Aims and objectivesThe purpose of this study is to investigate the effectiveness and safety of oral and injectable systemic treatments, such as methotrexate, azathioprine, cyclosporine, tofacitinib, baricitinib, corticosteroids, statins, zinc, apremilast, etc., for treating vitiligo lesions.MethodDatabases including PubMed, Scopus, and Web of Science were meticulously searched for studies spanning from 2010 to August 2023, focusing on systemic oral and injectable therapies for vitiligo, using comprehensive keywords and search syntaxes tailored to each database. Key data extracted included study design, treatment efficacy, patient outcomes, patient satisfaction, and safety profiles.ResultsIn a total of 42 included studies, oral mini‐pulse corticosteroid therapy (OMP) was the subject of six studies (14.2%). Minocycline was the focus of five studies (11.9%), while methotrexate, apremilast, and tofacitinib each were examined in four studies (9.5%). Antioxidants and Afamelanotide were the subjects of three studies each (7.1%). Cyclosporine, simvastatin, oral zinc, oral corticosteroids (excluding OMP) and injections, and baricitinib were each explored in two studies (4.8%). Azathioprine, mycophenolate mofetil, and Alefacept were the subjects of one study each (2.4%).ConclusionSystemic treatments for vitiligo have been successful in controlling lesions without notable side effects. OMP, Methotrexate, Azathioprine, Cyclosporine, Mycophenolate mofetil, Simvastatin, Apremilast, Minocycline, Afamelanotide, Tofacitinib, Baricitinib, Antioxidants, and oral/injectable corticosteroids are effective treatment methods. However, oral zinc and alefacept did not show effectiveness.

Background/PurposeAmong the characteristics that appear in the epidermis of the skin, erythema is primarily evaluated through qualitative scales, such as visual assessment (VA). However, VA is not ideal because it relies on the experience and skill of dermatologists. In this study, we propose a new evaluation method based on hyperspectral imaging (HSI) to improve the accuracy of erythema diagnosis in clinical settings and investigate the applicability of HSI to skin evaluation.MethodsFor this study, 23 subjects diagnosed with atopic dermatitis were recruited. The inside of the right arm is selected as the target area and photographed using a hyperspectral camera (HS). Subsequently, based on the erythema severity visually assessed by a dermatologist, the severity classification performance of the RGB and HS images is compared.ResultsErythema severity is classified as high when using (i) all reflectances of the entire HSI band and (ii) a combination of color features (R of RGB, a* of CIEL*a*b*) and five selected bands through band selection. However, as the number of features increases, the amount of calculation increases and becomes inefficient; therefore, (ii), which uses only seven features, is considered to perform classification more efficiently than (i), which uses 150 features.ConclusionIn conclusion, we demonstrate that HSI can be applied to erythema severity classification, which can further increase the accuracy and reliability of diagnosis when combined with other features observed in erythema. Additionally, the scope of its application can be expanded to various studies related to skin pigmentation.

BackgroundPermeation‐enhancing compounding bases are aimed to facilitate the penetration of the active pharmaceutical ingredients (APIs) across the skin barrier.ObjectivesThe purpose of this study was to evaluate the percutaneous absorption of radiolabeled human insulin (14C‐isototpe) when incorporated in a proprietary phospholipid base designed to deliver APIs with high molecular weights (HMW). The aim was not to claim the transdermal delivery of insulin with potential therapeutic applications in diabetes but, instead, to evaluate the ability of the compounding phospholipid base to deliver HMW drugs.MethodsThe percutaneous absorption of 14C‐insulin was determined using human torso skin and the Franz skin finite dose model. Two topical test formulations were prepared for in vitro evaluation: insulin 1% in phospholipid base (standard) and insulin 1% in phospholipid base HMW. The rate of percutaneous absorption (mean flux) and the distribution of 14C‐insulin through the skin were evaluated for both topical test formulations. A two‐way ANOVA was used to determine statistical differences.ResultsThe 14C‐insulin was distributed into the stratum corneum, epidermis and dermis. Mean flux values showed a rapid penetration upon application and the maximum flux was achieved at 30 min, followed by a slow decline. Subsequently, a slower decline was observed for the topical test formulation including the phospholipid base HMW.ConclusionThe phospholipid base HMW facilitates the percutaneous absorption of HMW drugs across human cadaver skin and, therefore, it may potentially be a useful option for compounding pharmacists and practitioners when considering the skin for the percutaneous delivery of large drugs.

IntroductionSoftware to predict the impact of aging on physical appearance is increasingly popular. But it does not consider the complex interplay of factors that contribute to skin aging.ObjectivesTo predict the +15‐year progression of clinical signs of skin aging by developing Causal Bayesian Belief Networks (CBBNs) using expert knowledge from dermatologists.Material and methodsStructures and conditional probability distributions were elicited worldwide from dermatologists with experience of at least 15 years in aesthetics. CBBN models were built for all phototypes and for ages ranging from 18 to 65 years, focusing on wrinkles, pigmentary heterogeneity and facial ptosis. Models were also evaluated by a group of independent dermatologists ensuring the quality of prediction of the cumulative effects of extrinsic and intrinsic skin aging factors, especially the distribution of scores for clinical signs 15 years after the initial assessment.ResultsFor easiness, only models on African skins are presented in this paper. The forehead wrinkle evolution model has been detailed. Specific atlas and extrinsic factors of facial aging were used for this skin type. But the prediction method has been validated for all phototypes, and for all clinical signs of facial aging.ConclusionThis method proposes a skin aging model that predicts the aging process for each clinical sign, considering endogenous and exogenous factors. It simulates aging curves according to lifestyle. It can be used as a preventive tool and could be coupled with a generative AI algorithm to visualize aging and, potentially, other skin conditions, using appropriate images.

BackgroundDopamine (D) and serotonin (5‐HT) pathways contribute to psoriasis pathobiology. Disruptions incite increased inflammatory mediators, keratinocyte activation and deterioration, and worsening symptoms. Brilaroxazine (RP5063), which displays potent high binding affinity to D2/3/4 and 5‐HT1A/2A/2B/7 receptors and a moderate affinity to serotonin transporter (SERT), may affect the underlying psoriasis pathology.MethodsAn imiquimod‐induced psoriatic mouse model (BALB/c) evaluated brilaroxazine's activity in a topical liposomal‐aqueous gel (Lipogel) formulation. Two of the three groups (n = 6 per) underwent induction with 5% imiquimod, and one group received topical brilaroxazine Lipogel (Days 1–11). Assessments included (1) Psoriasis Area and Severity Index (PASI) scores (Days 1–12), skin histology for Baker score based on H&E stained tissue (Day 12), and serum blood collection for serum cytokine analysis (Day 12). One‐way ANOVA followed by post hoc Dunnett's t‐test evaluated significance (p < 0.05).ResultsImiquimod‐induced animal Baker scores were higher versus Sham non‐induced control's results (p < 0.001). Brilaroxazine Lipogel had significantly (p = 0.003) lower Baker scores versus the induced Psoriasis group. Brilaroxazine PASI scores were lower (p = 0.03) versus the induced Psoriasis group (Days 3‐12), with the greatest effect in the last 3 days. The induced Psoriasis group showed higher Ki‐67 and TGF‐β levels versus non‐induced Sham controls (p = 0.001). The brilaroxazine Lipogel group displayed lower levels of these cytokines versus the induced Psoriasis group, Ki‐67 (p = 0.001) and TGF‐β (p = 0.008), and no difference in TNF‐α levels versus Sham non‐induced controls.ConclusionBrilaroxazine Lipogel displayed significant activity in imiquimod‐induced psoriatic animals, offering a novel therapeutic strategy.

BackgroundPrevious research has highlighted an association between alopecia areata (AA) and the collapse of hair follicle immune privilege, however, the causal linkage to specific immune cell traits remains to be elucidated. This study aimed to investigate the causal influence of immune cell traits on AA utilizing a two‐sample Mendelian randomization (MR) approach.MethodsLeveraging GWAS summary statistics of 731 immunological traits (n = 3757) and AA data (n = 211,428), MR analyses were conducted employing inverse‐variance weighted (IVW), weighted median, and MR‐Egger regression methodologies. Sensitivity analyses were undertaken using Cochran's Q test, MR‐Egger intercept test, and MR‐PRESSO analysis. A reverse MR analysis was performed for immune cell traits identified in the initial MR analysis.ResultsOur study unveiled multiple immune traits associated with AA. Protective associations were observed for CD62L‐ CD86+ myeloid dendritic cells (DCs), TD CD4+%CD4+ T cells, and others, with ORs ranging from 0.63 to 0.78. Conversely, traits like CD62L on CD62L+ plasmacytoid DCs, HLA‐DR on CD14‐ CD16+ monocytes, HLA‐DR on monocytes, and others, were determined to augment the risk of AA, with ORs ranging from 1.13 to 1.46. Reverse MR analysis signified a reduction in BAFF‐R on IgD‐CD24‐B cells post‐AA onset (OR: 0.97, 95% CI: 0.95–1.00), with no identified heterogeneity or horizontal pleiotropy among the instrumental variables (IVs).ConclusionsOur findings suggests that CD62L on certain subpopulations of DCs and HLA‐DR on monocytes may epitomize risk factors for AA, offering potential therapeutic targets for alleviating AA.

Dear Editors, Hypopigmented skin lesions are a common dermatological disease in pediatric patients.1 Vitiligo, nevus depigmentosus, lichen striatus, and lichen sclerosus can exhibit similar clinical manifestations, including flaky skin and linear white spots. Reflectance confocal microscopy (RCM) is a noninvasive skin imaging technique that enables evaluation of the superficial layers of the skin down to the papillary dermis, revealing specific diagnostic patterns and improving the diagnostic accuracy of skin diseases.2-4 In total, 52 children were recruited for this study (27 male and 25 female; 6.31 ± 1.23 years old), 14 of whom were diagnosed with vitiligo, 16 with nevus depigmentosus, 14 with lichen striatus and 8 with lichen sclerosus (Figure 1A1,B1,C1,D1). All children enrolled in the study were examined by the Vivascope 1500 RCM system (Lucid Inc., USA). Two clinically experienced dermatologists made the definitive diagnosis according to clinical presentations and RCM features. All procedures in this study were performed in accordance with the Declaration of Helsinki. Some unique diagnostic clues for hypopigmented skin lesions can be provided by RCM features (Table 1). Vitiligo, nevus depigmentosus and lichen striatus exhibited round to polygonal typical honeycomb patterns in the epidermis. In lichen sclerosus, the normal honeycomb pattern disappeared; the epidermis was disordered with some darker areas; and the number of epidermal scan layers was reduced, indicating epidermal atrophy (5/8, 63%). At the dermoepidermal junction, dermal papillary rings were generally present in vitiligo and nevus depigmentosus, but the bright rims were all weakened (30/30, 100%). Differentiation between the two lesions was accomplished using the distribution and refractive index. In vitiligo, the dermal papillary rings were intact and visible, but the normal bright rim was significantly weakened, even disappearing entirely in some cases (Figure 1A2). In nevus depigmentosus, the normal bright rim was only slightly weakened (Figure 1B2). In lichen striatus and lichen sclerosus, the dermal papillary rings all had varying degrees of destruction and were partially missing in lichen striatus (6/14, 42%) (Figure 1C2) and mostly disappearing or completely missing in lichen sclerosus (5/8, 63%)(Figure 1D2). In the dermis, small, round, bright perivascular cells (5/14, 36%) were detected in vitiligo (Figure 1A2), while these cells in nevus depigmentosus were absent; lichen striatus exhibited slightly small homogeneous cells aggregated in clusters (14/14, 100%)(Figure 1C2); lichen sclerosus exhibited whitish material with medium-to-high refractivity, numerous irregular structures and uniformly round cells with high refractivity (8/8, 100%)(Figure 1D2). Hypopigmented skin lesions have similar appearances and pose a diagnostic challenge for the clinician, dermoscopy is an useful technique to differential diagnosis, RCM is now believed to be a promising imaging technique for identification of hypopigmented skin diseases.5, 6 We evaluated vitiligo, nevus depigmentosus, lichen striatus, and lichen sclerosus and revealed specific confocal features to support clinical diagnosis and assist with patient management. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest to declare. The patients' guardians in this manuscript have given written informed consent to the publication of their case details.

To evaluate, in vivo, a recently developed imaging system (Aeva-HE™), based on fringe projection methodology: (i) its correlation with expert's assessments and real age of 85 French Caucasian women and (ii) its potential, as a screening tool, in rapidly selecting prototypes of tensile cosmetic products. First, the bare faces of 85 differently aged French/Caucasian women were photographed under standard conditions and further analyzed by the Aeva-HE™ device. An expert aesthetician graded the severity of wrinkling on a fixed scale, helped by the use of a dedicated Skin Aging Atlas. A panel of 15 judges performed the same task on full-face standard photographs. The Aeva-HE™ software yielded various wrinkle's parameters (density, volume, mean depth, etc.) on different facial locations, according to age-groups. Second, seven women, balanced in age and wrinkling severity, were recruited in a separate study. These women applied at Day 1 a prototype of the tensile product and at Day 2, they applied another prototype of the tensile product. The whole faces (before and after products application) of the seven studied women were captured and analyzed by the Aeva-HE™ system. The density of wrinkles was significantly highly correlated with the aesthetician scores and, unsurprisingly, with age. Some parameters (volume, depths) of different wrinkles (glabellar, crow's feet, cheeks) were quantified, showing different absolute values and of statistically different progressions with age. The amplitudes of the rapid effects brought by the two prototypes of tensile products were clearly differentiated. The recently developed deviceAeva-HE™ is an efficient system for rapidly establishing a faithful and precise status of facial wrinkles, in vivo and seems like a precious tool in the rapid screening of tensile products, possibly performed on a rather limited number of subjects.

To the Editor, In women in their 30s/40s with darker phototypes is more common to find melasma. It is an acquired hypermelanotic pathology that appears as irregular, light- to dark-brown-coloured macules on sun-exposed skin, especially on the face.1, 2 The most common treatments are chemical peels, lasers, topical and oral medications.3 The goal of laser therapy is to target a particular chromophore that absorbs the laser's wavelength in a specific manner while minimising collateral tissue damage, according to the selective photothermolysis theory.4 Specifically, picosecond lasers use pulse lengths much less than the target's thermal relaxation period to achieve a higher peak temperature without inflicting thermal damage to the surrounding tissues. Because of this, the picosecond 785-nm laser offers a superior safety profile compared to other laser types.5 In our experience, 12 Egyptian women were treated for facial melasma. They presented Fitzpatrick phototypes ranging from IV (66.7%) to V (33.3%). They were 27 to 42 years old. A picosecond 785 nm laser handpiece pumped by a QS laser (El.En Group, Florence, Italy) with the possibility of adding a contact sensor was utilised. The spot size ranged from 2 to 6 mm, the fluence from 0.4–2 J/cm2, and the frequency from 1 to 5 Hz. Two or three passes were made until the treated lesion turned white. Four laser treatments were performed, separated by 40/45 days, until the skin healed completely from the first treatment. As part of home therapy, a whitening cream with tranexamic acid was also applied. Three months after the last laser treatment, the final evaluation and follow-up visits took place. A 5-point (0-4) scale—Global Aesthetic International Score, GAIS (from No change/Worsening to Excellent improvement) was implied to evaluate the general treated area improvement. The medical study staff that performed the evaluation assessed that 17% of the patients obtained Excellent improvements, 50% Good improvements, 17% Moderate improvements, 5% Mild improvements and 5% No results. Moreover, at a 3-month follow-up (FU) the patients’ comfort/satisfaction was evaluated with a 5-Point Likert Scale Questionnaire (0 = worse; to 4 = very satisfied). The mean value obtained by this data was 2.4 ± 1.5. A Dermoscopic evaluation (DermLite III Pro; 3Gen, CA, USA) was performed at baseline and at 12-week FU to detect the pigmentation pattern (unpatterned, reticuloglobular, pseudoreticular/arcuate and honeycomb, and dots/granular) and vascular pattern (presence or absence of telangiectasia) of melasma lesion. Some examples of cases at 3 months FU are reported in Figures 1-3. The whole study population confirmed a near-complete resolution of melasma, with no adverse effects after treatment. In conclusion, we proposed for the first time the application of a 785 nm wavelength emitting device in treating facial melasma pigmentary symptoms in darker phototypes. Indeed, it was used based on its low affinity with the vascular component and so the little possibility of post-inflammatory effects. This was due to its high affinity for melanin and the characteristic anatomical capillary structure, supporting that this laser could lower the risk of adverse effects and streamline post-treatment maintenance. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.