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Introduction: Melasma is an acquired pigmentary disorder which currently has no definitive treatment. Although topical drugs containing hydroquinone are the basis of treatments, they are usually associated with recurrence. We aimed to evaluate the effectiveness and safety of monotherapy with topical methimazole 5% versus combination of Q‐Switched Nd: YAG Laser and topical methimazole 5% in patients with refractory melasma. Methods: A total of 27 women with refractory melasma were included. We applied topical methimazole 5% (once a day) with three passes of QSNd: YAG laser (Wavelength: 1064 nm, pulse energy: 750 mJ, fluence: 1.50 J/cm2, spot size: 4 × 4 mm, hand piece: fractional, JEISYS company) for six sessions on the right half of the face, and topical methimazole 5% (once a day) on the left half of the face, for each patient. The treatment course was 12 weeks. Evaluation of effectiveness was done with the Physician Global Assessment (PGA), Patient Global Assessment (PtGA), Physician satisfaction (PS), Patients satisfaction (PtS), and mMASI score. Results: PGA, PtGA, and PtS were not significantly different between the two groups at any time (p > 0.05). PS in the laser plus methimazole group was significantly better than methimazole group at 4th, 8th, and 12th weeks (p < 0.05). The rate of PGA improvement in the combination group was significantly better than the monotherapy over time (p < 0.001). The changes of mMASI score between the two groups did not significantly differ at any time (p > 0.05). There was no significant difference in the adverse events between the two groups. Conclusion: Combination therapy with topical methimazole 5% and QSNY laser can be considered as an effective way to treat refractory melasma. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Microcystic adnexal carcinoma (MAC) is a rare kind of cutaneous neoplasm with a very aggressive local infiltration that destructs the affected tissues. Its rate of recurrence is high and it mostly involves the face and scalp regions and most of the patients get affected in the fourth or fifth decades of their life. Here in, we report a 61‐year‐old woman with a right‐sided eyebrow MAC lesion with recurrency. Total excisional surgery was performed. A‐T Flap surgery was applied on the involved area, and after a 2‐year period of follow‐up, with no recurrency, hair transplantation with follicular unit transplantation method was successfully performed on the scarred area. Although microcystic adnexal carcinoma is an uncommon neoplasm; dermatologists and ophthalmologists should consider it as a differential diagnosis, due to its aggressive local infiltration. Complete surgical excision and long‐term follow‐up must be applied to manage the disease. Also, hair transplantation with follicular unit transplantation technique can be considered as a beneficial method for treating scars resulted from MAC excisional surgery. [ABSTRACT FROM AUTHOR]

Vitiligo is a pigment‐related disease with a global prevalence of 0.2% to 1.8% associated with considerable burden on quality of life. The treatment is still a challenge because of relapses and/or incomplete re‐pigmentation. Although the exact cause is still unclear, its pathogenesis seems to be justifiable with the autoimmune theory, supported by the results of clinical research. In this narrative review, we aimed to summarize the evidence related to cytokines and vitiligo development. This review is consisted of English articles published in PubMed and Google Scholar concerning levels of inflammatory mediators, especially interleukins, in vitiligo patients over the last 20 years. References of relevant articles were also considered for review. Crucial role of dysregulated levels of interleukins and their synergistic function to each other, in the onset or progression of the disease is evident. The theory of autoimmune vitiligo is reinforced by the results of the studies in the literature, due to the association of pathogenesis with increased secretion of pro‐inflammatory mediators and reduction of anti‐inflammatory mediators. Decreased vitamin D levels may have a considerable role in vitiligo development by affecting Th1‐ and Th17‐related immune responses. Cytokines play an important role in the pathogenesis or progression of the disease. Moreover, we believe that decreased vitamin D level has a considerable role in vitiligo development by affecting Th1‐ and Th17‐related immune responses. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has revolutionized dermatology by improving diagnostic accuracy and clinical decision-making. AI algorithms can identify features and patterns of various dermatologic conditions, including skin cancer, and personalize treatment recommendations based on patient data. However, challenges remain in applying AI to individuals with Skin of Color (SOC) due to limited representation in datasets and concerns about image quality and standardization. Efforts to diversify training data, reevaluate skin type classification, and enhance program development can help address these challenges and improve AI's effectiveness in dermatology for SOC. The integration of AI into primary care settings can also reduce health gaps and promote more equitable health outcomes. [Extracted from the article]

Tinea gladiatorum (TG) is a fungal skin infection that occurs among wrestlers and other contact sport athletes with a varied prevalence rate. The most common causative factor responsible as well for local outbreaks of the infection is an anthropophilic dermatophyte species—Trichophyton tonsurans (T. tonsurans). The purpose of this study was to gather current data about TG, including epidemiology, possible diagnosing methods, clinical features, treatment approaches, and potential prevention techniques. We also performed a systematic review of studies describing TG incidence. The prevalence of the disease varied from 2.4% up to 100%. That wide range of variability forces medical practitioners to update knowledge about TG and points to the fact that it still may be a diagnostic and therapeutic challenge. Spreading awareness among athletes and trainers is one of the most important preventive steps. [ABSTRACT FROM AUTHOR]

Skin resurfacing for cutaneous rejuvenation has evolved with the development of a plethora of nonsurgical and minimally invasive modalities. We have highlighted the advances in laser therapy, chemical peels, radiofrequency, microneedling, and platelet-rich plasma therapy. We have also included studies providing head-to-head comparisons between procedures and discussed relevant debates in the field. We have examined additionally combination treatments and resurfacing in acne scars, melasma, and skin of color. [ABSTRACT FROM AUTHOR]

10.3390/biology10121310 4 Lobiuc A., Sterbuleac D., Sturdza O., Dimian M., Covasa M. A Conservative Replacement in the Transmembrane Domain of SARS-CoV-2 ORF7a as a Putative Risk Factor in COVID-19. The coronavirus disease 2019 (COVID-19) pandemic has affected almost all aspects of daily life. 10.3390/biology10080752 11 Manríquez R., Guerrero-Nancuante C., Taramasco C. Protection Strategy against an Epidemic Disease on Edge-Weighted Graphs Applied to a COVID-19 Case. 10.3390/biology9090271 21 Duffey R.B., Zio E. COVID-19 Pandemic Trend Modeling and Analysis to Support Resilience Decision-Making. [Extracted from the article]

Objective: Treatment of recalcitrant moderate‐to‐severe psoriasis can be challenging. Combination therapy of biologics and immunosuppressive agents can be a new strategy for treating therapy‐resistant cases with comorbidities, where many systemic medications are contraindicated. Case presentation: We report a case of a 62‐year‐old diabetic man with a 30‐year history of severe plaque psoriasis and psoriatic arthritis with cirrhosis and diabetic nephropathy that was treated successfully in combination with apremilast and etanercept after multiple previous unsuccessful treatment attempts. Conclusion: There are no data supporting the combination of apremilast and etanercept in the management of recalcitrant cases of moderate‐to‐severe psoriasis and multiple comorbidities including psoriatic arthritis, diabetic nephropathy, and cirrhosis. In patients who do not respond to multiple approaches for the treatment of psoriasis, combination therapy with biologic agents and new systemic medications may lead to dramatic disease control. [ABSTRACT FROM AUTHOR]

In the era of staggering speed in development of the novel coronavirus disease (COVID‐19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), we have reviewed the dermatologists' tools at hand for their utility (and potential risks) in patients affected by COVID‐19. This review aims to shed light on the antiviral and proviral potential of drugs routinely used in dermatology to modulate COVID‐19. The literature search included peer‐reviewed articles published in the English language (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) from January 1990 to March 2020 and by reference lists of respective articles. Somewhat to our surprise, we have found that several of our drugs widely used in dermatology have antiviral potential. On the other hand, we also frequently use immunosuppressive drugs in our dermatologic patients that potentially pose them at increased risk for COVID‐19. [ABSTRACT FROM AUTHOR]

Angiosarcomas (ASs) are aggressive tumors of vascular endothelial origin, occurring sporadically or in association with prior radiotherapy or chronic lymphedema. With only 1–5% of all sarcomas, the incidence seems low, but for the affected patient due to the extremely poor prognosis and the limited treatment options, the fate is often inevitable. Radiotherapy, chemotherapy, or "target therapy" have been used in the management of AS, but represent individual case decisions without lasting evidence. Over the past few years, breast‐conserving surgery followed by radiation therapy, known as breast‐conserving therapy (BCT), is being employed as a standard treatment for early‐stage breast cancer, but there has been an increase in reports of AS following BCT. We report two cases of AS following BCT and one case of primary AS involving the lower limb. [ABSTRACT FROM AUTHOR]

This Special Issue highlights various aspects of the skin, including, but not limited to, cutaneous structure and the pathophysiology of skin disorders. Blicharz and colleagues stated that patients with atopic dermatitis have a high prevalence of Staphylococcus aureus encoding superantigens on lesional skin, nonlesional skin, and the anterior nares [[1]]. Skin plays an important role in protecting and enhancing health. [Extracted from the article]

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful recurrent inflammatory nodules, leading to the formation of abscesses and scarring. In this article, we aim to review the psychiatric comorbidities in HS patients. It is estimated that one in four adults with HS suffers from depression and one out of five patients HS patients has anxiety. Bipolar disorders, psychoses, schizophrenia, and suicide are more common in HS patients than healthy individuals. Given the high rates of psychiatric comorbidities in HS patients, a psychosocial evaluation at an early visit could be a great tool for monitoring patients experiencing emotional burden. Referrals to psychiatric specialists, psychologists, and behavioral counselors are a part of a multidisciplinary approach recommended for the management of HS. [ABSTRACT FROM AUTHOR]

Dear Editor, Merkel cell carcinoma (MCC) is a malignant tumor of the skin, which effects elder individuals. Carcinoma erysipeloides (CE) is an uncommon form of metastasis in which malignant cells spread to skin via superficial dermal lymphatic vessels. MCC is regarded as the most lethal cutaneous cancer and the incidence and mortality of this highly metastatic tumor is increasing (Czech-Sioli et al. [2]). [Extracted from the article]

This is the first case report of combination therapy in psoriasis with underlying thalassemia that failed after months. The relation of thalassemia with severity of psoriasis and response to treatment should be evaluated in more studies. [ABSTRACT FROM AUTHOR]

Viral skin infections are some of the most common skin diseases in medical dermatology. Despite all the advances in the understanding of these disorders, the viruses that lead to common skin infections continue to evade complete destruction. 35632621 4 Skubic L., Hosnjak L., Breznik V., Fujs Komlos K., Luzar B., Poljak M. An Improved Protocol for Comprehensive Etiological Characterization of Skin Warts and Determining Causative Human Papillomavirus Types in 128 Histologically Confirmed Common Warts. [Extracted from the article]

Objective: Hypertension exerts a subtle impact on the brain that is revealed by diminished cognitive function. This study aimed at evaluating the association between blood pressure components and cognitive functions and cognitive reserve.Methods: In this cross-sectional study, 500 subjects from general population were evaluated. All neuropsychological tests were negatively associated with age; memory and executive function were also positively related with education.Results: The hypertensives (HT) were less efficient than the normotensives (NT) in the test of memory with interference at 10 s (MI-10) (−32%,p = 0.043), clock drawing test (CLOX) (−26%,p < 0.001), and mini-mental state examination (MMSE) (−7.4%,p = 0.02). Lower MMSE, MI-10, and CLOX were predicted by higher systolic (OR, 0.94,p = 0.032; OR 0.96,p < 0.001; OR 0.94,p < 0.001) and higher pulse pressure (BP) (OR 0.95,p = 0.04; OR 0.97,p < 0.001; and OR 0.92,p < 0.001). The cognitive reserve index (CRI) was 8% lower in the HT (p = 0.04) and was predicted by higher pulse BP (OR 0.86,p < 0.001). The BP vectors of lower MMSE, MI-10, and CLOX were directed towards higher values of systolic and diastolic BP, that of low CRI towards higher systolic and lower diastolic.Conclusion: This study contributes to the belief that a link exists between BP and cognition, higher values of systolic BP being associated to impaired cognitive function. [ABSTRACT FROM AUTHOR]

To summarize, PCOS may represent a distinct subgroup of women at higher than average risk of adverse COVID-19-related outcomes.2 COVID-19 PCOS patients are at risk to develop mild-to-moderate symptoms. Isotretinoin in acne treatment during the coronavirus disease 2019 (COVID-19): a retrospective analysis of adherence to therapy and side effects. Awareness of these symptoms could improve the identification of a potentially high-risk population for COVID-19.9 Despite its lower incidence in hyperandrogenic women, serious symptoms that warrant hospitalization should be taken into consideration. [Extracted from the article]

The Varicella-zoster virus (VZV) or human herpes virus 3 is a neurotropic human alpha herpes virus responsible for chickenpox/varicella and shingles/Herpes zoster (HZ). This review will focus on HZ. Since HZ is secondary to varicella, its incidence increases with age. In children and youngsters, HZ is rare and associated to metabolic and neoplastic disorders. In adults, advanced age, distress, other infections (such as AIDS or COVID-19), and immunosuppression are the most common risk factors. HZ reactivation has recently been observed after COVID-19 vaccination. The disease shows different clinical stages of variable clinical manifestations. Some of the manifestations bear a higher risk of complications. Among the possible complications, postherpetic neuralgia, a chronic pain disease, is one of the most frequent. HZ vasculitis is associated with morbidity and mortality. Renal and gastrointestinal complications have been reported. The cornerstone of treatment is early intervention with acyclovir or brivudine. Second-line treatments are available. Pain management is essential. For (secondary) prophylaxis, currently two HZV vaccines are available for healthy older adults, a live attenuated VZV vaccine and a recombinant adjuvanted VZV glycoprotein E subunit vaccine. The latter allows vaccination also in severely immunosuppressed patients. This review focuses on manifestations of HZ and its management. Although several articles have been published on HZ, the literature continues to evolve, especially in regard to patients with comorbidities and immunocompromised patients. VZV reactivation has also emerged as an important point of discussion during the COVID-19 pandemic, especially after vaccination. The objective of this review is to discuss current updates related to clinical presentations, complications, and management of HZ. [ABSTRACT FROM AUTHOR]

Fordyce spots (FS) are heterotopic sebaceous glands affecting mostly oral and genital mucosa, commonly misdiagnosed with sexually transmitted infections. In a single-center retrospective study, we aimed to assess the ultraviolet-induced fluorescencedermatoscopy (UVFD) clues of Fordyce spots and their common clinical simulants: molluscum contagiosum, penile pearly papules, human papillomavirus warts, genital lichen planus, and genital porokeratosis. Analyzed documentation included patients' medical records (1 September–30 October 2022) and photodocumentation, which included clinical images as well as polarized, non-polarized, and UVFD images. Twelve FS patients were included in the study group and fourteen patients in the control group. A novel and seemingly specific UVFD pattern of FS was described: regularly distributed bright dots over yellowish-greenish clods. Even though, in the majority of instances, the diagnosis of FS does not require more than naked eye examination, UVFD is a fast, easy-to-apply, and low-cost modality that can further increase the diagnostic confidence and rule out selected infectious and non-infectious differential diagnoses if added to conventional dermatoscopic diagnosis. [ABSTRACT FROM AUTHOR]

Scabies, known colloquially as the 7-year itch, is a contagious skin infection that occurs among humans and other animals. The treatment of choice is still controversial. The aim of this study was to compare the efficacy and safety of topical ivermectin vs. crotamiton cream 10% for the treatment of scabies. In total, 340 patients with scabies were enrolled, and randomized into two groups. The first group received 1% ivermectin applied topically to the affected skin. The dose employed was 400 μg/kg, repeated once the following week, and the second group received crotamiton 10% cream and were told to apply this twice daily for five consecutive days. Treatment was evaluated at intervals of two and four weeks, and if there was treatment failure at the 2-week follow-up, treatment was repeated. Two applications of topical ivermectin provided a cure rate of 64.7% at the 2-week follow-up, which increased to 82.3% at the 4-week follow-up after repeating the treatment. Treatment with single applications of crotamiton cream 10% was effective in 41.2% of patients at the 2-week follow-up, which increased to 64.7% at the 4-week follow-up after this treatment was repeated. Ivermectin was quite safe in our cases. Two applications of ivermectin were as effective as single applications of crotamiton 10% cream at the 2-week follow-up. After repeating the treatment, ivermectin was superior to crotamiton cream 10% at the 4-week follow-up. [ABSTRACT FROM AUTHOR]

Comment on "Cutaneous manifestations of COVID-19: A case report and a new finding from Egypt" We read with interest the case report by Farouk and Sadek published recently in I Dermatologic Therapy i .1 The authors reported an Egyptian health care professional with coronavirus disease 2019 (COVID-19), presented with a progressive pruritic, polymorphic eruption: erythematous, morbilliform, and urticarial. Recently, Jimenez-Cauhe et al4 studied 21 patients with COVID-19 for possible enanthem to distinguish viral-related rash from confusing drug reactions. [Extracted from the article]

Coronavirus disease (COVID-19) emerged in Wuhan, China, in late 2019 and soon attained the status of a pandemic in early 2020. This pandemic has altered every aspect of patient care, comprising both indoor and outdoor patients. Many patients with skin cancer are already immunosuppressed, thus increasing their susceptibility to various infections including COVID-19. [Extracted from the article]

Dermatology and specialty rotations: COVID-19 may reemphasize the importance of internal medicine Since the first case was identified in Wuhan, China in November 2019, the novel coronavirus (COVID-19) has spread worldwide and affected almost all parts of the globe with unprecedented epidemiological, psychosocial, political, financial, and educational repercussions.1-3 In dire times like this, other specialists including dermatologists have stepped up and volunteered their services to help ease the burden and share the medical workload. In brief, internal medicine rotations should be made mandatory for dermatologists as this foundation may of use not only for our professional routine but also for exceptional healthcare crisis such as COVID-19. [Extracted from the article]

Objective: Cerebral stroke in young adults is not uncommon. Venous thromboses resulting from antiphospholipid antibodies (APAs) are one of causes of stroke in youths. This study aimed at evaluating the role of APAs in young patients with ischemic strokes. Methods: In this case-control study, 25 patients with diagnosis of ischemic stroke or transient ischemia attack in case group and 40 patients in control group were studied during one year. Medical history was obtained from all the patients. Levels of anticardiolipin and antiphospholipid antibodies including both IgG and IgM, were evaluated in all patients before consuming warfarin and using ELISA method. Results: Antiphospholipid antibodies or anticardiolipin antibody was high in six (24%) patients. In the control group, only two subjects had abnormally increased amounts of at least one antibody. The difference was significant between the case and control groups ( P < .05). The study demonstrated that history of at least one cerebral ischemic event was observed in two out of 6 patients (33.3%) with high APAs and two out of 19 patients (10.5%) without higher APAs. Conclusion: APAs increase risk of ischemic strokes independently or in association with other vascular risk factors. [ABSTRACT FROM AUTHOR]

Introduction: The accumulation of tissue‐advanced glycation end products in skin results from complex and consecutive reactions and can be measured by skin autofluorescence (SAF) reader devices. This overview discusses studies evaluating the utilization of SAF in screening renal and cardiac disease. Materials and methods: Literature search was performed using Google Scholar, PubMed, Springer, Ovid, and ScienceDirect. Results: SAF was an independent predictor of progression of chronic kidney disease (CKD) and was elevated in subjects on hemodialysis and peritoneal dialysis. Furthermore, SAF was significantly associated with cardiovascular events, cardiovascular mortality, and all‐cause mortality in CKD patients. Other studies revealed a correlation between SAF and arterial stiffness, vascular damage, and subclinical atherosclerosis. A vegetarian diet was associated with lower SAF levels, whereas malnutrition was correlated with higher levels and increased mortality. Conclusions: SAF measurement may be useful in managing renal and cardiac disease. Future studies are needed to clarify the specific role of SAF in the management of CKD and its noninvasive office utilization to identify comorbidities in inflammatory diseases, such as psoriasis. [ABSTRACT FROM AUTHOR]

Paraneoplastic SCLE is clinically similar to idiopathic SCLE, mostly with positive anti-Ro antibody, reported predominantly in male patients, and responds to the same treatment for idiopathic SCLE. Xie I et al i [2] reported three elderly patients with SCLE, 58, 77, and 61 years, who had developed small cell lung cancer, esophageal cancer, and bronchogenic carcinoma, respectively. Details of age-adapted malignancy workout were not reported by Litaiem I et al i .[1] According to Ashworth,[4] who reported a case of SCLE with Crohn's disease (CD) in 1992, certain immunological changes exist in both SCLE and CD that may suggest a possible common pathway. [Extracted from the article]

Background: COVID‐19 has been linked to a variety of dermatological conditions. Objective: To determine the presence of various cutaneous manifestations in patients with COVID‐19, also to define their features in relation to the systemic symptoms. Methods: This research enrolled a total of 1206 lab‐confirmed COVID‐19 individuals at a tertiary‐care hospital in Karachi, Pakistan. Expert dermatologists assessed patients for COVID‐related skin conditions. COVID‐19 severity was categorized as asymptomatic/mild, moderate, or severe. Results: Of the 102 (85.7%) patients with only one cutaneous sign, 26.5% developed maculopapular/morbiliform/erythematous rash; 14.7% urticaria; 9.85% vesicular/pustular exanthem; 14.7% vascular pattern; 12.7% infections, 7.8% miscellaneous and 9.8% late cutaneous findings A longer‐lasting vascular pattern was related with an older age and a fatal COVID‐19 outcomes (P: 0.000) compared with mild/moderate disease. Most of the retiform purpura presented exclusively with thromboembolic episodes. The moderate severity was correlated with maculopapular/morbiliform/exanthematous phenotype (P: 0.009), whereas urticaria was attributed to asymptomatic/mild disease (0.001) compared with moderate/severe infection. Limitations: Single‐Center and observational study. Conclusion: Vascular lesions were correlated with disastrous COVID‐19 outcomes, whereas retiform purpura was linked to adverse outcomes. The maculopapular/morbiliform/erythematous rash was associated with moderate severity, while the urticarial rash was linked to milder course compared with moderate/severe severity infection. [ABSTRACT FROM AUTHOR]

Since the emergence of the new coronavirus disease 19 (COVID‐19) pandemic, there has been a concern for the patients with chronic autoimmune diseases including dermatological conditions over the potential exacerbation of these underlying conditions after infection with severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV2). We performed a systematic review to evaluate presentations, postinfection change in the manifestation, diagnosis, and management of flare‐ups of underlying dermatologic disease in patients with COVID‐19. A total of 17 articles were recovered reporting on flare‐ups of dermatological disease including pemphigus vulgaris, psoriasis, subacute cutaneous lupus erythematosus, acrodermatitis continua of Hallopeau, systemic sclerosis sine scleroderma, and Sézary syndrome (SS). Out of these, psoriasis and alopecia areata were the most common conditions. However, most cases of psoriasis could have been attributed to either antimalarial agents that were initially used for the treatment of COVID‐19 or discontinuation of treatment following SARS‐CoV2 infection. [ABSTRACT FROM AUTHOR]

Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1‐6% of all live births and commonly classified based on the projected size in adults. Congenital melanocytic naevi appear in different colours, shapes, and sizes, and occasionally present with complications. In this review, we sought to evaluate congenital melanocytic naevi, their clinical, dermatoscopic, and reflectance confocal microscopic features, behavioural pattern over time, new trends in classification, underlying genetic factors and their influence on clinical manifestations and management, associated risks, complications, magnetic resonance imaging findings and their management in the light of recent literature. [ABSTRACT FROM AUTHOR]

Congenital triangular alopecia (CTA) is a benign noncicatricial localized pattern of hair loss with unknown etiology. Although referred to as "congenital," CTA may develop in adulthood. It is believed that many cases of CTA are never diagnosed or are misdiagnosed; causing the incidence to be underestimated. The present study evaluates a case of 20‐year‐old woman presenting with a single circular to oval area of hair‐loss in the mid‐frontal region of her scalp. To date, about 170 cases of CTA have been reported and we present the first case in which the alopecic patch is located in the mid‐frontal region of the scalp. We present this case not only to challenge the preconceived notion that all CTAs are frontotemporal, but also to inform other practitioners about this rare condition and prevent redundant medical treatment. [ABSTRACT FROM AUTHOR]