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Background Melioidosis, caused by the gram-negative bacterium Burkholderia pseudomallei , is a heterogeneous disease with diverse clinical manifestations, including cutaneous involvement in 10–20% of cases. Case presentation We report the first documented case of infection-induced panniculitis caused by direct inoculation of B. pseudomallei . A 32-year-old woman from Mukdahan, Thailand, with chronic myeloid leukemia treated with a tyrosine kinase inhibitor, was hospitalized for allogenic stem cell transplantation. Three days before admission, she developed a solitary erythematous papule on her left forearm, which rapidly progressed to a tender subcutaneous nodule following chemotherapy. Her hobby of caring for cacti exposed her to soil and caused repeated cactus pricks on her upper extremities. Incisional biopsy of the lesion revealed mixed lobular and septal neutrophilic panniculitis with ischemic fat necrosis, without evidence of vascular occlusion or vasculitis. B. pseudomallei was isolated from a tissue aerobic culture, while blood cultures were negative. She was diagnosed with cutaneous melioidosis. After intensive treatment, the lesion healed, leaving a hyperpigmented patch and a biopsy scar. Conclusion This case highlights the importance of considering melioidosis in patients presenting with panniculitis, particularly those with immunosuppression, minor trauma, and exposure in endemic regions.

Primary cicatricial alopecia (PCA) is known to be associated with various comorbidities; however, findings regarding the likelihood of specific comorbidities in PCA patients have been inconsistent. This study aimed to assess the prevalence and odds of specific comorbidities in patients with PCA compared to controls, and to explore the distribution of comorbidities across various types of PCA. Electronic searches were conducted using PubMed, Embase, and Scopus from the dates of their inception until July 2024. A total of 116 studies with 33,494 PCA patients that reported data allowing for the calculation of odds ratios (OR) or prevalences of certain comorbidities in PCA patients were included. Systemic lupus erythematosus is more prevalent among patients with lichen planopilaris (LPP) [OR 3.10 (95% confidence interval: 2.24-4.29), prevalence 2%], frontal fibrosing alopecia (FFA) [OR 6.92 (2.73-17.56), prevalence 5%], and central centrifugal cicatricial alopecia (CCCA) [OR 3.13 (1.03-9.49), prevalence 5%]. Hypothyroidism is more prevalent among patients with LPP [OR of 1.73 (1.24-2.42), prevalence 17%] and FFA [OR 1.86 (1.36-2.55), prevalence 19%]. LPP patients are prone to having dermatological diseases such as atopic dermatitis [OR 3.96 (1.14-13.81), prevalence 9%], lichen planus [OR 19.21 (1.47-251.02), prevalence 8%], psoriasis [OR 4.75 (2.04-11.06), prevalence 3%], and rosacea [OR 4.62 (2.96-7.19), prevalence 5%], while FFA patients are prone to having allergic contact dermatitis [OR 3.19 (1.44-7.08), prevalence 41%] and rosacea [OR 2.37 (1.72-3.29), prevalence 16%]. Coronary artery disease is found to be more common in LPP than controls [OR 1.63 (1.43-1.86), prevalence 8%], while dyslipidemia is more common among FFA [OR 1.41 (1.06-1.88), prevalence 20%] and CCCA [OR 4.46 (1.01-19.75), prevalence 54%] than controls, and diabetes mellitus is more prevalent among CCCA than controls [OR 1.67 (1.03-2.69), prevalence 26%]. While skin cancer [OR 2.22 (1.33-3.70), prevalence 2%] and melanoma [OR 4.46 (1.70-11.76), prevalence 1%] were found to be more common in LPP than controls, rheumatoid arthritis [OR 1.65 (1.09-2.51), prevalence 4%] was found to be more common in FFA than controls, and allergic rhinitis [OR 11.77 (1.55-89.24), prevalence 24%] and anxiety [OR 4.69 (1.29-16.98), prevalence 17%] were found to be more common in CCCA than controls. Patients with PCA are at higher risk of developing a wide range of comorbidities. Physicians should remain vigilant and conduct thorough investigations when clinical clues are present. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=564852, identifier CRD42024564852.

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].

Patients with psoriasis are more likely than matched controls in the general population to have advanced liver fibrosis; however, our understanding of these patients is limited. There is currently no systematic evaluation of the prevalence and risk factors of liver fibrosis in psoriasis patients. To evaluate the prevalence of psoriasis patients who are at high or low risk for advanced liver fibrosis and determine the risk factors for developing liver fibrosis. Electronic searches were conducted using the PubMed, Embase, Scopus, and Cochrane Library databases from the dates of their inception till May 2022, using the PubMed, Embase, Scopus, and Cochrane Library databases. Any observational study describing the prevalence and/or risk factors for liver fibrosis in patients with psoriasis was included. Patients with psoriasis at high risk for advanced liver fibrosis had a pooled prevalence of 9.66% [95% confidence interval (CI): 6.92-12.75%, = 76.34%], whereas patients at low risk for advanced liver fibrosis had a pooled prevalence of 77.79% (95% CI: 73.23-82.05%, = 85.72%). Studies that recruited methotrexate (MTX)-naïve patients found a lower prevalence of advanced liver fibrosis (4.44, 95% CI: 1.17-9.22%, = 59.34%) than those that recruited MTX-user cohorts (12.25, 95% CI: 6.02-20.08%, = 82.34%). Age, sex, BMI, PASI score, psoriasis duration, MTX cumulative dose, and the prevalence of obesity, MTX users, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were not identified as sources of heterogeneity by meta-regression analysis. The pooled odds ratios for age >50 years, BMI > 30, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were 2.20 (95% CI: 1.42-3.40, = 0%), 3.67 (95% CI: 2.37-5.68, = 48.8%), 6.23 (95% CI: 4.39-8.84, = 42.4%), 2.82 (95% CI: 1.68-4.74, = 0%), 3.08 (95% CI: 1.90-4.98, = 0%), and 5.98 (95% CI: 3.63-9.83, = 17%), respectively. Approximately 10% of the population with psoriasis is at high risk for advanced liver fibrosis, while 78% are at low risk. Patients over the age of 50 with obesity, diabetes, hypertension, dyslipidemia, and/or metabolic syndrome have an increased risk of developing liver fibrosis, necessitating monitoring. [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022303886], identifier [CRD42022303886].

The intradermal route has emerged as a dose-sparing alternative during the coronavirus disease 2019 (COVID-19) pandemic. Despite its efficacy in healthy populations, its immunogenicity has not been tested in immune-mediated dermatologic disease (IMDD) patients. This assessor-blinded, randomized-controlled, non-inferiority trial recruited patients with two representative IMDDs (i.e., psoriasis and autoimmune bullous diseases) to vaccinate with fractionated-dose intradermal (fID) or standard intramuscular (sIM) BNT162b2 vaccines as a fourth booster dose under block randomization stratified by age, sex, and their skin diseases. Post-vaccination SARS-CoV-2-specific IgG and interferon-γ responses measured 4 and 12 weeks post-intervention were serological surrogates used for demonstrating treatment effects. Mean differences in log-normalized outcome estimates were calculated with multivariable linear regression adjusting for their baseline values, systemic immunosuppressants used, and prior COVID-19 vaccination history. The non-inferiority margin was set for fID to retain >80% immunogenicity of sIM. With 109 participants included, 53 received fID (all entered an intention-to-treat analysis). The fID demonstrated non-inferiority to sIM in humoral (mean outcome estimates of sIM: 3.3, ΔfID-sIM [mean, 95%CI]: −0.1, −0.3 to 0.0) and cellular (mean outcome estimates of sIM: 3.2, ΔfID-sIM [mean, 95%CI]: 0.1, −0.2 to 0.3) immunogenicity outcomes. Two psoriasis patients from the fID arm (3.8%) developed injection-site Koebner’s phenomenon. Fewer fID recipients experienced post-vaccination fever (fID vs. sIM: 1.9% vs. 12.5%, p = 0.027). The overall incidence of disease flare-ups was low without a statistically significant difference between groups. The intradermal BNT162b2 vaccine is a viable booster option for IMDD patients troubled by post-vaccination fever; its role in mitigating the risk of flare-ups remains unclear.

Patients with psoriasis, particularly those receiving systemic therapies such as methotrexate (MTX), are at increased risk of developing significant liver fibrosis. Although MTX remains widely used, its hepatotoxic potential remains controversial. Transient elastography (TE) allows non-invasive monitoring of liver fibrosis; however, data on fibrosis regression after MTX discontinuation are limited. To assess the incidence of liver fibrosis regression in psoriasis patients following MTX withdrawal and to identify clinical and laboratory factors associated with this outcome. We conducted a pilot cross-sectional study involving 15 prospectively recruited psoriasis patients with significant liver fibrosis (liver stiffness measurement [LSM] ≥7.1 kPa) who had discontinued MTX for at least 6 months. Fibrosis regression was defined as a >30% reduction in LSM from baseline. Univariate logistic regression was used to evaluate associations between clinical variables and fibrosis regression. Fibrosis regression was observed in 5 patients (33.3%) who had remained MTX-free for a mean duration of 3.6 ± 3.1 years. MTX treatment duration >4 years was significantly associated with fibrosis regression (OR = 16.00, 95% CI: 1.09-234.25; p = 0.043). A cumulative MTX dose >2 grams showed a non-significant trend toward increased odds of fibrosis regression (OR = 6.00, 95% CI: 0.56-63.98; p = 0.138). Male gender (OR = 0.17, 95% CI: 0.02-1.78; p = 0.138) showed a non-significant trend toward reduced odds of fibrosis regression. One-third of psoriasis patients with significant liver fibrosis showed regression after a mean MTX-free duration of 3.6 years, with MTX use duration of more than 4 years significantly associated with this outcome. Given the small sample size, these results should be interpreted with caution. Nonetheless, these findings suggest a potential benefit of MTX withdrawal in selected patients and warrant confirmation in larger, prospective studies.

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.