Current Issue : April-June Volume : 2025 Issue Number : 2 Articles : 6 Articles
Background: Melasma is a challenging, acquired hyperpigmentary disorder. The gold standard treatment is Kligman’s formulation, which contains hydroquinone, tretinoin, and dexamethasone, but its long-term use is limited by the risk of exogenous ochronosis. Cysteamine, a tyrosinase inhibitor, reduces melanocyte activity and melanin production, showing strong depigmenting effects in patients resistant to Kligman’s formulation. Nonetheless, clinical studies have yielded inconsistent efficacy results. This meta-analysis aimed to assess the efficacy of cysteamine in treating melasma and to identify potential factors that may impact its therapeutic outcomes. Methods: A systematic search of PubMed, Embase, Web of Science, and CENTRAL, from the earliest record until August 2024, was conducted. Randomized controlled trials and quasi-randomized design studies related to topical cysteamine on melasma patients were included. The primary outcome was MASI or mMASI assessment after treatments. The current meta-analysis was conducted with a random-effects model. Subgroup analyses and meta-regressions were performed based on baseline MASI, disease duration of melasma, patient age, and sample size of the included studies. Funnel plots and Duval and Tweedie’s trim and fill method were adopted to assess the publication bias. Results: Eight studies were included for quantitative analysis. The analysis of MASI after topical cysteamine demonstrated a significant decrease compared to the placebo (p = 0.002). Compared to other melasma treatments, cysteamine did not show superior efficacy in mMASI (p = 0.277). The treatment efficacy of hydroquinone, modified Kligman’s formula, and tranexamic acid mesotherapy for melasma was not statistically different when compared to cysteamine (p = 0.434). Further analyses showed no benefit when allowing extended cysteamine application time (p < 0.0001). The meta-regression revealed the efficacy of cysteamine decreased as the duration of melasma increased (coefficient = 0.38, p = 0.0001, R2 = 0.99). The funnel plot displayed some asymmetry. The trim and fill method suggested the adjusted effect size was 0.607 (95% CI = −0.720 to 1.935). Conclusions: Cysteamine exhibited efficacy in treating melasma patients; however, its depigmentation effect was comparable to hydroquinone-based regimens, tranexamic acid mesotherapy, and modified Kligman’s formula. Using cysteamine in patients with a short duration of melasma may result in better efficacy....
Objectives: Artificial intelligence (AI) is transforming aesthetic dermatology, introducing new opportunities for personalized, predictive, and adaptive approaches in skin diagnostics, treatment planning, and patient management. This review examines AI’s evolving role in enhancing diagnostic precision, individualizing treatments, and supporting dynamic patient care, with a focus on practical implementation in clinical settings. Results: This piece highlights how AI-based imaging and predictive tools enable more precise diagnostics and tailored treatment protocols, leading to improved patient outcomes and satisfaction. Some of the key benefits of AI in aesthetic dermatology include the ability to detect subtle skin changes, simulate treatment outcomes, and adjust interventions in real time. However, this manuscript also addresses significant challenges that practitioners face, such as technical constraints, data privacy concerns, algorithmic biases, and financial barriers, which impact the accessibility and efficacy of AI across diverse patient populations. Conclusions: While AI holds significant potential to enhance aesthetic dermatology, its responsible integration requires addressing these challenges through clinician training, ethical guidelines, and robust data security measures. Effective use of AI will depend on collaboration between technology developers, clinicians, and regulatory bodies. Perspectives: Looking forward, the development of diverse, inclusive datasets and transparent, patient-centered AI models will be essential to ensure that AI’s benefits reach all patients equitably and safely. By prioritizing these factors, AI-driven technologies would become a reliable, accessible, and transformative element of aesthetic dermatology practice....
Objective: This systematic review evaluates the current applications, advantages, and challenges of large language models (LLMs) in melanoma care. Methods: A systematic search was conducted in PubMed and Scopus databases for studies published up to 23 July 2024, focusing on the application of LLMs in melanoma. The review adhered to PRISMA guidelines, and the risk of bias was assessed using the modified QUADAS-2 tool. Results: Nine studies were included, categorized into subgroups: patient education, diagnosis, and clinical management. In patient education, LLMs demonstrated high accuracy, though readability often exceeded recommended levels. For diagnosis, multimodal LLMs like GPT-4V showed capabilities in distinguishing melanoma from benign lesions, but accuracy varied, influenced by factors such as image quality and integration of clinical context. Regarding management advice, ChatGPT provided more reliable recommendations compared to other LLMs, but all models lacked depth for individualized decision-making. Conclusions: LLMs, particularly multimodal models, show potential in improving melanoma care. However, current applications require further refinement and validation. Future studies should explore fine-tuning these models on large, diverse dermatological databases and incorporate expert knowledge to address limitations such as generalizability across different populations and skin types....
The COVID-19 pandemic has encouraged the rapid development and licensing of vaccines against SARS-CoV-2. Currently, numerous vaccines are available on a global scale and are based on different mechanisms of action, including mRNA technology, viral vectors, inactive viruses, and subunit particles. Mass vaccination conducted worldwide has highlighted the potential development of side effects, including ones with skin involvement. This review synthesizes data from 62 manuscripts, reporting a total of 142 cases of autoimmune blistering skin diseases (AIBDs) following COVID-19 vaccination, comprising 59 cases of pemphigus and 83 cases of bullous pemphigoid. Among the 83 bullous pemphigoid cases, 78 were BP, with additional cases including 2 oral mucous membrane pemphigoid, 1 pemphigoid gestationis, 1 anti-p200 BP, and 1 dyshidrosiform BP. The mean age of affected individuals was 72 ± 12.7 years, with an average symptom onset of 11 ± 10.8 days postvaccination. Notably, 59% of cases followed vaccination with BNT162b2 (Pfizer-BioNTech), 51.8% were new diagnoses, and 45.8% occurred after the second dose. The purpose of our review is to analyze the cases of pemphigus and bullous pemphigoid associated with COVID-19 vaccination and to investigate the pathogenetic mechanisms underlying the new development or flare-up of these diseases in association with vaccination. Our results show that the association between COVID-19 vaccines and AIBDs is a possible event....
Background The incidence of non-tuberculous mycobacterium infection has shown a gradual increasing trend in recent years, among which cutaneous manifestations as an important aspect. This study aimed to describe the clinical features and microbiological findings in 6 cases of primary cutaneous nontuberculous mycobacterium infection. Methods In this retrospective study from June 2021 to June 2022, the clinical data and microbiological results of six cases diagnosed with primary cutaneous non-tuberculous mycobacterium infection in department of dermatology, Hangzhou Third People’s Hospital were analyzed. Results All six cases were primary cutaneous non-tuberculous mycobacterium infections, four of which had a history of trauma or exposure, and two had an underlying disease that could lead to compromised immunity. All patients presented with erythema nodular skin lesions, four on the upper or lower extremities, one on the face, and one on the right hip. The histopathological findings of five patients who underwent biopsy were granulomatous inflammatory changes with mixed infiltration. Laboratory cultures using tissue or tissue fluid were all successful, including four Mycobacterium marinum, one Mycobacterium abscessus, and one Mycobacterium avium. Metagenomics next-generation sequencing detected results consistent with culture colonies in only two cases. With the exception of case 4, all patients responded well to oral medication, with a course of treatment ranging from 4 months to 1 year, and the prognosis was good. Conclusions The clinical features of primary cutaneous non-tuberculous mycobacterium infection are often lacking in specificity, and the identification of related strains is difficult for a variety of reasons. Although the results of metagenomics next-generation sequencing are useful for pathogen spectrum identification, its diagnostic value should be carefully reevaluated under certain circumstances. Patients with suspected triggers who do not respond well to conventional treatments should be suspected as atypical infection and potential immunosuppression. If diagnosed and treated promptly, the prognosis of primary cutaneous non-tuberculous mycobacterium infection is generally good....
The human scalp is a common site of skin cancer in humans, with nonmelanoma skin cancer being exceedingly common. In this review, two dermatologists with extensive experience in cutaneous oncology will discuss unique features of the epidemiology of cancer of the scalp. Clinical observations on these common skin cancers lead to insight into the pathogenesis and potential prevention and treatment of cutaneous scalp neoplasia. Our hypothesis is that the presence of hair protects against the development of skin cancer but not by serving as a physical shield but rather by providing continuous IL-17-biased immunosurveillance. The loss of hair allows for a release from immunosurveillance, resulting in the expansion of neoplastic cells towards skin cancer. Both hair follicles and metabolic changes in stroma allow for permissiveness for tumor promotion....
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