Karl Herxheimer , the eponymous \"Pick-Herxheimer disease\" is named, a disorder also known as  acrodermatitis chronica atrophicans . [ 3 ]  He is credited for introducing  iodoform  into dermatology and for employing emplastrum saponatum salicylicum for the treatment of  eczema . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4777", "text": "In 1869, with  Heinrich Auspitz , he founded the journal  Archiv f\u00fcr Dermatologie und Syphilis , later to be known as the \" Vierteljahresschrift f\u00fcr Dermatologie und Syphilis \". [ 4 ]  In 1889, with  Albert Neisser , he founded the \" Deutschen Dermatologischen Gesellschaft \". [ 4 ] [ 5 ]  In 1888 he became an honorary member of the American Dermatological Association. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4778", "text": "Philipp Josef Pick is the father of the internist and medical historian  Friedrich Pick  (1867-1926), the dermatologist  Walter Pick  (1874-1932) and the chemist Hans Pick (1879-1942), who was deported from Prague to Theresienstadt on May 12, 1942, victim of the Holocaust in  Lublin ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4779", "text": "Joseph Jakob Ritter Plenk  or  Plenck  (28 November 1738 \u2013 24 August 1807) was a physician and polymath in the  Holy Roman Empire . He is now known as a pioneer  dermatologist . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4780", "text": "Plenck was born on 28 November 1738 in  Vienna , although some sources give a birth year of 1732. [ 2 ]  He graduated at the  University of Vienna  in 1763, and was a follower of Heinrich Johann Nepomuk von Crantz. An academic at the  University of Basel  in 1770, he then taught at  Tymau ,  Buda  and  Pesth . In 1783 he moved to the  Josephinum  in Vienna. [ 1 ]  He died on 24 August 1807. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4781", "text": "In 1861, botanist  Siegfried Reisseck  published  Plenckia , a genus of  flowering plants  from South America, belonging to the family  Celastraceae  and named in honour of Joseph Jakob Plenck. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4782", "text": "Plenck was a prolific writer, on subjects including  surgery . [ 4 ]  In 1776 he published a classification of skin diseases,  Doctrina de morbis cutaneis . [ 1 ] [ 5 ]  It introduced a consistent system, dividing  dermatosis  into 14 classes. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4783", "text": "Oskar Simon  (2 January 1845 \u2013 2 March 1882) was a German  dermatologist  who was a native of  Berlin ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4784", "text": "He studied medicine in  Berlin , where he earned his doctorate in 1868. He furthered his education in  Vienna , where he took classes from  Ferdinand von Hebra  (1816-1880) and  Hermann Edler von Zeissl  (1817-1884). During the  Franco-Prussian War  he was an assistant- surgeon , and in 1872 became a lecturer of skin diseases and  syphilis  in Berlin."}
{"_id": "WikiPedia_Dermatology$$$corpus_4785", "text": "In 1878 he succeeded  Heinrich Koebner  (1838-1904) as professor of dermatology at the  University of Breslau , and also became chief physician at Allerheiligen Hospital. Among his students were  Albert Neisser  (1855-1916),  Edmund Lesser  (1852-1918) and  Eduard Arning  (1855-1936). Oskar Simon died from  carcinoma  of the  stomach  on 2 March 1882 at the age of 37."}
{"_id": "WikiPedia_Dermatology$$$corpus_4786", "text": "Desmond John Tobin  is an Irish academic, researcher and author. He is a full professor of dermatological science at  University College Dublin  and the director of the Charles Institute of Dermatology. He was chair of British Society for Investigative Dermatology from 2018 to 2020. [ 1 ]  Tobin is a fellow of The  Royal College of Pathologists , of the  Higher Education Academy , of the  Royal Society of Biology ,  Institute of Biomedical Science , and of the Institute of Trichologists (where he is currently vice-president). [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4787", "text": "Tobin's research is focused on  pigmentation  and hair follicle health. He has conducted extensive research on  Alopecia areata , where he was the first researcher to show that patients with AA have circulating antibodies to hair follicle-specific antigens, including  trichohyalin . [ 3 ]  He is also a regional editor for the  International Journal of Trichology ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4788", "text": "A native of  Navan ,  County Meath , Ireland, Tobin completed high school education at St Patrick\u2019s Classical School, Navan, and was awarded a B.Sc. from  Maynooth University  in 1986. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4789", "text": "Tobin then joined  North East Surrey College of Technology  where he completed his G.I. in Biology (immunology) in 1987. In 1991, he received his Ph.D. from St John's Institute of Dermatology at  King's College London . Subsequently he moved to the  United States , where he completed his research post-doctoral training at the Dept. of Dermatology NYU, New York. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4790", "text": "Tobin briefly worked as Assistant Research Professor at the Department of Dermatology,  New York University  and Adjunct Assistant Professor at  City University of New York  before moving back to the  Europe  in 1996. There he joined  University of Bradford  as a lecturer in Biomedical Sciences. He moved up in the ranks becoming a Full Professor in 2004. From 2005 to 2008, he served as the director of the Medical Biosciences Research Group. In 2008, he was appointed the Associate Dean for Research and Knowledge Transfer at the Faculty of Life Sciences. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4791", "text": "Tobin founded the Center for Skin Sciences at University of Bradford in 2009 and served as its director until 2018. In 2018, he left University of Bradford to return home to Ireland to join the University College Dublin, where he was appointed the director of Charles Institute of Dermatology. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4792", "text": "In 2018, Tobin was appointed the chair of British Society for Investigative Dermatology. In May 2021, he was made a member of the  Royal Irish Academy . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4793", "text": "Tobin\u2019s lab developed an assay for tracking melanin transfer events, followed by a study on a key motor protein to drive melanin transfer between  melanocytes  and  keratinocytes  in human skin. [ 7 ]  These latter findings were translated in product development for pigmentation spots and potentially also melasma. Via university-owned IP, his team discovered a potential new \u2018sun-less tanning\u2019 small peptide technology. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4794", "text": "Tobin identified the basis for the clinically-observed preferential targeting of pigmented hair (and relative sparing of white hair) in  Alopecia areata  (AA), with his data showing that pigmented hair follicle melanocytes are destroyed in acute AA. This also explains rapid so-called \u2018going white overnight\u2019. [ 9 ]  Tobin's laboratory was the first to report that the opioid b-endorphin acts a surprising and potent pigmentary molecule. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4795", "text": "Tobin\u2019s work is also interested in the life and death of pigment cells; key not only for those with age-related loss of hair pigmentation, but also for those with malignant pigment cells. He reported the first recognized spontaneous and cyclical programmed cell death in the melanocyte system in humans, during the regression phase of the hair growth cycle. This may be harnessed in apoptosis-resistant malignant melanoma. [ 11 ]  With vitiligo, he and his colleagues challenged the prevailing view that all melanocytes were lost/destroyed in epidermis of patients with this skin-depigmenting disorder. He proposed that these cells survived best if un/dedifferentiated, opening up possibilities of treating even fully-white vitiligo skin of long duration. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4796", "text": "Tobin with others has assessed the genetics of hair traits, and revealed several novel genes including the first gene associated with gray hair, in addition to other hair traits like mono-brow, [ 13 ]  beard density, and straight vs curly hair. [ 14 ]  He has also advanced the understanding of how oxidative stress can weaken the melanocyte system of both the skin and aging hair follicle, and how this may be stabilized via anti-oxidant protection. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4797", "text": "Tobin has conducted extensive research on Alopecia areata (AA). He was the first to show that patients with AA have circulating antibodies to hair follicle-specific antigens, including trichohyalin. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4798", "text": "Paul Gerson Unna , (September 8, 1850,  Hamburg  \u2013 January 29, 1929, Hamburg) was a German physician specialized in  dermatology  and one of the pioneers in dermatopathology."}
{"_id": "WikiPedia_Dermatology$$$corpus_4799", "text": "Paul Unna was born to German Jewish parents Moritz Adolph Unna, a  physician  from  Hamburg . Unna was educated at the  Gelehrtenschule des Johanneums  and Ida Gerson, who descended from a long line of physicians. [ 1 ]  He began to study   medicine  at the  University of Heidelberg , but had to interrupt it in order to fight in the  Franco-Prussian war , where he was severely wounded. In 1871, he resumed his studies in Heidelberg and later went to the  University of Leipzig , finally attaining a  doctorate  under  Heinrich Wilhelm Waldeyer  in  Strasbourg . His doctoral work was on the subject of the  histology  and development of the  epidermis , and was published in 1876. The thesis contained a set of new ideas and aspects that were met with hard criticism. They were accepted only after some corrections were made."}
{"_id": "WikiPedia_Dermatology$$$corpus_4800", "text": "He went on to receive his training in dermatology in  Vienna , where he worked in cooperation with  Ferdinand von Hebra ,  Moritz Kaposi  and  Heinrich Auspitz , among others."}
{"_id": "WikiPedia_Dermatology$$$corpus_4801", "text": "After his return to Hamburg, Unna started working in the clinical practice of his father, then in the  Sankt Georg  Hospital. Unna's main interest resided on dermatology: he opened his own practice for skin diseases in Hamburg in 1881, and later opened the  Dermatologikum  private dermatological hospital in Hamburg  Eimsb\u00fcttel , so that he could concentrate entirely on the field, beginning in 1884. In that year, Unna published his first book,  Histopathologie der Hautkrankheiten  (Histopathology of Skin Diseases), which exposed the entire knowledge in the field at that time and which made him one of the most prominent dermatologists of his time. Besides describing all known skin diseases, Unna proposed new therapies. Among the innovations, in 1886 he proposed the use of  ichthyol  and  resorcinol  against skin diseases."}
{"_id": "WikiPedia_Dermatology$$$corpus_4802", "text": "He coined the term  acanthosis nigricans  in 1889. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4803", "text": "He investigated the biochemical processes of the skin and was the first to describe the  stratum granulosum . In 1894 he introduced layer projection as a method for skin investigations."}
{"_id": "WikiPedia_Dermatology$$$corpus_4804", "text": "In 1907 he received the title of professor from the  Hamburg senate , and in the following year he became the chief physician of the  Eppendorf   hospital . In 1919 he became a professor at the  University of Hamburg , receiving the first chair for dermatology."}
{"_id": "WikiPedia_Dermatology$$$corpus_4805", "text": "In 1927 he described for the first time what was to be called  Unna's disease , a chronic disease of the skin with  seborrhea  of the  scalp  and of the areas in the face and trunk that are rich in  sebaceous follicles . Along with  Arthur Thost ,  Unna\u2013Thost syndrome  is named after Unna; it is a rare hereditary skin disease affecting the soles and palms. Also, a compression gauze used to treat venous leg problems is named  Unna's boot ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4806", "text": "For many years Unna cooperated closely with the pharmacist  Paul Beiersdorf . The street in Hamburg where the  Beiersdorf  company is located is named Unnastrasse in his honor. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4807", "text": "Erich Urbach  (29 July 1893,  Prague  \u2013 17 December 1946) was an  Austrian   dermatologist  from  Vienna  who, in conjunction with  Camillo Wiethe , an  otorhinolaryngologist , first described  lipoid proteinosis . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4808", "text": "As a lieutenant in the Austrian army during  World War I , he was a member of a surgical group serving under professor  Anton von Eiselsberg . In 1919 he obtained his medical doctorate from the  University of Vienna . He worked in the  internal medicine  and dermatology departments at  Vienna General Hospital  and also at the  Breslau  skin clinic, where he was an assistant to  Josef Jadassohn . From 1936 to 1938, he was head physician in the dermatology department at Merchant's Hospital in Vienna, but in order to escape Nazi persecution, he emigrated to the  United States  in 1938. Here, he served as an associate of dermatology at the  University of Pennsylvania . From 1939 onward, he was head of the allergy department at the Jewish Hospital in  Philadelphia . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4809", "text": "His book,  Hautkrankheiten und Ern\u00e4hrung mit Ber\u00fccksichtigung der Dermatosen des Kindesalters , was translated into English and published in 1932 as  Skin Diseases and Nutrition, Including the Dermatoses of Children . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4810", "text": "Jonathan Zizmor  (born 1945) is an American  dermatologist  in  New York City  famous for his television commercials and prolific, colorful subway ads promising that \"Now you can have beautiful clear skin!\" [ 1 ] [ 2 ]  Zizmor received his MD from the  Albert Einstein College of Medicine ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4811", "text": "Zizmor was born to Julius and Felice Zizmor and grew up in New York City. He attended high school at  Yeshiva University High School for Boys . Zizmor completed his internship in internal medicine at the hospitals of  Albert Einstein College of Medicine  and his residency in dermatology at New York University Hospital."}
{"_id": "WikiPedia_Dermatology$$$corpus_4812", "text": "Comedian Nick Kroll has a sketch comedy series on Comedy Central \"partially based on Zizmor\" according to the  Daily News . [ 3 ]  Zizmor was the subject of a  Saturday Night Live  sketch featuring  Taran Killam  as Brad Pitt in a parody of a  Chanel  ad. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4813", "text": "Zizmor has authored seven books on skin care, including Dr. Zizmor's Skin Care Book and Dr. Zizmor's Guide To Clearer Skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_4814", "text": "Zizmor has been certified by the  American Board of Dermatology  and is a member of it. [ 5 ]  He served for over 10 years as Chief of Dermatology at St. Vincent's Hospital. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4815", "text": "Zizmor was offered a cameo appearance on  30 Rock , but turned it down, according to Tina Fey. [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4816", "text": "On January 4, 2016, it was announced that Zizmor had retired, and will study Talmud. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4817", "text": "A 2021 fashion review noted that people in New York City enjoy showcasing their particular local culture, and described this love as \"Zizmorcore\". [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4818", "text": "Zizmor's first subway advertisements appeared in 1981, with a tagline that promised \"Now You Can Have Beautiful, Clear Skin\". [ 11 ]  The subway advertisements appear in one out of every five subway cars, by some estimates, [ 12 ]  and were all created by Zizmor himself. [ 11 ]  They feature his face, often superimposed on a rainbow and/or a photograph of the New York skyline. [ 11 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4819", "text": "Alchimie Forever  is an anti-aging skin care line by  Swiss  dermatologist Dr. Luigi Polla."}
{"_id": "WikiPedia_Dermatology$$$corpus_4820", "text": "Upon completing his studies, Polla opened a  dermatology  practice in  Geneva ,  Switzerland  in 1986 [ 1 ]  and was the first dermatologist to offer pulsed dye laser technology to treat children with  Port-wine stains  and  hemangiomas . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4821", "text": "Polla's eldest daughter, Ada Polla, worked the practice's front desk during those years. She recalls her father's motivation to find products that would assist the skin in healing from these painful treatments. When he could not find products to calm the skin post-procedure, he decided to create them himself. The products were originally created at a nearby compounding pharmacy, and the first product Polla formulated was the Kantic Brightening Moisture Mask. Because the children's mothers also loved the products, that led to the development of additional products, which became the Alchimie Forever brand. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4822", "text": "The products sold well, and the Pollas decided to expand distribution beyond Geneva. [ 4 ]   Ada, started Alchimie Forever LLC, in  Washington, D.C. , to distribute Alchimie Forever products in the  United States . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4823", "text": "Alchimie Forever is distributed throughout UK, Switzerland,  France , and the United States. The products are distributed online, in independent beauty boutiques, pharmacies, drugstores, and by skincare professionals. In an interview with  PETA Prime , Polla says the product line is vegan and cruelty free. [ 6 ]  Ada Polla is the president and CEO of Alchimie Forever."}
{"_id": "WikiPedia_Dermatology$$$corpus_4824", "text": "Alchimie Forever products have appeared in numerous fashion magazines, including   Shape   Elle ,  Vogue ,  Glamour ,  Redbook , and  Men's Journal . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4825", "text": "The Best Drugstore Skin Treatments According to Pros,  People , ' [ 8 ]  Ashley Scott, a skin therapist at Heyday in N.Y.C., says that this pink-tinted brightening mask looks radiant when you apply it: \"Wear it on Zoom calls!\" Bonus: It also comes in travel size for an on-the-go glow."}
{"_id": "WikiPedia_Dermatology$$$corpus_4826", "text": "Baby Bottom Butter  is a  balm  sold by English  supermarket  chain  Waitrose , used upon  babies '  bottoms  to soothe them and prevent  nappy rash .  It is also popular as a  face cream  for women."}
{"_id": "WikiPedia_Dermatology$$$corpus_4827", "text": "The natural ingredients now include  olive oil ,  camomile  oil and  vanilla . [ 1 ]  When it was reformulated in 2008 to remove preservative  parabens  and other  petrochemicals , sales increased significantly as mothers started to use it themselves, in place of expensive  face cream . [ 2 ] [ 3 ]   As the word spread through  parenting  websites, with many women praising its softening and firming effect, the product sold out at many stores. [ 4 ]  In 2008, the product sold eight years worth of stock in just four months following this buzz. [ 5 ]  Enthusiasm for the balm continued, and in 2011, it was announced to be Waitrose's best-selling skincare product. [ 1 ]  It is produced in  Hampshire . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4828", "text": "People living in  New Zealand  made special arrangement to have it shipped to them and, in 2014, the luxury supermarket chain, Nosh, started stocking it. [ 6 ]  In 2016, Waitrose started exporting the product to China. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4829", "text": "Banila Co. ( Korean :\u00a0 \ubc14\ub2d0\ub77c\ucf54 ) is a South Korean cosmetics brand that is owned by F&F.[1] It was established by F&F in 2005. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4830", "text": "Banila Co. offers a range of cosmetic products including:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4831", "text": "Banila Co. also offers different varieties of products that are free of alcohol, artificial coloring, artificial fragrances, essential oil, parabens, and silicone. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4832", "text": "On March 9, 2011, actress  Min Hyo-rin  became the new model of Banila Co. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4833", "text": "On August 8, 2011,  SISTAR's   Hyorin  was named the new model of Banila Co. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4834", "text": "On September 25, 2012, it was announced that  Girls' Generation's   Jessica Jung  would be the new endorser of Banila Co. [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4835", "text": "On June 20, 2013, Banila Co. announced that singer  Roy Kim  will be their first male model. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4836", "text": "On August 19, 2014,  Song Ji-hyo  was named as the new model of Banila Co."}
{"_id": "WikiPedia_Dermatology$$$corpus_4837", "text": "On September 28, 2016, singer  Taeyeon  (Girls' Generation) was chosen as the new spokesmodel for Banila Co. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4838", "text": "On August 21, 2019,  Kim Min-kyu  was selected as new male model for Banila Co."}
{"_id": "WikiPedia_Dermatology$$$corpus_4839", "text": "On January 26, 2020, actor  Song Kang  was chosen as the new model for Banila Co. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4840", "text": "On February 26, 2020, actress  Shin Se-kyung  was chosen as the new model for Banila Co. [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4841", "text": "On October 21, 2021, singer  Jeonghan  ( Seventeen ) was chosen as the new ambassador for Banila Co. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4842", "text": "Bayankala  is a natural  skincare  brand originating from  Shanghai ,  China , that was conceived of by a French entrepreneur and long-time resident and  \"old China hand\" , Jean Zimmermann. [ 1 ]  Zimmermann founded the brand together with a Chinese herbalist. The inspiration for the brand came during his time as General Manager of Lane Crawford department stores in China when he decided to create a high-end Chinese brand. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4843", "text": "The brand itself is named after the  Bayan Har Mountains  in south-central  Qinghai , which contain the source of the  Yellow River . The symbol of the brand is the \"hulu,\" (\u846b\u82a6  pinyin : h\u00falu) the Chinese  bottle gourd  that was traditionally used as a vessel by and hung out front as a sign of the  Chinese pharmacy . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4844", "text": "Bayankala claims to be the first Chinese \"luxury skin care brand\"  [ 1 ]  with recipes from traditional Chinese herbal medicine. The brand concept features 5 traditionally used ingredients from  Chinese herbology . The brand is manufactured in  Guangzhou  in  Southern China , and some product has been certified organic in China. [ 3 ]  Zimmermann claims that the active ingredients are cultivated and harvested according to the wisdom of the traditional  Chinese lunar calendar  and each product is formulated using pure water from the source of the Yellow River. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4845", "text": "Beautycounter  was an American  direct to consumer  and  multi-level marketing [ 2 ] [ 3 ]  company that sold skin care and cosmetic products. [ 1 ]  As of 2018, the company had 150 products with over 65,000 independent consultants, and with national retailers. [ 4 ]  In April 2021, Beautycounter was acquired by  The Carlyle Group  in a deal that valued the company at $1 billion. In March 2024, Carlyle wrote off its investment in the company and the company went into administration in April 2024."}
{"_id": "WikiPedia_Dermatology$$$corpus_4846", "text": "Beautycounter was founded by  Gregg Renfrew  in 2013. [ 5 ]  Renfrew had previously worked with merchandising executives such as  Martha Stewart  and Susie Hilfiger. [ 4 ] [ 6 ]  Beautycounter released nine products in March 2013, including facial cleansers, eye creams, and shampoo. [ 4 ]  The company launched as a direct retail brand, selling through its website, independent consultants, and retailers including  J.Crew ,  Target  and  Sephora . [ 4 ] [ 7 ] [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4847", "text": "Beautycounter was one of  Allure  magazine's Best of Beauty award recipients for their lip sheer in twig (2014) [ 8 ]  and dew skin tinted moisturizer (2015). [ 9 ]  Beautycounter became a founding member of the nonprofit Environmental Working Group's verification program, which aims to make it easier for consumers to identify consumer goods that do not contain toxic ingredients. [ 10 ]  The company compiled a \"never list\" of reportedly harmful chemicals omitted from their products. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4848", "text": "In 2016, Beautycounter launched its first mascara line. [ 12 ]  Later that year, Beautycounter's Lengthening Mascara was one of Allure's Best of Beauty products in the natural category. [ 13 ]  In June 2016, Beautycounter acquired the worldwide assets of Nude Skincare, Inc. and Nude Brands, Ltd.,  Ali Hewson 's natural beauty line, from  LVMH . As part of the acquisition, Hewson's husband  Bono  became an investor in Counter Brands, LLC., Beautycounter's parent company, and Hewson became a board member. [ 14 ] [ 15 ] [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4849", "text": "In 2018, the company opened its first  brick and mortar  store in  Manhattan . [ 17 ]  A second location opened in 2019, in  Denver, Colorado . [ 18 ] [ 19 ]  In March, the company was named to Fast Company's Most Innovative Companies list, for its efforts to promote nontoxic ingredients in beauty products. [ 20 ]  In June, the company was also named to  CNBC 's 2020 Disruptor 50 list, as a next generation billion dollar business. [ 21 ]  In December, the company opened a hybrid retail store and livestream content studio in  Los Angeles . [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4850", "text": "In February 2020, the company released a documentary  Transparency: The Truth About Mica , as part of its efforts to promote ethical mining. The documentary films an in-person audit of the company's mica supply chain, to ensure responsible sourcing. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4851", "text": "In April 2021, American private equity firm  The Carlyle Group  acquired a majority stake in Beautycounter in a roughly $600 million acquisition which valued parent Counter Brands, LLC. at $1B. [ 2 ] [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4852", "text": "In January 2022, Marc Rey was named as the company's new CEO, and founder Renfrew became executive chair. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4853", "text": "In May 2023, Marc Rey stepped down as CEO and Beautycounter's board director, Mindy Mackenzie was announced as interim CEO before the return of Renfrew to lead the company. [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4854", "text": "The company went into administration in April 2024 following Carlyle's decision in mid-March to walk away from its investment in the company. [ 2 ] [ 27 ]  Renfrew purchased rights to the Beautycounter name and additional assets in administration at a cost of several million dollars with plans to relaunch the company later in the year. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4855", "text": "In 2014, Renfrew hired public health and environmental advocate Lindsay Dahl to lead company advocacy and lobbying efforts to reduce harmful chemicals used in the cosmetic industry. [ 4 ] [ 5 ] [ 28 ]  Renfrew and Beautycounter hosted a congressional briefing in Washington, D.C., in fall 2015, regarding the potential dangers of under-regulated beauty products. [ 5 ]  In May 2016, Renfrew went to Washington, D.C., with a group of 100 women representing all 50 U.S. states to discuss the importance of regulation in the beauty industry with senators, representatives, and legislative staff. [ 4 ] [ 12 ] [ 29 ]  Renfrew also testified in a congressional hearing on cosmetic reform in December 2019. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4856", "text": "In 2021, Beautycounter led two days of virtual lobbying with members of Congress on federal standards regarding clean beauty. [ 31 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4857", "text": "Blistex Inc.  is an American consumer products company headquartered in  Oak Brook ,  Illinois . Founded in 1947, in the business of developing and marketing lip care products, its offerings have grown to include other brands including  Odor-Eaters ,  Stridex , and  Kank-A ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4858", "text": "Blistex Inc. was founded in 1947 in the business of developing and marketing lip care products. [ 1 ]   It manufactures and sells a wide range of  lip balm , lip  ointment , and other  lip -related products under the Blistex brand name. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4859", "text": "Blistex is headquartered outside of Chicago in  Oak Brook ,  Illinois . [ 4 ]  The company operates a production facility in Oak Brook, Illinois, and is a member of the  Illinois Manufacturers' Association . As of November\u00a02021 [update] , Blistex products are sold around the world. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4860", "text": "Burt's Bees  is an American multinational  personal care  product company. The company is a subsidiary of  Clorox  that describes itself as an \" Earth-friendly , Natural Personal Care Company\" [ 6 ] \nmaking products for personal care, health, beauty and personal  hygiene . [ 2 ]  Its products are distributed globally. [ 2 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4861", "text": "Originating in  Maine  in the 1980s, the business began when co-founder  Roxanne Quimby  started making candles from  Burt Shavitz 's leftover  beeswax . [ 8 ]  The first headquarters was an abandoned one-room schoolhouse rented from a friend for $150 a year. [ 9 ]  This eventually led to the bottling and selling of  honey  by the two co-founders, and Quimby's focus on maintaining high quality helped to grow the business from an initial $200 at the  Dover-Foxcroft  Junior High School craft fair to $20,000 in sales by the end of its first year. The practice of bottling honey slowly diminished as the company evolved as a corporation. The company eventually began selling other products that used honey and beeswax, including furniture polish and edible spreads, before moving more fully into personal care products. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4862", "text": "Burt's Bees increased production in 1989, after a New York City boutique, Zona, ordered hundreds of their beeswax candles. Forty additional employees were hired and an abandoned bowling alley became their new manufacturing location. During this time, Quimby read one of Burt Shavitz's 19th-century books about bee-keeping, which included home-made personal care recipes, prompting Burt's Bees to enter into the personal care products industry. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4863", "text": "Burt's Bees became  incorporated  in 1991, and had a product line that included candles, natural  soaps ,  perfumes , and, eventually, lip balm, which became their best-selling product. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4864", "text": "In 1994, the business moved to North Carolina. Soon after, Quimby forced Shavitz out of the company's operations after learning he was having an affair with an employee. [ 11 ]  Burt's Bees changed its focus to exclusively personal care products. In 1995, the company moved its manufacturing operations into a 18,000-square-foot (1,700\u00a0m 2 ) former garment factory in  Creedmoor , North Carolina. Although Burt's Bees continued to focus on the \"homemade\" product theme, automated machines, such as a former cafeteria mixer from  Duke University , were introduced to increase production.  Chapel Hill  was the site of the first Burt's Bees retail store, which offered 50 natural personal care products, and distribution had also reached the Japanese market. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4865", "text": "In 1998, Burt's Bees was offering over 100 natural personal care products in 4,000 locations with sales in excess of $8 million. Distribution had reached national retailers, such as  Whole Foods Market , and restaurant chains, such as  Cracker Barrel . New product offerings branched into travel-sized skin care and hair care products. [ 2 ]  In 1999, with increasing demand and an increase in product offerings, including sugar and milk-based body lotions and bath products; Burt's Bees relocated to  Durham  among the many other enterprises located in the  Research Triangle  area of North Carolina. An eCommerce website was launched, increasing distribution to a much larger, nationwide scale. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4866", "text": "In 1999, Quimby bought out Shavitz's one-third stake in the company, in exchange for a house in Maine, valued at approximately $130,000. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4867", "text": "During 2002 and 2003, Burt's Bees launched its first  toothpaste , first  shampoo , and its successful Baby Bee product line of infant personal care products.  Co-founder Quimby also used company-earned profits to preserve 185,000 acres (750\u00a0km 2 ) of forest land in Maine, marking the beginning of a relationship with  The Nature Conservancy , an international organization engaged in  environmental protection  and  conservation . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4868", "text": "In 2004, private equity firm  AEA Investors  purchased 80% of Burt's Bees for US$173,000,000, with co-founder Quimby retaining a 20% share, and a seat on the company board. [ 13 ]  Upon seeking compensation from Quimby, after the deal, Shavitz was paid $4 million. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4869", "text": "As of 2007, the company manufactured over 197 products, [ 2 ]  which are distributed globally. [ 2 ]  In late 2007,  Clorox  acquired Burt's Bees for a reported sum of $925 million USD. [ 14 ]  The company subsequently released a statement to its customers. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4870", "text": "In February 2011, Burt's Bees CEO (2006\u20132011) John Replogle left to become CEO and president of  Seventh Generation Inc. [ 16 ]  In 2011,  Nick Vlahos , a 15-year veteran of  The Clorox Company , was named vice president and general manager of Burt's Bees, effective April 2011. [ 17 ]  In 2017, Vlahos left Clorox and was named CEO of  the Honest Company . By February 2014, the Clorox Company had increased \"advertising and sales promotion spending for Burt's Bees, particularly for its lip care lines\". At the time, \"Burt's Bees sales [were] outpacing volume due to price increases\". [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4871", "text": "Co-founder Shavitz died in July 2015 at the age of 80 and was buried in  Bangor, Maine . In his final years, he had lived on 37-acre (15\u00a0ha) plot of land in  Parkman, Maine . [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4872", "text": "In 2017, Burt's Bees introduced a full cosmetics line, including products such as foundation, mascara, eye shadow, and blush. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4873", "text": "As of March 2018, Burt's Bees lip balm had reached such a level of popularity that some reports claimed one tube of the lip balm was purchased every second. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4874", "text": "In 2022, Burt's Bees announced a multi-year partnership with rePurpose Global to finance a critical recycling infrastructure that prevents  plastic waste  from flowing into the ocean. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4875", "text": "In January 2024, the company announced a partnership with  Hidden Valley Ranch  to introduce limited-edition flavors including regular ranch, buffalo sauce, crunchy celery, and fresh carrot. The products came in response to an  April Fool's  social media post. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4876", "text": "In August 2014, a documentary film,  Burt's Buzz , by Jody Shapiro, which details the history between the company co-founders, was released. [ 24 ] [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4877", "text": "CBI Laboratories, Inc.  is a company founded in 1982 which develops and manufactures products targeting the  dermatological  market."}
{"_id": "WikiPedia_Dermatology$$$corpus_4878", "text": "The company has its own research and development department which is responsible for formulations concentrating on  skin care ,  sun protection , and  hair care ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4879", "text": "CBI also offers over products for private label at small order quantities targeting  spas , skincare boutiques, aestheticians, and physicians offices.  [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4880", "text": "Stock products include  bath salts ,  body lotions , body scrubs/sugar scrubs, body treatments/products, cleansers, eye treatments,  foot care  products, massage treatment, serums,  shower gel /body wash, and toners, as well as over the counter  pharmaceuticals ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4881", "text": "CBI Laboratories is also a member of Independent Cosmetic Manufacturers and Distributors (ICMAD)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4882", "text": "This  Texas -related article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4883", "text": "CellResearch Corporation  is a biotechnology company with a primary focus on skin cell and cord lining  stem cell  research. [ 1 ]  CellResearch has one of the world's largest private skin-, scar-, and keloid-cell libraries which have been used for research by cell culture laboratories worldwide, including those at  Harvard University ,  Procter & Gamble  and  Johnson & Johnson . [ 2 ]  It owns 39  patents  worldwide with intellectual property for the isolation of stem cells from the  umbilical cord lining  membrane of all mammals, which also includes the banking and cultivation of these cells, as well as the therapeutic applications of these cells. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4884", "text": "The firm was founded in 2002 by Phan Toan Thang, Ivor Lim and Gavin Tan  and originally sold skin cell samples for research. [ 3 ] [ 1 ]  In 2014, it was reported that the company was worth $640 million. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4885", "text": "In 2004, Phan found two unique kinds of stem cells from the outer lining membrane of the umbilical cord. [ 4 ]  The umbilical cord lining can yield 6 billion epithelial and 6 billion  mesenchymal stem cells  from a primary explant in one generation. In comparison, the bone marrow produces a few million mesenchymal stem cells per bone marrow aspiration. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4886", "text": "Initial studies focused on wound healing. [ 1 ] [ 2 ]  In 2015, the firm began developing current Good Manufacturing Practice (cGMP) grade cord lining mesenchymal stem cells, which could be used for human transplantation. The stem cell product, called CorLiCyte, was approved for a USFDA trial to heal diabetic wounds, to be completed around 2018-2019. [ 5 ] [ 3 ]  The firm also developed the skincare product CALECIM, made from red deer umbilical cord lining extract, which comprises secreted cell proteins integrated into a cream and serum cosmetic product. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4887", "text": "CordLabs licenses its proprietary  cord lining  stem cell storage technology to cord blood banks, allowing them to also bank cord tissue from which the cord lining stem cells are derived. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4888", "text": "ChapStick  is a  brand name  of  lip balm  owned by Suave Brands Company and is used in many countries worldwide. It is intended to help treat and prevent  chapped lips , hence the name. Many varieties also include sunscreen to avoid sunburn."}
{"_id": "WikiPedia_Dermatology$$$corpus_4889", "text": "Due to its popularity, the term has become a  genericized trademark . It popularly refers to any lip balm contained in a lipstick-style tube and applied in the same manner as lipstick. However, the term is still a  registered trademark , with rights exclusively owned by Suave Brands Company."}
{"_id": "WikiPedia_Dermatology$$$corpus_4890", "text": "ChapStick generated $142m in revenue in 2023. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4891", "text": "In the early 1880s,  Charles Browne Fleet , [ 2 ]  a physician and pharmacological thinker from  Lynchburg, Virginia , invented ChapStick as a lip balm product. The handmade product, which resembled a wickless candle wrapped in tin foil, was sold locally and did not have much success. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4892", "text": "In 1912, John Morton, also a Lynchburg resident, bought the rights to the product for five dollars. Mrs. Morton melted the pink ChapStick mixture in their kitchen, cooled it, and cut it into sticks. Their lucrative sales were used to found the Morton Manufacturing Corporation. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4893", "text": "In 1935,  Frank Wright, Jr. , a commercial artist from Lynchburg, Virginia, was commissioned to design the CHET ChapStick logo that is still used today. He was paid a one-time fee of $15. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4894", "text": "In 1963, The A.H. Robins Company acquired ChapStick from Morton Manufacturing Corporation. At that time, only the ChapStick Lip Balm regular stick was being marketed to consumers; subsequently, many more varieties were introduced. This includes ChapStick four-flavored sticks in 1971, ChapStick  Sunblock  15 in 1981, ChapStick Petroleum Jelly Plus in 1985, and ChapStick Medicated in 1992."}
{"_id": "WikiPedia_Dermatology$$$corpus_4895", "text": "Robins was purchased by American Home Products (AHP) in 1988. [ 4 ]  AHP later changed its name to  Wyeth .  ChapStick was a Wyeth product until 2009 when Wyeth was acquired by  Pfizer .  Pfizer sold the manufacturing facility in Richmond, Virginia, on October 3, 2011, to Fareva Richmond, which now manufactures and packages ChapStick for Pfizer. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4896", "text": "In 2019,  GlaxoSmithKline  Consumer Healthcare acquired ChapStick from Pfizer. In July 2022, GlaxoSmithKline spun off its consumer brands, including ChapStick, into a new consumer health company named  Haleon . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4897", "text": "In January 2024, it was announced that Suave Brands Co. (SBC) would acquire the brand from Haleon for $510 million. [ 7 ]  SBC had been formed a year earlier by Yellow Wood Partners, a  Boston -based private equity firm, to purchase the  North American  rights to the  Suave  brand previously owned by  Unilever ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4898", "text": "In June 2024, it was reported that SBC had completed the purchase of the brand in a deal valued at approximately $430 million. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4899", "text": "Ingredients commonly include  camphor ,  beeswax ,  menthol ,  petrolatum ,  phenol ,  vitamin E ,  aloe  and  oxybenzone . [ 9 ]  However, there are many variants of ChapStick, each with its composition. Due to safety concerns, phenol is banned from use in cosmetic products in the European Union and Canada."}
{"_id": "WikiPedia_Dermatology$$$corpus_4900", "text": "The full list of ingredients in a regular-flavored ChapStick is:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4901", "text": "arachidyl propionate,  camphor ,  carnauba wax ,  cetyl alcohol , D&C red no. 6 barium lake, FD&C yellow no. 5 aluminum lake, fragrance, isopropyl lanolate,  isopropyl myristate ,  lanolin , light  mineral oil ,  methylparaben ,  octyldodecanol ,  oleyl alcohol ,  paraffin , phenyl trimethicone,  propylparaben ,  titanium dioxide , white  wax ,  propanol . [ 10 ]  Its net weight is usually 4 grams (0.14\u00a0oz)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4902", "text": "When manufactured by Wyeth, Chapstick contained no  parabens ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4903", "text": "ChapStick functions as both a  sunscreen , available with  SPFs  as high as 50, and a skin lubricant to help prevent and protect chafed, chapped, sunburned, cracked, and windburned lips. \"Medicated\" varieties also contain  analgesics  to relieve sore lips.  In addition to medical uses, ChapStick has had other uses; the lubricating properties have been useful on precision instruments such as  slide rules .  Other lubricants, while appropriate to the instruments, might have been harmful to the skin, while ChapStick is not."}
{"_id": "WikiPedia_Dermatology$$$corpus_4904", "text": "ChapStick is sometimes available in special flavors developed in connection with marketing partners such as Disney (as in cross-promotions with  Winnie the Pooh  or the movie  Cars ) or with  charitable causes  such as  breast cancer awareness , in which 30\u00a2 is donated for each stick sold (as in the  Susan G. Komen  Pink Pack). The Flava-Craze line is marketed to preteens and young teens, with colorful applicators and \"fun\" flavors such as Grape Craze and Blue Crazeberry."}
{"_id": "WikiPedia_Dermatology$$$corpus_4905", "text": "US  Olympic  skier  Suzy Chaffee  starred in ChapStick television commercials in which she dubbed herself \"Suzy ChapStick\". Another very famous ChapStick advertisement includes basketball legend  Julius Erving  (commonly known as Dr. J) naming himself Dr. ChapStick and telling young children about the great things that ChapStick can do. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4906", "text": "Diana Golden , a U.S. Olympic gold medal-winning skier and 1988, Ski Racing Magazine and  United States Olympic Committee  female skier of the year, was also a spokesperson for ChapStick. [ 12 ]  Former ski racer  Picabo Street , for a time, was seen on television commercials as one of the company's endorsers. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4907", "text": "Its main competitors in the  United States \u2014 Carmex  and  Blistex \u2014also use the popular lipstick-style tube for their lip balm products. In  Iceland  and in the  United Kingdom , the product's main competitor is  Lypsyl , made by  Novartis  Consumer Health and distributed in similar packaging to ChapStick."}
{"_id": "WikiPedia_Dermatology$$$corpus_4908", "text": "Clearasil  is an American brand of skin care and  acne  medication, whose products contain chiefly  benzoyl peroxide ,  sulfur  and  resorcinol ,  triclosan , or  salicylic acid  as active ingredients. Clearasil has a wide range of products both for rapid and sometimes slow acne treatment and for everyday prevention. The products are marketed to customers worldwide."}
{"_id": "WikiPedia_Dermatology$$$corpus_4909", "text": "Clearasil was invented in the  United States  in 1950 by  Ivan Combe  with the help of chemist Kedzie Teller. At this time, it was the first dermatological brand created specially for younger skin to fight against pimples ( acne ). The active ingredients in the original product were  sulfur  and  resorcinol , similar to the pre-existing adult acne product  Acnomel . Combe used the popular  ABC  television show  American Bandstand  to help promote the product and its superior smell. [ 1 ] [ unreliable source? ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4910", "text": "In 1960 the brand was bought by  Richardson-Vicks . [ 1 ]  In 1975,  Wolfman Jack  signed a contract promoting the product Clearasil Acne Ointment. In 1985  Richardson-Vicks  was acquired by  Procter & Gamble  together with Clearasil. In 2000 Clearasil moved to the  Boots Group  portfolio. In 2006  Boots Healthcare International  was purchased by the  British - Dutch  company  Reckitt Benckiser ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4911", "text": "A 2018 ad titled  Pimples Make Terrible Prom Dates  was called homophobic by critics, who accused it of promoting  anti-gay stereotypes . The ad features 2 teenage girls preparing for Prom, when one discovers a pimple. The pimple is shown as an effeminate man with a shrieking voice in a pink ruffled suit who punctuates his words with a flamboyant kick before flipping his hair back and settling into a pointed toe pose. After, an application of Clearasil kills it, and their prom dates are saved. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4912", "text": "Cover FX  is an American cosmetics company headquartered in New York."}
{"_id": "WikiPedia_Dermatology$$$corpus_4913", "text": "Cover FX was founded in 1999 [ 1 ]  by  chemist  Victor Casale [ 2 ]  and Lee Graff in a  Toronto  clinic to create cosmetics specializing in skin issues and sensitivities. [ 3 ]  The line was first sold in 2002 solely through referral by  dermatologists . After the company and a client of theirs who had suffered from rosacea were profiled on  Citytv , the media and social exposure led them to sell their line in retail stores, [ 4 ]  initially through Canadian drug store chain  Shoppers Drug Mart , [ 5 ]  before chains in the UK, US, Hong Kong, and Australia. [ 6 ]  The company was acquired by  L Catterton  in 2011, [ 7 ]  which sold the company to AS Beauty in 2022. [ 8 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4914", "text": "In the 2010s Cover FX was picked up by social media influencers, [ 11 ]  after which it began releasing new products. In 2016 the company began producing highlighters, [ 12 ]  and in 2017 they added a line of shimmer products called Glitter Drops [ 13 ]  as well as a sealing spray. [ 14 ]  In 2018 the company released the Power Play Foundation, [ 15 ]  a forty color line of semi-matte foundation for oily skin types, [ 10 ]  as well as a concealer. [ 16 ]  The company also runs a shade matcher on its website for those looking to match colors to their skin shade. [ 17 ]  In 2020, it added a virtual try-on aspect to its website. Then, in 2021 the company released a skin moisturizer, [ 9 ]  as a part of a new skin care line. [ 18 ]  In 2024 Cover FX partnered with  Paris Jackson  for the  2024 Grammy Awards , where Jackson used the company's Total Cover Cream Foundation to cover-up the tattoos on her arms during the event. [ 19 ]  The company then partnered on the same product with several  TikTok  content creators in February. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4915", "text": "Dermalogica  is an American  personal care  company headquartered in  Carson, California . [ 1 ] [ 2 ]   Its products include cleansers, exfoliants, toners, masques, eye treatments, and moisturizers, as well as an acne treatment line for teens. [ 1 ] [ 3 ] [ 4 ] [ 5 ]  Dermalogica has primary operations in the  United States , the  United Kingdom ,  Canada ,  Australia ,  India ,  Pakistan , and  Ireland , and is sold in more than 80 countries worldwide."}
{"_id": "WikiPedia_Dermatology$$$corpus_4916", "text": "As of August 1, 2015, Dermalogica, Inc. operates as a subsidiary of  Unilever . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4917", "text": "In 1983, Jane Wurwand, a tenured skin therapist and licensed instructor, arrived in Los Angeles, following a brief time in South Africa. [ 6 ]  Approximately six months earlier, her then-boyfriend (now-husband) South African Raymond Wurwand took a job as a sales representative for a company selling equipment to the skin care industry. [ 6 ] [ 7 ]  Together, they hosted skin therapy classes in the company\u2019s showroom to educate students and promote the equipment. [ 6 ]  Following the success of their educational programs, Jane and Ray Wurwand created a business plan to continue their courses. By the end of 1983, the couple had launched the school that became the first International Dermal Institute (IDI) in Marina Del Rey. [ 6 ]  Two years later, Wurwand set out to develop products free of common skin irritants, including  lanolin ,  SD alcohol ,  mineral oil ,  artificial colors , and  fragrances . [ 8 ]  This was inspired by student requests, as well as a lack of existing products that Jane Wurwand could use on her skin, which experienced  dermatitis  and  chronic eczema . [ 6 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4918", "text": "Dermalogica was created and premiered in 1986 as a skin care line, sold in concept spaces and in authorized salons, spas, and beauty supply stores. [ 3 ] [ 7 ] [ 8 ]  As of 2013, Dermalogica has more than 100,000 trained skin therapists around the globe and 22 concept spaces in North America, Europe, Asia, Australia, Africa, and the Middle East; [ 3 ] [ 7 ] [ 10 ] [ 11 ]  the concept spaces and/or hybrid learning centers worldwide are dedicated to bringing consumer and professional education, professional treatments, and retail sales together under one roof. [ 3 ] [ 12 ] [ 13 ] [ 14 ]  Dermalogica continues to operate The International Dermal Institute (IDI), a provider of postgraduate skin care education. [ 15 ]  With 38 postgraduate training centers and 45 international affiliates, IDI trains more than 75,000 professional skin therapists every year. [ 15 ] [ 16 ]  IDI is also responsible for the research and development of Dermalogica treatments and products. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4919", "text": "In 2011,  The Sunday Times  published an article called \"The Woman Who Started a Cult,\" referring to the brand's cult-like following and Germany's suspicion that Dermalogica was affiliated with  Scientology . In the article, Jane Wurwand said, \"We had to sign a document declaring we had never been affiliated with Scientology, because there were all these people smiling, saying the same thing so enthusiastically. They assumed we did a form of brainwashing. I suppose I can see why \u2014 we do talk about Dermalogica like a tribe on a mission.\" [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4920", "text": "Dermalogica has won awards and been recognized by publications, including  InStyle ,  Harper's Bazaar ,  New Woman ,  Beauty LaunchPad , Cosmetic Executive Women (CEW),  Allure , American Spa, American Salon, Shecky's,  Life & Style , The UK Beauty Awards,  Vogue , Guild Awards of Excellence, and  CoolBrands . [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4921", "text": "Dr. Hauschka  is a German  skincare  company that produces natural skincare products using  biodynamic ,  fair trade , and sustainably produced ingredients. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4922", "text": "Dr. Hauschka was founded in 1967 in Germany by chemist  Rudolf Hauschka . [ 3 ] [ 4 ]  Hauschka had co-founded WALA Heilmittel (\"WALA\"), a holistic pharmaceutical company, in 1935. [ 5 ] [ 6 ]  The concept for the company, using holistic ingredients to create medicines, was inspired by the organic farming work of  Rudolf Steiner . [ 7 ]  Esthetician Elisabeth Sigmund contacted Hauschka in the early 1960s about her research using herbs in skincare. Sigmund and Hauschka worked together for two years to create what would become Dr. Hauschka. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4923", "text": "The first product created was a facial oil made with essential oils. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4924", "text": "In 2017, the brand launched a make up line. [ 8 ]  As of 2019, Martina Joseph serves as Dr. Hauschka's chief executive officer. [ 3 ]   [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4925", "text": "The company produces face and body products, including face creams, hair care, makeup, bronzers, bath oils, and deodorant. [ 10 ] [ 11 ]  Dr. Hauschka uses organic and biodynamic ingredients grown in company-owned and operated German farms. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4926", "text": "The brand's products have been endorsed by  Jennifer Lopez ,  Anne Hathaway ,  Julia Roberts ,  Jennifer Aniston , and  Nikki Reed . [ 9 ] [ 12 ] [ 13 ] [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4927", "text": "Estheticians are trained at the Dr. Hauschka Academy in Germany. At the academy, they are taught about the products and how to give facials.  [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4928", "text": "Dr. Jart+  ( Korean :\u00a0 \ub2e5\ud130\uc790\ub974\ud2b8 ; read simply as  Doctor Jart ) is a  South Korean   skin care  brand. It was founded in 2004 by  Lee Jin-Wook , with consultation from  dermatologist  Jung Sung-jae. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4929", "text": "In 2003, Lee Jin-Wook ( Korean :  \uc774\uc9c4\uc6b1 ) began research on  BB cream . [ 2 ]  To further develop his product, he reached out to Dr. Jung Sung-jae ( Korean :  \uc815\uc131\uc7ac ), who was testing new treatments for patients with severe skin issues. [ 3 ]  Lee asked Jung to invest in his product to bring Jung's formulations to a wider audience. [ 3 ]  The name \"Jart\" was initially coined as a  portmanteau  of \"Jung\" and \"art\". [ 2 ]  Jung remains the brand's chief dermatologist. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4930", "text": "Dr. Jart+ was in development for three years before being launched into dermatological clinics. [ 1 ]  It was officially launched for commercial use in December 2004. [ 2 ]  Dr. Jart+ was first sold through  e-commerce  sites. [ 2 ]  Its revenue in 2005 amounted to 500 million won (around $4.725million, in 2005). By 2008, sales had reached seven billion won. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4931", "text": "In the early days of Dr. Jart+, Lee focused mostly on exporting Dr. Jart+ from Asia, theorizing that the brand's popularity in Asian territories would translate to success in other regions. [ 5 ]  The brand partnered with the Japanese department store  Takashimaya  in June 2009 to offer its products at the store's now-defunct  Fifth Avenue  location. This move made Dr. Jart+ the second Korean brand since  Amorepacific  to have a presence in  New York . [ 2 ]  It entered the American market in early 2011 in partnership with cosmetics retailer  Sephora , offering two BB creams at ten of its then-locations. [ 5 ] [ 6 ]  The brand has since expanded to sell 50 products at Sephora outlets globally. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4932", "text": "Dr. Jart+ is composed of nine lines, each focused on a specific ingredient or skin issue:"}
{"_id": "WikiPedia_Dermatology$$$corpus_4933", "text": "Dr. Jart+ is considered to be one of the brands that led the  Korean beauty  wave. [ 7 ]  It avoids celebrity endorsements in favor of its own  animations  to communicate a sense of wittiness. [ 5 ]  In 2018, its branding and packaging was refreshed, starting with its newly created Ceramidin line. [ 8 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4934", "text": "According to Ju Rhyu, a  business-to-business  consultant, Dr. Jart+ already has a \"very clear brand identity\" and is therefore keen to downplay the K-beauty angle. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4935", "text": "Drunk Elephant  is a  Houston -based skincare brand that was acquired by  Shiseido  in 2019 for $845 million. [ 1 ] [ 2 ] [ 3 ]  The brand was originally founded in 2012 by \"stay-at-home mom\"  Tiffany Masterson [ 4 ]  as part of the clean beauty movement and had its public launch in August 2013."}
{"_id": "WikiPedia_Dermatology$$$corpus_4936", "text": "After its launch, Drunk Elephant became one of the fastest growing brands in the history of the cosmetics retailer  Sephora , [ 5 ]  fueled in part by its popularity among younger consumers, including pre-teens. Drunk Elephant gained popularity on  TikTok  from \"skincare smoothies\" and is the 4th rated skincare brand in the US.  [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4937", "text": "This United States corporation or company article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4938", "text": "Evolution of Smooth  (more commonly known as  EOS ) is a privately owned beauty and skincare company based in  New York City . EOS was founded in 2006 by Jonathan Teller, Sanjiv Mehra, and Craig Dubitsky. The company makes a variety of body care products such as  lip balm ,  lotion , and  shaving cream . [ 1 ]  Its products are known for using natural and organic ingredients, as well as for their colorful, minimalist packaging."}
{"_id": "WikiPedia_Dermatology$$$corpus_4939", "text": "Jonathan Teller created the EOS lip balm in 2006. In 2015, EOS was the second highest-selling lip care in the world, with 11.5% of the market share in the United States. [ 2 ]  The lip balms are sold at retail stores in 18 countries [ 3 ]  and online through the company's website."}
{"_id": "WikiPedia_Dermatology$$$corpus_4940", "text": "In 2017, EOS sold nearly 2 million units per week globally. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4941", "text": "Between August 6, 2014, and June 12, 2017, 126 complaints were filed to the  U.S. Food & Drug Administration  (FDA) by customers who experienced reactions to EOS lip balm. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4942", "text": "In 2016, a class-action lawsuit was filed against EOS, claiming that the lip balm caused bleeding and blistering. The preliminary settlement for those affected was a reimbursement with products, cash, or more depending on their reactions to the product. According to Buzzfeed News reports, \u201cAffected consumers are eligible to receive either $75 for verified medical expenses, a $15 cash award, $20 worth of EOS products, or up to $4,000 depending on their injuries.\" [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4943", "text": "Ultimately, EOS settled five proposed class action lawsuits. The final terms of the proposed EOS class action settlement were not disclosed, however, the company said it would include a warning on the lip balm packaging and the product website. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4944", "text": "The company later published on social media that its products are safe to use, [ 7 ]  claiming their products are \"hypoallergenic, dermatologist tested, made with the highest quality ingredients, meet or exceed all safety and quality standards set by our industry and are validated by rigorous safety testing conducted by independent labs\". [ 8 ]  The company also placed safety tips on its packaging to warn consumers of potential irritation. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4945", "text": "EOS products are known for using natural and organic ingredients as well as for their colorful, minimalist packaging and design targeted toward women. [ 10 ]  In its early days, EOS relied on endorsements from celebrities, such as  Kim Kardashian  and  Miley Cyrus , who frequently posted about EOS products on social media. [ 11 ]  Consequently,  Goldman Sachs  included EOS in its list of top 50 brands \"It Girls\" love. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4946", "text": "In March 2018, EOS launched an advertising campaign that provided free lip balm to customers of  Kellogg's Special K  products. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4947", "text": "Epi.logic  is an American  skincare  company headquartered in  Brooklyn, NY . Founded by oculofacial  plastic surgeon  Dr. Chaneve Jeanniton, [ 1 ] [ 2 ]  \nepi.logic develops products designed particularly for black and brown skin. [ 3 ] [ 4 ]  \nEpi.logic products are designed to address issues like  sensitive skin , [ 5 ]  over-drying, [ 6 ]  and  hyperpigmentation . [ 7 ] [ 8 ]  Hyperpigmentation is of particular concern to people with  melanin  overproduction, and many methods to treat it have been found to be unsafe. [ 9 ] [ 10 ]  Epi.logic develops formulas that eliminate unnecessary  additives [ 11 ]  present in other skin care products that can cause unwanted reactions."}
{"_id": "WikiPedia_Dermatology$$$corpus_4948", "text": "The Face Shop  ( Korean :\u00a0 \ub354\ud398\uc774\uc2a4\uc0f5 ) (stylized as  THE FACE SHOP ) is a  South Korea \u2013based  skincare and cosmetics  manufacturer, retailer and a franchise business. It is a subsidiary of  LG Household & Health Care  of  LG Corporation . Its products include body, bath, skin care and make-up aimed at both women and men. Its headquarters is in the LG Gwanghwamun Building in  Jongno-gu ,  Seoul ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4949", "text": "The Face Shop was launched in 1947 with one store in  Myeongdong . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4950", "text": "The company's marketing is largely based on natural products."}
{"_id": "WikiPedia_Dermatology$$$corpus_4951", "text": "The CEO of TheFaceShop Co., Ltd. is Jeong Un-ho ( Korean :\u00a0 \uc815\uc6b4\ud638 )."}
{"_id": "WikiPedia_Dermatology$$$corpus_4952", "text": "It opened its 100th store in June 2004 and became the third largest cosmetics company in South Korea in December 2005. It continued to expand and entered the overseas market opening its 100th store in April 2006 and flagship store in Beijing in March 2008. There are stores in countries including Australia, Brunei, Cambodia, Canada, China, the Dominican Republic, India, Indonesia, Japan, Jordan, Kuwait, Malaysia, Mongolia, the Philippines, Singapore, Sri Lanka, Taiwan, Thailand, UAE, United States, Costa Rica, and Vietnam. As of April 2012, it has 930 stores in 24 countries. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4953", "text": "In November 2009, the company was bought by LG Household & Health Care and became a subsidiary in January 2010. At the time of acquisition The Face Shop had annual sales of \u20a9250 billion with an operating margin of 19 percent. LG purchased a 90 percent stake with 70.2 percent from the biggest shareholder, Shepherd Detachering B.V., and 19.8 percent of the 29.8 percent from founder and president Jung Woon-ho. This amounted to a payment of \u20a9350 billion in total with \u20a9278.5 billion and \u20a971.5 billion paid respectively. [ 3 ]  In 2014, the company bought the Canadian bath and body line Fruits and Passion, and eventually most locations of Fruits and Passion were converted into The Face Shop. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4954", "text": "The Face Shop products include makeup, skin care, hair & body, nail, and men's care products, such as Hydro Splash BB Cream, Extreme Volume Mascara-Lash Stretch, [ 5 ]  Gel Eyeliner, [ 6 ]  and Natural Sun SPF 45. [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4955", "text": "In August 2012, as part of  Lotte Department Store 's expansion programme into China, a replica of Seoul\u2019s main shopping district  Myeongdong  was featured in its new store in  Tianjin , with outlets of  Missha , The Face Shop and  Skin Food . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4956", "text": "Actor  Bae Yong-joon  was the primary spokesperson in Korea and appeared in a variety of advertisements.  Kim Hyun-joong  of  SS501  has since 2010 been the official model for the brand, together with  Seohyun  of  Girls\u2019 Generation . Kim is the official international ambassador of the brand while Seohyun is the nationwide ambassador."}
{"_id": "WikiPedia_Dermatology$$$corpus_4957", "text": "In 2013,  Suzy  of  Miss A  joined as the new official international ambassador of the brand alongside  Seohyun . In early 2014,  Kim Soo-hyun  joined the brand as the new ambassador in  Asian  countries (except for South Korea, Japan, and Hong Kong)."}
{"_id": "WikiPedia_Dermatology$$$corpus_4958", "text": "In 2007, The Face Shop opened its first stores in the US in the San Francisco Bay Area and the west coast.  To search for spokesmodels for their USA division, they hosted the \"Natural Beauty Contest\".  The grand prize was over $20,000 in cash and prizes for the winners as well as a one-year contract as The Face Shop US spokesmodel. Hundreds of applicants were narrowed to 80 models for Round 1. The final round of 34 finalists yielded six winners."}
{"_id": "WikiPedia_Dermatology$$$corpus_4959", "text": "The Face Shop products can now be found in The Face Shop stores and Walgreens across the United States."}
{"_id": "WikiPedia_Dermatology$$$corpus_4960", "text": "Forever Living Products  is a  multi-level marketing  company which was founded in 1978 in  Tempe, Arizona  by  Rex Maughan . [ 1 ]  The company has reported a network of 9.3 million distributors and revenue of $4 billion in 2021, and in 2006 they reported having 4,100 employees. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4961", "text": "Forever Living was founded in 1978 in  Tempe, Arizona  by  Rex Maughan . [ 1 ]  By the 1990s, Rex Maughan had purchased the  Texas  company Aloe Vera of America, with Aloe Vera of America selling its products to Forever Living for distribution. [ 4 ]  Some journalists have likened the  multi-level marketing  business model of Forever Living's distribution system to that of a  pyramid scheme . [ 5 ] [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4962", "text": "In 1983, the company was named No. 6 on  Inc. Magazine 's annual Inc. 500 list of the fastest-growing private companies in the  United States . [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4963", "text": "According to Arthur Andersen's Top 100, as of 1993, Forever Living Products International was Arizona's second-largest private company. [ 9 ]  As of August 1995,  Forbes  reported the company's product line included \"deodorants, toothpaste,  laundry detergent  and three dozen other products, nearly all of which contain extract of aloe.\" [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4964", "text": "A three-part special report by the  Manila Times  in 2003 discussed similarities between FLPI's business model and an illegal  pyramid scheme , noting that FLPI participants are said to be rewarded primarily for recruiting new members to the organization, rather than for selling products to genuine end-users. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4965", "text": "Forever Living reported unaudited annual revenue exceeding $1.15 billion in 2005 [ 2 ]  and ended the year with around 150,000 distributors [ 12 ]  and 55 employees. [ 13 ]  The following year, Forever Living was listed at No. 340 on the  Forbes 400  list, which ranks the largest private companies in the United States. At the time, the company was described as having 4,100 employees and sold its product in 100 countries. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4966", "text": "In 2010, the company reported unaudited revenue of $1.7 billion and a network of 9.3 million distributors. [ 3 ] \nIn 2013 the publication  New Vision  reported that Forever Living had over 20,000 distributors in  Uganda , of which only 83 had reached a managerial level and begun to recoup expenses; their investigation concluded that Forever Living Products' \"distribution system does not guarantee profits and majority of members drop out along the way, after losing millions.\" [ 14 ] \nThe company was active in over 165 countries as of 2018. [ 1 ]  In February 2015, the company announced they had appointed a new management team to \"oversee the affairs of the company in  Nigeria .\" [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4967", "text": "In January 2023, the company named Aidan O'Hare as President with Gregg Maughan, son of founder  Rex Maughan , continuing as CEO. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4968", "text": "In 1996, upon suggestion of the American authorities, the  Internal Revenue Service  (IRS) and the  National Tax Agency  of Japan (NTA) initiated a joint audit of Rex and Ruth Maughan and related entities Aloe Vera of America (AVA), Selective Art Inc., FLP International, and FLP Japan for the period of 1991 to 1995. [ 17 ]  In 1997, the NTA imposed a penalty tax of 3.5 billion yen on Forever Living's  Japan  division for concealing income of 7.7 billion yen over the five-year period. [ 18 ]  Later that year, AVA, Rex and Ruth Maughan, Maughan Holdings, Gene Yamagata, and Yamagata Holdings [ 19 ]  sued the IRS for unauthorized disclosure of tax return information. [ 18 ]  In the midst of the lawsuit, The IRS asked the NTA to drop its decision against Forever Living, and in 2002, the agency \"grudgingly complied with the IRS's request\", announcing that the penalty tax had been effectively withdrawn. [ 18 ]  In February 2015, a US district court ruled that the IRS knowingly provided some false information about AVA to the NTA, in violation of the United States' tax treaty with Japan [ 20 ]  and awarded three of the plaintiffs one thousand dollars each in statutory damages. [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4969", "text": "In 2004, claims made about Forever Living products were found to be in violation of several laws in Hungary related to advertising, registration of nutritional products, and the use of cosmetics as medicinal agents. As a result, the company was fined 60 million HUF (approximately US$280,000). [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4970", "text": "In 2007, author  Richard Bach  made claims against the company for  copyright infringement  and  trademark infringement . [ 22 ]  The lawsuit stated that for over 20 years Forever Living had used the character, storyline, and copyrighted excerpts from the novel  Jonathan Livingston Seagull  to promote its marketing plan, and also used the  motion picture  and novel as its corporate logo. [ 23 ] [ 24 ]  The claim was satisfied through arbitration, [ 25 ]  and shortly after, Forever Living changed its company logo [ 26 ]  from a seagull to an eagle. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4971", "text": "In 2015, Forever Living was criticized by the UK Advertising Standards Authority for making false claims about the health benefits of its products, which were sold as a cure for various diseases ranging from diabetes to Crohn's disease. The company was also warned not to use health professionals in its promotional materials. Subsequently, the UK Medicines And Healthcare Products Regulatory Agency launched an investigation after it was revealed that  NHS  staff were moonlighting as sales people. [ 28 ] [ 29 ] [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4972", "text": "Between 2012 and 2016, several lawsuits were initiated by the Environmental Research Center (ERC) against Forever Living Products over alleged violations of  Proposition 65  (the Safe Drinking Water and Toxic Exposure Act). [ 31 ]  The ERC accused Forever Living Products of having unsafe levels of lead in products manufactured by Aloe Vera of America and distributed by Forever Living. [ 32 ]  The claims were determined to be unfounded and the case was dismissed in the  California Supreme Court  in October, 2016. [ 33 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4973", "text": "Freederm  is a UK brand of  acne  and skin care medication manufactured by Diomed Developments Limited. The products include  Nicotinamide  as an active ingredient, which is claimed by the company to be \"clinically proven to help get rid of inflamed red spots\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_4974", "text": "The brand has been heavily involved in  television sponsorship  in recent years, sponsoring series  11  &  12  of reality television show  Big Brother  and its  Celebrity  and  Ultimate  spin-offs in a reported \"multi-million pound deal\". [ 1 ]  It was also the sponsor for the second series of  ITV   dating gameshow   Take Me Out , [ 2 ]  and teenage vampire drama  The Vampire Diaries ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4975", "text": "Gold Bond  is a brand of  over-the-counter  skin care products produced by  Chattem  of  Chattanooga, Tennessee , now a subsidiary of the  French  pharmaceutical company  Sanofi . It is available as both a  powder  and a  topical  cream. Gold Bond is used to curb moisture, control odor, and soothe minor skin irritations, notably  jock itch . Spin-off products are designed for specific uses, such as foot powders or powders for infants to treat  diaper rash ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4976", "text": "The active ingredient of Original Strength Gold Bond Powder is  Menthol . [ 1 ]  Inactive ingredients include  talc  and  zinc oxide . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4977", "text": "The history of Gold Bond dates to 1882, when it was first developed by physicians of the Rhode Island State Medical Association. The formula was purchased by Arthur W. Guilford in 1908, who established the Gold Bond name and began making the product in  Fairhaven, Massachusetts . The formula and rights were sold in 1912 to John M. Chapman of  New Bedford, Massachusetts , who achieved greater brand recognition and distribution. Timothy F. Shea, who in 1930 joined what was then \"The Gold Bond Sterilizing Powder Company\", eventually rose to general manager and treasurer, and later took over as sole owner. His son, Robert J. Shea, took over as president of the company in 1965. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4978", "text": "The Gold Bond company sold rights to three of its brands, including Gold Bond Powder, to  Block Drug Corporation  in August 1987. [ 4 ]  The brand was then sold to Martin Himmel Inc. in March 1990. [ 5 ]  To this point, the brand had remained a regional product of New England; [ 5 ]  soon after its purchase, Himmel began a national marketing campaign which saw sales increase by over 70% annually. [ 6 ] [ 7 ]  By 1995, Gold Bond was a US$27 million business, [ 7 ]  and was sold to  Chattem  in April 1996 for $40 million. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4979", "text": "Head & Shoulders  ( H&S ) is an American  brand  of anti- dandruff  and non-dandruff  shampoo  produced by parent company  Procter & Gamble ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4980", "text": "The active anti-fungal ingredient in Head & Shoulders is  piroctone olamine [ 2 ]  or  zinc pyrithione , [ 3 ]  with some \"clinical strength\" varieties also containing  selenium disulfide . [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4981", "text": "Head & Shoulders was introduced in the  United States  on 1 January 1961 based in  Manhattan  and used the slogan \"THE AMERICA AND WORLD's NO. 1 SHAMPOO\". [ 4 ]  It was patented in January 1962. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4982", "text": "It was referred to as \"The America and World's Number One Anti- Dandruff  and Non- Dandruff  Shampoo Brand\" of shampoo, and it was noted that \"no one hair care brand gets so many ad dollars as Head & Shoulders, a twenty year old brand, and no other brand matches its sales\", despite it being a \"medicated\" shampoo. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4983", "text": "The brand has long been marketed under the  tagline  \"You Never Get a Second Chance to Make a First Impression\", which has been identified as an example of \"anxiety marketing\" commonly used by  Procter & Gamble  to drive sales by inducing fears of social consequences associated with the condition that the product claims to address. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4984", "text": "Official Website China"}
{"_id": "WikiPedia_Dermatology$$$corpus_4985", "text": "Official Website Hong Kong"}
{"_id": "WikiPedia_Dermatology$$$corpus_4986", "text": "Official Website Taiwan"}
{"_id": "WikiPedia_Dermatology$$$corpus_4987", "text": "Helioplex  is a formulation of broad-spectrum  ultraviolet  (UVA and UVB) skin protection containing  avobenzone  and  oxybenzone  made by  Neutrogena ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4988", "text": "Avobenzone-containing products have decreasing efficiency after a few hours of sun exposure, but the manufacturer claims that the addition of oxybenzone reduces the amount of degradation that occurs. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4989", "text": "Aveeno  advertises its products using this formulation under a different name of \"Active Photobarrier Complex.\""}
{"_id": "WikiPedia_Dermatology$$$corpus_4990", "text": "In'oya  is a French dermo-cosmetics company established in 2011 [ 1 ]  which centers its research around the specific characteristics of black and brown skin. Based on  genetic engineering  and its scientific research work around  melanogenesis , In'oya Laboratory has discovered the processes that cause the appearance of dark spots on skin of color and has patented a treatment to reduce these spots. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4991", "text": "In'oya Laboratory was founded in 2011 by Abd Haq Bengeloune, [ 3 ]  a young biomedical engineer of Senegalese origin working alongside a team of researchers from the  CNRS  of Saint-J\u00e9r\u00f4me in Marseille and the  INSERM  at the School of Pharmacy in La Timone. The goal was to create a dark spot reduction treatment which takes into account the specific genes of skin of color. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4992", "text": "In 2013, Cr\u00e9dit Agricole Alpes-Provence Cr\u00e9ation enters into a fundraising campaign with In\u2019oya Laboratory. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4993", "text": "In 2014, In'oya Laboratory develops a technological innovation capable of blocking the  TYRP1  gene and the  Tyrosinase  enzyme to act on hyper-pigmented spots. [ 7 ]  Applications for a European patent  EP 2705830 \u00a0  and an international patent  WO 2014037111 \u00a0  are filed in partnership with Aix-Marseille University and the  CNRS  ."}
{"_id": "WikiPedia_Dermatology$$$corpus_4994", "text": "In 2015, In'oya Laboratory wraps up a \u20ac430,000 fundraising campaign with PACA Investissement, CAAP Cr\u00e9ation and CPG with the goal of continuing its  R&D  efforts and launching a new line of skincare products in France and Africa."}
{"_id": "WikiPedia_Dermatology$$$corpus_4995", "text": "In 2015, In'oya Laboratory launches the sales of its products to French pharmacies. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4996", "text": "In 2011, In'oya Laboratory receives the \"Best Project of the Year\" prize during the 13th annual \"Le Phare de l\u2019Entrepreneuriat\" competition hosted by ACCEDE Provence. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4997", "text": "In 2011, Abd Haq Bengeloune is named \"Top African Entrepreneur in France\" by the Africangels business angels network, whose aim is to support and enhance the value of multicultural entrepreneurs contributing to the development of the French economy. [ 10 ] [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4998", "text": "In 2012, In'oya Laboratory is recognized at the 17th annual \"Troph\u00e9es de L\u2019Economie\" hosted by  La Provence  to highlight the value of innovative companies in the region. [ 12 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_4999", "text": "In 2012, In\u2019oya Laboratory wins the \"Innovate, Buzz, Win\" competition sponsored by  Carrefour , which awarded the company an opportunity to sell its products in more than 200 Carrefour shops in France. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5000", "text": "In'oya Laboratory is committed to a sustainable development approach through the sourcing of its supplies from the  Great Green Wall , a wall of trees that connects  Dakar  to  Djibouti  along the southern edge of the  Sahara , which is cultivated and maintained by local populations. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5001", "text": "Johnson's Baby  is an American brand of baby  cosmetics  and skin care products owned by  Kenvue . The brand was introduced in 1893 with Johnson's Baby Powder. The product line consists of  baby powder ,  shampoos , body  lotions , massage oil, shower gels and  baby wipes ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5002", "text": "Johnson's Baby Powder was an invention of Dr.  Frederick B. Kilmer , company's first director of scientific affairs. [ 1 ]  In 1892 responded to a letter from a physician about a patient suffering skin irritations after using medicated plasters. Kilmer suggested to use scented Italian  talcum  powder to mitigate the irritation and sent a can to the doctor. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5003", "text": "Baby Powder debuted in 1893 and went to the market in 1894. [ 3 ]  The earliest Baby Powder was in a yellow and red tin with a label \"For Toilet and Nursery\u201d. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5004", "text": "According to Robert Shook, sanitary napkins were included in the young mother's kit but never considered a separate product until customers asked the company for it."}
{"_id": "WikiPedia_Dermatology$$$corpus_5005", "text": "In 1893 the talc was packaged in a box that was originally distributed to midwives and given to mothers following childbirth... Also in the midwife's box were twelve sanitary napkins. Prior to this, there was no such product available to purchase... the company started to manufacture them \u2013 the first company to make sanitary napkins in the United States. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5006", "text": "The first baby to appear on Johnson's Baby powder label was  Mary Lea Johnson Richards , granddaughter of  Robert Wood Johnson I  (co-founder of  Johnson & Johnson ). [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5007", "text": "According to Johnson & Johnson's representative Fred Tewell, baby powder-scented cleaning products became almost a standard not only to cosmetics, but to diapers as well. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5008", "text": "Johnson & Johnson issued a recall of its Baby Powder in October 2019 after the  United States Food and Drug Administration  discovered trace amounts of  asbestos  in a bottle. [ 8 ]  After over 100 years, the company announced on May 20, 2020 that its talc-based Baby Powder would be discontinued in the  United States  and  Canada , following declining sales and backlash from recent lawsuits over allegations that the product contained  asbestos , which can cause  cancer . However, cornstarch-based Baby Powder will continue to be sold in both the  United States  and  Canada . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5009", "text": "On October 15, 2021, Johnson & Johnson put its talc liabilities into  Chapter 11 bankruptcy  in the United States. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5010", "text": "On April 4, 2023, J&J's talc liabilities once again filed for bankruptcy. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5011", "text": "Johnson's Baby cream was introduced in 1921. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5012", "text": "According to Margaret Gurowitz, Johnson & Johnson's corporate historian, in 1921 the company released its first \"Baby Gift Box\" that contained small packages of Baby Powder, Baby Cream and Baby Soap and \"was designed as a small gift that people could take when visiting a family with a new baby\". [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5013", "text": "Introduced in 1938 [ 13 ] [ 14 ]  Johnson's Baby massage oil was heavily advertised nationwide in  Life magazine [ 15 ]  since 1943 as a complementary product to Baby Powder. [ 16 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5014", "text": "Often referred as the \"Pink Brand\" [ 17 ]  (after the color of the bottle), Johnson's Baby Lotion appeared in 1942. [ 7 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5015", "text": "\"No More Tears\" shampoo was introduced in 1953. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5016", "text": "Nunes and Johnson wrote:"}
{"_id": "WikiPedia_Dermatology$$$corpus_5017", "text": "In 1953 Johnson & Johnson introduced its No More Tears baby shampoo... with the company introducing  amphoteric  cleansing agents to consumer use. Though these agents are not as effective as traditional soaps, they are extremely mild, which makes them quite literally  easy on the eyes  and perfect for a baby's sensitive but presumably not-too-dirty skin... Within six months of its introduction, Johnson & Johnson had captured 75 percent of the baby shampoo market, a share it held as recently as 1995. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5018", "text": "In 1955 Johnson & Johnson placed advertising at the \" Adventures of Robin Hood  TV series for  Band-Aid  and Johnson's baby shampoo. The latter was advertised with the tagline \"Johnson's can't burn eyes\". [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5019", "text": "\"No More Tears\" has been registered as a trademark only since 1959. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5020", "text": "A persistent myth holds that this should in fact be read as \"no more tears (/t\u025b\u0259/)\", in the sense meaning a rip in hair, but the correct reading is in fact \"no more tears (/t\u026a\u0259/)\" in the sense of ocular secretion, in this case meaning it does not sting eyes if a small amount accidentally enters them, due to the molecular structure of the formula. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5021", "text": "The company also made changes to their entire range of products, eliminating ingredients [ 23 ]  like  formaldehyde , parabens, triclosan and phthalates from all baby products. [ 24 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5022", "text": "\"No More Tangles\" shampoo (named after popular \"No More Tears\" shampoo) debuted in 1971. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5023", "text": "In 1976 the brand entered publishing business with the book  Infant development program: birth-12  months by Richard A. Chase, [ 26 ]  followed by  The First wondrous year: you and your baby  (1979) by Chase and Richard R. Rubin. [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5024", "text": "Johnson's baby wipes appeared in 1980 as Johnson's Baby Wash Cloths. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5025", "text": "The product was renamed \" wipes \" sometime during 90s (the product has already been present as early as 1990 [ 29 ] )."}
{"_id": "WikiPedia_Dermatology$$$corpus_5026", "text": "Sun screen was introduced in Spring 1991. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5027", "text": "Head-To-Toe ultra mild  cleanser  was introduced in 1997. [ 31 ] [ 32 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5028", "text": "Bedtime Bath introduced in 2000 [ 33 ]  was the first of products later known as Johnson\u2019s Baby Bedtime range with four products (Bedtime Bath, Bedtime Lotion, Bedtime Wash and Bedtime Oil) that contain  lavender  and  camomile . [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5029", "text": "Johnson's Baby products are also used for non-baby-related purposes. For example, Johnson's  Baby Oil  is used as a facial  cleanser  (it has been reported by the  New York magazine  that popular TV talk show host  Martha Stewart  uses it this way [ 35 ] ) and by male  strippers [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5030", "text": "In December 1985 two physicians urged parents not to use baby powder, stating that it was unsafe to inhale and Johnson & Johnson responded with an official statement that \"product is safe when used as it is intended\". [ 37 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5031", "text": "In February 2016, J&J was ordered to pay $72 million in damages to the family of Jackie Fox, a 62-year-old woman who died of ovarian cancer in 2015. She had used Johnson's Baby Powder for many years. J&J claimed that the safety of cosmetic talc is supported by decades of scientific evidence and it plans to appeal the verdict. The British charity, Ovacome was quoted as saying that while there were 16 studies which showed that using talc increased the risk of ovarian cancer by around a third, and a 2013 review of US studies had similar results for genital, but not general, talcum powder use they were not convinced that the results were reliable. Furthermore, they said, \"Ovarian cancer is a rare disease, and increasing a small risk by a third still gives a small risk.\" [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5032", "text": "In 2007  Johnson & Johnson  sponsored \"1st European Round Table meeting on 'Best Practice for Infant Cleansing\" (a panel of expert dermatologists and paediatricians from across Europe) focused on the use of liquid cleansers in bathing as opposed to washing with water which said that \"bathing is generally superior to washing, provided basic safety procedures are followed, and has psychological benefits for the infant and parents\". [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5033", "text": "A randomized clinical trial, sponsored by Johnson's baby brand in 2010, studied the effectiveness of using moisturizer as part of a standardized skin care regimen. Research showed that using baby lotion is effective for maintaining favorable moisture levels in baby skin (in comparison to not using baby lotion). [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5034", "text": "In February 2013  Journal of Obstetric, Gynecologic, & Neonatal Nursing  published a research by academics at  The University of Manchester  that showed that washing newborn babies with Johnson\u2019s Baby Top-to-Toe wash is just as safe as using water alone. [ 41 ]  Research has been sponsored by Johnson & Johnson \"but carried out under strict, independent scientific protocols, including blind testing and peer review\". [ 42 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5035", "text": "Jurlique International Pty Ltd , [ 1 ]  is an Australian cosmetics manufacturer specialising in  natural   botanical -based  skincare  and cosmetics under the brand name  Jurlique . Jurlique is considered  ethical [ 2 ]  and  environmentally friendly , [ 3 ]  although internationally, it does submit some samples for  animal testing  as mandated by Chinese local laws for products sold in that market. [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5036", "text": "Jurlique was founded in 1985 in the Australian state of  South Australia  by Dr Jurgen Klein and his wife Ulrike. [ 6 ]  The company's name is based on a phonetic combination of their first names. [ 7 ]  The native German couple relocated to a farm in the  Adelaide Hills [ 8 ]  a year prior to the launch of their brand, due to its warm climate. Jurgen was a  biochemist  and  naturopath , who had previously worked for German  holistic  skincare brand  Dr. Hauschka . [ 6 ]  and Ulrike was a  horticulturalist  and  botanist . [ 9 ]  Today [ when? ]  the farm is still part of the company [ 6 ]  and Jurlique claims to be the number two prestige skincare brand in Australia. The brand is sold in over 5,000 stores worldwide, including over 58 Jurlique concept stores, 18 of which located across Australia. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5037", "text": "Julia Roberts ' character (Cpt. Katherine \"Kate\" Hazeltine) was shown using Jurlique hand cream in an airplane rest room during the 2010 film  Valentine's Day ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5038", "text": "Originally created as a niche natural skincare range, [ 6 ]  in 2002, the company was purchased for $25\u00a0million by Australian billionaire businessman  Kerry Packer . [ 11 ]  Packer's son  James , along with American companies Triarc Companies and JH Partners resold the company in 2011. Public Japanese company Pola Orbis Holdings purchased Jurlique for $355\u00a0million. Orbis plans to expand the business, particularly into Asia. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5039", "text": "Keri  is an American brand of  moisturizing lotion  that was introduced by  Novartis Consumer Health . The brand has traditionally included different types of Keri Lotion such as Keri- Original, Keri- Advanced, Keri- Shea Butter, Keri- Basic Essential, Keri- Luxurious, and Keri- moisture rich oil. Keri lotion was a product of Westwood Pharmaceutical of  Buffalo, New York . It was later purchased by Bristol-Myers Squibb."}
{"_id": "WikiPedia_Dermatology$$$corpus_5040", "text": "Keri Lotion was first introduced by  Westwood Pharmaceuticals  to the American public in 1960. Keri lotion was put into doctor offices and hospitals, which was how the product was promoted. [ 1 ]  In 1998, Bristol Myers spent $6 million on advertising its original Keri Brand. In 1999, it was expected to double."}
{"_id": "WikiPedia_Dermatology$$$corpus_5041", "text": "Keri Lotion is now owned by Crown Laboratories, who purchased it on May 1, 2019."}
{"_id": "WikiPedia_Dermatology$$$corpus_5042", "text": "Keys Soulcare  is a beauty and wellness  lifestyle brand  by American singer and songwriter  Alicia Keys . [ 1 ]  It includes a variety of skincare and bodycare products, candles, and cosmetics."}
{"_id": "WikiPedia_Dermatology$$$corpus_5043", "text": "The brand's products were first sold in the UK with  Cult Beauty . [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5044", "text": "In September 2020, Keys announced plans to launch her own lifestyle brand, called Keys Soulcare. [ 4 ]  The brand is a joint venture between Keys and cosmetics retailer  e.l.f. cosmetics , [ 5 ] [ 6 ]  the latter's chief marketing officer Kory Marchisotto acting as the president of Keys Soulcare. [ 7 ] [ 8 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5045", "text": "The brand was launched in December 2020 in the US, early 2021 in the UK. [ 11 ] [ 12 ]  In April 2021, the brand was launched in France, [ 13 ]  then in Canada in March 2022. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5046", "text": "This  product  or  company  article is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5047", "text": "\u039aorres  is a  Greek  company founded in 1996 in  Athens  by pharmacist Georgios Korres from the island of  Naxos ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5048", "text": "The company produces beauty products for women and men, based on natural ingredients (and partly on  homeopathy ) and it was a pioneer in Greece in this sector. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5049", "text": "As of June 2015, the company had stores in ten European countries and in  Singapore  and South Korea."}
{"_id": "WikiPedia_Dermatology$$$corpus_5050", "text": "This article on a Greek company is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5051", "text": "Lypsyl  is a  brand  of moisturising  lip balm  owned by Lornamead. [ 1 ]  Marketing rights in the  UK  and  Ireland  are owned by Alliance Pharma since 2013. It is packaged in a small,  cylindrical , twist action tube and is applied like a  lipstick ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5052", "text": "Lypsyl moisturiser comes in six varieties, namely Original, Peach, Strawberry, Lemon, Cherry, and Mint. [ 2 ]  There is also Lypsyl Sun, with a  sun protection factor  of 35 to protect lips from sun damage and Lypsyl Cold Sore Cream and Gel to  treat and soothe   cold sores . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5053", "text": "Lypsyl is distributed in many countries, including  Scandinavia  and the  UK . It is designed to protect, moisturize, and repair chapped or damaged lips, and to keep them hydrated and soft."}
{"_id": "WikiPedia_Dermatology$$$corpus_5054", "text": "Each Lypsyl lip balm contains  Aloe vera  and  vitamin E . [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5055", "text": "A tube of Lypsyl Original is composed of the following:  petroleum ,  paraffin ,  glyceryl stearate  SE, paraffinum liquidum,  zinc oxide ,  tocopheryl acetate ,  Aloe barbadensis,  and \"aroma\". [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5056", "text": "A tube of Lypsyl Strawberry is composed of petrolatum, paraffin, glyceryl stearate, paraffinum liquidum,  polysorbate 65 , water, aroma,  zinc oxide ,  tocopheryl acetate ,  Aloe barbadensis ,  citric acid ,  sodium saccharin ,  methylparaben ,  CI 16255 ,  propylparaben , and  CI 47005 ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5057", "text": "Manscaped LLC  is a  male grooming  company based in  San Diego , California, United States. It was co-founded in 2016 by Steve King and Paul Tran and produces and distributes male grooming tools and hygiene products under the Manscaped brand. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5058", "text": "Manscaped was established in 2016 by co founders Steve King (original CEO) and Paul Tran (CEO) to provide  male grooming  products targeted at  pubic   hair removal . [ 1 ]  The company uses the term  manscaping , a long-standing  neologism , as the basis of its branding, and is referenced in the  Merriam-Webster  definition of the word. [ 2 ]  It has also capitalized on the shock factor of addressing male  hygiene   taboos , alongside the use of  pun -based  humour  and paid  celebrity  appearances, to build its name. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5059", "text": "In October 2018, Manscaped was featured in the 10th series of  ABC 's \" Shark Tank \", represented by co-founder Steve King and Josh king who sought $500,000 in funding for the company, and accepted a handshake offer for that amount from  Mark Cuban  and  Lori Greiner  in exchange for a 25 percent stake in the business. [ 4 ]  However, the deal never materialized after the show, according to Cuban. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5060", "text": "In late 2020, the company was reported to be exploring its options for further fundraising. At the time, it was backed by investment firms Kaktus Capital, Longley Capital, Rx3 Venture Partners and Scala Ventures. [ 5 ]  A prominent  advertisement campaign  for the company also aired in the same period featuring the  NFL 's  Rob Gronkowski  and US sportswear supermodel  Camille Kostek . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5061", "text": "In July 2021, Manscaped was revealed to be in ongoing merger discussion with Los Angeles-based  blank-check firm  Bright Lights to create a combined entity worth up to $1.4 billion. [ 1 ]  Led by Michael Mahan, the former CEO of  Dick Clark Productions , Bright Lights listed for $230 million on the  Nasdaq   stock market  in January 2021 on the promise of finding a merger target in the consumer products or media sectors. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5062", "text": "In November 2021, it was confirmed that the merger would be going ahead at a valuation of around $1 billion \"amid a difficult market\". This followed reporting in October that suggested the company was considering a $500 million sale. Reuters noted that the merger was all but guaranteed after being backstopped by the actor  Channing Tatum  and two investment firms, Endeavor and  Guggenheim Investments . [ 6 ]  Nevertheless the merger was cancelled by the two companies later the same year. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5063", "text": "Neutrogena Corporation , [ 1 ]  trading as  Neutrogena , is an American company that  produces   cosmetics ,  skin care  and  hair care , is owned by parent company  Kenvue  and is headquartered in  Skillman, New Jersey . [ 2 ]  According to product advertising  at their website, Neutrogena products are distributed in more than 70 countries. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5064", "text": "Neutrogena was founded in 1930 by Emanuel Stolaroff, and was originally a cosmetics company named Natone.  Johnson & Johnson  acquired the independent company in 1994. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5065", "text": "The company originally supplied to department stores and salons that catered for the  Hollywood film industry . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5066", "text": "In 1930, Emanuel Stolaroff started a small company called  Natone . [ 6 ]  Stolaroff met Belgian chemist Edmond Fromont in 1954, and acquired the rights to distribute his patented formula of a mild clear soap that cleared the skin, without drying it, in the US. [ 2 ]  By then, Lloyd Cotsen had entered the Stolaroff family by marrying his daughter Joanne Stolaroff. [ 5 ]  \nIn 1962, the company name was officially changed to Neutrogena Corporation; Cotsen became president in 1967. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5067", "text": "The company listed publicly on the  NASDAQ  in 1973,  with a market value of $1.2 million. [ 8 ]  Cotsen started marketing soap through two major channels:  dermatologists  and luxury hotels. [ 9 ]  The company launched product lines in acne and anti-aging areas. [ 5 ]  In 1982, profits reached US$3 million, and Cotsen was named the CEO. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5068", "text": "In 1994, Johnson & Johnson acquired Neutrogena for $924 million, at a price of $35.25 per share. [ 1 ]  Johnson & Johnson's international network helped Neutrogena boost its sales and enter newer markets including  India ,  South Africa , and  China . Priced at a premium, Neutrogena products are distributed in over 70 countries. The company has major subsidiaries in  Canada ,  United Kingdom ,  South Korea  and India. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5069", "text": "In 2020, Neutrogena launched Skin360, a free-to-use  web application  which employs advanced  algorithms  to analyze various aspects of a user's skin, taking into account factors such as hydration levels, texture, and fine lines. [ 10 ]  Additionally, it considers external elements like weather conditions and environmental changes, to provide a tailored assessment of the user\u2019s skin, personalized skin care routine, and ongoing monitoring. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5070", "text": "At the  Consumer Electronics Show  in January 2023, Neutrogena announced a partnership with Nourished, a vitamin brand that 3D-prints customized gummy supplements using Skin360. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5071", "text": "As of 2023, Neutrogena is not certified by any major cruelty-free organizations such as PETA ( People for the Ethical Treatment of Animals ), Leaping Bunny, or  Cruelty-Free International . This status indicates that Neutrogena products or the ingredients used in their products may be tested on animals, either by the company or its suppliers, or as required by law. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5072", "text": "The company has stated that it does not conduct animal testing on their cosmetic products or ingredients, except in rare situations where governments or laws require it. [ 13 ]  For instance, Neutrogena sells products in China, whose regulators conduct animal testing on cosmetics to be sold within its territory. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5073", "text": "Neutrogena has explored alternative testing methods in response to the growing consumer demand for  cruelty-free  products. The brand has invested in and utilized  in vitro  methods to ensure product safety and efficacy without the use of  animal testing  where regulations permit. For instance, the company has been a participant in industry consortia like the European Partnership for Alternative Approaches to Animal Testing ( EPAA ) since its inception in 2005. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5074", "text": "Neutrogena has a multitude of product lines available in different countries. In the United States, Neutrogena has products in categories such as  skin care  (including  sunscreen  and  acne  treatments),  makeup , and  hair care . [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5075", "text": "Neutrogena products are not the same globally. For example, in the United States, Neutrogena sells an \"Oil Free Acne Wash with Salicylic Acid,\" while in the United Kingdom, they sell the \"Clear & Defend 2% Salicylic Acid Face Wash.\" [ 16 ] [ 17 ]  Although both products contain 2%  salicylic acid , they contain different  inactive ingredients . Another example is the American \"Oil-Free Acne Wash Pink Grapefruit Foaming Scrub\" and the British \"Clear & Radiant Daily Face Scrub.\" [ 18 ] [ 19 ]  While both are face scrubs containing pink grapefruit, only the American version contains salicylic acid. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5076", "text": "Neutrogena also promotes various causes through their products. For example, Johnson & Johnson lists them as one of their brands pioneering sustainable techniques in their industry by creating products such as plant-based compostable cleansing wipes. [ 20 ]  They also have released limited edition packaging in partnership with Care With Pride, which is run by Johnson & Johnson in support of the  LGBTQ  community. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5077", "text": "Neutrogena has used celebrity endorsements for years. In 2022, actress  Jennifer Garner  celebrated the 15th anniversary of her promotions with Neutrogena, with whom she has worked on various campaigns. [ 22 ]  Other ambassadors for the brand include Chloe x Halle,  Lana Condor ,  Prachi Desai ,  Jenna Ortega , and  Sydney McLaughlin-Levrone . [ 23 ] [ 24 ] [ 25 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5078", "text": "While the brand was under Cotsen's leadership, they started to work with dermatologists in the US. Products are often labeled as recommended by or developed with dermatologists. The brand lists this as helping to \"drive the business to new heights.\" [ 27 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5079", "text": "In 2016, Neutrogena launched their first primarily digital campaign in the United States, The Power of Light, aligning with the launch of the Neutrogena Light Therapy Acne Mask. [ 28 ]  This campaign primarily consisted of short video ads and partnerships with influencers and public figures, such as  Nash Grier  and  Olivia Holt . The campaign aimed to make the product seem more \u201cfun, youthful, and vibrant.\u201d [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5080", "text": "The campaign was successful, the growth in product awareness outperformed that of Johnson & Johnson's other campaigns by thirteen times. [ 28 ]  Reportedly, executives from Johnson & Johnson started to lean more into digital campaigns following its success. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5081", "text": "To increase sales of their line of Hydro Boost products in India, Neutrogena used the  Demand Side Platform  of  Amazon . [ 29 ]  They created both video advertisements and display advertisements, linking viewers to the store. The project successfully drew consumers in, with a 9.8% conversion rate and a  return on advertising spending  of 4.8. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5082", "text": "Neutrogena partnered with  Spotify  to promote the launch of Neutrogena's Stubborn Acne (AM) and Stubborn Marks (PM) product lines. [ 30 ]  The target audience for Neutrogena's ads coincided with the majority of people who listened to Spotify ads, that is Spotify users without a premium subscription. They created audio and visual ads which successfully increased listeners brand awareness and intention to purpose by 12 and 13 points respectively. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5083", "text": "In July 2021, parent company Johnson & Johnson recalled four Neutrogena aerosol sunscreen products and one  Aveeno  branded spray from stores in the United States after detecting the  carcinogen   benzene  in some samples. [ 31 ] [ 32 ]  The recalled products were the following:"}
{"_id": "WikiPedia_Dermatology$$$corpus_5084", "text": "- Neutrogena Beach Defense\u00ae aerosol"}
{"_id": "WikiPedia_Dermatology$$$corpus_5085", "text": "- Neutrogena Cool Dry Sport aerosol"}
{"_id": "WikiPedia_Dermatology$$$corpus_5086", "text": "- Neutrogena Invisible Daily\u2122 defense aerosol"}
{"_id": "WikiPedia_Dermatology$$$corpus_5087", "text": "- Neutrogena Ultra Sheer\u00ae aerosol"}
{"_id": "WikiPedia_Dermatology$$$corpus_5088", "text": "The independent lab that conducted the research specified that the contamination was found in a specific batch of product rather than in a specific brand. The company went on to state that benzene is not used in the manufacturing process of the sprays and said it began an investigation into the source of the contamination. [ 33 ] [ 34 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5089", "text": "In July 2019, Neutrogena issued a recall of its  Light Therapy  Masks, originally released in October 2016, as it was found to be a \u201ctheoretical risk of eye injury\u201d for a small portion of the population with underlying eye conditions, as well as users taking medications that could enhance ocular  photosensitivity . The brand specified that the product is safe to use for the general population, and that the recall was made out of an abundance of caution. [ 35 ]  The blue lights in the masks reportedly caused mild and transient visual adverse events. [ 36 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5090", "text": "In 2020, parent company  Johnson & Johnson  decided to remove Neutrogena and Clean&Clear's \"dark spot reducers\" products from the shelves in Asia and the Middle East. The product, advertised as a dark spot reducer, was mainly purchased by consumers to lighten their skin tone. Accused of claiming that fairness or white was better than other skin colours, the company decide to discontinue the product. They also released a statement saying that \"This was never our intention - healthy skin is beautiful skin.\" The production and shipping of the product has since then been stopped. This controversy came in light of the  Black Lives Matter  movement in 2020, after backlash towards companies using racist imagery as a selling point started erupting. [ 37 ] [ 38 ] [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5091", "text": "Noxzema  ( / n \u0252 k \u02c8 s i\u02d0 m \u0259 /   nok- SEE -m\u0259 ) [ 1 ]  is an American brand of skin  cleanser  marketed by Elida Beauty. Since 1914, [ 2 ]  it was sold in a small  cobalt blue  jar; but is now sold in a blue plastic jar. Noxzema contains  camphor ,  menthol ,  phenol  and  eucalyptus , among other ingredients. Originally developed as a  sunburn  remedy, it is a type of cold cream or vanishing cream (so named because it disappears after being left on for a few minutes) which is used as a facial cleanser and  make-up  remover."}
{"_id": "WikiPedia_Dermatology$$$corpus_5092", "text": "It can also be used for soothing chapped, sunburned, or otherwise irritated skin; and for getting rid of acne and other blemishes (as it draws dirt out of pores when left on for a few minutes or more). Since the introduction of Noxzema, the brand name has appeared on  shaving cream ,  razors , and skin-cleansing cloths."}
{"_id": "WikiPedia_Dermatology$$$corpus_5093", "text": "The main product and its  line extensions  have been marketed by a series of companies: Noxzema Chemical Company,  Noxell Corporation ,  Procter & Gamble  and  Alberto-Culver  ( Unilever )."}
{"_id": "WikiPedia_Dermatology$$$corpus_5094", "text": "The original formula for Noxzema was invented by Dr. Francis J. Townsend [ 3 ]  (1875-?), a physician/druggist by 1900, in  Snow Hill, Maryland ; by 1910, in  Berlin, Maryland ; and by 1920, in  Ocean City, Maryland . [ 4 ]   The formula was called \"Townsend R22\" and referred to commonly as \"no-eczema\". [ 5 ]  Dr. Townsend, who practiced near the beaches of the  Atlantic Ocean ,  prescribed it as a remedy,  mainly to beach resort vacationers who were severely burned by  ultraviolet  sun rays."}
{"_id": "WikiPedia_Dermatology$$$corpus_5095", "text": "Townsend later gave the formula to druggist George Avery Bunting (1870\u20131959), who for many years denied the transaction. In about 1917, Bunting began producing and selling \"Dr. Bunting's Sunburn Remedy\", marketing the product as an alternative to the greasy,  tallow -based medicating creams in use during the period. For the first 3 years, George A. Bunting and Elizabeth Buck mixed, heated and poured the product themselves. The name was changed to Noxzema, supposedly because a satisfied customer exclaimed, \"Sure knocked my  eczema !\". [ 2 ]  An early slogan was \"The miracle cream of Baltimore\". [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5096", "text": "Beginning in 1920, the cream was produced by Bunting. In 1926, Noxzema Chemical Company broke ground and built a small factory in  Baltimore , Maryland at the corner of W. 32 St. & Falls Cliff Rd. [ 6 ]  In 1926, N.C.C. applied for a trade-mark with the U.S. Patent Office. [ 7 ]   By 1937, 15 million units were being sold yearly. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5097", "text": "By the 1940s, the product was being sold throughout the United States, and it continued to be produced by the Noxzema Chemical Company. Management moved to the founder's son in 1949. [ 9 ]  And, in 1966, the company was reorganized  Noxell Corporation , but still under the ownership of the Bunting family. [ 10 ]  Under a non-family member's leadership, the company \"moved its headquarters to a building complex in Cockeysville, MD.\" [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5098", "text": "In 1989 Procter & Gamble acquired the brand as part of the acquisition of Noxell.  Alberto-Culver  bought the rights to the brand in 2008 from  Procter & Gamble [ 12 ]  and operated the line of skin-care products [ 13 ]  until Alberto-Culver was acquired by Unilever in 2010. [ 14 ]  In October 2014, the Noxzema brand in Greece changed its ownership from Procter & Gamble to a domestic company, Sarantis, for \u20ac8.7 million. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5099", "text": "This \"knocks  eczema \" [ 5 ]  product, which says \"shaving cream\" on the container, was advertised from 1967 to 1973 as a medicated  shaving lotion  with the phrase \"Take it off, Take it all off\" [ 16 ]  (referring to facial hair). [ 17 ] [ 18 ]  Earlier advertising, which had begun in the 1940s, via radio and print advertisements, was handled locally. [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5100", "text": "In 1998  Proctor & Gamble  unveiled \"a foray into so-called nontraditional media\" as \"a break from traditional Noxzema advertising\" in order to \"stimulate sales of Noxzema skin cream among women ages 21 and over.\" [ 20 ]  In 1999 they introduced and advertised  product line extensions . [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5101", "text": "Olay  or  Olaz , previously  Oil of Olay ,  Oil of Olaz ,  Oil of Ulan , or  Oil of Ulay , is an American  skin care  brand owned by  Procter & Gamble . For the 2009 fiscal year, which ended on June 30, Olay accounted for an estimated $2.8 billion of P&G's revenue. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5102", "text": "Olay originated in  South Africa  as Oil of Olay. Graham Wulff (1916\u20132008), a former  Unilever  chemist from  Durban , [ 2 ]  started it in 1952. He chose the name \"Oil of Olay\" as a spin on the word \" lanolin \", a key ingredient."}
{"_id": "WikiPedia_Dermatology$$$corpus_5103", "text": "It was unique in the early days because it was a pink fluid rather than a cream, packaged in a heavy glass bottle. Wulff and his marketing partner, Jack Lowe, a former copywriter, had tested the product on their wives and friends and were confident in its uniqueness and quality. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5104", "text": "Olay's marketing was also unique, since it was never described as a moisturizer, nor even as beauty fluid. Nowhere on the packaging did it say what the product actually did. Print advertisements used copy such as \"Share the secret of a younger looking you\" and talked about the \"beauty secret\" of Oil of Olay. Other advertisements were written as personal messages to the reader from a fictitious advice columnist named Margaret Merril. They ran in  Reader's Digest  and newspapers and often looked like editorials. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5105", "text": "Wulff and Lowe, who ran the company under the banner of Adams National Industries (ANI), did not sell the product to the trade. It instead waited for pharmacies to ask for it based on consumer requests. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5106", "text": "As the company began to market the product internationally, the ANI decided to modify the name of the product in each country so it would sound pleasing and realistic to consumers. This led to the introduction of Oil of Ulay ( Ireland  and the  United Kingdom ), Oil of Ulan ( Australia ), and Oil of Olaz ( France ,  Germany ,  Italy , and the  Netherlands ). In 1970, the ANI opened a test market in the  United States  ( Chicago ) and was expanding into northern Germany. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5107", "text": "Richardson Merrell Inc.  (later Richardson-Vicks Inc.) acquired ANI in November 1970. [ 2 ]  RVI capitalized the \"Oil\" and added the sub-name \"Beauty Fluid\" to help protect the trademark. They further added a sales force and created TV advertising. The company extended the product range to include items such as Night of Ulay and Beauty Cleanser and expanded into more countries (Spain, France, and Germany)."}
{"_id": "WikiPedia_Dermatology$$$corpus_5108", "text": "The result of Richardson Merrell's efforts was a dramatic increase in sales. However, as with many brands, the business was not uniformly managed, so there were differences in performance between countries. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5109", "text": "RVI was acquired by  Procter & Gamble  in 1985. [ 3 ]  P&G greatly expanded Olay both in the line-up and internationally. Olay became P&G's 13th billion dollar brand in 2013. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5110", "text": "Since then, the range has been expanded to include a full range of  hypoallergenic  variants, cleansers and creams. The brand also includes soap, and body wash. Olay Cosmetics was launched in 1996 but discontinued in 2001. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5111", "text": "In 1999, P&G decided to unify the brand under a global name. Thus, Oil of Ulan and Ulay became Olay on a worldwide basis, [ 5 ]  except in German-speaking regions and Italy, where it remained \"Oil of Olaz\". In the Netherlands and Belgium, it renamed to just \"Olaz\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_5112", "text": "In October 2000, Olay was launched in the  Philippines , and in August 2007, it was launched in  India . From 2010 to 2020,  Oil of OLAZ  was simply known as  OLAZ  in German-speaking countries, with the slogan \"Olaz l\u00e4sst Sie strahlen\" (lit.: \"Olaz lets you shine\"). Since 2020 OLAZ has also been marketed as OLAY in German-speaking countries. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5113", "text": "In 2024, the company introduced a new cosmetics science course with the online learning platform  Coursera . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5114", "text": "Olay uses many different ingredients in the production of their skin care line. [ 7 ]  The main ingredients used include retinyl propionate ( vitamin A  derivative),  glycerin , niacinamide ( vitamin B3 ), broad spectrum sunscreen, coconut oil, and amino  peptides ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5115", "text": "In 2011, Olay ranked in 1st place among 50 of the industry leaders in Brand Finance's Top 50 Cosmetic Brands. [ 8 ]  A more recent report, dated 2021, has Olay maintaining its high position, ranking 19th in the Top 50. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5116", "text": "Origins Natural Resources, Inc. , trading as  Origins , is an American  cosmetics   brand  founded in 1990 by  Leonard Lauder , son of  Est\u00e9e Lauder . It is one of the original brands of The  Est\u00e9e Lauder Companies ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5117", "text": "The company is known for their natural skin care products. Notable lines include the \"A Perfect World\" line of products. Origins is also notable for its ongoing collaboration with Dr.  Andrew Weil  in his own line of products that target inflammation and sensitive skin."}
{"_id": "WikiPedia_Dermatology$$$corpus_5118", "text": "After 25 years, the brand now has approximately 1,400 stores globally and plans to expand by opening around 90 stores in  China . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5119", "text": "On May 14, 2015, Origins launched an interactive photo and video app on  iTunes  called #QuarterLifeCrisis that consumers can use to take sticker-decorated selfies with. [ 2 ] [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5120", "text": "In November 2007, Origins launched the first organic line of skin care products to carry a 95% organic  USDA  certification seal."}
{"_id": "WikiPedia_Dermatology$$$corpus_5121", "text": "In February 2011, Origins launched Happy Birthday\"Plantscription\", an anti-aging serum which claims to rival the leading anti-wrinkle prescription retinoid creams with 0% irritation."}
{"_id": "WikiPedia_Dermatology$$$corpus_5122", "text": "In June 2015, Origins launched a new skincare collection targeting the effects of global pollution called \"Three Part Harmony.\" This is in line with its global Pollution Defense campaign. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5123", "text": "The brand has also announced a new Original Skin collection later this year to target younger consumers' skin concerns with rough texture, enlarged pores, stressed skin, and loss of brightness. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5124", "text": "Origins' projections for 2015 include: continued strong top-line growth; increasing investment spending; constant currency net sales growth to be about 6%-7%; constant currency growth to be about 8%-10%; and emerging markets, excluding China, led by Turkey, Brazil, and South Africa to rise nearly 30%. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5125", "text": "At the end of the 2014 fiscal year, Europe, the Middle East, and Africa represented 38% of net sales and 51% of operating income, and Asia and the Pacific region represented 20% of net sales and 19% of operating income. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5126", "text": "Beginning July 1, 2015,  Est\u00e9e Lauder Companies  is set to lower prices on many of its most popular products in  China , affecting all skincare and makeup brands under the company and including Origins,  Est\u00e9e Lauder ,  Clinique ,  La Mer ,  MAC ,  Bobbi Brown , and Lab Series. The price reduction varies from 11% on the best-selling  La Mer  facial cream to 23% on an Origins fragrance. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5127", "text": "As of June 26, 2015, Origins recently opened its first  greenhouse  concept store in the  IFC  mall in Hong Kong to envelop its customers in an immersive and personalized space. The space showcases local material and artisanal work, including a locally sourced granite communal stone. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5128", "text": "St\u00e9phane de la Faverie, the Senior Vice President Global/General Manager of Origins, Ojon, and Darphin, says that this concept retail store \"represents a major milestone for Origins since its establishment 25 years ago.\" [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5129", "text": "Origins first launched in the  Philippines  in the early 2000s as the Sensory Therapy Peace of Mind product grew in popularity. A store-in-store is set to open in August 2015 at  SM Makati  after a 5-year absence in the country and region, except for Hong Kong. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5130", "text": "By age 25, Origins has helped to plant over 600,000 trees. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5131", "text": "In October 2020, Origins and its parent,  The Est\u00e9e Lauder Companies  announced their partnership with global chemical industry leader  SABIC  and packaging manufacturer Alb\u00e9a. Origins would be the first prestige cosmetics brand to utilize advanced recycled resin in their tube packs produced by SABIC\u2019s innovative recycling technology. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5132", "text": "Olivia Tong, a research analyst and director of  US  cosmetics, household and personal care at Bank of America Merrill Lynch, surveyed 1,000 women between the ages of 18 and 29 using 160 brands to find out preferred cosmetics and beauty brands. When asked what other important factors were not mentioned in their purchasing decisions, many said naturals and organics; Burt's Bees and Origins were the two most cited. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5133", "text": "Palmolive  is an American multinational brand of a  line of products  produced by  Colgate-Palmolive . The Palmolive brand grew from one product, Palmolive bar soap. Made of coconut, palm and olive oils, Palmolive bar soap was introduced in 1898. Originally, the bar soap floated like  Procter & Gamble 's  Ivory  bar soap. By the turn of the 20th century, Palmolive bar soap was the world's best-selling soap."}
{"_id": "WikiPedia_Dermatology$$$corpus_5134", "text": "Current Palmolive brand products include  dishwashing liquid  as well as personal care products such as  shampoo ,  hair conditioner ,  body wash , bar soap and liquid hand-wash."}
{"_id": "WikiPedia_Dermatology$$$corpus_5135", "text": "In 1864, Burdette Jay Johnson (1826\u20131902) founded the B.J. Johnson Co. in  Milwaukee, Wisconsin  producing soap, candles and cheese."}
{"_id": "WikiPedia_Dermatology$$$corpus_5136", "text": "In 1898, the company introduced a pale, olive-green-colored, floating bar of soap made of coconut, palm and olive oils aggressively marketed under the brand name \"Palmolive\". [ 1 ] [ 2 ] [ 3 ]  The soap became very popular, due to an advertising campaign promoting it as the type of soap that would have been favored in ancient Egypt by the Pharaohs and especially \"the Pharaoh's Daughter\". [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5137", "text": "In just two years, Palmolive bar soap was the world's best-selling soap. Originally, Palmolive Soap marketing claimed the soap contained \"Genuine Malaga (Spain) Olive Oil, the Oil of Palms, Glycerine, and the Oil of Lamb's Wool, Super-fatted with Cocoa Butter, the celebrated skin food\". [ 6 ]  By 1925, the olive oil was said to be \"Italian\"."}
{"_id": "WikiPedia_Dermatology$$$corpus_5138", "text": "Johnson's son Caleb Johnson became president of the company and in 1917 changed its name to \"Palmolive Soap Co.\". [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5139", "text": "The soap was extensively advertised, included the radio programs  The Palmolive Hour  (1927-1931) and  Palmolive Beauty Box Theater  (1934-1937). [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5140", "text": "Palmolive Shaving Cream was introduced in 1920. Its formula included the brand's familiar  palm oil  and olive oil."}
{"_id": "WikiPedia_Dermatology$$$corpus_5141", "text": "Palmolive Co. also produced other cleaning products. Among them was \"Salt Water Soap\", a circa 1920 bar soap specially produced and wrapped for use by passengers onboard  United States Lines  ships. [ 8 ]  \"China Soap\", a circa 1919 bar soap aimed at homemakers to be used in washing dishes. [ 9 ]  and \"Green Arrow Pure Soap\", a \"laundry and cleaning\" soap which contained olive oil and naphtha patented in 1920. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5142", "text": "In 1926 Charles S. Pierce, then president of Palmolive Soap Co. announced \"tentative plans for the consolidation\" of the Milwaukee-based Palmolive Soap company and the Peet Brothers Soap Company of Kansas City. It was said at the time the combined company assets would exceed  US$ 45,000,000 (equivalent to $774,000,000 in 2023). [ 11 ]  Peet Brothers' soap products were sold both nationally and internationally. Its brands included \"Crystal White\" soap in bar and chipped flake forms made with cottonseed and coconut oils, [ 12 ]  Ben-Hur \"White Bleaching\" laundry bar soap, Seafood Naphtha Soap powder and \"CremeOil\", a \"toilet, bath and shampoo\" bar soap made with olive and coconut oils. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5143", "text": "In June 1928, rumors started within the investment community that \"officials of the Palmolive-Peet Co. are negotiating to purchase the Colgate Co.\" privately held by the Colgate family. [ 14 ]  It was reported the combined assets of the merged company would exceed $66,000,000 (equivalent to $1,171,000,000 in 2023). [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5144", "text": "The merger combined the three oldest and largest soap and perfumery companies in the US and was effective July 1, 1928. The combined company was named the \"Colgate Palmolive Peet Company. [ 16 ]  The combined pre-merger sales in 1927 of the three companies exceeded $100,000,000 (equivalent to $1,774,000,000 in 2023). The newly combined company had seven US manufacturing facilities as well as factories in 14 foreign countries. [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5145", "text": "In 1953, the companies became a joint venture, known as the Colgate-Palmolive Company. [ 18 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5146", "text": "Pechoin  ( Chinese :  \u767e\u96c0\u7f9a ) is a  skin care  brand under  Shanghai Pehchaolin Daily Chemical Co Ltd  based in  Shanghai, China . [ 3 ]  Originally founded in 1931, Pechoin is China's first domestic skincare brand. [ 4 ] [ 5 ]  The company manufactures  cosmetic products  including skincare products and perfumes. [ 3 ] [ 4 ]  It is one of the largest skincare companies in China and a leading Chinese  cosmetics  brand. [ 2 ] [ 4 ] [ 5 ] [ 6 ]  In 2013, Pechoin products were recognized as \"national gifts (\u56fd\u793c)\" of the  People's Republic of China . [ 7 ] [ 8 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5147", "text": "In 1931, Pechoin was founded by Gu Zhimin (\u987e\u690d\u6c11) as a skincare brand under cosmetics company  Fu Bei Kang  (\u5bcc\u8d1d\u5eb7\u5316\u5986\u54c1\u6709\u9650\u516c\u53f8) in  Shanghai , making it the first domestic skincare brand in  China . [ 1 ] [ 5 ] [ 12 ]  In Chinese, the name \"Pechoin\" may be interpreted as a hundred birds paying tribute to  Fenghuang  or the Chinese  phoenix . [ 1 ] [ 12 ]  From 1937 to 1945, Pechoin survived the  second Sino-Japanese war . And in 1945, it became a top cosmetics brand in China. [ 1 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5148", "text": "The company's skincare products were often contained in an iconic round iron box (painted in blue and yellow). [ 1 ] [ 12 ]  One of Pechoin's main products at the time was its  moisturizing balm , which became widely popular in Shanghai and then nationwide. [ 1 ] [ 5 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5149", "text": "Notable patrons of Pechoin included the  Soong sisters , who then introduced the products to wives of foreign diplomats in China. [ 5 ] [ 9 ] [ 11 ]  Leading Chinese actresses and singers such as  Hu Die ,  Ruan Lingyu  and  Zhou Xuan  were also Pechoin's regular customers. [ 9 ] [ 11 ] [ 12 ] [ 13 ]  Some Pechoin products were further exported to countries in  Southeast Asia . [ 1 ] [ 12 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5150", "text": "In 1949, the  People's Republic of China  was established and Gu Zhimin chose to stay in Shanghai under the  Communist rule . [ 1 ] [ 12 ]  The company later provided its products to the  People's Volunteer Army  who fought in the  Korean war . [ 1 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5151", "text": "In 1956, Pechoin's parent company underwent the socialist transformation and became a state-private jointly owned enterprise (\u516c\u79c1\u5408\u8425 [ 14 ] ). [ 1 ]  In the same year, Gu Zhimin passed away due to  heart attack ; his wife Luo Weizhen (\u7f57\u4f1f\u8d1e) and his son Gu Jiongwei (\u987e\u70af\u4e3a) took charge of the company. [ 1 ] [ 12 ]  Pechoin's annual revenue soon approached 10 million  RMB . [ 1 ]  In 1962, the company was renamed as the  Shanghai Second Daily Chemical Factory  (\u4e0a\u6d77\u65e5\u7528\u5316\u5b66\u4e8c\u5382). [ 1 ] [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5152", "text": "In the 1960s and the 1970s, the company was impacted by the  Chinese Cultural Revolution , when many key figures of the company were persecuted. [ 12 ]  During the early phase of the  Reform and Opening  of China, however, Pechoin regained its productivity and was able to manufacture some 40 million units of skincare products per year in the 1980s. [ 1 ] [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5153", "text": "In the early 1990s, Pechoin suffered poor market performance due to the influx of foreign high-end cosmetic products, and as a result its parent company declared  bankruptcy . [ 1 ] [ 12 ] [ 13 ]  The brand  Pechoin  was subsequently acquired by a businessman from  Hong Kong  with 500,000  RMB . [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5154", "text": "In 2000, Pechoin restructured into a  private company , the  Shanghai Pehchaolin Daily Chemical Co Ltd . [ 3 ] [ 13 ]  The company then entered a period of rapid growth and the brand  Pechoin  was revived. [ 4 ]  In 2007-08, Pechoin as a brand won the title of  Well-known Trademark in China (\u4e2d\u56fd\u9a70\u540d\u5546\u6807) . [ 15 ]  In 2013, Pechoin's products were sent as Chinese \"national gifts (\u56fd\u793c)\" to national leaders in  Africa  by China's first lady  Peng Liyuan . [ 7 ] [ 8 ] [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5155", "text": "From 2013 to 2015, Pechoin saw a 56%  annual growth rate  and from 2015 to 2017, a 19% annual growth rate. [ 16 ]  In 2016, the annual revenue of Pechoin reached 13.8 billion  RMB , with its  market share  in mainland China ranking 4th, after foreign brands such as  L'Oreal  and  Olay . [ 17 ] [ 18 ]  In 2019, the estimated annual sales of Pechoin reached 17.7 billion RMB (2.26 billion  euros ), further expanding its market share to 7.3%, second only to L'Or\u00e9al. [ 2 ] [ 5 ] [ 6 ]  In 2020, Pechoin formed a  strategic partnership  with the  Merck Group  based in  Germany . [ 19 ] [ 20 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5156", "text": "As of 2023, Pechoin offers products under 8 different categories: [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5157", "text": "After 2000, the revived Pechoin tried to appeal to younger population as a fashion brand. [ 13 ] [ 22 ] [ 23 ]  In its advertisements, Pechoin started to use more graphical and video content as presentation. In addition, it also publishes advertisements on various digital platforms in order to draw attention of wider audience and increase public awareness. [ 13 ]  For example, one of its advertisements in 2017 fantasized a story taking place in wartime Shanghai ( Republic of China ), in which a Chinese woman \"Pechoin\", who was a  special agent , successfully killed her enemy \"time/old age\", and the company tried to tactfully promote its products through this story. [ 24 ] [ 25 ]  This advertisement reached over 30 million users through  WeChat  platform, and in the end the total number of views exceeded 100 million. [ 26 ]  In 2011, the company spent a total of  CNY\u00a5 150 million on advertising, while this figure increased to \u00a5380 million in 2014, \u00a5680 million in 2015, and \u00a51 billion in 2016. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5158", "text": "From 2012 to 2015, Pechoin co-sponsored the Chinese reality show  The   Voice of China  for four seasons. [ 13 ] [ 16 ]  In 2016, it also sponsored TV series  Ice Fantasy , an epic drama hugely popular with Chinese youngsters. [ 13 ] [ 16 ]  When it comes to  e-commerce , Pechoin joined the Chinese e-business platform  Taobao , for example, which has been called \"China's  Amazon \". Additionally,  Singles' Day  is the largest online shopping festival in China, and according to published data in 2016, a total number of 4,787,965 customers made purchases with Pechoin on that day, which was the highest daily record for a  cosmetics  brand; [ 27 ]  and in 2017, Pechoin's total sales volume on  Singles' Day  reached a record-breaking 294 million  RMB . [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5159", "text": "The following list includes Pechoin's current and past spokespeople."}
{"_id": "WikiPedia_Dermatology$$$corpus_5160", "text": "Proactiv  is an American brand of  skin-care products  developed by two American  dermatologists ,  Katie Rodan  and  Kathy A. Fields , and launched in 1995 by  Guthy-Renker , a California-based  direct marketing  company, that was endorsed by famous celebrities [ 2 ]  The range includes moisturizers, body washes and treatment products, but the brand is known for its three-step anti- acne  Solutions 3-step routine consisting of a BPO cleanser, glycolic toner and treatment lotion. [ 3 ] [ 4 ]  Proactiv+, a reformulation of the three-step kit, was introduced in 2013, and in 2017, ProactivMD launches powered by Adapalene. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5161", "text": "As a result of its celebrity endorsements and  infomercials , Proactiv is one of the most popular skincare brands of all time, according to the  Journal of Clinical and Aesthetic Dermatology . [ 6 ]  Sales amounted to $800 million a year as of 2010, with a media budget of nearly $200 million and $12\u201315 million for celebrity fees. [ 7 ]  The product is mostly sold at ULTA Beauty, Target, and online as single-unit items or as part of a  continuity program . A month after ordering, customers are sent a three-month supply, which continues until the subscription is cancelled. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5162", "text": "Proactiv was created in the late 1980s by Katie Rodan and Kathy A. Fields, who met while at  Stanford University School of Medicine . [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5163", "text": "Proactiv was offered to  Neutrogena , which declined it, but its CEO, Allan Kurtzman, suggested selling it via infomercials. [ 10 ] [ 11 ]  Guthy-Renker were already in the infomercial business and agreed to market and distribute it. The first infomercial appeared in October 1995, offering a money-back guarantee and fast delivery, and featuring spokesmodel  Judith Light , who suffered from acne problems herself. [ 11 ] [ 12 ]  Rodan and Fields later founded their own skincare brand, Rodan + Fields. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5164", "text": "Guthy-Renker LLC is a  direct-response marketing  company registered in  El Segundo , California. Founded in November 1988 by Bill Guthy and  Greg Renker , the company is known as \"the Rolls-Royce\" of the infomercial industry. [ 14 ] [ 15 ]  As of 2012 its portfolio of products was making $1.8 billion a year. [ 16 ]  The range includes  Victoria Principal 's Principal Secret skincare (its earliest skincare brand),  Wen Hair Care ,  Cindy Crawford 's Meaningful Beauty skincare, JLO Beauty [ 17 ] [ 18 ] [ 19 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5165", "text": "In March 2000,  Nestl\u00e9  joined Guthy-Renker as a majority owner of Proactiv. In October 2016, Nestle sold its shares to  EQT AB . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5166", "text": "In 2022, The Proactiv Company makers of the #1 selling acne regimen, is announcing its rebrand and repositioning under the new name Alchemee. [ 20 ]  In early 2022, Alchemee announces its acquisition by Taro Pharmaceutical Industries Ltd. (NYSE: TARO)  [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5167", "text": "Proactiv is a registered trademark of Alchemee/Taro Pharmaceutical Industries Ltd. The brand's primary products are three-step kits comprising a cleanser, toner/treatment and lotion/moisturizer, which sells for $36 a month in the United States."}
{"_id": "WikiPedia_Dermatology$$$corpus_5168", "text": "The Revitalizing Toner contains  glycolic acid , Aloe Barbadensis leaf juice, and  witch hazel , an  astringent . [ 22 ] [ 23 ]  The active ingredient in the cleanser and lotion, outside Europe, is a 2.5% concentration of micro-crystal  benzoyl peroxide . Benzoyl peroxide has been used since 1934 to kill  Cutibacterium acnes , the bacterium that causes acne. [ 24 ]  Several over-the-counter acne treatments contain it, including  Clean & Clear ,  Clearasil ,  Doctor's Dermatologic Formula ,  Neutrogena Advanced Systems ,  PanOxyl  and  Stridex . [ 25 ] [ 26 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5169", "text": "In 2013, Proactiv+ was introduced, it is a  paraben -free three-step kit comprising an exfoliating cleanser (Skin Smoothing Exfoliator), treatment (Pore Targeting Treatment) and hydrating moisturizer (Complexion Perfecting Hydrator). The exfoliator contains 2.5% micro-crystal benzoyl peroxide, the treatment contains 2.5% encapsulated benzoyl peroxide, and a moisturizer with 0.5% salicylic acid. It is more hydrating than the original program and designed for dry-to-sensitive skin types. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5170", "text": "Proactiv is aimed at customers with mild to moderate acne. [ 22 ]  According to a 2011 review, there have been few studies examining its efficacy. [ 3 ]  A 2007 study saw inflammatory lesions reduced by 39% in subjects using a combination of  butenafine  and benzoyl peroxide, compared with 34% in those using Proactiv containing only benzoyl peroxide. [ 3 ] [ 27 ]  A physician suggested in  Salon  that its three-step system might make it easier for teenagers to comply, but that the key to its success lay with its celebrity endorsements. [ 25 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5171", "text": "In 2011,  Consumer Reports  compared Proactiv (2.5% benzoyl peroxide) with two less expensive products, AcneFree (2.5% benzoyl peroxide) and OXY Maximum (10% benzoyl peroxide). [ 28 ]  At the time a two-month supply of Proactiv cost around $40 in the US, AcneFree $20 and OXY Maximum $5. [ 8 ]  Eighty-three subjects, aged 14 to 40, used one of the products twice a day for eight weeks. The magazine reported that, no matter which product was used, after two weeks around 75% of subjects saw a 35% reduction in blemishes on average. After eight weeks, around 50\u201366% saw a 40% reduction on average. [ 28 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5172", "text": "Benzoyl peroxide can have a drying effect on the skin, can cause  erythema  (redness) and fine scaling, though these effects are usually mild, and can increase sensitivity to sunlight. One in 500 may experience  allergic contact dermatitis . It is categorized as a  pregnancy category  C agent, \"suggesting that its use in pregnancy may not be prudent,\" according to a literature review in the  Journal of Clinical and Aesthetic Dermatology . [ n 1 ]  If benzoyl peroxide comes into contact with clothing it is likely to bleach it. [ 29 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5173", "text": "The US  Food and Drug Administration  (FDA) warned in 2014 that over-the-counter acne products containing benzoyl peroxide and/or salicylic acid, including Proactiv, can cause severe irritation, as well as rare but life-threatening allergic reactions. Consumers were advised to stop using the products if they experience hives or itching, and to seek emergency medical attention if they feel faint, or experience throat tightness, breathing problems, or swelling of the eyes, face, lips or tongue. The FDA noted that it remains unclear whether the reactions are caused by the active ingredients, inactive ingredients or a combination. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5174", "text": "Proactiv is marketed and distributed by Guthy-Renker, and is responsible for about half the company's revenue. [ 14 ] [ 16 ]  Sales of Proactiv amounted to $800 million as of 2010. [ 7 ]  70% of sales were in the United States as of 2007. [ 22 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5175", "text": "The product is available in some stores, including  Boots  in the UK, [ 31 ]  and in kiosks and vending machines (known as  ZoomShops ) in malls and airports through a partnership between American Kiosk Management and Guthy-Renker . [ 32 ] [ 33 ]  But the product is mostly sold online or through a toll-free number directly by Guthy-Renker; 60% of Proactiv orders were placed online as of 2010. [ 34 ]  In 2016, Proactive began selling their products at  Ulta Beauty . [ 35 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5176", "text": "Alchemee sells Proactiv as part of a  continuity program , also known as a  negative-option offer , whereby customers are sent repeat orders of the program until they cancel their subscription. [ 8 ] [ 36 ]  When purchasing directly from the company, customers automatically become members of a Proactiv club. A month after ordering, and every three months thereafter, they are sent a three-month supply costing $34.95 (in the US as of 2022). They are billed monthly until they cancel the subscription. [ 37 ]  The approach is based on the  customer lifetime value  model. [ 38 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5177", "text": "At the time Guthy-Renker owned Proactiv, they had a media budget of $200 million for the brand, much of it spent on air-time, and was spending another $12\u201315 million a year on celebrity endorsements. [ 7 ]   Justin Bieber  for example, was paid $3 million over two years. [ 34 ]  Its infomercials have featured celebrities who have themselves suffered from acne problems; the list includes  Jennifer Love Hewitt ,  Kelly Clarkson ,  P. Diddy ,  Avril Lavigne ,  Lindsay Lohan ,  Alyssa Milano ,  Katy Perry ,  Jessica Simpson ,  Britney Spears ,  Kendall Jenner  and  Vanessa Williams . [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5178", "text": "According to the  New York Times , until 2010 Proactiv infomercials were \"fast-talking\" and \"hard-selling\"; an announcer repeatedly advised viewers to \"call now,\" and offered faster shipping if the order was placed within three minutes. As infomercials became less popular, Proactiv sales stalled. [ 39 ]  Since 2010 Guthy-Renker has tried to move the brand into the mainstream cosmetics market, focusing on quality rather than price. [ 7 ]  It began advertising on network television during shows like  American Idol , and in  Elle ,  InStyle  and  People  magazines. [ 39 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5179", "text": "In 2012, the  Advertising Standards Authority  (ASA) in the UK banned some of Proactiv's advertising as misleading. A viewer complained that the celebrities were likely to have used the US version of Proactiv, which differs from the UK version. According to the ASA, the celebrities had signed statements saying they had used the UK version for a few weeks one to three years earlier, but the advertisements gave the appearance that they had continued to benefit from it, so the viewer's complaint was upheld. [ 40 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5180", "text": "\"Potential Signals of Serious Risks/New Safety Information Identified by the FDA Adverse Event Reporting System (FAERS) between July \u2013 September 2013\" , Food and Drug Administration, November 1, 2013, updated September 10, 2015."}
{"_id": "WikiPedia_Dermatology$$$corpus_5181", "text": "Mark Sweney (July 18, 2012),  \"Katy Perry and Justin Bieber zit ad campaign banned\" ,  The Guardian"}
{"_id": "WikiPedia_Dermatology$$$corpus_5182", "text": "Pulpe de Vie  is a French organic cosmetics brand created in 2009."}
{"_id": "WikiPedia_Dermatology$$$corpus_5183", "text": "Back in  France  in 2009 after a sabbatical year in  South America , [ 2 ]  Julie Ducret, together with an investor partner, created Bio Provence within the Marseille Innovation business incubator. [ 3 ] [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5184", "text": "In 2014, a 150,000 euros fundraising exercise was completed with various partners, including  Bpifrance  and  Cr\u00e9dit Agricole . [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5185", "text": "After 2015, the company made a strategical change: initially listed in para pharmacies and organic stores, it switched to large-scale distribution, increasing production from 5,000 to 10,000 units. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5186", "text": "In 2017, a second fundraising exercise of 400,000 euros was announced was announced. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5187", "text": "In 2018, its export policy was suspended  to refocus on the French market, in particular by developing marketing on social networks, for example, through partnering with influencers. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5188", "text": "In 2021, the brand invested in the hard discount sector and resold 450  Lidl  out of 1,006 stores in France. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5189", "text": "In 2023, the company completed a new funding round of 1.7 million euros to start exporting and triple its growth by 2026. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5190", "text": "With  Ecocert [ 9 ]  and Cosm\u00e9bio [ 10 ]  certified products, Pulpe de Vie, targets women aged twenty to thirty-five by focusing on the packaging [ 11 ]  and prices not exceeding twenty euros. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5191", "text": "Inspired by the  local purchasing  approach, [ 6 ]  the company works with around twenty regional producers, [ 12 ]  collecting their \"ugly\" and unsold fruits as part of an effort to combat  food waste , [ 4 ] [ 7 ]  Purchases are made by a service provider based in  Sisteron [ 11 ]  while the subcontracting laboratory is located in  La Fare-les-Oliviers . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5192", "text": "Rozalex  was a brand of Rozalex Limited, a subsidiary of the  Chloride Electrical Storage Company [ 1 ]  credited with being the first company in the United Kingdom to commercialise topical  barrier cream  for use in an industrial setting. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5193", "text": "The cream was originally developed for use in their  Exide  works at  Clifton Junction  near  Manchester . Battery manufacture was labour-intensive and used hazardous materials, so skin irritation and  contact dermatitis  were rife among workers. Chloride began researching and developing a barrier cream that could help protect workers and increase productivity."}
{"_id": "WikiPedia_Dermatology$$$corpus_5194", "text": "The company was founded in 1929 [ 3 ]  as a spin-off of The Chloride Electrical Storage Co. Ltd."}
{"_id": "WikiPedia_Dermatology$$$corpus_5195", "text": "In 1969,  Newton, Chambers & Company [ 4 ]  acquired Rozalex Limited and the brand sat along other household names such as IZAL and Zalpon."}
{"_id": "WikiPedia_Dermatology$$$corpus_5196", "text": "In 1972, Newton, Chambers & Co was acquired by the  Central & Sheerwood Trust , an Investment banking and financial services group."}
{"_id": "WikiPedia_Dermatology$$$corpus_5197", "text": "In 1973, Central & Sheerwood Trust sold the IZAL operation, which included Rozalex, to  Sterling Winthrop 's, Sterling Industrial."}
{"_id": "WikiPedia_Dermatology$$$corpus_5198", "text": "In 1981, Sterling Industrial acquired the Kerodex range of industrial barrier creams and merged them into the Rozalex Range."}
{"_id": "WikiPedia_Dermatology$$$corpus_5199", "text": "In 1987,  Unilever  acquired Sterling Industrial strategically to push into the business-to-business hygiene, janitorial, and floor care sectors."}
{"_id": "WikiPedia_Dermatology$$$corpus_5200", "text": "In 2002, Unilever sold the main equity share of its business-to-business division (Lever Industrial-DiverseyLever) to  SC Johnson  to form  JohnsonDiversey ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5201", "text": "In 2008, JohnsonDiversey divested the Rozalex brand to Present Value Limited, and Rozalex Limited was reinstated. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5202", "text": "In 2010, Rozalex sponsored the  Ginetta G50  car of the Barwell Motorsport team in the 2010 British Touring Car Championship TOCA series driven by Julien Draper."}
{"_id": "WikiPedia_Dermatology$$$corpus_5203", "text": "In 2011, Rozalex sponsored the Barwell Motorsport team's Aston Martin GT4 car at the 2011 British GT Championship, driven by Peter Erceg and Tiff Needell."}
{"_id": "WikiPedia_Dermatology$$$corpus_5204", "text": "In 2011, Rozalex sponsored the  Greenpower Education Trust  promoting sustainable engineering to young people."}
{"_id": "WikiPedia_Dermatology$$$corpus_5205", "text": "In 2011, Rozalex teamed up with Goodwood to supply limited edition tins of handcare products for the 2011  Goodwood Revival ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5206", "text": "In 2012, Present Value divested the Rozalex brand to Hughen Limited. Rozalex is currently a fully trading subsidiary of Hughen Limited."}
{"_id": "WikiPedia_Dermatology$$$corpus_5207", "text": "In 2013, Rozalex launched a new Pouch Dispensing System (PDS) for the Industrial / Engineering / Automotive / Marine / Construction and Energy sectors."}
{"_id": "WikiPedia_Dermatology$$$corpus_5208", "text": "Selsun Blue  is an  over-the-counter   brand  of  dandruff   shampoo  now owned by  Sanofi . First made by  Abbott Laboratories , the brand was bought by  Chattem  in 2002. Chattem was acquired by  Sanofi  in 2010, although in some markets, it is sold by  Rohto Pharmaceutical  instead. Selsun Blue has been marketed as a more effective alternative to brand leader  Head & Shoulders  due to its superior performance in randomized trials. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5209", "text": "Over the counter Selsun Blue contains 1%  selenium sulfide  as its active ingredient in its most popular version [ 2 ]  (the word \"Selsun\" is a portmanteau of  sel enium  su lfide +  n ).  Chattem announced that on November 1, 2005, they would introduce a new line of shampoos under the brand name Selsun Salon.  These contained a different active ingredient than Selsun Blue,  pyrithione zinc  1%, and are oriented toward the higher-end shampoo market. Other active ingredients such as salicylic acid and botanicals are in other versions of Selsun Blue brand dandruff shampoo."}
{"_id": "WikiPedia_Dermatology$$$corpus_5210", "text": "In 2011, the Selsun Blue brand consisted of 15 products spread across two brand segments, Naturals and Base.  The Naturals line of products contains the active ingredient  salicylic acid  in addition to 8 moisturizers & botanicals plus vitamins B5 & E.  Salicylic acid  is a  keratolytic  agent that assists with cell shedding or flaking. [ 3 ]   The base brand consists of six types including Medicated with menthol, 2-in-1, Normal to Oily, Moisturizing, Itchy Dry Scalp, and Deep Cleansing with micro beads. [ 4 ]   The first four types contain the active ingredient selenium sulfide which has been shown to have anti-fungal properties. More specifically, selenium sulfide, an anti-infective agent, relieves itching and flaking of the scalp and removes the dry, scaly particles commonly referred to as  dandruff  or  seborrhea . Selenium sulfide is also used to treat  tinea versicolor , a fungal infection of the skin. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5211", "text": "Deep Cleansing was launched by Chattem in January 2011.  In addition to the active ingredient salicylic acid, the product contains scrubbing micro beads."}
{"_id": "WikiPedia_Dermatology$$$corpus_5212", "text": "Like Chattem\u2019s other products, Selsun Blue is sold through mass merchandisers, drug and food retailers."}
{"_id": "WikiPedia_Dermatology$$$corpus_5213", "text": "SpazzStick  is a  caffeinated   lip balm . It was created by Richie Holschen, the only police officer in the remote  Alaskan  village of  Kaktovik , who needed to protect his lips and remain alert in an area so cold that coffee freezes. [ 1 ] [ 2 ]  When he first started making the product in 2004, he did so out of the police station. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5214", "text": "Tecnu  is an  over-the-counter  skin cleanser manufactured by  Tec Laboratories , a  pharmaceutical  company based in  Albany, Oregon . It is intended for use by humans and furry pets after topical exposure to  urushiol , the active ingredient in  poison oak ,  poison ivy , and  poison sumac . [ 1 ]   Tecnu is made from deodorized  mineral spirits , water,  propylene glycol , octylphenoxy-polythoxethanol, mixed  fatty acid  soap, and fragrance."}
{"_id": "WikiPedia_Dermatology$$$corpus_5215", "text": "The cleanser was invented by former  Mead Johnson  executive and  chemist  Robert Smith during the early 1960s. Tecnu, for \"Technically New,\" was intended to remove  radioactive fallout  dust from skin. [ 2 ] [ 3 ]  Several years later, his wife discovered another use for the cleanser. After an exposure to poison oak, she washed with Tecnu and did not get  urushiol-induced contact dermatitis . [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5216", "text": "In 1977, the company began to market Tecnu to  foresters ,  firefighters ,  surveyors , and utility crews. It has since become a popular remedy for gardeners and others who live and work around poison ivy. [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5217", "text": "Tecnu's effectiveness for postexposure treatment has been confirmed in a nonrandomized study, in which the authors concluded: \"Our study showed 70%, 61.8%, and 56.4% protection with Tecnu, Goop, and  Dial , respectively, when compared to the  positive control , or to the possible maximum response, with a cost per ounce (in a local drug and automotive store) of $1.25, $0.07, and $0.07, respectively, for a decrease in protection that is nonsignificant.\" [ 8 ]   A survey article is also available. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5218", "text": "Theraderm  is an American manufacturer of clinical-grade  skin care  products, including  anti-aging creams  and  moisturizers , as well as an acne system under an alternate brand: Reversion. The company was founded in 1996 by board-certified  plastic and reconstructive surgeon  James Beckman, M.D., who is also a biochemist and adjunct associate professor of dermatology at UAMS Medical School. [ 1 ]  The company is headquartered in  Springdale, Arkansas ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5219", "text": "In 1978, Dr. James Beckman set up a private practice for plastic and reconstructive surgery in  Mountain Home, Arkansas . After treating a number of burn patients, Dr. Beckman developed a cream, Beckman's Skin Care Cream, for restoring mobility and function to patients with skin-grafted hands. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5220", "text": "After further development and discovering new ingredients, he created a second product, resulting in a two-step system that moisturized skin and also reduced the appearance of lines and wrinkles. In 1996, the company was founded (initially as Therapon Skin Health), and even more research and development led to the four-step Skin Renewal System. This system  is still sold by the company today, along with a number of other products that each target a unique skin concern. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5221", "text": "Thirteen Lune  is an  e-commerce  beauty website launched in 2020 and based in  West Hollywood . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5222", "text": "Thirteen Lune was co-founded by Nyakio Grieco, a Los Angeles-based beauty entrepreneur, and Patrick Herning, the CEO of plus-sized fashion brand  11 Honor\u00e9 . [ 2 ]  The company initially launched with 13 brands. [ 3 ]  By the end of 2021 the company carried 100 brands. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5223", "text": "In October 2021, JCPenney announced a partnership with Thirteen Lune to bring their items into 10 of the retailer's physical stores. [ 1 ]  In January 2021, Thirteen Lune raised $1 million from  Sean Combs ,  Gwyneth Paltrow , [ 4 ]   Naomi Watts ,  Gregg Renfrew , Tracey Cunningham (M\u00e8che salon),  Nicole Avant , [ 4 ]  Patrick Finnegan (venture capitalist) and Sydney Holland (Urban and The Mystic). [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5224", "text": "In November 2021, Thirteen Lune closed a $3 million funding round by Fearless Fund, Capstar Ventures, Fab Ventures,  Swiftarc Ventures  and  Gaingels . [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5225", "text": "In September 2022,  JCPenney  announced plans to expand its partnership, adding Thirteen Lune products to more than 600 stores around the country, while also ending its brick-and-mortar relationship with  Sephora . [ 7 ]  In addition to offering 65  BIPOC -owned beauty brands, the store's associates will also receive training on how to address diverse beauty needs. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5226", "text": "Thirteen Lune is a  direct-to-consumer  company that highlights skin care, makeup, hair care and wellness items almost exclusively (90%) from Black and Brown-owned companies. [ 3 ]  Their products are primarily targeted at under-represented people of color. [ 8 ]  The remaining 10% represent Ally Brands, which are selected brands the retailer recognizes for their continued efforts to \"be exclusive in product assortment and promote change beyond beauty.\" [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5227", "text": "This article about a commerce website is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5228", "text": "vbeaut\u00e9  was founded by  Julie Macklowe  to provide women with Swiss made anti-age skincare products. vbeaut\u00e9 is a skin care line based on advanced botanical technology using  plant stem cell  complexes. Macklowe launched vbeaut\u00e9 on November 1, 2011. [ 1 ]   vbeaut\u00e9's range of products include: peptide-based anti-aging face and eye serums, moisturizers, eye cream, sunscreen, and a face cleanser and exfoliator. [ 2 ] [ 3 ] [ 4 ] \nvbeaut\u00e9\u2019s key ingredient in all of their products is Swiss Alpine Rose, a cold-resistant plant from the  Swiss Alps .  Together, along with several other botanical ingredients, these plant extracts combine to form a complex compound which has anti-aging and protective properties. All vbeaut\u00e9 products are formulated in Switzerland, free of fragrance and parabens, and dermatologist and allergy tested. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5229", "text": "vbeaut\u00e9 was launched by investor and former hedge fund manager  Julie Macklowe  in 2011. During her travels, Macklowe could not find a suitable skincare product to meet her everyday needs. She then partnered with molecular scientists from the Centre de Recherches Biocosm\u00e9tiques (CRB High Performance Care) of  Geneva  to formulate her products. By 2011, Macklowe had raised over $4,000,000 for lab work and testing.  The skin care line's main ingredient contains stem cells from the Alpine Rose flower. [ 6 ] [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5230", "text": "Macklowe launched vbeaut\u00e9 at a charity event coinciding with her 35th birthday. [ 8 ]  At the time of its launch in November 2011, the line was carried at 37 stores, some of which include:  Neiman Marcus ,  Fred Segal ,  Nordstroms , and  Bergdorf Goodman . [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5231", "text": "Initially, vbeaut\u00e9 was launched at Bergdorf Goodman's, a luxury goods department store based in New York City.  After two years at Bergdorf's, the company appeared on the Home Shopping Network. [ 9 ]  vbeaut\u00e9 is the first luxury skincare line that took exactly the same products, ingredients, and packaging offered at higher price points at  Bergdorf Goodman , and brought the same quality at more affordable pricing via  HSN . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5232", "text": "In 2019 the company went out of business. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5233", "text": "The product was featured in  O Magazine , which called it \"a gorgeous way to keep jet lag at bay.\" [ 11 ]  In 2013, vbeaut\u00e9 expanded to be sold at Look Boutiques in Duane Reade and Walgreens stores in  New York City ,  Los Angeles , and  Miami . [ 12 ]   Macklowe's goal for the company is to provide lightweight and affordable skin care products, saying that, \u201cWhen I think about all of the luxury lines out there, they feel like they were almost made for my mother. They\u2019re heavy, and their price points were also of such. I want to keep everything really affordable.\u201d [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5234", "text": "The vbeaut\u00e9 line offers a total of 8 products with 4 new products launching in 2016, as well as an extension to the line slated for 2017. [ citation needed ]  The different types of products offered by vbeaut\u00e9 include: light anti-aging serum,  exfoliant, foaming cleanser, moisturizer, peptide-based eye cr\u00e8me, and intense brightening treatment. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5235", "text": "The products can be bought together as part of the \"It Kit\" or individually, in larger amounts. All of vbeaut\u00e9\u2019s products are fragrance free, dermatologist and allergy tested, and paraben free, due to Macklowe\u2019s personal issues with sensitive skin. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5236", "text": "Veet , formerly called  Neet  and  Immac , is a Canadian brand of  chemical depilatory  products manufactured by the British-Dutch company  Reckitt Benckiser . [ 1 ]  Hair removal cream, lotions, gel, mousse, and wax products are produced under this brand, with differing variants being sold internationally. Previous products produced under the Neet and Immac brands were similar to those produced today."}
{"_id": "WikiPedia_Dermatology$$$corpus_5237", "text": "Veet's hair removal products contain  thioglycolic acid  and  potassium hydroxide . These ingredients react to generate the  depilatory chemical  potassium thioglycolate, which according to the company, increases hair loss. The effect is to break the  disulfide bonds  of the  keratin  molecules in hair. [ 2 ]   This reduces the  tensile strength  of the keratin so greatly that the hair can be wiped away."}
{"_id": "WikiPedia_Dermatology$$$corpus_5238", "text": "Previously called \"Neet,\" the hair removal product was originally manufactured by the Hannibal Pharmaceutical Company. In 1918 the company registered \u201cNeet\u201d as a trademark in Canada. [ 3 ]  Shortly thereafter, in 1921, the company filed for a trademark in the United States, with the subsequent trademark being granted in 1922. [ 4 ] [ 5 ]  In 1958; however, the trademark for Neet was transferred to the  American Home Products Corporation . Today, Reckitt Benckiser Group PLC, holds the trademark, having acquired it in 1990 (then called Reckitt & Colman (Overseas) Limited). [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5239", "text": "The Veet name was established in 1922 in the UK,  vite  meaning \"quickly\" in the  French language . [ 6 ]  The name was used in some European countries but was not used universally. For example, while the product was sold as Veet in France, [ 7 ]  the product was sold in Canada and the United States as Neet until 2002, when the Veet name was first used commercially in those countries. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5240", "text": "As for 2021, Veet has developed products for different types of skin such as normal, dry and sensitive. Additionally, they have expanded from wax strips to creams and selling a device called \"Sensitive Precision\" to style face, bikini and underarm. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5241", "text": "Veet was advertised in the 1920s (then known as Neet) as a product that was \"faster than shaving\", was called \"the ready to use hair removing cream,\" and was initially sold for about fifty  cents  in the United States. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5242", "text": "More recent advertising campaigns have used university students as spokespersons for their products [ 11 ]  or contained political commentary, such as the \"No More Bush\" ads after the  2008 United States Presidential Election . [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5243", "text": "Some advertising from Veet has been controversial.  A test website for the product in France offended some online users by claiming that the product was \"good for the pussy.\" [ 13 ]  A representative of Veet addressed the situation stating, \"We wanted to create an ad campaign that was a bit humorous and offbeat...we didn't want to shock, but we're not the experts on that.\"  The manager reported there were several complaints about the website, and it was summarily taken down so as not to \"tarnish the brand's image.\" [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5244", "text": "In April 2014, Veet released a number of controversial commercials. These were poorly received across social media, drawing wide criticism for their unkind depiction of unshaven women as being masculine. [ 15 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5245", "text": "The  AIM at Melanoma Foundation   (AIM)  is a nonprofit organization focused on  melanoma  research. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5246", "text": "AIM was created as a collaboration between the Charlie Guild Foundation and  James A. Schlipmann Melanoma Cancer Foundation . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5247", "text": "AIM is a partner of the  Society for Immunotherapy of Cancer . [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5248", "text": "In the first quarter of 2021, the foundation received a $10,000 grant from  Pfizer  for a project titled \u201cFrom the Clinic to the Living Room\u201d. [ 4 ]  Additional industry sponsors include: [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5249", "text": "The  American Academy of Dermatology  ( AAD ) is a non-profit professional organization of  dermatologists  in the  United States  and  Canada , based in  Rosemont, Illinois , near  Chicago . It was founded in 1938 and has more than 20,500 members. The Academy grants fellowships and associate memberships, as well as fellowships for nonresidents of the United States or Canada. [ 3 ]  Since 1979, the AAD also publishes a monthly  medical journal , the  Journal of the American Academy of Dermatology . [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5250", "text": "To become a Fellow of the American Academy of Dermatology (FAAD), a physician must be a resident of the United States of America or Canada and certified by the  American Board of Dermatology  or in dermatology by the  Royal College of Physicians and Surgeons of Canada . [ 5 ] [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5251", "text": "To become an associate member, a physician must have three years of experience in practice or as a teacher or graduate student of dermatology and must have had training that qualifies for examination by the American Board of Dermatology or the Royal College of Physicians and Surgeons of Canada. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5252", "text": "In 1938, the American Academy of Dermatology and Syphilology was founded at an organizational meeting at the  Statler Hotel  in  Detroit , Michigan. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5253", "text": "The Sulzberger Institute for Dermatologic Education was a grant-giving organization that funds research technology of education. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5254", "text": "The American Academy of Dermatology Political Action Committee (SKINPAC) donated nearly $1.3 million to both Democratic and Republican office-seekers during the 2016 election cycle. The PAC raised more than $1.4 million from 1,700 donors, who gave more than $200 each, with 49 donors, mostly dermatologists, making the maximum donation allowed by law, $5,000 each. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5255", "text": "SKINPAC gave: [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5256", "text": "Donations in the 2016 cycle were slightly down (6.6%) from the 2014 cycle. The PAC spent an additional $29,900 with the Mammen Group, a DC-based direct mail agency and $28,800 with Prevail Strategies, a political consulting and public affairs company. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5257", "text": "The  American Board of Dermatology  ( ABD ), located in  Newton, Massachusetts , United States, certifies physicians in  dermatology ,  dermatopathology , and pediatric dermatology. Board-certified physicians are known as diplomates. Since its inception in 1932, the ABD has certified over 15,000 physicians. The ABD was one of the original four sponsoring organizations of the  American Board of Medical Specialties  (ABMS). [ 1 ]  Dermatologists possess expertise in all aspects of healthy and diseased skin through basic scientific research and clinical care. In addition to the wide range of medical diseases, dermatologists have practices devoted to skin surgery (including aesthetic procedures), care of children with skin disease, immunologic diseases of the skin and pathology of the skin. Dermatologists play an important role in the maintenance of the general public health in educating people about sun avoidance, sun protection and the signs of  skin cancer ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5258", "text": "The  American Board of Dermatology and Syphilology  was incorporated in 1932 in order to set standards in the field of dermatology and to assure the adequate training and experience of those physicians wishing to call themselves dermatologists. Evaluation of the skin was instrumental in the diagnosis of syphilis before serologic studies became available. In 1955, the name was changed to the American Board of Dermatology. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5259", "text": "The ABD originally had nine directors but has expanded to 17, reflecting the increasing complexity of the field and in response to the public demand for physician accountability in matters of quality assurance. A major new role for the ABD lies in the rigorous maintenance of certification program that enrolls physicians in a lifelong certification process encompassing a variety of quality measures and outcomes."}
{"_id": "WikiPedia_Dermatology$$$corpus_5260", "text": "Initial certification is attained after post-graduate medical education, and the notation \"board-certified\" attests to the physician's successful mastery of a body of knowledge and set of skills. The ABMS and its affiliated boards strive for the highest standards to assure the public that a board-certified physician is current in medical knowledge and practices medicine ethically."}
{"_id": "WikiPedia_Dermatology$$$corpus_5261", "text": "To assure ongoing competence, maintenance of certification was enacted. As of 2006, all dermatologists successful in initial certification enter MOC. [ 3 ]  Through periodic self-assessment of medical knowledge, communication skills, patient safety and practice quality measures, physicians in MOC continue to document the high standards they have achieved."}
{"_id": "WikiPedia_Dermatology$$$corpus_5262", "text": "Maintenance of Certification has four elements: [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5263", "text": "The  American Osteopathic Board of Dermatology  ( AOBD ) is an organization that provides  board certification  to qualified  Doctors of Osteopathic Medicine  (D.O.) who specialize in the medical and surgical treatment of disorders of the skin ( dermatologists ). The board is one of 18  medical specialty  certifying boards of the  American Osteopathic Association Bureau of Osteopathic Specialists  approved by the  American Osteopathic Association  (AOA). [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5264", "text": "AOBD was established in 1945. [ 3 ]  It is one of two certifying boards for dermatologists in the United States. The other certifying authority is the  American Board of Dermatology , a member board of the  American Board of Medical Specialties . As of 2023, 687 osteopathic physicians held active certification with the AOBD. [ 4 ]  In addition to the fellows of the American Board of Dermatology, board certified osteopathic dermatologists are eligible for admission into the American Society for Mohs Surgery. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5265", "text": "Initial certification is available to osteopathic dermatologists who have successfully completed an AOA-approved  residency  in dermatology, two years of practice, successful completion of clinical and written exams. [ 6 ] [ 7 ]  Diplomates of the American Osteopathic Board of Dermatology requires osteopathic dermatologists to renew their certification every ten years to avoid expiration of their board certified status. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5266", "text": "The AOBD also oversees examinations for osteopathic dermatologists that seek to subspecialize in the fields of  Mohs micrographic surgery  and  dermatopathology . [ 8 ] [ 9 ] [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5267", "text": "The Australasian College of Dermatologists  ( ACD ) is an accredited specialist  medical college  comprising medical practitioners with specialist training in  dermatology ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5268", "text": "The Australasian College of Dermatologists was founded in 1967. There are currently over 550 Fellows of the College [ 1 ]  and over 100 registrars (doctors in training). [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5269", "text": "The ACD is the only recognised body for training as a dermatologist in Australia. [ 2 ] [ 3 ] [ 4 ] [ 5 ]  It is a member of the Council of Presidents of Medical Colleges. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5270", "text": "Australia and  New Zealand  have relatively high rates of both melanoma and non-melanoma skin cancer, thought to be due to combinations of fair-skinned population, temperate to subtropical locations and outdoor lifestyle with high sun exposure. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5271", "text": "Traditionally dermatology training was undertaken as part of General Physician training. In the 1960s, dermatologists in NSW and Victoria thought that a separate College was warranted. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5272", "text": "The College was inaugurated as the Australian College of Dermatologists on 1 May 1967. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5273", "text": "Candidates complete a four-year  fellowship  to be admitted as a Fellow of the ACD. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5274", "text": "Dermatologists are medical specialists and should be differentiated from primary-care doctors who work at \"skin screening\" clinics. All specialist dermatologists have a very high level of training and practice experience in their field. There is less regulation of primary-care skin clinics where quality and experience may therefore vary. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5275", "text": "In New Zealand, advanced training in dermatology can be done through the  Royal Australasian College of Physicians . [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5276", "text": "The ACD publishes  The Australasian Journal of Dermatology [ 10 ]  and position statements (e.g. \"Sun Protection and Sunscreen\"). [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5277", "text": "The  British Association of Dermatologists  is a charity established in 1920 whose charitable objects are the practice, teaching, training, and research of  dermatology .  It produces the  British Journal of Dermatology , a monthly peer-reviewed medical journal and organises annual conferences."}
{"_id": "WikiPedia_Dermatology$$$corpus_5278", "text": "This article about a charitable organisation in the United Kingdom is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5279", "text": "Centro Studi GISED  is an  Italian  research association with legal personality registered with no. 2096/2004 at the R.E.A. Register in  Bergamo  ( Italy ). It is a  non-profit  association established in 2002, and it develops research and educational programs with the aim of improving scientific knowledge, assistance and transparent and specific information to the public with regard to the main  dermatological diseases ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5280", "text": "The Italian Group for Epidemiological Research in Dermatology (GISED) was set up within the Italian Society of Dermatology and Venereology (formerly SIDEV, now SIDEMAST) in 1986 as a working group focusing on epidemiological research. It was a joint initiative of Prof. Tullio Cainelli, director of the Department of Dermatology,  University of Milan  at Ospedali Riuniti of Bergamo, and Prof. Alfredo Rebora, director of the Department of Dermatology,  University of Genoa . In the Scientific Committee were involved. Prof. Giuseppe Zina, director of the Department of Dermatology,  University of Turin , and Dr. Gianni Tognoni of the  Mario Negri Institute for Pharmacological Research . Dr. Luigi Naldi, at that time a young investigator at the Laboratory of Clinical Pharmacology of the Mario Negri Institute in Milan, was the person in charge of the organization of the coordinating centre. The headquarters of the coordinating centre had been located for several years, until March 2009, at the Dermatology Unit of Ospedali Riuniti of Bergamo."}
{"_id": "WikiPedia_Dermatology$$$corpus_5281", "text": "Since its founding in 1986, GISED grew progressively. Its activities ranged over the years from descriptive  epidemiology  to etiological research, randomized  clinical trials , registers, and  systematic reviews . [ 1 ] [ 2 ] [ 3 ]  A total of 50 academic and clinical centres contributed to these projects. Over the years, formal courses on research methodology and on  Evidence Based Medicine  were also organized. Overall, GISED proved to be not only an effective collaborative network but also a valuable tool for education and dissemination of an epidemiological and methodological culture. Over the years, several contacts have been established at the international level (among the others, the EuroSCAR and RegiSCAR networks, the European Dermato-Epidemiology Network (EDEN), the  Cochrane Collaboration )."}
{"_id": "WikiPedia_Dermatology$$$corpus_5282", "text": "A limiting factor for further possible development of GISED activities was the lack of a formal structure and legal basis for the coordinating centre. For this reason, in 2002, the Centro Studi GISED association was founded. Dr. Luigi Naldi was elected president, assisted by a scientific Board composed by the most active members of the group. In 2003, Centro Studi GISED got formal recognition as a non-profit association by the  Lombardy Region  and was registered in the Register of Companies (REA) with the n. 2096. Again in 2003, an agreement with the Inter-University Centre Thomas Chalmers at the University of Milan was signed and Centro Studi GISED became a component of the Italian Cochrane Network."}
{"_id": "WikiPedia_Dermatology$$$corpus_5283", "text": "Besides coordinating the research projects of the GISED network, Centro Studi GISED began to develop its own projects with particular attention to clinical research, combination of basic research and clinical research (translational research),  imaging  and information techniques in dermatology. [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ]  In 2008, GISED ceased to be a working group of SIDEMAST and was maintained as an informal group of people interested in working in multi-centre studies, the \"GISED network\". The headquarters of the Association were at Ospedali Riuniti of Bergamo until March 2009, when they moved to the Matteo Rota Hospital, collaborating with the newly formed Research Foundation Ospedale Maggiore of Bergamo (FROM). From 2009 to 2011 another office, primarily dedicated to the development of innovative imaging systems in dermatology, was activated at the Kilometro Rosso Science and Technology Park in Stezzano. In March 2018, Centro Studi GISED moved its headquarters to via Clara Maffei 4 in Bergamo, at the officies made available by the Health Protection Agency (ATS) of Bergamo."}
{"_id": "WikiPedia_Dermatology$$$corpus_5284", "text": "DEBRA  (formerly known as DebRA) is the name of an international medical  research   charity  dedicated to securing effective drug treatments and ultimately cures for every type of  epidermolysis bullosa , with national groups in over 40 countries including in the  United Kingdom  and the  United States . [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5285", "text": "\"Debra\" is the first name of the daughter of Phyllis Hilton, the original founder of the organisation in the UK, which began as a support group for parents, guardians and carers of other young children with the condition."}
{"_id": "WikiPedia_Dermatology$$$corpus_5286", "text": "Although the  backronym  of Dystrophic Epidermolysis Bullosa Research Association has been used by DEBRA UK [ 2 ]  in the past, the organisation provides information, research funding and support for  all  forms of EB, not just dystrophic, which is one of three main sub-types of the condition; the others being EB simplex and junctional EB."}
{"_id": "WikiPedia_Dermatology$$$corpus_5287", "text": "The DebRA US organisation have continued to use the aforementioned acronym DEBRA for the Dystrophic EB Research Association of America since their formation in 1980."}
{"_id": "WikiPedia_Dermatology$$$corpus_5288", "text": "Epidermolysis bullosa is a genetic condition that in its most severe forms affects all of the body's linings, the skin, the linings of the mouth and oesophagus, and even the eyes. [ 3 ]  In its most severe forms the linings blister or rip away from the flesh under the lightest of frictions. For example, rolling over in bed can cause skin to tear away from behind the ears, and the sufferer may wake up with up to 30 blisters each morning."}
{"_id": "WikiPedia_Dermatology$$$corpus_5289", "text": "There is no treatment bar the lancing and draining of these blisters to stop their growth. Sufferers of the severest form die prematurely of skin cancer (their life expectancy is usually reduced by 30\u201340 years); in some, death occurs in infancy. Each day sufferers face a battle against fluid loss and infections due to open wounds. Blistering can also affect inner body linings, such as the mouth and throat. Sufferers of the severest forms have difficulties with eating due to the rawness in their mouths and often have to have a feeding tube fitted."}
{"_id": "WikiPedia_Dermatology$$$corpus_5290", "text": "EB has a number of distinct forms: in the least severe form, blistering is confined to the hands and feet. In more severe cases, the whole body is affected and wounds heal very slowly, giving rise to scarring, physical deformity and significant disability."}
{"_id": "WikiPedia_Dermatology$$$corpus_5291", "text": "DEBRA UK is the national medical research charity and patient support organisation for individuals and families affected by EB. There are at least 5,000 people living with this devastating condition in the UK and 500,000 people worldwide. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5292", "text": "DEBRA UK was founded in 1978 and provides an enhanced specialist EB nursing service, in partnership with the NHS, to deliver optimal healthcare to children and adults living with EB and community support staff to work directly with families. The charity also commissions research into the condition with the aim of finding effective drug treatments and, ultimately, a cure for EB. DEBRA UK has over 90 charity shops across the country. Donations and proceeds from shops fund services for epidermolysis bullosa affected families and medical research into the condition. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5293", "text": "Debra of America was founded in 1980 by Arlene Pessar and her son, Eric Lopez, who was born with epidermolysis bullosa. [ 5 ]  It is the only U.S. nonprofit organization that provides all-inclusive support to the EB community, through funding research for a cure and by providing free programs and services for those with EB. The mission of debra of America is to improve the quality of life for all people living in the United States with EB, their families, and caregivers, through free programs and services [ 6 ]  while funding research to find a cure and treatments for EB. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5294", "text": "In 2015, Debra of America launched a series of TV and web commercials alongside a campaign titled #ItWontHurtToWatch [ 8 ]  These commercials, produced by health and wellness advertising agency  HAVAS Worldwide Tonic , are intended to spread awareness of the debilitating rare disease."}
{"_id": "WikiPedia_Dermatology$$$corpus_5295", "text": "A list of national groups may be found at DEBRA International. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5296", "text": "The  Deutsche Dermatologische Gesellschaft e.V.  ( DDG , German Dermatological Society; \" e.V. \" meaning \"registered association\") is a scientific specialized society for  dermatology  in  Germany . [ 1 ]  It is a member of the Association of Scientific Medical Societies in Germany (AWMF)."}
{"_id": "WikiPedia_Dermatology$$$corpus_5297", "text": "The aim is the promotion of scientific and professional concerns of dermatology,  venereology  and  allergology  and the support of specialization areas in dermatology,  andrology ,  phlebology , and  lymphology ,  proctology , operative dermatology and dermatooncology, dermatological  radiotherapy , dermatological  microbiology , occupational and environmental dermatology, and  derma histology , as well as  prevention  and  rehabilitation . The DDG also operates as advisor for German and international governments and authorities, public and non-public organizations, medical and  scientific societies , institutions, clinics, and individuals in scientific and professional quests. It was founded in 1889 in  Prague  and comprises almost 3,600 full and associated members. The society is based in  Berlin , where they operate a joint office with the  BVDD, Berufsverband der Deutschen Dermatologen  (Professional Association of Germany's dermatologists). In 1998 these two organizations founded the  DDA, Deutsche Dermatologische Akademie  (German dermatological academy), which is committed to the continued and advanced education of dermatologists."}
{"_id": "WikiPedia_Dermatology$$$corpus_5298", "text": "The DDG employs several different working groups which are dedicated to the science of specific topics and publish recommendations and guidelines. [ 2 ]  Among these working groups are:"}
{"_id": "WikiPedia_Dermatology$$$corpus_5299", "text": "The DDG is an association of German-speaking dermatologists and therefore collaborates closely with the dermatological professional societies of  Austria  (\u00d6GDV) and Switzerland (SGDV). It is also a member of the International League of Dermatological Societies (ILDS), the international umbrella organization of all scientific professional societies in the field of dermatology. The DDG also is represented in the European Academy of Dermatology and Venereology (EADV), the  European Dermatology Forum  (EDF), the  European Society Dermatological Research  (ESDR), and the Union of  European Union Medical Specialists  (UEMS). [ 3 ] [ 4 ] [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5300", "text": "The publication organ of the DDG is the magazine  Journal der Deutschen Dermatologischen Gesellschaft [ 6 ] [ 7 ]  (ISSN 1610-0387), published by  Wiley Online Library , and the society awards different scientific prizes, such as \"Deutschen Neurodermitis Preis\", \"Deutschen Psoriasis Preis\", \"Oscar-Gans-Preis\" [ 8 ]  etc. [ 9 ]  and grants research  fellowships . [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5301", "text": "Commemorating the 70th anniversary of the death of  Karl Herxheimer , who was a  Jewish  dermatologist from  Frankfurt am Main  in  Nazi Germany , the society organized a  Karl Herxheimer  commemoration lecture on 6 December 2012 and set up a memorial stone in the Jewish  graveyard  in Frankfurt."}
{"_id": "WikiPedia_Dermatology$$$corpus_5302", "text": "The award of the Karl Herxheimer Medal is the highest honor in German dermatology. [ 11 ]  It is given to outstanding scholars in the field of dermatovenerology in memory of the great doctor, teacher and researcher Karl Herxheimer."}
{"_id": "WikiPedia_Dermatology$$$corpus_5303", "text": "The  European Board of Dermatology-Venereology  (EBDV) represents the specialties of  dermatology  and  venereology  within the  European Union of Medical Specialists  (UEMS). [ 1 ] [ 2 ]  The EBDV is responsible for setting the charter of training in dermatology-venereology, [ 3 ]  the guidelines for the log book of training and visitation of training centres [ 1 ]  and the European board examination in dermatology-venereology [ 4 ]  in  UEMS  member states."}
{"_id": "WikiPedia_Dermatology$$$corpus_5304", "text": "The UEMS-EBDV board examination covers the specialties of  dermatology  and  venereology  and has been held annually since 2006. [ 1 ]  Trainees are eligible to sit the examination when they have fulfilled the requirements of their national training body or when approaching the end of their training. [ 5 ]  Candidates who successfully passed the board examination and are certified specialists in a  UEMS  member state can call themselves 'Fellow of the European Board of Dermatology-Venereology' (FEBDV), other successful candidates are considered 'European Board Certified'. [ 6 ]  The European examinations are compulsory in some member states. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5305", "text": "This article about a medical organization or association is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5306", "text": "International Dermoscopy Society (IDS)   is a  non-governmental organization  offering comprehensive promotion of dermoscopy, also known as  dermatoscopy . [ 1 ] [ 2 ]  It has over 16,000 international members from over 160 countries."}
{"_id": "WikiPedia_Dermatology$$$corpus_5307", "text": "Dermoscopy is a valuable diagnostic tool in dermatology for correct identification and management of skin tumors, inflammatory skin conditions and skin infections. [ 3 ] [ 4 ] [ 5 ]  Hans Peter Soyer (Past President), Rainer Hofmann-Wellenhof (Treasurer) and Giuseppe Argenziano (Past President) founded the society in 2003 in Graz, Austria, which is also home to the society's head offices. The current President is Aimilios Lallas and the General Secretary is Caterina Longo."}
{"_id": "WikiPedia_Dermatology$$$corpus_5308", "text": "Every three years, the IDS hosts a world congress and its 6th World Congress of Dermoscopy, [ 6 ]  will be held in Buenos Aires, Argentina in 2024. Each year, the IDS also organizes scientific meetings at the annual international congresses organized by the  American Academy of Dermatology  and the European Academy of Dermatology and Venereology."}
{"_id": "WikiPedia_Dermatology$$$corpus_5309", "text": "The IDS\u2019 official medical journal is  Dermatology Practical & Conceptual  (DPC). The DPC journal is an international, peer-reviewed and open-access journal indexed on PubMed. The journal focuses on clinical research articles within the field of dermatology."}
{"_id": "WikiPedia_Dermatology$$$corpus_5310", "text": "The IDS is also an Affiliated Member Society of the  International League of Dermatological Societies ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5311", "text": "The International League of Dermatological Societies  (ILDS) is a  non-governmental organization  that works closely with the  World Health Organization . It was founded in 1935, but because of  World War II  no congresses were held until 1952. It is governed by the International Committee of Dermatology."}
{"_id": "WikiPedia_Dermatology$$$corpus_5312", "text": "The ILDS is the parent organization of the International Foundation for Dermatology, [ 1 ]  founded in 1987."}
{"_id": "WikiPedia_Dermatology$$$corpus_5313", "text": "After the publication of  ICD-10 , the ILDS produced a series of compatible extensions for use in  dermatology ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5314", "text": "The  International Society of Dermatopathology  is a non-profit, international  society  for the discipline of  dermatopathology  which was founded in 1979.  It is based in  Half Moon Bay , California, US. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5315", "text": "It publishes a peer-reviewed journal,  The American Journal of Dermatopathology  (AJDP). [ 2 ]  It was founded by Helmut Kerl, MD; G\u00e9rald E. Pi\u00e9rard, MD; Jorge S\u00e1nchez, MD; and the late A. Bernard Ackerman, MD. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5316", "text": "The  National Psoriasis Foundation (NPF)  is one of the world's largest nonprofit organization [ citation needed ]  serving people with  psoriasis  and  psoriatic arthritis . The NPF provides information and services to help people manage their condition while supporting research to find a cure. In addition to serving more than 3 million people annually through patient and professional health education and  advocacy  initiatives, the NPF has funded more than $10 million in psoriatic disease  research grants  and fellowships."}
{"_id": "WikiPedia_Dermatology$$$corpus_5317", "text": "The National Psoriasis Foundation (NPF) focuses on improving the health of people with psoriasis and psoriatic arthritis. Through the organization's work to increase research, improve access to care, and expand knowledge of the psoriatic disease, the NPF aims to: [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5318", "text": "The NPF works to increase the number of dollars, scientists, and quality research projects devoted to psoriatic disease to find better treatments and a cure."}
{"_id": "WikiPedia_Dermatology$$$corpus_5319", "text": "Each year, the NPF awards Discovery Grants and Translational Grants to support the start-up of new and innovative studies."}
{"_id": "WikiPedia_Dermatology$$$corpus_5320", "text": "NPF Discovery Grants are one-year awards of up to $75,000 that fund researchers to explore preliminary ideas and conduct proof-of-concept experiments. The goal is to stimulate the development of new research programs in the field of psoriatic disease that are capable of competing for long-term funding from the National Institutes of Health or other agencies in the future. Funded research areas include, but are not limited to, genetics, cell biology, immunology, and epidemiology/health services. [ 5 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5321", "text": "NPF Translational Grants' are two-year awards up to $200,000 total that is focused on moving scientific discoveries generated during laboratory or clinical research into projects that clearly benefit patients. In 2015, the National Psoriasis Foundation and the Arthritis National Research Foundation collaborated on a special Psoriatic Arthritis Research Grant. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5322", "text": "To address the shortage of clinicians with in-depth knowledge of the psoriatic disease, the National Psoriasis Foundation awards annual Medical Dermatology Fellowships. The fellowships, one-year awards up to $50,000, aim to increase the number of scientists focused on studying and treating psoriatic disease by encouraging young scientists to become physician researchers and dedicate their careers to psoriatic disease. [ 7 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5323", "text": "The National Psoriasis Victor Henschel BioBank is a collection of biological samples and clinical information used by qualified scientists to advance the field of psoriasis genetics. It is one of the largest collections of psoriasis DNA samples in the United States. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5324", "text": "As the catalyst for psoriatic disease research, NPF is dedicated to promoting patient involvement in research studies and clinical trials. NPF offers research and clinical trial referral services that provide targeted outreach to people with psoriasis and psoriatic arthritis. [ 9 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5325", "text": "The National Psoriasis Foundation focuses on changing policy to increase the federal government's attention on psoriatic disease, and to ensure that people get access to the treatments and medical specialists they need to best manage their condition."}
{"_id": "WikiPedia_Dermatology$$$corpus_5326", "text": "Through the collective efforts of tens of thousands of advocates nationwide, NPF works to:"}
{"_id": "WikiPedia_Dermatology$$$corpus_5327", "text": "The National Psoriasis Foundation provides people with psoriasis and psoriatic arthritis and their healthcare providers the latest information, education, and critical support services so they can best manage their condition and improve overall health and well-being."}
{"_id": "WikiPedia_Dermatology$$$corpus_5328", "text": "Free health webcasts from leading psoriatic disease experts arm people with information to reduce pain, inflammation, and itching; clear skin; loosen joints; better understand future treatment options; and decrease their risk for related conditions associated with psoriatic diseases like heart disease and diabetes. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5329", "text": "More than Skin Deep is a series of live patient-focused events held nationwide. This educational program provides people with the latest information from leading experts to best manage their condition. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5330", "text": "The NPF offers people who are newly diagnosed support from trained peer mentors with its Psoriasis One-to-One mentor program. Additionally, the organization has a health educator on staff who is available to answer questions about psoriasis, psoriatic arthritis, treatment options, and related topics."}
{"_id": "WikiPedia_Dermatology$$$corpus_5331", "text": "The NPF also offers professional education for healthcare providers with CME events and other programs. [ 13 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5332", "text": "Founded and headquartered in Portland, Oregon, the Psoriasis Foundation opened its second office in Alexandria, Virginia, in 2013. As of 2015, the organization has 10 Community Divisions in Chicago, Dallas/Fort Worth, Florida South, Florida West, Los Angeles, New York City, Northern California, Portland, San Diego, and Washington, D.C. These community divisions, led by a National Psoriasis Foundation community development manager and a group of volunteers, focus on fundraising, patient and health care provider outreach, grassroots advocacy and local education."}
{"_id": "WikiPedia_Dermatology$$$corpus_5333", "text": "Team NPF is a group of everyday people with or without psoriatic disease who are walking, running, cycling, and DIY-ing for psoriasis and psoriatic arthritis cure. Team NPF Walks are held in communities around the country. In August 2015, the National Psoriasis Foundation hosted its inaugural Team NPF Cycle event. [ 14 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5334", "text": "The National Psoriasis Foundation is a  501(c)(3)   nonprofit organization ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5335", "text": "In 2012, the organization received Charity Navigator's four-star rating, its highest rating, for its sound fiscal management and commitment to accountability and transparency. [ 15 ]  The NPF receives funding and support from individuals affected by psoriatic disease and their families, friends, and medical providers. Corporations and foundations also fund the education, advocacy, and research programs that help people with psoriatic disease better manage their condition and improve their overall health."}
{"_id": "WikiPedia_Dermatology$$$corpus_5336", "text": "The National Rosacea Society  ( NRS ) is a  501(c)   nonprofit organization  dedicated to improving the lives of the estimated 16 million Americans who suffer from  rosacea , a chronic facial skin disorder. Its mission is to raise awareness, provide health information, and support medical research that may lead to improvement in the management, prevention, and potential cure for rosacea. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5337", "text": "Although rosacea was first described by  Guy de Chauliac  in the 14th century and included Chaucer's  The Canterbury Tales , [ 2 ]  when the National Rosacea Society was founded in 1992 rosacea was still considered a rare disease, and its first approved treatment, topical  metronidazole , received  orphan drug  designation by the  U.S. Food and Drug Administration  in the belief that fewer than 200,000 Americans suffered from it. [ 3 ]  It soon became evident that rosacea affected the lives of millions, who had previously failed to realize they had a medical condition that could be treated. A 2018 study estimated global incidence of rosacea to be more than 5%, or equivalent to around 415 million. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5338", "text": "The National Rosacea Society designates each April as Rosacea Awareness Month [ 5 ]  and conducts national communications, public relations, and social media activities throughout the year. The society also produces patient education materials. [ 6 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5339", "text": "In 2024, the Society launched a Seal of Acceptance program to identify gentle skin care and cosmetic products that have been clinically tested and evaluated to be unlikely to irritate rosacea skin. [ 7 ] [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5340", "text": "In 1999, [ 9 ]  the National Rosacea Society launched a patient-funded research grants program to support scientific research into potential causes and other key aspects of rosacea that may lead to improvements in its management, prevention, or potential cure. Because the etiology of rosacea is unknown, a high priority in awarding grants is given to studies relating to such areas as the pathogenesis, progression, mechanism of action, cell biology, and potential genetic factors of rosacea. Research in such areas as epidemiology, predisposition, quality of life, and relationships with environmental and lifestyle factors may also be funded. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5341", "text": "Since its inception, more than $1.5\u00a0million has been awarded to support more than 70 studies. [ 11 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5342", "text": "To provide a basis for meaningful scientific investigation, the NRS organized a consensus committee and review panel of 21 medical experts to establish a standard definition and classification system for rosacea, published in 2002, [ 12 ]  as well as a standard grading system published in 2004. [ 13 ]  The classification system was instrumental in establishing the clinical subtypes\u2014erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea\u2014commonly used to describe the disease. [ 14 ] [ 15 ]  In 2009, an NRS consensus committee and review panel of 26 medical experts published standard management options for rosacea. [ 16 ] [ 17 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5343", "text": "In 2017, an NRS consensus committee and review panel of 28 medical experts published an updated classification and pathophysiology of rosacea, [ 18 ]  reflecting the increased understanding of the disease and its progression gained in the 15 years since the original classification was published. The updated classification shifted focus away from subtypes to a phenotype approach to diagnosis. [ 19 ] [ 20 ]  The article was accompanied by an editorial on rosacea comorbidities and areas for future research. [ 21 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5344", "text": "In 2020, an NRS consensus committee and review panel of 27 medical experts published updates standard management options for rosacea, [ 22 ]  intended to provide a comprehensive summary of treatment options for the respective phenotypes identified in the updated standard classification of rosacea, and recommending that physicians to tailor therapy to each patient's individual case. [ 23 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5345", "text": "The  New Zealand Dermatological Society  is a  not-for-profit  incorporated  society  for  dermatologists  in  New Zealand . Its website for public education,  DermNet , was started in 1996. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5346", "text": "The  Saudi Society of Dermatology and Dermatologic Surgery  (in  Arabic   \u0627\u0644\u062c\u0645\u0639\u064a\u0629 \u0627\u0644\u0633\u0639\u0648\u062f\u064a\u0629 \u0644\u0623\u0645\u0631\u0627\u0636 \u0648\u062c\u0631\u0627\u062d\u0629 \u0627\u0644\u062c\u0644\u062f ), commonly abbreviated as SSDDS, (formerly  The Saudi Society of Dermatology and Venereology ), is a scientific organization that was established in 1989."}
{"_id": "WikiPedia_Dermatology$$$corpus_5347", "text": "Dr. Sami Al Sogair has been attributed to the foundation of the  society , who also stands as its president since 1989 until 1994."}
{"_id": "WikiPedia_Dermatology$$$corpus_5348", "text": "In 1994, an SSDDS election installed Dr Omar AlSheikh as president, succeeded by Dr Sami Alsuwaidan.\nDr. Abdullah Sulaiman Alakeel is the current president of the society. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5349", "text": "The 13th National Symposium of the SSDDS was held on 30\u201331 December 2009. [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5350", "text": "The  Sindh Institute of Skin Diseases  ( Urdu :  \u0633\u0646\u062f\u06be \u0627\u062f\u0627\u0631\u06c1 \u0628\u0631\u0627\u0626\u06d2 \u0627\u0645\u0631\u0627\u0636\u0650 \u062c\u0650\u0644\u062f ) known as Skin Hospital or Chamra Hospital ( Urdu :  \u0686\u0645\u0691\u06c1 \u06c1\u0633\u067e\u062a\u0627\u0644 ) is a 50-bed  dermatological   hospital .  It is the only public sector skin hospital in  Karachi  and is located in the Regal Chowk area. [ 1 ] [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5351", "text": "This hundred-bed hospital specializes in skin diseases exclusively. It does not charge any fees for services and is governed by the  Government of Sindh Province . Over 4,000 outpatients visit the hospital daily. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5352", "text": "The hospital has a minor operation theater that is used for surgical procedures like excision and  biopsies . The  pathology  laboratory has a facility for routine blood tests along with other special tests like fungal scraping,  Tzanck smear , LD bodies, tests for  syphilis ,  hepatitis B  and C virus,  HIV  serology\u2014all performed free of charge. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5353", "text": "Procedures like electric  cauterization , chemical cautery and  cryotherapy  are also performed. A facility for  light therapy  is also available. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5354", "text": "The head of the hospital in 2018 was Iqbal Soomro. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5355", "text": "The site where the hospital has been located since Pakistani independence was before 1947 a centre for treatment of socially transmitted diseases.  After 1947, it was converted to a centre for skin and social hygiene and treatment of lepers.  The 50-bed hospital for treatment of skin diseases was established in the 1990s. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5356", "text": "This article about a hospital in Pakistan is a  stub . You can help Wikipedia by  expanding it ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5357", "text": "The  Unilever Research & Development Port Sunlight Laboratory  is the multinational consumer goods company  Unilever 's main research and development facility in the United Kingdom. It is located in  Bebington , Merseyside."}
{"_id": "WikiPedia_Dermatology$$$corpus_5358", "text": "Unilever's predecessor companies conducted research in Bebington from 1890 and the first dedicated research building was built in 1911 by  Lever Brothers . Unilever was formed in 1929, and until 1951 Port Sunlight was its main research laboratory worldwide."}
{"_id": "WikiPedia_Dermatology$$$corpus_5359", "text": "In the 1920s the former site researched  vitamin A  and  D  in margarine. [ 1 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5360", "text": "It created a research division in 1961. In the early 1960s the site researched  colloid  chemistry,  surface active phenomena ,  rheology  of dispersions, surface chemistry, fluorescence of dyestuffs,  adsorbed films  on liquids,  germicides , timber technology (for West Africa), and  paper chromatography . Organic chemists, physical chemists and physicists worked there. In the 1960s the site was run by  Unilever Research . In 1964, newly-employed scientists would be earning \u00a31,450. New buildings in the mid-1960s meant more staff."}
{"_id": "WikiPedia_Dermatology$$$corpus_5361", "text": "In early 1963, 40 scientists working on margarine and edible oils, moved to the company's new site at  Welwyn  in  Hertfordshire . [ 2 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5362", "text": "In the 1960s it had strong family links with both  Wirral Grammar School for Boys , and the associated girls' grammar school. [ 3 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5363", "text": "In 1965 the site installed an  IBM System/360  (128k storage) computer at Port Sunlight, connected with  time-sharing  to  IBM 1050  consoles at other sites; it claimed to be the first time such a computer system had been installed in the UK for industrial research, and that networked across the country."}
{"_id": "WikiPedia_Dermatology$$$corpus_5364", "text": "In February 1964, planning permission was applied for a site at Spital, on Port Sunlight golf course. By 1964 the site had an  IBM 1620  computer. In 1965 the site formed an Operational Research Section at Port Sunlight, and their computers used  PL/I  and  Fortran  IV. In 1967 statisticians used  control charts ,  timeseries  analysis,  multivariate analysis  and  stochastic processes . From early 1969 the consoles at the site were  IBM 2780  with the  MFT2  and  HASP II operating systems. By 1969, new laboratories were built."}
{"_id": "WikiPedia_Dermatology$$$corpus_5365", "text": "In 1976, Dr Gordon Tiddy of Unilever studied  lyotropic liquid crystals  with the  University of Leeds  Chemistry department. In 1978, the site carried out  inelastic electron tunnelling spectroscopy  with  Leicester Polytechnic  on an  SRC  CASE studentship. In 1979 their statistical computer packages were  NAG , and  GLIM 1\u20133 ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5366", "text": "In the 1970s scientists at Port Sunlight discovered  tetraacetylethylenediamine  (TAED), which allows clothes to be washed at lower temperatures."}
{"_id": "WikiPedia_Dermatology$$$corpus_5367", "text": "By the 1970s, Unilever was also the UK's largest food processing company, and the world's second-largest company, outside the US. [ 4 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5368", "text": "In 1981 the site conducted work with the  University of Oxford , involving free radicals,  spin trapping  and redox-active enzymes with Dr (later Professor)  Allen Hill . In 1987 it conducted fluorescence-coupled  surface plasmon resonance  research with  Durham University Department of Physics ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5369", "text": "In 2017, Anglo-Dutch Unilever opened a \u00a324m Advanced Manufacturing Centre, built by BAM Construction (owned by the Dutch  Royal BAM Group ), at the site, [ 5 ]  with a Materials Innovation Factory [ 6 ]  at the  University of Liverpool , helped by the Regional Growth Fund."}
{"_id": "WikiPedia_Dermatology$$$corpus_5370", "text": "Construction of the new \u00a33m centre began in summer 1967. [ 7 ] \nStaff moved in from March 1969. [ 8 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5371", "text": "It was officially opened on Monday 20 July 1970 by Sir  Eric Rideal . [ 9 ] \nThe gross floor area of the research centre was 207,000 sq ft. Including ancillary buildings it was 350,000 sq ft. [ 10 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5372", "text": "The next door \u00a340m Manufacturing Technology Centre was built from July 1992, by Tarmac Construction. [ 11 ] \nopening in May 1995; the new site included different types of  pilot plants , and the five-storey Powder Technology Pilot Plant. [ 12 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5373", "text": "The first building was built in 1942, at a cost of \u00a3172,000, and with enlargements it was 160,000 sq ft by the early 1960s. A \u00a3270,000 extension, adding 27,000 sq ft was started in January 1963.\nAs part of the extension, a 250-seat demonstration theatre was added, with a revolving stage, for research conferences. The site had around 150 scientists and about 200 assistants."}
{"_id": "WikiPedia_Dermatology$$$corpus_5374", "text": "Unilever is the world's third-largest cosmetics company, after  L'Or\u00e9al  and P&G."}
{"_id": "WikiPedia_Dermatology$$$corpus_5375", "text": "In the 1960s Unilever Research worked with  J. D. Bernal  of Birkbeck College. [ 30 ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5376", "text": "The site is on the west side of the railway, between  Spital railway station , to the south, and  Port Sunlight railway station  to the north."}
{"_id": "WikiPedia_Dermatology$$$corpus_5377", "text": "By 1970 its research division had 4,600 scientists with a budget of \u00a332\u00a0million (current value \u00a3625.2 million), rising to \u00a3219\u00a0million in 1983 (current value \u00a3933.4 million), then \u00a3330\u00a0million in 1987 (current value \u00a31172.4 million). By the end of the 1980s there were around 400 scientists at Port Sunlight. [ citation needed ]"}
{"_id": "WikiPedia_Dermatology$$$corpus_5378", "text": "Over 750 scientists are currently [ when? ]  based at the laboratory. It conducts research for products including  Dove ,  Sunsilk  and  Domestos ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5379", "text": "Unilever operates similar research facilities in  Vlaardingen ,  Colworth , Shanghai,  Bangalore  and  Trumbull . Research was earlier carried out at 455 London Road ( A315 ) in  Isleworth  from 1950 to 1980, it looked at hair, skin and teeth; this research moved to Bebington at the end of 1980. American research was at  Edgewater, New Jersey , where  Vincent Lamberti  invented Dove soap. The industry is represented by the  UK Cleaning Products Industry Association ."}
{"_id": "WikiPedia_Dermatology$$$corpus_5380", "text": "Unilever had a  defined benefit pension plan  up until 2019. [ 31 ]"}
{"_id": "dermnetz_clean$$$corpus_1", "text": "Physical examination shows thickened and bumpy nasal skin; and pink patches with telangiectasia and red papules on the face, most prominently on the medial cheeks and forehead. This is rhinophyma, and he also has associated papulopustular rosacea. General skincare (emollients, soap substitutes) and lifestyle advice is important in managing rosacea in general. Keeping a symptom diary to identify and avoid triggers (eg, foods, hot beverages, spices, alcohol) for flare-ups can be helpful. Cool compresses are often used for flushing and various topical or systemic medications may be considered for symptom control. Sunscreens may help as many sufferers experience exacerbation with sunshine. This patient was prescribed the tetracycline antibiotic doxycycline, and advised to avoid spicy foods, alcohol, caffeine, and stress. He was also recommended to seek plastic surgery consultation to consider cosmetic facial resurfacing. Oral isotretinoin has also been reported to be useful in treating rhinophyma; the drug reduces the enlarged sebaceous glands that characterize rhinophyma. See: Rhinophyma."}
{"_id": "dermnetz_clean$$$corpus_2", "text": "This is a cutaneous squamous cell carcinoma (SCC). SCC is a common skin cancer derived from keratinocytes. It is invasive and can sometimes metastasise and be fatal. The mortality rate is around 25%. SCC usually begins as a tender erythematous papule or nodule. It usually has surface scales. It tends to grow faster than basal cell carcinomas (BCCs). Some SCCs can bleed or ulcerate. They are usually located on sun-exposed sites such as the face, lips, ears, bald scalp, forearms, hands, and lower legs. Most SCCs arise from actinic keratoses (AK) or SCC in situ. SCCs are five times more common in solid organ transplant recipients who are on systemic immunosuppressants. The longer the period of immunosuppression, the greater the risk of SCC development. Education regarding this risk of skin cancer, its early presenting features, and rapid access to specialists is essential. Vigilant sun protection is essential for high-risk patients. Patients should be advised to minimise sun/ultraviolet (UV) light exposure and wear sun protective clothing such as a wide-brimmed hat, long-sleeved shirt, and long pants. They should also apply SPF 50+ sunscreen with UVA and UVB blocking properties regularly when outdoors. Oral acitretin has been shown to reduce SCC development in solid organ transplant recipients by 2030%. See: Cutaneous squamous cell carcinoma."}
{"_id": "dermnetz_clean$$$corpus_3", "text": "Physical examination shows: She was diagnosed with confluent and reticulated papillomatosis. This uncommon skin condition has an unclear cause. Current studies support a bacterial aetiology (a gram-positive actinomycete Dietzia papillomatosis) and the condition responds well to antibiotics. Differential diagnoses include tinea versicolor (excluded by direct mycology) and acanthosis nigricans. Confluent and reticulated papillomatosis usually clears with a tetracycline antibiotic. This patient was prescribed minocycline, and the rash resolved. See: Confluent and reticulated papillomatosis."}
{"_id": "dermnetz_clean$$$corpus_4", "text": "Physical examination shows monomorphic pink papules and fine pustules with areas of redness and telangiectasia. She was diagnosed with papulopustular rosacea. Alcohol, spicy foods, hot beverages, and alcohol are frequently cited food triggers. Sunshine usually makes rosacea worse, though in a small minority it actually helps. Drugs that cause flushing may make rosacea worse. General skincare and lifestyle advice is important in managing rosacea. Keeping a symptom diary to identify and avoid triggers for flare-ups can be helpful. Cool compresses are often used for flushing and various topical or systemic medications may be considered for symptom control. This patient was prescribed oral doxycycline and advised to avoid sun exposure (see: Sun protection). Her symptoms responded gratifyingly. See: Rosacea."}
{"_id": "dermnetz_clean$$$corpus_5", "text": "Physical examination shows reticulate red-brown hyperpigmentation with telangiectasia and atrophy on the lateral cheeks and sides of the neck. This is poikiloderma of Civatte, which is typically seen on sun-exposed areas such as the lateral cheeks and sides of the neck, and spares the shaded area under the chin. This is a common and benign skin condition more frequently seen in post-menopausal women. Poikiloderma is characterised by hyperpigmentation, telangiectasia, and atrophy within the same lesion. In some instances, photosensitising fragrance constituents in personal care products may be responsible. Use a UVA- and UVB-blocking sunscreen, and avoid perfumed products on the affected area. Hydroquinone and retinoid creams may help. Intense pulsed light or pulsed dye laser are both advocated to reduce both the telangiectasia and hyperpigmentation. See: Poikiloderma of Civatte."}
{"_id": "dermnetz_clean$$$corpus_6", "text": "This is chronic perioral dermatitis. It usually consists of erythematous papules arranged around the chin and nasolabial folds. Similar lesions may develop at the outer canthi. Occasionally pustules develop, and it may be mistaken for a bacterial infectionor acne. In the latter condition comedones (blackheads and whiteheads) are present. In perioral dermatitis, topical products, especially topical steroids, should generally be stopped as they can worsen the condition. Mild cases may resolve with this zero-therapy approach. In moderate or severe cases, oral tetracycline antibiotics result in rapid resolution and a gratified patient! Topical pimecrolimus is an alternative. This patient was prescribed trimethoprim as she was allergic to tetracyclines, and instructed to use gentle facial products, avoid fragrances and sun exposure, and refrain from using topical steroids. See: Periorificial dermatitis."}
{"_id": "dermnetz_clean$$$corpus_7", "text": "The most likely diagnosis is erosive pustular dermatosis of the scalp. It is more common in elderly men with a sun-damaged bald scalp, a history of actinic keratoses, and/or a history of SCCs or basal cell carcinomas (BCCs) of the scalp. It is usually diagnosed by its characteristic clinical appearance. Initially, a small area of the scalp becomes red, crusted, and irritated. Crusting and superficial pustulation usually overlies a moist, eroded surface. Extensive disease can result in scarring and extensive alopecia. SCC can develop in the scars. Potent or ultrapotent topical steroids will suppress the inflammatory changes. Gradual reduction in the potency of topical steroid used over a 6-month period may result in cure. Failure to respond to this should prompt biopsyto exclude malignancy. There is some evidence for using oral zinc sulfate, topical calcipotriol, and topical dapsone. Oral retinoids may also be tried. Maintenance therapy with sun protection and intermittent moderate-potency topical steroids can provide long-term relief. See:Erosive pustular dermatosis."}
{"_id": "dermnetz_clean$$$corpus_8", "text": "Erythema multiforme is an immune-mediated condition generally characterised by target lesions which can blister centrally, and can also include erosions or bullae in the mucosae of the mouth, genitals, or conjunctivae. The target skin lesions may be pruritic and mucosal erosions can be very painful. The patient may experience fatigue, myalgias, and fevers Viral infections such asherpes simplexvirus (HSV) are often, although not always, involved in the development of this condition. SJS/TEN tends to produce coalescing lesions affecting more than 10% of the body surface area and is usually drug induced. Mycoplasma pneumonia-induced rash and mucositis has recently been distinguished from erythema multiforme; the skin lesions are less prominent and it carries a better prognosis than erythema multiforme triggered by other agents. Erythema multiforme is generally self-limiting and symptoms usually resolve in 46 weeks. Oralantihistaminesortopical steroidsmay be used for itch if required. It may recur with subsequent attacks of herpes simplex if this is the trigger and if frequent suppressive antiviral therapy may be indicated. In erythema multiforme major with severe mucosal erosion, support of oral intake (eg, lidocaine oral gel and nutritional supplements) may be necessary. Prednisoneis often used in practice to reduce the length of the illness and its severity, but its use is not strongly evidence-based. See:Erythema multiforme."}
{"_id": "dermnetz_clean$$$corpus_9", "text": "This is Hailey-Hailey disease. It is also calledbenign familial pemphigus. It is an autosomal dominant genodermatosis. It is due to a mutation in theATP2C1gene, causing dysfunction of a Golgi-associated protein and interfering with cellular calcium signalling. The onset of disease is usually during the second or third decade, but sometimes delayed into the fourth or fifth decade. It mainly affects the major body folds such as the axillary, inframammary, and groin folds, and sometimes the trunk. Widespread separation of the epidermal keratinocytes (acantholysis) resulting in a dilapidated brick wall appearance. There may be mild dyskeratosis. Direct immunofluorescenceis negative in Hailey-Hailey disease. There is currently no cure for Hailey-Hailey disease. Avoidance of triggers and symptom management are the mainstay of management. General measures include wearing lightweight clothing, antiseptic washes or bleach baths, and humectants. Symptom management options may include intermittenttopicalorintralesional steroids, topicalcalcineurin inhibitors,botulinum toxininjections, and low dose naltrexone. See:Benign familial pemphigus."}
{"_id": "dermnetz_clean$$$corpus_10", "text": "The diagnosis iskeratosis pilaris rubra. This condition is a variant ofkeratosis pilaris, and there are often typical lesions of keratosis pilaris on the upper arms and thighs. There may also be discernible pigmentation as well as redness on the cheeks, and it may extend onto the neck (often referred to as erythromelanosis faciei et coli). It is easier to discern in pale skin individuals. It is often associated withatopic eczemaand ichthyosis vulgaris. Emollients containingurea,lactic acidorsalicylic acid,ortopical retinoidsmay diminish the scale. Definitive treatments to reduce the redness includepulsed dye laserto help with erythema orlaser-assistedhair removalfor ingrown hairs. Differential diagnoses include: For more information, seeKeratosis pilaris."}
{"_id": "dermnetz_clean$$$corpus_11", "text": "Urticaria pigmentosa, also known asmaculopapular cutaneous mastocytosis, is due to abnormal collection of mast cells in the skin causing brown patches and freckles. It is the commonest type of cutaneousmastocytosis. It commonly affects infants, with first patches appearing at a few months of age. In young children, it is common for the patches to blister when rubbed. 50 to 70% of cases undergo spontaneous resolution before adolescence. Most children with urticaria pigmentosa do not require any treatment. Treatment modalities include: Children with urticaria pigmentosa may developanaphylaxisor anaphylactoid reactions to bee and wasp stings, hence it is advisable for them to carry an injectableadrenaline(epinephrine) kit."}
{"_id": "dermnetz_clean$$$corpus_12", "text": "Cutaneous squamous cell carcinoma(SCC) usually begins as a tender erythematous papule or nodule that may have a variable amount of hyperkeratosis. Older lesions may ulcerate. It is generally located on sun-exposed sites and usually enlarges over a period of months. They can arise in old scars, and in areas that have been subject to irradiation. Cutaneous SCC nearly always requiressurgical excision. Other methods of removal include: Cutaneous SCC can bleed or ulcerate if the lesion continues to grow. It can also become a nidus forinfectionsuch ascellulitis. Cutaneous SCC can also be invasive. In some cases, it may metastasise to both the lymph nodes and beyond, and be fatal."}
{"_id": "dermnetz_clean$$$corpus_13", "text": "There are annular, indurated, urticated plaques, with petechiae and purpura centrally in some areas. There are also targetoid lesions. Given the morphology and history of the rash, the differential diagnoses included: With the histology showing leukocytoclastic vasculitisin specimen one (arm), the likely diagnosis is urticarial vasculitis. Weals lasting more than 24 hrs, bruising, and pain with itch are typical clinical findings. Treatment is based on the systemic effects and the extent of cutaneous involvement. As this patient was very symptomatic, he was started on a weaning course of prednisoneand antihistamines (cetirizine 20 mg twice daily). Other potential treatment options for urticarial vasculitis include dapsone, colchicine, hydroxychloroquine, or immunosuppressive medications such as ciclosporin or azathioprine. Consideration should be given to possible underlying causes such as SLE, Sjogren syndrome, gammopathies, leukaemia, internal cancers, hepatitis B and the use of some drugs, although many cases are idiopathic."}
{"_id": "dermnetz_clean$$$corpus_14", "text": "Crusted scabies is a highly contagious hyperinfestation with Sarcoptes scabiei var hominis a parasitic mites, presenting in immunocompromised patients. It is previously known as Norwegian scabies. It is estimated that individuals with crusted scabies have up to 4,000 mites/g of skin. Patients are often infested with over 1 million mites. The majority of patients with normal scabies are infested with only with around 1020 mites. Scabies is readily diagnosed clinically and confirmed by identification of mites or eggs on dermoscopic or microscopic examination of burrows or scale in crusted disease. Treatment requires oral ivermectinand topical insecticides: Family members, carers, and close contacts should also be screened for scabies and treated accordingly. Regardless of examination findings, all family members who have had close contact with the index case should be treated with a topical scabicide and should repeat treatment in one week. Risk factors for crusted scabies include:"}
{"_id": "dermnetz_clean$$$corpus_15", "text": "The swiss cheese pattern is consistent with mid-borderline leprosy. Diagnosis can be confirmed via skin biopsyfor histopathology, and slit-skin smear for bacterial index (Bl) and morphological index (MI). After confirming the diagnosis, multi-drug therapy (MDT) should be initiated according to the type/grading of leprosy. For more information, see our page on leprosy."}
{"_id": "dermnetz_clean$$$corpus_16", "text": "The likely diagnosis is incontinentia pigmenti (IP). It is a rare genetic condition characterised by skin, eyes, teeth, and CNS abnormalities. The characteristic skin lesions of IP present at birth or develop in the first few weeks of life in about 90% of patients and tend to be linear or follow the lines of Blaschko. Incontinentia pigmenti is an X-linked dominant disorder, caused by mutation in the NF-kB essential modulator (NEMO or IKBKG) gene, which encodes for a protein that protects against TNF-alpha-induced apoptosis. Male patients with milder NEMO mutations may present with hypohidrotic ectodermal dysplasia with immunodeficiency. IP has 4 stages (some of which may be absent or overlapping) of cutaneous finding that follow the lines of Blaschko(with the exception of stage 4)."}
{"_id": "dermnetz_clean$$$corpus_17", "text": "This rash shows the classical deck chair sign, a clinical pattern characterised by selective sparing of skin folds and flexures in an erythematous eruption. Often widespread papules coalesce to form plaques,the papular component can be seen in the images. Deck chair sign is characteristic of papuloerythroderma of Ofuji (PEO). It has also been observed in: A high index of suspicion is needed to rule out associated malignancy. Comprehensive investigations including skin biopsy, tumour markers, and imaging are recommended."}
{"_id": "dermnetz_clean$$$corpus_18", "text": "Diagnosis: Linear IgA bullous disease (LABD) LABD is an autoimmune vesiculobullous disease. It can be idiopathic; secondary to medications or infections; or associated with some underlying disease (eg, inflammatory bowel disease, rheumatoid arthritis, malignancy). Vancomycin is the most common drug associated with LABD. Lesions typically appear 24 hours to 15 days after the first dose. Differential diagnoses: Blisters are sometimes seen showing thestring of beads sign with a large central blister surrounded by smaller peripheral ones as depicted in the image. The gold standard for diagnosis is direct immunofluorescence of perilesional skin which demonstrates linear deposition of IgA at the dermoepidermal junction. Skin biopsy shows subepidermal blisters with a predominantly neutrophilic dermal infiltrate. In the case of drug-induced LABD, many cases will resolve with withdrawal of the offending agent. In more severe or idiopathic cases, treatment options include:"}
{"_id": "dermnetz_clean$$$corpus_19", "text": "Clinically this resembles milia en plaque. However, the lesion is slightly infiltrated and other granulomatous conditions (eg, sarcoid) may be considered. Histology confirmed lichen planus follicularis tumidus, a very rare variant of lichen planus. A full skin check is needed for other signs of cutaneous or mucosal lichen planus. The retro-auricular site is the location of predilection. Lichen planus follicularis tumidus is in essence a chronic-relapsing disease, and very resistant to treatment. Ultrapotent topical steroids, systemic steroids, and retinoids (topicalor oral isotretinoin) have been suggested. In the case of our patient, the lesion was surgically excised."}
{"_id": "dermnetz_clean$$$corpus_20", "text": "This is an orf of the finger and a result of a zoonotic infection that often occurs in a person who have been handling sheep (such as lambing season in this farmer) or goats. Orf lesions are generally solitary or few in number, and can be tender. They occur most commonly on the fingers, hands or forearms but can appear on the face. Patients are largely asymptomatic although some may have some systemic upset or associated lymphadenopathy. In immunosuppressed individuals, they can develop into larger, persistent, or fungating lesions. Orf is caused by the parapoxvirus, Orfviridae. This infection is usually diagnosed clinically but can be confirmed on a viral swab, skin biopsy, or vesicular fluid by polymerase chain reaction (PCR). It can also be identified by electron microscopy. Orf is a self-limiting condition that usually resolves in 6 to 12 weeks. Secondary bacterial infectionand regional adenitis may require antibiotics. Orf can also be associated with immunologic reactions such as erythema multiforme, other non-specific toxic erythemas, and pemphigoid. The lesion should be covered to prevent transmission. It is highly transmissible between animals but human-to-human transmission is rare. It is advisable to use gloves or wash hands with antiseptics thoroughly when handling infected animals. People can develop recurrent orf infections, but some immunity to the virus is acquired after the first infection so that it is less severe on subsequent occasions."}
{"_id": "dermnetz_clean$$$corpus_21", "text": "This rash and history is classical for erysipelas. Erysipelas is a superficial form of cellulitis, a potentially serious bacterial infection affecting the skin. Erysipelas affects the upper dermis and extends into the superficial cutaneous lymphatics. Almost all erysipelas are caused by Group A beta-haemolytic streptococci (Streptococcus pyogenes). Staphylococcus aureus, including methicillin-resistant strains (MRSA), Streptococcus pneumoniae, Klebsiella pneumoniae, Yersinia enterocolitica, and Haemophilus influenzae have also been found rarely to cause erysipelas. Oral or intravenous penicillin is the antibiotic of first choice. Erythromycin, roxithromycin, or pristinamycin may be used in patients with penicillin allergy. Vancomycin may be used for facial erysipelas caused by MRSA and treatment duration is usually for 10 to 14 days. Erysipelas tend to recur in up to one-third of patients due to existing lymphoedema or poor lymphatic drainage as a complication of the condition."}
{"_id": "dermnetz_clean$$$corpus_22", "text": "Infantile haemangioma of the periorbital region, caused by the rapid growth of capillary blood vessels on the surface of the skin. Infantile haemangiomas characteristically develop in the first few weeks of life, up to three months of age. In view of its rapid progression and proximity to the eye, this patient underwent an MRI of the brain to exclude any extension in the orbit or brain. If the haemangioma is not in a high risk area, patients may not need further investigation or treatment. Infantile haemangiomas can be managed by observation only, as most will undergo spontaneous resolution by the age of 6, but may be treated with an oral beta-blocker. This causes resolution of the lesion by contracting the blood vessels and decreasing blood flow to the area. Treatment duration is dependent on the response, but can continue for up to 18 months. The indications for beta blockade include obliteration of the visual axis by the haemangioma, severe organ dysfunction as a result of the haemangioma, bleeding (often in the napkin area due to trauma) and cosmetic concerns. Some thin lesions may be amenable to the topical beta blocker timolol."}
{"_id": "dermnetz_clean$$$corpus_23", "text": "Drug-induced epidermal necrolysis. Differential diagnoses include: Since the lesions affected >30% of the body surface area with a history of taking supplements, and there was no malignancy suspected, the diagnosis suggests drug induced toxic epidermal necrolysis. This is a dermatological emergency. Eye care: Mouth care: Nutrition: Airway: Genitourinary care: Prevent recurrence: Systemic corticosteroids (12 mg/kg/day for 35 days) and ciclosporin could be used, although this remains controversial. The skin lesions will ultimately heal and any pigmentary changes will resolve. Potential long term problems include:"}
{"_id": "dermnetz_clean$$$corpus_24", "text": "A skin biopsy was obtained including subcutaneous fat, which demonstrated collagen bundles extending into the reticular dermis, enclosing the eccrine glands and blood vessels. With the clinical and histological findings, the likely diagnosis is plaque morphoea (morphea). There are many subtypes of morphoea such as plaque, linear, generalised, and pansclerotic. It is important to evaluate the patient for systemic symptoms and with laboratory tests such as ANA, anti-histone antibodies, and anti-SS DNA antibodies. In patients with superficial circumscribed lesions, topical treatments are appropriatesuch as: For patients with more widespread lesions and deep morphoea, consider: Rapidly progressive lesions require treatment with systemic corticosteroids or methotrexate. Morphoea can be chronically active or relapsing and remitting. Deep tissue involvement (eg, subcutaneous tissue, muscle, or bone) can lead to deformity and dysfunction."}
{"_id": "dermnetz_clean$$$corpus_25", "text": "The likely diagnosis is collodion baby, a rare congenital disorder due to a mutation of certain genes which manifest as a tight, clear sheath covering their skin called a collodion membrane, that usually dries and peels off during the first few weeks of life. The most common underlying diseases: Other rarer conditions that may present with a collodion membrane include: 10% of collodion babies have normal underlying skin  a mild presentation known as self-healing collodion baby. Management requires the expertise of a dermatologist and the paediatric team. The baby is initially kept in a humidified, neutral-temperature environment like an incubator. Other supportive treatments such as intravenous fluid and tube feeding may also be required to maintain hydration and nutrition. The skin should be kept soft to try and reduce scaling. The collodion membrane must not be debrided. Treatment may include: Collodion babies are at high risk of complications. The cracking and peeling of the membrane increases the risk of infectionfrom microorganisms. These infants are also at risk for: Prognosis depends upon the particular underlying condition."}
{"_id": "dermnetz_clean$$$corpus_26", "text": "This is recurrent erythema multiforme. He has some target-like lesionsthat are characteristic of this eruption. Recurrent disease is usually triggered either by intermittent drug exposure, or herpes simplex infections which may be overt or covert. It is important to accurately elucidate drug exposure history and seek symptoms of cold sores which can occur around the mouth, on the genitalia, or even affecting the uterine cervix. The lesions of erythema multiforme can be treated by a super potent topical steroid which will reduce symptoms and hasten resolution. If evidence of herpes simplex as a trigger can be found, then suppressive long-term oral aciclovir may be an option if the eruption is sufficiently problematic and frequent to merit this. If a drug is suspected it should be avoided."}
{"_id": "dermnetz_clean$$$corpus_27", "text": "The superficial brown scaly patches are highly suggestive of a yeast infection called pityriasis versicolor  it is due to a yeast called Malasseziaand not a dermatophyte fungus. The best way to confirm the diagnosis is by taking skin scrapings. The yeast pseudohyphae and spores are said to resemble spaghetti and meatballs when looked at using a potassium hydroxide wet preparation on microscopy. Unfortunately it does not respond to oral terbinafine, which is highly active against dermatophyte fungi but not the causative yeast. It can be treated by using topical azole shampoos or creams, or a short course of oral itraconazole. See: Pityriasis versicolor."}
{"_id": "dermnetz_clean$$$corpus_28", "text": "This is bilateral lower leg eczema, and it is often multifactorial. There is often underlying venous incompetence, compounded by both irritantor allergic contact dermatitis. It is often bilateral, which cellulitis is almost never! Rest, elevation, potassium permanganate compresses or soaks, a topical steroid to suppress the eczema, and compression. Doppler ankle brachial pressure index (ABPI) should be measured to assess the safety of high compression bandaging. Consideration should be given to what is being used topically, and patch testingis indicated to exclude an allergic contact dermatitis to a medicament dressing or bandage. See: Venous eczema."}
{"_id": "dermnetz_clean$$$corpus_29", "text": "The picture looks like acute discoid eczema there are exuding, excoriated, weepy well-defined plaques on the lower legs. Affected individuals are often atopic. Wet exuding lesions can be dried out with the use of one in 10,000 potassium permanganate soaks. Thereafter, a potent steroidand antibiotic combination cream will be needed to suppress the eczema and prevent the development of secondary staphylococcal superinfection. See: Discoid eczema."}
{"_id": "dermnetz_clean$$$corpus_30", "text": "There is a patchy and confluent erythematous rash studded with fine pseudo pustules andperipheral circular peeling seen over the abdomen. The likely cause is lamotrigine-induced generalised pustular psoriasis (GPP). Lamotrigine is a widely used antiepileptic commonly producing cutaneous side effects (incidence 10%). However, this is the first report of lamotrigine-induced GPP. Other differential diagnoses would include: After stopping the offending drug (lamotrigine in this case), the first-line treatment for generalised pustular psoriasis (GPP) would include acitretin, ciclosporin, or methotrexate. If this is insufficient, a biologic agentcould be considered. It is important to note that glucocorticosteroidstypically flare pustular psoriasis, particularly on withdrawal, so are contraindicated for GPP."}
{"_id": "dermnetz_clean$$$corpus_31", "text": "The likely cause of his reaction to the beach henna tattoo is an allergic contact dermatitis to the black dye chemical paraphenylenediamine (PPD). Although the tattoo solution does contain some henna, this is much less likely to be the sensitiser. The reaction will settle with the use of a topical steroid. However, he is now sensitised to PPD, and should he use a PPD-containing hair dye in the future, he will have a reaction to this. PPD-allergic individuals may also react to some azo clothing dyes, PABA-containing sunscreens, amine local anaesthetics(benzocaine and procaine), sulfonamides, and sulfone drugs. See: Tattoo-associated skin reactions."}
{"_id": "dermnetz_clean$$$corpus_32", "text": "There are clustered erosions on the left side of the palate. (They started with a prodrome of soreness and then vesicles developed, which have now eroded.) The recurrent nature of the eruption occurring in the same area of the palate and the clustering of the vesicles and later erosions is typical of herpes simplexvirus (HSV) infection, usually HSV type 1. By taking viral swabs this can be subjected to either viral culture or PCR. Aciclovir 200 mg five times a day for 5 days and chlorhexidine mouthwash twice a day for 5 days are reasonable options for an acute attack. Repetitive frequent recurrences may need long term suppressive aciclovir."}
{"_id": "dermnetz_clean$$$corpus_33", "text": "This is systemic lupus erythematosus (SLE)overlapping with psoriasis. There are no randomised controlled trials for concomitant SLE and psoriasis, as limited cases are reported worldwide. Apremilast 30 mg oral twice daily and methylprednisolone25 mg oral once daily along with sunscreen and topical steroids were used. She responded very well and is now in complete clinical remission. Antimalarials were avoided as although these can be very helpful for the joint and skin manifestations of SLE, they can cause an exacerbation of psoriasis. Interleukin (IL) 17A inhibitors may help both diseases; TNF antagonists may exacerbate SLE."}
{"_id": "dermnetz_clean$$$corpus_34", "text": "Pityriasis rubra pilaris (PRP) is a group of papulosquamous dermatoses. There are 5 major types of PRP, plus an HIV-associated type has been described. The distinction is mostly based on age of onset and distribution. Adult classic form (type 1) is the most common form. Localised PRP can be treated with topical emollients and medium-potency topical corticosteroids. Extensive or disabling PRP usually requires systemic treatment. Treatment options include:"}
{"_id": "dermnetz_clean$$$corpus_35", "text": "Sweet syndrome(acute febrile neutrophilic dermatosis). It is a type of neutrophilic dermatosis. Sweet syndrome usually has an acute onset of erythematous, oedematous plum coloured papules and plaques that are tender but not pruritic, with the face and trunk being the common areas to be affected. Lesions may occur in the mouth and conjunctivitis and episcleritis are well reported. There is often peripheral blood neutrophilia and fever. A dense neutrophilic dermal infiltrate with disintegration of neutrophils producing nuclear dust. There should not be inflammatory changes in the blood vessels, which distinguishes it from a leukocytoclastic vasculitis. The exact cause for neutrophilic dermatosis is unknown. Sweet syndrome can be caused by underlying disorders such as: In mild disease, neutrophilic dermatosis may respond to topical corticosteroids. In moderate-to-severe disease, the treatment options are:"}
{"_id": "dermnetz_clean$$$corpus_36", "text": "Acute generalised exanthematous pustulosis (AGEP), also known as toxic pustuloderma. AGEP is an uncommon pustular drug eruption characterised by superficial pustules coalescing to form pustular lakes on an erythematous base. There is superficial epidermal detachment in areas where the pustules have become confluent. The time interval between drug ingestion and onset is short (23 days). Occasionally it may be localised to limited areas of skin such as the face (acute localised exanthematous pustulosis) Over 90% cases of AGEP are provoked by medications, most often beta-lactam antibiotics (eg, penicillins, cephalosporins). Other medications include tetracyclines, sulfonamides, oral antifungals, hydroxychloroquine, carbamazepine, calcium-channel blockers and more. Viral infections such as EBV, CMV, Hepatitis B, adenovirus and enterovirus are also common triggers of AGEP in children."}
{"_id": "dermnetz_clean$$$corpus_37", "text": "Aquagenic wrinkling of the palms. It is a rare dermatosis that usually presents in the 2nd decade of life with equal sex incidence. It is an exaggeration of the normal finger wrinkling that occurs when fingers are soaked in water for a prolonged period. The exact pathology is unknown, however it is likely due to salt imbalance in the skin cells, resulting in increased water retention and transepidermal water loss. Aquagenic wrinkling of the palms has a strong association with cystic fibrosis (CF), affecting up to 84% of patients with CF and 35% of carriers. It can be the first presenting sign of CF carrier status in otherwise healthy individuals or non-classical CF. It can also be drug related (aspirin and COX inhibitors)."}
{"_id": "dermnetz_clean$$$corpus_38", "text": "Eczema herpeticum is also known as Kaposi varicelliform eruption. It is a skin infection caused by Herpes simplex virus (HSV) type I and II. It most commonly develops in individuals who already have atopic dermatitis/eczema. Eczema herpeticum can cause an acute exacerbation of eczema. It is usually very painful and young children can be unwell with fever and swollen lymph nodes. Eczema herpeticum can become infected with bacteria, commonly Staphylococcus or Streptococcus. Secondary bacterial infection can lead to impetigo or cellulitis. It can cause herpetic keratitis if the eyes are infected by HSV from the surrounding lesions, which if left untreated, can lead to blindness. Eczema herpeticum is considered as one of the few dermatological emergencies. Prompt treatment with antiviral medication (eg, aciclovir, valaciclovir) should eliminate the need for hospital admission."}
{"_id": "dermnetz_clean$$$corpus_39", "text": "Infantile haemangiomas (IH) are the most common benign vascular skin tumour in children. They are caused by proliferating vascular endothelial cells. They usually appear shortly after birth (rarely at birth), and grow rapidly in the first 6 months. Most IH stop growing by 6-9 months. They involute over years. Most IH do not require treatment as they usually involute with time. Depending on the location, size, and presence of ulceration, some require treatment. Treatment with beta blockers (oral propranolol) has now replaced oral corticosteroids as the gold standard treatment for complicated or ulcerated IH. The earlier treatment is commenced, the more effective it is likely to be in preventing further growth. Other treatment options include:"}
{"_id": "dermnetz_clean$$$corpus_40", "text": "A linear epidermal naevus. It is an overgrowth of the epidermis and usually presents at birth or during early childhood. It is mostly flat and hyperpigmented, but there is slight thickening and scale around the ankle. Epidermal naevi present as streaks and swirls of thickened (verrucous, hyperkeratotic, or velvety) skin along the lines of Blaschko, usually with hyperpigmentation and sometimes with adnexal involvement.They are usually unilateral, and only rarely generalised, when they may be associated with skeletal abnormalities (epidermal naevus syndrome). In infancy, epidermal naevi can present as flat tan or brown marks, but as the child ages, they become thickened and verrucous. Most epidermal naevi do not require treatment. Topical calcipotriolmay reduce the thickness of the verrucous lesions. Verrucous epidermal naevi can be treated with an ablative laserwith good long-term aesthetic results."}
{"_id": "dermnetz_clean$$$corpus_41", "text": "Subcutaneous fat necrosis of the newborn. This is an uncommon panniculitis of neonates. It usually occurs in the first days of life. There has often been fetal distress in labour and it may be associated with therapeutic hypothermia for hypoxic ischaemic encephalopathy. It can be painful. It usually, ultimately, self-resolves. It is associated with symptomatic hypercalcemia (irritability, constipation, poor weight gain, and arrhythmia) as frequently as in 50% of cases. A baby with subcutaneous fat necrosis should have their blood calcium checked periodically for the first few months of life. Hypercalcaemia can be treated with low calcium milk feeds, increasing fluid intake, frusemide, or bisphosphonates. Sclerema neonatorum is an extremely rare disorder which was described in premature or debilitated children who developed a diffuse board-like stiffness due to generalized fat necrosis.\n\nThis condition usually appears in the first days after birth and is usually fatal. Read more on subcutaneous fat necrosis of the newborn."}
{"_id": "dermnetz_clean$$$corpus_42", "text": "This is nipple eczema. It is a localised dermatitis involving the nipple and areola. This is frequently bilateral and fluctuates in severity. Lichenification due to scratching can be conspicuous, as can hyperpigmentation, particularly in skin of colour. It improves in response to topical steroids and can deteriorate rapidly when irritated by scratching, soaps, shower gels, and detergents. Nipple eczema is a common local manifestation of atopic dermatitis but can occur in isolation. Patients should avoid any precipitating irritants and allergens. Regular emollients and topical corticosteroids are the mainstay of treatment. Moderate potency topical steroids are usually very effective, followed by low potency topical steroids as maintenance therapy if necessary.Topical coal tar preparations are an effective old fashioned remedy. Sometimes, use of a potent topical steroid with hydrocolloid dressing occlusion for a few days will break the itch-scratch cycle that perpetuates the problem."}
{"_id": "dermnetz_clean$$$corpus_43", "text": "This is a granuloma resulting from a dental sinus. They arise when there is longstanding dental abscess or necrosis of a tooth. When a dental sinus connects with the skin rather than the intraoral mucosa, they characteristically occur along the border of the mandible, but may also arise around the maxilla. The tethering of the skin around the sinus opening is a feature and may be appreciated either visually or on palpation. The teeth adjacent to the sinus should be inspected for signs of previous fillings, caries, and local tenderness on tapping. Radiology is the most important investigation and will show bone loss around the root tip of the affected tooth. MRI or CT may be required. Occasionally insertion of a radio-opaque probe into the sinus may be needed to identify the affected tooth. Removal of the affected tooth, retained root or necrotic material is required and the sinus should heal readily thereafter."}
{"_id": "dermnetz_clean$$$corpus_44", "text": "There are superficial erosions over the scalp surmounted with thick pus. There are also several actinic keratoses. The picture is typical of erosive pustular dermatosis of the scalp. It is seen mostly in older bald men with sun damaged scalps. It has also been reported on the lower leg, a heavily sun exposed site particularly in women. Removing the overlying crusts and using a potent topical steroid and antibiotic combination cream can be very gratifying. Areas that do not heal should be re-evaluated and possibly biopsied to exclude squamous cell carcinoma."}
{"_id": "dermnetz_clean$$$corpus_45", "text": "There is a slightly scaly net-like (reticulate) eruption on the abdomen. The features are typical of confluent and reticulated papillomatosis. It is frequently misdiagnosed as pityriasis versicolor, but mycology is negative and oral azoles are not as effective as tetracycline antibiotics. Recent evidence suggests it is due to infection with a Gram-positive actinomycete called Dietzia papillomatosis. It usually responds to a course of tetracyclines. For more information, see the topic page on confluent and reticulated papillomatosis."}
{"_id": "dermnetz_clean$$$corpus_46", "text": "There is striking telangiectasia over the light-exposed area of her upper chest. The likely cause is amlodipine-induced phototelangiectasia. Telangiectasia in light-exposed areas has been reported with nifedipine and diltiazem, although it has had a more common association with amlodipine. In some cases, its resolution has been noted after substitution of the calcium channel antagonist with a different class of antihypertensive."}
{"_id": "dermnetz_clean$$$corpus_47", "text": "This is typical of a phytophotodermatitis, a rash that results from a phototoxic plant sap coming into contact with the skin, and subsequent light exposure. It results in redness and sometimes blistering of the exposed skin. He has used a strimmer, or string weeder, and has been working with his top off! The strimmer has spattered phototoxic sap over his trunk. His face was unaffected because he had correctly used a face mask as personal protection. With photoprotection, the rash will heal, but will leave marked post-inflammatory pigmentation which may last for several months."}
{"_id": "dermnetz_clean$$$corpus_48", "text": "The recurrent development of redness and blistering in exactly the same place on the skin is very suggestive of a fixed eruption, most commonly caused by drugs. Occasionally they can be caused by foodstuffs, preservatives and other food and beverage additives. Lesions may be solitary or multiple. Uncommon sites to develop fixed eruptions are the lids, lips, palms, soles, and genitalia. They frequently arise within minutes or hours after exposure to the offending agent, once sensitisation has occurred. When they resolve, they commonly leave areas of hyperpigmentation. The likely cause in this case is the antibiotic used to treat her urinary tract infections. Avoiding the offending drug, and similar potentially cross reacting drugs, is the most important aspect of treatment. If there is a blister, then this can be aspirated leaving the roof intact as a biological dressing. A potent topical steroidcan then be applied until the inflammation resolves."}
{"_id": "dermnetz_clean$$$corpus_49", "text": "He has streaked erythema where there has been accidental skin exposure to his faeces. Sadly, his opiates have constipated him, and this has been treated with co-danthrusate (dantron and docusate), an anthralin-like agent that acts as a stimulant laxative. It is metabolised in the gut to anthralin, and when there is accidental contact with faeces and the skin, it produces an irritant dermatitis. It may oxidise to a purple-brown colour just as anthralin (dithranol) does in the treatment of psoriasis. The co-danthrusate should be stopped and substituted with a different aperient; the erythema can be treated with a short course of a potent topical steroid."}
{"_id": "dermnetz_clean$$$corpus_50", "text": "These acute haemorrhagic lesions are the early stages of coumarin necrosis. Shortly after initiation of a coumarin, there may be a temporary state of thrombophilia, as coumarin reduces the effect of both natural anticoagulants and coagulants. The former (Proteins C and S) have shorter half-lives than the coagulants, hence the early temporary thrombophilic state before anticoagulation is effected. The same situation may occur with longstanding coumarin use if control has been erratic. It is more likely to develop if heparin is not used in the early initiation of coumarins, or if the coumarin loading dose is too high. Lesions tend to occur on the fatter areas of the body such as the thighs and breasts. The coumarins should be stopped and heparin initiated. The condition does not occur with newer oral anticoagulants. Ulceration is likely to happen; surgical debridement may be required."}
{"_id": "dermnetz_clean$$$corpus_51", "text": "These are typical syringomas (syringomata)in the most frequently encountered location. They occasionally develop in the bathing trunk area and on the upper trunk. They are benign tumours of the sweat duct; they may be familial. Unlike xanthelasma, which tend to produce plaques, syringomas remain as discrete papules. There are no easy treatments. Light electrocautery can help as may laser, but all modalities may scar, and recurrent lesions are common."}
{"_id": "dermnetz_clean$$$corpus_52", "text": "The eruption shows the classical wood graining with redness and scale of erythema gyratum repens. The erythema slowly spreads in a gyrate fashion, leaving scale on the trailing edge of the advancing edge. The term repens probably best translates as creeping. 80% of cases are associated with an underlying malignancy; often affecting the lung, oesophagus, breast, and stomach. Full clinical investigation and meticulous history taking should be performed. This includes probing for symptoms of an underlying cancer, tumour markers, mammography, and PET CT scanning."}
{"_id": "dermnetz_clean$$$corpus_53", "text": "The forefoot is dry, red and fissured; the typical features of juvenile plantar dermatosis. It occurs more commonly in boys with an average age of onset of 8. It is more common in atopic children. It is thought to be due to impervious occlusive footwear, and exacerbated by friction. In a small proportion of children, it is due to an allergic footwear dermatitis, identified by patch testing. Avoiding synthetic socks, and wearing two pairs of cotton or wool socks may help. Emollients or humectantssuch as urea cream may help. Applying steroid impregnated tape over fissures or using paste bandages accelerates healing. Topical steroidointments are sometimes useful."}
{"_id": "dermnetz_clean$$$corpus_54", "text": "There is wrinkling and rippling of the central portion of the nail plate, also there is loss of the cuticle at the proximal nail fold. This is a habit-tic nail deformity. It is caused by frequent subconscious picking of the proximal nail fold either from the adjacent or the contralateral index finger. The repetitive pushing back of the cuticle results in minor trauma to the nail matrix; secondary rippled central dystrophy subsequently develops. The affected patient is often unaware of the habit but is often appreciated by spouses or other family members. Applying a hydrocolloid dressingaround the nail including the proximal nail fold can break the habit, allowing the nail to regrow normally."}
{"_id": "dermnetz_clean$$$corpus_55", "text": "This is the early vesicular phase of incontinentia pigmenti, an inherited condition which affects the skin, eyes, teeth, and central nervous system. It is inherited as a sex-linked dominant condition on the X chromosome. It is usually incompatible with life in utero in males, and therefore manifests only in females. Early in life, the rash is vesicular with eosinophil-filled vesicles. Later, lesions become warty (verrucous phase), before becoming hyperpigmented. In all phases, the rash follows the lines of Blaschko. Read more on Incontinentia pigmenti"}
{"_id": "dermnetz_clean$$$corpus_56", "text": "There is a rippled hyperpigmented maculopapular eruption on the neck. These features are typical of macular amyloidosis, a reaction that is thought to result from perpetual scratching of the affected areas. It is common in both men and women of Asian heritage. Histopathologically, amyloid deposits are seen within a skin biopsy; furthermore, macular amyloid is not associated with systemic disease as opposed to systemic AL amyloid that is associated with plasma cell dyscrasias."}
{"_id": "dermnetz_clean$$$corpus_57", "text": "The groove has been caused by pressure from a myxoid cyst (digital mucous cyst) which overlies the nail matrix. Pressure applied to the nail matrix from any cause will result in either a line or groove in the nail plate distally. The discharge of clear, sticky, mucoid material is typical of intermittent rupture of the false cyst. The diagnosis is usually made clinically, but the presence of a pseudocyst can be confirmed by high resolution MRI scanning of the affected digit. Treatment is difficult and is frequently advocated by recurrence. Under a digital block, the proximal nail fold can be reflected back, the cyst identified, and its communication with the synovium ligated. More proximal digital myxoid cysts can be treated by repetitive puncture and expression of the contents, injection of sclerosants, or surgery."}
{"_id": "dermnetz_clean$$$corpus_58", "text": "There is roughness of the nail plates (trachyonychia) affecting all finger and toenails. With repeatedly negative mycology, and absent skin problems elsewhere, the likely diagnosis is twenty-nail dystrophy. This may be associated with previous, concurrent, or the ultimate development of alopecia areata or lichen planus. Evidence of these conditions should be sought in the scalp, mouth, and elsewhere on the skin. Less convincing associations are with psoriasis and eczema. The condition is difficult to treat, but may undergo spontaneous resolution. For more information, see twenty-nail dystrophy."}
{"_id": "dermnetz_clean$$$corpus_59", "text": "The eruption has a violaceous hue, and the area covered by his hat and shirt (below the collar line) is spared. These features together suggest a photolichenoid eruption. Biopsy will show epidermal hyperkeratosis, hypergranulosis, basal cell liquefactive degeneration, and a dense upper dermal band-like lymphocytic infiltrate. For more information see lichenoid drug eruption pathology. Photolichenoid eruptions are usually due to medication, and quinine is a well-known cause. Some HIV medications, thiazide diuretics, and docetaxel are other incriminated drugs. Stop suspect medicines (eg, quinine) and use a sunscreen with a good UVA spectrum of protection, as well as other general sun protection measures. A potent topical steroid will need to be used for a short period of time to suppress the lichenoid reaction."}
{"_id": "dermnetz_clean$$$corpus_60", "text": "This is scleroedema (U.S. scleredema), not to be confused with scleroderma. It occurs as a result of the accumulation of mucin in the dermis. It may be associated with a paraprotein, diabetes, and can occur acutely after a respiratory infection. Less robust associations include Sjogren syndrome, rheumatoid arthritis, hyperparathyroidism, and HIV infection. Testing for associated biochemical abnormalities (paraprotein, immunoglobulins, HbA1c) should be conducted. Skin biopsy will show accumulation of dermal mucin."}
{"_id": "dermnetz_clean$$$corpus_61", "text": "The nail plates are yellow in colour, and have excessive transverse and longitudinal curvature. These features are typical of yellow nail syndrome, and patients usually describe the need to only infrequently cut their nails as the nail growth rate is substantially slower than normal. It is most commonly associated with lymphoedema, pleural effusions, and bronchiectasis. The cause is unknown; there is limited evidence that it may improve with oral or topical vitamin E supplements, and the antifungal agents. Oral itraconazole and fluconazole are oral antifungal agents. It has been noted that they appear to speed up the rate of growth of nails, which may be of benefit in yellow nail syndrome even though it is not caused by fungal infection."}
{"_id": "dermnetz_clean$$$corpus_62", "text": "A papulosquamous eruption with lesions on the palms and soles should always raise suspicion of secondary syphilis. This should initiate questioning regarding sexual contacts, and recent history of genital, oral, or perianal primary syphilis lesions (chancres). There may be scars at the site of a recent chancre, and mucosal lesions of secondary syphilis (snail track ulcers and condylomata lata). Other sexually transmitted disease lesions should be sought eg, warts, mollusca. The VDRL test will always be positive in secondary syphilis unless there is co-infection with HIV. Treponema pallidum PCR testing may be positive from mucosal lesions. Referral to STD services is mandatory to both contact trace and identify co-infection with other sexually transmitted diseases. The syphilis infection will be treated with intramuscular penicillinaccording to local guidelines."}
{"_id": "dermnetz_clean$$$corpus_63", "text": "The subtle but slowly spreading red ring is characteristic of erythema migrans, the early cutaneous manifestation of Lyme disease. Inoculation occurs after a bitefrom an infected tick. The rash often starts days after inoculation of the skin with a causative bacterium, Borrelia burgdorferi, and slowly spreads over a number of weeks. It is usually the case that the tick needs to feed from the human victim for at least 24-hours in order for infection to occur. A significant proportion of those infected have no recollection of the tick attachment. Early associated symptoms include fever, chills, muscle and joint aches, swollen lymph nodes, and erythema migrans (in about 80%). Late symptoms include arthritis, carditis and arrhythmias, neuritis, and encephalitis. Late skin manifestations include acrodermatitis chronica atrophicans and lymphocytoma cutis. Children under the age of nine should be treated with amoxicillinor azithromycinif they have non-focal symptoms. The presence of carditis or central nervous system disease would require intravenous treatment."}
{"_id": "dermnetz_clean$$$corpus_64", "text": "This is periocular dermatitis; it often coexists with perioral dermatitis. It produces small red papules and occasionally pustules firstly at the lower lateral lid, then may spread around the entire periocular skin. It is often sore rather than itchy. It is quite distinct from other causes of periocular eczema, such as atopic, seborrhoeic, or contact eczema. Many cases of perioral and periocular dermatitis (periorificial dermatitis) are due to either intentional or inadvertent topical steroid exposure to the affected sites. Back spray from the nasal steroid aerosol onto the periocular skin has caused this young womans problem. Treatment involves improvement of spray technique to prevent accidental exposure or withdrawal of topical steroids. Oral tetracyclines are very effective and may be needed for a few months; repeat courses may be given should it recur. Other oral antibiotics such as macrolides and metronidazole are effective. Topical therapies such as metronidazole, clindamycin, and calcineurin antagonists have been used but are often not tolerated."}
{"_id": "dermnetz_clean$$$corpus_65", "text": "The image shows monomorphic papules over the interscapular area. There are no comedones, and there is no variety in the size and shape of lesions as one sees in acne. These features all suggest Malassezia (pityrosporum) folliculitis. The condition results from the overgrowth of pityrosporum yeasts within the hair follicles. Humidity, heat, seborrhoea, immunosuppression, and HIV contribute to the overgrowth of the yeasts. The back is the most frequently affected area; it can also occur on the chest. It is often associated with seborrhoeic dermatitis in other sites. Routine bacteriology from affected follicles is negative as the causative yeasts require very specialised culture media to grow them. They are most easily visualised on biopsy. Topical antifungals such as selenium sulfide shampoo, or azoles such as econazole lotion or ketoconazole shampoo, can be helpful both in initial treatment and recurrence prevention. Oral fluconazole or itraconazole are sometimes more convenient to use."}
{"_id": "dermnetz_clean$$$corpus_66", "text": "Linear IgA bullous dermatosis. There are blisters arranged in a ring  the so-called string of pearls sign, which is most often seen in this condition. Perilesional immunofluorescence will show a linear band of IgA at the dermoepidermal junction, in contrast to the granular deposits of IgA seen in dermatitis herpetiformis. The blisters are sub-epidermal. As opposed to dermatitis herpetiformis, linear IgA disease is not associated with gluten enteropathy. Linear IgA disease may be associated with solid cancers and lymphomas, inflammatory bowel disease, and rheumatoid disease. Several drugs have been implicated in initiating this condition. Treatment of this condition involves the use of potent topical steroids, but oral steroids combined with oral dapsone are usually required."}
{"_id": "dermnetz_clean$$$corpus_67", "text": "This is dissecting cellulitis of the scalp, also known as perifolliculitis capitis abscedens et suffodiens and Hoffman disease. It produces nodules, cysts, and discharging scalp lesions with eventual patchy scarring hair loss (alopecia). It may be associated with severe acne(including acne conglobata) and hidradenitis suppurativa, collectively called the follicular occlusion triad. More recently, pilonidal sinus diseasehas been added to this list (follicular occlusion tetrad). Therapy is difficult. It involves considering the following:"}
{"_id": "dermnetz_clean$$$corpus_68", "text": "There is a well-circumscribed plaque on a sun exposed area. Centrally, there is some atrophy. There is some scaling and follicular plugging. The lesion is red. Coupled with the pathology, the features suggest discoid lupus erythematosus (DLE). The patient requires routine haematology, lupus serology, and urinalysis. If she is a smoker, this should be strongly discouraged. Treatment strategies include:"}
{"_id": "dermnetz_clean$$$corpus_69", "text": "The photograph shows a well circumscribed scaly patch of erythema as well as early atrophy. Coupled with history of the patch of alopecia, discoid lupus erythematosus is the most likely diagnosis. Skin biopsy is required for diagnostic confirmation; it can be expected to show hyperkeratosis and follicular plugging. There may be epidermal atrophy, and patchy basal cell keratinocyte degeneration. PAS stainingmay show thickening of the basement membrane. In the dermis, there will be dense perivascular and periadnexal chronic lymphocytic inflammation. Topical treatments will include photo protection with sunscreens. Super potent topical steroids, which are usually avoided on the face, can be accurately applied to the lesions. Additional benefit is sometimes shown by combining the use of topical steroids with topical tacrolimus. Intralesional steroids may be useful for recalcitrant disease. Antimalarials, such as mepacrine (quinacrine) or hydroxychloroquine are indicated. If the condition is progressive despite the above, immunosuppression with either methotrexate or azathioprine may be offered as progressive disease will result in permanent scarring and hair loss."}
{"_id": "dermnetz_clean$$$corpus_70", "text": "This man has dermatitis herpetiformis. This is an immunobullous disorder associated with gluten sensitivity. The vesicles and blisters that arise in this condition are small (2 to 4 mm) and because the condition is so itchy, they are often excoriated so that intact blisters are seen only infrequently. The clue to the diagnosis is often from the rash distribution. It affects symmetrically the elbows and knees, sacrum, interscapular area, scalp, and beard area. Itch is usually severe. It is slightly more common in atopic individuals. The diagnostic test is direct immunofluorescence from a perilesional skin biopsy. Granular IgA deposits are seen at the dermo-epidermal junction. It is positive in 80% of sufferers on the first biopsy, 95% with the second biopsy, and close to 100% on the third biopsy so repeat investigation may be needed if clinical suspicion persists. Coeliac serology may be positive. Gluten-sensitive enteropathy is always present but may be asymptomatic and may be unassociated with biochemical evidence of malabsorption. However, ironor folic acid deficiency may be identified. There is a known association with haemochromatosis. Treatment requires a rigorous gluten-free diet; this may take two years to be fully effective. It can reduce the incidence of small-bowel lymphoma that can complicate the enteropathy. Oral dapsone usually results in the welcome and rapid relief of itch. The dose can be reduced to the lowest that maintains symptom relief."}
{"_id": "dermnetz_clean$$$corpus_71", "text": "This is a cutaneous calculus, or subepidermal calcified nodule, a lesion caused by the accumulation of calcium in the upper dermis. They have a cream white colour, are usually solitary, often appear filiform, and most commonly occur in children on the head and neck, especially the ear. It is thought that they usually arise in a pre-existing skin lesion, possibly a viral wart. They are usually not associated with disorders of calcium metabolism. They respond well to curettage or shave excision, and usually do not recur."}
{"_id": "dermnetz_clean$$$corpus_72", "text": "This is coumarin necrosis. It most frequently occurs shortly after the introduction of a coumarin anticoagulant (eg, warfarin). Natural anticoagulants reduce in concentration before natural pro-coagulants, so that there is the potential for a short period of relative thrombophilia and this can result in dermal vessel thrombosis andsubsequent skin necrosis. Dermal vessel thrombosis and skin necrosis has been reported in persons with protein S and C deficiency. It is occasionally seen later during anticoagulant treatment particularly if there has been erratic warfarin control. It can be managed by initiation of heparin, withdrawal of warfarin, and then the use of a new oral anticoagulant which directly inhibits either thrombin or factor Xa. Established necrosis may require devitalised tissue debridement."}
{"_id": "dermnetz_clean$$$corpus_73", "text": "Purpura can be seen affecting the upper and lower lids of both eyes. It is quite common for lid purpura to be precipitated after bouts of coughing. In the absence of any clotting or platelet problems, systemic amyloidosis should be considered. The presence of amyloid in the upper dermis disrupts the integrity of the support around small blood vessels making them susceptible to rupturing, and this accounts for the physical signs. Amyloid deposits under the flexor retinaculum of the wrists has produced carpal tunnel syndrome which is quite common in systemic amyloid. Systemic AL amyloid is usually associated with a plasma cell dyscrasia, so serum electrophoresis, estimation of immunoglobulins, and detection of Bence Jones proteins should be undertaken. Skin biopsies from affected skin may show amorphous upper dermal accumulation of amyloid protein."}