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Introduction: Isotretinoin is an effective treatment for acne vulgaris; however, many patients experience anxiety while deciding to get it. Isotretinoin, indeed, has significant adverse effects. On the other hand, effective treatment of acne vulgaris may reduce dermatological and psychiatric complications. Objectives: The present study aims to develop and validate the Isotretionin Hesitancy Scale to measure the patients' drawbacks to the treatment. Methods: The specialists, including dermatologists and mental health professionals, determined an item pool of 30 items. Before the data collection, all items were checked by the researchers in terms of clarity and acceptability. Thus, the eight items were removed from the questionnaire due to having similar meanings, measuring the facts about treatments that are not the study's objective, and containing unclear statements. The final version of the questionnaire, which consists of 22 items, was applied to the participants. Results: One hundred patients with acne vulgaris were recruited. Among the participants, 72% were women, and the mean age was 22.72. Most patients' acne severity was group 2 (40%) and group 3 (36%). Three items were removed because of having low item-total score correlations. Five items were removed in factor analysis because of low factor loading or cross-loading. Exploratory factor analysis results of the scale are presented in Table 1. Table 1. Exploratory Factor Analysis Results of the Scale Factor 1 (min-max) Factor 2 (min-max) Factor 3 (min-max) Isotretinoin treatment can lead to dryness of lips, nose, and eyes. Isotretinoin treatment may have many side effects. Isotretinoin treatment may cause damage to the liver. Side effects of isotretinoin treatment may affect my daily life. Isotretinoin treatment may cause depression. Isotretinoin treatment may cause elevation of cholesterol level. 0.516-0.842 Isotretinoin treatment may cause infertility in men. Isotretinoin treatment may cause infertility in women. Isotretinoin treatment may prevent height gain. In case of pregnancy, isotretinoin treatment may cause congenital defects in the baby. 0.425-0.945 I'm afraid of using isotretinoin for a long period. I stop the isotretinoin treatment as soon as possible. I will wait as long as I can before using isotretinoin treatment. I need more reassurance about isotretinoin treatment. 0.569-0.890 The Cronbach alpha score of the final form of the scale was found to be.81, the internal consistency of the first factor (hesitancy related to reversible adverse effects) was calculated as .79, the second factor (hesitancy related to irreversible adverse effects) was calculated as.78, and the final factor (isotretinoin-related anxiety) was found to be.72. Conclusions: The Isotretionin Hesitancy Scale is valid and reliable among patients with acne vulgaris. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

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., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Medical emergency complications may occur during dermatological, surgical, and cosmetic procedures., Aims: This study aimed to investigate the frequency of dermatologists who experienced emergency complications as well as their level of knowledge regarding emergencies and basic life support., Methods: The cross-sectional descriptive study was conducted online among 240 dermatologists to whom a questionnaire was sent via email and a closed social media group. The survey instrument asked about emergency complications during dermatological, surgical, or cosmetic procedures and the dermatologists' level of knowledge regarding emergencies and basic life support., Results: Among the dermatologists, 53% reported emergency complications during dermatological and surgical procedures and 43.2% during cosmetic procedures. The most common complications were vasovagal syncope, hypotension/bleeding, and seizures. Emergency complications were more common among specialists, those with more than 15 years of professional experience, those working in their private clinics, and those performing an average of 10-50 dermatological/surgical procedures per week and fewer than 10 cosmetic procedures per week (p < 0.05). The knowledge level of dermatologists was highest among residents, dermatologists with 0-4 years of professional experience, those working in university hospitals, and those who had both theoretical and practical training in basic life support., Conclusions: This study shows a relatively high frequency of dermatologists who experienced emergency complications during dermatological, surgical, or cosmetic procedures. Although these complications seem to be common; most of them are mild, self-limiting, and not life-threatening. Nevertheless, dermatologists should be competent and prepared to intervene in medical emergencies in daily practice., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Anti-MDA-5 dermatomyositis (DM) is a subtype of idiopathic inflammatory myopathy, commonly presenting as clinically amyopathic dermatomyositis. It is associated with rapidly progressive interstitial lung disease and a poor prognosis. Here, we present two cases of anti-MDA-5 DM and discuss the challenges associated with timely diagnosis, and the importance of early and aggressive treatment., Competing Interests: The authors have no conflicts of interest to declare., (© The Author(s) 2024. Published by Oxford University Press.)

Introduction: Pityriasis lichenoides (PL) is a papulosquamous disease affecting both children and adults, for which narrowband-UVB (NB-UVB) phototherapy is regarded as a commonly used treatment option. The aim of this study was to investigate the efficacy of NB-UVB phototherapy in the management of PL and to compare response rates in pediatric and adult age groups., Materials and Methods: This observational, retrospective study included 20 PL patients (12 pityriasis lichenoides chronica; PLC, 8 pityriasis lichenoides et varioliformis acuta; PLEVA) who failed to respond to other treatment modalities. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit., Results: A complete response (CR) was obtained in all pediatric patients with PL, while 53.8% of adult patients had achieved CR. The mean cumulative dose required to achieve the CR was higher in pediatric patients than adult patients with PL (p < .05). The CR was achieved in 6 (75%) of 8 PLEVA patients, while 8 (66.7%) of 12 PLC patients had reached to CR. The mean number of exposures for patients with PLC to achieve a CR was higher than patients with PLEVA (p < .05). Erythema was the most common adverse effect during phototherapy particularly in 5 (35.7%) of the patients with PL who had achieved CR., Conclusions: NB-UVB is an effective and well-tolerated treatment option for PL especially in diffuse types. A higher response can be obtained in children with higher cumulative dose. Patients with PLC may require more exposures for CR than patients with PLEVA., (© 2023 The Authors. Photodermatology, Photoimmunology & Photomedicine published by John Wiley & Sons Ltd.)

Aims: Decongestion strategies for acute decompensated heart failure (ADHF) characterized by volume overload differ widely. The aim of this independent international academic web-based survey was to capture the therapeutic strategies that physicians use to treat ADHF and to assess differences in therapeutic approaches between cardiologists versus non-cardiologists., Methods and Results: Physicians were invited to complete a web-based questionnaire, capturing anonymized data on physicians' characteristics and treatment preferences based on a hypothetical clinical scenario of a patient hospitalized with ADHF. A total of 641 physicians from 60 countries participated. A wide variation in the management of the patient was observed. There was conservative use of diuretics, i.e. only 7% started intravenous furosemide at a dose ≥2 times the baseline oral dose, and infrequent use of ultrasound in assessing congestion (20.4%). Spot urinary sodium was infrequently or never measured by ≥85% of physicians. A third considered a patient with ongoing oedema as being stabilized. There were significant differences between cardiologists and non-cardiologists in the management of ADHF, the targets for daily body weight loss and urine output, diuretic escalation strategies (66.3% vs. 40.7% would escalate diuresis by adding a thiazide) and assessment of response to treatment (27.0% vs. 52.9% considered patients with minimal congestion as stabilized)., Conclusions: There is substantial variability amongst physicians and between cardiologists and non-cardiologists in the management of patients with ADHF, with regard to clinical parameters used to tailor treatment, treatment goals, diuretic dosing and escalation strategies., (© 2023 European Society of Cardiology.)

Background: Sunlight contains ultraviolet B (UVB) radiation that triggers the production of vitamin D by skin. Vitamin D has widespread effects on brain function in both developing and adult brains. However, many people live at latitudes (about > 40 N or S) that do not receive enough UVB in winter to produce vitamin D. This exploratory study investigated the association between the age of onset of bipolar I disorder and the threshold for UVB sufficient for vitamin D production in a large global sample., Methods: Data for 6972 patients with bipolar I disorder were obtained at 75 collection sites in 41 countries in both hemispheres. The best model to assess the relation between the threshold for UVB sufficient for vitamin D production and age of onset included 1 or more months below the threshold, family history of mood disorders, and birth cohort. All coefficients estimated at P ≤ 0.001., Results: The 6972 patients had an onset in 582 locations in 70 countries, with a mean age of onset of 25.6 years. Of the onset locations, 34.0% had at least 1 month below the threshold for UVB sufficient for vitamin D production. The age of onset at locations with 1 or more months of less than or equal to the threshold for UVB was 1.66 years younger., Conclusion: UVB and vitamin D may have an important influence on the development of bipolar disorder. Study limitations included a lack of data on patient vitamin D levels, lifestyles, or supplement use. More study of the impacts of UVB and vitamin D in bipolar disorder is needed to evaluate this supposition., (© 2023. The Author(s).)

Objective: Circadian rhythm disruption is commonly observed in bipolar disorder (BD). Daylight is the most powerful signal to entrain the human circadian clock system. This exploratory study investigated if solar insolation at the onset location was associated with the polarity of the first episode of BD I. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area of the Earth., Methods: Data from 7488 patients with BD I were collected at 75 sites in 42 countries. The first episode occurred at 591 onset locations in 67 countries at a wide range of latitudes in both hemispheres. Solar insolation values were obtained for every onset location, and the ratio of the minimum mean monthly insolation to the maximum mean monthly insolation was calculated. This ratio is largest near the equator (with little change in solar insolation over the year), and smallest near the poles (where winter insolation is very small compared to summer insolation). This ratio also applies to tropical locations which may have a cloudy wet and clear dry season, rather than winter and summer., Results: The larger the change in solar insolation throughout the year (smaller the ratio between the minimum monthly and maximum monthly values), the greater the likelihood the first episode polarity was depression. Other associated variables were being female and increasing percentage of gross domestic product spent on country health expenditures. (All coefficients: P ≤ 0.001)., Conclusion: Increased awareness and research into circadian dysfunction throughout the course of BD is warranted., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Early-onset androgenetic alopecia (AGA) is the most common cause of alopecia in men under 30 years of age; however, its prevalence and non-genetic risk factors are not well documented. The aim of our study was to determine the early-onset AGA prevalence and to evaluate its relationship with lifestyle and dietary habits., Methods: This study was conducted on 1507 male university students aged 18-30 years. Students with AGA were grouped as mild and moderate-severe according to the Hamilton-Norwood classification. They were asked to complete a questionnaire regarding information about lifestyle and dietary habits including the Adolescent Food Habits Checklist (AFHC) and International Physical Activity Questionnaire (IPAQ) short form., Results: The prevalence of early-onset AGA was 19.2% in the students. Each year over the 18 years age, positive family history, unhealthy vegetable-fruit and red meat consumption, presence of a hair disease apart from AGA and smoking were associated with increased risk for early-onset AGA. The median score of AFHC was lower than those without early-onset AGA which reflects the unhealthy dietary habit. Students with moderate-severe AGA had a higher body mass index and waist circumference than those with mild AGA (P<0.05)., Conclusions: In addition to family history, lifestyle and dietary habits have roles in early-onset AGA. Therefore, regulation of lifestyle and dietary habits may have a possible contribution in the prevention of early-onset AGA.

Background: Burn scar and alopecia on hair-bearing areas can severely affect the social life of patients. Unlike healthy skin, poor biological and mechanical properties of scar tissue in the recipient area can reduce the survival rate of hair graft following hair transplantation., Objectives: The authors sought to determine if combined non-ablative fractional laser (NAFL) and microfat injection could improve the survival rate of hair grafts on post burn scar., Methods: Thirteen patients with alopecia resulting from burn scar in hair-bearing areas of the scalp and face were treated with combined NAFL and microfat graft and subsequent follicular unit extraction hair transplantation. Cicatricial alopecia occurred on the scalp, eyebrow, mustache, and beard areas. Patients were treated with 3 to 6 sessions of NAFL and 2 to 5 sessions of microfat graft injections, followed by 1 session of hair transplantation employing the follicular unit extraction technique., Results: Hair transplantation was successfully performed with good to excellent results. The survival rate of transplanted follicular units ranged from 76% to 95% (mean, 85.04%), and the density success rate per square centimeter ranged from 76.9% to 95.2% (mean, 84.54%). All patients expressed high satisfaction with the results and no complication was encountered., Conclusions: Hair transplantation, after combined NAFL and microfat injection, is a promising treatment for post burn alopecia., (© 2021 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.)

Background: Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries., Methods: Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun's electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries)., Results: This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01., Conclusion: A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed., (© 2021. The Author(s).)

Background: Anxiety sensitivity (AS) is a continuous fundamental fear and defined as extreme fear of anxiety sensations and symptoms. High AS can cause tendency to anxiety disorders. There are many studies evaluating the anxiety in patients with acne; however, AS has not been investigated., Objective: We aimed to investigate AS in patients with acne., Methods: Two hundred and fourteen acne patients and 117 healthy control subjects, aged older than 16 years were enrolled in the study. Severity of acne was evaluated by Global Acne Grading System. The acne patients and healthy controls were asked to complete the anxiety sensitivity index-3 (ASI-3), the Beck anxiety inventory (BAI) and the Turkish version of acne quality of life index., Results: Anxiety and AS levels in acne patients were significantly higher than healthy controls ( p <0.001). Quality of life was impaired in acne patients. Quality of life was negatively correlated with anxiety and AS levels in acne patients ( p =0.014, p =0.019, respectively). There was no correlation between quality of life and disease severity ( p =0.556) and also there was no correlation between psychiatric scale scores (ASI-3, BAI) and disease severity ( p =0.147, p =0.871, respectively)., Conclusion: To our knowledge, our study is the first to report that AS is high in acne patients. Clinically, our results suggest that there might be a relationship between AS and acne. We conclude that further studies are needed in order to clarify the relationship between acne and AS and to investigate the efficacy of cognitive behavioral treatments in acne patients., Competing Interests: CONFLICTS OF INTEREST: The authors have nothing to disclose., (Copyright © 2019 The Korean Dermatological Association and The Korean Society for Investigative Dermatology.)