Background: Rituximab provides more effective and less adverse effects than the standard dose of corticosteroids, but evidence on its efficacy and safety in the Thai population is lacking. Objective: To evaluate the efficacy and safety of rituximab in the treatment of pemphigus and also to determine prognostic factors linked to the treatment outcomes. Methods: Pemphigus patients who received rituximab from November 2017 to December 2020 were retrospectively reviewed. The outcome was evaluated by using early (end of consolidation phase [ECP]) and late endpoints (complete remission [CR] on/off therapy, immunological remission [IR], and relapse). Adverse events were noted. Prognostic factors associated with remission and relapse were analyzed. Results: Of 53 pemphigus patients, all attained ECP within 1.61 months. Almost 80% achieved CR on therapy within a median time of 6.36 months, while 33.9% reached CR off therapy in 19.74 months. Nearly half had IR within a median time of 6.88 months. Relapse occurred in 33.3% with a median time of 14 months. In multivariate analysis, receiving rituximab within 12 months of disease duration was more likely to achieve CR off therapy and IR (hazard ratio [HR] 3.79; 95% confidence interval [CI] 1.38, 10.42; P = 0.01 and HR 2.74; 95% CI 1.12, 6.69; P = 0.027, respectively), whereas older patients and positive antidesmoglein 1 levels at the time of CR were predictive indicators for relapse (HR 1.07; 95% CI 1.01, 1.13; P = 0.036 and HR 4.38; 95% CI 1.24, 15.46; P = 0.022, respectively). The treatment-related adverse effects occurred in 33.9%. Conclusion:Rituximab is effective and safe in Thai pemphigus patients. Early administration of rituximab was a predictor of clinical and immunological remission. Older age and persistently positive anti-Dsg1 were correlated with disease relapse.

Treatment of extensive or recalcitrant alopecia areata (AA) is a major clinical challenge. Even after thorough investigation of several medications, its treatment outcomes have remained unsatisfactory. While there is no US Food and Drug Administration-approved medication for AA yet, topical immunotherapy has been a well-documented treatment option. Dinitrochlorobenzene, squaric acid dibutylester, and diphenylcyclopropenone are three substances that have demonstrated efficacy in the treatment of extensive or recalcitrant AA. Despite being commonly used, the mechanism underlying topical immunotherapy is not well-elucidated and a wide range of clinical efficacies have been reported in the literature. The aim of this review was to summarize and update the pharmacology, mechanism of action, therapeutic efficacy, and tolerability of topical immunotherapy in the treatment of AA.

<b><i>Background:</i></b> Palmoplantar and periungual warts tend to be recalcitrant. Intralesional immunotherapy can provide high efficacy with additional benefit to distant warts. However, evidence on comparative effects between intralesional immunotherapy with measles, mumps, rubella vaccine (MMR) and tuberculin purified protein derivative (PPD) and roles of dermoscopy in predicting treatment outcomes in palmoplantar/periungual warts is limited. <b><i>Objectives:</i></b> The study aimed to compare efficacy and safety of intralesional MMR and PPD injections in treatment of palmoplantar/periungual warts and explore associations between dermoscopic findings and treatment outcomes. <b><i>Methods:</i></b> We conducted a double-blind randomized controlled trial involving 40 patients with palmoplantar/periungual warts who were equally assigned to receive MMR or PPD. Intralesional injection was done every 2 weeks until clearance or maximum of 5 treatments. <b><i>Results:</i></b> Complete resolution was higher in MMR than PPD group (90.0% vs. 80.0% in index lesion and 81.3% vs. 54.6% in distant lesions, respectively), although the differences were statistically nonsignificant. Dermoscopic findings were not significantly associated with complete resolution. Local swelling, i.e., the most common adverse event, occurred more frequently in PPD (40.0%) than MMR group (10.0%). <b><i>Conclusion:</i></b> This study suggests that intralesional immunotherapy with either MMR or PPD is efficacious in palmoplantar/periungual warts, with MMR showing a trend toward higher clearance and lower adverse events.

Background: Enlarged facial pores are a common cosmetic complaint in practice.Microfocused ultrasound with visualization (MFU-V) and low-degree crosslinked hyaluronic acid filler (L-HA) injection has recently become a popular procedure for skin rejuvenation. The effectiveness of the combined MFU-V and L-HA injection in the treatment of enlarged pores has not been evaluated. Objectives:To compare the efficacy of MFU-V monotherapy (single technique) and MFU-V combined with L-HA injection (combined technique) for the treatment of enlarged facial pores in Asians. Methods:We conducted a randomized, single-blinded, split-face study on participants with enlarged facial pores. Each side of the face was randomly assigned to treatment with one session of single technique or combined technique. Pore volume was objectively measured by an Antera 3D ® system. Subjective assessment was evaluated by one-blinded physician using a pore grading score (0-4). Patients rated the improvement in terms of satisfaction using the visual analog scale (VAS, 0-10).Results: Forty-six participants completed the study. The mean pore volume of both sides declined with statistical significance at every visit compared to baseline, with the lowest mean at 4 months post-treatment. The combined technique showed a lower mean pore volume than single technique throughout the follow-ups. Physician's subjective evaluation showed no statistically significant difference between the two techniques. The patient satisfaction score showed a similar trend to the mean pore volume, with a statistically significant difference at 4 and 6 months post-treatment.Conclusions: Both techniques are effectively minimize enlarged facial pores. The combined technique resulted in more patient satisfaction.