Dermato

The barrel jellyfish (Rhizostoma pulmo), like other cnidarians, shows cnidocytes containing cnidae, responsible for the jellyfish’s stinging properties. The sting of R. pulmo can cause contact dermatitis or urticaria and even systemic symptoms. Recent studies have identified stinging-cell structures in the mucous secretion released in the water column by Cassiopea xamachana, belonging to the same order as R. pulmo. The present paper verifies the release of stinging-cell structures in the water by R. pulmo and reports the case of two 17-year-old adolescents (one male and one female) who were affected by epidermal rashes consistent with the irritating sensations of stinging water. The reaction happened twice in the Ionian Sea; the patients were in proximity to R. pulmo but, on both occasions, there had been absolutely no direct contact with the jellyfish’s tentacles. To test the hypothesis of stinging water caused by R. pulmo, samples of sea water and mucous harvested in close proximity to a living jellyfish were taken and analyzed under a microscope at different magnifications. The microscopic analysis showed the presence of free and aggregated nematocysts in both the samples of water and mucous. It is likely that the free and aggregated nematocysts observed were discharged in the water by the jellyfish and were dispersed by water currents that led them to come into contact with the patients’ skin. At present, it is not known what predisposes humans to the perception of stinging water, and it is reasonable to affirm that caution should be advised for people with an allergic history when entering the water in the presence of jellyfish. Further investigations are required to better understand both the pathophysiological pathways underlying the stinging water phenomenon and the minimum concentration of urticating elements that is able to trigger the onset of stinging water. Full article

Acne vulgaris is a common skin condition often causing physical and emotional distress. We reported a case of 27-year-old female with rash and acne over the chest and upper back following continuous application of moisturizer. This case emphasizes the role of comedogenic moisturizers in acne development or worsening by disrupting the skin’s natural barrier, especially on oily areas including the chest and upper back. We aim to highlight an underrecognized but significant factor in developing acne vulgaris resulting in psychosocial impact and morbidity. Full article

Background: Artificial intelligence (AI) has emerged as a transformative tool in modern medicine, particularly in dermatology, where it supports the diagnosis and management of various skin diseases, including skin cancer. Through machine learning and deep learning techniques, AI enables accurate analysis of clinical and dermoscopic images, improving early detection and clinical outcomes. Objective: This systematic review aimed to evaluate the clinical applications of AI in dermatology, focusing on its impact on diagnostic accuracy, workflow efficiency, and access to specialized care. Methods: The review was conducted according to PRISMA guidelines. Peer-reviewed studies published between January 2020 and March 2025 in English or Spanish were included if they evaluated AI-based tools for dermatological diagnosis, classification, or treatment. Animal studies, editorials, non-peer-reviewed articles, and studies with an unclear methodology were excluded. A comprehensive search was performed in PubMed, Scopus, IEEE Xplore, and Google Scholar between December 2024 and March 2025. The risk of bias was assessed qualitatively, using a tailored framework based on study design, dataset transparency, and clinical applicability. Results: A total of 29 studies met the inclusion criteria. AI tools demonstrated high performance in melanoma detection, achieving up to 90% accuracy and 85% sensitivity. In clinical settings, AI support reduced mismanagement of malignant lesions from 58.8% to 4.1% and avoided 27% of unnecessary procedures in benign cases. Additional tools such as convolutional neural networks and imaging systems like FotoFinder also showed promising results. Limitations: Limitations of the evidence include the heterogeneity of AI models, lack of external validation, and a moderate-to-high risk of bias. Conclusions: AI has demonstrated robust clinical potential in dermatology, particularly in cancer detection and workflow optimization. However, further studies are required to address challenges such as algorithmic bias, data privacy, and regulatory oversight. Funding and registration: This review received no external funding and was not registered in a systematic review registry. Full article

Background/objectives: According to the Chapel Hill Consensus Conference nomenclature, single-organ cutaneous small vessel vasculitis (SOCV) is defined histopathologically by immune complex-mediated vasculitis of the dermal capillaries/venules without systemic involvement. There is a lack of investigations studying predictors of SOCV outcomes. This multicenter retrospective study aimed to assess whether baseline serum liver scores could predict SOCV recurrence. Methods: Data from 204 inpatients with histopathologically confirmed idiopathic SOCV treated between 2000 and 2022 were analyzed. All patients had baseline blood tests for platelets and liver parameters; those with systemic diseases were excluded. The study evaluated the AST to Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) index, and De Ritis ratio (DRR). Results: Recurrence was observed in 17.6% of patients. Univariable analysis identified hospital stay length, DRR, cutaneous extent, and cardiovascular comorbidities as predictors, but logistic regression confirmed only cutaneous extent and DRR as independent predictors of disease recurrence. Conclusions: A higher DRR (cut-off > 1.13) may indicate necrosis from reduced blood flow, making it a potential predictor of SOCV recurrence. Full article

Background/Objectives: Skin lesions, ranging from benign to malignant diseases, are a difficult dermatological condition due to their great diversity and variable severity. Their detection at an early stage and proper classification, particularly between benign Nevus (NV), precancerous Actinic Keratosis (AK), and Squamous Cell Carcinoma (SCC), are crucial for improving the effectiveness of treatment and patient prognosis. The goal of this study was to test deep learning (DL) models to determine the best architecture to use in classifying lesions and create a web-based platform for improved diagnostic and educational availability. Methods: Various DL models, like Xception, DenseNet169, ResNet152V2, InceptionV3, MobileNetV2, EfficientNetV2 Small, and NASNetMobile, were compared for classification accuracy. The top model was incorporated into a web application, allowing users to upload images for automatic classification, thereby offering confidence scores as a measure of the reliability of predictions. The tool also has enhanced visualization capabilities, which allow users to investigate feature maps derived from convolutional layers, enhancing interpretability. Web scraping and summarization techniques were also employed to offer concise, evidence-based dermatological information from established sources. Results: Of the models evaluated, DenseNet169 achieved the best classification accuracy of 85% and was, therefore, chosen as the base architecture for the web application. The application enhances diagnostic clarity by visualizing features and promotes access to trustworthy medical information on dermatological disorders. Conclusions: The developed web application serves as both a diagnostic support system for dermatologists and an educational system for the general public. By using DL-based classification, interpretability techniques, and automatic medical information extraction, it facilitates early intervention and increases awareness regarding skin health. Full article

Background/objectives: Stimulator of Interferon Genes (STING)-associated vasculopathy with onset in infancy (SAVI) is a rare autoinflammatory disorder caused by gain-of-function mutations in the TMEM173 gene. These mutations result in chronic activation of the STING pathway and excessive type I interferon production, leading to systemic inflammation, vascular abnormalities, interstitial lung disease, and skin ulcerations. Janus kinase (JAK) inhibitors, including baricitinib, have shown promise in mitigating systemic and organ-specific manifestations. However, these inhibitors broadly suppress immune pathways, potentially increasing vulnerability to infections. Case presentation: This case report describes a 21-year-old woman with SAVI (due to a heterozygous TMEM173 mutation) who developed disseminated molluscum contagiosum (MC) while receiving baricitinib therapy. Laboratory results revealed lymphopenia, low CD4/CD8 ratio, and impaired immune cell activity, suggesting compromised antiviral immunity. Discussion: Despite SAVI’s association with excessive type I interferon signaling, this chronic hyperactivation may cause immune dysregulation, exhausting T cells and natural killer cells vital for viral defense. Furthermore, baricitinib suppresses interferon signaling via the JAK-STAT pathway, reducing inflammatory damage in SAVI but also impairing antiviral responses. Moreover, MC viruses evade host immune defenses by antagonizing STING and TANK-binding kinase 1-mediated interferon activation, further contributing to infection risk. This report is the first to document MC in a SAVI patient and highlights the rare complication of disseminated MC due to impaired type I interferon signaling and immune suppression from baricitinib therapy. This case underscores the need for vigilance regarding viral infections in SAVI patients treated with JAK inhibitors. Full article

Background and Objective: Age-related skin changes affect the skin’s structural and functional integrity and reduce the ability of the skin to perform its key barrier functions. Skin breakdown associated with dryness and itch becomes very common and older individuals are at an increasing risk. We aimed to evaluate a daily cleansing–moisturizing routine and conduct a skin assessment for the presence of five underlying skin integrity parameters among aged-care residents. Methods: This small, 6-week evaluation study included four participants over 80 years of age, all of whom were residents at OLC Care, Rocky Point Residence, Beverley Park, NSW, Australia. Skin assessment for the presence of five underlying clinical parameters including itchy skin, dry skin, bruising, skin tears and pressure injuries was conducted for all four participants at baseline and during the evaluation period. Clinical notes were also taken at baseline, during the evaluation and at the post-evaluation. Furthermore, clinical photographs were taken at baseline and after 2–3 weeks of the cleansing–moisturizing routine. Results: Of the four aged-care residents who participated in this evaluation study, all four showed overall improvement in the appearance of the skin with a reduction in severity of the five underlying skin integrity parameters, including itchy skin, dry skin, bruising, skin tears and pressure injuries, where present. Discussion and Conclusions: This case study has produced basic evidence to support a daily cleansing–moisturizing routine (comprising QV cleansers and moisturizers, and/or a protective barrier cream) as it provides moisturizing and protective benefits to the delicate and fragile skin of aged-care residents, where the aim is to reduce skin integrity associated issues. Full article

Background/Objectives: Rice bran oil (RBO) is rich in phytochemical compounds and has many pharmaceutical applications. This work evaluated the regenerative potential of nanofibers incorporating RBO, focusing on their efficacy in tissue engineering and dermatological formulations. The main objective was to investigate the impact of RBO on SK-MEL-28 melanoma cell migration and wound closure through an in vitro healing assay. In addition, the biocompatibility and cell adhesion properties of the nanofibers were examined. Methods: The study employed cell culture techniques and field emission gun scanning electron microscopy (FEG-SEM) investigation. RBO was tested at different concentrations (0.5%, 1%, 5%, or 10%), both in isolation and incorporated into nanofibers. Cell migration was assessed through a wound-healing assay, while cell adhesion to the nanofibers was assessed using FEG-SEM. Statistical analyses were conducted to assess the significance of the findings. Results: Higher cell migration was achieved with 5% (p < 0.002) and 10% (p < 0.05) RBO nanofibers compared to the control and isolated RBO. The biocompatibility study found cell adhesion capability, highlighting the potential of these nanofibers for tissue engineering applications. Conclusions: Our results showed enhanced SK-MEL-28 cell migration and wound closure with RBO-incorporated nanofibers compared to isolated RBO. Biocompatibility was confirmed, suggesting potential for tissue engineering. Our findings indicate that the incorporation of RBO into nanofibers improves their oxidative stability, which is essential for preserving their phytochemical compounds and their beneficial effects on human skin cells in vitro. Full article

Background/objectives: Ultraviolet-B (UVB) represents a major extrinsic factor in skin cancer development, causing cellular changes that are not yet fully understood. Aquaporins (AQPs) are a family of transmembrane proteins that favor water transport and are involved in several pathways. Nicotinamide (NAM), a vitamin B3 derivate, is a safe molecule able to reduce UVB-induced damages. This study aims to verify whether AQP expression is affected by UVB exposure at different dosages and times and to evaluate NAM’s effects against UVB-induced damages. Methods: A375 cells were exposed to 40, 100, and 200 mJ/cm² UVB doses and analyzed 0, 1, 18, and 24 h post-irradiation. Results: We found that the 40 mJ/cm² UVB dose, 24 h post-irradiation, caused the most detrimental effects an overall overexpression and dimerization of AQPs. However, in the presence of NAM 25 μM, the cell cycle was restored, leading to improved cell viability and proliferation, reduced ROS levels, and reduced DNA damage. Moreover, we found decreased AQPs expression and dimerization. Conclusions: Overall, NAM effectively mitigates UVB-induced cellular damage, including AQPs overexpression, and may serve as a protective agent against UVB-related skin damage. Full article

Background: Actinic keratoses (AKs) are epidermal neoplasms with a risk of progression to squamous cell carcinoma. Multiple therapeutic options targeting single or multiple lesions, with varying degrees of clearance, have been described. Objective: Evaluate the number of cycles of 5% potassium hydroxide (KOH) solution required for the resolution of actinic keratosis. Methods: This study was conducted on 261 AK lesions in 29 patients. A cycle of application of KOH was indicated in 28 doses with a subsequent monthly clinical and dermoscopic review for a maximum of three cycles of application. Resolution was determined dermoscopically. Results: Dermoscopic resolution was observed in 203 (77.7%) lesions, obtaining a mean number of cycles for a complete resolution of 2.4. Better results were observed in patients who received three cycles than in those who received one or two cycles (p = 0.003 and p = 0.000, respectively). The most common adverse effect was burning, followed by xerosis (69 and 21%, respectively). Conclusions: The 5% KOH solution represents a promising therapeutic option for the treatment of single lesions of actinic keratosis, with an adequate response and tolerable use profile for patients. Based on our results, we suggest the use of 5% KOH solution in AKs with Olsen clinical classification I or II. Full article

Background/Objectives: As the incidence of melanoma and skin cancer is increasing, awareness campaigns can be a useful tool to prevent these conditions. To optimize these campaigns, it is important to establish what the population really know about photoprotection and how they comply with photoprotection habits. Methods: We conducted a survey on the knowledge, behavior, and attitudes related to sun exposure in the Spanish population across the country. The results were analyzed globally and also differentiating by age between those under 25 years of age and those over 25 years of age. Results: Responses from 12,597 respondents were analyzed. Globally, 97% associate bad sun exposure habits with skin cancer; however, when we analyze the results in more detail, the prevalence of an association between tanning and skin damage and the prevalence of the correct use of sunscreens and photoprotective attitudes are lower, especially in people under 25 years old. Conclusions: The data from this survey reinforce the idea that dermatologists need to promote greater awareness among the Spanish population regarding both the skin damage induced by solar radiation and the importance of good photoprotection and preventive habits, specifically in men and people under 25 years of age. To our knowledge, this is the biggest survey to date performed in Spain. Full article

Background/Objectives: A prior placebo-controlled, double-blind clinical study demonstrated the superiority of a topical combination of heparin and levomenol over the control and single active constituents. The effect on pruritus and the total SCORAD index were used to evaluate efficacy, but not the effect on the individual SCORAD items. This analysis investigates the overall efficacy of the treatment and the relative contributions of heparin and levomenol to symptom relief in atopic dermatitis, including the effects on the affected body area and its implications for sleeplessness. Methods: The ITT group (combination group A: n = 79; levomenol group B: n = 80; heparin group C: n = 78; placebo group D: n = 41) of the previously published study was re-analysed. Results: The combination significantly improved symptoms such as erythema, edema/papulation, excoriations, and skin dryness compared to the control after eight weeks of treatment. No significant differences were observed for oozing/crust and lichenification among the active groups. Levomenol and heparin exhibited significant advantages over the control for erythema and excoriations, while heparin improved edema/papulation significantly. The inflamed body area significantly decreased using the combination or single active constituents, and sleeplessness significantly improved with the combination or with heparin alone compared to the control. Conclusions: These findings highlight the efficacy of the combination and individual active constituents in addressing specific symptoms of atopic dermatitis, providing insights into their therapeutic effects. The combination’s advantage over the control is most evident in improving excoriations, skin dryness, inflamed skin area, and sleeplessness, justifying its documented use as an intervention in the early stages of atopic dermatitis episodes. Full article

Background/Objectives: IgA vasculitis, formerly Henoch-Schönlein purpura (HSP), is a form of systemic vasculitis that most commonly affects children. We present a case of hard-to-heal lower extremity lesions in a patient with confirmed IgA vasculitis or HSP. Methods: The patient was serially imaged with a handheld, bacterial autofluorescence imaging device across subsequent visits. Results: Due to the identification of bacterial burden presence that was not clinically evident, the patient was prescribed antibiotics and promptly healed. Conclusions: This case illustrates the value of bacterial fluorescence imaging in dermatological cases. Full article

Background: Narrowband ultraviolet B (nb-UVB) is one of the most popular and effective modalities to treat vitiligo. Given the importance of nb-UBV, as well as its associations, this research searched the literature for answers on how to best treat vitiligo. Objective: To conduct a systematic literature review assessing the efficacy of narrowband ultraviolet B (NB-UVB) therapy for the treatment of vitiligo, in comparison with psoralen plus ultraviolet A (PUVA) therapy and other topical or systemic treatment modalities. Methods: The databases included were PubMed, Embase, Cochrane, Scopus, Web of Science, and LILACS. Gray literature was also used: Google Scholar, Open Grey, and Library of Thesis and Dissertations-CAPES. The search used the keywords: “Vitiligo” AND “Ultraviolet Therapy OR Actinotherapy”. The risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool by two independent, blinded reviewers, with disagreements resolved by a third reviewer. The outcome assessed was repigmentation. Results: Three randomized controlled trials were selected from 2973 records. In three studies, Nb-UVB had superior effects to the comparator. Conclusion: Nb-UVB phototherapy improves repigmentation in patients with vitiligo, with few side effects. However, the variability in the protocols and the risk of bias require caution when interpreting the results. Full article

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