Clinical, Cosmetic and Investigational Dermatology最新文献

This scoping review synthesizes existing research comparing traditional Chinese medicine (TCM) and contemporary treatments (CTs) for managing psoriasis vulgaris (PsV). A thorough literature search was conducted across multiple databases through February 2024, identifying relevant systematic reviews, randomized controlled trials (RCTs), quasi-experimental, and observational studies that contrast TCM approaches with CTs for PsV. From an initial pool, 195 articles were analyzed, indicating a growing interest in this comparative area, with most studies involving sample sizes between 30 and 100 participants. Key interventions included both internal and topical applications of Chinese herbal medicines, notably Rehmanniae Radix, Arnebiae Radix, and Smilacis Glabrae Rhizoma. Outcomes focused on PASI scores, quality of life metrics, and adverse effects. Results suggest that TCM offers efficacy in improving PASI scores and quality of life; however, evidence concerning toxicity profiles, recurrence rates, and comorbidity outcomes remains sparse. Notable research gaps include a lack of comprehensive data on newer treatment modalities, particularly biologics. Future studies should aim to delineate subjects and interventions in greater detail to support clinical applicability.

Background: Oxidative stress is associated with both vitiligo and periodontitis, but the detailed pathogenesis requires further elucidation. Evidence suggests a connection between periodontitis and autoimmune as well as chronic inflammatory skin diseases. The objective of this study is to investigate shared biomarkers related to oxidative stress in periodontitis and vitiligo using an integrated approach of bioinformatics and machine learning.

Methods: Data for periodontitis and vitiligo were downloaded from the NCBI GEO public database. After batch effect removal, differentially expressed genes (DEGs) were identified and combined with weighted gene co-expression network analysis (WGCNA) to pinpoint shared genes. Pathway enrichment analysis using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) was conducted for the shared genes. We identified hub genes with least absolute shrinkage and selection operator (LASSO) regression and Support Vector Machine (SVM) machine learning algorithms. Finally, the ssGSEA method was used to analyze the level of immune cell infiltration.

Results: Ninety-three shared genes between periodontitis and vitiligo were identified, with GO and KEGG enrichment analyses revealing a significant association with oxidative stress. Through machine learning algorithms, PTGS2, CCL5, and PRDX4 were identified as hub genes serving as shared biomarkers for oxidative stress in both diseases. Furthermore, immune cell infiltration revealed that periodontitis and vitiligo share similar immune infiltration patterns.

Conclusion: Our study has identified PTGS2, CCL5, and PRDX4 as key biomarkers for vitiligo and periodontitis, two diseases linked by similar immune infiltration patterns. These biomarkers offer new diagnostic insights and potential therapeutic targets.

Background: Vitiligo causes significant psychological stress, creating a strong demand for accessible educational resources beyond clinical settings. This demand remains largely unmet. Large language models (LLMs) have the potential to bridge this gap by enhancing patient education. However, uncertainties exist regarding their ability to accurately address individualized patient inquiries and whether comprehension capabilities vary between LLMs.

Purpose: This study aims to evaluate the applicability, accuracy, and potential limitations of OpenAI o1, DeepSeek-R1, and Grok 3 for vitiligo patient education.

Methods: Three dermatology experts first developed sixteen vitiligo-related questions based on common patient concerns, which were categorized as descriptive or recommendatory with basic and advanced levels. The responses from the three LLMs were then evaluated by three vitiligo-specialized dermatologists for accuracy, comprehensibility, and relevance using a Likert scale. Additionally, three patients rated the comprehensibility of the responses, and a readability analysis was performed.

Results: All three LLMs demonstrated satisfactory accuracy, comprehensibility, and completeness, although their performance varied. They achieved 100% accuracy in responding to basic descriptive questions but exhibited inconsistency when addressing complex recommendatory queries, particularly regarding treatment recommendations for specific populations. Pairwise comparisons indicated that DeepSeek-R1 outperformed OpenAI o1 in accuracy scores (p = 0.042), while no significant difference was observed compared to Grok 3 (p = 0.157). Readability assessments revealed elevated reading difficulty across all models, with DeepSeek-R1 exhibiting the lowest readability (mean Flesch Reading Ease score of 19.7; pairwise comparisons showed DeepSeek-R1 scores were significantly lower than those of OpenAI o1 and Grok 3, both p < 0.01), potentially reducing accessibility for diverse patient populations.

Conclusion: Reasoning-LLMs demonstrate high accuracy in responding to simple vitiligo-related questions, but the quality of treatment recommendations declines as question complexity increases. Current models exhibit errors in providing vitiligo treatment advice, necessitating enhanced filtering mechanisms by developers and mandatory human oversight for medical decision-making.

Background: Scar hyperplasia is a common problem after surgical incision healing, and incision tension is an important factor affecting scar formation. Although the traditional super-tension-reducing suture method can improve incision scars, there are problems such as exposure of the needle entry and exit points, which may cause adverse reactions such as pigmentation and scar hyperplasia.

Methods: This prospective study proposes a new super-tension-reducing suture method-distal complete dermal undermining super-tension-reducing suture, which aims to reduce scar hyperplasia by reducing the needle entry and exit points on the incision. This method inserts the needle subcutaneously, undermines 1 cm in the dermis, and then withdraws the needle from the subcutaneous layer, which effectively avoids suture exposure and incision edge irritation. At the same time, by increasing the stress-bearing site, the maintenance time of the super-tension-reducing effect is prolonged.

Results: This study was clinically applied to 50 patients with oral and maxillofacial surgery. The results showed that the observation group was superior to the control group in terms of scar score, pigmentation, centipede-foot scars and delayed incision healing, indicating that this new suture technique can effectively reduce scar hyperplasia and improve incision healing.

Conclusion: This method provides a new technical option for surgical wound healing and has good clinical application prospects.

Purpose: Exogenous ochronosis is a challenging condition that requires multifaceted modalities. This investigation delineates a case of hydroquinone-induced exogenous ochronosis that improved following treatments with a bipolar non-insulated microneedle radiofrequency (MNRF). To report the efficacy and safety of microneedle radiofrequency as a novel treatment for exogenous ochronosis, and to review the role of energy-based devices as treatment options for this condition.

Patients and methods: A 63-year-old patient with a history of long-term application of hydroquinone-containing products for the treatment of melasma gradually developed hyperpigmented lesions on the face, which were later confirmed the diagnosis of exogenous ochronosis by skin biopsy. Three sessions of bipolar non-insulated MNRF with four-week intervals were employed to treat the affected areas. The clinical improvement of the ochronotic lesion was assessed by digital photograph and Trica facial analysis instrumentation.

Results: There was a discernible enhancement in exogenous ochronosis and preexisting melasma within one month after the initial session of bipolar non-insulated MNRF. Following three sessions of MNRF, the patient also demonstrated a further diminution of ochronotic substances and a substantial improvement in the overall dermal texture of the treated regions as assessed by the Trica facial analysis system. Adverse effects were mild erythema and edema, which were transient and self-resolving within four to five days. No post-inflammatory hyperpigmentation, hypopigmentation, or prolonged erythema was detected after the intervention.

Conclusion: This case of exogenous ochronosis demonstrates the role of bipolar non-insulated MNRF as a viable and safe therapeutic option for the management of hydroquinone-induced exogenous ochronosis.

Talaromyces marneffei (TM) infection is a rare but potentially fatal deep fungal disease that typically affects immunocompromised individuals in endemic regions. However, an increasing number of cases have been reported in HIV-negative, immunocompetent patients without classical risk factors. We report the case of a 15-year-old girl residing in urban southern China who presented with chronic cutaneous plaques and cervical lymphadenopathy, initially misdiagnosed as tuberculous lymphadenitis. Despite one year of anti-tuberculosis therapy, her condition worsened and liver dysfunction developed. Subsequent skin biopsy, fungal culture, and metagenomic next-generation sequencing (mNGS) confirmed localized cutaneous TM infection. The patient responded well to oral itraconazole, and lesions resolved after four months of treatment, with no recurrence during an 18-month follow-up. This case highlights the importance of considering deep fungal infections in the differential diagnosis of chronic granulomatous skin lesions, even in immunocompetent hosts, and emphasizes the diagnostic utility of mNGS in atypical presentations.

Lichen planus pemphigoides (LPP) is a rare autoimmune subepidermal bullous disorder characterized by lichenoid lesions resembling lichen planus (LP) and bullous pemphigoid(BP). LPP may be triggered by medications, malignancies, or viral infections. Herein, we present a 67-year-old male patient with brain-metastatic non-small cell lung cancer (NSCLC) who developed pruritic violaceous plaques, tense bullae, and verrucous hyperplasia on the trunk and extremities following tislelizumab therapy. Histopathological examination confirmed LPP. The condition significantly improved with methylprednisolone combined with dupilumab treatment, and there was no recurrence during a 10-month follow-up.

Purpose: Children with facial and cervical birthmarks display unique physical and psychological complexities that demand multifaceted, long-term care following laser treatment. Integrated care based on the integrated care models is a promising approach to address these needs. This study aimed to assess the efficacy of integrated care for children with large facial and cervical birthmarks who were undergoing laser treatment.

Patients and methods: This retrospective study analyzed clinical data of children who received laser treatment under general anesthesia at our clinic from March 2022 to August 2024. Children were divided into a control group, which received conventional care, and a study group, which received integrated care based on the integrated care models in addition to conventional care. Outcomes compared between the groups included the children's FPS-R and medication awareness rates on the seventh day post-discharge, parental satisfaction at seven days and three months, and the incidence of adverse reactions within three months.

Results: A total of 153 children were enrolled in the study, with 76 in the study group and 77 in the control group. Under the premise of comparable clinical characteristics, the study group exhibited significantly lower FPS-R (P=0.012) on the seventh day and higher parental satisfaction at both seven days and three months post-discharge (P<0.001) compared to the control group. There was no significant difference in parental medication awareness rates between the groups, despite the study group achieving 100%. No significant differences were observed in the rates of adverse reactions; however, the control group reported severe local or systemic reactions, whereas the study group experienced only transient, mild adverse reactions.

Conclusion: This study provided the first evidence of the efficacy of integrated care in laser treatment for pediatric facial and cervical birthmarks, particularly in alleviating pain levels and enhancing parental satisfaction. It also mitigated the severity of post-discharge adverse reactions. Integrated care improves treatment outcomes and the care experience for families of these special children, warranting further investigation.

Lichen planus pigmentosus (LPP), a rare variant of lichen planus, characterized by the insidious onset of dark brown to gray macules. In this report, we present a unique case of LPP in a 30-year-old female patient who developed diffuse hyperpigmented macules with nail dystrophy. Notably, histopathology revealed classic lichenoid interface dermatitis with predominant plasma cell infiltration in the papillary dermis, confirmed by strong CD38 and CD138 immunoreactivity. Laboratory evaluation revealed elevated serum Kappa light chain and thyroid stimulating hormone levels, raising the possibility of immune dysregulation. No evidence of plasma cell malignancy was found after further hematologic evaluation. To our knowledge, this may be the first reported case of plasma cell-rich LPP in a young female with concurrent nail involvement and isolated serum kappa light chain elevation without evidence of clonality. Awareness of this entity is essential for differentiating it from mimickers such as cutaneous plasmacytosis, multicentric Castleman disease, and secondary syphilis. This case highlights the need for heightened awareness of this variant and its possible systemic associations, and underscores the importance of integrating histopathology, immunophenotyping, and laboratory workup to avoid misdiagnosis and guide clinical care.

This case report describes a pioneering approach to address severe alopecia following free flap reconstruction for malignant scalp tumor resection. A 41-year-old female with recurrent malignant fibrous histiocytoma underwent extensive scalp resection (10 cm × 21 cm defect) repaired with a free anterolateral thigh flap. While the flap healed successfully, the resulting baldness caused significant psychological distress, leading her to decline conventional scalp expansion due to its invasiveness. Instead, we performed staged autologous hair transplantation directly onto the flap-a technically challenging endeavor given the flap's thin skin, thick subcutaneous fat, and compromised vascularity. Using follicular unit extraction (FUE), the first session (2,289 grafts) followed partial flap resection, and the second session (2,571 grafts) was conducted 18 months later. Key adaptations included low-density implantation (30-40 FU/cm²), controlled graft depth, and tumescent solution to maintain skin tension. Follow-up revealed encouraging graft survival (~60% initially, rising to ~70% in the second session), achieving complete coverage at ~35 FU/cm² with no complications. The patient expressed high satisfaction with the natural aesthetic outcome. To our knowledge, this represents the first such case reported in China and only the third globally, demonstrating that staged FUE transplantation on free flaps is a viable, minimally invasive solution for post-oncologic alopecia when traditional methods are contraindicated or refused. This technique expands reconstructive options for patients prioritizing both cure and quality of life.