Clinical, Cosmetic and Investigational Dermatology最新文献

Subacute cutaneous lupus erythematosus (SCLE) is a clinical subtype of cutaneous lupus erythematosus (CLE), an autoimmune connective tissue disease characterized by photosensitive rashes. This report presents a rare case of SCLE involving the chin. The patient presented with an annular, erythematous, scaling plaque on the left chin, which had been repeatedly misdiagnosed. Through integrated analysis of dermoscopic features, reflectance confocal microscopy (RCM) findings, and skin biopsy, a definitive diagnosis was established. Combination therapy with systemic corticosteroids and immunomodulators was initiated. Significant lesion regression was observed at the 19-week follow-up. The combined application of dermoscopy and RCM optimizes clinical management by reducing diagnostic errors and enabling real-time treatment monitoring.

Keloids have traditionally been classified as fibroproliferative disorders; however, emerging evidence establishes chronic inflammation and immune dysregulation as the central pathogenic nexus, orchestrating a self-sustaining cycle of pathological healing. This review proposes a paradigm shift toward understanding keloids as a spectrum of auto-inflammatory fibrotic disorders. We synthesize recent advances to demonstrate how genetic predisposition and epigenetic modifications prime a hyperinflammatory response, which is then amplified by endocrine factors and executed through aberrant signaling pathways. Crucially, this inflammatory milieu drives the metabolic reprogramming of fibroblasts toward a Warburg-like phenotype, providing the bioenergetic and biosynthetic substrate for relentless proliferation and extracellular matrix (ECM) deposition. Infiltration and skewed polarization of immune cells further fuel this fibro-inflammatory cascade. Our integrative framework, positioning dysregulated immunity as the disease core, explains keloid persistence, recurrence, and heterogeneity, thereby providing a rationale for combination-based, mechanism-driven therapies. Ultimately, this perspective illuminates novel therapeutic strategies that target the inflammatory core (eg, biologic agents against Th2 cytokines and mast cell products) and its downstream consequences (eg, metabolic inhibitors), offering hope for more effective, mechanism-based interventions against this recalcitrant condition.

Background: Poly-L-Lactic acid (Sculptra^®, PLLA-SCA^®) is a biodegradable bio-stimulating agent composed of irregularly shaped PLLA particles capable of inducing extracellular matrix regeneration. Beyond traditional volumisation, emerging evidence suggests broader epigenetic and adipogenic effects, positioning PLLA as a key agent in regenerative aesthetics.

Objective: To retrospectively evaluate long-term outcomes of PLLA-SCA treatment in 28 female patients using 3D imaging analysis, focusing on two protocols; (1) full-face skin firming and (2) skin firming with additional targeted volumisation and/or asymmetry correction.

Methods: A retrospective review of clinical data and standardised 3D stereophotogrammetric imaging was performed two years post-treatment. Patients were divided into the two treatment strategy groups. Volume differences were quantified using validated reconstruction software, and clinical outcomes were assessed through physician evaluation and patient-reported satisfaction.

Results: All patients demonstrated measurable soft tissue volume formation at two years, ranging from 0.75cc to 6.4cc per vial of PLLA-SCA. Skin quality improvement and facial harmonisation were consistently observed. No untoward effects, such as vascular compromise, nodules, or granulomas, were reported.

Conclusion: PLLA-SCA produces sustained soft-tissue formation and skin firming effects, persisting for at least two years. The findings support PLLA-SCA as an effective regenerative agent with long-lasting volumising and tissue enhancing properties.

Purpose: This study aims to develop and validate machine learning models for predicting hyperglycemia risk in psoriasis patients.

Methods: Clinical data from 575 psoriasis patients admitted to the Department of Dermatology were collected and randomly split into a training set and an internal test set in a 7:3 ratio. An external test set was derived from 135 psoriasis patients enrolled in the National Health and Nutrition Examination Survey (NHANES) during 2003-2004 and 2011-2012. Eleven machine learning algorithms, including decision trees, random forests, extreme gradient boosting (XGboost), light gradient boosting machine, support vector machines, multilayer perceptron, K-nearest neighbors, logistic regression, lasso regression, ridge regression, and elastic net, were systematically compared. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration curves and clinical decision curve (DCA).

Results: The extreme gradient boosting (XGboost) was selected as the final predictive model due to its robust performance across multiple evaluation metrics. The area under the curve values for the training, internal, and external test sets were 0.821 (95% confidence Interval (CI): 0.775-0.866), 0.820 (95% CI: 0.751-0.888), and 0.788 (95% CI: 0.695-0.881), respectively. Calibration and clinical decision curve analysis confirmed the model's accuracy and clinical utility. Additionally, a web-based calculator was developed to improve the model's accessibility and application.

Conclusion: The XGBoost-based model effectively predicts hyperglycemia risk in psoriasis patients, emphasizing personalized treatment plans for high-risk individuals to manage hyperglycemia progression and psoriasis-related inflammation.

Cheilitis simplex is a prevalent form of cheilitis that is characterized by the presence of cracked lips, fissures, or desquamation, due to various etiologies. Utilization of "boosters" as a treatment for chapped lips has not been extensively researched. This case report aimed to describe the efficacy of lip booster injection comprising active ingredients of 1% hyaluronic acid (HA) and 1% polynucleotides (PN), with 0.3% lidocaine as anesthetic agent. A 30-year-old female patient presented with a chief complaint of dry and chapped lips that occasionally bleed. This condition had recently deteriorated, and the application of topical treatment had not yielded substantial improvement, which led to a state of distress for the patient. She was diagnosed with cheilitis simplex and was subsequently treated with a single subdermal injection of a combination of 1% HA, 1% PN, and 0.3% lidocaine. Lip hydration was increased gradually, as measured by tewameter, with peak rate of hydration (26.218 g/m²/h) occurred two weeks after injection, and subsequently decreased gradually until six weeks after injection (29.926 g/m²/h); however, the rate of hydration remained higher than the baseline value (34.386 g/m²/h). Additionally, the lips exhibited an increase in brightness and a shift in pigmentation toward a rosier hue, as substantiated by spectrophotometric analysis. The mechanism of HA and PN include providing hydration and stimulating dermal fibroblast activity. However, PN may also exert an additional effect of improving lip pigmentation by reducing melanin and increasing hemoglobin levels. In conclusion, the lip booster injection, comprising 1% PN, 1% non-cross-linked HA, and 0.3% lidocaine, is an efficacious and practical treatment option for cheilitis simplex. This treatment option offers the additional benefits of being pain-free and enhancing lip pigmentation. Further studies are required to confirm these findings.

Purpose: Dermatofibrosarcoma protuberans (DFSP) and dermatofibroma (DF) are cutaneous lesions with overlapping clinical features, often requiring histopathological confirmation. This study aims to evaluate and compare the diagnostic utility of high-frequency ultrasound (HFUS) and ultra-high-frequency ultrasound (UHFUS) in distinguishing these two entities over 15-year period.

Methods: A retrospective analysis was conducted on 334 patients (127 DFSP, 207 DF) with pathologically confirmed diagnoses. HFUS or UHFUS was used to assess lesion characteristics, including demographics, location, size, morphology, echogenicity, homogeneity, posterior acoustic features, and vascularity. Univariate and multivariate logistic regression analyses were performed to identify significant predictors.

Results: DFSP patients were significantly older than DF patients (40.99 years vs 34.00 years; P < 0.001). DFSP lesions were predominantly on the trunk, while DF was more common on the extremities (P < 0.001). DFSP lesions were significantly larger (mean 43.02 mm vs 10.34 mm; P < 0.001), and exhibited more aggressive sonographic features, including tentacle-like borders, internal hyperechoic areas, peripheral hyperechoic rims, mixed echogenicity, irregular shape, ill-defined margins, internal heterogeneity, and frequent posterior enhancement (all P < 0.005). DFSP also showed higher vascularity with random, peripheral, or arborizing patterns and higher Adler grades (all P < 0.001). Multivariate analysis identified tumor location (extremities favoring DF), size, ultrasound pattern (tentacle-like border pattern, internal hyperechoic area, peripheral hyperechoic rim, and mixed echogenicity pattern favoring DFSP) as independent predictors.

Conclusion: HFUS and UHFUS demonstrates strong diagnostic utility in differentiating DFSP from DF based on key clinical and sonographic features. These findings support the use of HFUS and UHFUS as a valuable non-invasive tool for preoperative diagnosis. Future studies should validate these criteria in multi-center settings and exploring artificial intelligence integration to further enhance diagnostic accuracy and standardization.

Background: Vitiligo is a chronic pigmentary disorder characterized by the progressive loss of melanocytes, resulting in skin depigmentation. Although UV-based therapies, such as narrowband UVB, are commonly used for treatment, excessive sun exposure may aggravate the disease. Understanding patients' perceptions and behaviors related to sun exposure is crucial, particularly in tropical countries like Thailand, where UV levels are high.

Purpose: To assess the knowledge, attitudes, and photoprotection behaviors of Thai vitiligo patients compared to healthy controls.

Patients and methods: A cross-sectional study was conducted from January to August 2025 using a self-administered questionnaire. The questionnaire assessed participants' demographics, vitiligo-related characteristics, knowledge and attitudes toward sun exposure, perceived skin cancer risk, and sun protection practices. Data from 105 vitiligo patients and 85 controls were analyzed using chi-square and descriptive statistics.

Results: Vitiligo patients showed greater awareness of the effects of sunlight on their condition than the control group. A higher proportion thought mild sunlight may improve vitiligo (57.1% vs 31.8%, p < 0.001). Only 25.7% of patients believed they had an increased risk of skin cancer. Vitiligo patients were more likely to use sunscreen regularly (53.3% vs 37.6%, p = 0.031) and during outdoor activities (61.0 vs 40.0%, p = 0.004) compared to control. However, reapplication rates were suboptimal with 75.2% of vitiligo patients never reapplied sunscreen, and fewer patients reapplied occasionally compared to controls (18.1% vs 37.6%, p = 0.002).

Conclusion: Thai vitiligo patients demonstrated moderate understanding of photoprotection and skin cancer risk, but significant behavioral gaps exist, notably in terms of sunscreen reapplication and comprehensive sun protection methods. These findings underscore the need for focused educational efforts to close the knowledge-practice gap, highlighting both the benefits and risks of UV exposure in vitiligo treatment.

Targeted biologics have proven to be highly effective treatments for both psoriasis and atopic dermatitis; however, they may occasionally induce the onset of the opposite disease phenomenon known as paradoxical reaction. The underlying mechanisms of these reactions remain largely unclear. This review summarizes all currently reported cases of paradoxical reactions and integrates findings from recent sequencing studies to elucidate the latest progress in this field, raising new concerns for dermatologists regarding the long-term use of biological therapies.

Background: This study aimed to elucidate IL-17 inhibitors' mechanisms in psoriasis, offering a theoretical basis for tackling clinical issues like treatment resistance and relapse.

Methods: Datasets GSE226244 and GSE31652 served as the training set, and GSE201827 served as the testing set. Differential hub genes post-IL-17 inhibitor treatment identified via Limma and WGCNA. DEGs were defined by a |log2 fold-change (FC)| greater than 0.585 and a stringent FDR threshold of less than 0.05. CIBERSORT evaluated immune cell infiltration. Comprehensive analysis of 113 machine learning methods identified optimal predictive model. qPCR validated CLCNKB and GFRA3 expression in psoriasis cell models post-IL-17 inhibitor treatment. Mendelian randomization analysis explored causal links between CLCNKB, GFRA3 and cytokines.

Results: Analysis of gene expression in psoriasis patients treated with IL-17 inhibitors identified 95 differential genes enriched in FoxO signaling, Lysine degradation, and cGMP-PKG pathways. The LASSO-glmBoost (a hybrid machine learning method combining Lasso regularization with gradient boosting) model exhibited superior diagnostic performance (AUC: 0.920 in training, 0.858 in test), highlighting CLCNKB and GFRA3 as key genes in the optimal predictive framework. qPCR confirmed their upregulation in IL-17-inhibitor-treated psoriasis cells, and Mendelian randomization linked both genes causally to cytokine dysregulation.

Conclusion: The study reveals new insights into IL-17 inhibitors' mechanisms in psoriasis, suggesting that upregulation of CLCNKB and GFRA3, along with cytokine dysregulation (eg, IL-13, IL-10, IL-12, TGF-β, TNF-α), may underlie potential resistance and relapse in patients. This work demonstrates a novel approach to clinical outcome prediction with potential utility for specific clinical application, warranting further validation in clinical settings.

Objective: The aim of this study was to compare the clinical efficacy of liquid and hydrocolloid dressings in the management of incontinence-associated dermatitis (IAD) among critically ill patients and to evaluate their effects on skin lesion healing, symptom improvement, and complication prevention.

Methods: A total of 136 critically ill patients diagnosed with IAD and admitted to the hospital between January 2023 and January 2024 were included. Patients were randomly assigned using the random number table method to the hydrocolloid dressing group (n = 68) or the liquid dressing group (n = 68). The hydrocolloid dressing group received DuoDERM^® hydrocolloid dressing, while the liquid dressing group received 3M™ Cavilon™ liquid dressing. Outcomes assessed included the Scoring Atopic Dermatitis (SCORAD), Dermatology Life Quality Index (DLQI), Perineal Assessment Tool (PAT) score, Visual Analogue Scale (VAS), skin lesion healing time, recurrence rate, and complications. Measurements were recorded before and after treatment, and clinical efficacy was evaluated.

Results: Following treatment, SCORAD, DLQI, PAT, and VAS scores decreased significantly in both groups compared with baseline (all p < 0.05). SCORAD, PAT, and VAS scores in the hydrocolloid dressing group were significantly lower than those in the liquid dressing group, while the DLQI scores were higher (all p < 0.05). In addition, the hydrocolloid dressing group demonstrated a shorter skin lesion healing time, lower recurrence rate, and reduced overall complication rate (all p < 0.05). The difference in clinical efficacy between the two groups was statistically significant, favoring the hydrocolloid dressing group (p < 0.05).

Conclusion: For critically ill patients with IAD, hydrocolloid dressings demonstrated superior efficacy compared with liquid dressings. Hydrocolloid dressings promoted faster healing of skin lesions, decreased recurrence and complication rates, and improved overall clinical outcomes.