Background: Basal cell carcinomas (BCCs) are often misdiagnosed as benign lesions, leading to inappropriate laser ablation. Misidentification may cause delays in proper diagnosis and surgical intervention, potentially affecting patient outcomes. Objective: We investigated the percentage of patients with BCC who were inappropriately treated with laser ablation following the introduction of dermoscopic examination reimbursement and analyzed their clinical and histological characteristics. Methods: We retrospectively reviewed the data of 106 patients with histologically confirmed BCC after reimbursement for dermoscopic examinations was implemented. Results: Among the 106 patients pathologically diagnosed with BCC, 11 patients (10.4%) had a history of laser ablation after being misdiagnosed with a benign lesion. All patients had pigmented BCCs on their faces, with the cheeks and nose (36.4% each) being the most frequent sites of involvement. The mean time between laser treatment and hospital visits was 30.9 months, and six patients (54.5%) were diagnosed with BCC within 1∼5 years after laser ablation. Of the 11 patients, six were treated by dermatologists, two by non-dermatologists, and two by non-licensed personnel. Nine patients showed at least one classic dermoscopic pattern, and the most common dermoscopic finding was the presence of multiple blue/gray globules (7/10, 70.0%). No recurrence after wide excision was observed during the last follow-up. Conclusion Despite dermoscopic examination reimbursement, our findings indicate that approximately 10.0% of BCCs are still misdiagnosed as benign lesions, as reported in a previous study. Therefore, when a malignancy is suspected, dermoscopic examination and biopsy should be considered to ensure an accurate diagnosis and facilitate appropriate treatment.

Background: Radiofrequency (RF) and intense pulsed light (IPL) have been reported as efficient adjuvant treatment modalities for acne vulgaris. Objective: We sought to evaluate the clinical efficacy and safety of a combined needle RF and vacuum IPL device for acne treatment without the use of other conventional topical or oral agents. Methods: This randomized, split-faced study was designed to include patients with moderate to severe acne vulgaris. Comedone extraction was performed on both parts of the face prior to laser treatment. One side of the face was treated with RF and IPL in 2-week intervals, while the other side was left untreated as a control. Two independent blinded investigators evaluated the patients for improvement using clinical photographs. We also assessed for possible adverse effects. Results: The study included 44 patients with acne vulgaris (27 men and 17 women). Their ages ranged from 19–39 years (average, 23 years). At the final 12-week follow-up visit, the acne reduction rate was 34.80% (±33.45%; range, 30.92%–19.03%) on the treated side and 13.76% (±37.58%; range, 28.26%–23.27%) in the control group compared to baseline, constituting a significant difference. The difference in reduction rate between the treated and control sides was 21.03% (±25.09%), with the treated side experiencing more significant improvement (p<0.05).In the assessment of adverse events, one patient experienced mild surrounding erythema that spontaneously improved. Conclusion Combined treatment of needle RF and IPL could improve acne lesions.

Background: Patients with skin barrier dysfunction often coincides with pruritus, creating a ‘vicious cycle’ of dry skin and itching. Recently, Cynanchum atratum (CA) extract and its constituents have demonstrated effects on atopic dermatitis both in vivo and in vitro. Objective: This study aimed to assess the safety and efficacy of a moisturizer infused with CA extract in enhancing epidermal barrier function and reducing pruritus. Methods: A total 36 participants with skin barrier dysfunction with pruritus (mean age: 46.22±12.48 years) applied the CA-containing moisturizer topically twice daily for up to 4 weeks. Treatment efficacy was assessed by the investigator using the erythema scaling induration fissuring (ESIF) scale, transepidermal water loss (TEWL), skin hydration, visual analogue scale (VAS) for pruritus, and overall patient satisfaction assessed via questionnaire. Results: The CA-containing moisturizer demonstrated favorable tolerability, and yielded significant pruritus relief as evidenced by VAS scores after 2 and 4 weeks of application (p＜0.05). Significant decreases in TEWL (p＜0.05) and skin hydration (p＜0.05) were observed after 2 and 4 weeks, indicating enhanced skin barrier function. Moreover, significant relief from pruritus and reductions in ESIF were observed at 2 and 4 weeks of application (p ＜0.05), aligning with the high levels of patient satisfaction was high. Conclusion The CA-infused moisturizer emerged as a safe and effective intervention for restoring skin barrier function and providing itch relief.

Cytomegalovirus (CMV) infection is common among immunocompromised hosts; however, its cutaneous manifestation is considered rare in comparison to internal organ involvement. Clinical manifestations of cutaneous CMV infection generally include perioral or perianal ulcerations. On the other hand, autoimmune bullous dermatosis can have bullae and ulcerations similar to those caused by cutaneous CMV infection. Autoimmune bullous dermatosis requires treatment with immunosuppressive agents for relatively long periods, which may cause reduction of immunocompetence. Because of this iatrogenic immunosuppression, patients with autoimmune bullous dermatosis subsequently acquire increased risk for opportunistic infections. However, cases of bullous pemphigoid (BP) complicated by cutaneous CMV infection are rarely reported. Herein, we report the case of an 88-year-old male who had BP and subsequently recalcitrant perianal skin lesions, which were eventually diagnosed as cutaneous CMV infections.

Intralymphatic histiocytosis (ILH) is a rare cutaneous condition with uncertain pathogenesis. It is characterized by dilated lymphatic vessels that contain histiocytes within their lumina. Although the etiology of ILH remains unknown, it has been associated with various inflammatory and neoplastic diseases, such as rheumatoid arthritis (RA), reaction to metal joint implants and Merkel cell carcinoma, breast cancer and colon cancer. An 83-year-old female presented with an erythematous patch on the left forearm that had appeared six months previous. She had suffered from osteoarthritis (OA) and the cutaneous lesion was located in the vicinity of the affected joint. Skin biopsy from the lesion showed dilated dermal vessels and some ectatic vessels that contained many mononuclear histiocytes. Based on the clinical and histopathological findings, we diagnosed her with ILH with OA. Two sessions of intralesional triamcinolone acetonide injection (5 mg/ml) were administered to treat the skin lesion, which gradually improved over a period of a few months. We here report a rare case of ILH associated with degenerative OA.

Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by multiple nodules and papules, which are accompanied by intense pruritus. Treatment is challenging and requires a diverse approach. Recently, a few reports have described successful treatment of PN with dupilumab. We report a case of a patient with treatment-resistant PN who was successfully treated with dupilumab. Dupilumab was administered at the standard dose: an initial induction dose of 600 mg, followed by 300 mg every 14 days. Pruritus reduced after 2 weeks and almost completely disappeared after 4 weeks of treatment.

Background: Discoid lupus erythematosus (DLE) with alopecia of the scalp can result in permanent hair loss. Therefore, it is important to evaluate skin lesions and establish appropriate treatment plans for scalp DLE with alopecia. Objective: We aimed to investigate the dermoscopic features of scalp DLE with alopecia and to determine the correlation between dermoscopic findings and treatment efficacy. Methods: Thirty-one patients histopathologically diagnosed with scalp DLE and alopecia were included. We reviewed clinical photographs and dermoscopic findings of the patients and evaluated their treatment responses. Results: The most frequent dermoscopic features of DLE with alopecia were follicular keratotic plugs (96.8%), white scales (71.0%), telangiectatic vessels (67.7%), and pigmentation (64.5%); followed by absent follicular openings (48.4%), white structureless areas (35.5%), follicular red dots (16.1%), and perifollicular whitish halo (12.9%). After at least 6 months of treatment, hair regrowth was observed in 22 patients (71.0%). Dermoscopic findings showed that white structureless areas, perifollicular whitish halo, absent follicular openings (especially when the alopecic patch involved ＞25% of the scalp), and moderate to severe telangiectatic vessels were associated with absence of hair regrowth. Conclusion Dermoscopy is a promising tool for evaluating lesions and predicting therapeutic outcomes in scalp DLE with alopecia. It may contribute to the establishment of appropriate treatment plan by determining whether hair loss is reversible.