Skin, eye and other problems

The introduction of the anti-interleukin 4 receptor antagonist dupilumab for treatment of moderate to severe atopic eczema was a revolution in the field, and a new era began. There is one minor problem that had already appeared in early clinical trials but is now also observed in daily practice, namely the fact that ca. 10% or sometimes more of the patients develop conjunctivitis. This can be a major problem for some patients. The nature of this conjunctivitis is not well established; it is a bilateral inflammation of the anterior conjunctiva with hyperaemia of the limbus. The mechanism how anti-interleukin 4 triggers this condition is not known. An expert consensus gives recommendations how to deal with this problem in clinical practice (Thyssen et al. in this issue).1 Independent from any kind of treatment, often people with ‘sensitive skin’ also complain about ocular problems. The nature of ‘sensitive eyes’ is not well defined. In a large study in France, 50% of people reported to have ‘sensitive eyes’, and the majority of them were women. Moreover, 18% reported to suffer from ‘sensitive eyelids’. As potential triggering factors they mentioned sun, dust, dry air or work with a computer. The mechanisms underlying this phenomenon of sensitive eyes or sensitive eyelids are not well understood. But obviously triggers are perceived as coming from the environment (Misery et al. in this issue).2 A study from South Korea investigated the effect of air pollutants upon healthy skin in 188 volunteers, mostly women, who for at least 2 weeks took daily selfies of their faces using a special smartphone application. A score with regard to wrinkles, spots and other problems was developed and correlated with the concentration of various air pollutants. There was a significant association of fine particles (PM2.5) exposure with the wrinkle index for facial skin (Park et al. in this issue).3 The study shows that ambient air pollution affects individuals not only with sensitive skin or atopic eczema as has been shown previously also in this journal, but also normal skin. The chance to study these phenomena by new technologies such as smartphone applications opens the way to new and large studies in various populations. Drug intake is often regarded as elicitor of untoward symptoms especially after long-term use. There is a continuous debate as to whether finasteride used for treatment of androgenetic alopecia has an influence on the sexual health of men. In a recent study from USA and Canada, 762 male participants were examined for their sexual life experiences and possible problems using the Arizona Sexual Experience scale (ASEX). The majority of them were finasteride users; they showed no difference in the sexual experience scale compared to men of equal age who did not use finasteride. The authors conclude that there is no measurable effect on libido or other sexual life parameters by use of finasteride (Haber et al. in this issue).4 Psychosocial influences can also be regarded ‘environmental’, in the worst cases occurring under circumstances such as crime, war or abuse of political power. Unfortunately, the occurrence of torture has become more frequent in some parts of the world more than ever. Torture victims most often show signs on the skin. The skin can serve as an organ to document injustice or criminal behaviour in torture victims. This is a new aspect of dermatology in the sense of ‘forensic dermatology in vivo’. One has to be aware of this problem especially in refugee populations and also learn to see and understand the various sequelae of torture on the skin (Clarysse et al, this issue).5 So the dermatologist becomes involved not only in treating the manifold skin problems in refugees, but also in evaluating torture sequelae and giving recommendations for psychological rehabilitation. At the same time, also the critical skin examination can provide evidence for self-inflicted or ‘fake’ lesions which makes the issue more difficult. For most of our readers, we hope that sun exposure may be the most important environmental hazard in the next summer months – as proverb goes, prevention is better than cure!

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