Background:Lupus erythematosus tumidus (LET) is a rare photosensitive skin lupus subtype. Its erythematous swelling easily mimics erysipelas, cellulitis or herpes zoster, leading to frequent misdiagnosis. Atypical cases complicated by interface dermatitis and patient self-medication create prominent differential diagnostic difficulties. Case Presentation:A 58-year-old woman had scalp and facial erythema swelling for 1 year, worsened over 4 days. She was repeatedly misdiagnosed with bacterial infectious skin diseases and given ineffective antibiotics. Before admission, she took herbal decoctions and received bloodletting acupuncture by herself, aggravating facial edema. Examination showed infiltrative erythema and scalp alopecia. Full autoantibody, complement and routine lab tests were nearly normal. Cheek biopsy showed typical LET mucin deposition and periadnexal lymphocytic infiltration, while scalp biopsy unexpectedly revealed focal basal liquefaction degeneration. The final diagnosis of atypical LET was made after comprehensive clinicopathological evaluation. Combined hydroxychloroquine and methylprednisolone therapy induced obvious lesion remission within 6 months of follow-up. Conclusion:This atypical LET case illustrates key differential diagnostic traps caused by long-term misdiagnosis and conflicting pathological findings. Unsupervised herbal treatment and blood-letting acupuncture disturbs clinical manifestations and delays formal therapy. For patients presenting with facial edematous erythema accompanied by atypical epidermal pathological changes, comprehensive serological screening and thorough histopathological examination are warranted. Early clinicopathological combined diagnosis, antimalarial drugs and strict sun protection help avoid misdiagnosis and recurrence.
Hsin-Kai Chen,1,2 Hsi-Cheng Liu,3 Heng-Ju Lin,4 Donghui Wu51Xiamen Siming Ruilijia Plastic Surgery Clinic, Xiamen, Fujian Province, 361001, People’s Republic of China; 2Department of Plastic Surgery of Ruilijia Health & Aesthetic Clinic, Taipei City, 105, People’s Republic of China; 3Dermatology Department of POLI Dermatology Clinic, Jiaxing City, Zhejiang Province, People’s Republic of China; 4Department of Plastic Surgery of NovelLife Medical Group Co., Ltd, Shanghai, People’s Republic of China; 5Department of Plastic Surgery of Changsha Jiexi Medical Aesthetic Clinic, Changsha City, Hunan Province, 410004, People’s Republic of ChinaCorrespondence: Hsin-Kai Chen, Xiamen Siming Ruilijia Plastic Surgery Clinic, Xiamen, Fujian Province, 361001, People’s Republic of China, Email mk1011@ms61.hinet.netBackground: Nonsurgical rhinoplasty using hyaluronic acid fillers provides minimally invasive correction of selected nasal contour irregularities. Hybrid formulations incorporating biodegradable polymeric microspheres have been developed to provide immediate volumetric correction together with additional structural support; however, clinical evidence regarding these formulations remains limited.Objective: To evaluate the short-term safety, tolerability, preliminary aesthetic effectiveness, and patient satisfaction associated with an investigational hybrid filler containing cross-linked hyaluronic acid, polycaprolactone, and polylactic acid microspheres.Methods: This prospective, single-center, uncontrolled pilot study included 150 adults undergoing nonsurgical rhinoplasty. Participants were assessed at baseline, Day 2, Week 2, Month 1, and Month 3. Outcomes included treatment-emergent adverse events, Global Aesthetic Improvement Scale ratings, patient satisfaction, nasal tip projection, dorsal height, and procedural characteristics.Results: Improved or Very Improved GAIS ratings were observed in 86.7% of participants at Month 1 and 83.3% at Month 3. Satisfaction scores of 4– 5 were reported by 90.0% at Month 1 and 86.7% at Month 3. Tip projection increased by more than 1.5 mm in 70.0%, while dorsal height increased by more than 2.0 mm in 63.3%. Mild events included transient erythema in 3.3%, minor bruising in 13.3%, and injection-site pain with a VAS score greater than 5 in 10.0%. No serious or treatment-requiring adverse event, vascular compromise, skin necrosis, visual disturbance, infection, granuloma, delayed inflammatory reaction, or filler migration was observed during three months of follow-up.Conclusion: The investigational formulation demonstrated favorable short-term tolerability and early aesthetic improvement in an uncontrolled pilot setting. These findings do not establish comparative effectiveness, long-term durability, tissue integration, or long-term biocompatibility. Controlled studies with extended follow-up are required.Keywords: hyaluronic acid filler, nasal contouring, polymeric microspheres, biocompatibility, aesthetic dermatology
Sejin Cheon,1,* Haeun Lee,1,* Da Yeong Nam,2,* Seokjun Kim,3,4,* Kyeongeun Kim,4 Jaeyu Park,4 Dong-Geol Lee,1 Chun Ho Park,1 So Min Kang,2 Young Mok Heo,1 Hyun Ho Han,5 Dong Keon Yon3,4,6,71Research and Innovation Center, COSMAX BTI, Seongnam, South Korea; 2Korea Biomedical Research Institute (KBI), Seongnam, South Korea; 3Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea; 4Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea; 5Department of Plastic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea; 6Department of Precision Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea; 7Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea*These authors contributed equally to this workCorrespondence: Dong Keon Yon, Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea, Email yonkkang@gmail.comObjective: Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by epidermal barrier disruption and immune dysregulation. Live-MB2 and CX-2 were used in an ex vivo human skin AD-like model, which provides a biologically relevant platform for assessing cosmetic ingredients targeting AD-like features.Methods: An AD-like condition was induced in ex vivo human skin explants by repeated tape stripping followed by 2,4-dinitrochlorobenzene stimulation. Skin tissues were treated with Live-MB2 or CX-2 via topical or dermal exposure. Epidermal thickness, IgE, and filaggrin levels were evaluated using hematoxylin and eosin, immunofluorescence, and Enzyme-Linked Immunosorbent Assay analyses.Results: Topical application of Live-MB2 and CX-2 significantly reduced epidermal thickness compared with AD-induced controls. IgE levels were significantly reduced, while filaggrin expression indicated a marked increase, indicating barrier recovery. No treatment-related tissue damage was observed.Conclusion: Live-MB2 and CX-2 showed favorable effects on inflammatory and barrier-related parameters in an ex vivo human skin AD-like model, supporting their potential application as cosmetic ingredients for sensitive and atopic-prone skin.Keywords: Ex vivo human skin, atopic dermatitis, live biotics, skin barrier, filaggrin, cosmetic ingredients
Elena Caride MianaClínica Dra Caride, Alicante, EspañaCorrespondence: Elena Caride Miana, Clínica Dra Caride, Calle Berenguer de Marquina 24, Alicante, España, Tel +34 677142744, Email dracaride@gmail.comBackground: Lip augmentation with hyaluronic acid (HA) fillers remains one of the most technically demanding procedures in aesthetic medicine due to the complex interaction between anatomical variability, tissue quality, dynamic muscular activity, aging-related changes, and previous aesthetic interventions. Although several assessment tools exist for evaluating lip volume, there is currently no standardized system designed to stratify lip treatment complexity and guide therapeutic decision-making. This study proposes the Lip Complexity Classification (LCC), a novel framework intended to correlate anatomical complexity with treatment objectives and injection strategies.Methods: A conceptual classification system was developed based on anatomical principles and clinical experience. The LCC integrates five key assessment domains: relative lip volume, shape and symmetry, signs of perioral aging, tissue quality, and history of previous treatments. Patients are stratified into three complexity grades (Grade I–III) according to the highest-complexity criterion identified during clinical assessment. For each grade, specific therapeutic objectives, proposed treatment strategies, and technique-oriented approaches were defined.Results: The proposed classification distinguishes three progressively complex clinical scenarios. Grade I (low complexity) is characterized by preserved anatomy and is primarily managed through compartment-based volumization strategies. Grade II (moderate complexity) includes early structural deterioration, mild asymmetry, or functional imbalance, requiring combined restoration of lip architecture and selective treatment of adjacent perioral structures. Grade III (high complexity) encompasses advanced anatomical deterioration, significant tissue compromise, and sequelae of previous aesthetic treatments, frequently requiring multilayer lip and perioral rehabilitation. The framework establishes a direct relationship between complexity grade, therapeutic objectives, anatomical targets, product selection, injection depth, and technical approach.Conclusion: The Lip Complexity Classification (LCC) provides a structured, multidimensional framework for assessing lip treatment complexity beyond lip volume alone. As a conceptual framework requiring further validation, the LCC may support treatment planning, procedural standardization, and medical education, while providing a basis for future integration with AI-assisted assessment, non-invasive imaging, and multimodal treatment strategies. Its reliability, validity, clinical utility, safety, and potential impact on treatment outcomes and procedural standardization remain to be established. Prospective studies are required to establish its reproducibility and clinical utility before routine implementation in clinical decision-making.Keywords: lip augmentation, hyaluronic acid fillers, lip complexity classification, lip rejuvenation, perioral rejuvenation
Drug-induced bullous pemphigoid (BP) is an increasingly recognized variant of BP with unique challenges in management, particularly when patients require continuation of the offending medication or are contraindicated to conventional immunosuppressive therapies. We report 4 patients with drug-induced BP, three associated with dipeptidyl peptidase-4 inhibitors and one with immune checkpoint inhibitor, successfully treated with dupilumab. All four patients had failed or were intolerant to conventional therapies. Following dupilumab initiation, all patients experienced significant improvement in pruritus within 2 weeks. Complete remission was achieved in 3 patients within 1-5 months of treatment and one patient had stable disease, enabling him to resume pembrolizumab therapy for esophageal cancer while on dupilumab. No significant adverse effects were reported during treatment periods. Our findings, supported by a literature review, suggest that dupilumab demonstrates promising efficacy and safety in treating drug-induced BP, with rapid improvement in pruritus and resolution of skin lesions. It may offer a valuable therapeutic alternative as a steroid sparing agent for elderly patients with multiple comorbidities and provides the potential to continue necessary medications (eg, cancer therapy) that may have triggered BP.
Purpose:We describe a rare case of panniculitis following aesthetic thermotherapy in a patient with psoriasis, who responded well to tofacitinib. To the best of our knowledge, this is the first reported case of aesthetic thermotherapy-induced panniculitis in a patient with psoriasis. Case Report:A 39-year-old female with a 4-year history of psoriasis vulgaris developed multiple subcutaneous nodules on the extremities and abdomen one month after completing a one-week course of whole-body aesthetic thermotherapy (approximately 40-50 ° C, approximately one hour per session). Physical examination revealed firm, mobile, mildly tender nodules, with the largest measuring 5 cm in diameter and overlying skin appearing normal or slightly reddish. Laboratory investigations to exclude other causes of panniculitis, including autoimmune markers and infection screening, were unremarkable except for an elevated C-reactive protein level (118.6 mg/L). Ultrasound demonstrated subcutaneous inflammatory changes, and percutaneous biopsy confirmed chronic inflammation with histiocytic infiltration, consistent with panniculitis. The patient was treated with oral tofacitinib (5 mg once daily) for six months, resulting in significant clinical improvement during follow-up; the underlying psoriasis remained stable. Conclusion:Aesthetic thermotherapy can rarely induce panniculitis, especially in patients with underlying psoriasis and immune dysregulation. This case highlights the need to consider panniculitis when patients present with new subcutaneous nodules after cosmetic thermal procedures. Tofacitinib appears to be an effective treatment option.
Background:Facial-predominant inflammatory dermatoses are diagnostically heterogeneous and may overlap with atopic dermatitis (AD), contact dermatitis, rosacea-like inflammation, and autoimmune mimics. Stapokibart, an IL-4Rα-targeted monoclonal antibody, has demonstrated efficacy in moderate-to-severe AD, but real-world experience in facial-predominant AD-like presentations remains limited. Methods:We retrospectively reviewed five unpublished patients with facial-predominant inflammatory dermatoses treated with stapokibart in routine practice. Clinical phenotype, diagnostic work-up, prior and concomitant therapy, dosing, symptom scores, treatment course, recurrence, and adverse events were summarized descriptively. The cohort was not intended as a diagnostically uniform efficacy population, and no formal hypothesis testing was performed. Results:Five women aged 28-75 years were included. Pruritus numerical rating scale changed from a median of 3 (range, 2-4) at baseline to 1 (range, 0-3) at first follow-up; four patients improved and one worsened. All three patients with a well-supported facial-predominant AD phenotype showed rapid improvement in facial lesions and pruritus after stapokibart. One of these patients developed an injection-site reaction that led to treatment discontinuation; no serious adverse events were observed. One patient initially treated for AD-like facial dermatitis was subsequently evaluated for possible early clinically amyopathic dermatomyositis after telangiectatic and mildly atrophic features became more apparent. Another patient with an incompletely characterized AD-like facial eruption worsened on day 2 after stapokibart. Conclusion:In this small case series, rapid improvement was observed in all three patients with a well-supported facial-predominant AD phenotype, whereas atypical or incompletely characterized eruptions showed greater diagnostic complexity and variable outcomes. These preliminary observations support further investigation of stapokibart in facial-predominant AD while underscoring the need for careful phenotyping before IL-4Rα blockade.
Jiaxin Meng, Lingzhu Liao, Shi Wu, Yong He, Yunfeng Hu, Saijun LiuDepartment of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510632, People’s Republic of ChinaCorrespondence: Saijun Liu, Department of Dermatology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510632, People’s Republic of China, Email saijun_l@jnu.edu.cnAbstract: Moulin’s linear atrophoderma (LAM) is a rare acquired pigmentary atrophic dermatosis distributed along Blaschko’s lines, with an unclear etiology and poorly understood pathogenesis. This report presents two cases of LAM. Both patients were male, with onset during adolescence. Notably, one patient exhibited elevated antinuclear antibody (ANA) levels (1:320). Histopathological examination of both cases revealed a generally normal or mildly hyperplastic epidermis, hyperpigmentation of the basal layer, and a mixed inflammatory cell infiltrate (predominantly lymphocytes) in the dermis. Based on their clinical presentation and histopathological findings, both patients were diagnosed with LAM.Keywords: atrophic patch, Blaschko’s lines, linear atrophoderma of the skin
Jie Zhou, Shichen Jiang, Weimian XiaoDepartment of Dermatology, Qingyuan Chronic Disease Prevention Hospital, Qingyuan, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jie Zhou, Department of Dermatology, Qingyuan Chronic Disease Prevention Hospital, Qingyuan, Guangdong, 511500, People’s Republic of China, Email 516631535@qq.comAbstract: Telangiectasia macularis eruptiva perstans (TMEP) is a rare subtype of cutaneous mastocytosis with a favorable prognosis and typically no systemic involvement. Although mast cell infiltration is a key histopathological feature, the cost and invasiveness of biopsy can deter patients from undergoing the procedure. Non-invasive techniques such as dermoscopy and reflectance confocal microscopy (RCM) can be helpful in the diagnosis of TMEP. However, the dermoscopic and RCM features of TMEP have not been fully elucidated. Herein, we report a case of TMEP and describe its dermoscopic and RCM features.Keywords: dermoscopy, reflectance confocal microscopy, Telangiectasia macularis eruptiva perstans, TMEP
Yu-Hao Song,1 Ying-Qi Zhang,1 Bin Zhang,2 Qiang Zhang,3 Ri-Ga Wu11Department of Dermatology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, People’s Republic of China; 2Beijing Children’s Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Inner Mongolia Medical University, Hohhot, Inner Mongolia, People’s Republic of ChinaCorrespondence: Ri-Ga Wu, Email wuriga301@163.com Qiang Zhang, Email 735739102@qq.comBackground: Severe alopecia areata (AA) in very young children is difficult to manage because evidence-based treatment options are limited and currently approved Janus kinase (JAK) inhibitor therapies do not cover children younger than 12 years. Type 2 immune activity may contribute to AA in a subset of patients with atopic features, providing a rationale for considering dupilumab.Case Presentation: A 2-year-and-5-month-old girl with a 2-year history of progressive scalp hair loss presented with severe diffuse AA (Severity of Alopecia Tool [SALT] score, 85%). She had a history of eczema, a family history of eczema, and mildly elevated total serum immunoglobulin E. Baseline dermoscopy showed sparse vellus hairs and occasional black dots without prominent perifollicular erythema or vascular changes. Previous topical and systemic treatments had produced minimal improvement.Intervention and Outcome: After discussion with the family regarding the off-label nature, uncertainties, potential risks, and alternatives, subcutaneous dupilumab was initiated together with topical 5% minoxidil. Initial regrowth was observed at week 7, followed by progressive improvement; the SALT score decreased to approximately 9% by week 37. No treatment-related adverse events were reported during 9 months of follow-up.Conclusion: This case adds to emerging evidence that dupilumab may be considered in carefully selected pediatric patients with severe, treatment-refractory AA and features suggestive of type 2 immune involvement. Because minoxidil was continued concomitantly, baseline inflammatory activity was limited, and spontaneous regrowth cannot be excluded, the clinical improvement cannot be attributed to dupilumab alone.Keywords: alopecia areata, dupilumab, pediatric, minoxidil, type 2 inflammation, SALT score
Chaochao Lu,1,* Chenchang He,1,* Guofang Wang,1,* Shuo Zhao,2 Heling Huang31Department of Medical and Radiation Oncology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 2Cixi Biomedical Research Institute, Wenzhou Medical University, Cixi, Zhejiang, People’s Republic of China; 3Department of Geriatrics, The Second Affiliated Hospital and Yuying Childrens Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Heling Huang, Email wzhhl10000@163.comBackground: Malignant melanoma(MM) is a significant global health concern, with increasing incidence worldwide. However, comprehensive assessments of its burden in Asia remain limited.Methods: Based on the Global Burden of Disease Study (GBD) data for 2023, an analysis was conducted on the disease burden of MM across 48 countries in Asia from 1990 to 2023. The trends in the disease burden of MM were assessed using the Estimated Annual Percentage Change (EAPC). Furthermore, the Bayesian Age-Period-Cohort (BAPC) model was employed to predict the future burden of MM to 2050.Results: From 1990 to 2023, age-standardized incidence rates (ASIR) increased across most of Asia, with the most pronounced positive EAPC values observed in low- and middle-SDI regions. In contrast, high-SDI areas exhibited stable incidence rates but declining mortality and disability-adjusted life year (DALY) rates. The epicenter of the burden shifted from affluent nations to rapidly developing economies; by 2023, East Asia reported the highest absolute case numbers and prevalence. The age distribution has shifted from the 45– 64 age group to those aged 65 years and older, with individuals aged 75 and above dominating both prevalence and mortality rates in East Asia. Key drivers of these trends include cumulative UV exposure, lifestyle changes, and disparities in diagnosis and treatment. The BAPC forecasts for East Asia from 2024 to 2050 predict continued increases in ASIR and prevalence, stabilization of mortality rates, and modest declines in DALYs; however, uncertainty intervals widen as the forecast horizon extends.Conclusion: Asia faces a dual challenge: rising incidence and a progressive eastward/southward burden shift to lower‑SDI countries. Effective responses require equitable, context‑specific strategies combining sun‑safety campaigns, early detection, advanced diagnostics, and affordable treatments across socioeconomic strata. Strengthening prevention, healthcare infrastructure, and surveillance is essential to reduce the long‑term human and economic impact of melanoma in the region.Keywords: Malignant melanoma, Asia, Global burden of disease, Sociodemographic index, Average annual percent change
Chaerani Pratiwi Firdaus, Reiva Farah Dwiyana, Laila Tsaqilah, Endang Sutedja, Oki Suwarsa, Miranti Pangastuti, Erda Avriyanti, Devina Gracia PratamaDepartment of Dermatology, Venereology, and Aesthetics, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, 40161, IndonesiaCorrespondence: Chaerani Pratiwi Firdaus, Department of Dermatology, Venereology, and Aesthetics, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Email chaerani.pratiwi@unpad.ac.idAbstract: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening mucocutaneous reactions causing necrosis of external and internal body surfaces, thereby predisposing patients to multiorgan complications. Numerous internal organ systems are impacted by SJS-TEN, encompassing the skin, ocular, ear, nose, and throat (ENT), pulmonary, gastrointestinal (GIT), and genitourinary systems. The acute and long-term organ complications associated with SJS-TEN have not been comprehensively documented. The objective of this review is to systematically delineate multiorgan complications in cases of SJS-TEN. A comprehensive search of the available literature was conducted on electronic databases (PubMed and Scopus) published between 2019 and 2024, reporting SJS-TEN patients with multiorgan complications using predefined search terms and inclusion/exclusion criteria. The terms "Stevens-Johnson syndrome”, "toxic epidermal necrolysis”, "organ complication”, "multiorgan involvement”, and "sequelae” were used as keywords. We included 38 articles reporting SJS-TEN patients with multiorgan complications, comprising 15 reviews, 11 original studies, 9 case reports, and 3 case series; data were synthesized descriptively, and no quantitative meta-analysis was performed. Reported percentages therefore reflect the proportion of included studies reporting a given complication, not patient-level prevalence. Among studies providing extractable patient-level data, the mean age of the subject population was 36.72 ± 26.58 years, with female predominance (88.2%). Ocular involvement was the complication most frequently reported across the included studies (65.8% of studies), followed by pulmonary and genitourinary involvement (26.32% of studies each) and skin complications (21.05% of studies). The most frequently reported ocular complications were trichiasis, distichiasis, and symblepharon, each noted in 60% of studies reporting ocular involvement. SJS-TEN represents a severe delayed-type hypersensitivity reaction with a high risk of long-term mucocutaneous disabling effects. Given the heterogeneity of the included study designs, these findings should be interpreted as an indication of how frequently each complication has been reported in the literature rather than as an estimate of true patient-level risk. This systematic review emphasizes the importance of clinician awareness to ensure early detection of multiorgan complications associated with SJS-TEN, thereby ensuring optimal, multidisciplinary patient management.Keywords: organ involvement, Stevens-Johnson syndrome, toxic epidermal necrolysis
Pemphigus erythematosus (PE) is a rare subtype of pemphigus, and management may be particularly challenging when prolonged systemic corticosteroid exposure is undesirable. We report a 31-year-old woman with PE and concomitant erosive gastritis who received off-label treatment with the selective Janus kinase 1 (JAK1) inhibitor upadacitinib after continued systemic corticosteroid therapy was considered unsuitable. Despite initial treatment with methylprednisolone plus upadacitinib 15 mg daily, the disease progressed rapidly, prompting escalation of upadacitinib to 30 mg daily. New blister formation ceased within 1 week, methylprednisolone was discontinued by week 4, complete clinical resolution was achieved by week 8, and anti-desmoglein 1 antibody levels normalized by week 11. After disease control had been achieved, upadacitinib was reduced to 15 mg daily and discontinued after 8 months, with sustained remission and no treatment-related adverse events during 1 year of follow-up. In the context of limited published experience with JAK inhibitors in pemphigus, this single case provides preliminary evidence that upadacitinib may warrant further investigation as a potential corticosteroid-sparing option for selected patients with PE and treatment-limiting comorbidities.
Background:Isotretinoin is first-line for moderate-to-severe acne. Its common adverse reactions involve the mucocutaneous system, liver, and lipid metabolism, while renal dysfunction is often overlooked with scarce reports. Case Presentation:A 34-year-old female without prior renal dysfunction received isotretinoin 20 mg/day for acne. Serum creatinine rose after 3 weeks, reached 82.6 μmol/L by week 5, then decreased stepwise after discontinuation and normalized on follow-up. Urinary ultrasound was unremarkable. Observations and Analysis:The Naranjo score was 7, indicating a probable association. Unlike previous renal adverse events presenting with dysuria, edema, flank pain, or hematuria, this case was asymptomatic, which may be attributed to individual differences in drug metabolism. Conclusion:This case report describes a mild elevation in serum creatinine that was possibly associated with isotretinoin therapy and highlights the importance of clinical awareness of potential renal function changes during treatment, particularly in patients receiving long-term therapy or concomitant medications.
Menglin Li, Tao Guo, Junling ZhangDepartment of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin Institute of Integrative Dermatology, Tianjin, People’s Republic of ChinaCorrespondence: Junling Zhang, Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital; Tianjin Institute of Integrative Dermatology, No. 354, Beima Road, Hongqiao District, Tianjin, 300120, People’s Republic of China, Tel +86 13920301679, Email 13920301679@126.comBackground: Lupus erythematosus tumidus (LET) is a rare photosensitive skin lupus subtype. Its erythematous swelling easily mimics erysipelas, cellulitis or herpes zoster, leading to frequent misdiagnosis. Atypical cases complicated by interface dermatitis and patient self-medication create prominent differential diagnostic difficulties.Case Presentation: A 58-year-old woman had scalp and facial erythema swelling for 1 year, worsened over 4 days. She was repeatedly misdiagnosed with bacterial infectious skin diseases and given ineffective antibiotics. Before admission, she took herbal decoctions and received bloodletting acupuncture by herself, aggravating facial edema. Examination showed infiltrative erythema and scalp alopecia. Full autoantibody, complement and routine lab tests were nearly normal. Cheek biopsy showed typical LET mucin deposition and periadnexal lymphocytic infiltration, while scalp biopsy unexpectedly revealed focal basal liquefaction degeneration. The final diagnosis of atypical LET was made after comprehensive clinicopathological evaluation. Combined hydroxychloroquine and methylprednisolone therapy induced obvious lesion remission within 6 months of follow-up.Conclusion: This atypical LET case illustrates key differential diagnostic traps caused by long-term misdiagnosis and conflicting pathological findings. Unsupervised herbal treatment and blood-letting acupuncture disturbs clinical manifestations and delays formal therapy. For patients presenting with facial edematous erythema accompanied by atypical epidermal pathological changes, comprehensive serological screening and thorough histopathological examination are warranted. Early clinicopathological combined diagnosis, antimalarial drugs and strict sun protection help avoid misdiagnosis and recurrence.Keywords: lupus erythematosus tumidus, diagnosis, histopathology
Saeed A AL-Qahtani,1 Amal A Alqahtani,2 Hadi Almansour,1 Moaddey Alfarhan,1 Amani Khardali,1 Mohammad Jaffar Sadiq Mantargi,3 Ali Mohamed Alshabi,4 Saleh Alghamdi,5 Mohammad Algarni51Department of Pharmacy Practice, College of Pharmacy, Jazan University, Jazan, Saudi Arabia; 2Dermatology Department, King Khalid University, Abha, Saudi Arabia; 3Department of Pharmaceutical Sciences, Pharmacy Program, Batterjee Medical College, Jeddah, Saudi Arabia; 4Department of Clinical Pharmacy, College of Pharmacy, Najran University, Najran, Saudi Arabia; 5Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Baha University, Al-Baha, Saudi ArabiaCorrespondence: Mohammad Algarni, Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Baha University, Al-Baha, Saudi Arabia, Email maalqarni@bu.edu.saPurpose: Isotretinoin remains the most effective treatment for moderate-to-severe acne vulgaris; however, its use is frequently associated with mucocutaneous and metabolic adverse effects that may necessitate active clinical intervention. Data evaluating predictors of clinically significant toxicity in Saudi populations remain limited.Patients and Methods: A retrospective cohort study was conducted at a tertiary academic hospital in Saudi Arabia. Electronic medical records of patients with acne vulgaris treated with isotretinoin between January 2020 and December 2024 were reviewed. Demographic variables, acne severity, isotretinoin dosing characteristics, laboratory findings, adverse effects, management strategies, and treatment outcomes were extracted. Multivariable regression analysis was performed to identify predictors of adverse effects requiring clinical intervention.Results: A total of 444 patients were included. Most participants were aged 21– 30 years (60.4%), and females represented 50.9% of the cohort. Clinical intervention was required in 70.7% of patients, including supportive care, treatment reduction and dose discontinuation to manage isotretinoin-related adverse effects. Mucocutaneous adverse effects, particularly cheilitis and xerosis, were the most frequently documented complications. Laboratory abnormalities were observed less frequently, although elevated LDL levels were identified in 9.9% of patients, followed by elevated total cholesterol (7.2%) and triglycerides (4.5%). Elevated liver enzymes were relatively uncommon (AST 4.1%, ALT 3.2%). Higher cumulative dose, dose escalation during therapy, and higher maximum dose significantly increased the likelihood of requiring clinical intervention. Female sex and higher body weight were associated with lower odds of intervention. Major improvement was achieved in 37.4%, complete clearance in 28.8%, giving a combined rate of 66.2% while recurrence after discontinuation occurred in 19.4%.Conclusion: Isotretinoin, proved efficacious clinically in the management of acne vulgaris, however was identified to be associated with high number of adverse effects which require active management. Multivariable regression identified that the increasing dose and cumulative dose were the most influential determinants of the drug therapy. Particularly, lipid abnormalities (elevated LDL) were clinically relevant for the included cohort of patients. The outcomes therefore emphasize the need for a personalised approach to dosing along with continuous monitoring to achieve the optimal results.Keywords: cheilitis, xerosis, hyperlipidemia, pharmacovigilance, retinoids, dermato-pharmacology
Background:Vitiligo is a chronic autoimmune disease characterized by depigmented patches on the skin. Despite the availability of several therapeutic options, treatment outcomes remain variable, particularly in extensive or refractory disease. Tofacitinib, a Janus kinase (JAK) inhibitor, has emerged as a potential therapeutic option for vitiligo. Here we aimed to review the existing evidence on the efficacy and safety of tofacitinib for the treatment of vitiligo. Methods:A comprehensive search was conducted in PubMed, Scopus, and Web of Science identify English-language studies evaluating the use of tofacitinib in vitiligo patients. Results:Twenty-five studies evaluating oral and topical tofacitinib were reviewed. Reported repigmentation rates ranged from 14.4% to 90%, with several studies also demonstrating improvements in disease activity scores. Most adverse events were mild and infrequent. However, the available evidence is derived predominantly from case reports, case series, and small observational studies, and many patients received concomitant therapies such as phototherapy, limiting the interpretation of treatment efficacy. Conclusion:Current evidence suggests that tofacitinib may represent a promising therapeutic option for vitiligo. However, the available evidence remains limited by the predominance of small uncontrolled studies, heterogeneous treatment protocols, and concomitant therapies. Larger prospective controlled studies are needed to better establish its efficacy, long-term safety, and role within current vitiligo treatment strategies.
Background:Bullous pemphigoid research spans autoantigen and basement membrane biology, diagnosis, comorbidity, inflammatory pathways, and treatment, but its long-term conceptual development has not been mapped. Methods:English-language articles and reviews indexed in the Science Citation Index Expanded through December 31, 2025, were retrieved from title, author-keyword, and abstract fields. Records underwent AI-assisted first-pass screening followed by human review. Bibliometrix and VOSviewer were used for parameter-tested author-keyword clustering and a full-corpus title-term sensitivity analysis. Results:Of 3,471 screened records, 2,121 were eligible. Annual output accelerated after 2015 and exceeded 100 publications in 2022, 2023, and 2025. Author keywords were available for 55.1% of publications. The selected network contained 112 keywords, 889 links, and eight clusters. Among 924 keyword-mappable publications, autoantigens, autoantibodies, and basement membrane zone biology declined from 51.9% in 1959-1998 to 14.6% in 2021-2025. Therapeutic management and clinical outcomes increased from 7.7% to 37.8%, epidemiology and comorbidities from 1.9% to 20.8%, dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid from 0% to 12.7%, and immune checkpoint inhibitor-associated bullous pemphigoid from 0% to 10.8%. Diagnosis and related autoimmune blistering diseases peaked at 50.0% in 1999-2013 before declining to 24.3%. Inflammatory and immune effector mechanisms showed no statistically significant period variation after multiplicity adjustment. The title-term analysis recovered the major domains. Conclusion:Bullous pemphigoid research diversified from structural, immunological, and diagnostic foundations toward treatment, clinical outcomes, comorbidity, and medication-associated disease. Although author-keyword availability was incomplete and varied substantially over time, the findings provide a longitudinal map of the field, with temporal estimates reflecting relative prominence within keyword-mappable publications.
