Blepharoptosis as an Aesthetic ComplicationEyelid ptosis, or blepharoptosis, following esthetic treatment of the upper third with botulinum toxin Type A (BoNT-A) is a complication with a variable incidence depending on the injector's experience. Among unexperienced injectors, it ranges from 2.5% to 5.4% and approximately 0.51% to 1% in experienced injectors. Blepharoptosis is commonly defined as an eyelid located between 1.5 and 2 mm below the scleral-corneal limbus. It occurs because of the local spread of botulinum toxin, affecting the levator palpebrae superioris muscle, one of the principal muscles for elevating the superior eyelid. It typically becomes evident 3–14 days after BoNT-A application and resolves spontaneously after approximately 3 months, once the toxin's effect subsides. Even though it resolves with time, it can cause great distress for the patient and the physician.Treatment ModalityIn turn, knowing the anatomy of the face in high detail will help the physician treat and prevent this complication, which can be avoided with correct training and application. Once it has happened, it is important to recognize the severity of the blepharoptosis (which is classified as mild, moderate, or severe), in order to decide whether to use oxymetazoline or apraclonidine eye drops, muscle exercises, vibrating devices, radiofrequency, and the latest option described with pretarsal BoNT-A application. Even though the treatment is challenging, and evidence is scarce, here we present a literature review and some clinical cases of successful treatment with pretarsal BoNT-A in iatrogenic blepharoptosis following esthetic treatment of the upper third.ObjectiveThis review highlights the importance of facial anatomy knowledge to minimize potential complications associated with BoNT-A application. It also describes the clinical classification and management of iatrogenic blepharoptosis based on severity, with special emphasis on the pretarsal BoNT-A application technique.Methods of Literature SearchA literature search was conducted using electronic databases (PubMed, MEDLINE, Embase, and Google Scholar), focusing on upper third anatomy, prevention of iatrogenic blepharoptosis secondary to BoNT-A application, classification, and therapeutic options based on severity.ResultsIatrogenic eyelid ptosis after BoNT-A application results from the neurotoxin spreading to the levator palpebrae superioris muscle. Current therapeutic options include sympathomimetic eye drops, vibration therapy, facial exercises, radiofrequency, and pretarsal BoNT-A application. This review emphasizes anatomical knowledge, risk factors' identification, and anatomical landmarks to minimize complications. The pretarsal treatment technique for iatrogenic ptosis using BoNT-A is also detailed.LimitationsThe limitations of this review consist of the number of patients, which is very limited; another limitation is that none of the patients had severe ptosis to prove the treatment.ConclusionBlepharoptosis following esthetic BoNT-A treatment is a rare complication among trained injectors. Knowledge of therapeutic options, including pretarsal BoNT-A injection techniques, is crucial for managing this complication, which can have significant esthetic and functional impacts.

Acne is a chronic inflammatory skin disease of the sebaceous unit of the facial hair follicle that occurs mainly in adolescence. The four major pathogenesis of acne are excessive secretion of sebum by sebaceous glands, abnormal keratosis of sebaceous glands in hair follicles, reproduction of skin microorganisms such as Cutibacterium acnes (C. acnes), and inflammatory reaction. Among the skin microbiota, C. acnes and Malassezia affect the secretion of sebaceous glands, mediate inflammation, and are closely related to the pathogenesis of acne. With the development of the theory of “Gut–skin axis,” the role of intestinal microbiota and skin microecology in acne regulation has gradually become the focus of researchers. The purpose of this study is to investigate the influence of skin microbiota and the interaction between gut and skin on the pathogenesis of acne and to analyze the potential mechanism of skin microbiota during the pathogenesis of acne. It is expected that further understanding of skin microbiota (including its potential mechanism) will help clarify its role in acne and provide new ideas for the pathogenesis and clinical treatment of acne and other inflammatory skin diseases.

Acne scars, particularly in individuals with pigmented skin, can lead to significant psychosocial distress, yet the extent of this impact remains underexplored. This study aimed to assess the psychosocial effects of acne scars on patients with skin Phototypes IV–VI. This retrospective multicenter observational study involved 86 patients with acne scars who had previously consulted general practitioners. Scar severity was assessed using the Echelle d'évaluation Clinique des Cicatrices d'Acné (ECCA). Validated measures were used to evaluate psychological and quality-of-life impacts: the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms and the Dermatology Life Quality Index (DLQI) for quality of life. The study revealed that 62% of patients exhibited depressive symptoms according to the PHQ-9, and 84% reported a diminished quality of life according to the DLQI. A significant correlation was observed between acne scar severity and both psychosocial measures: ECCA and DLQI (r = 0.31, p=0.003), and ECCA and PHQ-9 (r = 0.27, p=0.010). Many participants had modified their clothing and daily activities due to their scars. The findings illustrate the profound psychosocial burden of acne scars, with a notable percentage of individuals experiencing depressive symptoms and reduced quality of life. The strong correlation between scar severity and psychosocial outcomes emphasizes the need for early, comprehensive care that addresses both dermatological and psychological aspects.

For a given skin cancer, a number of treatment options are often available. The decision of which method to use is usually made by the treating physician. Despite significant changes to the healthcare system of the United States over the past 10 years, healthcare costs continue to rise. These costs often affect patients in the form of higher deductibles, copays, and insurance premiums. The goal of this study was to determine patient attitudes regarding discussion of cost of skin cancer removal procedures and repairs. A 12-question survey was administered to 100 patients presenting for treatment of a skin cancer at an academic center. The first six questions addressed the importance the patient placed on treatment cost and related discussions, and the final six questions addressed repair cost. Greater than two-thirds of respondents felt that cost of both treatment (76%) and repair (67%) is somewhat or very important. Most patients reported that the cost of skin cancer treatment (56%) and repair (54%) should be considered by their surgeon. Furthermore, a majority of participants felt that cost differences should be discussed prior to treatment (67%) or repair (67%). Most respondents believed that cost discussion prior to treatment (64%) and repair (67%) would not affect their level of procedural anxiety. In conclusion, patients value cost discussions for treatment and repair of skin cancer. Surgeons should consider discussing these issues with patients in the appropriate clinical setting.

Background: Tinea of vellus hair is a rare condition that is recalcitrant to treatment. It is typically caused by nonanthropophilic dermatophytes. Extant data on this disease remain scarce.Aims/Objectives: This study aimed to delineate the clinical features and treatment outcomes of patients with tinea of vellus hair and to compare the characteristics of patients infected by anthropophilic and nonanthropophilic species.Methods: A 10-year retrospective study was conducted at the Department of Dermatology in a tertiary hospital in Thailand. The study included all patients with tinea of glabrous skin involving vellus hair. Baseline characteristics, clinical data, and treatment outcomes were analyzed.Results: Of the 31 patients in the study, two-thirds of the patients (69%) had a history of using topical medications, mainly steroids and antifungals. The face and extremities were the most common locations for lesions with positive vellus hair. There were no significant differences in data between patients infected with anthropophilic and nonanthropophilic species. Most patients received oral antifungals (80.6%). There was no significant difference in the cure rate between patients who were administered oral antifungals and those who solely utilized topical antifungals. Kaplan–Meier analysis demonstrated the overall median duration to achieve a cure was 5 weeks.Conclusion: The diagnosis of tinea of vellus hair should be considered in cases of tinea of the glabrous skin in exposed areas, especially in patients with a history of topical treatments. Nonanthropophilic dermatophytes are the primary causative agents of tinea of vellus hair. Systemic antifungals with prolonged duration are recommended.

Objectives: Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is an autoinflammatory disease with a wide spectrum of manifestations and no standard treatment. Janus kinase inhibitors (JAK-I) are small-molecule drugs that affect many molecular pathways. We aim to investigate the safety and efficacy of JAK-I in the treatment of VEXAS syndrome.Methods: A systematic search was conducted using MeSH terms/keywords related to JAK-I and VEXAS syndrome through PubMed/Medline, Scopus, Web of Science, and Embase until July 6, 2025.Results: We included 29 articles: 8 cohort, 8 case series, and 13 case reports. Our study includes data for 186 cases. The mean age was 69.64 years, and 83.33% were male. The most frequent manifestations were skin lesions (64.51%), fever (64.51%), arthritis and arthralgia (61.29%), lung involvement (31.72%), and venous thrombosis (24.19%). In general, 33.87% had a complete response, and 29.57% had a partial response. Ruxolitinib was used in 117 patients. Thirty-four out of 117 (29.06%) experienced complete to partial remission. Tofacitinib was used in 31 patients. About 29% of them showed complete to partial remission. Baricitinib was used in 25 patients; 12% had complete remission, and 16% had partial remission. Upadacitinib was used in 13 patients, which led to a complete remission in 38.46%. Filgotinib was used in four patients, leading to partial remission in one case. Among all, 36.55% showed adverse effects. Of these, eight were on Ruxolitinib, two on Tofacitinib, two on Baricitinib, and three on Upadacitinib.Conclusion: JAK-I seems to be a promising treatment option with tolerable adverse effects for VEXAS syndrome.

Background: Vitiligo is a hypopigmentation skin disease that is easy to diagnose but difficult to treat. The etiology of vitiligo is unknown, which may be related to genetic and immune factors.Objective: To provide potential targets for the treatment of vitiligo through identifying signature genes based on an artificial neural network (ANN) model.Methods: We downloaded two publicly available datasets from GEO database and identified DEGs. We trained the random forest and ANN algorithm using training set GSE75819 to further identify new gene features and predicted the possibility of vitiligo. In addition, we further validated the performance of our model through the test set GSE53148 and verified the diagnostic value of our model with the validation set GSE53148. Finally, we used RT-qPCR to compare the expression of two genes randomly selected in this study in patients with vitiligo and healthy people.Results: Two genes were randomly selected from the 30 key genes identified by ANN and validated through RT-qPCR in 6 vitiligo patients. The results showed that compared with the control group, the mRNA expression of FLJ21901 in the disease group was significantly upregulated, and the mRNA expression of MAST1 was significantly downregulated, with statistical significance.Conclusions: Through the identification of characteristic genes and the construction of a neural network model, it was found that the differentially expressed genes can provide a new potential target for the treatment of vitiligo.

Background: Acrocyanosis is a functional peripheral vascular disorder, currently categorized under the canopy of acrosyndromes, i.e., a group of clinically similar and significantly overlapping vascular disorders involving the acral skin. The disorder might be primary or secondary, depending on the cause. Recently, there has been a remarkable surge in acrocyanosis prevalence along with the COVID-19 pandemic. Both COVID-19 infection and vaccines for COVID-19 have been affixed to the list of disorders instigating acrocyanosis. Objectives: The goal of this narrative review was to evaluate the existing literature, project acrocyanosis from the viewpoint of dermatologists in the face of the COVID-19 pandemic, and assess the need for targeted research, education, and/or clinical practice. Methods: An English literature search was conducted using PubMed and Google. All abstracts on acrocyanosis, irrespective of the article type and publication date, were retrieved and reviewed and those most relevant for the focus of this article were selected and summarized. Discussion/Results: A narrative review was carried out. There is paucity of randomized, double-blind, placebo-controlled studies on acrocyanosis in the English literature, implicating the need for targeted research. Pertinent information still relies on anecdotal observations, case reports, case series, or scarce reviews, which are dated rather old and published in vascular-oriented journals. The scarcity of published literature on acrocyanosis in dermatology-oriented journals points to the necessity of professional education and improvement of clinical diagnostic skills for dermatologists. Conclusions: Although acrocyanosis is the least known and the least studied acrosyndrome, it is increasingly more commonly confronted in the COVID-19 era. The diagnosis still largely relies on clinical findings. Accordingly, it has become a growing necessity for a dermatologist to remain updated on this peculiar disorder and be able to differentiate acrocyanosis from clinically similar cold-induced or cold-exacerbated acrosyndromes. Acrocyanosis is still misdiagnosed, underdiagnosed, underreported, and undertreated by the dermatology community.

Melasma, a pigmentary disorder that particularly affects Asian women, has been clinically proven to respond effectively to combination therapy of Q-switched lasers and tranexamic acid (TXA), especially with the advancements in laser aesthetics in recent years. However, treatment outcomes can be influenced by factors such as the wavelength and spot size of the Q-switched laser, the route of administration for TXA (including injectable, oral, or topical), as well as the dosage and duration of treatment. This article presents 13 different combination approaches from six randomized controlled trials, indicating that oral administration of TXA in combination with a 1064 nm Q-switched laser is currently the most widely used and effective treatment approach.

SCORring atopic dermatitis (SCORAD) is widely used to assess the severity of atopic eczema, but score systems based on the entire body may be limited in effective monitoring and intervention. It is crucial to monitor moisture levels in each affected body part, but empirical research is still lacking. The objective of this study was to analyze the levels of stratum corneum hydration (SCH) and transepidermal water loss (TEWL) in atopic dermatitis (AD) patients, focusing on the presence and location of atopic lesions at different body sites. The levels of TEWL and SCH were measured using the AF200 AquaFlux and the Corneometer, respectively, at 15 body sites. 98 children under the age of 10 were measured, including 83 AD patients and 15 in the control group. Patients were also assessed with SCORAD and for the presence of atopic lesions at each body site. 58.7% of AD patients had lesions in the antecubital fossa and popliteal fossa, with corresponding low SCH levels and high TEWL in the upper body. The differences in TEWL between the control group and AD patients were confirmed significant in the neck and antecubital fossa regions, while differences in SCH were identified in the face, antecubital fossa, and popliteal fossa regions. A higher TEWL was found among AD patients with atopic lesions in the face and ankle. This study suggests that continuous monitoring of SCH and TEWL levels at specific body sites can provide insights into identifying vulnerable body areas to AD and supplement the SCORAD system for more effective clinical intervention and prevention strategies.