Both exposed-surface exudative wounds (e.g., burns and infected wounds) and intertriginous exudative wounds (e.g., intertrigo wounds) are characterized by excessive exudation, localized hyperthermia, and pathogen infection, yet effective dressings that simultaneously regulate these micro environmental factors remain limited. Herein, a sandwich-structured nanofiber membrane is developed with upper and lower hydrophobic pumping/antimicrobial layers and a middle hydrophilic xylitol-loaded cooling layer. Benefiting from the hydrophobic-hydrophilic-hydrophobic architecture, liquid is rapidly pumped from both sides into the middle layer, where xylitol dissolution is activated to induce localized endothermic cooling. The cooling effect is xylitol-dependent, reaching a temperature reduction of 6.5 °C within 5 min. This cascaded moisture-thermal regulation capability is validated in rat dorsal wounds and human skinfolds, representing exposed-surface and intertriginous exudative wounds, respectively. Moreover, incorporation of Ag nanoparticles confers broad-spectrum antimicrobial activity against S. aureus, E. coli, and C. albicans. The membrane significantly accelerates infected wound healing through synergistic moisture-thermal microclimate regulation and antibacterial action. This work provides an integrated strategy for microclimate management in complex exudative wounds and offers a promising platform for improving wound healing outcomes.

Inflammatory dermatoses are increasingly linked to systemic metabolic factors. Obesity and insulin resistance create a pro-inflammatory milieu that affects the skin. Adipose tissue functions as an endocrine organ secreting adipokines and cytokines that drive chronic inflammation with notable skewing toward T-helper 1 (Th1)/Th17 signaling. Hyperinsulinemia, elevated insulin-like growth factor-1 promote keratinocyte proliferation, sebum production, and autoinflammation, contributing to a multitude of skin diseases including hidradenitis suppurativa, acne, psoriasis, atopic dermatitis (AD), acanthosis nigricans, hirsutism, scarring alopecias, intertrigo, and chronic idiopathic urticaria. Concomitantly, ultra-processed diets low in fiber and high in additives detrimentally affect the gut-skin axis. Diets rich in emulsifiers, sugars, and fructose alter the gut microbiome and increase intestinal permeability, leading to metabolic endotoxemia and increased systemic inflammation. High-fructose corn syrup in sweetened beverages is metabolized via hepatic fructokinase, promoting de novo lipogenesis and excess uric acid, a cascade implicated in metabolic fatty liver disease and heightened inflammation. These dietary factors have been correlated with aggravated skin diseases, where fast-food intake (≥3× weekly) is associated with increased risk of severe AD in children. Emerging evidence suggests that dietary modifications may help mitigate skin inflammation in select patients. At the same time, the advent of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists may improve metabolic parameters and could represent promising adjunctive therapies in select inflammatory dermatoses. Dermatologists can serve as sentinels, identifying cutaneous signs of insulin resistance (eg, acanthosis nigricans, acrochordons, and other skin diseases driven by insulin resistance) and addressing lifestyle factors as part of routine care.

Udder cleft dermatitis (UCD) is an endemic disease in dairy cows, initially presenting as skin lesions, which can lead to ulceration and deep, persistent infection. Early lesions may go undetected due to their location deep in the intermammary cleft. There is little existing evidence on the prevalence of UCD in dairy cattle in the United Kingdom (UK), but studies in other European countries with similar climates and dairy production systems have found prevalence to be highly variable between herds. The aim of this study was to investigate the prevalence, severity, and location of UCD lesions in UK dairy herds, as well as to explore potential risk factors for the disease at both the cow and herd level. An observational cross-sectional study was carried out, with 8,302 cows examined for UCD lesions on 28 farms. All participating farms were recruited via random selection from the client list of a single large animal practice. Data were collected by the research team in the parlor during routine milking or in locking head yokes in herds with automatic milking systems. The presence, severity, and location of any UCD lesions were recorded. In addition, fore udder attachment score, udder depth score, body condition score, hock score, and cleanliness score were recorded. A questionnaire was also used to collect additional information about the herd. Descriptive statistics were compiled in Microsoft Excel, then data were transferred to IBM SPSS for further analysis. Within-herd prevalence of UCD lesions ranged from 0.7% to 27.4%, with 9.9% (95% CI: 9.3%-10.6%) of all sampled cows being affected. In total, 39.6% of cows with lesions (3.2% of all cows examined) were classed as having very severe lesions greater than 5 cm in size. A 2-level logistic regression model, with cows clustered within herds, was used to explore risk factors for the presence of UCD lesions. Cows with strong fore udder attachments and tight udders had lower odds of lesions, whereas those with loose fore udder attachments and deep udders had higher odds. The final model selected explained only 12.5% of the variance, suggesting that there are likely other cow- and herd-level variables associated with the presence of lesions, which were not captured. The association between udder conformation and UCD lesions suggests that this may be a key area of focus for reducing prevalence of this disease. However, the findings should be interpreted with caution, as the primary focus of the study was to accurately describe prevalence in UK herds, rather than to explore risk factors. Further work is needed to explore additional risk factors and examine the progression of these lesions over time.

Infected interdigital intertrigo is an exudative, macerating, mixed infection of the toe webs in which gram-negative bacteria (Pseudomonas aeruginosa and Enterobacterales) seem prevalent, but in which gram-positive pathogens (Staphylococcus [S.] aureus, streptococci, enterococci) and fungi (dermatophytes, yeasts) also occur. The former German term "gram-negative foot infection" misleadingly implied a soft-tissue infection of the foot caused by gram-negative bacteria. The updated term "infected interdigital intertrigo" is an internationally used designation, as is the term "gram-negative toe web infection". This superficial infection may yet progress to soft tissue infection (phlegmon, cellulitis) of the foot but in immunocompetent patients is usually caused by S. aureus. Complicated courses, as well as the development of interdigital intertrigo itself, are facilitated by diabetes mellitus, polyneuropathy, and peripheral arterial disease. Diagnosis is made clinically, based on painful macerated erosions or ulcers with yellow-green exudate, putrid odor and edema. Superficial swabs are not always diagnostically required or relevant. Management focuses on local therapy with anti-inflammatory, antiseptic, antimycotic agents, dry wound care and reduction of edema. Systemic antibiotics are indicated only in cases of associated soft-tissue infection, which in immunocompetent patients present as uncomplicated cellulitis and therefore require coverage limited to S. aureus. Early vascular evaluation, imaging and surgical assessment in cases of deep infection or necrosis are essential.

Lichen planus pigmentosus inversus (LIPPI) is a rare variant of lichen planus, predominantly affecting intertriginous skin areas. Existing knowledge is mostly based on case reports, with few systematic reviews available. A systematic literature search identified 105 cases from case reports and series. Extracted data included demographics, clinical features, comorbidities, treatments, and outcomes. Statistical analysis included descriptive methods and uni-/multivariate logistic regression. The cohort was 64.8% female, with a median age of 58 years. Most lesions affected multiple inverse areas (55.2%). Pruritus was reported only in 44.8% of patients. Median time to diagnosis was 6 months. Treatment response was observed in 47.6% of cases, mostly with topical corticosteroids or calcineurin inhibitors. Pruritus proved to be a strong predictor of treatment response (odds ratio [OR] 4.17), as did, to a lesser extent, shorter disease duration until diagnosis (OR 0.93 per month). Ethnicity and comorbidities had no significant effect in multivariate analysis. LIPPI presents with considerable clinical and demographic variability. Pruritus and early diagnosis may be associated with better treatment outcomes and could serve as relevant prognostic indicators.

Dear Editor, Pityriasis versicolor (PV) is a superficial mycosis caused by Malassezia species and most often affects the trunk and upper limbs. Flexural or inverse variants, however, may differ markedly from classical morphology due to the influence of moisture, temperature, and friction. These atypical presentations frequently mimic erythrasma, candidal intertrigo, tinea cruris, seborrheic dermatitis, and pigmentary disorders. [...].

Granuloma annulare (GA) is a benign, non-infectious granulomatous skin condition of uncertain etiology, often presenting as annular erythematous plaques. While commonly localized to the hands and feet, GA has multiple clinical variants and can mimic other dermatologic conditions, leading to diagnostic challenges. We report a rare case of GA localized to the inguinal region in a 55-year-old female initially treated empirically for candidal intertrigo without improvement. Biopsy demonstrated interstitial histiocytic infiltrates dissecting between collagen bundles with increased dermal mucin, confirming a diagnosis of interstitial GA. The patient was subsequently treated with triamcinolone 0.1% ointment and hydroxychloroquine 200 mg twice daily and is currently pending follow-up. While GA often resolves spontaneously, refractory cases require individualized management, as no gold-standard therapy exists. The objective of this report is to highlight an atypical presentation of GA and emphasize the importance of maintaining a broad differential diagnosis for annular skin lesions. Further research is needed to elucidate GA's pathogenesis and optimize treatment strategies for chronic or widespread disease.

Brachioplasty is also referred to as an 'upper arm lift procedure.' Nearly 20,000 upper arm lifts were performed in 2019, an increase of 20% from 2015.[1] It is most commonly performed for patients following massive weight loss (MWL), and 256,000 bariatric procedures were performed in 2019, representing a 31% increase in these operations performed since 2015.[2]  Other patient groups that may request brachioplasty include patients presenting following pregnancy and aging (senile) brachial laxity. Excess skin and ptosis can result in functional problems such as intertrigo, poor hygiene, infections, and psychosocial morbidity.[3][4] Furthermore, body contouring procedures, including brachioplasty following bariatric surgery, improve satisfaction, function, and quality of life and reduces BMI, and aid weight loss.[5][6] Brachioplasty entails the excision of excess skin and lipodystrophy of the upper arm, which can extend onto the lateral chest wall. Patient assessment and classification of the degree of skin and subcutaneous fat excess are crucial to identify the most appropriate procedure for each patient. This is because alternatives to brachioplasty can include liposuction and liposuction combined with brachioplasty; additionally, there are variations of brachioplasty depending on the scar length and placement. Several classification systems exist, which can guide the surgeon in selecting the most appropriate procedure.[7][8][9]