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At least 235 records · Page 13Linked to original sources
PubMed2004

[Erythema nodosum: etiological changes in the last two decades].

OBJECTIVE: To study the etiological factors associated with erythema nodosum in children hospitalized between January 1985 and December 2003. MATERIAL AND METHODS: We performed a retrospective, descriptive study through review of the medical records of children with a diagnosis of erythema nodosum (MBDS-ICD 9-CM, code 6952). Forty-five patients (27 boys and 18 girls) aged between 10 months and 14 years were studied. The following variables were analyzed: age, sex, associated symptoms, complementary investigations (blood count, erythrocyte sedimentation rate, throat swab, chest x-ray, Mantoux test, ASLO titer, stool culture, serology) and final diagnosis. RESULTS: The most frequent etiology was tuberculosis (10 patients), followed by Salmonella enteritidis (7 patients), group A beta -hemolytic Streptococcus (3 patients), Salmonella typhimurium (2 patients), Campylobacter jejuni (2 patients), Yersinia enterocolitica (1 patient), infectious mononucleosis caused by Epstein Barr virus (1 patient), cat scratch disease (1 patient), BCG vaccination (1 patient), associated chronic hepatitis B infection (1 patient), and associated amoxicillin treatment (1 patient). Etiology was unknown in 15 patients. The last case of erythema nodosum associated with tuberculous infection dated back to 1991, after which the most frequent etiologic factors associated with erythema nodosum were gastrointestinal pathogens. CONCLUSIONS: According to our results, the main etiological factor currently associated with erythema nodosum is gastrointestinal infection. Consequently, stool cultures, especially when there are associated gastrointestinal symptoms, are essential.

Adolescent↗
PubMed2000

Erythema migrans--influence of posture. Case report.

Despite widespread awareness of the most classical clinical presentation with central clearing of erythema migrans, a pathognomonic sign of infection with Borrelia burgdorferi, diagnosis of other forms of erythema migrans remains more difficult. We describe a case of a patient with secondary lesions of erythema migrans that within three months formed a complicated pattern and affected at last nearly the entire lower limb of the patient. In addition, the erythema appeared to be posture-dependent in the way that the lesion was with central clearing in the supine and with homogeneous appearance in the upright position. The borrelial infection was confirmed by PCR sequencing that detected DNA of B. afzelii in the skin biopsy specimen. The lesions disappeared during antibiotic therapy. This case shows how posture can be important in the examination of patients with a suspected erythema migrans.

Borrelia burgdorferi Group↗
PubMed2002

Physical and transcriptional map of the critical region for keratolytic winter erythema (KWE) on chromosome 8p22-p23 between D8S550 and D8S1759.

Keratolytic winter erythema is an autosomal dominant skin disorder characterised by erythema, hyperkeratosis, and peeling of the skin of the palms and soles, especially during winter. The keratolytic winter erythema locus has been mapped to human chromosome 8p22-p23. This chromosomal region has also been associated with frequent loss of heterozygosity in different types of cancer. To identify positional candidate genes for keratolytic winter erythema, a BAC contig located between the markers at D8S550 and D8S1695 was constructed and sequenced. It could be extended to D8S1759 by a partially sequenced BAC clone identified by database searches. In the 634 404 bp contig 13 new polymorphic microsatellite loci and 46 single nucleotide and insertion/deletion polymorphisms were identified. Twelve transcripts were identified between D8S550 and D8S1759 by exon trapping, cDNA selection, and sequence analyses. They were localised on the genomic sequence, their exon/intron structure was determined, and their expression analysed by RT-PCR. Only one of the transcripts corresponds to a known gene, encoding B-lymphocyte specific tyrosine kinase, BLK. A putative novel myotubularin-related protein gene (MTMR8), a potential human homologue of the mouse acyl-malonyl condensing enzyme gene (Amac1), and two transcripts showing similarities to the mouse L-threonine 3-dehydrogenase gene and the human SEC oncogene, respectively, were identified. The remaining seven transcripts did not show similarities to known genes. There were no potentially pathogenic mutations identified in any of these transcripts in keratolytic winter erythema patients.

Chromosomes, Artificial, Bacterial↗
PubMed2000

Psoralen-ultraviolet A-induced erythema: sensitivity correlates with the concentrations of psoralen in suction blister fluid.

Since the advent of psoralen-ultraviolet A (PUVA) therapy, the value of plasma 8-methoxypsoralen (8-MOP) concentrations to predict PUVA-induced erythema has been widely investigated. Plasma 8-MOP concentrations have not been proportional to, and cannot alone predict, the degree of PUVA-induced erythema. We assumed that PUVA-induced erythema was related more closely to psoralen concentrations in the skin tissue rather than those within blood vessels. This study was designed to investigate the correlations between the 8-MOP concentrations in suction blister fluid (SBF) and in plasma, with the degree of PUVA-induced erythema. 8-MOP concentrations in plasma and SBF were measured in 15 vitiligo patients and 11 volunteers. Blood and SBF samples were collected 2 h after taking 8-MOP, and 8-MOP concentrations in plasma and SBF were quantified using reverse-phase high-performance liquid chromatography. Eleven volunteers were phototested using a series of doses of ultraviolet A at the time of sampling. The erythema responses were estimated visually to determine the minimal phototoxic dose (MPD). SBF 8-MOP concentrations showed a weak positive correlation with plasma 8-MOP concentrations, which means that we could not predict the exact SBF 8-MOP concentrations using the plasma 8-MOP concentrations. The MPD showed a better correlation with the log of the SBF 8-MOP concentration than with that of the plasma 8-MOP concentration. These results show that plasma 8-MOP concentration cannot represent the exact SBF 8-MOP concentration, and that SBF 8-MOP concentrations, which are representative of the skin tissue 8-MOP level, are more closely related to the erythemal sensitivity during PUVA therapy.

Adolescent↗
PubMed2000

Differential expression of cytokine mRNA in skin specimens from patients with erythema migrans or acrodermatitis chronica atrophicans.

Erythema migrans, the characteristic skin manifestation of acute Lyme borreliosis, is a self-limited lesion. In contrast, acrodermatitis chronica atrophicans, the typical cutaneous manifestation of late Lyme borreliosis, is a chronic skin condition. In an effort to understand pathogenic factors that lead to different outcomes in dermatoborrelioses, skin biopsy samples from 42 patients with erythema migrans and 27 patients with acrodermatitis chronica atrophicans were analyzed for mRNA expression of five pro-inflammatory cytokines (tumor necrosis factor alpha, interleukin-1 beta, interleukin-6, interferon-gamma, and interleukin-2) and two anti-inflammatory cytokines (interleukin-4 and interleukin-10) by in situ hybridization with cytokine-specific riboprobes. Among the 27 patients who had erythema migrans alone with no associated signs or symptoms, the major cytokines expressed in perivascular infiltrates of T cells and macrophages were the pro-inflammatory cytokine interferon-gamma and the anti-inflammatory cytokine interleukin-10. In the 15 erythema migrans patients who had associated signs and symptoms, including headache, elevated temperature, arthralgias, myalgias, or fatigue, a larger number of macrophages and greater expression of macrophage-derived pro-inflammatory cytokines, tumor necrosis factor alpha, interleukin-1 beta, and interleukin-6, were also found. In comparison, infiltrates of T cells and macrophages in the skin lesions of acrodermatitis chronica atrophicans patients had very little or no interferon-gamma expression. Instead, they usually expressed only the pro-inflammatory cytokine tumor necrosis factor alpha and the anti-inflammatory cytokine interleukin-4. Thus, the activation of pro-inflammatory cytokines in erythema migrans lesions, particularly interferon-gamma, seems to be important in the control of the spirochetal infection. In contrast, the restricted pattern of cytokine expression in acrodermatitis chronica atrophicans, including the lack of interferon-gamma, may be less effective in spirochetal killing, resulting in the chronicity of this skin lesion. J Invest Dermatol 115:1115-1123 2000

Acrodermatitis↗
PubMed1984

[Spirochete etiology of erythema chronicum migrans disease].

From ticks of the type Ixodes ricinus, 19 strains of a spirochete were isolated at three places of infection of erythema chronicum migrans disease. The spirochete was immunologically related to Borrelia duttoni, Treponema pallidum and Ixodes dammini spirochete, the causative organism of North American erythema chronicum migrans disease (Lyme disease). The isolated spirochete differed from the North American one in its reaction with monoclonal antibodies and possibly in its electronmicroscopic structure. A corresponding spirochete was isolated from the blood of a woman with erythema chronicum migrans. Of 39 patients with erythema chronicum migrans mostly treated with antibiotics 50% had increased IgG antibody titre (1:64 to 1:1024) against the isolated spirochete, while among 51 untreated patients with tick-transmitted meningopolyneuritis 90% had increased IgG antibody titres. Fourfold antibody titres increases or falls were found on 50 occasions. IgG antibody titres up to 1:64 were demonstrated also in CSF, in 22 instances with significant changes. Increased serum IgM antibody titres of 1:32 to 1:256 were observed in 20% and 68%, respectively, of patients. These findings suggest that the isolated spirochete is the causative agent of erythema chronicum migrans disease in Europe. Its antigen structure and arrangement is similar to that of the causative agent of Lyme disease.

Animals↗
PubMed2003

Characteristics of erythema migrans in Borrelia afzelii and Borrelia garinii infections.

Erythema migrans is the most common manifestation of stage I Lyme borreliosis. This study investigated the relation between the subspecies of Borrelia burgdorferi involved, the time of development and the appearance of the manifestation. The study comprised 33 cases of erythema migrans yielding B. burgdorferi sensu lato by culture of skin biopsy. The species was determined by polymerase chain reaction analysis of the cultivated spirochaetes. In 22 of the cases, B. afzelii was demonstrated, whereas 11 yielded growth of B. garinii. All 11 erythemas associated with B. garinii were homogeneous, whereas 20 of the 22 associated with B. afzelii were annular. The garinii erythemas developed more rapidly, and were generally larger than the afzelii erythemas. The observations call for comparison with other geographical areas with similar, and with different, borrelial infection spectra.

Borrelia Infections↗
PubMed1993

Carcinogenic potential of fluorescent UV tanning sources can be estimated using the CIE erythema action spectrum.

In legislation the CIE human erythema action spectrum is used to assess the risk of UV radiation appliances for household use. The most popular type of UV radiation source for private use is the low pressure 'UVA' radiation source, which mainly emits in the UVA area, but also has some emission in the UVB area. Recently reports have raised doubt whether the CIE erythema action spectrum is a good approximation for the carcinogenic risk. Therefore, it was investigated whether the carcinogenic potential of differing UV tanning sources, which mainly emit in the UVA area, could be assessed by using the CIE erythema spectrum. Two groups of lightly pigmented C3H/Tif mice were initially exposed to broad spectrum UV radiation with a high output of UVB (UVB emission 16.7%) during 84 days, in a daily dose of 4.67 Basic minimal erythema doses (Basic-MED). Subsequently, one group was exposed to Bellarium-S SA-1-12 (UVB emission 6.9%), the other to Philips TL 09R (UVB emission 2.2%), in a daily dose of 1 Basic-MED. The time to occurrence of seven tumour end-points was almost identical in the two groups, p > 0.4. To obtain further information on the relationship between the daily dose of common UV tanning sources measured in Basic-MED and tumour development, we combined the result of this experiment with the results of two others. There existed a negative correlation between the daily exposure dose measured in Basic-MED and the tumour induction time, p < or = 0.05. This inverse relationship was observed both when the UV tanning sources were administered with or without a prior exposure to broad spectrum UV irradiation. Our results indicate that the carcinogenic risk of UV tanning sources in the hairless C3H/Tif mouse can be estimated by the CIE erythema action spectrum.

Animals↗
PubMed1989

Skin temperature changes after irradiation with UVB or UVC: implications for the mechanism underlying ultraviolet erythema.

Measurement of the temperature change of skin exposed to ultraviolet radiation can be used to draw conclusions on the mechanism responsible for the development of ultraviolet erythema and on the question of which blood vessels are involved in the erythema. Under controlled environmental conditions we measured temperature change of skin areas, mainly on the back, irradiated with UVB (wavelengths between 280 nm and 315 nm) or UVC (wavelengths between 100 nm and 280 nm). Elevated skin temperature was measured after both types of irradiation. The influence of experimental conditions (ambient temperature, part of the body exposed to the radiation) was investigated. Ambient temperature did not influence the temperature difference measured significantly. The skin region used for the measurements did influence the results; temperature elevation after irradiation with UVC was markedly smaller on the forearm than on the back, for the same number of MED (minimal erythema dose; the dose required to elicit a just-perceptible redness of the skin). The fact that temperature elevations were found after UVC and after UVB irradiations points to involvement of arteriolar vessels in UVC as well as UVB erythema. The arteriolar dilation found speaks for the concept that both types of erythema are caused by a vasoactive substance, probably diffusing from the epidermis to the dermal blood vessels.

Adult↗
PubMed1996

European Lyme borreliosis: 231 culture-confirmed cases involving patients with erythema migrans.

In 1994, we isolated Borrelia burgdorferi sensu lato from 231 patients with erythema migrans who presented to the University Medical Center in Ljubljana, Slovenia. Samples of erythema migrans-affected skin were placed in media to support the growth of Borrelia species and evaluated in Ljubljana and Chicago. Patients whose cultures were positive included 132 women and 99 men; 136 of these 231 patients recalled a tick bite. Patients noted a rash an average of 24 days after a bite and presented a mean of 34 days after the bite with erythema migrans (mean diameter. 16 cm). Itching (44%) burning (18%), and pain (11%) were the most common local symptoms. Systemic complaints (40%) included headache, fatigue, malaise, and arthralgia. Other than erythema migrans, findings on physical examination were minimal (< 5% had fever, and in < 10% local lymph nodes were affected). Serial serological studies using indirect immunofluorescence assay, ELISA, and Western blot methods were performed, and antibodies to B, burgdorferi sensu lato were detected in < 50% of samples from patients. This is the largest series reported to date of patients with culture-confirmed Lyme borreliosis. It highlights the deficiencies of serological tests in early disease, demonstrates the sensitivity of direct detection methods for evaluation of patients with erythema migrans, and suggests that patients with early Lyme borreliosis in Slovenia may suffer a milder illness than those in the United States.

Adolescent↗
PubMed2003

Supplementation with beta-carotene or a similar amount of mixed carotenoids protects humans from UV-induced erythema.

Carotenoids are useful oral sun protectants, and supplementation with high doses of beta-carotene protects against UV-induced erythema formation. We compared the erythema-protective effect of beta-carotene (24 mg/d from an algal source) to that of 24 mg/d of a carotenoid mix consisting of the three main dietary carotenoids, beta-carotene, lutein and lycopene (8 mg/d each). In a placebo-controlled, parallel study design, volunteers with skin type II (n = 12 in each group) received beta-carotene, the carotenoid mix or placebo for 12 wk. Carotenoid levels in serum and skin (palm of the hand), as well as erythema intensity before and 24 h after irradiation with a solar light simulator were measured at baseline and after 6 and 12 wk of treatment. Serum beta-carotene concentration increased three- to fourfold (P < 0.001) in the beta-carotene group, whereas in the mixed carotenoid group, the serum concentration of each of the three carotenoids increased one- to threefold (P < 0.001). No changes occurred in the control group. The intake of either beta-carotene or a mixture of carotenoids similarly increased total carotenoids in skin from wk 0 to wk 12. No changes in total carotenoids in skin occurred in the control group. The intensity of erythema 24 h after irradiation was diminished in both groups that received carotenoids and was significantly lower than baseline after 12 wk of supplementation. Long-term supplementation for 12 wk with 24 mg/d of a carotenoid mix supplying similar amounts of beta-carotene, lutein and lycopene ameliorates UV-induced erythema in humans; the effect is comparable to daily treatment with 24 mg of beta-carotene alone.

Adult↗
PubMed2001

Erythema gyratum repens.

BACKGROUND: Erythema gyratum repens is a rare, clinically specific, and distinctive paraneoplastic syndrome. It is associated with internal malignancy in 82% of patients. OBJECTIVE: A 58-year-old man with erythema gyratum repens is described. On diagnosis of his eruption, a malignancy work-up revealed a 9-mm pulmonary adenocarcinoma. Removal of the carcinoma resulted in clearing of the erythema. RESULTS: Erythema gyratum repens is most commonly associated with bronchial, esophageal, and breast cancer. It has also rarely been reported in patients without evidence of malignancy. The histopathologic findings are nonspecific. Direct immunofluorescence has sometimes revealed C3, C4, or immunoglobulin G at the basement membrane zone. CONCLUSION: The etiology of erythema gyratum repens is unknown, although an immune response is postulated. Treatment involves treating the underlying malignancy.

Erythema↗
PubMed1985

Comparative protection efficiency of UVA- and UVB-induced tans against erythema and formation of endonuclease-sensitive sites in DNA by UVB in human skin.

UVA- and UVB-induced tans which were visually identical with each other were induced in separate sites on the lower back of 5 normal human volunteers of good tanning ability. Tanning was achieved by 4 exposures to UVA and UVB administered over an 8-day period. One week after the last exposure the protection afforded by the two types of tan against UVB-induced erythema and against UVB-induced DNA damage was measured. Protection against erythema was measured by comparison of the minimal erythema doses of UVB in tanned and untanned skin. Protection against DNA damage was assessed by comparing the numbers of endonuclease-sensitive sites in epidermal DNA extracted from biopsies taken from tanned and untanned sites exposed to the same dose of UVB. The UVB tans conferred significant protection (mean 2.98-fold) against UVB-induced erythema. UVA tans were not associated with significant protection (mean 1.4-fold). In contrast, both UVA- and UVB-induced tans were associated with a similar reduction in yield of endonuclease-sensitive sites in epidermal DNA (in UVA tan to 47% and in UVB tan to 45% of the yield in untanned skin). Protection conferred by the tans against erythema was therefore not paralleled by protection against DNA damage.

Adult↗
PubMed1994

Successful amplification of DNA specific for Finnish Borrelia burgdorferi isolates in erythema chronicum migrans but not in circumscribed scleroderma lesions.

Early diagnosis of Borrelia burgdorferi infection, hampered by the absence of detectable antibodies in most patients with erythema chronicum migrans is important to prevent late-stage neurologic, rheumatologic, and skin disorders. Furthermore, B. burgdorferi has been claimed to be the causative agent in localized scleroderma (morphea). We used PCR amplification to search for B. burgdorferi outer surface protein OspA-specific sequences in DNA obtained from lesional skin biopsies on Finnish patients with clinically suspect erythema chronicum migrans, lymphocytoma, morphea, or with diverse skin manifestations and persistent high antibodies to B. burgdorferi flagellar antigen. Seronegative patients with other skin lesions served as controls. The amplicons obtained with primers specific for B. burgdorferi type strain B31 ospA sequence did not hybridize to the corresponding probes, and thus the DNA amplified from a Finnish B. burgdorferi erythema chronicum migrans skin isolate was sequenced. This 98-nucleotide sequence of ospA (332-429) showed 11% to 14% nucleotide divergence compared with the North American type strain (B31), several European strains, and an East Siberian tick strain. The sequence was almost identical (99%) to a Swedish isolate from acrodermatitis chronica atrophicans. Using oligonucleotides specific for the Finnish strain, a positive polymerase chain reaction-based hybridization was obtained in six of seven untreated erythema chronicum migrans patients infected in Finland or in Estonia, and in the lymphocytoma patient. Only two of the erythema chronicum migrans patients had IgG or IgM antibodies to flagellin. However, all seven morphea lesions as well as the other lesions were polymerase chain reaction negative. Polymerase chain reaction-based hybridization of B. burgdorferi OspA gene from skin-derived DNA thus provides a sensitive and specific diagnostic tool. In conditions not unequivocally known to be caused by B. burgdorferi, like in morphea, this assay was negative. We also demonstrate that peri-Baltic B. burgdorferi isolates show homology in their OspA genes but differ from geographically more distant isolates.

Antibodies, Bacterial↗
PubMed1994

The degrees of UVB-induced erythema and pigmentation correlate linearly and are reduced in a parallel manner by topical anti-inflammatory agents.

To examine whether it is possible to evaluate the degree of ultraviolet B (UVB)-induced inflammation by measuring the degree of hyperpigmentation, we investigated the relationship between UVB-induced erythema and the subsequent pigmentation quantitatively. At 24 h and 7 d after irradiation with erythemogenic doses of UVB to the backs of 16 Japanese subjects, the degree of induced erythema (delta erythema index) and that of pigmentation (delta melanin index) were examined by an image analytic method using a videomicroscope interfaced with a computer. The relationship between two indices was linear in each subject, and the correlation coefficient was 0.83 when evaluated using whole data. The slope of the regression line for the delta melanin index against delta erythema index tended to become steeper as non-irradiated skin color became darker (r = 0.63), suggesting that more efficient melanogenesis takes place after the same level of inflammation in the subject with darker skin. Both erythema and hyperpigmentation were suppressed significantly and in a parallel manner by corticosteroids and indomethacin applied topically immediately after UVB irradiation. These results imply that the post-inflammatory hyperpigmentation correlates closely with the severity of the prior inflammation and that chemical mediators released in the inflammatory process have considerable influence on the melanogenesis. We conclude that the measurement of UVB-induced hyperpigmentation can be utilized for the assessment of topical anti-inflammatory agents, unless these have direct actions on the tyrosinase activity of melanocytes.

Administration, Topical↗
PubMed1988

Do oral carotenoids protect human skin against ultraviolet erythema, psoralen phototoxicity, and ultraviolet-induced DNA damage?

This study was performed in order to (1) assess the magnitude of a possible protective effect of oral carotenoids on ultraviolet B (UVB)-, ultraviolet A (UVA)-, and psoralen ultraviolet A (PUVA)-induced erythema in human skin and (2) to evaluate whether the postulated prevention of skin cancer by prophylactic administration of carotenoids is based on a decrease in UVB-induced DNA damage. Twenty-three healthy volunteers received oral carotenoids (150 mg/day) for 4 weeks. Serum levels were quantitated, and ranged from 390 to 1710 micrograms/dl. Before and after carotenoid administration, the UVA- and UVB-MEDs and the PUVA-MPD were determined by standard phototesting. DNA damage was assessed by autoradiographical measurement of unscheduled DNA synthesis (UDS) following UVB exposure before and after treatment. No statistically significant carotenoid-dependent protection was found against UVA, UVB, and PUVA erythema by comparing the pre- and postcarotenoid erythema doses. Also at the DNA level there was no indication of a protective effect that could be detected with the methods employed: the amount of UVB-induced UDS was not decreased after carotenoid treatment. We conclude that (1) carotenoids do not reduce UVB-, UVA-, or PUVA-induced erythema in human skin; that (2) reactive oxygen species may not be involved in PUVA-erythema production or, alternatively, carotenoids may not quench these radicals sufficiently in vivo; and that (3) carotenoid protection against UVB-induced carcinogenesis does not operate by reducing the number of mutagenic lesions in DNA.

Administration, Oral↗
PubMed1982

The interaction of UVA and UVB in the production of threshold erythema.

A study was done to demonstrate quantitatively and graphically the way in which suberythemogenic doses of broadband UVA and UVB interact in producing a visible erythema. On the backs of fair-skinned human volunteers the minimal erythema dose (MED) was determined for polychromatic UVA and UVB. Increasing fractions of the UVA MED were given to sites already exposed to various fractions of the UVB MED resulting in sites exposed to various doses of both UVA and UVB. The same experiment was repeated with the order of wavebands reversed. It was demonstrated that when UVA was followed by UVB an erythema was produced in those sites where the sum of the fractions was equal to one, an interaction termed photoaddition. When the UVA exposure followed the UVB, erythema was again predominantly noted in those sites demonstrating photoaddition. However, in the latter case, numerous sites of threshold erythema were noted where the sum of the fractions was greater than one. This is suggestive of photorecovery. No evidence of photoaugmentation was observed with either order of exposure.

Erythema↗
PubMed1976

Prolonged ultraviolet light-induced erythema and the cutaneous carcinoma phenotype.

A considerable amount of evidence exists in support of the role of ultraviolet radiation as a major etiologic factor in human skin cancer, both melanoma and carcinoma types. On the basis of epidemiologic studies a phenotype has been described which helps to identify the persons who are more susceptible to skin cancer. In an attempt to further define this population, patients with cutaneous carcinoma and a normal control group were exposed to artificial ultraviolet light (UVL) and the erythema and tanning responses of each group were measured over a 21-day period. UVL-induced erythema was prolonged in a significantly higher percentage of patients with skin cancer than in control patients, lasting two to three weeks after single exposures to 6 and 8 times the patient's minimal erythema dose. The presence of prolonged erythema correlated with this history of previous skin cancer but did not correlate with other established risk factors for cutaneous carcinoma, i.e., fair skin, light hair and light eyes, easy sunburning and poor tanning, and Celtic ancestry. Prolonged erythema following UVL radiation may therefore represent an additional risk factor and help to identify the skin cancer-susceptible population.

Adult↗