Short sequence amino acids or oligopeptides represent a relatively new and promising area of dermatology. Oligopeptides are defined as peptide sequences ranging from 2 to 20 amino acids. This class of proteins includes potent biologically active compounds, which can modulate various cellular and molecular processes. The medical potential of short sequence peptides was initially characterized many decades ago with the identification of biological mediators such as angiotensin, vasopressin, oxytocin and bradykinin. However, the role of oligopeptides in affecting biological activity within the skin has only recently been explored. Currently, the dermatologic use of protein peptide fragments is a rapidly growing field of research. Recent studies suggest that treatment with various biologically active peptides can result in favourable clinical outcomes such as for the treatment of hyperpigmentation disorders with tyrosinase inhibitors and the use of collagen synthesis modulators to diminish skin laxity. In this review, we explore the roles of biologically active short sequence peptides as potential therapeutics through the modulation of collagen, elastin and melanin synthesis.

Peptides are central to the regulation and modulation of the chemical reactions and biological responses that occur in nature. Many physiological processes are affected by the interactions of these peptides, including cell proliferation and migration, inflammation, melanogenesis, angiogenesis and innate immunity. Thus, biologically active peptides offer a great potential medically and therapeutically. Moreover, the ability to generate synthetic peptides with attention to specifically modulating their pharmacokinetics and properties for increased potency, delivery and stability has spurred much interest in this rapidly growing field of research. In this review, we focus on the therapeutic uses of bioactive peptides as antimicrobials and effectors of neurotransmitter release. We also highlight the advantages and challenges associated with this new technology and discuss methods for improving oligopeptide transdermal delivery.Abbreviations: AMP, antimicrobial peptide; BoNT-A, botulinum neurotoxin type A; DMSO, dimethyl sulphoxide; HD, human a-defensin; hBD, human b-defensin; HNP, human neutrophil peptide; MDA, microdermabrasion.

Melasma is an acquired cutaneous disorder caused by an overproduction of melanin by the enzyme tyrosinase. Melasma remains a therapeutic challenge and no definitive standard therapy exists. Although hydroquinone (HQ) has emerged as the most common treatment, its popularity has recently waned because of concerns about its potential carcinogenicity and manufacturing challenges. The adverse effects of HQ range from the common irritant contact dermatitis to the less frequent exogenous ochronosis (EO). Previous reports suggest that the risk of leukoderma from HQ treatment is limited to individuals of African descent. Herein, we describe for the first time the development of depigmentation and paradoxical hyperpigmentation in 2 patients with Fitzpatrick skin type III/IV after brief treatment of their melasma with the HQ-containing Nu-Derm and Reverse systems.

The use and success of high-energy, short-pulse, Q-switched lasers for tattoo removal has been well demonstrated. Three types of lasers are currently commercially available for tattoo removal: the Q-switched ruby laser (694 nm), the Q-switched alexandrite laser (755 nm) and the Q-switched Nd:YAG laser (532 nm and 1064 nm). Multiple parameters such as tattoo type, color, location, and patient skin type dictate which laser is optimal in each patient. Despite the demonstrated efficacy of these modalities, there are few papers that address some of the long-term issues of tattoo removal, such as patient compliance, and how these issues impact on the success rates of optimal tattoo removal treatments. In this retrospective study, 10-year data from a single center are presented. Our data include parameters such as clearance rates, number of treatments, wavelength of the utilized laser, and fluence and spot-size setting. In addition, potential complications such as scarring, hypopigmentation, and pain were analyzed. Finally, we examine the patient compliance that accompanied tattoo removal and the reasons behind the typically low success rates for total tattoo clearance.

5176 Introduction Telangiectasia macularis eruptiva perstans (TMEP) is a rare form of cutaneous mastocytosis seen commonly in adults. TMEP may show systemic manifestations and may be associated with myelodysplasia, myeloproliferative disorders, acute myeloid leukemia, and/or lymphoproliferative disease, but is not well recognized by hematologists. We present two cases of this rare but fascinating disease that illustrate the wide range of associated findings that may be present. Case 1 A 73-year-old female presented with hyperpigmented patches on her thighs, knees, and ankles/dorsal feet. She had no systemic symptoms. Skin biopsy showed dilated vessels and associated mast cells indicative of TMEP. A toluidine blue stain highlighted increased mast cells around the superficial vessels in the papillary dermis. Some mast cells in the superficial dermis also showed c-kit immunoreactivity. After four years she is still asymptomatic and no further studies have been performed. Case 2 A 28-year-old female presented to a doctor's office with a three day history of oral labial edema with burning and pruritus. She took Benadryl at home and also received Benadryl injection without relief. She had lesions on her forehead that spread to involve the remainder of her body, lasting from five minutes to hours. She also experienced flushing, dizziness, tinnitus, dyspnea, wheezing, cough, arthralgia and daily abdominal cramps with diarrhea. She was referred for bone marrow biopsy and further evaluation, and was diagnosed with TMEP on skin biopsy. The diagnosis was confirmed with positive toluidine blue and Giemsa stains and c-kit immunoreactivity. She had no bone marrow involvement. Case 3 A 36 old female presented with a rash for over a year. It initially started on her face and then spread to the chest, upper arms and hands. It was focally pruritic and painful. She also complained of fatigue, muscle pain on the shoulders and weight gain. Physical examination showed diffuse scattered telengiectasias of the face, upper palate, buccal- labial mucosa, neck, upper chest, upper arms, palms and fingers. A skin biopsy revealed dilated blood vessels and increased mast cells in the superficial dermis. Toluidine blue and Giemsa stains demonstrated the mast cells and the c-kit immunostain was also reactive. Cutaneous mastocytosis is a mast cell proliferative disorder with at least four different clinical forms: urticaria pigmentosa, solitary mastocytoma, diffuse cutaneous mastocytosis, and TMEP. In TMEP, characteristically, lesions are ill defined, non-pruritic, but urticate on rubbing, telengiectatic tan/brown 2–6 mm macules located symmetrically over the trunk and extremities and rarely on the face. Occasionally, urticaria pigmentosa may coexist with this lesion; however TMEP should be distinguished from urticaria pigmentosa with overlying telangiectases. Darier's sign is usually absent or minimal. This is because the lesions are characteristically paucicellular, and the few mast cells may not yield significant degranulation to exhibit Darier's sign and dermographism. Symptoms are the result of degranulation of mast cells with the release of multiple mediators. Flushing, blistering, pruritus, cardiac arrhythmias, dyspnea, asthma exacerbations, hypotension, gastrointestinal upset, acid reflux, peptic ulcer disease, diarrhea, splenomegaly, increased numbers of mast cells in the bone marrow, abnormal skeletal radiographs, irritability and nonspecific neuropsychiatric symptoms can be seen. TMEP is characteristically composed of subtly increased numbers of ovoid to spindle shaped mast cells infiltrating the papillary dermis and surrounding dilated superficial capillaries and venules. To distinguish mast cells from histiocytes, Giemsa and toluidine blue stains are useful. Tissue sections showing more than 5–10 mast cells are confirmatory for the diagnosis. c-Kit immunohistochemistry can be used to confirm the diagnosis. c-Kit is a proto-oncogene that codes for a tyrosine kinase receptor (CD117) present on mast cells and melanocytes. The present cases illustrate the wide diversity of systemic manifestations of mastocytosis that may accompany TMEP. Case one showed no systemic signs at all, whereas cases two and three showed significant systemic disease. In case three lesions started on the face, an unusual location for TMEP. Appropriate work-up is mandatory in cases presenting with TMEP. Disclosures: No relevant conflicts of interest to declare.