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Review Article
Ozone in Dermatology – Between Science and Therapy
Valentina Broshtilova,
Ivan Vasilevski,
Yoanna Velevska,
Irina Yungareva,
Alexander Trenovski,
Yoanna Petkova,
Sonya Marina*
Issue:
Volume 9, Issue 1, June 2026
Pages:
1-9
Received:
27 November 2025
Accepted:
10 December 2025
Published:
26 January 2026
Abstract: Ozone therapy is increasingly utilized in dermatology owing to its multimodal antimicrobial, anti-inflammatory, antioxidant, and regenerative properties; however, its clinical implementation remains heterogeneous and the quality of supporting evidence varies across indications. This review critically evaluates the mechanisms of action, clinical applications, safety profile, and future perspectives of ozone therapy in dermatological practice. A structured literature search of PubMed, Scopus, and Web of Science covering the period from January 2000 to December 2024 identified 60 eligible human studies, which were assessed according to study design and methodological quality. Biologically, ozone exerts its effects through controlled oxidative stimulation, leading to activation of the Nrf2/EpRE pathway, improvement of microcirculation, and promotion of immunomodulation, tissue oxygenation, and wound healing. Moderate-quality evidence supports the use of ozone as an adjunctive treatment for chronic ulcers and burns (evidence level B), while limited to moderate evidence suggests potential benefits in acne, atopic and seborrheic dermatitis, cutaneous infections, and psoriasis (evidence levels C–D). Aesthetic and regenerative applications remain largely experimental (evidence level D). When administered by trained professionals using appropriate protocols, ozone therapy demonstrates a generally favorable safety profile, with adverse events being infrequent and typically mild. Overall, ozone therapy shows meaningful therapeutic potential as an adjunctive modality in dermatology, particularly for chronic and treatment-resistant dermatoses; nevertheless, broader adoption will require standardized dosing and delivery protocols, high-quality randomized clinical trials, and robust long-term safety data, supported by continued technological advances and molecular research to enable more targeted, evidence-based integration into clinical practice.
Abstract: Ozone therapy is increasingly utilized in dermatology owing to its multimodal antimicrobial, anti-inflammatory, antioxidant, and regenerative properties; however, its clinical implementation remains heterogeneous and the quality of supporting evidence varies across indications. This review critically evaluates the mechanisms of action, clinical app...
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Research Article
Clinico-epidemiological and Therapeutic Aspects of Alopecia Areata in Children at the Dermatology Department, University Hospital of Antananarivo, Madagascar
Herin'Ny Fitiavana Princia Andriatahina*
,
Andrianandrianina Mbolatiana Kiady Armando Rakotomanana,
Fandresena Arilala Sendrasoa,
Tsiory Iarintsoa Razafimaharo,
Moril Sata,
Fenohasina Rakotonandrasana,
Onivola Raharolahy,
Malalaniaina Andrianarison,
Irina Mamisoa Ranaivo,
Lala Soavina Ramarozatovo,
Fahafahantsoa Rabenja Rapelanoro
Issue:
Volume 9, Issue 1, June 2026
Pages:
10-16
Received:
13 January 2026
Accepted:
26 January 2026
Published:
9 February 2026
Abstract: Introduction: Alopecia areata (AA) is an autoimmune disease of the hair follicles that causes non-scarring hair loss. We aim to describe the epidemiological, clinical, and therapeutic aspects of AA seen in Malagasy children. Materials and Methods: A descriptive retrospective study was conducted over a 71-month period in children <15 years old with AA, seen in the two dermatology departments of the University Hospital Joseph Raseta Befelatanana, Antananarivo Madagascar. Results: Twenty-five cases of AA in children were included. The sex ratio was 0.47. The mean age was 10.36 ± 3.7 years. Patchy alopecia was the most frequent presentation (n=12), then totalis alopecia (n=3), ophiasis alopecia (n=2), and finally alopecia universalis (n=1). An association of patchy and ophiasis alopecia was found in 7 cases. The first-line treatments used were very potent topical corticosteroids in 18 cases, combined with systemic treatment in 8 cases. Mini-pulse corticosteroid therapy was used in 10 cases. Corticosteroid boluses (5-10 mg/kg/day for 3 days) were used in 5 cases. As a second-line treatment, methotrexate (5-7.5 mg/week) was used in 3 cases. After first-line treatment, complete regrowth (≥80%) was observed in 3 patients, and partial regrowth (29 to 80%) in 14 patients. Conclusion: AA has a heterogeneous presentation and unpredictable clinical course. Our study shows the therapeutic difficulty of AA in children.
Abstract: Introduction: Alopecia areata (AA) is an autoimmune disease of the hair follicles that causes non-scarring hair loss. We aim to describe the epidemiological, clinical, and therapeutic aspects of AA seen in Malagasy children. Materials and Methods: A descriptive retrospective study was conducted over a 71-month period in children ...
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Review Article
Modulating the Gut–Skin Axis in Dermatological Diseases: Mechanisms and Clinical Applications of Probiotics, Prebiotics, Synbiotics, and Postbiotics
Issue:
Volume 9, Issue 1, June 2026
Pages:
17-28
Received:
30 January 2026
Accepted:
10 February 2026
Published:
25 February 2026
Abstract: The gut–skin axis represents a bidirectional regulatory network linking intestinal microbiota composition and function to cutaneous inflammation and barrier integrity through interconnected immune, metabolic, barrier-related, and neuroendocrine pathways. Key mechanisms include microbiota-driven immune modulation, production of short-chain fatty acids (SCFAs), regulation of epithelial permeability and lipopolysaccharide (LPS) translocation, and modulation of the hypothalamic–pituitary–adrenal (HPA) axis and insulin-like growth factor-1 (IGF-1) signaling. Increasing evidence supports the role of these pathways in the pathogenesis and clinical course of inflammatory dermatological diseases, including atopic dermatitis, acne vulgaris, rosacea, and psoriasis. This narrative review critically evaluates current experimental and clinical evidence on probiotics, prebiotics, synbiotics, and postbiotics as therapeutic modulators of the gut–skin axis in dermatology. A targeted literature search covering the period 2000–2025 was conducted using PubMed/PMC, Scopus, Web of Science, and Google Scholar, prioritizing systematic reviews, meta-analyses, and randomized controlled trials reporting clinically relevant outcomes. Available data indicate that selected Lactobacillus and Bifidobacterium strains are associated with improvements in skin barrier function, modulation of inflammatory responses, and clinically meaningful benefits, most consistently in atopic dermatitis. The strongest evidence supports preventive and adjunctive use in pediatric atopic dermatitis. In acne vulgaris, psoriasis, and rosacea, reported efficacy appears moderate and heterogeneous, reflecting substantial variability in strains, formulations, dosing regimens, and study design. Prebiotics and synbiotics demonstrate favorable effects on microbial balance and inflammatory activity, while postbiotics and microbiota-modulating topical agents represent emerging therapeutic approaches with promising safety and tolerability profiles. Overall, microbiota-targeted interventions act on distinct nodes within the gut–skin axis and may serve as rational adjunctive strategies in selected dermatological conditions. However, clinical efficacy is strain- and formulation-specific, and further well-designed, adequately powered, and mechanism-driven clinical trials are required to define their precise role in routine dermatological practice.
Abstract: The gut–skin axis represents a bidirectional regulatory network linking intestinal microbiota composition and function to cutaneous inflammation and barrier integrity through interconnected immune, metabolic, barrier-related, and neuroendocrine pathways. Key mechanisms include microbiota-driven immune modulation, production of short-chain fatty aci...
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Case Report
Combination Therapy for Extensive Tumoral Calcinosis in Juvenile Dermatomyositis
Issue:
Volume 9, Issue 1, June 2026
Pages:
29-33
Received:
1 January 2026
Accepted:
19 January 2026
Published:
26 February 2026
Abstract: A 8-year-old girl presented with pain in bilateral hip and thigh with progressive difficulty in getting up and walking for last 2 years. Patient had difficulty with activities such as rising from a chair, climbing stairs, lifting objects, or washing her hair. There was no dysphagia, dysphonia, difficulty in swallowing and no weakness in the muscles of respiration. On examination child was very thin with areas of scalp alopecia. Multiple small, flat-topped, reddish-purple, non-tender papules were seen on the back of the hands and fingers indicative of Gottrons papules. Severe muscle wasting in both upper and lower limbs was seen. Gowers sign was positive. Extensive calcifications were seen in bilateral axillary region, around knee, hip and occipital region. ANA (Antinuclear Antibody) test by indirect immunofluorescence on Hep 2 cells showed speckled 2+ positivity (1:80). EMG (Electromyogram) and MRI (Magnetic Resonance Imaging) findings were consistent with dermatomyositis. Child was started on high dose corticosteroids along with oral methotrexate and hydroxychloroquin. Child improved and muscle strength improved. Subsequently child got readmitted in the next 6 months multiple times with cellulitis. Each time Staph aureus was obtained on aspiration and child responded to intravenous vancomycin. Child was started on Pamidronate infused intravenously at 1 mg/kg/day for 3 consecutive days every 3 months. Inaddition child received intravenous immunoglobulin monthly for 6 months. On follow-up after one year, there was complete clearance of calcinosis at all sites and good disease control without signs of myositis. Thus it appears that multiple drugs can resolve extensive calcinosis when used in combination.
Abstract: A 8-year-old girl presented with pain in bilateral hip and thigh with progressive difficulty in getting up and walking for last 2 years. Patient had difficulty with activities such as rising from a chair, climbing stairs, lifting objects, or washing her hair. There was no dysphagia, dysphonia, difficulty in swallowing and no weakness in the muscles...
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Case Report
The Classic Dermatological Signs of Iron Deficiency:
A Case-Series
Bhokare Anil Balkrishna*
Issue:
Volume 9, Issue 1, June 2026
Pages:
34-39
Received:
12 February 2026
Accepted:
24 February 2026
Published:
9 March 2026
Abstract: Introduction: Anaemia is defined as a decrease in the total amount of RBCs or haemoglobin in the blood. Anaemia patients show skin signs like pallor, koilonychias, and hair loss. Aim: The aim of the study is to find the cause of typical rash and confirm the diagnosis. Materials/Methods: This retrospective study involves collection of 26 patients showing typical skin lesions. All subjects involved in this study are categorized according to age, sex, type of lesions and site involved. All were investigated for hematological parameters mainly haemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH). Everyone was showing reduced parameters with microcytic hypochromic red blood cells suggesting iron deficiency anaemia. These patients were further investigated for other causes of anaemia and diagnosis was confirmed by serum iron levels, total iron binding capacity, serum ferritin and transferrin saturation. Other causes like zinc deficiency, pellagra, contact dermatitis were also ruled out. Results: Almost all patients are females except two males. Majority of them are young females. The skin lesions can present isolated on face or hands or both sites. Each and every subject is confirmed to have iron deficiency anemia. Limitations: This is a single center study. Conclusion: These typical eczematous hand and perioral lesions were highlighting the importance of looking for iron deficiency in affected patients without a more obvious cause.
Abstract: Introduction: Anaemia is defined as a decrease in the total amount of RBCs or haemoglobin in the blood. Anaemia patients show skin signs like pallor, koilonychias, and hair loss. Aim: The aim of the study is to find the cause of typical rash and confirm the diagnosis. Materials/Methods: This retrospective study involves collection of 26 patients sh...
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Research Article
Psoriasis and Comorbidities: Diagnostic and Therapeutic Challenges in Madagascar
Issue:
Volume 9, Issue 1, June 2026
Pages:
40-46
Received:
14 February 2026
Accepted:
2 March 2026
Published:
14 March 2026
DOI:
10.11648/j.ijcd.20260901.16
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Views:
Abstract: Psoriasis is a common chronic inflammatory skin disease, but it is still poorly understood by physicians. It evolves in flare-ups of varying intensity and is often associated with comorbidities that worsen the severity of the disease and complicate its management. Our objective was to identify these comorbidities in order to optimize the follow-up of patients with psoriasis in Madagascar. A retrospective, multicenter, descriptive, and analytical study was conducted over six years, including all patients with psoriasis regardless of age or gender, in the dermatology departments of Toamasina and Antananarivo, Madagascar. A total of 224 cases of psoriasis were included, with a slight male predominance and a mean age of 40.2 ± 20 years. Comorbidities were present in 61.6% of patients, mainly dominated by cardiovascular and metabolic risk factors and diseases, as well as psychoaffective disorders, particularly stress and depression. A significant association was observed between the presence of cardiovascular, metabolic, or psychoaffective comorbidities and the severity of psoriasis, suggesting that chronic systemic inflammation and high-risk lifestyles contribute to a vicious cycle of disease worsening. Unemployment, older age (50–60 years), and male sex were also correlated with moderate to severe forms. Our study highlights the importance of systematic screening for comorbidities, an early and multidisciplinary therapeutic approach, and improved awareness among healthcare professionals to enhance the prognosis and quality of life of patients with psoriasis in a resource-limited setting.
Abstract: Psoriasis is a common chronic inflammatory skin disease, but it is still poorly understood by physicians. It evolves in flare-ups of varying intensity and is often associated with comorbidities that worsen the severity of the disease and complicate its management. Our objective was to identify these comorbidities in order to optimize the follow-up ...
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