Abstract Accurate segmentation of alopecia areata (AA) lesions is crucial for the diagnosing and staging this non-scarring autoimmune disease, marked by patchy hair loss and psychological impact. However, reliable segmentation remains challenging due to limited annotated datasets, uneven hair distribution, vague lesion boundaries, variability in scalp and hair color, and low quality of photographic images. 1) A novel multi-task network that incorporates a shared segmentation subnetwork and a structure-preserved data augmentation (SDA) subnetwork is proposed. DAGC enhances contextual aggregation, and SDA exploits unlabeled data to improve diversity and robustness. 2) A hierarchical prototype alignment (HPA) module is presented to match graph prototype to the accumulated class-level prototype bank, while simultaneously aligning unlabeled features through contrastive learning. 3) A hierarchical regularization via class-wise voting histogram (HRCVH) strategy is presented by dividing pseudo labels into reliable, fuzzy and unreliable sets with class-wise voting histogram, which is computed by summing the predicted probability scores from the unlabeled image and its perturbed images. Extensive experiments on an in-house AA dataset, the publicly available ISIC dataset and a large-scale CelebAMask-HQ dataset demonstrate that our method significantly outperforms state-of-the-art methods in semi-supervised scenarios. This work introduces a novel framework designed to enhance semantic consistency and facilitate efficient representation learning, particularly in challenging semi-supervised and uncertainty-aware scenarios. In clinical routines, this study is beneficial for quantitative diagnosis, treatment and staging of alopecia areata, which profoundly impacts individual quality of life and mental well-being.

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition that significantly impairs quality of life (QoL) and imposes a substantial socioeconomic burden. Abrocitinib, a selective Janus kinase 1 inhibitor, has shown promise in clinical trials, yet real-word data in Chinese patients remain limited. This interim analysis of the AHEAD (Abrocitinib Chinese rEgistry on Atopic Dermatitis, ChiCTR2400086045) registry aims to characterize treatment patterns and early effectiveness in real-world settings. AHEAD is an ongoing, prospective, multicenter, observational study enrolling adults with AD initiating abrocitinib across 42 sites in China. This interim analysis included data from 314 patients enrolled between 18 October 2023 and 30 April 2024, with assessments through week 12. Clinical effectiveness, QoL, adherence, and flare incidence were evaluated using validated physician- and patient-reported outcome measures. A total of 314 patients were enrolled. At baseline, most patients exhibited moderate to severe AD [mean Investigator’s Global Assessment (IGA) score of 3.0; Eczema Area and Severity Index (EASI) score of 13.5] with impaired QoL [Dermatology Life Quality Index (DLQI) score of 12.0]. Treatment with abrocitinib led to rapid and sustained improvement across all measures through week 12: IGA (40

Androgenetic alopecia (AGA) is the most common type of hair loss worldwide, characterized by progressive miniaturization of hair follicles and a shortened anagen phase. Currently, FDA-approved drugs for AGA treatment, minoxidil and finasteride, cannot provide satisfactory outcomes for all patients and can sometimes cause side effects. Therefore, there has been an urgent need for novel and safer therapeutic strategies. At the cellular and molecular level, the pathogenesis of AGA is closely associated with the dysregulation of signaling pathways in hair follicles. As nano-sized extracellular vesicles secreted by cells, exosomes carry bioactive substances such as proteins, lipids, and nucleic acids, thereby playing a crucial role in intercellular and intracellular communication. By modulating dysregulated signaling pathways in hair follicles, exosome therapy offers a highly promising therapeutic option for AGA patients. However, it should be noted that current evidence remains limited, and more well-designed studies are required to validate the long-term efficacy and safety of exosome-based therapies for AGA. Also, addressing challenges in the production, application, and regulation of exosomes is indispensable for promoting the future clinical application of exosome-based therapies in AGA treatment. This review summarizes the preclinical and clinical progress in exosome-based therapies for AGA treatment, with a particular focus on their molecular mechanisms, especially their regulation of key signaling pathways involved in AGA pathogenesis, such as Wnt/β-catenin, Shh, TGF-β/Smad, PI3K/AKT, and MAPK signaling pathways. These endeavors are expected to provide researchers with valuable scientific insights and practical information for AGA drug discovery.

Androgenetic Alopecia (AGA) is a common type of alopecia. The pathogenesis of AGA involves genetic predisposition, androgen metabolism, inflammation, fibrosis, and impaired energy metabolism. The choice of therapeutic agents for the treatment of AGA remains controversial globally, with finasteride and minoxidil being the only two widely recognized and legally approved therapeutic options. In recent years, significant progress has been made in the development of drugs targeting different pathogenic mechanisms of AGA. This article reviews the main drugs currently used for AGA treatment. By summarizing their mechanisms of action and clinical efficacy, it aims to provide a comprehensive theoretical basis and clinical reference for the treatment of AGA.

Background: Epidemiological evidence hints at a connection between thyroid dysfunction and chronic spontaneous urticaria (CSU), but the causality is obscure. This study applies a two-sample Mendelian randomization (MR) method to explore the causality between them. Methods: We utilized bidirectional MR to explore the causality between CSU and thyroid autoimmunity in Europeans and East Asians. The SNPs examined in this study were sourced from the Open GWAS database, the ThyroidOmics Consortium, the FinnGen Consortium, and BioBank Japan. In the forward MR analysis, we considered thyroid dysfunction, AITD, and thyroid function indicators—FT3, FT4, TT3, ln (FT3/FT4), ln (TT3/FT4), TSH and TPOab—as exposures, with CSU as the outcome in a cohort of 398,763 individuals. Conversely, in the reverse MR analysis, CSU served as the exposure, and thyroid function phenotypes were the outcomes. The primary analytical method was IVW, complemented by sensitivity analyses to evaluate pleiotropy and robustness. Results: IVW analysis indicates that genetic predisposition to thyroid disorders is linked to increase CSU risk in Europeans, with significant odds ratios noted for Graves’ disease, hyperthyroidism, and Hashimoto’s disease. Reverse MR suggests possible causal links between a genetic propensity for CSU and a decrease in hyperthyroidism and the ln (FT3/FT4) ratio. No evidence was found linking thyroid function phenotypes with CSU in East Asians. Conclusion: Our research indicates that genetic susceptibilities to thyroid disorders are associated with a higher risk of CSU in European populations, with no observed link in East Asian populations. These findings may offer new avenues for future investigation into the relationship between thyroid autoimmunity and CSU.

Introduction: Allergen distribution varies geographically, and local epidemiological data can guide disease prevention and management. We investigated allergen sensitization among patients with three types of allergic skin disease in Suzhou, East China, from 2021 to 2023. Methods: Serum-specific immunoglobulin E levels were analyzed from 4,603 patients who visited the First Affiliated Hospital of Soochow University between January 2021 and December 2023. Sensitization prevalence of 20 allergen species was assessed, considering age, sex, year, and disease type. Results: Common aeroallergens included Dermatophagoides farinae, Dermatophagoides pteronyssinus, and house dust, while major food allergens were soybean, egg, and crab. Children exhibited higher sensitization rates, with males more sensitized to D. farinae, D. pteronyssinus, Alternaria, and milk, and females more sensitized to Blattella germanica and egg. Compared with previous years, sensitization rates for soybean and milk decreased in 2023, whereas those for D. farinae and crab increased. Patients with atopic dermatitis had the highest overall sensitization rates. Conclusion: Allergen sensitization patterns in Suzhou varied by age, sex, year, and disease type. Understanding these patterns can help improve the management of allergic skin diseases in this region. (c) 2024 S. Karger AG, Basel

Microneedling is a simple,safe,effective,minimally invasive,and economical treatment technique with a wide range of indications.Studies in China and other countries have showed that microneedling plays a role in the treatment of androgenetic alopecia.Compared with traditional therapies,combined microneedling has better therapeutic efficacy,shorter treatment course and a better safety profile.This review summarizes the therapeutic efficacy,mechanisms of action and safety of combined microneedling,and describes prospective trends in the treatment of androgenetic alopecia with combined microneedling based on recent relevant Chinese and international literature.

Background:Multiple eruptive dermatofibroma (MEDF) is a rare presentation of dermatofibroma which is frequently associated with underlying diseases such as human immunodeficiency virus infection or systemic lupus erythematosus. It generally presents a characteristic histology with hyperplasia of the epidermis, prominent bundles of collagen and a diffuse proliferation of fibrocytes.Case Summary:We report a case of MEDF in a 30-year-old man who presented with a large number of dark brownish red maculopapules distributed over the trunk and extremities for more than 10 years. According to the pathology, the patient was diagnosed with MEDF. Infections and autoimmune diseases were ruled out. As he had no clinical symptoms, and presented with lesions widely distributed over the body, we gave no special treatment, but suggested a regular examination.Conclusion:Patients with MEDF usually have no pain and pruritus. If human immunodeficiency virus infection and systemic lupus erythematosus and other causes are ruled out, and lesions are widely distributed over the body, regular check-up is recommended without specific treatment.

Currently,the evaluation of keloids is mostly based on clinical observation and many clinical evaluation scales,and there is still a lack of a"gold standard"to objectively evaluate keloids.Imaging examinations are of great value to the diagnosis,differential diagnosis of and efficacy evaluation in keloids.This review summarizes the research progress in the application of imaging techniques in keloids,thereby helping clinicians choose the appropriate equipment.

PurposeIn this study, we identified and diagnosed a novel inherited condition called Dyschromatosis, Ichthyosis, Deafness, and Atopic Disease (DIDA) syndrome. We present a series of studies to clarify the pathogenic variants and specific mechanism.MethodsExome sequencing and Sanger sequencing was conducted in affected and unaffected family members. A variety of human and cell studies were performed to explore the pathogenic process of keratosis.ResultsOur finding indicated that DIDA syndrome was caused by compound heterozygous variants in the oxysterol-binding protein-related protein 2 (OSBPL2) gene. Furthermore, our findings revealed a direct interaction between OSBPL2 and Phosphoinositide phospholipase C-beta-3 (PLCB3), a key player in hyperkeratosis. OSBPL2 effectively inhibits the ubiquitylation of PLCB3, thereby stabilizing PLCB3. Conversely, OSBPL2 variants lead to enhanced ubiquitination and subsequent degradation of PLCB3, leading to epidermal hyperkeratosis, characterized by aberrant proliferation and delayed terminal differentiation of keratinocytes.ConclusionsOur study not only unveiled the association between OSBPL2 variants and the newly identified DIDA syndrome but also shed light on the underlying mechanism.

ObjectivesTo establish accurate and objective dermoscopic diagnostic criteria and grading standards for males and females with androgenetic alopecia (AGA).MethodsTwenty patients each with AGA, diffuse alopecia areata, telogen effluvium, and healthy controls were enrolled in the current study. In addition, 60 patients with grades F1/V1, F2/V2, and F3/V3 AGA (20 cases each) were enrolled. The patients underwent dermoscopic examinations. The sensitivity and specificity of the diagnostic criteria were based on the 60 AGA and 60 non-AGA. In addition, 150 patients diagnosed with AGA clinically and by dermoscopy were enrolled to calculate the accuracy of the grading criteria.ResultsThe diagnostic criteria included primary, secondary, and exclusion criteria. The grading criteria included three indices, which divided the severity of AGA into grades 1, 2, and 3. The sensitivity and specificity of the diagnostic criteria were 98.3% and 96.7% respectively. The accuracy of grade 1, 2, and 3 dermoscopic grading criteria were 96%, 92%, and 100% respectively, with a total accuracy of 96%.LimitationsTo test the diagnostic and grading criteria, more patients need to be collected.ConclusionsThe dermoscopic diagnostic and grading criteria are objective with good accuracy, which could provide a reasonable basis for the early diagnosis, grading treatment, and improved prognosis for AGA.

摘要： 患者男，37岁，因全身红斑伴黏膜糜烂4 d、发热2 d，于2022年9月14日收住我科。患者4 d前四肢出现散在红斑、丘疹，自觉瘙痒，皮疹迅速增多并泛发全身，伴有口腔黏膜及肛周皮肤破溃，疼痛明显……

摘要: 【摘要】 以程序性细胞死亡蛋白1(PD-1)/程序性细胞死亡蛋白配体1(PD-L1)抑制剂为代表的免疫检查点抑制剂是治疗恶性肿瘤的突破方案,随之而来的免疫治疗相关不良反应不容忽视,而Stevens-Johnson综合征(SJS)/中毒性表皮坏死松解症(TEN)则是其最为严重的表现之一,可危及生命。与其他药物引起的SJS/TEN相比,PD-1/PD-L1抑制剂相关的SJS/TEN潜伏期往往更长,皮损更为泛发和严重,易发生严重感染和器官衰竭等并发症,预后差,死亡率更高,故早期发现并正确处理有重要的意义。本文综述目前PD-1/PD-L1抑制剂相关的SJS/TEN研究进展。

目的 探讨高分辨率磁共振成像(HR-MRI)在发生于头面部中高危区域的皮肤基底细胞癌(BCC)的术前诊断中的价值.方法 收集13例头面部中高危区域BCC患者的临床及影像资料,对病变的大小、信号特征、边缘、强化、动态增强时间-信号强度曲线(TIC)类型、深度及累及层次进行观察和评估.结果 病灶平均最大径为(19.4±11.0)mm.T1WI均呈等或低信号,T2WI信号表现多样.9例病灶边界模糊.10例病灶均匀强化,所有病灶均呈等、低强化,TIC表现为I型或 Ⅱ型.病灶平均深度为(7.2±3.2)mm,9例累及皮下脂肪以下深层结构.结论 BCC在HR-MRI表现多样,低强化、低灌注为相对特异表现.HR-MRI可以术前无创评估病变的范围及对周围结构的浸润,对指导治疗和手术决策具有较大价值.

Introduction Psoriasis is an immune-mediated chronic inflammatory skin disease. As our understanding of the pathogenesis of psoriasis has improved, biologic agents have become increasingly important in the treatment of psoriasis. However, the use of biologic agents is associated with cutaneous side effects. A new type of side effect called paradoxical reactions is an emerging threat arising from the increasing use of biologic agents. Case Here, we present a case of paradoxical skin reactions – pyoderma gangrenosum (PG) and eczema – induced by biologic therapy. The case was successfully and eventually treated with baricitinib. Discussion PG is a rare inflammatory disease characterised by painful and necrotic ulcerations containing neutrophils. It has been associated with autoimmune diseases such as inflammatory bowel disease (IBD). TNF (tumor necrosis factor) -α inhibitors can effectively treat refractory PG, while IL (interleukin) −17A inhibitors may worsen IBD symptoms. The cause of PG in this case was believed to be secukinumab, not adalimumab. The patient was diagnosed with eczematous dermatitis due to TNF-α inhibitors, and baricitinib was added to treat eczematous dermatitis. Conclusion Paradoxical reactions are unpredictable events that may occur during treatment with biologics at anytime. They need further research in order to formulate personalised treatment.

Background:The management and treatment of psoriasis has rarely considered patient needs, which are numerous, multi-dimensional and are of great importance to improving treatment outcomes. Objectives:This study aimed to evaluate and compare the patients' needs for psoriasis treatment and identify factors predicting the need to make patient-centred decisions about treatment. Materials and Methods:This nationwide multicentre cross-sectional study included subjects between October 2020 and August 2021. The status quo of the needs in psoriasis treatment and their influencing factors were analysed mainly using the Chi-square test and binary logistic regression. Results:Information on sociodemographic and clinical characteristics were obtained. Factor analysis of a specially designed questionnaire showed that rapid skin clearance, reduced treatment expense and fewer hospital visits or treatment time were the first three patient needs in psoriasis treatment. Several influencing factors were important including the sociodemographic characteristics of gender, marital status, education level and family history, special location of skin lesions, dermatology life quality index (DLQI), Investigator's Global Assessment modified 2011 (IGA mod 2011), condition of the episode, clinical type of psoriasis, seasonal exacerbation and therapy. Conclusions:Patients with psoriasis pursued a wide range of treatment goals, with the most desired being rapid skin clearance, reduced treatment expense and time-saving. Paying attention to sex, marital status, education level, the special location of skin lesions and the DLQI will help dermatologists develop patient-centred treatment, meet the patient's needs and eventually improve the treatment outcomes.

Background and aimNo previous study investigated the anatomical changes of the scalp and hair follicles between tertiary androgenetic alopecia and severe alopecia areata using high-resolution magnetic resonance imaging (HR-MRI). This study aimed to explore the value of HR-MRI in assessing alopecia. Materials and methodsForty-eight people were included in this study. The imaging indicators of the vertex and occipital scalp were recorded and compared. The logistic regression model was developed for the indicators that differed between tertiary androgenetic alopecia and severe alopecia areata. The receiver-operating characteristic (ROC) curve was used to assess the diagnostic efficacy of the model for tertiary androgenetic alopecia and severe alopecia areata. ResultsAt the vertex, the thickness of the subcutaneous tissue layer, follicle depth, relative follicle depth, total number of follicles within a 2-cm distance, and number of strands reaching the middle and upper third of the subcutaneous fat layer within a 2-cm distance were statistically different between patients with tertiary androgenetic alopecia, those with severe alopecia areata, and healthy volunteers (p < 0.05). The logistic regression model suggested that the subcutaneous tissue layer thickness was important in discriminating tertiary androgenetic alopecia from severe alopecia areata. The ROC curve showed that the area under the curve, sensitivity, specificity, and best cutoff values of the subcutaneous tissue layer were 0.886, 94.4%, 70%, and 4.31 mm, respectively. ConclusionsHR-MRI can observe the changes in anatomical structures of the scalp and hair follicles in patients with alopecia. HR-MRI can be applied to the differential diagnosis of tertiary androgenetic alopecia and severe alopecia areata.

Dermatofibrosarcoma protuberans (DFSP) is a type of intermediately malignant cutaneous spindle cell neoplasms, which is easy to be confused with several benign ones even after needle biopsy, especially cellular fibrous histiocytoma (cFH), resulting in inadequate excision and local recurrence. We found that as a novel skin imaging technique, high-resolution (HR) DCE MRI could distinguish DFSP. The features include infiltration of surrounding fat, ill-defined margins and large quantitative parameters. Both DFSP and cFH have type-III time-signal intensity curves (TICs). In contrast, other confused lesions presented type-II-or-I TIC. The recommendation of preoperative HR-MRI could assist dermatologists to perform surgical plan more confidently.