Background A distinctive and difficult phenotype, head and neck atopic dermatitis (AD) is linked to a higher disease burden and inconsistent treatment response. The effectiveness of targeted systemic therapy in this field is currently little understood. Objectives To evaluate both the safety and effectiveness of targeted systemic therapies for individuals’ AD affecting the head and neck, such as tralokinumab, dupilumab, and upadacitinib. Methods A meta‐analysis and systematic review were conducted using PRISMA guidelines. In three databases (PubMed, Web of Science, and EMBASE), we searched for relevant research. The qualifying research included observational studies and randomized controlled trials that reported outcomes among patients with head and neck involvement. The primary findings included the head and neck Eczema Area and Severity Index (H&N EASI‐75) and the percentage change in EASI. The Numerical Rating Scale for pruritus, the Dermatology Life Quality Index for quality of life, and safety outcomes were secondary results. The meta‐analysis was conducted using a random‐effects model. Results Twelve studies were included. The pooled H&N EASI‐75 response rate was 51% (95% CI: 40–62), with a mean percentage reduction in EASI of −72.86% (95% CI: −78.98 to −66.74). Significant improvements were observed in pruritus (mean change −4.38) and quality of life (−9.97). Across indirect, between‐study subgroup comparisons, studies of upadacitinib showed numerically greater effect estimates than studies of dupilumab or tralokinumab; in the absence of head‐to‐head trials, these comparisons are hypothesis‐generating rather than definitive. The overall prevalence of adverse events was 48%, with conjunctivitis (7%) and herpes zoster (2%) reported. Substantial heterogeneity was noted. Conclusions Targeted systemic therapies were associated with clinically meaningful improvements in head and neck AD, although substantial heterogeneity and the indirect nature of the drug‐specific comparisons warrant cautious interpretation. Differences in efficacy and safety profiles across agents highlight the importance of individualized treatment selection, and further head‐to‐head comparative studies are warranted.
Background Telogen effluvium is a common diffuse nonscarring alopecia that can cause substantial psychological distress, while currently available treatments are often slow to provide symptom relief. Methods We performed a retrospective single‐center analysis of 149 patients with TE treated between January 2023 and December 2025. Patients received intramuscular injections of compound betamethasone. Outcomes extracted from medical records included early treatment response, time to symptom improvement, duration of effect, recurrence‐free intervals, and adverse events. Results The mean patient age was 33.5 ± 9.0 years, and 98.0% were female. A chronic disease course was present in 73.8% of patients. After the first injection, 38.9% of patients achieved marked improvement without an immediate need for further injections, whereas most patients required repeated treatment. A total of 40.0% of patients showed improvement within 7 days, followed by 14 days (26.7%) and 3 days (16.7%). The most frequently documented duration of benefit after a single injection was 21 days. Except for 3.3% of the patients experiencing menstrual disorders, no serious side effects were documented. Limitations This was a retrospective, single‐center study without a control group. The efficacy outcomes rely largely on patient‐reported improvement in hair shedding, without standardized objective measurements, and detailed onset and duration data were available for only a subset of treated patients. Conclusions Intramuscular compound betamethasone may provide a rapid short‐term reduction in hair shedding in selected patients with TE and may be a useful adjunctive option in chronic or recurrent disease.
Background Androgenetic alopecia (AGA) has been suggested as a clinical marker of cardiovascular risk, but the strength of this association remains uncertain, especially in mixed‐race populations. Objective To evaluate the relationship between AGA severity, classified by the Hamilton–Norwood scale, and cardiovascular risk estimated by the Framingham Risk Score in an admixed population. Methods Cross‐sectional study including 152 men with AGA and 151 age‐ and sex‐matched controls, conducted in a dermatology outpatient setting. AGA severity was classified using the Norwood scale (Grades III–VII). Cardiovascular risk was categorized as low (< 10%), moderate (10%–20%), or high (> 20%) with the Framingham Risk Score. Associations were tested with chi‐square and Cramér’s V. Results Norwood grades among AGA patients were as follows: III (19.1%), IV (16.4%), V (22.4%), VI (13.8%), and VII (28.3%). The study population was admixed: White (37.5% AGA vs. 49.4% controls), Black (19.1% vs. 8.6%), and Brown (43, 4% vs. 38.3%); Asian participants were absent in the AGA group but represented 3.7% of controls. Cardiovascular risk in AGA patients was low in 59.2%, moderate in 21.1%, and high in 19.7%. High cardiovascular risk was significantly more prevalent ( p = 0.0026) in AGA patients (53.3%) than controls (13.3%). Hypertension, diabetes, and smoking were also more frequent in the AGA group. Conclusions Increasing AGA severity was associated with higher cardiovascular risk. AGA may serve as a simple clinical marker to prompt early cardiovascular assessment and preventive strategies. In this mixed population, AGA was more common among Black individuals, suggesting potential ethnic‐related vulnerability.
Subcutaneous fascia has attracted increasing attention as a possible contributor to deep cutaneous wound repair. Murine lineage‐tracing and skin–fascia chimera studies suggest that fascia‐associated fibroblasts and pre‐existing extracellular matrix can be mobilized into the wound bed, where they contribute to matrix deposition and wound contraction. How far these findings apply to human pathological scars, however, remains uncertain. Hypertrophic scars and keloids are distinct disorders, and their development reflects the combined effects of mechanical tension, persistent inflammation, endothelial dysfunction, fibroblast heterogeneity, genetic susceptibility, and anatomical site. At present, there is no direct evidence that fascia‐derived fibroblasts are the main cellular source of human keloids. In this review, we examine the evidence for fascia involvement alongside the broader literature on human scar biology. We also discuss several fascia‐related therapeutic targets, including retinoic acid signaling, HIF‐1α, p120‐catenin, N‐cadherin, and connexin 43. Most of these approaches are supported mainly by cell and animal studies, and their clinical value remains to be established. Fascia is therefore best viewed as one context‐dependent component of scar formation rather than a universal explanation for pathological scarring.
Background and Objectives Port‐wine stain (PWS) is a congenital capillary malformation with highly variable response to pulsed dye laser (PDL) therapy. This study developed and temporally validated a prognostic model incorporating cumulative treatment exposure, presented as a nomogram, to estimate the probability of complete lesion clearance for patient counseling. Methods We conducted a single‐center retrospective cohort study including 823 treatment‐naive Chinese patients with PWS who had completed ≥ 2 PDL sessions with ≥ 6 months of follow‐up between August 2010 and June 2022. An independent temporal external validation cohort of 134 consecutive patients treated from July 2022 to June 2025 was analyzed retrospectively. Treatment response was graded using a four‐point ordinal scale. Generalized ordered logistic regression was used to identify determinants across the full response spectrum, and a binary logistic model was constructed specifically for complete clearance prediction. Internal and temporal external validations were performed to evaluate model performance. Results Five clinical factors were identified as independent predictors of complete lesion clearance: cumulative completed treatment sessions (aOR 1.281), lesion area (aOR 0.976 per cm2), lesion color grade (aOR 0.468 per grade), sex, and age. The anatomical site was nonsignificant across all subgroups (all global p > 0.05). All significant predictors except cumulative completed treatment sessions exhibited threshold‐varying effects in the partial proportional odds model for ordinal treatment efficacy grade. The final prognostic model incorporating cumulative treatment exposure showed good apparent discriminative performance (AUC 0.748) in the derivation cohort. Bootstrap resampling (B = 500) yielded an optimism‐corrected AUC of 0.739, and performance was further validated in an independent temporal external cohort (AUC 0.789). Conclusions We constructed a nomogram for static prognostic assessment following PDL therapy in patients with PWS who had completed ≥ 2 sessions with ≥ 6 months of follow‐up. This prognostic model, incorporating cumulative treatment exposure and routinely collected clinical predictors, estimates the probability of complete lesion clearance to support prognostic counseling. Both optimism‐corrected internal and independent temporal external validation demonstrated satisfactory discrimination. Prospective validation and clinical impact studies are required before clinical implementation.
With the increasing prevalence of facial skin tumors among aging populations and growing concerns regarding anesthesia‐related risks in elderly surgical patients, this retrospective cohort study (March 2021–April 2025) evaluated the safety, clinical efficacy, and cost‐effectiveness of wide‐awake local anesthesia (WALA) compared to general anesthesia (GA) in 243 patients aged 65–90 years undergoing facial skin tumor resection. To mitigate selection bias, a propensity‐score matching was performed and the final cohort included 196 patients with comprehensive analysis of perioperative parameters, postoperative complications, hospitalization duration, and total costs. Results demonstrated that WALA significantly reduced preoperative preparation time (12 ± 3.4 versus 35 ± 9.8 min, p < 0.001), total hospitalization costs ($954 ± $187 versus $1480 ± $352, p < 0.001), and length of stay (5.2 ± 1.8 versus 11.3 ± 3.7 days, p < 0.001). Postoperative complications were markedly lower in the WALA group (2 versus 15 cases, p = 0.002), with no intensive care unit (ICU) admissions required compared to four in the GA group, while wound‐healing outcomes remained comparable between groups. These findings indicate that WALA represents a safe, clinically effective, and economically advantageous alternative to GA for facial skin tumor resection in elderly patients, offering substantial benefits in reducing complications, shortening recovery, optimizing resource utilization, and enhancing perioperative safety without compromising surgical quality. This approach holds particular promise for improving care pathways in geriatric dermatologic surgery.
Background and Aim Psoriasis is a chronic immune‐mediated inflammatory skin disease characterized by erythematous plaques with silvery scales and potential nail involvement. Jing Si herbal tea (JSHT), a formulation comprising eight medicinal herbs, has been reported to exert anti‐inflammatory and immunomodulatory effects through the regulation of proinflammatory cytokines and signaling pathways. This study aimed to evaluate the efficacy and safety of JSHT as a complementary herbal medicine compared with placebo in patients with psoriasis receiving conventional or biologic treatments. Methods This double‐blind randomized controlled trial enrolled 63 patients with psoriasis and was conducted over 3 months at a single medical center. Results JSHT administration was associated with reduced interleukin (IL)‐17 and tumor necrosis factor‐beta levels in patients receiving conventional therapy and increased IL‐10 levels in those receiving biologic therapy. However, no statistically significant differences were observed between the JSHT and placebo groups in clinical outcomes, including the Psoriasis Area and Severity Index (PASI) and body surface area (BSA). Only mild gastrointestinal adverse events were reported in the JSHT group. Conclusions JSHT demonstrated immunomodulatory effects and a favorable safety profile when used as a complementary herbal medicine in patients with psoriasis. However, no significant improvement in clinical disease severity was observed, and further studies are warranted to clarify its clinical efficacy.
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder characterized by epidermal barrier dysfunction, immune dysregulation, and intense pruritus. Although existing treatments, including topical corticosteroids, calcineurin inhibitors, and biologic agents, are effective for many patients, concerns regarding long‐term safety, cost, and incomplete disease control have driven interest in nonimmunosuppressive and complementary therapeutic strategies. L‐histidine is an essential dietary amino acid that has emerged as a potential biologic modulator in AD due to its central role in filaggrin metabolism and natural moisturizing factor (NMF) production. This narrative review synthesizes the current mechanistic, preclinical, and clinical evidence evaluating L‐histidine as a therapeutic or adjunctive intervention in AD. L‐histidine supports epidermal hydration, pH homeostasis, and barrier integrity through its role as a precursor of filaggrin‐derived NMF components. In vitro and skin‐equivalent models demonstrate that L‐histidine enhances filaggrin processing and improves functional barrier properties. Importantly, mechanistic studies indicate that histidine supplementation does not promote pathological histamine production, alleviating concerns regarding histamine‐mediated disease exacerbation. Clinical evidence, though limited to small exploratory trials and case reports, shows reductions in disease severity and pruritus in both pediatric and adult patients receiving oral L‐histidine supplementation. However, these findings should be regarded as preliminary rather than conclusive. The magnitude of improvement reported in these small trials has been described by the authors as similar to SCORAD reductions historically reported for mid‐potency topical corticosteroids. However, this is a benchmark comparison against external historical literature, not a head‐to‐head assessment. Since no head‐to‐head trial has directly compared L‐histidine with topical corticosteroids, its efficacy should not be considered equivalent or directly comparable to that of topical corticosteroids. Oral L‐histidine has demonstrated a favorable safety and tolerability profile to date, with no serious adverse events reported. L‐histidine is a low‐cost, well‐tolerated, barrier‐targeted adjunct with potential utility in AD management. Larger, long‐term randomized controlled trials incorporating genetic stratification and combination therapy designs are warranted to better define its optimal role in clinical practice.
Background Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs), widely used for diabetes and obesity, possess anti‐inflammatory and tissue‐reparative properties. Their dermatological relevance is increasingly recognized, but the available evidence remains heterogeneous and lacks integrated evaluation with exploratory genetic evidence. Objective To map the clinical evidence landscape of GLP‐1RAs in skin diseases and to investigate the genetically predicted association between GLP‐1 receptor (GLP‐1R) signaling and dermatological outcomes. Methods We performed an updated scoping review of published clinical evidence integrated with a two‐sample Mendelian randomization (MR) analysis. The MR analysis utilized large‐scale plasma proteome genome‐wide association study data (n = 35,559) and FinnGen datasets. Mediation analyses incorporating 1091 blood metabolites and 91 inflammatory proteins were conducted to explore potential underlying pathways. Results The updated scoping review included 113 published studies. Psoriasis/psoriatic disease, diabetic foot ulcers, and hidradenitis suppurativa represented major beneficial‐effect categories, whereas cutaneous adverse events such as dermal hypersensitivity reactions and hair loss were also frequently reported. Building upon these clinical findings, our exploratory MR analysis showed that genetically predicted GLP‐1R levels were nominally associated with lower psoriasis vulgaris risk (OR = 0.29; 95% CI = 0.10–0.80; p = 0.017). Mediation analysis suggested a potential overall association between GLP‐1R and psoriasis risk (OR = 0.986; 95% CI = 0.976–0.997; p = 0.014), with possible mediation by metabolites including 3‐hydroxydodecanedioate (mediation proportion, 6.8%) and the mannose‐to‐fructose ratio (5.3%), as well as the inflammatory protein interleukin‐9 (−5.7%). Conclusions This integrative study synthesizes evidence from a scoping review and exploratory genetic analysis, suggesting a potential protective association between GLP‐1R signaling and psoriasis. The findings support further investigation of incretin‐based strategies in psoriatic disease and provide hypothesis‐generating genetic insights into potential metabolic and inflammatory mechanisms.
Background Fingernail onychomycosis differs clinically from toenail disease. While toenail onychomycosis has been extensively studied, research investigating demographic characteristics, histopathology, and causative organisms as prognostic factors for cure specifically in fingernail cases remains notably limited. Although prognostic factors for toenail onychomycosis have been extensively documented, these findings cannot be directly extrapolated to fingernail infections due to distinct environmental and occupational exposures. Consequently, conducting a direct comparative study between these two anatomical sites remains challenging and represents an important avenue for future research. Objectives This retrospective cohort study aims to identify prognostic factors associated with the cure of fingernail onychomycosis. Methods This study included patients aged 18 years or older diagnosed with fingernail onychomycosis who underwent histopathological examination of nail specimens, excluding those with incomplete records. Clinical evaluation and laboratory investigation were studied. Descriptive statistics, chi‐square tests, and independent t‐tests were utilized for data analysis. Results A total of 45 patients (predominantly female, 71.1%) with a mean age of 48.0 ± 20.5 years were enrolled. Distal and lateral subungual onychomycosis and proximal subungual onychomycosis were found in 38 (84.4%) and 7 (15.6%) patients, respectively. Ring finger involvement (18 cases, 40.0%) was significantly associated with younger patients (p = 0.003) and presented with periungual inflammation at the proximal nail fold (p = 0.021). Thirteen cases (28.9%) failed to respond to standard systemic therapy. Within the population with ring finger involvement, the treatment failure rate was 55.6% (10 out of 18 cases). These nonresponders were significantly younger (p = 0.014), more likely to have ring finger involvement (p = 0.001) and presented with septate hyphae on histology (100.0%, p = 0.010). Conclusion Onychomycosis of the ring finger in young patients was observed to be recalcitrant to treatment, suggesting that these cases may require closer monitoring or alternative therapeutic approaches in clinical practice. Histopathological features, including mold invasion of the nail plate and polymorphonuclear cells infiltration, tended to be found in treatment failure cases.
Background Current assessment of rosacea relies on subjective visual scoring, which often fails to capture subtle changes predictive of treatment response or progression. Multimodal imaging may provide complementary quantitative structural, vascular, and biomechanical information to improve disease evaluation. Objective To evaluate the feasibility of multimodal ultrasound, including grayscale ultrasound (GSUS), shear wave elastography (SWE), and ultramicro angiography (UMA)—combined with multispectral skin imaging (MSI) and investigator global assessment (IGA) scores in detecting rosacea and monitoring treatment response. Methods Forty participants (20 rosacea and 20 healthy controls) were examined. IGA erythema and papule scores and all imaging parameters were obtained from identical facial sites before and after 4‐week barrier‐repair therapy. The epidermal thickness (ET), dermal thickness (DT), color pixel percentage (CPP), SWE elasticity values (E_mean, E_max, and E_min), and erythema indices (EAR and REI) were extracted from the images. Data between the two groups were compared using Student’s t ‐test for normally distributed variables, the Mann–Whitney U test for nonnormal variables, and the chi‐square or Fisher’s exact test for categorical variables. Diagnostic performance was assessed by measuring the area under the curve of a receiver operator characteristic curve (ROC). Results Compared with healthy controls, patients with rosacea exhibited significant alterations in ultrasound parameters, including reduced ET and DT and increased CPP, alongside significant changes in erythema‐related parameters on multispectral imaging. ROC analysis showed that ET and CPP may have potential value in distinguishing rosacea from healthy skin. Following treatment, ET and DT increased, while CPP and IGA scores decreased, whereas SWE parameters showed no significant change. Conclusion MMUS combined with MSI and IGA enables quantitative assessment of structural, vascular, and erythema‐related changes in rosacea. This multimodal imaging clinical approach may serve as an adjunctive objective tool for the evaluation and monitoring of rosacea. Trial Registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR2600128241
Background Radiofrequency (RF) treatment improves chronologically aged and photodamaged skin with rhytids. The patterns of RF‐induced thermal tissue reactions can vary depending on the tissue resistance and treatment settings. In this study, we aimed to histologically and thermometrically evaluate the patterns of 6.78‐MHz monopolar and 1‐MHz mono‐/bipolar RF‐induced thermal tissue reactions in animal skin in vivo and ex vivo. Methods Various settings of 6.78‐MHz monopolar RF at two different pulse mode characteristics (types S and H) were applied in vivo to minipigs, whereas various settings of 6.78‐MHz monopolar RF or 1‐MHz monopolar or bipolar RF were applied in vivo to rats. Subsequently, samples of the treated tissues were evaluated histologically. Ex vivo, porcine skin samples were treated with 6.78‐MHz monopolar RF, and real‐time noncontact infrared thermometry was used to monitor their surface and deep temperatures. Results In the in vivo porcine skin study, 6.78‐MHz monopolar RF treatments at both pulse characteristics generated similarly effective thermal tissue reactions in the entire dermis and the fibrous septa of subcutaneous fat. However, RF treatment at the type‐S setting delivered RF energy preferentially through the fibrous septa of subcutaneous fat into the muscular fibrous layers. Meanwhile, RF treatment at the type‐H setting induced volumetric thermal reactions in the mid‐ to deep dermis and the fibrous septa of the subcutaneous fat layer. Thirty days post‐treatment, qualitatively increased numbers of thickened and elongated elastic fibers were noted in the lower reticular dermis and the fibrous septa of the subcutaneous fat layer across all experimental settings. RF treatments with three or five stacked passes using two pulse types resulted in different thermometric reactions in the surface and subcutaneous fat areas of ex vivo porcine skin. Additionally, the in vivo rat skin study revealed histopathologic differences based on experimental settings using 1‐MHz RF. Conclusion Our histologic and thermometric pilot experiments demonstrated various patterns of RF‐induced early and late thermal tissue reactions based on the treatment settings, including 6.78‐MHz monopolar, 1‐MHz monopolar, and 1‐MHz bipolar RF delivery.
Background Scalp conditions such as dandruff and pruritus are common even among otherwise healthy individuals and have been associated with impaired skin barrier function and abnormal epidermal differentiation. Moisturizers containing celastrol and Cichorium intybus root extract have previously demonstrated clinical benefits in patients with psoriasis, a condition characterized by similar pathogenic abnormalities. Objective To evaluate changes in scalp condition following the use of a scalp moisturizer containing celastrol and C. intybus root extract and to assess the clinical utility of an artificial intelligence–based scalp assessment system (SPI‐AI) in detecting treatment‐related improvements. Methods This prospective clinical trial enrolled 23 participants with scalp conditions, including erythema, dryness, scaling, and dandruff, who applied the moisturizer once daily for 4 weeks. The primary outcome was the change in scalp condition, assessed using SPI‐AI. Secondary outcomes included biophysical parameters (erythema index, stratum corneum hydration, and transepidermal water loss [TEWL]) and patient‐reported symptoms assessed using the visual analog scale (VAS). Results At Week 4, the total SPI‐AI score showed significant improvement (23.7 ± 4.5 to 20.5 ± 4.3, p = 0.005), with the erythema (9.5 ± 3.5 to 7.6 ± 2.9, p = 0.003) and folliculitis (4.0 ± 1.6 to 2.7 ± 1.1, p = 0.008) components exhibiting the most pronounced changes. In parallel, patient‐reported symptoms improved significantly (5.9 ± 1.8 to 3.7 ± 1.7, p < 0.001). Among the secondary outcomes, erythema index decreased significantly at Week 2 (139.3 ± 37.3 to 131.4 ± 40.4, p = 0.020), whereas no significant changes were observed in stratum corneum hydration or TEWL. Treatment compliance was high without serious adverse events reported. Conclusions A scalp moisturizer containing celastrol and C. intybus root extract significantly improved scalp condition and exhibited a favorable safety profile. SPI‐AI sensitively detected early changes in scalp condition in a clinical trial setting. Trial Registration: ClinicalTrials.gov Identifier: NCT07459023
Photodynamic therapy (PDT) is a noninvasive therapeutic strategy that utilizes the synergistic interaction among a photosensitizer, light of a specific wavelength, and tissue oxygen to generate cytotoxic reactive oxygen species (ROS), thereby selectively destroying pathological tissues. Against the backdrop of increasingly severe global antibiotic resistance, PDT has demonstrated significant potential in the treatment of infectious skin diseases, owing to its unique multitarget mechanism of action and low propensity for inducing resistance. This review systematically elucidates the core antimicrobial mechanisms of PDT, summarizes its clinical advances in bacterial, fungal, and viral skin infections, and specifically discusses treatment strategies for special populations (such as children and pregnant women) and refractory cases. Finally, the article analyzes the current challenges in the clinical translation of PDT, including the lack of standardized treatment parameters and limited PS delivery efficiency, and offers perspectives on future directions, encompassing the development of novel PSs, the application of nanotechnology, and personalized treatment.
Background Prurigo nodularis (PN) is a chronic, neuroimmune‐mediated dermatosis characterized by intense pruritus and nodular lesions that severely impair patient quality of life. The limitations of conventional therapies in providing more than symptomatic relief have necessitated novel approaches targeting the disease’s heterogeneous pathogenesis. Objective This review evaluates current treatment algorithms and the potential future clinical frameworks tailored to the immunological and neuropathic endotypes of PN. Methods A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, and Google Scholar databases for English‐language peer‐reviewed articles, clinical trials, and guidelines published up to December 2025, focusing on targeted and conventional therapies for prurigo nodularis. Results In addition to approved biologics such as the IL‐4/IL‐13 pathway inhibitor dupilumab and the IL‐31 receptor antagonist nemolizumab, this review discusses emerging options, including JAK inhibitors, mast cell–targeted therapies, and opioid modulators. Current evidence suggests that these targeted agents offer significant improvements in both pruritus and lesion resolution by addressing specific molecular drivers. Conclusion The management of PN is entering a transitional phase, with an emerging goal to evolve from uniform approaches toward future biomarker‐ and phenotype‐based, disease‐modifying, and personalized strategies. Defining these endotypes more precisely will be essential for optimizing potential therapeutic individualization and long‐term clinical success.
Background HMME‐PDT has been proven to be safe and effective for treating port‐wine stains (PWS). However, due to the relatively high overall cost of a single session, particularly for patients with large‐area PWS, some patients may forego treatment due to financial constraints. There is a need to explore new treatment methods for HMME‐PDT for large‐area PWS. Objective To investigate the safety and effectiveness of modified HMME‐PDT, aiming to provide a more efficient treatment option for large‐area PWS. Methods Patients with large‐area PWS were treated with modified HMME‐PDT. Modified HMME‐PDT consists of two treatment stages, with the first stage being equivalent to the traditional HMME‐PDT for partial lesions, continuously followed by the second stage in which the treatment device heads were moved to remaining untreated lesions for irradiation. Initially, all patients received an intravenous injection of 5 mg/kg HMME, and then the partial lesions of the patients were exposed to 532 nm LED green light after 10 min. The irradiation power density ranged between 80 and 100 mW/cm2. Treatment parameters in the second stage remained consistent with the first stage. Efficacy was evaluated 2 months after treatment, and adverse reactions were recorded and compared. Results A total of 27 patients with large‐area PWS were included in the study. In Stage 1, 1 patient (3.7%) achieved cured, 5 patients (18.6%) achieved good efficacy, 12 patients (44.4%) achieved alleviation, and 9 patients (33.3%) showed no effect, with a total effective rate of 66.7%. In the second stage treatment, 1 patient (3.7%) achieved cured, 6 patients (22.2%) achieved good efficacy, 9 patients (33.3%) achieved alleviation, and 11 patients (40.7%) showed no effect, with a total effective rate of 59.3%. No statistically significant difference in efficacy between the two stages was observed (p > 0.05). The occurrence and severity of adverse reactions did not differ significantly (p > 0.05). Conclusion Modified HMME‐PDT can provide effective treatment for double the area in a single session for patients with large‐area PWS, potentially reducing the cost and time per unit area.
Type V nodular port‐wine birthmarks (PWBs) are challenging to treat due to dilated vasculature and potential arteriovenous malformations, with conventional therapies such as pulsed dye laser often yielding limited results. Polidocanol foam sclerotherapy, though promising for vascular malformations, remains underexplored for PWB. This retrospective study evaluated the safety and efficacy of polidocanol foam sclerotherapy in patients with nodular Type V PWB at our institution. A total of 10 patients (3 male, 7 female; mean age: 41.1 ± 14.0 years) were treated with 1% or 3% polidocanol foam injections administered at monthly intervals. Efficacy was measured by nodule volume reduction, clinical improvement, and patient satisfaction. At 1‐month follow‐up, median nodule volume reduction was 77.5%, with a mean clinical improvement score of 3.1 ± 1.0 and a mean patient satisfaction score of 7.2 ± 1.7. No disease progression or major complications occurred during extended follow‐up (mean duration: 13.4 ± 10.4 months), although one patient developed a hypertrophic scar. These results suggest that polidocanol foam sclerotherapy is a safe and effective option for managing Type V nodular PWB, with minimal adverse events and high patient satisfaction, warranting further investigation in larger, prospective studies.
Background Recent research has revealed that adults make up a large share of atopic dermatitis (AD) cases and that moderate‐to‐severe AD is most common in this group. However, there are very few studies reporting on the association between dietary factors and AD in adults. Objective To explore changing trends in AD prevalence across countries and regions and the association between AD incidence rate and dietary factors among individuals aged 25 years and older from 1990 to 2021. Methods We extracted incidence rates and disability‐adjusted life year (DALY) estimates for AD, along with their 95% uncertainty intervals (UIs), from the Global Burden of Disease (GBD) study (1990–2021) to analyze disease burden and prevalence trends at the global, regional, and national levels. To assess the effects of dietary factors on AD, we used the age–period–cohort (APC) model to compare local and net drift effects of milk, red meat, sugar‐sweetened beverages (SSBs), and fiber on the incidence of AD in France (the country with the highest incidence rate) and Congo (the country with the lowest incidence rate). Age‐deviation analyses were then used to investigate the overall age‐trend effect of diet on the incidence of AD in both countries. Results From 1990 to 2021, the global incidence and DALY rates of AD showed a slight decline, with an estimated annual percentage change (EAPC) of −0.04 (95% CI: −0.06, −0.03). The AD incidence rate remained higher in females than in males. AD incidence rates were significantly positively correlated with sociodemographic index (SDI) levels (p < 0.001). Decomposition analysis showed that age contributed more to incidence in high‐than low‐SDI regions (8.94% vs. −0.16%). Dietary analysis revealed that SSBs, milk, and red meat were positively associated with AD incidence (r > 0.5, p < 0.001), while fiber was negatively associated with AD incidence (r = −0.297, p < 0.001). The APC model revealed that the net drift values for the three dietary factors—SSBs, milk, and red meat—in both France and Congo were statistically significant (p < 0.05), and the local and net drift curves exhibited significant differences. Age‐deviation analysis further confirmed consistent age‐related dietary influences on AD incidence in both countries (p < 0.001). Conclusion The incidence of AD among individuals aged ≥ 25 years showed no upward trend and was influenced by multiple factors, including socioeconomic status, geography, population aging, and dietary habits. Notably, specific dietary patterns (e.g., red meat and SSB intake) were possibly linked to AD incidence rates.
Background Periorbital wrinkles are among the earliest signs of facial aging. Objective This study evaluates the efficacy, safety, and associated histological changes of 1565‐nm Er:glass nonablative fractional laser (NAFL) for periorbital wrinkle reduction. Methods In this assessor‐blinded, prospective, split‐face randomized study, 20 Asian patients received 5 sessions of 1565‐nm NAFL on one periorbital side at 4‐week intervals. Wrinkle severity was assessed via the Fitzpatrick Wrinkle Classification System (FWCS), standardized photograph‐based wrinkle length measurements, and wrinkle reduction rate. Transepidermal water loss (TEWL), pain visual analog scale (VAS), patient satisfaction (LSS), and adverse events were recorded. A parallel animal study ( n = 9) was performed to evaluate histological changes after treatment. Results In the clinical study, the treated side showed significant improvement in periorbital wrinkles, with the FWCS score decreased from 3.23 ± 1.10 at baseline to 2.09 ± 1.00 at 3 months after treatment ( p < 0.001). Standardized photograph‐based assessment showed a mean wrinkle length reduction of 14.60% on the treated side. No severe adverse events were reported, and TEWL remained stable from baseline to the 3‐month follow‐up. The animal study showed increased epidermal and dermal thickness and collagen deposition in treated skin. Conclusion The 1565‐nm Er:glass NAFL may be an effective and safe treatment for improving mild‐to‐moderate periorbital wrinkles in young Asian adults, with supportive histological evidence of epidermal and dermal remodeling.
Allergic contact dermatitis (ACD) represents a prevalent inflammatory skin condition resulting from exposure to environmental chemicals. The landscape of ACD has evolved significantly beyond traditional occupational settings, with widespread integration of allergens into cosmetics, consumer goods, and medical devices, creating new sensitization patterns among the general population. This review summarizes the pathophysiology of ACD, reviews the most clinically important contact allergens with attention to regional variation in prevalence, and discusses the regulatory and educational implications of these trends. Key allergen categories include surfactants (alkyl glucosides), acrylates (isobornyl acrylate), metals (nickel, cobalt, chromium, and aluminum), fragrances (hydroperoxides), preservatives (benzisothiazolinone), and dyes (p‐phenylenediamine [PPD] and toluene‐2,5‐diamine sulfate [PTDS]). Pediatric populations show particularly high sensitization rates to alkyl glucosides (19.5% for decyl glucoside). Medical device–related allergens, particularly acrylates in continuous glucose monitors, represent a growing concern. Prevalence differs substantially between regions: for example, nickel sulfate positivity is 24.9% in the North American Contact Dermatitis Group (NACDG) 2021‐2022 data but considerably lower in Europe after the 1994 EU Nickel Directive, and neomycin contact allergy is 6.4% in North America versus 2.5% in Europe, reflecting differences in over‐the‐counter availability and regulation. Regulatory interventions have successfully reduced some allergen exposures but have led to substitution with potentially problematic alternatives. Effective allergen management requires proactive surveillance, comprehensive patch testing, enhanced clinician education, and coordinated regulatory responses. The appearance of new allergens following restrictions on established sensitizers underscores the need for systematic premarket evaluation and industrywide adoption of safer alternatives.
