Autoimmune blistering diseases (AIBDs) encompass various skin conditions that involve the production of autoantibodies that attach to specific antigens found in the skin and mucous membranes. This systematic review examined the efficacy and safety of intravenous immunoglobulin (IVIG) therapy for AIBDs. The search included PubMed, Science Direct, Google Scholar, Wiley, and EBSCO using the following keyword combinations: (Pemphigus Vulgaris OR Bullous Pemphigoid OR Autoimmune Blistering Disease) AND (Intravenous Immunoglobulin OR IVIG) AND (Efficacy OR Long-term Outcomes) AND (Safety OR Adverse Effects OR Quality of Life). Of 617 papers, 12 articles were considered suitable for the systematic review and extracted through the database search. A meta-analysis demonstrated an efficacy of 85.0% (95% confidence interval [CI]: 75.5-92.3, p<0.001) for IVIG therapy in AIBDs. Subgroup analyses showed relapse rates of 18.2% (95% CI: 9.3-27.0, p<0.001) and adverse event rates of 48.0% (95% CI: 28.7-67.3, p<0.001). Rapid clinical responses occurred within 1-4 weeks, with sustained remission lasting up to 44 months. Corticosteroid use was reduced by 76-90%, and autoantibody titers declined significantly. While adverse events were common (26-88% of patients), most were mild, with severe complications (<5%). IVIG is effective for AIBDs, offering rapid control, durable remission, and significant steroid reduction. Standardized protocols for dosing and monitoring are needed, and future research should focus on large-scale trials to confirm long-term benefits.
Dear Editor, Sweet syndrome (SS) is a rare inflammatory dermatosis characterized by the abrupt onset of painful erythematous plaques, papules and nodules associated with a neutrophilic dermal infiltrate, fever, and peripheral neutrophilia. It is classified into three major subtypes: the classical form, frequently associated with infections, pregnancy, inflammatory bowel disease and other autoimmune disorders; the malignancy-associated form, linked to both solid-organ and hematologic malignancies, particularly acute myeloid leukemia and myelodysplastic syndromes; and the drug-induced form. [...]
Dear Editor, We report a rare unilateral presentation of pretibial Flegel’s disease displaying a folliculocentric dermoscopic pattern not previously described in the literature. A 58-year-old woman presented with a 4-year history of multiple firm, brownish, keratotic papules confined to the right pretibial region, gradually extending toward the knee. The lesions were dome-shaped, rough, and scaly, partially coalescing into small plaques. [...]
Artificial intelligence (AI)-based dermoscopic analysis is increasingly being used to assist dermatologists in the early detection and monitoring of pigmented skin lesions. However, discrepancies between AI-generated assessments and clinical evaluation may occur. This retrospective study aimed to evaluate the level of agreement between dermatologist assessment and AI-generated analysis in the dermoscopic evaluation of skin lesions. The study included 71 dermoscopic cases examined at two time points between September 2024 and January 2026 at a dermatologic clinic in Tirana, Albania. Dermoscopic images were acquired using a digital dermoscopy platform equipped with an integrated AI algorithm for automated lesion analysis. Agreement between the dermatologist and the AI system was observed in 58 cases (81.7%), whereas 13 cases (18.3%) demonstrated discordance. The 95% confidence interval for the agreement rate was 72.7%-90.7%, indicating a high level of concordance between clinical assessment and AI-based evaluation. These findings suggest that AI-assisted dermoscopic analysis demonstrates substantial agreement with clinical evaluation and may serve as a valuable supportive tool in dermatologic practice. Nevertheless, the observed discordant cases highlight the continuing importance of clinical expertise and established dermoscopic criteria in guiding patient management. AI systems should therefore be regarded as complementary decision-support tools rather than independent diagnostic systems.
Dear Editor, Kimura disease (KD) is a rare, chronic inflammatory condition characterized by subcutaneous nodules, lymphadenopathy, peripheral and tissue eosinophilia, and markedly elevated serum IgE concentrations. Although its precise etiopathogenesis remains incompletely defined, accumulating evidence supports its classification as a type 2 immune-mediated disorder, sustained by Th2 lymphocyte activation and overexpression of interleukin (IL)-4 and IL-13 signaling pathways. This immunological milieu promotes eosinophilic infiltration, vascular proliferation, IgE overproduction, and persistent pruritus, ultimately driving both systemic and cutaneous manifestations of the disease. [...]
Actinic keratosis (AK) is a common skin disorder resulting from chronic sun exposure, which can be treated with various treatment modalities, including ablative CO2 laser. Dermoscopic evaluation is fundamental in diagnosis and post-procedural follow-up. This study aimed to achieve radical clearance of AK cancerization fields through a combined approach using an ablative CO2 laser and intra-procedural dermoscopy, rather than a pre- and post-procedural approach only. Twenty patients with 25 AKs were included in the study. Treatment with ablative CO2 laser through a dermoscopic intra-procedural approach was performed for every patient with Olsen grade I or II AK. The results of this study showed that 100% of patients treated with this method achieved clinical clearance at follow-up, and 92% had no clinical recurrence after 2 months. The intra-procedural dermoscopic approach demonstrated to be useful to extend laser ablation to the AK cancerization field. According to the results of our study and after a comprehensive literature review, we conclude that intra-procedural dermatoscopy combined with ablative CO2 laser therapy can be considered a valid alternative to CO2 laser therapy alone.
Dear Editor, Harlequin syndrome is a rare autonomic disorder characterized by unilateral facial flushing and sweating caused by dysfunction of sympathetic innervation. Although generally considered a benign condition, it may occasionally represent the first manifestation of underlying neurological or structural abnormalities, including brainstem lesions, multiple sclerosis, or thoracic spinal cord disorders. Due to its striking clinical appearance, Harlequin syndrome may be misinterpreted as an allergic reaction, chronic urticaria, or other dermatological conditions, potentially delaying diagnosis. We report a case of idiopathic Harlequin syndrome in a middle-aged woman, highlighting the importance of recognizing this uncommon autonomic disorder in dermatological practice. [...]
Atopic dermatitis (AD) and hidradenitis suppurativa (HS) are two common chronic inflammatory skin diseases associated with a significant impairment of patients’ quality of life. Although AD and HS are substantially different from a pathogenetic perspective, recent findings have indicated the existence of potential common pathogenetic mechanisms, including skin barrier alteration. We describe a 29-year-old male with concomitant HS and AD who obtained a marked improvement of both diseases under treatment with dupilumab, a monoclonal antibody that inhibits interleukin (IL)-4/IL-13 signaling. This finding supports the hypothesis that type 2 inflammation and skin barrier dysfunction play a significant role in the pathogenesis of HS.
Dear Editor, Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that predominantly affects women of childbearing age. Cutaneous involvement represents one of the most common clinical manifestations of SLE and may occur in acute, subacute, or chronic forms. SLE disease activity can be assessed with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the severity of cutaneous disease activity using the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Management of mucocutaneous SLE during pregnancy and breastfeeding remains challenging. In recent years, novel targeted therapies such as anifrolumab, a monoclonal antibody directed against the type I interferon receptor, have shown efficacy in patients with active SLE, particularly in those with prominent mucocutaneous manifestations. [...]
Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit in which skin microbiome dysbiosis plays a key pathogenic role. This study, based on full-length 16S rRNA gene amplicon sequencing (V1-V9), characterized facial microbial diversity in 45 participants classified as healthy (n=15), mild acne (n=15), and moderate-severe acne (n=15), using pooled samples for downstream microbiome analyses. Samples from the skin surface and sebaceous follicles were analyzed by 16S rRNA (V1-V9) sequencing using Illumina MiniSeq and processed via QIIME2. Alpha diversity (observed taxa, Shannon index), beta diversity (Bray-Curtis dissimilarity, permutational multivariate analysis of variance [PERMANOVA]), and biomarker taxa (linear discriminant analysis effect size [LEfSe]) were assessed. Bacillota, mainly Staphylococcus spp., predominated on the skin surface, with relative abundance increasing with acne severity, whereas follicles were dominated by Cutibacterium acnes (Actinomycetota). Follicular samples showed lower richness and Shannon diversity than surface samples, though intergroup differences were not significant. Principal coordinates analysis (PCoA) explained >65% of variation, revealing greater dispersion among surface communities but no clear clustering by severity (PERMANOVA p>0.3). LEfSe identified distinct bacterial biomarkers across clinical groups. Overall, site-specific microbial shifts – particularly C. acnes and Staphylococcus dysbiosis – appear central to acne development, suggesting microbiome-targeted interventions as potential therapeutic strategies.
Rhinophyma is a progressive, disfiguring form of rosacea that affects the nasal soft tissues and leads to functional and cosmetic challenges. Surgical excision is the primary treatment, but healing can be complicated by scarring, infection, and graft failure, especially in extensive lesions. Hyperbaric oxygen therapy (HBOT) has been suggested as an adjunctive treatment to enhance healing, reduce inflammation, and improve skin-graft survival. This case series presents three patients with giant rhinophyma who underwent surgical excision, with one requiring a split-thickness skin graft (STSG). Postoperatively, HBOT sessions (90 minutes at 2.4 atmospheres absolute [ATA]) were administered for 5-10 days, depending on the lesion severity. All patients demonstrated excellent healing with complete epithelialization and no evidence of hypertrophic scarring or short-term recurrence. HBOT contributed to faster recovery, improved skin-graft survival, and enhanced cosmetic outcomes. These findings suggest that HBOT is a promising adjunct in the surgical management of rhinophyma, although larger studies are required to validate its efficacy.
Dear Editor, Morphea (localized scleroderma) is a cutaneous inflammatory fibrosing disorder characterized by heterogeneous clinical presentation and variable disease activity. Although diagnosis is predominantly clinical, accurate assessment of activity can be challenging, particularly in plaque-type disease where inflammatory and sclerotic components coexist. Non-invasive imaging may support the identification of active disease areas and help guide correct clinical management. [...].
Xerosis is a prevalent skin disorder among patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). While both Aloe vera cream 30% and urea cream 20% have been shown to improve skin hydration in cases of xerosis cutis, direct comparisons between the two are limited. This study aims to compare the effectiveness of both creams in treating xerosis cutis in patients with chronic kidney disease on hemodialysis (CKD-HD). A randomized controlled trial was conducted involving 35 eligible CKD-HD patients. Each patient received either urea cream 20% or A. vera cream 30%, which was applied to both their left and right arms. Skin moisture was assessed weekly using corneometer readings and overall dry skin (ODS) scores over 4 weeks. The present study reveals that both treatments significantly increased corneometer readings and decreased ODS scores compared to baseline (p<0.05), but no significant difference was found between the two creams (p>0.05). In conclusion, A. vera cream 30% and urea cream 20% demonstrate similar effectiveness in improving skin moisture for patients with xerosis cutis associated with CKD-HD.
Obesity impacts both the clinical management and therapeutic strategies for psoriasis. This study aims to describe the use of biological medicines in treating obese patients with moderate-to-severe psoriasis. We conducted a retrospective cohort study (2007-2022) of obese patients who initiated biological treatments for moderate-severe psoriasis. The primary outcome was the number of biological treatment lines required to achieve an optimal or adequate Psoriasis Area and Severity Index (PASI) score reduction. Secondary outcomes included the duration of biological use and reasons for discontinuation. We included 58 patients (mean age 50 years, body mass index [BMI] 35.9 kg/m2, psoriasis duration 16.5 years). Biological treatments enabled 77.6% (45) of patients to achieve an optimal response, and 87.9% (51) achieved an adequate response. The median time-to-response was 2-7 months, with the greatest improvements seen with adalimumab, etanercept, and ustekinumab. The primary reason for discontinuation was lack of effectiveness (50% of first-line treatments). This study suggests that systemic biologics are effective for obese psoriasis patients and emphasizes the need for close monitoring of reasons that lead to discontinuation. As biologics evolve, refining guidelines will be essential for optimizing psoriasis management in obese patients.
Dear Editor, Merkel cell carcinoma (MCC) is defined as a rare but highly aggressive skin cancer originating from neuroendocrine cells. Clinically, it usually appears as a rapidly growing, solid, asymptomatic, redviolaceous nodule. Its development is primarily associated with the integration of the Merkel cell polyomavirus (MCPyV) and extended exposure to ultraviolet (UV) radiation. The disease predominantly affects older individuals with fair skin. There is an increased incidence of MCC among immunocompromised individuals, such as patients suffering from hematological malignancies. [...]
An 82-year-old female presented to the dermatology department with a primary complaint of an achromatic tumorous lesion measuring 1.5×1.5 cm, protruding above the surrounding skin, covered with hemorrhagic crust, with irregular borders, located in the right zygomatic region. Based on the clinical presentation, squamous cell carcinoma was suspected and surgical excision under local anesthesia was recommended. Additionally, a solitary formation was observed in the right parotid region, suspected to represent a lymph node conglomerate. A lymph node biopsy has been scheduled in another department for further evaluation. [...]
This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy and safety of topical sofpironium bromide in patients with primary axillary hyperhidrosis (PAH) in various published randomized controlled trials (RCTs). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched PubMed, Scopus, Web of Science, Embase, and Medline databases through April 30, 2025, using keywords related to sofpironium and PAH. The odds ratio (OR) or mean difference (MD) was calculated using a random effects model with 95% confidence interval (CI). Three RCTs of sofpironium were included in the meta-analysis, with 1,209 patients with PAH. Sofpironium, compared to the vehicle, showed statistically significant improvement in the Hyperhidrosis Disease Severity Measure–Axillary (HDSM-Ax) score (OR=2.35, 95% CI [1.82 to 3.04]), Hyperhidrosis Disease Severity Scale (HDSS) score (OR=2.02, [1.46 to 2.79]), Dermatology Life Quality Index (DLQI) score (MD=−2.75, [−3.58 to −1.92]), and gravimetric sweat production (MD=−26.39, [−44.65 to −8.12]). The incidences of anticholinergic adverse events (AEs) and application site AEs were statistically higher in patients treated with sofpironium. Sofpironium is an effective treatment for PAH associated with significant improvements in sweat reduction and QOL for patients, although the drug also has risks of anticholinergic or application-site AEs.
A 62-year-old male presented to the dermatology department with a primary complaint of an achromatic tumorous lesion protruding above the surrounding skin, with central atrophy, irregular borders, and visible telangiectasias, located on the nasal distal third, slightly toward the left nasal dorsum. Based on the clinical presentation, basal cell carcinoma was suspected and surgical excision under local anesthesia was recommended. [...]
Dear Editor, Pancreatic panniculitis (PP) is a rare form of lobular panniculitis associated with pancreatic disorders, including acute and chronic pancreatitis and pancreatic neoplasms. It develops in a small percentage of patients with pancreatic disease and may represent the first manifestation of an occult malignancy. Clinically, PP usually presents with painful erythematous-to-violaceous nodules on the lower extremities, which may ulcerate and discharge oily brown material secondary to liquefactive fat necrosis induced by circulating pancreatic enzymes. Because of its rarity and heterogeneous presentation, diagnosis is frequently delayed or initially misdirected toward more common inflammatory or vascular conditions. [...]
Dear Editor, Keratosis lichenoides chronica (KLC), also known as Nekam’s disease, is a rare and recalcitrant lichenoid dermatosis. It manifests with keratotic violaceous papules arranged in linear or reticulated patterns and typically follows a chronic and disabling course. Therapeutic guidelines are lacking, and conventional treatments – including corticosteroids, retinoids, immunosuppressants, and phototherapy – often fail to provide sustained benefit. Given its rarity, each therapeutic observation carries significant relevance. [...]
