Background/Objectives: Actinic keratoses (AKs), also known as solar keratoses, are considered premalignant skin lesions that can evolve into squamous cell carcinoma (SCC). Among the available options, 5-fluorouracil (5-FU) remains a cornerstone. Methods: This study is a retrospective analysis of our database of the non-melanoma skin cancer outpatient clinic. The main objective was to evaluate patients treated with 4% 5-FU cream for AK lesions. The efficacy of 4% 5-FU was evaluated retrospectively by measuring the percentage of patients who achieved complete clearance. A secondary efficacy measure was the percentage of partial clearance, defined as at least a 75% reduction in lesion count. Additionally, the study aimed to assess the safety of 4% 5-FU cream. Results: We included 150 patients clinically diagnosed with AK, treated with 4% 5-FU cream and evaluated 432 lesions. Complete clearance of lesions was observed in 138 patients (92%) with partial clearance in 12 patients (8%). At 12 months, the recurrence rate was 11%. Conclusions: Based on our analysis, 4% 5-FU cream is an effective and well-tolerated treatment for AKs, particularly in patients with extensive field cancerization. While local skin reactions are a natural part of its mechanism, they are manageable and do not outweigh clinical benefits.

Vitiligo is a chronic autoimmune depigmenting disorder. Ruxolitinib 1.5% cream is currently the only therapy specifically approved for its treatment. In addition, clinical guidelines recommend off label standard therapies, including topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), phototherapy (narrowband UVB or excimer devices), and selected off-label systemic regimens. This review summarizes the scientific evidence on approved and guideline-recommended treatments for adult vitiligo, using a PRISMA-based approach. Only English-language articles published between 2000 and 2025 were included. Interventions comprised approved therapies and standard treatments recommended by guidelines. Outcomes evaluated were changes in Facial and Total Vitiligo Area Scoring Index (F-VASI/T-VASI), quality of life, and safety. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for non-randomized studies. Ruxolitinib cream demonstrated superior F-VASI responses compared with vehicles in phase II-III RCTs. Evidence supports the efficacy of potent or very potent TCS, TCI, and NB-UVB or targeted 308-nm devices in localized disease. Systemic regimens show benefits in selected clinical scenarios, although supporting evidence remains heterogeneous. Treatment selection should be individualized based on disease activity, extent, anatomical site, and patient preferences.

Photodynamic therapy (PDT) is a minimally invasive treatment choice whose clinical success in dermatology relies on the interaction between a photosensitizer, light of an appropriate wavelength, and tissue oxygen, leading to reactive oxygen species generation and selective cytotoxicity. This narrative review summarizes contemporary mechanisms and clinical evidence supporting PDT across neoplastic, inflammatory, infectious, and esthetic indications. A comprehensive literature search included randomized trials when available, systematic reviews, meta-analyses, and guideline and consensus documents, complemented by mechanistic and translational studies relevant to clinical outcomes. In premalignant and neoplastic disease, strongest evidence supports field-directed PDT for actinic keratosis and high efficacy in Bowen’s disease, with favorable cosmetic outcomes and acceptable recurrence patterns. PDT plays a more selective role in basal cell carcinoma, particularly superficial and selected nodular lesions, while its routine use as monotherapy in squamous cell carcinoma remains limited by higher recurrence. Beyond oncology, PDT shows expanding utility in acne via sebomodulatory and immunomodulatory effects, and in infectious dermatoses through broad antimicrobial activity and biofilm disruption with low resistance potential. Cosmetic applications, including photorejuvenation, benefit from protocol tailoring and combination strategies that enhance penetration and remodeling. Overall, PDT is evolving into an adaptable therapeutic framework best positioned within mechanism-oriented, multimodal algorithms.

Dear Editor, Vitiligo is a chronic autoimmune disorder affecting 0.5-1% of the population, characterized by progressive melanocyte loss and depigmented macules. Non-segmental vitiligo (NSV) is the most common subtype, typically involving the face and acral areas, with relevant psychosocial impact. Conventional therapies frequently provide delayed or incomplete responses. Recently, topical Janus kinase (JAK) inhibitors, such as ruxolitinib 1.5% cream, have shown promise in promoting repigmentation.