Tapinarof is an aryl hydrocarbon receptor agonist approved for the treatment of atopic dermatitis (AD) and psoriasis. While common adverse events include headache and folliculitis, comedones and perifollicular hyperpigmentation are under-recognized. Here, we report eight patients with AD or psoriasis who developed comedones and/or perifollicular hyperpigmentation during therapy. Lesions developed primarily at application sites; however, in one patient, lesions occurred at a distant site. Lesions appeared on the face in six patients, the legs in one and the arms in one. Time of onset ranged from 1 to 8 months after initiation of tapinarof therapy. Tapinarof was discontinued in all cases. Three patients were treated with topical adapalene/benzoyl peroxide, with partial improvement in one and minimal improvement in two. One patient showed gradual improvement without additional treatment, whereas the remaining five showed no or minimal improvement during follow-up. Our cases provide important information on under-recognized adverse events during tapinarof therapy.

Folliculitis decalvans (FD) is a chronic neutrophilic cicatricial alopecia characterized by recurrent scalp inflammation, pustules, tufted hairs, and progressive permanent hair loss. Owing to its relapsing course and the absence of standardized treatment guidelines, therapeutic management remains challenging. This systematic review summarizes available treatment approaches and reported outcomes in FD. A systematic literature search of PubMed, Web of Science, Embase, and Cochrane databases was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42023467796). Studies published between 1999 and December 2024 reporting treatment outcomes in at least one patient with FD were included. Full remission was defined as complete absence of inflammatory activity with stable disease, while partial remission indicated clinical improvement without relevant alopecia progression. Overall, 64 studies comprising 300 patients were included, mainly retrospective studies, case series, and case reports with low levels of evidence. Antibiotic-based therapies, particularly rifampicin-clindamycin combinations, showed favorable initial responses but frequent relapse after discontinuation. Isotretinoin demonstrated comparatively durable responses, with remission rates up to 82%. Biologic and targeted immunomodulatory therapies, including TNF-α inhibitors, apremilast, and various JAK inhibitors, showed promising outcomes in refractory cases. Current evidence supports individualized long-term treatment strategies focused on inflammation control and prevention of irreversible scarring.

Yeasts of the Malassezia genus are implicated in numerous skin conditions, including seborrheic dermatitis, pityriasis versicolor, and folliculitis. While ciclopirox olamine (CPO) and piroctone olamine (OCT) are effective anti-Malassezia agents, the activity of magnetized water against pathogenic yeasts remains unclear. The aim of this study was to examine the in vitro efficacy of magnetized saline water (MSW), alone or combined with CPO plus OCT, against three Malassezia species (M. furfur, M. globosa, and M. restricta) using broth microdilution to determine minimal inhibitory concentrations (MICs). A proof-of-concept study evaluating a shampoo containing MSW 30% + CPO 0.5% + OCT 1.0% in 20 patients with scalp seborrheic dermatitis (SSD) was subsequently conducted. Participants applied the shampoo four times per week for 12 weeks; efficacy was assessed by changes in a validated 16-point SSD severity score. The triple combination demonstrated additive-to-synergistic activity, with MIC values of 3.91 mg/L across all three species, representing a 2.0- to 4.0-fold MIC reduction compared to CPO + OCT alone, and synergy (FIC=0.31) for M. furfur. The total SSD score decreased by 33.9% after 12 weeks (p<0.001), with improvements in pruritus (49.0%), erythema (54.3%), and scaling (24.2%); all p values remained significant after Bonferroni correction (α=0.0125). These findings support MSW as a vehicle to potentiate the anti-yeast activity of CPO and OCT while reducing the chemical load, potentially offering a novel strategy for Malassezia-associated skin disorders. The open-label, single-arm design limits causal attribution, and larger controlled trials are needed.

High-resolution ultrasound with Doppler (HRUD) is an emerging imaging modality that enables noninvasive visualization of hair follicles, perifollicular structures, and vascular changes. Recent studies have identified characteristic ultrasonographic findings in nonscarring and scarring alopecia, expanding ultrasound's role in clinical evaluation. This narrative review summarizes HRUD principles, sonoanatomy of the hair, scanning techniques, indications, and representative imaging findings in alopecia. PubMed and Scopus were searched to identify publications describing HRUD applications in alopecia, and ultrasonographic images and illustrative cases from the authors' collections were included to demonstrate key findings. Across alopecias, HRUD shows recognizable imaging patterns that may support diagnosis and clinical assessment. Reported findings include follicular miniaturization in pattern alopecia, drop-like follicular widening in alopecia areata, perifollicular inflammatory changes and increased vascularization in scarring alopecia, follicular fusion in folliculitis decalvans, and fistulous tracts in dissecting cellulitis of the scalp. HRUD may also facilitate assessment of disease activity, treatment response, and clinicopathologic correlations. In conclusion, HRUD provides clinically useful structural and vascular information on alopecia and may complement clinical examination and trichoscopy. Standardizing imaging protocols and conducting further clinical studies may help define its role in diagnosis, monitoring, and research.

Folliculitis decalvans (FD) is a primary cicatricial alopecia characterised by recurrent pustulation, tufting and progressive scarring hair loss. Familial clustering is rarely reported, limiting understanding of potential genetic susceptibility. We describe five cases of FD occurring in two unrelated families: three sisters with adolescent-onset disease and a mother-daughter pair with adult-onset disease, with a possible history in a preceding generation. Clinical and histopathological findings were consistent with FD in all cases. Staphylococcus aureus was identified in three of the affected individuals. Compared with previously reported familial cases, which predominantly involve male relatives or twins, this series represents the largest female-predominant familial cluster and the first clear mother-daughter occurrence. These findings support a potential heritable component in FD and highlight the need for further genomic and mechanistic studies.