Contemporary population-based data on incidence trends and in-hospital outcomes of pemphigus vulgaris remain limited, particularly in Southeast Asia. This study aimed to characterize incidence patterns and identify factors associated with severe in-hospital outcomes. We conducted a nationwide retrospective cohort study using Thailand's national administrative health database from 2015 to 2024. Incident cases were defined using a two-year washout period. Crude and age-standardized incidence rates were estimated, and temporal trends were evaluated using Poisson regression. Hospitalization analyses were restricted to index hospitalizations. Severe in-hospital outcomes were defined as a composite of in-hospital mortality, invasive mechanical ventilation, renal replacement therapy, or shock. Associations with severe in-hospital outcomes were evaluated using multivariable logistic regression, with sensitivity analyses accounting for repeated admissions using generalized estimating equations. A total of 2 542 incident adult cases were identified, corresponding to a mean annual incidence of 6.03 per 1 000 000 population. Incidence increased over time (adjusted incidence rate ratio 1.20; 95% CI 1.18-1.22), was higher with advancing age, and among females (female-to-male ratio 1.41:1). Increasing age-standardized incidence rates suggested that the temporal increase was not fully explained by population aging. This trend was accompanied by increasing annual hospitalizations. Among 1 537 index hospitalizations, 8.1% experienced severe in-hospital outcomes. Acute kidney injury, malnutrition, and infection were associated with severe in-hospital outcomes. In sensitivity analyses accounting for repeated admissions, advancing age and cardiovascular comorbidity were also associated with increased risk. Pemphigus vulgaris demonstrates a rising incidence beyond the effects of population aging, accompanied by increasing hospitalizations and a growing burden of severe in-hospital outcomes. These findings support early identification of high-risk patients and appropriate clinical management.

The pro-inflammatory cytokines interleukin(IL)-1β and IL-36γ are key drivers of psoriasis, an inflammatory skin disease for which a causal therapy is not available. However, the mechanisms underlying regulation of these cytokines in psoriasis remain poorly understood. Generation of IL-1β activity is regulated by inflammasomes. We activated the NLRP1 inflammasome in human keratinocytes cultivated in three-dimensional skin equivalents. NLRP1 activation induced histological and molecular features highly reminiscent of psoriasis. Mechanistically, the phenotype was dependent on IL-1, which triggered a pro-inflammatory epidermal-dermal crosstalk. This included induction of IL-36γ expression, which was released from keratinocytes through NLRP1 inflammasome-induced gasdermin D pores. The relevance of these findings is reflected by the expression of NLRP1 and inflammasome activation in lesions of psoriasis patients. Finally, we discovered endogenous cytoplasmic double stranded (ds) RNA, recently associated with cellular perturbations in psoriasis, as a novel NLRP1 activator. Our results identify a novel endogenous dsRNA-mediated NLRP1-IL-1-IL-36γ signaling axis relevant in psoriasis and suggest its targeting as a promising treatment strategy.

The growing use of synthetic skin substitutes versus autologous grafts in dermatologic reconstruction represents a significant development in the field that extends beyond technical surgical considerations into broader questions of medical ethics. Physicians deciding which graft is preferable are increasingly facing ethical dilemmas. They are balancing clinical outcomes, patient preferences, procedural risks, and healthcare costs. Each of these issues is associated with distinct implications concerning patient autonomy, beneficence, nonmaleficence, justice, and financial stewardship. Notably, the expanding use of synthetic skin substitutes has also generated increasing ethical concern about financial incentives and conflicts of interest.

Chronic ear pruritus, itching of the ear that lasts longer than six weeks, is a common symptom with a wide differential diagnosis, and can significantly impair the quality of life. It can arise from primary dermatologic conditions such as psoriasis, seborrheic dermatitis, contact dermatitis, atopic dermatitis, and lupus erythematosus, as well as infestations such as scabies and pediculosis capitis. Otolaryngologic causes, for example: otomycosis, chronic otitis externa, and temporomandibular joint disorders, may also lead to chronic ear pruritus. Systemic diseases like diabetes, hematologic malignancies, or chronic liver and kidney disorders manifest as generalized pruritus involving the ears, as well. Accurate diagnosis of the cause requires careful medical history-taking and physical examination, with consideration of both local and systemic factors. Management depends on the underlying cause and may include topical corticosteroids, antifungals, calcineurin inhibitors, or systemic immunomodulators. Identifying and avoiding allergens, especially from jewelry or topical ear medications, is important in contact dermatitis. In refractory or severe cases, newer therapies such as biologics and targeted immunologic agents may be useful.

Persistent somatic symptoms (PSS) are common, functionally disruptive, and stable over time. Understanding symptom interactions may clarify transdiagnostic patterns and inform treatment. This study investigated symptom interrelations in a transdiagnostic sample to identify central symptoms and assess temporal stability.

Porphyrias are rare metabolic disorders caused by inherited or acquired enzymatic defects in the heme biosynthesis pathway, resulting in the accumulation of heme precursors or toxic porphyrin intermediates. The cutaneous porphyrias arise from enzymatic defects in later steps of the heme biosynthesis pathway, which lead to the build-up of photoactive porphyrins in the skin and liver, such as coproporphyrins, protoporphyrins, and uroporphyrins. These photoactive porphyrins generate reactive oxygen species that drive the characteristic cutaneous manifestations, including painful photosensitivity, skin fragility, and blistering. The cutaneous porphyrias encompass both blistering and non-blistering subtypes, which include erythropoietic protoporphyria, X-linked protoporphyria, congenital erythropoietic porphyria, porphyria cutanea tarda, and hepatoerythropoietic porphyria, each distinguished by specific biochemical patterns and clinical features. Acute hepatic porphyrias, which include acute intermittent porphyria, variegate porphyria, hereditary coproporphyria, and aminolevulinic acid dehydratase deficiency porphyria, result in the accumulation of neurotoxic precursors, such as δ-aminolevulinic acid and porphobilinogen. While acute neurovisceral attacks predominate in acute hepatic porphyrias, certain subtypes, such as variegate porphyria and hereditary coproporphyria, may present with blistering photosensitivity, creating a significant diagnostic overlap between cutaneous porphyrias and other photodermatoses. This overlap underscores the importance of awareness of acute hepatic porphyrias among dermatologists, who may be the first clinicians to encounter patients with these disorders. In addition, recent treatment breakthroughs will likely bring patients with porphyrias to pursue care, changing the likely underestimated disease prevalence rates. This narrative review provides a comprehensive overview of the pathobiology, clinical features, diagnostic strategies, and management approaches for the cutaneous and acute hepatic porphyrias.

Anaplastic large cell lymphoma (ALCL) is part of the spectrum of CD30-positive lymphoproliferative disorders within cutaneous T-cell lymphomas. These disorders account for approximately 25%-30% of all primary cutaneous lymphomas (PCLs). Primary cutaneous ALCL (pcALCL) is an uncommon entity with heterogeneous clinical and histopathologic features, often posing a diagnostic challenge. We report a 79-year-old man who presented with a three-month history of a non-healing ulcer on the right lower limb following minor trauma. The lesion measured 6.7 × 9.8 × 0.3 cm and showed irregular erythematoviolaceous borders with areas of eschar. Histopathologic evaluation revealed a dense infiltrate of large atypical mononuclear cells with pleomorphic nuclei, prominent nucleoli, and atypical mitoses, accompanied by angiocentric and angiodestructive features. Immunohistochemistry demonstrated CD30 positivity in more than 75% of atypical cells and negative anaplastic lymphoma kinase (ALK) expression, confirming pcALCL. The patient responded favorably to electron beam radiotherapy. This case underscores the importance of early biopsy in atypical or treatment-refractory ulcers and highlights the diagnostic relevance of recognizing rare variants such as the angiocentric subtype.

Background Artificial intelligence (AI)-based skin analysis enables objective, large-scale assessment of dermatologic features; however, population-specific normative reference ranges for Indian skin remain limited. This exploratory study aimed to establish percentile-based reference distributions for facial skin parameters in Indian adults, predominantly comprising Fitzpatrick skin types III-V, who demonstrate distinct pigmentary and aging patterns that are underrepresented in the existing literature. Methods This retrospective, cross-sectional study analyzed de-identified facial scan data from 20,914 healthy Indian adults (≥18 years) obtained through the SkinSensAI™ platform (Ningen Skin Sciences Pvt. Ltd., New Delhi, India), of whom 20,913 with complete age data were included in age-stratified analyses. Facial images were processed using an AI engine to generate standardized severity scores (1-5 scale) for 12 facial skin parameters. Descriptive statistics, age-, gender-, and Fitzpatrick-stratified analyses, and inter-parameter correlations were performed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results Dark circles and enlarged pores emerged as the most prevalent concerns, while wrinkle severity remained low in participants younger than 45 years. Wrinkles showed the strongest correlation with age (r = 0.57, p < 0.001). Male participants exhibited significantly higher scores for pores, spots, wrinkles, and skin laxity than female participants (p < 0.001). Darker Fitzpatrick skin types demonstrated a higher pigmentary burden, whereas wrinkle severity was relatively lower, consistent with melanin-associated photoprotection. Distinct correlation clusters reflected aging-related, pigmentation-sebaceous, and independent skin domains. Conclusion This study establishes the first large-scale, AI-derived reference database of facial skin parameters specific to the Indian population. These population-specific benchmarks support objective dermatologic assessment, personalized patient counseling, and equitable AI application in clinical dermatology.