All Articles

Mayer Brezis

Braun School of Public Health & Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

Finasteride, widely prescribed for androgenetic alopecia and increasingly obtained online, has been associated with persistent neuropsychiatric adverse effects, including depression, anxiety, cognitive impairment, and suicidality. This Mini Review examines the strength of evidence supporting a causal relationship between finasteride and these reactions, evaluates the drug’s benefit–risk balance in cosmetic use, and discusses implications for clinical practice and regulation. Evidence from experimental, clinical, and epidemiological studies across multiple countries fulfills key Bradford–Hill criteria for causality, including temporality, consistency, biological plausibility, and reversibility, with reports of persistent symptoms after drug discontinuation. Mechanistically, inhibition of 5α-reductase reduces neurosteroid synthesis—particularly allopregnanolone—affecting mood regulation, neurogenesis, and neuroinflammatory pathways. Regulatory agencies have responded by updating safety warnings, and some countries now require formal informed consent prior to prescription.

Although finasteride demonstrates short-term efficacy for hair loss, evidence for long-term benefit is limited, while meta-analytic data suggest an approximately 50% relative increase in depression risk. Given the baseline prevalence of depression, this translates into a clinically meaningful absolute risk, with rare but grave outcomes including suicide. Because alopecia is a cosmetic condition with alternative management options, application of the precautionary principle is warranted. Clinicians should ensure comprehensive disclosure of potential neuropsychiatric harms, screen for prior mood disorders, and engage in genuine shared decision-making. In light of persistent adverse effects, limited long-term efficacy data, and broader public health costs, avoidance of finasteride for hair loss and strengthened regulatory oversight should be seriously considered.

Mary C. Swaim and Tony A. Slieman^*

Department of Biomedical and Anatomical Sciences, NYIT College of Osteopathic Medicine at Arkansas State University, P.O. Box 119, State University, AR 72467.

Obsessive-compulsive disorder (OCD) and body-focused repetitive behaviors (BFRBs) are becoming increasingly prevalent in dermatology. Patients presenting with cutaneous concerns may have underlying psychiatric conditions, such as excoriation disorder, trichotillomania, and onychophagia. Despite up to 12% of the population meeting BFRB criteria, these disorders frequently go undetected due to stigma, underreporting, and a primary focus on cutaneous symptoms. Data suggest a substantial overlap in clinical presentation, neurobiology, genetics, and interventions among obsessive-compulsive spectrum disorders. Affected individuals experience elevated risks of comorbid anxiety, depression, and additional compulsive disorders. Dermatologists are uniquely positioned as the first to detect sequelae of these conditions, including alopecia, excoriations, nail deformities, and secondary infections. Validated screening tools, along with dermoscopy and full-body skin examinations, can aid in earlier detection. Treatment interventions for BFRBs remain inconsistent, with behavioral therapies showing more promising results and pharmacologic interventions demonstrating variable efficacy. This review synthesizes the current knowledge of OCD and BFRBs, including their relevance in dermatology and the importance of interdisciplinary collaboration. Increasing awareness and strengthening the dermatology-psychiatry partnership allows practitioners to address both the physical and psychological manifestations accompanying these conditions, ultimately leading to better treatment outcomes.

Ahmed M. Al-Jumaily^* and Hassan Liaquat

Institute of Biomedical Technologies, Auckland University of Technology

Richard J. Moraga

Rosalind Franklin University of Medicine & Science, North Chicago IL 60064.

Chronic burn scars represent a unique dermatologic substrate characterized by persistent inflammation, altered immune surveillance, and long-term structural skin changes that may predispose patients to cutaneous malignancy. Squamous cell carcinoma arising in burn scars, often referred to as Marjolin’s ulcer, is a well-documented but frequently delayed diagnosis associated with aggressive behavior and poor outcomes. While acute burn management is typically overseen by burn specialists and reconstructive surgeons, long-term surveillance of healed burn scars often falls outside structured care pathways. Dermatologists are uniquely positioned to identify early malignant transformation within burn scars due to their expertise in skin cancer recognition and longitudinal outpatient follow-up. This mini-review summarizes the epidemiology and pathophysiology of burn scar–associated malignancy, highlights clinical features suggestive of malignant transformation, and proposes a dermatology-centered framework for surveillance and early intervention. Increased awareness of burn scars as oncogenic risk sites may improve diagnostic timeliness and patient outcomes.

Caroline Thorup Ladegaard^1*, Henrik Frank Lorentzen¹, Mathias Tiedemann Svendsen^1,2

¹The Department of Dermatology and Allergy, Odense University Hospital, Denmark

²Department of Clinical Research, University of Southern Denmark, Denmark

Trigeminal Trophic Syndrome (TTS) is a rare, well-documented neurocutaneous condition characterized by the triad of paresthesia, analgesia, and ulcerations caused by self-manipulation, most commonly affecting the ala nasi. It typically arises following injury to the trigeminal nerve, either centrally or peripherally.

We report the case of a 75-year-old woman who developed TTS following a cerebral stroke. Initially, her symptoms were misinterpreted as a psychiatric disorder, but the diagnosis of TTS was ultimately made based on the combination of prior trigeminal nerve injury and the classical symptom triad. This case highlights the diagnostic challenges of TTS and emphasizes the need to consider neurological etiologies in patients with atypical facial ulcerations.

Dieter Leupold

Formerly LTB Lasertechnik Berlin GmbH, D-12489 Berlin, Germany.

Anne Stockmann¹, Lisbeth Lützen², Karen M. T. Astvad³, Kristin Bergmann⁴, Sebastian V. Svendsen^1,5, Mathias T. Svendsen^1,5

¹The Department of Dermatology and Allergy, Odense University Hospital, Denmark

²Department of Clinical Microbiology, Vejle Hospital, Denmark

³Bacteria, Parasites & Fungi, Statens Serum Institute, Copenhagen, Denmark

⁴The Department of Dermatology and Venereology, Aarhus University Hospital, Denmark

⁵Department of Clinical Research, University of Southern Denmark, Denmark

Tinea capitis is a superficial dermatophyte infection affecting the hair and scalp. The zoophilic dermatophyte Microsporum canis is one of the most frequent causes of both tinea capitis and tinea corporis in humans, particularly in children.

We present a case report involving whole-family transmission of M. canis due to close contact with a neighbor’s cat. All five children in the household developed scaly scalp lesions consistent with tinea capitis, while the parents exhibited only mild cutaneous involvement. Skin scrapings and hair samples from all family members were collected and analyzed using PCR, confirming M. canis in all family members.

The children were successfully treated with oral griseofulvin, while the parents responded well to topical ketoconazole shampoo.

This case highlights the importance of clinical awareness of tinea capitis, as early diagnosis and treatment are essential to prevent chronic hair changes and limit further transmission. Additionally, treatment of the infected animal under veterinary supervision is crucial to avoid reinfection.

Frederik Bloch Mangaard^1*, Ileana Codruta Vasilescu², Lisbeth Lützen³, Karen Marie Thyssen Astvad⁴, and Mathias Tiedemann Svendsen^1,5

¹Department of Dermatology and Allergy Center, Odense University Hospital, Denmark

²Department of Pathology, Odense University Hospital, Denmark

³Department of Clinical Microbiology, Lillebælt Hospital, Vejle, Denmark

⁴Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen

⁵Department of Clinical Research, University of Southern Denmark, Denmark

Miranda L. Yousif MD MPH¹, Stefanie Nguyen MS MMS¹, Jordan Ward MD^1,2, Margaret Kessler MD FAAD2^1,2,3

¹ University of Arizona College of Medicine-Phoenix

² Banner University Medical Center

³ Medical Dermatology Specialists

Monika Bapna B.S¹, Emily S. Ruiz², Catherine Pisano M.D²

¹Georgetown University School of Medicine, Washington, DC, USA

²Brigham and Women’s Hospital, Boston, MA, USA

Purpose:

The management of multifocal perianal high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma in situ (SCCIS) remains challenging, especially in immunosuppressed populations such as individuals with HIV. Current treatments are often invasive and associated with high recurrence rates. This case report explores the use of combination 5% fluorouracil and 0.005% calcipotriene cream (5FU/C) as a non-invasive therapeutic alternative for recurrent perianal HSIL and SCCIS.

Methods:

We present a case of a 57-year-old HIV-positive male on antiretroviral therapy with recurrent HSIL and SCCIS involving the perianal, gluteal, perineal, and inguinal regions. After failing multiple surgical excisions, the patient was treated with 5FU/C cream applied topically twice daily for 8 days.

Results:

The patient experienced a strong inflammatory response and discontinued therapy prior to the recommended 10-day course. However, at 1-month follow-up, there was complete clinical resolution of external lesions. Four months later, internal recurrence was detected via digital rectal exam and high-resolution anoscopy, but external lesions remained clear. Biopsies confirmed HSIL without invasive disease.

Conclusion:

This case illustrates the potential of 5FU/C as a non-invasive treatment option for extensive external HSIL and SCCIS in immunocompromised patients. While external lesion resolution was achieved, internal disease recurrence at 4 months after 5-FU/C treatment emphasizes the importance of comprehensive internal evaluation. These findings support further investigation of 5FU/C as an adjunct or alternative to surgical treatment in the multidisciplinary management of anal neoplasia.

¹Michaela N. Crawford, ²Victoria S. Jiminez, ³Tiffany T. Mayo

¹School of Medicine, Meharry Medical College

²School of Medicine, University of Alabama at Birmingham

³Department of Dermatology, University of Alabama at Birmingham 500 22nd Street South, Floor 3, Birmingham, AL 35233

Atopic Dermatitis (AD) affects those of all ages and demographics. AD is known to be cumbersome and financially taxing, significantly affecting patients’ quality of life (QoL). The purpose of this study is to assess the financial implications across various socioeconomic backgrounds and community types from the patient perspective within a single institution in the Southeastern U.S. A cross-sectional survey was administered to those ≥18 years old diagnosed with AD. Patients self-reported information on their socioeconomic status (SES), education level, affordability, expenses related to their AD, and factors affecting their QoL. In our cohort of sixty-four patients, we found that one in five patients have been unable to afford treatment at some point. This finding is not confined to the lowest income group, but rather all groups have experienced affordability difficulty. It is clinically significant that patients chose financial burden, transportation and access to medical care as one of their top three factors that decreased their QoL. We also found that the understanding of disease and treatment options may not be based on education level. Understanding the socioeconomic impact of disease facilitates ber resource allocation and knowledge of how we can better serve the evolving patient population.

Ernest C. Lee, MD, MPH

Principal Investigator, Scottsdale Clinical Trials, Harvard Medical Consultant, 8997 East Desert Cove FL2, Scottsdale, Arizona 85260

Juan M. Guzmán-Flores¹, María L. Ramírez-de los Santos¹, Araceli López-Navarro¹, Cecilia Rico-Fuentes¹, Adrián Ramírez-de Arellano², Ana L. Pereira-Suárez³, and Edgar I. López-Pulido^1*

¹Biosciences Research Laboratory, Department of Health Sciences, University Center of los Altos, University of Guadalajara, 47620 Tepatitlan de Morelos, Jalisco, Mexico.

²Biomedical Sciences Research Institute, Department of Molecular and Genomics, University Center of Health Sciences, University of Guadalajara, 44340 Guadalajara, Jalisco, Mexico.

³Department of Microbiology and Pathology, University Center of Health Sciences, University of Guadalajara, 44340 Guadalajara, Jalisco, Mexico.

Skin cancer is a disease marked by the presence of abnormal cells within the skin tissues. These cells grow in a disorganized manner and reproduce uncontrollably at a rapid pace. Various factors contribute to the onset and progression of skin cancer; these can be genetic and environmental, psychological, microbiological, and immunological, such as inflammation and a weakened immune system. Signal transducers and activators of transcription (STATs) are a family of latent transcription factors activated in response to various cytokines and growth factors. This study aims to identify the association of STAT3 activation with pro-inflammatory cytokines such as IL-1 β, IL-6, and TNF-α. The phospo-STAT3/STAT3 ratio indicates significant activation levels of this transcription factor in skin cancer patients versus the control group. Also, we encountered higher serum concentrations of IL-1𝛽, IL-6, and TNF-𝛼 compared to the control group. Although our analysis did not show a correlation between STAT3 activation and cytokines, elevated levels of activated STAT3 offer new insights into the practical application of STAT3, which could help develop more effective treatments for this malignancy. In addition, the fact that patients show a higher serum concentration of cytokines highlights their key role in the pathophysiology of skin cancer.

Mingxing Ding¹, Xue Zhao¹, Xiaoxiao Jia², Joshua H Shofaro³, Zhaohui Ma², Mizhou Hui^2*

¹Dermatology Unit, Changchun Jiahe Surgery Hospital, Jilin Province, PRC

²Hynaut Laboratories, Hynaut Group, Shandong province, PRC

³Letters and Science, University of California at Santa Barbara, California, USA

Purpose: This study aims to evaluate the short-term effectiveness and safety of 35 kDa low molecular weight Hyaluronan (HA35) combined with negative pressure microneedling technology in improving skin hydration, brightness, and inflammation within a four-week observation period.

Patients and methods: Sixteen subjects with skin issues—including dryness, roughness, dull complexion, and enlarged pores—were recruited, with seven participants also presenting with chronic skin inflammation. Each subject received a single treatment using DermaShine PRO microneedling combined with HA35. Skin condition was evaluated 20 minutes post-treatment and during follow-up using a skin analyzer, an improved Visual Analog Scale (VAS), and patient satisfaction surveys.

Results: The results demonstrated significant improvement in skin dryness and roughness (P<0.01) and increased brightness (P<0.05) within 20 minutes of treatment. Subjects with chronic inflammation showed a marked reduction in inflammation hardness and erythema (P<0.01). The treatment effect persisted for over one month, with 100% of participants reporting satisfaction during the follow-up period. No adverse reactions related to the procedure or product were observed throughout the study.

Conclusion: Negative pressure microneedling combined with HA35 offers an effective, non-pharmaceutical approach for improving skin hydration, brightness, and mild to moderate inflammation within a short-term period. This treatment demonstrates sustained effects over the four-week observation period and maintains high patient satisfaction. Given its safety and non-invasive nature, it represents a promising option for aesthetic dermatology, with potential for further optimization in future studies.

Iu Tong Mak*, Jay H. Kramer*, Joanna J. Chmielinska*, William B. Weglicki

Department of Biochemistry and Molecular Medicine, The George Washington University, School of Medicine and Health Sciences, Ross Hall, Rm 228, 2300 Eye Street, NW. Washington DC 20037; USA

Erlotinib, an EGFR-TKI, has been used as an effective anti-tumorigenesis agent against several cancers including lung, colon, head and neck. However, it has been reported to cause significant and severe cutaneous side effects. Our previous studies implicated substance P, a neuropeptide, as a significant mediator of skin toxicity. Our present study was designed to determine if the topical application of aprepitant, a specific substance P receptor blocker, would be protective against these skin side effects. Erlotinib in the diet was administered to the rats for 12 weeks. Facial rash and hair loss began to occur after 6 weeks and were most severe at 12 weeks when animals were sacrificed. Topical treatment of aprepitant to the facial area 3 times a week showed dose-dependent and progressive inhibition up to 70% of the induced dermatitis/hair loss. These results were comparable to the effects produced by oral doses in our prior study. At sacrifice, we also found significant elevations of neutrophil superoxide, that were inhibited by topical aprepitant, along with elevated plasma 8-isoprostane levels, that were also suppressed. Facial skin samples revealed increased leukocyte (CD11b positive) infiltration in the erlotinib-treated rats, which were substantially reduced by the topical aprepitant. In conclusion, the indicators of reactive oxidative species (ROS) suggest that neurogenic inflammation played a critical role in causing EGFR-TKI-induced toxicity; it also confirmed that the systemic inhibition of ROS production due to blockade of substance P action was significantly protective against the dermatitis/hair loss pathology.

Wei Zhang, M.D., Ph D, Yan Li, M.D

Department of Dermatology, Henan Provincial People′s Hospital, Zhengzhou University People′s Hospital, Henan University People′s Hospital, Zhengzhou 450003, China

Wei Zhang, Huiqian Yu, Shuping Wu, Yuhui Shi, Siyuan Chang, Yan Li^*

Department of Dermatology, Henan Provincial People′s Hospital, Zhengzhou University People′s Hospital, Henan University People′s Hospital, Zhengzhou 450003, China

Tania Flutto^*, Laura Thedy, Simona Zenato, Rita Pramotton, Luca Vernetti-Prot, Sabina Valentini

Institut Agricole Régional, 11100 Aosta, Italy

In case of impairments in skin integrity, the use of dermatological treatments may prevent the outbreaks of diseases, by restoring the physiological homeostasis of the injured tissue. Against this background, a method for preparing an active ingredient effective on wound healing has been developed, starting from sweet whey, a by-product of Fontina PDO cheese processing. Following the fractionation of whey constituents by ultrafiltration processes, the obtained permeate underwent controlled fermentation by a newly characterized Lactobacillus delbrueckii MF-20/7A/24 (BCCM accession number LMG P-31789) isolated in alpine pasture of Aosta Valley, a little region in the Northwest of Italy. The ability of the native bacterial strain was exploited to ferment the whey permeate fraction, in order to enhance its potentially bioactive components. In particular, the whey-based fermented product was rich in biomolecules with a potentially beneficial effect on human skin, including galacto-oligosaccharides and organic acids. The prepared ingredient, subject of a specific Italian patent (N. 102021000011006), showed the ability in vitro to induce skin wound healing, due to the presence of galacto-oligosaccharides (GOS) and butyric acid. As evidenced by the tests carried out, no cytotoxic reactivity or interferences with cell growth and cytoplasmatic metabolism were found out. Moreover, data from patch test on adult volunteers with sensitive skin confirmed the absence of irritating properties of the preparation.

Elzbieta Izbicka^*, Robert T. Streeper

New Frontier Labs LLC, San Antonio, Texas, U.S.A

Both the authors contributed equally to this work

Yashbir Singh¹, Quincy A. Hathaway², Bradley J. Erickson³

¹Radiology, Mayo Clinic, Rochester, MN, USA

²Department of Medical Education, West Virginia University, Morgantown, West Virginia, USA

³Radiology, Mayo Clinic, Rochester, MN, USA

B. S. Chandrashekar¹, Thomas Luger², S. C. Rajendran³, Anchala Parathasaradhi⁴, Jayakar Thomas⁵, Anil Ganjoo⁶, Divya Sharma⁷, Rajetha Damishetty⁸, Nazima Ruby⁹, Vijayalakshmi Sujay¹⁰, Snehal Sriram¹¹, Satish Udare¹², Dhara Shah¹³, Jayesh Rajgopal^*14

¹Chief Dermatologist / Medical Director: Cutis, Academy of Cutaneous Sciences, Bengaluru

²Department of Dermatology, University of Muenster, Muenster, Germany

³Director and Senior Consultant Dermatologist at Cosmetic Skin Care Clinic, Koramangala, Bengaluru

⁴Senior Consultant Dermatologist at Anchala’s Skin Institute, Hyderabad

⁵Professor & Head, Chettinad Hospital and Research Institute, Chennai

⁶Director, Skinnovation Clinics, New Delhi

⁷Chief Consultant at Dr Divya’s Skin and Hair Solutions, Bangalore

⁸Additional Medical director, Oliva chain of 23 Hair and Skin Clinics

⁹Consultant Dermatologist, Radiant Skin Clinic, Bengaluru

¹⁰Consultant Dermatologist and Cosmetologist, Shree Skin and Cosmetic Clinic, Bengaluru

¹¹Consultant and Head of Cosmetic Dermatology Department at Nahar Medical Center, Mumbai

¹²Medical Director of ‘Sparkle’ Skin and Aesthetic Centre, Vashi and ‘Disha Skin and Laser Institute’ Thane, Mumbai

¹³Head Medical Affairs, Mylan Pharmaceuticals Private Limited - A Viatris Company

¹⁴Senior Medical Manager, Mylan Pharmaceuticals Private Limited - A Viatris Company

The prevalence of atopic dermatitis (AD) in India is 2.7% (age 6–7 years) and 3.6% (age 13–14 years). Emollients remain mainstay treatment for atopic dermatitis. The present review article focuses on the role of active ingredients in emollients towards the management of AD. Article were selected by searching in database like Google Scholar and PubMed and were reviewed by the authors. Daily use of emollients from birth may significantly reduce the incidence of AD in a high-risk population. Emollients with a variety of active ingredients to target AD pathophysiology have been developed which contain active ingredients like liquorice extract (anti-inflammatory and anti-pruritic), niacinamide (restoration of barrier function), sterols (restoration of barrier function), laureth-9-polydocanol (anti-pruritic), xylitol (microbiome maintenance) and galacto-oligosaccharide (GOS) (microbiome maintenance). Emollient plus may be a useful adjunct to pharmacological therapy in AD and as maintenance therapy, providing rapid and significant improvements in skin moisture, epidermal barrier function, and signs and symptoms of AD.

Akira Hagino^*, Mitsuhiro Gomi

Central R&D Laboratories, KOBAYASHI Pharmaceutical Co., Ltd., 1-30-3, Toyokawa, Ibaraki 567-0057, Japan

Vitamin C, known for its various effects on the skin, promotes epidermal differentiation and enhances skin barrier function. However, the underlying mechanism remains unclear. Autophagy is an intracellular degradation system that maintains cellular homeostasis. Although autophagy decrement has been associated with barrier defects in skin diseases, the mechanism by which autophagy regulates skin barrier function remains insufficiently understood. Therefore, this study aimed to investigate the relationship between autophagy and transglutaminase-1 (TGase-1), a molecule required to form the cornified envelope that contributes to skin barrier function. We also examined the effect of vitamin C on autophagy in epidermal keratinocytes. Autophagy modulation through the knockdown of autophagy-related molecules (ATG5, ATG7, and ATG13) significantly decreased TGase-1 expression in human epidermal keratinocytes. Furthermore, vitamin C treatment enhanced the autophagic activity of epidermal keratinocytes and suppressed TGase-1 expression decrease in ATG13 knockdown cells. In conclusion, TGase-1 expression can be regulated by autophagy, and vitamin C may be involved in skin barrier function through autophagy activation.

Abbreviations: TGase-1: transglutaminase-1; CE: cornified envelope; ATG5: autophagy related 5; ATG7: autophagy related 7, ATG13: autophagy related 13, LOR: loricrin; FLG: filaggrin; TBP: TATA-box binding protein; LC3: microtubule-associated protein 1 light chain 3; CQ: chloroquine; VC: vitamin C; CTL: control.

Roy S. Rogers¹, Suha Zawawi¹, Thais Pincelli²*, Markéta Janovská², Alison Bruce¹

¹Department of Dermatology– Mayo Clinic Florida –Jacksonville, FL, USA

²Department of Oral Medicine, Institute of Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University - Prague, Czech Republic

Roy S. Rogers, III, MD¹; Suha Zawawi MBBS^1*; Thais Pincelli MD¹; Markéta Janovská MDDr.²; Alison Bruce MD¹

¹Department of Dermatology – Mayo Clinic Florida – Jacksonville, FL, USA

²Department of Oral Medicine, Institute of Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University - Prague, Czech Republic.

Jacobus van der Velden^*, Ming Tjiong

Amsterdam UMC, location University of Amsterdam, Gynecologic Oncology, Meibergdreef 9, Amsterdam, the Netherlands

Guidelines recommend adjuvant treatment when positive lymph nodes are found after surgical treatment for squamous cell cancer of the vulva except for cases with a single occult intranodal metastasis. Recent studies questioned these recommendations and showed benefit of adjuvant radiotherapy for all patients with positive nodes irrespective of number of nodes. However, these studies did not take into account important nodal characteristics, such as clinical node status, extranodal spread or size of the metastasis. When these variables are taken into account, adjuvant radiotherapy does not seem to result in a better survival for patients with a single occult intranodal metastasis. Whether the addition of chemotherapy to the radiotherapy for patients with more than one positive node or extracapsular spread results in a better survival remains uncertain. Only a few studies have been published on this subject and come to the conclusion that adding chemotherapy results in a better survival. The conclusion is that adjuvant radiotherapy improves survival of patients with positive groin nodes, with the exception of patients with a single intranodal metastasis. The beneficial effect of chemo radiotherapy for subgroups of patients with positive nodes seems likely, although more data are needed before a definite conclusion can be made.