Search Results (86)

Background: Follicular unit extraction (FUE) has become the dominant donor site harvesting technique in modern hair transplantation due to its ability to avoid linear scar formation and its procedural flexibility. However, the donor site is a limited non-regenerative source. Excessive or poorly planned extraction can lead to visible thinning, hypopigmented scarring, and reduced reserve for future procedures. Objective: This study aimed to synthesize current evidence on donor biology, preoperative assessment, extraction strategy, and complication prevention in FUE, and to propose a reproducible clinical framework for donor preservation. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Google Scholar to identify English-language publications related to donor site biology, donor evaluation, extraction density thresholds, complication prevention, repeat session planning, and emerging FUE technologies. Priority was given to recent reviews, clinical trials, consensus statements, and practice-oriented surgical literature. Articles were selected not for formal meta-analytic pooling, but because of their relevance to donor conservation and long-term donor management. Results: The literature reviewed consistently identifies excessive local extraction density, harvesting beyond conservative limits, donor miniaturization, and inadequate reassessment before repeated procedures as the primary drivers of donor morbidity. Evidence from reviews, clinical trials, and expert guidelines supports conservative extraction thresholds, widespread spatial distribution, individualized donor mapping, and phased long-term planning as key strategies for preserving donor aesthetics and reserve. Conclusions: Donor preservation is central to ethical and sustainable FUE surgery. Integration of biologically informed assessment, disciplined extraction control, and mandatory reassessment protocols can reduce morbidity while preserving long-term graft flexibility in patients with progressive androgenetic alopecia. 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

Background: Alopecia areata (AA) is a chronic autoimmune disorder characterized by non-scarring hair loss and commonly coexists with other autoimmune diseases, suggesting systemic immune dysregulation. An association between AA and iron deficiency anemia (IDA) has been proposed, though prior studies have yielded conflicting results. Objective: Our aim was to examine the association between AA and IDA in a large, population-based cohort. Methods: We conducted a retrospective case–control study using data from a health maintenance organization (HMO) serving approximately 2.35 million individuals. We included 33,401 AA patients diagnosed between 2005 and 2019, matched 1:2 by age and sex with 66,802 controls without AA. Diagnoses of AA and IDA were confirmed through clinical coding by board-certified dermatologists and primary care physicians. Statistical analyses employed Kruskal–Wallis, Pearson’s χ², and Fisher’s exact tests. Results: IDA prevalence was significantly higher in AA patients than in controls (15% vs. 10%; OR 1.61, 95% CI: 1.55–1.67; p < 0.01). IDA preceded AA in 40% of cases, followed AA in 58%, and occurred concurrently in 2%. Limitations: The retrospective design limits causal inference. Conclusion: This study reinforces an association between AA and IDA, highlighting the need to assess and manage IDA as a potential treatable comorbidity in AA patients. Full article

Background and Objectives: Frontal bone osteomas are benign tumors characterized by the abnormal proliferation of bone. Though typically asymptomatic, these masses often produce visible forehead deformity and may cause localized discomfort. Endoscopic resection has emerged as an optimal technique for appropriately selected frontal osteomas because it enables complete excision while minimizing visible scarring and risk of neurovascular injury. This case series reviews the senior author’s patient outcomes and complications using a scalp-based, endoscopic-assisted surgical approach for frontal bone osteoma excision. Materials and Methods: A review was conducted of all patients (n = 22) who underwent endoscopic-assisted frontal bone osteoma excision performed by a single surgeon between February 2019 and December 2025. All procedures involved endoscopic visualization through remote scalp incisions, osteoma excision, and frontal bone contouring. Patient demographics, presenting symptoms, CT imaging findings, operative details, histopathology results, and postoperative outcomes were recorded. Results: Twenty-two patients underwent endoscopic-assisted excision of frontal bone osteomas performed by the senior author (NT). The primary concern prompting surgical intervention was aesthetic deformity, with localized pain reported in some cases. For all patients, CT imaging was obtained preoperatively to evaluate lesion size and anatomical relationships to nearby facial structures. Histopathology confirmed cortical bone consistent with osteoma in all cases. Postoperative swelling and ecchymosis were common in the first week but resolved spontaneously. No contour irregularities, fluid collections, residual bone, or sensory deficits were observed. Some alopecia was noted in the first three patients, prompting the senior author to modify the technique. All patients healed with small, flat, well-concealed scars adjacent to the hairline. Conclusions: This single-surgeon experience demonstrates that endoscopic-assisted excision of frontal bone osteomas is a safe and effective technique that permits complete excision with excellent aesthetic outcomes and minimal morbidity. The operative framework presented in this study, including surgical planning, technique steps, and postoperative management, supports endoscopic resection as an ideal alternative to traditional direct approaches for frontal bone osteomas. Full article

Background: Alopecia areata (AA) is an autoimmune disease characterized by diverse patterns of non-scarring hair loss. Due to its susceptibility to immune dysregulation and psychological stress, there is growing speculation regarding the potential role of SARS-CoV-2 infection and the COVID-19 pandemic in its development, recurrence, or exacerbation. This retrospective study aimed to evaluate patients affected by AA from a single dermatological center, specifically focusing on the impact of the COVID-19 pandemic on hospitalization rates. Methods: Data comprising demographic characteristics, disease subtype, number, and duration of hospitalizations were digitized and statistically analyzed. The five-year period prior to the pandemic (2015–2019) was compared with the subsequent four years (2020–2023) to assess any changes. Results: The study involved 428 individuals (256 children and 172 adults), with a slight predominance of women (68.2%). The median ages in adults and children were 39.13 years and 8.66 years, respectively. Following the pandemic, there was a 13.81% decrease in the mean age among adult males. Hospitalizations surged by 207.62% after the pandemic, increasing from 223 to 686 admissions. Additionally, the diagnosis of alopecia areata totalis increased significantly by 55.6%. The residential distribution of pediatric patients also shifted notably, with 72.16% residing in urban areas and 27.84% in rural areas between 2020 and 2023. Conclusions: The significant increase in hospitalization rates and the diversity of disease subtypes observed in this study may suggest a potential correlation between COVID-19 and the development or altered course of alopecia areata. A deeper understanding of this association could enhance treatment outcomes in dermatology, ultimately improving patient care. Full article

Background: Deep burns in pediatric population often require split-thickness skin grafts (STSGs) and the identification of an optimal donor site is crucial to minimize morbidity, accelerate healing and reduce short- and long-term complications. The scalp appears to be increasingly used in clinical practice, but evidence remains limited, despite the promise of novel bioengineering and regenerative approaches. Methods: A systematic review about the use of scalp for STSG in pediatrics was conducted across PubMed, Scopus, and Cochrane (2005–2025). Clinical outcomes considered were donor-site healing time, early and late complications, perioperative practices, and quality of scars. Results: Four studies met the inclusion criteria (n = 417, mean age 2.9–7.3 years) with follow-up periods up to 27 years. Epithelialization occurred between 7 and 25 days. Early complications included folliculitis (up to 44% in certain hair types) and delayed healing (n = 13; 52%). A rigorous harvesting technique is needed to avoid preventable complications. Late sequelae included alopecia (1.6% to 33%—the latter largely unperceived by patients) and hypertrophic scarring (1.6–4%). Scar quality was rated good in >80% of cases. Conclusions: Evidence supports the scalp as a safe, efficient, and cosmetically favorable donor site for pediatric STSG. Based on evidence and clinical experience, we propose the first structured scalp-donor management algorithm to optimize safety, reduce complications, and standardize perioperative care in the management of pediatric burns. Full article

Skin and its appendages form an integrated system of ectodermal mini-organs that rely on Wnt signaling for lifelong homeostasis and regeneration; yet, the pathway operates in a highly organ-specific manner in each compartment. In interfollicular epidermis, the Wnt activity is spatially graded, thus maintaining the balance between basal progenitor proliferation and terminal differentiation. The hair follicle is governed by an intrinsic oscillator based on cross-regulation between Wnt and BMP signaling, providing a cell-autonomous layer of control over hair cycle dynamics. Finally, the nail organ is characterized by the spatial compartmentalization of Wnt activity, with a distal matrix activation zone supported by specialized mesenchymal niche cells that sustain continuous nail plate growth and coordinate the digit tip regeneration. Understanding these divergent regulatory architectures provides a conceptual framework for targeted regenerative strategies aimed at enhancing repair in skin and its appendages. Therefore, in this review, we synthesize recent molecular studies on Wnt signaling in the adult skin, hair follicles, and nail mini-organs, highlighting appendage-specific features that underlie their distinct regenerative capacities. We further discuss how dysregulated Wnt signaling contributes to skin, hair, and nail pathologies such as alopecia, chronic wounds, excessive scarring, skin cancer, and nail deformations, and summarize the emerging strategies that target Wnt pathway to therapeutically enhance hair regrowth, wound repair, cancer treatment, and digit tip regeneration. Full article

Background/Objectives: Platelet-rich plasma (PRP)–based regimens are widely used in non-scarring alopecia, yet objective response is variable and clinic-ready predictors are lacking. We evaluated short-term trichoscopic outcomes in routine practice and tested whether baseline complete blood count–derived inflammatory status, quantified by the neutrophil-to-lymphocyte ratio (NLR), can stratify response under PRP-based therapy. Methods: We performed an ambispective observational cohort study (October 2024–October 2025) in an outpatient dermatology practice. The final analytic cohort included 129 patients allocated to four treatment groups: PRP alone (n = 54), PRP combined with microneedling-assisted Purasomes Hair & Scalp Complex (HCS50+, Dermoaroma; exosome-containing) (n = 33), PRP combined with microneedling-assisted Mesoaroma Hair Cocktail (scalp formulation; nutrient complex) (n = 24), and a nutrient complex alone (n = 18). Trichoscopy (FotoFinder ATBM; FotoFinder Systems GmbH, Bad Birnbach, Germany) was obtained at baseline (T1) and first follow-up (T2). Density response was defined as a ≥10% increase in total hair density and hair-cycle response as an anagen fraction increase ≥5 percentage points. Predictive analyses were prespecified and restricted to PRP-containing regimens, using logistic regression and a multilayer perceptron with repeated cross-validation for internal validation. Results: Across the full cohort (n = 129), total hair density and hair-cycle parameters improved from T1 to T2. In the PRP-containing subgroup (n = 111), baseline NLR strongly discriminated density responders (AUC 0.85, bootstrap 95% CI 0.77–0.91). In multivariable models, NLR remained independently associated with density response (OR 0.31 per 1-unit increase, 95% CI 0.20–0.48). Conclusions: In this cohort, baseline NLR was associated with discrimination of early trichoscopic response in PRP-based treatment of non-scarring alopecia. Using the Youden-derived cut-off (NLR = 2.202), patients with NLR > 2.202 had a higher risk of density non-response (72.1% vs. 4.7%), corresponding to a 15.49-fold increased failure risk in this cohort. These findings are exploratory and hypothesis-generating, and external validation and calibration are required before any routine clinical or decision-support use. Full article

Dissecting cellulitis of the scalp (DCS) is a chronic, inflammatory follicular occlusion disorder characterized by painful nodules, abscesses, and sinus tracts that lead to scarring alopecia. The therapeutic goal is to limit disease progression and the extent of scarring. Although DCS is traditionally managed with systemic retinoids, antibiotics, and surgical interventions, therapeutic responses are variable and long-term remission remains challenging. Recent insights into the immunological overlap between DCS, hidradenitis suppurativa (HS), and other autoinflammatory follicular disorders have expanded therapeutic options, particularly with biologic agents targeting tumor necrosis factor alpha (TNF-α), interleukin (IL)-17, and IL-23 pathways, as well as Janus kinase (JAK) inhibitors. This review synthesizes the current evidence on medical, procedural, and emerging targeted therapies for DCS, incorporating data from case reports, case series, retrospective cohorts, and recent systematic reviews up to 2025. Special emphasis is placed on the evolving role of biologics and small-molecule inhibitors, which show growing promise for refractory or syndromic presentations. Current evidence supports a stepwise, phenotype-driven approach in which systemic retinoids remain first-line systemic therapy, while biologics represent a rational and increasingly evidence-supported option for moderate-to-severe, treatment-resistant, or syndromic disease. Further controlled studies are needed to define optimal sequencing, duration, and combination strategies for long-term management. Full article

Exosomes are small extracellular vesicles that package DNA fragments, several classes of RNA, lipids, and proteins, and are now regarded as active messengers between cells rather than as cellular debris. This narrative review synthesizes dermatologic and related regenerative applications reported between 2020 and 2025, drawing on PubMed and Scopus searches. In skin, exosomes regulate inflammation, angiogenesis, matrix remodeling, pigmentation, and hair cycling. Preclinical models show faster wound closure, improved scar architecture, attenuation of photoaging changes, and stimulation of hair growth, with additional signals in inflammatory dermatoses and fungal skin disease. Early human studies in wound care, rejuvenation, scars, and alopecia suggest acceptable safety and a recurring pattern of benefit when exosomes are used as adjuncts to microneedling, lasers, or standard dressings, although products, dosing, and outcome measures remain heterogeneous. Beyond dermatology, early work in osteoarticular and soft tissue repair points toward meaningful regenerative potential, but clinical programs are still at an early stage. In practice, exosomes are being positioned as acellular alternatives or add-ons to platelet-rich plasma, bone marrow aspirate concentrate, and conventional topicals and as emerging carriers for small molecules and biologics. Key limitations include low yields, product and cargo heterogeneity, lack of agreed quality and potency metrics, and uncertain regulatory status. Whether exosomes remain boutique adjuncts or become part of standard dermatologic and musculoskeletal practice will depend on what happens next: consistent manufacturing, agreed-upon characterization panels, meaningful potency assays, robust pharmacokinetic and biodistribution data, and comparative trials that track outcomes and safety over years rather than weeks. 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

Alopecia areata (AA) is a chronic autoimmune disease characterized by non-scarring hair loss, where pathogenesis is closely linked to the collapse of hair follicle immune privilege and dysregulated T-cell responses. Increasing evidence suggests that gut dysbiosis may contribute to systemic immune alterations relevant to autoimmune disorders, yet its role in AA remains largely unexplored. In this study, we aimed to characterize the gut microbiota composition of AA patients and evaluate its potential as a biomarker for disease discrimination. Fecal samples from patients with AA and healthy controls were analyzed by 16S rRNA sequencing and processed through QIIME2 and MicrobiomeAnalyst platforms. Diversity metrics, differential abundance, and microbial network correlations were assessed, and supervised machine learning models were developed to classify AA versus control profiles. Our results revealed distinct microbial signatures in AA, with enrichment of pro-inflammatory genera such as Methanobrevibacter, Collinsella, and Ruminococcus gnavus, and depletion of immunoregulatory commensals, including Faecalibacterium and Eubacterium eligens group. Network analyses showed more complex microbial interactions in AA, and Random Forest models achieved 92% accuracy in discriminating AA from controls. These findings indicate that gut dysbiosis may play a role in AA pathogenesis, providing potential diagnostic biomarkers and supporting microbiota-targeted interventions as future therapeutic strategies. Full article

We present the case of a 95-year-old female patient who presented with erosions and scarring of the scalp, accompanied by long-term hair loss. Due to multiple comorbidities, she was treated with several medications, including zolpidem for insomnia. Clinical examination revealed scars and ulcers in the parietal region, along with diffuse age-related hair thinning. Histopathological analysis demonstrated scarring alopecia with features of local trauma. This case illustrates a rare instance of secondary cicatricial alopecia associated with zolpidem-induced complex sleep-related amnestic behavior. Detailed information on the patient’s medication history was crucial for establishing the correct diagnosis. Full article

Background/Objectives: Tinea capitis is traditionally a childhood infection, yet recent reports describe its emergence among older adults. In this population, hormonal changes, comorbidities, and frequent corticosteroid use may modify clinical presentation and delay diagnosis. This systematic review aimed to consolidate current evidence on Tinea capitis in individuals aged 65 years or older, focusing on epidemiologic, clinical, and mycological characteristics as well as therapeutic outcomes. Methods: Following PRISMA 2020 guidelines, a comprehensive search was conducted in the PubMed, Scopus, and SciELO databases for studies published between 1978 and February 2025. Eligible articles included case reports, case series, and clinical studies involving patients ≥65 years with confirmed Tinea capitis. Two independent reviewers screened and extracted data on demographics, comorbidities, risk factors, clinical manifestations, diagnostic methods, etiologic agents, and treatment response. Results: Sixty-three studies comprising 91 patients from 19 countries were included. Most cases originated from Spain (n = 27) and the United States (n = 12). Females accounted for 90.1% of cases. The leading comorbidities were diabetes mellitus (37.5%) and hypertension (21.9%). Topical corticosteroid use (40.7%) and pet exposure (27.8%) were frequent risk factors. Misdiagnosis occurred in 37.4% of patients, commonly as seborrheic dermatitis or erosive pustular dermatosis. The inflammatory variant predominated (65.9%), with kerion reported in 42.9%. Microsporum canis was the predominant agent (26.9%, n = 24), while Trichophyton rubrum and Trichophyton tonsurans were equally frequent (both 19.1%, n = 17). Systemic antifungal therapy achieved clinical cure in 91.2% of cases. Conclusions: Tinea capitis in the elderly is an underrecognized and often misidentified scalp infection. Awareness of its variable presentation and systematic mycological assessment are crucial to ensure timely therapy and prevent scarring alopecia. Full article

Background and Objectives: Alopecia areata (AA) is an autoimmune disorder characterized by non-scarring hair loss and has been associated with systemic immune-inflammatory activity and potential cardiometabolic risk. This study aimed to evaluate cardiovascular risk markers—including ECG parameters, arterial stiffness indices, anthropometric measurements, and body composition—in patients with AA according to disease severity and duration, and to compare these findings with healthy controls. Materials and Methods: This case–control study included 50 AA patients (32 men, 18 women; mean age: 28.98 ± 9.81 years) and 50 healthy controls (30 men, 20 women; mean age: 28.00 ± 7.86 years). All participants underwent anthropometric and electrocardiographic evaluations. Body composition was assessed, and arterial stiffness was measured. Subgroup analyses were performed according to SALT score (mild vs. moderate-to-severe) and disease duration (≥10 years vs. <10 years). Results: Heart rate was lower in AA patients compared with controls (mean difference −5.14 bpm; 95% CI −10.267 to −0.013). No significant differences were found between the groups regarding anthropometric variables, body composition, or arterial stiffness indices. Among AA patients, those with moderate-to-severe disease had significantly lower body fat mass (mean difference 4.95 kg; 95% CI 0.26 to 9.644) and lower visceral fat rating (mean difference 2.428 units; 95% CI 0.800 to 4.056) compared with mild AA. Conclusions: AA patients demonstrated lower heart rate and disease-severity-related alterations in body composition, although the clinical significance of these findings remains uncertain. Larger longitudinal studies are needed to clarify whether these subclinical differences translate into meaningful cardiovascular risk over time. Full article