Dermato

With the growing complexity of skin disorders and the challenges of traditional diagnostic methods, AI offers exciting new solutions that can enhance the accuracy and efficiency of dermatological assessments. Reflectance Confocal Microscopy (RCM) stands out as a non-invasive imaging technique that delivers detailed views of the skin at the cellular level, proving its immense value in dermatology. The manual analysis of RCM images, however, tends to be slow and inconsistent. By combining artificial intelligence (AI) with RCM, this approach introduces a transformative shift toward precise, data-driven dermatopathology, supporting more accurate patient stratification, tailored treatments, and enhanced dermatological care. Advancements in AI are set to revolutionize this process. This paper explores how AI, particularly Convolutional Neural Networks (CNNs), can enhance RCM image analysis, emphasizing machine learning (ML) and deep learning (DL) methods that improve diagnostic accuracy and efficiency. The discussion highlights AI’s role in identifying and classifying skin conditions, offering benefits such as a greater consistency and a reduced strain on healthcare professionals. Furthermore, the paper explores AI integration into dermatological practices, addressing current challenges and future possibilities. The synergy between AI and RCM holds the potential to significantly advance skin disease diagnosis, ultimately leading to better therapeutic personalization and comprehensive dermatological care. Full article

Background: Lichen sclerosus (LS) is a chronic, inflammatory dermatosis that affects both genital and extragenital sites. It is often difficult to treat and may lead to a variety of complications if not adequately treated. The mainstay of therapy involves topical corticosteroids, topical calcineurin inhibitors, and systemic immunomodulators. Although a variety of topical, oral, and procedural therapies are available, a review comparing relative efficacy is lacking. To this end, this systematic review aimed to summarize the literature regarding treatment modalities and their respective response rates in patients with genital LS. Methods: A literature search was conducted in accordance with PRISMA guidelines. Results: This review qualitatively summarizes information from 31 randomized controlled trials, encapsulating a total of 1507 patients with LS, the majority of which were female (n = 1374, 91%). Topical corticosteroids, the mainstay of therapy for LS, were discussed throughout the literature, and proved to be more efficient than topical calcineurin inhibitors, topical hormonal therapy, topical vitamin E oil and cold cream. However, other treatment modalities proved to be more efficient than topical corticosteroids, including CO₂ and Nd:YAG laser therapies, and the addition of polydeoxyribonucleotide intradermal injections, to steroid therapy. Finally, other modalities that proved to be efficient in the treatment of LS included silk undergarments, human fibroblast lysate cream, platelet-rich plasma, acitretin, and surgical intervention. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Limitations included the inclusion of only randomized controlled trials, moderate or high risk of bias, and heterogeneity in treatment regimens, among others. Conclusion: Although high-potency topical corticosteroids have validated efficacy in the management of LS, other treatment modalities, including steroid-sparing agents and/or procedural adjuncts, have been demonstrated to have a beneficial role in the treatment of LS. Full article

Large language models (LLMs) are trained using large datasets and may be applied to language-based tasks. Studies have demonstrated their ability to perform and pass postgraduate medical examinations, and with the increasingly sophisticated deep learning algorithms and incorporation of image-analysis capabilities, they may also be applied to the Specialty Certificate Examination (SCE) in Dermatology. The Dermatology SCE sample questions were used to assess the performance of five freely available and high-performance LLMs. The LLMs’ performances were recorded by comparing their output on multiple-choice questions against the sample answers. One hundred questions, four of which included photographs, were entered into the LLMs. The responses were recorded and analysed, with the pass mark set at 77%. The accuracies for Claude-3.5 Sonnet, Copilot, Gemini, ChatGPT-4o, and Perplexity were 87, 88, 75, 90, and 87, respectively (p = 0.023). The LLMs were generally capable of interpreting and providing reasoned responses to clinical scenarios and clinical data. This continues to demonstrate the potential of LLMs in both medical education and clinical settings. Full article

The concept of gender has evolved significantly in recent decades, moving from a binary status to a multiplicity of gender types. In today’s world, the new reality of the concept of masculinity, as defined socially and historically, must be recognized and accepted by aesthetic medicine. Consequently, aesthetic doctors will have to adapt the views and treatment plans that they propose in their consultations to the ideals of beauty, as well as with the roles, behaviors, and attributes considered masculine within their society. Each facial feature suggests a personality characteristic that represents that individual. This expert opinion article aims to assess Caucasian male gender-related anatomical facial features and achieve an expert agreement on the association of specific features with the perception of attractiveness, masculinity, and personality traits in order to cover the wide range of current male representations, as well as to provide orientation for clinical practice improvement in the contemporary landscape of facial masculinization. Full article

Artificial intelligence (AI) based on convolutional neural networks (CNNs) has recently made great advances in dermatology with respect to the classification and malignancy prediction of skin diseases. In this article, we demonstrate how we have used a similar technique to build a mobile application to classify skin diseases captured by patients with their personal smartphone cameras. We used a CNN classifier to distinguish four subtypes of dermatological diseases the patients might have (“pigmentation changes and superficial infections”, “inflammatory diseases and eczemas”, “benign tumors, cysts, scars and callous”, and “suspected lesions”) and their severity in terms of morbidity and mortality risks, as well as the kind of medical consultation the patient should seek. The dataset used in this research was collected by the Department of Telemedicine of Albert Einstein Hospital in Sao Paulo and consisted of 146.277 skin images. In this paper, we show that our CNN models with an overall average classification accuracy of 79% and a sensibility of above 80% implemented in personal smartphones have the potential to lower the frequency of skin diseases and serve as an advanced tracking tool for a patient’s skin-lesion history. Full article

Image-guided superficial radiation therapy (IGSRT) combines superficial radiation therapy (SRT) with full dermal visualization (FDV) via high-resolution dermal ultrasound (HRDUS) for the treatment of non-melanoma skin cancer (NMSC). The gold standard for IGSRT delivery includes a comprehensive cancer care model with support for dermatologists from a multidisciplinary team. When delivered in this model, IGSRT can achieve cure rates of 99% for treatment of NMSC. This paper focuses on the benefits of HRDUS used in conjunction with SRT for NMSC. Medical records from 7 dermatology clinics of 883 patients with 1507 cases of NMSC treated with IGSRT between 2017 and 2018 were retrospectively reviewed. In total, 92% of the NMSC lesions showed daily depth fluctuations, 60.32% of lesions did not require changes during therapy, and nearly 40% of lesions required at least one compensatory change during therapy. In total, 83% of NMSC lesions were labeled as high risk based on the 2024 NCCN guidelines. Increasing and decreasing tumor depth measurements during IGSRT inform dermatologists when adaptive changes in energy (kV), TDF, and dose will result in more efficacy and less toxicity, respectively. Full article

Micellar waters are widely used skincare cleansing products. It is commonly considered that micellar waters do not need to be rinsed off. Products left on the skin can affect its pH, which typically ranges from 4.1 to 5.8. and plays a vital role in maintaining the integrity of the skin barrier. Our objective was to evaluate the pH of micellar waters and investigate product claims, and differences according to target skin type. The pH of 30 samples of different micellar waters was tested. The products were categorized into groups based on target skin type. Statistical analysis was performed on both quantitative and qualitative data. In addition to descriptive statistics, the Shapiro–Wilk test, Fischer’s Exact test, and the Kruskal–Wallis test were used considering the minimal significance level of 95%. The pH of the tested micellar waters ranged from 4.25 to 7.87. Most samples, 21 (70%), claimed to have a no-rinse formula. Most products, 18 (60%), also reported some type of testing having been performed. There were no statistically significant differences in pH between target skin types but products “for all skin types” were the most likely to lack rinsing instructions. In conclusion, most micellar water samples had skin-friendly pH levels and providers should carefully consider product characteristics for patients with skin conditions. Full article

Actinomycosis, an uncommon granulomatous infection caused by the Actinomyces species, rarely targets as primary involvement the limb and is often linked to traumatic incidents. In this report, we present the case of a 44-year-old female who developed multiple small nodules on her left foot over approximately 12 months. Some nodules exhibited firmness and a violet hue, while others discharged a yellowish fluid. The patient had no significant comorbidities. Despite thorough blood paraclinical assessments, including complete blood count, serological HIV testing, and QuantiFERON-TB Gold testing, no abnormalities were detected. Bacteriological examinations and cultures of the discharge yielded negative results. Dermatoscopic examination revealed ovoid yellowish structures, with confocal microscopy highlighting granulomas. A subsequent skin biopsy confirmed characteristic changes indicative of actinomycosis. Although systemic antibiotic therapy with penicillin derivatives was initially considered, the patient’s documented allergic history to this medication class, verified through allergological testing, prompted the initiation of doxycycline treatment. Notably, significant improvement was observed at the 3-month follow-up. This case underscores the importance of reporting rare instances of actinomycosis due to its diagnostic complexity and management challenges. Full article

Pemphigus vegetans and pemphigus foliaceus are rare autoimmune blistering diseases characterized by the disruption of desmosomal adhesion proteins, particularly desmoglein 3 and desmoglein 1. We report the case of a 62-year-old male who presented initially with scaly red plaques posing several diagnostic challenges. A histopathological examination revealed subcorneal acantholysis, matching the suspected clinical diagnosis of pemphigus foliaceus. The patient progressed, developing vegetating plaques, and a new biopsy was performed. The new histopathological and direct immunofluorescence exams were consistent with pemphigus vegetans. This case highlights the diagnostic challenges posed by the transition of pemphigus foliaceus to its vegetating form. We discuss the role of desmogleins in the pathogenesis of pemphigus and explore potential therapeutic strategies targeting these specific autoantigens. Full article

In fair-skinned populations worldwide, skin cancer is a serious public health threat. A significant percentage of all reported occupational diseases fall back on skin cancer. Over the past few decades, there has been a rise in the frequency of skin cancer diagnoses among outdoor workers. The main cause of non-melanoma skin cancer is solar ultraviolet radiation (UVR), which is also the most common occupational carcinogenic exposure in terms of the number of exposed workers (i.e., outdoor workers). Sun protection—and concomitantly the prevention of occupational skin cancer—is a component of workplace safety. The risks of solar UVR exposure at work are often disregarded in practice, despite the recent recognition of the need for measures to support outdoor workers’ sun protection behavior. It is anticipated that occupational dermatology will become increasingly focused on sun safety in the coming decades. To handle current hurdles in a sustainable manner, the full range of preventive measures should be utilized. Existing strategies for the prevention of occupational skin cancer might be evolved and enriched by new (educational) concepts, methods, and/or technologies. In this, not only components of general prevention and individual prevention but also setting-based prevention and behavior-based prevention might be freshly thought through. Full article

Acrodermatitis chronica atrophicans (ACA) is not an infrequent condition in Europe. However, the characteristic skin lesions are often confused by non-dermatologists with other conditions. We report three unusual cases in which we made a definitive diagnosis of ACA complicated by cutaneous marginal zone lymphoma, juxta-articular fibrotic nodules, or bilateral sensory polyneuropathy. In all cases, correct diagnosis and adequate treatment was delayed over a period of at least 12 months. We initiated systemic antibiotics resulting in full recovery in these patients. The present case reports underscore that ACA may be associated with unusual clinical presentation which potentially result in delay of correct diagnosis and treatment. Hence, ACA diagnosis may be considerably delayed leading to inappropriate therapy exposure, prolonged patients’ suffering, and causing unnecessary cost. Thus, physicians who are not familiar with skin conditions should seek a timely dermatologist consultation. Full article

Psoriasis is an immune-mediated disease, with various triggering factors, genetic predisposition, and an altered immune response concurring in the development of this disease. The eosinophil is a cell with an important role in various kinds of inflammatory processes. Scarce data are available regarding the role of the eosinophil in psoriasis. This study aims to address the overall relationship between eosinophil-count-derived inflammatory markers and psoriasis severity. There were 366 patients fulfilling the inclusion criteria included in this retrospective study and they were divided based on the body surface area (BSA) scale in mild and moderate-to-severe psoriasis. White blood cell (WBC), neutrophil, lymphocyte, monocyte, and eosinophil count, along with eosinophil-to-monocyte ratio (EMR) and eosinophil-to-neutrophil ratio (ENR) differed significantly between the two study groups. Eosinophil count, EMR, and ENR negatively correlated with disease severity. ENR is the most reliable eosinophil-count-derived marker in assessing psoriasis severity with an AUC of 0.627 and a cut-off value of 0.03. Eosinophil-count-derived inflammatory markers’ usefulness in appreciating disease severity was assessed for the first time in the literature in this study and proved to be reliable for the eosinophil count, EMR, and ENR. Full article

This review provides an overview of the structural and functional features of key phytosphingosine-based ceramides (CERs), notably CER[EOP], CER[NP], and CER[AP], and their role in atopic skin health. Herein, we discuss how these indispensable stratum corneum (SC) lipids maintain skin barrier homeostasis and contribute to the skin’s barrier function in terms of its cohesiveness and resilience. We also consider the usefulness of CER[EOP], CER[NP], and CER[AP] in preserving skin hydration and protecting and/or repairing dry, itchy, or sensitive skin. Next, we explore how and to what extent an imbalance or inadequate amounts of CER[EOP], CER[NP], and CER[AP] contribute to the hallmark characteristics of atopic skin diseases like eczema. Furthermore, we discuss the importance of complementary SC resident lipids such as cholesterol (CHOL) and free fatty acids (FFAs), which are crucial for optimal CER function. Studies have shown that delivering topical CERs in balanced and optimal combination with CHOL and FFAs—while supporting and boosting the endogenous biosynthesis of CERs using ingredients such as niacinamide and lactic acid—helps relieve symptoms of atopic diseases to provide some measure of relief. Finally, we look at some emerging ingredients that can complement the science of CERs in healthy and diseased skin. Full article

The most frequent primary cutaneous lymphomas observed in childhood and adolescence are mycosis fungoides (MF) and CD30-positive lymphoproliferative diseases. We report a 22-year-old female who presented with a 6-year history of multiple well-demarcated large roundish-oval scaly and reddish-brownish patches and plaques on the trunk and extremities. Histopathology revealed the focal parakeratosis and prominent epidermotropism of atypical lymphocytes, which were positive for CD8, CD56, and TIA-1 and showed a loss of CD7 and CD5 expression. T-cell receptor (TCR) gene rearrangement analysis (multiplex-PCR, BIOMED-2) of the lesional skin demonstrated the rearrangement of the gamma chain (tube A: 162 nt). Based on clinicopathological findings and a complete work-up, she was diagnosed with juvenile non-poikilodermatous C8+/CD56+ MF in stage IA. Resolution of the skin lesions was achieved by 16-week narrowband UVB phototherapy and clobetasol propionate 0.05% ointment. Juvenile-onset non-poikilodermatous CD8+CD56+ MF represents a very rare MF subtype and is associated with an indolent course. In order to avoid too aggressive diagnostics and treatments, clinicians should be aware of this rare and indolent MF variant in childhood and adolescence. Full article

Adenosquamous carcinoma of the skin (ASCS) or primary cutaneous adenosquamous carcinoma is a rare malignant neoplasm. It is characterized by the presence of both glandular and squamous cell components and a propensity for aggressive clinical behavior. Due to its rarity, it continues to pose diagnostic challenges. To date, only a few cases of this tumor have been reported, and even fewer have been thoroughly investigated via immunohistochemistry. Full article

Rosacea is a common chronic inflammatory skin condition. It mainly affects the cheeks, nose, chin, and forehead, causing flushing or transient erythema, persistent erythema, phymatous changes, papules, pustules, and telangiectasias, and the eyes may also be affected by rosacea. Rosacea is more common in women than in men and can start at any age. Rosacea affects both fair-skinned and darker-skinned people. Physical changes in the face due to rosacea can cause embarrassment, leading to reduced quality of life and self-esteem. Rosacea has several triggers, and its pathogenesis involves multiple factors, which means there are several treatment options, and these options can be combined. A patient’s clinical findings and symptoms will help a doctor to diagnose and classify the condition. Treatment options may include lifestyle changes, topical medications, systemic antibiotics and light-based therapy. The best approach is to tailor the treatment to the individual’s condition and preferences. The aim of treatment is to manage symptoms and prevent the progression of the disease. Full article

Multisystem inflammatory syndrome in children (MIS-C) is a rare, systemic inflammation following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We report a case of a 2-year-old male who presented with an exanthem and aberrant laboratory markers, mimicking Kawasaki disease but failing to meet the full diagnostic criteria. His course was further complicated by herpes Simplex Virus-1 (HSV-1) stomatitis. Full article