Search Results (105)

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 and Objectives: Palmoplantar pustulosis (PPPust) and palmoplantar psoriasis (PPso) are distinct palm/sole dermatoses that have historically shared the abbreviation “PPP”. Though the two—since the advent of advanced biotechnology—are now deemed separate diagnoses, each still falls under the ‘palmoplantar spectrum’. It is important to note that PPso and PPPust are each distinct from generalized pustular psoriasis (GPP), a condition that is outside the scope of our study. We quantified the relative efficacy of biologic and small-molecule monotherapies on the palmoplantar spectrum using Bayesian network meta-analyses (NMAs). Materials and Methods: On 6 November 2025, we searched PubMed, Scopus, ClinicalTrials.gov, and citations (i.e., citation mining) for randomized trials of monotherapy reporting PPP Area and Severity Index (PPPASI) outcomes at 12 or 16 weeks; we secondarily investigated fresh pustule-related outcomes at 4 weeks. We ran Bayesian NMAs with uniform priors; nodes were defined by dose and timepoint. Interventions’ Surface Under the Cumulative Ranking Curve (SUCRA) values were computed; pairwise effects with 95% credible intervals were also estimated. Sensitivity analyses adjusted for diagnosis (pustulosis vs. psoriasis) via network meta-regression. Results: Twenty trials (n = 2030) with 23 active comparators provided data for 10 endpoints (fresh pustules at 4 weeks; PPPASI-50/75 and mean percentage and absolute PPPASI change at 12 and 16 weeks). Conclusions: The NMA indicates efficacy of ixekizumab and brodalumab (IL-17 inhibitors), guselkumab (IL-23 inhibitor), and spesolimab (IL-36 inhibitor) in managing palmoplantar pustulosis. Full article

Background: With the worldwide resurgence of Mpox in 2022, understanding its regional features is important. This systematic review aimed to provide an overview of the epidemiology, risk factors, clinical features, and outcomes of Mpox in Saudi Arabia to fill the knowledge gaps in this area. Methods: Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic search was performed on PubMed, MEDLINE (via Ovid), Scopus and Wiley Online Library for case reports and series published on Mpox in Saudi Arabia after 2022. Results: Analysis included eight studies comprising a total of 410 patients with confirmatory data. The cohort was predominantly male (91%), with a mean age of 32.8 years. Extramarital sexual contact was the most frequently identified risk factor (28.8%), whereas most patients (63.4%) had unknown or denied exposure routes. The most common clinical manifestations were fever (97.1%) and rash (96.8%). Dermatological findings were usually pleomorphic. These included umbilicated pustules, crusted papules, and vesiculopustular lesions. Although management was primarily supportive, rare complications, such as keratitis and neurological deficits, were observed. Conclusions: In Saudi Arabia, Mpox primarily affects young adult males, particularly individuals with high-risk sexual behaviors. Much of this transmission remains undetermined, and better contact tracing and focused public health efforts are urgently required. 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

Background and Clinical Significance: Cutaneous lupus erythematosus (CLE) is an autoimmune condition characterized by a wide range of cutaneous manifestations, classified into three major subtypes—chronic (CCLE), subacute (SCLE), and acute (ACLE)—based on clinical morphology and lesion duration. Discoid lupus erythematosus (DLE), the most common form of CCLE, predominantly affects sun-exposed areas and presents as erythematous macules that progress to well-demarcated, disc-shaped plaques. If left untreated, DLE may lead to scarring and permanent alopecia. Diagnosis is primarily clinical, with skin biopsy performed when indicated. Management includes photoprotection and topical corticosteroids, with systemic immunosuppressive therapy reserved for severe cases. Case Presentation: We report a case of a 38-year-old female patient presenting with confluent lesions with indurated borders and multiple pustules, initially raising suspicion of cutaneous infection. A broad differential diagnosis was considered, including fungal and bacterial infections, demodicosis, and cutaneous tuberculosis, all of which were excluded through comprehensive clinical and laboratory investigations. Ultimately, DLE was diagnosed based on serologic and histopathologic findings. During the course of immunosuppressive therapy, her condition deteriorated, and she developed pulmonary tuberculosis. Conclusions: The presented case underlines the rarity and broad differential diagnosis of DLE as well as the possibility of complications. Full article

Background/Objectives: Balanoposthitis encompasses a variety of non-infectious conditions that, in some cases, are risk factors for penile cancer. Clinical signs of non-infectious balanoposthitis are often unspecific, whereas dermoscopic features of dermatoses in the genital area can be altered. Current knowledge of the dermoscopy of balanoposthitis is incomplete. This study aimed to evaluate the dermoscopic features of non-infectious balanoposthitis and correlate these features with distinct balanoposthitis types. Methods: Patients with histopathologically confirmed non-infectious balanoposthitis (N = 78) were enrolled in a prospective study, including lichen planus, psoriatic, lichen sclerosus and Zoon’s balanoposthitis. Dermoscopic features were compared between each type of non-infectious balanoposthitis using non-parametric statistics. Results: White and purple reticular lines and purple focal structureless areas were dermoscopic variations in Wickham striae were associated with lichen planus, as well as curved linear vessels at the periphery of Wickham striae. Dotted and linear curved vessels in an unspecific arrangement were associated with lichen sclerosus. Other structures included white lines in an unspecific arrangement, white dots and globules and structureless areas. Red and purple globules in lichen sclerosus represented purpura. Notable dermoscopic features that were associated with psoriatic balanoposthitis were yellow-white globules that represented pustules, as well as dotted vessels in a uniform arrangement and patchy white scales. Conclusions: Distinct types of non-infectious balanposthitis are associated with certain dermatoscopic features. Wickham striae have a variable dermoscopic presentation. Some dermoscopic structures can mimic Wickham striae, but vascular patterns can help in differentiating these cases. Pustules can be observed dermoscopically in some psoriasis cases. Full article

Acne is a multifactorial skin condition characterized by an infection in the pilosebaceous units in the skin. Patients with acne suffer from comedones, papules, pustules and nodules or cysts in severe cases. These clinical features might cause disfigurmentation, depression, anxiety and significantly impact the quality of life of patients. Systemic and continuous exposure of antibiotics put patients at risk of developing systemic toxicity, bacterial resistance and gut dysbiosis. Microneedles offer an innovative approach of providing targeted topical delivery of minocycline while insuring efficient permeation through skin layers. Methods: minocycline microneedles were formulated using casting method and characterized for insertion ability, mechanical strength, drug content, antibacterial activities, deposition and dissolution behavior using ex vivo full-thickness rat skin. Results: Insertion tests confirmed effective skin penetration and mechanical integrity with only 9.5% height reduction. Drug content was 673.06 ± 5.34 µg/array. Dissolution occurred within 2 min in skin, indicating user-friendly wear time. Ex vivo Franz diffusion studies showed 26% of the drug deposited into the skin, significantly higher (p = 0.0068) than the 18.3% that permeated through it. Antibacterial testing revealed strong activity against S. aureus, S. epidermidis, and C. acnes, with MIC values < 0.146 µg/mL and MBC values ranging from 9.375–18.75 µg/mL. Conclusions: The result of this research demonstrate that minocycline microneedles effectively deliver minocycline into the skin highlighting their potential as a safer and more efficient alternative for acne therapy. Full article

Background/Objectives: Sweet’s syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare inflammatory skin disorder that may also present with extracutaneous manifestations. Liver involvement is thought to result from sterile neutrophilic infiltration, mirroring the skin pathology and highlighting the syndrome’s systemic inflammatory nature. Timely recognition, exclusion of infectious or autoimmune etiologies, and prompt corticosteroid therapy are critical for favorable outcomes. Methods: Herein, we present the case of a 73-year-old man with hyperuricemia who developed both cutaneous and systemic manifestations of SS seven days after initiating allopurinol treatment. His symptoms included fever, conjunctivitis in the right eye, and painful, non-pruritic erythematous plaques, some with pustules, on the lower limbs, palms, and face. Results: Initial laboratory investigations revealed neutrophilic leukocytosis, elevated inflammatory markers, and renal and hepatic dysfunction. Empirical treatment with antibiotics and antivirals failed to improve his condition. The patient discontinued allopurinol and initiated a high-dose corticosteroid regimen, leading to rapid resolution of fever and improvement in skin lesions. Laboratory parameters gradually normalized, except for persistent high liver enzymes. A comprehensive diagnostic workup ruled out infectious, autoimmune, and malignant causes. Imaging studies, including CT, MRI, and MRCP, showed no structural liver abnormalities. Skin biopsy findings were consistent with SS, demonstrating dense neutrophilic infiltrates in the reticular dermis and papillary dermal edema. After his discharge, he was followed up by the Hepatology unit. The patients’ liver enzyme levels normalized within three months with no recurrence or late complications one year later. Conclusions: In the context of drug-induced SS, persistent hepatic abnormalities, although rare, may occur in patients without underlying liver disease. Full article

The ongoing mpox clade Ib outbreak was first detected in the eastern Democratic Republic of Congo (DRC) and was associated with sexual transmission. It emerged in Kamituga, a mining city and spread rapidly in surrounding health zones and reached cities like Bukavu and Goma. Here, we describe the clinical, epidemiological, and virological characteristics of the first case of clade Ib in Kinshasa, the capital city in the western DRC. The case involved a young adult woman from Kinshasa who reported unprotected sexual contact with an occasional partner, a former friend, and subsequently developed genital lesions, including vesicles and pustules. These lesions evolved and spread to the entire body, including the limbs, eyes, and soles. The diagnosis was confirmed by PCR and sequencing allowed us to assign clade Ib. We show that infection with mpox clade Ib through sexual transmission can lead to limbal nodular keratoconjunctivitis and focal conjunctivitis as complications. Importantly, these results suggest that clade Ib may have been circulating silently in Kinshasa prior to the official declaration by the Ministry of Health. This also raises concerns about the potential risk of global spread, as is currently being observed. Further studies are needed to investigate whether subsequent outbreaks of clade Ib in Kinshasa may have emerged independently of introductions from Kivu, pointing to a more complex pattern of co-circulation that could define the mpox epidemic in the capital. Full article

Background/Objectives: Acne vulgaris can be non-inflammatory lesions, i.e., closed comedones, open comedones, inflammatory lesions, i.e., papules, pustules, cysts, and post-acne lesions. This study aimed to evaluate the expression of TLR2 and TLR4 receptors on classical, intermediate, and non-classical monocyte subpopulations in 38 women with acne vulgaris and to correlate the results with clinical features of the disease and selected skin parameters. Methods: The skin parameters were assessed: level of oiliness, hydration, pH, skin pigmentation (phototype, erythema) using a special diagnostic device (Scientific multi-probe system MPA 6, Courage + Khazaka) with simultaneous determination of monocyte subpopulations in peripheral blood expressing TLR2 and TLR4 using a CytoflexLX flow cytometer (Beckman Coulter). Results: In the study group, the percentage of non-classical monocytes expressing TLR2 was statistically significantly lower than the classical and intermediate monocytes expressing TLR2 (p < 0.001). However, the level of TLR2 receptor expression (MFI) was significantly higher on intermediate monocytes compared to the level of TLR2 expression on classical and non-classical monocytes. In the group of patients with post-acne lesions, a statistically significantly higher percentage of non-classical monocytes with TLR4 expression was observed compared to patients without post-acne lesions (p = 0.009). A statistically significant negative correlation was also observed between the percentage of intermediate and non-classical monocytes with TLR4 expression and the results of the mexameter measurements. Acne has a significant impact on the percentage of monocyte subpopulations expressing TLR2 and TLR4. A higher percentage of non-classical monocytes TLR4+ in the blood is associated with a higher incidence of post-acne lesions. Conclusions: The positive correlation between the degree of skin hydration and the level of TLR2 expression on classical monocytes suggests that these cells play an important role in skin homeostasis and defense against C. acnes. Proper acne care is not only important for aesthetic aspects, but may also have a positive impact on immunological phenomena. Full article

Malassezia folliculitis, previously known as Pityrosporum folliculitis, is a common yet frequently misdiagnosed dermatologic condition caused by Malassezia yeast overgrowth in hair follicles. Its monomorphic, pruritic papules and pustules closely mimic acne vulgaris, often leading to inappropriate antibiotic use. This review summarizes current evidence on the epidemiology, clinical presentation, diagnostic challenges, and management of Malassezia folliculitis. A high index of clinical suspicion is critical in patients with recalcitrant acneiform eruptions. Diagnosis is supported by dermoscopy, potassium hydroxide preparation, Wood’s lamp, and response to antifungal therapy. Topical and oral antifungal agents are highly effective although relapses are common and access to off-label treatments may be limited. Greater awareness of the distinct clinical features of Malassezia folliculitis and treatment response can improve diagnostic accuracy and enhance patient outcomes. Full article

Soybean rust, caused by Phakopsora pachyrhizi, is a major foliar disease that often escapes fungicide control, necessitating alternative strategies. We investigated whether phyllosphere arthropods, such as mites and thrips, facilitate the secondary dispersal of the mycoparasitic fungus Simplicillium under controlled conditions. Detached soybean leaves inoculated with P. pachyrhizi were subjected to either arthropod-exposed or arthropod-excluded treatments. Simplicillium isolates were significantly more abundant in the presence of arthropods. Molecular identification revealed identical ITS genotypes of S. lamellicola from both infected pustules and thrips, indicating vector-mediated fungal transmission. While some Simplicillium strains persisted epiphytically without vectors, their spread was minimal. These results highlight a promising approach to enhance the effectiveness of Simplicillium-based biocontrol through natural arthropod-mediated dissemination, warranting field validation of this self-disseminating strategy. Full article

Acne vulgaris is a chronic disease that occurs in the pilosebaceous units and ranks eighth in the global prevalence of all diseases. In its severe forms such as pustules, cysts, and nodules, acne can lead to permanent scarring and post-inflammatory hyperpigmentation, which are often difficult to reverse in the short term and significantly affect patients’ psychological well-being and social interactions. Although a variety of pharmacological treatments are available, including retinoids, antibiotics, anti-androgens, benzoyl peroxide, and corticosteroids, the high recurrence rate and limited efficacy in scar prevention highlight the urgent need for innovative therapeutic strategies. Electrospinning technology has recently gained attention for fabricating nanofibrous patches with high porosity, biocompatibility, and biodegradability. These patches can offer antibacterial activity, absorb exudates, and provide mechanical protection, making them promising platforms for acne wound care. This review first outlines the pathophysiology of acne and the biological mechanisms underlying scar formation. We then present an overview of electrospinning techniques, commonly used polymers, and recent advancements in the field. Finally, we explore the potential of electrospun nanofibers loaded with mesenchymal stem cells or exosomes as next-generation therapeutic systems aimed at promoting scarless acne healing. Full article

During infectious disease outbreaks, acquiring genetic data across various kingdoms offers essential information to tailor precise treatment methodologies and bolster clinical, epidemiological, and public health awareness. Metagenomics sequencing has paved the way for personalized treatment approaches and streamlined the monitoring process for both co-infections and opportunistic infections. In this study, we conducted long-read metagenomic DNA sequencing on mpox-like lesion pustules from six suspected patients who were positive and confirmed to be infected with MPXV during the MPXV subclade Ib outbreak in the Eastern Democratic Republic of the Congo. The sequenced data were taxonomically classified as bacterial, fungal, and viral in composition. Our results show a wide spectrum of microorganisms present in the lesions. Bacteria such as Corynebacterium amycolatum, Gardnerella vaginalis, Enterococcus faecium, Enterobacter clocae, Staphylococcus epidermidis, and Stenotrophomonas maltophilia were found in the lesions. The viral classification of the reads pointed out the absolute predominance of the monkeypox virus. Taken together, the outcomes of this investigation underscore the potential involvement of microorganisms in mpox lesions and the possible role that co-infections played in exacerbating disease severity and transmission during the MPXV subclade Ib outbreak. Full article