Skin Research Center

INTEGUMENT-PED/NCT04845620, a 4-week, phase 3 trial, demonstrated efficacy and safety of roflumilastcream 0.05% in children aged 2-5 years with mild-to-moderate atopic dermatitis (AD). A phase 3 open-label extensiontrial(INTEGUMENT-OLE [NCT04804605]) investigated long-term outcomes continuing roflumilast cream for ≤ 56 weeks. Caregivers of eligible patients from INTEGUMENT-PED applied roflumilast cream 0.05% once-daily in INTEGUMENT-OLE. Patients achieving Validated Investigator Global Assessment for AD (vIGA-AD) clear (0) at/afterweek4 of INTEGUMENT-OLE switched to twice-weekly (BIW) application. Evaluation of safety (adverse events [AEs] and application-site tolerability) was the primary objective. Efficacy endpoints assessed from INTEGUMENT-PED baseline included vIGA-AD success (clear/almost clear [0/1] plus ≥ 2-point improvement), vIGA-AD 0/1, ≥ 75% improvement in Eczema Area and Severity Index, and Worst Itch-Numeric Rating Scale success (≥ 4-point improvement in patients with baseline score ≥ 4). Duration of vIGA-AD 0/1 and sign/symptom control ("disease control") with BIW application was determined. Among 562 patients, 14 (2.5%) had treatment-related AEs reported. Roflumilast was well tolerated; application-site pain AEs were reported for four (0.7%) patients. At treatment-week 56, AD signs/symptoms continued to improve (63.1% of patients achieved vIGA-AD 0/1). Of 170 (30.2%) patients who switched to BIW application, the median Kaplan-Meier duration of "disease control" was 238 days. Roflumilast cream 0.05% demonstrated a favorable long-term safety profile and durable efficacy for up to 56 weeks of treatment in children aged 2-5 years with AD, and "disease control" was maintained with BIW application. These results are consistent with previous studies, including patients aged ≥ 6 years from INTEGUMENT-OLE. Clinicaltrials.gov identifier: NCT04845620.

Traditional Chinese Medicine (TCM) is a well-known and a commonly used approach in medical practice most common in Asian countries, however it is increasingly used in other regions in the world. The usage of it is less well characterised in young population. The purpose of this article will be to synthesise evidence of clinical trials in which treated population is young population aged between 12-25 years old. Highlighted will be the outcome of the clinical trials, intervention used, targeted condition that was treated In the clinical trials and the methodology of the clinical trial. The searches were conducted in commonly used databases like PubMed, Web of Science, Scopus and the China National Knowledge infrastructure for clinical trials performed in the last 25 years from year of 2000 to 2025. Included studies were only studies in which the targeted population is in ages between 12-25 years and the treatment in the clinical trial Is related to Traditional Chinese Medicine, such as Acupuncture, herbal medicine, moxibustion, etc. The found result will show that most of the conditions treated with Traditional Chinese Medicine are related to skin disorders, gastrointestinal disorders, insomnia and anxiety. In most of the cases, the most used interventions are Acupuncture and form of Herbal Medicine. The results will also show that there is improvement of moderate symptoms of the diseases and low number of adverse events. In conclusion the research is showing that interventions with Traditional Chinese Medicine can be beneficial in treatment of some form of the diseases in young population aged 12-25 years.

Senile purpura is characterized by the recurrent ecchymoses following minor trauma [1]. This condition arises due to the weakening of the structural integrity of dermal collagenous tissues and increased fragility of blood vessels. Therapeutic approaches that restore the structural support of the dermal extracellular matrix (ECM) in patients with senile purpura may lead to progressive improvements. Calcium hydroxylapatite (CaHA) has been used as a dermal filler and is known to improve skin quality by inducing mechanotransduction, a process in which mechanical stimuli are converted into biochemical signals [2]. The transcriptional regulator YAP has been highlighted as a key cellular mechanotransducer that exerts influence over collagen synthesis and skin regeneration [3]. A 65-year-old male and a 67-year-old male presented with recurrent bruises on the dorsum of hands (Figure 1a). Despite the regular use of moisturizers and physical protection, purpura continued to worsen. Consequently, 1.5 cc of CaHA (Radiesse; Merz, Raleigh, NC) was diluted in a 1:1 ratio with 0.1% lidocaine and injected subdermally into the dorsum of the hand using a proximal-to-distal fanning technique. The injection was performed on the left hand at baseline, while the right hand remained untreated to serve as a comparison control. After 3 months, gross examination revealed clinical improvements in senile purpura, skin texture, and volume, compared to the baseline (Figure 1a,b). Two punch biopsy specimens were obtained for histopathological examination. The treated side tended to have greater epidermal thickness compared to the control side. Additionally, special stains demonstrated more prominent collagen and elastic fibers in the treated area (Figure 1c–e). Immunohistochemistry analysis also revealed the number of cells exhibiting increased YAP expression after the treatment (Figure 1f,h). The expression of vascular endothelial growth factor is higher in the treated side compared to the control (Figure 1g,i). Given that YAP regulates collagen production in fibroblasts and mediates feedback mechanisms in cellular mechanotransduction, these findings suggest that ECM synthesis following CaHA treatment occurs via a mechanotransduction pathway involving YAP activation. In both patients, CaHA was also administered to the control hand at 3 months, with follow-up for another 3 months post-procedure. Both hands demonstrated sustained improvement in hand volume and skin quality, with favorable clinical results up to 6 months. To address whether CaHA modulates the YAP-mediated mechanotransduction pathway, we performed a 3-dimensional spheroid culture experiment using benign immortalized human dermal fibroblasts and retinal pigment epithelium-1 (RPE1) cells (Supplementary Text, available via Mendeley at https://doi.org/10.17632/b2j2rdxv5n.1), more relevant to the in vivo condition (Figure 2 and Supplementary Figure 1) [4]. Cells exhibiting high levels of nuclear YAP enrichment, indicative of YAP activation, were more frequent in the condition where CaHA was supplemented, compared to the control (Figure 2b,c). Fibroblasts adhering to CaHA microspheres exhibited actin cytoskeletal remodeling (Figure 2c), which is known to strongly influence YAP activity. Our study shows that injecting diluted CaHA into the dorsum of the hand improves senile purpura, accompanied by histological evidence of epidermal and dermal proliferation, increased collagen and elastic fiber density. This dermal ECM reinforcement likely stabilizes fragile vasculature [3]. Notably, we observed a significant increase in YAP-positive cells in the dermis post-CaHA injection, supported by in vitro spheroid culture. Since YAP regulates ECM homeostasis and is suppressed in aged fibroblasts due to reduced mechanical cues, CaHA may restore dermal stiffness and activate YAP-dependent mechanotransduction, promoting neocollagenesis and skin integrity [5]. Nevertheless, this study represents a preliminary and exploratory observation intended to stimulate further controlled trials. Moreover, the clinical inference of our findings is limited by the sample size, male sex homogeneity, and a short follow-up period. While further studies are required to determine whether CaHA can provide long-term improvement for senile purpura, its use may be considered a treatment option for patients unresponsive to conservative therapies. This study was supported by a research grant from Merz Asia Pacific Pte. Ltd. The patient provided written informed consent for the use of clinical images and related data for research and publication purposes. The authors declare no conflicts of interest. The data that supports the findings of this study are available in the supporting information of this article.

Suction blister epidermal grafting (SBEG) is a time-tested surgical treatment to correct small patches of stable vitiligo on any part of the body. The cosmetic result, especially on the lips, is highly satisfying. The most difficult part of this procedure is graft retention on the dermabraded lip. In this article, we present our observation of open and closed dressing in the same patient who underwent SBEG on the lip and chin simultaneously. We find that the results of the open dressing are equally good as the closed dressing area.

Abstract Background Pemphigus vulgaris (PV) is a potentially fatal autoimmune mucocutaneous blistering disease. Rituximab (RTX) is a chimeric anti-CD20 monoclonal antibody that is increasingly being used and becoming the first-line therapy in the management of PV. Its impact on cervical cytology and human papillomavirus (HPV) infection risk in this population remains unclear. Objectives To prospectively evaluate cervical Papanicolaou ( Pap) smear results and HPV prevalence before and 6 months after rituximab therapy in women with PV. Methods Twenty-eight women with PV underwent Pap smear and HPV genotyping before and after two rituximab infusions (1 gram, 2 weeks apart) Results The mean age was 55.5 ± 12.1 years; 75% were postmenopausal. After treatment, the proportion of inflammatory smears increased (from 35.7% to 57.1%), though no high-grade lesions appeared ( p = 0.368). HPV DNA was detected in 25% of patients, predominantly high-risk genotypes. HPV positivity correlated with shorter disease duration (24.0 vs. 84.0 months, p = 0.005) and mucosal PV type (66.7%, p = 0.019). Conclusions Rituximab did not significantly alter Pap smear Bethesda categorization at 6 months, but coincided with increased inflammatory cytology and frequent high-risk HPV. Findings support regular Pap/HPV co-testing and vaccination in women with PV undergoing B-cell depletion therapy.

Introduction: Molluscum contagiosum (MC) is an easily transmitted poxvirus infection most commonly affecting children, where it normally causes multiple benign papules associated with itching, pain, and inflammation. Typical treatment guidance includes a watch and wait approach over 2 to 4 years with no current consensus on the best form of active therapy. This retrospective chart review aimed to determine whether microwave therapy could be a suitable and safe treatment modality for children and adults with MC. Methods: 35 patients were treated at a single podiatry clinic in Geelong, Australia, with microwave energy in up to 3 sessions, 4 weeks apart, being monitored for resolution and adverse events. Results: All patients’ lesions resolved after an average of 2.1 treatments. There was no difference in the number of treatments required for children versus adults to achieve complete resolution. Treatment-associated pain was transient, localized, and tolerable. No other adverse events were observed. Conclusion: These outcomes suggest that microwave therapy has the potential to be a new modality for the treatment of MC as it can be highly efficacious, safe, and equally applicable to children and adults.