Background: There is a growing demand for extending dosing intervals of dupilumab injections in patients with atopic dermatitis (AD) due to treatment burden and side effects. However, studies on successful dose reduction in real-world settings are lacking. Objective: To assess the efficacy of a patient-centered dupilumab tapering regimen and to propose guidelines for target patients, appropriate intervals, and timing for tapering. Methods: This single-center retrospective study included moderate to severe adult AD patients who underwent at least 16 weeks of dupilumab treatment. Interval prolongation was considered in controlled patients assessed by Eczema Area and Severity Index (EASI) score and serum inflammatory markers after at least 40 weeks of treatment with a standard regimen. Logistic regression model with generalized estimating equations was used to compare repetitive measurements over time between the two groups. Results: A total of 52 patients were included with 11 patients extending intervals to 3–4 weeks without flare-ups. The mean duration of dupilumab treatment before tapering was 53.27 weeks. The tapering group exhibited significantly lower body mass index. All patients of the tapering group showed EASI scores under 4 and immunoglobulin E (IgE) levels under 1,000 IU/mL at week 40. EASI scores and IgE levels remained consistently low after dose reduction, with a mean follow-up time of 14.36 months. Conclusion Patients with extended dosing intervals demonstrated sustained effectiveness. Dose tapering might be a valuable option for non-obese patients with positive clinical response characterized by an EASI score under 4 and IgE levels under 1,000 at week 40.

The treatment of pathological scars, such as keloids and hypertrophic scars, can be challenging for dermatologists. The first-line treatment is intralesional corticosteroid injection, especially when patients complain of pain or discomfort. Laser treatment can also be used in patients with keloids and hypertrophic scars. However, even after multiple sessions of intralesional corticosteroid injections and laser treatment, desirable outcomes may not be achieved, and recurrence is common. Recent studies on the efficacy of intralesional bleomycin injection (BLMILI) in treating keloids and hypertrophic scars have suggested that a significant improvement is observed after BLMILI. However, there is limited research on the effectiveness of BLMILI for patients who do not respond to other treatments, such as intralesional corticosteroid injection or laser treatment. Here, we report four cases of BLMILI in keloids and hypertrophic scars that were unresponsive to previous intralesional corticosteroid injection and/or laser treatment.

Background: Various treatments exist for addressing volume loss in atrophic scars. Although laser therapy has gained traction in treating atrophic scars, it is associated with side effects, such as post-inflammatory hyperpigmentation or erythema. Additionally, not all types of atrophic scars respond optimally to laser therapy, even after multiple sessions. Objective: This study aimed to evaluate the efficacy and safety of punch elevation for atrophic scars that yielded unsatisfactory outcomes after repeated laser treatment sessions. Methods: Seven patients with atrophic scars on their facial area underwent punch elevation, concurrently supplemented by fractional CO2 laser application to the scar margins. Improvement in volume restoration of atrophic scars was assessed via investigator evaluation and 3-dimensional (3D) image analysis. Results: After 1 month, median volume (interquartile range) of depression improved from 4.39 mm3 (2.23∼9.90 mm3 ) to 1.97 mm3 (1.46∼7.50 mm3 ), indicating a statistically significant difference post-punch elevation (p=0.018). No serious adverse events were reported during follow-up. Conclusion The efficacy of the punch elevation was objectively evaluated. Punch elevation is a safe and effective therapeutic avenue for atrophic scars that exhibit resistance to laser or alternative interventions.

Background: Intradermal injection of botulinum toxin A (BTXA) is used for cosmetic purposes without strong evidence for clinical use, as opposed to intramuscular injection. Objective: To evaluate the efficacy and safety of intradermal injection of incobotulinum toxin A (iBTXA) in the cheeks. Methods: We conducted a study with 18 volunteers who received intradermal injection of iBTXA into one cheek and normal saline into the contralateral side as a control. Volunteers visited the clinic at weeks 2, 4, 8, and 12 after injection. At each visit, pores and wrinkles were evaluated by a facial analyzer, sebum secretion by a sebumeter, skin texture by both volunteers and clinicians, and wrinkles of the nasolabial fold were graded with photographic reviews. Results: There were no significant effects on the wrinkles of the infraorbital area and sebum secretion. However, there were significant improvements in the wrinkles of the nasolabial fold and skin texture on the iBTXA injected side. The effects on the wrinkles of the nasolabial fold lasted 12 weeks, and those on skin texture lasted 8 weeks. Improvement in the pore size was observed only at week 2. No serious adverse events were reported except one volunteer who complained of facial palsy after the injection of 30 units of iBTXA in one cheek. However, injection of 20 units of iBTXA in one cheek was not associated with any adverse events. Conclusion Intradermal injection of iBTXA, could provide clinical benefits for skin texture and wrinkles overcoming the skin prick effect without obvious side effects.

Aggressive digital papillary adenoma (ADPA) is a rare tumor of the sweat glands. They usually present as solitary masses, with or without pain, and are most commonly observed in the fingers. A 19-year-old man presented with a solitary, protruding lesion on the right big toe that had enlarged 6 months previously. The biopsy specimen revealed a well-marginated mass with papillary projections and tubular structures. On foot magnetic resonance imaging, there was no invasion, and chest radiography showed no metastasis. Based on these findings, the tumor was diagnosed as ADPA, and wide excision was performed. Herein, we report a rare sweat gland tumor on the toe that was diagnosed as an ADPA.