{"title":"Exosomes as Regenerative Therapeutics in Non-Scarring Alopecia: Current Perspectives and Future Directions.","authors":"Aishwarya Lakshmi Sekar, Monisha V","doi":"10.1159/000551007","DOIUrl":"https://doi.org/10.1159/000551007","url":null,"abstract":"<p><strong>Background: </strong>Non-scarring alopecias, including androgenetic alopecia and alopecia areata, are common hair loss disorders with significant psychosocial impact. Conventional treatments such as minoxidil, finasteride, corticosteroids, and platelet-rich plasma (PRP) often demonstrate variable efficacy, relapse rates, or adverse effects. Emerging interest in regenerative dermatology has positioned exosome-based therapy as a potential next-generation solution.</p><p><strong>Summary: </strong>This narrative review synthesizes current evidence from experimental, translational, and clinical studies evaluating the role of exosomes in hair regeneration. Exosomes, nanosized extracellular vesicles rich in proteins, nucleic acids, and lipids, modulate the hair follicle microenvironment through activation of Wnt/β-catenin signaling, promotion of angiogenesis, immunomodulation, and prolongation of the anagen phase. Preclinical investigations consistently demonstrate robust follicular regeneration, while early clinical studies report improvements in hair density, shaft diameter, and patient satisfaction with favorable short-term safety. Compared with PRP and cellular therapies, exosomes offer a potentially standardizable, cell-free, and scalable biologic approach. However, challenges persist regarding isolation methods, dosing protocols, delivery techniques, regulatory frameworks, and production costs.</p><p><strong>Key messages: </strong>Exosomes exhibit multimodal biological actions supporting hair follicle regeneration. Early clinical data show improvements in hair density, thickness, and growth with good safety. Exosomes represent a cell-free and potentially standardizable biologic approach with improved reproducibility compared with autologous therapies, although full standardization has not yet been achieved. Standardization, cost reduction, and high-quality trials are needed for clinical translation.</p>","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Case Report with Hutchinson's Sign: What Could It Be Other than Melanoma in situ?","authors":"Güldehan Atış, Gaye Güldiken Doğruel, Pembegül Güneş, Eckart Haneke","doi":"10.1159/000548665","DOIUrl":"https://doi.org/10.1159/000548665","url":null,"abstract":"<p><strong>Introduction: </strong>Many conditions, such as malnutrition, radiation exposure, drugs, trauma, and systemic and metabolic disorders, can lead to nail pigmentation. Many other dermatological and systemic conditions, mycologic and bacterial infections, and repetitive trauma can be associated with non-melanoma-related Hutchinson's sign.</p><p><strong>Case presentation: </strong>We report a 68-year-old woman with the complaint of darkening of her existing nail bands and development of a newly pigmented lesion on the edge of her left thumb after taking chemotherapy. Lateral longitudinal biopsy, including Hutchinson's sign, was performed. Melanocytes in normal number and localization in the nail matrix on histopathological evaluation. The patient was diagnosed with frictional hypermelanosis.</p><p><strong>Conclusion: </strong>It is very important to exclude subungual melanoma and to find out the etiology of Hutchinson's sign. Repetitive trauma can be a cause of non-melanoma Hutchinson's sign.</p>","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"12 2","pages":"138-141"},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tattoos and Hidradenitis Suppurativa: What the Dermatologist Should Know?","authors":"Nicolas Kluger","doi":"10.1159/000548642","DOIUrl":"https://doi.org/10.1159/000548642","url":null,"abstract":"<p><strong>Background: </strong>Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent painful nodules, abscesses, and scarring, primarily affecting intertriginous areas. As tattoos have gained widespread popularity, individuals with HS may consider getting tattooed.</p><p><strong>Summary: </strong>Patients with HS are exposed to the same potential risks as the general population and they include the possibility of delayed healing, tattoo allergies, or infections. Additionally, future location of the tattoo and timing of the procedure need to be considered. While no extensive clinical studies specifically address the relationship between tattoos and HS, anecdotal reports suggest that individuals with well-controlled HS may tolerate tattoos in unaffected areas.</p><p><strong>Key-message: </strong>HS is not a contraindication for tattooing, but patients need proper guidance. Proper pre-tattoo consultation with dermatologists, careful site selection, tattooing by a professional artist in a tattoo parlor and strict aftercare protocols are essential to minimize complications.</p>","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"12 2","pages":"124-128"},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hidden Beneath the Nail Plate: A Case Report of Subungual Squamous Cell Carcinoma Mimicking Benign Nail Dystrophy.","authors":"Gökçe Işıl Kurmuş, Sedef Çakal Güngörür, Selin Çolak, Özay Gököz, Selda Pelin Kartal","doi":"10.1159/000548466","DOIUrl":"https://doi.org/10.1159/000548466","url":null,"abstract":"<p><strong>Introduction: </strong>Subungual squamous cell carcinoma (SCC) is a rare malignancy often misdiagnosed due to its clinical resemblance to benign nail conditions.</p><p><strong>Case presentation: </strong>A 26-year-old male neurosurgeon presented with a 4-year history of isolated nail changes, including longitudinal erythronychia and distal splitting of the left fourth fingernail. Despite the absence of pain or mass, his occupational exposure to ionizing radiation and active tobacco use raised suspicion. Dermoscopy was inconclusive, and imaging ruled out bone involvement. Histopathological evaluation of the excised nail unit confirmed SCC in situ. The patient underwent complete nail unit excision with periosteal dissection, followed by flap reconstruction. At 4-month follow-up, he showed no signs of recurrence.</p><p><strong>Conclusion: </strong>This case underscores the need for early biopsy in persistent nail alterations, even among young patients, particularly when risk factors such as radiation exposure exist. Prompt histologic diagnosis allowed for timely, function-preserving surgical intervention.</p>","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"12 2","pages":"148-154"},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zineb Loubaris, Rasha Moumna, Anas Ahmed Mountassir, Majdouline Obtel, Laila Benzekri, Mariame Meziane
{"title":"Frontal Fibrosing Alopecia and Cyclines in Skin of Color Patients: A Retrospective Study of 50 Patients.","authors":"Zineb Loubaris, Rasha Moumna, Anas Ahmed Mountassir, Majdouline Obtel, Laila Benzekri, Mariame Meziane","doi":"10.1159/000548844","DOIUrl":"https://doi.org/10.1159/000548844","url":null,"abstract":"<p><strong>Introduction: </strong>Frontal fibrosing alopecia (FFA) is a scarring alopecia that mainly affects women and is characterized by progressive frontal hairline recession and eyebrow loss. The efficacy of doxycycline in patients with skin of color remains underexplored. The objective of our study is to assess the clinical and dermoscopic response to doxycycline in patients with FFA and skin of color.</p><p><strong>Methods: </strong>A retrospective study was conducted over 4 years at Ibn Sina University Hospital, Rabat. Fifty female patients with FFA received oral doxycycline (100 mg/day) for at least 6 months. Disease patterns, associated conditions (lichen planus pigmentosus and rosacea), and treatment response were evaluated. Statistical significance was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Median age was 52 years; 60% were postmenopausal. Linear FFA was most common (70%), and 46% had lichen planus pigmentosus. Doxycycline led to improvement in 57% of patients (<i>p</i> = 0.02), particularly in linear and pseudo-fringe patterns. Dermoscopic improvements included decreased perifollicular erythema and hyperkeratosis (<i>p</i> = 0.01). All patients with rosacea improved. Adverse events occurred in 16% of cases.</p><p><strong>Conclusion: </strong>Doxycycline appears effective and well-tolerated in managing FFA in patients with skin of color, especially in cases associated with lichen planus pigmentosus or rosacea.</p>","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":"12 2","pages":"81-84"},"PeriodicalIF":1.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Azhar Ahmed, Azhar Alali, Mohammed Alahmadi, Sara Alghamdi, Zakaria Khawaji, Abdulsalam Humedi, Shaden Alqurashi
{"title":"Association between Serum Trace Elements and Telogen Effluvium: A Systematic Review and Meta-Analysis.","authors":"Azhar Ahmed, Azhar Alali, Mohammed Alahmadi, Sara Alghamdi, Zakaria Khawaji, Abdulsalam Humedi, Shaden Alqurashi","doi":"10.1159/000550921","DOIUrl":"https://doi.org/10.1159/000550921","url":null,"abstract":"<p><strong>Introduction: </strong>Telogen effluvium (TE) affects the scalp and is marked by widespread, non-scarring hair loss. This systematic review and meta-analysis aimed to evaluate the association between these micronutrients and TE across different age-groups.</p><p><strong>Methodology: </strong>Eligible studies included RCTs, clinical trials, cohort, case-control, and cross-sectional studies that reported serum levels of zinc, copper, or vitamin D in TE patients versus healthy controls. Meta-analyses were conducted using RevMan 5.3 with a random-effects model; heterogeneity was assessed via <i>I</i> <sup>2</sup> and chi<sup>2</sup> statistics.</p><p><strong>Results: </strong>Out of 372 papers, 29 articles were considered suitable for the systematic review extracted through the database search. Diagnostic methods included trichoscopy and standardized assays (e.g., AAS, ICP-MS). This review analyzed TE patients as predominantly female. Meta-analyses revealed significantly lower serum ferritin (SMD = -0.57, 95% CI: -1.01 to -0.12, <i>p</i> = 0.01) and vitamin D (SMD = -0.87, 95% CI: -1.49 to -0.25, <i>p</i> = 0.006) levels in TE cases versus controls.</p><p><strong>Conclusion: </strong>TE is strongly associated with deficiencies in ferritin and vitamin D. Despite high heterogeneity, findings underscore the role of trace element imbalances in hair loss. Personalized nutritional interventions and standardized diagnostic protocols are recommended to address variability and improve clinical outcomes.</p>","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dalel Kemicha, Maha Lahouel, Sana Mokni, Najet Ghariani, Mohamed Denguezli
{"title":"Impact of Onychomycosis on Quality of Life: A Cross-Sectional Study Using the Dermatology Life Quality Index.","authors":"Dalel Kemicha, Maha Lahouel, Sana Mokni, Najet Ghariani, Mohamed Denguezli","doi":"10.1159/000551412","DOIUrl":"https://doi.org/10.1159/000551412","url":null,"abstract":"<p><strong>Introduction: </strong>Onychomycosis is a common nail disorder that can impair patients' quality of life (QoL). This study aimed to assess the impact of onychomycosis on QoL.</p><p><strong>Methods: </strong>QoL was evaluated using the Dermatology Life Quality Index (DLQI). Diagnosis was confirmed by microscopy and culture. Clinical features were recorded.</p><p><strong>Results: </strong>Forty patients were included (mean age 52.6 years; 70% female). Trichophyton species were found in 62.5%, Candida in 32.5%, and both in 5%. The mean DLQI was 6.1, indicating moderate impact. Women had higher scores than men (6.68 vs. 4.75; <i>p</i> = 0.03). Total nail involvement and combined fingernail/toenail infection were linked to greater QoL impairment (<i>p</i> < 0.05). The \"symptoms and feelings\" domain was higher in women (<i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>Onychomycosis moderately impairs QoL, especially in women and patients with extensive nail involvement.</p>","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147842683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patricia Garbayo-Salmons, Albert Rodrigo-Parés, Ester Saus, Mireia Moreno, Anna Carreras, Clara Feliu-Hernàndez, Vicente Exposito-Serrano, Miquel Ribera, Mireia Sabat, Joan Calvet
{"title":"Increased Healthcare Utilization in Hidradenitis Suppurativa and Arthritis: A Propensity Score-Matched Analysis from a Hospital-Based Cohort.","authors":"Patricia Garbayo-Salmons, Albert Rodrigo-Parés, Ester Saus, Mireia Moreno, Anna Carreras, Clara Feliu-Hernàndez, Vicente Exposito-Serrano, Miquel Ribera, Mireia Sabat, Joan Calvet","doi":"10.1159/000551410","DOIUrl":"https://doi.org/10.1159/000551410","url":null,"abstract":"<p><strong>Introduction: </strong>Hidradenitis suppurativa (HS) has been linked to arthritis, but large real-world analyses remain limited. This study evaluated the prevalence, risk, and clinical impact of arthritis in patients with HS, focusing on healthcare use.</p><p><strong>Methods: </strong>A retrospective multicenter cohort was assembled using the TriNetX network. Adults with HS (<i>n</i> = 226,047) were compared with matched controls without HS (<i>n</i> = 12,286,573). Arthritis prevalence, 5-year risk, and healthcare utilization were assessed after 1:1 propensity score matching.</p><p><strong>Results: </strong>Arthritis prevalence was higher in the HS group (6.22% vs. 5.66%). Over 5 years, HS patients had a higher risk of arthritis than the general hospital population (2.22% vs. 1.73%; risk ratio 1.29, 95% CI: 1.23-1.34). Within the HS cohort, those with arthritis showed greater use of systemic therapies, including tumor necrosis factor inhibitors (27% vs. 6%) and interleukin inhibitors (12% vs. 2%). They also had more outpatient visits, emergency visits, and hospitalizations across 1-, 3-, and 5-year periods.</p><p><strong>Conclusions: </strong>Findings should be interpreted considering the limitations of administrative datasets, including potential misclassification and underreporting. Overall, HS is associated with a higher 5-year risk (cumulative incidence) of arthritis, and patients with both conditions exhibit substantially increased healthcare use.</p>","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Onychoscopic Alterations in Newborns with Early Congenital Syphilis: A Single-Center Cross-Sectional Study of 10 Cases.","authors":"Cuauhtli Emmanuel Arambul-Carrillo, Rocío Concepción Albores-Arguijo, Andrea Biviana Ruíz-Leal, Nicole Orendain-Koch, Melisa Rivera, Xochitl Valenzuela-Barba","doi":"10.1159/000551006","DOIUrl":"https://doi.org/10.1159/000551006","url":null,"abstract":"<p><strong>Introduction: </strong>Early congenital syphilis (ECS) is a vertically transmitted infection that remains difficult to diagnose in the neonatal period, as many newborns are asymptomatic at birth. Although mucocutaneous manifestations are well recognized, nail involvement has been rarely described.</p><p><strong>Methods: </strong>We conducted a prospective, single-center study including neonates with ECS fulfilling scenario 1 or 2 criteria established by the Centers for Disease Control and Prevention and the American Academy of Pediatrics. Ten neonates admitted to the neonatal intensive care unit between April and July 2025 were enrolled. Systematic onychoscopy (10×) of all 20 nails was performed. Findings were analyzed according to serum Venereal Disease Research Laboratory (VDRL) titers, comparing group 1 (<1:128) and group 2 (≥1:128 or prozone phenomenon).</p><p><strong>Results: </strong>The most frequent abnormalities were onycholysis and onychoschizia (100%), herringbone nail pattern (80%), and periungual scaling (90%). Mega lunula and anonychia (40% each) were significantly associated with VDRL titers ≥1:128 and/or prozone phenomenon (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Mega lunula and anonychia may serve as clinical markers of ECS in neonates with high VDRL titers, supporting onychoscopy as a complementary diagnostic tool.</p>","PeriodicalId":21844,"journal":{"name":"Skin Appendage Disorders","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}