Facial wrinkles are a major concern in aesthetic dermatology, particularly in patients with darker phototypes, in whom laser treatments require careful parameter selection to minimize pigmentary adverse events. This retrospective study evaluated the effectiveness and tolerability of a nanosecond Q-switched 1064 nm Nd laser for the management of facial photoaging in Asian patients. Fifty Asian patients with Fitzpatrick skin types III-IV and facial wrinkles underwent three monthly treatment sessions with a Q-switched 1064 nm Nd: YAG laser. Clinical outcomes were assessed using the Fitzpatrick Wrinkle and Elastosis Scale, standardized pre- and post-treatment photographs, pain Visual Analogue Scale, and adverse event monitoring. Mean Fitzpatrick Wrinkle and Elastosis Scale score significantly decreased from 4.54 ± 1.55 at baseline to 3.42 ± 0.97 at three-month follow-up after the last treatment, corresponding to a mean absolute reduction of 1.12 ± 0.75 points. Forty-one patients showed an improvement of at least one FWS point, while thirteen patients improved by two or more points. Nine patients remained stable, and no clinical worsening was observed. Treatment was well tolerated, with a mean pain score of 2.0 ± 0.78. Mild transient erythema occurred in four patients, while no cases of blistering, scarring, burns, hypopigmentation, or post-inflammatory hyperpigmentation were recorded. Nanosecond Q-switched 1064 nm Nd laser treatment may represent a well-tolerated option for mild-to-moderate facial photoaging in Asian skin. However, the retrospective design, lack of a control group, and absence of instrumental objective measurements should be considered when interpreting these findings.

With the rising popularity of minimally invasive facial aesthetic procedures, injection-related complications in the cranio-maxillofacial region pose an increasing diagnostic and therapeutic challenge. We report a rare case of refractory delayed-onset inflammatory nodules in a 36-year-old woman with a self-reported allergic history following sequential injections of polyvinyl alcohol (PVA), poly-L-lactic acid (PLLA), and polycaprolactone (PCL) based biostimulatory fillers in distinct facial subunits. More than one year post-injection, the patient developed progressive erythema, induration, tenderness, and nodular swelling at multiple sites. Lesions showed poor response to intralesional corticosteroids and aspiration. High-frequency ultrasonography and magnetic resonance imaging facilitated precise lesion mapping and guided surgical excision. Site-specific histopathology revealed retained particulate material with foreign-body giant cells, granulomatous inflammation, and collagen-rich fibrosis. Exploratory transcriptomic profiling and immunofluorescence supported a shared inflammatory-fibrotic response but remained hypothesis-generating. This case underscores the clinical importance of refractory multisite foreign-body granulomas after sequential exposure to different persistent or biostimulatory injectable materials. It raises, but does not establish, the possibility of a host-related contribution and highlights the value of detailed injection history, multimodal imaging, site-specific histopathology, judicious material selection, and individualized management.

BACKGROUND Stevens-Johnson syndrome (SJS) is characterized by widespread, epidermal necrosis and mucosal involvement mediated by a delayed-type hypersensitivity reaction. Although rapidly progressive epidermal detachment is known to result in blister formation, pustular lesions are rare in SJS. CASE REPORT A 25-year-old male patient with no significant medical history or regular medication presented to the emergency department with a fever and rash. The fever had developed 7 days before the current presentation and was followed 4 days later by lip swelling, conjunctival hyperemia, and sore throat, which caused difficulty with oral intake. Two days before presentation, a generalized rash and dysuria developed, prompting evaluation at our hospital. A clinical examination found multiple, 3-mm pustules surrounding erythema on the face, chest, and back. Scattered erosions were observed on less than 10% of body surface, including the distal extremities, lips, buccal mucosa, and genital area. The conjunctivae displayed marked pseudomembrane formation. Histopathological analysis found that the erosions contained necrotic keratinocytes in the epidermis, with mild vacuolar changes at the dermo-epidermal junction, while the pustules contained serous exudate with scattered neutrophils. Based on these findings, SJS was diagnosed. A drug-induced lymphocyte stimulation test was positive for loxoprofen. The patient responded well to prednisolone therapy. CONCLUSIONS Although no drug exposure or infection preceding the symptoms was identified at admission, SJS was diagnosed by exclusion on the basis of the clinical manifestations and diagnostic criteria. A drug-induced lymphocyte stimulation test may help identify the causative drug. Neutrophilic infiltration into blisters formed by progressive, epidermal necrosis may occasionally result in pustule-like eruptions in SJS.

Scalp rosacea, also known as red scalp disease (RSD), is an inflammatory dermatosis that remains underrecognized and frequently misdiagnosed because of its clinical overlap with other inflammatory scalp disorders and the relative nonspecificity of its findings. It is characterized by diffuse scalp erythema, dry scaling, vascular alterations, and inflammatory papules or pustules, often accompanied by pruritus or burning sensations. Despite being described several decades ago, scalp rosacea has only recently gained attention, and no standardized diagnostic criteria or therapeutic guidelines have yet been established. The prevalence of scalp rosacea is unknown; however, it appears to predominantly affect middle-aged men and has been associated with androgenetic alopecia, suggesting a potential role for increased ultraviolet exposure. Current evidence supports a multifactorial pathogenesis involving genetic susceptibility, dysregulation of the innate immune response, neurovascular alterations, and environmental triggers. Keratinocyte activation by exogenous stimuli induces cathelicidin/LL-37-driven inflammation, promoting macrophage activation, vasodilation, and angiogenic signaling. In addition, Demodex folliculorum infestation may contribute to disease persistence, with the scalp acting as a potential reservoir. Clinically, scalp rosacea presents with diffuse erythema and scaling, with sparse, non-follicular papules or pustules surrounded by dilated capillaries. Trichoscopy has emerged as a valuable diagnostic tool, revealing characteristic vascular and perifollicular patterns that aid in distinguishing scalp rosacea from other inflammatory scalp conditions. Histopathology, when required, demonstrates vascular ectasia and perifollicular inflammation without follicular destruction, confirming its non-scarring nature. Management relies on topical and systemic therapies extrapolated from facial rosacea, with oral tetracyclines as first-line treatment. Overall, prognosis is favorable, as progression to cicatricial alopecia does not occur. The aim of this review is to synthesize current evidence on the pathogenesis, clinical presentation, trichoscopic and histopathologic features, differential diagnosis, and therapeutic approaches to scalp rosacea, in order to improve its recognition and clinical management.

A 6-year-old boy with sickle cell disease and a recent episode of acute chest syndrome presented to the emergency department with chest tightness and a 4-day history of progressive right eye swelling, along with pain in the left hand and left leg. Initial laboratory tests showed a hemoglobin level of 6.1 g/dL (61 g/L) (low), hematocrit level of 19.5% (low), white blood cell count of 16 000/μL (16 × 10[9]/L) (high), red blood cell count of 3.03 million/μL (3.03 × 10[12]/L) (low), platelet count of 338 × 10[3]/μL (338 × 10[9]/L) (normal), reticulocyte count of 4.79% (high), total bilirubin level of 2.3 mg/dL (39 μmol/L) (high), aspartate aminotransferase level of 62 U/L (1.0 μkat/L) (high), alanine aminotransferase level of 16 U/L (0.27 μkat/L) (normal), and alkaline phosphatase level of 660 U/L (11 μkat/L) (high). The differential count was as follows: neutrophils, 69.1% (high); lymphocytes, 22.7% (low); monocytes, 7.2% (normal); basophils, 0.3% (normal); and immature granulocytes, 0.7% (high). Physical examination demonstrated swelling and erythema of the right eye but no significant discomfort or tenderness with eye movement. There was no eye discharge or conjunctival redness. Contrast-enhanced CT of the face was performed, followed by MRI of the brain and orbits with and without intravenous contrast agent.

Anaphylaxis during pregnancy is rare but potentially fatal. Limited evidence is available to guide decisions regarding delivery timing during maternal anaphylaxis. A 26-year-old woman at 38.5 weeks scheduled for elective cesarean delivery developed anaphylaxis immediately after prophylactic cefazolin infusion, presenting with hypotension, tachycardia, dyspnea, erythema, and facial edema. She was treated promptly with intramuscular and intravenous adrenaline, fluids, corticosteroids, oxygen, and left uterine displacement, achieving hemodynamic stabilization without biphasic reaction. Continuous fetal monitoring was reassuring, allowing cesarean section to be postponed. At 23 h, spontaneous labor commenced, and delivery was performed safely under spinal anesthesia following negative allergy testing. A healthy neonate was delivered, and both mother and infant recovered uneventfully. Anaphylaxis following cefazolin administration during pregnancy is extremely uncommon. This case suggests that, when fetal status remains reassuring, cesarean delivery may be postponed until maternal stabilization in selected patients.

To evaluate changes in facial contour and skin elasticity following full-face treatment with 40.68-MHz unipolar radiofrequency (RF), and to assess its safety and tolerability in adults with mild-to-moderate facial laxity. This prospective single-arm interventional clinical study evaluated adults with mild-to-moderate facial laxity who underwent three full-face 40.68-MHz unipolar RF treatment sessions at 4-week intervals. The primary endpoint was the change in VECTRA-derived three-dimensional facial volumetric parameters from baseline to Week 20. Secondary outcomes included Cutometer-derived skin elasticity parameters (R2 and R5), Global Aesthetic Improvement Scale (GAIS), FACE-Q satisfaction scores, visual analog scale (VAS) pain scores, and adverse event monitoring. Of the 30 enrolled participants, 26 completed follow-up and were included in the final analysis. By Week 20, VECTRA 3D analysis demonstrated modest volume reductions in the cheek (- 2.2 mL), jowl (- 1.7 mL), and submental region (- 2.9 mL). Skin elasticity parameters increased over time, with R2 increasing from 0.62 to 0.69 and R5 from 0.53 to 0.59. GAIS improvement was observed in 88.5% of participants, and the mean FACE-Q score increased to 72.4 ± 10.1. Treatment was well tolerated, with low mean pain scores (VAS 1.2 ± 0.9). Only transient erythema and mild edema were reported, with no serious adverse events observed. Three sessions of 40.68-MHz unipolar RF were associated with modest measurable improvements in facial contour and skin elasticity that were maintained during the 20-week observation period, with good tolerability and no serious adverse events. Because this was an uncontrolled single-arm study, these findings should be interpreted as preliminary and require confirmation in controlled studies with longer follow-up.