Associations between endothelial cell characteristics and corneal topography findings in different stages of keratoconus.

PURPOSE: This study aimed to compare and correlate specular microscope indices and corneal topography indices in different stages of keratoconus. METHODS: Two hundred forty-six eyes of 123 participants were enrolled in the study. Corneal topography was performed using Sirius (CSO, Italy), with a rotating Scheimpflug camera and a Placido disc topographer. Corneal endothelial cell indices were assessed using a specular microscope (Nidek CEM-530, Japan). Eyes were graded as keratoconus stages 0-4 according to the Amsler-Krumeich classification. Corneal topography and endothelial cell indices were compared among the groups, and the correlations between them were analyzed. RESULTS: The mean age of the patients was 23.26 ± 6.75 years (range, 14-47 years). Forty-eight cases were male (39%) and 75 were female (61%). There were no statistically significant age (p = 0.578) or sex ratio (p = 0.529) differences between the groups. Twenty-nine eyes were included in the control group (11.78%), while 41 (16.67%) had stage 1 keratoconus, 88 (35.77%) had stage 2, and 88 (35.77%) had stage 3. Measurement was not possible in stage 4 keratoconus. No statistically significant difference was determined in specular microscopy values according to the stage of keratoconus, except for the number of analyzed cells (NUM) (p > 0.05). The lowest NUM values were observed in stages 1, 2, and 3, with values of 184.34 ± 67.62 cells/mm2, 155.07 ± 59.48 cells/mm2, and 127.06 ± 64.39 cells/mm2, respectively (p = 0.001). In the keratoconus group, weak statistically significant negative correlations were observed between NUM and SimK1, SimK2, KVf, BCVf, KVb, and BCVb, while a weak positive correlation was noted between NUM and central corneal thickness (p < 0.05). CONCLUSIONS: NUM seems to decrease, while endothelial cell density exhibits no significant changes, with the progression of keratoconus. It appears that as keratoconus index values increase, NUM may decrease in different stages of keratoconus.

Development and Validation of the Isotretinoin Hesitancy Scale for Acne Vulgaris: A Preliminary Study.

BACKGROUND: Oral isotretinoin is the most effective systemic treatment for acne patients who fail to respond to other forms of therapies. However, hesitations and concerns regarding its side effect profile may detain the patients from treatment. This study aimed to develop and validate the Isotretinoin Hesitancy Scale (IHS) among acne patients. METHODS: A cross-sectional study was conducted with 100 acne patients who had not used isotretinoin previously. A 22-item scale was created based on the related literature and expert opinions. The items of the scale related to beliefs and worries about isotretinoin were formatted with response options: agree, indecisive, and disagree. In this study, construct validity was tested with exploratory factor analysis, and reliability was tested with internal consistency and split-half reliability. RESULTS: The results of exploratory factor analysis indicated a three-factor solution with a total of 14 items, explaining 57% of the total variance. The first factor (Hesitancy Related to Reversible Adverse Effects: 6 items) accounted for 30% of the variance, the second factor (Hesitancy Related to Irreversible Adverse Effects: 4 items) accounted for 16% of the variance and the third factor (Isotretinoin-related Anxiety: 4 items) accounted 11% of the variance. The internal consistency of the three factors was calculated as 0.79, 0.78, and 0.72, respectively. The Cronbach's alpha score of the total scale was found to be 0.81, and split-half reliability was found to be 0.87. CONCLUSIONS: The IHS is the first scale that provides a valid and reliable assessment of isotretinoin hesitancy in acne patients. Eliminating isotretinoin hesitancy may reduce acne-related clinical and psychosocial consequences.

Application of purple basil leaf anthocyanins-loaded alginate-carrageenan emulgel beads in gelatin-based jelly candies.

Jelly candies could be considered promising food matrices for the delivery of bioactive compounds such as anthocyanins (ACNs). In this study, gelatin-based jelly candies were fortified with free ACNs-rich purple basil leaf extract (PBLE) and PBLE-loaded emulgel beads. The interaction between free ACNs and gelatin in the jelly matrix resulted in a lower release of ACNs in the mouth (8.27 %) and gastric stage (74.44 %) compared to those of free extract (24.92 and 86.13 %), as well as some protection in the intestinal stage. The release of ACNs from the jellies enriched with PBLE-loaded emulgel beads only began in the intestinal stage and reached 66.34-70.75 % of the initial load. Compared to those of PBLE-loaded emulgel beads, the introduction of beads within the jelly matrix increased the in vitro release of ACNs. The jelly samples enriched with PBLE-loaded emulgel beads yielded higher hardness, adhesiveness, flexibility, and chewiness compared to samples with free PBLE. While the color and appearance of jellies fortified with encapsulated PBLE were impaired, they got the highest sensory acceptance scores due to the masking of the bitter taste of the free extract. ACNs-loaded emulgel beads could be a viable method for fortifying jelly candies.

Investigation of the in-vitro lethal effect of spilanthol on demodex and finding the most effective dose.

Demodex species are associated with many dermatological diseases, so an acaricidal agent that is effective against them and safe for skin applications may benefit many diseases. This study aims to investigate the anti-demodex potential of spilanthol, a product obtained from the Spilanthes Acmella plant, by determining the minimal effective dose for the first time in the literature. Demodex mites were obtained from 70 patients with standard superficial skin biopsy. Spilanthol extract was used at 1%, 2%, 3%, 4%, and 5%. Standard immersion oil was used for the negative control, and permethrin 5% was used for the positive control group. The dependent variable is the survival time of the mite. Comparisons with the negative control group, the anti-demodex effect demonstrated itself in all groups, creating a statistically significant difference (p < 0.001). The positive control group, had 3%, 4%, and 5% spilanthol rates which were very similar to the results with 5% permethrin (p > 0.05). Higher concentrations than 3% did not make any additional contribution to survival times. This is the first attempt to show the dose-dependent acaricidal effect of spilanthol on demodex mites. Even the 3% dose shows similar results to 5% permethrin, and no additional effect increase was observed at higher doses. Therefore, in vivo, studies may be planned with a 3% spilanthol dose for further studies.

Clinical practice guidelines for the diagnosis and treatment of scabies.

Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global impact is considerable, affecting more than 200 million individuals annually and posing significant challenges to healthcare systems worldwide. Transmission occurs primarily through direct skin-to-skin contact, contributing to its widespread prevalence and emergence as a substantial public health concern affecting large populations. This review presents consensus-based clinical practice guidelines for diagnosing and managing scabies, developed through the fuzzy Delphi method by dermatology, parasitology, pediatrics, pharmacology, and public health experts. The presence of burrows containing adult female mites, their eggs, and excreta is the diagnostic hallmark of scabies. Definitive diagnosis typically involves direct microscopic examination of skin scrapings obtained from these burrows, although dermoscopy has become a diagnostic tool in clinical practice. Treatment modalities encompass topical agents, such as permethrin, balsam of Peru, precipitated sulfur, and benzyl benzoate. In cases where topical therapy proves inadequate or in instances of crusted scabies, oral ivermectin is recommended as a systemic treatment option. This comprehensive approach addresses the diagnostic and therapeutic challenges associated with scabies, optimizing patient care, and management outcomes.

Emulsion-based edible chitosan film containing propolis extract to extend the shelf life of strawberries.

In this study, propolis was first loaded into a conventional oil-in-water emulsion, which was combined with a chitosan film-forming solution to produce propolis emulsion-loaded film (PEF). Strawberries inoculated with Botrytis cinerea coated with PEF and blank emulsion-loaded films (BEF) were stored for 14 days at 4 °C. Compared to BEF, PEF showed superior mechanical and oxygen barrier properties, as well as antioxidant activities, but higher moisture permeability. PEF showed less oil agglomeration on the film surface after drying, as demonstrated by scanning electron microscopy (SEM) analysis. Compared to uncoated strawberries, coatings did not have a significant effect on weight loss or firmness during storage. In contrast, coated strawberries showed elevated total phenolics, anthocyanins, and ascorbic acid retention; however, PEF-coating yielded higher values. Moreover, the PEF coating resulted in a significantly lower reduction of organic acid and total soluble solids. Mold growth was visible in both uncoated and BEF-coated strawberries after 7 days of storage, while PEF-coated fruits showed no visible mold until the end of storage. Starting from day 4, PEF-coated fruits showed lower mold counts (~2 log CFU/g) than other samples. Therefore, the PEF prepared in this study has application potential for the preservation of fresh fruits.

The evaluation of L-arginine solution as a solvent for propolis extraction: The phenolic profile, antioxidant, antibacterial activity, and in vitro bioaccessibility.

Ethanol has been widely used for the extraction of propolis. Due to its certain disadvantages, there has been an ongoing search to find alternative non-ethanolic extraction solvents. This study aimed to compare the phenolics, antioxidant, and antibacterial activity of propolis extracts prepared with 70% ethanol (EWE), propylene glycol (PGE), and L-arginine solution (BE). All extracts were subjected to an in vitro simulated digestion procedure, and the phenolic profile of non-digested and digested samples was determined by using LC-MS/MS. Additionally, the change in total phenolic (TPC), total flavonoid content (TFC), and antioxidant capacities were determined at each digestion phase. TPC and TFC of non-digested propolis extracts had similar values, although BE showed higher antioxidant capacity (p < .05). The amount of TPC reached or transformed at the intestinal stage was higher for BE and PG compared to EWE. BE also provided the highest antioxidant capacity assay in digested samples. The most common phenolics were pinocembrin, pinobanskin, galangin, and CAPE in non-digested extracts. However, their concentration was drastically reduced by digestion, and their recovery (R%) ranged from 0% to 9.38% of the initial amount detected in the non-digested extracts. Chrysin was the most bioaccessible flavonoid in all extracts. Among phenolic acids, the highest R% was determined for trans-cinnamic acid (22.14%) from BE. All extracts showed in vitro inhibitory activity against Escherichia coli and Staphylococcus aureus. This study suggests that an L-arginine solution could be used as an alternative solvent to ethanol and propylene glycol for propolis extraction.

Enzyme-Based Antiviral Potential of Cinnamomum verum J. Presl. Essential Oil and Its Major Component (E)-Cinnamaldehyde.

In the present study, Cinnamomum verum J. Presl. bark essential oil and its main component cinnamaldehyde was evaluated in vitro for neuraminidase (NA), transmembrane serine protease (TMPRSS2), and angiotensin converting enzyme 2 (ACE2) inhibitory activities. The chemical composition of C. verum essential oil was confirmed by both gas chromatography-mass spectrometry (GC/MS), and gas chromatography-flame ionization detection (GC-FID), where 75.9% (E)-cinnamaldehyde was the major component. The ACE2, NA, and TMPRSS2 enzyme inhibitions of C. verum bark essential oil at 20 µg/mL concentration, and (E)-cinnamaldehyde (5 µg/mL) were calculated and compared in the range of 54.2-89.9%. Molecular docking results supported that (E)-cinnam-aldehyde was specific to ACE2 with 89.9% inhibition. Our findings suggest further in vivo studies to confirm the effective and safe use of the essential oil as well as the (E)-cinnamaldehyde.

Propolis-loaded liposomes: characterization and evaluation of the in vitro bioaccessibility of phenolic compounds.

Background and purpose: Propolis has low water solubility, poor stability, and limited bioaccessibility of phenolic constituents when subjected to in vitro digestion. To overcome these drawbacks, the liposomal encapsulation method can be employed. Experimental approach: Soybean phosphatidylcholine lecithin mixed with Tween 80 (T80) and ammonium phosphatides (AMP) was used to produce propolis extract (PE)-loaded liposomes. The mean particle size, zeta potential, encapsulation efficiency values, and transmission electron microscopy analysis were used to characterize liposomes. Individual phenolics were determined for digested and nondigested propolis-loaded liposomes and propolis extract. Key results: Tween 80 incorporation reduced the size of unloaded liposomes, whereas AMP inclusion yielded larger liposomes. In both formulations, PE loading significantly increased the size and reduced the zeta potential values and homogeneity of the size distribution. In free PE, the most bioaccessible polyphenols were phenolic acids (3.20 to 5.63 %), and flavonoids such as caffeic acid phenethyl ester, galangin, pinobanksin, and pinocembrin (0.03 to 2.12 %) were the least bioaccessible. Both liposomal propolis provided significantly higher bioaccessibility of phenolic compounds. The liposomes with T80 and AMP in their compositions recovered 52.43 and 185.90 % of the total amount of phenolic compounds in the nondigested samples, respectively. The liposomes containing AMP not only exhibited high solubility for PE but also provided protection to the phenolic compounds during in vitro digestion. Conclusion: Liposomal encapsulation could be a promising approach to improving the solubility and stability of PE in digestive fluids, making it suitable for the delivery of propolis in oral formulations.

Social Media Use in Dermatology in Turkey: Challenges and Tips for Patient Health.

Social media has established its place in our daily lives, especially with the advent of the COVID-19 pandemic. It has become the leading source of information for dermatological literacy on various topics, ranging from skin diseases to everyday skincare and cosmetic purposes in the present digital era. Accumulated evidence indicates that accurate medical content constitutes only a tiny fraction of the exponentially growing dermatological information on digital platforms, highlighting an unmet patient need for access to evidence-based information on social media. However, there have been no recent local publications from Turkey analyzing and assessing the key elements in raising dermatological literacy and awareness in digital communication for patients. To the best of our knowledge, this study is the first collaborative work between health care professionals and a social media specialist in the medical literature. Furthermore, it represents the first author-initiated implementation science attempt focusing on the use of social media in addressing dermatological problems, with the primary end point of increasing health literacy and patient benefits. The multidisciplinary expert panel was formed by 4 dermatologists with academic credentials and significant influence in public health and among patients on digital platforms. A social media specialist, who serves as a guest lecturer on "How social media works" at Istanbul Technical University, Turkey, was invited to the panel as an expert on digital communication. The panel members had a kickoff meeting to establish the context for the discussion points. The context of the advisory board meeting was outlined under 5 headlines. Two weeks later, the panel members presented their social media account statistics, defined the main characteristics of dermatology patients on social media, and discussed their experiences with patients on digital platforms. These discussions were organized under the predefined headlines and in line with the current literature. We aimed to collect expert opinions on identifying the main characteristics of individuals interested in dermatological topics and to provide recommendations to help dermatologists increase evidence-based dermatological content on social media. Additionally, experts discussed paradigms for dermatological outreach and the role of dermatologists in reducing misleading information on digital platforms in Turkey. The main concluding remark of this study is that dermatologists should enhance their social media presence to increase evidence-based knowledge by applying the principles of patient-physician communication on digital platforms while maintaining a professional stance. To achieve this goal, dermatologists should share targeted scientific content after increasing their knowledge about the operational rules of digital channels. This includes correctly identifying the needs of those seeking information on social media and preparing a sustainable social media communication plan. This viewpoint reflects Turkish dermatologists' experiences with individuals searching for dermatological information on local digital platforms; therefore, the applicability of recommendations may be limited and should be carefully considered.

The Effects of Different Drying Methods on the In Vitro Bioaccessibility of Phenolics, Antioxidant Capacity, and Morphology of European Plums (Prunes domestica L.).

Four different drying methods, hot-air-drying (HAD), vacuum-drying (VD), ultrasound-assisted vacuum-drying (US-VD), and freeze-drying (FD), were used to obtain dried plums (Prunes domesticaL.). These prunes were evaluated for their physical properties (such as color, rehydration ratio, and microstructural properties), phenolic compounds, and antioxidant activities before and after being subjected to in vitro digestion. TPC (total phenolic content) of plums ranged from 196.84 to 919.58 mg of GAE (gallic acid equivalent)/100 g of dw, and neochlorogenic acid was the most abundant phenolic compound. FD prunes had the highest levels of phenolics, whereas US-VD caused the most significant loss. During in vitro digestion, the phenolics were present at higher levels at the gastric medium but failed to maintain their stability at the small intestinal stage. Among the samples, FD along with HAD prunes exhibited a higher bioaccessibility index for most of the phenolic compounds. The ratios of TPC, TFC (total flavonoid content), and individual phenolics determined in the digested residues to the initial values of the undigested samples ranged from 0.23 to 31.03%. It could be concluded that the majority of the phenolics were extracted during digestion. Our findings showed that the different drying methods would alter the microstructure, which would affect the extractability and release of phenolics in the simulated digestion model.

Development of microencapsulated grape juice powders using black 'Isabel' grape peel pectin and application in jelly formulation with enhanced in vitro bioaccessibility of anthocyanins.

In this study, pigmented pectin (grape pectin, GP) was extracted from the peels of black Isabel grapes. This highly methoxylated GP was composed mainly of galacturonic acid, arabinose, and other neutral monosaccharides. Its red color was ascribed to the anthocyanin content, and the main contribution was from malvidin-3-O-glucoside. To improve the yield and color properties of spray-dried Isabel grape juice powders, maltodextrin (MD) was substituted with this colored GP. When 25% of MD was substituted with GP, the powder yield increased from 46.0% to 60.4%, but it decreased to 21% when the substitution was 40%. GP inclusion increased the encapsulation efficiency of total anthocyanin in powders from 55.70% to 88.66%. When this spray-dried grape juice powder containing GP was utilized in a jelly recipe (4%-10%), a higher level of inclusion yielded stronger and more brittle jellies. When the jellies containing varying amounts of GP were subjected to in vitro digestion, the formulation with a higher amount of GP yielded a higher recovery of anthocyanins. In addition to being utilized as a carrier agent for spray-drying applications, this pigmented GP can also be tailored for a variety of applications, such as the development of pH-sensitive edible films and functional beverage formulations.

Comparative In Vitro and In Silico Enzyme Inhibitory Screening of Rosa x damascena and Pelargonium graveolens Essential Oils and Geraniol.

The present work aims to evaluate Rosa x damascena Herrm. and Pelargonium graveolens L'Hér. essential oils, and the major constituent geraniol for their in vitro and in silico inhibitory activities against 5-lipoxygenase (5-LOX), cyclooxygenase (COX), acetyl cholinesterase (AChE), butyryl cholinesterase (BuChE), and angiotensin converting enzyme (ACE2) enzymes. Geraniol most potently inhibited the ACE2 relative to other enzymes. R. damascena essential oil moderately inhibited the cancer cell lines with no toxic effects on healthy HEK 293 cells. P. graveolens essential oil inhibited a number of cancer cell lines including A549, MCF7, PC3, and HEK 293 that are reported here for the first time. The molecular docking of geraniol with the target enzymes revealed that it binds to the active sites similar to that of known drugs. Geraniol carries the potential for further drug development due to its drug-like binding mode for the target enzymes. Our work confirms that these essential oils possess similar biological activities due to their similar phytochemistry in terms of the major constituents of the plants. The promising biological activities reported in this work further warrant the inclusion of in vivo studies to establish safe use of the target essential oils and their constituents.

Hair Loss Profiles and Ritlecitinib Efficacy in Patients with Alopecia Areata: Post Hoc Analysis of the ALLEGRO Phase 2b/3 Study.

INTRODUCTION: Ritlecitinib demonstrated efficacy in patients with alopecia areata (AA) in the ALLEGRO phase 2b/3 study (NCT03732807). However, hair loss presentation may vary based on location (e.g., scalp, eyebrow/eyelash, body). Here, we sought to identify distinct hair loss profiles at baseline and evaluate whether they affected the efficacy of ritlecitinib. METHODS: Patients with AA aged ≥ 12 years with ≥ 50% scalp hair loss were randomized to daily ritlecitinib 10 mg (assessed for dose ranging only), 30 or 50 mg (± 4-week, 200-mg loading dose), or placebo for 24 weeks. Latent class analysis (LCA) identified hair loss profiles based on four baseline measurements: clinician-reported extent of scalp (Severity of Alopecia Tool score), eyebrow hair loss, eyelash hair loss, and patient-reported body hair loss. Logistic regression evaluated ritlecitinib (50 and 30 mg) efficacy vs placebo using Patient Global Impression of Change (PGI-C) and Patient Satisfaction with Hair Growth (P-Sat; amount, quality, and overall satisfaction) responses at Week 24, adjusting for key covariates, including latent class membership. RESULTS: LCA identified five latent classes: (1) primarily non-alopecia totalis (AT; complete loss of scalp hair); (2) non-AT with moderate non-scalp involvement; (3) extensive scalp, eyebrow, and eyelash involvement; (4) AT with moderate non-scalp involvement; and (5) primarily alopecia universalis (complete scalp, face, and body hair loss). Adjusting for latent class membership, patients receiving ritlecitinib 30 or 50 mg were significantly more likely to achieve PGI-C response (30 mg: odds ratio, 8.62 [95% confidence interval, 4.42-18.08]; 50 mg: 12.29 [6.29-25.85]) and P-Sat quality of hair regrowth (30 mg: 6.71 [3.53-13.51]; 50 mg: 8.17 [4.30-16.46]) vs placebo at Week 24. Results were similar for P-Sat overall satisfaction and amount of hair regrowth. CONCLUSION: Distinct and clinically relevant hair loss profiles were identified in ALLEGRO-2b/3 participants. Ritlecitinib was efficacious compared with placebo, independent of hair loss profile at baseline. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT03732807.

Encapsulation of purple basil leaf extract by electrospraying in double emulsion (W/O/W) filled alginate-carrageenan beads to improve the bioaccessibility of anthocyanins.

The purple basil leaf extract (PBLE) was encapsulated in double emulsion (W1/O/W2)-loaded beads (emulgel) by electrospraying. The influence of κ-carrageenan (κ-CG) and cross-linking agents (Ca2+/K+) on the properties of alginate (SA) beads were assessed. In emulgel beads, κ-CG inclusion resulted in larger sizes and more distorted shapes, wrinkles on the surface, and lower gel strength. The encapsulation efficiency of anthocyanins (ACNs) in emulgel beads ranged from 70.73 to 87.89 %, whereas it ranged from 13.50 to 20.67 % in emulsion-free (hydrogel) beads. Fourier transforms infrared (FTIR) revealed the crosslinking of SA and κ-CG with Ca2+ and K+, thermogravimetric analysis (TGA), derivative thermogravimetric (DTG), and differential scanning calorimetry (DSC) thermograms showed emulgel beads yielded higher thermal stability. The emulgel beads elevated the in vitro bioaccessibility of ACNs under simulated digestion. At the gastric phase, 86 % of ACNs in PBLE, and 46 % of loaded ACNs in hydrogel beads were released, whereas no release was occurred in emulgel beads. At the intestinal phase, after 150 min of digestion, no ACNs were detected in PBLE and hydrogel beads, whereas all emulgel beads continued to release ACNs until 300 min. The incorporation of double emulsions in hydrogel beads can be utilized in the development of functional foods.

Annular neutrophilic dermatoses.

Neutrophilic dermatoses (NDs) constitute a group of diseases characterized by sterile neutrophilic infiltrations. Many NDs usually present with infiltrated erythematous plaques, nodules, urticarial plaques, or pustules. Lesions may show variability, and atypical presentations may develop among NDs. Annular lesions have been reported in many NDs and may lead to diagnostic problems. Clinical features and histopathologic findings such as localization of the neutrophilic infiltrate, existence of other cell types, and absence of true vasculitis may be helpful to distinguish NDs. Some of these NDs are associated with infections, inflammatory diseases, and malignancies. In most NDs, systemic steroids and dapsone are very effective and usually first choices. Colchicine, antimicrobials such as doxycycline, tetracycline, and sulfapyridine, and other immunosuppressants such as cyclosporin, methotrexate, and mycophenolate mofetil have been used successfully in treating many NDs. Tumor necrosis factor α inhibitors have also been used successfully in treating many NDs. Janus kinase inhibitors are effective in CANDLE (chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature) syndrome, anakinra in neutrophilic urticarial dermatosis, and intravenous immunoglobulin in resistant pyoderma gangrenosum. We discuss the diagnosis and management of NDs that may present with annular lesions.

Miscellaneous annular diseases.

Annular lesions represent a unique macro-morphologic pattern in various skin disorders that may be found in pityriasis rotunda, elastosis perforans serpiginosa, subacute nodular migratory panniculitis, keratolysis exfoliativa, neutrophilic eccrine hidradenitis, hemophagocytic lymphohistiocytosis, and intentionally induced annular lesions. This group is highly heterogenous and variable in clinical presentation. Whereas some are benign self-limiting disorders like pityriasis rotunda, others such as hemophagocytic lymphohistiocytosis follow a chronic course or have a potential of being life-threatening. Epidemiology, pathogenesis, histopathology, clinical presentation and diagnosis, differential diagnosis, and treatment are discussed.

Granulomatous annular diseases.

Granulomatous skin disorders comprise a large group of diseases that are typically characterized by granuloma formation both in the skin and in many other tissues. Cutaneous lesions are usually seen as erythematous papules and plaques that may occasionally be arranged in an annular, ringlike configuration. The etiopathogenesis is unclear in most cases, and granuloma formation may be associated with various systemic, infectious, and metabolic disorders, foreign bodies, environmental antigens, or malignancies. Treatment options are dependent on the etiology, extent, and severity of the lesions. This review includes the clinical, histopathologic, and dermatoscopy findings, differentials, and treatment options for noninfectious granulomatous annular skin disorders.