Search Results (166)

Background and Objectives: Oral Janus kinase (JAK) inhibitors have become an important therapeutic class in dermatology, with approved indications including atopic dermatitis and alopecia areata. Owing to their broad immunomodulatory effects and rapid onset of action, these agents are increasingly used off label for a variety of inflammatory skin disorders that are often refractory to standard therapies. The objective of this review was to provide a comprehensive overview of the published literature on the off-label dermatologic use of oral JAK inhibitors, summarizing clinical outcomes, safety profiles and treatment durations reported in real-world settings. Materials and Methods: A literature search was conducted in PubMed to identify case reports and case series describing off-label dermatologic use of baricitinib, abrocitinib, upadacitinib, and ritlecitinib. Extracted data included authorship and year, article type, treatment regimen, treatment duration and follow-up, prior systemic therapies, clinical outcomes, and reported adverse events. Results: A total of 136 articles were included, comprising 45 articles on abrocitinib (63 patients), 55 on upadacitinib (94 patients), 35 on baricitinib (45 patients), and 2 on ritlecitinib (2 patients). Across a wide spectrum of dermatological conditions, oral JAK inhibitors showed consistent clinical efficacy. Responses were frequently rapid and disease control was often maintained over several months of treatment. In many cases, dose reduction or treatment discontinuation did not lead to immediate relapse. Overall tolerability was favorable, with adverse events reported in a minority of patients and predominantly described as mild and transient. Conclusions: Although our data is limited to case-based literature, this review highlights the broad off-label therapeutic potential of oral JAK inhibitors in dermatology. Their rapid onset of action, sustained clinical responses, frequent maintenance of remission after dose tapering or discontinuation and generally acceptable safety profile support their consideration as treatment options in selected patients. Full article

Pathological scars (PSs), which encompass hypertrophic scars (HSs and keloids, pose significant challenges in the realm of plastic surgery due to their characteristics of excessive fibrosis and persistent pruritus. This fibrosis can lead to both functional limitations and aesthetic issues, while pruritus often indicates ongoing scar development and greatly impacts quality of life. Although the underlying cause of both conditions is linked to dysregulated inflammation, the specific connections between fibrosis and pruritus are not well understood. Transient receptor potential channels (TRP), known for their roles in systemic fibrotic diseases and as mediators of chronic pruritus in skin disorders, may play a crucial role in the environment of pathological scars. This review compiles existing research to investigate the idea that certain TRP subfamilies (TRPA1, TRPV1, TRPV3, TRPV4) could link fibrosis and pruritus in pathological scars by interacting with common inflammatory mediators. We suggest that these channels might act as central molecular hubs that connect the signaling pathways of fibrosis and pruritus in these scars. Therefore, targeting TRP channels pharmacologically could be a promising approach to simultaneously alleviate both fibrosis and pruritus, potentially leading to a new dual-pathway treatment strategy for managing pathological scars. Our review also critically examines the current landscape of TRP-targeted therapies, pointing out challenges such as limited selectivity for specific subtypes and the lack of clinical trials focused on pathological scars, while emphasizing the necessity for interdisciplinary advancements in this area. In conclusion, while TRP channels are attractive targets for therapeutic intervention in pathological scars, their effective clinical application necessitates a more profound understanding of the mechanisms specific to scars and the creation of targeted delivery methods. Full article

Introduction: Toxic Epidermal Necrolysis (TEN) and Steven–Johnson Syndrome (SJS) are rare yet dangerous dermatological emergencies presenting as necrosis of the skin and mucous membranes due to an immune reaction which may be associated with the use of pharmaceuticals—predominantly non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and antiretroviral drugs. During the postpartum period, women are administered numerous pharmaceuticals, including NSAIDs, analgesics, and antibiotics, due to pain and their susceptibility to infections, exposing them to potential adverse effects including allergies and immune reactions. Case Report and Review: The case reported here is a rare description of a patient in the early postpartum phase who presented with epidermal necrolysis whilst remaining hospitalized after a cesarean delivery. The multidisciplinary approach, early diagnosis, and treatment ensured the patient’s full recovery. Intravenous immunoglobulin treatment resulted in a rapid therapeutic effect. This literature review offers an insight into the epidemiology, diagnostic process, and treatment of this infrequent dermatological syndrome during the postpartum period. Results: Antibiotic treatment is a common culprit of TEN in this population; hence, clinicians should remain vigilant during antibiotic administration. Differential diagnosis with toxic shock syndrome is crucial, as TEN and SJS symptoms may mimic sepsis, which is a more common diagnosis in the postpartum period. Conclusions: The condition of the skin during the postpartum period should be closely monitored, as some systemic diseases may manifest abruptly as profound, postpartum hormonal changes affect the immunological response. Upon the discovery of suspicious skin lesions concomitant with systemic symptoms, an immediate multidisciplinary approach involving obstetricians and dermatologists is key to a rapid diagnosis and treatment to avoid maternal mortality. Full article

Background: Cutaneous viral infections, defined as viral pathogens that either primarily affect the skin (e.g., herpesviruses, enteroviruses) or frequently produce dermatologic manifestations despite systemic tropism (e.g., HIV, SARS-CoV-2), can trigger systemic inflammatory and neurotropic responses that extend their impact to the nervous system. A growing body of evidence suggests that viruses with dermatologic manifestations may play a significant role in the pathogenesis of neurologic disorders. Summary: Although individual viruses have been studied in isolation, the skin–brain axis in viral infections remains incompletely characterized. This review synthesizes existing knowledge and highlights gaps in understanding the mechanisms linking cutaneous viral infections to neurologic disease. We explore the principal mechanisms linking viral skin infections to central and peripheral nervous system damage, including direct neuroinvasion, immune-mediated injury, and vascular or endothelial dysfunction. Particular attention is given to herpesviruses, retroviruses, enteroviruses, and respiratory viruses, which have been associated with conditions such as dementia, multiple sclerosis, myelopathies, Guillain-Barré syndrome, and the post-acute neurologic sequelae of COVID-19. Furthermore, we discuss the role of neuroinflammation in viral-associated neurodegeneration and highlight emerging evidence supporting the recombinant zoster vaccine (Shingrix) as a potential modulator of neuroinflammatory processes and a protective factor against dementia. Conclusions: Cutaneous viral infections extend beyond local skin pathology, contributing to a broad spectrum of neurologic complications through intertwined infectious and inflammatory mechanisms. A clearer understanding of how peripheral viral activity shapes central nervous system vulnerability remains a major unmet need. A multidisciplinary approach integrating dermatologic and neurologic perspectives is essential for early recognition and prevention. While observational studies suggest that zoster vaccination may reduce viral reactivation and modulate neuroinflammatory pathways, definitive evidence of neuroprotection is still lacking. Future studies should clarify causal relationships, test mechanistic hypotheses regarding skin–brain immune crosstalk, and explore vaccine-mediated neuroprotection as a novel therapeutic strategy. Full article

The skin is exposed to many environmental stressors, such as UV rays, pollution, and smoke, and psychological stress, which can compromise its structure and function. These factors can cause premature aging, weaken the skin barrier, worsen or induce pathological conditions such as acne and eczema, hyperpigmentation, and melanoma, and slow healing. Ellagic acid (EA) is a polyphenol with various pharmacological effects important for the treatment of skin conditions. It has antioxidant, anti-inflammatory, and depigmenting properties, and it inhibits the enzyme tyrosinase, involved in melanin production, helping reduce dark spots and exhibiting antiproliferative effects against melanoma cells. With its antioxidant effect, it protects the skin against photoaging, combats oxidative stress and signs of aging, such as wrinkles and loss of elasticity, and strengthens collagen and elastin. However, the main limits of EA are its low aqueous solubility, instability, and poor skin permeability that limit its clinical efficacy. This review focuses on EA formulations developed to overcome these limitations and improve its therapeutic effects for skin diseases. Nano-delivery systems such as vesicles, lipidic and polymeric nanoparticles, nanospheres, cyclodextrins, and nanogels have been reported alongside other innovative preparations such as biscuits, sponges, and nanosheets and conventional ones such as ointments, creams, and films. Full article

Inflammatory cytokines and proteins are essential indicators of immune status and disease progression; however, conventional assays rely on invasive sampling and complex processing, restricting their use in real-time monitoring. Here, we present a 3D-printed poly(methyl methacrylate) (PMMA) microneedle-based biosensing platform integrated with a tyramide signal amplification–enhanced enzyme-linked immunosorbent assay (TSA–ELISA) for noninvasive and highly sensitive detection of inflammatory biomarkers in interstitial fluid. The microneedles exhibit precise geometry, adequate mechanical strength, and excellent biocompatibility, facilitating efficient skin penetration and biomarker capture. Stepwise chemical functionalization ensured stable antibody immobilization, while TSA significantly amplified detection signals. The platform achieved reliable, reproducible, and multiplex detection of cytokines and albumin in both healthy individuals and patients with inflammatory skin conditions. Notably, the measured cytokine level in lesional skin of eczema patients was 97.7 pg/mL, showing a significant difference from the 62.8 pg/mL observed in healthy subjects. This MN-based TSA–ELISA system offers a robust and minimally invasive strategy for monitoring inflammation-related biomarkers, holding great potential for clinical diagnostics and personalized healthcare applications. Full article

Acute inflammatory visceral pain (AIVP) is a prevalent yet challenging clinical condition associated with inflammatory diseases, characterized by diffuse pain that often escalates into nausea, vomiting, and systemic autonomic disturbances. The absence of effective and patient-centered therapies remains a significant clinical challenge. While dexmedetomidine (Dex) has demonstrated promising analgesic effects, its conventional intravenous administration involves slow infusion, heightening risks of infection and compromising patient comfort and compliance. Here, we present a breakthrough strategy using a hyaluronic acid (HA) hydrogel and microneedle-based transdermal system for Dex delivery to enhance clinical practicality. We successfully fabricated Dex-loaded HA hydrogel microneedles (MN/Dex), enabling efficient skin penetration and controlled drug release. Comprehensive biosafety evaluations, including skin irritation, cytotoxicity, and hemolysis assays, confirmed the excellent biocompatibility of the HA hydrogel microneedle system (HA-MN). In the acetic-acid-induced AIVP model, MN/Dex not only produced significant and sustained reduction in visceral and somatic hyperalgesia but also maintained normal physiological activity, avoiding sedation burden, preserving feeding behavior, and supporting natural mobility. MN/Dex offers a minimally invasive, easy-to-administer, and well-tolerated alternative to intravenous therapy, with the potential to transform outpatient management and improve quality of life for patients suffering from AIVP. This advanced delivery platform bridges a critical translational gap in pain management, combining efficacy with outstanding clinical adaptability. Full article

Careya arborea, commonly known as wild guava, is a deciduous tree native to Asia, including Sri Lanka. Traditionally used to treat various ailments such as skin diseases, tumors, gastrointestinal disorders, and inflammation, it is valued for its notable astringent properties. Rich in phytochemicals, including phenolics, terpenes, sterols, tannins, and saponins, Careya arborea exhibits potent antioxidant, anti-inflammatory, and anticancer activities. Its anticancer effects are primarily attributed to the induction of apoptosis and the inhibition of cancer cell proliferation, with several extracts such as chloroform, ethyl acetate, and methanol demonstrating selective cytotoxicity against cancer cell lines. The high phenolic content of Careya arborea underpins its antioxidant potential, which plays a crucial role in mitigating oxidative stress and associated inflammatory conditions. Despite its medicinal potential, Careya arborea remains an underutilized plant in Sri Lanka. Greater attention should be given to promoting its use in both traditional and modern healthcare systems to harness its therapeutic benefits. Given its therapeutic potential, sustainable harvesting and conservation efforts are essential to protect this plant from overexploitation and habitat loss. Taking all these factors into account, this review emphasizes Careya arborea’s potential as a source of natural therapeutic agent, highlighting the importance of further research and conservation to unlock its full medicinal value for clinical applications. Full article

Psoriasis vulgaris is a polygenic, immunomediated dermatological condition, characterized pathophysiologically by abnormal proliferation of the epidermis and immune response disorders, evidenced by the presence of a dermal inflammatory infiltrate accompanied by exocytosis. The prevalence of this disease is continuously increasing, and the significant impact on quality of life is determined by both the severity of the skin manifestations and the associated comorbidities, which underlines the importance of early diagnosis. Among the imaging methods useful in the diagnosis and monitoring of psoriasis vulgaris are dermatoscopy and high-frequency cutaneous ultrasonography (HFUS). Dermatoscopy is a valuable complementary imaging tool in assessing the therapeutic response in patients with psoriasis vulgaris. Although clinical lesions may show partial or complete remission, the persistence of the specific vascular architecture—characterized by dilated and branched capillaries—suggests the maintenance of disease activity and justifies the need for continued treatment. HFUS allows the identification of characteristic changes in psoriatic plaques, such as homogeneous thickening of the epidermis, visible as a hyperechoic band, the presence of a hypoechoic subepidermal band, and thickening of the dermis. Evaluation with 20 MHz probes can significantly contribute to monitoring therapeutic efficacy, since the first observable changes under topical and/or systemic treatment include a reduction in the thickness of the epidermis, dermis, and hypoechoic subepidermal band. The integration of dermatoscopy and HFUS within the clinical evaluation allows for a complex and precise approach to the management of patients with psoriasis vulgaris, facilitating objective monitoring of disease progression and appropriate adjustment of 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

Background/Objectives: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease, but its relationship with gastric cancer (GC) remains unclear. This study aimed to investigate the association between AD and GC using a nationwide Korean database. Methods: Using the Korean National Health Insurance Service-National Sample Cohort, we conducted a nested case–control study including 10,174 GC patients and 40,696 matched controls (1:4 by age, sex, income, and region). Overlap propensity score weighting was used to control for confounders. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated via logistic regression. Results: AD was significantly associated with an increased risk of GC (adjusted OR = 1.08; 95% CI: 1.01–1.15). Subgroup analyses revealed stronger associations among individuals aged ≥ 65 years (OR = 1.12), men (OR = 1.10), rural residents (OR = 1.14), and those without comorbidities (CCI = 0, OR = 1.15). Higher risks were also observed in participants with non-allergic rhinitis (OR = 1.43) or no asthma (OR = 1.12). Conclusions: AD may be associated with an increased risk of GC in the Korean population. These findings may highlight the importance of considering dermatological conditions in the context of systemic cancer risk. Full article

Psoriasis is a chronic, immune-mediated dermatosis that affects approximately 125 million people worldwide. Traditionally considered a dermatologic condition, it is now perceived as a systemic disease with numerous comorbidities. While its associations with psoriatic arthritis, metabolic syndrome, and psychiatric disorders are well established, less attention has been given to its coexistence with other dermatoses. This narrative review aims to explore and summarize the existing evidence on the relationships between psoriasis and other skin diseases, highlighting potential overlaps in clinical presentation, pathogenesis, and treatment challenges. Psoriasis may coexist with several inflammatory and autoimmune skin disorders, including atopic dermatitis, lichen simplex chronicus, anti-p200 pemphigoid, pityriasis rubra pilaris, seborrheic dermatitis, inflammatory linear verrucous nevus (ILVEN), Sneddon–Wilkinson disease, and vitiligo. The review highlights the shared genetic pathways (e.g., the Th1/Th17 axis and IL-17 pathway), diagnostic challenges (e.g., sebopsoriasis and psoriasis–eczema overlap), and therapeutic considerations (e.g., paradoxical reactions to biologics and effectiveness of JAK inhibitors in both psoriasis and vitiligo). The coexistence of psoriasis with other dermatoses is more common and clinically significant than previously appreciated. Recognizing these associations is crucial for an accurate diagnosis, avoiding mismanagement, and optimizing individualized treatment strategies. Further research is needed to elucidate the underlying mechanisms and improve the multidisciplinary care for patients with complex dermatologic presentations. Full article

Castleman disease and Kaposi sarcoma (KS) are both associated with infection by human herpesvirus 8 (HHV-8), also known as Kaposi’s sarcoma-associated herpesvirus (KSHV). This virus plays a critical role in the pathogenesis of both conditions, particularly in immunocompromised individuals, such as those with HIV/AIDS. Multicentric Castleman disease (MCD) generally presents with systemic inflammatory symptoms, lymphadenopathy, and organ dysfunction, while Kaposi sarcoma typically appears as vascular tumors on the skin, with occasional involvement of mucous membranes or internal organs. We present four clinical cases, with concurrent KS and MCD, treated with chemotherapy and rituximab, with a satisfactory response. We highlighted the essential role of prompt investigation of systemic or inflammatory manifestations (fever, vital parameter alterations such as palpitation, high breath frequency, edema, and kidney impairment) as underlined in our case series, which might underscore possible complications. Multiorgan failure, opportunistic infections, or rapid clinical deterioration might occur if the diagnosis is not adequately assessed. Therefore, this paper emphasizes the importance of timely diagnosis, as it enables the prompt initiation of appropriate antiviral, immunomodulatory, or oncologic therapies—interventions that can significantly improve outcomes and may be life-saving in advanced or aggressive disease presentations. Full article

Chronic inflammatory skin diseases such as atopic dermatitis, psoriasis, and hidradenitis suppurativa are systemic conditions marked by persistent immune activation. Growing evidence links them to molecular and vascular ageing, including oxidative stress, endothelial dysfunction, and reduced expression of longevity-related proteins like Klotho and SIRT1. This narrative review examines how Th17- and Th2-driven inflammation contributes to systemic inflammageing. Key cytokines—IL-17, IL-23, IL-4, IL-13, and IL-31—promote endothelial damage, oxidative stress, and metabolic dysfunction. We highlight the role of vascular biomarkers (e.g., VCAM-1, ICAM-1, ST2, P-selectin) and immune cell senescence as indicators of ageing. Finally, we explore whether biologic therapies targeting these pathways may attenuate inflammation-driven ageing. Chronic skin diseases may thus serve as accessible models of systemic inflammageing and targets for early intervention. Full article

Hidradenitis suppurativa (HS) is a debilitating inflammatory skin condition with unclear underlying mechanisms. Recent studies suggest pyroptosis, a highly inflammatory form of programmed cell death, could significantly contribute to the disease process. This study aimed to investigate the roles of gasdermin D (GSDMD) and gasdermin E (GSDME), two key mediators of pyroptosis, in HS pathogenesis. Serum and skin samples from HS patients and healthy individuals were analyzed. Serum gasdermin D levels were significantly elevated in HS patients, although gasdermin E showed no significant difference compared to controls. Skin tissue analysis revealed increased expression of both GSDMD and GSDME in inflamed HS lesions compared to unaffected skin from the same patients and healthy control skin. However, these molecules did not correlate directly with disease severity. Interestingly, systemic metabolic markers showed some associations with gasdermin expression, suggesting potential connections between systemic health and inflammation in HS. These findings confirm a critical role of gasdermins in HS-related inflammation and identify pyroptosis as a promising therapeutic target. Further exploration of these pathways could yield valuable treatment strategies for managing this challenging skin condition. Full article