Therapeutic agents approved for the topical treatment of dermatological diseases have diverse physicochemical properties, but they are frequently poorly water-soluble, which makes it a challenge to prepare stable aqueous formulations with good delivery characteristics. Several types of nanocarrier have been reported to facilitate formulation and to enhance cutaneous delivery but there are few direct comparisons of nanocarriers in terms of their ability to deliver a specific molecule to the skin under the same controlled conditions. The present study aimed to address this by developing, optimizing, and comparing different nanocarriers with respect to their ability to deliver ciclosporin A (CsA) to the skin and the hair follicle. Nanoconstructs were categorized as vesicular carriers (micelles and liposomes), emulsion-based systems (microemulsions and nanoemulsions), and nanoparticle systems (e.g. polymeric nanoparticles, solid lipid nanoparticles, nanostructured lipid carriers). Formulations were optimized using a design of experiments approach and were characterized with respect to size, morphology and incorporation efficiency. Cutaneous and follicular delivery experiments were performed using porcine skin. CsA deposition, cutaneous biodistribution, follicular delivery and targeting potential (ratio of delivery to skin with and without pilosebaceous units) were assessed. Nanoemulsions, kinetically stable systems with high thermodynamic activity, showed the highest cutaneous delivery of CsA among the nanosystems tested followed by solid lipid nanoparticles and mPEG-dihexPLA micelles - i.e. three different types of nanocarrier. The results confirmed the pivotal role of thermodynamic activity in determining delivery efficiency of a nanocarrier and its greater importance than other routinely studied morphological parameters such as nanocarrier size: the smallest nanocarriers did not yield the highest delivery.

Ultrasound-guided Percutaneous Galvanic Current Compared to Ultrasound-guided Intralesional Corticosteroid Infiltration in Tunnels of Hidradenitis Suppurativa.

Maternal diabetes is a known driver of fetal metabolic programming, yet its impact on offspring cutaneous health remains poorly characterized. We investigated the impact of intrauterine exposure to various maternal diabetes subtypes on the risk of offspring seborrheic dermatitis (SD), and to explore whether this risk is modulated by maternal glycemic control or treatment modality. This large-scale, population-based cohort study included 331,335 mother-child pairs. Maternal diabetes subtypes-type 1 (T1DM), type 2 (T2DM), and gestational diabetes mellitus (GDM)-were assessed, along with glycemic control (HbA1c) and pharmacological treatment. SD was identified using physician-documented diagnoses and medication records. Multivariable logistic regression models adjusted for maternal and perinatal factors were used to estimate adjusted odds ratios (aORs). The incidence of SD was 4.5%. SD was significantly more frequent among offspring of mothers with diabetes (4.9% vs. 4.4%, p < 0.001), primarily driven by GDM. T1DM and T2DM showed similar trends but weren't statistically significant. SD risk did not differ by treatment modality or glycemic control. While overall associations for T1DM and T2DM did not reach significance in the full cohort, age-stratified analysis revealed that maternal diabetes was significantly associated with increased SD risk across all subtypes within the first year of life (T1DM: p = 0.033, T2DM: p = 0.024, GDM: p = 0.019). Multivariable analysis showed maternal diabetes was independently associated with increased SD risk (aOR 1.16, 95% CI 1.08-1.24). Maternal diabetes is associated with a significantly increased risk of infantile SD across all diabetes subtypes, suggesting that the intrauterine diabetic environment may influence early-life cutaneous homeostasis through metabolic programming of the pilosebaceous unit.

ABSTRACTRhinophyma recurrence after surgical excision poses a significant therapeutic challenge, often stemming from the incomplete removal of deep hyperplastic pilosebaceous units. We present the case of a 66‐year‐old male with a third occurrence of rhinophyma after two prior failed cold‐steel excisions. The definitive intervention consisted of a modified deep tangential excision, removing all rhinophymatous tissue to a deep dermal plane that approached, but did not violate, the nasal perichondrium, thereby eradicating the pathologic glandular nidus while preserving the deepest adnexal remnants essential for re‐epithelialization. The wound was primarily managed by secondary intention healing, guided by selective, tension‐free suture re‐approximation of key wound edges to optimize contour. Cold‐steel excision was specifically chosen to ensure a specimen free of thermal artifact for definitive histopathology, a critical step in a recurrent case, which ultimately confirmed marked sebaceous gland hypertrophy and excluded malignancy. The postoperative course was uneventful, and at an 18‐month follow‐up, the patient demonstrated a stable, successfully restored nasal contour with no signs of recurrence. This case demonstrates that for severe, recurrent rhinophyma, a surgical strategy that balances thorough debulking of pathologic tissue with meticulous preservation of deep adnexal structures is critical for achieving a durable, long‐term outcome.

Background: Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit characterized by comedones, papules, pustules, nodules, and cysts. It affects a large proportion of adolescents and adults and has significant psychological and social impact. Conventional topical therapies often show limitations such as poor drug penetration, skin irritation, and frequent dosing requirements. Objective: The present study aims to formulate and evaluate a microsponge-based topical gel containing anti-acne drugs to achieve controlled drug release, enhanced skin deposition, improved therapeutic efficacy, and reduced side effects compared to conventional formulations. Materials and Methods: Microsponges were prepared using techniques such as quasi-emulsion solvent diffusion, employing polymers like ethyl cellulose. The selected drugs, nicotinamide and clindamycin phosphate, were incorporated due to their anti-inflammatory and antibacterial properties. The optimized microsponges were further incorporated into a Carbopol gel base. The formulation was evaluated for: Results: The microsponge-based gel demonstrated: Controlled and sustained drug release, Improved penetration into the pilosebaceous unit, Enhanced antimicrobial activity against acne-causing bacteria, Reduced irritation and side effects compared to conventional formulations, Good physicochemical stability and patient acceptability Conclusion: The developed microsponge-loaded topical gel represents a novel and effective drug delivery system for acne treatment. It offers improved therapeutic outcomes, better patient compliance, and reduced adverse effects, making it a promising alternative to conventional anti-acne formulations. Keywords: Acne vulgaris; Microsponges; Nicotinamide; Clindamycin phosphate; Topical gel; Controlled drug delivery.

Cutaneous delivery of bioactive components from a rice bran oil nanoemulsion and their biodistribution in porcine and human skin.

Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit and one of the most prevalent dermatological conditions globally. Its multifactorial pathogenesis and variable clinical presentation necessitate a multimodal therapeutic approach. While pharmacological interventions remain first-line therapy, cosmetic and dermatologic procedures are increasingly utilized as adjunctive strategies to enhance clinical outcomes. This narrative review synthesizes current evidence on four commonly employed cosmetic modalities in acne management: chemical peels, mechanical peels, light-based therapies, and radiofrequency-assisted microneedling. The aim of this study is to evaluate the role of procedural treatments as adjunctive options in the management of acne vulgaris. A literature search was performed in PubMed, Web of Science, and Scopus with no time restrictions, focusing on patients with acne vulgaris and adjunct cosmetic/procedural interventions. Given the narrative scope, this was a non-comprehensive, non-exhaustive evidence synthesis, with treatment options organized thematically. Overall, these cosmetic procedures can provide meaningful adjunctive benefits when integrated into individualized acne treatment plans. However, variability in study designs, procedural parameters, and outcome measures limits direct comparison across modalities. Further high-quality randomized controlled trials are necessary to establish standardized protocols and to determine long-term safety and efficacy. Procedural treatments can serve as valuable adjuncts in the management of acne vulgaris by enhancing therapeutic outcomes and addressing treatment-resistant cases. However, individualized treatment selection and further high-quality studies are needed to optimize their use and long-term benefits.

Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit. Accurate and objective assessment of inflammatory activity remains a challenge in clinical practice. Dermoscopy, as a noninvasive imaging technique, enables visualization of vascular and color changes associated with inflammation. In this cross-sectional study, 40 patients with mild-to-moderate acne vulgaris were enrolled, and 80 dermoscopic images were obtained. Background color, vascular morphology, vascular distribution, and perifollicular yellow halo were analyzed and compared between severity grades (mild vs. moderate) and among lesion types (comedonal, papular, pustular). In the mild group, a light-red background predominated (41.7%), whereas red and dark-red backgrounds were more common in the moderate group (both 38.6%), with a significant difference (χ2 = 10.13, P = 0.006). Vascular morphology suggested a trend toward transition from dotted to branched forms with increasing inflammation, although this did not reach statistical significance (P > 0.05). By lesion type, comedonal lesions mainly displayed light-red backgrounds with dotted vessels, while papular and pustular lesions exhibited red-to-dark-red backgrounds with branched or atypical vessels (P < 0.05). Progressive deepening of background color and transformation of vascular morphology on dermoscopy are associated with increasing inflammatory activity in acne vulgaris. Quantitative evaluation of these dermoscopic parameters may contribute to preliminary objective severity grading and therapeutic monitoring. Dermoscopy may represent a potentially valuable, noninvasive imaging modality for assessing inflammatory activity in acne.

Hidradenitis suppurativa (HS) is an autoinflammatory keratinisation disease affecting the pilosebaceous unit and hallmarked by a complex and multifactorial pathogenesis. Although genomic and transcriptomic investigations have substantially advanced our understanding of key mechanisms underlying HS pathogenesis, proteomic studies remain limited, despite the significant potential of serum proteomics to identify molecular signatures reflecting both cutaneous and systemic inflammatory activity. This exploratory study presents a serum proteomic analysis of patients with moderate-to-severe HS, identifying 306 differentially abundant proteins out of 3153 profiled (FDR q < 0.10). Sensitivity analysis at q < 0.05 (194 proteins) confirmed a robust inflammatory signature, while the FDR q < 0.10 threshold was necessary to preserve markers of epidermal homeostasis, which are inherently diluted in systemic circulation. Enrichment analyses revealed dysregulated pathways related to keratinisation, epidermal differentiation and extracellular matrix (ECM) remodelling, indicating impaired skin barrier function. Concurrent higher abundance of immune-related pathways, including defence response to bacterium, complement activation and neutrophil degranulation, suggest systemic inflammation potentially linked to microbial dysbiosis. These findings suggest the dual role of epithelial dysfunction and autoinflammation in HS pathogenesis. Integration of proteomic data with genomic and transcriptomic findings underscores the value of multi-omics approaches in guiding targeted therapeutic development.

Spanish Clinical Management Guideline for Hidradenitis Suppurativa. Part I: Pathogenesis, Diagnosis, and Disease Staging.

This review discusses the microbiology of acne vulgaris, a chronic inflammatory condition of the pilosebaceous unit that affects most adolescents and can persist into adulthood. The current standard of care consists largely of antibacterial interventions, based on the traditional view of Cutibacterium acnes as a pathogen. Alternative treatments are suggested by the "comedo switch" hypothesis, which attributes acne to aberrant differentiation of LRIG1+ sebaceous progenitor cells. While there is strong evidence to support this idea, it does not explain the efficacy of antibacterial interventions. We propose a unified mechanism wherein C. acnes phylotype IA1 can act as a trigger for the comedo switch. Unlike commensal strains, phylotype IA1 has high lipase activity, hydrolyzing sebum triglycerides into free fatty acids, specifically palmitic acid. This metabolite stimulates LRIG1+ progenitors, inducing inflammation and initial comedo formation. The review discusses C. acnes phylotypes, emphasizing known virulence factors of IA1, such as enhanced biofilm formation. We evaluate the efficacy and limitations of both old and new antibacterials, noting how newer materials that selectively remove C. acnes IA1 can reduce non-inflammatory acne lesions, supporting a key role for this phylotype in the pathogenesis of acne.

Background: Acne vulgaris (AV) is a chronic inflammatory disorder of the pilosebaceous unit that significantly impacts patients' quality of life. The inflammatory process involves immune responses partially regulated by IL-24, suggesting its potential role in AV pathophysiology and clinical severity. However, data on serum IL-24 levels based on AV severity remain limited, particularly in Indonesia. This study aims to evaluate the relationship between serum IL-24 levels and acne vulgaris severity to further elucidate its molecular mechanisms. Methods: This observational analytical study with a cross-sectional design was conducted at Dr. Moewardi General Hospital, Surakarta, Indonesia, from November 2025 to January 2026, involving healthy individuals and acne vulgaris patients. AV severity was assessed using the Lehmann classification, and serum IL-24 levels were measured by ELISA. Results: A total of 60 subjects were involved, consisting of 15 healthy controls, 15 patients with mild AV, 15 with moderate AV, and 15 with severe AV. Pearson correlation analysis showed no significant relationship between serum IL-24 levels and AV severity (p = 0.186). However, there was a trend towards increasing serum IL-24 levels along with acne severity. In the healthy control group, IL-24 levels were lower than in the AV group. Conclusions: Serum IL-24 levels are not associated with acne vulgaris severity. This is likely due to its effect on local keratinocyte proliferation. Further research is needed to elucidate the pathophysiology using histopathological examination of skin tissue from patients with AV

A BSTRACT Introduction: Nevus comedonicus (NC), a rare developmental anomaly in the pilosebaceous unit, is characterized by grouped, dilated follicular orifices filled with keratinous material. NC is usually solitary but may be part of nevus comedonicus syndrome with extracutaneous abnormalities. This study aimed at comprehensively analyze and meticulously document demographic data, clinical presentations, and patterns of cutaneous involvement, concurrent dermatologic or systemic conditions, and complications. Methods: An observational study was conducted at a tertiary health centre for the period of one year. This study included patients clinically diagnosed with nevus comedonicus and subjected to further evaluation to rule out systemic involvement and pattern of cutaneous involvement and associated complication in these patients were recorded. Results: The study included nine patients diagnosed with nevus comedonicus, showing slight female preponderance and predominantly affecting the face. Clinical manifestations varied from asymptomatic to inflammatory or lesions leading to secondary complications such as bacterial superinfection, cyst formation in a few patients, and scarring in all the patients. All patients had single area of involvement, while the pattern of cutaneous involvement was mainly dermatomal in five patients. All patients had cosmetic disfigurement to some extent. No patient had any abnormalities of the eyes, skeleton, or central nervous system. None of the patients showed spontaneous resolution of nevus comedonicus, and lesions persisted after evolution. Therapeutic interventions offered to patients included a spectrum of modalities, including topical retinoids, keratolytics, systemic antibiotics, and surgical approaches such as incision and drainage of cysts, laser therapy, or surgical excision. Conclusion: Nevus comedonicus is a rare cutaneous hamartoma with clustered, dilated pits filled with soft, black keratin. The study highlights demographic data, clinical presentations, and complications. Therapeutic options are variable, necessitating further research to understand the underlying pathophysiology and develop more effective treatments.

Background: Young adults and adolescents are predominantly affected by acne vulgaris, a chronic inflammatory condition of the pilosebaceous unit. Comedones, papules, nodules, pustules and scarring, which is occasional, are its defining features. Follicular hyperkeratinization, increased sebum production, inflammatory reaction and Cutibacterium acnes are all part of the etiology. In addition to its physical effects, acne has a substantial negative impact on psychological health, resulting in anxiety, social disengagement and despair. While topical benzoyl peroxides, retinoids, antibiotics, isotretinoin and hormonal therapies all are examples of conventional treatments that may alleviate symptoms, they have frequently linked to side effects, recurrence and antibiotic resistance. Aim: Explore the role of an integrative homoeopathic approach in the management of acne vulgaris by using topical application of specific homoeopathic mother tincture and constitutional prescribing. Materials and Methods: This narrative review analyses available literature on the conventional management and pathophysiology of acne vulgaris along with the principles of homoeopathy. Particular emphasis is placed on homoeopathic individualized constitutional treatment and topical use of mother tincture such as Calendula officinalis, Berberis aquifolium and Echinacea angustifolia in dermatological practice. Result: Available preliminary studies and clinical observations suggest that homoeopathic constitutional treatment, combined with topical application of selected mother tincture, may help in promoting healing, reducing inflammatory lesions and improving post-inflammatory pigmentation. The integrative approach also aims to address the underlying susceptibility and maintain overall systemic balance. Conclusion: Homoeopathy offers a holistic and individualized approach in the management of acne vulgaris. Previous evidence indicated potential benefits of combining constitutional treatment with topical mother tincture; current data remain limited due to small sample size and methodological variations. Well-designed clinical trials are required to establish stronger scientific evidence for the effectiveness of integrative homoeopathic management in acne vulgaris.

Integrated in vitro - in vivo evaluation of Angelica sinensis essential oil as an anti-acne agent: Mechanistic insights into bioactive compounds and multi-target therapeutic actions.

Acne vulgaris is a commonest chronological inflammatory disease of the pilosebaceous unit, which is predominant among teenagers and young adults all over the world. This will be a thorough review of the existing pharmacotherapy treatments of acnes vulgaris with highlight to its evidence-based understanding and new modalities of treatment. Traditional treatment, incorporating topical retinoids, benzoyl peroxide, antibiotics, hormonal agents and systemic retinoids, such as isotretinoin, continue to be the mainstay of treatment. Nevertheless, problems related to antibiotic resistance, side effects and drug compliance have led to the creation of new therapeutics. The latest developments are a focus on the use of topical and systemic agents that address individual pathogenic processes, including: sebum production, colonization of Cutibacterium acnes, inflammation, and follicular hyper keratinization. New formulations like fixed-dose combinations, retinoid analogs (trifarotene), selective androgen receptor modulators, probiotics and photodynamic therapies have demonstrated good outcomes. Moreover, biologic agents which inhibit inflammatory pathways such as interleukin and toll-like receptor modulators are a possible paradigm shift in management of refractory acne. The combination of personalized medicine and pharmacogenomics is likely to maximize the effectiveness of the therapeutic process and reduce the number of adverse effects. The review brings together the existing clinical evidence to help dermatologists make evidence-based decisions and points to the new therapies that are transforming the treatment of acne. Further studies and extensive randomization and controlled trials are needed to determine long-term safety and effectiveness of these new interventions, thus improving patient-centered dermatology.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the general population. HS primarily targets the pilosebaceous unit, particularly the follicular epithelium and associated apocrine glands, and is characterized clinically with abscesses, fistulae and sinus tracts appearing most commonly in the axillae, genital and inguinal areas.1 The underlying aetiology and pathogenesis of HS are multifactorial and complex, with an interplay of genetics, hormonal, mechanical and lifestyle factors eventually leading to this condition. Some HS patients have been identified with mutations in the genes encoding γ-secretase, including NCSTN, PSENEN and PSEN1. These genetic mutations result in hyperkeratosis, aberrantly regulated hair follicle differentiation and cyst formation through irregular Notch signalling. In general, the pathogenesis of HS involves both aberrant keratinization and autoinflammation.2 This concept has been previously described in detail as a combination of the innate immune system and cell differentiation in follicular, epidermal and glands.3 However, there is still a gap in our knowledge on how these processes interact. Hence, I have read with great interest the study of Onfroy et al. published in this issue of JEADV.4 They have found two differentiation pathways of the hair follicle stem cells: one leading to interfollicular epidermal basal cells and the second to the outer root sheath cells. The former is abundant with inflammatory pathways, and the latter is associated with keratinization. They conducted a single-cell RNA sequencing of hair follicle cell population from 49 HS patients and healthy donors and established three major endotypes: (1) an inflammatory subtype, (2) a keratinizing subtype and (3) a mixed subtype, characterized by both follicular remodelling and variable immune involvement. Their findings stress the heterogeneity of HS, revealing more about the pathogenesis of this disease; specifically, the role of follicular epithelium is not only structural but serves as a prime activator of the innate immune system. This perhaps better classifies the disease into three endotypes that in turn dictate their personalized management; namely, the inflammatory endotype with anti-inflammatory agents, such as tetracycline, clindamycin-rifampicin and biologics in more advanced disease. The keratinizing endotypes that would benefit mostly from surgical interventions, in addition to systemic medications to reduce flares, and finally the mixed endotypes, that may require newer medications targeting both inflammation and keratinization. Moreover, these stratifications will pinpoint towards potential and more ‘pathogenesis-specific’ novel therapeutics that will provide better outcomes for our patients and improve disease burden. Naturally, it is essential that larger, prospective trials will corroborate these findings. In summary, perilesional skin in HS patients exhibited imbalanced hair follicle stem cell differentiation that may pave the way to novel and personalized precision therapeutic strategies. None. None declared. Not applicable. Not applicable. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit influenced by innate and adaptive immune responses. Interleukin-17 (IL-17) and cardiotrophin-1, two mediators involved in inflammation and metabolic stress, have been proposed as potential contributors to acne pathophysiology. This study aimed to compare serum IL-17 and cardiotrophin-1 levels between acne patients and healthy controls and to assess their relationship with disease severity. In this study, 57 acne patients and 57 healthy controls were enrolled. Serum IL-17 and cardiotrophin-1 levels were measured by ELISA. Acne severity was classified using the Global Acne Grading System. Lipid profiles and hematological parameters were also assessed. Serum IL-17 and cardiotrophin-1 levels were significantly higher in the acne group compared to controls (p < 0.001). Within the patient cohort, the severe acne subgroup had significantly higher levels of both cytokines than the mild acne subgroup. A positive correlation was found between IL-17 and cardiotrophin-1 (r = 0.549, p < 0.001), and both were correlated with acne severity (cardiotrophin-1: r = 0.735; IL-17: r = 0.453; p < 0.001). ROC analysis demonstrated high diagnostic accuracy for both biomarkers, with an AUC of 0.945 (95%CI:0.909–0.981) for cardiotrophin-1 and 0.904 (95%CI:0.852–0.956) for IL-17. Additionally, leukocyte, neutrophil, and platelet indices, as well as total cholesterol and high-density lipoprotein cholesterol levels, were significantly elevated in patients. The elevated levels of IL-17 and cardiotrophin-1 and their correlation with disease severity suggest their potential role as inflammatory biomarkers in acne. ROC analysis showed strong discrimination, but acne is clinically diagnosed; biomarkers require multicenter, longitudinal validation.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting the pilosebaceous unit and is linked to several comorbid disorders as well as an economic impact burden. Variations in clinical presentation, comorbidities and healthcare delivery across regions necessitate localised guidelines. This consensus aims to provide evidence-based, expert-driven recommendations tailored to the United Arab Emirates (UAE) healthcare context to standardise and improve HS management. A three-phase modified Delphi methodology was employed to develop consensus statements among 14 experts based in the UAE. A comprehensive literature review informed the development of 61 draft statements covering diagnosis, classification, comorbidities, treatment and multidisciplinary care. Statements achieving ≥ 80% agreement in two rounds of voting were included. Final recommendations reflect expert consensus and current best evidence. A total of 58 consensus statements were adopted. Key recommendations address clinical diagnosis on the basis of lesion type and anatomical location, the use of Hurley staging and International Hidradenitis Suppurativa Severity Score System (IHS4) for severity assessment, and the need for screening for metabolic and inflammatory comorbidities. Treatment guidance includes lifestyle modifications, the use of topical and systemic antibiotics, hormonal therapy, biologics and surgical options, based on disease severity. Supportive care, including pain management, psychological support and multidisciplinary coordination, was emphasized. A management algorithm was developed for practical application. This consensus provides the first UAE-specific guidelines for HS diagnosis and management. It supports a comprehensive, stepwise and multidisciplinary approach to reduce disease burden and improve patient outcomes. Adoption of these recommendations is expected to harmonise clinical practice and foster improved quality of care for patients with HS in the UAE.

Acne vulgaris is a common chronic inflammatory disorder of the pilosebaceous unit, frequently affecting adolescents and young adults. It is often associated with physical discomfort, cosmetic concern, and significant psychological distress, thereby impairing quality of life. Conventional management primarily includes topical and systemic therapies aimed at controlling inflammation and reducing sebum production; however, recurrence, adverse effects, and incomplete resolution remain persistent challenges. This case demonstrates the potential role of individualised homoeopathic treatment in acne vulgaris. The prescription was based on the totality of symptoms after repertorial analysis and administered in a suitable potency. Subsequent follow-ups revealed marked clinical improvement, including reduction in active lesions, decreased recurrence of eruptions, and relief from associated discomfort. Healing occurred steadily with minimal scarring, and no relapse was noted during the observation period. Additionally, a significant improvement in the patient’s mental and emotional well-being was observed, reflecting an overall holistic recovery.