Ultraviolet B (UVB) phototherapy is an important treatment modality for inducing repigmentation in vitiligo. Wavelength and fluence (dose; J/m(2)) are well-recognized parameters influencing phototherapy outcomes. Irradiance (power density; W/m(2)), the total photon density received by the skin per unit area, has also been demonstrated to be an important parameter in photomedicine using animal and cellular models. In this study, we aimed to illustrate the crucial role of irradiance in vitiligo treatment by retrospectively reviewing treatment records of patients receiving excimer light treatment for nonsegmental vitiligo from May 2018 to January 2024. A total of 79 vitiligo lesions were analyzed. Lesions receiving high irradiance (HI) excimer light (n = 35) showed repigmentation at lower fluence compared to lesions receiving low irradiance (LI) excimer light (n = 44) treatments (213.93 +/- 20.06 vs. 272.37 +/- 32.75 mJ/cm(2); P < 0.001). Of the 38 lesions with no new repigmentation for 3 months after initial repigmentation under LI excimer treatment, 31 lesions demonstrated new repigmentation after switching to HI therapy. In conclusion, irradiance is also a crucial factor affecting phototherapy outcomes and should be taken into consideration when choosing the optimal treatment strategy for treating vitiligo patients.

Abstract Background: Intravenous methylprednisolone pulse (IVMP) therapy has been widely used for treating severe or recalcitrant alopecia areata (AA), but treatment protocols and efficacy vary. Objectives: This study aims to evaluate the efficacy of IVMP, identify predictive factors for treatment response, and optimize treatment protocols. Methods: A total of 122 AA patients received IVMP (500 mg/day for 3 consecutive days) and were followed for 12 months. Treatment response was classified as remarkable response (RR, ≥75% hair regrowth), partial response (PR, 25%–75% regrowth), and relapse (>10% new-onset hair loss). Results: RR was achieved in 55 patients (45.1%), with a relapse rate of 27.4% (mean interval: 5.3 months). Patients with a disease duration of <6 months had significantly better responses than those with ≥6 months (odds ratio = 0.148, P < 0.0001). RR rates did not significantly differ among IVMP session groups (1–3: 42.5%, 4–6: 60.9%, >6: 20%; P = 0.161). However, among patients with a disease duration ≥6 months, repetitive IVMP (2–11 sessions) was more effective than a single session (RR + PR: 68.6% vs. 20%, P = 0.0497). No severe adverse effects were observed. Conclusion: Monthly IVMP is a safe and effective treatment option for severe AA. Treatment regimens should be individualized based on disease duration and clinical response.

BACKGROUND:Melasma, an acquired hyperpigmentation disorder, affects individuals of all ethnicities. Its multifactorial aetiology, high recurrence rates and psychosocial impact complicate management and necessitate comprehensive, evidence-based recommendations. OBJECTIVES:The objective was to develop an international consensus on the diagnosis and management of melasma by synthesizing expert opinions and the latest scientific evidence. METHODS:This consensus was developed using a modified Delphi approach. A core group of two senior dermatologists who were experts in pigmentary disorders guided the process, and a diverse panel of 38 dermatologists with a special interest in pigmentary disorders from 11 countries (Australia, Brazil, France, India, Italy, Mexico, Philippines, South Africa, South Korea, Taiwan and the USA) participated in three rounds of surveys and discussions, under the aegis of the Pigmentary Disorders Society (PDS). A literature search of articles published between 2014 and 2024 identified key studies that were graded using the Oxford levels of evidence (2009). Consensus statements were drafted, refined and finalized based on expert feedback. Responses were assessed using a 5-point Likert scale, with predefined thresholds for high (≥75%), moderate (55%-74%) and low (<55%) agreement. RESULTS:The consensus development process started with 34 statements, and at the end of the third round of the Delphi process, 21, 4 and 1 statement reached high, moderate and low consensus, respectively. Key recommendations highlighted photoprotection with broad-spectrum sunscreens as essential, regulated and supervised use of hydroquinone-based triple combination creams as the gold standard, and alternatives such as topical azelaic acid, kojic acid and oral tranexamic acid. Adjunctive procedural therapies, such as chemical peels and microneedling, were suggested to enhance topical efficacy, while lasers were reserved for refractory cases. CONCLUSIONS:These recommendations aim to improve the outcomes of melasma patients globally by integrating expert opinion and evidence-based strategies. Future research should focus on evaluating emerging therapies and optimizing long-term maintenance strategies.

Prurigo nodularis (PN) is a chronic neuroinflammatory skin disease that, while considered rare, is likely underestimated. Due to its complex presentation, misdiagnosis is not uncommon, highlighting the need for greater awareness among healthcare professionals to ensure the accurate diagnosis and appropriate management. To address this need, the Taiwanese Dermatological Association (TDA) established an expert panel to develop a consensus on the management of PN in Taiwan, aiming to enhance the clinicians’ understanding and guide their therapeutic approaches to improve the clinical outcomes for PN patients. A panel of eight core members was convened to review and discuss the aspects of PN management, drafting a consensus during the meetings. The 2020 Germany Diagnostic and Treatment Algorithm and the 2021 United States Expert Panel Consensus for chronic PN, along with recent literature and local practices, served as the foundation for this consensus. The information was agreed upon by the expert panel during TDA PN consensus core meetings held on January 25, June 1, and August 1, 2024. This consensus provides a comprehensive overview of the diagnosis and treatment of PN, with considerations specific to practitioners in Taiwan. Topical and systemic treatments, as well as phototherapy are utilized to manage the disease. The recent approval of dupilumab and the emerging targeted therapies are expected to significantly benefit patients who are inadequately managed by existing options.

A 56-year-old woman presented with progressive scalp nodules, macroglossia, anaemia and hypercalcaemia. Histopathology confirmed amyloid deposits in the scalp, and bone marrow biopsy revealed plasma cell infiltration with lambda light chain restriction.

This subgroup analysis of the ALLEGRO phase 2b/3 study (NCT3732807) assessed the efficacy and safety of multiple doses of ritlecitinib, an oral JAK3/TEC family kinase inhibitor, in Asian patients with alopecia areata (AA). Patients aged ≥12 years with AA and ≥50% scalp hair loss received once‐daily ritlecitinib 50 or 30 mg (with or without 4‐week 200‐mg loading dose [“200/50” or “200/30”]) or 10 mg or placebo for 24 weeks, followed by a 24‐week extension, in which patients initially assigned to placebo switched to 200/50 or 50 mg. In this subgroup analysis, Asian patients with response based on achieving a Severity of Alopecia Tool (SALT) score ≤20, SALT ≤10, ≥2‐grade improvement or normal score on the eyebrow assessment (EBA) scale, and ≥2‐grade improvement or normal score on the eyelash assessment (ELA) scale were evaluated through week 48. Safety was monitored throughout. In total, 186 Asian patients were randomized to ritlecitinib 200/50 mg ( n = 33), 200/30 mg ( n = 28), 50 mg ( n = 43), 30 mg ( n = 34), 10 mg ( n = 17), placebo to 200/50 mg ( n = 14), or placebo to 50 mg ( n = 17). The proportions of patients treated with ritlecitinib ≥30 mg achieving a SALT score ≤20 response were 9.1%–36.4% at week 24 vs 0% for the 10‐mg group and 3.2% for placebo. At week 48, 26.5%–55.6% of patients treated with ritlecitinib ≥30 mg achieved a SALT ≤20 response. At week 48, the proportions of patients treated with ritlecitinib ≥30 mg with EBA response were 41.9%–71.1% and with ELA response were 40.7%–57.9%. The most common adverse events were nasopharyngitis, folliculitis, upper respiratory tract infection, and urticaria. No serious or opportunistic infections, major adverse cardiovascular events, thromboembolic events, malignancies, or deaths were reported. Ritlecitinib demonstrated clinical efficacy and acceptable safety over 48 weeks in Asian patients ≥12 years with AA and ≥50% hair loss. Results for the Asian subpopulation were consistent with the overall population in the ALLEGRO‐2b/3 study.

Alopecia areata (AA), an autoimmune disorder that causes well defined patches of scalp hair loss, significantly impacts the quality of life and mental well being of patients and their families. However, the paucity of treatment guidelines and expert consensus for AA in Taiwan, compared to other dermatological conditions, leads to substantial heterogeneity in the therapeutic strategies employed by clinicians. To discuss strategies for managing AA, address knowledge gaps, and provide a reference for dermatologists and other specialists in Taiwan. The Taiwanese Dermatological Association held Expert Panel meetings between 2023 and 2024, during which experts reviewed existing evidence, shared clinical experiences, and reached consensus on recommendations for clinical classification, diagnosis, severity evaluation, and treatment options for AA. The statements were approved if they received agreement from more than 75% of the committee members. For mild to moderate AA, the consensus suggests that first line therapy may include topical corticosteroids or intralesional corticosteroid injections, with or without adjunctive topical 5% minoxidil. In severe AA cases, initial treatment options include oral or intravenous corticosteroids or oral Janus kinase inhibitors, potentially combined with topical or intralesional corticosteroids. AA not only impacts patients’ physical appearance but also their mental and social well-being. Therefore, in addition to hair recovery, it is crucial to address patients’ psychological adjustment. Given the diverse treatment options and the varying psychological impacts on AA patients, the most appropriate personalized treatment plan should be established through shared decision making between physicians and patients.

Vitiligo is a prevalent autoimmune skin disorder that presents as patches of depigmentation. While the disease is typically asymptomatic, the lesions are highly noticeable and can cause substantial psychosocial distress. Depending on the subtype, extent, and activity of the disease, various topical treatments, systemic treatments, phototherapy modalities, and surgical interventions are used to halt disease progression and facilitate repigmentation. However, there is generally a lack of evidence from well-designed, large-scale, controlled trials supporting specific treatment approaches, and recommendations of existing clinical guidelines frequently differ. To address these challenges, the Taiwanese Dermatological Association established an expert committee to develop consensus recommendations to provide clinicians with guidance on the diagnosis, assessment, and management of vitiligo to improve the quality of patient care in Taiwan.

AbstractSolar radiation is essential for life on Earth but is also a major contributor to skin carcinogenesis. Solar radiation, particularly ultraviolet (UV) B (280–320 nm) and UVA (320–400 nm), induces photocarcinogenesis via various pathways. UV light can directly cause DNA damage, resulting in genetic mutations if not repaired correctly. UV light can also induce photocarcinogenesis by generating reactive oxygen species, inducing immunosuppression and inflammation. Recently, visible light (400–760 nm) has been shown to contribute to photocarcinogenesis by activating oxidative pathways. In addition to the irradiation dose (fluence, J/m2), UVB irradiance (W/m2) is also considered a factor influencing photocarcinogenesis. In this review, we summarize the mechanisms of photocarcinogenesis and provide strategies to prevent skin cancer.

While the effect of hyperglycemia on cutaneous wound healing is well recognized, the impact of high-glucose (HG) environment on UVB-induced skin tumor formation remains inconclusive. Similar to impaired wound healing, skin tumor formation involves keratinocyte proliferation and migration. Intriguingly, SOX2 has been recognized to play an important role in both wound healing and UVB-induced skin tumor formation by modulating cell proliferation and migration. As hyperglycemia results in impaired cutaneous wound healing, we hypothesized that the HG environment also impacts UVB-induced tumor formation of the skin. This study aimed to explore the effects of HG environment on epidermal keratinocytes, focusing on the impact of UVB-induced cell proliferation and migration via SOX2 expression. In cultured keratinocytes, HG-cultivated keratinocytes showed reduced SOX2 levels compared to control with or without UVB treatment. SOX2 regulates keratinocyte migration and proliferation via modulation of AKT phosphorylation. Additionally, O-linked-N-acetylglucosamine glycosylation contributed to reduced SOX2 levels in HG-cultivated keratinocytes. Animal studies demonstrated that diabetic mice skin has significantly less UVB-induced tumor formation, epidermal thickening, SOX2, and pAKT expression than the control mice; mutant p53 expression was also lower in diabetic mice but did not reach statistical significance compared to control. In conclusion, HG environment reduces UVB-induced keratinocyte proliferation and migration, in association with decreased SOX2 expression and downstream AKT signaling. The current findings provide novel insights regarding UVB-induced skin tumor formation of skin in patients with diabetes.

Ultraviolet (UV) B-induced damage in human epidermal keratinocytes (HEKs) initiates photocarcinogenesis. However, how diabetes influences photocarcinogenesis is not well understood. To investigate the impact of high-glucose environments on responses to UVB, we cultured HEKs in normal-glucose (NG) or high-glucose (HG) conditions (G6 and G26), followed by UVB irradiation at 25 mJ/cm2 (G6UVB and G26UVB). We performed next-generation sequencing and analyzed HEKs' expression profiles bioinformatically to identify candidate genes and cellular responses involved. We found UVB induced consistent responses in both NG- and HG-cultivated HEKs, but it also triggered certain distinct processes and pathways specifically in the HG groups. The 459 differentially expressed (DE) genes in the HG groups revealed their roles in chromatin remodeling, nucleosome assembly, and interferon signaling activation. Moreover, the 29 DE genes identified in G26UVB/G6UVB comparison, including the potent tumor suppressor gene TFPI2, were considered key genes contributing to HEKs' altered response to UVB in HG environments. UVB irradiation induced significantly higher TFPI2 expression in HG-cultivated HEKs than their NG-cultivated counterpart. Finally, HG-cultivation significantly increased oxidative stress, cyclobutane pyrimidine dimer formation, and apoptosis, while reducing HEKs' viability after UVB irradiation. These changes under HG conditions probably mediate cell fate toward death and tumor regression. Overall, our findings provide evidence and associated molecular basis on how HG conditions reduce keratinocytes' photocarcinogenic potential following UVB exposure.

Ingrown toenails and paronychia are common conditions that may cause long-lasting pain and functional impairment in patients of any age. 1 Haneke E. Controversies in the treatment of ingrown nails. Dermatol Res Pract. 2012; 2012783924https://doi.org/10.1155/2012/783924 Crossref PubMed Scopus (87) Google Scholar Possible causes include tyrosine kinase inhibitors (TKI)-epidermal growth factor receptor (EGFR) use, ill-fitting shoes, infection, trauma, inappropriate manicure, etc. Patients often experience chronic painful inflammatory reactions, wherein the distal end of the nail edges form spicule (spiky pieces) that pierce into the skin and push on the surrounding soft tissue. Aside from traditionally used antiseptic soaks and topical medicaments, packing, taping, gutter treatment, and nail braces are options for managing patients with this condition. 1 Haneke E. Controversies in the treatment of ingrown nails. Dermatol Res Pract. 2012; 2012783924https://doi.org/10.1155/2012/783924 Crossref PubMed Scopus (87) Google Scholar ,2 Robert C. Sibaud V. Mateus C. Verschoore M. Charles C. Lanoy E. et al. Nail toxicities induced by systemic anticancer treatments. Lancet Oncol. 2015; 16: e181-e189https://doi.org/10.1016/s1470-2045(14)71133-7 Abstract Full Text Full Text PDF PubMed Google Scholar However, these techniques require special tools and nail packing materials that are expensive or difficult to obtain.