Tapinarof, a novel topical aryl hydrocarbon receptor (AhR) modulator, has demonstrated promising therapeutic efficacy in the treatment of plaque psoriasis. However, its comprehensive safety profile in real-world settings remains underexplored.

Alopecia areata (AA) is an autoimmune disorder characterized by non-scarring hair loss. Current treatment options, such as intralesional corticosteroid (ILCS) injections, are effective but often associated with adverse effects, including pain, skin atrophy, and reduced patient compliance. This study investigates the efficacy and safety of a corticosteroid-loaded microneedle patch as an alternative treatment modality for AA.

Wells syndrome (eosinophilic cellulitis) is a rare inflammatory dermatosis characterized by erythematous, edematous plaques and dermal eosinophilic infiltration. Understanding its evolving triggers and treatment options is critical for optimizing management, particularly in corticosteroid-refractory cases.

Scarring alopecias, including lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, central centrifugal cicatricial alopecia, discoid lupus erythematosus, and dissecting cellulitis cause permanent destruction of hair follicles, resulting in patches of hair loss that can be devastating for patients. Treatment options for scarring alopecias focus on disease stabilization and currently include corticosteroids and immunosuppressive agents, which often offer inconsistent disease improvements with waning patient satisfaction, especially in severe stages of the condition. Recent advances in therapeutics such as biologics and JAK inhibitors may offer some potential for disease stabilization and resolution through modulation of the inflammatory and immune-mediated pathways of scarring alopecias. This review examines literature reporting the off-label use of biologics and JAK inhibitors for the treatment of scarring alopecias. We find that TNF-α, IL-17, and JAK inhibitors demonstrate the most potential of currently available agents, with IL-23 and Interferon Alpha Receptor 1 inhibitors also showing some benefit.

Nicotinamide has many well-established chemopreventive properties in protecting against ultraviolet-induced skin damage, mitigating inflammation, and reducing keratinocyte carcinoma (KC) development among immunocompetent individuals. Its effectiveness in immunosuppressed patients, however, is unclear. There is conflicting research on whether nicotinamide effectively decreases KCs in immunosuppressed solid organ transplant recipients (SOTRs). This study assesses the effectiveness of nicotinamide in the secondary prevention of KC in immunosuppressed patients. We conducted a retrospective cohort study in a single tertiary care institution. The primary outcome was KC incidence in the year before and after nicotinamide supplementation. Secondary outcomes included the incidence of invasive squamous cell carcinoma (SCC), SCC in situ (SCCis), and basal cell carcinoma (BCC) over one- and two-year intervals. All included patients had taken oral nicotinamide, 500 milligrams twice daily, for at least one year. A total of 47 SOTRs (74.5% male; mean age 65.2 years) were included in our retrospective cohort study. Of 81 patients initially screened, 34 were excluded due to inadequate follow-up, dermatologic care outside our institution, or early discontinuation of nicotinamide. At one year post-nicotinamide supplementation, total KC incidence decreased from 224 (78 SCC, 103 SCCis, 43 BCC) to 121 cases (40 SCC, 55 SCCis, 26 BCC), a mean reduction of 2.19 KCs (95% CI: -3.48 to -0.90; p = 0.0012). Significant reductions were observed in SCC (mean decrease of 1.15; 95% CI: -1.78 to -0.52; p = 0.00081) and SCCis (mean decrease of 1.37; 95% CI: -2.61 to -0.13; p = 0.032). BCC reduction was not statistically significant (p = 0.13). In the 31 patients with two-year follow-up data, KC incidence declined from 234 to 167, a mean reduction of 2.18 KCs (95% CI: -4.18 to -0.14; p = 0.037). Sensitivity analyses excluding patients on concomitant acitretin confirmed that reductions in total KC incidence maintained significance at both one-year and two-year intervals. Nicotinamide supplementation significantly decreased KC incidence in immunosuppressed SOTRs over the one-year and two-year intervals. We recommend nicotinamide as a low-risk, low-cost chemopreventive supplement for reducing KCs in SOTRs.

Although different treatment modalities are available, the treatment of warts is still challenging with recalcitrant and recurrent lesions. Given that warts are viral in nature, acyclovir might be a viable treatment option. Intralesional acyclovir and 5-fluorouracil (5-FU) injections have been described for treating common warts and achieved a complete response in most of the patients.

Anti TNFα agents can induce cutaneous adverse events in both adults and children. While drug-related alopecia was reported in adults treated with TNFα inhibitors for various indications, pediatric data are scarce. To describe clinical characteristics and outcomes in pediatric patients with TNFα inhibitor-induced alopecia we conducted a single center retrospective study (0748-21-RMC, retrospectively registered on January 2nd 2022) including all patients aged < 18 years who were treated with TNFα inhibitors for any indication and developed drug-induced alopecia between the years 2018-2023. A comprehensive literature review was also performed. Twenty patients were included (mean age 12.9 ± 3.1 years, male:female ratio 1:1.4). Fourteen were diagnosed with Crohn's disease, three with ulcerative colitis, and three with juvenile idiopathic arthritis. Half of the patients were treated with adalimumab and half with infliximab. Overall, alopecia was observed after 14.8 ± 10.8 months of treatment. Eighteen (90.0%) patients presented with psoriatic-like inflammatory alopecia, and two with alopecia areata-like lesions. Seventeen (85.0%) patients discontinued their anti-TNFα therapy due to the alopecia, all presented hair regrowth within six months. Hair regrowth was not recorded in three patients who continued TNFα inhibitors. Literature review of pediatric TNFα inhibitor-induced alopecia revealed comparable patients' demographics and response to treatment discontinuation. In conclusion, TNFα inhibitor-induced alopecia is a rare adverse event in children, occurring mainly in adolescents with inflammatory bowel diseases. Our relatively large cohort provides further evidence for the need for TNFα inhibitor cessation to improve drug-induced alopecia in pediatric patients.

Acne vulgaris (AV) is a persistent inflammatory skin disease that affects the pilosebaceous units. Oral azithromycin has shown significant effectiveness in treating AV, attributed to its robust anti-inflammatory and antimicrobial properties. This study aimed to evaluate the efficacy of azithromycin in patients with moderate-to-severe AV, with a focus on its influence on sebum composition and specific biomarkers, including pyridoxine (B6), biotin (B7), cobalamin (B12) (measured by HPLC), and homocysteine (measured by ELISA). A case-control study was conducted at the dermatology department of Al-Imamain-Alkadhimain Medical City, Baghdad. The study included thirty patients aged 15-35 years with moderate-to-severe AV, and thirty healthy individuals of the same age and sex served as a control group. Patients received 500 mg of azithromycin on alternate days for 12 weeks. Laboratory and clinical parameters were assessed at baseline and compared to the control group, then re-evaluated after treatment. The findings indicated a significant decrease in serum levels of folic acid, B7, and B6 at both 6 and 12 weeks post-treatment (p < 0.05). Serum homocysteine levels increased slightly over time, but this change was not statistically significant (p > 0.05). No significant difference in serum B12 levels was observed at 6 weeks (p > 0.05); however, a significant increase was noted at 12 weeks (p < 0.05). Clinical score, skin moisture, and sebum squalene (Sebum-SQ) content improved significantly post-treatment (p < 0.05), while sebum cholesterol (Sebum-Chol.) levels showed significant change only at 12 weeks (p < 0.05). The finding supports the efficacy of azithromycin in managing inflammatory acne and modulating sebum composition and specific biomarkers. However, the relatively small sample size and absence of power analysis limit the generalizability of the results. Future studies with larger cohorts are recommended to validate these findings.

Keloids and hypertrophic scars (HTS) can cause physical discomfort and- psychosocial distress, especially in individuals with darker Fitzpatrick skin types. These scars often recur and may lead to itching, pigmentation changes, pain, and reduced self-esteem.

Melasma therapy remains challenging due to limited effectiveness, side effects, and relapses. Topical tranexamic acid (TXA) is promising but requires further research to optimize its formulation. Alongside the therapeutic benefit of fractional CO2 laser (FCL) in melasma, FCL and microneedling (MN) are recognized methods for transepidermal drug delivery. Nanotechnology-based topicals can enhance drug penetration and reduce side effects. Objectives were to evaluate and compare the effectiveness of combined FCL- or MN-assisted transepidermal delivery of TXA 3% gel and FCL monotherapy versus nanotechnology-based TXA 1% microemulsion monotherapy in melasma treatment. Fifty-two melasma females were divided randomly into three groups (A, B & C) for a five-month treatment. Group A (n = 20), using a split-face design, received FCL on the right side (A1) and MN on the left (A2), both with TXA 3% gel applied post-session and daily. Group B (n = 21), also with a split-face design, received FCL with TXA 3% gel post-session only on the right side (B1), while the left side (B2) received FCL alone. Group C (n = 11) received TXA 1% microemulsion daily for the whole face. Evaluations included clinical, dermoscopic, and immunohistochemical SOX10 assessments, with a three-month follow-up. All groups showed a significant reduction of Hemi Melasma Area and Severity Index (Hemi-MASI), dermoscopic, and SOX10 immunoreactivity scores. Groups A1, A2, and C exhibited greater improvement compared to B1 and B2. No recurrence occurred during follow-up. Concluding that TXA 1% microemulsion is effective and safe, procedure-free monotherapy with outcomes comparable to FCL- and MN-assisted TXA 3% gel delivery for melasma.

The prevalence of overweight/obesity is continuing its relentless global rise. In this condition, the risk of some disorders such as cardiovascular diseases, hypertension, diabetes mellitus, hirsutism, menstrual abnormalities, gallbladder disease, arthritis, and some site-specific cancers is increased. In the current study, we assessed the efficacy of carboxytherapy in reducing thickness of the abdominal subcutaneous fat through clinical and ultrasonographical studies. Our study was a prospective, randomized, single-blind, 2-split clinical trial in which 30 obese subjects with abdominal adiposity were recruited. In each case carboxytherapy was randomly done on the one side of abdomen (interventional group) every 2 weeks for 5 sessions, while the contralateral side was left without therapy (control group). Before every session, data of subjective and objective clinical assessments, body weight, BMI, waist circumference, and waist to hip circumference ratio were collected. Two weeks after the last session, the thickness of different skin layers was measured by ultrasonography in the both study groups. Of 30 subjects, 20 were female (66.67%) and 10 were male (33.33%), with mean age of 39.16 years (± 9.51). The mean weight, BMI, waist circumference, and waist to hip circumference ratio demonstrated significant decrease during the study. The subjective and objective assessments both showed significant improvement. The subcutis thickness revealed a statistically significant decrease in the interventional group, with no significant difference between males and females. No significant complication was reported. Carboxytherapy is a safe and effective modality in the management of local fat deposits.Clinical trial registry code: IRCT20220517054900N1.

Poorly healing wounds represent the primary health-related burden for hereditary recessive dystrophic epidermolysis bullosa (RDEB) patients. Contribution of wound-associated soluble constituents to wound progression remains not well defined.

Osteomyelitis results principally from endo-/exogenous bacterial infections, whose incidence that complicating bone injuries reaches approximately 30%, with the risk of disability and teratogenicity. Skin microbiota has been found to be clinically linked to osteomyelitis, but substantial evidence is lacking.

Chronic spontaneous urticaria (CSU) characterized by recurrent wheals and/or angioedema, remains a challenging condition. Autoallergic and autoimmune mechanisms (Type I and IIb) have been recognized for CSU pathogenesis. Studies have demonstrated the association between CSU and serum anti-thyroid peroxidase (TPO) antibodies (Abs). However, the potential for increased TPO expression within affected skin tissue of CSU patients is unclear. Patients diagnosed with CSU were recruited from the UCARE center of Mashhad University of Medical Sciences, the case group. Matched healthy individuals who underwent cosmetic surgery served as the control group. Skin biopsies were obtained from active wheal lesions in the CSU patients. Thyroid function tests (TFTs) and serum anti-TPO Ab levels were measured in both groups. Immunohistochemistry (IHC) staining was used to assess skin biopsy samples. A total of 60 participants were enrolled, including 30 CSU patients and 30 healthy controls. Hypothyroidism was significantly more prevalent in the case group compared to controls (p = 0.007). Additionally, the patients exhibited a significantly higher rate of positive serum anti-TPO Ab compared to the healthy individuals (p = 0.001). Notably, IHC staining revealed no TPO expression in the skin samples of either group. This study demonstrated that elevated serum anti-TPO Ab levels in CSU patients may not directly translate to TPO expression within affected skin tissue. While further research with larger cohorts is warranted, our findings contribute to the understanding of the histopathological underpinnings of CSU in relation to TPO, anti-TPO Ab, and potential autoimmune mechanisms.

Clinical research is a cornerstone of academic dermatology, including research in cosmetic and laser procedures. However, numerous barriers exist to conducting clinical research in an academic setting as compared to private practice. The objective of this study was to describe the barriers to clinical research in cosmetic and laser dermatology in the academic setting under three common funding scenarios: (1) industry sponsored, (2) unfunded, investigator-initiated, and (3) publicly funded, investigator-initiated. A systematic review of the literature was conducted to identify 17 publications regarding funding of clinical dermatology research. Inductive content analysis was used to extract, categorize, and understand the barriers related to clinical dermatology research, specifically in cosmetic dermatology, based on the type of funding. An expert panel of 11 board-certified dermatologists who practice and conduct research in cosmetic and laser dermatology at academic institutions reviewed these barriers, interpreted each barrier's implications for academic cosmetic and laser dermatology research, and proposed possible approaches to overcoming each. Nine barriers were identified for each funding scenario, and a total of 60 approaches for mitigating these were suggested. Most barriers to industry sponsored research were related either to institutional hurdles or industry preferences. The most cited barrier to unfunded, investigator-initiated research was limited protected academic time. The most frequently cited barriers to publicly funded, investigator-initiated research were grant availability and disproportionate awarding of grants based on investigator demographics. Proposed approaches for overcoming barriers included recruiting the help of trainees, streamlining administrative paperwork, fostering collaboration between industry and academic centers, providing financial incentives, seeking out mentorship from other faculty, and collaborating with other investigators, departments, and institutions.

Morphea (localized scleroderma) is a chronic, autoimmune disease of connective tissue that has been known for many years. However, the etiology of the disease is still not fully understood. The study was conducted on a group of 88 people, including 59 patients with morphea and 29 people qualified for the control group. We attempted to assess gene expression and plasma concentration IL-1β, IL-18 and IL-33. In the group of patients with morphea, a lower expression of and genes was observed in PBMC compared to the control group, and no significant differences in plasma concentrations of IL-1β, IL-18 and IL-33 were found in the group of patients with morphea compared to the control group.