The rising incidence of dermatophytosis, marked by atypical presentations and increasing resistance to treatment, has posed significant challenges to effective clinical management, particularly in regions like Nepal, where localized guidance is limited. In response, a panel of dermatology experts in Nepal conducted a structured literature review and employed a modified Delphi process to develop updated consensus recommendations. These guidelines aim to assist clinicians in making informed decisions regarding diagnosis and treatment, with an emphasis on improving patient outcomes. The consensus highlights key treatment principles, including the potential role of combination therapy and considerations for both localized and more complex presentations of the disease.

Background. Granulomatous dermatoses, particularly on facial skin, pose a diagnostic challenge, as similar histologic patterns can be produced by different causes. Aim. To evaluate the correlation between clinical suspicion and histopathological findings in various facial granulomatous dermatoses. Materials and Methods. This retrospective, cross-sectional study included all patients with the histopathological diagnosis of facial granulomatous dermatoses from the years 2016 to 2021 in an academic hospital. Demographic, clinical, and histopathologic features were reviewed and analyzed. Results. In this study, 150 histopathological records with the diagnosis of facial granulomatous dermatoses from the years 2016 to 2021 were reviewed. The most common clinical diagnosis was rosacea 34 (23.6%), followed by sarcoidosis 27 (18.8%), leishmaniasis 15 (10.4%), and granulomatous rosacea 10 (6.9%). The frequency of clinical diagnosis of rosacea (70.6), sarcoidosis (66.7), foreign body G (62.5), TB (75), pseudolymphoma (75), acne agminata (66.7), and granulomatous rosacea (70) in female patients was higher than that in males (P value = 0.03). The effect of age on the type of both clinical and histopathological diagnosis was statistically significant (P value = 0.0001 and 0.004, respectively). Conclusion. Our study contributed significantly to the understanding of the clinicopathological aspects of facial granulomatous dermatoses and advocated for a multidisciplinary approach to the diagnosis and management of these complex skin conditions.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially life-threatening mucocutaneous blistering diseases that clinically can resemble autoimmune bullous diseases. Moreover, it has been shown that autoantibodies against epidermal proteins are present in SJS/TEN. To establish the presence of antibodies against desmosomal and hemidesmosomal proteins in confirmed SJS/TEN patients. Serum of SJS/TEN patients diagnosed based on clinical criteria, e.g., epidermal detachment with erosions and severe mucosal lesions, (suspicion of) a culprit drug, and matching histologic results was evaluated by various techniques, e.g., indirect immunofluorescence on monkey esophagus, salt split skin and rat bladder, immunoblotting (IB) and immunoprecipitation (IP), ELISAs against desmogleins and BP180, keratinocyte footprint assay, and keratinocyte binding assay. A total of 28 patients were included in this study, 15 men and 13 women with a mean age of 56 years. In most patients, none of the serological tests were positive. In two patients, an elevated DSG3 titer was found suspicious for pemphigus vulgaris. Three patients had elevated NC16a titers, suggesting bullous pemphigoid. However, in all these patients, no other tests were positive and in these patients, the biopsy for direct immunofluorescence showed no evidence for an autoimmune bullous disease. Three patients showed reactivity against rat bladder rat bladder; these were, however, completely negative for A2ML1, envoplakin, and periplakin in the IB as well as the IP. Serological analysis for desmosomal and hemidesmosomal antibodies is reliable to rule an autoimmune bullous disease in patients with suspected SJS/TEN. However, one should not rely on one single test method since false positive results can occur. Moreover, this study also makes it less plausible that antibodies against desmosomal and/or hemidesmosomal components are involved in the pathogenesis of SJS/TEN.

The purpose of this study was to study the quality of life and psychiatric comorbidities of subjects practicing voluntary skin depigmentation in the city of Cotonou. A cross-sectional, prospective, and analytical study, based on a three-stage probabilistic sampling method, included from June to October 2020, consenting subjects over 15 years of age, practicing artificial skin depigmentation, and residing for at least one year in Cotonou. The Dermatology Life Quality Index, Rosenberg, and Hospital Anxiety and Depression scales allowed us to evaluate the quality of life and self-esteem, and identify anxiety and depression, respectively. A p value <0.05 indicated a significant result. We included 330 subjects. The mean age was 33.6 ± 11.6 years and the sex ratio was 0.4. Impaired quality of life was observed in 93.7% of subjects. Anxiety was diagnosed in 11.2% and depression in 5.8% of them. Self-esteem was low or very low in 24.2%. The degree of quality of life and the alteration of self-esteem, and the frequency of anxiety and depression were proportional to the number of skin lesions, the lightening products used, and the monthly cost of the products. The use of several lightening products exposes patients to numerous skin lesions, which are a source of impaired quality of life and whose persistence leads to psychiatric comorbidities.

Young people and athletes willing to gain muscle mass and strength are likely to consume whey protein supplements. The effect of milk as a dietary source of whey protein on acne is still controversial. At the same time, a few studies have suggested an acnegenic impact of whey protein supplements. To examine the association of whey protein supplements on acne risk among male adolescents and young adults. 201 male teenagers and young adults attending fitness centers in Irbid/Jordan were involved in an observational case-control research; those with acne were deemed cases, and those without acne were considered controls. The primary outcome was a comparison of the proportion of participants in each group who consumed whey protein supplements within the previous three months. 100 acne-afflicted participants were compared to 101 healthy controls with similar demographics, including age, body mass index, educational level, and smoking habits, as well as intake of vitamin B12, corticosteroids, and anabolic steroids. However, considerably more participants in the acne group (47%) were taking whey protein supplements than in the control group (27.7%) (p=0.0047). The significance of this difference was maintained after multivariate analysis. This case-control study provides evidence of a positive association between whey protein consumption and acne risk.

To review the scientific literature related to human microbiota and cutaneous T-cell lymphoma. Methodology. An exploratory and systematic review of the articles retrieved from the bibliographic databases MEDLINE (PubMed), Embase, The Cochrane Library, and Scopus, published in the last 10 years with the following descriptors: "lymphoma, T-cell, cutaneous," "microbiota," "Mycosis Fungoides," "Sézary Syndrome," "lymphoma, primary cutaneous anaplastic large cell," "Lymphomatoid Papulosis" and "Microbiota," "microbiota," "Microbial Community," and "Microbial Communities." Of the 87 references retrieved, after applying the inclusion and exclusion criteria, 21 articles were selected. Most studies linking cutaneous T-cell lymphoma and the microbiota focus on the cutaneous microbiome, with Staphylococcus aureus being the main related agent. Skin colonization by this bacterium could be involved in the hyperactivation of the STAT3 inflammatory pathway and in the overproduction of IL-17, both of which are widely related to the development of more aggressive and advanced forms of cutaneous T-cell lymphoma. We also found evidence of a possible relationship between intestinal dysbiosis and the development of cutaneous T-cell lymphoma, observing a decrease in taxonomic variability and an increase in certain genera such as Prevotella in the intestinal microbiome of patients with cutaneous T-cell lymphoma. The possible etiopathogenic mechanism underlying this relationship could be explained by an increase in systemic cytokine release, promoting the hyperactivation of STAT3 at the skin level. There appears to be a relationship between cutaneous T-cell lymphoma and the cutaneous and intestinal microbiome, as well as a possible pathophysiological pathway involved. The possible modulation of the cutaneous and intestinal microbiome or the action on the signaling inflammatory pathway, using pharmacological tools such as JAK inhibitors or IL-17 inhibitors in the latter case, could open the possibility for future therapeutic studies for cutaneous T-cell lymphoma.

Papulopustular rash (PPR) is the most frequent cutaneous adverse event during treatment with epidermal growth factor receptor inhibitors (EGFRis). Although often mild in severity, it can impair patients' quality of life and may also be a reason for discontinuing or changing the dose of the antineoplastic treatment. During COVID-19 pandemics, the use of surgical masks drastically increased and it had an impact on the face skin microenvironment, favoring the worsening of dermatological pathologies. We reported the relapse of PPR in patients treated with EGFR inhibitors who consistently wore face masks (>6 hours/day). All the patients developed the PPR within 6 months of starting mask use. Compared to the PPR occurred previously, after mask use, the skin eruption was more severe and affected mainly those regions of the face which came into contact with the mask. Patients received topical or systemic treatment, obtaining complete response in 65.7% of the cases. The establishment of an early treatment for the PPR allows continuing the oncologic treatment, without any suspension which could result in a decreased oncologic outcome. In conclusion, when using these devices, it is recommended to use special precautions, particularly in oncologic patients, by using a daily prophylactic skincare and replacing masks regularly with regular and frequent breaks.

Background: Fungal cultures are unavailable in many hospitals. The development of an effective sample storage solution for timely transportation would improve management of patients with superficial fungal skin and nail infections. Objectives: This study aimed to evaluate the efficacy of sample storage envelopes to preserve skin and nail samples for timely microscopic examination and culture for superficial fungal infections. Methods: Patients aged 18 years and above with suspected superficial fungal infections were enrolled. The samples were divided into four envelopes. The baseline 20% potassium hydroxide (KOH) examination and fungal culture served as reference points. The stored samples were reexamined on Days 3, 7, 14, and 28. Results: The study included 90 patients with suspected superficial fungal infections (45 skin and 45 nail lesions). Reference KOH examinations showed branching septate hyphae in 36 (80.0%) for skin and 35 (77.8%) for nail infections. Reference fungal cultures were positive for the growth of dermatophyte and nondermatophyte molds in 34 (75.6%) and 28 (62.2%) in skin and nail infections, respectively. Sample storage envelopes maintained 100% sensitivity and specificity for up to 28 days with KOH examination for both skin and nail samples. On Day 28, the fungal culture sensitivity was 70.6% for the skin and 64.3% for the nail samples, with specificities of 100.0% and 88.2%, respectively. Conclusions: Sample storage envelopes effectively maintained diagnostic accuracy for up to 28 days with KOH examination for both skin and nail samples. Given the high specificity even on Day 28 for fungal culture, transferring samples within 28 days remains a reliable practice.

Mycosis fungoides (MF) is a type of cutaneous T-cell lymphoma where red rash exists on the skin. Understanding the role of miRNAs and ncRNAs in p53-response has become an open discussion, as they can regulate p53 or its downstream targets, and ncRNAs themselves. To evaluate the serum levels of NEAT-1, miR-34a, and p53 in MF patients and its relation to healthy controls to indicate whether it has a potential role in the pathogenesis of the disease. Subjects and Methods. This prospective case-control study was carried out on 75 subjects subdivided into two groups, 35 MF patients (stages 1 and II) and 40 matched healthy controls. Their clinical investigations and serum biomarkers (NEAT-1, miR-34a, and p53) were measured. There were significant elevations in the expression levels of both NEAT-1 (5.10 ± 1.16) and p53 (277.28 ± 62.02) in the serum of MF patients in comparison with controls (1.01 ± 0.031) and (194.29 ± 16.039), respectively, while the level of miR-34a tends to decrease in MF patients (0.24 ± 0.15). There are no significant difference between MF stages and the level of miR-34a, while in NEAT-1 and p53, there are significant differences with p value <0.05 between the stages and the biomarkers. There is a positive correlation between the %BSA and miR-34a and a slightly positive correlation between NEAT-1 and P53 with (r = 0.353, p=0.037) and (r = 0112, p=0.05), respectively. There were also negative correlations between disease duration and NEAT-1 with (r = -0.341, p=0.045) and between B2 microglobulin level and p53 (r = -0.373, p=0.027). The combination of miR-34a, NEAT-1, and p53 may be considered as potential biomarkers that play an active role in the disease process of MF for helping in its early diagnosis and stage identification as well.

Background: Cutaneous leishmaniasis (CL) is an endemic disease in Ethiopia, mainly caused by L. aethiopica. Limited reports are available related to histopathological features of the skin lesion caused by L. aethiopica. This study aimed to analyze the histopathological features of CL due to L. aethiopica. Materials and Methods: A similar cohort polymerase chain reaction (PCR) confirmed CL patients from a previous own study, who were prospectively enrolled from All Africa Leprosy, Tuberculosis and Rehabilitation Training (ALERT) Hospital Addis Ababa, Kela Health Center in Gurage Zone, Siliti Health Center in Silit zone of southern nations and nationalities, as well as Ankober Health Center in Amhara region was used for data analysis. The histopathology was analyzed by performing hematoxylin and eosin (H&E) staining to look for the presence of general and specific histopathology patterns of the disease. Descriptive statistics was utilized using SPSS version 26.0 (SPSS, Inc., Chicago, United States of America). Results: Amastigotes were observed in skin biopsies of 29% (n = 2) mucocutaneous leishmaniasis (MCL) and 58% (n = 6) localized cutaneous leishmaniasis (LCL) patients. Diffused inflammatory cell infiltrate was observed in the dermal compartment of 77% (n = 20) samples while the remaining 23% (n = 6) had patchy or nodular inflammatory cell infiltrate. The dominant type of inflammatory cell infiltrate in the dermal compartments is macrophages and lymphocytes with a similar proportion, 23/26 (88.5%), followed by plasma cells, 21/26 (80.8%). Among all cases, 38.5% (n = 10) of them were categorized under the Type I pattern while Types IV and V patterns were reported in 26.9% (n = 7) and 34.6% (n = 9) of the remaining samples, respectively. The study found statistically significant correlations between necrosis and MCL (p=0.01), unorganized granulomas and LCL (p=0.04), and the presence of eosinophils and giant cell Langerhans with MCL (p=0.002 and p < 0.001, respectively). Conclusion: In our study, the histopathological patterns of the CL caused by L. aethiopica were shown to have a dermal change that was characterized by a domination of diffused inflammatory cell infiltrate. Most of the cell types in the infiltrate were macrophages and lymphocytes. In addition, amastigote resided in the histiocyte with a varying degree of intensity, and both the organized and unorganized granulomas were shown with a considerable proportion.