Marco Virone

Background: Non‐invasive imaging techniques can support assessment of lesions suspicious for basal cell carcinoma (BCC) when dermoscopy is inconclusive. We compared reflectance confocal microscopy (RCM), line‐field confocal optical coherence tomography (LC‐OCT), and the device‐integrated LC‐OCT artificial intelligence (AI) output. Methods: This retrospective comparative observational study included 100 facial and scalp lesions evaluated by RCM and LC‐OCT before excisional biopsy. Two expert and two non‐expert dermatologists independently interpreted anonymized images while blinded to histopathology and recorded confidence on a four‐point scale. Diagnostic performance, inter‐reader agreement, reader‐specific receiver operating characteristic analyses, and an exploratory post hoc dermoscopically equivocal subgroup were assessed. The categorical AI output was analyzed at a single operating point. Results: Histopathology identified 69 basal cell carcinomas (BCCs) and 31 non‐BCC lesions. Expert mean sensitivity, specificity, and accuracy were 95.7%, 85.5%, and 92.5% for RCM versus 86.2%, 67.7%, and 80.5% for LC‐OCT. The AI output yielded 87.0% sensitivity, 83.9% specificity, and 86.0% accuracy. In the equivocal subgroup ( n = 51; 31 BCCs), RCM sensitivity was 96.8% across readers, with specificity ranging from 65.0% to 85.0%. RCM AUCs exceeded LC‐OCT AUCs for all readers, but no paired comparison remained significant after Holm adjustment. Inter‐reader agreement was higher for RCM than LC‐OCT (Fleiss' κ = 0.809 vs. 0.563). Conclusions: Both modalities provided diagnostic information as second‐level adjuncts. RCM showed higher observed performance and agreement, particularly in exploratory equivocal lesions, whereas the categorical LC‐OCT AI output showed comparatively high specificity. Prospective validation is required. image

Background: Superficial facial vascular lesions such as telangiectasia and persistent erythema are common, and 532-nm laser platforms are widely used, although published evidence is heterogeneous. Our primary aim is to illustrate, in practical terms, how a 532-nm laser is applied across diverse superficial facial vascular phenotypes and to document the treatment parameters used, with a focused contextual review providing clinical background rather than an efficacy assessment. We describe 10 patients treated with a 532-nm platform, set against this focused review. Methods: Retrospective, single-arm, uncontrolled, non-consecutive descriptive case series of 10 outpatients (Fitzpatrick phototypes I–III) treated with a 532-nm platform (QuadroStarPRO GREEN); outcomes were assessed by paired clinical photographs and the patient-reported Global Aesthetic Improvement Scale (GAIS). Results: Photographic review suggested near-complete apparent improvement in three cases, marked in five, and moderate in two. GAIS was very much improved in 4/10, much improved in 4/10, and improved in 2/10. Mild transient erythema or edema occurred in 6/10; no persistent adverse events occurred. Conclusion: This illustrative, hypothesis-generating series documents practical 532-nm parameters across diverse superficial facial vascular phenotypes, with favorable short-term outcomes and acceptable tolerability; it is not intended to establish efficacy. Confirmation requires prospective, consecutive cohorts with standardized imaging and longer follow-up.

Food allergy is an increasingly prevalent global health condition characterized by immune-mediated reactions to dietary antigens and a substantial clinical burden. Growing understanding of IgE-mediated mechanisms has highlighted the central role of type 2 inflammation, effector-cell activation, and impaired immune regulation. These advances have prompted the development of disease-modifying therapies beyond allergen avoidance. This narrative review summarizes recent advances in the therapeutic management of IgE-mediated food allergy. A structured PubMed search was performed to identify clinical trials, randomized studies, and meta-analyses published within the last five years. Both allergen-specific and non-allergen-specific interventions were evaluated. Current evidence supports oral immunotherapy as the most effective strategy for increasing reaction thresholds and inducing desensitization in peanut, milk, and egg allergies. However, safety concerns remain, and sustained unresponsiveness after treatment discontinuation is achieved inconsistently. Sublingual and epicutaneous immunotherapy show improved safety but lower efficacy. Modified allergen approaches, including baked milk and processed peanut products, may improve tolerability and facilitate immune modulation in selected patients. Biologic therapies, particularly anti-IgE agents, demonstrate efficacy both alone and when combined with immunotherapy. Emerging approaches include peptide vaccines, DNA immunization, microbiome-targeted interventions, and early dietary modulation. These strategies may improve durable immune tolerance through personalized, mechanism-based therapeutic approaches. Future progress will depend on optimizing safety, identifying predictive biomarkers, and integrating multimodal approaches to achieve durable immune tolerance.

Photodynamic therapy (PDT) is a minimally invasive treatment choice whose clinical success in dermatology relies on the interaction between a photosensitizer, light of an appropriate wavelength, and tissue oxygen, leading to reactive oxygen species generation and selective cytotoxicity. This narrative review summarizes contemporary mechanisms and clinical evidence supporting PDT across neoplastic, inflammatory, infectious, and esthetic indications. A comprehensive literature search included randomized trials when available, systematic reviews, meta-analyses, and guideline and consensus documents, complemented by mechanistic and translational studies relevant to clinical outcomes. In premalignant and neoplastic disease, strongest evidence supports field-directed PDT for actinic keratosis and high efficacy in Bowen’s disease, with favorable cosmetic outcomes and acceptable recurrence patterns. PDT plays a more selective role in basal cell carcinoma, particularly superficial and selected nodular lesions, while its routine use as monotherapy in squamous cell carcinoma remains limited by higher recurrence. Beyond oncology, PDT shows expanding utility in acne via sebomodulatory and immunomodulatory effects, and in infectious dermatoses through broad antimicrobial activity and biofilm disruption with low resistance potential. Cosmetic applications, including photorejuvenation, benefit from protocol tailoring and combination strategies that enhance penetration and remodeling. Overall, PDT is evolving into an adaptable therapeutic framework best positioned within mechanism-oriented, multimodal algorithms.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and draining tunnels in areas such as the axillae, groin, and inframammary regions. It typically emerges in early adulthood, with a global prevalence of approximately 1%, though regional variations exist. HS significantly affects patients’ quality of life and imposes considerable socioeconomic burdens. It is frequently associated with metabolic syndrome, inflammatory arthritis, and inflammatory bowel disease, reflecting its underlying systemic inflammatory nature. The pathogenesis of HS involves innate immune mechanisms, including macrophages, neutrophils, interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and granulocyte colony-stimulating factor, alongside adaptive immune responses mediated by T cells (IL-17, interferon [IFN]-γ) and B cells, which contribute to autoantibody formation and tertiary lymphoid structures. Chronic inflammation results in irreversible tissue damage, tunnel formation, and severe scarring. Treatment strategies vary based on disease severity. Early inflammatory stages benefit from pharmacological therapies, while later stages require a combination of medical and surgical interventions, with surgery often necessary for advanced cases. The introduction of targeted biologic therapies, including TNF-α (adalimumab) and IL-17 inhibitors (secukinumab, bimekizumab), has expanded treatment options beyond traditional antibiotic regimens. Effective management focuses on early intervention to prevent irreversible damage, control symptoms such as pain, and address systemic comorbidities. A timely diagnosis, along with a multidisciplinary and personalized approach, is essential for improving patient outcomes and quality of life.