AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2578-8949/003
*Corresponding Author: Cesar Ricardo, Department of Dermatology, Sweden.
Citation: Cesar Ricardo, Brady Mark, Diego Luis, A unique type of Hereditary Punctate Palmoplantar Keratodermas J .Dermatology and Dermatitis. Doi:10.31579/2578-8949/003
Copyright: © 2017 Cesar Ricardo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 06 February 2017 | Accepted: 22 February 2017 | Published: 26 February 2017
Keywords: punctate palmoplantar keratoderma; palmoplantar keratoderma; punctate keratoderma; buschke-fischer-brauer syndrome; acrokeratoelastoidosis; focal acral hyperkeratosis
Keratodermas encompass a wide spectrum of disorders of keratinization that may be acquired or hereditary. We present two cases of focal acral hyperkeratosis (FAH), a subtype of punctate palmoplantar keratoderma. We review the literature and attempt to clarify the confusing classification of the heritable punctate palmoplantar keratodermas.
Capsule Summary
1. (First bullet) what is already known on this topic
a. Punctate PPK is an esoteric topic within the field of dermatology that has been discussed both clinically and histologically.
2. (Second bullet) what this article adds to our knowledge
a. Despite this, the nosography and classification of punctate PPKs have been confused in published literature.
3. (Third bullet) How this information impacts clinical practice and/or changes patient care
a. This article hopes to clarify the terminology and classification of punctate PPKs, thereby increasing awareness of this disease, with the hope of advancing treatment options.
Palmoplantar keratodermas (PPK) may be categorized as acquired or hereditary. Acquired PPK have been associated with paraneoplastic syndromes and HIV/AIDS [1]. Inherited PPK are further classified by their distribution of epidermal involvement. The three classes of inherited PPKs are diffuse keratodermas, focal keratodermas and punctate keratodermas. These three classes of inherited PPKs can manifest in three ways; simple manifestation remains limited to the skin; complex manifestation includes lesions of nonvolar skin, hair, teeth, nails and sweat glands and syndromic manifestation can involve other organ systems, deafness, and/or cancer [2].
There are several types of punctate palmoplantar keratodermas (punctate PPK) described in the literature; however, classification is complicated by the misuse of names and redundant terminology. Type 1 punctate PPK, also known as Buschke-Fischer-Brauer disease, has been referred to in the literature as punctate PPK, lending to further confusion. Type 2 punctate PPK was referred to as porokeratosispunctata palmaris etplantaris; however, spiny keratoderma of the palms and soles is now favored (discussion to follow). Type 3 punctate PPK, or the marginal keratodermas, consist of focal acral hyperkeratosis and acrokeratoelastoidosis.
We present two cases of punctate PPK that were clinically and histologically consistent with the diagnosis of focal acral hyperkeratosis. In addition, the second patient presented with the rare association of FAH with keratosis punctata of the palmar creases. Recent literature demonstrates a renewed interest in these entities; however, ambiguous terminologies persist [3,4]. We therefore present an overview of hereditary punctate PPK, focusing on clarifying the terminology.
Punctate palmoplantar keratoderma. Multiple keratotic papules and crateiform pits overlying hyperpigmentation and lichenification traversing the Achilles tendon and limited to the right (1A) and left (1B) posterior ankles.
A healthy 29-year old African American woman presented to the clinic for evaluation of an asymptomatic lesions. The lesions were present for a number of years with a progressive worsening over this time. She received no previous treatment of the condition. The lesions remained localized to the areas of friction located over the posterior and posteriolateral ankles. The patient denied other skin concerns and had no past dermatologic history, including no history of atopic dermatitis or nail complaints. Of note, the patient reported that a sibling had similar lesions, but less severe invovement.
On physical examination, the patient was well-nourished. There were multiple papules with a central keratotic core and 2-5 mm circular depressions overlying hyperpigmented plaques, with mild lichenification located bilaterally on her posterior ankles, overlying the Achilles tendon (Figure 1a and b). Her palms and soles were spared and her fingers and toenails were normal in appearance.
A shave biopsy showed hypergranulosis and compact hyperkeratotic epidermis with focal overlying depressions. No columns of parakeratosis or elastorrhexis were noted (Figure 2a and b). These finding are consistent with punctate keratoderma [5]. Our patient was educated on pressure and friction reduction to the affected areas. Additionally, she was treated with keratolytics comprised of Urea 40% cream mixed with Tretinoin 0.025% cream applied twice daily to the affected areas. At follow-up 6 weeks later, there was significant improvement, with thinning of the lichenified plaques and spicules.
Case Presentation Two
A healthy 51 year old African American woman presented to clinic for presumed dyshidrotic eczema of the hands with secondary mild dyschromia that was initially treated with Fluocinonide 0.05% ointment (Lidex) twice daily and Ammonium Lactate 12% lotion (AmLactin) twice daily. The patient states that for years she had an increasing number of papules along the lateral aspects of her hands and fingers as well as a new mildly eczematous rash on her dorsal hands that improved with Lidex ointment. The patient denied other skin concerns and had no other past dermatologic history beyond skin xerosis. The patient reported that her father may have had similar skin findings.
On physical examination, the patient was well appearing. There were multiple umbilicated hyperpigmented papules bilaterally along the lateral aspect of the thenar and hypothenar eminences as well as pitted depressions on the creases of her palms. (Figures 3a and b) There were also multiple umbilicated hyperpigmented papules bilaterally in a linear like distribution, adjacent to the medial and lateral malleoli, sparing the soles (Figure 3c).
A shave biopsy showed compact hyperkeratosis with a focal depression (Figure 4a and b). An elastin stain was performed showing preservation of the elastin fibers (Figure 4c). The patient was started on Urea 40% cream once daily and was instructed to continue her previous regimen with Fluocinonide 0.05% ointment (Lidex) as needed for eczematous flares. She was also educated touse emollients liberally and to keep her hands dry and wear gloves whenever her hands are submerged in water. At followup 2 weeks later the patient noted diminished eczematous flares, with no other significant changes in her skin examination.
Punctate palmoplantar keratoderma. Skin biopsy revealed hypergranulosis with a compact hyperkeratotic epidermis and multiple epidermal depressions. Columns of parakeratosis and elastorhexis were not seen (A: Hematoxylin and eosin stain, original magnification x100, B: Hematoxylin and eosin stain, original magnification x200).
Punctate palmoplantar keratoderma. Multiple umbilicatedhyperpigmented papules bilaterally along the lateral aspect of the thenareminence (3A) associated with pitted depressions on the creases of the palms. (3B) and multiple umbilicatedhyperpigmented papulesadjacent to the medial malleoli, sparing the sole (3C).
Palmoplantar keratodermas (PPK) comprise a diverse group of inherited or acquired disorders that are characterized histologically by hyperkeratosis of the palmar and plantar skin. Punctate palmoplantar keratoderma (punctate PPK) is considered a hereditary subtype of PPK, so named for its presentation of multiple hyperkeratotic papules, spicules or nodules, classically found on the palms and soles in varying distributions. Genetic and environmental factors both play a role in the pathogenesis of punctate PPK. Keratodermas in general have been found with a greater prevalence in working class members (e.g. agriculturists), supporting the suggestion that the environmental influence of manual labor aggravates PPK [6]. Similarly, because of the continuous exposure to high pressure, lesions located on the soles of the feet can become confluent with time [7]. Several distinct subtypes of punctate PPK exist and are reviewed.
Type 1 punctate PPK, referred to by several other names (Table 2), most often occurs in adulthood but can range in onset from 12 to 30 years of age [8].The lesions have also been reported as presenting for the first time in the fifth decade of life [7]. It is characterized by multiple round or oval, firm and elevated hyperkeratotic papules that are yellow to dark brown in color, ranging from 2 - 9 mm in diameter [9]. The papules of Type 1 punctate PPK are diverse in appearance and may evolve with time, becoming translucent, opaque or verrucous in nature. Some papules may form a keratotic core and detachment of the core can result in a characteristic central depression [5]. These lesions are usually asymptomatic; however, patients may occasionally experience pain when pressure is applied to the affected areas [10].
Type 2 punctate PPK, erroneously referred to as porokeratosis of the palms and soles, has a distinct clinical manifestation of acuminata, or spiny, spike-like, keratoses in the palmoplantar region. When the filiform projections are not clinically obvious, spiny keratoderma of the palms and soles can be differentiated from other punctate keratodermas by histologic examination (Table 1). Onset of the lesions most often occurs between the second and fourth decade of life but case reports include ages ranging from 12 to 70 years old [11]. This disease entity is known for its confusing amalgam of terminology . The literature is increasingly advocating for adoption of the more accurate term “spiny keratoderma of the palms and soles” [12,13]. The accurate use of nomenclature is clinically important because in contrast to Type 2 punctate PPK, true porokeratosis can be associated with an increased risk of squamous cell carcinoma in the affected areas. Type 2 punctate PPK can easily be distinguished from porokeratosis both clinically and histologically. Histologically, Type 2 punctate PPK (spiny keratoderma) is composed of a column of parakeratotic cells, which is cornoid lamella-like, however it lacks the dyskeratotic and vacuolar changes that are found in true porokeratosis [11].
Type 3 punctate PPK consists of acrokeratoelastoidosis(AKE) and focal acral hyperkeratosis (FAH). AKE and FAH are also grouped to gether and referred to as marginal papularacrokeratodermas. AKE and FAH are clinically similar, presenting as 2-4 mm skin colored papules or plaques, uniquely presenting on the marginal borders of the hands, feet and/or digits [14]. AKE and FAH are inherited in an autosomal dominant fashion; however, sporadic cases have also been reported [15]. Lesions often present in the second or third decade of life, with one study reporting 87% of patients with symptoms before 20 years of age [16]. Lesions of AKE and FAH can appear umbilicated (crateriform) [17], often increasing in number and size over the years [18]. The distinction between AKE and FAH is made by the histological presence of elastorrhexis in AKE and its absence in FAH [17].
The lesions of AKE and FAH are typically asymptomatic but have been associated with hyperhidrosis in several case reports of AKE [19]. Both AKE and FAH may be associated with nail dystrophy [20,21]. Unusual reported variants of AKE/FAH include acquired crateriform hyperkeratotic papules of the lower limbs sparing the hands and feet [22] and acquired hyperkeratotic papules of the feet involving the dorsal and lateral aspects of the feet with sparing of the palms and soles [23].
Although many authors support the histologic distinction between AKE and FAH, others still debate the defining characteristics of these conditions [19,24]. The marginal papularacrokeratodermas (MPA) have had a complicated history of nosography. In 1994, Rongioletti et al. [14], proposed the division of MPA into hereditary and acquired forms, with further subdivision of the hereditary group based on the histologic presence or absence of elastorrhexis (Table 3). Among the hereditary MPA without elastorrhexis, they included FAH, acrokeratoelastoidosis of Matthews and Harman, hereditary papulotranslucent acrokeratoderma, and acrokeratoderma hereditarium punctatum. Mosaic acral hyperkeratosis was rescinded from this list by Rongioletti et al. [25]. The report concluded that the differences between these entities (hereditary MPA without elastorrhexis) should not be viewed as distinctive and should instead be considered variants of the same entity [14]. In 2000, Abulafia and Vignale disputed the classification of Rongioletti et al. [25], stating that the hereditary MPAs should not be considered as separate entities and are instead clinicopathologic variants of AKE [26]. Based on literature found in Pubmed under a search for “focal acral hyperkeratosis”, FAH has been adopted, with few dissentions, as its own disease entity with acknowledgement that it is clinically similar but histologically distinct from AKE. Despite the attempt to simplify and unify the nomenclature, the FAH variants reported by Rongioletti et al. [25], continue to be reported [3].
FAH, first named by Dowd et al. [17], was originally reported as a condition unique to the Afro-Caribbean population but it has since been found in Caucasians [14,19] and Asians [27,28,29]. However, a recent multicenter study performed in 2011 reported that a racial predominance of FAH in patients of African descent does exist. The study also noted that patients of African descent can have punctate keratosis limited to the creases of the palms, fingers and soles. This unique finding is referred to as keratosis punctata of the palmar creases, and is seen more often than FAH alone [30]. Furthermore, the coexistence of FAH with keratosis punctata of the palmar creases has rarely been reported in the literature [31,32]. Our second patient presents a case of FAH associated with keratosis punctate of the palmar creases.
The differential diagnosis of palmoplantar hyperkeratos is includes consideration of digitate keratoses of the palmoplantar surface, which includes spiny keratoderma, verrucae vulgaris and arsenical keratosis [13]. In contrast to Type 1 and Type 3 punctate PPK, digitate keratoses have a characteristic finding of minute fingerlike projections, descriptively referred to as “spiked,” “spiny,” “filiform” and so forth, or by the more imaginative name, “music box spines.” As discussed for spiny keratoderma of the palms and soles, the clinical distinction of spiny projections versus punctate papules is not always obvious. Furthermore, verrucae vulgaris and arsenical keratosis can manifest as both filiform and papular, making histologic examination essential for diagnosis. Verrucae vulgaris papules develop pinpoint bleeding when the lesions are pared [33]. Furthermore, dermoscopy reveals thrombosed capillaries in verrucae vulgaris, but not in punctate PPK. Arsenical keratoses may also appear clinically similar to punctate PPK, but a history of long-term arsenic exposure is required [34]. Arsenical keratoses lesions differ histologically with thick, compact hyperkeratosis and parakeratosis. Some epidermal keratinocytes may show atypia histologically. While the presence of numerous vacuolated keratinocytes and the absence of solar elastosis suggest arsenical keratoses, these findings are not definitive [35]. Important considerations in the differential diagnosis of palmoplantar pits also include nevoid basal cell carcinoma syndrome and plantar pitted keratolysis, hereditary and acquired disorders, respectively. Both disorders are easily distinguished from punctate PPK by histologic focal areas of absent or reduced stratum corneum [9].
Because it is an asymptomatic and benign condition, treatment of FAH is largely dependent on the patient’s desires and is often indicated for cosmetic reasons alone. A therapeutic goal in the treatment of FAH is to decrease hyperkeratosis with topical keratolytics such as urea, salicyclic acid and topical retinoids. Liquid nitrogen cryotherapy and prednisone have also been attempted, with poor results [36]. There is one report in the literature of acitretin successfully being used for treatment [29]. An earlier report published successful treatment of AKE with etretinate [37-39]. Our first patient responded to twice daily application of Urea 40% cream mixed with Tretinoin 0.025% cream, with significant improvement after 6 weeks. The second patient reported no significant improvement at 2 weeks follow-up with Urea 40% cream applied once daily. Longer follow-up of treatment for this patient is necessary to determine treatment efficacy.
Skin biopsy revealed compact acral hyperkeratosis with focal depression. The elastin stain showed preservation of the elastin fibers.
(A: Hematoxylin and eosin stain, original magnification x40, B: Hematoxylin and eosin stain, original magnification x200, Hematoxylin and eosin stain with EVG x200).
This reportpresents two cases of a unique type of hereditary punctate PPK known as FAH, or Type 3 punctate PPK. Owing to its asymptomatic nature, FAH has been underreported in the literature, therefore leading to a decreased awareness of its existence. With this case we hope to further elucidate an understanding of the classification of hereditary punctate PPK, thereby bringing greater awareness of FAH as a diagnostic potential. Furthermore, we propose inclusion of the Type 1A/B, 2 and 3 designations, as outlined in when referring to the various forms of hereditary punctate PPK. Although more cumbersome, it avoids ambiguity. It is our hope that a uniformly adopted terminology will facilitate further study and research of the punctate PPK group, thereby advancing our understanding of the disease and improving potential treatment options.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
