Androgenetic alopecia (AGA) affects about half of men and many women worldwide, yet current treatments often fall short. This review summarizes key pathogenic mechanisms of AGA, centering on three interconnected processes: the dihydrotestosterone–prostaglandin D2 (DHT–PGD2) loop, oxidative stress and inflammation, and lipid metabolism dysregulation. These factors converge to suppress Wnt/β-catenin signaling, the core pathway for hair growth. DHT and PGD2 reinforce each other to drive follicular miniaturization via CXXC5 and GSK-3β activation. Oxidative stress and chronic inflammation—exacerbated by scalp microbiome imbalance, notably excess Cutibacterium acnes and Malassezia—further damage the follicular environment. Suppressed PPARγ signaling disrupts adipocyte-follicle crosstalk, reducing growth factor support. These insights reveal emerging therapeutic targets, including DP2 antagonists, CXXC5/GSK-3β inhibitors, antioxidants, microbiome modulators, and PPARγ agonists. By integrating molecular, microbial, and metabolic perspectives, this review outlines a framework for multitarget strategies to address the limitations of existing AGA treatments.
Background and Purpose: Many people with atopic dermatitis seek treatment with Chinese herbal medicine (CHM). However, the evidence that informed clinical guideline recommendations is outdated. This research updates the evidence on the efficacy and safety of CHM for atopic dermatitis and supports clinical decision-making.
Methods: Randomised controlled trials (RCTs) were identified from the World Health Organization’s International Clinical Trials Registry Platform. RCTs that compared CHM with a placebo, waitlist control or conventional medicine were eligible if they reported patient-reported outcomes, clinician-reported symptoms, long-term control, health-related quality of life or safety. Characteristics and results were extracted, risk of bias assessed and the certainty of evidence determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Meta-analysis was conducted where possible.
Results: Seven RCTs (862 participants) were included. Topical CHM was not statistically different to placebo in reducing visual analogue scale itch score (MD −2.15 [−5.64, 1.34], I2 = 95%; evidence not graded) but was more effective than placebo in reducing Eczema Area and Severity Index scores (MD −2.75 [−4.07, −1.44], I2 = 0%; low certainty evidence). CHM was not statistically different to placebo in improving health-related quality of life (MD −2.20 [−5.27, 0.88], I2 = 0%; moderate certainty evidence). More adverse events were reported in the CHM groups than in the comparator groups.
Conclusion: There is limited evidence to support a change in clinical practice using CHM for atopic dermatitis. Future research should focus on patient-reported symptoms and clinician-reported signs and should carefully assess adverse events.
Background: Prurigo nodularis (PN) is a chronic skin condition characterized by intensely itchy nodules. Accurate identification and treatment of PN-like lesions are crucial due to their association with various dermatoses. Direct immunofluorescence (DIF) assays play a significant role in distinguishing PN from similar conditions.
Methods: We conducted a retrospective analysis on patients referred to a tertiary dermatology hospital between 2017 and 2022. These patients presented with pruritus and PN-like lesions and underwent skin biopsies. PN diagnosis relied on clinical evidence, laboratory results, and histopathology, ruling out other differentials. Collected data included demographics, clinical manifestations, histology, and final diagnoses. Statistical analysis employed SPSS Version 26, using mean, standard deviation, frequency, and percentage. Significance was set at p < 0.05.
Results: Our study included 746 individuals (mean age 45.34 ± 22.05; 423 females and 323 males) with pruritus and PN-like lesions. Clinical evidence and laboratory findings established final diagnoses: PN (51.1%), dermatitis (17.6%), lichen planus (8.4%), perforating disease (7.0%), and bite reaction (3.1%). DIF assays were performed on 177 patients, with 26 (19.2%) yielding positive results. Bullous pemphigoid (50%) and dermatitis herpetiformis (11.5%) were the most common diagnoses.
Conclusion: Our study emphasizes the need for comprehensive diagnostic approaches, including DIF, to accurately diagnose PN-related conditions. The high PN confirmation rate validates initial clinical suspicion and expert judgment. Considering the potential confusion with dermatitis and immunobullous disorders, targeted health policies and resource allocation are essential for improved diagnostic capabilities and treatment outcomes in patients with PN-like lesions.
Background: Melasma is a common hyperpigmentation skin disorder with a high recurrence rate. Mast cell activation plays a role in its pathogenesis, with melanocyte activation via histamine receptor 2 (H2R) considered a potential mechanism. This study aims to evaluate the efficacy of topical famotidine combined with 1927 nm thulium fractional laser in treating melasma and reducing recurrence.
Methods: The study was designed as a split-face, randomized-controlled, single-blind trial. Participants underwent four full-face 1927 nm fractional laser treatments at 4-week intervals and applied 2% famotidine solution on a randomly assigned side and control solution on the opposite side of the face twice daily for 16 weeks. Skin assessments including VISIA imaging, modified melasma area severity index (mMASI) score, and DermaLab skin color detection were conducted by blinded dermatologists at Weeks 0, 4, 8, 12, and 16. Self-assessment scores and the melasma quality of life (MELASQoL) index were collected at baseline and Week 16. Long-term follow-up was performed at Week 64. All side effects were recorded. Statistical analyses included paired t-tests, repeated measures ANOVA, and Wilcoxon and Friedman tests.
Results: A total of 16 patients were enrolled in the study. At Week 16, the famotidine-treated side showed significant reductions in mMASI (p = 0.019, = 0.598) and melanin index (MI) (p = 0.006, = 0.672), with a slight improvement in erythema index (EI). ∆MI was significantly lower on the famotidine-treated side than the control (p = 0.012, Cohen’s d = 0.710). Both MELASQoL scores and patient self-assessments improved, with no obvious adverse effects observed. Long-term evaluation at Week 64 revealed sustained improvement in mMASI on the famotidine-treated side compared to the control side (p = 0.029, Cohen’s d = 0.686).
Conclusions: This study provides clinical evidence supporting H2R blockade as a potential melasma treatment. Famotidine may enhance laser efficacy and modulate histamine-mediated melanogenesis, offering long-term benefits in reducing recurrence.
Trial Registration: ClinicalTrials.gov identifier: NCT06313307
Eyelid edema is a common clinical presentation with multiple etiologies, some of which can pose life-threatening risks to patients. Isolated eyelid edema, without additional significant signs or symptoms, presents a diagnostic challenge. A growing number of drugs are associated with the development of eyelid edema, particularly new-generation small molecules. To identify the most frequently implicated drugs in this clinical scenario, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Forty-three studies met the inclusion criteria, identifying the drug groups most frequently associated with isolated eyelid edema: mammalian target of rapamycin (mTOR) inhibitors (sirolimus and everolimus), atypical antipsychotics (clozapine, risperidone, and olanzapine), fillers (hyaluronic acid and polyalkylimide), and oncologic drugs (imatinib and pemetrexed). The epidemiological characteristics of the patients in each group were highly variable and reflected the use of the aforementioned drugs in heterogeneous populations. The response to eyelid edema treatments also varied significantly. Patients with eyelid edema induced by atypical antipsychotics showed the highest response to conservative therapy, with a 100 percent response following either dose reduction or drug discontinuation. On the other hand, the response to conservative treatments for eyelid edema caused by oncologic drugs was inconsistent, with cases of persistent edema even after drug cessation. In these cases, blepharoplasty proved to be an effective and long-lasting solution. Lastly, in most filler-induced cases, an excellent response was observed following treatment with intralesional hyaluronidase.
Introduction: Alopecia areata (AA) is a chronic, remitting–relapsing dermatological disease that is associated with a substantial psychological impact. Despite the availability of a wide range of therapeutic options, none provides a cure for AA. This study aimed to compare the effectiveness of topical betamethasone as a monotherapy with combinations of topical betamethasone with either topical minoxidil 5% or a herbal preparation of castor and jojoba oils.
Methods: This was a multicenter, cohort study in which patients diagnosed with AA were taking one of three treatment regimens: a reference monotherapy of topical betamethasone 0.064% w/w; combined topical minoxidil and betamethasone 0.064% w/w; or combined topical betamethasone 0.064% w/w and a herbal preparation of castor and jojoba oils. The data were collected at the beginning of the study using a questionnaire. Patients were assessed at three follow-up visits for hair regrowth using trichoscopy as the primary outcome. Patient satisfaction and compliance were assessed using 10-point scales.
Results: The final sample consisted of 278 patients. Combined topical minoxidil–betamethasone therapy was significantly associated with higher rates of hair regrowth (p = 0.006), patient satisfaction (p < 0.001), and shorter median time to first improvement (p < 0.001). Combined minoxidil/betamethasone was more likely to achieve hair regrowth than the other two treatments at the multivariate level (aRR = 2.239, CI = 1.153–4.347). Moreover, hair regrowth was significantly different between the treatment groups after each phase, with hair regrowth at the final phase observed in 83.2% of patients using combined topical minoxidil and betamethasone.
Conclusions: The use of topical minoxidil–betamethasone combination for AA was superior to betamethasone monotherapy or combined with herbal preparations. Randomized clinical trials are needed to strengthen the evidence.
Isotretinoin is a widely prescribed medication for severe acne and other dermatological conditions. While effective in managing acne, some of its systemic effects were widely discussed. However, its impact particularly on thyroid function remains underexplored. This narrative review highlights current evidence on the relationship between isotretinoin use and thyroid dysfunction, evaluating the need for routine thyroid function testing to help clinicians assess the risk of thyroid dysfunction in their patients. We searched PubMed, Scopus, and Google Scholar from inception to February 2025. Interpretation was guided by a systematic approach emphasizing study relevance, methodological quality, and recency. Inclusion criteria focused on peer-reviewed research addressing isotretinoin’s impact on thyroid function. Study designs, sample sizes, and risk of bias were critically assessed to maintain objectivity and reliability in synthesizing current evidence. Studies consistently report alterations in thyroid hormone levels during isotretinoin therapy, including elevated thyroid-stimulating hormone (TSH) and decreased free triiodothyronine (FT3) and free thyroxine (FT4) levels. Studies suggest that these changes may be mediated through mechanisms involving thyroid cell apoptosis, immunomodulatory effects, or central regulatory disruptions. Females and individuals undergoing prolonged isotretinoin therapy appear to be at higher risk. These findings highlight the importance of routine thyroid function monitoring in patients on isotretinoin, particularly those with a predisposition to autoimmune disorders or prolonged treatment courses. Further research with larger sample sizes and rigorous methodologies is needed to comprehend the underlying mechanisms and refine clinical guidelines. This review emphasizes on the need for a multidisciplinary approach involving dermatologists and endocrinologists to ensure optimal patient care and safety.
Background: Current therapies for epidermal growth factor receptor inhibitor (EGFRI)–related paronychia demonstrate effectiveness; however, some patients respond poorly and experience recurrent painful granulation tissue, particularly in weight-bearing areas such as the big toes. Based on promising results from our previous pilot study by Hsu and colleagues, novel kinesiology tape wrapping, which physically shields the inflamed periungual tissue from irritation by the nail plate, has emerged as a potentially effective adjunct therapy.
Objectives: This open-label, randomized-controlled, single-center study was aimed to evaluate the efficacy and safety of kinesiology tape wrapping in cancer patients with EGFRI-related paronychia.
Materials and Methods: Eligible participants were assigned to receive either kinesiology tape wrapping in combination with conventional therapies or conventional therapies alone for 12 weeks. Efficacy outcomes, including the reduction of subjective pain assessed by the numerical rating scale (NRS) and the objective single-digit scoring system for paronychia related to oncologic treatments (single-digit SPOT), as well as adverse events (AEs), were recorded at baseline and at Weeks 1, 2, 4, 8, and 12 postenrollment.
Results: A total of 24 patients were randomized, of which, 22 qualified for analysis. The rate of continuous tape use was 36.3%. At Week 12, pain NRS scores showed no significant differences between groups, while patients treated with continuous or intermittent kinesiology tape wrapping demonstrated notably greater reductions in single-digit SPOT scores compared to those receiving conventional therapy alone (NRS: 3.27 vs. 2.78, p = 0.586; single-digit SPOT: 5.32 vs. 1.52, p = 0.022). No serious AEs were reported.
Conclusion: Kinesiology tape wrapping is an effective and safe adjunct noninvasive therapy that offers additional benefits in managing EGFRI-related paronychia. Further studies with longer follow-ups and improved patient compliance may help fully evaluate its effectiveness in pain reduction.
Trial Registration: ClinicalTrials.gov identifier: NCT06411093
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