IgA nephropathy (IgAN) is a common autoimmune kidney disease and a leading cause of chronic kidney disease (CKD), yet the immune cell-specific mechanisms underlying disease progression remain incompletely understood, particularly with respect to macrophage heterogeneity. We analyzed single-cell RNA sequencing (scRNA-seq) data from IgAN and CKD kidney samples to characterize macrophage subpopulations and identify differentially expressed genes. Mendelian randomization analyses using publicly available genome-wide association study data were performed as an exploratory approach to prioritize macrophage-associated genes potentially linked to IgAN risk. Bulk RNA-seq datasets were used for transcriptomic validation. In silico molecular docking was conducted to explore potential small-molecule interactions with prioritized targets. Alternatively activated macrophages were the predominant macrophage subpopulation in both IgAN and CKD samples compared with controls. Exploratory Mendelian randomization analyses highlighted several macrophage-associated genes, including RGS1 and HLA-DPA1, as candidates potentially linked to IgAN susceptibility. Bulk RNA-seq analyses showed downregulation of RGS1 and upregulation of HLA-DPA1 in IgAN, supporting their transcriptional relevance. Molecular docking suggested isotretinoin as a potential small-molecule interactor with RGS1, although this finding is based solely on computational prediction. This integrative, hypothesis-generating study highlights the expansion of alternatively activated macrophage in IgAN and prioritizes macrophage-associated genes that may contribute to disease susceptibility. These findings provide a computational framework for future experimental validation and mechanistic studies, rather than definitive evidence of causality or therapeutic efficacy.

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia characterized by the presence of the promyelocytic leukemia-retinoic acid receptor alpha (PML::RARA) fusion gene. The combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) has significantly improved outcomes in patients with APL. Isotretinoin (13-cis retinoic acid), a stereoisomer of ATRA commonly used for acne vulgaris, shares a similar mechanism of action and has demonstrated differentiation-inducing activity in vitro and in limited clinical reports. We present the case of a 38-year-old uninsured male with low-risk APL, defined by a presenting white blood cell count of ≤10,000/µL per the Sanz risk stratification system, who achieved hematologic complete remission following standard induction therapy with ATRA plus ATO but was transitioned to isotretinoin during consolidation because he was unable to obtain ATRA due to financial constraints. The patient achieved molecular complete remission within two months of initiating isotretinoin-based consolidation therapy and continues to have negative PML::RARA reverse transcriptase polymerase chain reaction (RT-PCR) results, with sustained remission at 18 months of follow-up with ongoing molecular monitoring every three months. Although the concurrent use of ATO and prior ATRA-based induction are important confounders, this case highlights the potential role of isotretinoin as a cost-effective alternative retinoid for consolidation therapy in APL when ATRA is inaccessible, although ATRA remains the recommended standard treatment.

A 16-year-old boy with cystic fibrosis (CF) on fat-soluble vitamin (including vitamin A) supplementation develops severe acne. He is commenced on isotretinoin, a vitamin A derivative. The package insert says that vitamin A supplementation should be stopped, presenting a therapeutic dilemma. We review the literature and previous reports of isotretinoin use in patients with CF to provide guidance on how to successfully treat acne while minimizing adverse effects, including in patients on genomodulatory therapy.

Childhood granulomatous periorificial dermatitis is an uncommon variant of periorificial dermatitis seen in patients under 18 years of age with several proposed triggers, including topical or inhaled corticosteroid exposure. We report and discuss a case of refractory childhood granulomatous periorificial dermatitis in a 14-year-old female with past inhaled corticosteroid use. After 7 months of isotretinoin therapy followed by 3 months of oral methotrexate, we observed complete resolution of her facial eruption.

Acne vulgaris is a common skin condition that affects mainly the dermal pilosebaceous glands, with symptoms range from open comedones to pustular cysts leading to inflammatory scars. Oral isotretinoin is used by dermatologists mainly for severe cases or resistance to topical treatments. This research determined bone health status in patients treated with a 6-month course of oral isotretinoin. The follow up duration of all 57 patients, 30 females and 27 males, who received a 0.5-1 mg/kg daily dose of oral isotretinoin through-out the study. The present investigation exhibited a significant decline in osteoblastic activity, markedly procollagen type 1 N-terminal propeptide (P1NP) and bone specific alkaline phosphatase (bsALP), accompanied by raised osteoblastic marker C-terminal telopeptide of type 1 collagen (bCTX), which suggests a shift towards bone resorption. Oxidative stress markers were also affected, with significantly decreased levels of glutathione (GSH) alongside elevated malondialdehyde (MDA). In addition, there were no such changes in liver function markers and parathyroid hormones (PTH). Such outcomes require a careful attention to bone health in patients with extended periods of oral isotretinoin therapy and in those with well-known skeletal disorders or risks.

Thick skin is a challenge in secondary rhinoplasty, frequently compromising both aesthetic outcomes and the predictability of surgical interventions. This article presents an integrated approach to the management of thick skin in patients undergoing secondary rhinoplasty. The described protocol encompasses preoperative, intraoperative, and postoperative strategies designed to reduce and control swelling, edema, and inflammation as much as possible. It incorporates topical and systemic medical therapies, dietary modifications, structured skin stretching exercises, and surgical techniques including superficial musculoaponeurotic system debulking, skeletal augmentation, structural grafting, and control of dead space formation.

This case describes a 29-year-old man with Morbihan disease, characterized by a 5-year history of recurrent facial erythema, papules, and pustules, followed by persistent right face edema. Initially misdiagnosed as lupus erythematosus, he received multiple treatments with only transient relief. Clinical manifestations combined with pathological findings confirmed a diagnosis of Morbihan disease associated with rosacea. Notably, the patient developed erythema and papules on the inner thighs, along with small papules on the trunk and upper limbs for 3 months. A biopsy revealed nonspecific inflammation. Since the morphology of these lesions differed from any known skin disease and no other cause could be identified, we believe this may be a manifestation of the disease. Extra-facial manifestation not previously reported. Various therapies were attempted: doxycycline and azelaic acid improved erythema; baricitinib was ineffective; while omalizumab and intense pulsed light (IPL) achieved partial improvement in erythema and edema. Long-term isotretinoin therapy provided sustained remission without relapse during tapering, confirming its efficacy and safety. This case expands the clinical spectrum of Morbihan disease by documenting extra-facial involvement and reported isotretinoin as an effective long-term therapy, with omalizumab and IPL as promising adjuncts. Furthermore, the literature review (2004-2025) summarizes the clinical features, pathology, and treatment responses of reported cases, showing a male-to-female ratio of 2.81:1. Lymphatic or vascular dilation was significantly correlated with a favorable outcome. Conversely, dermal edema and granuloma were inversely associated with treatment efficacy, indicating poorer prognosis. However, based on uncontrolled data, these findings are strictly hypothesis-generating and do not establish a definitive treatment hierarchy.

Harlequin ichthyosis is a rare and life-threatening congenital disorder with high neonatal mortality, particularly in settings lacking specialized neonatal intensive care. We report a preterm newborn managed in a rural hospital without modern incubators, continuous monitoring, systemic retinoids at birth, or specialized personnel. Survival was achieved through pragmatic, low-cost interventions including an improvised humidified incubator, intensive topical emollient therapy, basic respiratory support, umbilical venous access for fluid and electrolyte management, and later initiation of oral isotretinoin. This case highlights that essential supportive care and adaptive use of available resources can improve outcomes in resource-limited settings.

Oral potentially malignant disorders (OPMD) are associated with high risk of progression to oral squamous cell carcinoma (OSCC) and remain difficult to manage, due to limited effective localized therapies, underscoring the urgent need for novel, targeted drug delivery systems. A mucoadhesive buccal patch loaded bioactive components such as isotretinoin, bromelain, and limonene (IBL patch) was fabricated and evaluated for its anticancer potential against OPMD-associated OSCC. The cytotoxic study demonstrated that the IBL patch significantly reduced CAL-27 cells viability and found IC50 value around 650 μg/mL, while exhibiting minimal cytotoxicity toward human gingival fibroblast (HGF) cells, indicating selective anticancer activity. In comparison to HGF cells, the IBL patch significantly reduced the migration and invasion of CAL-27 cells. Colony formation assays further confirmed that the IBL patch significantly suppressed the long-term proliferative and clonogenic potential of CAL-27 cells, without affecting HGF cells division. Genotoxicity analysis revealed increased micronucleus formation in CAL-27 cells, suggesting DNA damage-mediated apoptotic induction. Then IBL patch showed molecular effects by suppressing EMT and fibrosis associated TGF-β/SMAD signaling, inhibiting inflammatory (NF-κB), Wnt/β-Catenin pathways and Cytokeratin 17 (CK-17) and restoring epithelial identity through E-Cadherin and CK-18 upregulation. Furthermore, pathway analysis in both monolayer and co-culture inflammatory models demonstrated that the IBL patch effectively suppressed LPS-induced inflammatory markers, including TGF-β, MMP-2, IL-6, and TNF-α expression. Oral acute toxicity testing (OECD 423) confirmed safety of the IBL patch, with no mortality or adverse effects up to 2000 mg/kg (LD50 > 2000 mg/kg; GHS Category 5). Collectively, these findings highlights that the IBL mucoadhesive buccal patch has therapeutic potential against OPMD and controlling pathological epithelial remodeling.

We report the case of a 45-year-old woman with recalcitrant perioral dermatitis resistant to multiple topical and systemic therapies who achieved complete remission following treatment with oral isotretinoin. The patient presented with persistent periorificial papules despite ivermectin-based topical regimens, calcineurin inhibitors, compounded anti-inflammatory formulations, and repeated courses of doxycycline. Sustained disease control was achieved with low-dose isotretinoin maintenance therapy. This case highlights the therapeutic challenges associated with refractory perioral dermatitis and supports the potential role of isotretinoin as an antibiotic-sparing strategy in selected patients.