Combined platelet-rich plasma and hyaluronic acid (PRP-HA) offers a promising nonsurgical technique for tissue regeneration through synergistic efficacy and longevity effects. This study aims to investigate PRP-HA's efficacy and safety for neck rejuvenation. This 32-week prospective trial enrolled 30 Thai participants with mild-to-moderate neck aging. Treatment consisted of three monthly intradermal PRP-HA injections to the anterior neck surface, with follow-ups at 2weeks, and 1, 2, 3, and 6months posttreatment completion. Assessment included skin firmness, elasticity, biometric parameters, pain scores, and adverse effects. Of 29 completing participants, neck skin firmness improved 54% from baseline at 3-month posttreatment completion, increasing to 65% at 6months (p < 0.0001). While gross elasticity initially improved at 1month posttreatment (p = 0.0217); it subsequently declined. The 6-month follow-up showed substantial reductions in melanin and erythema (p < 0.01). Sustained improvements were observed in hydration through study completion (p < 0.01). Sebum levels decreased significantly after the first two treatments and at 3months posttreatment (p < 0.05). No significant changes appeared in skin texture, wrinkles, and brightness. Most participants reported 51-75% improvement after the third treatment, maintaining through 6months. No severe adverse effects were reported. PRP-HA demonstrates safe and effective improvements in neck skin firmness, hydration, and pigment and sebum regulation, with benefits lasting 6months after three treatment sessions. However, variable effects on elasticity and modest results on wrinkles, texture, and brightness warrant further controlled trials to further elucidate and confirm its rejuvenative properties on the neck. This trial is registered under the Thai Clinical Trials Registry (TCTR20230212003).

Treatment adherence is crucial for managing chronic diseases, including plaque psoriasis. In Bulgaria, patients with plaque psoriasis can receive treatment with reimbursed biologics, such as guselkumab, if they meet National Health Insurance Fund (NHIF) requirements. These requirements include stringent disease criteria and a complex administrative process. The objective of this analysis is to assess the proportion of patients adhering to the guselkumab administration schedule, as specified in the summary of product characteristics (SmPC), after the first continuation of the NHIF treatment approval period (approximately 48weeks). This was a prospective, multicenter, single-country, noninterventional study. The primary endpoint was the proportion of patients adhering to the guselkumab administration schedule as outlined in the SmPC after the first continuation of the NHIF treatment approval period. Secondary endpoints included evaluating guselkumab's safety and efficacy, as well as patient profile. This study included 39 female and 61 male patients with plaque psoriasis, with a mean age of 51.5years. Overall, 95% of enrolled patients adhered to the guselkumab dosing regimen (i.e., received all seven doses) at 50weeks after study initiation. Treatment with guselkumab led to a rapid and sustained reduction in Psoriasis Area and Severity Index (PASI) scores, with 84.4% of patients achieving PASI 90 and 42.7% reaching PASI 100 by the final visit. Significant improvements were also observed in absolute PASI, body surface area (BSA), and Dermatology Life Quality Index (DLQI) scores, indicating marked disease control and enhanced quality of life across the study period. There were ten adverse events during the study, and no new safety signals for guselkumab were identified. Bulgarian patients treated with guselkumab adhered well to treatment in this study, with an adherence rate comparable to that observed in randomized clinical trials and higher than the drug survival rates reported in real-world studies. This may be owing, in part, to the existing patient support programs specific to Bulgaria. Treatment with guselkumab in real-life clinical practice in Bulgaria was well tolerated and effective in reducing signs and symptoms of plaque psoriasis, consistent with the overall efficacy and safety profile demonstrated in randomized controlled trials.

Atopic dermatitis (AD) is a chronic inflammatory skin condition often associated with skin pain and sleep disturbance. The AD Skin Pain Numeric Rating Scale (SP-NRS) and Sleep Disturbance NRS (SD-NRS) are single-item patient-reported outcome measures developed to assess AD-related skin pain and sleep disturbance severity, respectively, in AD clinical trials. We used data from three randomized, double-blinded, placebo-controlled clinical trials of rocatinlimab in adults (aged ≥ 18years) (ROCKET-IGNITE and ROCKET-SHUTTLE) and adolescents (aged ≥ 12 to < 18years) (ROCKET-ASTRO) with moderate-to-severe AD to assess the reliability, validity, and responsiveness of the AD SP-NRS and SD-NRS. Clinical outcome assessments (COAs) supported the psychometric evaluation, and we estimated meaningful change thresholds for the AD SP-NRS and SD-NRS using anchor-based methods, which we confirmed with distribution-based methods. We included data from both the treatment arm and placebo in our analyses, and we analyzed results from adult and adolescent populations separately. This psychometric analysis sample used 262 adults (ROCKET-IGNITE, n = 145; ROCKET-SHUTTLE, n = 117) and 109 adolescents (ROCKET-ASTRO, n = 109), subsets from the initial data cuts of the respective clinical trials, in the psychometric analysis sample. Both AD SP-NRS and SD-NRS scores demonstrated high test-retest reliability for both adults and adolescents (intraclass correlation coefficients ≥ 0.80) and moderate-to-strong (|r| ≥ 0.30) positive correlations with most supporting COAs. Anchor-based meaningful within-patient change threshold ranges derived for AD SP-NRS and SD-NRS scores supported both 3-point and 4-point improvement thresholds for characterizing clinically meaningful changes. The AD SP-NRS and SD-NRS are reliable, valid, and responsive measures for assessing moderate-to-severe AD in adults and adolescents in clinical trials. The meaningful change thresholds identified in this study can be used in future clinical trials to interpret treatment effects.

Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition that disproportionally affects older adults. First-line oral treatments often yield suboptimal relief and may cause systemic side effects and drug-drug interactions. Effective topical treatments offer the potential to address this significant unmet medical need in PHN. This CASPAR analysis evaluated real-world effectiveness and safety of the high-concentration capsaicin patch (HCCP) in patients with PHN. Real-world data were evaluated for a large PHN cohort extracted from the German Pain e-Registry as part of the retrospective, noninterventional, multicohort CASPAR study. Patients received one to four HCCP treatments over 12months. Patient-reported outcomes included average pain intensity (API), quality of life (QoL), sleep impairment, mood, concurrent pain medications, and safety. This analysis included 961 patients with PHN (mean age: 63.8years, female: 69.7%; mean pain duration: 3.3years) receiving one (n = 187), two (n = 209), three (n = 207), or four HCCP treatments (n = 358). Mean 24-h API decreased from 61.8 at baseline to 46.8by month 3 (P < 0.001), and to 31.8 at month 12 (P < 0.001). Patients receiving four treatments had the greatest API reductions (63.7 at baseline versus 19.6 at month 12; P < 0.001), whereas improvements were lost in those who discontinued treatment. While ≥ 30% API response rates were similar across treatment groups at month 3 (25.6-30.7% of patients), those receiving additional treatments showed continued improvement, peaking at 99.7% by month 12 after four HCCP treatments. Trends were similar for other patient-reported outcomes, including QoL, sleep, and mood. Concomitant pain medication use decreased over time. Most adverse drug reactions were mild and application site-specific. HCCP is an effective and well-tolerated topical treatment for patients with PHN, including older adults. After one treatment, improvements were noted in API, QoL, sleep, and mood outcomes, alongside decreased concomitant pain medication use, with progressive improvements following additional treatments. A Graphical Abstract is available for this article.

There is increasing evidence suggesting that ultraviolet-induced fluorescence dermoscopy (UVFD) may enhance the diagnostic accuracy of various skin entities. This study aimed to evaluate the utility of UVFD for visualizing the discriminative features of the most common non-pigmented tumors of the face, including basal cell carcinoma (BCC), dermal nevus (DN), sebaceous hyperplasia (SebH), and seborrheic keratosis (SebK). A total of 181 lesions were examined using polarized dermoscopy (PD) and UVFD. For assessment, established dermato-oncologic criteria for PD, as well as previously defined and newly observed features for UVFD, were used. The most common UVFD findings in BCCs were dark silhouettes (84.48%), interrupted follicle patterns (54.83%), arborizing vessels (54.83%), and well-demarcated borders (41.93%). DNs exhibited dark silhouettes (72.72%), interrupted follicle patterns (66.66%), and well-demarcated borders (54.54%). SebHs presented with punctate pink central fluorescence (43.63%) and 2-3 central plugs with or without fluorescence (36.36%). SebK showed well-defined borders (70.96%), white-blue fluorescence at the ridge edges (41.93%), and an interrupted follicle pattern (41.93%). Several UVFD features were indicative of specific entities, such as black globules, which are characteristic of BCC, central plugs or punctate pink central fluorescence (SebH), and white-blue fluorescence at the ridges or warty surface (SebK). However, other findings, such as an interrupted follicular pattern or absence of follicular fluorescence, were common across lesions and did not allow for differentiation. The study offers new insights into the presentation of non-pigmented facial lesions under UVFD, with several features indicative of particular entities. Incorporating this method into daily practice may improve diagnostic accuracy and reduce unnecessary biopsies.

Plaque psoriasis (PsO) is an inflammatory skin disease that can impair quality of life. Tildrakizumab, an anti-IL-23 p19 monoclonal antibody, offers a treatment option for patients eligible for systemic therapy or phototherapy, but real-world results have not been comprehensively analyzed. This systematic review and meta-analysis evaluated real-world effectiveness, quality-of-life impact, and safety of tildrakizumab for treatment of moderate-to-severe plaque PsO, alone and relative to guselkumab and risankizumab. MEDLINE® and Embase were searched on November 16, 2023, along with meeting abstracts (2021-2023) and bibliographies of previous reviews, for English-language real-world studies of tildrakizumab (singly or comparative) in adults with chronic moderate-to-severe plaque PsO. Outcomes included effectiveness (Psoriasis Area and Severity Index [PASI], Physician's Global Assessment [PGA], body surface area percentage [%BSA] affected), Dermatology Life Quality Index (DLQI), and safety (adverse events [AEs], serious AEs [SAEs], treatment-related AEs [TRAEs], or withdrawals due to AEs [WDAEs]). Meta-analyses were performed at 12-16, 24-28, and 36-52weeks. Of 6982 records screened, 37 studies (45 publications) were analyzed. Tildrakizumab-treated patients experienced 78-87% improvement from baseline to 36-52weeks across mean absolute PASI (12.81 [95% confidence interval 11.69, 13.92] to 1.62 [1.03, 2.20]), %BSA (16.21% [13.72%, 18.70%] to 3.27% [1.26%, 5.28%]), PGA (3.18 [2.89, 3.47] to 0.70 [0.08, 1.33]), and DLQI (14.59 [12.32, 16.87] to 1.83 [0.84, 2.82]), with low rates of AEs, SAEs, TRAEs, and WDAEs. Benefits and safety of tildrakizumab were similar to guselkumab and risankizumab. Tildrakizumab demonstrated effectiveness, with reduction from moderate-to-severe to mild disease and improved DLQI scores, without notable safety concerns, for up to 1year in this real-world meta-analysis. Although real-world data must be interpreted cautiously because of heterogeneity and potential bias, these findings align with randomized trial results, further supporting the use of tildrakizumab in clinical practice.

Randomized clinical trials (RCTs) in atopic dermatitis (AD) often exclude older adults and patients with comorbidities, limiting the generalizability of trial findings to real-world populations. Despite the growing use of biologics and Janus kinase inhibitors (JAKis) in clinical practice, the extent to which real-world patients meet RCT eligibility criteria and their associated safety outcomes remains unclear. We conducted a retrospective analysis of a large, multicenter international cohort of adolescents and adults with AD treated with biologics (dupilumab, tralokinumab) or systemic JAKis (abrocitinib, baricitinib, upadacitinib) between October 2017 and March 2023 across 16 dermatology centers. Eligibility was defined according to commonly applied RCT criteria. Patients meeting ≥ 1 exclusion criterion were classified as ineligible. Demographic, clinical, and safety outcomes were analyzed. Among 2154 patients, 514 (23.9%) were ineligible. The most frequent reasons were Eczema Area and Severity Index (EASI) < 16 (67.9%), age ≥ 75years (21.8%), and cardiovascular disease (13.0%). Ineligibility patterns differed across treatments: patients receiving JAKis were most often ineligible because of EASI < 16 (92.8%), whereas ineligibility among biologic users more commonly reflected also age or cardiovascular comorbidity. Ineligible patients were older, had more non-atopic comorbidities, and had lower measured baseline disease activity. Safety profiles were generally favorable. Among biologic-treated patients, adverse event rates were similar between eligible and ineligible groups. In the JAKi cohort, overall adverse events were more frequent in ineligible patients (52.9% vs. 42.6%; p = 0.051), with acneiform eruption and lipid abnormalities emerging as the most distinct differences. No unexpected safety signals were identified in either treatment group. Nearly one-quarter of real-world patients with AD would not have met eligibility criteria for pivotal RCTs, yet both biologics and JAK inhibitors demonstrated acceptable safety profiles in these populations. While adverse events were more frequent among ineligible patients receiving JAKis, findings require further investigation to determine their clinical relevance, particularly regarding long-term cardiovascular outcomes.

Visible light (VL; 400-700nm) constitutes nearly half of solar radiation and has distinct biological effects on human skin. High-energy visible light (HEVL), particularly blue light (400-490nm), contributes to erythema, persistent pigmentation, and photoaging. Emerging data also demonstrate synergistic pigmentary interactions between VL and long-wavelength ultraviolet A1 (UVA1). Individuals with skin of colour (SOC) and patients with visible-light-sensitive dermatoses are particularly susceptible to the cutaneous effects of visible light. This review aims to provide an evidence-based overview of VL interactions with skin, the mechanisms driving VL-induced cutaneous changes, and current VL-directed photoprotection strategies, with emphasis on their relevance for SOC populations and visible-light-sensitive dermatoses. PubMed and Google Scholar were searched to identify studies addressing VL properties, cutaneous biological effects, and VL-specific photoprotection, including sunscreens, pigments, novel organic filters, antioxidants, and behavioural approaches. VL, especially blue light, induces oxidative stress, melanogenesis via opsin 3-mediated pathways, and degradation of dermal extracellular matrix. Tinted sunscreens containing iron oxides and pigmentary titanium dioxide provide the most effective and cosmetically acceptable VL protection, reducing HEVL transmission by up to 80-97% and improving clinical outcomes in melasma and other hyperpigmentation disorders. Novel organic UV filters such as TriAsorB™ expand absorbance into the VL spectrum, while adjunctive topical and oral antioxidants may attenuate VL-induced oxidative stress. VL may exacerbate photodermatoses, including autoimmune connective tissue diseases, porphyria, and solar urticaria. VL is a biologically active and clinically relevant component of sunlight with disproportionate effects in SOC and certain photosensitive dermatoses. Optimal photoprotection requires a multimodal approach integrating UV and VL protection through physical measures, tinted formulations, emerging broad-spectrum filters, antioxidants, and patient-centred photoeducation. Standardised VL-protection labelling and further clinical research are needed to guide future practice.

Alopecia areata (AA), pressure-induced alopecia (PIA), and telogen effluvium (TE) are nonscarring forms of hair loss reported in patients undergoing surgical procedures under general anesthesia (GA). While AA is primarily autoimmune and stress-mediated, PIA arises from prolonged scalp pressure during surgery, and TE is typically triggered by metabolic or physiological stressors that induce a premature transition of anagen hairs into the telogen phase. This review aims to explore the emerging evidence linking GA to the onset or exacerbation of these alopecic types. Authors review currently available literature found in MEDLINE and Google Scholar databases and present it in a structured way. Currently available literature supports the existence of a link between GA and AA, PIA, and TE, and proposes several potential mechanisms including immune dysregulation, ischemia, hypoxia, and systemic stress responses on the basis of current findings. Despite existing evidence, significant gaps remain in understanding the associations between various forms of alopecia and GA, owing to a lack of high quality, structured research. There is a possible link between GA and various forms of alopecia, although further research to clarify the relationships, identify at-risk individuals, and inform perioperative hair loss management strategies is needed.

Several treatments are available for actinic keratosis (AK), many of which are hampered by local inflammation, pain, long duration, and slow healing. Indoor daylight photodynamic therapy (idl-PDT) is an effective, well-tolerated, first-line treatment for both AK and field cancerization, but its feasibility is limited by the long time required for illumination (2h). The objective of our study was to evaluate the efficacy of idl-PDT with an illumination time of 1h versus 2h in the treatment of scalp AK. We conducted an intrapatient, comparative study of idl-PDT with two illumination durations, 1h versus 2h, using methyl aminolevulinate (MAL, Metvix®) and a white light-emitting diode (LED) light (Dermaris®) for the treatment of scalp AK. Patients were evaluated 3months and 6months after one session of idl-MAL-PDT for AK response rate, both overall and by AK grade, and tolerability. Physicians' and patients' satisfaction were also investigated. A total of 55 patients were enrolled with a total of 955 AK (grade I-II). The AK clearance rate was 72.9% in 1h-half and 71.1% in 2h-half after 3months, and 76.2% in 1h-half and 78.9% in 2h-half after 6months. No statistically significant difference in efficacy (overall, grade I and II AK) was observed between the two illumination times, both at 3 and 6months. The local skin reaction score and pain numeric rating scale (NRS) were very low, and comparable between the two treatment arms. Both physicians and patients expressed very good opinion on effectiveness and cosmetic outcome. Overall, 96.4% of patients would undergo idl-PDT again. The efficacy of idl-PDT in treating grade I and II AK of the scalp was comparable using 1h or 2h as illumination time. Both treatment schedules were well tolerated, with a very high rate of satisfaction from both physicians and patients. This trial was retrospectively registered on the 4th of December 2025. ClinicalTrials. gov identifier, NCT07290959.