Skin dysbiosis plays a crucial role in inflammatory skin diseases, particularly in genodermatoses such as Netherton syndrome (NS). This case report aimed to investigate changes in the skin microbiome of a patient with Netherton syndrome before and during dupilumab therapy, with the goal of expanding the limited evidence currently available on this topic. We report the case of a 35-year-old woman diagnosed with NS at birth, who, prior to dupilumab therapy, presented with atopic dermatitis (AD), ichthyosis linearis circumflexa, and severe pruritus. Dupilumab therapy was initiated, and skin swabs were collected from lesional sites at three different time points: at baseline, after 1 month, and after 1 year of continuous dupilumab therapy. At baseline, a microbiome analysis revealed low microbial diversity with a predominance of Pantoea and Pseudomonas species. After 1 year, a significant increase in microbial diversity, with a predominance of Staphylococcus species and an increase in Malassezia species, was observed. Clinically, the patient experienced remission in parallel with these microbiome shifts. Post-treatment, the skin microbiome showed increased microbial diversity and re-establishment of beneficial commensals, more closely resembling healthy skin. The findings of this case report underscore the role of dupilumab in restoring a healthy skin microbiome along with symptomatological and clinical improvement in the genodermatosis Netherton syndrome.
Psoriasis is a chronic inflammatory disease induced by genetic, immune and environmental interactions. The central mechanism is the aberrant activation of the Th17/IL-23 pathway, which leads to uncontrolled proliferation of keratinocytes and systemic inflammation. Psoriasis affects about 1-3% of the global population, with 70-90% of patients suffering from moderate to severe itching of the skin, 50% of patients suffering from thickening or loss of nails, and even 30% of patients suffering from a combination of arthropathy, and 59.1% of patients suffering from a psychological burden due to social discrimination, which greatly reduces the quality of life. Moreover, there has been no bibliometric analysis of studies on smart diagnosis and treatment of psoriasis, and it is hoped that this study will contribute to the development of smart diagnosis and treatment. By integrating cutting-edge research trends into intelligent diagnostic and therapeutic systems, advancing precision diagnosis and personalized treatment for psoriasis. Retrieve literature related to intelligent diagnosis and treatment of psoriasis from the Web of Science Core Collection (WoSCC), The search period spans from January 1, 2005, to December 31, 2025. VOSviewer 1.6.20 and CiteSpace 6.4.1 software were employed to analyze co-cited literature, keywords, research trends, and international collaboration patterns. With the help of intelligent image recognition, multimodal data fusion to carry out intelligent diagnosis and treatment, to promote the development of precision medicine, reduce medical costs, and achieve the purpose of improving long-term management, the technology can be further expanded to atopic dermatitis, eczema, etc, to further improve the quality of life of patients, and is expected to become a new model of dermatology diagnosis and treatment.
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Rituximab can cause immediate and delayed immune reactions, including rituximab-induced serum sickness (RISS). However, the temporal and mechanistic relationship between these reactions is unclear. We report a case in which RISS developed several days after rituximab-induced anaphylaxis. A 70-year-old woman with stage I mucosa-associated lymphoid tissue lymphoma was initially treated with weekly rituximab monotherapy. Four days after the third infusion, she developed fever, nonpruritic erythema, and arthralgia, which resolved spontaneously. When rituximab was re-administered, she immediately developed symptoms consistent with anaphylaxis, prompting treatment discontinuation. One year later, rituximab was re-started due to slight disease progression. The infusion induced nasal congestion and hoarseness but was completed under hydrocortisone. Eight days later, she presented with fever, widespread pruritic plaques, vomiting, diarrhea, and hypotension. Laboratory testing revealed elevated inflammatory markers without evidence of bacterial infection. Human anti-chimeric antibody levels were markedly elevated (> 5000 ng/mL). Intradermal testing with rituximab induced both an immediate wheal and a delayed erythematous flare lasting several days, indicating coexisting immediate-type hypersensitivity and RISS. This case demonstrates that RISS may occur several days after the resolution of rituximab-induced anaphylaxis. When immediate reactions occur after rituximab administration, patient education to ensure prompt reporting of delayed reactions is essential. Skin testing supported the identification of sequential immediate and delayed rituximab hypersensitivity in this case.
Dermatologic abnormalities are common in patients with hepatic disorders, with the skin being one of the major target organs for extrahepatic manifestations. Common skin findings in liver disease include spider angiomas, palmar erythema, caput medusa, and nail changes. This report details a case of arteriovenous hemangiomas in a patient with alcohol-induced chronic liver disease. The patient received an orthotopic liver transplant, and follow-up 10 weeks later showed a marked reduction in the size of the arteriovenous hemangiomas as well as significant improvement of spider angiomas. Abnormal skin findings can be the first patient-reported symptoms or findings on exam. The marked reduction in this patient's arteriovenous hemangiomas after liver transplantation supports prior evidence that treating underlying liver disease leads to arteriovenous hemangioma regression. While most cutaneous conditions are asymptomatic, familiarity and prompt recognition of common and uncommon skin changes of liver dysfunction, including arteriovenous hemangiomas, are important for early diagnosis and treatment initiation.
Patients with herpes zoster neuralgia (HZN) and comorbid diabetes mellitus (DM) often experience persistent pain that markedly undermines quality of life. Most of these patients respond poorly to oral anticonvulsants or conventional pulsed radiofrequency (PRF). Repeated application of high-voltage PRF may offer superior clinical benefits and improve patient satisfaction. This retrospective study aimed to analyze the outcomes of single versus repeated high-voltage PRF for thoracic HZN in patients with DM. We retrospectively analyzed data from 109 thoracic HZN patients with DM who underwent CT-guided high-voltage PRF targeting the thoracic selective dorsal root ganglia (DRG) during a one-week hospitalization period. Outcome measures included the incidence of clinically meaningful postherpetic neuralgia (PHN) and the HbA1c level at 12 weeks post-PRF, Numeric Rating Scale (NRS) score, Pittsburgh Sleep Quality Index (PSQI) score at baseline (pre-PRF) and 1, 4, 8, and 12 weeks following PRF (post-PRF), and the adverse events associated with PRF. 56 patients received the single high-voltage PRF group (one PRF session, Group SHV-PRF) and 53 patients received the repeated high-voltage PRF group (two PRF sessions, Group RHV-PRF). The incidence of clinically meaningful PHN at 12 weeks post-PRF was lower in group RHV-PRF than in group SHV-PRF (20.8%vs 41.1%, P < 0.05). NRS and PSQI scores were lower in group RHV-PRF than in group SHV-PRF at 1, 4, 8, and 12 weeks post-PRF (P < 0.05). The HbA1c level at 12 weeks post-PRF was lower in group RHV-PRF than in group SHV-PRF (P<0.05). No severe adverse events were recorded in either group. Repeated high-voltage pulsed radiofrequency confers favorable therapeutic outcomes for thoracic herpes zoster neuralgia in patients with diabetes mellitus, with an acceptable safety profile.
The coexistence of extramammary Paget disease and clinically apparent herpes simplex virus (HSV) infection is extremely uncommon, with only two cases previously described in detail. Herein, we present the case of an elderly woman with an extensive vulvar lesion showing concurrent extramammary Paget disease and HSV infection. Triple immunohistochemical staining for cytokeratin 7, cytokeratin 10, and HSV antigen was performed to re-evaluate the hypothesis that HSV-mediated fusion between Paget cells and keratinocytes contributes to multinucleated giant cell formation. HSV antigen was detected in both Paget cells and keratinocytes. HSV-positive multinucleated giant cells displayed a cytoplasmic staining pattern similar to that of keratinocytes, whereas no Paget cell-like cytoplasmic staining pattern was observed. These findings indicate that HSV can directly infect Paget cells and that the multinucleated giant cells in this case were of keratinocytic origin. No definitive evidence of cell fusion-either among Paget cells or between Paget cells and keratinocytes-was observed in the examined sections. However, the possibility of rare fusion events in unexamined tissue cannot be entirely excluded.
Cutibacterium acnes is recognized as a key contributor to acne, but recent evidence suggests that shifts in skin microbial diversity, rather than simple overgrowth, are critical in disease progression. Despite the unique genetic and environmental characteristics of the Middle East and North Africa, microbiome data on acne remain scarce. To characterize the skin microbiome associated with acne vulgaris in Egyptian urban and rural populations and assess the influence of acne severity and lifestyle factors on microbial diversity. We recruited 45 acne patients (urban n=37, rural n=8) and 25 healthy urban controls. Skin swabs were collected and analyzed by 16S rRNA sequencing. Microbial community profiles were generated with QIIME2, while differential taxa and functional pathways were evaluated using ANCOM-BC and PICRUSt2. In urban patients, moderate-to-severe acne was associated with greater microbial evenness and diversity, though species richness was unchanged. Community composition differed significantly by severity. Functional analysis revealed enrichment of amino acid biosynthesis pathways. Rural patients showed greater diversity, distinct microbial structures, and functional enrichment in amino acid and lipid metabolism pathways, with reduced enrichment in energy metabolism pathways. A depletion of C. acnes ASVs in patients with more severe acne across both cohorts was observed, possibly indicating a strain-specific behavior of C. acnes. Interventions that selectively eliminate pathogenic C. acnes strains while conserving beneficial ones may prove more efficacious for managing acne than broad-spectrum approaches. Environmental context significantly shapes the acne-associated skin microbiome. It influences both the taxonomic composition and potential function.
Chronic spontaneous urticaria (CSU) has been associated with psychiatric comorbidity, but previous studies have often been limited by cross-sectional designs, reverse causation and surveillance bias. We conducted a retrospective matched cohort study using the TriNetX US Collaborative Network to evaluate the risk of incident psychiatric disorders after CSU diagnosis. Adults with newly diagnosed CSU and no prior psychiatric diagnosis were propensity score matched 1 : 1 to non-CSU controls. Outcomes were depression, reaction to severe stress and adjustment disorders, schizophrenia and suicidal ideation or suicide attempts during 3 years of follow-up. After matching, 98,785 individuals were included in each group. CSU was associated with a modestly increased risk of reaction to severe stress and adjustment disorders (hazard ratio 1.15, 95% confidence interval 1.09-1.22), consistent across sensitivity analyses. No consistent increased risk was observed for depression, schizophrenia or suicide-related outcomes. A complementary asso ciation analysis including patients with pre-existing psychiatric disease reproduced previously reported associations with depression and stress-related disorders. These findings suggest that CSU is not broadly associated with incident psychiatric disease but is linked to a small, reproducible increase in stress-related psychiatric morbidity.
Xeroderma pigmentosum (XP) is a rare autosomal recessive disorder characterized by defective DNA repair, leading to extreme photosensitivity Affected individuals have a profoundly elevated risk estimated to be more than 10,000-fold greater than the general population of developing cutaneous malignancies, primarily squamous cell carcinoma (SCC). Management requires rigorous photoprotection and prompt, often repeated, surgical excisions. This is critically challenging in resource-limited settings with high ultraviolet exposure and limited surgical/oncological infrastructure. We report a 7-year-old female from rural Somaliland, born to consanguineous parents, She presented with a 6-month history of an ulcerated, bleeding plaque on her right temple. Two younger siblings also exhibited milder dermatological symptoms, raising suspicion of familial XP with a 2-year history of progressive photosensitivity, xerosis, and freckling. Examination revealed characteristic XP findings including diffuse poikiloderma and ocular involvement (conjunctival growths, dry eyes). A clinical diagnosis of XP with suspected SCC was made. The lesion was initially excised with a 2mm margin; however, the SCC recurred within three months. A second, more extensive wide local excision with a 4mm margin and flap reconstruction was successful. Histopathology confirmed well-differentiated SCC invading the deep dermis. This case highlights the aggressive and recurrent nature of cutaneous SCC in XP patients, It underscores the necessity of standard 4mm surgical margins even in anatomically challenging areas to prevent recurrence. Even in childhood. It underscores the immense challenges of managing this life-threatening genodermatosis in settings with limited access to specialized multidisciplinary care, advanced reconstructive surgery, and lifelong photoprotective resources. The iterative surgical approach, complicated by graft failure, illustrates the need for robust primary excision and highlights the role of pragmatic, adaptive surgical planning in low-resource contexts.
Baboon syndrome, also known as symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), is a rare reaction characterised by distinct, bilateral erythema in the flexural and intertriginous regions, occurring without systemic symptoms. We present a 53-year-old gentleman who, 3 days after commencing diclofenac potassium for knee pain, exhibited symmetrical, well-defined erythema affecting the neck, axillae, cubital and popliteal fossae, forearms, inguinal folds, thighs, legs, and feet. He displayed no systemic symptoms or fever. The time and distinctive distribution of SDRIFE induced by diclofenac potassium were congruent. Following the cessation of diclofenac potassium, the patient received topical corticosteroids and oral antihistamines. The symptoms resolved after 1 week. This case highlights the necessity for physicians to identify this presentation for prompt diagnosis and care and also indicates diclofenac potassium as a possible cause of SDRIFE. Plain language summaries may be submitted for research articles and review articles. The summary should not exceed 250 words and be written in plain English avoiding the use of technical language. If a technical term must be used, then authors must explain it the first time that it is used. The summary must be distinct from the abstract and provide readers with an easy-to-understand description of the manuscript. Authors should avoid the use of personal opinions and/or speculation on the results of the manuscript. No page charges will be incurred by the inclusion of the plain language summary. Use neither bibliographic references nor references to figures or tables in the summary. Some medications can cause skin reactions shortly after they are started. One uncommon reaction causes red, symmetrical skin patches in body folds such as the armpits, groin, and behind the knees. This reaction is known as baboon syndrome. We describe a 53-year-old man who developed this skin reaction a few days after taking diclofenac potassium for knee pain. He had no fever or other general symptoms. After stopping the medication and using simple treatments, the skin changes resolved completely within 1 week. Recognising this reaction early helps ensure prompt treatment and patient reassurance.
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Skin aging increases transepidermal water loss (TEWL), reduces elasticity, and perturbs the skin microbiome. Adipose tissue-derived stem cell exosomes (ASCE) show regenerative potential; however, their clinical effects on skin physiology and microbiome remain unclear. We conducted a split-face, randomized controlled trial in 16 adults aged ≥ 40 years with visible facial aging. One facial side received ultrasound-assisted transdermal delivery of a human ASCE-containing solution (HACS), whereas the other side received normal saline, at two-week intervals for three sessions. Biophysical outcomes (TEWL, stratum corneum hydration, and elasticity parameters R2/R5/R7) were assessed at baseline and week 2, 4, and 8. Wrinkles, pigmentation, and sebum levels were quantified using Mark-Vu imaging, and the Physician's Global Aesthetic Improvement Scale (PGAIS) and patient satisfaction assessment scores were recorded. Skin swabs from ten participants were subjected to 16S rRNA and ITS1 sequencing. HACS treatment significantly reduced TEWL (p = 0.006 at week 2; p = 0.009 at week 8) and increased hydration (p < 0.001 at all time points) with a significant increase in elasticity (R2/R5/R7 values, p < 0.001). Both the PGAIS and patient satisfaction scores were significantly higher on the experimental side. Bacterial α/β-diversity remained largely unchanged, and no bacterial taxa remained significantly associated with skin parameters after FDR correction. In contrast, several fungal taxa showed significant positive associations with skin parameters after FDR correction, detectable only on the HACS-treated side. No significant adverse events were observed. HACS improved barrier function, elasticity, and aesthetic outcomes, whereas microbiome analyses suggested a modest fungal response associated with treatment-related skin changes in aging skin.
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To analyse the biopsychosocial impact of burning mouth syndrome (BMS) on quality of life related to oral health, and to study the influence of perceived invalidation, stigma, and catastrophising on the experience of pain. Observational study of cases and controls with a sample of 226 participants (BMS group n = 156 and Control group n = 70), recruited at the University Dental Clinic of the Morales Meseguer Hospital. The following tests were administered: BPI-SF (pain and functioning interference), SSCI-8 (global stigma), ISC (internalised stigma), 3*I (perceived invalidation), HADS (anxiety and depression), PCS-6 (catastrophising scale), OHIP-14 (quality of life related to oral health) and the diagnostic legitimacy perception scale. The BMS patients presented significantly worse scores in all the variables analysed with respect to the healthy controls (p < 0.001), especially in oral health quality of life and catastrophising. In the regression models, the perceived invalidation showed an independent and consistent association with a worse oral health quality of life (p < 0.001), higher intensity of pain (p < 0.001) and higher perceived stigma (p < 0.001). BMS had a strong impact on the quality of life and emotional well-being of the patients. The perceived invalidation emerged as a factor that is closely related to pain, stigma, and deterioration of quality of life, which supports the need for a comprehensive approach that includes not only clinical management but also the recognition and validation of the experience of the patient. These findings reinforce the need for a multidisciplinary approach that includes clinical, psychological, and social dimensions in the management of BMS.
Measles is a highly contagious viral exanthematous disease, caused by a Morbillivirus, that continues to cause outbreaks in under-immunized populations. While neurologic complications are rare, the progression to meningoencephalitis with convulsive status epilepticus is exceptional, particularly in immunocompetent adolescents. We report a 17-year-old unvaccinated male who presented with a febrile, descending asymptomatic maculopapular rash, lacking Koplik spots, followed by rapid onset of severe headache, photophobia, vomiting, and convulsive status epilepticus. Day-7 IgM was negative, and PCR was unavailable, prompting a broad viral, bacterial, and autoimmune workup, all of which were excluded. Cerebrospinal Fluid (CSF) showed mild protein elevation without pleocytosis, and repeat serology confirmed measles (IgM 1210 IU/mL; IgG 1980 IU/mL). The patient received meningeal-dose ceftriaxone, acyclovir, antiepileptics, and high-dose vitamin A per World Health Organization (WHO) recommendations, with complete neurologic recovery. This case highlights an uncommon but severe neurologic complication of measles in an unvaccinated adolescent, emphasizing the risk of diagnostic delay due to atypical features and early seronegativity. It reinforces the need for high clinical suspicion, broad etiologic evaluation, early empiric therapy, and sustained efforts to ensure complete vaccination.
Giant cutaneous squamous cell carcinoma (cSCC) of the scalp is rare and presents significant therapeutic challenges due to its size, proximity to critical neurovascular structures, and complex reconstructive requirements. We report a 68-year-old woman with a 20 cm exophytic occipito-parietal cSCC that had been evolving over one year. Biopsy confirmed a well-differentiated cSCC, and imaging revealed a heterogeneous mass abutting the skull without nodal or distant metastases. The tumor was managed with wide surgical excision, including the cranial periosteum and outer table curettage, followed by staged reconstruction using pedicled transposition flaps and split-thickness skin grafts. Histopathology confirmed a well-differentiated infiltrative cSCC (T3N0M0, American Joint Committee on Cancer (AJCC) stage III) with clear margins. Postoperative outcomes were satisfactory, both functionally and aesthetically. This case underscores the importance of early detection, multidisciplinary management, and individualized surgical planning in giant scalp cSCC, with adjuvant therapies offering additional options for advanced disease.
Rosacea is a common chronic inflammatory disease. Among its four subtypes, phymatous rosacea predominantly affects middle-aged and elderly men and is characterized by hyperplasia and hypertrophy of both fibrous tissue and sebaceous glands of the nose. The visible manifestation is often considered a disfigurement and the accompanying social stigma often cause serious emotional and physical impact. In this article, we describe a combination therapy of a 1064nm Nd:YAG laser (Sichuan Aerospace World Guidance Co., Ltd.; fiber core diameter: 0.6 mm; laser energy: 100-200 mJ) and ALA-PDT (20% 5-aminolevulinic acid: Fudan Zhangjiang Co., Ltd., Shanghai, China and red light: Sigma, 635 nm wavelength, 60-80 mW/cm² irradiation energy for 15-20 minutes). This combined regimen achieved satisfactory clinical outcomes with minimal adverse effects, including little bleeding and a low risk of postoperative infection. Furthermore, it facilitated convenient postoperative home care for the patient.