Skin photoaging, induced by excessive ultraviolet exposure, leads to microvascular and appendage degeneration, extracellular matrix degradation, and cellular senescence. The limited efficacy of current treatments for photoaging is partly due to underlying microvascular dysfunction. This study introduces a microneedle patch incorporating decellularized adipose-derived matrix (DAM) to enhance microvascular remodeling and mitigate photoaging. In vitro studies demonstrate that DAM enhances the function of photoaged endothelial cells via the VEGFA/PI3K/Akt pathway while simultaneously alleviating senescence in both fibroblasts and keratinocytes through intercellular communication. In a UVB-induced photoaged mouse model, DAM promotes angiogenesis, reduces matrix metalloproteinase expression, and stimulates collagen synthesis, ultimately restoring local homeostasis and reversing aging signs. Notably, DAM treatment not only reverses these signs but also regulates the hair follicle cycle, underscoring its dual impact on appendage regeneration and microvascular repair. In conclusion, the integration of DAM into a microneedle patch provides a clinically translatable and minimally invasive platform for addressing photoaging. These findings not only advance the understanding of photoaging mechanisms but also propose a novel microvascular-focused strategy for skin regeneration. Future research will focus on optimizing patch design and establishing standardized DAM quality control protocols, with potential applications in other age-related disorders.
As a cutaneous appendage, the hair follicle is tightly associated with the skin during growth, pigmentation, and aging. These two interconnected tissues share evolutionarily conserved regulatory mechanisms-including stem cell niche signaling, inflammatory cascades, and oxidative stress-and collectively function as hallmarks of systemic organismal aging. Hair abnormalities are well-established concomitant manifestations of aged skin. The crosstalk between skin aging and hair aging is particularly pronounced in several hereditary progeroid disorders, which are typified by concurrent premature aging in both tissues. Notably, multiple intervention strategies have shown promising therapeutic efficacy against both aging processes. To date, numerous molecular cascades have been implicated in skin aging, including DNA damage accumulation, telomere attrition, oxidative stress, chronic low-grade inflammation, and stem cell exhaustion. Given the intricate interplay among these pathways, this review systematically dissects the contributions of each mechanism to hair follicle aging and further clarifies the mechanistic links underlying skin and hair aging.
Frontal fibrosing alopecia (FFA) is a scarring alopecia that mainly affects women and is characterized by progressive frontal hairline recession and eyebrow loss. The efficacy of doxycycline in patients with skin of color remains underexplored. The objective of our study is to assess the clinical and dermoscopic response to doxycycline in patients with FFA and skin of color. A retrospective study was conducted over 4 years at Ibn Sina University Hospital, Rabat. Fifty female patients with FFA received oral doxycycline (100 mg/day) for at least 6 months. Disease patterns, associated conditions (lichen planus pigmentosus and rosacea), and treatment response were evaluated. Statistical significance was set at p < 0.05. Median age was 52 years; 60% were postmenopausal. Linear FFA was most common (70%), and 46% had lichen planus pigmentosus. Doxycycline led to improvement in 57% of patients (p = 0.02), particularly in linear and pseudo-fringe patterns. Dermoscopic improvements included decreased perifollicular erythema and hyperkeratosis (p = 0.01). All patients with rosacea improved. Adverse events occurred in 16% of cases. Doxycycline appears effective and well-tolerated in managing FFA in patients with skin of color, especially in cases associated with lichen planus pigmentosus or rosacea.
Adverse drug reactions (ADRs) to Antiretroviral Therapy (ART) among people living with HIV/AIDS (PLWHA) can significantly affect treatment adherence, viral suppression and contribute to HIV-related morbidity and mortality. ADRs to long-term ART use is not well understood in resource-constrained countries like Nigeria. This study identified the determinants and outcomes of ADRs to ART among PLWHA in Nigeria. Secondary data analysis of the 2014 to 2018 National Pharmacovigilance records was conducted using 3,397 individual case safety reports (ICSRs). The outcome variables were the actual adverse drug reactions reported (e.g., headache, dizziness, anaemia) and the seriousness of the ADR (Serious vs. Non-serious ADR). In contrast, the explanatory variables included the patient's age, sex, weight, duration of ADR, concomitant medicines used, and ART regimen. ADRs were determined using the WHO System Organ Classification, which groups ADRs by the organ system or body part affected. Data were analysed using multivariate logistic regression, with a p-value set at 5%. The mean age of the participants was 34.7 ± 11 years, and the majority were female (71.5%). The most commonly reported ADRs were neuropsychiatric disorders (29.8%), skin and appendage disorders (17.1%), peripheral nervous system disorders (6.7%), musculoskeletal disorders (4.3%), and anaemia (2.1%). On multivariate analysis, factors associated with development of neuropsychiatric disorders were female were female gender (AOR = 1.43, 95% CI (1.20-1.71): p < 0.001), Efavirenz-based therapy (AOR = 5.58, 95% CI: (4.41-7.05) p < 0.001), older age [16-35 years [AOR = 3.34; 95% CI: (1.72-6.48); p-value: <0.001, [36-50 years: AOR = 2.32; 95% CI: (1.19-4.52); p-value: 0.014; > 50 years AOR = 2.77; 95% CI: (1.36-5.63); p-value: 0.005] Use of Tenofovir [AOR = 1.65; 95% CI: (1.20-2.30); p-value: 0.002], and Zidovudine [AOR = 1.44; 95% CI: (1.13-1.85); p-value: 0.003] were associated with cutaneous adverse drug reactions. Anaemia was associated with the use of Zidovudine [AOR = 32.56; 95% CI: (4.41 - 7.05); p-value: <0.001], but was inversely associated with cotrimoxazole use [AOR = 0.58; 95% CI: (0.42- 0.79); p-value: 0.001]. Some (22%) of the patients recovered from ADRs; 1.2% were fatal, while 71.5% outcomes were unknown. ADRs were common among ART patients in Nigeria., with female gender, older age and types of ART regimen being major determinants of ADRs Active surveillance is necessary to ensure early detection of ADRs among patients on ART and thereby prevent ART-associated morbidity and mortality. Not applicable.
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Body-focused repetitive behaviors (BFRBs), including skin picking, onychophagia, onychotillomania, and trichotillomania, are psychodermatologic conditions characterized by repetitive self-injury. While neuropsychiatric comorbidities are common in neurofibromatosis type 1 (NF1), prevalence and quality-of-life (QoL) impact of BFRBs in these individuals are underexplored. We aimed to characterize BFRB prevalence and assess association with dermatology-related QoL in a national NF1 cohort. A voluntary online survey was distributed to NF1 registry members. Participants reported BFRBs and dermatology-related QoL using the Dermatology Life Quality Index (DLQI). Multivariable logistic regression assessed predictors of moderate-severe QoL impairment. Among 143 respondents, 73.4% reported ≥1 BFRB. Skin picking was most common (55.3%), followed by onychophagia (39.8%), onychotillomania (35.2%), and trichotillomania (17.9%). Respondents with any BFRB had significantly worse QoL vs. those without (mean DLQI score 7.28 vs. 4.03; p < 0.001). Any BFRB increased odds of moderate-severe impairment (OR 4.88; p = 0.007) with higher odds per additional BFRB (OR 1.93; p < 0.001). We found that BFRBs are highly prevalent and independently associated with poorer QoL in NF1 patients. Screening for BFRBs during dermatologic evaluation in patients with NF1 may improve early recognition and reduce grooming-related skin and nail injury.
Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder associated with substantial psychiatric comorbidity. Although repetitive and compulsive behaviors are reported in NF1, the risk of body-focused repetitive behaviors is understudied. We performed a retrospective cohort study using the TriNetX research network (2006-2026). On January 14, 2026, individuals with a first recorded diagnosis of NF1 were compared with matched controls. Patients with prior trichotillomania or skin-picking disorder were excluded. Cohorts were balanced using 1:1 propensity score matching for demographics, psychiatric comorbidities, and healthcare utilization. Five-year hazard ratios (HRs) were calculated using Cox proportional hazards models with Bonferroni correction. After matching, 33,841 individuals were included in each cohort. NF1 was significantly associated with increased incidence of trichotillomania over 5 years compared with controls (HR 2.46; 95% CI: 1.43-4.22; p < 0.001), which remained significant after Bonferroni correction. No significant association was observed for skin-picking disorder (HR 1.25; 95% CI: 0.65-2.40; p = 0.670). In sensitivity analyses adjusting for ADHD, autism, and tic disorders, NF1 remained significantly associated with trichotillomania. We found that NF1 was associated with increased risk of trichotillomania. Increased clinical awareness and screening may help improve recognition and management and improve quality of life.
Hidradenitis suppurativa (HS) is a debilitating skin disease marked by recurrent abscesses and chronic inflammation. Immune checkpoint inhibitors (ICIs) are widely used oncologic treatments that can provoke immune-mediated effects. The ICI potential to precipitate HS onset or influence HS disease activity remains uncharacterized. We aim to characterize the timing, clinical features, severity, and outcomes of HS in this context. Scoping review according to PRISMA guidelines was conducted. Studies were identified through PubMed and MEDLINE searches and were eligible if they reported at least 1 case of HS onset or worsening in the setting of ICI therapy. Five publications comprising 13 patients were included. Pembrolizumab was the most frequently used ICI (46.2%). Eight individuals (61.5%) had pre-existing HS, of whom 3 (37.5%) experienced flares during therapy. Five patients (38.5%) developed new-onset HS after ICI initiation, within 2-4 months. Treatment approaches varied and included topical and systemic therapies for HS. Four patients (30.8%) experienced complete resolution of HS lesions following ICI discontinuation. ICI therapy may precipitate new-onset HS or exacerbate pre-existing disease in a subset of patients. Increased clinical vigilance and early dermatologic involvement may support timely diagnosis, optimize management, and preserve continuity of oncologic care. Hidradenitis suppurativa (HS) is an inflammatory skin condition that has overlap with other conditions such as cancer. It is not well described how a type of cancer treatment, called immune checkpoint inhibitors (ICI), can affect HS. This scoping review evaluated case reports, totaling 13 patients. Less than half developed new HS, and of the patients with existing HS, only half experienced a flare. More research is needed to further understand the incidence, clinical course, and management of HS patients taking ICI treatment.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent painful nodules, abscesses, and sinus tracts in apocrine gland-bearing areas. Penoscrotal lymphedema represents a rare but devastating complication, predominantly affecting patients with longstanding Hurley stage III disease. We present 3 cases of severe penoscrotal lymphedema in middle-aged males with longstanding HS. Case 1 involved a 42-year-old smoker with 10-year HS history who developed progressive lymphedema with violaceous nodules and sinus tracts over 5 years. Case 2 involved a 45-year-old male with Fitzpatrick skin phototype IV and adolescent-onset HS who developed massive scrotal lymphedema with characteristic verrucous lymphostasis and adult-acquired buried penis over 8 years. Case 3 involved a 53-year-old male with 16-year HS history who developed massive penoscrotal lymphedema complicated by secondary (AA) amyloidosis with chronic kidney disease and proteinuria. All patients demonstrated profound quality of life impairment and underwent systematic exclusion of alternative etiologies. Treatment included systemic antibiotics and TNF-alpha inhibitors (adalimumab), with variable clinical response. These cases highlight the importance of early recognition as timely biologic therapy may prevent progression to irreversible complications requiring surgical intervention. Lymphedema in HS requires multidisciplinary management involving dermatology, plastic surgery, urology, nephrology, and psychological support services.
Trichoteiromania is a friction-induced hair shaft disorder caused by repetitive rubbing/scratching and is often considered the hair shaft expression of lichen simplex chronicus ("scratching-pseudo-alopecia"). It is classically described on the scalp and presents with lichenified plaques and characteristic trichoscopy such as broom hairs and V-hairs. Pruritus or an urge to rub is common and may help distinguish it from trichotillomania (hair pulling), which is often asymptomatic. To date, the condition has been described almost exclusively as a scalp disorder. We report a 55-year-old man working in finance with a 15-year history of asymptomatic skin changes on the dorsal hands, initially unilateral and later bilateral, who was referred because of concern about malignancy. Examination revealed symmetric lichenified plaques with excoriations, erythema, haemorrhagic crusts, and numerous short broken hairs on the dorsal aspects of the index fingers and thumb, as well as bilateral enlarged lunulae of the thumbnails. Trichoscopy was diagnostic, showing broom hairs, V-shaped hairs, short broken hairs at different lengths, perifollicular and interfollicular scale, and irregular perifollicular brown pigmentation, consistent with trichoteiromania. No biopsy was required. The patient was reassured regarding the benign nature of the condition, started on topical urea and clobetasol, and referred for psychiatric follow-up to address the underlying compulsive rubbing behaviour. This case represents, to our knowledge, the first description of trichoteiromania affecting a non-scalp site and demonstrates that its full trichoscopic signature can occur on extracranial hair-bearing skin. This case expands the anatomical spectrum of trichoteiromania beyond the scalp and highlights trichoscopy as a rapid, non-invasive tool to attribute hair shaft damage to chronic friction.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a disproportionately high burden of metabolic comorbidities, including obesity, metabolic syndrome, type 2 diabetes mellitus (T2DM), dyslipidaemia, and polycystic ovary syndrome. Despite this, clinical management of HS has historically remained siloed within dermatology, with insufficient integration of cardiometabolic risk management. GLP-1 receptor agonists (GLP-1 RAs) - a drug class now established for T2DM, obesity, and cardiovascular risk reduction - have recently emerged as candidate agents for HS. A systematic review published in 2024 and two pivotal real-world studies published in 2025 provide preliminary evidence that GLP-1 RAs improve HS disease activity through both weight loss and direct anti-inflammatory mechanisms. We argue that this evidence base is already sufficient to justify a paradigm shift: GLP-1 RAs should be considered as adjunctive components of a multidisciplinary treatment strategy for HS patients with concurrent cardiometabolic disease. We propose a practical clinical framework for patient selection and monitoring and call for dedicated randomised controlled trials. Metabolic comorbidities are mechanistically linked to HS pathogenesis and are inadequately addressed in current clinical practice. GLP-1 RAs offer dual benefit in HS - improving both metabolic outcomes and HS disease activity. Dermatologists should screen every HS patient for cardiometabolic comorbidities and advocate for GLP-1 RA therapy in eligible patients as part of a multidisciplinary approach.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent painful nodules, abscesses, and scarring, primarily affecting intertriginous areas. As tattoos have gained widespread popularity, individuals with HS may consider getting tattooed. Patients with HS are exposed to the same potential risks as the general population and they include the possibility of delayed healing, tattoo allergies, or infections. Additionally, future location of the tattoo and timing of the procedure need to be considered. While no extensive clinical studies specifically address the relationship between tattoos and HS, anecdotal reports suggest that individuals with well-controlled HS may tolerate tattoos in unaffected areas. HS is not a contraindication for tattooing, but patients need proper guidance. Proper pre-tattoo consultation with dermatologists, careful site selection, tattooing by a professional artist in a tattoo parlor and strict aftercare protocols are essential to minimize complications.
Non-scarring alopecias, including androgenetic alopecia and alopecia areata, are common hair loss disorders with significant psychosocial impact. Conventional treatments such as minoxidil, finasteride, corticosteroids, and platelet-rich plasma (PRP) often demonstrate variable efficacy, relapse rates, or adverse effects. Emerging interest in regenerative dermatology has positioned exosome-based therapy as a potential next-generation solution. This narrative review synthesizes current evidence from experimental, translational, and clinical studies evaluating the role of exosomes in hair regeneration. Exosomes, nanosized extracellular vesicles rich in proteins, nucleic acids, and lipids, modulate the hair follicle microenvironment through activation of Wnt/β-catenin signaling, promotion of angiogenesis, immunomodulation, and prolongation of the anagen phase. Preclinical investigations consistently demonstrate robust follicular regeneration, while early clinical studies report improvements in hair density, shaft diameter, and patient satisfaction with favorable short-term safety. Compared with PRP and cellular therapies, exosomes offer a potentially standardizable, cell-free, and scalable biologic approach. However, challenges persist regarding isolation methods, dosing protocols, delivery techniques, regulatory frameworks, and production costs. Exosomes exhibit multimodal biological actions supporting hair follicle regeneration. Early clinical data show improvements in hair density, thickness, and growth with good safety. Exosomes represent a cell-free and potentially standardizable biologic approach with improved reproducibility compared with autologous therapies, although full standardization has not yet been achieved. Standardization, cost reduction, and high-quality trials are needed for clinical translation.
Hidradenitis suppurativa (HS) may be linked to behavioral factors that exacerbate inflammation, gut microbiome, and healing. This review evaluates current evidence on the relationship between alcohol consumption and HS. Emerging studies show high incidences of alcohol and substance use disorders in HS patients. However, observational studies remain inconsistent: HS patients may experience higher alcohol-related burden, yet its association to disease progression and baseline severity remains unclear. Limitations of existing studies include self-reported exposures of alcohol, heterogeneous outcome measures, and potential confounding factors, such as stress. Biologic plausibility remains, as alcohol can promote dysbiosis, inflammation, and oxidative stress that may influence disease activity and healing. This review highlights the need for larger, controlled trials that determine whether the reduction or elimination of alcohol may improve HS outcomes.
Many conditions, such as malnutrition, radiation exposure, drugs, trauma, and systemic and metabolic disorders, can lead to nail pigmentation. Many other dermatological and systemic conditions, mycologic and bacterial infections, and repetitive trauma can be associated with non-melanoma-related Hutchinson's sign. We report a 68-year-old woman with the complaint of darkening of her existing nail bands and development of a newly pigmented lesion on the edge of her left thumb after taking chemotherapy. Lateral longitudinal biopsy, including Hutchinson's sign, was performed. Melanocytes in normal number and localization in the nail matrix on histopathological evaluation. The patient was diagnosed with frictional hypermelanosis. It is very important to exclude subungual melanoma and to find out the etiology of Hutchinson's sign. Repetitive trauma can be a cause of non-melanoma Hutchinson's sign.
Frontal fibrosing alopecia (FFA) is a scarring alopecia increasingly recognized in men, with potential psychological repercussions. This study aimed to assess the impact of FFA on men's quality of life (QoL). A multicenter cross-sectional study was conducted including men diagnosed with FFA who completed the Hair-Specific Skindex-29 (HSS29), Women's AGA Quality of Life Questionnaire (WAA-QoL), and Hospital Anxiety and Depression Scale (HADS). Associations were analyzed using Spearman's correlation, Kruskal-Wallis, and chi-square tests. Eighty-one men (mean age 54.7 years) participated. Moderate to severe emotional impairment was present in 39.5% of patients, particularly in younger individuals and those with temporal hairline involvement. Mean HADS scores indicated mild psychological distress. FFA significantly affects men's QoL, especially younger patients, underscoring the need for psychosocial assessment regardless of disease severity. FFA is a type of scarring alopecia that is increasingly affecting men [J Am Acad Dermatol. 2022;86(2):481-484; J Am Acad Dermatol. 2014;70(4):670-678]. A negative impact on the emotional and psychological health of patients has been reported [JAMA Dermatol. 2018;154(4):479-480]. The aim of our study was to evaluate the impact of FFA on the QoL in men.
Microinfusion of drugs into the skin (MMP®) is an intradermal drug delivery technique combining microneedling with controlled microinfusion using professional tattoo devices. In androgenetic alopecia (AGA), MMP has been proposed to enhance local follicular drug exposure while potentially minimizing systemic absorption, although evidence remains limited. Thirty male patients (20-45 years) with AGA (Hamilton-Norwood stages I-IV) were treated in strict monotherapy with scalp microinfusion of dutasteride 0.05%. Treatments were performed using a rotary tattoo device with sterile 49-needle cartridges (0.30-mm diameter), delivering 1 mL per session at a depth of 1.0 mm. Four monthly sessions were followed by bimonthly maintenance. Outcomes were assessed using physician global assessment, standardized photography, and patient self-assessment over 12 months. At 12 months, stabilization or improvement was observed in 96.7% of patients, with clinical improvement in 76.7%. Patient-reported improvement occurred in 80.0%. Responses were more consistent in early to intermediate AGA. Treatment was well tolerated, with only mild transient local reactions. Scalp microinfusion with dutasteride using MMP® appears to be a safe and promising adjunctive treatment for male AGA. Further controlled studies are needed.
Although trauma-associated basal cell carcinoma (BCC) has been described, the exact etiological role of repeated mechanical microtrauma remains incompletely understood. A 31-year-old male patient presented with a progressively enlarging lesion on the left frontal scalp at the frontal hairline that had been growing for 6 months. He reported daily use of a microneedling device for 3 months for the treatment of male androgenetic alopecia prior to the onset of the lesion. The patient had no classical risk factors for BCC and had Fitzpatrick skin type III. Total excision was performed, and histopathological examination was consistent with nodular BCC. To our knowledge, this is the first reported case of BCC developing at the site of repeated microneedling application for androgenetic alopecia. Further studies are needed to better define the long-term safety of microneedling devices.
Nail changes often reflect underlying systemic disease and may be the presenting manifestation of rare genetic disorders. Here, we report 2 siblings with congenital insensitivity to pain with anhidrosis (CIPA) with prominent nail findings. We report two brothers who presented with prominent nail abnormalities including dystrophy, brachyonychia, anonychia, paronychia, and pseudo-clubbing, along with acro-osteolysis of distal phalanges. Subsequent evaluation revealed insensitivity to pain and temperature, intellectual disability, recurrent fractures, self-mutilation, and anhidrosis, leading to a diagnosis of CIPA. Genetic analysis confirmed a novel homozygous NTRK1 gene deletion. This report highlights the importance of nail manifestations as potential diagnostic indicators of CIPA.
Pseudofolliculitis barbae (PFB) is a chronic inflammatory condition of hair follicles characterized by inflamed papules and pustules, with increased risk in individuals with curly or coarse hair. While psychiatric comorbidities in acne are well studied, limited research exists on PFB's psychological impact. We conducted a cross-sectional analysis of individuals with PFB using the All of Us dataset, which includes EHR data from US adults since 2018. A total of N = 1,668 individuals were included in the matched dataset, with 834 PFB cases and 834 controls and were assessed for diagnosis of attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), major depressive disorder (MDD), and general anxiety disorder (GAD). The association between the presence of ADHD and PFB was significant (p value = 0.009). Similarly, the presence of GAD (23% of PFB patients and 10% of patients without PFB) and MDD (48.4% of PFB patients and 26.3% of patients without PFB) was significantly associated with the presence of PFB (p value <0.001 for both conditions). However, OCD was found not to be significantly associated with the presence of PFB (p = 0.15). Our study demonstrated a significant association between PFB and mood disorders like depression or anxiety. Future studies should examine PFB severity and treatment efficacy on psychological outcomes.