Abstract: Mycosis fungoides (MF) and Sézary syndrome (SS) are the most prevalent forms of cutaneous T-cell lymphoma (CTCL) and are characterized by the proliferation of CD4+ T-helper cells. The pathogenesis of CTCLs involves a critical interaction between neoplastic cells and the tumor microenvironment. This interaction is driven not only by cytokines but also by surface proteins that mediate cell-to-cell contact. One such protein, OX40 (also known as CD134), is a member of the TNF receptor superfamily and serves as an induced costimulatory molecule that facilitates the interaction between T cells and antigen-presenting cells. In this narrative review, we explore the literature surrounding the OX40-OX40L interaction in CTCLs, highlighting its pathogenic and prognostic significance. Additionally, we compare the expression and function of OX40-OX40L in chronic inflammatory skin diseases, such as atopic dermatitis and psoriasis, with their role in CTCLs. Finally, we provide an overview of the current state of therapeutic research, discussing the potential of targeting the OX40-OX40L axis in CTCL treatment.

Abstract: Background: Psoriasis is a chronic inflammatory disease with significant physical and psychological impacts. Among its forms, moderate-to-severe psoriasis often requires systemic treatment. Despite the availability of biologics, treatment discontinuation remains a concern. Understanding the reasons behind discontinuation is essential for optimizing therapeutic strategies and patient management. Methods: This retrospective study analyzed data from 255 patients with moderate-to-severe psoriasis treated with biologics between January 2019 and June 2023 at the Dermatology Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna. The primary objective was to assess the frequency and causes of treatment discontinuation. Data on demographic and clinical characteristics, previous treatments, type and duration of biologic therapy, and reasons for discontinuation were collected and analyzed. Results: Out of 255 patients, 107 (42%) discontinued at least one biologic during the study period. The most frequently discontinued agents were anti-IL17 drugs (40.2%), followed by anti-IL12/23 (21.5%), anti-IL23 (21.5%), and anti-TNFα (16.8%). The main reasons for discontinuation were primary inefficacy (35.5%) and secondary inefficacy (30.8%). Adverse events accounted for 12.1% of discontinuations, while other reasons (including patient decision and comorbidities) represented 21.6%. Older patients showed a higher discontinuation rate, and female patients reported a greater frequency of adverse events. A higher number of previous biologic therapies was associated with increased risk of discontinuation. Conclusions: Biologic discontinuation in patients with moderate-to-severe psoriasis remains a frequent challenge, primarily due to inefficacy. Patient age, gender, and treatment history influence discontinuation patterns. These findings highlight the need for personalized therapeutic approaches and closer monitoring to improve long-term treatment adherence and outcomes.

Abstract: This study evaluated the effects of two therapeutic approaches using a Bovine Collagen Matrix (BCM) and an innovative Amniotic Membrane Dressing (hAM-pe) in wound healing, integrating both clinical and mechanistic perspectives. Both treatments are collagen-based biomaterials, which play a crucial role in modulating the wound mi-croenvironment, supporting cellular adhesion, and delivering bioactive molecules. While collagen-based therapies have been extensively studied in vitro and in small animal models, clinical translation remains limited. This study’s approach involved the simul-taneous application of both treatments within a single patient, allowing a direct com-parison of therapeutic outcomes. Clinically, hAM-pe demonstrated superior outcomes, accelerating wound closure, re-ducing inflammation, and eliminating the need for surgical intervention. Its practical advantages, including ease of application in outpatient settings, further enhance its translational potential. Mechanistically, hAM-pe treatment was associated with reduced expression of inflammatory markers (IL-1β, TNF-α, and CXCL-10), enhanced vascular-ization (VEGF, CD34), and a shift toward a regenerative macrophage phenotype (Ar-ginase-1 expression). Conversely, BCM treatment led to prolonged inflammation, de-layed tissue remodeling, and an adverse granulomatous response. These findings underscore the potential of hAM-pe as an alternative, non-invasive therapy for chronic wounds. Further investigations into its immunoregulatory mecha-nisms, particularly its influence on macrophage subsets and extracellular matrix re-modeling, will provide valuable insights for optimizing regenerative wound care strategies.

Abstract: Background/objectives: Despite advancements in early diagnosis and clinical practices guided by standardized care protocols, Merkel cell carcinoma (MCC) is still marked by an unfavorable prognosis with a 5-year relative survival rate of 65%. Indeed, regional nodal metastases affect 40-50% of MCC patients, while approximately 33% experience distant dissemination. Among these, bone and bone marrow metastases are particularly notable, although the characteristics and clinical implications of this metastatic disease in MCC remain poorly understood. Methods: A comprehensive review was conducted using the Medline database (via PubMed) up to January 2024. The search strategy included the string “(Merkel cell carcinoma AND (bone OR marrow))”. Results: A total of 1,133 (69.3% male and 30.7% female) patients diagnosed with advanced MCC were collected. The median (IQR) age at diagnosis was 67.5 (12.65) years old. 201 (20.8%) cases of bone and/or bone marrow metastases were identified and linked to a primary known MCC in 75.7% of cases. Bone metastases (BMs) appear as the third most common metastatic site, following the liver (2nd) and lymph nodes (1st). They show a mixed biological and radiological behavior, with a marked preference for the axial skeleton over the appendicular one. Addressing characteristics of bone metastatic disease, neurological symptoms were the most documented, whereas bone marrow involvement and leukemic spread seemed to be primarily related to immunosuppression. Multimodal treatment including platinum-based chemotherapy and radiotherapy represented the primary approach for effective management. Conclusions: The pattern of metastatic spread in MCC differ among studies, with the bones resulting as the third most common site of distant spread. Excluding head and neck MCC, which seems to be more regularly associated with liver metastases, the relationship between the primary tumor site and the development of bone or bone marrow metastases appears inconsistent. Overall, BMs mostly correlated with advanced MCC stages and poorer survival outcomes, with a median OS of 8 months (range 12.75-4). The integration of international guidelines alongside the ongoing findings from clinical trials will contribute to improve systemic disease control and enhance patient care.

Abstract: Psoriasis, a chronic immune-mediated inflammatory skin disorder characterized by keratinocyte hyperproliferation and inflammatory cell infiltration, involves multiple distinct programmed cell death pathways in its pathogenesis. Following the Nomenclature Committee on Cell Death recommendations, we analyzed current literature examining diverse modes of cellular death in psoriatic lesions, with particular focus on keratinocyte cell death patterns and their molecular signatures. Analysis revealed several distinct cell death mechanisms: autophagy dysfunction through IL-17A pathways, decreased apoptotic activity in lesional skin, medication targeting anoikis in psoriasis, upregulated necroptosis mediated by RIPK1/MLKL signaling, gasdermin-mediated pyroptosis with enhanced IL-1β secretion, coordinated PANoptotic activation through specialized complexes, PARP1-mediated parthanatos promoting cutaneous inflammation, iron-dependent ferroptosis correlating with Th22/Th17 responses, copper-dependent cuproptosis with elevated MTF1/ATP7B/SLC31A1 expression, and NETosis amplifying immune responses through interaction with the Th17 axis. The intricate interplay between these cell death mechanisms has led to the development of targeted therapeutic strategies, including mTOR inhibitors for autophagy modulation, RIPK1 inhibitors for necroptosis, and various approaches targeting ferroptosis and NETosis, providing new directions for more effective psoriasis treatments.

Abstract: Facial skin appearance is a critical psychosocial component in today's consumer culture, leading to an increase in people taking care of their appearance by using skincare products. With various topical active ingredients in skincare, arbutin and niacinamide are among the safest and most effective for improving hyperpigmentation. This study assesses the efficacy of a Facial Toner containing 2% Arbutin and 3% Niacinamide, which was developed to improve the appearance of pores, uneven skin texture, and brightness. The test material was a Facial Toner containing 2% Arbutin and 3% Niacinamide. Volunteers with varying skin phototypes applied the toner twice daily for four weeks, and a dermatological clinical efficacy study was conducted. Efficacy was assessed subjectively by photographs and self-perception questionnaires and objectively by expert grading and CIEL*a*b* measurements. Expert grading demonstrated significant improvement in the appearance of pores, skin brightness, and uneven skin texture. Colorimetry measurements further support the improvement of facial skin tone and brightness after four weeks. Furthermore, these results demonstrated a significant increase in the Individual Typology Angle (ITA°) of 23% of volunteers, leading to a change in their skin color subtype. Additionally, volunteers noticed substantial improvements in smoothness (96.8%) while observing that their skin was looking more radiant (93.6%) and youthful (87.1%). Our Facial Toner containing 2% Arbutin and 3% Niacinamide improved the appearance of pores and uneven skin texture, demonstrating a noticeable enhancement in skin brightness and leaving users with a more radiant and youthful complexion.

Abstract: This study investigates the Quality by Design-driven development and optimization of a nanoemulgel incorporating Kunzea ericoides oil for transdermal therapy. Nanoemulgels enhance percutaneous drug delivery, sustain release profiles, and improve bioavailability. A Central Composite Design was employed to optimize critical formulation parameters, with ANOVA confirming a statistically significant impact on particle size and drug release kinetics (p < 0.05). The optimized formulation exhibited a particle size of 112.38 nm, a polydispersity index of 0.203, and a zeta potential of -29.0 mV, ensuring colloidal stability. In vitro drug release followed the Higuchi model (R² = 0.989, kH = 4.776), indicating diffusion-controlled kinetics, while the Korsmeyer-Peppas model (n = 0.88) suggested an anomalous transport mechanism. Antibacterial studies determined minimum inhibitory concentrations of 250 µg/mL for Staphylococcus aureus and 500 µg/mL for Escherichia coli, indicating greater susceptibility in S. aureus. In vivo anti-inflammatory evaluation using a carrageenan-induced paw edema model demonstrated a statistically significant reduction in inflammation (p = 0.005 at 60 min), with near-complete resolution by 240 min. These findings underscore the potential of Kunzea ericoides nanoemulgel as a promising transdermal therapeutic, integrating controlled drug release with potent anti-inflammatory and antibacterial properties for dermatological and inflammatory conditions.

Abstract: Xeroderma Pigmentosum (XP) is a rare autosomal recessive disorder characterized by extreme ultraviolet (UV) sensitivity, predisposing patients to multiple cutaneous malignancies. We present the case of a 26-year-old male with XP diagnosed with three distinct skin cancers: Superficial Spreading Melanoma (SSM), Basal Cell Carcinoma (BCC), and Squamous Cell Carcinoma (SCC). Among these, the melanoma had metastasized. A CT scan revealed a suspicious pulmonary nodule, prompting further metabolic characterization via [18F]FDG PET/CT. The scan detected significant hypermetabolism not only in the lung lesion but also in an unsuspected right parotid gland lesion, refining disease staging and guiding treatment decisions. The patient underwent immunotherapy with nivolumab, achieving a complete metabolic response in both metastatic lesions, as confirmed by follow-up PET/CT. This case underscores the critical role of [18F]FDG PET/CT in staging and treatment monitoring for selected XP patients, a population in which advanced imaging is rarely employed. Moreover, the patient’s remarkable response to immunotherapy suggests a potential link between XP-related DNA repair defects and increased sensitivity to PD-1 blockade. These findings highlight the importance of integrating metabolic imaging into XP management and warrant further investigation into the immunogenicity of XP-associated malignancies.

Abstract: Background/Objectives: Skin cancer is the most common cancer worldwide, primarily divided into melanoma and non-melanoma types, with non-melanoma being the most prevalent. Cutaneous squamous cell carcinoma (cSCC) represents 50% of primary skin cancers and is characterized by uncontrolled keratinocyte proliferation. cSCC current standard treatment is surgical resection and chemotherapy. Unfortunately these methods often lead to disfigurement, functional morbidly and compromised function. In contrast from immunotherapy emerging scenarios that have shown promising results, especially in neoadjuvant settings. Cemiplimab (Libtayo®; Regeneron, Tarrytown, New York, United States), a PD-1 monoclonal antibody, has shown efficacy in treating advanced or metastatic cSCC, and its use as a neoadjuvant therapy has been recently explored. This review aims to evaluate Cemiplimab neoadjuvant setting on cSCC treatment. Methods: Following PRISMA guidelines, this review analyzed studies on Cemiplimab as neoadjuvant therapy for cSCC, sourced from PubMed, Web of Science, and Scopus. Only controlled trials, cohort studies, case series, and systematic reviews were included. A total of 21 studies were examined, focusing on response rates, adverse effects, and outcomes. Results: From 341 records, 21 studies were included, and six clinical trials provided key data.The targeted data revealed that neoadjuvant Cemiplimab showed a mean pathologic response rate of 72%, with a 62% objective response rate. The most commonly found treatment-related adverse events (TRAEs) included fatigue, maculopapular rash, and diarrhea, affecting 66% of patients, with few severe cases. The studies demonstrated high rates of complete pathological responses (cPR) and major pathological responses (mPR), suggesting a strong therapeutic potential. Conclusions: Neoadjuvant Cemiplimab for cSCC therapy shows high response rates, low recurrence, improved survival, and manageable side effects. Despite more research is still needed to confirm its long-term benefits and real-world settings feasibility, some case series already indicate comparable results in immunosuppressed patients. Finally, there is strong evidence to consider neoadjuvant Cemiplimab as a promising and efficient treatment

Abstract: The COVID-19 pandemic has led to persistent complications beyond the respiratory system, with emerging evidence highlighting the role of gut dysbiosis in long COVID. Given the established gut-skin axis, alterations in gut microbiota post-COVID-19 may contribute to persistent dermatologic conditions such as eczema, acne, and rosacea. This review explores the mechanisms by which SARS-CoV-2 disrupts the gut microbiome, leading to systemic inflammation and skin disease. Furthermore, it examines potential interventions, including probiotics, prebiotics, and dietary modifications, as microbiome-targeted therapeutic strategies for post-COVID dermatologic recovery. Understanding this link may open new avenues for treating chronic inflammatory skin conditions in long COVID patients.

Abstract: For patients suffering from actinic keratosis (AK) and clinical evidence of chronic sun damage, achieving both actinic keratosis eradication and treating field cancerization is essential. AKs should not be underestimated. While the majority does not progress to squamous cell carcinoma (SCC), most cases of SCC develop from pre-existing AKs and nobody can differentiate between AKs that will develop into SCC and those that will either resolve on their own or remain unchanged. Photodynamic therapy (PDT) ad-dresses AKs and also targets surrounding sun-damaged areas with precancerous cells. This dual action reduces the risk of new AK formation, making PDT a valuable ap-proach for comprehensive skin cancer prevention in chronically sun-exposed individ-uals. The conventional PDT (cPDT) has already been proven a safe and effective method to treat non hyperkeratotic actinic keratosis and field cancerization. However, in the real world, PDT has not reached its maximum potential use, possibly due to the need of an office-based light source equipment and the associated peri-procedural pain. The daylight variation of PDT, which uses natural sunlight to activate the pho-tosensitizer and eradicate the premalignant cells. Daylight PDT (dPDT) is an effective, well-tolerated, and convenient treatment for AKs and field cancerization, with high satisfaction rates reported by both patients and physicians. Although its efficacy may be reduced in hyperkeratotic lesions and areas with insufficient sunlight, combining daylight PDT with lesion-targeted treatments and using indoor alternatives can help overcome these limitations. Additionally, the reduced peri-procedural pain and fewer topical side effects provide a significant advantage over other field treatments, such as 5-FU, imiquimod, and cPDT, making dPDT a highly practical and accessible option in real-world clinical practice in Dermatology.

Abstract: Staphylococcus aureus is one of the most prevalent bacteria in skin and soft tissue infections (SSTIs). Multidrug-resistant strains emergence, particularly methicillin-resistant S. aureus (MRSA), highlights the need for alternative treatments. This study investigates the antimi-crobial properties of olive leaf extract (OLE) and defines the profile of patient with SSTI who may benefit from it. OLE was tested in two reference strains, methicillin-sensitive S. aureus (MSSA) ATCC 29213 and MRSA ATCC 700699, and in 126 clinical isolates from patients with SSTIs. The minimum bactericidal concentration (MBC) ranged from 3.12% to 6.25% w/v for MSSA and 1.56% to 3.12% for MRSA. The lethal curve showed a reduction of 6 log10CFU/ml after two hours of incubation. Most of the 126 clinical samples (103 MSSA and 23 MRSA) came from skin lesions, surgical wounds, and ulcers. Over 90% of MSSA strains were resistant to less than five antibiotics, while 82% of MRSA to more than six. Penicillins demonstrated the lowest susceptibility rate (19.8%), whereas linezolid, daptomycin, pristinamycin, trimethoprim-sulfamethoxazole, teicoplanin, vancomycin, and OLE (25%, 12.50%, and 6.25% w/v) exhibited 100% susceptibility. The findings sug-gest that OLE could serve as a promising alternative treatment for skin infections, partic-ularly in the context of increasing antibiotic resistance.

Abstract: Itch is a commonly experienced problem by individuals with chronic wounds and it greatly compromises their quality of life, while scratching can further hinder the wound healing process. Despite this being a clinically recognized issue, our knowledge of its exact prevalence in chronic wounds of different types and the molecular mechanisms driving it is limited. The multifactorial nature of wound itch makes its characterization particularly challenging. The present review has been based on a thorough PubMed search and it aims to provide an overview of existing evidence on the epidemiology, impact and pathophysiology of wound itch, along with general recommendations on its management. Importantly, our work highlights the merit of screening chronic wound patients for associated pruritus and incorporating anti-itch measures in mainstream wound care.

Abstract:

Background/Objectives: Furocoumarins, chemical compounds found in many plant species, have a photosensitizing effect on the skin when topically applied and, in interaction with ultraviolet radiation (UVR), stimulate melanoma cells to proliferate. Whether dietary intake of furocoumarins acts as a melanoma risk factor has been investigated in several epidemiological studies that are synthesized in our systematic review. Methods: The study protocol is registered with PROSPERO (registration number: CRD42023428596). We conducted an in-depth literature search in three databases coupled with forward and backward citation tracking and expert consultations to identify all epidemiological studies, irrespective of their design, addressing the association between furocoumarin-containing diet and melanoma risk. We extracted information on the study details and results in a standardized manner and evaluated the risk of bias of the results using the Joanna Briggs Institute’s critical appraisal tools. Results: We identified 20 publications based on 19 distinct studies providing information on the furocoumarin-melanoma association. We refrained from a meta-analytical synthesis of the results because of the large heterogeneity in exposure assessment, operationalization of furocoumarin intake in the analyses, and analytical methods of the studies. In a qualitative synthesis, we found moderate evidence supporting the notion that dietary furocoumarin intake at higher levels acts as a risk factor for cutaneous melanoma. Conclusions: Our systematic review provides an overview of the current epidemiological knowledge but could not answer unambiguously whether and, if so, to what extent dietary furocoumarin intake increases melanoma risk. The future epidemiological analysis focusing on this topic requires more comprehensive dietary and UVR exposure data to better characterize the individual total furocoumarin intake and its interplay with individual UVR exposure patterns.

Abstract: Several studies have suggested that adiponectin is an anti-aging molecule based on its potential involvement of adipose tissue in skin aging. In this study, we investigated the anti-photoaging efficacies of an adiponectin expression-stimulating peptide derivative in in vitro and ex vivo human skin explant models. A double-blind, randomized, placebo-controlled study was performed to confirm the clinical efficacies. UV-induced decrease in adiponectin expression and increase in inflammatory cytokines were prevented by the test peptide. Mitigation of cellular senescence and senescence-associated secretory phenotype (SASP) expression has also been observed in ex vivo human skin. Restoration of filaggrin, loricrin, and claudin-1 protein expression was observed. A clinical study further confirmed that the restoration of UVB-induced skin damage, represented by increased skin redness and trans-epidermal water loss, was accelerated by the use of test peptide-containing products. These results suggest that targeting adiponectin may be a plausible strategy for the development of anti-aging ingredients.

Abstract: The development of cutaneous lesions in areas of the skin previously affected by a healed, unrelated disease is known as the Wolf isotopic response (WIR). The most common scenario of WIR is reactions following herpes zoster, although it has been reported in many other settings. These affected areas are though to suffer from immune system dysregulation, lymphatic vessel dysfunction, and altered neuromediator activity, leading to increased susceptibility to inflammatory, neoplastic, and infectious pathologies. This phenomenon falls under the broader concept of the “immunocompromised district”, which also includes the Koebner phenomenon and its reverse. We report the case of a 96-year-old woman who developed multiple cysts and comedones at the site of a healed herpes zoster. Persistent and intractable inflammation prompted curettage of the lesions, and histopathological examination revealed an angiosarcoma with a pseudolymphomatous reaction interspersed among the cysts. The coexistence of multiple types of WIR is rare but not exceptional, underscoring the need for awareness of the wide spectrum of pathologies that can arise in such settings. In this review, we provide an updated explanation of current pathogenic theories and a practical compilation of postherpetic reactions reported to date.

Abstract: Globally, skin cancer accounts for more than all other malignancies combined. Skin cancer imposes a significant financial and societal burden. UVR exposure is responsible for 90% of skin cancer and is a major source of exogenous free radicals. The free radical theory of aging and cancer led to the investigation of polyunsaturated lipids, antioxidants (including synthetic phenols, polyphenols, flavonoids) and ß-carotene as potential modulators of UVR-carcinogenesis. Experimentally, both dietary lipids and antioxidants modified the tumor latent period and multiplicity. Increasing levels of omega-6 fatty acids exacerbated UVR-carcinogenesis in a near linear fashion. However, omega-3 fatty acid inhibited UVR-carcinogenesis. Both types of lipids exhibit the same level of saturation. Thus, the inhibition of UVR-carcinogenesis by omega-3 fatty acid must rest with differential metabolic intermediates that each generate, both tumor-promoting and immune-modulating. Clinically, a low-fat dietary intervention trial has shown that reduced fat intake significantly reduces the occurrence of nonmelanoma skin cancer. Dietary supplementation of antioxidants and ß-carotene into the complex milieu of the cell with its own intricate and complex free radical defense system has resulted in detrimental responses and antioxidant dietary supplements, as well as ß-carotene, are no longer recommended for the public as a mean to prevent cancer.

Abstract: Background: Dandruff and related scalp disorders, often caused by Malassezia furfur, pose significant dermatological challenges. This study evaluates FERMENZA®, a novel, patented formulation derived from pomegranate and beetroot fermented extracts, as a natural alternative to synthetic agents like ketoconazole and zinc pyrithione. Methodology and Results: In this study, mixed substrate fermentation was utilized for synergistic effect on bioactivity of natural fruits and vegetable extracts. The pomegranate-beetroot fermented extract demonstrated impressive antifungal efficacy against Malassezia furfur MTCC 1374, with percent inhibition of 96% and 86.7% compared to active pharmaceutical ingredients ketoconazole and zinc pyrithione, respectively. The investigational formulation FERMENZA® derived from pomegranate and beetroot fermented extract exhibited the highest zone of inhibition (ZOI) of 28 ± 0.12 mm, outperforming marketed products A and B lotions by achieving 93 ± 0.04% and 60 ± 0.09% inhibition, respectively. Minimum inhibitory concentration (MIC) studies revealed potent activity of the formulation at 8mg/ml. The MIC90 value was observed at 20µg/mL achieving 92 ± 0.01% inhibition compared to ketoconazole. A time-kill assay highlighted the superior antifungal potency of FERMENZA® against M. furfur, significantly reducing fungal growth intensity within 48 hours, starting from 6 hours of incubation. The mechanism of fungicidal action is attributed to gallic acid, a key active component of pomegranate and beetroot fermented extract which disrupts fungal cell structures.Conclusion: Efficacy and sensory evaluation confirmed FERMENZA®’s ability to alleviate dandruff, itching, flaking, and scaling within 10 days, with moderate benefits in reducing hairfall. These results underscore FERMENZA®'s potential as a comprehensive, natural solution for managing dandruff and scalp disorders, providing a safer alternative to synthetic antifungal agents.

Abstract: Background: Dermoscopy, a non-invasive diagnostic tool, is increasingly used to evaluate cutaneous T-cell lymphomas such as Mycosis Fungoides (MF) and Sézary Syndrome (SS). However, its diagnostic accuracy and role in staging remain underexplored. Objective: This study aimed to assess dermoscopic patterns in MF and SS, correlating findings with disease stages and lesion types to evaluate diagnostic utility. Methods: A retrospective, monocentric analysis was conducted on patients with histologically confirmed MF or SS. Dermoscopic images were evaluated for vascular patterns, pigmentation, scaling, and keratin plugs. Statistical analysis assessed correlations with TNMB staging and lesion types. Results: All lesions were pigment-free, with vascular patterns being the predominant dermoscopic feature. Linear vessels (40%) and serpentine vessels (13.3%) were most common. Scaling, observed in 76.7% of lesions, showed diffuse or perifollicular distribution. No statistically significant correlations were found between dermoscopic features, TNMB stages, or lesion types. Cluster analysis suggested variability but no definitive patterns for disease staging. Conclusion: Dermoscopy reveals consistent vascular patterns but lacks sensitivity for staging MF and SS. More significant prospective studies with standardised descriptors are needed to refine its diagnostic and staging utility. Histopathological confirmation remains essential for accurate diagnosis.

Abstract: Acne vulgaris and Malassezia folliculitis are common dermatological conditions that require effective treatments to avoid antimicrobial resistance development. Natural postbiotic extracts, offers a potential alternative therapy due to its antimicrobial, anti-inflammatory, and skin-renewing properties. This study aims to evaluate the antimicrobial efficacy, chemical composition, and efficacy assessment of FERMENZA postbiotic gel for the treatment of acne vulgaris and malassezia folliculitis, in comparison to traditional antimicrobial treatments. Metabolite profiling of the postbiotic extract through LC-MS analysis revealed presence of compounds such as gallic acid and ellagic acid, which exhibit synergistic antimicrobial and anti-inflammatory properties. The postbiotic extract and FERMENZA gel showed significant antimicrobial activity, with inhibition rates of 85% and 81%, respectively, against P. acnes (MTCC 1951) compared to clindamycin 2% active ingredient. The MIC50 for FERMENZA postbiotic gel against P. acnes was 0.25 mg/ml. The MIC potency against M. furfur (MTCC 1374) was found to be 8 mg/ml in our previous study which was comparable to ketoconazole 2% active ingredient. Time-kill assays confirmed that FERMENZA gel reduced bacterial counts within 24 hours, with efficacy comparable to clindamycin 2% marketed gel. Nucleotide efflux assays indicated that postbiotic components compromised bacterial membrane integrity, causing leakage of intracellular contents. Stability studies showed that FERMENZA gel remained stable and within acceptable limits for all tested parameters over six months. Consumer trials indicated that FERMENZA gel provided superior pain relief and fading of acne spots compared to clindamycin, with a gentle, non-irritating formulation. This study positions FERMENZA postbiotic gel as a promising alternative for the treatment of Acne vulgaris and Malassezia folliculitis. The formulation's dual-action mechanism, driven by natural phenolic acids and polyphenols, provides an effective, sustainable solution without the risks of resistance development.