Gerardo Uriel Viquez Burboa

Background: GLP-1 receptor agonists (GLP-1 RAs) are among the fastest-growing pharmacological classes globally. Alopecia has emerged as a clinically relevant adverse effect, yet subtype-specific pooled estimates of risk are lacking. Methods: PubMed/MEDLINE, Embase, Cochrane Central, Web of Science, and Scopus were searched from inception to March 2026 with no language restrictions. Studies reporting alopecia in adult GLP-1 RA users were eligible. Of 1,847 records identified, 17 met eligibility criteria. Random-effects meta-analyses (DerSimonian-Laird) were performed. The protocol was registered in PROSPERO (CRD420261335458). Results: Seventeen studies encompassing 1,091,743 patient-exposures were included. The pooled OR for any non-scarring alopecia was 1.40 (95% CI, 1.33–1.48; I²=0%). Significant associations were found for telogen effluvium (aOR, 1.76; 95% CI, 1.34–2.32) and androgenetic alopecia (aOR, 1.64; 95% CI, 1.35–1.99) at 12 months. Semaglutide (ROR, 2.46) and tirzepatide (ROR, 1.73) showed the highest pharmacovigilance signals. Paradoxically, 58% of patients with central centrifugal cicatricial alopecia showed improvement. Conclusion: GLP-1 RAs are associated with a significant 40% increased risk of non-scarring alopecia, primarily mediated by weight loss-induced micronutrient deficiency. Dermatologists should counsel patients proactively and avoid premature drug discontinuation.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a high burden of metabolic comorbidities, including obesity, metabolic syndrome, type 2 diabetes mellitus, and polycystic ovary syndrome. GLP-1 receptor agonists (GLP-1 RAs) — established for diabetes, obesity, and cardiovascular risk reduction — have recently emerged as candidate agents for HS. A 2024 systematic review and two pivotal 2025 real-world studies now provide preliminary evidence that GLP-1 RAs improve HS disease activity through weight loss and direct anti-inflammatory mechanisms. We argue that this evidence is sufficient to justify a paradigm shift: GLP-1 RAs should be integral components of multidisciplinary HS management in patients with concurrent cardiometabolic disease. We propose a practical patient selection framework and monitoring protocol, and call for dedicated randomised controlled trials.

Chronic inflammatory skin disorders have traditionally been regarded as localized dermatologic entities; however, increasing evidence from cutaneous immunology supports their interpretation as visible manifestations of underlying immune dysregulation. Across a broad spectrum of inflammatory, autoimmune, and autoinflammatory dermatoses, reproducible immune pathways have been shown to drive stable clinical phenotypes, positioning the skin as a sentinel organ of systemic immune imbalance. This review synthesizes current immunopathological evidence linking major chronic inflammatory skin disorders with dominant immune-dysregulation domains, including polarized cytokine-driven inflammation, cytotoxic T-cell–mediated autoimmunity, innate immune hyperreactivity, autoantibody-mediated tissue injury, and immune-driven fibrosis. By comparatively analyzing mechanistic, clinical, and therapeutic literature, the review identifies shared and disease-specific immune signatures that explain phenotypic diversity while supporting a unified conceptual framework. The findings highlight that conditions such as psoriasis, atopic dermatitis, vitiligo, alopecia areata, hidradenitis suppurativa, chronic urticaria, autoimmune bullous diseases, cutaneous lupus erythematosus, rosacea, and systemic sclerosis can be systematically interpreted through their immunological architecture rather than solely by morphology. Framing chronic inflammatory dermatoses as markers of immune dysregulation enhances diagnostic reasoning, strengthens medical education, and reinforces the clinical relevance of dermatologic findings in recognizing broader immune-mediated disease, particularly in diverse international healthcare settings.

The skin frequently reflects internal pathological processes, making cutaneous manifestations valuable indicators of systemic disease. This narrative integrative review analyzes current scientific evidence on dermatologic findings that function as early or concurrent markers of underlying systemic disorders. The study synthesizes peer-reviewed literature addressing renal–metabolic, inflammatory–immune, malignancy-related, and vascular–calcific conditions, emphasizing recognizable cutaneous patterns and their clinical context. Results demonstrate that paraneoplastic dermatoses are commonly described as early indicators that may precede the diagnosis of internal malignancy, whereas renal–metabolic and vascular–calcific manifestations are more frequently reported as concurrent expressions of established systemic disease. Inflammatory and immune-mediated dermatoses exhibit variable timing, reflecting heterogeneous triggers and systemic associations. Across categories, cutaneous findings consistently mirror immune dysregulation, metabolic imbalance, vascular injury, or neoplastic activity. This review highlights the diagnostic and educational relevance of dermatologic examination in general medical practice, particularly in settings where access to advanced diagnostic resources may be limited. Integrating systematic skin assessment into routine clinical evaluation can strengthen diagnostic reasoning, support earlier recognition of systemic illness, and promote a more holistic approach to patient care.

Spinal fractures are frequently associated with prolonged functional impairment, delayed ambulation, and reduced independence, particularly when neurological involvement or prolonged immobilization is present. Conventional rehabilitation remains the cornerstone of recovery; however, its capacity to deliver early, intensive, and repetitive gait training may be limited in patients with pain, biomechanical instability, or reduced motor control. In this context, robotic lower-limb exoskeletons have emerged as a promising rehabilitative technology capable of supporting upright mobility and structured gait practice. This review analyzes current evidence on robotic exoskeleton-assisted rehabilitation with specific emphasis on its potential role in post-fracture spinal recovery and the acceleration of functional reintegration. A structured narrative review methodology was employed, integrating findings from neurological rehabilitation, spinal cord injury studies, orthopedic rehabilitation research, and biomechanical analyses. The results indicate that exoskeleton-assisted gait training is associated with improved walking initiation, increased training intensity, reduced assistance requirements, and acceptable safety profiles when applied under appropriate clinical protocols. Although direct evidence in spinal fracture populations remains limited, the biomechanical rationale and indirect clinical findings support the conceptual applicability of exoskeleton-assisted rehabilitation in this group.

Clinically significant drug–drug interactions (DDIs) remain a major source of preventable harm in modern pharmacotherapy, particularly in patients exposed to polypharmacy and complex medication regimens. Traditional rule-based clinical decision support systems have contributed to improved medication safety but are frequently limited by alert fatigue, inadequate prioritization, and limited support for actionable clinical decisions. In recent years, deprescribing has emerged as a structured, patient-centered strategy to reduce medication burden and optimize therapeutic outcomes. This review examines the convergence of deprescribing principles with algorithm-driven decision support, a concept referred to as smart deprescribing, aimed at proactively reducing clinically significant DDIs. Through an integrative analysis of international evidence, this study synthesizes findings on rule-based systems, machine learning, and deep learning approaches, highlighting their respective strengths, limitations, and roles within deprescribing-oriented frameworks. The results indicate that algorithm-assisted deprescribing can improve prioritization of high-risk interactions, reduce low-value alerts, and support medication optimization when grounded in robust clinical frameworks. The review further explores implementation pathways across diverse healthcare contexts, including middle-income settings, emphasizing the importance of scalability, interpretability, and workflow integration. Overall, smart deprescribing represents a promising evolution in medication safety that complements clinical judgment while supporting rational prescribing and medical education.

Chronic inflammatory skin diseases have increasingly been recognized as systemic disorders with clinically significant extracutaneous manifestations. Among these, the association between chronic cutaneous inflammation and metabolic syndrome has emerged as a relevant and reproducible pattern across epidemiological, clinical, and mechanistic studies. This review synthesizes current evidence examining the bidirectional relationship between chronic inflammatory dermatoses—primarily psoriasis and moderate-to-severe atopic dermatitis—and metabolic syndrome, including its key components: obesity, insulin resistance, dyslipidemia, hypertension, and type 2 diabetes mellitus. Population-based studies and meta-analyses consistently demonstrate a higher prevalence of metabolic syndrome and related metabolic abnormalities in patients with chronic inflammatory skin disease, with stronger associations observed in more severe disease phenotypes. Mechanistic data support these observations, highlighting shared inflammatory pathways, cytokine signaling, adipokine imbalance, and immunometabolic interactions as common underlying processes. The findings discussed in this review reinforce the concept of systemic inflammation as a unifying framework linking skin and metabolic disease. Recognizing chronic inflammatory dermatoses as markers of increased metabolic risk has important implications for clinical practice, preventive strategies, and medical education. An integrated, multidisciplinary approach may facilitate earlier identification of cardiometabolic risk and improve long-term outcomes, particularly in regions experiencing a rising burden of metabolic disease, such as Latin America.