This expert recommendation addresses key challenges encountered in the long-term maintenance treatment of psoriasis with biologic agents. Based on current evidence from evidence-based medicine and accumulated clinical experience, experts from the Psoriasis Quality Control Group of Guangdong Provincial Quality Control Center systematically outline the therapeutic goals, principles, and strategies for long-term biologic maintenance therapy in psoriasis. The recommendations emphasize sustained and stable disease control as the primary objective. After achieving the expected therapeutic response during the induction phase, treatment strategies should be dynamically individualized according to relapse risk assessment. Potential approaches include maintaining the initially effective regimen, optimizing treatment, stepwise dose reduction or discontinuation, and switching therapy when necessary. The recommendations also highlight the importance of long-term follow-up and standardized monitoring. Additionally, lifestyle factors, including body weight management, dietary optimization, smoking cessation, alcohol restriction, and regular physical activity, are incorporated into long-term outcome optimization. Overall, these recommendations aim to balance efficacy, safety, and long-term patient management needs, providing a structured decision-making framework for clinical practice.

Objective To analyze the clinical characteristics of patients with generalized pustular psoriasis, we aimed to provide stronger theoretical support for the health management of GPP patients. Methods A retrospective analysis was conducted on the data of 150 patients with generalized pustular psoriasis (GPP) who visited the Dermatology Hospital, Southern Medical University from July 2017 to July 2023. The patients were grouped according to age of onset, gender, and whether GPP was accompanied by psoriasis vulgaris (PV). The analysis aimed to explore the differences in clinical characteristics among different groups of GPP patients, including the season of onset and triggers, recurrence frequency, comorbidities, and treatment outcomes. Results A total of 150 patients with generalized pustular psoriasis (GPP), with a mean onset age of 32.83±21.65 years, were included in the analysis. The mean age of onset was significantly lower in patients with GPP alone than in those with both GPP and psoriasis vulgaris (PV) (28.30±19.27 vs. 40.87±23.43 years, t=-3.51, P<0.05). The proportion of patients who were overweight was significantly higher in those with an onset age of ≥18 years (39.4%) compared to those with an onset age of <18 years (17.4%) (χ²=7.04, P<0.05). The mean waist circumference of all adult male and female patients met the criteria for abdominal obesity. GPP had a predilection for onset in spring and summer. The probability of onset in spring and summer was significantly higher in patients with GPP alone (70.3%) than in those with GPP and PV (50.0%) (χ²=5.45, P<0.05). Improper treatment was identified as the primary triggering factor for GPP. The proportion of patients with improper treatment as a triggering factor was significantly higher in the GPP+PV group than in the GPP alone group (71.7% vs. 5.2%,²=74.22,P<0.001). Regarding triggering factors for relapse, improper treatment was the most common in patients with an onset age of >18 years (39.5%), while upper respiratory tract infections were predominant in patients with an onset age of ≤18 years (40.0%). In female patients, some relapses were associated with special physiological states such as pregnancy and menstruation. The recurrence rate was significantly higher in patients with an onset age of ≤18 years than in those >18 years (91.3% vs. 71.7%,²=7.39,P<0.05). Females had a significantly higher probability of experiencing 3 to 4 relapses within a year than males (χ²=4.20, P<0.05). Patients with GPP alone were more prone to recurrence, with significantly higher probabilities of experiencing 1 to 2 relapses and 1 to 4 relapses within one year compared to the GPP+PV group (all P<0.05). Males had a significantly higher probability of nail involvement and moderate fever than females (both P<0.05) but a significantly lower probability of high fever (χ²=3.90, P<0.05). The probability of joint involvement was significantly higher in the GPP+PV group than in the GPP alone group (χ²=7.55, P<0.05). Furthermore, hypertension was more commonly associated with GPP+PV than with GPP alone (χ²=5.79, P<0.05). Acitretin was the most commonly used drug. Patients receiving combination therapy with immunosuppressants had the longest hospital stay (12.57±5.47 days), while those treated with biological agents alone had the shortest hospital stay (5.61±2.33 days) (P<0.05). Conclusions Factors such as gender, age, and comorbidity with PV significantly impact the clinical presentation and treatment response of GPP. Early identification of triggering factors, precise subgroup-based interventions, and monitoring of biomarkers are crucial strategies to improve the clinical outcomes of GPP patients.

Objective To reveal the clinical characteristics of cosmetic adverse reactions (CARs) and relevant information in a pediatric population regarding pathogenic cosmetics in Chongqing from 2017 to 2024. This study aimed to provide characteristics of CARs in the pediatric population and to serve as an early warning and objective risk assessment tool for CARs in this demographic. Methods We extracted data from the Chongqing Drug Administration's cosmetic adverse events reporting system from 2017 to 2024 and screened the information of individuals under the age of 18 years for analysis. Results A total of 1,578 cases were reported, of which 1,165 were girls (73.83%) and 413 were boys (26.17%). Among these cases, 289 (18.31%) were caused by children's cosmetics. The most frequently reported clinical sign was erythema (73.95%), followed by papules (39.67%) and scales (15.59%). Itching, burning, and tightness were the most prominent symptoms, accounting for 82.83%, 35.17%, and 24.90%, respectively. The face was the most vulnerable site for lesions, accounting for 78.45% of all areas, followed by the cheeks (31.18%), forehead (24.08%), and perioral/lips (13.75%). Girls had a significantly higher rate of facial damage than boys, while boys had a significantly higher rate of scalp damage than girls. Contact dermatitis (89.35%) was the most common diagnosis of CARs, followed by acne (2.60%) and cheilitis (1.90%). The majority of CARs were reported to be due to creams, ointments, lotions, and toners (48.32%), followed by facial masks (8.18%), cleaning products (7.41%), and hair products (6.89%). Sunscreen products (6.64%) and whitening products (3.93%) were frequently reported among cosmetics with special functions. There were 15 cases with a history of cosmetic allergy, and 1 case each of a history of adverse reactions to food and medication. Conclusions From 2017 to 2024, the incidence of adverse reactions to cosmetics among children in the Chongqing region has been increasing year by year, with a higher occurrence in girls than boys. The head, face, and neck are the most affected areas, and contact dermatitis is the most common type of reaction. Acne-like lesions gradually appear after puberty, and ordinary cosmetics are more likely to cause adverse reactions. Pediatricians and dermatologists should actively submit reports of cosmetic adverse reaction events and encourage consumers to report when products have a negative impact on children's health.

Objective To evaluate the efficacy and safety of micro-punch excision combined with CO₂ fractional laser treatment for facial atrophic acne scars, and to compare it with CO₂ fractional laser therapy alone. Methods From September 2023 to September 2024, 70 patients with facial atrophic acne scars admitted to the Department of Dermatology at the Third Affiliated Hospital of Henan Medical University were randomly divided into an experimental group and a control group, with 35 cases in each group. The experimental group received micro-punch excision combined with CO₂ fractional laser treatment, while the control group received CO₂ fractional laser monotherapy. Prior to treatment and three months after the first and second treatments, clinical efficacy, ECCA scores, pain VAS scores, adverse reactions, anxiety scores, and patient satisfaction were compared between the two groups. Results Three months after the first treatment, the total effective rate in the experimental group was significantly higher than that in the control group (97.14% vs. 82.86%, χ²=8.57, P=0.003). Three months after the second treatment, the total effective rate in the experimental group remained higher than that in the control group (100% vs. 82.86%, χ²=13.79, P=0.006). Additionally, combination therapy significantly reduced acne scars (ECCA score) compared to the control group (18.91±9.05 vs. 25.46±8.04, t=4.53, P<0.05). Moreover, the pain VAS score was higher in the experimental group than in the control group (6.02±1.03 vs. 4.96±1.92, t=4.07, P<0.001). After the second treatment, patient satisfaction scores were also higher in the experimental group compared to the controls (8.89±1.35 vs. 6.98±1.76, t=7.20, P<0.001). The SAS score of the observation group was significantly higher than that of the control group after the first treatment (t=4.57, P<0.001), but there was no significant difference after the second treatment (t=1.09, P=0.279). However, the incidence of adverse reactions was comparable between the two groups (P>0.05). Conclusions Micro-punch excision combined with CO₂ fractional laser therapy exhibits superior benefits compared to CO₂ fractional laser monotherapy for the treatment of atrophic acne scars. This combination therapy can markedly improve acne scars, mitigate patient anxiety, and enhance patient satisfaction scores.

Objective In this study, we aimed to comprehensively assess the burden of 17 common skin diseases (SSDs) over the past three decades and project future trends to guide healthcare planning and resource allocation. Methods Using data from the Global Burden of Disease Study, we employed Bayesian Age-Period-Cohort modeling to estimate disability-adjusted life years (DALYs) for each of the SSDs from 1990 to 2021, at global, regional, and national levels. We also conducted projections to 2036. All estimates were accompanied by 95% uncertainty intervals (UIs). Results Between 1990 and 2021, global DALYs due to SSDs increased from 30.02 million (95% UI: 20.40 million-42.12 million) to 44.84 million (95% UI: 30.29 million-62.97 million), reflecting a 49.37% rise. Projections indicated an additional 16.60% increase by 2036. In particular, inflammatory skin diseases represented the largest share of the burden (49.95%), followed by infectious skin diseases (33.93%) and skin tumors (6.45%). Among specific diseases, atopic dermatitis ranked highest in DALYs, followed by scabies, acne vulgaris, and viral skin diseases. From an economic perspective, high-income regions bore a higher burden from inflammatory and tumorous conditions, whereas infectious skin diseases were concentrated in low-income settings. The five countries with the highest total DALYs were China (7.99 million), India (7.02 million), the United States (2.61 million), Indonesia (1.75 million), and Brazil (1.56 million). Furthermore, the burden of these SSDs exhibited significant gender and age preferences. Males experienced a higher burden of cellulitis, malignant melanoma, and non-melanoma skin cancer, while females were more affected by alopecia areata, acne vulgaris, atopic dermatitis, pruritus, and urticaria. Most SSDs showed age-specific patterns, with the exception of seborrheic dermatitis and pruritus. Conclusions The burden of SSDs is significant and is projected to continue rising in the future, with marked heterogeneity across nations and regions. Factors such as geographic location, economic conditions, hygiene status, age, and gender influence the burden of SSDs.

Objective To compare the safety and efficacy of three different hyaluronic acid (HA) injection techniques for treating infraorbital hollowing. Methods A total of 80 eligible participants were enrolled and randomly assigned to three groups: sharp-needle group (n=27), blunt cannula single-plane group (n=26), and blunt cannula multi-plane group (n=27). All participants received commercially available cross-linked HA injections and were followed up at weeks 8, 24, 48, and 96. Efficacy was assessed using the Infraorbital Hollow Severity Scale (IOHSS) and Global Aesthetic Improvement Scale (GAIS). Injection volume, incidence of adverse events, and patient satisfaction were also evaluated. Results By week 96, the response rates (≥1-point improvement in IOHSS) were 77.3% in the sharp-needle group, 47.6% in the single-plane blunt-needle group, and 87.0% in the multi-plane blunt-needle group, with a statistically significant difference among the groups (χ²=8.86,P=0.012). GAIS scores assessed by investigators showed an improvement rate of 78.3% in the multi-plane group. The proportion of patients reporting being ″very satisfied″(56.5%) was also significantly higher in this group (χ²=6.38, P=0.041). Adverse event rates were similar across groups (χ²=1.13,P=0.862), with mild bruising, erythema, and tenderness being the most common. No serious adverse events were reported. Total HA usage per participant did not differ significantly among the groups (F=0.12,P=0.886). Conclusions All three injection techniques are safe and effective for improving infraorbital hollowing. The use of a blunt needle for multi-plane injections shows a more stable trend in therapeutic efficacy and has advantages in terms of subjective satisfaction among the subjects.

Objective To analyze the “aging” trend and epidemiological characteristics of HIV/AIDS prevalence in the Binhu District of Wuxi City from 2005 to 2024 and to provide evidence for optimizing prevention and control strategies for the elderly population. Methods Based on data from the China Disease Prevention and Control Information System, historical data of HIV/AIDS cases with current addresses in the Binhu District of Wuxi City were collected to analyze the trends, demographic characteristics, transmission modes, and avenues of identification for cases aged 50 years and older. Results A total of 753 HIV/AIDS cases were reported, with an average annual incidence rate of 3.90/100,000, showing an overall upward trend (trend χ²=226.28, P<0.01). The proportion of cases in the elderly group aged ≥50 years continued to rise from 11.11% in 2005 to 26.00% in 2024. This population primarily featured heterosexual transmission (68.29%), a significantly higher proportion than that of the 15-24 years group (18.56%, P<0.01). The proportion of migrant population was 49.80%, and over 90% were diagnosed through passive screening at medical institutions. Conclusions The HIV/AIDS epidemic in the Binhu District shows significant “aging” and “mobility” characteristics. It is recommended to establish a comprehensive prevention and control system centered on active HIV testing counseling (PITC) by medical staff, with elderly-oriented health education and connectivity for migrant population services as support.

A case of cutaneous focal mucinosis on the dorsal foot is reported. A 63-year-old female presented with a plaque on the left dorsal foot that had been present for one year. Dermatological examination revealed an 8 cm×10 cm red plaque on the left dorsal foot. The lesion was hard in texture, with clear borders and minimal mobility. Histopathological examination of the lesion revealed epidermal hyperkeratosis, papillomatous hyperplasia, and focal spongiosis. In the superficial dermis, a few lymphocytes were present around the blood vessels, with mucin deposition between the collagen fibers. Alcian blue staining was positive. The diagnosis was cutaneous focal mucinosis. The patient was treated with local corticosteroid injections. After four treatments, there was significant improvement in the lesion, but the patient was lost to follow-up.

A 50-year-old man presented with red papules, plaques, and desquamation for 15 years, as well as vesicles and desquamation for the past 25 days. He was diagnosed with psoriasis vulgaris a month ago and was treated with a subcutaneous injection of secukinumab at 300 mg weekly for 4 weeks. New vesicles and desquamation appeared on the trunk and limbs 25 days ago. A pemphigus antibody test showed Dsg1 at 222.76 U/mL, with Dsg3 and BP180 results negative. Histopathological examination showed focal parakeratosis with Munro microabscesses, as well as acantholytic cells in the superficial epidermis. Direct immunofluorescence revealed intercellular IgG (+++) and C3 (++) between epidermal prickle cells. Diagnosis: Psoriasis vulgaris and pemphigus foliaceus. Treatment with prednisone and methotrexate for 11 weeks resulted in significant improvements in erythema, vesicles, and desquamation.

Treponema pallidum is capable of invading the central nervous system, thereby causing neurosyphilis. The pathogenesis of neurosyphilis is closely related to the ability of T. pallidum to penetrate the blood-brain barrier. The clinical manifestations of neurosyphilis are diverse and often lack specificity, which poses challenges for early diagnosis. Both domestic and international guidelines for the diagnosis of neurosyphilis indicate that diagnosis should be based on a comprehensive assessment of epidemiological history, clinical manifestations, and laboratory test results. This article systematically reviews recent domestic and international literature on neurosyphilis, analyzes the cellular and molecular mechanisms underlying blood-brain barrier disruption by T. pallidum, and summarizes the diagnostic value of differential cerebrospinal fluid metabolites, chemokines, proteins, and serum biomarkers, with the aim of providing references for the diagnosis of neurosyphilis.

Acne vulgaris is a common inflammatory skin disease involving the pilosebaceous unit. Squalene in sebum serves as a key mediator in the pathogenesis of acne. Due to its unsaturated structure, squalene is prone to peroxidation under the influence of environmental factors such as ultraviolet radiation and air pollutants. The generated peroxidation products participate in the pathological process of acne vulgaris through mechanisms that include inducing follicular hyperkeratosis, activating inflammatory responses, and promoting the colonization of Cutibacterium acnes. This review summarizes the structural characteristics, oxidative susceptibility, and sources of squalene, with a focus on elaborating the roles of squalene and its oxidation products in the pathogenesis of acne vulgaris. Meanwhile, it explores the clinical correlation between squalene and acne vulgaris, as well as their application value in the development of acne models and the exploration of therapeutic targets, providing insights for further elucidating the pathogenesis of acne vulgaris and developing novel therapeutic approaches.

Vulvovaginal candidiasis (VVC) has a high incidence rate, and vaginal administration is one of the main routes for its treatment. In recent years, there have been some advances in vaginal drug formulations. Among them, vaginal mucoadhesive gels can extend the retention time in the vagina; vaginal thermosensitive gels are easy to apply and dispense; vaginal films are small in volume, simple to prepare, and possess strong mucosal adhesion; vaginal sponges with dense voids have a large drug-loading capacity and can also achieve the purpose of targeted drug delivery through rational design; vaginal microspheres have high bioavailability, can improve drug solubility, and enhance patient compliance; liquid crystal pre-formulations can reduce drug irritation and can also perform sustained and controlled drug release. These novel vaginal drug formulations can be used not only alone to exert therapeutic advantages but also in combination with existing technologies, such as tablets and gels, to prepare composite formulations. This article will review the research progress of these new formulations that are being actively studied in the field of VVC treatment, aiming to provide a reference for the development of new vaginal formulations for VVC therapy.