Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 5 Articles
Background: Nontuberculous mycobacteria (NTM) skin infections pose significant diagnostic challenges in clinical practice, due to nonspecific clinical/histopathological features and limitations of conventional pathogenic detection methods. Metagenomic next-generation sequencing (mNGS) offers a promising approach but requires further evaluation. Methods: A prospective pilot study at Peking Union Medical College Hospital enrolled 20 patients with cutaneous NTM infection, confirmed by positive skin culture or mNGS. All patients underwent thorough clinical assessment, skin biopsy for histopathology and culture, and mNGS testing of skin tissue. Treatment was based on identified species and disease extent. Treatment outcomes were tracked. Results: Among 20 patients (median age 45.5 years), fingers were the most common site affected (n = 10), followed by forearms (n = 7), hands (n = 4), and face (n = 4). Mycobacterium marinum was the predominant pathogen (n = 12), associated with fish bone puncture, followed by M. abscessus (n = 4). mNGS demonstrated a substantially higher positivity rate than culture (95% [19/20] vs. 30% [6/20]) and delivered results faster. Histopathology revealed granulomatous inflammation in all cases. Nineteen patients presented with non-disseminated disease; one immunocompromised patient (GATA2 deficiency) had disseminated M. abscessus infection. Treatment success was achieved in 17 patients (85%) with tailored antibiotic regimens. Adverse drug effects occurred in seven patients. Conclusions: In this pilot study of cutaneous NTM infections, mNGS enabled more rapid diagnosis relative to conventional culture. Clinical presentation and exposure history correlate with specific NTM species. Integrating mNGS with clinical assessment significantly improves diagnosis and management....
Background: Cutaneous warts, caused by HPV, are common, and conventional destructive treatments often fail to prevent recurrence. Intralesional immunotherapy offers a promising alternative. Specifically, purified protein derivative (PPD) and vitamin D have demonstrated efficacy; however, a direct comparison of their therapeutic value and safety profiles is needed. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare the efficacy and safety of intralesional PPD versus intralesional Vitamin D for cutaneous warts. Methods: A comprehensive search of PubMed, Scopus, CENTRAL, and Google Scholar was conducted for RCTs up to November 2025. Primary outcomes were the complete and partial clinical response rates of warts. Secondary outcomes included recurrence and adverse events. Risk ratios (RRs) with 95% confidence intervals (CIs) and p-values were pooled using STATA 19.5. Results: Seven RCTs involving 520 patients were included. The analysis found no significant difference in the rate of complete clinical response (RR: 1.07, 95% CI [0.95, 1.21]; p = 0.24) or partial clinical response (RR: 0.90, 95% CI [0.56, 1.46]; p = 0.68) between the two groups. Also, the two groups showed no significant difference in recurrence rate (RR: 1.14, 95% CI [0.48, 2.68]; p = 0.77). Regarding safety, PPD was associated with a significantly higher risk of injection site erythema (RR: 4.76, 95% CI [2.08, 10.93]; p < 0.001) and flu-like symptoms/fever (RR: 8.28, 95% CI [1.59, 43.18]; p = 0.01). Still, no significant differences were found for injection site pain (p = 0.12) or swelling (p = 0.68). Conclusions: With uncertain evidence, intralesional PPD and vitamin D demonstrate comparable overall efficacy in clearing cutaneous warts. However, PPD carries a higher risk of systemic adverse events (fever) and injection site erythema, with a more effective potential to clear distant warts. The choice between the two agents should be based on the clinical profile and patient preference....
Cutaneous lichen amyloidosis (CLA) is a rare dermatological condition characterized by amyloid deposition in the skin, presenting as pruritic, hyperkeratotic papules. Although most cases are sporadic, CLA has been associated with multiple endocrine neoplasia type 2A (MEN2A), a hereditary syndrome caused by germline alterations in the RET protooncogene. In MEN2A, CLA is typically localized to the interscapular region and linked to RET codon 634 variants, whereas generalized forms are rare. We report a male patient with MEN2A and a generalized form of CLA that preceded the diagnosis of primary hyperparathyroidism (PHPT) and medullary thyroid carcinoma (MTC). Genetic testing using Sanger sequencing identified an ultra-rare heterozygous RET variant, p.Y806C, in exon 14, currently classified as a variant of uncertain significance (VUS). This variant has not been previously described in association with MEN2A. This case may contribute to understanding genotype–phenotype correlations in MEN2A and suggests that atypical or generalized CLA may be an early clinical clue warranting consideration of RET genetic testing....
Background: Scarring is a common dermatologic concern with both aesthetic and functional implications. Polynucleotide (PN)- based injectables have emerged as medical devices in dermatologic practice; however, real- world evidence on their use in scar management remains limited. Objective: To describe current clinical practices, application patterns, and perceived roles of PN injections in scar prevention and management among dermatologists belonging to the Korean Society for Anti- Aging Dermatology (KAAD). Methods: A nationwide, cross- sectional, web- based survey was conducted among KAAD dermatologists. The questionnaire assessed PN use by scar type and etiology, injection techniques, combination strategies, and barriers to adoption. Data were analyzed descriptively. Results: Among 501 respondents, 73.0% reported using PN for scar management. PN was most commonly used for scar prevention (81.4%) and atrophic scars (74.9%), with limited use in hypertrophic scars (10.1%). Intradermal injection over three sessions was the most common approach. PN was frequently incorporated into multimodal protocols, including botulinum toxin, fillers, corticosteroids, bleomycin, and energy- based devices. Reported benefits included improved tissue response, enhanced skin texture, and accelerated wound recovery. Key barriers to PN adoption were product cost (66.7%), limited awareness of its role in scar management (52.6%), and injection discomfort (25.2%). Conclusion: PN injections are commonly incorporated into scar prevention and management among KAAD dermatologists participating in this survey, particularly for acne- related, surgical, and traumatic scars. These findings provide real- world insight into current practice patterns and are hypothesis- generating. Prospective studies are needed to define optimal treatment protocols, including dosing, treatment intervals, and combination strategies....
Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis characterized by recurrent nodules, abscesses, and sinus tract formation in intertriginous skin. Although HS is increasingly recognized as an autoinflammatory condition rather than a classical infection, antimicrobial therapies remain central to disease management, implicating a potential role for the cutaneous microbiome in disease activity. Recent advances in culture-independent sequencing techniques have enabled more detailed characterization of microbial communities in HS, revealing consistent alterations in microbial composition and diversity. Compared with healthy skin, HS lesions exhibit reduced microbial diversity, depletion of commensal organisms such as Cutibacterium acnes, and enrichment of anaerobic bacteria including Prevotella, Porphyromonas, and Finegoldia. These alterations are more pronounced in chronic, tunnel-forming disease and are frequently associated with biofilm formation, which may contribute to treatment resistance and persistent inflammation. Microbiome changes have also been observed beyond overtly lesional skin, suggesting a broader field effect. Evidence regarding extracutaneous microbial compartments, particularly the gut microbiome, remains limited and heterogeneous, while methodological variability in sampling, sequencing, and treatment exposure continues to complicate cross-study comparisons. Emerging data further suggest that immune-targeted therapies, including biologic and small-molecule agents, may indirectly influence microbial community structure through modulation of the inflammatory milieu. Collectively, the available evidence supports cutaneous dysbiosis as a characteristic feature of HS that may potentially interact bidirectionally with immune dysfunction. Future longitudinal, multi-omic studies integrated with clinical phenotyping will be critical to clarify causal relationships and to determine whether microbiome modulation can be leveraged to improve therapeutic outcomes in HS....
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