ABSTRACT Background Despite widespread use as an effective systemic therapy for adolescent acne, the effects of isotretinoin on pediatric skeletal development remain a subject of debate in the medical literature. Evidence characterizing its potential influence on growth plate maturation and skeletal outcomes is limited. Objectives To evaluate whether adolescent isotretinoin exposure affects final height, growth velocity, bone age, and growth plate integrity. Methods We conducted a qualitative systematic review following PRISMA guidelines. Human studies of adolescents exposed to isotretinoin reporting height, growth velocity, bone age, or epiphyseal changes were included. Studies on other retinoids, non‐human data, and reports without relevant outcomes were excluded. Results Twenty studies met inclusion criteria: two (2) trials ( n = 575 patients), six (6) observational studies, seven (7) case reports, three (3) narrative reviews, and two (2) regulatory sources. In a randomized double blind trial ( n = 358), lumbar spine bone mineral density increased 1.7 to 2.0 percent, with no change after height adjustment. An open‐label multicenter trial ( n = 217) showed a 1.4 percent increase in spine bone mineral density with stable hip measurements. Observational cohorts found no reduction in adult height, with some reporting slightly greater height compared to doxycycline controls. Case reports described rare physeal arrest, primarily in younger patients and with higher or prolonged exposure. Limitations Most included studies were small cohorts, case reports, or conference abstracts, limiting precision in estimating rare events. Outcome heterogeneity and inconsistent follow‐up precluded meta‐analysis. Large electronic health record cohorts lacked data on dose, duration, adherence, pubertal stage, and parental height, and the search was restricted to English‐language publications. Findings therefore argue against large differences in final height rather than excluding subtle effects. Conclusions Current evidence does not demonstrate a clinically significant reduction in final adult height among adolescents receiving standard acne‐dose isotretinoin. Rare growth‐plate complications have been reported, primarily in younger patients and in settings of higher cumulative exposure, prolonged treatment duration, or non‐acne indications. Further prospective studies are needed to better characterize rare physeal outcomes and dose–duration relationships.
ABSTRACT We present a child with autosomal dominant anhidrotic ectodermal dysplasia with immunodeficiency (AD‐EDA‐ID) due to a pathogenic missense variant in NFKBIA presenting with atypical cutaneous manifestations. Our patient was born with a shiny ichthyotic rash on her extremities, developing into a pustulo‐vesicular and papulo‐vesicular rash. Skin biopsy showed interface vacuolar dermatitis. The rash improved with corticosteroids and resolved post‐haematopoietic stem cell transplant (HSCT). Clinicians should consider this diagnosis in treatment‐resistant eczematous/vesicular rashes in infancy, especially if systemic non‐infectious inflammation present.
ABSTRACT Ultraviolet‐induced fluorescence dermoscopy (UVFD) is a novel adjunct technique in neoplastic and non‐neoplastic dermatoses. Ochre fluorescence (OF) in dermoscopically suspect lesions has been recently reported to be a strong clue to invasive melanoma. We report the case of a 76‐year‐old male with a multi‐coloured, irregularly shaped pigmented macule located on his sun‐damaged back. Dermoscopy was suggestive of superficial spreading melanoma (SSM), whereas UVFD revealed a central OF area. Although the lesion was scheduled for excision, the patient was subsequently lost to follow‐up and returned after 5 months. The lesion markedly enlarged clinically and dermoscopically, whereas the OF area expanded and became more pronounced. Pathology report confirmed the diagnosis of SSM.
ABSTRACT Background Basal cell carcinoma (BCC) subtypes differ in biological behaviour, with aggressive variants demonstrating increased invasiveness and recurrence risk. Reliable dermoscopic indicators require further investigation. Objectives To evaluate whether semi‐quantitative assessment of dermoscopic ulceration and selected features improves recognition of aggressive BCC. Methods This retrospective study included histopathologically confirmed BCCs (April 2020–April 2024). Inclusion required definitive subtype classification and a pre‐treatment dermoscopic image. Tumours were categorised as superficial, non‐superficial low‐risk, or aggressive. Ulceration (0%, < 50%, > 50%, 100%) and dermoscopic features were assessed by three blinded investigators. Subgroup analyses investigated ulceration extent in infiltrative BCC, and brown globules in micronodular BCC. Results Of 1040 lesions, 842 BCCs from 759 patients were included (22.6% superficial, 64.1% low‐risk, 13.3% aggressive). Increasing ulceration extent demonstrated a dose–response relationship with aggressiveness (univariate OR: 1.80, 95% CI: 1.01–3.20 for 50%–99% ulceration; OR: 2.94, 95% CI: 1.60–5.40 for 100% ulceration). Ulceration ≥ 50% was associated with a twofold increased risk of aggressive BCC (adjusted OR [aOR]: 2.03, 95% CI: 1.30–3.16, p = 0.002), showing 36.6% sensitivity, 78.8% specificity, 20.9% PPV, and 89.0% NPV. Infiltrative BCC significantly associated with ulceration extent (χ 2 =9.146, p = 0.027). Brown globules increased the likelihood of aggressive BCC (aOR: 2.21, 95% CI: 1.00–4.87, p = 0.049) and were significantly associated with micronodular BCC (χ 2 =12.681, p = 0.005; 19.0% vs. 4.5% in non‐micronodular lesions). Limitations Retrospective design, reliance on dermoscopic images, and lack of external validation. Conclusions Extensive ulceration and brown globules aid recognition of aggressive BCC subtypes, being associated with infiltrative and micronodular BCC, respectively.
