Dermato doi: 10.3390/dermato6020021

Authors: Daniele Cecere Giuseppe Lauletta Luca Potestio Cataldo Patruno Maddalena Napolitano

Background: Difficult-to-treat anatomical areas in atopic dermatitis (AD), including the head and neck, hands, genital and intertriginous regions, are frequently associated with therapeutic refractoriness, persistent pruritus, and substantial functional and psychosocial burden. Real-world evidence (RWE) regarding the effectiveness of Janus kinase (JAK) inhibitors in these site-dominant phenotypes remains fragmented. This structured narrative review aimed to synthesize available RWE on abrocitinib, baricitinib, and upadacitinib in AD involving difficult-to-treat areas. Methods: A comprehensive search of PubMed, Ovid MEDLINE, Scopus, Embase, and the Cochrane Library was conducted up to 31 December 2025. Real-world observational studies reporting site-specific outcomes in patients with AD treated with JAK inhibitors were included. Primary randomized controlled trial efficacy analyses were excluded, while relevant post hoc regional analyses were considered. A total of 22 studies met eligibility criteria for qualitative synthesis. Results: Across heterogeneous real-world cohorts, JAK inhibitors demonstrated clinically meaningful improvement in difficult anatomical regions, particularly the head and neck and hands. Rapid pruritus reduction was a consistent and clinically relevant finding. Safety profiles were broadly aligned with clinical trial data. Conclusions: Real-world data support JAK inhibitors as effective options for anatomically complex AD phenotypes, warranting further standardized regional assessment.

Dermato doi: 10.3390/dermato6020020

Authors: Alejandra Curbelo-Paz Ellen T. Lee Alana K. Sadur Nicholas D’Angelo Sonal Choudhary

Emerging research highlights the complex interplay between the gut microbiome, skin health, and environmental exposures, forming what is now recognized as the gut–skin–exposome axis. This narrative review explores the role of gut microbiome dysbiosis—a disruption in the balance of intestinal microorganisms—in the pathogenesis and progression of various non-communicable inflammatory skin diseases, including acne, atopic dermatitis, psoriasis, rosacea, systemic lupus erythematosus, chronic spontaneous urticaria, hidradenitis suppurativa, and alopecia areata. This review synthesizes mechanistic studies, clinical trials, and Mendelian randomization data to elucidate how altered gut microbial composition contributes to systemic and cutaneous inflammation. Key modifiable factors, such as diet, antibiotics, stress, and sleep, as well as interventions like probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, are discussed for their potential therapeutic value. By integrating clinical insights with microbiome science, this review underscores the importance of a holistic, systems-based approach in managing inflammatory skin diseases, offering clinicians evidence-based strategies to improve patient outcomes through gut microbiome modulation.

Dermato doi: 10.3390/dermato6020019

Authors: Giuseppe Lauletta Luca Potestio Paola Nappa Maddalena Napolitano

Introduction: Alopecia areata (AA) is a chronic immune-mediated disorder characterized by non-scarring hair loss and a significant psychosocial burden. Ritlecitinib, a selective Janus kinase 3 (JAK3) and tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinase inhibitor, has recently emerged as a targeted systemic therapy for moderate-to-severe AA. While randomized clinical trials have demonstrated its efficacy, real-world evidence remains limited and heterogeneous. Methods: A structured narrative review was conducted to summarize current evidence on ritlecitinib in AA, with a focus on real-world outcomes. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to March 2026 using predefined keywords. Eligible studies included real-world observational studies, case series, and post hoc analyses of randomized controlled trials reporting clinical outcomes. Two independent reviewers performed study selection. Results: A total of 14 studies were included. Clinical trial analyses suggested sustained efficacy over time, with progressive improvement in Severity of Alopecia Tool (SALT) scores up to 24 months. Real-world studies reported clinically meaningful hair regrowth across diverse populations, including severe, pediatric, and treatment-experienced patients. Response rates increased over time, with a proportion of patients achieving SALT ≤ 20 or ≥80% improvement. Lower baseline severity and shorter disease duration were reported in several studies as potential factors associated with a better response. Safety profiles were favorable, with predominantly mild adverse events. Discussion: Ritlecitinib shows consistent effectiveness and acceptable safety in both clinical trials and real-world settings. Treatment response appears progressive and heterogeneous, supporting the importance of early intervention and adequate treatment duration. Further large-scale and long-term real-world studies are needed to better define predictors of response and optimize patient selection.

Dermato doi: 10.3390/dermato6020018

Authors: Umberto Santaniello François Rosset Luca Mastorino Orsola Crespi Pietro Quaglino Simone Ribero

Elderly psoriasis patients (≥65 years) demonstrate mainly preserved but substantially delayed therapeutic responses to IL-17 and IL-23 inhibitors, achieving lower PASI90 rates at early time-points with eventual “catch-up” by week 52, alongside increased adverse-event-driven discontinuation. This review synthesizes clinical efficacy data from real-world studies with emerging mechanistic evidence on immunosenescence and cellular senescence to propose the “Inflammatory Noise Floor” hypothesis. We postulate that senescent keratinocytes and fibroblasts constitutively secrete SASP cytokines (IL-6, IL-8, TNF-α) through pathways partially independent of IL-23/IL-17, potentially establishing a persistent baseline inflammation that IL-23/IL-17 blockade might not suppress. Concurrently, immunosenescence, characterized by CD8+CD28− T-cell accumulation, exhaustion marker upregulation, and Treg dysfunction, is hypothesized to impair adaptive immune re-equilibration. This dual mechanism represents one plausible, albeit theoretical, explanatory framework for the temporal lag, PASI plateau effects, and infection risk observed in elderly patients. Optimizing outcomes in the elderly may require a pragmatic approach: accepting stable PASI 75-90 as a successful endpoint and prospectively validating extended assessment timelines. While a direct correlation remains to be proven, this framework identifies cellular and immunosenescence as potential targets for future senotherapeutic interventions.

Dermato doi: 10.3390/dermato6020017

Authors: Pedro Moltó-Balado Andrea Simeó-Monzo Alba del Barrio-Gonzalez

Background: Biotin (vitamin B7) is widely marketed and used as an over-the-counter supplement for hair, skin, and nails, despite uncertainty about its clinical benefit for alopecia and hair growth. While overt biotin deficiency can be associated with hair changes, clinically meaningful deficiency is uncommon in individuals consuming a balanced diet, and published findings on biotin status in hair loss populations are inconsistent. Methods: This is a systematic review following PRISMA. A search was conducted in PubMed/MEDLINE (PROSPERO: CRD420251274919) for human studies evaluating biotin (alone or in combination) and including hair outcomes. The synthesis was qualitative due to clinical and methodological heterogeneity. Results: Ten studies were included. Across controlled and quasi-experimental interventions, biotin monotherapy did not show consistent benefit on objective hair growth outcomes; when improvements were reported, they typically occurred in combined regimens and were difficult to attribute specifically to biotin. Studies showed mixed findings on “low” biotin levels in hair loss populations, whereas controlled studies in telogen effluvium found no significant differences in serum biotin versus controls. No serious adverse events attributable to biotin were identified; however, high-dose biotin may interfere with immunoassays, potentially leading to clinically relevant false laboratory results. Conclusions: Current evidence does not support routine biotin supplementation for alopecia in the absence of documented deficiency, although it may be considered in scenarios with risk or confirmation of deficiency/malabsorption.

Dermato doi: 10.3390/dermato6020016

Authors: Dalibor Mijaljica Joshua P. Townley Kira Torpy Sharon Meere Fabrizio Spada Mikayla Lai

The skin serves as a primary defensive barrier to protect the body from environmental contaminants, infections and trauma. Unfortunately, skin barrier’s structural and functional integrity can be compromised, disrupted or impaired due to a combination of internal and external factors, making it vulnerable and often leading to a wide range of skin conditions characterized by dryness, heightened sensitivity, and increased susceptibility to damage and infections. In addition, the integrity of the skin barrier tends to deteriorate progressively with age. As people age, their skin naturally changes and can also be compromised by a plethora of factors that reduce its strength and resilience. The aging skin becomes thinner and more sensitive, coinciding with a variety of structural–functional alterations, decreased levels of natural moisturizing factor (NMF), lipid content and hydration, increased transepidermal water loss (TEWL), altered skin surface pH (pHss) and microbiome diversity. All these age-related skin integrity alterations make the skin drier, flakier, itchy, and fragile, and more susceptible to damage and breakdown, thus diminishing its ability to effectively protect, repair and heal efficiently. Identifying skin integrity issues before they progress will foster positive outcomes through effective preventive measures. Hence, it is important to understand the impact of skincare formulations on skin integrity in compromised aging skin. A well-considered, evidence-based approach to skincare can provide cleansing, moisturizing and protective benefits, while aiding the reduction in skin integrity issues like dry and itchy skin, sensitive skin, bruising, skin tears, pressure injuries (PIs), lower leg ulcers and moisture-associated skin damage (MASD). Managing skin integrity in compromised aging skin begins with gentle skin cleansing, adequate moisturization and protective barrier care to ensure the skin’s function is maximized.

Dermato doi: 10.3390/dermato6020015

Authors: Jia Qi Adam Bai Ilya Mukovozov

Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis characterized by recurrent nodules, abscesses, and sinus tract formation in intertriginous skin. Although HS is increasingly recognized as an autoinflammatory condition rather than a classical infection, antimicrobial therapies remain central to disease management, implicating a potential role for the cutaneous microbiome in disease activity. Recent advances in culture-independent sequencing techniques have enabled more detailed characterization of microbial communities in HS, revealing consistent alterations in microbial composition and diversity. Compared with healthy skin, HS lesions exhibit reduced microbial diversity, depletion of commensal organisms such as Cutibacterium acnes, and enrichment of anaerobic bacteria including Prevotella, Porphyromonas, and Finegoldia. These alterations are more pronounced in chronic, tunnel-forming disease and are frequently associated with biofilm formation, which may contribute to treatment resistance and persistent inflammation. Microbiome changes have also been observed beyond overtly lesional skin, suggesting a broader field effect. Evidence regarding extracutaneous microbial compartments, particularly the gut microbiome, remains limited and heterogeneous, while methodological variability in sampling, sequencing, and treatment exposure continues to complicate cross-study comparisons. Emerging data further suggest that immune-targeted therapies, including biologic and small-molecule agents, may indirectly influence microbial community structure through modulation of the inflammatory milieu. Collectively, the available evidence supports cutaneous dysbiosis as a characteristic feature of HS that may potentially interact bidirectionally with immune dysfunction. Future longitudinal, multi-omic studies integrated with clinical phenotyping will be critical to clarify causal relationships and to determine whether microbiome modulation can be leveraged to improve therapeutic outcomes in HS.

Dermato doi: 10.3390/dermato6020014

Authors: José Maria Zepeda Torres Valeria Contreras Oceguera

Surgery continues to represent the central curative modality for melanoma despite major advances in systemic immunotherapy and targeted treatments. Contemporary surgical strategies aim to maintain oncologic safety while minimizing functional and aesthetic morbidity through optimized excision margins, highly selective use of sentinel lymph node biopsy (SLNB), and the omission of routine completion lymph node dissection (CLND). Rapid integration of neoadjuvant and adjuvant immunotherapies has begun to redefine surgical indications, timing, and extent—particularly for intermediate-stage and locoregionally advanced disease. Parallel innovations in Mohs micrographic surgery, reconstructive flap design, lymphatic reconstruction, and minimally invasive techniques further broaden the possibilities for individualized intervention. This expanded review synthesizes current evidence, ongoing controversies, and emerging trends that are shaping the future of melanoma surgery, highlighting how precision oncology, immunologic profiling, and technological advances are transforming the surgeon’s role and enabling more tailored, less invasive, and outcome-focused management.

Dermato doi: 10.3390/dermato6020013

Authors: Ornella Rossi Giovanna Perrotti Massimo Del Fabbro Tiziano Testori

Background: Conventional therapies for moderate-to-severe inflammatory acne include topical agents, systemic antibiotics, hormonal treatments, and oral isotretinoin. However, increasing resistance of Cutibacterium acnes to antibiotics and the potential adverse effects of systemic agents have prompted growing interest in non-pharmacological alternatives such as fractional microneedling radiofrequency (RF-MN), recently introduced in the clinical practice. Objective: This report of five cases aims to document the clinical benefits and safety of RF-MN using the Focus Dual® device in the treatment of moderate-to-severe inflammatory acne vulgaris. Methods: Five patients (2 male, 3 female; aged 19–28 years; Fitzpatrick skin types II–III) with moderate-to-severe acne were treated with two RF-MN sessions at 4-week intervals using the Focus Dual® device (Med & Tech, Occhiobello (RO), Italy). Acne severity was assessed using the Face Global Acne Grading System (F-GAGS) and the 5-point Global Improvement Score (GIS), with evaluations performed by two independent blinded raters (G.P and O.R). Standardized photographic documentation and lesion counting were conducted at baseline (T0) and 4 weeks after the second session (T2). All individual F-GAGS scores for each of the five patients showed a reduction from baseline to T2, as consistently assessed by both evaluators. Two patients improved from moderate to mild acne, one improved from severe to moderate, and one remained mild. GISs indicated clinical improvement ranging from Grade 1 to Grade 2 in all cases, with individual improvements between 8.33% and 37.93%. No adverse events were reported during treatment or follow-up. Conclusions: RF-MN appears to be a promising therapeutic option for moderate-to-severe inflammatory acne, providing clinical improvement and reduction in acne severity without adverse effects. Prospective studies with a larger sample are needed to confirm these preliminary results and support the potential role of RF-MN as an adjunctive or standalone treatment in patients with limited tolerance or response to conventional therapies.

Dermato doi: 10.3390/dermato6020012

Authors: Miranda A. Farage Christian Geneus Christopher Farina Beth Baldys

Sensitive Skin Syndrome (SSS) is a worldwide condition characterized by sensory symptoms such as stinging, burning, and itching, often without visible signs. This pilot study investigated individuals with self-reported SSS, focusing on the specific skin conditions, motivations and barriers for seeking medical attention. SSS individuals were divided into two groups: those who consulted a doctor (n = 16) and those who did not (n = 10). While SSS symptom severity was similar in both groups, those with greater severity were five times more likely to seek medical help. Key symptoms prompting consultations included morphological symptoms (papules, macules), sensory symptoms (itch, discomfort), and inflammatory symptoms (redness, rash). Notably, altered sensation and macules/papules showed the strongest trends towards influencing care-seeking behavior. Differences in anatomical sites affected were significant, with the head and face having the highest odds of doctor visits. Barriers to care included high specialist costs, travel distances, and a lack of remote consultation options, particularly for rural residents. Although treatments recommended by healthcare providers often fell short of expectations, partially effective options were more acceptable when endorsed by doctors. Subjects reported improvements within weeks of starting new treatments, though many remained only partially satisfied. This study highlights important aspects of SSS and its entanglement with other skin conditions, as well as how individuals navigate their symptoms and make treatment decisions amidst their sufferings.

Dermato doi: 10.3390/dermato6020011

Authors: Thilo Gambichler Yusa Devrim Sera S. Weyer-Fahlbusch Laura Susok

Background: This study aimed to assess the prevalence of PD-L1 protein expression in dermatofibrosarcoma protuberans (DFSP) to provide insights into the potential use of immune checkpoint inhibitors. Methods: We retrospectively analyzed formalin-fixed, paraffin-embedded primary DFSP specimens (n = 17). Diagnoses were confirmed by two senior dermatopathologists according to guideline criteria, including diffuse CD34 positivity and storiform spindle cell morphology. All cases represented conventional DFSP without fibrosarcomatous transformation. PD-L1 immunohistochemistry was carried out using a rabbit monoclonal antibody (ab205921, clone 28-8; Abcam). Only membranous staining in viable tumor cells was scored as a tumor proportion score (TPS), where >1% was considered positive. Any cytoplasmic staining without convincing membranous accentuation was not scored. PD-L1 staining in tumor-infiltrating immune cells was recorded separately. Five pleomorphic dermal sarcomas served as positive controls. Results: The median age was 62 years (IQR 55–74); 12 patients were men and 5 were women. The primary sites were trunk (59%), upper extremity (35%), and lower extremity (6%); immunosuppression was present in 18%. By FNCLCC, 82% of tumors were G1 and 18% were G2; no G3 tumors were identified. All DFSPs were PD-L1-negative in DFSP cells (TPS ≤ 1%) and in tumor-infiltrating lymphocytess. Among controls, 3/5 pleomorphic dermal sarcomas were PD-L1-positive with the expected membranous pattern and variable intensity. Conclusions: PD-L1 expression was absent in this cohort of conventional, predominantly low-grade DFSP, suggesting that classic DFSP is generally not an ideal candidate for PD-1/PD-L1-directed checkpoint blockade. These conclusions should not be extrapolated to fibrosarcomatous DFSP or metastatic disease, where PD-L1 expression has been reported. Selective PD-L1 testing may still be warranted in clinically aggressive scenarios (e.g., fibrosarcomatous transformation, unresectable recurrence, or metastasis).

Dermato doi: 10.3390/dermato6010010

Authors: Natalia Correa Maya Kumar Jessica Gonzalez Lynell Martinez Ashli Alexander Karen Manzur Francisco Bermudez

Introduction: Myxoid liposarcoma (MLPS) is a rare soft tissue sarcoma comprising 5–10% of adult cases, most often in the thigh. Diagnosis is challenging due to nonspecific imaging findings and resemblance to benign lesions. Case Report: A 42-year-old male presented with a painless, enlarging upper right medial thigh mass. CT and ultrasound suggested a complex solid lesion, possibly benign. Outpatient surgical excision revealed a red, gelatinous, non-encapsulated mass. Frozen section suggested a myxomatous spindle cell tumor. Final pathology confirmed MLPS FNCLCC grade 2 (intermediate grade) with DDIT3 rearrangement on fluorescence in situ hybridization (FISH). Margins were negative but close. Postoperative PET scan and Signatera MRD assay were negative for metastasis. Given the tumor’s size (>10 cm) and known radiosensitivity, adjuvant radiotherapy (60–66 Gy) was initiated. Discussion: MLPS features myxoid stroma, plexiform vasculature, and, in high-grade tumors, a round cell component. The FUS::DDIT3 fusion gene is diagnostic. While MRI offers superior soft tissue characterization, definitive diagnosis requires pathology and molecular testing. Surgical excision with negative margins remains standard, with radiotherapy recommended for large tumors or close margins to reduce recurrence. This case highlights the limitations of preoperative imaging and the value of intraoperative pathology in guiding management. Conclusions: Early recognition, accurate diagnosis, and tailored multimodal treatment are essential for MLPS. Given the potential for recurrence, late extrapulmonary metastases, long-term surveillance with imaging, and molecular assays are critical for optimizing outcomes.

Dermato doi: 10.3390/dermato6010009

Authors: Serap Maden

Rosacea is a chronic skin condition characterized by persistent inflammation, manifesting primarily on the face and causing redness, papules, pustules, and phymatous changes. The etiology of rosacea is multifactorial, with immune system factors playing a crucial role in its pathogenesis. The scientific literature contains an increasing number of studies that suggest a correlation between rosacea and the gut microbiota. Small intestinal bacterial overgrowth (SIBO) is defined as an excessive proliferation of potentially pathogenic bacteria within the small intestine of the gastrointestinal system. Multiple factors have been posited to explain the pathogenesis of rosacea, and the presence of SIBO has been identified as a potential factor in its occurrence. A decrease in the Lactobacillus genus, Prevotella copri, Lachnospiraceae, and Faecalibacterium within the gut microbiota may initiate inflammation related to rosacea. These bacterial species are crucial for regulating the intestinal mucosa. The findings indicate that there is an increase in Bacteriodes, Acidaminococcus, Megasphaera, and Ruminococcus in the gut microbiome of patients with rosacea. Probiotics can be advantageous for managing the intestinal microbiome, while Rifaximin treatment has shown efficacy in addressing inflammatory rosacea lesions associated with SIBO. The present review has been undertaken with the objective of enhancing our comprehension of SIBO in rosacea. The emphasis has been placed on the pathogenetic mechanisms and the shift in the gut microbiota that will lead to understanding probiotic benefits and therapy options in rosacea patients.

Dermato doi: 10.3390/dermato6010008

Authors: Patrícia Mathias Döll-Boscardin Amábile Cristine Woinarovicz Carolina Bacila de Sousa Edher Lucas Antunes Frederico Machado de Sousa Lessa Giselle Ariana Otto Mackeivicz Júlia Borges de Macedo Mariana Kapp Isadora Machinski

Background/Objectives: Metformin, a widely used antidiabetic drug, has recently gained attention in dermatology due to its pleiotropic effects. Given the high prevalence, chronicity, and therapeutic challenges of several dermatological conditions, there is growing interest in repurposing metformin as a topical agent with anti-inflammatory, antioxidant, metabolic, and regenerative properties. This narrative review aimed to synthesize and critically analyze the available preclinical and clinical evidence regarding the mechanisms of action, efficacy, safety, and therapeutic potential of topical metformin across different skin disorders. Methods: A literature search was conducted in PubMed and complementary databases for studies published between 2015 and 2025 addressing topical metformin in dermatology, including experimental, observational, interventional, and review articles. Results: The findings indicate that topical metformin has been associated with beneficial biological effects in conditions such as melasma, photoaging, wound healing, psoriasis, acne, skin cancer, and hair disorders, largely through AMPK activation, modulation of inflammation and oxidative stress, inhibition of melanogenesis, enhancement of tissue regeneration, and regulation of immune and metabolic pathways, although evidence remains predominantly preclinical and methodologically heterogeneous. Conclusions: Topical metformin represents a promising investigational multifunctional dermatological agent; however, its clinical translation depends on well-designed randomized controlled trials with standardized formulations, adequate sample sizes, and long-term follow-up to establish its efficacy, safety, and optimal therapeutic protocols.

Dermato doi: 10.3390/dermato6010007

Authors: Lara Camillo Elisa Zavattaro Paola Savoia

Background/Objectives. Ultraviolet B (UVB) radiation is a key etiological factor for skin cancer, inducing oxidative stress, DNA damage and apoptosis. Nicotinamide (NAM), a NAD+ precursor, has shown photoprotective properties, although the mechanisms underlying this effect have not been fully elucidated. This study sought to elucidate the role of NAM in counteracting UVB-induced oxidative damage in HaCaT cells and to assess the contribution of NAD+ metabolism to these effects. Methods. HaCaT were exposed to low-dose UVB irradiation (40 mJ/cm2) and treated with NAM (25 μM), alone or in combination with the NAMPT inhibitor FK866 (1 nM) for 4 and 24 h. Oxidative stress, lipid peroxidation and DNA damage were evaluated by DCFDA assay, TBARS assay and comet assay, respectively. Cell proliferation, cell cycle progression and apoptosis were assessed using Ki67 immunofluorescence, flow cytometry analysis and Annexin V/PI staining. Transcriptional activity for oxidative stress- and apoptosis-related markers was analyzed by RT-qPCR. Results. NAM significantly reduced UVB-induced ROS production at both 4 and 24 h post-irradiation in an NAD+-dependent manner, as demonstrated by the reversal of its effects following NAMPT inhibition. NAM also decreased oxidative DNA damage accompanied by reduced OGG1 expression, a marker of oxidative stress. Moreover, NAM restored HaCaT proliferation and reduced early apoptosis, particularly at 24 h post-UVB exposure. These protective effects were mediated by NAD+. Conclusions. Our results show that NAM confers robust protection to HaCaT cells from UVB-induced oxidative stress and cellular damage, largely mediated by NAD+-dependent pathways, supporting its potential role as a systemic photoprotective agent in skin cancer prevention.

Dermato doi: 10.3390/dermato6010006

Authors: Serra Aksoy Pinar Demircioglu Ismail Bogrekci

Background/Objectives: Melanoma remains one of the most malignant types of skin cancer with rising incidence numbers, despite the progress made in the prevention and management of the disease. Recent technological advancements, such as developments in the field of molecular biology, imaging, and artificial intelligence (AI), have led to a paradigm shift in the diagnosis, assessment, and management of melanoma. The current review aims to integrate current research on melanoma, moving beyond the boundaries of conventional histological analysis. Methods: This is a critical appraisal narrative review that focuses on recent studies in the areas of translation research and digital health with regard to melanoma. This research particularly targeted recent studies within the last five years, with landmark studies implicated when appropriate. Evidence was synthesized within the major categories that include epidemiology, early diagnosis, histopathology, predictive biomarkers, genetic/epigenetic changes, AI-assisted diagnostic platforms, and novel therapeutic platforms & targets. Results: Early detection techniques, innovative imaging, and biomarker-guided risk adjustment can improve diagnostic accuracy and prognostic stratification. The potential of AI in dermoscopy, digital pathology, and decision analytical systems is evident, although validation, bias, and integration issues need to be addressed. Advances in immunotherapy, targeted therapies, and novel molecular/immunological targets are expanding and facilitating integrated and personalized management. Conclusions: There is a trend in melanoma research to shift towards an integrated diagnostic platform that involves the use of AI, molecular characterization, and clinical inputs to enable more accurate and personalized diagnoses. To realize this potential, there is a need to validate, collaborate, and address ethics and implementation.

Dermato doi: 10.3390/dermato6010005

Authors: Giulia de Lara Quagliotto Nathalia Bakes Teodoro Cristiane Buzanello Donin Gladson Ricardo Flor Bertolini Márcia Rosângela Buzanello

Background/Aims: This study aimed to undertake a systematic literature review to compare the effectiveness of narrowband UVB (nb-UVB) therapy with Psoralen + UVA (PUVA) or Psoralen + UVB treatments in individuals with vitiligo. Methods: A comprehensive search was executed across multiple electronic databases (PubMed, Embase, Cochrane, Scopus, Web of Science, LILACS) and grey literature repositories (Google Scholar, LIVIVO, OpenGrey, ProQuest). Methodological quality was independently assessed by two reviewers employing the Cochrane RoB 2 tool; consensus was achieved through consultation with a third reviewer when necessary. The main efficacy endpoint was repigmentation. Results: From 4758 initial records, four randomized controlled trials that satisfied the inclusion criteria were identified. The aggregated results from these studies indicated that nb-UVB, either alone or combined with psoralen (P-nbUVB), produced better repigmentation outcomes compared to PUVA. Conclusions: Nb-UVB phototherapy demonstrated superior repigmentation efficacy, improved color matching, and a faster clinical response relative to PUVA. The addition of psoralen (P-nbUVB) further enhanced therapeutic outcomes, particularly in VASI scores and in areas typically less exposed to resunlight.

Dermato doi: 10.3390/dermato6010004

Authors: Saeed Ali Alshehri Toka Mahmoud R. Abdelwahed Hussein Mahmoud Rezk Abdelwahed Hussein

Background and Objectives: Merkel cell carcinoma (MCC) is a rare, aggressive, invasive cutaneous neuroendocrine carcinoma. It commonly affects the skin of the extremities and head and neck regions in elderly patients. In situ MMC represents MMC confined to the epidermis. Incipient MCC is a descriptive term that represents in situ MCC with early focal dermal microinvasion. In situ MCC and incipient MCC have a much better prognosis than MCC. In this study, we aimed to address the clinicopathologic features of early lesions of MCCs, including both incipient and in situ forms. Methods: We conducted a PubMed search using the following keywords: (“Merkel cell carcinoma” OR “Merkel carcinoma” OR “Merkel” OR “MCC”) AND (“in situ” OR “incipient” OR “intraepidermal”) AND (“skin” OR “cutaneous”. The inclusion criteria included (i) human studies, and (ii) case reports and series published in the English language with the above-mentioned search keywords. Studies not meeting all inclusion criteria were excluded. Results: Incipient and in situ MCCs are extremely rare events (15 case reports). They usually appear as tiny (2 mm to 6 mm) erythematous papules or nodules over the skin. Immunohistology (for CK20, EMA, and neuroendocrine markers) was required to establish the diagnosis of these lesions. Conclusions: MCCs carry a significantly high mortality rate due to their aggressive nature. However, for in situ MCC and incipient MCC, local surgical excision is usually curative, and the prognosis is excellent. Therefore, dermatologists and dermatopathologists should remain vigilant for these forms of early lesions of MCCs. This will help with early detection and prompt treatment.

Dermato doi: 10.3390/dermato6010003

Authors: Esteban Zavaleta-Monestel Audry Escudero-Correa Jeaustin Mora-Jiménez Andy Jesús Hernández-Vásquez Luis Carlos Monge-Bogantes Josephine Hernández-López Sebastián Arguedas-Chacón

Background/Objectives: Acute generalized exanthematous pustulosis (AGEP) is a severe drug-induced cutaneous reaction characterized by the abrupt onset of sterile pustules, fever, neutrophilia, and a T cell-mediated type IVd hypersensitivity response. This narrative review synthesizes current evidence on pharmacological triggers, immunopathogenic mechanisms, diagnostic criteria, and differential diagnosis to provide a clinically oriented framework. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, ScienceDirect, and SpringerLink for studies published between 2000 and 2025, complemented by selected clinical reference sources. Studies addressing clinical features, immunological pathways, pharmacovigilance signals, and diagnostic tools for AGEP were included. Synthesis of Evidence: β-lactam antibiotics remain the most frequent triggers, while increasing associations have been reported with hydroxychloroquine, targeted therapies, immune checkpoint inhibitors, psychotropic agents, and vaccines. Immunopathogenesis is driven by IL-36 activation, CXCL8/IL-8–mediated neutrophil recruitment, and IL36RN mutations, explaining overlap with pustular psoriasis. Diagnostic accuracy improves through integration of drug latency, clinical morphology, histopathology, biomarkers, and standardized tools such as the EuroSCAR score. Conclusions: AGEP is a complex pustular reaction induced by diverse drugs and amplified by IL-36-mediated inflammation. Accurate diagnosis requires a multidimensional approach supported by structured algorithms and robust pharmacovigilance to identify evolving drug-associated patterns.

Dermato doi: 10.3390/dermato6010002

Authors: Saud Aleissa Ahmed Baabdullah Bader Zimmo Mohammed H. Abduljabbar Jehad Hariri Yara Alghamdi Samia N. Almutairi Sahar Alsifri

Background/Objectives: Acne is a common skin condition that is characterized by the manifestation of comedones, erythematous papules, pustules, and nodules over follicular areas. A huge contributing factor in the pathogenesis is colonization by Cutibacterium acnes (C. acnes) (formerly Propionibacterium acnes). Conventional treatments for acne range from topical to systemic agents with variable side effects and safety profiles. Adherence to prescribed treatments for acne is a huge challenge. Method: A quantitative cross-sectional study was conducted among 198 patients with dermatologist-confirmed acne vulgaris at King Abdulaziz University Hospital, Jeddah. Eligible participants had received topical and/or systemic treatment for at least one month. Exclusion criteria included other acne variants and inflammatory follicular disorders. Data on sociodemographics, medical and treatment history, and clinical characteristics were collected using a structured questionnaire. Treatment adherence was assessed with the validated ECOB scale. Associations between adherence and relevant variables were analyzed using Chi-squared and Mann–Whitney tests in SPSS v26, with significance set at p ≤ 0.05. Results: Non-adherence to anti-acne medications was 50.5% and was significantly associated with experiencing side effects, particularly skin dryness, and with moderate acne severity and topical treatment (p ≤ 0.05). No significant associations were found between adherence and demographic or medical history variables. Conclusions: Adherence to acne treatment remains a significant challenge for many patients. Improving patient education, addressing concerns about side effects, and providing practical support may help patients follow their prescribed therapies more consistently. Incorporating tools like the ECOB questionnaire into routine dermatology visits can support ongoing assessment and better management of treatment adherence.

Dermato doi: 10.3390/dermato6010001

Authors: Sara Missaoui Imane Abbari Halima Kholaiq Zahra Aadam Khaoula Oussama Abdelrrahmane Errami Fatima Ailal Ibtihal Benhsaien Bouchra Baghad Jalila El Bakkouri Ahmed Aziz Bousfiha

Introduction: Atopic dermatitis (AD) is driven by complex pathways that mediate inflammation and pruritus. The pathophysiology of AD’s disease involves multiple pathways. Interleukin-13 (IL-13) is considered a major cytokine in Th2-type inflammation, responsible for changing the epidermal barrier and producing chronic inflammation, whereas interleukin-31 (IL-31) is considered a major inducer of pruritus. The exact correlation of each of these cytokines with disease severity in children with AD appears to vary across studies. This study was therefore designed to evaluate whether IL-13 and IL-31 levels contribute complementarily or independently to the overall clinical severity of AD in the Moroccan pediatric population and to analyze the correlation between serum IL-13 and IL-31 levels and investigate their correlation with disease severity in a pediatric cohort. Methods: A total of 52 children with moderate to severe AD were included. The severity of the disease was measured using the SCORing Atopic Dermatitis (SCORAD) index. Serum levels of IL-13 and IL-31 were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Results: The IL-13 serum level showed a considerable positive correlation with the SCORAD score (rs = 0.7, p < 0.0001). On the other hand, IL-31 levels revealed no correlation with SCORAD (rs = 0.07, p = 0.62) but were positively correlated with pruritus intensity (rs = 0.91, p < 0.001). Conclusion: Our results support the presence of different pathophysiological axes in pediatric AD, where IL-13 functions as a reliable biomarker of inflammatory severity. IL-31 acts as a systemic marker of the pruritic pathway.

Dermato doi: 10.3390/dermato5040024

Authors: Andrea Michelerio Livio P. Tronconi Giuseppe Basile Valeria Brazzelli Vittorio Bolcato

Italian Court of Cassation Ruling Decree 30032 of 30 October 2023 discusses a medical malpractice case concerning the diagnosis of dermatofibrosarcoma protuberans and the alleged diagnostic and therapeutic delay. By examining how the ruling frames the role of histopathology in proving pathology benignity, authors prompt to reflect on diagnostic path, the allocation of the burden of proof, and the role of dermatologist’s expertise in professional liability issues. Over a four-year period, five health professionals were involved in a claim concerning an initial diagnosis of an epidermoid cyst and a subsequent diagnosis of dermatofibrosarcoma protuberans. The plaintiff questioned the delay in diagnosis, and the Court of Cassation found two physicians liable because they could not prove that the treated pathology was initially benign. We argue that equating diagnostic correctness exclusively with histological confirmation is unnecessary, both clinically and legally, in typical cases, if the reasoning and findings are adequately documented. Additionally, we examine the value of dermatologists’ experience and the scope of professional competence as measures of liability. Finally, we outline the minimum standards of clinical documentation necessary to make the diagnostic pathway traceable and verifiable. The diagnostic process is a discretionary effort that integrates multiple sources of information, both instrumental and experiential, to reach the most reasonable hypothesis. While histopathology is a crucial tool, it is not the sole gateway to a correct diagnosis of every cutaneous alteration. Adequate disclosure and structured documentation of the diagnostic reasoning are fundamental to the care process and fair assessment of professional responsibility.

Dermato doi: 10.3390/dermato5040023

Authors: Thilo Gambichler Heinz-Wolfram Bernd Sera Weyer-Fahlbusch Anke Lücke Johann Lorenzen Laura Susok

Immune checkpoint inhibitors (ICIs), particularly PD-1/PD-L1 antibodies, have significantly improved outcomes in a variety of solid tumors, including urothelial carcinoma. However, their use is frequently associated with immune-related adverse events (irAEs) which frequently affect the skin and mucous membranes. Among these, plasma-cell-rich infiltrates are exceptionally rare. Circumorificial plasmacytosis (COP) is a rare, predominantly reactive condition typically involving mucosal transition zones, with histologic features characterized by dense, polyclonal plasma cell infiltrates and a benign clinical course. Only two case reports have described COP in association with ICI therapy and, to date, transformation or overlap with lymphoproliferative disorders such as marginal zone lymphoma has not been documented. We report the case of an 86-year-old male with urothelial carcinoma who developed a progressive, ulcerated, bleeding lesion of the lower lip during adjuvant nivolumab therapy. Histologic examination revealed a dense subepithelial infiltrate of mature plasma cells and lymphocytes. Direct and indirect immunofluorescence studies were negative, excluding autoimmune blistering disorders. Immunohistochemistry showed a predominance of CD138-positive plasma cells with a moderate kappa light-chain shift, CD19 expression, and absence of CD56, Cyclin-D1, and CD117, arguing against a plasma cell neoplasm. Molecular analysis via multiplex PCR revealed a clonal B-cell population with distinct IgH rearrangements, and some EBV-positive cells were also identified by EBER in situ hybridization. The histopathologic and molecular findings suggested a marginal zone lymphoma-like, plasmacytic proliferation arising in the setting of COP. This case illustrates a rare and diagnostically challenging constellation at the intersection of reactive and clonal B-cell proliferations in the context of ICI therapy. Although the lesion demonstrated features of clonality, the overall low B-cell content, indolent clinical course, and lack of systemic involvement support a reactive, immunodeficiency-associated lymphoproliferation rather than overt lymphoma. This case expands the known spectrum of mucocutaneous irAEs and highlights the need for careful clinicopathologic correlation, including immunophenotyping and molecular diagnostics. Awareness of such rare presentations is essential to avoid overdiagnosis and unnecessary systemic treatment in patients with otherwise indolent lesions.

Dermato doi: 10.3390/dermato5040022

Authors: Luis Alonso-Mtz de Salinas Emilio Berna-Rico

Linear atrophoderma of Moulin (LAM) is a rare, benign dermatosis characterized by unilateral, hyperpigmented, slightly atrophic plaques distributed along Blaschko’s lines. We report the case of an 18-year-old woman with a four-year history of asymptomatic lesions on the right abdomen, thigh, and foot. Histopathology revealed basal layer hyperpigmentation, mild collagen thickening, and a sparse perivascular lymphocytic infiltrate, without sclerosis. The clinical and histological findings confirmed the diagnosis of LAM. Given the stable course and absence of symptoms, a conservative approach with follow-up was adopted. This case underscores the importance of recognizing LAM’s distinctive presentation to avoid unnecessary treatments.

Dermato doi: 10.3390/dermato5040021

Authors: Jéssica Ferreira Xavier-Souza Raquel Allen Garcia Barbeto Siqueira Beatriz Silva Moreira Stephany Garcia Barbosa Estella Souza Nascimento Mariano Layra Inês Marinotti Isabelle Gomes Costa Bruna Sousa Requena Thais Porta Lima Iveta Hradkova Vânia Rodrigues Leite-Silva Newton Andréo-Filho Patricia Santos Lopes

The human skin microbiome, defined as a multifaceted ecosystem comprising bacteria, fungi, viruses, and mites, plays a pivotal role in maintaining skin homeostasis and regulating immune responses. In recent years, an increasing amount of evidence has illuminated the considerable influence exerted by microbiomes on the pathophysiology of dermatological ailments. This review provides a comprehensive synthesis of contemporary findings concerning the microbiome’s role in acne, aging, hyperpigmentation, and hair disorders, while also addressing the emerging concept of the gut–skin axis and how it could interfere in these skin disorders. Alterations in microbial composition, referred to as dysbiosis, have been associated with inflammatory processes and barrier dysfunction, thereby contributing to the severity and chronicity of diseases. Distinct microbial profiles have been identified as correlating with specific skin conditions. For instance, variations in Cutibacterium acnes phylotypes have been associated with the development of acne, whereas alterations in Corynebacterium and Staphylococcus species have been linked to the processes of aging and pigmentation patterns. Furthermore, the composition of the microbiome is examined in relation to its impact on cosmetic outcomes. It also engages with increasing interest in the modulation of microbiota through the topical application of bioactive compounds. The incorporation of prebiotics, probiotics, and postbiotics into cosmetic formulations constitutes a novel strategy aimed at enhancing skin health. In the domain of dermatological therapies, postbiotics have emerged as a significant class of substances, particularly due to their remarkable stability, safety, and immunomodulatory properties. These characteristics position them as promising candidates for incorporation into dermatological treatments. Recent studies have underscored the significance of microbiome-informed strategies within the domains of therapeutic and preventive dermatology, emphasizing the potential of such approaches to positively influence patient outcomes. As our understanding of this field continues to evolve, skin microbiomes are poised to emerge as a pivotal area of focus in the realm of personalized skin care and treatment. This development presents novel and innovative approaches for the management of skin conditions, characterized by enhanced specificity and efficacy.

Dermato doi: 10.3390/dermato5040020

Authors: Yerin Yun Seol-Hoon Lee

Background: The lipid components of the skin barrier have the strongest structure when arranged in an orthorhombic packing. This structure can be influenced by the external supply of lipophilic ingredients. While the benefits of ceramide supplementation are well-documented, the effects of the cosmetic formulation’s oil-based ingredients have been less explored. Methods: The packing structures of commonly used oil and wax ingredients in cosmetics were analyzed using FT-IR. These components were then combined to formulate a cosmetic composition with an orthorhombic packing structure. The strength of the skin barrier was assessed by measuring transepidermal water loss (TEWL), and the lipid packing of the porcine skin was analyzed using FT-IR. Results: In cosmetic oil ingredients, structurally simple oils such as mineral oil and squalane exhibited orthorhombic lipid packing, while more complex oils like isopropyl myristate (IPM) and isononyl isononanoate (ININ) showed hexagonal packing. Based on these structural characteristics, cosmetic formulations were designed by selectively combining oils, waxes, and emulsifiers to achieve a desired packing structure. Formulations incorporating orthorhombically packed oils successfully resulted in orthorhombic overall structures, whereas those including hexagonally packed oils tended to form hexagonal packing. The orthorhombic oils and formulation effectively maintained the structure and function of the porcine skin lipid barrier without disruption. Conclusions: This study demonstrated that orthorhombic oils and emulsions with orthorhombic packing effectively maintained skin barrier integrity, unlike hexagonal structures.

Dermato doi: 10.3390/dermato5040019

Authors: Gisláine C. da Silva Rodney A. F. Rodrigues Carla B. G. Bottoli

Background: currently, there is a growing trend toward multifunctional cosmetics, which combine several active ingredients in a single product to enhance efficacy and user convenience. As ingredients may influence one another, it is important to study the behavior of mixing multiple compounds in complex formulations, especially regarding their interaction with the skin. Piceatannol, for instance, is a naturally occurring stilbene recognized for its in vitro potent antioxidant, anti-inflammatory, and anti-aging activities, making it a promising candidate for dermocosmetic use in suncare. But despite its beneficial biological activities, its cutaneous permeation remains poorly understood, particularly when delivered from complex formulations containing multiple ingredients. Objectives: in this sense, this study aimed to evaluate the in vitro skin diffusion profile of piceatannol from a passion fruit seed extract (Pext) incorporated into a topical base (Bem) or an organic sunscreen emulsion (Oem), with or without a spilanthol-rich Acmella oleracea extract (Jext) used as a natural permeation enhancer. Methods: due to ethical and variability issues with human and animal skins, the Strat-M™ synthetic membrane was chosen as a standardized model for the in vitro skin permeation assays. Piceatannol localization within membrane layers was examined by confocal Raman microscopy (CRM), while compound identification in donor and receptor compartments was performed via UHPLC-DAD. Results: piceatannol from Bem was detected up to 140 µm from the Strat-M™ surface and exceeded 180 µm in depth when Jext and organic sunscreens were included in the formulation. Notably, formulations containing Jext and those based on Oem promoted enhanced accumulation in both the stratum corneum and deeper skin layers, suggesting an improved delivery potential in lipid-rich vehicles. Conclusions: even though some instability issues were observed, piceatannol penetration into Strat-M™ from the proposed formulations was confirmed, and the results provide a foundation for further research on its topical delivery, supporting the rational development of formulations capable of harnessing its demonstrated biological properties.

Dermato doi: 10.3390/dermato5040018

Authors: Andreea Cătălina Tinca Bianca Andreea Lazar Andreea-Raluca Cozac-Szőke Ovidiu Simion Cotoi

Cutaneous leiomyosarcoma is a rare, malignant tumor that arises from smooth muscle cells, accounting for less than 3% of all cutaneous sarcomas. Our case report details a 63-year-old male patient who presented with a rapidly growing, painful nodule in the popliteal region. The patient underwent initial surgical excision in September 2021, followed by three subsequent resections until March 2022 due to local recurrence. Histopathological analysis of all specimens revealed a dermal neoplasm composed of spindle cells arranged in intersecting fascicles with storiform patterns. The immunohistochemistry profile showed strong positivity for the markers SMA and desmin, confirming the diagnosis. Despite early interventions, the deep surgical margins were positive, and further surgeries were required until tumor-free margins were achieved. This case emphasizes the morphological characteristics, clinical behavior, and therapeutic challenges in managing cutaneous leiomyosarcoma. A favorable prognosis is achieved with long-term follow-up and a multidisciplinary approach.

Dermato doi: 10.3390/dermato5030017

Authors: Mark Cannon Sabrina Baghaie Lara Guzman Ashlee Cosantino Brian Maurer

Background/Objectives: Epidermolysis bullosa (EB) is a rare genetic disease often requiring extensive dental interventions. Whole genome sequencing of the oral microbiome may provide essential information on the pathogenic shifts reported in the literature, resulting in significant plaque development. Methods: Three EB patients had a proprietary whole genome sequencing completed. The samples were deidentified and compared to a library of 30,000 bacterial genomes. Results: The oral microbiome of the three individuals was significantly different from normotypical samples. Although a commonality was presented between the three individuals, differences were also noted. Neisseria sicca is present across all samples with relatively high percentiles (>95th percentile in all 3). Streptococcus mitis is also present in all samples, with its percentile and abundance differing significantly. With one sample, BHU, Morococcus cerebrosus was the top species with 19.74% relative abundance (100th percentile), an outlier compared to the other samples, and present in the highest concentration yet noted in the database. All three samples had at least one Actinomyces species in the 70th percentile or greater. Conclusions: Within the limitations of this small sampling, the oral microbiome of patients with Epidermolysis bullosa may be unique and require further investigation with the study of preventatives capable of inhibiting inflammation and overgrowth of pathogens.

Dermato doi: 10.3390/dermato5030016

Authors: Guilherme dos Anjos Camargo Daniella Woinarovicz Menegheti Leticia Simeoni Avais Evelyn Assis de Andrade Patrícia Mathias Döll Boscardin Giovani Marino Favero

Melasma is an acquired hyperpigmentation that is more common in women and mainly affects the face. It can significantly reduce quality of life due to its chronic nature and resistance to treatment. Objectives: This study aimed to compare the clinical efficacy of azelaic acid peeling and combined tranexamic acid microneedling in patients with melasma, evaluating the impact of these therapies on skin depigmentation. Methods: This was a prospective clinical trial with a split-face design, using a convenience sample. Patients were recruited and divided into two groups for comparative treatment. Microneedling with 4 mg/mL tranexamic acid was applied to the right hemiface and 30% azelaic acid peeling to the left hemiface. The protocol included five sessions with a 15-day interval. Photographic records were taken before treatment, in the fifth session, and 15 days after the last session. The Melasma Area and Severity Index (MASI) and non-parametric tests were used to analyze the results. Results: The study included 10 patients, of whom 9 completed the treatment. The average age was 42 years. The most common skin phototype was type III (50%) and the predominant locations were the central facial area, forehead, and cheeks (55.6%). The photographic evaluation and MASI showed a significant improvement on both sides of the face, with the final values better than the initial ones. It was possible to observe that the azelaic acid peeling showed a significant whitening after the fourth session when compared to the other method. Conclusions: The clinical study of hemifaces concluded that both the azelaic acid peeling and microneedling with tranexamic acid are effective in the treatment of melasma, with the azelaic acid peeling showing results after the fourth session. Further studies with larger, randomized samples are recommended.

Dermato doi: 10.3390/dermato5030015

Authors: Thilo Gambichler Priyanka Gaertner Nessr Abu Rached Laura Susok Sera Weyer-Fahlbusch

Background: Melanoma of unknown primary (MUP) is a rare and distinct clinical subtype of metastatic melanoma, in which no identifiable primary tumor is found. The prognosis of MUP compared to melanoma with known primary (MKP) remains unclear, especially in the era of novel therapies like immune checkpoint inhibitors (ICIs) and targeted therapies. This meta-analysis aims to compare the overall survival (OS) of MUP and MKP patients under these therapies. Methods: This systematic review was conducted in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). A systematic search of major databases was conducted, yielding six eligible studies (nine study arms) that assessed the survival outcomes of MUP and MKP patients treated with immunotherapies and targeted therapies. We pooled the hazard ratios (HRs) for OS using both fixed and random effects models. Heterogeneity was assessed with the I2 statistic followed by a Baujat plot, and publication bias was evaluated using funnel plots and Egger’s test. Results: Our analysis revealed a borderline significant HR of 0.90 (95% CI: [0.81, 1.00], p = 0.04) under the fixed effect model, suggesting a potential survival benefit for MUP patients. However, the random effects model, accounting for study heterogeneity, showed no significant difference in OS between MUP and MKP (HR = 0.87, 95% CI: [0.73, 1.05], p = 0.15). Significant heterogeneity (I2 = 66.9%, p = 0.0022) was observed across studies. No substantial publication bias was detected. Conclusion: While the trend observed in the fixed effect model suggests a potential benefit for MUP patients, the random effects analysis indicates no significant difference between MUP and MKP in terms of OS. These findings underscore the importance of accounting for study heterogeneity and highlight the need for further prospective studies to better understand the impact of novel therapies on MUP.

Dermato doi: 10.3390/dermato5030014

Authors: Leonardo Ribeiro Alves de Souza Camila Freze Baez Thiago Rubim Bellott Milena Siqueira Pereira Marianna Tavares Venceslau Gonçalves Maria Angelica Arpon Marandino Guimarães Flávio Barbosa Luz Rafael Brandão Varella

Background: Merkel cell polyomavirus (MCPyV) has been established as an etiological agent in Merkel cell carcinoma (MCC), yet its role in other cutaneous neoplasms remains under investigation. The impact of the host’s immunogenetic characteristics on the persistence of Merkel cell polyomavirus (MCPyV) in non-melanoma skin cancer (NMSC) is not yet well understood. Objective: Our aim was to investigate the presence of MCPyV in various skin lesions, particularly NMSC, and its association with cytokine gene polymorphisms related to immune regulation. Methods: We analyzed 274 skin biopsies (lesional, perilesional, and healthy skin) from 84 patients undergoing dermatological evaluation. MCPyV DNA and polymorphisms in IL-6, IL-10, IFN-γ, and TNF-α genes were detected using PCR-based assays. Results: MCPyV was significantly more prevalent in NMSC and non-cancerous lesions than in surgical margins or healthy skin (p = 0.050 and 0.048, respectively). Concordance between lesion and margin samples was low (κ = 0.305), suggesting microenvironment-specific viral persistence. Notably, high-expression IL-10 genotypes (-1082 GG) and low-expression IL-6 genotypes (-174 AA) were significantly associated with MCPyV detection (p = 0.048 and p = 0.015, respectively). Conclusions: MCPyV preferentially localizes to NMSC lesions, particularly in individuals with immunogenetic profiles favoring viral persistence. Since the role of MCPyV in the pathogenesis of NMSC remains uncertain, our results highlight the need for further studies to clarify whether the lesion’s microenvironment supports viral persistence or indicates a more intricate interaction between the virus and the host, which could be significant for the development of skin cancer.

Dermato doi: 10.3390/dermato5030013

Authors: Alana Sadur Lucie Joerg Amelia Stapleton Van Doren Ellen T. Lee Dia Shah Aniket K. Asees Sonal Choudhary

Sleep is crucial to overall health and plays a significant role in skin function. While the circadian rhythm has been extensively researched for its impact on the body’s optimal functioning, the skin also possesses an independent circadian system that serves many important functions. Sleep disruptions or deprivation can significantly affect skin conditions, by compromising the skin barrier and impairing processes such as collagen production, cellular repair, and wound healing. Given the commonality of sleep disturbances, it is crucial to understand the connection between sleep, circadian regulation, and skin health. This is particularly important in understudied populations, such as those with occupational sleep disruption and individuals with hormone-related conditions like PCOS and menopause. Bidirectional relationships have been established between sleep and several inflammatory skin conditions, including atopic dermatitis, psoriasis, rosacea, and hidradenitis suppurativa. While acne is influenced by sleep, the reverse relationship, how acne affects sleep quality, has not been well established. Chronic sleep disruption can increase cortisol levels and oxidative stress, both of which contribute to skin aging and the progression of autoimmune skin conditions, including systemic lupus erythematosus. As sleep is a modifiable risk factor, it is crucial to consider therapeutic options and interventions to prevent or alleviate skin conditions. This review discusses various therapeutic approaches, including melatonin, L-Theanine, Magnesium-L-threonate, Inositol, Cinnamomi cortex, nervous system regulation, and proper sleep hygiene. These therapeutic options have been studied for their impact on sleep, and importantly, several have been evaluated for their utility as adjuncts for treating skin conditions. Overall, the relationship between sleep and skin health is clear, and incorporating sleep-focused therapeutic interventions offers potential to improve both sleep quality and skin health in individuals with a variety of skin conditions.

Dermato doi: 10.3390/dermato5030012

Authors: Nathalia Bakes Teodoro Giulia De Lara Quagliotto Gladson Ricardo Flor Bertolini Cristiane Buzanello Donin Márcia Rosângela Buzanello

Objective: To conduct a systematic review of the literature evaluating the efficacy of the 308 nm excimer lamp in comparison to narrowband ultraviolet B (NB-UVB) and the 308 nm excimer laser for inducing repigmentation in vitiligo. Methods: A comprehensive search was performed in PubMed, Embase, Cochrane Library, Scopus, Web of Science, and LILACS databases, as well as in gray literature sources including Google Scholar, OpenGrey, Livivo, and ProQuest. Risk of bias was assessed independently by two blinded reviewers using the Cochrane RoB 2 tool, with disagreements resolved by a third reviewer. The primary outcome was the degree of repigmentation. Results: Of 3825 records identified, four randomized controlled trials met the inclusion criteria. The findings suggest that the 308 nm excimer lamp provides superior repigmentation outcomes compared to NB-UVB and demonstrates comparable efficacy to the 308 nm excimer laser. Conclusions: Phototherapy using the 308 nm excimer lamp appears effective in promoting repigmentation in vitiligo patients and is associated with minimal adverse effects. Nevertheless, variations in treatment protocols and potential bias across studies warrant cautious interpretation of the results.

Dermato doi: 10.3390/dermato5030011

Authors: Leonardo Brustenga Giuseppe Di Cara Chiara Pantella Flavia Chiavoni Francesco Valerio Di Pietro Elena Giannico Livia Lucentini

The barrel jellyfish (Rhizostoma pulmo), like other cnidarians, shows cnidocytes containing cnidae, responsible for the jellyfish’s stinging properties. The sting of R. pulmo can cause contact dermatitis or urticaria and even systemic symptoms. Recent studies have identified stinging-cell structures in the mucous secretion released in the water column by Cassiopea xamachana, belonging to the same order as R. pulmo. The present paper verifies the release of stinging-cell structures in the water by R. pulmo and reports the case of two 17-year-old adolescents (one male and one female) who were affected by epidermal rashes consistent with the irritating sensations of stinging water. The reaction happened twice in the Ionian Sea; the patients were in proximity to R. pulmo but, on both occasions, there had been absolutely no direct contact with the jellyfish’s tentacles. To test the hypothesis of stinging water caused by R. pulmo, samples of sea water and mucous harvested in close proximity to a living jellyfish were taken and analyzed under a microscope at different magnifications. The microscopic analysis showed the presence of free and aggregated nematocysts in both the samples of water and mucous. It is likely that the free and aggregated nematocysts observed were discharged in the water by the jellyfish and were dispersed by water currents that led them to come into contact with the patients’ skin. At present, it is not known what predisposes humans to the perception of stinging water, and it is reasonable to affirm that caution should be advised for people with an allergic history when entering the water in the presence of jellyfish. Further investigations are required to better understand both the pathophysiological pathways underlying the stinging water phenomenon and the minimum concentration of urticating elements that is able to trigger the onset of stinging water.

Dermato doi: 10.3390/dermato5020010

Authors: Farnaz Azizi Katie Sum Nazanin Azizi Howard I. Maibach

Acne vulgaris is a common skin condition often causing physical and emotional distress. We reported a case of 27-year-old female with rash and acne over the chest and upper back following continuous application of moisturizer. This case emphasizes the role of comedogenic moisturizers in acne development or worsening by disrupting the skin’s natural barrier, especially on oily areas including the chest and upper back. We aim to highlight an underrecognized but significant factor in developing acne vulgaris resulting in psychosocial impact and morbidity.

Dermato doi: 10.3390/dermato5020009

Authors: Ernesto Martínez-Vargas Jeaustin Mora-Jiménez Sebastian Arguedas-Chacón Josephine Hernández-López Esteban Zavaleta-Monestel

Background: Artificial intelligence (AI) has emerged as a transformative tool in modern medicine, particularly in dermatology, where it supports the diagnosis and management of various skin diseases, including skin cancer. Through machine learning and deep learning techniques, AI enables accurate analysis of clinical and dermoscopic images, improving early detection and clinical outcomes. Objective: This systematic review aimed to evaluate the clinical applications of AI in dermatology, focusing on its impact on diagnostic accuracy, workflow efficiency, and access to specialized care. Methods: The review was conducted according to PRISMA guidelines. Peer-reviewed studies published between January 2020 and March 2025 in English or Spanish were included if they evaluated AI-based tools for dermatological diagnosis, classification, or treatment. Animal studies, editorials, non-peer-reviewed articles, and studies with an unclear methodology were excluded. A comprehensive search was performed in PubMed, Scopus, IEEE Xplore, and Google Scholar between December 2024 and March 2025. The risk of bias was assessed qualitatively, using a tailored framework based on study design, dataset transparency, and clinical applicability. Results: A total of 29 studies met the inclusion criteria. AI tools demonstrated high performance in melanoma detection, achieving up to 90% accuracy and 85% sensitivity. In clinical settings, AI support reduced mismanagement of malignant lesions from 58.8% to 4.1% and avoided 27% of unnecessary procedures in benign cases. Additional tools such as convolutional neural networks and imaging systems like FotoFinder also showed promising results. Limitations: Limitations of the evidence include the heterogeneity of AI models, lack of external validation, and a moderate-to-high risk of bias. Conclusions: AI has demonstrated robust clinical potential in dermatology, particularly in cancer detection and workflow optimization. However, further studies are required to address challenges such as algorithmic bias, data privacy, and regulatory oversight. Funding and registration: This review received no external funding and was not registered in a systematic review registry.

Dermato doi: 10.3390/dermato5020008

Authors: Thilo Gambichler Larisa Ardabili Belanna Domin Laura Susok Nessr Abu Rached

Background/objectives: According to the Chapel Hill Consensus Conference nomenclature, single-organ cutaneous small vessel vasculitis (SOCV) is defined histopathologically by immune complex-mediated vasculitis of the dermal capillaries/venules without systemic involvement. There is a lack of investigations studying predictors of SOCV outcomes. This multicenter retrospective study aimed to assess whether baseline serum liver scores could predict SOCV recurrence. Methods: Data from 204 inpatients with histopathologically confirmed idiopathic SOCV treated between 2000 and 2022 were analyzed. All patients had baseline blood tests for platelets and liver parameters; those with systemic diseases were excluded. The study evaluated the AST to Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) index, and De Ritis ratio (DRR). Results: Recurrence was observed in 17.6% of patients. Univariable analysis identified hospital stay length, DRR, cutaneous extent, and cardiovascular comorbidities as predictors, but logistic regression confirmed only cutaneous extent and DRR as independent predictors of disease recurrence. Conclusions: A higher DRR (cut-off > 1.13) may indicate necrosis from reduced blood flow, making it a potential predictor of SOCV recurrence.

Dermato doi: 10.3390/dermato5020007

Authors: Serra Aksoy Pinar Demircioglu Ismail Bogrekci

Background/Objectives: Skin lesions, ranging from benign to malignant diseases, are a difficult dermatological condition due to their great diversity and variable severity. Their detection at an early stage and proper classification, particularly between benign Nevus (NV), precancerous Actinic Keratosis (AK), and Squamous Cell Carcinoma (SCC), are crucial for improving the effectiveness of treatment and patient prognosis. The goal of this study was to test deep learning (DL) models to determine the best architecture to use in classifying lesions and create a web-based platform for improved diagnostic and educational availability. Methods: Various DL models, like Xception, DenseNet169, ResNet152V2, InceptionV3, MobileNetV2, EfficientNetV2 Small, and NASNetMobile, were compared for classification accuracy. The top model was incorporated into a web application, allowing users to upload images for automatic classification, thereby offering confidence scores as a measure of the reliability of predictions. The tool also has enhanced visualization capabilities, which allow users to investigate feature maps derived from convolutional layers, enhancing interpretability. Web scraping and summarization techniques were also employed to offer concise, evidence-based dermatological information from established sources. Results: Of the models evaluated, DenseNet169 achieved the best classification accuracy of 85% and was, therefore, chosen as the base architecture for the web application. The application enhances diagnostic clarity by visualizing features and promotes access to trustworthy medical information on dermatological disorders. Conclusions: The developed web application serves as both a diagnostic support system for dermatologists and an educational system for the general public. By using DL-based classification, interpretability techniques, and automatic medical information extraction, it facilitates early intervention and increases awareness regarding skin health.

Dermato doi: 10.3390/dermato5020006

Authors: Thilo Gambichler Yusa Devrim Laura Susok

Background/objectives: Stimulator of Interferon Genes (STING)-associated vasculopathy with onset in infancy (SAVI) is a rare autoinflammatory disorder caused by gain-of-function mutations in the TMEM173 gene. These mutations result in chronic activation of the STING pathway and excessive type I interferon production, leading to systemic inflammation, vascular abnormalities, interstitial lung disease, and skin ulcerations. Janus kinase (JAK) inhibitors, including baricitinib, have shown promise in mitigating systemic and organ-specific manifestations. However, these inhibitors broadly suppress immune pathways, potentially increasing vulnerability to infections. Case presentation: This case report describes a 21-year-old woman with SAVI (due to a heterozygous TMEM173 mutation) who developed disseminated molluscum contagiosum (MC) while receiving baricitinib therapy. Laboratory results revealed lymphopenia, low CD4/CD8 ratio, and impaired immune cell activity, suggesting compromised antiviral immunity. Discussion: Despite SAVI’s association with excessive type I interferon signaling, this chronic hyperactivation may cause immune dysregulation, exhausting T cells and natural killer cells vital for viral defense. Furthermore, baricitinib suppresses interferon signaling via the JAK-STAT pathway, reducing inflammatory damage in SAVI but also impairing antiviral responses. Moreover, MC viruses evade host immune defenses by antagonizing STING and TANK-binding kinase 1-mediated interferon activation, further contributing to infection risk. This report is the first to document MC in a SAVI patient and highlights the rare complication of disseminated MC due to impaired type I interferon signaling and immune suppression from baricitinib therapy. This case underscores the need for vigilance regarding viral infections in SAVI patients treated with JAK inhibitors.

Dermato doi: 10.3390/dermato5010005

Authors: Dalibor Mijaljica Joshua P. Townley Fabrizio Spada Maria Nguyen Yenny Cheung Wendy Chow Sandra Brown Sharon Meere Mikayla Lai

Background and Objective: Age-related skin changes affect the skin’s structural and functional integrity and reduce the ability of the skin to perform its key barrier functions. Skin breakdown associated with dryness and itch becomes very common and older individuals are at an increasing risk. We aimed to evaluate a daily cleansing–moisturizing routine and conduct a skin assessment for the presence of five underlying skin integrity parameters among aged-care residents. Methods: This small, 6-week evaluation study included four participants over 80 years of age, all of whom were residents at OLC Care, Rocky Point Residence, Beverley Park, NSW, Australia. Skin assessment for the presence of five underlying clinical parameters including itchy skin, dry skin, bruising, skin tears and pressure injuries was conducted for all four participants at baseline and during the evaluation period. Clinical notes were also taken at baseline, during the evaluation and at the post-evaluation. Furthermore, clinical photographs were taken at baseline and after 2–3 weeks of the cleansing–moisturizing routine. Results: Of the four aged-care residents who participated in this evaluation study, all four showed overall improvement in the appearance of the skin with a reduction in severity of the five underlying skin integrity parameters, including itchy skin, dry skin, bruising, skin tears and pressure injuries, where present. Discussion and Conclusions: This case study has produced basic evidence to support a daily cleansing–moisturizing routine (comprising QV cleansers and moisturizers, and/or a protective barrier cream) as it provides moisturizing and protective benefits to the delicate and fragile skin of aged-care residents, where the aim is to reduce skin integrity associated issues.

Dermato doi: 10.3390/dermato5010004

Authors: Karina Bispo-dos-Santos Ingrid Mayara Cavalcante Trevisan Catarina Rapôso Paulo Eduardo Neves Ferreira Velho Gislaine Ricci Leonardi

Background/Objectives: Rice bran oil (RBO) is rich in phytochemical compounds and has many pharmaceutical applications. This work evaluated the regenerative potential of nanofibers incorporating RBO, focusing on their efficacy in tissue engineering and dermatological formulations. The main objective was to investigate the impact of RBO on SK-MEL-28 melanoma cell migration and wound closure through an in vitro healing assay. In addition, the biocompatibility and cell adhesion properties of the nanofibers were examined. Methods: The study employed cell culture techniques and field emission gun scanning electron microscopy (FEG-SEM) investigation. RBO was tested at different concentrations (0.5%, 1%, 5%, or 10%), both in isolation and incorporated into nanofibers. Cell migration was assessed through a wound-healing assay, while cell adhesion to the nanofibers was assessed using FEG-SEM. Statistical analyses were conducted to assess the significance of the findings. Results: Higher cell migration was achieved with 5% (p < 0.002) and 10% (p < 0.05) RBO nanofibers compared to the control and isolated RBO. The biocompatibility study found cell adhesion capability, highlighting the potential of these nanofibers for tissue engineering applications. Conclusions: Our results showed enhanced SK-MEL-28 cell migration and wound closure with RBO-incorporated nanofibers compared to isolated RBO. Biocompatibility was confirmed, suggesting potential for tissue engineering. Our findings indicate that the incorporation of RBO into nanofibers improves their oxidative stability, which is essential for preserving their phytochemical compounds and their beneficial effects on human skin cells in vitro.

Dermato doi: 10.3390/dermato5010003

Authors: Lara Camillo Elia Esposto Laura Cristina Gironi Elisa Zavattaro Paola Savoia

Background/objectives: Ultraviolet-B (UVB) represents a major extrinsic factor in skin cancer development, causing cellular changes that are not yet fully understood. Aquaporins (AQPs) are a family of transmembrane proteins that favor water transport and are involved in several pathways. Nicotinamide (NAM), a vitamin B3 derivate, is a safe molecule able to reduce UVB-induced damages. This study aims to verify whether AQP expression is affected by UVB exposure at different dosages and times and to evaluate NAM’s effects against UVB-induced damages. Methods: A375 cells were exposed to 40, 100, and 200 mJ/cm2 UVB doses and analyzed 0, 1, 18, and 24 h post-irradiation. Results: We found that the 40 mJ/cm2 UVB dose, 24 h post-irradiation, caused the most detrimental effects an overall overexpression and dimerization of AQPs. However, in the presence of NAM 25 μM, the cell cycle was restored, leading to improved cell viability and proliferation, reduced ROS levels, and reduced DNA damage. Moreover, we found decreased AQPs expression and dimerization. Conclusions: Overall, NAM effectively mitigates UVB-induced cellular damage, including AQPs overexpression, and may serve as a protective agent against UVB-related skin damage.

Dermato doi: 10.3390/dermato5010002

Authors: Juan David Dufflart Ocampo Carlos Sánchez Cárdenas Elizabeth Hernández Aguilar Verónica Fonte Ávalos María Elisa Vega Memije Gabriela Moreno-Coutiño

Background: Actinic keratoses (AKs) are epidermal neoplasms with a risk of progression to squamous cell carcinoma. Multiple therapeutic options targeting single or multiple lesions, with varying degrees of clearance, have been described. Objective: Evaluate the number of cycles of 5% potassium hydroxide (KOH) solution required for the resolution of actinic keratosis. Methods: This study was conducted on 261 AK lesions in 29 patients. A cycle of application of KOH was indicated in 28 doses with a subsequent monthly clinical and dermoscopic review for a maximum of three cycles of application. Resolution was determined dermoscopically. Results: Dermoscopic resolution was observed in 203 (77.7%) lesions, obtaining a mean number of cycles for a complete resolution of 2.4. Better results were observed in patients who received three cycles than in those who received one or two cycles (p = 0.003 and p = 0.000, respectively). The most common adverse effect was burning, followed by xerosis (69 and 21%, respectively). Conclusions: The 5% KOH solution represents a promising therapeutic option for the treatment of single lesions of actinic keratosis, with an adequate response and tolerable use profile for patients. Based on our results, we suggest the use of 5% KOH solution in AKs with Olsen clinical classification I or II.

Dermato doi: 10.3390/dermato5010001

Authors: María Teresa Truchuelo María Vitale Francisca Rius-Diaz María José Gomez-Sánchez

Background/Objectives: As the incidence of melanoma and skin cancer is increasing, awareness campaigns can be a useful tool to prevent these conditions. To optimize these campaigns, it is important to establish what the population really know about photoprotection and how they comply with photoprotection habits. Methods: We conducted a survey on the knowledge, behavior, and attitudes related to sun exposure in the Spanish population across the country. The results were analyzed globally and also differentiating by age between those under 25 years of age and those over 25 years of age. Results: Responses from 12,597 respondents were analyzed. Globally, 97% associate bad sun exposure habits with skin cancer; however, when we analyze the results in more detail, the prevalence of an association between tanning and skin damage and the prevalence of the correct use of sunscreens and photoprotective attitudes are lower, especially in people under 25 years old. Conclusions: The data from this survey reinforce the idea that dermatologists need to promote greater awareness among the Spanish population regarding both the skin damage induced by solar radiation and the importance of good photoprotection and preventive habits, specifically in men and people under 25 years of age. To our knowledge, this is the biggest survey to date performed in Spain.

Dermato doi: 10.3390/dermato4040018

Authors: Marie Hladíková Mathias Schmidt

Background/Objectives: A prior placebo-controlled, double-blind clinical study demonstrated the superiority of a topical combination of heparin and levomenol over the control and single active constituents. The effect on pruritus and the total SCORAD index were used to evaluate efficacy, but not the effect on the individual SCORAD items. This analysis investigates the overall efficacy of the treatment and the relative contributions of heparin and levomenol to symptom relief in atopic dermatitis, including the effects on the affected body area and its implications for sleeplessness. Methods: The ITT group (combination group A: n = 79; levomenol group B: n = 80; heparin group C: n = 78; placebo group D: n = 41) of the previously published study was re-analysed. Results: The combination significantly improved symptoms such as erythema, edema/papulation, excoriations, and skin dryness compared to the control after eight weeks of treatment. No significant differences were observed for oozing/crust and lichenification among the active groups. Levomenol and heparin exhibited significant advantages over the control for erythema and excoriations, while heparin improved edema/papulation significantly. The inflamed body area significantly decreased using the combination or single active constituents, and sleeplessness significantly improved with the combination or with heparin alone compared to the control. Conclusions: These findings highlight the efficacy of the combination and individual active constituents in addressing specific symptoms of atopic dermatitis, providing insights into their therapeutic effects. The combination’s advantage over the control is most evident in improving excoriations, skin dryness, inflamed skin area, and sleeplessness, justifying its documented use as an intervention in the early stages of atopic dermatitis episodes.

Dermato doi: 10.3390/dermato4040017

Authors: Homer-Christian J. Reiter Charles A. Andersen

Background/Objectives: IgA vasculitis, formerly Henoch-Schönlein purpura (HSP), is a form of systemic vasculitis that most commonly affects children. We present a case of hard-to-heal lower extremity lesions in a patient with confirmed IgA vasculitis or HSP. Methods: The patient was serially imaged with a handheld, bacterial autofluorescence imaging device across subsequent visits. Results: Due to the identification of bacterial burden presence that was not clinically evident, the patient was prescribed antibiotics and promptly healed. Conclusions: This case illustrates the value of bacterial fluorescence imaging in dermatological cases.

Dermato doi: 10.3390/dermato4040016

Authors: Ana Luisa Tenani Pereira da Costa Julya Gracite de Menezes Mayara Louise Beltrame Bianca Veronese da Silva Dartel Ferrari Lima Dérrick Patrick Artioli Márcia Rosângela Buzanello Gladson Ricardo Flor Bertolini

Background: Narrowband ultraviolet B (nb-UVB) is one of the most popular and effective modalities to treat vitiligo. Given the importance of nb-UBV, as well as its associations, this research searched the literature for answers on how to best treat vitiligo. Objective: To conduct a systematic literature review assessing the efficacy of narrowband ultraviolet B (NB-UVB) therapy for the treatment of vitiligo, in comparison with psoralen plus ultraviolet A (PUVA) therapy and other topical or systemic treatment modalities. Methods: The databases included were PubMed, Embase, Cochrane, Scopus, Web of Science, and LILACS. Gray literature was also used: Google Scholar, Open Grey, and Library of Thesis and Dissertations-CAPES. The search used the keywords: “Vitiligo” AND “Ultraviolet Therapy OR Actinotherapy”. The risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool by two independent, blinded reviewers, with disagreements resolved by a third reviewer. The outcome assessed was repigmentation. Results: Three randomized controlled trials were selected from 2973 records. In three studies, Nb-UVB had superior effects to the comparator. Conclusion: Nb-UVB phototherapy improves repigmentation in patients with vitiligo, with few side effects. However, the variability in the protocols and the risk of bias require caution when interpreting the results.

Dermato doi: 10.3390/dermato4040015

Authors: Serra Aksoy Pinar Demircioglu Ismail Bogrekci

With the growing complexity of skin disorders and the challenges of traditional diagnostic methods, AI offers exciting new solutions that can enhance the accuracy and efficiency of dermatological assessments. Reflectance Confocal Microscopy (RCM) stands out as a non-invasive imaging technique that delivers detailed views of the skin at the cellular level, proving its immense value in dermatology. The manual analysis of RCM images, however, tends to be slow and inconsistent. By combining artificial intelligence (AI) with RCM, this approach introduces a transformative shift toward precise, data-driven dermatopathology, supporting more accurate patient stratification, tailored treatments, and enhanced dermatological care. Advancements in AI are set to revolutionize this process. This paper explores how AI, particularly Convolutional Neural Networks (CNNs), can enhance RCM image analysis, emphasizing machine learning (ML) and deep learning (DL) methods that improve diagnostic accuracy and efficiency. The discussion highlights AI’s role in identifying and classifying skin conditions, offering benefits such as a greater consistency and a reduced strain on healthcare professionals. Furthermore, the paper explores AI integration into dermatological practices, addressing current challenges and future possibilities. The synergy between AI and RCM holds the potential to significantly advance skin disease diagnosis, ultimately leading to better therapeutic personalization and comprehensive dermatological care.

Dermato doi: 10.3390/dermato4040014

Authors: Santina Conte Sarah Daraj Mohamed Mahek Shergill Alexandra Yacovelli Leah Johnston Samantha Starkey Yossi Cohen Angela Law Ivan V. Litvinov Ilya Mukovozov

Background: Lichen sclerosus (LS) is a chronic, inflammatory dermatosis that affects both genital and extragenital sites. It is often difficult to treat and may lead to a variety of complications if not adequately treated. The mainstay of therapy involves topical corticosteroids, topical calcineurin inhibitors, and systemic immunomodulators. Although a variety of topical, oral, and procedural therapies are available, a review comparing relative efficacy is lacking. To this end, this systematic review aimed to summarize the literature regarding treatment modalities and their respective response rates in patients with genital LS. Methods: A literature search was conducted in accordance with PRISMA guidelines. Results: This review qualitatively summarizes information from 31 randomized controlled trials, encapsulating a total of 1507 patients with LS, the majority of which were female (n = 1374, 91%). Topical corticosteroids, the mainstay of therapy for LS, were discussed throughout the literature, and proved to be more efficient than topical calcineurin inhibitors, topical hormonal therapy, topical vitamin E oil and cold cream. However, other treatment modalities proved to be more efficient than topical corticosteroids, including CO2 and Nd:YAG laser therapies, and the addition of polydeoxyribonucleotide intradermal injections, to steroid therapy. Finally, other modalities that proved to be efficient in the treatment of LS included silk undergarments, human fibroblast lysate cream, platelet-rich plasma, acitretin, and surgical intervention. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Limitations included the inclusion of only randomized controlled trials, moderate or high risk of bias, and heterogeneity in treatment regimens, among others. Conclusion: Although high-potency topical corticosteroids have validated efficacy in the management of LS, other treatment modalities, including steroid-sparing agents and/or procedural adjuncts, have been demonstrated to have a beneficial role in the treatment of LS.

Dermato doi: 10.3390/dermato4040013

Authors: Ka Siu Fan Ka Hay Fan

Large language models (LLMs) are trained using large datasets and may be applied to language-based tasks. Studies have demonstrated their ability to perform and pass postgraduate medical examinations, and with the increasingly sophisticated deep learning algorithms and incorporation of image-analysis capabilities, they may also be applied to the Specialty Certificate Examination (SCE) in Dermatology. The Dermatology SCE sample questions were used to assess the performance of five freely available and high-performance LLMs. The LLMs’ performances were recorded by comparing their output on multiple-choice questions against the sample answers. One hundred questions, four of which included photographs, were entered into the LLMs. The responses were recorded and analysed, with the pass mark set at 77%. The accuracies for Claude-3.5 Sonnet, Copilot, Gemini, ChatGPT-4o, and Perplexity were 87, 88, 75, 90, and 87, respectively (p = 0.023). The LLMs were generally capable of interpreting and providing reasoned responses to clinical scenarios and clinical data. This continues to demonstrate the potential of LLMs in both medical education and clinical settings.

Dermato doi: 10.3390/dermato4030012

Authors: Javier Anido Nozay Guzmán Marta Serna Jesús Quero Pedro Santos

The concept of gender has evolved significantly in recent decades, moving from a binary status to a multiplicity of gender types. In today’s world, the new reality of the concept of masculinity, as defined socially and historically, must be recognized and accepted by aesthetic medicine. Consequently, aesthetic doctors will have to adapt the views and treatment plans that they propose in their consultations to the ideals of beauty, as well as with the roles, behaviors, and attributes considered masculine within their society. Each facial feature suggests a personality characteristic that represents that individual. This expert opinion article aims to assess Caucasian male gender-related anatomical facial features and achieve an expert agreement on the association of specific features with the perception of attractiveness, masculinity, and personality traits in order to cover the wide range of current male representations, as well as to provide orientation for clinical practice improvement in the contemporary landscape of facial masculinization.

Dermato doi: 10.3390/dermato4030011

Authors: Aline Lissa Okita Raquel Machado de Sousa Eddy Jens Rivero-Zavala Karina Lumy Okita Luisa Juliatto Molina Tinoco Luis Eduardo Pedigoni Bulisani Andre Pires dos Santos

Artificial intelligence (AI) based on convolutional neural networks (CNNs) has recently made great advances in dermatology with respect to the classification and malignancy prediction of skin diseases. In this article, we demonstrate how we have used a similar technique to build a mobile application to classify skin diseases captured by patients with their personal smartphone cameras. We used a CNN classifier to distinguish four subtypes of dermatological diseases the patients might have (“pigmentation changes and superficial infections”, “inflammatory diseases and eczemas”, “benign tumors, cysts, scars and callous”, and “suspected lesions”) and their severity in terms of morbidity and mortality risks, as well as the kind of medical consultation the patient should seek. The dataset used in this research was collected by the Department of Telemedicine of Albert Einstein Hospital in Sao Paulo and consisted of 146.277 skin images. In this paper, we show that our CNN models with an overall average classification accuracy of 79% and a sensibility of above 80% implemented in personal smartphones have the potential to lower the frequency of skin diseases and serve as an advanced tracking tool for a patient’s skin-lesion history.

Dermato doi: 10.3390/dermato4030010

Authors: Jeffrey Stricker Janine Hopkins Aaron Farberg Peyton Harris

Image-guided superficial radiation therapy (IGSRT) combines superficial radiation therapy (SRT) with full dermal visualization (FDV) via high-resolution dermal ultrasound (HRDUS) for the treatment of non-melanoma skin cancer (NMSC). The gold standard for IGSRT delivery includes a comprehensive cancer care model with support for dermatologists from a multidisciplinary team. When delivered in this model, IGSRT can achieve cure rates of 99% for treatment of NMSC. This paper focuses on the benefits of HRDUS used in conjunction with SRT for NMSC. Medical records from 7 dermatology clinics of 883 patients with 1507 cases of NMSC treated with IGSRT between 2017 and 2018 were retrospectively reviewed. In total, 92% of the NMSC lesions showed daily depth fluctuations, 60.32% of lesions did not require changes during therapy, and nearly 40% of lesions required at least one compensatory change during therapy. In total, 83% of NMSC lesions were labeled as high risk based on the 2024 NCCN guidelines. Increasing and decreasing tumor depth measurements during IGSRT inform dermatologists when adaptive changes in energy (kV), TDF, and dose will result in more efficacy and less toxicity, respectively.

Dermato doi: 10.3390/dermato4030009

Authors: Dēna Skadiņa Ināra Nokalna Alise Balcere

Micellar waters are widely used skincare cleansing products. It is commonly considered that micellar waters do not need to be rinsed off. Products left on the skin can affect its pH, which typically ranges from 4.1 to 5.8. and plays a vital role in maintaining the integrity of the skin barrier. Our objective was to evaluate the pH of micellar waters and investigate product claims, and differences according to target skin type. The pH of 30 samples of different micellar waters was tested. The products were categorized into groups based on target skin type. Statistical analysis was performed on both quantitative and qualitative data. In addition to descriptive statistics, the Shapiro–Wilk test, Fischer’s Exact test, and the Kruskal–Wallis test were used considering the minimal significance level of 95%. The pH of the tested micellar waters ranged from 4.25 to 7.87. Most samples, 21 (70%), claimed to have a no-rinse formula. Most products, 18 (60%), also reported some type of testing having been performed. There were no statistically significant differences in pH between target skin types but products “for all skin types” were the most likely to lack rinsing instructions. In conclusion, most micellar water samples had skin-friendly pH levels and providers should carefully consider product characteristics for patients with skin conditions.

Dermato doi: 10.3390/dermato4030008

Authors: Alexandra Maria Dorobanțu Mihai Lupu Liliana Gabriela Popa Raluca Tatar Calin Giurcaneanu Irina Tudose Olguta Anca Orzan

Actinomycosis, an uncommon granulomatous infection caused by the Actinomyces species, rarely targets as primary involvement the limb and is often linked to traumatic incidents. In this report, we present the case of a 44-year-old female who developed multiple small nodules on her left foot over approximately 12 months. Some nodules exhibited firmness and a violet hue, while others discharged a yellowish fluid. The patient had no significant comorbidities. Despite thorough blood paraclinical assessments, including complete blood count, serological HIV testing, and QuantiFERON-TB Gold testing, no abnormalities were detected. Bacteriological examinations and cultures of the discharge yielded negative results. Dermatoscopic examination revealed ovoid yellowish structures, with confocal microscopy highlighting granulomas. A subsequent skin biopsy confirmed characteristic changes indicative of actinomycosis. Although systemic antibiotic therapy with penicillin derivatives was initially considered, the patient’s documented allergic history to this medication class, verified through allergological testing, prompted the initiation of doxycycline treatment. Notably, significant improvement was observed at the 3-month follow-up. This case underscores the importance of reporting rare instances of actinomycosis due to its diagnostic complexity and management challenges.

Dermato doi: 10.3390/dermato4020007

Authors: Olguța Anca Orzan Liliana Gabriela Popa Iulia Badiu Ana Ion Călin Giurcăneanu Beatrice Bălăceanu-Gurău Irina Tudose

Pemphigus vegetans and pemphigus foliaceus are rare autoimmune blistering diseases characterized by the disruption of desmosomal adhesion proteins, particularly desmoglein 3 and desmoglein 1. We report the case of a 62-year-old male who presented initially with scaly red plaques posing several diagnostic challenges. A histopathological examination revealed subcorneal acantholysis, matching the suspected clinical diagnosis of pemphigus foliaceus. The patient progressed, developing vegetating plaques, and a new biopsy was performed. The new histopathological and direct immunofluorescence exams were consistent with pemphigus vegetans. This case highlights the diagnostic challenges posed by the transition of pemphigus foliaceus to its vegetating form. We discuss the role of desmogleins in the pathogenesis of pemphigus and explore potential therapeutic strategies targeting these specific autoantigens.

Dermato doi: 10.3390/dermato4020006

Authors: Cara Symanzik Swen M. John

In fair-skinned populations worldwide, skin cancer is a serious public health threat. A significant percentage of all reported occupational diseases fall back on skin cancer. Over the past few decades, there has been a rise in the frequency of skin cancer diagnoses among outdoor workers. The main cause of non-melanoma skin cancer is solar ultraviolet radiation (UVR), which is also the most common occupational carcinogenic exposure in terms of the number of exposed workers (i.e., outdoor workers). Sun protection—and concomitantly the prevention of occupational skin cancer—is a component of workplace safety. The risks of solar UVR exposure at work are often disregarded in practice, despite the recent recognition of the need for measures to support outdoor workers’ sun protection behavior. It is anticipated that occupational dermatology will become increasingly focused on sun safety in the coming decades. To handle current hurdles in a sustainable manner, the full range of preventive measures should be utilized. Existing strategies for the prevention of occupational skin cancer might be evolved and enriched by new (educational) concepts, methods, and/or technologies. In this, not only components of general prevention and individual prevention but also setting-based prevention and behavior-based prevention might be freshly thought through.

Dermato doi: 10.3390/dermato4020005

Authors: Thilo Gambichler Rim Jridi Heinz-Wolfram Bernd Andrea von Stemm Stefanie Boms

Acrodermatitis chronica atrophicans (ACA) is not an infrequent condition in Europe. However, the characteristic skin lesions are often confused by non-dermatologists with other conditions. We report three unusual cases in which we made a definitive diagnosis of ACA complicated by cutaneous marginal zone lymphoma, juxta-articular fibrotic nodules, or bilateral sensory polyneuropathy. In all cases, correct diagnosis and adequate treatment was delayed over a period of at least 12 months. We initiated systemic antibiotics resulting in full recovery in these patients. The present case reports underscore that ACA may be associated with unusual clinical presentation which potentially result in delay of correct diagnosis and treatment. Hence, ACA diagnosis may be considerably delayed leading to inappropriate therapy exposure, prolonged patients’ suffering, and causing unnecessary cost. Thus, physicians who are not familiar with skin conditions should seek a timely dermatologist consultation.

Dermato doi: 10.3390/dermato4020004

Authors: Oana Mirela Tiucă Silviu Horia Morariu Claudia Raluca Mariean Robert Aurelian Tiucă Alin Codrut Nicolescu Ovidiu Simion Cotoi

Psoriasis is an immune-mediated disease, with various triggering factors, genetic predisposition, and an altered immune response concurring in the development of this disease. The eosinophil is a cell with an important role in various kinds of inflammatory processes. Scarce data are available regarding the role of the eosinophil in psoriasis. This study aims to address the overall relationship between eosinophil-count-derived inflammatory markers and psoriasis severity. There were 366 patients fulfilling the inclusion criteria included in this retrospective study and they were divided based on the body surface area (BSA) scale in mild and moderate-to-severe psoriasis. White blood cell (WBC), neutrophil, lymphocyte, monocyte, and eosinophil count, along with eosinophil-to-monocyte ratio (EMR) and eosinophil-to-neutrophil ratio (ENR) differed significantly between the two study groups. Eosinophil count, EMR, and ENR negatively correlated with disease severity. ENR is the most reliable eosinophil-count-derived marker in assessing psoriasis severity with an AUC of 0.627 and a cut-off value of 0.03. Eosinophil-count-derived inflammatory markers’ usefulness in appreciating disease severity was assessed for the first time in the literature in this study and proved to be reliable for the eosinophil count, EMR, and ENR.

Dermato doi: 10.3390/dermato4020003

Authors: Thilo Gambichler Chalid Assaf

We are very happy that Dermato has now entered its fourth year, having published notable papers covering the wide field of dermatology and other closely related disciplines [...]

Dermato doi: 10.3390/dermato4010002

Authors: Dalibor Mijaljica Joshua P. Townley Angelina Hondros Caroline Hewson Ian P. Harrison Fabrizio Spada

This review provides an overview of the structural and functional features of key phytosphingosine-based ceramides (CERs), notably CER[EOP], CER[NP], and CER[AP], and their role in atopic skin health. Herein, we discuss how these indispensable stratum corneum (SC) lipids maintain skin barrier homeostasis and contribute to the skin’s barrier function in terms of its cohesiveness and resilience. We also consider the usefulness of CER[EOP], CER[NP], and CER[AP] in preserving skin hydration and protecting and/or repairing dry, itchy, or sensitive skin. Next, we explore how and to what extent an imbalance or inadequate amounts of CER[EOP], CER[NP], and CER[AP] contribute to the hallmark characteristics of atopic skin diseases like eczema. Furthermore, we discuss the importance of complementary SC resident lipids such as cholesterol (CHOL) and free fatty acids (FFAs), which are crucial for optimal CER function. Studies have shown that delivering topical CERs in balanced and optimal combination with CHOL and FFAs—while supporting and boosting the endogenous biosynthesis of CERs using ingredients such as niacinamide and lactic acid—helps relieve symptoms of atopic diseases to provide some measure of relief. Finally, we look at some emerging ingredients that can complement the science of CERs in healthy and diseased skin.

Dermato doi: 10.3390/dermato4010001

Authors: Thilo Gambichler Andrea Thiele Hartmut Merz Laura Susok Stefanie Boms

The most frequent primary cutaneous lymphomas observed in childhood and adolescence are mycosis fungoides (MF) and CD30-positive lymphoproliferative diseases. We report a 22-year-old female who presented with a 6-year history of multiple well-demarcated large roundish-oval scaly and reddish-brownish patches and plaques on the trunk and extremities. Histopathology revealed the focal parakeratosis and prominent epidermotropism of atypical lymphocytes, which were positive for CD8, CD56, and TIA-1 and showed a loss of CD7 and CD5 expression. T-cell receptor (TCR) gene rearrangement analysis (multiplex-PCR, BIOMED-2) of the lesional skin demonstrated the rearrangement of the gamma chain (tube A: 162 nt). Based on clinicopathological findings and a complete work-up, she was diagnosed with juvenile non-poikilodermatous C8+/CD56+ MF in stage IA. Resolution of the skin lesions was achieved by 16-week narrowband UVB phototherapy and clobetasol propionate 0.05% ointment. Juvenile-onset non-poikilodermatous CD8+CD56+ MF represents a very rare MF subtype and is associated with an indolent course. In order to avoid too aggressive diagnostics and treatments, clinicians should be aware of this rare and indolent MF variant in childhood and adolescence.

Dermato doi: 10.3390/dermato3040020

Authors: Rim Jridi Franziska Hartmann Stefanie Boms Andrea Tannapfel Thilo Gambichler

Adenosquamous carcinoma of the skin (ASCS) or primary cutaneous adenosquamous carcinoma is a rare malignant neoplasm. It is characterized by the presence of both glandular and squamous cell components and a propensity for aggressive clinical behavior. Due to its rarity, it continues to pose diagnostic challenges. To date, only a few cases of this tumor have been reported, and even fewer have been thoroughly investigated via immunohistochemistry.

Dermato doi: 10.3390/dermato3040019

Authors: Serap Maden

Rosacea is a common chronic inflammatory skin condition. It mainly affects the cheeks, nose, chin, and forehead, causing flushing or transient erythema, persistent erythema, phymatous changes, papules, pustules, and telangiectasias, and the eyes may also be affected by rosacea. Rosacea is more common in women than in men and can start at any age. Rosacea affects both fair-skinned and darker-skinned people. Physical changes in the face due to rosacea can cause embarrassment, leading to reduced quality of life and self-esteem. Rosacea has several triggers, and its pathogenesis involves multiple factors, which means there are several treatment options, and these options can be combined. A patient’s clinical findings and symptoms will help a doctor to diagnose and classify the condition. Treatment options may include lifestyle changes, topical medications, systemic antibiotics and light-based therapy. The best approach is to tailor the treatment to the individual’s condition and preferences. The aim of treatment is to manage symptoms and prevent the progression of the disease.

Dermato doi: 10.3390/dermato3040018

Authors: Raven Bennett Katherine Bradley Iman Salem David Weiner Dhrumil Patel Jeffrey Cloutier Nicole Pace Dorothea Barton

Dermatomyositis (DM) is a rare autoimmune inflammatory disease characterized by pathognomonic skin findings, often accompanied by myositis beginning with proximal weakness [...]

Dermato doi: 10.3390/dermato3030017

Authors: Emma L. Hodson Iman Salem Katherine E. Bradley Chiamaka L. Okorie Arthur Marka Nigel D. Abraham Nicole C. Pace Alicia T. Dagrosa Ryan C. Ratts Julianne A. Mann

Multisystem inflammatory syndrome in children (MIS-C) is a rare, systemic inflammation following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We report a case of a 2-year-old male who presented with an exanthem and aberrant laboratory markers, mimicking Kawasaki disease but failing to meet the full diagnostic criteria. His course was further complicated by herpes Simplex Virus-1 (HSV-1) stomatitis.

Dermato doi: 10.3390/dermato3030016

Authors: Marta Gerasymchuk Gregory Ian Robinson Nataliia Vardinska Samuel Abiola Ayedun Sandra Chinwe Alozie John Wesley Robinson Olga Kovalchuk Igor Kovalchuk

The skin, the largest external organ, serves as the primary defensive barrier against various environmental factors such as ultraviolet exposure, pollution, dietary habits, pathogens, and chemical compounds. Consequently, the skin reflects our age through visible signs of aging, such as wrinkles, age spots, dullness, and sagging. This review explores the gender-related aspects of cutaneous aging and the associated dermatological conditions. It highlights the different manifestations of aging in females and males that become evident after the age of 12, emphasizing the susceptibility to conditions such as seborrheic eczema, acne, and rosacea. Treatment strategies often vary between genders due to these disparities. While men tend to experience accelerated skin aging, most anti-aging products and strategies primarily target females. However, there has been a recent shift in men’s priorities, leading to increased interest in maintaining a youthful appearance and seeking cosmetic treatments. The manuscript covers a comprehensive range of modern dermal anti-aging and rejuvenation procedures, including plastic surgery, bio-revitalization methods, lasers, microneedling, and topical treatments. Additionally, it explores promising natural and synthetic therapeutics for combating age-related skin changes. The focus is on understanding the physiological aspects of gender-related cutaneous structure and aging to guide effective and tailored approaches in dermatological practice.

Dermato doi: 10.3390/dermato3030015

Authors: Thilo Gambichler Milan Barras Rene Stranzenbach Christina H. Scheel Nessr Abu Rached

Dear Editors: In 2016, Bessis and coworkers first reported Bier anemic spots, cyanosis, and urticaria-like eruption (BASCULE) syndrome [...]

Dermato doi: 10.3390/dermato3030014

Authors: Candice Menozzi-Smarrito Stéphane Smarrito

This current retrospective study, including 98 patients aged 21 to 71 years, aims to assess the safety and the efficiency of a picosecond 755 nm/532 nm laser in the removal of complex eyebrows tattoos. Patients were treated with a picosecond laser at 755 nm with fluences ranging from 0.69 to 6.37 J/cm2 and at 532 nm with a fluence of 0.64 or 1.12 J/cm2. Analyses of Variance (ANOVA, single factor) and comparison tests (F-test) were conducted. A total of 70 subjects finished the full treatment. An average of three laser sessions were necessary to achieve the patients’ objective (total removal, attenuation for redo, or correction). The number of sessions was significantly higher if cosmetic tattoos contained visible warm pigments (red, orange, yellow). A total of 18 patients experienced immediate grey discoloration, although this was not found to significantly influence the number of laser sessions. The main side effects were redness, swelling, and bleeding points. One patient experienced a bruise immediately after laser shots. This retrospective study has shown the picosecond laser to be safe and efficient in removing complex cosmetic tattoos. Further investigation is ongoing to assess optimal parameters for treating red and white pigments.

Dermato doi: 10.3390/dermato3020013

Authors: Shazli Razi Samavia Khan Thu M. Truong Shamail Zia Farozaan Feroz Khan Khalid Mahmood Uddin Babar K. Rao

Cutaneous squamous cell carcinoma (cSCC) arises from the abnormal proliferation of keratinocytes of the epidermis, most commonly due to UV-light-induced DNA damage. Although histopathological assessment is the gold standard for diagnosing cSCC, nascent optical imaging diagnostic modalities enable clinicians to perform “optical or virtual biopsy” in real-time. We aim to report advances in optical imaging diagnostics for cSCC, along with an updated review of the literature. A comprehensive literature review was performed using PubMed, Embase, and Cochrane databases for manuscripts published from 2008 to 2022. The search yielded a total of 9581 articles, out of which 136 relevant articles were included in the literature review after fulfilling screening and eligibility criteria. This review highlights the current optical imaging devices used for diagnosing cSCC and their diagnostic features. These devices include in vivo and ex vivo reflectance confocal microscopy, optical coherence tomography, line-field confocal optical coherence tomography, multiphoton tomography, and high-frequency ultrasonography. Although surgical excision or Mohs micrographic surgery is considered the gold standard, the latest developments in nonsurgical management of cSCC are discussed. Based on he review of the literature, we conclude that contemporary optical imaging devices such as confocal microscopy, optical coherence tomography, line-field confocal optical coherence tomography and multiphoton tomography have revolutionized real-time diagnostic imaging in dermatology, particularly within the realm of skin cancer. These devices enable rapid diagnoses and allow for a faster initiation of therapy. The application of newer imaging devices to cSCC management may benefit high-risk patients (e.g., chronic UV radiation exposure or organ transplant recipients) or patients with multifocal cSCC, for whom multiple biopsies would be impractical, thus avoiding unnecessary biopsies. Together with dermoscopy, optical imaging technologies can help to improve the efficiency of diagnosis by reducing the turnaround time and the need for extensive laboratory processing resources.

Dermato doi: 10.3390/dermato3020012

Authors: Thilo Gambichler Rosanna Schacht Kathrin Noldes Stefanie Boms

A 63-year-old woman presented to the emergency department with acute dyspnea and progressive swelling of the face (Figure 1), neck, and upper trunk [...]

Dermato doi: 10.3390/dermato3020011

Authors: Manthan Kaushik Uzma Farooq Mohd Shoab Ali Mohammad Javed Ansari Zeenat Iqbal Mohd Aamir Mirza

Cosmetics and personal care products (PCPs) are a few of the most commonly used products across the globe with a whopping market share of approximately USD 500 billion. These products are used for cleansing purposes and for improving the quality and beauty of the face, hair, and skin. There are many chemical substances involved in the manufacturing of cosmetics and PCPs. These chemical substances incorporated in cosmetics or PCPs are crucial to develop high-quality products with superior appearance, applicability, and stability; however, excessive use of such chemicals in cosmetics and PCPs has become a safety concern as many of these are reported to cause severe health complications. Overuse of cosmetics and PCPs with hazardous material should be minimized, especially by pregnant women and children. Gynecologists advise pregnant women not to use cosmetics and PCPs with hazardous chemicals. The implementation of a lawful framework is crucial to establish the safety of cosmetics and PCPs. Cosmetic companies/industries must be strictly regulated and made compliant to the guidelines in order to protect human health and minimize safety concerns. In this review, hazardous chemicals incorporated in the personal care products/cosmetics and their related risk and health complications have been discussed in detail. Additionally, regulatory status and clinical trials of chemical substances that involve toxicity and causing severe complications have also been discussed.

Dermato doi: 10.3390/dermato3020010

Authors: Vivek Gupta Rohan Singla Arnab Chanda

Split-thickness skin grafting is a well-known procedure for the treatment of small- and medium-sized burns. However, its effectiveness has been reported to be limited in the case of large and severe burns due to much lower real expansion offered by the grafts than the claimed expansion by graft mesh manufacturers. Recent computational studies have indicated that the collagen fiber orientation within the skin layers have a significant effect on the skin graft expansion. In this study, biofidelic anisotropic synthetic skin with one and two layers and all possible fiber orientations were developed, and incision patterns used in traditional graft meshing techniques were projected to fabricate novel synthetic skin grafts with a theoretical meshing ratio of 3:1. A biaxial tensile testing device was designed to simulate skin graft stretching in clinical settings, and a wide range of synthetic skin graft variants were mechanically tested. The measured quantities included induced nonlinear stress–strain, void area, and meshing ratio. In addition, the stress–strain responses were characterized using nonlinear hyperelastic models. The key observations include the generation of higher induced stresses in two-layer grafts. In the one-layer graft models, a 15° fiber orientation produced the highest expansion at a minimal stress value of 0.21 MPa. In the two-layer graft models, the 45°–15° fiber orientation generated the maximum expansion with minimum stress. A range of such findings were analyzed to determine the graft orientations that may allow enhanced expansion without generating much stress. This information would be indispensable not only for understanding the expansion potential of skin grafts, but also for further research and the development of skin grafts with enhanced expansion for severe burn injury treatment.

Dermato doi: 10.3390/dermato3020009

Authors: Teresa Rodenas-Herranz Marta Cebolla-Verdugo Carlos Llamas-Segura Ricardo Ruiz-Villaverde Maria Teresa Herranz-Marín

Dear Editor: Alopecia areata (AA) is a form of alopecia whose prevalence ranges from 0 [...]

Dermato doi: 10.3390/dermato3020008

Authors: Iman Salem Katherine Bradley Julianne A. Mann Joseph H. Shin Matthew LeBoeuf Aravindhan Sriharan

Dermatofibrosarcoma protuberans (DFSP) is a rare mesenchymal tumor of intermediate malignant potential. The neoplasm is locally aggressive with a high rate of recurrence. It typically presents in adults. Atrophic congenital DFSP is extremely rare. The few reported cases have presented as a morphea-like plaque that persists for years, before progressing into a nodular form. To our knowledge, congenital atrophic DFSP has been only reported fourteen times, and of those, only nine were confirmed by molecular studies. Herein we report a congenital case of atrophic DFSP, which initially presented as a bruise-like atrophic plaque on the dorsal forearm, initially mistaken for child abuse. The clinical appearance, histopathology, and molecular features of this rare form of DFSP are reviewed. Our case highlights the importance of early detection and adequate sampling of congenital DFSP; early treatment allows for treating small lesions without large, disfiguring, and potentially disabling excisions.

Dermato doi: 10.3390/dermato3010007

Authors: Milan Barras Lutz Schmitz Chris Braumann Waldemar Uhl Marina Skrygan Marie Buchholz Thomas Meyer Eggert Stockfleth Thomas Müller Jürgen C. Becker Thilo Gambichler

Advanced cutaneous squamous cell carcinoma (cSCC) can be a life-threatening disease for which effective and safe treatment in advanced stages is very limited. GP-2250 has been recently proven to have—in vitro and in vivo—antineoplastic effects on cancer cells. This study aims to investigate the potential anti-neoplastic effects of GP-2250 on the cSCC cell lines SCC13 and A431 through dose finding assessments, MTT cytotoxicity assays, cell migration assays, BrdU proliferation assays and FCM analysis. Our preliminary results have shown for the first time evidence for anti-neoplastic effects of GP-2250 on cSCC cells, enhancing cytotoxicity, attenuating cancer cell proliferation, inducing apoptosis and reducing tumour cell migration. Further investigations evaluating the modes of action of GP-2250 on cSCC cell lines are warranted in order to justify the use in vivo studies.

Dermato doi: 10.3390/dermato3010006

Authors: Zoltan Vilagosh Negin Foroughimehr Alireza Lajevardipour Andrew W. Wood

Advances in Terahertz frequency electromagnetic radiation (THz) production technologies have produced an increasing interest in exploring possible applications. New applications will inevitably lead to increased incidental interaction of humans with THz radiation. Given that the wavelength of THz radiation is in the same order of magnitude as the dimensions of skin structures such as hair and sweat ducts, the possibility of interaction among these structures is of interest. The interaction was studied utilizing Finite Difference Time Domain (FDTD) simulations using a far-field excitation of 0.45 THz. No antenna-like effects were detected. Regions of increased specific absorption rate (SAR) due to reactive near-field effects with both the hair and sweat ducts were found in the order of 0.01–0.05 mm and 0.001–0.002 mm, respectively. Simulations using unwound sweat ducts yielded the same penetration pattern as the helical structure, indicating that the helical structure has no impact on the propagation of THz radiation in skin.

Dermato doi: 10.3390/dermato3010005

Authors: Alessandro Pileri Gionathan Orioni Corrado Zengarini Vieri Grandi Bianca Maria Piraccini Valeria Gaspari

With this work, we aimed to review the principal benign and malignant tumors (including vascular, keratinocytic/epidermal, melanocytic, hematopoietic, and lymphoid origin), primarily affecting the leg’s skin. The lesions’ location can also help focus on a spectrum of differential diagnoses in clinical practice. All the diseases present the same clinical presentation characterized by erythematous to violaceous nodules. Despite the same clinical presentation, each disease’s prognostic outcome and therapeutic management can be somewhat different. Since clinical diagnosis may sometimes be challenging, histology and immunohistochemistry play a fundamental role in recognizing and staging these types of lesions. Molecular studies can help to determine the exact nature of lesions with no specific characteristics. Kaposi’s sarcoma is an angioproliferative neoplasm that typically occurs in the lower limbs and can enter into differential diagnosis with several other rarer skin diseases. The principal differential diagnosis concerns primary cutaneous lymphomas, of which mycosis fungoides represent the most frequent primary cutaneous T-cell lymphoma. Other rare forms include primary cutaneous B-cell lymphomas, which can be divided into indolent and aggressive forms, such as the primary cutaneous diffuse large B-cell lymphoma, leg type, and lymphomatoid papulomatosis (LyP). In the case of indolent lesions, skin-directed therapies, limited-field radiotherapy, and surgical approaches can be good options. At the same time, different management, with systemic chemotherapy and allogenic bone marrow transplant, is required with aggressive neoplasms, such as blastic plasmacytoid dendritic cell neoplasia or advanced mycosis fungoides. The dermatologist’s role can be crucial in recognizing such diseases and avoiding misdiagnosis, giving the pathologist the correct clinical information for an accurate diagnosis, and starting the suitable therapy.

Dermato doi: 10.3390/dermato3010004

Authors: Thilo Gambichler Kathrin Noldes Yousef Arafat Matthias Neid Arno Rütten Stefanie Boms

Dear Editors: Giant congenital melanocytic naevus (GCMN)-associated melanoma in adults is very rare [...]

Dermato doi: 10.3390/dermato3010003

Authors: Henry H. L. Wu Isobel Pye Rajkumar Chinnadurai

Merkel cell carcinoma (MCC) is an uncommon form of skin neoplasm with poor histological differentiation and an aggressive disease process, leading to high recurrence and mortality. There are multiple risk factors in which being in an immunocompromised state is a significant factor, and the discovery of Merkel cell polyomavirus (MCPyV) since 2008 has strengthened causal associations between MCC and immunosuppression. Individuals who have undergone kidney transplantation are therefore more susceptible to having MCC, secondary to post-transplant immunosuppression which plays a vital role in reducing the risk of transplant kidney rejection. Over recent years a rise in the incidence of MCC following kidney transplantation is noted, with increased reporting of such cases. Whilst localized MCC is observed, MCC metastasis to the lymphatic system, brain, bone, liver, lung, and heart has been previously observed in patients with transplanted kidneys. Kidney metastasis is less common and has been only reported in recent years with greater frequency. The management of aggressive, metastatic MCC has historically been palliative, and prognosis is poor. Recently, the use of immune checkpoint inhibitors for metastatic MCC in multi-center phase II clinical trials have shown promising survival outcomes and have been approved for use in countries such as the United States as a first-line treatment. In this review we will explore the potential pathophysiological processes of MCC manifesting post-kidney transplantation. We will then evaluate the epidemiology of MCC within the context of kidney transplantation, before discussing the various clinical presentations, diagnostic measures, surveillance strategies, and current treatment options as well as future directions to best manage MCC in kidney transplant recipients.

Dermato doi: 10.3390/dermato3010002

Authors: Keshav Kc Hua Hu Tilak Mahatara Sunil Koirala Samjhana Shrestha Shiv K. Sharma Xiangfeng Song Zhongwei Tian

Psoriasis is a common genetic autoimmune disorder with a global prevalence of 2–3%. The clear pathogenesis of psoriasis is not fully understood, but hyperproliferation and inflammation of the epidermis with marked infiltration of immune cells have been indicated in psoriasis with such cells producing different types of cytokines- interleukin. As such a new member of the IL-1 cytokine family, in some research, IL-33 has been linked with psoriasis showing high serum concentration of IL-33 in human psoriatic plaques compared to normal healthy skin. Despite this, the association between IL-33 and psoriasis is not clear. Herein, in this review, we aim to investigate the correlation between serum IL-33 levels and psoriasis. We conducted meta-analysis using fixed or random-effects models to calculate pooled standard mean differences. We found that the mean IL-33 serum levels were reported between 0.35 pg/mL to 586 pg/mL in the psoriatic group and 0 pg/mL to 87.7 pg/mL in the healthy control group. Out of five, four individual studies included in the analysis reported statistically significant differences in IL-33 levels, the pooled estimate (SMD = 0.340 95% CI: −0.308 to 0.988), however, did not indicate a significant relation between IL-33 and psoriasis. This analysis revealed no significant difference between serum IL-33 levels in the psoriatic population in comparison to healthy controls. This may be because we did not include any animal studies, lab-based studies, any other markers mixed together, or any other cases of diseases mixed together. However, further research is warranted to confirm the reported association as this analysis is limited by the low-quality and observational nature of the included studies.

Dermato doi: 10.3390/dermato3010001

Authors: Marcelo de Paula Corrêa Fabrina Bolzan Martins Ana Letícia Campos Yamamoto Natana Batista Paiva Luiz Felipe Silva Reynaldo José Sant’Anna Pereira de Souza Mayara Motta Melo Clarissa Santos de Carvalho Ribeiro

Daily photoprotection (PhP) is essential in preventing harmful effects from solar ultraviolet radiation (UVR) exposure. For that reason, we interviewed students aged from 4 to 20 years old about their knowledge on sun exposure and PhP habits. Age, sex, family income, and skin phototype were statistically related to the proposed questions. Our results show that Brazilian youngsters do not have the habit of wearing long-sleeved clothing (<15% in summer), sunglasses (0.0%), or hats (2.1%). More than 40% had no knowledge about ultraviolet index (UVI), while another 30% misinterpreted what it is. Less than half of all students wear sunscreen when out in the sun. Despite this low PhP use-rate, more than 90% know that UVR causes skin cancers. Low income was the factor that showed the greatest number of significant relationships with respect to the lack of PhP. The findings suggest that current traditional PhP campaigns are not efficient. We propose that PhP should be part of school curricula from elementary school onwards. After all, the lack of educational programs predisposes these youngsters to an increased chance of skin diseases in the future.

Dermato doi: 10.3390/dermato2040011

Authors: Thilo Gambichler Ekaterina Heinzer Carlo Hendricks Nicole Duschner Stefanie Boms

Dear Editors: Pityriasis lichenoides-like mycosis fungoides (MF) is a rare variant of MF, presenting clinical findings of pityriasis lichenoides (PL) but histological features of MF [...]

Dermato doi: 10.3390/dermato2040010

Authors: Evgenia Makrantonaki Christos C. Zouboulis

Acne tarda is defined as acne that develops (late-onset acne) or continues (persistent acne) after 25 years of age. The disease is more common in women. The etiology of acne tarda is still controversial, and a variety of factors such as endocrinological disorders including hyperandrogenism and hyperandrogenemia, stress, modern western diet, ultraviolet irradiation, drugs and cosmetics have been implicated. In particular, women with acne tarda and other symptoms of hyperandrogenism such as hirsutism and androgenetic alopecia have a high probability of endocrine abnormalities such as polycystic ovarian syndrome, primary ovarian insufficiency, Cushing’s syndrome and late-onset adrenogenital syndrome. Virilization is a relatively uncommon feature of hyperandrogenemia and its presence often suggests an androgen-producing tumor. Treatment is similar to that of acne in adolescence; however, long-term treatment over years or decades may be required. A thorough history, a focused clinical examination and an interdisciplinary approach together with gynecologists and endocrinologists are extremely helpful in diagnostic evaluation and therapy of patients with acne tarda.

Dermato doi: 10.3390/dermato2030009

Authors: Ichiro Hatta

X-ray diffraction is one of the powerful tools in the study of a variety of structures in the stratum corneum at the molecular level. Resolving structural modifications during functioning is an important subject for clarifying the mechanism of operating principles in the function. Here, the X-ray diffraction experimental techniques used in the structural study on the stratum corneum are widely and deeply reviewed from a perspective fundamental to the application. Three typical topics obtained from the X-ray diffraction experiments are introduced. The first subject is concerned with the disruption and the recovery of the intercellular lipid structure in the stratum corneum. The second subject is to solve the moisturizing mechanism at the molecular level and the maintenance of normal condition with moisturizer, being studied with special attention to the structure of soft keratin in the corneocytes in the stratum corneum. The third subject is the so-called 500 Da rule in the penetration of drugs or cosmetics into skin, with attention paid to the disordered intercellular lipid structure in the stratum corneum.

Dermato doi: 10.3390/dermato2030008

Authors: Thilo Gambichler Christina H. Scheel Yousef Arafat Ekaterina Heinzer Kathrin Noldes Zenaida Bulic Stefanie Boms

There is increasing evidence of adverse events associated with the use of COVID-19 vaccines. Here, we report a case of the SARS-CoV-2-vaccination-related onset of pityriasis rubra pilaris (PRP) and provide an analysis of previously reported cases in the medical literature. A 67-year-old male presented with a 1-year history of histopathologically proven PRP that first developed 14 days after receiving a COVID-19 booster vaccination. Skin symptoms improved under ustekinumab medication after unsuccessful previous treatment approaches using systemic corticosteroids, brodalumab, and risankizumab. Among the published cases of post-COVID vaccination PRP, 12 (75%) males and 4 (25%) females were reported. The median age of the reported patients was 59 years. In 10 out of 16 patients (62.5%), PRP was diagnosed after the first vaccine dose, in 4 (25%) after the second dose, and in 2 of 15 patients (12.5%) after the third dose. The median time between COVID-19 vaccination and the onset of PRP was 9.5 days (range: 3–60 days). The majority of patients required systemic treatment, including systemic retinoids and methotrexate. PRP might be a rare adverse event after COVID-19 vaccination, particularly affecting older males. Even though most reported patients with COVID-19-vaccination-related PRP could be successfully treated with PRP standard medications, therapy refractory cases may also occur. Thus, clinicians must be aware of this rare but potentially severe complication.

Dermato doi: 10.3390/dermato2030007

Authors: Piyu Parth Naik

Cutaneous squamous cell carcinoma (cSCC) is one of the most prevalent neoplasms worldwide. Important risk factors for cSCC include sun exposure, immunosuppression, pale skin, and aging. White people are more likely to develop cSCC, and men are more affected than women. In advanced cases, surgery and/or radiotherapy are no longer effective. Due to a historical lack of treatment options, some medications have been used in these patients without sufficient recommendation. There is an urgent need to identify patients at an increased risk of recurrence and spread early for timely diagnosis and treatment. Despite extensive data on the high-risk features and prognostication, considerable variation remains globally regarding high-risk cSCC and the delivery of oncology services. The current comprehensive review evaluated and summarized contemporary knowledge of various management options for cSCC to simplify the integrated treatment plans.

Dermato doi: 10.3390/dermato2020006

Authors: Tom Möller Hans-Joachim Schulze

The high metastasis and mortality rates of melanoma in the era of chemotherapy have decreased significantly over the last 10 years. The success is owed largely to the introduction of targeted therapy of oncogenes and immunotherapies, such as checkpoint inhibitors. The aim of the present retrospective, monocentric study is to investigate the impact of chemotherapy or immunotherapy in 550 patients with metastatic melanoma between the years of 2010 and 2019, looking at overall survival while considering BRAF/NRAS/c-KIT mutation status. A total of 17 patients were found to have a c-KIT mutation in exon 11, 13 or 17, including 58.3% with acral lentiginous melanoma, with 53% localized primarily in the lower limbs. In 13.3% of the 231 NRAS-mutated melanomas, primary tumor location was found to be in UV-exposed skin such as on the head and neck, thus about 50% lower than in the 302 patients with wild-type (BRAF-/NRAS-/cKIT-negative) melanoma. Patients with NRAS-mutated melanomas had a significantly lower probability of survival compared to patients with wild-type melanomas, irrespective of the recommendations of the clinical guideline on drug therapy for metastatic melanoma that have been in force since 2010. In contrast to patients with wild-type melanoma who showed a higher probability of survival receiving immune checkpoint inhibitors, the overall survival of patients with NRAS-mutated metastatic melanoma was not more favorable after therapy with immune checkpoint inhibitors compared to chemotherapy treatment.

Dermato doi: 10.3390/dermato2020005

Authors: Laura Huuskonen Anna Lyra Eunju Lee Jahyun Ryu Hyunjin Jeong Jihwoon Baek Youngkyoung Seo Minkyung Shin Kirsti Tiihonen Tommi Pesonen Antti Lauerma Jenni Reimari Alvin Ibarra Heli Anglenius

The effects of orally consumed probiotics on skin wrinkles and dryness are not fully known. A randomized, placebo-controlled, triple-blinded study was conducted with 148 healthy Korean female volunteers aged between 33 and 60 years, who were administered 1.75 × 109 colony-forming units (CFUs) of Bifidobacterium animalis subsp. lactis Bl-04 (Bl-04) (N = 74) or matching placebo (N = 74) for 12 weeks. Facial wrinkles (with 3-dimensional (3D) imaging), skin hydration, transepidermal water loss (TEWL), elasticity, and gloss were assessed at baseline and after every 4 weeks of the intervention. Questionnaire-based subjective evaluations of product efficacy and usability were also analyzed. The consumption of Bl-04 was safe and ameliorated significantly facial skin wrinkle parameters (total wrinkle area and volume, average depth of wrinkles, and arithmetic average roughness (Ra)) versus placebo at 4 weeks, but there were no differences at Week 8 or 12 between groups. Skin hydration, TEWL, elasticity, and gloss were similar between treatment groups, as were the subjective evaluation scores. Oral consumption of Bl-04 indicated promising short-term effects on skin appearance from the winter toward the spring. In future study designs, special attention should be paid to environmental conditions as well as to the skin condition and age of the participants.

Dermato doi: 10.3390/dermato2020004

Authors: Christoph Liebich Jana Nadine Bartsch Irene Schubert Marie-Luise von Bruehl Christian Sander

There has recently been an increased interest in the use of novel automated technologies for the early detection of skin malignancies. We performed a retrospective analysis of the clinical effectiveness of electrical impedance spectroscopy (EIS) in detecting malignancies in an everyday clinical setting. After a thorough visual examination and dermoscopy, 909 abnormal lesions suspicious for malignancy were detected in 481 patients who presented in a private dermatology practice between 2015 and 2017 and evaluated with the EIS system. The histopathological results of the excised lesions were compared to the Neviscore, the output of the device. In total, 443 lesions (49%) received a negative Neviscore and were thus benign. On the other hand, 466 lesions received a positive Neviscore, indicating aberrations of the physiological cell structure. Of the 909 lesions, 45% were excised after visual and EIS examination. Of the excised lesions, 16% were diagnosed histopathologically as malignant. The EIS detected melanomas with 100% accuracy. The number needed to excise decreased from 17.5 to 7.8. The predictive value for a negative Neviscore was 98.9% (true negative results). EIS was found to be a valuable adjunct support tool when making clinical assessments of potentially malignant lesions.

Dermato doi: 10.3390/dermato2020003

Authors: Thilo Gambichler Rita Mansour Christina H. Scheel Shayda Said Nessr Abu Rached Laura Susok

The purpose was to evaluate the prognostic performance of the derived neutrophil–to-lymphocyte ratio (dNLR) in patients with metastatic cutaneous melanoma (CM) treated with immune checkpoint inhibitors (ICI). We retrospectively investigated 41 CM patients with stage IV disease who had the indication for treatment with ICI. dNLR as well as NLR were routinely determined prior to the start of ICI treatment. The dNLR and NLR were calculated as follows: dNLR = absolute neutrophil counts (ANC)/white blood cell count −ANC and NRL = ANC/absolute lymphocyte counts, respectively. Follow-up of the patients was performed in line with current guidelines. In univariate analysis, dNLR (p = 0.027 and p = 0.032) as well as NLR (p = 0.0023 and p = 0.0036) were the only parameters which were significantly associated with the best overall response (BOR) and disease control rate (DCR) on ROC curve analyses. NLR negatively correlated with CM-specific survival (r = −0.32, p = 0.043). CM-specific deaths were significantly associated with the absence of immune-related adverse events (p = 0.043), elevated S100 calcium-binding protein B (S100B) at baseline (p = 0.0006), and dNLR (p = 0.024). In multivariate analyses, NLR was the only significant independent predictor for BOR (p = 0.014; odds ratio: 1.7; and 95% CI 1.11 to 2.61) and DCR (p = 0.019; odds ratio: 1.5; and 95% CI 1.07 to 2.19). Regarding CM-specific death, however, normal baseline S100B was the only significant independent predictor (p = 0.0020; odds ratio: 0.074; and 95% CI 0.014 to 0.38) for survival. Our data demonstrate that baseline NLR seems to be superior to dNLR in the prediction of ICI response in CM patients.

Dermato doi: 10.3390/dermato2010002

Authors: Thilo Gambichler Yi-Pei Lee Milan Barras Christina H. Scheel Laura Susok

Immune checkpoint inhibitors (ICI) and other antineoplastic treatment regimens can trigger cutaneous immune-related adverse events (irAEs). There is a tendency for underreporting of such cases, as cutaneous irAEs are typically perceived as mild and transient. However, more serious cutaneous irAEs can occur which, despite their lower frequency, deserve attention and require specific care. Here, we report a case of extensive hyperpigmented scleroderma-like lesions (SLL) on the lower extremities under combination treatment with pembrolizumab and pemetrexed in a patient with metastatic non-small cell lung cancer. The present case in conjunction with a review of the current literature underscores the potential risk of developing SLL under treatment with anti-PD-1 antibody and/or pemetrexed. Moreover, it is possible that this particular combination treatment synergistically increases the risk of SLL. As a result, more such cases may arise in the future, as ICI/pemetrexed combination treatment might be employed more often. As drug-induced SLL usually require systemic treatment with high dose-corticosteroids, physicians should be aware of SLL as an irAE when cancer patients present with sclerotic and/or fibrotic skin lesions.

Dermato doi: 10.3390/dermato2010001

Authors: Mathias Bonmarin Severin Läuchli Alexander Navarini

As the skin is an accessible organ and many dermatological diagnostics still rely on the visual examination and palpation of the lesions, dermatology could be dramatically impacted by augmented and virtual reality technologies. If the emergence of such tools raised enormous interest in the dermatological community, we must admit that augmented and virtual reality have not experienced the same breakthrough in dermatology as they have in surgery. In this article, we investigate the status of such technologies in dermatology and review their current use in education, diagnostics, and dermatologic surgery; additionally, we try to predict how it might evolve in the near future.

Dermato doi: 10.3390/dermato1020009

Authors: Karolina Krawczyk Ewelina Mazur Jaromir Kargol Robert Kijowski Adam Reich

About 20% of patients with systemic sclerosis have symptoms of another connective tissue disease (CTD). Interstitial lung disease (ILD) is one of the most common organ manifestations in systemic sclerosis (SSc) as well as viral illnesses, such as COVID-19, and can lead not only to diffuse alveolar damage, but also trigger an exacerbation of fibrosis among patients with preexisting ILD. It is also associated with substantial morbidity and mortality. According to the World Scleroderma Foundation, SSc-ILD can mask or mimic early COVID-19 lesions and there are no available computed tomography guidelines on how to discern those two conditions. We present a case of systemic sclerosis exacerbation after COVID-19 in a patient with SSc-Lupus Overlap Syndrome.

Dermato doi: 10.3390/dermato1020008

Authors: Katrine Baumann Niels Peter Hell Knudsen Anne-Sofie Østergaard Gadsbøll Anders Woetmann Per Stahl Skov

Skin-barrier restoration following abrasive trauma is facilitated by mediator release from skin-resident cells, a process that has been investigated primarily in mice or simplified human systems with previous studies focusing on a limited number of biomarkers. Here, we demonstrate how early events caused by skin-barrier disruption can be studied in a human ex vivo skin model. Ten relevant biomarkers were recovered from the interstitial fluid by skin microdialysis with subsequent sample analysis using a multiplex platform. As a control, the biomarker profiles obtained from microdialysis sampling were compared to profiles of skin biopsy homogenates. We found that nine (GM-CSF, CXCL1/GROα, CXCL8/IL-8 CXCL10/IP-10, IL-1α, IL-6, MIF, TNF-α, and VEGF) of the 10 biomarkers were significantly upregulated in response to abrasive trauma. Only dialysate levels of CCL27/CTACK were unaffected by skin abrasion. Biomarker levels in the homogenates corresponded to dialysate levels for CCL27/CTACK, CXCL1/GROα, CXCL8/IL-8, and IL-6. However, IL-1α showed an inverse trend in response to trauma, and biopsy levels of MIF were unchanged. GM-CSF, CXCL10/IP-10, TNF-α, and VEGF were not detected in the biopsy homogenates. Our results suggest that the human ex vivo skin model is a reliable approach to study early events after disruption of the skin barrier.

Dermato doi: 10.3390/dermato1020007

Authors: Yujin Han Se-Hoon Lee Minah Cho Sang-Hyun Cho Jeong-Deuk Lee Yu-Ri Woo Hei-Sung Kim

Klippel-Trenaunay syndrome (KTS) is a rare complex vascular syndrome with limb hypertrophy. KTS is diagnosed if at least two of the three features of capillary malformation, venous malformation, and soft tissue and/or bone overgrowth are present. Of these, capillary malformation (i.e., port-wine stain) is the most commonly observed feature but may be absent in atypical KTS. We herein report a case of atypical KTS with venous malformation and unilateral soft tissue hypertrophy.

Dermato doi: 10.3390/dermato1020006

Authors: Yujin Han Se-Hoon Lee Minah Cho Sang-Hyun Cho Jeong-Deuk Lee Yu-Ri Woo Hei-Sung Kim

Dermal melanocytic disorders present as bluish pigmentation on the skin. Several entities including Mongolian spot, aberrant Mongolian spot, nevus of Ota, and nevus of Ito have been reported. It is often difficult to distinguish between the different entities from their overlapping features. Although they share similar etiologies and histologic findings, their co-morbidities and prognosis differ. In this paper, we report four cases of dermal melanocytic disorders of which we were not able to make a clear-cut diagnosis. Also, we briefly review the dermal melanocytic disorders.

Dermato doi: 10.3390/dermato1010005

Authors: Thilo Gambichler Laura Susok Marc H. Segert

Primary cutaneous amyloidoses (PCA) are a group of conditions characterized by deposition of amyloid in previously normal skin, without association with other skin or systemic diseases. We describe a Kazakhstani female with a 30-year history of increasingly spreading hyperpigmented macular as well papular skin lesions on her upper trunk accompanied by pruritus. Moreover, her medical history included intensely rubbing her skin with a cotton towel following bathing and showering. On the basis of the clinical and histopathological findings, the diagnosis of biphasic cutaneous amyloidosis was made. The present unusual case of biphasic cutaneous amyloidosis can be subsumed under mechanically-induced forms of cutaneous amyloidosis. In conclusion, the present case underscores the necessity to explore carefully the patient’s history in order to discover the cause of PCA.

Dermato doi: 10.3390/dermato1010004

Authors: Yujin Han Se-Hoon Lee Minah Cho Sang-Hyun Cho Jeong-Deuk Lee Yu-Ri Woo Hei-Sung Kim

Phytophotodermatitis is a cutaneous phototoxic reaction resulting from contact with plant compounds such as furocoumarin in citrus fruits, followed by exposure to ultraviolet light. Erythema and vesicles appear on the contact area, followed by hyperpigmented lesions. Hyperpigmentation may exist for weeks to months before fading but can remain up to several years. Diagnosis is often challenging due to the variety of clinical presentations, and it is not always easy to identify trigger exposures. A detailed history is key to diagnosis. We herein report a case of lime-induced phytophotodermatitis which was initially mistaken for unilateral lentiginosis. The patient underwent Q-switched Nd:YAG laser and intense pulsed light (IPL) treatment with immediate improvement.