Psoriasis is a chronic immune-mediated inflammatory disease that affects both the skin and musculoskeletal system. Recent evidence suggests an elevated risk of low bone mineral density (BMD) in patients with psoriasis. However, BMD assessment is rarely performed in routine clinical practice due to limited access to dual-energy X-ray absorptiometry (DXA). To evaluate BMD in patients with psoriasis using an artificial intelligence (AI)-based tool applied to routine chest radiographs, and to investigate associations with disease duration, disease severity (measured by Psoriasis Area and Severity Index [PASI]), and disease subtype. We retrospectively analysed 132 Japanese patients with psoriasis who underwent chest radiographs prior to initiating biologic therapy between 2010 and 2023. BMD was estimated using an original AI model for predicting BMD on chest radiographs. Patients were categorized as having normal BMD, osteopenia, or osteoporosis based on T-scores. Clinical associations were assessed using statistical methods, including ROC curve analysis to determine cut-off values for disease duration and PASI scores. A higher prevalence of AI-estimated osteoporosis was observed among middle-aged male patients compared to the general population. Longer disease duration (≥seven years, as determined by ROC analysis) was significantly associated with lower AI-estimated BMD (p=0.0032). Although patients with PASI scores ≥10.4 and those with the pustular subtype exhibited trends toward lower BMD, these differences did not reach statistical significance. Our findings indicate a substantial reduction in BMD among male psoriasis patients in their 40s and 50s.
High-frequency high-intensity focused ultrasound (HF-HIFU) is a non-invasive ablative technology that enables precise, depth-controlled thermal destruction of superficial cutaneous lesions. Its potential dermatological applications include benign, premalignant, and selected malignant tumours; however, current evidence is fragmented across indications and study designs. This systematic review evaluated the clinical role of HF-HIFU for cutaneous lesion ablation. The review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261326294). Eligible studies investigated HF-HIFU for benign, premalignant, or malignant skin lesions. Methodological quality was assessed using the Newcastle-Ottawa Scale and the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Given substantial heterogeneity in lesion types, treatment parameters, and outcome reporting, results were synthesized narratively with pooled descriptive outcomes. Fifteen studies including 92 patients treated with a 20-MHz dermatological HF-HIFU system were analysed. For malignant lesions, lesion-level analysis suggested high initial clearance rates (96%, n=28), although evidence was limited and largely noncomparative. Actinic keratosis demonstrated complete clearance rates exceeding 70%, with additional partial responses in most remaining lesions. Outcomes for benign lesions varied by depth and histology, with best results in superficial epithelial tumours and lower efficacy for deeper dermal lesions. Procedural pain depended on anatomical location and treatment extent, being higher in head-and-neck and acral lesions. Adverse events were predictable, and transient. Follow-up was generally short, and histological confirmation was infrequent. HF-HIFU appears to be a promising minimally invasive option for selected cutaneous lesions, but larger prospective studies with long-term follow-up and routine histological verification are needed to define its clinical role.
Postherpetic neuralgia (PHN) is a common but feared complication of herpes zoster (HZ) caused by latent varicella-zoster virus (VZV) reactivation. Objectives: To investigate the relationship between the late-to-early acute phase VZV immunoglobulin (Ig)G antibody (Ab) titre ratio (VZV IgG L/E ratio) and pain intensity after 90 days from onset in patients with HZ. In this hospital-based retrospective cohort study, we analysed the data of patients who met the following criteria between July 2019 and September 2024: 1) those clinically diagnosed with HZ within seven days from onset; 2) those in whom VZV IgG Ab titres were measured twice in the early and late acute phases; and 3) those in whom pain intensity was assessed at the earliest time point after 90 days from onset, using the numerical rating scale (NRS). VZV IgG Ab titres were measured by enzyme-linked immunosorbent assay. A total of 21 patients were included in the analysis. The VZV IgG L/E ratio negatively correlated with NRS score after 90 days from onset (ρ= -0.53). When PHN was defined as pain associated with HZ (rated as 3 or more on the NRS), persisting or appearing for more than 90 days after the onset of HZ, the receiver operating characteristic curve analysis revealed a cut-off value of the VZV IgG L/E ratio for PHN to be 1.8, with 100% sensitivity and 93% specificity. Our results suggest that the VZV IgG L/E ratio could serve as a novel PHN indicator.
This article reviews novel data presented at the 2025 Annual Congress of the European Society for Photodynamic Therapy (Euro-PDT). Photodynamic therapy (PDT) has been investigated for the treatment of a broad spectrum of neoplastic, infectious and inflammatory dermatoses. PDT remains an effective treatment for actinic keratoses/field cancerization with increased interest in delivery of treatment indoors using artificial daylight sources as well as in home-administered daylight PDT. Sustained clearance has remained an important marker of the success of PDT for superficial and thin nodular basal cell carcinomas and updated data is presented. New studies confirm the potential for wider use of PDT for bacterial, fungal, and viral infections, including refractory cutaneous and mucosal warts, with encouraging results also in the treatment of necrobiosis lipoidica and erythropoietic protoporphyria.
Data on the clinical characteristics of keratoacanthomas (KAs) associated with Muir-Torre syndrome (MTS) and xeroderma pigmentosum (XP) are limited. To compare the clinical features of KAs in patients with MTS and XP. Consecutive patients diagnosed with MTS or XP were evaluated for the occurrence of KA in a single dermatology centre. Age at onset, number, size, localization, association with cutaneous horn, and regression patterns of KAs were compared in both groups and with sporadic KAs. A total of 26 KAs were observed in 7 of 38 patients with XP and 11 lesions in 4 of 8 patients with MTS with a mean age at onset of 11.4±6.5 and 50.5±8.5 years, respectively. Most individuals with both syndromes presented with multiple KAs. In MTS patients, lesions involved both facial and truncal sites and were frequently >1 cm in diameter, and spontaneous regression commonly resulted in depressed or hypopigmented, atrophic scars surrounded by a thin rim, and mutilation was observed in one case. In contrast, KAs in XP patients were predominantly localized to the head and neck, with occasional mucosal involvement, and were sometimes associated with cutaneous horn and typically healed with minimal or no scarring. Sporadic KAs manifested mostly as solitary lesions, predominantly on the face, in 14 patients with a mean age of 60.2±14.2 years. KAs in XP and MTS patients differ with regards to age at onset, distribution, associated features, and regression patterns. Truncal involvement, larger size and prominent scarring favour MTS, whereas early onset, mucosal involvement, and association with cutaneous horn are more characteristic of XP.
