搜索结果：Dermatology practical & conceptual

Dermatological delusional disorders, such as delusional infestation (DI), are a unique type of psychosis in which the patient experiences specific delusions, such as parasites or inorganic materials that come out of their skin. Originally, this type of "encapsulated psychosis" was thought to be unresponsive to antipsychotic agents. However, over the past half a century, several medications with antipsychotic properties have been found to be effective in the treatment of these conditions in the USA, especially pimozide and risperidone. Despite effective treatments, several challenges may arise for clinicians in successfully treating patients with these conditions. These challenges include selecting an efficacious medication and skillfully practicing diplomacy and empathy while guiding patients toward effective management. Navigating interactions with patients with DI and their frequent denial of a psychiatric component to their condition often poses additional challenges to patient-provider rapport and proper and timely management. In the USA, many patients with DI are opposed to trying the conventional approach of psychiatric care and immediate trial of antipsychotic medications. This manuscript represents a single-center psychodermatology perspective on managing dermatologic delusional disorders. This article synthesizes clinical experience from a US clinic and situates that experience within the available evidence. High-quality comparative data are limited. Therefore, this paper highlights pragmatic engagement strategies, pharmacotherapy principles, essential safety monitoring, and research priorities. Experience-based recommendations are clearly labeled as such.

For over a century, dilute sodium hypochlorite (NaOCl), historically recognized as the antiseptic component of bleach, has been well established in wound care, primarily owing to its broad antimicrobial activity and ability to penetrate soft tissue and necrotic debris. NaOCl has been increasingly utilized and studied in clinical dermatology owing to its broad ranging antimicrobial, skin healing, and more recently described anti-inflammatory properties. This scoping review (Open Science Network; osf.io/6hyru) synthesizes current evidence of NaOCl's applications in skin care, highlighting mechanistic insights, clinical trends, and knowledge gaps. A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov was conducted from inception through November 2024. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 6959 deduplicated records, 222 studies published between 1915 and 2024 were identified for final inclusion. Four key clinical themes for NaOCl use emerged upon analysis of these publications: antimicrobial properties (n = 57), wound care (n = 64), eczematous skin disease (n = 78), and noneczematous inflammatory skin conditions (n = 23). NaOCl exhibits broad-spectrum activity against various organisms, notably Staphylococcus aureus and Pseudomonas aeruginosa, contributing to its effectiveness in treating chronically infected burns, ulcers, and other wounds. Limited studies also suggest NaOCl's potential role in modulating critical processes that support wound repair. In addition, the anti-inflammatory effects of NaOCl have supported its utility in treating eczematous and noneczematous skin disorders. Current literature provides broad and extensive evidence supporting NaOCl's role in wound-healing, antimicrobial, and anti-inflammatory activity. However, considerable heterogeneity exists in recommended concentrations, preparation methods, and usage instructions across studies. There is a need for more randomized controlled trials and standardized protocols to better define the efficacy, safety, and optimal use of NaOCl in dermatologic practice.

Skin cancers are some of the most common types of cancer. Dermatology services receive about 1.2 million referrals a year, but only a small minority are confirmed skin cancer. Artificial intelligence may be helpful in the diagnosis of skin cancer by identifying lesions that are or are not cancerous. To investigate the clinical and cost-effectiveness of two artificial intelligence technologies: DERM (Deep Ensemble for Recognition of Malignancy, Skin Analytics) and Moleanalyzer Pro (FotoFinder), as decision aids following a primary care referral. A rapid systematic review of evidence on the two technologies was conducted. A narrative synthesis was performed, with a meta-analysis of diagnostic accuracy data. Published and unpublished cost-effectiveness evidence on the named technologies, as well as other diagnostic technologies were reviewed. A conceptual model was developed that could form the basis of a full economic evaluation. Four studies of DERM and two of Moleanalyzer Pro were subject to full synthesis. DERM had a sensitivity of 96.1% to detect any malignant lesion (95% confidence interval 95.4 to 96.8); at a specificity of 65.4% (95% confidence interval 64.7 to 66.1). For detecting benign lesions, the sensitivity was 71.5% (95% confidence interval 70.7 to 72.3) for a specificity of 86.2% (95% confidence interval 85.4 to 87.0). Moleanalyzer Pro had lower sensitivity, but higher specificity for detecting melanoma than face-to-face dermatologists. DERM might lead to around half of all patients being discharged without assessment by a dermatologist, but a small number of malignant lesions would be missed. Patient and clinical opinions showed substantial resistance to using artificial intelligence without any assessment of lesions by a dermatologist. No published assessments of the cost-effectiveness of the technologies were identified; three assessments related to skin cancer more broadly in a National Health Service setting were identified. These studies employed similar model structures, but the mechanism by which diagnostic accuracy influenced costs and health outcomes differed. An unpublished cost-utility model was provided by Skin Analytics. Several issues with the modelling approach were identified, particularly the mechanisms by which value is driven and how diagnostic accuracy evidence was used. The conceptual model presents an alternative approach, which aligns more closely with the National Institute for Health and Care Excellence reference case and which more appropriately characterises the long-term consequences of basal cell carcinoma. The rapid review approach meant that some relevant material may have been missed, and capacity for synthesis was limited. The proposed conceptual model does not capture non-cash benefits associated with demand on dermatologist time. An assessment of the likely budget impact and resource use could not be provided. DERM shows promising diagnostic accuracy for triage and diagnosis of suspicious cancer lesions in selected patients referred from primary care. Its impact on the diagnostic pathway and patient care is, however, uncertain. Moleanalyzer Pro shows promising accuracy for diagnosing melanoma, but its evidence base is limited. While artificial intelligence has the potential to be cost-effective for the identification of benign lesions, further research addressing the limitations in the diagnostic accuracy evidence is necessary. Without comparative evidence on the diagnostic accuracy of artificial intelligence technologies, their value will remain uncertain. This study is registered as PROSPERO CRD42023475705. This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR136014) and is published in full in Health Technology Assessment; Vol. 30, No. 10. See the NIHR Funding and Awards website for further award information. Skin cancers and suspicious skin lesions are very common. People with moles or lesions that might be cancerous are referred to a skin cancer specialist (a dermatologist) to make a diagnosis. This places a very high burden on dermatology clinics and, as a result, there can be delays in seeing a dermatologist and getting a diagnosis. Artificial intelligence systems could potentially use a high-quality photograph to identify which lesions do not need to be seen by a specialist. This could be done by the artificial intelligence system alone, or in combination with remote review by a dermatologist. This project investigated whether two artificial intelligence technologies: DERM (Skin Analytics) and Moleanalyzer Pro (FotoFinder) could be useful in reducing the burden on dermatology services while helping to identify skin cancer. The evidence was reviewed to investigate whether the technologies can accurately identify skin cancer cases, and whether their use might improve the diagnosis process for patients. We also designed a theoretical model in which the economic value of artificial intelligence technologies for the diagnosis of skin cancer could be assessed. As part of this process, we sought to outline what further evidence would be needed to implement a full assessment. The evidence we reviewed suggests DERM could potentially reduce by half the number of patients that would be referred to specialist dermatologists, while still identifying 95% of all skin cancers. Moleanalyzer Pro could identify about 85% of malignant melanomas. This appears to be a similar accuracy to that achieved by using a remote view of the lesions by dermatologists alone. How DERM or Moleanalyzer Pro use would impact diagnosis and treatment for patients in practice, and the burden on clinicians, is currently unclear. Because of limitations in the evidence on the diagnostic accuracy of artificial intelligence technologies, a full assessment of their economic value is not possible at this time. Further research should focus on better establishing the diagnostic accuracy of both artificial intelligence technologies and current service provision.

Immune-mediated inflammatory diseases (IMID) are a group of chronic, systemic inflammatory diseases caused by immune dysregulation. IMID often involve multiple organs or systems, are characterized by complex clinical manifestations and significant overlap across different diseases, and may coexist as multiple comorbidities, significantly increasing the disease burden and complicating diagnosis and management. To promote the standardized management of IMID in China, Specialty Committee on Prevention of Rheumatologic and Immunologic Diseases, Chinese Preventive Medicine Association, Chinese Society of Dermatology, Chinese Medical Association and Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association organized experts in rheumatology, dermatology, gastroenterology, and pharmacy. Based on domestic and international research advances from the past decade and integrated with clinical practice experience, they developed this consensus document. This consensus systematically summarizes the conceptual origin, disease burden, pathogenesis, diagnostic and treatment models, and therapeutic agents for IMID. It establishes a multi-disciplinary team (MDT) diagnosis and treatment system for IMID and provides systematic management recommendations and medication selection strategies for common IMID and their related comorbidities in the fields of rheumatology, dermatology, and gastroenterology. The purpose of this consensus is to provide a comprehensive, standardized, and operable diagnosis and treatment framework for IMID patients in China, aiming to optimize clinical practice and improve long-term outcomes. 免疫介导炎症性疾病（IMID）是一类由免疫失衡引起的慢性炎症性、系统性疾病。IMID常累及多个器官或系统，具有临床表现复杂、疾病间共性明显的特点，并可伴随多病种共存，显著增加了疾病负担和诊治难度。为推动我国IMID的规范化管理，中华预防医学会风湿免疫病预防专委会、中华医学会皮肤性病学分会、中华医学会消化病学分会炎症性肠病学组组织风湿免疫、皮肤、消化及药学等领域专家，基于国内外近十年研究进展，结合临床实践经验，制订本共识。共识系统总结了IMID的概念来源、疾病负担、发病机制、诊疗模式、治疗药物等，制定IMID多学科团队（MDT）诊疗体系，并针对风湿免疫科、皮肤科、消化科常见IMID及其相关合并症提出系统化管理建议和药物选择方案。共识旨在为IMID患者提供全程、规范、可操作的诊疗框架，促进临床实践优化并改善长期结局。.

Pathological scars manifest as firm, elevated, erythematous plaques, or nodules after skin injury. As challenging wound-healing complications, hypertrophic scars and keloids significantly compromise aesthetics while causing functional impairment and psychosocial distress. Consequently, their management remains a central focus in dermatology. The skin punch has undergone substantial technical advancements, emerging as a promising therapeutic modality. To evaluate the efficacy of punch-based techniques in managing pathological scars, we conducted a comprehensive literature search using Boolean logic across electronic databases, with the core search strategy built upon the following terms: ("skin punch" OR "punch excision" OR "punch volume reduction") AND ("pathological scar" OR "hypertrophic scar" OR "keloid"). Additional relevant studies were identified through citation tracking of the retrieved articles. This review systematically examines recent advancements in punch-assisted scar management, with particular focus on the mechanistic basis, diverse therapeutic modalities, clinical efficacy, and associated complications. This systematic appraisal of punch volume reduction for pathological scars affirms its robust efficacy in restoring aesthetic contour and functional integrity, while concurrently revealing substantial interpatient heterogeneity in therapeutic response and protracted convalescence intervals. Although the technique's clinical value is well-established, a critical deficit persists in stratified evidence across scar phenotypic spectra and temporal disease dynamics, with no codified protocols to direct therapeutic application. Confronted by the profound quality-of-life impairment attributable to pathological scars and accelerating clinical necessities, forthcoming research mandates large-scale prospective cohorts with prolonged surveillance, emphasizing technical innovation, preemptive complication management, and individualized treatment algorithms. The consolidated insights presented herein deliver both actionable guidance for contemporary evidence-based practice and a foundational conceptual architecture for future technological evolution in scar therapeutics.

Patients with immune-mediated inflammatory diseases are routinely transitioned from originator biologics to biosimilars to reduce healthcare costs. While barriers related to patient and practitioner beliefs and knowledge are well-documented, less focus has been placed on system-level factors that may hinder biosimilar uptake. This review aims to identify system-level factors that impact biosimilar brand transitions for treatment of immune-mediated inflammatory diseases, as reported by key stakeholders involved in real-world brand changes. A scoping review was conducted following the Arksey and O'Malley framework and was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews (PRISMA-ScR). A comprehensive search was performed in APA PsycInfo, Embase, PubMed, Scopus, and Web of Science, and databases for major conferences in rheumatology, dermatology, and gastroenterology. Data from relevant studies were extracted and summarized onto a structured coding sheet before being synthesized. Of 2301 articles screened, 47 journal articles and five conference abstracts were included. Most studies were conducted in the United States and focused primarily on rheumatology. Barriers and facilitators were organized into four overarching themes. These were regulatory and approval processes (e.g., tendering practices, interchangeability policies, prescriber guidelines), healthcare system policies and incentives (including quotas, insurance coverage, reimbursement mechanisms, and rebates), infrastructure and logistics (such as supply chain considerations and storage requirements), and communication and education (including media and expert influence and the involvement of patient organizations). Multiple components of the healthcare system play a role in successful biosimilar transitions. Leveraging regulations, policies, infrastructure, and communication before, during, and after transition offers a practical blueprint for managing brand changes across health systems and therapies.

This is the official English summary of the Japanese 2025 guide. The first edition of the guide for the diagnosis and management of connective tissue disease (CTD) associated with interstitial lung disease (ILD) was published in 2020 as a joint initiative by the Japanese Respiratory Society and the Japanese College of Rheumatology. This updated edition reflects major advances over the past five years, incorporating the latest international guidelines, consensus statements, and considerations unique to the Japanese healthcare reimbursement system. The guide is structured to facilitate timely clinical decision-making by highlighting key diagnostic and therapeutic milestones. The newly added content includes a conceptual framework for understanding ILD in CTD, practical clinical flowcharts, screening strategies, and risk factors, an overview of acute exacerbations, and a comprehensive approach to rehabilitation. Notably, treatment algorithms for ILD associated with polymyositis/dermatomyositis and systemic sclerosis have been revised to align with the most recent evidence and disease-specific recommendations, thereby enhancing their relevance to real-world practice. In addition, a provisional algorithm was proposed for the management of rheumatoid arthritis-associated ILD. The updated guide aims to standardize the multidisciplinary management of CTD-associated ILD and offers future perspectives to guide research and improve patient outcomes.

BACKGROUND: Beyond the physical symptoms of leprosy, persons affected by leprosy (PAL) continue to face stigma and discrimination, also in the low-endemic setting of Pakistan. Leprosy-related stigma and misinformation impacts treatment adherence and health-seeking behavior of PAL, ultimately increasing risks of disability and increased disease transmission. Healthcare workers (HCW) play a pivotal role in detecting, diagnosing, counseling and supporting PAL. Their insights are essential in developing effective interventions to combat the stigma and improve the overall well-being and confidence in healthcare of those affected. METHODS: Twenty-one in-depth individual interviews were conducted with dermatologists, dermatology residents, general physicians, leprosy technicians and nurses. A combined inductive-deductive thematic analysis approach was applied based on a “conceptual framework of the dimensions of stigma, its manifestations and impact on health outcomes” developed by Mukerji and Turan. RESULTS: The study revealed that stigma and misinformation were shaped by contextual factors, including the absence of a national leprosy program, limited public awareness, patriarchal gender norms and socio-economic disadvantages. HCW reported frequent delays in diagnosis, psychological distress, limited awareness and socio-economic burden due to leprosy and its stigma among PAL. Although HCW demonstrated strong medical knowledge, low levels of leprosy exposure outside specialized centers reduced diagnostic confidence of non-dermatologists. Trust-building, psychosocial counseling and sensitive handling of disclosure proved essential for treatment adherence. Gender dynamics also affected care: women were more likely to hide symptoms due to the anticipated stigma, whereas men were more likely to comprise treatment adherence due to economic responsibilities. CONCLUSIONS: In low-endemic settings like Pakistan, stigma, misinformation, and structural barriers intersect to drive diagnostic delay and limited access to care. Strengthening leprosy care requires (1) Increasing public awareness and reaching broader audiences through social media and digital health tools (2) collaboration with local and alternative medicine providers to reduce misdiagnosis (3) targeted training for HCW on psychosocial counselling and gender responsive care; and (4) evaluating and improving care interventions through close collaboration with PAL and community leaders. Further, integrating leprosy control into national programs and mental health services would improve comprehensive care and support stigma reduction. CLINICAL TRIAL NUMBER: Not applicable.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent nodules, abscesses, and sinus tracts that lead to significant morbidity and impaired quality of life. Although both biologic therapies and surgical interventions are effective when used independently, their combined use has gained increasing attention. This systematic review aimed to evaluate the efficacy and safety of combining immunomodulatory therapy with surgical procedures in HS. A conceptual framework was applied that distinguished three modalities of combined treatment according to the temporal relationship between biologic therapy and surgery: pre-biologic surgery, post-induction surgery, and concomitant approaches. A comprehensive search identified eight eligible studies, including 508 patients. Most studies were retrospective and of low methodological quality. Across studies, combination therapy (particularly with adalimumab, secukinumab, or bimekizumab) was generally associated with improved clinical outcomes compared to biologic monotherapy, including higher response rates (Hidradenitis Suppurativa Clinical Response [HiSCR]; 55% reduction in the International Hidradenitis Suppurativa 4 [IHS4-55]), greater reductions in pain, disease flares, and Dermatology Life Quality Index scores. Safety profiles were comparable between groups, with no consistent increase in postoperative complications or serious adverse events. However, key outcomes such as wound healing time were poorly reported. Substantial heterogeneity in study design, treatment protocols, and timing of interventions limited comparability and precluded meta-analysis. Overall, the available evidence preliminarily supports combined medical and surgical treatment as a potentially beneficial and well-tolerated strategy for moderate-to-severe HS, in line with current expert practice. However, given the low quality and substantial heterogeneity of the included studies, these findings should be considered exploratory and require confirmation in higher-quality prospective studies that adopt standardized definitions of combination therapy and report wound healing as a core outcome.

Regenerative medicine is a rapidly evolving field focused on restoring tissue form and function by harnessing the body's intrinsic reparative mechanisms. In dermatology, regenerative strategies include both cellular therapies (e.g., stem cells) and acellular products (e.g., biostimulatory polymers and exosomes), emphasizing the need for responsible translation from conceptual innovation to clinical application. The 21st Century Cures Act has accelerated the development of regenerative therapies through the Regenerative Medicine Advanced Therapy (RMAT) designation, which supports products that address serious diseases or unmet medical needs. Guided by the "from the patient to the patient" paradigm, this article reviews the regenerative medicine lexicon, evolving biotechnologies, and strategies for patient management. As many current therapies enhance healing rather than achieve full tissue regeneration, careful distinction and evidence-based evaluation are critical. Regenerative biotherapeutics hold promise to transform dermatologic care by targeting root causes of disease and advancing skin health.

Cervical aging is a multifactorial process affecting skin quality, fat distribution, and platysmal activity, yet existing assessment tools typically address these elements in isolation. A need remains for a comprehensive, intuitive, and clinically applicable classification model to guide diagnosis and treatment planning. To propose a unified anatomical-functional classification system for cervical aging that integrates three independent axes-Skin (S), Fat (F), and Muscle (M)-into a visual mandala model, allowing for personalized treatment strategies. A structured literature review was performed to evaluate existing cervical classification scales and their anatomical foundations. Based on the synthesis of validated criteria, the S-F-M Score was developed, with each axis graded from 0 (normal) to 3 (severe alteration). These scores are combined into a cervical phenotype (e.g., S2-F1-M3) and plotted on a radial diagram to visually guide diagnosis and therapeutic focus. The S-F-M Score enables a modular and reproducible assessment of cervical aging. The visual mandala representation enhances communication and decision-making by highlighting the dominant aging vector. Practical examples demonstrate its application in selecting tailored treatments, such as biostimulators for skin laxity, lipolytic approaches for submental fat, and botulinum toxin for platysmal hypertonia. The S-F-M classification and mandala model offer an integrative and scalable tool for cervical aesthetic evaluation. By aligning clinical diagnosis with anatomical targets, this system supports individualized, layer-specific treatment planning and provides a foundation for standardization in both clinical practice and future research. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Psoriasis vulgaris is a chronic immune-mediated inflammatory disease with substantial clinical, psychosocial, and public health impact. Despite advances in therapeutic options, disease management continues to rely predominantly on clinical assessment, which remains limited in its ability to detect early disease, quantify subclinical inflammation, monitor disease progression, and anticipate long-term outcomes. These limitations are further compounded by marked interindividual heterogeneity in disease course, systemic inflammatory burden, comorbidity risk, and treatment response. Although a growing body of research has identified numerous candidate biomarkers related to genetic susceptibility, epidermal pathology, immune activation, and systemic inflammation, their clinical relevance and integration into routine practice remain unclear. A comprehensive synthesis that bridges molecular biomarkers with clinically meaningful applications is therefore needed. This review critically examines the current landscape of biomarkers in psoriasis vulgaris and explores their potential roles in diagnosis, assessment of disease progression, and prediction of therapeutic response. This review discusses genetic biomarkers associated with disease susceptibility and immune pathway regulation, tissue- associated biomarkers reflecting epidermal dysfunction and local inflammatory activity, and soluble biomarkers indicative of systemic inflammation and metabolic dysregulation. By organizing existing evidence across these biomarker domains, this review seeks to highlight conceptual frameworks, unresolved challenges, and future directions for biomarker-informed psoriasis management.

Atopic dermatitis is a chronic immune-inflammatory skin disease that significantly impairs quality of life, with itch representing a key, but not exclusive, contributor to this burden. We aimed to evaluate itch relief and quality-of-life improvements with abrocitinib or dupilumab for 16 weeks alongside topical therapy in patients with moderate-to-severe atopic dermatitis. This post hoc analysis included pooled data from patients who received abrocitinib (200 mg/day) or dupilumab (300 mg/every 2 weeks) in phase III JADE COMPARE and JADE DARE. Assessments included proportions of patients achieving a ≥ 4-point improvement from baseline in Peak Pruritus Numerical Rating Scale (PP-NRS4), itch-free state (PP-NRS 0/1) by baseline itch severity, and proportions of patients with residual itch achieving Dermatology Life Quality Index score of 0/1 (DLQI 0/1), total Patient-Oriented Eczema Measure (POEM) score ≤ 2, SCORing Atopic Dermatitis (SCORAD) sleep loss visual analog scale score of 0/1 (SCORAD sleep loss visual analog scale 0/1), and POEM sleep item score of 0 (POEM sleep 0). Among 1196 patients (abrocitinib, n = 588; dupilumab, n = 608), those with greater baseline itch severity experienced greater atopic dermatitis severity and worse quality of life than patients with less severe itch. At week 16, numerically more patients achieved PP-NRS4 (67% vs 63%) and PP-NRS 0/1 (36% vs 27%) with abrocitinib versus dupilumab, respectively, regardless of baseline itch severity, although 95% confidence intervals overlapped for both measures. Median time to achieve PP-NRS4 (11 vs 29 days) and PP-NRS 0/1 (57 vs 139 days) was shorter with abrocitinib versus dupilumab, respectively. Numerically greater proportions of patients achieving PP-NRS 0/1 also achieved DLQI 0/1, POEM ≤ 2, SCORAD sleep loss visual analog scale 0/1, or POEM sleep 0 than patients with residual itch (PP-NRS ≥ 2). In this post hoc pooled analysis of the JADE COMPARE and JADE DARE trials, the proportion of patients with moderate-to-severe atopic dermatitis achieving clinically meaningful itch responses, including an itch-free state, was generally higher with abrocitinib compared with dupilumab. Median time to achievement of both PP-NRS4 and an itch-free state was shorter with abrocitinib than with dupilumab. Patients who achieved an itch-free state experienced greater improvements in quality of life and sleep compared with patients with residual itch. JADE COMPARE (NCT03720470; registration date: 2018/10/24); JADE DARE (NCT04345367; registration date: 2020/04/10).

Acquired progressive kinking of the hair (APKH) is an underrecognized hair disorder characterized by a gradual change in hair texture, often manifesting as increased curliness, frizziness, and darkening of the shafts. While various systemic triggers and congenital conditions can induce similar phenotypes, a subset of cases-particularly those involving the frontal and temporal scalp in young males-appears to be linked to androgen-mediated mechanisms. This narrative review focuses on the androgen-dependent phenotype of APKH, integrating clinical, trichoscopic, and histopathological findings and presenting a representative case. We also propose a conceptual framework for distinguishing between androgen-dependent and non-androgen-dependent subtypes. A detailed analysis of all published cases meeting criteria for androgen-sensitive APKH is provided, highlighting patterns of progression, diagnostic clues, and therapeutic implications. Recognizing this presentation as a potential early manifestation of androgenetic alopecia may inform clinical decisions and prompt timely intervention.

Remote robotic surgery (RRS) represents a frontier in surgical innovation, integrating robotics, artificial intelligence (AI), and high-speed communication networks. Despite its clinical significance, the global research landscape and conceptual evolution of RRS remain insufficiently mapped. A comprehensive bibliometric analysis of 857 Scopus-indexed documents (1980-2025) was conducted using Bibliometrix (R-package), VOSviewer, and CiteSpace. Analyses covered descriptive trends, country productivity, citation impact, collaboration networks, keyword co-occurrence, Bradford's Law of journal concentration, CiteSpace co-citation clustering, and thematic evolution. Thematic mapping was performed using the Walktrap clustering algorithm (250 words, minimum cluster frequency = 5) to visualize conceptual structures and developmental trajectories. RRS research exhibited an annual growth rate of 10.35%, with strong international collaboration (26.96%). The United States, China, Japan, and France dominated global contributions. Keyword co-occurrence and CiteSpace clustering revealed five thematic domains-robotic systems, telemedicine integration, surgical innovation, AI-assisted imaging, and 5G-enabled connectivity. Bradford's Law identified a small core of specialized journals as primary publication outlets. Thematic evolution (1980-2025) indicated three conceptual eras: foundational simulation and telepresence (1980-2013), technological integration with 5G and AI (2014-2022), and intelligent convergence emphasizing deep learning, blockchain, and ultra-low-latency communication (2023-2025). Thematic mapping further highlighted telesurgery as a basic theme and surgery as a motor theme driving interdisciplinary expansion. This bibliometric synthesis reveals a paradigm shift from early teleoperation frameworks to AI-driven, 5G-powered, and cybersecure surgical ecosystems. Future research should prioritize real-time data fusion, robotic autonomy, and ethical frameworks guiding intelligent telesurgical networks.

The concept of a therapeutic window of opportunity, defined as the period from symptom onset during which treatment initiation yields the most favorable patient outcomes, is applied in routine clinical practice across a range of inflammatory conditions. It has become an increasingly important area of interest in hidradenitis suppurativa (HS), a disease in which recurrent inflammation and accumulating damage can lead to irreversible destruction of skin architecture. Biologic therapies, aiming to suppress the inflammatory burden and prevent disease progression, are currently only permitted in moderate to severe HS. However, as there is no consensus definition of moderate disease, physicians may face uncertainty about when to consider or switch biologic therapy. To identify the boundaries of the window of opportunity within HS, global HS experts have developed frameworks for defining moderate HS and disease progression. It is proposed that prompt medical treatment should be administered to patients with moderate HS, defined as patients with inadequate control of HS symptoms on conventional therapies, or one inflamed skin tunnel (draining/non-draining), or four or more inflammatory lesions (including inflammatory nodules and abscesses) involving two or more anatomic areas. Furthermore, the proposed definition for disease progression is the development of one or more new tunnel(s) and/or the extension of existing tunnels, or development of one or more persistent HS lesions in an anatomical region not previously affected, or any increase in the number of persistent HS lesions in an affected anatomical region. The proposed frameworks aim to provide practical advice to physicians and support targeting the window of opportunity during routine clinical practice.

Hidradenitis suppurativa is a chronic recurrent inflammatory disease in which conventional clinical examination frequently underestimates subclinical extension and fails to distinguish between lesion types that carry different therapeutic implications. High-frequency ultrasound has emerged as a valuable adjunct, enabling detection of deep and occult disease, more granular assessment of inflammatory activity, and refined classification beyond traditional Hurley staging and the International Hidradenitis Suppurativa Severity Score System (IHS4). Over the last decade, multicenter studies and expert consensus have progressively defined high-frequency ultrasound lesion phenotypes, sonographic scoring systems, and workflow recommendations, positioning ultrasound as a practical bedside imaging tool for hidradenitis suppurativa. This Leading Article provides a concise balanced overview of high-frequency ultrasound in hidradenitis suppurativa, with an emphasis on unified lesion terminology, Doppler-based activity assessment, and an iconographic color-coded mapping strategy that links each ultrasound-defined lesion to its exact clinical location. The article highlights how such approaches can bridge communication between dermatologists, sonographers, and surgeons, support lesion-level decision making, and guide surgical planning, while also discussing current limitations, implementation barriers, and priorities for future research.

Acne vulgaris is one of the most prevalent chronic inflammatory skin diseases worldwide, characterized by marked clinical heterogeneity, fluctuating disease course, and strong sensitivity to environmental and lifestyle factors. The exposome, encompassing lifelong environmental, lifestyle, psychosocial, microbial, and intrinsic exposures, offers an integrative framework for re-conceptualizing acne as an environmentally modulated inflammatory disease. This review synthesizes external and internal exposomal drivers of acne, including pollution, radiation, climate and occupational factors, diet, smoking, cosmetics, psychosocial stress, and microbial ecosystems. We highlight the sebaceous gland as a central exposome sensor that integrates metabolic, immune, microbial, and neuroendocrine signals. Genetic susceptibility, epigenetic reprogramming, and non-coding RNA networks are key modifiers translating environmental exposures into persistent inflammatory and metabolic responses within the pilosebaceous unit. Importantly, adopting a health equity and social determinants of health (SDOH) perspective, we emphasize how structural and socioeconomic inequalities shape exposome burden, disease severity, and access to care. We propose that exposome-informed, low-cost, community-level prevention strategies, combined with evidence-based therapies, offer a pragmatic and equitable approach to acne management. Integrating molecular mechanisms with real-world and equity considerations, this framework advances understanding of acne pathophysiology and supports translation into more inclusive clinical practice.

Primary cutaneous cryptococcosis (PCC) is a rare, localized fungal infection caused by Cryptococcus species, typically following direct inoculation of the yeast into the skin in immunocompetent individuals. Unlike disseminated cryptococcosis, which is more common in immunocompromised hosts, PCC remains confined to the skin and often arises after minor trauma or environmental exposure. Although traditionally associated with Cryptococcus neoformans (C. neoformans), Cryptococcus gattii (C. gattii) is also increasingly recognized in immunocompetent hosts. Dermatologists are crucial in the early identification of PCC, as its clinical presentation can resemble other dermatologic conditions such as bacterial cellulitis, pyoderma gangrenosum, or atypical mycobacterial infections. This review provides a comprehensive overview of the epidemiology, clinical features, diagnostic methods, and management strategies for PCC. It emphasizes the importance of differentiating PCC from disseminated cryptococcosis and other mimicking conditions. Treatment with oral azoles, such as fluconazole, is typically effective, with a favorable prognosis for most immunocompetent patients. The review also includes practical diagnostic algorithms to assist clinicians in the accurate and timely management of PCC, ultimately improving patient outcomes and reducing unnecessary interventions.