Metformin, a well-established, first-line therapy for type 2 diabetes mellitus, is still gaining interest for its potential applications beyond glycaemic control. In addition to its insulin-sensitising effects, metformin exhibits anti-inflammatory, antioxidant, anti-proliferative, and immunomodulatory properties, rendering it a promising candidate for various dermatological conditions. Emerging evidence suggests that metformin may play a beneficial role in inflammatory skin diseases, such as acne, hidradenitis suppurativa, acanthosis nigricans, rosacea and psoriasis. Furthermore, recent studies highlight its potential in promoting wound healing and modulating skin ageing. This narrative review summarises current knowledge of the mechanisms of action of metformin in dermatology and explores its potential as a novel therapeutic approach for skin disorders.

Visual art images narrate the evolution of humankind including different and specific wound managing strategies. Through the observation of some notable art works we explore the empiric historical progress in wound healing and the main reasons they may have been represented. We briefly examine the cultural, symbolic, magical or religious beliefs that have conditioned the approach to a fundamental vital need of humanity: to heal a wound.

Glucagon-like peptide 1 receptor agonists (GLP-1RAs) and dipeptidyl peptidase 4 inhibitors (DPP-4is) are well-established agents for type 2 diabetes mellitus (T2DM) management. Ongoing research has provided data on their both beneficial and adverse effects on the skin. For instance, GLP-1RAs have exhibited therapeutic benefits in psoriasis, while DPP-4is may reduce the risk of melanoma. Moreover, both of these agents may play a pivotal role in improving wound healing. However, untoward effects, such as bullous pemphigoid, highlight the need for patient monitoring. This review summarises the beneficial and adverse effects of GLP-1RAs and DPP-4is in dermatological conditions and in systemic diseases with cutaneous manifestations.

The observation of the nails represented in art masterpieces encourages to catch details which allow us to suspect skin disorders of the past, still commonly encountered in our daily clinical activity. Nails are cutaneous annexes reflecting the state of health and unveiling, through their alterations, the presence of specific systemic and cutaneous diseases, as well as the damage which environmental factors and some cosmetic procedures may cause. In the works of visual arts, there are several examples of nail alterations, either related to the job of the models illustrated by the artist (e.g., traumas from heavy activity) or representing signs of concomitant diseases. The works of art also allow to outline a sort of history of nails and of the social meaning nails have been given to and at the same time, they show biological and pathological aspects of human beings and their health, social and religious characteristics. The careful analysis of the nails in the masterpieces of visual art may improve our observational skills and create a direct relationship with the subject that has been portrayed. The manuscript is focused on the main nail alteration decoration which can be observed in the history of art.

Welcome to the first issue of 2023. Similar to the last issue of the previous year, it has a high number of pages. This continues to be possible thanks to changes in publishing policy. Accordingly, several original articles, case reports, and letters advance our knowledge on the constant theme of wound healing.2–4 Among these, Aragón-Sánchez et al have demonstrated that diabetic foot osteomyelitis is not associated with sinister outcomes in comparison with soft tissue infections. Tsitsou et al have reported no difference in vitamin D levels between patients with and without diabetic foot ulcers. This should be seen in the emerging context of vitamin assessment in the diabetic foot. Intriguingly, Iacopi et al provide data that males with diabetic foot exhibit more frequent comorbidities, previous ulcers, and revascularisation procedures, as well as longer healing time and higher mortality rates after amputations. In venous ulcers, combined physical therapy significantly improves oxygen partial pressure in surrounding tissues among both genders. Overall, it is an amazing scientific production. We are now happy to enjoy the springtime blooming of all these efforts.

This is the second issue of 2023. Similar to the previous two issues, it has a high number of pages. We thank all authors contributing to our passion for improved wound healing. Among these, de Sousa et al have carried out a systematic review on topical medications to improve healing of diabetic foot ulcers, updating our knowledge on a multitude of options. Mani et al discuss dynamic optical coherence tomography to evaluate skin microcirculation in an effort towards improved therapeutic decisions for chronic wounds. In addition, there are many important original studies and case reports covering a wide spectrum of subjects pertaining to wounds and their healing. Our journal is now the top journal in terms of number of articles on diabetic foot. This is based on the modern concept of bibliometric analysis, and it is an excellent piece of news for us to enjoy during a golden summer.

This is the longest and scientifically richest issue ever published by The International Journal of Lower Extremity Wounds. It aims to pursue knowledge and research in the main fields covered by our journal.1–3 Indeed, the only area not covered is medical writing and education, a favourite subject during the last 3 years.4–6 Dettori et al. have carried out a systematic review examining the role of blood cell count indices of systemic inflammation in the risks and outcomes of ischaemic lower limb amputations. Another systematic review and meta-analysis has been conducted by Shahrokh et al. to investigate bacterial isolates and resistance to antibiotics in infected diabetic foot ulcers in Iran. Ahluwalia et al. discuss the potential of novel diagnostic modalities in even earlier diagnosis of Charcot osteoarthropathy in the diabetic foot. Reviews are followed by more than 30 original articles. These cover a wide scope of research relevant to wounds, traumas and their healing. It is impossible to provide an accurate and just account of all of them. So, please enjoy this extensive issue. The next year is expected to be fruitful, as well.

The first 2022 issue is rich in scientific content, as usual. Yammine and Assi have conducted a meta-analysis of surgical compared with non-surgical methods in treating neuropathic plantar forefoot ulcers in diabetes, reporting superiority of the former. Abazari et al. have systematically reviewed classification, identification, and healing of burn wounds. A further meta-analysis is offered by Haykal et al. relating to intermittent lower-extremity pneumatic compression to avert deep vein thrombosis and pulmonary embolism in critically ill patients. Arab-Zozani et al. have looked at health-state utility values among patients with diabetic foot ulcerations. Peng et al. provide evidence on the cost-effectiveness of outpatient expert multidisciplinary diabetic foot care. In surgically treated diabetic foot osteomyelitis, Iacopi et al. share their favourable preliminary experience on the therapeutic utility of add-on S54P4 bioactive glass. Gökdeniz and Akgün Şahin have turned their attention to knowledge on foot care and self-care activities in subjects with diabetes. Koukourakis et al. have examined the contribution of 3 herbal formulations to the amelioration of radiation-induced dermatitis. Ni et al. have demonstrated the advantages of wet healing therapy for uninfected chronic limb wounds. Finally, Su et al. have shown that denatured collagen increased autophagy and inhibited fibroblast apoptosis, thereby promoting wound healing in vitro. Overall, this issue pleases us with articles skillfully taking “the winds of Μarch with beauty”.

The summer issue of 2022 continues our tradition of rich scientific content. Anichini et al explore how diabetic foot management could be improved in the era of COVID-19 (Coronavirus infectious disease). Doucette et al report on the efficacy of dehydrated human amniotic membrane allograft in preventing diabetic foot amputations. Carro et al provide a comparison between various classification systems of the diabetic foot. A case series of minimally invasive floating metatarsal osteotomy for diabetic foot ulcers is presented by Tamir et al Another case series is presented by Brocco et al: it relates to photodynamic topical antimicrobial therapy for infected diabetic foot ulcers. Again in infected diabetic foot ulcers, Taghavifar et al have achieved satisfactory results with Curcumin nanoparticles. Appil et al have demonstrated that family empowerment may contribute to improved glycaemic control and faster healing of diabetic foot ulcers. Impressively, Jiang et al found very frequent depression among patients with diabetic foot ulcerations. In critical limb ischemia, Bisdas et al share their experience as a specialist center. Shimekaw et al provide data on bacterial isolates and antibiotic susceptibility among patients with various wounds in Ethiopia. Finally, two papers describe cases of ischemia in the context of COVID-19, a complication already highlighted in our journal. We shall enjoy all these articles, as we shall enjoy sweet sunshine of the season.

Editorial Autumn is approaching, but our rich scientific tradition 2 is still flourishing in this issue. Wijesooriya and Waidyathilake discuss non-antibiotic therapeutic approaches towards localised infections, especially of chronic wounds. Aagaard et al provide the evidence on advantages and disadvantages of exercise therapy for patients with diabetic foot ulcers (DFUs). Yıldırım Ayaz et al have carried out a systematic review and meta-analysis on the beneficial effects of foot care education in terms of subjects’ behaviour. Nancy et al summarise current evidence on diagnosis, evaluation and treatment of pressure ulcers. Goswami et al focus their attention on non-healing chronic wounds among elderly subjects. Finally, continuing the journal’s educational tradition, Eleftheriou et al discuss the efficacy and disadvantages of web-based medical education during COVID-19 lockdown. In Nigeria, Anumah et al have demonstrated that education is an inexpensive and effective approach towards prevention of lower-limb amputations. Colak et al have compared collagen granule dressings with conventional dressings in patients with DFUs, showing the benefits of the former. In 3 UK centres, Lim et al have looked at the real-world experience with VACOped boot for DFUs management. Aldana et al have re-examined the clinical manifestations, diagnostic challenges, standard therapy and alternative treatments of DFUs. In Ghana, Menlah et al have assessed the experience of patients with Buruli ulcers after hospital discharge. Onoyama et al have identified the importance of psychological issues in terms of ulcer development among patients with peripheral arterial disease. Tang et al have documented the efficacy of debridement followed by topical polymyxin B ointment for the management of chronic recalcitrant ulcers. The issue is completed by interesting case presentations17–19 and letters. We are confident that readers will appreciate the scientific content.

And this is our autumn issue. In line with our tradition of educational articles, Derraik et al discuss the major principles of how to increase the impact of research findings. Eleftheriadou et al provide an update of nonpharmacological therapy for diabetic foot ulcers. Santos et al have carried out a systematic review and meta-analysis on lowlevel laser therapy for the management of diabetic foot ulcers. The issue’s review articles are completed by Nair et al discussing maggot debridement. Çetinkalp et al have compared the efficacy and safety of collagen laminin-based dermal matrix combined with resveratrol microparticles and standard care for diabetic foot ulcers. Xu et al have successfully combined erythrocyte sedimentation rate with a probe-to-bone test for timely diagnosis of diabetic foot osteomyelitis. Ersen et al have examined prefabricated total contact cast kits in diabetic neuropathy. Abdulhamid et al have compared systemic versus local antibiotics versus their combination for the management of infected venous leg ulcers. Ruznan et al have evaluated the effects of stress on fabrics in compression bandaging. Elessawy et al have examined the effect of light-emitting diode irradiation on chronic nonhealing amputation stumps. Cheng et al report on negativepressure wound dressing for burns. In rats, Kardan et al have demonstrated that polyethylene glycol-based nanocerium facilitates healing in excisional and incisional wounds. Again in rats, Javanmardi et al have examined the effect of Gundelia tournefortii L extract and milk cream on burns. Meanwhile, our journal’s impact factor has increased again: for the first time in our history, it is above 2. We thank all authors and reviewers for their valuable contributions and “mighty harmonies.” All this encourages us to pursue in our zeal to improve knowledge in wound healing.

Neurocutaneous syndromes are a group of genetic disorders affecting the skin, the central and peripheral nervous system, and the eye with congenital abnormalities and/or tumors. Manifestations may also involve the heart, vessels, lungs, kidneys, endocrine glands and bones. When people with these disorders are portrayed in works of art, physicians have speculated on possible diagnoses. In particular, many figures have been labeled as possibly having a neurocutaneous disorder, sometimes distorting the popular conception of these diseases. We review numerous documents, drawings, prints, lithographs, xylographs, and portraits which span the ages from antiquity to the era of the pioneers behind the eponyms, depicting a large spectrum of neurocutaneous disorders.

This is the first 2021 issue. Please enjoy the journal’s new front cover. But please also cherish the scientific content, rich and variegated, indeed. Thanganadar Appapalam and colleagues1 have revisited multi-drug resistant bacteria in diabetic foot ulcers. In a similar context, Körpinar2 has carried out a retrospective enquiry into bacterial isolates of diabetic foot infections in end-stage renal disease. Pincelli and colleagues3 describe the clinical picture and hallmarks of Livedo racemosa. Three further works explore innovations in chronic wound healing.4-6 In rats, Bilgic7 has studied the efficacy of local and systemic resveratrol in wound healing. Two very interesting case reports8,9 and other very useful contributions enrich the present issue. And the theme is set for 2021: the journal will continue pursuing progress in wound healing.10,11 It will also publish some new educational articles, as in the past.12 Meanwhile, this issue of young 2021 is to be treasured, like tender spring around us.13

This is the last issue of the year. In 2021, the journal has successfully published educational articles, as well as articles on all aspects of wound management. The present issue is also interesting. Anastasiou et al discuss the evidence on the therapeutic properties of honey for diabetic foot ulcers. Knowledge on the diabetic foot is enriched by new data on cultures (swab vs. bone sampling) in subjects with diabetic foot osteomyelitis and soft tissue infection, FlowAid FA100 SCCD to ameliorate pain and improve tissue oxygenation in contralateral limbs of amputees with neuroischaemia, and maggot debridement therapy. Hape et al have indentified microorganisms and their antibiotics susceptibility in chronic leg ulcers. Wu et al have examined the microvascular control mechanism of the plantar area in response to walking. Goudarzi et al discuss the effects of ROCEN on burn wound healing and thermal pain. In patients with comorbidities, Baek et al have studied multimodal conservative wound treatment after total knee replacement. Shanmugarajan et al provide data on squalene-loaded topical agar-based emulgel scaffold for burns. Two further groups illustrate innovations in flaps for special settings. In this issue, again all colleagues zealously improve wound management, fighting “against a sea of troubles”.

Our summer issue, here it is. Continuing the journal’s tradition of educational articles, Lazarides et al provide a review of medical reviews and their kinds. Loh et al discuss the utility of the topical hemoglobin wound spray Granulox in promoting wound healing. Serban et al have carried out a systematic review of diabetic retinopathy in patients with diabetic foot ulceration. Kardoust et al have studied the contribution of a wound dressing with kiwifruit extract to the healing of diabetic foot ulcers. Ena et al have conducted a meta-analysis of the efficacy of daily foot temperature monitoring in reducing the recurrence of foot ulcers. The cost-effectiveness of platelet-rich plasma for the treatment of diabetic foot ulcers in Spain has been examined by Linertová et al. Dalla Paola et al have investigated the role of the dermal substitute Integra in improving outcomes among diabetic patients with critical ischaemia. Yin et al have demonstrated that autologous stromal vascular fraction cells plus platelet-rich plasma improve the healing of chronic lowerextremity ulcerations in subjects with diabetes mellitus. Zhu et al have found that preconditioning local vibrations might help towards the prevention of foot ulcers in high-risk subjects. The issue is completed by case reports and letters. This journal is unswerving in its mission to advance our knowledge of wound healing. Science is still here in the summer.

The history of the restoration of the masterpiece the Virgin and Child with Canon van der Paele by Jan van Eyck focuses on the expertise of an acute observer, a dermatologist, who noted the removal of an important clinical skin detail-a lesion on the lower lip. The author's re-evaluation of the historic images before and after the restoration confirms the observation made by Jules Desneux, a Belgian dermatologist, in 1951. The author read the book that Cesare Brandi, an Italian restorer, published in 1960 technically detailing the error and the inattentive restoration. In addition, the author found and read the book published in 1951 by Desneux, in which the dermatologist accurately and brilliantly reports the skin lesions of the aged canon and brings to life the absence of the nodule of the lip.

We report the interesting experience of the African Village of Hope (Dodoma, Tanzania) where HIV-positive orphan children have been hosted, cured, and educated in the last 15 years. The particular attention to beauty in the education of the children amazed us when we were in the village working as doctors. The project and the effort to create such a model of social and medical assistance were born from the idea of the founders, Sister Maria Rosaria Gargiulo and Don Vincenzo Boselli. In light of this experience and of the healthy result obtained in the village, we believe that education in the perception of beauty is a formative aspect for all children, but may also be a powerful adjuvant therapy in severely immunocompromised young patients.

September has come with new optimism, and the journal’s favorite themes will continue.1-3 Among these, during the past 2 years, we have published a series of educational articles on medical writing.4 In the same spirit, Lazarides et al5 provide a brief Decalogue on optimal reviewing of scientific articles. Tehan et al6 discuss the updates on noninvasive assessment of peripheral arterial blood flow in the wounded lower limb. McCann and Wells7 review the epidemiology, clinical manifestations, diagnosis, medical management, and prognosis of calcaneal osteomyelitis. Petrakis et al8 provide an update on the utility and limitations of the newer antibiotic dalbavancin for the treatment of complicated gram-positive skin and soft tissue infections of the lower extremities. Goodall et al9 shed light on the implications for neuromuscular electrical stimulation in subjects with recalcitrant diabetic foot ulcers. Karahan et al10 inform us that Twitter may prove useful as a tool for accurate information on the diabetic foot. This holds especially true for health care professionals wishing to increase public awareness.10 In a surgical viewpoint, Bali et al11 emphasize the continuity of the recipient artery and its importance for cross-leg free flaps. Ozturk et al12 analyze coldness, ecchymosis, and related symptoms among subjects with peripheral varicose veins. Toygar et al13 have suggested a useful Turkish adaptation of diabetic foot ulcer scale. Meloni et al14 have demonstrated that a multidisciplinary team of excellence succeeds in accomplishing satisfactory limb salvage rates of diabetic ischemic heel ulcers. Finally, Uccioli et al15 have successfully managed ischemic postoperative diabetic foot ulcers with a dermal-epidermal substitute of 3-dimensional porous matrix of type 1, purified, stabilized, collagen. The new issue is here, and the charms of autumn begin. Shall we follow John Keats to witness “gathering swallows twitter in the skies?”16