Elucidating transcriptome in the peripheral edge of the lesional (PE) skin could provide a better understanding of the molecules or signalings that intensify inflammation in the PE skin. Full-thickness biopsies of PE skin and uninvolved (UN) skin were obtained from psoriasis patients for RNA-seq. Several potential differentially expressed genes (DEGs) in the PE skin compared to those in the UN skin were identified. These DEGs enhanced functions such as angiogenesis, growth of epithelial tissue, chemotaxis and homing of cells, growth of connective tissues, and degranulation of myeloid cells beneath the PE skin. Moreover, the canonical pathways of IL-17A, IL-6, and IL-22 signaling were enriched by the DEGs. Finally, we proposed that inflammation in the PE skin might be driven by the IL-36/TLR9 axis or IL-6/Th17 axis and potentiated by IL-36α, IL-36γ, IL-17C, IL-8, S100A7, S100A8, S100A9, S100A15, SERPINB4, and hBD-2. Along with IL-36α, IL-17C, and IκBζ, ROCK2 could be an equally important factor in the pathogenesis of psoriasis, which may involve self-sustaining circuits between innate and adaptive immune responses via regulation of IL-36α and IL-36γ expression. Our finding provides new insight into signaling pathways in PE skin, which could lead to the discovery of new psoriasis targets.

The 589/1319 nm solid-state dual-wavelength (SSDW) laser, which does not require consumable dye, has the potential to target inflammation and sebum production in acne vulgaris pathogenesis. To assess the efficacy and safety of 598/1319 nm SSDW laser as an adjunctive treatment to conventional treatment, 18 patients with bilateral facial acne, with inflammatory papules or pustules, were recruited. Patients were instructed to apply 2.5% benozoyl peroxide (BPO), the drug for inflammatory acne, to their entire face throughout the study. One side of the face was randomly assigned to receive 4 sessions of 589/1319 nm SSDW laser treatments, administered every 2 weeks. After the last laser treatment, 3 monthly follow-ups were scheduled. Inflammatory lesion count (ILC) and acne-related skin parameters, including hemoglobin level, melanin level, skin depression, and skin roughness were measured. Adverse events (AEs) and patients’ satisfaction were assessed. At the 3-month follow-up, the ILC reduced by 46% on the adjunctive laser (BPO + laser) side (p = 0.0080), compared with a 29% reduction on the BPO monotherapy side (p = 0.1875). On the adjunctive laser side, the change in ILC positively correlated with the change in melanin level (r = 0.51, p = 0.0301) and showed a trend towards a positive correlation with the change in depression volume (r = 0.45, p = 0.0606) and roughness level (r = 0.42, p = 0.0806). The patients reported a pain score of 3.4 ± 2.3 on scale of 10. No serious AEs occurred. Patients’ satisfaction scores were higher with the adjunctive laser therapy, although this was not statistically significant (p = 0.2758). In conclusion, the 589/1319 nm SSDW laser provided a synergistic effect as an adjunctive treatment to BPO in inflammatory acne in terms of reducing ILC and improving post inflammatory hyperpigmentation without causing discomfort or downtime.

Introduction: Enlarged facial pores are a common cosmetic concern caused by excessive sebum production, visible hair shafts, and a reduction in skin elasticity, leading to a decrease in skin quality and overall appearance. Various treatment modalities have been explored to address this issue. This study focuses on the efficacy and safety of combining Onabotulinumtoxin A (OnaBoNT-A) and hyaluronic acid filler (HA filler) to target enlarged facial pores in Asians. Materials and Methods: This study aimed to compare the efficacy and safety of OnaBoNT-A monotherapy in combination with HA filler for the treatment of enlarged facial pores. This study was a prospective, randomized, single-blinded, split-face, controlled trial that enrolled 32 subjects with visibly enlarged pores on both cheeks. One side of the face received intradermal injections of OnaBoNT-A, while the other side received OnaBoNT-A in combination with intradermal hyaluronic acid filler injection. The outcomes were measured by pore volume, visual assessment, pain score, improvement score, and side effects at various time intervals up to 24 weeks. Results: This study investigated the effects of onaBoNT-A monotherapy or in combination with HA filler on facial pore size and skin roughness. The results showed that both sides exhibited a reduction in pore volume and skin roughness over time, but the side treated with onaBoNT-A monotherapy had a slightly better improvement than the combination side at the 6-month follow-up. Subjects with histories of facial oiliness were more likely to respond to onaBoNT-A monotherapy, while those without histories of facial oiliness were more likely to respond to the side treated with combined treatment. The most common adverse events were erythema, bruising, and edema, which were more frequent on the combination side. Additionally, 18 subjects (56.25%) experienced a palpable lump on the combination side, which resolved in most cases within a few months. Conclusion: BoNT-A and HA dermal filler had a role in reducing pore size. Nonetheless, individuals with enlarged pores who exhibited beneficial effects to botulinum toxin injection typically had a background of facial oiliness. Adverse incidents like dermal edema and palpable nodules were observed, underscoring the significance of meticulous patient selection and accurate injection technique.

Standard treatment of pemphigus vulgaris (PV) includes corticosteroid, immunosuppressants, and biologics such as rituximab, a monoclonal antibody targeting CD20⁺ B cells. However, some patients develop resistance to rituximab, requiring alternative therapeutic approaches. We report a 15-year-old female with severe PV who developed rituximab refractoriness after an initially effective response. Despite treatment with a combination of intravenous immunoglobulin, corticosteroid, and immunosuppressants, the patient failed to achieve disease control. Consequently, dupilumab, an interleukin-4 receptor α antagonist, was initiated on a biweekly regimen. Her lesions showed dramatic improvement, with the pemphigus disease area index (PDAI) reaching 0. Her anti-desmoglein 1 antibody level became negative, and T helper (Th)-2 inflammatory markers, including eosinophil count and immunoglobulin E (IgE) level, was normalized, allowing corticosteroid tapering after the 8th dose (last dose) of dupilumab. She has maintained complete remission for at least 28 weeks with regular follow-ups. We additionally propose possible mechanisms underlying rituximab refractoriness and how dupilumab modulates this treatment response. Our case highlights dupilumab’s potential in modulating Th-2-driven autoantibody production for PV patients with high peripheral eosinophils and IgE levels who have severe disease resistant to corticosteroids or rituximab. Plain Language Summary: This is a report on a case with severe pemphigus vulgaris (PV) unresponsive to rituximab (anti-CD20) and successfully treated with dupilumab (anti-IL4Rα), suggesting a potential role for dupilumab in severe recalcitrant PV.

Background: Enlarged facial pores are a common cosmetic concern among Asians. Polynucleotides (PN) show potential for skin rejuvenation and pore reduction; however, the optimal delivery approach remains unclear. Objectives: To compare the efficacy, safety, and patient satisfaction of PN injections administered using two technique‐based approaches: an intradermal needle technique (needle technique) and a subdermal cannula technique (cannula technique) for enlarged facial pores. Methods: A randomized, split‐face, evaluator‐blinded clinical trial was conducted in 30 participants. Each underwent three PN treatments at 4‐week intervals, with the needle technique applied to one side and the cannula technique to the contralateral side. Quantitative assessments included pore volume, skin texture, sebum level, and hydration. Blinded dermatologists and participants performed visual evaluations. Results: The needle technique significantly reduced mean pore volume from 1.48 mm ³ at baseline to 1.10, 0.93, and 0.88 mm ³ at months 3, 4, and 5, respectively. The cannula technique demonstrated comparable reductions from 1.27 mm ³ to 0.94 and 0.82 mm ³ at months 4 and 5, with no significant difference between techniques. Skin texture improved by 15.45% and 12.89%, respectively. Hydration and sebum showed no significant changes. The needle technique was associated with higher pain scores and more frequent minor adverse events. Conclusions: Both techniques improved pore appearance and skin texture with comparable efficacy and acceptable safety. The needle technique showed a trend toward earlier improvement, whereas the cannula technique demonstrated greater tolerability. Findings reflect comparison of two clinical delivery approaches rather than isolated device effects. Trial Registration: This study was registered in Clinical Trials (TCTR20240716010), available at www.thaiclinicaltrials.org