Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition characterized by painful nodules, abscesses, and sinus tracts, causing significant physical and psychological distress. The profound impact of HS underscores the need for comprehensive management strategies to enhance patient outcomes and quality of life. This S1 guideline, developed by the Swiss HS Foundation, provides evidence-based recommendations for systemic and surgical treatments in HS, emphasizing the importance of standardized care practices. It incorporates insights and an informal expert consensus of Swiss dermatologists and dermatosurgeons. The guideline addresses conventional therapies, such as antibiotics and retinoids, as well as emerging biological treatments and surgical interventions, offering a holistic approach to managing this challenging disease.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects about 1% of the world’s population. It is characterized by round, painful nodules, abscesses or sinuses, often in the genital area. HS has the worst impact on quality of life (QoL) of any dermatological condition. Methods: The aim of this systematic review is to analyze how HS affects patients’ sexual quality of life (SQoL), herein defined as a person’s evaluation of their sexual relationships, including physical and mental aspects, and their response to this evaluation. Results: The systematic search yielded 41 primary results. After screening, 6 studies were selected for this review. Men with HS suffer from lower SQoL than male controls and sexual dysfunction is more common in both male and female patients than in controls. Sexual dysfunction is worse in all HS patients than in controls, and worse in female patients than in male patients. Disease severity is not related to any of the sexual concepts analysed. Conclusions: HS has a strong impact on SQoL, as patients suffer from sexual dysfunction and sexual distress more often than healthy controls, and feel that their relationships are negatively affected by the disease. Therefore, the impact of HS on SQoL should be further investigated, especially the psychological aspect of SQoL.

Topical minoxidil is the mainstay of treatment for androgenic alopecia and is also used off-label for other forms of hair loss. Despite its efficacy and favourable safety profile, the use of minoxidil is associated with various side effects, the most commonly reported of which is contact dermatitis. A clear distinction between allergic contact dermatitis and irritant contact dermatitis to minoxidil is critical for management of androgenic alopecia. This article presents a systematic review of the current literature, evaluating minoxidil-induced allergic contact dermatitis. Of the 251 records identified through the database search, a total of 21 studies were included in the review. Most patients presented with classic signs of contact dermatitis, including erythema, pruritus, and increased scaling of the scalp. Of the patients with positive patch tests, a total of 54 patients showed sensitization to minoxidil itself and 12 patients to vehicle components. Patients with suspected signs of contact dermatitis such as erythema, scaling, and pruritus after minoxidil application should undergo patch testing to confirm or exclude allergy. For the test, the differential reactivity of minoxidil in various vehicles should be considered. Patients who are sensitive to propylene glycol should be offered alternative minoxidil formulations.

Due to the risk of scarring and the psychological impact on affected patients, folliculitis decalvans (FD) requires prompt and focused care to control inflammation and prevent disease progression. This study aimed to provide a comprehensive long-term evaluation of treatment outcomes in difficult-to-treat cases of FD by analysing the effectiveness of various therapies and identifying reasons for treatment switches or discontinuation. The single-centre, retrospective cohort study collected information on patient characteristics and management strategies, focusing on different treatment groups and reasons for discontinuation or switching. Eighteen patients with biopsy-confirmed FD were included in the study because of their recalcitrant course (38.9% females, median age 33.0 years), with a median follow-up period of 1.5 years. During the study period, all patients received at least one pre-scription for topical therapies, primarily non-antibiotic disinfectants, topical corticosteroids, topical antibiotics, and topical dapsone. Systemic antibiotics were prescribed for 88.9% of patients, predominantly tetra-cyclines and a combination of rifampicin and clindamycin. Non-biological systemic therapies, excluding steroids, were used in 61.1% of patients, with isotretinoin being the most common (27.8%). Among immunomodulatory drugs, apremilast was prescribed to 11.1% of patients. Overall, the highest treatment discontinuation rates were observed with systemic antibiotics (risk ratio: 1.63; 95% confidence interval: 1.46–1.82), followed by systemic steroids. The treatment of patients with severe FD requires a personalized, multifaceted approach, typically involving a combination of local and systemic therapies. Antibiotics are often used as a first-line treatment, but they are associated with a high rate of discontinuation. This highlights the urgent need for effective immunomodulatory treatments, either as alternatives or as adjuncts to current options.

Despite the globally rising incidence of melanoma, mortality rates have decreased by approximately 18% in Caucasian populations following the introduction of effective systemic treatments. Thanks to new molecular insights, the management of cutaneous melanoma has undergone several transformations over the past decade. The existing guidelines were last updated in 2016 to provide evidence-based practical recommendations for melanoma specialists across Switzerland. Recent data on surgical, radiotherapeutic and mainly systemic treatment with the implementation of adjuvant and neoadjuvant treatments in the current melanoma management have made modifications of the treatment and follow-up recommendations necessary.

ABSTRACT Background Despite the existence of therapeutic approaches, effective management of hidradenitis suppurativa (HS) remains elusive in many cases. In addition, most of the current studies focus on treatment response in a cross‐sectional analysis of patients, and therefore a proper study analysing different treatment strategies longitudinally in each individual patient is still lacking. Objectives The current study aimed to provide insight into HS patients treated with different treatment strategies and to clarify the reasons for switching or discontinuing each treatment group. Methods The single‐center, retrospective study collected information on patient characteristics and management strategies, focusing on different treatment groups and reasons for discontinuation or switching. Results Ninety‐eight patients were included in the study (53.1% males, median age 38.5 years). During the study period, 98.0% of patients had at least one prescription of topical therapy, particularly non‐antibiotics disinfectants. 92.9% of patients also received a prescription for systemic antibiotics, especially tetracyclines (86.7%). 26.5% were prescribed biologic therapies, mainly TNF‐alpha blockers (25.5%), with a median time to start treatment of 0.9 years. Non‐biologic systemic therapies (relative risk [RR]: 1.54; 95% confidence interval [CI] 1.28–1.85) and systemic antibiotics (RR: 1.97; 95% CI: 1.56–2.48) showed a moderate‐to‐high risk of discontinuation. The most frequent switching patterns were from topicals plus systemic antibiotics to the same combination plus other therapies (11.2%), including surgery and laser, to topical treatment alone (8.5%), or to topicals plus biologics (4.5%). Conclusions Standard care management of HS requires a personalized, multifaceted approach, typically involving a combination of local and systemic treatments, with antibiotics often used first. When antibiotics and other systemic agents are ineffective, biologics may be used alone or with antibiotics; delaying their use can miss the chance to prevent disease progression and the possible ‘window of opportunity’ in the treatment of HS.

Abstract Background Following the pivotal phase II trial BOLT, the Hedgehog (Hh) inhibitor sonidegib was approved in the EU to treat locally advanced basal cell carcinoma (laBCC) in patients not amenable to surgery or radiotherapy. We report safety data from the interim analysis of the real-world NISSO study. Methods NISSO is an ongoing non-interventional, multinational, post-authorization safety study (NCT04066504). Patients with laBCC are treated with sonidegib 200 mg orally once daily and followed for 3 years. Dose modifications were allowed according to the local prescribing information. Results Between May 6, 2019, and March 15, 2022, 321 patients with laBCC were enrolled at 46 European sites (data cut-off: June 22, 2023). Treatment was discontinued in 241 (75.1%) patients, with the main reasons being the patient/guardian decision (n = 69, 28.6%), treatment success (n = 40, 16.6%) and the physician decision (n = 35, 14.5%). The median duration of sonidegib exposure was 8.8 months (4.4–13.7 months). Overall, 284 (88.5%) patients had ≥ one treatment-emergent adverse event (TEAE). Most TEAEs were ≤ grade 2 and the most common were muscle spasms (n = 141; 43.9%), dysgeusia (n = 119; 37.1%), and alopecia (n = 97; 30.2%). After 3 months of treatment, the cumulative rates of muscle spasms, dysgeusia, and alopecia were 21.8%, 16.2%, and 3.7%, respectively. TEAEs led to treatment discontinuation in 59 (18.4%) patients, while 149 (46.4%) patients had at least one TEAE leading to dose reduction or interruption. Serious drug-related TEAEs were reported in 13 (4.1%) patients. Conclusions These results confirm the safety profile previously observed. Most patients experienced the onset of common TEAEs after 3 months of treatment, and the cumulative incidence of most common TEAEs was 10–20% lower compared to the BOLT study, except for dysgeusia and fatigue that had a similar incidence. The percentage of patients experiencing TEAEs requiring interruption or dose reduction was similar to the BOLT study, while the proportion of patients with TEAE leading to discontinuation of sonidegib was lower. This study demonstrates that the tolerability of sonidegib is manageable in routine clinical practice. Trial registration. NCT04066504.

The most common type of alopecia in women is female androgenetic alopecia (FAGA), characterized by progressive hair loss in a patterned distribution. Many oral therapies, including spironolactone (an aldosterone antagonist), androgen receptor blockers (e.g., flutamide/bicalutamide), 5-alpha-reductase inhibitors (e.g., finasteride/dutasteride), and oral contraceptives, target the mechanism of androgen conversion and binding to its respective receptor and therefore could be administered for the treatment of FAGA. Despite significant advances in the oral treatment of FAGA, its management in patients with a history of gynecological malignancies, the most common cancers in women worldwide, may still be a concern. In this review, we focus on the safety of antiandrogens for the treatment of FAGA patients. For this purpose, a targeted literature review was conducted on PubMed, utilizing the relevant search terms. To sum up, spironolactone seems to be safe for the systemic treatment of FAGA, even in high-risk populations. However, a general uncertainty remains regarding the safety of other medications in patients with a history of gynecologic malignancies, and further studies are needed to evaluate their long-term safety in patients with FAGA and risk factors to establish an optimal risk assessment and treatment selection protocol.

INTRODUCTION:This second part of the S2k guidelines is an update of the 2015 S1 European guidelines. OBJECTIVE:These guidelines aim to provide an accepted decision aid for the selection, implementation and assessment of appropriate and sufficient therapy for patients with hidradenitis suppurativa/acne inversa (HS). METHODS:The chapters have been selected after a Delphi procedure among the experts/authors. Certain passages have been adopted without changes from the previous version. Potential treatment complications are not included, being beyond the scope of these guidelines. RESULTS:Since the S1 guidelines publication, validation of new therapeutic approaches has almost completely overhauled the knowledge in the field of HS treatment. Inflammatory nodules/abscesses/draining tunnels are the primary lesions, which enable the classification of the disease severity by new validated tools. In relation to the degree of detectable inflammation, HS is classified into the inflammatory and the predominantly non-inflammatory forms. While the intensity of the inflammatory form can be subdivided by the IHS4 classification in mild, moderate and severe HS and is treated by medication accordingly, the decision on surgical treatment of the predominantly non-inflammatory form is based on the Hurley stage of the affected localization. The effectiveness of oral tetracyclines as an alternative to the oral combination of clindamycin/rifampicin should be noted. The duration of systemic antibiotic therapy can be shortened by a 5-day intravenous clindamycin treatment. Adalimumab, secukinumab and bimekizumab subcutaneous administration has been approved by the EMA for the treatment of moderate-to-severe HS. Various surgical procedures are available for the predominantly non-inflammatory form of the disease. The combination of a medical therapy to reduce inflammation with a surgical procedure to remove irreversible tissue damage is currently considered a holistic therapeutic approach. CONCLUSIONS:Suitable therapeutic options while considering HS severity in the therapeutic algorithm according to standardized criteria are aimed at ensuring a proper therapy.

The importance of eosinophilic granulocytes in cancer has been widely discussed in recent years. The current study reviews the evidence on the role of eosinophilic granulocytes in melanoma as a prognostic marker for cancer progression and the efficacy of treatment with modern immune checkpoint inhibitors. A total of 33 human clinical studies were included in the review, with heterogeneous data due to differences in patients populations, study design and inclusion of small study groups. However, 28 of the 33 studies suggested that eosinophilic granulocytes could be used as a prognostic biomarker for outcome and/or potential response to systemic treatment and/or occurrence of adverse events in melanoma patients. Nevertheless, the exact role of eosinophils remains to be elucidated. Further prospective, larger and better controlled studies are warranted to clarify the significance of eosinophilic granulocytes in patients with melanoma, in more details.

Journal of the European Academy of Dermatology and VenereologyEarly View LETTER TO THE EDITOR Skin redness index: A new practical method for unbiased automated quantification of skin redness Simon Bossart, Simon Bossart orcid.org/0000-0003-1285-302X Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorSimone Cazzaniga, Simone Cazzaniga orcid.org/0000-0001-8161-6138 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Centro Studi GISED, Bergamo, ItalySearch for more papers by this authorKristine Heidemeyer, Kristine Heidemeyer orcid.org/0000-0001-9217-6086 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorLaurence Feldmeyer, Laurence Feldmeyer orcid.org/0000-0002-4858-5525 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorDagmar Simon, Dagmar Simon Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorRobert E. Hunger, Robert E. Hunger Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorS. Morteza Seyed Jafari, Corresponding Author S. Morteza Seyed Jafari [email protected] orcid.org/0000-0002-6466-2199 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Correspondence S. Morteza Seyed Jafari, Department of Dermatology, University Hospital, Inselspital Bern, 3010 Bern, Switzerland. Email: [email protected]Search for more papers by this author Simon Bossart, Simon Bossart orcid.org/0000-0003-1285-302X Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorSimone Cazzaniga, Simone Cazzaniga orcid.org/0000-0001-8161-6138 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Centro Studi GISED, Bergamo, ItalySearch for more papers by this authorKristine Heidemeyer, Kristine Heidemeyer orcid.org/0000-0001-9217-6086 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorLaurence Feldmeyer, Laurence Feldmeyer orcid.org/0000-0002-4858-5525 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorDagmar Simon, Dagmar Simon Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorRobert E. Hunger, Robert E. Hunger Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandSearch for more papers by this authorS. Morteza Seyed Jafari, Corresponding Author S. Morteza Seyed Jafari [email protected] orcid.org/0000-0002-6466-2199 Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Correspondence S. Morteza Seyed Jafari, Department of Dermatology, University Hospital, Inselspital Bern, 3010 Bern, Switzerland. Email: [email protected]Search for more papers by this author First published: 01 November 2023 https://doi.org/10.1111/jdv.19619 Simon Bossart and Simone Cazzaniga contributed equally to this work. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Open Research DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. REFERENCES 1Clarys P, Alewaeters K, Lambrecht R, Barel AO. Skin color measurements: comparison between three instruments: the chromameter(R), the DermaSpectrometer(R) and the Mexameter(R). Skin Res Technol. 2000; 6(4): 230–238. 10.1034/j.1600-0846.2000.006004230.x PubMedWeb of Science®Google Scholar 2 International Color Consortium, ICC.1:2004–10, Profile version 4.2.0.0. Google Scholar 3Perruchoud DL, Cazzaniga S, Heidemeyer K, Weber B, Dietrich N, Borradori L, et al. Treatment of sporadic port-wine stains: a retrospective review of 17 cases consecutively treated by pulsed sequential dual wavelength 595 and 1064 nm laser. J Eur Acad Dermatol Venereol. 2017; 31(3): 557–563. 10.1111/jdv.13975 CASPubMedWeb of Science®Google Scholar 4Healy ZR, Dinkova-Kostova AT, Wehage SL, Thompson RE, Fahey JW, Talalay P. Precise determination of the erythema response of human skin to ultraviolet radiation and quantification of effects of protectors. Photodermatol Photoimmunol Photomed. 2009; 25(1): 45–50. 10.1111/j.1600-0781.2009.00404.x PubMedWeb of Science®Google Scholar 5Tan J, Liu H, Leyden JJ, Leoni MJ. Reliability of clinician erythema assessment grading scale. J Am Acad Dermatol. 2014; 71(4): 760–763. 10.1016/j.jaad.2014.05.044 PubMedWeb of Science®Google Scholar 6McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Methods. 1996; 1: 30–46. 10.1037/1082-989X.1.1.30 Web of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Background: The first-line treatment of the localized form of cutaneous squamous cell carcinoma (cSCC) remains surgical excision. Either conventional excision (CE) with margins or Mohs micrographic surgery (MMS) may be preferred, depending on the risk factors of cSCC, the characteristics of the tumor, and the available technical facilities. Methods: This article presents a systematic review of the current literature spanning from 1974 to 2023, comparing outcomes of cSCC treated with MMS versus cSCC treated with conventional excision. Results: Out of the 6821 records identified through the database search, a total of 156 studies were screened, of which 10 were included in the review. The majority of the included studies showed that treatment of cSCC with MMS consistently exhibits a significantly lower risk of recurrence compared to treatment with CE. In addition, MMS is emerging as the preferred technique for the resection of cSCC located in aesthetically or functionally challenging anatomical areas. Conclusion: The studies generally demonstrate that MMS is a safer and more effective treatment of cSCC than CE. Nevertheless, outcomes such as recurrence rates and cost-effectiveness should be assessed more precisely, in order to allow for a more tailored approach in determining the appropriate indication for the use of MMS.

Background: Chronic leg ulcers present a global challenge in healthcare, necessitating precise wound measurement for effective treatment evaluation. This study is the first to validate the “split-wound design” approach for wound studies using objective measures. We further improved this relatively new approach and combined it with a semi-automated wound measurement algorithm. Method: The algorithm is capable of plotting an objective halving line that is calculated by splitting the bounding box of the wound surface along the longest side. To evaluate this algorithm, we compared the accuracy of the subjective wound halving of manual operators of different backgrounds with the algorithm-generated halving line and the ground truth, in two separate rounds. Results: The median absolute deviation (MAD) from the ground truth of the manual wound halving was 2% and 3% in the first and second round, respectively. On the other hand, the algorithm-generated halving line showed a significantly lower deviation from the ground truth (MAD = 0.3%, p < 0.001). Conclusions: The data suggest that this wound-halving algorithm is suitable and reliable for conducting wound studies. This innovative combination of a semi-automated algorithm paired with a unique study design offers several advantages, including reduced patient recruitment needs, accelerated study planning, and cost savings, thereby expediting evidence generation in the field of wound care. Our findings highlight a promising path forward for improving wound research and clinical practice.

This investigation demonstrates the use of dimethyl fumarate (DMF) for the treatment of disseminated granuloma annulare (GAD), a rare and chronic inflammatory skin disease. In this case, progressive GAD was treated with DMF, resulting in significant improvement of skin lesions within 5 weeks and complete healing within 7 months. Clinical response was associated with a reduction in inflammatory cells, including both T cell subsets (CD4+ > CD8+), CD183+/CXCR3+ cells, Langerhans cells (CD1a+), myeloid DCs, M1- and M2-like macrophages and the activation marker HLA-DR in immunohistochemical analysis. These findings support the use of DMF as a promising treatment option for this rare skin condition.

Background: The study investigated the long-term efficacy of imiquimod 5% cream for LM, with a focus on disease recurrence and the possible prognostic factors of disease-free survival (DFS) in a cohort, with long-term follow-up. Methods: Consecutive patients with histologically confirmed LM were included. Imiquimod 5% cream was applied until weeping erosion appeared on the LM-affected skin. The evaluation was performed through clinical examination and dermoscopy. Results: We analyzed 111 patients with LM (median age: 72 years, 61.3% women) with tumor clearance after imiquimod therapy, with a median follow-up of 8 years. The overall patient survival rates were 85.5% (95% confidence interval (CI): 78.5–92.6) and 70.4% (95% CI: 60.3–80.5) at 5 and 10 years, respectively. Among the 23 patients (20.1%) with relapse at follow-up, 17 (73.9%) were treated with surgery, five (21.7%) continued imiquimod therapy, and one (4.3%) underwent both surgery and radiotherapy. After adjustment for age and LM area in multivariable models, localization of LM in the nasal region was identified as a prognostic factor for DFS (HR = 2.66; 95% CI: 1.06–6.64). Conclusion: If surgical excision is not possible due to the patients’ age/comorbidities or critical cosmetic localization, imiquimod could provide optimal outcomes with an optimal risk of relapse for the management of LM.

Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer in Switzerland and worldwide. Most BCCs can be treated in a curative setting. However, patients can develop locally destructive and, rarely, metastatic tumors that require a different treatment approach. The clinical subtype of individual lesions provides prognostic information and influences management decisions. Surgical excision, topical therapies, and radiotherapy are highly effective in the majority of subtypes as well as in low- and high-risk diseases. For patients with low-risk diseases and superficial tumors not amenable to surgery, several nonsurgical alternatives are available. Systemic therapy is indicated for high-risk BCCs, which are not amenable to either surgery or radiotherapy. Hedgehog pathway inhibitors (HHI) are currently approved. Other therapeutic options such as immune checkpoint inhibitors show promising results in clinical trials. This first version of Swiss recommendations for diagnosis and management of BCC was prepared through extensive literature review and an advisory board consensus of expert dermatologists and oncologists in Switzerland. The present guidelines recommend therapies based on a multidisciplinary team approach and rate of recurrence for individual lesions. Based on the risk of recurrence, two distinct groups have been identified: low-risk (easy-to-treat) and high-risk (difficult-to-treat) tumors. Based on these classifications, evidence-based recommendations of available therapies are presented herein.

Skin hyperpigmentation after sclerotherapy with polidocanol‐containing sclerosants is a common local side effect. Sclerotherapists should be familiar with factors that trigger hyperpigmentation after sclerotherapy with polidocanol‐containing sclerosants. A systematic literature review of works reporting hyperpigmentation after sclerotherapy for telangiectasias, reticular veins, side branches and truncal varices with polidocanol‐containing sclerosants was performed. Reported incidence rates, follow‐up periods and potentially triggering factors were assessed and analysed. The search yielded 1687 results; of these, 27 reports met the inclusion criteria. The incidence of hyperpigmentation seemed to increase with higher concentrations of polidocanol and was more evident after sclerotherapy for epifascial veins than for intrafascial truncal veins when the polidocanol concentration was more than 0.25%. Regarding sclerotherapy for telangiectasias and reticular veins, the incidence of hyperpigmentation ranged between 2% and 25% for polidocanol 0.25% (liquid and foam), between 12.5% and 67.9% for polidocanol 0.5% (liquid and foam) and between 13% and 73% for polidocanol 1% (liquid and foam). Regarding truncal veins, the incidence ranged from 7% to 45.8% for polidocanol 1% (liquid and foam), from 16% to 17% for polidocanol 2% (foam) and from 7.4% to 32.5% for polidocanol 3% (liquid and foam). Regarding the treatment of side branches, the incidence of hyperpigmentation ranged from 5.6% to 53% for both foam and liquid sclerotherapy. Regarding the duration of hyperpigmentation, there are few data describing reticular veins and telangiectasias. Hyperpigmentation persisting for more than 6 months has been reported to have an incidence of up to 7.5%. Hyperpigmentation persisting for more than 1 year after foam polidocanol 1%–3% treatment for truncal veins has an incidence ranging from 8.1% to 17.5%. Other factors such as higher volumes and compression therapy after treatment seem to have a minor influence. Data regarding hyperpigmentation after polidocanol‐related sclerotherapy are poor and should be improved by higher‐quality research.