Dermato, Volume 6, Issue 1 (March 2026) – 10 articles

Introduction: Myxoid liposarcoma (MLPS) is a rare soft tissue sarcoma comprising 5–10% of adult cases, most often in the thigh. Diagnosis is challenging due to nonspecific imaging findings and resemblance to benign lesions. Case Report: A 42-year-old male presented with a painless, enlarging upper right medial thigh mass. CT and ultrasound suggested a complex solid lesion, possibly benign. Outpatient surgical excision revealed a red, gelatinous, non-encapsulated mass. Frozen section suggested a myxomatous spindle cell tumor. Final pathology confirmed MLPS FNCLCC grade 2 (intermediate grade) with DDIT3 rearrangement on fluorescence in situ hybridization (FISH). Margins were negative but close. Postoperative PET scan and Signatera MRD assay were negative for metastasis. Given the tumor’s size (>10 cm) and known radiosensitivity, adjuvant radiotherapy (60–66 Gy) was initiated. Discussion: MLPS features myxoid stroma, plexiform vasculature, and, in high-grade tumors, a round cell component. The FUS::DDIT3 fusion gene is diagnostic. While MRI offers superior soft tissue characterization, definitive diagnosis requires pathology and molecular testing. Surgical excision with negative margins remains standard, with radiotherapy recommended for large tumors or close margins to reduce recurrence. This case highlights the limitations of preoperative imaging and the value of intraoperative pathology in guiding management. Conclusions: Early recognition, accurate diagnosis, and tailored multimodal treatment are essential for MLPS. Given the potential for recurrence, late extrapulmonary metastases, long-term surveillance with imaging, and molecular assays are critical for optimizing outcomes. Full article

Rosacea is a chronic skin condition characterized by persistent inflammation, manifesting primarily on the face and causing redness, papules, pustules, and phymatous changes. The etiology of rosacea is multifactorial, with immune system factors playing a crucial role in its pathogenesis. The scientific literature contains an increasing number of studies that suggest a correlation between rosacea and the gut microbiota. Small intestinal bacterial overgrowth (SIBO) is defined as an excessive proliferation of potentially pathogenic bacteria within the small intestine of the gastrointestinal system. Multiple factors have been posited to explain the pathogenesis of rosacea, and the presence of SIBO has been identified as a potential factor in its occurrence. A decrease in the Lactobacillus genus, Prevotella copri, Lachnospiraceae, and Faecalibacterium within the gut microbiota may initiate inflammation related to rosacea. These bacterial species are crucial for regulating the intestinal mucosa. The findings indicate that there is an increase in Bacteriodes, Acidaminococcus, Megasphaera, and Ruminococcus in the gut microbiome of patients with rosacea. Probiotics can be advantageous for managing the intestinal microbiome, while Rifaximin treatment has shown efficacy in addressing inflammatory rosacea lesions associated with SIBO. The present review has been undertaken with the objective of enhancing our comprehension of SIBO in rosacea. The emphasis has been placed on the pathogenetic mechanisms and the shift in the gut microbiota that will lead to understanding probiotic benefits and therapy options in rosacea patients. Full article

Background/Objectives: Metformin, a widely used antidiabetic drug, has recently gained attention in dermatology due to its pleiotropic effects. Given the high prevalence, chronicity, and therapeutic challenges of several dermatological conditions, there is growing interest in repurposing metformin as a topical agent with anti-inflammatory, antioxidant, metabolic, and regenerative properties. This narrative review aimed to synthesize and critically analyze the available preclinical and clinical evidence regarding the mechanisms of action, efficacy, safety, and therapeutic potential of topical metformin across different skin disorders. Methods: A literature search was conducted in PubMed and complementary databases for studies published between 2015 and 2025 addressing topical metformin in dermatology, including experimental, observational, interventional, and review articles. Results: The findings indicate that topical metformin has been associated with beneficial biological effects in conditions such as melasma, photoaging, wound healing, psoriasis, acne, skin cancer, and hair disorders, largely through AMPK activation, modulation of inflammation and oxidative stress, inhibition of melanogenesis, enhancement of tissue regeneration, and regulation of immune and metabolic pathways, although evidence remains predominantly preclinical and methodologically heterogeneous. Conclusions: Topical metformin represents a promising investigational multifunctional dermatological agent; however, its clinical translation depends on well-designed randomized controlled trials with standardized formulations, adequate sample sizes, and long-term follow-up to establish its efficacy, safety, and optimal therapeutic protocols. Full article

Background/Objectives. Ultraviolet B (UVB) radiation is a key etiological factor for skin cancer, inducing oxidative stress, DNA damage and apoptosis. Nicotinamide (NAM), a NAD⁺ precursor, has shown photoprotective properties, although the mechanisms underlying this effect have not been fully elucidated. This study sought to elucidate the role of NAM in counteracting UVB-induced oxidative damage in HaCaT cells and to assess the contribution of NAD⁺ metabolism to these effects. Methods. HaCaT were exposed to low-dose UVB irradiation (40 mJ/cm²) and treated with NAM (25 μM), alone or in combination with the NAMPT inhibitor FK866 (1 nM) for 4 and 24 h. Oxidative stress, lipid peroxidation and DNA damage were evaluated by DCFDA assay, TBARS assay and comet assay, respectively. Cell proliferation, cell cycle progression and apoptosis were assessed using Ki67 immunofluorescence, flow cytometry analysis and Annexin V/PI staining. Transcriptional activity for oxidative stress- and apoptosis-related markers was analyzed by RT-qPCR. Results. NAM significantly reduced UVB-induced ROS production at both 4 and 24 h post-irradiation in an NAD⁺-dependent manner, as demonstrated by the reversal of its effects following NAMPT inhibition. NAM also decreased oxidative DNA damage accompanied by reduced OGG1 expression, a marker of oxidative stress. Moreover, NAM restored HaCaT proliferation and reduced early apoptosis, particularly at 24 h post-UVB exposure. These protective effects were mediated by NAD⁺. Conclusions. Our results show that NAM confers robust protection to HaCaT cells from UVB-induced oxidative stress and cellular damage, largely mediated by NAD⁺-dependent pathways, supporting its potential role as a systemic photoprotective agent in skin cancer prevention. Full article

Background/Objectives: Melanoma remains one of the most malignant types of skin cancer with rising incidence numbers, despite the progress made in the prevention and management of the disease. Recent technological advancements, such as developments in the field of molecular biology, imaging, and artificial intelligence (AI), have led to a paradigm shift in the diagnosis, assessment, and management of melanoma. The current review aims to integrate current research on melanoma, moving beyond the boundaries of conventional histological analysis. Methods: This is a critical appraisal narrative review that focuses on recent studies in the areas of translation research and digital health with regard to melanoma. This research particularly targeted recent studies within the last five years, with landmark studies implicated when appropriate. Evidence was synthesized within the major categories that include epidemiology, early diagnosis, histopathology, predictive biomarkers, genetic/epigenetic changes, AI-assisted diagnostic platforms, and novel therapeutic platforms & targets. Results: Early detection techniques, innovative imaging, and biomarker-guided risk adjustment can improve diagnostic accuracy and prognostic stratification. The potential of AI in dermoscopy, digital pathology, and decision analytical systems is evident, although validation, bias, and integration issues need to be addressed. Advances in immunotherapy, targeted therapies, and novel molecular/immunological targets are expanding and facilitating integrated and personalized management. Conclusions: There is a trend in melanoma research to shift towards an integrated diagnostic platform that involves the use of AI, molecular characterization, and clinical inputs to enable more accurate and personalized diagnoses. To realize this potential, there is a need to validate, collaborate, and address ethics and implementation. Full article

Background/Aims: This study aimed to undertake a systematic literature review to compare the effectiveness of narrowband UVB (nb-UVB) therapy with Psoralen + UVA (PUVA) or Psoralen + UVB treatments in individuals with vitiligo. Methods: A comprehensive search was executed across multiple electronic databases (PubMed, Embase, Cochrane, Scopus, Web of Science, LILACS) and grey literature repositories (Google Scholar, LIVIVO, OpenGrey, ProQuest). Methodological quality was independently assessed by two reviewers employing the Cochrane RoB 2 tool; consensus was achieved through consultation with a third reviewer when necessary. The main efficacy endpoint was repigmentation. Results: From 4758 initial records, four randomized controlled trials that satisfied the inclusion criteria were identified. The aggregated results from these studies indicated that nb-UVB, either alone or combined with psoralen (P-nbUVB), produced better repigmentation outcomes compared to PUVA. Conclusions: Nb-UVB phototherapy demonstrated superior repigmentation efficacy, improved color matching, and a faster clinical response relative to PUVA. The addition of psoralen (P-nbUVB) further enhanced therapeutic outcomes, particularly in VASI scores and in areas typically less exposed to resunlight. Full article

Background and Objectives: Merkel cell carcinoma (MCC) is a rare, aggressive, invasive cutaneous neuroendocrine carcinoma. It commonly affects the skin of the extremities and head and neck regions in elderly patients. In situ MMC represents MMC confined to the epidermis. Incipient MCC is a descriptive term that represents in situ MCC with early focal dermal microinvasion. In situ MCC and incipient MCC have a much better prognosis than MCC. In this study, we aimed to address the clinicopathologic features of early lesions of MCCs, including both incipient and in situ forms. Methods: We conducted a PubMed search using the following keywords: (“Merkel cell carcinoma” OR “Merkel carcinoma” OR “Merkel” OR “MCC”) AND (“in situ” OR “incipient” OR “intraepidermal”) AND (“skin” OR “cutaneous”. The inclusion criteria included (i) human studies, and (ii) case reports and series published in the English language with the above-mentioned search keywords. Studies not meeting all inclusion criteria were excluded. Results: Incipient and in situ MCCs are extremely rare events (15 case reports). They usually appear as tiny (2 mm to 6 mm) erythematous papules or nodules over the skin. Immunohistology (for CK20, EMA, and neuroendocrine markers) was required to establish the diagnosis of these lesions. Conclusions: MCCs carry a significantly high mortality rate due to their aggressive nature. However, for in situ MCC and incipient MCC, local surgical excision is usually curative, and the prognosis is excellent. Therefore, dermatologists and dermatopathologists should remain vigilant for these forms of early lesions of MCCs. This will help with early detection and prompt treatment. Full article

Background/Objectives: Acute generalized exanthematous pustulosis (AGEP) is a severe drug-induced cutaneous reaction characterized by the abrupt onset of sterile pustules, fever, neutrophilia, and a T cell-mediated type IVd hypersensitivity response. This narrative review synthesizes current evidence on pharmacological triggers, immunopathogenic mechanisms, diagnostic criteria, and differential diagnosis to provide a clinically oriented framework. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, ScienceDirect, and SpringerLink for studies published between 2000 and 2025, complemented by selected clinical reference sources. Studies addressing clinical features, immunological pathways, pharmacovigilance signals, and diagnostic tools for AGEP were included. Synthesis of Evidence: β-lactam antibiotics remain the most frequent triggers, while increasing associations have been reported with hydroxychloroquine, targeted therapies, immune checkpoint inhibitors, psychotropic agents, and vaccines. Immunopathogenesis is driven by IL-36 activation, CXCL8/IL-8–mediated neutrophil recruitment, and IL36RN mutations, explaining overlap with pustular psoriasis. Diagnostic accuracy improves through integration of drug latency, clinical morphology, histopathology, biomarkers, and standardized tools such as the EuroSCAR score. Conclusions: AGEP is a complex pustular reaction induced by diverse drugs and amplified by IL-36-mediated inflammation. Accurate diagnosis requires a multidimensional approach supported by structured algorithms and robust pharmacovigilance to identify evolving drug-associated patterns. Full article

Background/Objectives: Acne is a common skin condition that is characterized by the manifestation of comedones, erythematous papules, pustules, and nodules over follicular areas. A huge contributing factor in the pathogenesis is colonization by Cutibacterium acnes (C. acnes) (formerly Propionibacterium acnes). Conventional treatments for acne range from topical to systemic agents with variable side effects and safety profiles. Adherence to prescribed treatments for acne is a huge challenge. Method: A quantitative cross-sectional study was conducted among 198 patients with dermatologist-confirmed acne vulgaris at King Abdulaziz University Hospital, Jeddah. Eligible participants had received topical and/or systemic treatment for at least one month. Exclusion criteria included other acne variants and inflammatory follicular disorders. Data on sociodemographics, medical and treatment history, and clinical characteristics were collected using a structured questionnaire. Treatment adherence was assessed with the validated ECOB scale. Associations between adherence and relevant variables were analyzed using Chi-squared and Mann–Whitney tests in SPSS v26, with significance set at p ≤ 0.05. Results: Non-adherence to anti-acne medications was 50.5% and was significantly associated with experiencing side effects, particularly skin dryness, and with moderate acne severity and topical treatment (p ≤ 0.05). No significant associations were found between adherence and demographic or medical history variables. Conclusions: Adherence to acne treatment remains a significant challenge for many patients. Improving patient education, addressing concerns about side effects, and providing practical support may help patients follow their prescribed therapies more consistently. Incorporating tools like the ECOB questionnaire into routine dermatology visits can support ongoing assessment and better management of treatment adherence. Full article

Introduction: Atopic dermatitis (AD) is driven by complex pathways that mediate inflammation and pruritus. The pathophysiology of AD’s disease involves multiple pathways. Interleukin-13 (IL-13) is considered a major cytokine in Th2-type inflammation, responsible for changing the epidermal barrier and producing chronic inflammation, whereas interleukin-31 (IL-31) is considered a major inducer of pruritus. The exact correlation of each of these cytokines with disease severity in children with AD appears to vary across studies. This study was therefore designed to evaluate whether IL-13 and IL-31 levels contribute complementarily or independently to the overall clinical severity of AD in the Moroccan pediatric population and to analyze the correlation between serum IL-13 and IL-31 levels and investigate their correlation with disease severity in a pediatric cohort. Methods: A total of 52 children with moderate to severe AD were included. The severity of the disease was measured using the SCORing Atopic Dermatitis (SCORAD) index. Serum levels of IL-13 and IL-31 were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Results: The IL-13 serum level showed a considerable positive correlation with the SCORAD score (r_s = 0.7, p < 0.0001). On the other hand, IL-31 levels revealed no correlation with SCORAD (r_s = 0.07, p = 0.62) but were positively correlated with pruritus intensity (r_s = 0.91, p < 0.001). Conclusion: Our results support the presence of different pathophysiological axes in pediatric AD, where IL-13 functions as a reliable biomarker of inflammatory severity. IL-31 acts as a systemic marker of the pruritic pathway. Full article