International Journal of Research in Dermatology

Familial coexistence of vitiligo and alopecia areata: successful treatment with intralesional corticosteroids

Nermeen Elhofy, Sarah Yousef Alyaseen, Sara Khalid Almukhaimar, Abdulla Alghatam — Fri, 21 Aug 2026 00:00:00 +0530

Vitiligo and alopecia areata are autoimmune dermatological conditions that may coexist due to shared immunopathogenic mechanisms, although their occurrence within the same anatomical site is uncommon. We report the case of a 33-year-old Indian male with a familial history of autoimmune skin disease who presented with co-localized vitiligo and alopecia areata on the posterior scalp, with an additional vitiligo lesion on the left tibia. Vitiligo preceded the onset of alopecia areata within the same scalp lesion by approximately four months. Dermoscopic examination confirmed features of both conditions, including depigmentation with loss of pigment network and characteristic alopecia areata findings such as yellow dots, black dots, and exclamation mark hairs. The patient was treated with intralesional triamcinolone acetonide injections for the scalp lesion, along with topical corticosteroids, topical tacrolimus, minoxidil, and vitamin D supplementation. Marked hair regrowth and near-complete repigmentation of the scalp lesion were observed at follow-up. Notably, the vitiligo lesion on the tibia demonstrated significant repigmentation following intralesional corticosteroid therapy after limited response to topical treatment alone. This case highlights the rare co-localization of vitiligo and alopecia areata, supports a shared autoimmune pathogenesis, and suggests that intralesional corticosteroids may be an effective therapeutic option for selected localized vitiligo lesions, particularly when associated with alopecia areata.

Tinea corporis overlying post-herpetic neuralgia: a novel manifestation of wolf’s isotopic response

Pihu Sethi, Mehak Gupta, Saema Nizam — Fri, 21 Aug 2026 00:00:00 +0530

Wolf’s isotopic response is characterized by the occurrence of a new dermatosis at the site of a previously healed and unrelated skin disorder, most commonly following herpes zoster. A wide spectrum of secondary dermatoses has been described, including granulomatous, lichenoid, autoimmune, and neoplastic conditions. However, infectious etiologies-particularly superficial fungal infections-are exceedingly rare in this setting. We report the case of a 58-year-old female who developed tinea corporis localized strictly to the same dermatome previously affected by herpes zoster and persistent post-herpetic neuralgia. Clinical examination revealed an annular erythematous scaly plaque over the left T11 dermatome, corresponding to the healed zoster site. Potassium hydroxide examination demonstrated septate branching hyphae, confirming dermatophytosis. The strict dermatomal localization, along with the temporal sequence of events, supports the diagnosis of Wolf’s isotopic response. To the best of our knowledge, this is the first reported case of dermatophytosis occurring over a site affected by post-herpetic neuralgia. This case highlights the role of persistent neuroimmune dysregulation in creating a localized area of immune vulnerability, predisposing to secondary infections.

Herpetic folliculitis: a lesser-known folliculitis and a review of herpes infections

Rashmi R. Mallya — Fri, 21 Aug 2026 00:00:00 +0530

Herpetic folliculitis is a rare disease that involves the pilosebaceous units. It is caused by varicella zoster virus or by herpes simplex virus. It is an infrequently reported entity in literature. Presentations of this disease are quite variable and it can mimic several other more common diseases such as acne, gram negative folliculitis, demodicosis and pustular rosacea, often leading to misdiagnosis and incorrect or delayed treatment. Diagnosis using bedside tests like Tzanck smear, serological tests for herpes and skin biopsy wherever necessary can aid in the early diagnosis and timely intervention in this condition. Herpetic folliculitis can be considered as a sign of immunosuppression and its presence warrants screening for the same. We hereby report a case of herpetic folliculitis in an anemic 23-year-old female patient admitted in a tertiary care hospital with predominantly unilateral pustular, follicular oriented lesions on the right side of her face, unexplained fever and headache.

Use of onabotulinum toxin a in the management of benign essential blepharospasm: a case report

Nitika Deshmukh Wagh — Fri, 21 Aug 2026 00:00:00 +0530

Benign essential blepharospasm (BEB) is a focal cranial dystonia characterized by involuntary eyelid contractions that may lead to marked visual and functional disability. Botulinum toxin type A (BotnA) is considered the treatment of choice for symptomatic relief. We describe a case of a 40-year-old male with BEB who showed significant clinical improvement following treatment with onabotulinum toxin A, emphasizing its efficacy and safety profile. In our case, botulinum toxin A was injected at specific points in orbicularis oculi muscle (affected side), corrugator supercilli, procerus, frontalis (forehead). Relief from symptoms was achieved after 5 to 7 days. No side effects were noted. After day 15, complete resolution of symptoms was achieved, effect was maintained till 6 months. BotnA is a minimally invasive and safe procedure for management of BEB. It can be easily performed in minutes in OPD set up under sterile environment.

Indian dermatological experts’ opinion on clotrimazole dusting powder in superficial fungal infection

Wed, 01 Jul 2026 00:00:00 +0530

Dermatophytosis is among the most common skin infections in India and continues to pose a major therapeutic challenge because of increasing chronicity, recurrence, and partial treatment response. Recent years have witnessed significant epidemiological and mycological changes, including the emergence of multidrug-resistant T. mentagrophytes/T. interdigitale complex. In addition to pathogen-related factors, excessive sweating, humidity, occlusion, and skin maceration contribute substantially to persistence and relapse by creating an environment favourable for fungal growth.

Real-world symptom improvement in paediatric atopic dermatitis: insights from patient‑reported outcome measures with mometasone furoate

Sachin Kumar, Dhiraj Dhoot, Sheela Gaikwad — Wed, 08 Jul 2026 00:00:00 +0530

Patient‑reported outcome measures (PROMs) are validated tools that complement physician assessments and play a crucial role in guiding treatment decisions and monitoring disease burden in atopic dermatitis (AD). However, their use in routine clinical practice stays limited due to low physician awareness and adoption1. Additionally, topical corticosteroid (TCS) phobia among patients and caregivers can adversely affect adherence and treatment outcomes.

A cross-sectional content analysis of the psychosocial sequelae of vitiligo using Reddit

Salma Bennis, Taylor Rechter, Chris Alihosseini — Fri, 21 Aug 2026 00:00:00 +0530

Background: Vitiligo is a chronic autoimmune disorder associated with significant psychosocial burden, including depression, anxiety, and impaired quality of life. Despite this, providers frequently underestimate its psychological impact, and existing qualitative research has relied primarily on structured clinical settings that may limit candid patient disclosure. This study aimed to characterize the psychosocial sequelae of vitiligo as expressed organically by patients on an anonymous online forum.

Methods: A cross-sectional content analysis was conducted on posts from the Reddit forum r/vitiligo. Posts were manually screened by two independent researchers using predefined inclusion and exclusion criteria. Relevant posts were analyzed using an inductive grounded theory approach, with iterative coding until thematic saturation was reached.

Results: Forty-four posts published between January 2022 and August 2025 were analyzed. Six preliminary themes were identified: disease progression and development, treatment options and outcomes, excessive disease preoccupation, implications on mental health, implications on interpersonal relationships, and implications on self-confidence and vitiligo-positivity. Three emergent concepts were derived: heightened distress associated with lesions in visible areas particularly the face, frustration with suboptimal treatment outcomes, and broad psychosocial impairment coexisting alongside an emerging vitiligo-positive movement within the online community.

Conclusions: Anonymous online forums such as Reddit capture candid patient perspectives that may not surface in clinical encounters, revealing a substantial and under-recognized psychosocial burden in vitiligo. These findings highlight a persistent gap between patient experience and clinical recognition, and underscore the importance of integrating psychosocial assessment into routine vitiligo care.

A retrospective study of GLP-1 receptor agonists uses in the management of hidradenitis suppurativa

Fatima Khan, Nneka Ede, Emily Clarke, Venessa Pena-Robichaux — Fri, 21 Aug 2026 00:00:00 +0530

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder frequently associated with metabolic comorbidities. Given the anti-inflammatory and metabolic effects of GLP-receptor agonists (GLP-1Ras), these agents have been proposed as a potential adjunctive therapy for HS.

Methods: A retrospective chart review identified 151 HS patients prescribed a GLP-1RA between January 2020 and January 2025. After excluding individuals younger than 18 years and those initiating biologics, long-term immunomodulators, or anti-hormonal therapies after GLP-1RA start, 22 patients met inclusion criteria. Clinical improvement was assessed qualitatively through provider documentation of symptom or disease-status improvement.

Results: Among 22 patients, 63.6% demonstrated clinical improvement following GLP-1RA therapy. The cohort included 10 Black, 6 Hispanic, 5 White, and 1 Asian patient. Semaglutide was the most common agent (n=14), followed by tirzepatide (n=7), and exenatide (n=1). Race was significantly associated with improvement (p= 0.025). 92% of non-Black patients improved compared with 30% of Black patients (p= 0.011). This disparity persisted after adjusting for HS severity, treatment duration, comorbidities, insurance type, and income. No significant associations were observed for gender, age, ethnicity, comorbidities, or insurance type.

Conclusions: GLP-1RAs may offer symptomatic benefit for HS, with nearly two-thirds of patients showing improvement. However, marked racial differences in response highlight the need for equitable HS research and investigation into biological, structural, and socioeconomic contributors to treatment variability. Larger prospective studies are warranted to clarify therapeutic efficacy and drivers of demographic disparities.

A questionnaire-based study on current trends and clinical decision drivers in the topical management of tinea infections: a cross-sectional study

Thu, 02 Jul 2026 00:00:00 +0530

Background: Dermatophytosis is a common superficial fungal infection that has increasingly become recurrent and difficult to manage in routine clinical practice. However, multicentric real-world data on topical antifungal prescribing trends in India remain limited.

Methods: This multicentric, cross-sectional, questionnaire-based study was conducted among 373 dermatologists across India to evaluate current prescribing trends and clinical decision drivers in the topical management of tinea infections, with particular emphasis on luliconazole use. Data regarding disease burden, treatment practices, combination therapy, and perceptions toward advanced topical formulations were collected using a structured electronic questionnaire and analyzed descriptively.

Results: A substantial proportion of dermatologists reported that dermatophytosis accounted for 30% to 42% of routine outpatient consultations (42.09%). Poor hygiene (74.26%) and climatic factors (61.39%) were commonly perceived risk factors, while itching (94.10%) was the predominant symptom. Topical antifungal therapy was mainly preferred for localized lesions (58.45%). Luliconazole emerged as the preferred topical antifungal agent (22.25%), and 56.57% of dermatologists reported prescribing it in most patients. Combination therapy with systemic antifungal agents was frequently practiced (67.02%), particularly in recurrent or difficult-to-manage infections. High efficacy, better penetration, and improved spread ability were the most perceived benefits associated with technology-based topical formulations.

Conclusions: Dermatophytosis continues to represent a substantial burden in routine dermatology practice in India. The findings highlight widespread use of luliconazole-based topical therapy and frequent adoption of combination treatment approaches, emphasizing the importance of individualized and rational management strategies in contemporary dermatophytosis care.

Evaluation of efficacy and in-use tolerability of a non-foaming cleanser (Venusia® cleanser) in adult men and women

Fri, 21 Aug 2026 00:00:00 +0530

Background: Proper cleansing is essential for maintaining skin barrier integrity, hydration, and overall skin health. Harsh cleansers can disrupt the stratum corneum, increase transepidermal water loss (TEWL), and alter skin pH, particularly in sensitive or barrier-compromised skin. This study evaluated the efficacy and in-use tolerability of Venusia® cleanser, a non-foaming formulation, in adults with different skin types.

Methods: In this single-centre, single-arm, non-randomized interventional study, participants with all skin types used Venusia® cleanser for 15 days. Efficacy was assessed using TEWL (VapoMeter), skin pH (pH meter), and pore-cleansing (3D imaging) at baseline, immediately post-application (15–20 minutes), and on day 15. In-use tolerability was evaluated using the Draize scale for erythema and oedema, along with participant self-assessment questionnaires on day 15.

Results: During the study period, 77 healthy adults with a mean age of 35.64 years were enrolled, and 76 participants completed the study. Of these, 14.5% participants had sensitive skin. TEWL decreased significantly by 9.1% at 15–20 minutes and by 17.5% at day 15 (p<0.01), indicating improved barrier function. Skin pH remained within the physiological acidic range (5.0–6.0), with a modest but significant increase of 5% at day 15 (p<0.01). Pore depth showed no significant change. Self-assessments revealed high satisfaction: 100% of participants found the cleanser gentle and easy to use, 100% reported improved skin softness and smoothness, while 98.7% experienced effective cleansing without dryness, and 98.7% observed a healthy, radiant appearance of the skin after use. No participant experienced any skin intolerance or adverse events during the study period.

Conclusions: Venusia® cleanser is a well-tolerated and effective non-foaming cleanser suitable for all adult skin types, demonstrating efficacy and high user acceptability.

Evaluation of potential inflammatory biomarkers of disease severity in psoriasis: a case control study

Akhila Pandigunta, Hari Kishan Kumar Yadalla — Fri, 21 Aug 2026 00:00:00 +0530

Background: Psoriasis is a chronic inflammatory skin disorder affecting approximately 2-4% of the global population, characterized by immune dysregulation and keratinocyte hyperproliferation. Although multiple investigations have identified potential biomarkers, no validated panel exists for assessing disease severity. Objectives of the study were to determine levels of serum uric acid (SUA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), CRP/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in psoriasis patients versus controls, and assess their correlation with disease severity using psoriasis area severity index (PASI).

Methods: This case-control study included 50 psoriasis patients and 50 age- and sex-matched controls. Participants underwent complete blood count, CRP, ESR, serum albumin, and SUA measurements. Disease severity was categorized as mild (PASI <7), moderate (PASI 7-15), or severe (PASI >15).

Results: ESR was significantly elevated in cases versus controls (33.24±22.75 versus 19.44±11.50 mm/hour, p<0.001). CAR distribution differed significantly (p<0.001), with 56% of cases having CAR ≤0.1 mg/l versus 2% of controls. SUA showed no overall difference between groups (p=0.468) but significantly correlated with disease severity (p=0.028), increasing from mild (4.76±0.97 mg/dl) to moderate (5.47±1.50 mg/dl) to severe disease (5.77±1.01 mg/dl). CRP, albumin, NLR, and PLR showed no significant differences.

Conclusions: ESR and CAR significantly differentiate psoriasis patients from controls. SUA, while not discriminating between cases and controls, correlates with disease severity. These cost-effective biomarkers can complement clinical assessment in psoriasis management.

Clinical evaluation of EqualsTwo® under eye gel in the management of periorbital issues in pregnant and lactating women: an open-label study

Fri, 21 Aug 2026 00:00:00 +0530

Background: Periorbital hyperpigmentation, puffiness, and fine lines are common dermatological concerns adversely impacting quality of life. Conventional therapies, including hydroquinone and retinoids have safety limitations in pregnant and lactating women, necessitating exploration of botanical alternatives. This study evaluated the safety and efficacy of a natural-origin EqualsTwo^® under eye gel in improving periorbital concerns within this sensitive population.

Methods: In this prospective, open-label, single-arm exploratory study, 72 women (12 pregnant, 60 lactating; aged 22-40 years) were enrolled; 65 completed the trial. Participants applied approximately 0.2 gm of the investigational product twice daily for 42 days. Dermatological assessments were performed using a 6-point grading scale for dark circles, Investigator's Global Assessment Scale for puffiness, and Allergan fine lines scale. Melanin concentration and fine-line metrics (count, length, width, depth) were assessed using the Antera 3D system, supported by subject-reported outcomes. Safety was monitored throughout.

Results: By day 42, 55.38% of participants achieved grade 0 for both dark circles and puffiness, while 66.15% demonstrated minimal fine lines. Instrumental assessments revealed a 10.47% reduction in melanin concentration (p<0.0001), 32.36% decrease in fine-line count (p<0.0001), 86.22% reduction in line depth (p<0.0001), and 69.98% decrease in line width (p<0.0001). All participants reported visible improvements in hydration, softness, and firmness. 100% participants expressed satisfaction, and no adverse events were recorded.

Conclusions: The investigation product demonstrated improvements across all periorbital parameters with no treatment related adverse events, supporting botanical formulations as effective alternatives in pregnant and lactating women.

Correlation of newer hematological parameters and IL-17A with severity of psoriasis in obese and non-obese patients

Atmaja Jadhav, Anita Tahlan, Gurvinder Pal Thami, Anshu Palta — Fri, 21 Aug 2026 00:00:00 +0530

Background: Psoriasis is a chronic immune-mediated inflammatory disorder associated with obesity and metabolic dysfunction. Interleukin-17A (IL-17A) and newer haematological indices are emerging as markers of systemic inflammation.

Methods: This analytical cross-sectional study included 46 psoriasis patients categorized into obese and non-obese groups based on BMI. Hematological parameters, NLR, PLR, and reticulocyte indices were analyzed, and serum IL-17A levels were measured using ELISA. Disease severity was assessed using PASI and CPSS. Statistical analysis was performed using Welch’s t-test and Pearson’s correlation.

Results: Obese patients showed higher PASI, CPSS, IL-17A, and ESR levels, though differences were not statistically significant. IL-17A showed a strong positive correlation with PASI in obese patients (r=0.791, p<0.001) and a significant correlation with ESR (r=0.341, p=0.02). ESR showed significant negative correlations with RBC indices. In non-obese patients, IL-17A correlated negatively with reticulocyte indices.

Conclusions: IL-17A and hematological inflammatory markers are significantly associated with psoriasis severity. IL-17A may serve as a useful adjunctive biomarker for assessing systemic inflammation in psoriasis.

Clinico-epidemiological profile and morphological patterns of an institutional outbreak of paederus dermatitis from North India: a descriptive study

Sushma Muralidharan, Mehak Gupta — Fri, 21 Aug 2026 00:00:00 +0530

Background: Paederus dermatitis (PD) is an acute irritant contact dermatitis caused by pederin, a vesicant toxin in the hemolymph of beetles of the genus Paederus. Despite its occurrence across tropical India, published data from north India and documented institutional cluster outbreaks among young adults remain scarce.

Methods: A descriptive observational study was conducted at a tertiary care teaching hospital in Greater Noida, Uttar Pradesh, over 15 days in April 2026. All 106 patients clinically diagnosed with PD from a single university hostel campus were consecutively enrolled. Data on demographics, symptom onset, morphological patterns, sites of involvement, and risk factors were recorded using a structured proforma. Descriptive statistics- frequencies, percentages, mean and standard deviation were used for analysis.

Results: Of 106 patients (60 males, 46 females), the mean age was 20.27±1.48 years (range 18-24). Mean duration of symptoms at presentation was 1.86±0.74 days. The predominant symptoms were erythema (97.2%) and burning sensation (95.3%). Linear erythematous plaque was the most common morphological pattern (67.9%), followed by kissing lesions (38.7%), herpetiform lesions (38.7%), Nairobi eye variant (21.7%), and erythematous patch with central gray necrotic area (18.9%). The neck was the most frequently involved site (76.4%). Sleeping with windows open (69.8%) and proximity to campus vegetation (100%) were the predominant risk factors.

Conclusions: This study reports one of the first institutional cluster outbreaks of Paederus dermatitis from north India, occurring in April- a pre-monsoon season not previously highlighted for PD in this region. The diverse morphological spectrum, including herpetiform and kissing variants, highlighting the importance of clinical awareness to prevent misdiagnosis in hostel settings.

Clinical and safety outcomes of a prospective, eight-week and monocentric study of a multi-active topical serum in facial hyperpigmentation in Indian skin

Ketan Kulkarni, Anil Kukreja, Monika Chinda — Fri, 21 Aug 2026 00:00:00 +0530

Background: Facial hyperpigmentation is a common dermatological concern in individuals with Fitzpatrick skin phototypes III-IV. Current treatment options are often limited by tolerability issues and restrictions on long-term hydroquinone use. This study evaluated the efficacy and safety of SOLGLO-AZ Serum, a hydroquinone-free multi-active topical formulation, in Indian adults with facial hyperpigmentation.

Methods: In this prospective, open-label, monocentric study, 34 adults with facial hyperpigmentation were enrolled, of whom 32 completed the study. Participants applied SOLGLO-AZ serum once nightly for 8 weeks. Efficacy was assessed at baseline, day 30, and day 60 using clinical blemish scores and Antera 3D imaging-derived skin luminance (L*) and pigmentation indices. Safety and participant satisfaction were evaluated using clinical assessments and self-assessment questionnaires.

Results: By day 60, mean blemish scores decreased by 25% (p<0.05), skin luminance (L*) increased by 18.8% (p<0.05), and mean pigmentation values decreased by 9.2% (p<0.05) compared with baseline. More than 93% of participants reported improvement in pigmentation, skin tone evenness, overall appearance, and satisfaction with the product. No clinically significant adverse events, erythema, edema, or irritation were observed.

Conclusions: Once-nightly application of SOLGLO-AZ Serum for 8 weeks resulted in significant improvement in facial hyperpigmentation, high patient satisfaction, and excellent tolerability in Indian adults with Fitzpatrick skin phototypes III–IV. These findings support the use of hydroquinone-free multi-active topical formulations for the management of facial hyperpigmentation.

Study to assess the association between screen time, other life style factors and hair fall

Jahnavi Kodaru, Uma Prasanna Laxmi Bikkasani — Fri, 21 Aug 2026 00:00:00 +0530

Background: Hair fall is one of the most common cosmetic concerns among young adults and is influenced by genetic, environmental, nutritional, hormonal, and lifestyle factors. With the rapid increase in digital device usage, screen time has emerged as a potential lifestyle factor affecting overall health. The present study aimed to assess the association between screen time, sleep duration, stress levels, and hair fall among young adults.

Methods: A cross-sectional questionnaire-based study was conducted among 300 young adults aged 15-25 years. Data regarding demographic characteristics, average daily screen time, sleep duration, perceived stress, family history of hair fall, medical conditions affecting hair, and hair fall characteristics were collected using a structured online questionnaire. Descriptive statistics were used to summarize the data. Associations between lifestyle factors and hair fall were assessed using Chi-square tests. A p value less than 0.05 was considered statistically significant.

Results: Among 300 participants, 57.3% belonged to the age group of 21-25 years and 66.3% were females. Increased hair fall during the preceding six months was reported by 65.3% of participants. Significant associations were observed between screen time and increased hair fall (χ²=10.624, p=0.014), screen time and hair fall severity (χ²=15.377, p=0.018), and stress levels and increased hair fall (χ²=11.793, p=0.019). No significant association was found between sleep duration and increased hair fall (χ²=3.028, p=0.387).

Conclusions: Higher screen time and elevated stress levels were significantly associated with self-reported hair fall among young adults. These findings highlight the importance of lifestyle modification and stress management in maintaining hair health.

Efficacy of Venusia max cream and lotion on skin hydration, barrier function and consumer perception: a 72-hour interventional study

Fri, 21 Aug 2026 00:00:00 +0530

Background: Adequate skin hydration is essential for maintaining epidermal barrier integrity and preventing dryness and irritation in normal to dry skin. This study evaluated the effects of Venusia max cream and Venusia max lotion on skin hydration, transepidermal water loss (TEWL), and consumer perception in healthy adults with normal to dry skin.

Methods: This single-center, non-randomized, within-subject, controlled interventional study enrolled healthy volunteers aged 18-55 years with normal to dry skin. Venusia max cream and Venusia max lotion were applied to designated test sites, with untreated sites serving as controls. Skin hydration was measured using the MoistureMeter-D, and TEWL was assessed using a closed-chamber VapoMeter at baseline and 15 minutes, 12, 24, 48, and 72 hours post-application. Consumer perception and safety were evaluated at 72 hours.

Results: Thirty-four participants (mean age 29.21±8.63 years; 82.4% female) were analyzed. Both formulations produced rapid increases in skin hydration within 15 minutes. Venusia max cream showed sustained numerical improvements at 72 hours (+0.98 and +1.13 with M25 and S15 probes; p=0.073 and p=0.054). Venusia max lotion demonstrated significant hydration improvements at multiple time points, including 72 hours (+3.15 and +3.77; both p=0.001). TEWL decreased with both formulations, with significant reductions up to 48 hours for the cream and at 12 hours for the lotion (p=0.001). Consumer satisfaction and tolerability were high, with no adverse events reported.

Conclusions: Venusia max cream and lotion provided rapid hydration, supported epidermal barrier function, and were well tolerated, supporting their use in routine care of normal to dry skin.

Neurological complications of herpes zoster in adult patients receiving Janus kinase inhibitors: a systematic review

Fri, 21 Aug 2026 00:00:00 +0530

Herpes zoster (HZ) is a recognized infectious adverse event among adult patients receiving Janus kinase (JAK) inhibitors. Although most cases are cutaneous, neurological complications such as post-herpetic neuralgia (PHN), meningitis, and encephalitis may cause substantial morbidity. This systematic review was conducted at the Dermatology and Venereology Department, Mangusada Regional Hospital, Badung, Bali, Indonesia. PubMed, Cochrane Library, and ScienceDirect were searched from 1 May to 15 May 2026 using terms related to HZ, neurological complications, and JAK inhibitors. Eligible studies included clinical trial safety analyses, observational studies, pharmacovigilance studies, and case reports. Seven studies were included and synthesized narratively because of clinical and methodological heterogeneity. Seven studies were included. Evidence consisted of one matched cohort study, one case report, three tofacitinib clinical safety analyses, one ruxolitinib cream safety analysis, and one pharmacovigilance study. Tofacitinib accounted for most systemic JAK inhibitor evidence. In ulcerative colitis studies, HZ occurred in 5.6-8.2% of tofacitinib-treated patients, with PHN reported in 0.3% and one case of HZ encephalitis/meningitis. In rheumatoid arthritis, PHN occurred after first HZ events in 6.9% of patients. A case report described severe HZ meningitis after tofacitinib, with residual visual loss and facial nerve paralysis. Ruxolitinib cream was associated with rare HZ and isolated PHN. Pharmacovigilance data detected PHN signals for tofacitinib, ruxolitinib, and baricitinib. Clinicians should anticipate HZ risk during JAK inhibitor therapy and promptly evaluate neurological symptoms.

Systemic medication as a safety variable in dermatologic laser and energy-based device procedures: a practical risk-stratification framework

Stefan Bigge, Bianca Bigge — Fri, 21 Aug 2026 00:00:00 +0530

Dermatologic laser and energy-based device procedures are increasingly performed in patients receiving systemic medication. Traditional pre-procedure screening often treats selected drugs as binary contraindications, although the relevance of medication exposure depends on device type, wavelength, pulse duration, cooling, treatment endpoint, tissue depth, epidermal barrier disruption, treatment area, skin phenotype, and follow-up capacity. This practical review proposes a structured framework for incorporating systemic medication into laser and energy-based device safety assessment. PubMed-based evidence mapping was organized by medication class and procedure category. Evidence was graded pragmatically as direct laser or energy-based device evidence, indirect procedural evidence, pharmacologic or biologic plausibility, or absent evidence. The strongest medication-specific laser evidence concerns isotretinoin, where historical blanket delays have been reconsidered for many low-injury and fractional procedures. Antithrombotic agents and Bruton tyrosine kinase inhibitors primarily modify bleeding and purpura risk, with most evidence extrapolated from dermatologic surgery. Direct laser-specific evidence remains sparse for biologics, Janus kinase inhibitors, conventional immunosuppressants, systemic corticosteroids, targeted oncologic therapies, and immune checkpoint inhibitors. Photosensitizing and pigment-altering drugs are most relevant for intense pulsed light, photodynamic therapy, pigment lasers, and darker phototypes. Systemic medication should be considered a procedure-dependent safety variable rather than an automatic contraindication. The proposed framework integrates medication class, procedure injury profile, patient phenotype, and evidence grade to support individualized risk assessment and shared decision-making.

Ocular and cutaneous rosacea: early diagnosis and comprehensive approach

Fri, 21 Aug 2026 00:00:00 +0530

Rosacea is a common chronic inflammatory disease, traditionally classified as a purely dermatological disorder. However, ocular involvement (ocular rosacea) occurs in up to 58% of patients and frequently precedes dermal manifestations, underscoring the need for early diagnosis and a transdisciplinary approach. Objective of the study was to analyze the common pathophysiological aspects, clinical criteria for early diagnosis, and current strategies for the comprehensive management of cutaneous and ocular rosacea. Literature review of scientific papers published in biomedical databases, focusing on the immunopathology of the disease, clinical manifestations according to current phenotypes, and topical, systemic, and light-based therapeutic profiles. The pathophysiology of rosacea is driven by a dysregulation of innate immunity (overexpression of LL-37 cathelicidin) and neurovascular dysfunction. Ocular rosacea shares this inflammatory cascade, manifesting primarily as meibomian gland dysfunction (MGD), blefaritis, and evaporative dry eye. Early diagnosis is crucial to prevent severe sequelae such as corneal neovascularization. In the therapeutic field, subantimicrobial-dose tetracyclines (doxycycline 40 mg) and topical 1% ivermectin stand out for their anti-inflammatory efficacy, while intense pulsed light (IPL) emerges as an effective dual alternative to simultaneously treat facial erythema and eyelid alteration. Rosacea is a complex-local pathology that requires transcending the boundary of isolated dermatology. A proper literature review of the evidence shows that cooperative work between dermatology and ophthalmology optimizes symptom control, prevents the progression of ocular damage, and mitigates the negative impact on the patient's quality of life.

1064-nm Nd:YAG laser as an antibiotic-sparing treatment option for inflammatory acne: a narrative review and evidence-informed practical treatment framework

Stefan Bigge, Bianca Bigge — Wed, 01 Jul 2026 00:00:00 +0530

Antibiotic stewardship has become an increasingly important consideration in acne management. Systemic antibiotics remain useful for selected patients with inflammatory acne, but repeated or prolonged exposure raises concerns regarding antimicrobial resistance, microbiome disruption, tolerability, and adherence. Non-antibiotic procedural approaches may therefore have a role as adjunctive or antibiotic-sparing options in carefully selected patients. To review the clinical rationale, evidence base, safety considerations, and practical integration of 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy for inflammatory acne. A narrative PubMed-based review was conducted focusing on 1064-nm Nd:YAG laser therapy for active acne, antibiotic stewardship, standard acne therapy, device-based acne treatment, safety in skin of color, isotretinoin and energy-based devices, and competing technologies. Studies exclusively addressing acne scars, post-acne erythema, hidradenitis suppurativa, or acne keloidalis nuchae were excluded from the core evidence synthesis. Evidence for 1064-nm Nd:YAG laser therapy includes microsecond-domain 650-usec studies, millisecond long-pulsed protocols, Q-switched and carbon-assisted approaches, and comparative studies against other procedural modalities. A sham-controlled randomized trial supports 650-usec 1064-nm treatment, and prospective and retrospective studies report improvement across a range of acne severities and Fitzpatrick skin types. Comparative studies suggest benefit for inflammatory lesions, but protocols, outcomes, comparators, and follow-up periods remain heterogeneous. No study has definitively demonstrated reduced cumulative antibiotic exposure as a predefined endpoint. 1064-nm Nd:YAG laser therapy should not be presented as a replacement for guideline-based pharmacologic acne treatment. The most defensible role is as an adjunctive or potential antibiotic-sparing procedural option for selected patients with inflammatory acne. Future trials should prospectively measure antibiotic exposure, relapse, maintenance needs, patient-reported outcomes, and cost-effectiveness.

Tranexamic acid versus kojic acid in facial post-inflammatory hyperpigmentation following acne: a narrative review

Sanjana R. Tummala, Swetha Donakonda, B. Uday Kumar — Thu, 16 Jul 2026 00:00:00 +0530

Facial post-inflammatory hyperpigmentation (PIH) following acne is a frequent and distressing sequela, especially in darker Fitzpatrick skin phototypes. Tranexamic acid (TXA) and kojic acid are increasingly used as non-hydroquinone depigmenting agents, but their comparative role in acne-induced PIH remains insufficiently defined. Objective of the study was to compare the mechanistic rationale, clinical evidence, safety profile, and practical role of TXA versus kojic acid in facial PIH after acne. A focused narrative review was performed using DOI-traceable studies and reviews on acne-induced PIH, TXA, kojic acid, and facial hyperpigmentation. Evidence from acne-specific PIH studies was prioritized, while melasma studies were used only as indirect supportive evidence because melasma and PIH differ in pathogenesis. Acne-induced PIH is driven by inflammation-mediated melanocyte stimulation, excess epidermal melanin, and, in some cases, dermal melanophages. TXA acts upstream by inhibiting plasminogen activation and reducing inflammatory and vascular mediators involved in melanogenesis. Clinical evidence for TXA in PIH includes systematic review data and a randomized trial showing topical 5% TXA to be comparable to 20% azelaic acid for acne-related PIH, with favourable early tolerability. Kojic acid acts mainly by copper chelation and tyrosinase inhibition. Its evidence in acne-PIH is more limited, with small preliminary data in post-acne hyperpigmentation and stronger indirect evidence from melasma studies, often in combination with hydroquinone, glycolic acid, or vitamin C. No robust direct head-to-head trial of TXA versus kojic acid for facial post-acne PIH was identified. Current evidence supports both agents as useful non-hydroquinone options. TXA may be preferable where inflammation, erythema, recurrence, or sensitive skin are prominent, while kojic acid may be useful for epidermal brown macular pigmentation in patients tolerating tyrosinase inhibitors. Direct comparative randomized trials are needed.

Low-dose oral tranexamic acid for melasma: a narrative review and practical thromboembolic risk assessment framework

Stefan Bigge — Wed, 22 Jul 2026 00:00:00 +0530

Oral tranexamic acid has become an important off-label option for melasma, but persistent concern about thromboembolism limits its use in routine dermatologic practice. This narrative review summarizes current evidence on the efficacy and thromboembolic safety of low-dose oral tranexamic acid and translates the findings into a practical pretreatment risk assessment framework. Peer-reviewed randomized trials, comparative studies, observational cohorts, systematic reviews, and meta-analyses identified through PubMed/MEDLINE, Embase, and reference screening up to March 2026 were reviewed qualitatively. The clinical literature consistently shows improvement in melasma severity, most often with 250 mg twice daily for 8 to 12 weeks. The placebo-controlled trial by Del Rosario et al reported a 49% reduction in modified melasma area and severity index after 3 months, compared with 18% under placebo. Melasma-specific safety evidence is reassuring in carefully selected patients. The most relevant propensity score-matched cohort found no significant increase in venous thromboembolism through 365 days, and pooled randomized-trial data reported no thromboembolic events. However, broader database analyses have produced conflicting signals, and a small residual risk cannot be excluded. Adverse effects are usually mild and include menstrual changes, gastrointestinal symptoms, and headache. Low-dose oral tranexamic acid should not be used casually but may have a favorable benefit-risk profile only after structured screening and avoidance of major thrombotic risk factors.