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Superficial fungal skin infections are common but often misdiagnosed, which may result in inappropriate treatment and the worsening of symptoms. An accurate and timely diagnosis is essential to differentiate these infections from similar conditions such as secondary syphilis, annular psoriasis, and pityriasis rosea. This single-centre prospective cohort study at the National Skin Centre, Singapore, evaluated the diagnostic agreement between direct microscopy and fungal culture. Between August and December 2022, 268 skin scrape samples were collected from 149 patients with suspected fungal infections. Microscopy identified 67 (25.0%) positives, while fungal culture detected 42 (16.7%) positives. Among the 252 samples tested with both methods, 213 (84.5%) showed concordant results (κ = 0.487, p < 0.0001), a finding that indicates moderate agreement. The most commonly cultured organisms were Trichophyton rubrum and T. mentagrophytes. Our findings suggest that both microscopy and fungal culture may be performed to prevent true-positive cases from being missed. However, in cases where cost is a concern, microscopy can be selected as an initial diagnostic tool. Should microscopy be negative in cases with high clinical suspicion for fungal infection or when empirical treatment fails, culture remains a valuable follow-up test. These findings support a stepwise diagnostic approach—using microscopy first, then followed by culture when necessary—to improve diagnostic accuracy while enabling timely treatment.

Microneedles (MNs) is an emerging technology that employs needles ranging from 10 to 1000 μm in height, as a minimally invasive technique for various procedures such as therapeutics, disease monitoring and diagnostics. The commonly used method of fabrication, micromolding, has the advantage of scalability, however, micromolding is unable to achieve rapid customizability in dimensions, geometries and architectures, which are the pivotal factors determining the functionality and efficacy of the MNs. 3D printing offers a promising alternative by enabling MN fabrication with high dimensional accuracy required for precise applications, leading to improved performance. Furthermore, enabled by its customizability and one-step process, there is propitious potential for growth for 3D-printed MNs especially in the field of personalized and on-demand medical devices. This review provides an overview of considerations for the key parameters in designing MNs, an introduction on the various 3D-printing techniques for fabricating this new generation of MNs, as well as highlighting the advancements in biomedical applications facilitated by 3D-printed MNs. Lastly, we offer some insights into the future prospects of 3D-printed MNs, specifically its progress towards translation and entry into market.Microneedles (MNs) is an emerging technology that employs needles ranging from 10 to 1000 μm in height, as a minimally invasive technique for various procedures such as therapeutics, disease monitoring and diagnostics. The commonly used method of fabrication, micromolding, has the advantage of scalability, however, micromolding is unable to achieve rapid customizability in dimensions, geometries and architectures, which are the pivotal factors determining the functionality and efficacy of the MNs. 3D printing offers a promising alternative by enabling MN fabrication with high dimensional accuracy required for precise applications, leading to improved performance. Furthermore, enabled by its customizability and one-step process, there is propitious potential for growth for 3D-printed MNs especially in the field of personalized and on-demand medical devices. This review provides an overview of considerations for the key parameters in designing MNs, an introduction on the various 3D-printing techniques for fabricating this new generation of MNs, as well as highlighting the advancements in biomedical applications facilitated by 3D-printed MNs. Lastly, we offer some insights into the future prospects of 3D-printed MNs, specifically its progress towards translation and entry into market.

Confluent and reticulated papillomatosis (CRP) of Gougerot and Carteaud was first typified in 1927. With the help of electron microscopy, it has been elucidated that CRP arises due to aberrant keratinization. However, till date, there is no clear consensus on the etiologic trigger for CRP. Prevailing postulates include a bacterial trigger by Dietzia papillomatosis (type strain N 1280(T)), an exaggerated cutaneous response to Malassezia furfur, an endocrine basis stemming from insulin resistance, ultraviolet light-induced epidermal change, amyloid deposition, and a loss-of-function mutation in keratin 16. CRP typically presents as asymptomatic hyperpigmented papules and plaques with peripheral reticulation over the nape, axillae, upper chest, and upper back, occasionally with extension superior to the forehead and inferior to the pubic region. Dermoscopy may be used in the evaluation of CRP, but its diagnosis is made on clinical grounds given its nonspecific histopathological findings. Although successful treatment with topical keratolytics, retinoids, or antifungals has been reported, antibiotics, such as minocycline, at anti-inflammatory doses have emerged as a preferred therapeutic option. In this article, we review the diagnostic considerations in CRP and its therapeutic options.

Chronic pruritus is a defining and therapeutically challenging symptom of atopic dermatitis (AD). Recent advances highlight the mast cell–neuron axis as a central neuroimmune interface orchestrating bidirectional crosstalk between the immune and peripheral nervous systems. Skin mast cells located in close proximity to sensory nerve endings release pruritogenic and neuroregulatory mediators, including histamine, tryptase, and nerve growth factor (NGF), and also modulate IL-31 signaling pathways. These mediators act on neuronal receptors such as IL-31RA, protease-activated receptors 1/2 (PAR-1/2), TrkA, and the adenosine triphosphate (ATP)-gated P2X3 receptor, thereby enhancing neuronal excitability and sensitizing transient receptor potential (TRP) channels (TRPV1, TRPA1). Conversely, sensory neurons release neuropeptides, among which substance P (SP) has been clearly demonstrated to activate Mas-related G protein–coupled receptor X2 (MRGPRX2) on mast cells, inducing non-IgE-mediated degranulation, whereas calcitonin gene-related peptide (CGRP) primarily regulates vascular tone and inflammation, with its direct role in MRGPRX2 activation remaining under investigation. This bidirectional interaction drives a feed-forward itch–inflammation loop. This circuit is further amplified by epidermal barrier dysfunction, microbial dysbiosis, type 2 immune polarization, and neurovascular remodeling. Structural adaptations–including intraepidermal nerve fiber branching and synapse-like mast cell–neuron junctions–provide anatomical substrates for chronic peripheral sensitization. While IL-31RA antagonists such as nemolizumab have demonstrated clinical efficacy, emerging targets like MRGPRX2 and TRPV1/TRPA1 channels offer additional therapeutic avenues but face challenges in translation and safety. Moreover, the P2X3 receptor has been proposed as a potential target for neurogenic itch in AD, but current research remains at an early stage and lacks direct clinical validation, highlighting limitations in its therapeutic development. This review provides a comprehensive mechanistic synthesis of the mast cell–neuron axis in AD-associated pruritus, critically evaluates current and investigational therapies, and explores the potential of multi-target interventions, including traditional Chinese medicine (TCM), for axis-level modulation. These efforts support the advancement of precision therapies targeting neuroimmune circuits in chronic inflammatory dermatoses.

Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting approximately 20% of children globally. While studies have been conducted elsewhere, air pollution and weather variability is not well studied in the tropics. This time-series study examines the association between air pollution and meteorological factors with the incidence of outpatient visits for AD obtained from the National Skin Centre (NSC) in Singapore. The total number of 1,440,844 consultation visits from the NSC from 2009 to 2019 was analysed. Using the distributed lag non-linear model and assuming a negative binomial distribution, the short-term temporal association between outpatient visits for AD and air quality and meteorological variability on a weekly time-scale were examined, while adjusting for long-term trends, seasonality and autocorrelation. The analysis was also stratified by gender and age to assess potential effect modification. The risk of AD consultation visits was 14% lower (RR 10th percentile : 0.86, 95% CI 0.78–0.96) at the 10th percentile (11.9 µg/m 3 ) of PM 2.5 and 10% higher (RR 90th percentile : 1.10, 95% CI 1.01–1.19) at the 90th percentile (24.4 µg/m 3 ) compared to the median value (16.1 µg/m 3 ). Similar results were observed for PM 10 with lower risk at the 10th percentile and higher risk at the 90th percentile (RR 10th percentile : 0.86, 95% CI 0.78–0.95, RR 90th percentile : 1.10, 95% CI 1.01–1.19). For rainfall for values above the median, the risk of consultation visits was higher up to 7.4 mm in the PM 2.5 model (RR 74th percentile : 1.07, 95% CI 1.00–1.14) and up to 9 mm in the PM 10 model (RR 80th percentile : 1.12, 95% CI 1.00–1.25). This study found a close association between outpatient visits for AD with ambient particulate matter concentrations and rainfall. Seasonal variations in particulate matter and rainfall may be used to alert healthcare providers on the anticipated rise in AD cases and to time preventive measures to reduce the associated health burden.

Introduction: Herpes zoster is caused by the reactivation of latent varicella infection within the sensory ganglia, caused by the varicella-zoster virus (VZV). The disease is classically characterized by a painful unilateral vesicular eruption. Complications of the disease include herpes zoster ophthalmicus, Ramsay Hunt syndrome, acute retinal necrosis, and post-herpetic neuralgia. In this paper, we discuss the epidemiology, pathogenesis, clinical features, diagnosis, management, and vaccination strategies of herpes zoster and post-herpetic neuralgia. Method: This paper was developed with input from specialists from Singapore’s public sectors—dermatologists, family physicians, and infectious diseases specialists. Results: The diagnosis of herpes zoster is clinical and can be aided with laboratory investigations. Early initiation of antivirals, within 72 h of onset, can reduce the severity and duration of the condition and decrease the intensity of pain. In patients with a high risk of post-herpetic neuralgia, early initiation of anticonvulsants or tricyclic antidepressants can be considered. Herpes zoster is highly preventable, with the advent of the recombinant zoster vaccine (RZV) providing an overall vaccine efficacy of 97.2%. Procedures such as epidural blocks and subcutaneous or intracutaneous injections of local anesthetics and steroids can be considered for patients with a high risk of post-herpetic neuralgia to reduce its incidence. Conclusion: This article serves as a guideline for clinicians in the diagnosis, investigations, management, and prevention of herpes zoster. With the majority of adults in Singapore currently at risk of developing herpes zoster due to varicella immunization being only introduced in 2020, it is important for clinicians to recognize and manage herpes zoster appropriately.

In this quasi-experimental before-and-after study in a methicillin-resistant staphylococcus aureus (MRSA) high-prevalence acute-care dermatology ward from August 2016 to November 2018, patients admitted during intervention period who received additional topical intranasal octenidine were 63% less likely to acquire MRSA than those receiving universal daily octenidine bathing alone during baseline period (aOR, 0.37; 95% CI, 0.14–0.98).

Self-sampling for SARS-CoV-2 would significantly raise testing capacity and reduce healthcare worker (HCW) exposure to infectious droplets personal, and protective equipment (PPE) use. We conducted a diagnostic accuracy study where subjects with a confirmed diagnosis of COVID-19 (n = 401) and healthy volunteers (n = 100) were asked to self-swab from their oropharynx and mid-turbinate (OPMT), and self-collect saliva. The results of these samples were compared to an OPMT performed by a HCW in the same patient at the same session. In subjects confirmed to have COVID-19, the sensitivities of the HCW-swab, self-swab, saliva, and combined self-swab plus saliva samples were 82.8%, 75.1%, 74.3% and 86.5% respectively. All samples obtained from healthy volunteers were tested negative. Compared to HCW-swab, the sensitivities of a self-swab sample and saliva sample were inferior by 8.7% (95%CI: 2.4% to 15.0%, p = 0.006) and 9.5% (95%CI: 3.1% to 15.8%, p = 0.003) respectively. The combined detection rate of self-swab and saliva had a sensitivity of 2.7% (95%CI: -2.6% to 8.0%, p = 0.321). The sensitivity of both the self-collection methods are higher when the Ct value of the HCW swab is less than 30. The specificity of both the self-swab and saliva testing was 100% (95% CI 96.4% to 100%). Our study provides evidence that sensitivities of self-collected OPMT swab and saliva samples were inferior to a HCW swab, but they could still be useful testing tools in the appropriate clinical settings.

To provide a comprehensive narrative synthesis of recent advances in the pharmacological actions and therapeutic potential of natural flavonoids in atopic dermatitis (AD), with emphasis on their multi-target pharmacological effects across core pathological mechanisms. The review also addresses pharmacokinetic limitations, formulation challenges, delivery innovations, safety concerns, and emerging clinical evidence to inform translational research and therapeutic development. This narrative review is based on a targeted literature search of PubMed, Web of Science, ScienceDirect, and SpringerLink, covering English-language, peer-reviewed articles published between 2010 and 2025. Search terms included natural flavonoid metabolites (e.g., quercetin, baicalin, epigallocatechin-3-gallate [EGCG]) combined using Boolean operators (e.g., AND, OR) with keywords related to atopic dermatitis, its underlying mechanisms, and therapeutic interventions. Studies focusing on , , or clinical evaluations of mechanistic pathways, therapeutic potential, or delivery strategies were included, while those addressing synthetic flavonoids, non-AD models, or lacking mechanistic relevance were excluded. This review does not follow a systematic review protocol. Natural flavonoids exert multi-target effects in AD models by restoring skin barrier integrity, modulating immune and chemokine dysregulation, alleviating pruritus, regulating microbial homeostasis and programmed cell death, and attenuating oxidative stress. However, pharmacokinetic and physicochemical limitations such as poor solubility, low bioavailability, metabolic instability, and limited dermal targeting currently constrain clinical application. Potential safety concerns, including hepatotoxicity and endocrine disruption, also warrant careful evaluation. To address these challenges, advanced delivery platforms including microneedles, hydrogels, nanocarriers, microsponges, and liposomes have been explored to improve dermal delivery. Additionally, oral delivery systems developed in other inflammatory and oncological models provide valuable insights for guiding translational strategies in AD. Preliminary clinical evidence suggests potential benefits of flavonoid-based interventions; nevertheless, larger and well-controlled trials are necessary to substantiate their pharmacological effects and evaluate long-term safety. Natural flavonoids exhibit multi-target effects in AD by modulating core pathological processes. Although challenges such as limited bioavailability and safety concerns continue to impede clinical translation, these limitations may be addressed through the optimization of delivery strategies, rigorous pharmacokinetic and toxicological assessments, mechanism-driven , , studies, and well-designed clinical trials.

The fungal scraping and culture can produce false-negative results, and sensitivity decreases after treatment with steroids and antifungal medications.2 Rarely, a punch biopsy is needed to diagnose the infection or evaluate for other possible causes. Summary Table Condition Characteristics Acne rosacea Erythematous papules, pustules, and telangiectasias on the cheeks, forehead, and nose; flushing and redness with consumption of spicy foods or alcohol are common Acute cutaneous lupus erythematosus Erythematous patches or plaques on the malar eminence and nasal bridge in a typical “butterfly” configuration; most common on sun-exposed areas; systemic signs and symptoms of lupus erythematosus may be present Atopic dermatitis Eczematous morphology; most common on the flexor surfaces of the extremities; often associated with a history of other atopic diseases (e.g., asthma, allergic rhinitis) Dermatomyositis Periorbital, symmetrical, violaceous patches (heliotrope rash); proximal muscle weakness Tinea faciei Papulosquamous plaques with an annular, scaly edge Address correspondence to Benson Koon Wee Yeo, MBBS, at yeoben son@gmail.com. Levitt JO, Levitt BH, Akhavan A, Yanofsky H. The sensitivity and specificity of potassium hydroxide smear and fungal culture relative to clinical assessment in the evaluation of tinea pedis: a pooled analysis.