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Introduction: Academic dermatologists in Australia and New Zealand provide high‐quality and meaningful contributions to the understanding of disease and therapeutic translational research. Concerns have been raised by the Australian Medical Association regarding the decline of clinical academics in Australia as a whole, however, such trends in scholarly output have not previously been analysed for Australasian dermatologists. Methods: A bibliometric analysis of dermatologists in Australia and New Zealand was conducted in January and February 2023. Available Scopus profiles for all dermatologists were used to measure lifetime H index, scholarly output, citation counts and field‐weighted citation impact (FWCI) in the last 5 years (2017–2022). Trends in output over time were measured using non‐parametric tests. Differences in output between subgroups stratified by gender and academic leadership positions (associate professor or professor) were measured using Wilcoxon rank‐sum and one‐way ANOVA tests. The scholarly output of recent College graduates was also analysed as a subgroup, comparing the same bibliographic variables in the 5 years preceding and 5 years following awarding of their fellowships. Results: From the 463 practising dermatologists in Australia and New Zealand, 372 (80%) were successfully matched to Scopus researcher profiles. Of these dermatologists, 167 were male (45%) and 205 (55%) were female, and 31 (8%) held academic leadership positions. Most dermatologists (67%) published at least one paper in the last 5 years. The median lifetime H index was 4, and between 2017 and 2022 median scholarly output was 3, the median citations were 14 and the median FWCI was 0.64. There was a non‐significant trend towards fewer publications per year, however, citation count and FWCI decreased significantly. By subgroups, female dermatologists published significantly more papers between 2017 and 2022, and other bibliographic variables were comparable to male dermatologists. However, women were underrepresented in positions of academic leadership—comprising only 32% of this cohort despite representing 55% of dermatologists. Professors were also significantly more likely to have higher bibliographic outcomes than associate professors. Finally, analysis of recent College graduates highlighted a significant decline in bibliometric outcomes pre‐ and post‐fellowship. Conclusion: Overall, our analysis identifies a trend towards decreased research output by dermatologists in Australia and New Zealand in the last 5 years. Strategies to support dermatologists in research endeavours, particularly women and recent graduates, will be essential in maintaining strong scholarly output among Australasian dermatologists and thereby sustaining optimal evidence‐based patient care. [ABSTRACT FROM AUTHOR]

Thus, no cases of true cribriform or wrinkled paper scarring were seen in any of the 62 scars with 59 of them ultimately healing with smooth and even scars. Reported examples of cribriform scarring and wrinkled paper scarring appear to be examples of incomplete epithelialisation or residual scaliness rather than true scarring.2,5 Our cases suggest that these changes resolve with continued healing or maturation of the scar. [Extracted from the article]

Sirolimus is a mammalian target of rapamycin inhibitor (mTORI) with anti‐proliferative, antiangiogenic and immunosuppressive properties. While approved in Australia as an anti‐rejection medication for renal transplant patients, there is mounting evidence regarding the utility of oral and topical sirolimus in treating a plethora of dermatological conditions or conditions with cutaneous manifestations. Our aim was to present an overview of the evidence for current usage and breadth of the application of sirolimus in dermatology. We carried out a systematic review of all the literature published up to 31 August 2019 on oral and topical sirolimus with respect to dermatological conditions or conditions otherwise relevant to dermatology. While 3368 papers were initially produced in our search, 238 papers met our inclusion criteria and were examined in our review. The conditions examined were categorised into genodermatoses (9 conditions), infection (1 condition), inflammatory/autoimmune (10 conditions), neoplasm (3 conditions) and vascular (17 conditions). We extracted data on first author, publication year, journal, characteristics of the study and study patients, condition, drug modalities, drug efficacy, side effects, blood level of mTORI, co‐interventions and follow‐up. While there is level 1 evidence for the efficacy of sirolimus in conditions such as tuberous sclerosis complex (TSC) and GVHD prophylaxis, for many other conditions, the evidence is limited to level 4 evidence. Regarding oral systemic therapy, dosing regimens varied with the most common for children 0.8mg/m2 twice daily and for adults 1 mg twice daily. Doses were often adjusted to reach a typical trough level of between 5 and 15 ng/mL, though targets often varied. In the overall majority of cases, side effects were minimal or tolerable, including mucositis, cytopenias, lipid abnormalities and nausea/vomiting, and only a few cases had to stop due to adverse effects. Regarding topical therapy, concentration of formulations varied from 0.1% to 1% and were compounded into creams, ointments or gels and administered typically once or twice per day. The most common side effect was skin irritation. There were a number of limitations to our study. In particular, many of the published studies were case reports or case series with no comparator arm, leading to susceptibility of bias in conclusions drawn, in particular a high likelihood of publication bias. Given the heterogeneity amongst studies, comparisons or aggregation of results was difficult. There continues to be growing use of oral and topical sirolimus in dermatological conditions. It provides new therapeutic options to patients where previous therapies have either failed or are limited due to toxicity. However, further studies are warranted. [ABSTRACT FROM AUTHOR]

Vitiligo is a chronic depigmenting disorder that significantly impacts the quality of life of patients. Though there have been significant advancements in targeted therapies in skin diseases such as psoriasis or eczema, the progress in the treatment of vitiligo has been slow, with minimal studies assessing the effect of biologics, though there has been recent evidence of the effectiveness of JAK inhibition. This paper reviews the published case reports and studies for the use of systemic targeted therapies including biologics and JAK inhibitors in vitiligo. [ABSTRACT FROM AUTHOR]

Treatment with Hedgehog Inhibitors in Gorlin‐Goltz syndrome (GGS) yields favourable objective clinical responses, yet secondary resistance and class‐related toxicity restrict treatment duration. This study aims to review current data on GGS patients undergoing vismodegib therapy, focusing on treatment duration, clinical outcomes and schedule modifications. A systematic search of the PubMed database was conducted for English articles from 1993 to 2023, identifying 31 papers suitable for inclusion. A total of 351 patients, with a mean age of 52 years, were analysed. The average treatment duration was 9.3 months for patients who discontinued treatment, and 25.1 months for those who continued vismodegib at the time this study was published. Vismodegib achieved a complete response rate of 44%. Treatment interruption predominantly occurred due to side effects (69.1%) and secondary resistance (9.1%). The use of alternative regimens, although not compromising efficacy, may enhance treatment compliance. Further investigations are warranted to ascertain the optimal treatment regimen and timeline for GGS patients. Schedule modifications offer promise in ameliorating side effects and facilitating long‐term treatment. [ABSTRACT FROM AUTHOR]

Primary focal hyperhidrosis (PFH) is an idiopathic excessive perspiration not related to external factors such as stress or temperature.[[1], [3]] In children, this condition usually involves the palms.[[2], [4]] PFH has its onset during childhood[[5]] and has an estimated prevalence of 3%.[[4], [7]] PFH is associated with profound levels of physical and social distress, having great impact on quality of life.[4] Children have difficulties in performing simple tasks, such as handling writing utensils or keeping papers dry.[4] Bilateral thoracoscopic sympathotomy (BTS) has become standard of care for PFH[3] as is safe and effective in paediatric patients.[[8]] The aim of this study is to evaluate effectiveness and satisfaction with BTS in paediatric age. We recommend BTS as treatment of choice for PFH patients. RESULTS Thirty-four patients were submitted to BTS; two patients were discharged after the first 24 hours due to residual pneumothorax, resolved with oxygen therapy. [Extracted from the article]

Background/Objectives: Non‐invasive skin imaging features of main skin inflammatory and autoimmune diseases have been reported, although a comprehensive review of their correlation with histopathologic features is currently lacking. Therefore, the aim of this paper was to review the correlation of dermoscopic, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) criteria of main inflammatory and autoimmune skin diseases with their corresponding histopathologic criteria correlation. Methods: Studies on human subjects affected by main inflammatory and autoimmune diseases, defining the correlation of dermoscopic, RCM or OCT with histopathologic criteria, were included in the review. Five groups of diseases were identified and described: psoriasiform, spongiotic and interface dermatitis, bullous diseases and scleroderma. Results: Psoriasiform dermatitis was typified by white scales, corresponding to hyperkeratosis, and vessels, observed with RCM and OCT. Spongiosis, corresponding to dark areas within the epidermis with RCM and OCT, was the main feature of spongiotic dermatitis. Interface dermatitis was characterised by dermoepidermal junction obscuration. Blisters, typical of bullous diseases, were visualised as dark areas with RCM and OCT while scleroderma lesions were characterised by dermoscopic fibrotic beams, related to dermal thickness variations, with specific OCT and histopathologic correlations. Conclusions: Although the role of RCM and OCT has yet to be defined in clinical practice, non‐invasive skin imaging shows promising results on inflammatory and autoimmune skin diseases, due to the correlation with histopathologic features. [ABSTRACT FROM AUTHOR]

We read with interest the paper by I Kok et al i . regarding initial biopsy technique in melanoma diagnosis.1 Shave biopsy is singled out for criticism. I Shao et al i . reported fifty consecutive melanomas diagnosed by shave excision with no base transections, and a rate of lateral margin involvement equivalent to elliptical excision.3 I Pitney et al i . looked at 227 consecutive melanomas. The proportion of partial biopsies by shave technique in patients referred to the Victorian Melanoma Service (VMS) increased from 42% in 2014-16 to 44.6% in 2017-19.1 The high rate of margin involvement in I Kok et al i . can likely best be explained by widespread, intentional partial biopsy. [Extracted from the article]

A wood lamp is used at the time of excision to identify siteBiopsy tools can be stained easilySafe, cheap and accuratePatient's may not like itRisk of granulomatous reaction/allergyFluorescence can be variable at f/upSmartphone/online apps (e.g. Private photo [Linkus], Dermengine)Utilises applications that are readily downloadable on both iPhone and android smartphones. Frozen Section or watch and wait methods also part of protocol algorithmLarge studyGreat efficacy demonstrated.0 cases of wrong-site surgery.18 cases (0.2%) of failure of biopsy site identificationSingle clinical site/single practitionerUnclear frequency of use of techniques including photographyRetrospective study.Possible documentation errorsPossible recall and confirmation biasIbrahim5Practitioner perspective - no formal study designLevel V - Expert opinionDecision-tree is helpful in clinical practice. [Extracted from the article]

Jacquet erosive dermatitis (JED) is a rare, severe form of napkin dermatitis associated with friction and irritant exposure in the napkin area. The condition typically causes erosions and erythematous punched‐out ulcerations. We present two cases of JED in infants associated with the use of a common brand barrier cream Curash. This appeared to present following a change of several active ingredients. [ABSTRACT FROM AUTHOR]

Reflectance confocal microscopy (RCM) is a non-invasive imaging technique with high sensitivity and specificity used for the diagnosis of equivocal skin lesions.1 More recently, it has been used to assess for residual tumour or tumour recurrence after surgery. To assess whether RCM may be more efficacious than dermoscopy, Navarrete-Dechent I et al i . retroactively analysed 30 areas of pigmentation with a mean recurrence time of 5.6 years.4 The most common RCM features found to be significant for LM/LMM were the presence of bright large nucleated cells at the dermal/epidermal junction, folliculotropism and dendritic cells. Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are histologically distinct forms of melanoma where surgery is the gold standard. [Extracted from the article]

Background/Objectives: There is limited literature focussing on the demographics of patients presenting to public dermatology outpatient clinics, with an even smaller amount focussing on clinics in regional Australia. This study presents the first patient demographic analysis for the Cairns Hospital's Dermatology Outpatient Department and analyses the cohort of patients who did not attend their appointments. In doing so, it recommends potential strategies that should be considered to address the issues of patient absenteeism and wait times in a regional setting, while also suggesting future data points that should be collected for analysis. Methods: A 4‐year retrospective cohort study using demographic data from all referrals with medical officers (N = 10,333) from 1 January 2018 to 31 December 2021 at the Cairns Hospital Dermatology Outpatient Department. The hospital is the only facility with a dermatology service within the Cairns and Hinterland Hospital and Health Service. Data were extracted from the Cairns Hinterland Analytical Intelligence (CHAI) system. Results: Data pertaining to patient demographics, attendance of appointments, triage categories and wait times were collected and reviewed for patients referred during the study period. Conclusion: The Dermatology Outpatient Department services an ever‐growing and diverse patient cohort. Barriers to access and long wait times exist for patients referred to the Department. Strategies to combat these issues, such as an increase in funding and resourcing, should be considered to better optimise patient care and the utilisation of health resources. [ABSTRACT FROM AUTHOR]

Linear IgA/IgG bullous dermatosis (LAGBD) is a relatively rare autoimmune bullous disease characterized by both IgA and IgG antibodies to basement membrane zone. The heterogeneity and pathogenesis of antibodies and the relationship between IgA and IgG in LAGBD have not been fully elucidated. We observed clinical, histological and immunological features of three LAGBD cases at different time points in the disease course. In our cohort, two cases showed IgA antibodies to epidermal antigens vanished when their lesions cleared after 3 months of treatment. One refractory case showed increasing antigens targeted by IgA antibodies with the progression of the disease. Collectively, the results suggest that IgA antibodies may play a major role in LAGBD. In addition, epitope spreading may be related to disease relapse and treatment refractory. [ABSTRACT FROM AUTHOR]

Background: Risk prediction tools have been developed for keratinocyte cancers (KCs) to effectively categorize individuals with different levels of skin cancer burden. Few have been clinically validated nor routinely used in clinical settings. Objectives: To assess whether risk prediction tool categories associate with interventions including chemoprophylaxis for skin cancer, and health‐care costs in a dermatologist‐run screening clinic. Methods: Adult participants who presented to a walk‐in screening facility were invited to participate. A self‐completed KC risk prediction tool was used to classify participants into one of the five risk categories. Participants subsequently underwent full skin examination by a dermatologist. Dermatological interventions and skin cancer‐related medical prescriptions were documented. Total health‐care costs, both to the health‐care system and patients were evaluated. Results: Of the 507 participants recruited, 5‐fluorouracil cream and nicotinamide were more frequently prescribed in the higher risk groups as chemoprophylaxis (p < 0.005). A significant association with high predicted risk was also observed in the use of cryotherapy and curettage and cautery (p < 0.05). The average health‐care costs associated with a skin check visit increased from $90 ± 37 (standard deviation) in the lowest risk group to $149 ± 97 in the highest risk group (p < 0.0001). Conclusions: We observed a positive association between higher predicted risk of skin cancer and the prescription of chemoprophylaxis and health‐care costs involved with opportunistic community skin cancer screening. A clinical use of risk stratification may be to provide an opportunity for clinicians to discuss skin cancer prevention and chemoprophylaxis with individual patients. [ABSTRACT FROM AUTHOR]

Background/objectives: Artificial intelligence (AI) holds remarkable potential to improve care delivery in dermatology. End users (health professionals and general public) of AI-based Software as Medical Devices (SaMD) require relevant labelling information to ensure that these devices can be used appropriately. Currently, there are no clear minimum labelling requirements for dermatology AI-based SaMDs., Methods: Common labelling recommendations for AI-based SaMD identified in a recent literature review were evaluated by an Australian expert panel in digital health and dermatology via a modified Delphi consensus process. A nine-point Likert scale was used to indicate importance of 10 items, and voting was conducted to determine the specific characteristics to include for some items. Consensus was achieved when more than 75% of the experts agreed that inclusion of information was necessary., Results: There was robust consensus supporting inclusion of all proposed items as minimum labelling requirements; indication for use, intended user, training and test data sets, algorithm design, image processing techniques, clinical validation, performance metrics, limitations, updates and adverse events. Nearly all suggested characteristics of the labelling items received endorsement, except for some characteristics related to performance metrics. Moreover, there was consensus that uniform labelling criteria should apply across all AI categories and risk classes set out by the Therapeutic Goods Administration., Conclusions: This study provides critical evidence for setting labelling standards by the Therapeutic Goods Administration to safeguard patients, health professionals, consumers, industry, and regulatory bodies from AI-based dermatology SaMDs that do not currently provide adequate information about how they were developed and tested., (© 2024 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)

For tumours of the ear that are suspected to involve auricular cartilage, precise definition of the extent of involved deep margin can be difficult. As large resections of cartilage can be cosmetically disfiguring with limited repair options, we propose a simple and effective technique to facilitate a targeted deep margin resection using a curette and a surgical marking pen. [ABSTRACT FROM AUTHOR]

Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited. [ABSTRACT FROM AUTHOR]

Background/Objective: Photographic aides are increasingly used in melanoma surveillance. We report melanoma characteristics detected using traditional surveillance without photographic technologies. Methods: Retrospective study of melanomas diagnosed by three dermatologists at a private dermatology practice over 7 years. Patients underwent full skin examinations with dermoscopy and suspect lesions were excised or biopsied. Total body photography (TBP) and serial digital dermoscopic imaging (SDDI) were not used. Patient demographics, melanoma subtype and thickness, location, biopsy technique and keratinocyte cancers diagnosed at the same visit were recorded. Ratio of in situ to invasive melanomas was calculated. Melanoma risk factors were recorded for 69 randomly‐selected patients. Results: 492 patients were diagnosed with 615 melanomas during 579 visits. 505 (82%) were in situ (in situ to invasive ratio of 4.6:1). Of the invasive melanomas, 85.5% had a Breslow thickness <0.8 mm, 10 (9.1%) 0.8–1 mm and 6 (5.5%) >1 mm. 43.3% of in situ melanomas were lentiginous or lentigo maligna and 41.6% were superficial spreading melanomas (SSM). Of invasive melanomas, 24.3% were lentigo maligna melanoma and 59.5% were SSM. 48.4% of melanomas were diagnosed by shave procedures. Where risk factors were known, 25% were very‐high‐risk and 43% had a history of melanoma. Keratinocyte carcinoma was diagnosed by biopsy at 26.1% of visits. Studies using TBP and/or SDDI report in situ to invasive ratios of 0.59:1 to 2.17:1. Conclusion: Tradiational melanoma surveillance with immediate biopsy of suspect lesions results in high in situ to invasive ratios. Studies using photographic surveillance show lower ratios of in situ to invasive disease. [ABSTRACT FROM AUTHOR]

Background: Despite a high frequency of dermatological general practice and emergency department presentations, including serious and potentially fatal skin conditions, evidence suggests that undergraduate dermatological education remains sparse. Given this, there exists a need to gauge dermatology‐relevant knowledge and skill in our new doctors. Methods: An online survey was completed by final‐phase medical students and junior doctors from Australian medical schools. The survey appraised self‐perceived confidence of dermatology knowledge and skills, in addition to 5 knowledge‐based multiple‐choice questions. Results: Nine hundred and forty‐two eligible responses were completed. Respondents reported low confidence in identifying dermatological conditions in people with skin of colour (μ = 1.69), handing over to dermatology colleagues (μ = 2.00) and in diagnosing and managing acute/emergency dermatology conditions (μ = 1.84). In contrast, participants felt most confident in counselling sun‐protective behaviours (μ = 3.95) and suturing small wounds (μ = 3.43). 76.4% of respondents had not undertaken any dermatology placement, and 70.9% had never been formally assessed in dermatology. Those who received dermatology placement had a significantly higher aggregated self‐reported confidence (p < 0.0001) and answered significantly more MCQs correctly (p = 0.0419). Those who had been formally assessed had a significantly higher self‐reported confidence (p < 0.001) and answered significantly more MCQs correctly (p = 0.007). Conclusion: Final‐phase medical students and junior doctors exhibit low confidence across many dermatology competencies. Participants believed they need more dermatology education, and seldom feel prepared when exposed to dermatologic pathologies. Introduction of a standardised curriculum, formal assessments and increased clinical exposure are possible solutions. [ABSTRACT FROM AUTHOR]

As we commence treatment with the Isotretinoin or Vit A,we eventually reduce size and activity of sebaceous glands, measured clinically by reduced acne and surface dryness. George Varigos I Royal Melbourne Hospital, Parkville, Victoria, Australia i Sebaceous glands secrete a lipid rich sebum which functions in the skin as maintaining the microbiome, skin integrity, thermoregulatory and UV protection. However the common occurrence of elevation of Lipids in 10 to 40% of these patients, which often correlates with effectiveness of treatment may be otherwise explained by this new understanding of sebaceous gland and lipid mobilisation. [Extracted from the article]

Background: Investigation of tools used for candidate selection as predictors of future performance in medical education has been primarily undertaken within the undergraduate setting, but little is known about the selection to medical specialist programs. This retrospective longitudinal study aims to explore correlations between selection tools and the performance of trainees enrolled in the Australasian College of Dermatologists (ACD), the accredited specialist medical college for training in dermatology in Australia. Methods: Data were collected from consecutive cohorts of ACD trainees commencing from 2007 to 2015. Predictive variables were trainee demographics and selection tools (prior academic qualification; research experience; clinical experience; curriculum vitae [CV] rating; interview scores). The outcome variables were exam performance. First Year ([Pharmacology and Clinical Sciences] and Fellowship Exam [Written, Clinical, and Overall Score]). Statistical analyses included: descriptive statistics summaries; bivariate correlation of selection criteria and demographic data with exam performance; and linear regression analysis to identify predictors of exam performance. Results: Demographic analysis (N = 172) showed that 64% of trainees were female, the average age was 30.5 years (± 3.47) and trainees living in high socioeconomic status (SES) areas were over‐represented. Using Pearson correlation analysis, interview scores were significantly positively correlated with First Year Pharmacology results (p = 0.018), Fellowship Written results (p = 0.002), and Fellowship Overall Scores (p = 0.006). First Year Pharmacology Exam performance was most highly correlated with Fellowship Exam performance (p = 0.000). No association was identified between exam performance and gender, SES, prior academic qualification, research experience or CV rating. Linear regression analysis showed that interview score (p = 0.012), entry age (p = 0.026) and First Year Pharmacology score (p = 0.002) were predictors of Fellowship exam performance. Conclusion: These results suggest that the comprehensive selection tools used by ACD are effective, with interviews being a highly valid tool linked to exam performance. These findings have important practical implications for assessing the selection process in specialist dermatology training. [ABSTRACT FROM AUTHOR]

Therefore, the mechanisms that promote interactions between metastatic tumour cells and activated tumour-associated lymphatic endothelium in primary tumours and draining lymph nodes should be investigated in more detail to prevent and treat EMPD. Extramammary Paget's disease (EMPD) is a rare tumour presenting with an erythematous spread in elderly patients, mainly in the genital region.[[1]] It is most common in Caucasian women, but in Asian populations, there is a male predominance.[[3]] Given the rarity of this disease, limited studies have reported the 5-year outcomes on the Chinese population; hence a comprehensive survival analysis on the Chinese mainland is still lacking. Additional prospective data are needed to clarify the characteristics of high-risk EMPD patients and to further identify better and more effective superior management approaches to recurrent and potential tumour metastasis. [Extracted from the article]

Background: Skin grafting reflects a common dermatological procedure for closing skin defects. Patient education is important for managing expectation and optimising skin graft take. While health information is increasingly accessed on the internet, there are no existing studies assessing their quality. Methods: The first 25 results from Google, Microsoft Bing and Yahoo! search engines using the term 'skin graft' were analysed using a variety of standard instruments. Readability was assessed using the Flesch–Kincaid Grade score (FKG), Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG) and the New Dale‐Chall Readability Index (NDC). Reliability was assessed using the DISCERN instrument and credibility with the Journal of the American Medical Association Benchmark Criteria (JAMA). Transparency was identified by presence of the Health On the Net Foundation Code certification (HON‐code). Results: Seventy‐five websites were identified. After exclusion, forty‐three remaining websites were analysed with average FKG, GFI and SMOG scores of 7.8, 10.1 and 10.7, respectively. The average NDC was 5.9. The average reliability was fair with a DISCERN score based on the first 15 questions of the instrument of 42.6. The mean JAMA score was 2, and 9 websites displayed the HON‐code certificate. Conclusions: Readability, reliability and credibility of online health information regarding skin grafting can be improved. Health care providers should critically assess existing online patient information or develop alternative material to educate patients undergoing skin graft surgery. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) is the ability for computers to simulate human intelligence. In dermatology, there is substantial interest in using AI to identify skin lesions from images. Due to increasing research and interest in the use of AI, the Australasian College of Dermatologists has developed a position statement to inform its members of appropriate use of AI. This article presents the ACD Position Statement on the use of AI in dermatology, and provides explanatory information that was used to inform the development of this statement. [ABSTRACT FROM AUTHOR]

Globally, healthcare systems can account for up to 10% of national CO 2 emissions. There is increasing awareness of the need to act to reduce the impact on our planet by living sustainably in our personal and professional lives. Literature on sustainability can be complex, and with so many demands on our attention and time, it is challenging for the practising dermatologist to grasp where to begin. This manuscript provides a practical guide with quantifiable impacts for each action. With mindful use of resources, both profitability and the well-being of patients and doctors can align with environmental protection., (© 2023 Australasian College of Dermatologists.)

Background/Objectives: Dupilumab‐associated ocular surface disease (DAOSD) is of particular relevance in patients with atopic dermatitis (AD). Guidance on DAOSD assessment and management in the Australian setting is needed to reduce its impact and minimise disruption to treatment. Methods: A systematic review of the literature was undertaken to identify data pertaining to the incidence, pathophysiology, risk factors and management of DAOSD. A critical review of this literature was used to inform a decision framework for dupilumab‐prescribers and develop a graded severity scoring tool to guide appropriate management options. Results: DAOSD typically emerges within 4 months of commencing dupilumab and the occurrence of new events diminishes over time. The reported incidence varies widely depending on the nature and source of the data: 8.6–22.1% (clinical trials programme), 0.5–70% (real‐world data; differences in study size, duration of follow‐up, ophthalmologist intervention, use of prophylaxis). Occurrence increases with AD severity and in patients with prior history of ocular disease; pathophysiology is still to be fully characterised. Management options have evolved over time and include lubricants/artificial tears, corticosteroids, calcineurin inhibitors, antihistamines, anti‐inflammatory agents and antimicrobial agents. Current therapies aim to resolve symptoms or reduce severity to levels sufficiently tolerable to enable continuation of dupilumab therapy. Conclusions: Recommendations for DAOSD assessment and management include identification of high‐risk patients, vigilance for red flags (keratoconus, herpetic and bacterial keratitis), regular assessment of symptom severity (before and during dupilumab therapy), conservative management of mild DAOSD by the prescribing physician and ophthalmologist referral for collaborative care of moderate–severe DAOSD and high‐risk patients. [ABSTRACT FROM AUTHOR]

Discoid (nummular) eczema is a common and distinctive eczema variant, which has not been studied in depth. Although the principles of management are similar to that of classic atopic dermatitis, distinctions are made due to its unique presentation and persistent clinical course in children. Australian and New Zealand dermatologists with an interest in paediatric eczema developed a consensus narrative to assist clinicians in diagnosing and treating this subtype of eczema. Identifying triggers, potent topical corticosteroids under occlusion, skin barrier support and management of pruritus are first‐line therapies, however, many eventually require systemic immunomodulatory agents. [ABSTRACT FROM AUTHOR]

Symmetrical drug‐related intertriginous and flexural exanthema (SDRIFE), previously termed drug‐related baboon syndrome, is an uncommon drug eruption. It is characterized by symmetrical erythema involving the gluteal and/or inguinal area in association with one other intertriginous area in the absence of systemic involvement. It typically develops a few hours to days after drug exposure. The diagnosis is based on clinical presentation and drug history. The treatment consists mainly of withdrawal of the causative agent; corticosteroids (topical or systemic) are prescribed to accelerate the resolution. We present three cases that appeared after proton‐pump inhibitors (PPIs) intake. [ABSTRACT FROM AUTHOR]

Toxic epidermal necrolysis (TEN) is a rare and life‐threatening mucocutaneous disease triggered by a reaction to a drug. Despite reported mortality of 30%, management differs between healthcare settings. Our hospital was established in February 2015 becoming the new state burns centre in Western Australia (WA). Following this, we collaborated on comprehensive multidisciplinary guidelines for the management of TEN. These guidelines are updated annually to reflect the weight of emerging evidence in managing TEN. Our aim was to review the management and outcomes of TEN patients presenting to our hospital between February 2015 and May 2021 (inclusive). We collected data for 10 patients on year, age, ethnicity, gender, medical history, culprit drug and exposure, SCORTEN, length of stay, maximum percentage of skin detachment, mucosal surface involvement, ophthalmic amniotic membrane transplant, burns unit input/admission, intensive care unit admission, weight, systemic treatment(s), complications and outcome. We excluded 7 out of 17 flagged patients who did not strictly meet the definition of TEN as greater than 30% epidermal detachment, with epidermal detachment defined as bullae, erosions, and/or positive Nikolsky. We found that the mortality rate in WA from TEN is improving compared with two previous WA studies, with a mortality rate in our study of 20% (2 deaths). Though limited by small sample size and retrospective design, our study suggests a shift towards at least one systemic therapy per patient (most commonly cyclosporine), the growing use of etanercept and the ophthalmic use of amniotic membrane transplants. It demonstrates the importance of burns unit input and the utility of comprehensive multidisciplinary guidelines. While the management and outcomes of TEN patients in WA are continuing to improve, we support calls for large registry data to facilitate evidence growth and collaboration for this rare life‐threatening condition. [ABSTRACT FROM AUTHOR]

Psoriasis is one of the most prevalent diseases in the world and it affects up to 2% of the worldwide population. Its pathogenesis is complex and the lesions may be triggered by multiple factors. Human papillomavirus (HPV) is associated with anogenital cancers, cutaneous warts and is considered one of the most prevalent infections in the world. In this review, the available literature on the systemic treatment of patients with psoriasis and concomitant HPV infection was analysed. [ABSTRACT FROM AUTHOR]

We present a case of a neonate who presented with multiple cutaneous and subcutaneous nodules, which was found to be metastatic embryonal rhabdomyosarcoma. Rhabdomyosarcoma is a soft tissue malignancy that usually occurs in children aged one to five but is rare in neonates. The histopathological analysis and molecular genetics are important in the classification of subtype and in guiding treatment options and informing prognosis. [ABSTRACT FROM AUTHOR]

Background: Clinical quality registries aim to identify significant variations in care and provide anonymised feedback to institutions to improve patient outcomes. Thirty‐six Australian organisations with an interest in melanoma, raised funds through three consecutive Melanoma Marches, organised by Melanoma Institute Australia, to create a national Melanoma Clinical Outcomes Registry (MelCOR). This study aimed to formally develop valid clinical quality indicators for the diagnosis and early management of cutaneous melanoma as an important step in creating the registry. Methods: Potential clinical quality indicators were identified by examining the literature, including Australian and international melanoma guidelines, and by consulting with key melanoma and registry opinion leaders. A modified two‐round Delphi survey method was used, with participants invited from relevant health professions routinely managing melanoma as well as relevant consumer organisations. Results: Nineteen participants completed at least one round of the Delphi process. 12 of 13 proposed clinical quality indictors met the validity criteria. The clinical quality indicators included acceptable biopsy method, appropriate excision margins, standardised pathology reporting, indications for sentinel lymph node biopsy, and involvement of multidisciplinary care and referrals. Conclusion: This study provides a multi‐stakeholder consensus for important clinical quality indicators that define optimal practice that will now be used in the Australian Melanoma Clinical Outcomes Registry (MelCOR). [ABSTRACT FROM AUTHOR]

Background: Over the last decade, the treatment landscape for moderate-severe psoriasis has rapidly evolved. The Australasian College of Dermatologists sought to review and update previously published treatment goals for moderate-severe psoriasis., Methods: A modified Delphi approach was used. Comprehensive literature review and guideline evaluation resulted in the development of statements and other questions to establish current clinical practices. Two rounds of anonymous voting were undertaken, with a collaborative meeting held in between to discuss areas of discordance. Overall, consensus was defined as achievement of ≥75% agreement in the range 7-9 on a 9-point scale (1 strongly disagree; 9 strongly agree)., Results: Consensus was achieved on 26/29 statements in round 1 and a further 20 statements in round 2. There was strong agreement to expanding the classification/definition of psoriasis severity by including a choice of metrics, incorporating quality of life measures, and widening the scope of high-impact sites. Consensus was also reached on revised treatment response criteria, which were then incorporated into a new treatment algorithm. There was discordance with the current requirement to undertake a trial with established systemic agents before accessing targeted therapy., Conclusion: The ability of new targeted treatment options to change the narrative in psoriasis patient care can only be properly realised if challenges to timely and equitable access are addressed. The proposed framework for the assessment, classification and management of moderate-severe psoriasis aligns with international recommendations. Its adoption into Australian clinical practice is hoped to improve treatment outcomes and patients' satisfaction with their care., (© 2023 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)

He also had treatment-resistant disease requiring high-dose glucocorticoid steroid treatment and trialling of multiple steroid-sparing agents to manage disease flares. Kelvin Truong SP 1 sp , Shimren Rajbhandari SP 1 sp , Jennifer Kim SP 2 sp , Abiramy Ragunathan SP 3 sp , Raquel Ruiz Araujo SP 1 sp SP I 1 i sp I Department of Dermatology, Westmead Hospital, Westmead, Australia i SP I 2 i sp I Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research (ICPMR) Westmead Hospital, Westmead, Australia i SP I 3 i sp I Westmead Familial Cancer Service, The Crown Princess Mary Cancer Centre Westmead, Westmead, Australia i B Aim: b CYLD Cutaneous Syndrome is a rare genetic syndrome characterised by multiple tumour formation of the skin appendages in the head and neck region. Mortality with VEXAS syndrome is high, and patients often have severe, treatment-refractory disease. Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is a recently identified disorder describing patients with adult-onset autoinflammatory conditions such as Sweet's syndrome who have associated haematological dysfunction. [Extracted from the article]

Background and objective: General practitioners manage more melanomas than dermatologists or surgeons in Australia. Previously undescribed, the management and outcomes of melanoma patients treated by multiple Australasian general practitioners are examined. Methods: The characteristics, management and outcomes of 589 melanoma patients, managed by 27 Australasian general practitioners and documented on the Skin Cancer Audit Research Database (SCARD), were analysed. Results: Most patients (58.9%) were males with mean age at diagnosis of 62.7 years (range 18–96), and most melanomas were in situ or thin‐invasive. Patients aged under 40 years had fewer melanomas, but a higher proportion (the majority) were invasive, compared with older patients (P < 0.0001). Most (55.9%) melanomas were diagnosed following elliptical excision biopsy, the rate of unintended involved margins being eightfold higher for shave biopsies. Wide re‐excision was performed by the treating general practitioner for most (74.9%) melanomas, with thick melanomas preferentially referred to surgeons. The average Breslow thickness of invasive melanomas re‐excised by general practitioners was 0.67 mm compared with 1.99 mm for those referred to other specialists (P < 0.0001). Of 205 patients with invasive melanoma, 14 progressed to metastatic disease, 50% of these being associated with nodular melanoma. Nine patients progressed to melanoma‐specific death. The 5‐year survival rate for patients with invasive melanoma was 95.2% (95% CI: 91.2–98.5%). Conclusions: Diagnostic and therapeutic management of a series of melanoma patients by Australasian general practitioners were closely aligned with current guidelines and 5‐year survival with respect to invasive melanoma was at least as favourable as national population‐based metrics. [ABSTRACT FROM AUTHOR]

Idiopathic eruptive macular hyperpigmentation is a rare entity that should be considered in the differential diagnosis for children or adolescents presenting with hyperpigmentation disorders. Sarah amr Dawood SP 1 sp , Richard Goodwin SP 2 sp SP I 1 i sp I NHS, ULVERSTON, United Kingdom i SP I 2 i sp I Aneurin Bevan University Health Board i Epidermolysis bullosa acquisita (EBA) is a rare autoimmune condition that typically presents in the fourth or fifth decade of life. Abnormal hair that is sparse, short, brittle, fragile is characteristic of a range of isolated hereditary hair shaft disorders, with variable sparing of non-scalp hair. Idiopathic eruptive macular hyperpigmentation may be underdiagnosed as it is often mistaken for disorders that are morphologically very similar including lichen planus pigmentosus, ashy dermatosis, fixed drug eruption, urticaria pigmentosa, and post-inflammatory hyperpigmentation. [Extracted from the article]

We identified 118 patients and assessed patient demographics, associated conditions, comorbidities; number and size of the PG ulcers, anatomical location; subtype of PG, pathergy, histology, immunosuppressive therapy and prophylaxis used to prevent adverse effects of corticosteroid and immunosuppressive therapy B Results: b Of the 118 patients, 74 (63%) were female and 97% were Caucasian. Real-world disease characteristics and treatment patterns amongst patients with atopic dermat... Saxon D Smith SP 1 sp , Patrick Mahar SP 2 sp , David Truong (Non-Author Presenter) SP 3 sp , Can Mert SP 4 sp , John W Frew SP 5 sp SP I 1 i sp I Department of Dermatology, Sydney Adventist Hospital, Wahroonga, New South Wales, Australia,The Dermatology and Skin Cancer Centre, Gosford, Sydney, New South Wales, Australia, ANU Medical School, ANU College Health and Medicine, The Australian National University, Canberra, Australia i SP I 2 i sp I Eli Lilly and Company, West Ryde, Australia i SP I 3 i sp I Eli Lilly and Company, Australia i SP I 4 i sp I HaaPACS GmbH, Schriesheim, Germany i SP I 5 i sp I University of New South Wales, Ingham Institute of Applied Medical Research, Department of Dermatology Liverpool Hospital, Sydney, Australia i B Aims: b Atopic dermatitis (AD) is a complex, heterogenous disease that remains difficult to treat. Pyoderma Gangrenosum - A review of patient demographics, disease and treatment in 118 patient... Anthony Honigman SP 1 sp , Robert Kelly SP 2 sp SP I 1 i sp I Royal Melbourne Hospital, Melbourne, Australia i SP I 2 i sp I St Vincent's Hospital, Melbourne i B Aim: b To review and describe the epidemiology, presentation and management of patients diagnosed with pyoderma gangrenosum (PG) at St Vincent's hospital Melbourne (SVHM) Method: We reviewed patients with a diagnosis of PG treated at SVHM from January 20021 to November 2020. [Extracted from the article]

Lichen planus pemphigoides (LPP) and bullous lichen planus (BLP) are rare dermatoses, which are characterised by blisters and lichenoid lesions. Their clinical presentation is heterogenous, displaying overlapping features or mimicking other dermatological diseases. Therefore, diagnosis can often be challenging, requiring a thorough dermatological examination along with distinctive histological and immunopathological characteristics. Lichenoid degeneration of the basal epidermis exposes various antigens of the dermal–epidermal junction in LPP, resulting in the breakdown of immune tolerance, hence, the production of autoantibodies against type XVII collagen. Conversely, no pathogenic autoantibodies are detected in BLP. However, some cases of mucosal lichen planus might display immunopathological features suggestive of autoimmune blistering diseases. Therefore, a better understanding of the pathophysiology of these two distinct dermatoses is imperative. The aim of this review was to provide a summary of the current knowledge on the clinical hallmarks, diagnosis and available therapeutic options in LPP and BLP. [ABSTRACT FROM AUTHOR]

Background: Histone deacetylase 1 (HDAC1) belongs to class I histone deacetylases, which are zinc‐dependent enzymes that remove the acetyl group from histones and other proteins providing epigenetic regulation of gene expression. It plays an important role in the hair follicle and epidermal homeostasis in addition to its immunomodulatory roles. Alopecia areata (AA) and acne vulgaris are common skin diseases in which epigenetic factors have been proposed. However, studies of epigenetic modifications in both diseases are quite limited. Objective: This study aimed at elucidation of HDAC1 deregulation in AA and acne vulgaris. Methods: A case‐control study was conducted on 76 participants: 25 patients with patchy alopecia areata, 26 patients with acne vulgaris and 25 healthy controls. Blood samples were collected for the measurement of HDAC1 level by ELISA. Results: A significant difference in the serum level of HDAC1 was found between the studied groups being highest in the AA group (P = 0.0001). It was significantly higher in the AA group than the acne vulgaris group (P = 0.0001). Conclusion: HDAC1 appears to be deregulated in patients with AA and acne vulgaris. This may suggest a potential therapeutic opportunity for HDAC inhibitors for the treatment of such diseases. [ABSTRACT FROM AUTHOR]

Case 2's anterior torso and arms at age 3 show violaceous punctate macules forming a serpiginous pattern with a symmetrical distribution (b). gl Skin biopsy demonstrated lobular proliferation of ectatic capillaries in the papillary dermis with no endothelial hyperplasia. Histopathology from Case 1's skin biopsy showing collections of ectatic capillaries in the papillary dermis (d). gl Skin biopsy of her left thigh showed collections of ectatic capillaries in the papillary and superficial reticular dermis. Angioma serpiginosum (AS) is a rare, benign vascular condition of unknown aetiology.[1] It is characterised by punctate red to violaceous macules that form a serpiginous, gyrate or linear (Blaschkoid distribution) pattern, usually distributed asymmetrically on the lower limbs or buttocks.[[1], [3]] We report two cases of early onset extensive and symmetrical AS. [Extracted from the article]

Introduction: The Virtual Lesion Clinic (VLC) of Waitematā District Health Board (WDHB) improves melanoma assessment and treatment using teledermatology. The VLC is reserved for pigmented lesions referred as suspected melanoma from primary care but indeterminate at the initial triage. Objectives: To assess the efficacy of the VLC diagnosis of melanoma. Methods: A retrospective audit of suspected melanoma referrals (1 January 2012 to 31 December 2016) was conducted. Lesions were referred to the VLC if diagnostic uncertainty remained at the initial triage. VLC patients attended MoleMap imaging centres, a dermatologist reviewed history and images remotely and suggested a diagnosis and management plan. Post VLC provisional diagnosis of melanoma, all lesions subsequently excised were reviewed. A positive predictive value (PPV) was calculated using concordance between VLC diagnosis of melanoma and histopathological diagnosis of melanoma. Number needed to excise (NNE) for melanoma was derived, as well as an invasive to in‐situ melanoma ratio (IM:MIS) and false negative rate (FNR). Results: The VLC received 1874 referrals for 3546 lesions during the 5‐year study period. Six hundred and seventy‐nine lesions were recommended excision/biopsy or specialist face‐to‐face assessment, and 504 lesions were subsequently excised. The PPV was 62%, NNE 1.62 and IM:MIS 0.76 for lesions suspected to be melanoma at VLC assessment. The VLC had a melanoma‐specific FNR of 7%. Conclusions: The VLC is effective in early diagnosis of melanoma with a high positive predictive value, low number needed to excise and low false negative rate amongst lesions referred as suspected melanoma. [ABSTRACT FROM AUTHOR]

Anecdotal evidence suggests that selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) cause cutaneous adverse drug reactions (CADRs). However, there is limited information on the factors associated with these occurrences. In this study, we aimed to describe the demographic, clinical and pharmacological characteristics associated with CADRs encountered by patients administered SSRIs and/or SNRIs for psychiatric diagnoses and to compare the differences in these factors between severe and non‐severe CADRs. A protocol was developed a priori (PROSPERO: CRD42020204830) in line with the PRISMA guidelines. We searched PubMed/Medline, PsycINFO and SCOPUS from inception to October 2020 to identify case reports and/or case series of SSRI and SNRI associated CADRs. Additional cases were obtained from the retrieved articles' bibliography. A total of 141 articles were included in the study, documenting 173 CADRs. Females accounted for 128 (74.0%) of the analysed CADRs. The median age of the cases was 42 IQR (27; 53) with no statistically significant differences in age between males and females (P = 0.542). A total of 157 (90.8%) of the reported CADRs were associated with SSRIs, particularly fluoxetine 68 (39.5%), sertraline 30 (17.4%) and paroxetine 25 (14.5%). Non‐severe CADRs and severe CADRs accounted for 23 (13.4%) and 149 (86.6%) reports respectively. No statistically significant differences were observed for gender (P = 0.616), age at onset (P = 0.493) and time to onset (P = 0.105) between non‐severe CADRs and SCARs. In conclusion, CADRs following SSRIs and SNRIs disproportionately affect females in the reproductive age group compared to males and are mostly associated with SSRIs. [ABSTRACT FROM AUTHOR]

Background: Taking the perspectives of patients into consideration is of the utmost importance when defining treatment goals for psoriasis. The patient‐acceptable symptom state (PASS) is a dichotomised question that captures patients' perceptions of their overall health state. Objectives: To evaluate PASS and determine the factors associated with a satisfactory PASS for psoriatic patients. Methods: Three questions were asked: (Q1) Considering the ways that your skin symptoms affect your functioning, is your current skin psoriasis satisfactory? (Current PASS), (Q2) Considering the ways that your psoriasis is affecting you, if you were to remain in this state for the next few months, would this be satisfactory? (Future PASS) and (Q3) If you were to remain for the rest of your life as you were during the last 48 hours, would this be satisfactory? (Lifelong PASS). Disease severity, symptoms and health‐related quality of life (HRQoL) were collected. Results: Of 140 patients, 74.3%, 70.0% and 85.7% expressed satisfaction with their current, future and lifelong skin psoriasis conditions respectively. A satisfactory PASS was significantly associated with older and married patients; lower disease severity; fewer skin symptoms; and a higher HRQoL. A multivariate analysis revealed that the independent factors associated with a satisfactory PASS were being older than 40 years, being married, practising meditation, not having extensive lesions at sensitive areas and having a high HRQoL. Conclusions: PASS is a simple and easily administered questionnaire that reflects both disease severity and HRQoL. Understanding patients' needs and satisfaction levels will result in better care for psoriatic patients than otherwise. [ABSTRACT FROM AUTHOR]

Background/Objectives: Allergic contact dermatitis, photoallergic contact dermatitis and irritant reactions to sunscreens are common reasons for dermatology consultation. Patch testing for contact allergy relies on up‐to‐date knowledge of allergen exposures. The aim of this study was to investigate contact allergens and photoallergens in sunscreens commercially sold on the shelves of supermarkets and pharmacies in New Zealand. Methods: A comprehensive market data review of suppliers' websites was performed from March to August 2019 to obtain a list of the commonly sold sunscreens in our region. Ingredients were collated and analysed according to International Nomenclature of Cosmetic Ingredients (INCI) names. Ultraviolet (UV) filters, preservatives and fragrances were included for analysis. Place of sale and cost of sunscreens were also recorded. Results: Ninety‐five sunscreens were analysed: 36% sold in supermarkets, 43% in pharmacies and the remainder available in both. The most frequent UV filters were butyl methoxydibenzoylmethane (contained in 70% of products) followed by octocrylene (63%) and homosalate (50%). The common photoallergen benzophenone 3 was found in 19% of products. Phenoxyethanol was the most common preservative (68%) followed by disodium EDTA (30%) and propylparaben (26%). Two sunscreens contained methylisothiazolinone. Sixty‐one per cent contained at least one fragrance, the most frequent being limonene (17%) and linalool (13%). There was an average of 1.1 New Zealand baseline series allergens per product (range 0 to 6, standard deviation 1.27). Conclusion: Common allergens including those with high sensitising potential were frequently found in New Zealand sunscreen. Knowledge of ingredients used by manufacturers is useful in dermatological assessment of skin contact reactions. [ABSTRACT FROM AUTHOR]

Hypertrophic scars present collagen deposition and an abnormal extracellular matrix that cause abnormal shape changes and limit normal movement. Although fractional carbon dioxide (CO2) laser therapy has provided promising evidence, the improvement of scarring has not been thoroughly reviewed. A systematic review of prospective randomised trial articles collected from PubMed, MEDLINE, EMBASE, Cochrane and Scopus databases was conducted on 15 March 2020 in accordance with the PRISMA‐P statement. Types and duration of fractional carbon dioxide laser used in this study along with the comparative modalities were recorded in this review. Treatment efficacy was assessed as the primary outcome. Adverse events and patient satisfaction were assessed as the secondary outcome. Five prospective randomised studies were included in this study. All studies included showed a consistent result with a conclusion that CO2 fractional laser treatment demonstrated statistically significant improvement for various scar scoring methods. Combination with other modalities may yield better results in some studies with the risk of more severe adverse events. Temporary side effects such as itching or burning sensation, erythema and oedema were present but appeared to be minimal and well tolerated. Overall patients reported significant improvement in quality of life. Some of the studies are uncontrolled with relatively short‐term follow‐up. Controlled comparative studies within the same scar with larger sample size and longer follow‐up period are required. This evidence suggests that fractional CO2 laser treatment is effective for improving the clinical appearance of hypertrophic scars with a good safety profile. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) technology is becoming increasingly accurate and prevalent for the diagnosis of skin cancers. Commercially available AI diagnostic software is entering markets across the world posing new legal and ethical challenges for both clinicians and software companies. Australia has the highest rates of skin cancer in the world and is poised to be a significant benefactor and pioneer of the technology. This review describes the legal and ethical considerations raised by the emergence of artificial intelligence in skin cancer diagnosis and proposes recommendations for best practice. [ABSTRACT FROM AUTHOR]

Isobornyl acrylate (IBOA) has recently caused a number of cases of allergic contact dermatitis (ACD) from its use in medical devices. We would like to enhance the awareness of this issue with the reporting of three Australian cases, involving two adults and a child. We also report a successful solution by using hydrocolloid wafer (Stomahesive®) as a barrier. As IBOA is not usually found on baseline patch test series and does not cross‐react with other acrylic monomers, ACD to IBOA may be missed by clinicians. [ABSTRACT FROM AUTHOR]