Aim: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that causes a high wound burden. Diagnosis is difficult, and treatment is inconsistent. We aimed to describe clinical features, treatments administered, outcomes, and the safety profile of those treatments in a tertiary-center cohort. Materials and Methods: We performed a single-center retrospective study (2020-2025). PG was diagnosed by clinicopathologic assessment using the PARACELSUS scoring system and by exclusion of mimicking conditions. Responses were predefined: [complete response (CR), >= 75% ulcer reduction without active inflammation or new ulcers], [partial response (PR), 30-< 75% with supportive signs], and [no response (NR), < 30% or progression]. We recorded total treatment duration (TTD) and total number of treatments (TNTs). Results: Fourteen patients were included (7 women, 7 men; mean age 53.0). The ulcerative subtype was most common (n = 12/14, 85.7%); pathergy was present in 35.7% (n = 5/14). The lower limbs were the most frequent sites (n = 5/14, 35.7%). First-line therapy consisted mainly of topical and/or systemic corticosteroids (CR 57.1%, PR 7.1%, NR 35.7%). Second-line regimens (steroids, cyclosporine, colchicine, adalimumab) resulted in CR, PR, and NR rates of 28.6%, 28.6%, and 42.9%, respectively. Third-line therapy (steroids, intravenous immunoglobulin, or cyclosporine) produced PR in all cases. Infliximab, administered as fourth-line therapy (n = 3), achieved CR in 66.7% and PR in 33.3%; one wound infection occurred. The overall TTD was 4.61 +/- 4.48 months (median 3, range 1.5-18) and TNT was 1.93 +/- 1.21 (median 2, range 1-4). Adverse events occurred in 35.7% of patients overall and in 44.4% of steroid-exposed patients, typically at 3 months. TTD correlated with adverse events [r = 0.74; P = 0.002; 95% confidence interval (0.34, 0.91)]. No statistically significant sex-related differences were observed in treatment response distribution, TTD, or TNT (P > 0.05); however, descriptive trends suggested that females tended toward longer TTD, whereas males exhibited higher TNT. Conclusion: Corticosteroids are effective, but time-dependent toxicity is common. Early steroid-sparing strategies are advisable. Infliximab showed favorable response rates in refractory PG. Structured wound care should accompany all pharmacologic treatments. Larger prospective studies are needed.
Aim: Biologic treatments have become important for optimal disease control in patients with moderate to severe plaque psoriasis. The term "super response" is used to describe a faster and more sustained response to biologic treatment. This study aimed to determine the characteristics of non-super-responder (NSR) and super-responder (SR) patients with psoriasis receiving interleukin (IL)-17 or IL-23 inhibitors. Materials and Methods: Patients with plaque psoriasis who were treated with IL-17 or IL-23 inhibitors between 2020 and 2024 were retrospectively analyzed. A super response was defined as a psoriasis area and severity index (PASI) 100 response at week 16 that was maintained through week 28. The patients were divided into the NSR and SR groups and compared in terms of sociodemographic characteristics, clinical findings, biological treatments, and lipid profiles. Results: A total of 200 patients were included in the study; 96 (48%) were SRs. The frequency of super response was significantly higher among patients with an initial PAST score of >= 10 (P = 0.041). Compared with the SR group, the NSR group was more likely to have a history of biologic therapy (P = 0.002). Continued use of the same biological agent was more frequent among SRs (P = 0.019). In the multivariate logistic regression analysis, prior biologic therapy was independently associated with a lower likelihood of achieving a super response [odds ratio (OR) = 0.30; 95% confidence interval (CI): 0.15-0.61; P = 0.001]. Additionally, low high-density lipoprotein (HDL) levels were identified as independent negative predictors of super response (OR = 0.44; 95% CI: 0.24-0.81; P = 0.008). Conclusion: Prior biologic therapy and HDL level were identified as the most important factors associated with super response.
Pigmented purpuric dermatoses (PPD) are chronic capillaritides characterized by petechiae, purpura, and brown macules. We present a biopsy-confirmed case of Schamberg disease with rapid clinical improvement following a 2-week course of oral pentoxifylline. A 25-year-old woman presented with an approximately 5-year history of recurrent asymptomatic petechial eruptions affecting the upper and lower extremities. Dermoscopy demonstrated reddish, round-to-oval globules and dots on a brownish background. Ultraviolet-induced fluorescence (UV-F) dermoscopy enhanced the visibility of active petechial foci and assisted in selecting an optimal biopsy site. Histopathology revealed a superficial perivascular lymphocytic infiltrate with focal erythrocyte extravasation and pigment-laden macrophages in the papillary dermis; features of leukocytoclastic vasculitis were absent. After failure of topical high-potency corticosteroids and topical calcineurin inhibitors, controlled-release pentoxifylline 600 mg once daily was initiated. Near-complete clinical resolution was observed by day 14. Treatment was discontinued because of nausea and vomiting, and remission persisted at 2-month follow-up. This case suggests that pentoxifylline may be associated with early clinical improvement in selected patients with PPD and highlights UV-F dermoscopy as a practical adjunct for identifying active purpuric foci and selecting a biopsy site.
Aim: This study aimed to evaluate and compare the readability and quality of information in responses generated by artificial intelligence (AI) models to patients' frequently asked questions about systemic isotretinoin, a medication commonly prescribed in dermatology. Materials and Methods: Thirty-four frequently asked questions from patients using isotretinoin were prepared by a team of dermatology specialists. These questions were posed to three AI-based text-generation tools (ChatGPT, Gemini 2.0, and Copilot), and the responses were analyzed. The resulting texts were compared in terms of readability levels [Flesch Reading Ease score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), Gunning Fog index (GFOG), Coleman-Liau index (CLI), and automated readability index (ARI)], sentence lengths, and content quality, which was evaluated by dermatologists. Results: None of the AI models achieved the optimal readability threshold (FRES >= 60). Readability metrics differed significantly among models. Gemini produced responses that were significantly less readable and more complex than those produced by ChatGPT and Copilot across all readability indices, including FRES, FKGL, SMOG, GFOG, CLI, and ARI; post-hoc analyses confirmed differences between Gemini and the other models. Sentence counts also differed significantly, with Gemini generating longer responses than Copilot. In contrast, Likert-based quality scores and response appropriateness were comparable across models, with no statistically significant differences observed. Conclusion: This study demonstrates that AI models produce academic responses that are difficult for those unfamiliar with medical terminology to understand, and can generate outputs with variable readability in health-related content. These findings highlight the need for careful evaluation of AI-based content for use in healthcare.
Aim: Atopic dermatitis (AD) is a chronic inflammatory disease with systemic involvement. Severity is usually assessed using the scoring AD (SCORAD) index, but this method is partly subjective. Blood-derived markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), high-sensitivity C-reactive protein (hsCRP), and mean platelet volume (MPV) may provide objective indicators. This study evaluated their diagnostic value in assessing disease severity in adults with AD. Materials and Methods: A cross-sectional study was conducted among 112 adults with AD at Ho Chi Minh City Hospital of Dermato-Venereology Hospital from March to September 2024. Demographics, clinical features, and SCORAD scores were recorded. Laboratory analyses included NLR, PLR, hsCRP, and MPV. Receiver operating characteristic (ROC) analysis determined the ability of these markers to identify severe AD (SCORAD >= 51). Results: A total of 112 patients were included (62.5% female; mean age 48 years); 20% had severe AD (median SCORAD 30.7). Higher SCORAD was associated with increased neutrophils, NLR, PLR, and hsCRP, and with decreased lymphocytes (all P < 0.05). NLR best predicted severe AD, with an area under the receiver operating characteristic curve (AUROC) of 0.805 (cut-off 2.59; sensitivity 77.3%; specificity 80.0%), followed by PLR (AUROC: 0.754) and hsCRP (AUROC: 0.734), whereas MPV showed no predictive value (AUROC: 0.530; P = 0.663). Conclusion: NLR, PLR, and hsCRP are simple, low-cost, and reliable biomarkers that correlate withAD severity, with NLR showing the highest diagnostic accuracy. Incorporating these indices may improve objective assessment and serve as an adjunctive tool in clinical practice.
Crusted scabies is a severe, highly contagious variant of scabies that predominantly affects immunocompromised individuals. Although it usually involves extensive areas of the body, isolated scalp involvement in adults is exceedingly rare. This report describes a case of crusted scabies confined to the scalp in a 63-year-old male liver transplant recipient receiving everolimus therapy. The case emphasizes the importance of considering atypical presentations of scabies in immunosuppressed patients and highlights the diagnostic value of dermoscopy in challenging clinical scenarios.
Granulomatous cheilitis (GC) is a rare, idiopathic inflammatory disorder usually affecting young adults. Various treatment modalities have been suggested in the literature, but some cases remain recalcitrant and result in significant emotional distress owing to facial disfigurement. We present a 20-year-old woman with a two-year history of asymptomatic lip swelling, diagnosed as biopsy-proven GC and refractory to topical corticosteroids, tacrolimus, intralesional corticosteroids, and systemic corticosteroids. After failure of these therapies, oral tofacitinib (5 mg twice daily) for 3 months, administered with emollients, resulted in a significant improvement in swelling and disfigurement. The exact etiology of GC remains unknown, but T-helper 1-driven cytokines contribute to granuloma formation via the Janus kinase-signal transducer and activator of transcription pathway. In this refractory case, tofacitinib, a JAK1/3 inhibitor, showed promising results. While this suggests potential as a therapeutic option in recalcitrant GC, larger studies are needed to establish efficacy, safety, and the role in treatment algorithms. Known risks of JAK inhibitors, including infections, thromboembolism, cardiovascular events, and malignancy, should be considered.
Aim: We aimed to investigate the clinical, demographic, and laboratory factors associated with a personal history of skin cancer in patients with actinic keratosis (AK), incorporating the actinic keratosis area and severity index (AKASI) and systemic inflammatory markers to identify potential risk factors for malignancy. Materials and Methods: This single-center, cross-sectional study enrolled 110 patients with AK. Participants were categorized as having a histopathologically confirmed personal history of skin cancer (n = 33) or no personal history of skin cancer (n = 77). Demographic data, clinical characteristics, AKASI scores, and systemic inflammatory indices derived from complete blood counts were collected. Between-group comparisons were performed using appropriate statistical tests. Results: Patients with a history of skin cancer were significantly older (73.6 +/- 12.5 vs. 69.0 +/- 9.3 years; P = 0.036), had longer AK duration (median, 60 vs. 36 months; P = 0.003), and had higher total AKASI scores (median, 5.4 vs. 3.9; P = 0.044) than those without a history of skin cancer. Right facial AKASI scores were also significantly higher (P = 0.035). Receiver operating characteristic analysis identified a total AKASI cut-off of 3.75, with fair discriminatory performance (area under the curve = 0.621, P = 0.044). No significant differences were observed in systemic inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), derived NLR, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, mean platelet volume-to-platelet ratio, systemic immune-inflammation index, and systemic inflammation response index, between groups. Conclusion: Older age, longer disease duration, and greater AK severity, as measured by AKASI, are associated with a personal history of skin cancer among patients with AK, whereas systemic inflammatory indices are not associated. AKASI may be useful for clinical risk stratification and patient surveillance.
Benign melanosis of the nipple and areola is a rare pigmentary disorder that may clinically mimic malignant melanoma and pigmented Paget's disease, particularly during pregnancy. We report a 30-year-old woman at 28 weeks' gestation who presented with bilaterally asymmetric, heterogeneously hyperpigmented macules on the nipples and areolae. Dermoscopy revealed a prominent and regular pigment network with heterogeneous light-and dark-brown coloration. Multiple punch biopsies were performed to exclude melanoma in situ. Histopathological examination showed irregular acanthosis and increased basal layer pigmentation without melanocytic atypia. Immunohistochemical staining demonstrated scattered MART-1-and HMB-45-positive melanocytes without an increase in number, supporting the diagnosis of benign melanosis of the nipple and areola. The coexistence of vitiligo represents a rare and noteworthy feature of this case. This report emphasizes the importance of histopathological evaluation in differentiating benign melanosis from malignant pigmented lesions in pregnant patients.
Aim: Mycosis fungoides [(MF) the most common primary cutaneous T-cell lymphoma] is difficult to diagnose early, and treatment access is uneven in middle-income countries; therefore, we aimed to describe current practice, identify barriers, and propose guideline-aligned, resource-adapted solutions. Materials and Methods: Cross-sectional anonymous online survey of dermatologists (May-June 2025) on diagnostic workflows/access, treatments, and barriers. Analyses were performed using SPSS v23, with descriptive statistics and Spearman's rho correlations. Two-tailed P < 0.05 was considered significant. Results: Among 239 respondents, 61.1% managed MF; 49.3% reported diagnostic uncertainty, and T-cell receptor testing was rarely available. The use of diagnostic algorithms and structured training was inconsistent. Basic topical agents and retinoids were widely available, whereas advanced systemic and device-based options were scarce. Barriers clustered around registration and market availability, workforce constraints, and equipment and maintenance issues. Reported workarounds included evidence-based substitutions, interim symptom-directed therapy, repeat biopsies, and referrals; multidisciplinary tumor boards were underused. Conclusion: MF care is heterogeneous and resource constrained. A four-component plan - a national diagnostic algorithm with a minimum package and a re-biopsy-consultation-multidisciplinary team loop; targeted capacity building; tiered treatment pathways prioritizing narrow-band ultraviolet B +/- retinoids with clear referral thresholds; and system integration via centers of excellence, a national registry, and device uptime programs - may standardize care and improve outcomes.
Aim: Allergic contact dermatitis (ACD) may accompany atopic dermatitis (AD) more frequently than previously recognized. This study aimed to identify concomitant contact sensitization and common allergens in patients with refractory AD. Materials and Methods: In this prospective single-center study (September 2022-February 2024), 62 AD patients with treatment-resistant or atypically distributed lesions suggestive of contact dermatitis underwent patch testing using the European baseline series. Patch test reactions were evaluated on days 2 and 4 according to International Contact Dermatitis Research Group criteria; reactions graded as + or higher were considered positive. Results were compared with those of 306 non-AD patients who underwent patch testing for suspected ACD during the same period. Results: The positivity rate for at least one allergen in AD patients was 62.9%, which was significantly higher than that observed in non-AD patients (40.2%). Nickel sulfate was the most frequently identified allergen. Conclusion: These findings suggest that patients with AD may have increased susceptibility to contact sensitization, and patch testing in recalcitrant cases may help identify potential triggering allergens.
Missed pathology follow-up is a preventable cause of delayed melanoma diagnosis and can be compounded by cognitive biases. We report two cases in which failure to review pathology results led to delayed recognition of nodular melanoma. Both cases highlight the interplay between system failures and anchoring bias. Strengthening result verification processes, incorporating electronic alerts for unreviewed reports indicating malignancy, and promoting patient access to results are essential to preventing similar diagnostic delays.
