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Introduction: Enlarged facial pores are a common cosmetic concern caused by excessive sebum production, visible hair shafts, and a reduction in skin elasticity, leading to a decrease in skin quality and overall appearance. Various treatment modalities have been explored to address this issue. This study focuses on the efficacy and safety of combining Onabotulinumtoxin A (OnaBoNT-A) and hyaluronic acid filler (HA filler) to target enlarged facial pores in Asians. Materials and Methods: This study aimed to compare the efficacy and safety of OnaBoNT-A monotherapy in combination with HA filler for the treatment of enlarged facial pores. This study was a prospective, randomized, single-blinded, split-face, controlled trial that enrolled 32 subjects with visibly enlarged pores on both cheeks. One side of the face received intradermal injections of OnaBoNT-A, while the other side received OnaBoNT-A in combination with intradermal hyaluronic acid filler injection. The outcomes were measured by pore volume, visual assessment, pain score, improvement score, and side effects at various time intervals up to 24 weeks. Results: This study investigated the effects of onaBoNT-A monotherapy or in combination with HA filler on facial pore size and skin roughness. The results showed that both sides exhibited a reduction in pore volume and skin roughness over time, but the side treated with onaBoNT-A monotherapy had a slightly better improvement than the combination side at the 6-month follow-up. Subjects with histories of facial oiliness were more likely to respond to onaBoNT-A monotherapy, while those without histories of facial oiliness were more likely to respond to the side treated with combined treatment. The most common adverse events were erythema, bruising, and edema, which were more frequent on the combination side. Additionally, 18 subjects (56.25%) experienced a palpable lump on the combination side, which resolved in most cases within a few months. Conclusion: BoNT-A and HA dermal filler had a role in reducing pore size. Nonetheless, individuals with enlarged pores who exhibited beneficial effects to botulinum toxin injection typically had a background of facial oiliness. Adverse incidents like dermal edema and palpable nodules were observed, underscoring the significance of meticulous patient selection and accurate injection technique.

Immune-mediated alopecias (IMAs), a group of hair disorders associated with immunological reactions, remain a therapeutic challenge since available treatments are generally unfavorable with potential side effects. Platelet-rich plasma (PRP) has been recently proposed as a treatment option based on several limited-quality studies; however, there is no systematic evaluation of PRP efficacy on IMAs in the literature. To assess PRP's effects in treating IMAs using a systematic review. Electronic searches were conducted using PubMed, Embase, Scopus, and Cochrane Library databases. A search strategy was designed to retrieve all studies exploring PRP in treating IMAs, including alopecia areata (AA) and primary cicatricial alopecias (PCAs). In addition, all randomized and non-randomized studies reporting subjective and/or objective outcomes of alopecia treatment with PRP were included. Thirty-two studies were included, comprising 621 patients with AA and 19 patients with PCAs. PRP had superior efficacy as monotherapy in five studies, comparable to intralesional corticosteroids in six studies in AA treatment. In addition, in the analysis of PCAs, including lymphocytic and neutrophilic subtypes, PRP was efficacious in alleviating disease progression in nine studies. PRP is considered a promising treatment for AA and PCAs in patients who experienced unfavorable outcomes from conventional treatment. However, its clinical application remains to be standardized, and its recommendation as a treatment for IMAs could not be ascertained due to a lack of high-quality evidence. [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=353859], identifier [CRD42022353859].

Papular acantholytic dyskeratosis (PAD) of the vulva is an uncommon benign condition characterized by multiple hyperkeratotic papules in the anogenital region. First described in 1984, PAD belongs to the spectrum of focal acantholytic dyskeratoses and shares histopathological features with Darier disease and Hailey-Hailey disease. Despite its persistence, PAD is benign, requiring only reassurance in many cases. However, various treatment modalities have been reported for symptomatic patients, including topical and systemic therapies, and procedural interventions. We present a case of a 21-year-old Thai woman with asymptomatic perivulvar papules with typical histopathological features of PAD. After conservative management, the patient remained asymptomatic during follow-up. Additionally, we present a review of the current literature on this uncommon entity. This case highlights the importance of clinicopathological correlation in diagnosing PAD and distinguishing it from other clinically similar disorders. We discuss the clinical presentation, histopathological features, differential diagnosis, potential genetic associations, and management options for PAD.

Background Q‐switched (QS) Nd: YAG laser is one of the treatment options for solar lentigines (SLs). However, the incidence of post‐inflammatory hyperpigmentation (PIH) is a common complication, especially in dark‐complexioned skin. Isobutylamido thiazolyl resorcinol (ITR) has been reported as a preventive modality for ultraviolet B (UVB)‐induced hyperpigmentation. Aims This study aims to evaluate the efficacy and safety of ITR for the prevention of laser‐induced PIH. Patients/Methods A randomized, evaluator‐blinded study including 24 subjects with SLs was conducted. Three SLs of each patient were randomized into three groups, which were to apply ITR twice daily, once daily, and no application for 2 weeks. Thereafter, 532‐nm QS Nd: YAG laser was performed. Incidence of laser‐induced PIH, relative melanin index (RMI), mean luminance score (L*), hyperpigmentation score, and adverse events were recorded for 2 months post‐laser. Results The incidence of PIH at the 4th week after laser treatment was significantly lower in the ITR twice‐daily group compared to the no‐application group (20.83% vs. 50%, p = 0.028). There was no statistically significant difference in RMI, mean L*, and hyperpigmentation score between treatments at all visits. No serious adverse events were reported regarding ITR application and laser treatment. Conclusion Two‐week application of ITR prior to QS: Nd YAG laser treatment may potentially reduce the incidence of PIH. A longer duration of application, including after the laser procedure, may be more beneficial for the prevention of laser‐induced PIH.

Background Melasma management remains challenging due to its multifactorial nature pathogenesis and recurrent nature. Previous studies showed positive effects of botulinum toxin A (BoNT‐A) for treating and preventing ultraviolet‐induced hyperpigmentation. Objective To evaluate the effectiveness of adjunctive incoBoNT‐A injection combined with triple combination cream (TCC, 4% hydroquinone, 0.05% tretinoin, and 0.01% fluocinolone acetonide) for treating and preventing melasma recurrence compared to topical therapy alone. Methods A split‐face study was conducted in 30 female patients with melasma. One side of the face was randomly applied TCC to the melasma‐affected areas for 12 weeks (monotherapy), while the contralateral side received TCC and intradermal incoBoNT‐A at baseline and week 12 (combination therapy side). Evaluations were performed at baseline and 2, 4, 8, 12, 16, 20, and 24 weeks. Clinical improvement and melanin index were assessed using the MASI score on the malar area (MASIm), and Colorimeter respectively. Patient satisfaction was also evaluated. Results Twenty‐eight subjects completed the study. The combination therapy side showed significant MASIm decrease at week 2 (p = 0.0032), while the monotherapy side showed no significant change. At 4 weeks, a greater reduction of MASIm was observed in the combination therapy side (MASIm 14.5 and 11.54, 20.41% reduction) when compared to the monotherapy side (MASIm 11.68 and 11.79, 0.93% worsening). At week 12, worsening of melasma was observed on both sides during the summer period. At week 24 (3 months after discontinuing TCC), MASIm was 14.79 on the monotherapy side (worsen 21.03% from baseline) and 9.14 on the combined technique (36.97% improvement, p = 0.0003). Patients' satisfaction was higher for the combination therapy when compared to the monotherapy at the end of the study (8.92 vs. 7.04, p < 0.0001). No serious adverse events occurred. Conclusion Intradermal incoBoNT‐A injection combined with TCC demonstrated superior efficacy in melasma treatment and recurrence prevention compared to TCC monotherapy.

Background Various therapeutic options have been introduced for enlarged facial pores including low cross‐linked hyaluronic acid (HA) fillers. Newer formulations of HA‐based dermal fillers are continuously introduced into the market, but their effectiveness in reducing enlarged facial pores has not yet been determined. Objectives To compare the efficacy of HA‐based dermal fillers (Cohesive Polydensified Matrix HA filler; CPM‐HA20) versus CPM‐HA20 with glycerol (CPM‐HA20G) in terms of minimizing enlarged facial pores and skin quality improvement. Methods Thirty subjects with enlarged facial pores were enrolled in this randomized, double‐blinded, split‐face study. Participants were randomly assigned to be injected with 1 mL of CPM‐HA20 filler on one side of their medial cheek and 1 mL of CPM‐HA20G on the contralateral side for 3 sessions spaced 4 weeks apart. Pore volume was objectively measured by an Antera 3D. Skin biophysical properties were evaluated. Participant satisfaction and adverse events were recorded. Results Twenty‐nine participants completed the study. Both treatment groups showed a reduction in the mean pore volume from the baseline through Week 32. The CPM‐HA20G treated side showed a 24.2% higher reduction in mean pore volume from baseline compared to the CPM‐HA20 treated side (p = 0.038). Both treatment groups showed improvement in skin hydration from baseline to Week 32. There was no significant difference in patient satisfaction between the CPM‐HA20G and CPM‐HA20 treated sides. Only mild adverse events such as pain, edema, and bruising were reported. Conclusion Three‐monthly injections of CPM‐HA20G and CPM‐HA20 were effective in minimizing enlarged face pores and improving skin hydration. CPM‐HA20G demonstrated superior efficacy in terms of pore size reduction. Adverse events were generally mild and tolerable.

Background Top surgery masculinizes the chest appearance for transgender men (TM); however, some individuals may experience hypertrophic scars (HTS) or keloids following the surgery. Objectives This study aimed to evaluate the efficacy of combined 595‐nm pulsed dye laser (PDL) and intralesional triamcinolone acetonide injection (IL TAC) compared to IL TAC monotherapy for treating HTS and keloids. Methods Twenty‐five TM with 35 pairs of bilateral symmetric postmastectomy HTS or keloids were randomly allocated to receive the combined PDL and IL TAC on the scar(s) on one side of the chest and IL TAC monotherapy on the contralateral scar(s) in four monthly treatment sessions. Clinical improvement was evaluated using the Vancouver Scar Scale (VSS). Melanin index, hemoglobin index, and scar roughness were determined before each treatment session and at 1, 3, and 6 months after the last treatment. Participant‐rated satisfaction and adverse events were documented. Results After two treatment sessions, scars treated with combined PDL and IL TAC demonstrated significantly greater improvements in the VSS (p = 0.012) and melanin index (p = 0.004) compared to those treated with IL TAC alone. The superior outcomes of the combined therapy persisted for 3 and 6 months after the end of treatment sessions for the VSS (p = 0.001) and melanin index (p = 0.048), respectively. Participants reported higher satisfaction for combined PDL and IL TAC than IL TAC monotherapy (p = 0.005). No serious or permanent adverse event was reported. Conclusion The addition of 595‐nm PDL to IL TAC may provide more favorable outcomes for treating postmastectomy HTS and keloids among TM.

Pretibial pruritic papular dermatitis (PPPD) is a distinctive skin disorder in response to persistent pretibial manipulation. Clinically, it manifests as multiple discrete, pruritic, flesh-colored-to-erythematous papules and plaques confined to the pretibial area. The histological hallmark of PPPD comprises irregular epidermal psoriasiform hyperplasia with parakeratosis and spongiosis, dermal fibrosis, and lymphohistiocytic infiltration. Due to its rarity and underrecognition, the prevalence and standard treatment of the disease have yet to be well elucidated. Here, we present a case of PPPD in a 60-year-old female presenting with numerous pruritic, erythematous-to-brownish papules and plaques on bilateral pretibial areas for 1.5 years. The lesions were significantly improved after 1 month of additional treatment with oral pentoxifylline. In this report, we aim to raise awareness in recognizing PPPD since it manifests unique clinical, dermoscopic, and histological features, representing pretibial skin's response to chronic rubbing. In addition, we proposed a novel effective therapy for the disease using pentoxifylline.

Syphilitic alopecia (SA) and alopecia areata (AA) are two distinct conditions that frequently present diagnostic difficulties, especially when differentiating between them due to their similar clinical presentations. Trichoscopy may help in differential diagnosis, but a comparison between trichoscopic features of SA and AA is yet to be researched.BackgroundSyphilitic alopecia (SA) and alopecia areata (AA) are two distinct conditions that frequently present diagnostic difficulties, especially when differentiating between them due to their similar clinical presentations. Trichoscopy may help in differential diagnosis, but a comparison between trichoscopic features of SA and AA is yet to be researched.To compare trichoscopic features between SA and AA and determine their discriminative values.ObjectiveTo compare trichoscopic features between SA and AA and determine their discriminative values.Electronic medical records and trichoscopic images of patients diagnosed with SA or AA between January 2000 and February 2022 were retrieved. Trichoscopic features were statistically compared, and their discriminative values were demonstrated as sensitivity, specificity, predictive value, likelihood ratio, and area under the receiver operating characteristic curve (AUC).MethodsElectronic medical records and trichoscopic images of patients diagnosed with SA or AA between January 2000 and February 2022 were retrieved. Trichoscopic features were statistically compared, and their discriminative values were demonstrated as sensitivity, specificity, predictive value, likelihood ratio, and area under the receiver operating characteristic curve (AUC).A total of 69 patients were included: 23 SA and 46 AA cases were matched with a 1:2 ratio. Black dots, broken hairs, pigtail hairs, exclamation mark hairs, tapered hairs, angulated hairs, and non-pigmented regrowing hairs were significantly more prevalent in AA than in SA (all P<0.05), whereas erythematous background was more prevalent in SA than in AA patients (P=0.008). Among the aforementioned trichoscopic features, exclamation mark hairs and non-pigmented regrowing hairs had a high positive likelihood ratio for AA (16.17 and 8.34, respectively); however, only exclamation mark hairs revealed high AUC (AUC=0.816).ResultsA total of 69 patients were included: 23 SA and 46 AA cases were matched with a 1:2 ratio. Black dots, broken hairs, pigtail hairs, exclamation mark hairs, tapered hairs, angulated hairs, and non-pigmented regrowing hairs were significantly more prevalent in AA than in SA (all P<0.05), whereas erythematous background was more prevalent in SA than in AA patients (P=0.008). Among the aforementioned trichoscopic features, exclamation mark hairs and non-pigmented regrowing hairs had a high positive likelihood ratio for AA (16.17 and 8.34, respectively); however, only exclamation mark hairs revealed high AUC (AUC=0.816).Despite the presence of several similar trichoscopic features between SA and AA, trichoscopy can aid in distinguishing between the two diseases. Exclamation mark hairs are the only trichoscopic feature that can be used to differentiate patients with clinically suspicious SA from those with AA.ConclusionDespite the presence of several similar trichoscopic features between SA and AA, trichoscopy can aid in distinguishing between the two diseases. Exclamation mark hairs are the only trichoscopic feature that can be used to differentiate patients with clinically suspicious SA from those with AA.

Female pattern hair loss (FPHL) is the most common hair loss disorder in women that can be classified into three patterns, including Ludwig, Olsen, and Hamilton-Norwood subtypes. Information regarding the comparison of demographics, clinical characteristics, and associated comorbidities among subtypes of FPHL is scarce and contradictory. To evaluate and compare the epidemiology, clinical manifestations, and comorbid conditions of FPHL subtypes and determine their associated factors. This retrospective study included patients who were diagnosed with FPHL between January 2000 and November 2021. Participants were classified into three subtypes, namely Ludwig, Olsen, and Hamilton-Norwood, and were statistically compared. Variables significantly associated with each FPHL subtype were identified using multivariable multinomial logistic regression analysis. Among the 519 patients with FPHL, the Ludwig subtype was the most prevalent (51.1%), followed by the Olsen (32.9%) and Hamilton-Norwood (16%) subtypes. The Hamilton-Norwood subtype revealed significantly higher frequencies of early disease onset (61.4%), menstrual irregularity (22.9%), polycystic ovary syndrome (PCOS, 18.1%), and seborrhea (30.1%) but lower frequencies of overweight (24.1%) and type 2 diabetes mellitus (DM, 2.4%). Multivariable multinomial regression analysis demonstrated that the Hamilton-Norwood subtype was a predictor for early disease onset and PCOS compared to Ludwig (early onset: odds ratio (OR) = 2.14, 95% confidence interval (CI) = 1.39-4.22, P = 0.02; PCOS: OR = 2.02, 95% CI = 1.55-4.84, P = 0.03), and Olsen (early onset: OR = 1.89, 95% CI = 1.03-3.92, P = 0.04; PCOS: OR = 2.24, 95% CI = 1.89-5.31, P = 0.01). In contrast, the Hamilton-Norwood pattern was at decreased risk for type 2 DM compared to Ludwig (OR = 0.51, 95% CI = 0.03-0.82, P = 0.02), and Olsen (OR = 0.68, 95% CI = 0.04-0.79, P = 0.03). The Ludwig pattern was found to be the most prevalent FPHL subtype among Thai patients. Moreover, the Hamilton-Norwood subtype was associated with early disease onset and PCOS, whereas the Ludwig and Olsen subtypes were associated with type 2 DM.