International Journal of Research in Dermatology

Direct intraindividual comparison of wound healing after fractional picosecond laser-induced optical breakdown at 0.2 versus 0.3 J/cm² under topical postprocedural care: a prospective intraindividual case series

2026-06-12T07:10:59+0530

This prospective intraindividual case series evaluated early visible wound healing after fractional 1064 nm picosecond laser-induced optical breakdown (LIOB) at two intermediate fluence settings under standardized topical postprocedural care. Ten adult volunteers with Fitzpatrick skin type II underwent paired treatment of volar forearm fields at 0.2 and 0.3 J/cm². Six predefined topical preparations were applied to adjacent areas: Bepanthen wound and healing ointment, Medigel, Laser doctor cream, SkinCeuticals RGN 6, Teoxane post procedure, and Vichy collagen specialist 16 serum. Dermatoscopic images were obtained on days 1, 4, and 8 using non-polarized, polarized, and 405 nm illumination and were rated by two blinded dermatologists on a seven item 5-point scale. The complete case-series dataset included 10 participants, 6 products, 2 fluence levels, and 3 time points. Across all 18 product-timepoint composite comparisons, scores were higher at 0.3 than at 0.2 J/cm², with median paired differences of 1.0 to 3.5 points. After Holm adjustment, the day 4 comparison for Vichy collagen specialist 16 serum remained significant. Item-level signals mainly involved crusting/scabbing, surface texture, vascularization, irritation, and overall assessment, while surface level remained unchanged. Both fluence settings showed progressive visible improvement by day 8. This case series suggests that a moderate increase from 0.2 to 0.3 J/cm² increases short-term visible post-LIOB reaction without evidence of delayed early healing in this small Fitzpatrick type II cohort.

Pruritus among adult psoriatic patients attending Khartoum dermatology and venereology teaching hospital (2019-2020)

2026-05-30T07:36:52+0530

Background: Pruritus is one of the most common subjective symptoms in dermatological diseases and significantly affects the quality of life of psoriasis patients. Psoriasis is a chronic inflammatory skin disease with complex and multifactorial pathogenesis.

Methods: A hospital-based descriptive cross-sectional study was conducted at Khartoum Dermatology and Venereology Teaching Hospital from August 2019 to August 2020. Sixty adult psoriasis patients fulfilling the inclusion criteria were enrolled in the study. Data were collected using structured questionnaires and analyzed using SPSS version 25.0.

Results: Among the study participants, 50% were older than 40 years and 56.7% were males. Plaque psoriasis was the most common clinical type (41.8%). Pruritus was reported in 68.3% of patients, with localized pruritus observed in 60% of cases. Severe pruritus was present in 45% of patients, while weather was identified as the main aggravating factor by 46% of participants. Medications were reported as the primary relieving factor by 97.6% of patients.

Conclusions: Pruritus is highly prevalent among psoriasis patients and represents an important clinical symptom that may significantly affect patients’ quality of life. Proper evaluation and management of pruritus should be integrated into psoriasis care.

Investigation of the effect of diet on acne: a case-control study

2026-06-06T06:50:10+0530

Background: This study aimed to explore the association between acne vulgaris and dietary habits among young individuals.

Methods: A case-control study was conducted involving 100 individuals with acne and 100 without. Detailed dietary intake, demographic data, body mass index, and family history of acne were collected using questionnaires. The severity of acne was evaluated by physicians.

Results: The body mass index (BMI) was significantly lower in the acne group (21.97±3.74) than in the control group (23.67±3.96) (p=0.001). Family history of acne was more common in patients with acne (p=0.034). The consumption of bakery products, French fries, nuts, and pumpkin seeds once a week, once a week, once a day, and once a week, respectively, in the control group was significantly higher than that in the acne group (p<0.05). French fries consumption 3-4 times a week was higher in patients with acne (p<0.05).

Conclusions: Low BMI and a positive family history of acne were identified as risk factors for acne. While excessive consumption of French fries is frequently observed in patients with acne, normal consumption of nuts and pumpkin seeds may be beneficial for acne, and warrants investigation in large-scale studies.

Combined short-pulsed Nd:YAG laser therapy with intralesional triamcinolone injection for hypertrophic scar and keloid treatment

2026-06-22T19:55:29+0530

Background: Hypertrophic scars and keloids are difficult to treat and are associated with pain, pruritus, functional impairment, and cosmetic burden. This study evaluated the effectiveness of combining short-pulsed 1064 nm Nd:YAG laser therapy with intralesional triamcinolone injection compared with conventional treatment approaches.

Methods: Between October 2016 and March 2021, 52 patients with hypertrophic scars or keloids were treated at Hautärzte Köln Mülheim, Buchheimer Str. 53-55, 51063 Cologne, Germany, a private dermatology practice specializing in dermatology and laser medicine. Patients were classified into three treatment cohorts according to the treatment received: triamcinolone acetonide (TAC) monotherapy (n=13), TAC plus 5-fluorouracil (5-FU) (n=13), and combination therapy with short-pulsed 1064 nm Nd:YAG laser plus intralesional TAC in the same session (n=26). Laser treatment was performed in Genesis mode using a pulse duration of 0.33 ms, fluence of 4.4 J/cm², and repetition rate of 6 to 8 Hz. Spot size from 4 to 8 mm was adjusted according to scar thickness. Outcomes were assessed using the patient and observer scar assessment scale (POSAS) at baseline and at 3 and 12 months after treatment.

Results: The combination group required fewer treatment sessions than the TAC+ 5-FU group and the TAC monotherapy group (mean 7.2 versus 10.6 and 12.2 sessions, respectively). At 12 months, the combination group showed significantly better POSAS scores than TAC monotherapy on both the patient scale (20.65 versus 30.08, p=0.006) and observer scale (17.81 versus 28.15, p=0.001). No dropouts or serious adverse events occurred.

Conclusions: Short-pulsed 1064 nm Nd:YAG laser combined with intralesional triamcinolone is an effective, safe, and time-efficient treatment for hypertrophic scars and keloids, with superior outcomes compared with steroid monotherapy.

Comparative safety and efficacy evaluation of terbinafine and itraconazole: dose-based monotherapy versus combination therapy in the management of dermatophytosis: a pilot study in Bangladesh

2026-06-22T19:55:24+0530

Background: Dermatophytosis is highly prevalent in South Asia and increasingly chronic and treatment‑resistant, with poor responses to standard systemic regimens in Bangladesh. This study compared dose‑based terbinafine and itraconazole monotherapies and their combination to identify an optimal regimen.

Methods: In a randomized, open‑label, parallel‑group trial at a tertiary hospital, adults (18-60 years) with KOH‑confirmed tinea corporis/cruris/faciei were assigned to: T1 (terbinafine 250 mg/day), I1 (itraconazole 200 mg/day), T+I (terbinafine 250 mg+itraconazole 200 mg/day), T2 (terbinafine 500 mg/day), or I2 (itraconazole 400 mg/day). Follow‑up at weeks 2, 4, 6 and 8 assessed total symptom score (itching, erythema, scaling; 0-9), Physician global assessment, composite cure (clinical plus negative KOH) and safety.

Results: One hundred fifty patients (30/group) were randomized with comparable baselines. Symptom scores declined significantly in all arms (p<0.001 within‑group). Week‑8 composite cure was highest with I2 (96.3%), followed by T+I (89.7%) and I1 (83.3%); T1 and T2 had higher failure (both 51.9%). Adverse events were mild and infrequent.

Conclusions: Itraconazole, particularly 400 mg/day, achieved the best efficacy with good tolerability, whereas escalating terbinafine to 500 mg/day conferred no benefit. Treatment of contemporary dermatophytosis in Bangladesh should prioritise itraconazole‑based regimens.

Comparative efficacy of topical hair growth serums on hair density and shedding: a double-blinded and randomized clinical trial

2026-06-22T19:55:34+0530

Background: This clinical evaluation conducted with the objective of comparing the efficacy of two topical hair growth serum formulations on healthy Indian adults (men and women) suffering from hair loss, by randomized, double blinded controlled study.

Methods: Two topical formulations (product A - Indulekha Bringha scalp serum and product B – 3% Redensyl in serum vehicle) were evaluated over 3 months, with a 2-week regression phase. The study included a wash out period, following which subjects were randomized in one of the treatment groups. Subjects visited the study centre once every month for their follow-up assessments during treatment period. Efficacy endpoints included anagen hair density, A:T ratio, hair pull test, hair fall assessments, scalp barrier function, and hair thickness evaluation.

Results: The Indulekha Bringha scalp serum (product A) was found to be significantly efficacious in reducing hair shedding, improving hair density in all the subjects in comparison to baseline and was significantly superior to product B in the studied hair growth parameters.

Conclusions: Both test products demonstrated statistically significant improvements from baseline across all evaluated hair growth parameters. However, Indulekha Bringha scalp serum (product A) showed significantly superior efficacy compared to the product B in improving Anagen density, reducing hair fall.

Evaluating the non-comedogenic profile of Venusia Sun Unseen: a prospective, double-blind, randomized and controlled study

2026-06-22T19:55:32+0530

Background: The comedogenic potential of topical sunscreens is an important consideration for both skin safety and long-term adherence to photoprotective regimens. This study aimed to evaluate the comedogenicity of Venusia Sun Unseen sunscreen under occluded conditions, compared with positive and negative controls.

Methods: A prospective, randomized, double-blind, positive- and negative-controlled, two-cohort parallel-group study was conducted involving 30 healthy adults aged 18 to 55 years with prominent follicular orifices on the upper back. The test sunscreen (Venusia Sun Unseen) was evaluated against coconut oil as the positive (comedogenic) control, and glycerine as the negative (non-comedogenic) control. Products were applied under occlusive patch chambers on three designated sites on the upper back. Follicular biopsies were obtained before and after 12 alternate-day applications over a 4-week period. Microcomedones were graded on a four-point scale using light microscopy. Statistical comparisons were performed using the Mann–Whitney U test.

Results: The method was validated as the positive control showed significantly higher mean comedone grades (2.07±0.84) than the negative control (0.76±0.58; p=0.001). The test product, Venusia Sun Unseen, demonstrated a significantly lower mean comedone grade (0.86±0.95) compared to the positive control (p=0.001), indicating non-comedogenicity. No adverse events related to the test or control products were reported.

Conclusions: Venusia Sun Unseen sunscreen is non-comedogenic and safe when applied topically under occluded conditions.

Comparative study of terbinafine or itraconazole monotherapy versus combined therapy in dermatophytosis

2026-05-05T07:02:56+0530

Background: Dermatophytosis, is a very frequent fungal infection of skin prevailing in underprivileged countries. As drug resistance of monotherapy is rising rapidly, combination therapy is blooming as the preferred choice. Itraconazole and terbinafine are widely used antifungal drugs in Bangladesh. Although many studies on monotherapy of these drugs have been done for the treatment of fungal infections, but study on their combined use showing difference with cure rates and recurrence rates in our country is still inadequate. Objectives were to determine and compare the clinical outcome of monotherapy with terbinafine or itraconazole comparing with combined therapy in various dermatophytosis (tinea infections).

Methods: Clinically diagnosed patients suffered from various tinea infections at multiple private clinics in Gazipur district of Bangladesh were treated from January to June 2024. Total 150 patients were divided into three groups (Itraconazole only, terbinafine only and combination of both). The therapeutic effects were evaluated by clinical cure rate by clinical symptoms, mycological cure rate by mycology examination, adverse effects, and recurrence rates of disease.

Results: The data of patients were evaluated biweekly period and at 4 and at end of 8 weeks of therapy. In the combined group, the symptoms were significantly cured, in comparison to the terbinafine or itraconazole group (p1<0.05 and p2<0.05). The clinical cure rate, mycological cure rate, recurrence rate showed 92%, 90% and 4% in combined group, 78%, 74% and 14% in terbinafine group, 74%, 70% and 18% in Itraconazole group respectively. The combination therapy achieved better results. Adverse effects were less in each group during follow-up. The 96% patients was satisfied with combined treatment.

Conclusions: Combination therapy is more efficacious than monotherapy for treatment of tinea infections and demonstrates more successful strategy for treating resistant dermatophytosis.

Stevens-Johnson syndrome and toxic epidermal necrolysis prevalence and causative factors at Khartoum dermatology teaching hospital (2010-2020)

2026-05-27T09:48:57+0530

Background: Cutaneous drug reactions mainly Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) and their overlap are rare but potentially fatal reactions endangers patient’s life, they are characterized by epidermal necrosis which causes erosions of the mucous membranes, extensive detachment of the epidermis. Drugs are the major causes of SJS\TEN. The types of the drugs depend on the prevalent diseases in the country and the protocols of management in that country. The aim of this study was to determine prevalence, causative factors and their correlation with SJS / TEN and their overlap, among patients admitted to Khartoum Dermatology and Venereology Hospital from January 2010 to September 2020.

Methods: This retrospective cross-sectional study investigated 295patients with severe cutaneous reactions. Information collected included participants’ socio-demographic variables, clinical characteristics of the disease and the possible triggers. Data were analyzed using SPSS version 23.0.

Results: The main age distribution was between 20-40 years in (42.7%), 48.8% of the cases had SJS, 44.4% had TEN and only 6.8% had SJS\TEN overlap. Seventy-two percent of the patients had no past history of similar condition. Sixty-six percent of the patients developed cutaneous symptoms from first till the seventh day after drugs intake. Drugs were determined to be the causative agent in 90.5% followed by other risk factors 7.5% mainly; chicken pox and dukhan dermatitis, (2%) of cases were idiopathic. The most common drugs implicated were antibiotics (75.6%), followed by NSAIDs (37.6 %). Patients who passed away during the study period were 24/295 cases (8.1%), 16 patients due to TEN, 6 patients with SJS and 2 patients with SJS/TEN overlap.

Conclusions: SJS was the most common subtype of SJS/TEN in Khartoum Dermatology Hospital but most deaths occur among TEN patients. Women and persons aged 21–40 years were the most affected groups and was attributed to use of drugs, especially antibiotics (Ciprofloxacin), followed by NSAIDs (Diclofenac sodium).

Real-world prescribing patterns of topical agents and treatment outcomes in melasma: a retrospective analysis

2026-06-22T19:55:20+0530

Background: The present study aims to address the existing evidence gap by assessing prescription patterns for melasma management. Additionally, therapeutic effectiveness is measured through the melasma area and severity index (MASI) score over a structured 3 months observational period.

Methods: The present study is a retrospective, observational, multicentre study that includes data from dermatology OPD across various centres in India. The primary outcome was the assessment of frequency and type of topical agent prescribed, determining prescribing patterns of topical agents. Secondary outcomes included evaluation of effectiveness and safety of topical agents with changes in MASI score from baseline to 3 months post-treatment. Data from all centres were collected as per the protocol and proforma and compiled to summarize prescribing pattern of topical agents and associated demographic data.

Results: The prescribing patterns showed that there was greater use of depigmenting agents. Most frequently used depigmenting agents were kojic acid (KA) (70.72%) and hydroquinone (HQ) (70%). Mean reduction in MASI score of 39.5% was identified from baseline to 3 months post-treatment. Adverse event frequency was relatively minimal. Most patients tolerated the treatment well. Few patients experienced adverse events such as skin irritation (0.46%), erythema (0.24%), peeling (0.18%), and hyperpigmentation (0.16%).

Conclusions: This retrospective study provides an understanding of the role of KA and HQ as common prescribing topical agents for the management of melasma, exhibiting a safe and tolerable profile in large sample size. Significant improvement in MASI scores in 3 months suggests therapeutic advantage in routine clinical practice for melasma treatment.

Resolution of oxidative stress on dandruff scalps with Ayurvedic anti-dandruff regime: a clinical study

2026-06-22T19:55:33+0530

Background: This study is aimed to evaluate the efficacy and safety of ayurvedic anti-dandruff regime (Indulekha - Svetakutaja oil and dandruff treatment shampoo) in the management of dandruff in healthy, Indian participants suffering from dandruff.

Methods: A total of 53 subjects with clinically diagnosed moderate dandruff were selected based on inclusion and exclusion criteria. Study was conducted in 3 phases, wash-off phase for 2 weeks, treatment phase for 4 weeks, followed by a regression phase of 2 weeks (during which ayurvedic anti-dandruff regime was withdrawn). Participants applied anti-dandruff regime on their scalp as per the instructions provided.

Results: After 4 weeks of treatment, ayurvedic anti-dandruff regime demonstrated a significant reduction in dandruff flakes in 100% of participants, resolution of scalp itch in 100% participants with reduced levels of histamines (by 30%) and oxidative stress marker on scalp as measured by 13-hydroxyoctadecadienoic acid (HODE) by 50%. There were no reported side effects like oiliness/redness/irritation, during treatment and regression phase.

Conclusions: Ayurvedic anti-dandruff regime is a safe and highly effective solution designed to combat dandruff and oxidative stress on scalp, while simultaneously improved overall health of the scalp and hair.

Evaluation of skin irritation and skin sensitization potential of Venusia sunscreen using human repeat insult patch test

2026-06-22T19:55:30+0530

Background: Sunscreens are widely used for daily photoprotection, making evaluation of their dermatological safety essential. This study aimed to assess skin irritation and sensitization (hypoallergenic) potential of Venusia Sun Unseen (sunscreen) in healthy human participants.

Methods: This single-centre, evaluator-blinded study using human repeat insult patch test (HRIPT). It was conducted in three phases: induction (21 days), rest (14 days) and challenge phase (4 days), with skin reactions in the induction and challenge phases graded using the Draize scale and International Contact Dermatitis Research Group (ICDRG) scale, respectively. Test product and a negative control (0.9% isotonic saline) were applied occlusively on the back of participants using patch chambers.

Results: Out of 220 participants, 218 completed the study (mean age 38.8 years; 94.5% female). Among them, 64.2% had normal skin and 35.8% had sensitive skin. Venusia Sun Unseen was classified as non-irritant, with a mean cumulative Draize score of 0.21 (induction phase). Negative control showed a score of 0, confirming the absence of irritation. ICDRG assessments demonstrated predominantly negative responses with test product, with 176 participants exhibiting no reaction at 48 hours and any doubtful or weak reactions resolving by 96 hours (challenge phase). It showed no strong positive reactions at any time point, while negative control showed negative responses throughout the study. No adverse events (AEs) or serious AEs were reported.

Conclusions: Venusia Sun Unseen was found to be non-irritant and hypoallergenic, with no clinically significant irritation or sensitization observed. It was well-tolerated, supporting its routine use for photoprotection.

Ultraviolet risk in elite sport requires policy integration: implications for the 2026 World Cup

2026-06-22T19:55:25+0530

Ultraviolet radiation is a well-established cause of photoaging and malignancy, yet sun protection remains absent from elite sport even as FIFA adds cooling breaks and physicians publicly push for stronger heat protocols ahead of the 2026 World Cup. Roughly 1,200 athletes, plus coaches and officials, will play summer matches across high-UV regions. Predicted mean UV indices were calculated across all 2026 host cities using NASA satellite data, with values ranging from 6-10 (high to extreme risk). FIFA’s medical regulations address heat exposure but not UV. Feasible, low-cost fixes—standardized sunscreen provision, reapplication education, UV-informed scheduling—could close this gap using infrastructure FIFA already has. The World Cup offers dermatology a rare, high-visibility platform to model occupational sun-safety policy.

Systemic immunomodulatory therapies in severe atopic dermatitis: a comprehensive review of mechanisms, efficacy and long-term management stratagems

2026-06-22T19:55:37+0530

Severe atopic dermatitis (AD) represents a complex, chronic inflammatory dermatosis characterized by a profoundly debilitating course, significant comorbid burden and a substantial deterioration in quality of life. The pathophysiological paradigm has evolved beyond a purely T-helper 2 (Th2)-centric model to incorporate a broader spectrum of immune dysregulation, including roles for Th22, Th17 and IL-31-driven pathways, alongside crucial epithelial barrier dysfunction mediated by filaggrin and other structural protein deficiencies. This shift has catalyzed the development and clinical deployment of novel, targeted systemic agents that move beyond traditional immunosuppressants. This exhaustive review synthesizes contemporary evidence from recent clinical trials, real-world efficacy studies and international consensus guidelines to critically appraise the current therapeutic arsenal. We provide a detailed analysis of the pharmacodynamics, clinical trial data and safety profiles for biologic agents such as dupilumab, tralokinumab and lebrikizumab, which selectively inhibit key interleukins. Furthermore, we examine the emerging role of Janus kinase (JAK) inhibitors, including abrocitinib, upadacitinib and baricitinib, focusing on their rapid onset of action and the nuanced risk-benefit calculus mandated by their safety advisories. The review also contextualizes the enduring, though carefully circumscribed, role of conventional systemic immunosuppressants like cyclosporine, methotrexate and mycophenolate mofetil in the modern treatment algorithm. Particular emphasis is placed on therapeutic sequencing, combination approaches, management of secondary infections and strategies for long-term disease control while mitigating adverse effects. The concluding synthesis projects future directions, including combination biologic therapy and personalized medicine approaches guided by endotypic stratification, underscoring the transformative nature of current systemic treatments in altering the disease trajectory for patients with severe atopic dermatitis.

Psoriasis and increased cardiovascular risk: cutaneous inflammation as a systemic marker – the role of IL-17 and endothelial dysfunction

2026-06-22T19:55:28+0530

Pruritus in the senile population, or geriatric pruritus, represents a pervasive and clinically significant dermatological condition that substantially impairs quality of life and often signals underlying systemic pathology. This extensive review synthesizes current medical literature to elucidate the complex, multifactorial etiology of this condition, which extends beyond mere xerosis cutis to encompass neuropathic, systemic, psychogenic, and iatrogenic pathways. We delve into the age-related physiological alterations, including epidermal barrier dysfunction, diminished immune function, and neurodegeneration of cutaneous sensory nerves, that create a predisposed state for chronic itch. A critical analysis of diagnostic algorithms is presented, emphasizing the necessity of a thorough, systematic evaluation to rule out occult renal, hepatic, hematologic, and endocrine disorders, as underscored by recent consensus guidelines from the International Forum for the Study of Itch (IFSI). Therapeutically, this review advocates for a stratified, patient-centric approach, integrating rigorous skin barrier repair with emollients containing physiologic lipids, targeted pharmacotherapy (including neuromodulators such as gabapentinoids and selective serotonin reuptake inhibitors, and novel agents targeting the interleukin-31 and Janus kinase pathways), and non-pharmacological interventions. Special consideration is given to the principles of geriatric pharmacodynamics, highlighting the imperative of mitigating polypharmacy risks and adverse drug events. The synthesis of evidence from recent randomized controlled trials and cohort studies informs a pragmatic framework for management, aiming to optimize patient outcomes through an interdisciplinary care model involving dermatology, geriatrics, and palliative medicine.

Hidradenitis suppurativa: a comprehensive review of pathogenetic mechanisms, clinical phenotypes, and evolving therapeutic paradigms

2026-06-22T19:55:27+0530

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, recurrent, and debilitating inflammatory skin condition characterized by deep-seated nodules, abscesses, fistulating sinus tracts, and scarring, primarily affecting apocrine gland-bearing skin. Historically dismissed as a disorder of poor hygiene or mere follicular occlusion, contemporary research has redefined HS as a systemic immune-mediated disease with profound implications for patient quality of life and metabolic comorbidities. This exhaustive review synthesizes the most current understanding of HS pathogenesis, which is now recognized as a multifactorial interplay of genetic predisposition, follicular hyperkeratosis and occlusion, dysbiosis of the cutaneous microbiome, and a profound dysregulation of the innate and adaptive immune system, with a prominent role for interleukin (IL)-17, IL-1β, and tumor necrosis factor-alpha (TNF-α). We meticulously detail the clinical spectrum, from prodromal manifestations to advanced Hurley stage III disease, emphasizing the nuances of phenotype classification and the critical importance of early diagnosis to mitigate disease-associated morbidity. A principal focus is dedicated to the rapidly expanding therapeutic landscape, moving beyond traditional antibiotics and surgery to include biologic agents that target specific inflammatory cytokines, with adalimumab (anti-TNF) as a cornerstone and emerging evidence for secukinumab (anti-IL-17A) and apremilast (PDE4 inhibitor). We further examine the robust association of HS with cardiometabolic syndrome, inflammatory bowel disease, and psychiatric comorbidities, advocating for a holistic, multidisciplinary management approach. This review consolidates evidence from recent clinical trials, consensus guidelines, and mechanistic studies to provide a foundational resource for clinicians and researchers navigating the complexities of this challenging disease.

A case of alopecic primary cutaneous adenoid cystic carcinoma successfully managed with the aid of prostate-specific membrane antigen-positron emission tomography imaging

2026-06-22T19:55:23+0530

Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare adnexal malignancy, most commonly affecting the scalp, and typically characterised by slow growth, marked local invasiveness and a high rate of local recurrence. Distant metastasis however remains uncommon. We report a case of a 58-year-old woman with a 6-year history of a progressively enlarging tender alopecic scalp lesion. Histopathology demonstrated a dermal basaloid neoplasm with tubular, nested and cribriform architecture and prominent perineural invasion, consistent with adenoid cystic carcinoma. Immunohistochemical studies highlighted a ductal cell component positive for cytokeratin 7 and CD117, and a myoepithelial cell component positive for smooth muscle actin and p40. Initial staging with ¹⁸F-fluorodeoxyglucose-positron emission tomography/ computed tomography (¹⁸F-FDG PET/CT) showed no significant metabolic activity or metastatic disease. Given emerging evidence of prostate-specific membrane antigen (PSMA) expression in adenoid cystic carcinoma, ⁶⁸Ga-PSMA PET/CT was performed and demonstrated moderate uptake confined to the primary scalp lesion without regional or distant disease. The patient underwent staged wide local excision with clear histological margins and split-thickness skin graft reconstruction. Six-month follow-up ⁶⁸Ga-PSMA PET/CT showed no evidence of residual or recurrent disease. To the authors’ knowledge this is first documented case of PSMA-avid PCACC and suggests that ⁶⁸Ga-PSMA PET/CT may have a role in staging and surveillance of this rare tumour. Further studies are required to support these findings.

Transient acantholytic dermatosis mimicking pemphigus foliaceus: a report of 2 cases

2026-06-22T19:55:36+0530

Transient acantholytic dermatosis (TAD) is a relatively uncommon acquired acantholytic disorder of unknown etiology, typically characterized by pruritic papulovesicular eruptions predominantly affecting the trunk, however atypical presentations can occur and pose diagnostic challenges, as illustrated in this report of two female patients aged 29 and 50 years who presented with rapidly evolving vesiculobullous lesions that ruptured to form erosions and extensive crusted plaques involving the scalp, face, neck, and trunk, thereby closely mimicking pemphigus foliaceus, while routine laboratory investigations including complete hemogram, serum biochemistry, thyroid profile, lipid profile, viral markers, and serum electrophoresis were within normal limits, histopathological examination revealed features of acantholysis with subcorneal blister formation in one case and suprabasal clefting in the other along with hyperkeratosis and mild dermal inflammatory infiltrate, and direct immunofluorescence studies were negative effectively ruling out autoimmune blistering disorders, based on detailed clinical evaluation and clinicopathological correlation a diagnosis of TAD was established, following which both patients were managed with parenteral corticosteroids, systemic antibiotics, saline soaks, and supportive care leading to near-complete resolution of lesions within a short duration, thus these cases highlight an unusual presentation of TAD with predominant head and neck involvement that can closely resemble pemphigus foliaceus, emphasizing that a high index of suspicion along with appropriate use of histopathology and immunofluorescence is essential for accurate diagnosis, differentiation from other acantholytic disorders, and timely institution of effective management while avoiding misdiagnosis and unnecessary prolonged therapy.

Gorlin-Goltz syndrome presenting with multiple basal cell carcinomas and odontogenic keratocysts: a case report

2026-06-22T19:55:35+0530

Gorlin-Goltz syndrome, also known as nevoid basal cell carcinoma syndrome (NBCCS), is a rare autosomal dominant disorder characterized by multiple basal cell carcinomas, odontogenic keratocysts, skeletal anomalies, and intracranial calcifications. It results from mutations in the PTCH1 gene, leading to dysregulation of the Hedgehog signaling pathway. Early diagnosis is crucial due to its multisystem involvement and potential for malignancy. We report a case of a 45-year-old male presenting with multiple facial lesions of long duration associated with jaw swelling and palmar pits. Radiological evaluation including CBCT revealed multiple well-defined radiolucencies involving the maxilla and mandible along with bifid ribs and calcification of the falx cerebri. Histopathological examination confirmed basal cell carcinoma and odontogenic keratocysts. Based on clinical, radiological, and histopathological findings, a diagnosis of Gorlin-Goltz syndrome was established. The patient was managed with a multidisciplinary approach including dermatological and surgical interventions with satisfactory outcome on follow-up. This case highlights the importance of early recognition, multidisciplinary management, and long-term surveillance in preventing complications associated with this syndrome.

Zosteriform lichen planus preceding ipsilateral breast carcinoma: a possible paraneoplastic association

2026-06-22T19:55:26+0530

Lichen planus (LP) is a chronic, T-cell-mediated inflammatory dermatosis involving the skin and mucous membranes, with multiple clinical variants. Zosteriform lichen planus (ZLP) is a rare variant characterized by a unilateral, dermatomal or band-like distribution that may mimic herpes zoster. While mucosal LP, particularly oral lichen planus, has been associated with malignancy, the role of cutaneous LP, especially ZLP as a paraneoplastic manifestation remains unclear. A 54-year-old woman presented with a one-year history of asymptomatic violaceous papules and plaques arranged in a unilateral, band like pattern over the left chest extending to the neck, without crossing the midline. The distribution corresponded to C3-T2 dermatomes. Mucosa, scalp, and nails were uninvolved. Clinical findings suggested zosteriform lichen planus, which was confirmed on histopathology. During follow-up, six months after the onset of cutaneous lesions, the patient developed a palpable lump in the left breast. Imaging revealed a suspicious lesion, and histopathology examination confirmed invasive ductal carcinoma. Notably, the malignancy was ipsilateral to the cutaneous eruption. The temporal sequence, strict dermatomal localization, and absence of known triggers raised suspicion of a paraneoplastic association. The association between LP and malignancy is controversial, with stronger evidence for oral LP and lichen planus pemphigoides. In this case, a neuro-immunologic mechanism may be implicated, wherein tumour related immune activation selectively affects contiguous dermatomes, leading to a localized lichenoid eruption. To our knowledge, ZLP has not previously been reported as a paraneoplastic manifestation. This case highlights a rare presentation of ZLP potentially associated with underlying breast carcinoma and suggests a possible paraneoplastic role.

Tuberculosis verrucosa cutis presenting as a chronic verrucous foot plaque: a diagnostic quandary

2026-06-22T19:55:26+0530

Cutaneous tuberculosis (CTB) is a rare manifestation of extra-pulmonary tuberculosis; tuberculosis verrucosa cutis (TBVC) presents as a slowly enlarging verrucous lesion, often misdiagnosed due to its atypical presentation. A 22-year-old male driver presented with a 2-year history of a pruritic, intermittently discharging, well-defined verrucous plaque with central depigmentation over the medial right foot, gradually enlarging to ~7×5 cm. KOH and fungal cultures were negative; Tuberculin skin test was strongly positive. Histopathology revealed pseudoepitheliomatous hyperplasia, mid-dermal well-formed tuberculoid granulomas with Langhans giant cells and neutrophilic microabscesses. No organisms were seen. Biopsy samples for cartridge based nucleic acid amplification test (CBNAAT) documented mycobacterium tuberculosis (MTB) genome. Imaging ruled out bone involvement. Diagnosis of TBVC was made, and anti-tuberculosis (ATT) therapy was initiated with clinical improvement. This case underscores the importance of considering TBVC in chronic verrucous skin lesions, particularly in endemic areas, and highlights the diagnostic value of histopathology and CBNAAT testing. The diagnostic puzzle was resolved using nucleic acid amplification testing of the biopsy sample, which should be considered in all skin lesions suspected of tuberculosis.

Plantar sea urchin spine injury after travel to Thailand: clinical, dermoscopic and optical coherence tomography documentation with practical recommendations

2026-06-22T19:55:22+0530

Sea urchin spine injuries are frequent marine related puncture injuries in tropical and subtropical travel settings. Retained fragments may cause persistent pain, foreign body granuloma, tenosynovitis, synovitis, arthritis or infection. We report a 38 year old woman who stepped on a sea urchin on the penultimate day of a vacation in Thailand. She presented after travel with multiple punctate brown black lesions on the plantar hallux and forefoot. She was afebrile, C reactive protein was below the detection limit and tetanus protection had been refreshed before travel during pre travel medical counseling. Clinical examination and dermoscopy demonstrated superficial foreign body associated puncture lesions. Visible and accessible fragments were removed, and macroscopic inspection showed dark, longitudinally ridged, tapering fragments consistent with sea urchin spine material. Dermoscopy guided optical coherence tomography (OCT) was performed as adjunctive documentation and showed focal superficial architectural disruption, hyperreflective signal alteration and posterior attenuation at selected puncture sites. OCT did not determine treatment. Topical antiseptic wound care was performed and the clinical course was uncomplicated. This case highlights a structured approach to plantar sea urchin injuries: careful removal of visible accessible fragments, wound cleansing, pain control, tetanus assessment, patient education and selective conventional imaging or referral when deeper retention or critical structure involvement is suspected.