Search Results (113)

Background/Objectives: Onychomycosis is a common fungal nail infection that may contribute to foot morbidity in adults with type 2 diabetes mellitus (T2DM), particularly when neuropathy, peripheral vascular disease, nail dystrophy, local trauma, tinea pedis, or poor glycaemic control coexist. This systematic review and meta-analysis aimed to estimate the prevalence of onychomycosis in adults with T2DM and to explore sources of between-study heterogeneity. Methods: MED-LINE/PubMed, Scopus, Web of Science, LILACS, and EMBASE were searched from 1 January 2000 to 31 January 2026. Observational studies reporting onychomycosis prevalence in adults with T2DM were included. Pooled prevalence was estimated using a random-effects model, and subgroup, sensitivity, and exploratory meta-regression analyses were performed according to diagnostic method, sampling type, geographic region, publication year, and mean age. Results: Eighteen studies, including 6764 participants, were included. The random-effects pooled prevalence was 31.4% (95% CI: 21.7–42.0%), with extreme heterogeneity (I² = 98.8%). Prevalence ranged from 3.8% to 71.7% across studies. Laboratory- or histology-confirmed studies showed a lower pooled prevalence than clinically diagnosed studies, suggesting that clinical diagnosis alone may overestimate onychomycosis prevalence. Exploratory meta-regression indicated that diagnostic method was the main methodological factor associated with prevalence differences, whereas publication year, sampling type, and mean age did not explain heterogeneity. Conclusions: Onychomycosis is frequent among adults with T2DM, but prevalence estimates vary substantially across studies. The pooled estimate should be interpreted cautiously because of extreme heterogeneity and differences in diagnostic definitions. Future studies should use standardised clinical and mycological or histological diagnostic criteria and report diabetes-related risk factors to improve comparability. Full article

Background/Objectives: Metatypical basal cell carcinoma (MTBCC) is a rare and aggressive variant of non-melanoma skin cancer (NMSC) characterised by overlapping histological features of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). Owing to its increased propensity for local invasion, recurrence, and metastasis, MTBCC poses diagnostic and therapeutic challenges. This study aimed to characterise the epidemiological, histopathological, and clinical features of MTBCC and to evaluate temporal changes in tumour characteristics and aggressiveness before, during, and after the COVID-19 pandemic. Methods: A retrospective cohort study was conducted on 129 histologically confirmed MTBCC lesions diagnosed in the Pathology Department of the Mures Clinical County Hospital, Targu Mures, Romania, between January 2017 and December 2025. Demographic data, tumour location, histological subtypes, differentiation of the squamous component, aggressiveness parameters, and volumetric measurements of tumours and excision specimens were analysed. Volumetric analyses were restricted to cases with complete three-dimensional measurements. Statistical comparisons were performed across demographic variables and the following three time periods: pre-pandemic, pandemic, and post-pandemic. Results: The median age at diagnosis was 71 years, with a slight male predominance (p = 0.25) and a significant predominance of patients from urban areas (p < 0.001). Most tumours were located in the head and neck region. Mixed-type MTBCC was significantly associated with higher tumour aggressiveness (p = 0.0019) and with high-risk histological subtypes, particularly micronodular and adenoid–cystic variants. Tumour volume showed a significant inverse correlation with year of diagnosis (p = 0.0139; r = (−) 0.50), whereas excision specimen volume differed significantly according to year of diagnosis (p = 0.0425). Neither tumour volume nor excision specimen volume was associated with histopathological aggressiveness. Conclusions: Metatypical basal cell carcinoma is a rare skin malignancy in which biological behaviour appears to be determined primarily by histopathological architecture rather than tumour size. Mixed-type lesions were associated with significantly higher aggressiveness, underscoring the need for accurate histopathological assessment. These findings support a pathology-driven approach to management and emphasise the importance of adequate surgical treatment and long-term follow-up in patients with MTBCC. Full article

Background/Objectives: Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), originally developed for Type II Diabetes, has become popular for weight loss due to its ability to suppress appetite and promote fat loss. Although semaglutide’s metabolic benefits are well established, many patients have also reported unintended facial changes including facial fat atrophy, skin laxity, and an aged appearance, collectively known as “Ozempic face.” Methods: To better understand these dermatological effects, a narrative review was conducted using PubMed and Google Scholar to identify relevant peer-reviewed literature published between 2010 and 2025. Search terms included “semaglutide,” “GLP-1 receptor agonists,” “Ozempic face,” and “facial fat loss.” Peer-reviewed clinical studies, reviews, and relevant commentary were included; articles not written in English or unrelated to weight-loss aesthetic outcomes were excluded. Results: Weight loss induced by semaglutide is distinctly characterized by rapid, disproportionate depletion of sensitive facial fat compartments such as the malar, temporal, and buccal regions. Preliminary findings also suggest that GLP-1RAs may impact dermal white adipose tissue, affecting collagen production and elastin structure. Findings highlight both the biological mechanisms underlying facial aging in semaglutide users and the current lack of research-based strategies to prevent or treat these changes. Conclusions: Although aesthetic interventions such as dermal fillers and energy-based treatments may help restore volume and contour, more research is needed to characterize long-term effects and develop objective clinical guidelines. Increased counseling and awareness regarding GLP-1RA-induced facial changes should be integrated into patient care, especially as these agents continue to expand in popularity. Full article

Atopic dermatitis (AD) is a chronic inflammatory skin disease in which type 2 immune activation, epidermal barrier dysfunction, microbial dysbiosis, and neurosensory pathways interact to sustain disease activity and symptom burden. Despite major advances with biologics and Janus kinase inhibitors, residual xerosis, pruritus, sleep disturbance, and barrier fragility may persist in otherwise controlled patients. This narrative review evaluates balneotherapy as adjunctive supportive care in AD, focusing on skin barrier function, microbiome-related effects, pruritus, and clinical integration. A narrative literature review was conducted using PubMed/MEDLINE, Ovid, and Scopus from database inception to 31 December 2025. Search terms addressed AD, type 2 inflammation, skin barrier dysfunction, transepidermal water loss, pruritus, microbiome dysbiosis, thermal spring water, spa therapy, seawater therapy, Dead Sea climatotherapy, hydrotherapy, and balneophototherapy. Clinical, mechanistic, translational, and methodological studies were considered. Available evidence suggests that water-based interventions may improve selected patient-centred outcomes, particularly xerosis-related discomfort, pruritus, sleep impairment, quality of life, and global severity scores. Thermal spring water programmes, Dead Sea climatotherapy, seawater-based approaches, and balneophototherapy differ substantially in exposure characteristics, co-interventions, and outcome reporting. Objective endpoints such as transepidermal water loss, skin hydration, tape stripping biomarkers, and microbiome profiling may help clarify biological plausibility, although current evidence is limited by heterogeneity, short follow-up, and difficulty isolating water-specific effects. Balneotherapy should be positioned as an adjunctive, supportive intervention rather than an alternative to evidence-based anti-inflammatory therapy in AD, particularly for selected patients with persistent barrier- and symptom-dominant residual burden. Full article

Introduction: Chronic lymphedema (CL) can lead to infectious complications, skin inflammation, and tumors. Consequently, patients with CL are at increased risk of developing several malignant cutaneous neoplasms, including Kaposi sarcoma, B-cell lymphoma, and angiosarcoma. T-cell lymphomas are rarely associated with CL. Additionally, systemic anaplastic large cell lymphomas (ALCLs) are usually positive for anaplastic lymphoma kinase (ALK). We present the case of a 73-year-old patient who exhibited angiomatous-appearing cutaneous lesions, ultimately leading to a diagnosis of ALK-negative systemic ALCL, exclusively localized to the CL of the left lower limb. Case Report: A 73-year-old man presented with a 12-year history of CL affecting his left lower limb. He subsequently developed, over a three-month period, an angiomatous-like plaque accompanied by multiple nodules on the same limb. Physical examination showed widespread lymphadenopathy. A skin and lymph node biopsy specimen displayed CD3+, CD30+, ALK-negative atypical lymphoid infiltrates consistent with ALK-negative systemic ALCL with secondary cutaneous involvement. A total body computed tomography (CT) scan showed hepatosplenomegaly and generalized lymphadenopathy. In the Department of Hematology, combination chemotherapy of cyclophosphamide, Adriamycin, vincristine, and prednisolone (CHOP) was started, but the patient was lost to follow-up. Conclusions: We report a unique case of ALK-negative systemic ALCL in a 73-year-old man who presented with angiomatous-like nodular lesions occurring at the site of chronic limb lymphedema. This case demonstrates the importance of a systemic evaluation of all CD30-positive cutaneous lymphoid infiltrates and suggests that chronic lymphatic stasis may be a predisposing factor in the development of ALCL. Full article

Background: Acne is a common inflammatory dermatosis with well-documented epidemiology in urban populations; however, data from rural sub-Saharan African settings remain limited. Objective: To characterize the demographic profile, clinical subtypes, severity spectrum, complications, and comorbidities of acne among patients attending a rural tertiary dermatology centre in the Eastern Cape, South Africa. Methods: A quantitative, retrospective cross-sectional study was conducted using census sampling of dermatologist-confirmed acne cases diagnosed between 2022 and 2025. Demographic and clinical variables were extracted from medical records and analysed using descriptive and inferential statistics (p < 0.05). Results: A total of 166 patients were included, all of African ethnicity. Females predominated (89.2%), yielding a female-to-male ratio of 8.2:1. Adult-onset acne was most common (85.5%), with a median onset age of 26 years. Acne vulgaris represented the predominant subtype (83.1%). Papules and comedones were the most frequent lesions, and facial involvement was nearly universal (94.8%). Moderate disease (Grade 2) was most prevalent. Post-acne complications were highly frequent (92.8%), with post-inflammatory hyperpigmentation being the most frequent of these (87.0%). Comorbidities were observed in 52.4% of patients, most commonly eczema and pigmentary disorders. Conclusions: Acne in this rural cohort demonstrated a predominance of adult-onset disease, marked female susceptibility, moderate severity, and a high burden of pigmentary sequelae. These findings highlight the need for context-specific diagnostic and management strategies in underserved rural populations. Full article

Lichen planus pigmentosus inversus (LIPPI) is a rare variant within the spectrum of lichenoid dermatoses, characterized by sharply demarcated hyperpigmented lesions predominantly affecting intertriginous areas. Its pathogenesis remains incompletely understood, but immune-mediated mechanisms triggered by exogenous factors have been proposed. We report the case of an 80-year-old Caucasian female who developed extensive, reticulated brownish-grey hyperpigmentation involving multiple flexural sites shortly after the fifth intra-articular injection of the homeopathic combination preparation Zeel comp. N for knee pain. Histopathological examination showed a markedly atrophic epidermis with compact orthokeratosis, focal hypergranulosis, basal vacuolar/interface change, pigment incontinence, and a band-like lymphocytic infiltrate; these findings were compatible with LIPPI. The temporal association with repeated intra-articular administration of botanical and sulfur-containing compounds suggests a possible trigger; however, causality remains speculative. Prick and patch testing with the injection solution were negative, no rechallenge was performed, and pharmacovigilance assessment by the Naranjo algorithm supported only a possible adverse drug reaction. Several constituents, including Toxicodendron derivatives, Arnica montana and Solanum dulcamara, are recognized sensitizers capable of inducing delayed-type immune responses. Importantly, allergic contact sensitization and lichenoid interface dermatitis are distinct processes; in the present case, sensitization or systemic immune stimulation is considered only as a potential upstream trigger of a lichenoid reaction pattern. Similar lichenoid eruptions, including LIPPI, have been reported after systemic immune stimulation such as COVID-19 vaccination or targeted therapies. Differential diagnoses, particularly ashy dermatosis, were considered less likely because of the inverse/flexural distribution and clinico-pathological evidence of lichenoid interface dermatitis with epidermal atrophy. Treatment with systemic corticosteroids, acitretin, and topical tacrolimus improved pruritus, whereas hyperpigmentation persisted. This case highlights a possible temporal association between intra-articular administration of biologically active compounds and LIPPI, while emphasizing the need for cautious interpretation, pharmacovigilance data, and further reports. Full article

Introduction: High-Intensity Focused Ultrasound (HIFU) is a widely used non-invasive esthetic treatment for facial/neck rejuvenation, inducing thermal coagulation for neocollagenesis. Despite its general safety, its non-optimal application risks neurological adverse events like tinnitus, trigeminal neuralgia, and headaches. Materials and Methods: Out of a pool of 124 patients treated with HIFU (Dual Hi; Med & Tech, Occhiobello, Italy) by experienced esthetic clinicians, four patients developed neurological or otological disturbances, which are presented as descriptive clinical case reports. These included acute tinnitus, exacerbation of pre-existing tinnitus, trigeminal neuralgia during treatment, and post-procedural headaches. To contextualize the clinical findings, relevant published literature on neurological adverse events associated with esthetic HIFU was reviewed in a non-systematic manner using major scientific databases, and used to support descriptive clinical interpretation rather than formal systematic analysis. Results: Rare transient events include acute tinnitus post-HIFU; exacerbated pre-existing tinnitus; trigeminal neuralgia during a procedure; and post-session headaches. Potential mechanisms might include thermal and mechanical nerve injury adjacent to the superficial musculoaponeurotic system (SMAS); all cases resolved successfully through tailored approaches—spontaneous resolution, corticosteroids plus hyperbaric oxygen therapy, analgesics, or ibuprofen. Conclusions: Neurological adverse effects from esthetic HIFU are uncommon/self-limiting but underscore the need for operator training, anatomical expertise, and patient history screening. Standardized protocols are essential for safety. Full article

Background/Objectives: Vision Transformers (ViTs) have demonstrated impressive performance in dealing with large-scale natural image datasets. They have started to be used in medical image classification problems as well. However, how they behave under real-world conditions, such as data scarcity and extreme class imbalance, has not been well investigated. In this study, we examine the feasibility of using a standard Vision Transformer Base model that learned from scratch how to classify skin lesion images into multiple classes using the ISIC 2019 dataset. Methods: The Vision Transformer architecture was trained from scratch using stratified splitting of the data, class-balanced cross-entropy loss, multi-seed initialization, and control of hyperparameters such as patch size and dropout rate. The evaluation of the Vision Transformer architecture was performed using a hold-out test set with metrics such as accuracy, macro-F1, weighted-F1, and analysis of the confusion matrix. Results: Across all configurations, the training exhibited substantial instability and consistent overfitting behavior, with an average accuracy gap between validation and test sets of 22.7%. Test accuracy ranged from 8.0% to 37.8%, showing high sensitivity to initialization. For minority classes, the F1-score remained very low (F1 < 0.05) even though the classes were balanced in the loss function. Conclusions: The results indicate that a standard ViT-Base model trained from scratch can exhibit pronounced instability and a tendency toward majority-class bias when applied to multi-class skin lesion classification under conditions of extreme class imbalance and data scarcity. The findings point to the limitations of using simple transformer models without pre-training or other forms of inductive bias in scarce data settings. Full article

Background: Difficult-to-treat anatomical areas in atopic dermatitis (AD), including the head and neck, hands, genital and intertriginous regions, are frequently associated with therapeutic refractoriness, persistent pruritus, and substantial functional and psychosocial burden. Real-world evidence (RWE) regarding the effectiveness of Janus kinase (JAK) inhibitors in these site-dominant phenotypes remains fragmented. This structured narrative review aimed to synthesize available RWE on abrocitinib, baricitinib, and upadacitinib in AD involving difficult-to-treat areas. Methods: A comprehensive search of PubMed, Ovid MEDLINE, Scopus, Embase, and the Cochrane Library was conducted up to 31 December 2025. Real-world observational studies reporting site-specific outcomes in patients with AD treated with JAK inhibitors were included. Primary randomized controlled trial efficacy analyses were excluded, while relevant post hoc regional analyses were considered. A total of 22 studies met eligibility criteria for qualitative synthesis. Results: Across heterogeneous real-world cohorts, JAK inhibitors demonstrated clinically meaningful improvement in difficult anatomical regions, particularly the head and neck and hands. Rapid pruritus reduction was a consistent and clinically relevant finding. Safety profiles were broadly aligned with clinical trial data. Conclusions: Real-world data support JAK inhibitors as effective options for anatomically complex AD phenotypes, warranting further standardized regional assessment. Full article

Emerging research highlights the complex interplay between the gut microbiome, skin health, and environmental exposures, forming what is now recognized as the gut–skin–exposome axis. This narrative review explores the role of gut microbiome dysbiosis—a disruption in the balance of intestinal microorganisms—in the pathogenesis and progression of various non-communicable inflammatory skin diseases, including acne, atopic dermatitis, psoriasis, rosacea, systemic lupus erythematosus, chronic spontaneous urticaria, hidradenitis suppurativa, and alopecia areata. This review synthesizes mechanistic studies, clinical trials, and Mendelian randomization data to elucidate how altered gut microbial composition contributes to systemic and cutaneous inflammation. Key modifiable factors, such as diet, antibiotics, stress, and sleep, as well as interventions like probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, are discussed for their potential therapeutic value. By integrating clinical insights with microbiome science, this review underscores the importance of a holistic, systems-based approach in managing inflammatory skin diseases, offering clinicians evidence-based strategies to improve patient outcomes through gut microbiome modulation. Full article

Introduction: Alopecia areata (AA) is a chronic immune-mediated disorder characterized by non-scarring hair loss and a significant psychosocial burden. Ritlecitinib, a selective Janus kinase 3 (JAK3) and tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinase inhibitor, has recently emerged as a targeted systemic therapy for moderate-to-severe AA. While randomized clinical trials have demonstrated its efficacy, real-world evidence remains limited and heterogeneous. Methods: A structured narrative review was conducted to summarize current evidence on ritlecitinib in AA, with a focus on real-world outcomes. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to March 2026 using predefined keywords. Eligible studies included real-world observational studies, case series, and post hoc analyses of randomized controlled trials reporting clinical outcomes. Two independent reviewers performed study selection. Results: A total of 14 studies were included. Clinical trial analyses suggested sustained efficacy over time, with progressive improvement in Severity of Alopecia Tool (SALT) scores up to 24 months. Real-world studies reported clinically meaningful hair regrowth across diverse populations, including severe, pediatric, and treatment-experienced patients. Response rates increased over time, with a proportion of patients achieving SALT ≤ 20 or ≥80% improvement. Lower baseline severity and shorter disease duration were reported in several studies as potential factors associated with a better response. Safety profiles were favorable, with predominantly mild adverse events. Discussion: Ritlecitinib shows consistent effectiveness and acceptable safety in both clinical trials and real-world settings. Treatment response appears progressive and heterogeneous, supporting the importance of early intervention and adequate treatment duration. Further large-scale and long-term real-world studies are needed to better define predictors of response and optimize patient selection. Full article

Elderly psoriasis patients (≥65 years) demonstrate mainly preserved but substantially delayed therapeutic responses to IL-17 and IL-23 inhibitors, achieving lower PASI90 rates at early time-points with eventual “catch-up” by week 52, alongside increased adverse-event-driven discontinuation. This review synthesizes clinical efficacy data from real-world studies with emerging mechanistic evidence on immunosenescence and cellular senescence to propose the “Inflammatory Noise Floor” hypothesis. We postulate that senescent keratinocytes and fibroblasts constitutively secrete SASP cytokines (IL-6, IL-8, TNF-α) through pathways partially independent of IL-23/IL-17, potentially establishing a persistent baseline inflammation that IL-23/IL-17 blockade might not suppress. Concurrently, immunosenescence, characterized by CD8⁺CD28⁻ T-cell accumulation, exhaustion marker upregulation, and Treg dysfunction, is hypothesized to impair adaptive immune re-equilibration. This dual mechanism represents one plausible, albeit theoretical, explanatory framework for the temporal lag, PASI plateau effects, and infection risk observed in elderly patients. Optimizing outcomes in the elderly may require a pragmatic approach: accepting stable PASI 75-90 as a successful endpoint and prospectively validating extended assessment timelines. While a direct correlation remains to be proven, this framework identifies cellular and immunosenescence as potential targets for future senotherapeutic interventions. Full article

Background: Biotin (vitamin B7) is widely marketed and used as an over-the-counter supplement for hair, skin, and nails, despite uncertainty about its clinical benefit for alopecia and hair growth. While overt biotin deficiency can be associated with hair changes, clinically meaningful deficiency is uncommon in individuals consuming a balanced diet, and published findings on biotin status in hair loss populations are inconsistent. Methods: This is a systematic review following PRISMA. A search was conducted in PubMed/MEDLINE (PROSPERO: CRD420251274919) for human studies evaluating biotin (alone or in combination) and including hair outcomes. The synthesis was qualitative due to clinical and methodological heterogeneity. Results: Ten studies were included. Across controlled and quasi-experimental interventions, biotin monotherapy did not show consistent benefit on objective hair growth outcomes; when improvements were reported, they typically occurred in combined regimens and were difficult to attribute specifically to biotin. Studies showed mixed findings on “low” biotin levels in hair loss populations, whereas controlled studies in telogen effluvium found no significant differences in serum biotin versus controls. No serious adverse events attributable to biotin were identified; however, high-dose biotin may interfere with immunoassays, potentially leading to clinically relevant false laboratory results. Conclusions: Current evidence does not support routine biotin supplementation for alopecia in the absence of documented deficiency, although it may be considered in scenarios with risk or confirmation of deficiency/malabsorption. Full article