Search

Case Presentation: A patient with a known history of pustular psoriasis presented with sub-acute development of diffuse erythema and scaling of the skin with areas of exfoliation consistent with erythroderma.  She was ill appearing and required admission and aggressive treatment with steroid-impregnated wet dressings, topical emollients, analgesics and systemic immunosuppressants.Discussion: Erythroderma is a dermatologic emergency characterized by diffuse erythema and scaling spanning >90% of skin surfaces and is associated with a mortality rate as high as 64%.  It is initially a clinical diagnosis and needs to be recognized and aggressively treated expeditiously to improve chances of a good outcome.

PURPOSE OF REVIEW: Machine learning (ML), a subset of artificial intelligence (AI), has been vital in advancing tasks such as image classification and speech recognition. Its integration into clinical medicine, particularly dermatology, offers a significant leap in healthcare delivery. RECENT FINDINGS: This review examines the impact of ML on psoriasis-a condition heavily reliant on visual assessments for diagnosis and treatment. The review highlights five areas where ML is reshaping psoriasis care: diagnosis of psoriasis through clinical and dermoscopic images, skin severity quantification, psoriasis biomarker identification, precision medicine enhancement, and AI-driven education strategies. These advancements promise to improve patient outcomes, especially in regions lacking specialist care. However, the success of AI in dermatology hinges on dermatologists oversight to ensure that MLs potential is fully realized in patient care, preserving the essential human element in medicine. SUMMARY: This collaboration between AI and human expertise could define the future of dermatological treatments, making personalized care more accessible and precise.

Due to working in static positions and use of repetitive movements over long periods of time, dermatologists are at increased risk of work-related musculoskeletal injury. Historically, studies on procedural ergonomics have focused on dermatologic surgery, however, laser procedures can also have a significant cumulative effect on physician posture. Here, we aim to highlight ergonomic challenges specific to dermatologic laser procedures and suggest areas of improvement in operating room organization, patient positioning, physician mechanics, and instrumentation. For the operating room, it is beneficial to store several devices in the same room, have central placement of electrical outlets, and to position the devices on the same side of the bed as the laser operator. When considering patient positioning, a Trendelenburg bed position can be helpful for vascular lesions on the head, and frequent repositioning of the patient can prevent uncomfortable bending of the operator and laser arm for circumferential lesions. Physicians should maintain a working position with a neutral spine and wrist position, moving the patient and bed as needed to reduce muscle tension. Lastly, laser instrumentation in the future could be improved upon with lightweight consoles and hand pieces, long multi-articulated device arms, and lightweight laser goggles with adjustable head straps. With the use of organizational, ergonomic positioning, and teamwork strategies, we can reduce the risk of musculoskeletal injury for our laser operators.

INTRODUCTION: Psoriasis, a chronic inflammatory skin condition, affects approximately 3.0% of the US population, with patients often experiencing significant sleep disturbances. These disturbances include a higher prevalence of conditions such as obstructive sleep apnea, restless leg syndrome, and insomnia. Given the additional risks for cardiovascular disease, metabolic disorders, and depression linked to both poor sleep and psoriasis, addressing sleep issues in this patient group is critical. METHODS: The study utilized National Health and Nutrition Examination Survey (NHANES) data, focusing on individuals aged ≥ 20 years who provided information on psoriasis status and sleep. Multistage stratified survey methodology was applied, with multivariable logistic regression models used to examine the association between psoriasis and sleep issues, adjusting for factors such as age, gender, and health history. RESULTS: Psoriasis diagnosis was significantly associated with trouble sleeping (adjusted odds ratio [aOR] 1.88; 95% confidence interval [CI] 1.44-2.45). There was no significant association between psoriasis and sleep quantity. Older age, female gender, and a history of sleep disorders were predictors of trouble sleeping among psoriasis patients. CONCLUSIONS: Psoriasis is significantly associated with sleep disturbances, independent of sleep duration. This underscores the need for clinical screening focusing on sleep quality rather than quantity in psoriasis patients to effectively identify and treat sleep-related comorbidities. Further research using objective sleep measures is warranted to guide clinical management and improve patient quality of life.

Mitochondria are eukaryotic cellular organelles that function in energy metabolism, ROS production, and programmed cell death. Cutaneous epithelial and hair follicle dermal papilla cells are energy-rich cells that thereby may be affected by mitochondrial dysfunction and DNA mutation accumulation. In this review, we aimed to summarize the medical literature assessing dermatologic conditions and outcomes associated with mitochondrial dysfunction. A search of PubMed and Embase was performed with subsequent handsearching to retrieve additional relevant articles. Mitochondrial DNA (mtDNA) deletions, mutation accumulation, and damage are associated with phenotypic signs of cutaneous aging, hair loss, and impaired wound healing. In addition, several dermatologic conditions are associated with aberrant mitochondrial activity, such as systemic lupus erythematosus, psoriasis, vitiligo, and atopic dermatitis. Mouse model studies have better established causality between mitochondrial damage and dermatologic outcomes, with some depicting reversibility upon restoration of mitochondrial function. Mitochondrial function mediates a variety of dermatologic conditions, and mitochondrial components may be a promising target for therapeutic strategies.

IL-17C is an epithelial cell-derived proinflammatory cytokine whose transcriptional regulation remains unclear. Analysis of the IL17C promoter region identified TCF4 as putative regulator, and siRNA knockdown of TCF4 in human keratinocytes (KCs) increased IL17C. IL-17C stimulation of KCs (along with IL-17A and TNF-α stimulation) decreased TCF4 and increased NFKBIZ and ZC3H12A expression in an IL-17RA/RE-dependent manner, thus creating a feedback loop. ZC3H12A (MCPIP1/Regnase-1), a transcriptional immune-response regulator, also increased following TCF4 siRNA knockdown, and siRNA knockdown of ZC3H12A decreased NFKBIZ, IL1B, IL36G, CCL20, and CXCL1, revealing a proinflammatory role for ZC3H12A. Examination of lesional skin from the KC-Tie2 inflammatory dermatitis mouse model identified decreases in TCF4 protein concomitant with increases in IL-17C and Zc3h12a that reversed following the genetic elimination of Il17c, Il17ra, and Il17re and improvement in the skin phenotype. Conversely, interference with Tcf4 in KC-Tie2 mouse skin increased Il17c and exacerbated the inflammatory skin phenotype. Together, these findings identify a role for TCF4 in the negative regulation of IL-17C, which, alone and with TNF-α and IL-17A, feed back to decrease TCF4 in an IL-17RA/RE-dependent manner. This loop is further amplified by IL-17C-TCF4 autocrine regulation of ZC3H12A and IL-17C regulation of NFKBIZ to promote self-sustaining skin inflammation.

Patients with chronic inflammatory disorders such as psoriasis have an increased risk of cardiovascular disease and elevated levels of LL37, a cathelicidin host defense peptide that has both antimicrobial and proinflammatory properties. To explore whether LL37 could contribute to the risk of heart disease, we examined its effects on lipoprotein metabolism and show that LL37 enhanced LDL uptake in macrophages through the LDL receptor (LDLR), scavenger receptor class B member 1 (SR-B1), and CD36. This interaction led to increased cytosolic cholesterol in macrophages and changes in expression of lipid metabolism genes consistent with increased cholesterol uptake. Structure-function analysis and synchrotron small-angle x-ray scattering showed structural determinants of the LL37-LDL complex that underlie its ability to bind its receptors and promote uptake. This function of LDL uptake is unique to cathelicidins from humans and some primates and was not observed with cathelicidins from mice or rabbits. Notably, Apoe-/- mice expressing LL37 developed larger atheroma plaques than did control mice, and a positive correlation between plasma LL37 and oxidized phospholipid on apolipoprotein B (OxPL-apoB) levels was observed in individuals with cardiovascular disease. These findings provide evidence that LDL uptake can be increased via interaction with LL37 and may explain the increased risk of cardiovascular disease associated with chronic inflammatory disorders.

Direct-to-patient mobile teledermoscopy is a feasible and useful adjunct to smartphone imaging for monitoring patient-identified lesions of concern, achieving comparable diagnostic and management accuracy as in-office dermatology.

Hidradenitis suppurativa (HS) is a chronic skin condition affecting approximately 1% of the US population. HS skin lesions are highly inflammatory and characterized by a large immune infiltrate. While B cells and plasma cells comprise a major component of this immune milieu, the biology and the contribution of these cells in HS pathogenesis are unclear. We aimed to investigate the dynamics and microenvironmental interactions of B cells within cutaneous HS lesions. Combining histological analysis, single-cell RNA sequencing, and spatial transcriptomics profiling of HS lesions, we defined the tissue microenvironment relative to B cell activity within this disease. Our findings identified tertiary lymphoid structures (TLSs) within HS lesions and described organized interactions among T cells, B cells, antigen-presenting cells, and skin stroma. We found evidence that B cells within HS TLSs actively underwent maturation, including participation in germinal center reactions and class switch recombination. Moreover, skin stroma and accumulating T cells were primed to support the formation of TLSs and facilitate B cell recruitment during HS. Our data definitively demonstrated the presence of TLSs in lesional HS skin and point to ongoing cutaneous B cell maturation through class switch recombination and affinity maturation during disease progression in this inflamed nonlymphoid tissue.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by abscesses, nodules, dissecting/draining tunnels, and extensive fibrosis. Here, we integrate single-cell RNA sequencing, spatial transcriptomics, and immunostaining to provide an unprecedented view of the pathogenesis of chronic HS, characterizing the main cellular players and defining their interactions. We found a striking layering of the chronic HS infiltrate and identified the contribution of 2 fibroblast subtypes (SFRP4+ and CXCL13+) in orchestrating this compartmentalized immune response. We further demonstrated the central role of the Hippo pathway in promoting extensive fibrosis in HS and provided preclinical evidence that the profibrotic fibroblast response in HS can be modulated through inhibition of this pathway. These data provide insights into key aspects of HS pathogenesis with broad therapeutic implications.

Tik Tok is an emerging social media platform that provides a novel opportunity for health practitioners such as dermatologists to disseminate accurate health information.

Otolaryngologists frequently serve as the first touchpoint for patients presenting with dermatologic conditions of the head and neck. This study aims to identify and quantify gaps in dermatologic training among otolaryngology residents, and to assess their diagnostic accuracy in comparison to dermatology residents. It comprised 14 multiple-choice questions focused on common dermatologic diagnoses related to the head and neck. Sixty-one dermatology and 36 otolaryngology residents participated in the study. Dermatology residents significantly outperformed otolaryngology residents, with average scores of 90% (SD = 8) compared to 71% (SD = 10) (P

ChatGPT is a publicly available chatbot released by OpenAI. Its usefulness in responding to medical questions has been assessed in several specialties, but there is limited literature in dermatology. This study seeks to understand how well ChatGPT4 can provide accurate diagnoses and appropriate workup suggestions for clinical vignettes describing common dermatologic conditions. Ten vignettes were input into ChatGPT4 representing presentations of common dermatologic conditions, written from the perspective of a physician not board-certified in dermatology. ChatGPT4 was asked to identify the top five most likely diagnoses and its recommended workup for each vignette. Responses were assessed quantitatively by calculating the percentage of correct diagnoses, with accurate diagnoses defined by three board-certified dermatologists, and qualitatively using Likert scales describing the accuracy of diagnoses and appropriateness of workups scored by eleven board-certified dermatologists. Overall, 52% of ChatGPT4's diagnoses were accurate and 62% of its recommended workup suggestions were deemed completely correct by board-certified dermatologists. ChatGPT4 was better at recommending an appropriate workup than identifying accurate diagnoses across vignettes. ChatGPT4 was able to accurately diagnose and workup common dermatologic conditions in slightly more than half of cases. ChatGPT4 was better at determining an appropriate workup than an accurate diagnosis.Keywords: artificial intelligence, ChatGPT, dermatology, diagnosis, OpenAI, workup

A simple and rapid method that is not based on race and ethnicity for classifying people with skin of color is of paramount importance in dermatology. The currently used Fitzpatrick classification of sun-reactive skin types is inadequate. Newer scales that have been used in immigration surveys and sociology studies are not applicable in the office setting. A new, non-racial and non-ethnic, colorimetric scale for skin of color has recently been proposed that is simple to perform. The scale has five colors: very light beige (skin color type 1), light brown (skin color type 2), medium brown (skin color type 3), dark brown (skin color type 4) and very dark brown (skin color type 5); an individual with white skin, such as in albinism, would have a skin color type 0 in this classification. In conclusion, the colorimetric scale enables the rapid classification of individuals with skin of color and allows for accurate assessment of skin cancer risk, more appropriate management of cosmetic dermatologic procedures and aesthetic devices, and enhanced ability for focused counseling regarding hair products, skin care interventions, and color-targeted makeup based on the person's skin tone.

Febrile ulceronecrotic Mucha-Habermann disease is a rare and severe variant of pityriasis lichenoides, characterized by sudden onset of generalized ulceronecrotic papules that rapidly coalesce into ulcers associated with high fever. Systemic manifestations such as intravascular disseminated coagulation and pulmonary, cardiac, gastrointestinal, and central nervous system involvement are common. Treatment is based on oral corticosteroids, immunosuppressive drugs such as methotrexate, and general supportive treatment. The present case describes a stepwise approach to a patient with Mucha-Habermann disease with insufficient response to methotrexate.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful sinus tracts and significant scarring. Recent evidence suggests that vitamin D deficiency may play a role in the pathogenesis and outcomes of HS. This systematic review aims to evaluate the relationship between vitamin D levels and HS, exploring potential therapeutic benefits of vitamin D supplementation. This systematic review followed PRISMA guidelines and was registered with PROSPERO (ID:CRD42024566092). A comprehensive literature search was conducted in PubMed, Medline (OVID), and Web of Science using the keywords "hidradenitis suppurativa" and "vitamin D." Studies were screened for relevance, and non-randomized studies were assessed for quality using the MINORS score. Due to the heterogeneity of clinical outcome measures, a qualitative analysis was performed. A total of 77 records were identified, with 38 articles remaining after duplicates were removed. After full-text screening, 8 studies met the inclusion criteria. These studies, published between 2014 and 2024, included case-control, cross-sectional, and cohort studies. High prevalence rates of vitamin D deficiency (75–100%) were consistently observed among HS patients. Improved clinical outcomes with vitamin D supplementation were noted in several studies. There were significant correlations between vitamin D deficiency and higher clinical severity, and genetic alterations in vitamin D metabolism and keratinization pathways were identified in HS patients. This systematic review demonstrates a significant association between vitamin D deficiency and HS. Vitamin D's role in immune regulation and anti-inflammatory processes suggests its potential as a therapeutic agent for HS. However, further research is needed to determine optimal dosing and assess the protective effects of vitamin D supplementation in HS management. [ABSTRACT FROM AUTHOR]

The connection between stress and skin disease has been extensively documented; however, there are no empirical studies investigating the incidence of traumatic event exposure and posttraumatic stress (PTS) symptoms among dermatology patients. To address this gap in the literature and begin to understand the associations between PTS symptoms and skin disease symptoms, this study used a sample of adults with self-reported skin disease symptoms to examine: (1) rates of potentially traumatic event (PTE) exposure and PTS symptoms; and (2) the association between PTS symptoms and skin-related quality of life, controlling for relevant covariates. Data were collected online through Cloud Research, and participants completed a battery of self-report measures. The sample included 310 participants (68.4% female) who endorsed current skin disease symptoms. Results indicated that 47.1% of participants endorsed clinical levels of PTS symptoms. Consistent with hypotheses, greater levels of PTS symptoms were associated with worse skin-related quality of life, and this association was particularly robust for arousal-related symptoms. Results shed light on the occurrence of trauma-related experiences among individuals with self-reported skin disease and indicate a link between PTS symptoms and the perceived burden of skin disease symptoms on daily living. However, this study was cross-sectional and relied on self-report measures; therefore, findings should be interpreted with caution, particularly since diagnoses could not be verified. Replication of this work in dermatology patients is needed to further understand these connections. [ABSTRACT FROM AUTHOR]

Background Objectives Animals Materials and Methods Results Conclusions and Clinical Relevance Hospital‐related dermatological conditions are well‐studied and reported in human medicine. However, studies about these dermatological disorders in veterinary medicine are lacking.To report the incidence, type and distribution of hospital‐acquired skin lesions (HASL) in dogs, and to investigate risk factors that may be associated with their development.Hospitalised client‐owned dogs with HASL and a control group of hospitalised dogs without skin lesions.Prospective clinical evaluation of all HASL and dermatological tests, when indicated, were performed, over 6 months. A variety of potentially predisposing factors also were recorded.Thirty‐one dogs with HASL and a matched control group of 60 hospitalised dogs without skin lesions were included. The incidence of HASL was 11.2% (31 of 278). The most common lesion was erythema in 74.2% of dogs (23 of 31) and the most affected area was the abdomen in 58.1% (18 of 31) of dogs. Faecal and/or urinary incontinence was identified as an important risk factor for the development of skin lesions during hospitalisation (odds ratio 14.445, 95% confidence interval 1.444–144.479, p = 0.023). Immobilisation and changes in body temperature also may play a role in the development of such lesions in dogs.Faecal and/or urinary incontinence was found to be an important factor in the development of HASL. The impact of HASL on patient outcomes and the prevention of these lesions requires further investigation. [ABSTRACT FROM AUTHOR]

The article discusses the impact of venue selection and attendance format on the carbon footprint of air travel to the Australasian College of Dermatologists ASM. It compares emissions from in-person gatherings to hybrid models and virtual conferences, highlighting the significant reduction in emissions with virtual attendance. The study emphasizes the importance of host city location in minimizing carbon emissions and suggests a hybrid model as a way to further reduce environmental impact while maintaining strong attendance. [Extracted from the article]

ABSTRACT Background Aims Methods Results Conclusions Recent advancements in artificial intelligence (AI) have significantly impacted dermatology, particularly in diagnosing skin diseases. However, aesthetic dermatology faces unique challenges due to subjective evaluations and the lack of standardized assessment methods.This review aims to explore the current state of AI in dermatology, evaluate its application in diagnosing skin conditions, and discuss the limitations of traditional evaluation methods in aesthetic dermatology. Additionally, the review proposes strategies for future integration of AI to address existing challenges.A comprehensive review of AI applications in dermatology was conducted, in both diagnostic and aesthetic fields. Traditional methods such as subjective surveys and hardware devices were analyzed and compared with emerging AI technologies. The limitations of current AI models were evaluated, and the need for standardized evaluation methods and diverse datasets was identified.AI has shown great potential in diagnosing skin diseases, particularly skin cancer. However, in aesthetic dermatology, traditional methods remain subjective and lack standardization, therefore limiting their effectiveness. Emerging AI applications in this field show promise, but they have significant limitations due to biased datasets and inconsistent evaluation methods.To develop the potential of AI in aesthetic dermatology, it is crucial to create standardized evaluation methods, collect diverse datasets reflecting various ethnicities and ages, and educate practitioners on AI's utility and limitations. Addressing these challenges will improve diagnostic accuracy, better patient outcomes, and help integrate AI effectively into clinical practice. [ABSTRACT FROM AUTHOR]

Background: Proper diagnosis in primary care is crucial due to the large number of skin cancer diagnoses each year and its associated growing economic burden. Understanding how primary care providers can be best trained in dermoscopy is instrumental in helping primary care providers differentiate benign and malignant cutaneous lesions so that appropriate action can be taken (eg, biopsy/referral to dermatology or reassurance). Objective: To assess the success of concise dermoscopy training among primary care providers. Design: A cohort study was conducted in primary care at Mayo Clinic, Rochester, including primary care physicians, nurse practitioners, and physician assistants in internal medicine and family medicine. Diagnostic accuracy was measured on standardized testing through image-based recognition and in clinical practice through observation of referral and biopsy patterns both before and after dermoscopy education, focused on the TADA plus method. Results: Forty-three primary care providers completed the image-based recognition tests, with significant improvement in mean score measured after dermoscopy training workshop (20%). Among the thirteen primary care providers who continued to use dermoscopy in clinical practice, a significant improvement (31%) in mean clinical diagnostic accuracy was observed comparing 1 year of practice data before versus after dermoscopy training. Conclusion: Improvement in diagnostic accuracy with utilization of the TADA plus method translates into clinical practice. Therefore, training primary care providers in dermoscopy may improve the dermatologic care patients receive in primary care, especially in rural or medically underserved areas where access to dermatology is limited. [ABSTRACT FROM AUTHOR]

Introduction: Telehealth is an emerging tool used to improve access to care for patients. However, there is a lack of literature comparing the use of telehealth between patients of different age groups in dermatology. Our study aims to determine whether differences exist in teledermatology usage between elderly and younger dermatology patients. Methods: We conducted a cross-sectional study using the 2020–2021 Medical Expenditure Panel Survey. Our study population included a weighted total of 150,290,604 patients: Of these, 16.35% were young adults (18–44 years old), 26.32% were midlife adults (45–64 years old), and 57.33% were elderly (65+ years old). Results: Our results showed that elderly patients had significantly lower rates of teledermatology use than young adults (odds ratio [OR] = 0.184, (confidence interval [CI]: 0.081–0.421)), p < 0.000) and midlife adults (OR = 0.193, [CI: 0.091–0.406], p < 0.000). Midlife adults had similar rates of telehealth use when compared with young adults (OR = 1.044, [CI: 0.508–2.145], p = 0.907). Our results were adjusted for sex, race, ethnicity, insurance type, education level, income, travel time, and medical comorbidities. Discussion: We found that elderly patients seeking dermatology care are less likely to use telehealth than younger dermatology patients. Our results demonstrate that barriers to telehealth use for the elderly may be more prohibitive than expected. Understanding these differences in teledermatology use is essential for improving teledermatology delivery across all age groups. [ABSTRACT FROM AUTHOR]

Introduction: The disposal of regulated medical waste (RMW) in the healthcare setting can be both costly and environmentally harmful. Prior studies have found large amounts of waste disposed of in RMW containers are inappropriately placed. Few studies to date have investigated the efficacy of waste reduction practices in the dermatology setting. Methods: This study aims to evaluate the effectiveness of a practice-wide intervention in reducing RMW in the outpatient dermatology setting. By performing daily waste audits and two concurrent educational interventions, the amount of RMW produced and percent of appropriately placed RMW will be measured. Further analysis will occur by comparing pre-intervention values to post-intervention values. Results: The percentage of waste properly placed in RMW containers prior to any intervention was 11%. Following both educational interventions, the percentage of waste properly placed in RMW containers increased by 56.1% (CI 43.7–68.5%) and the percentage of total waste produced that was identified and disposed of as RMW decreased by 6.0% (95% CI 1.2–10.8%). Conclusion: Our study provides practical data for dermatology providers to make small changes which can result in significant reductions of regulated medical waste, potentially providing benefits to the environment and cost-savings. [ABSTRACT FROM AUTHOR]

Introduction A rise in tinea cruris among Thai Naval Cadets has been observed. Clotrimazole powder has been shown to be effective as an adjunct treatment for tinea cruris; however, its efficacy as a monotherapy is limited. Objectives The aim is to determine the efficacy of 1% clotrimazole cream versus 1% clotrimazole powder in treating tinea cruris. Material and Methods A randomized trial was conducted at the Thai Naval Rating School, Chonburi, Thailand. Naval rating cadets with suspected tinea cruris were randomly assigned to one of two groups: 1% clotrimazole cream or 1% clotrimazole powder, and they were instructed to apply the related medication to the affected lesion twice daily for 4 weeks. Clinical and symptomatic evaluations were carried out at 4 and 8 weeks. Results All 17 and 14 participants who received 1% clotrimazole cream and powder, respectively, were included. After 4 weeks, the clinical cure rates were 76.5% in the cream group and 85.7% in the powder group (P  = .664). All participants were clinically cured within 8 weeks. The self-evaluation of itch severity using a visual analog scale (VAS) revealed no significant difference between the two groups (P  = .343). The dermatology quality of life index decreased as clinical improvement was achieved in both the clotrimazole cream and powder groups (6.0 vs. 7.5 score reductions, respectively; P  = .765). The score for sweat reduction was higher in the 1% clotrimazole powder group compared to the cream group (5.0 vs. 4.0, respectively; P  = .006). Conclusion Monotherapy with 1% clotrimazole powder showed comparable efficacy to 1% clotrimazole cream. Furthermore, the powder treatment reduced sweat more effectively compared to the cream. [ABSTRACT FROM AUTHOR]

Cannabidiol (CBD) is a non-psychotropic cannabinoid with multiple pharmacological properties. Cannabidiol has attracted growing attention in the cosmetic industry, with an increasing number of CBD-containing skincare products on the market in recent years. The aim of this review is to evaluate the current evidence on the use of CBD for cosmetic purposes. Following an overview of CBD and the endocannabinoid system in the skin, we summarize pre-clinical and clinical studies that address the potential of CBD in cosmetic dermatology. Available in vitro and in vivo evidence suggests that CBD has anti-oxidant, anti-inflammatory, moisturizing, anti-acne, wound-healing, and anti-aging properties. However, only a few clinical studies have been conducted on the use of CBD in the skin. In addition, there is a critical need to develop an efficient drug-delivery system for topical/transdermal application of CBD. Further research, including clinical and pharmacokinetic studies, are needed to fully evaluate the role of CBD in cosmetic dermatology. [ABSTRACT FROM AUTHOR]

Seborrheic dermatitis (SD) is a highly prevalent dermatological condition globally. The condition demonstrates bimodal presentation with what is commonly thought to be two subtypes: adult/adolescent seborrheic dermatitis (ASD) and infantile seborrheic dermatitis (ISD). Despite the common prevalence of ASD and ISD, there remains uncertainty around the underlying pathogenetic mechanisms, risk factors, and appropriate classification of the disease(s). This narrative review summarizes the current understanding of the epidemiology, presentation, and pathogenetic factors like epidermal barrier dysfunction, lipid abnormalities, and cutaneous microbiome for ASD and ISD. Elements such as immune responsiveness, neuroendocrine factors, and genetics in these disease states are also investigated. Throughout our review, we highlight shared features and discrepancies between ASD and ISD that are present in the literature and discuss potential avenues for future research that explore these disease states. We aim to contribute to the medical discourse on ASD and ISD and increase awareness of the need for additional research around these conditions, ultimately informing better targeting of therapeutics moving forward. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the level of burden in pediatric and adolescent atopic dermatitis (AD) patients in Japan, the associated burden on caregivers/families, and whether this burden varied with age. Methods: Data were drawn from the Adelphi Pediatric AD Disease Specific Programme (DSP)™, a cross‐sectional survey of physicians and their patients conducted in Japan between July and December 2022. Physicians reported patient demographics, clinical characteristics, disease burden, and current/previous therapies. Patients and/or caregivers reported perceived disease severity and impact of AD, including the Children's Dermatology Life Quality Index (CDLQI) and Dermatitis Family Impact questionnaire (DFI). Results: Overall, 55 physicians provided data for 537 AD patients aged ≤17. Mean (SD) overall scores for CDLQI, POEM, and DFI were 9.3 (6.3), 8.3 (6.8), and 11.7 (7.2), respectively. Age was associated with higher patient and/or caregiver‐reported CDLQI scores, which increased by 0.543 points per year of age (P = 0.01). Patients with severe disease reported a more significant impact on quality of life factors compared with mild patients (P < 0.001). Age was associated with higher caregiver‐reported burden, with DFI scores increasing by 0.325 per year (P = 0.01). Physician‐reported impact on caregivers showed that age was significantly associated with increased burden on sleep, daily activities, work, and mood (P < 0.05), with disease severity associated with impact across all factors (P < 0.01). Conclusions: Both increasing age and disease severity were associated with the increased impact of AD on patients and their caregivers. Disease control/modification through appropriate therapeutic intervention at a younger age may relieve the burden of pediatric AD on patients and their families. [ABSTRACT FROM AUTHOR]

Background: Neomycin is an aminoglycoside antibiotic that may cause contact allergy. It was withdrawn as a medicine for human use in Denmark in October 2009 but is still found in some vaccines. Objectives: To identify time trends in contact allergy to neomycin in the period from 2000 to 2023. Methods: A cross‐section study of patients ≥18 years consecutively patch‐tested with neomycin sulfate (20% in pet.) at Gentofte Hospital, Denmark, during the period 2000–2023 was conducted. Results: The overall prevalence of contact allergy to neomycin was 1.4%. The prevalence was significantly lower in the period '2010–2023' (1.2%) than in '2000–2009' (1.8%) (p < 0.005). Contact allergy to neomycin was significantly positively associated with facial dermatitis and age >40 years, and significantly negatively associated with occupational dermatitis and hand dermatitis. No changes in sex, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis, or age > 40/≤40 (the MOAHLFA‐index) were identified when comparing neomycin contact allergic‐patients in the two periods '2010–2023' and '2001–2009'. Conclusion: Neomycin is a rare cause of contact allergy in Denmark with a significantly lower prevalence following its withdrawal as a medicinal product for human use in Denmark in 2009. [ABSTRACT FROM AUTHOR]

The American Academy of Dermatology launched DataDerm in 2016 as the clinical data registry platform of American Academy of Dermatology. DataDerm has evolved to be the largest database in the world containing information about dermatology patients, capturing information about their course of disease, associated therapeutic interventions, and health outcomes. As of December 31, 2022, DataDerm contained data from 14.2 million unique patients and 53.5 million unique patient visits, with 415 practices representing 1663 clinicians actively participating in DataDerm in 2022. This article is the fourth in a series of Annual Reports about the status of DataDerm. This year's 2023 Annual Report presents the progress DataDerm has made in conjunction with OM1, the data analytics partner of DataDerm, with a special highlight on the longitudinal care of common dermatologic conditions in the registry and a detailed focus on skin cancer. Furthermore, we review the current status of DataDerm as a robust representation of real world specialty data, reflecting the day-to-day dermatologic care of patients over time. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion High positivity rate of skin phosphorylated α‐synuclein (P‐SYN) was observed in Parkinson's disease (PD). Bullous pemphigoid (BP) is one of the most common autoimmune skin diseases associated with PD.Our aim was to investigate whether BP patients might be a targeted risk population for the screening of skin P‐SYN.Skin P‐SYN expression was evaluated by immunohistochemistry in BP patients with/without PD.Twenty‐two BP patients with PD, 24 BP patients without PD, and seven healthy donors were enrolled. Colocalization of P‐SYN and PGP9.5 was found in all BP patients, but only one healthy control, whereas BP patients with PD showed higher expression than BP patients without PD (mean ± standard deviation, 10.7 ± 6.7 vs. 7.3 ± 3.2; P = 0.027). Positive expression was mainly observed in basement membrane zone and dermis.These results indicated BP patients might be a targeted risk population for the screening of skin P‐SYN, which was helpful for the detection of PD early. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Background Objective Methodology Results Conclusions The shortage of dermatologists in rural and regional Australia is acutely felt in north Queensland where the population experiences a leading burden of skin cancer and tropical dermatoses. Store‐and‐forward teledermatology (SAFT) is recognised as a potential solution to improve accessibility of dermatology specialist care in rural communities. eConsult (a SAFT service) was piloted for the broader Townsville community in 2022. Evaluation was necessary to ensure wider implementation would meet stakeholder needs and improve patient care.To evaluate clinician perspectives and use of eConsult within the Townsville Hospital and Health service catchment over the pilot period (up to 9 months).Pre‐engagement interviews with clinicians assessed their management of dermatoses and service expectations prior to eConsult usage. eConsult referrals identified case characteristics, outcomes and uptake of the service amongst clinicians. Post‐engagement interviews assessed clinician perceptions and their suggestions for the service at the conclusion of the pilot period.In total, 24 and 17 clinicians participated in the pre‐ and post‐engagement interviews respectively, and 38 referrals were submitted by clinicians. The service assisted diagnosis and management of non‐urgent skin conditions for any age group. Clinicians generally had positive perceptions and appreciated timely access to local specialist advice. This study suggests a SAFT service can improve access to dermatology specialist opinion and increase management of dermatoses in primary care.Establishing sustainable teledermatology services with strong engagement from users is important for accessible care. Future research may investigate similar SAFT models involving more specialists and assess long‐term cost‐effectiveness. [ABSTRACT FROM AUTHOR]

Background: Bullous pemphigoid is an autoimmune bullous disease that frequently affects a large skin surface area, but it can also present in localized areas. It has been hypothesized that bullous pemphigoid affects the systemic functioning of different organs because inflammatory cells and cytokines circulate throughout numerous organs. Results: Recent clinical and experimental studies have revealed an association between bullous pemphigoid and systemic organ disorders. To avoid the emergence of systemic organ diseases, the significance of systemic treatment in cases of severe bullous pemphigoid should be emphasized. Conclusions: Here, we discuss the specific molecular processes underlying typical systemic organ inflammatory diseases associated with bullous pemphigoids. [ABSTRACT FROM AUTHOR]

Background/Objectives: Aggregate prescribing behavior for inflammatory lesions of rosacea has been described, but individual physician behavior has not been characterized. This study aims to assess the modern state of topical rosacea drug selection by analyzing prescribing patterns among individual dermatologists. Methods: We assessed utilization patterns of four topical papulopustular rosacea agents in 2021 Medicare Part-D data. K-means cluster analysis identified prescriber phenotypes based on the proportion of claims for each drug by physician. Results: Cluster analysis identified four prescriber phenotypes for topical rosacea agents, with the majority favoring metronidazole. In each of the other clusters, metronidazole was co-prescribed alongside the primary agent. Significant predictors of phenotype included patient ages, patient risk scores, and a group practice setting. Conclusions: The study reveals nonuniform prescribing patterns for topical papulopustular rosacea treatments among U.S. dermatologists. While aggregate data indicate diverse drug utilization, cluster analysis suggests that individual prescribers tend to use a limited selection of agents. [ABSTRACT FROM AUTHOR]

Background: Although the number of teledermatology studies is increasing, not all variables have been researched in equal depth, so there remains a lack of robust evidence for some teledermatology initiatives. This review describes the landscape of teledermatology research and identifies knowledge gaps and research needs. This evidence map can be used to inform clinicians about the current knowledge about teledermatology and guide researchers for future studies. Methods: Our evidence map was conducted according to the Campbell Collaboration checklist for evidence and gap maps. Eight databases were searched (CINAHL, Embase, PubMed, Scopus, Web of Science, Cochrane Library, JBI Database of Systematic Reviews and Implementation Reports, and OpenGray), and only included systematic reviews of teledermatology involving humans published in English; while excluding non-systematic reviews (i.e., abstracts, conference proceedings, editorials, commentaries, or letters). From 909 records, 14 systematic reviews published between 2004 and 2022 were included. Our analysis focused on the systematic reviews' characteristics, dermatological conditions studied, rate of overlap and quality assessment of primary studies reviewed, and main findings reported. Results: Teledermatology was reportedly comparable with clinic dermatology and generally accepted by patients as a mode of care delivery for dermatological conditions. However, there are concerns about privacy, communication, completeness of information transmitted, familiarity with the technology, and technical problems. Healthcare professionals were generally satisfied with teledermatology but found telemedicine consultations longer than face-to-face consultations, and less confident in asynchronous teledermatology than conventional consultations. Teledermatology was reportedly more cost-effective than clinic dermatology; especially considering the distance traveled by patients, referral volume to teledermatology, and clinic dermatology costs. Although patients and providers are satisfied with teledermatology, face-to-face dermatology has higher diagnostic and management accuracy. Teledermatology was also used for training medical professionals. Regarding the validity and reliability of teledermatology outcome measures, no significant discussions were found. Conclusions: COVID-19 spotlighted telemedicine in clinical care, and we must ensure telemedicine continually improves with robust research. Further research is necessary for establishing a standardized outcome set, enhancing accuracy, concordance, cost-effectiveness, and safety, comparing teledermatology with non-dermatologist care, examining its effectiveness in non-Western low and middle-income countries, and incorporating patient involvement for improved study design. Systematic review registration: https://www.researchregistry.com/ (Unique Identifying Number: reviewregistry878). [ABSTRACT FROM AUTHOR]

Background: Skin cancer in African countries results primarily from exposure to high ambient ultraviolet radiation. It is an emerging public health issue with limited improvement in management services. Mohs surgery, a renowned surgical procedure in the treatment of skin cancer, involves exact tumor excision along with horizontal frozen tissue examination. It is known to minimize the defect size and improve patient outcomes. Therefore, Mohs surgery is highly effective for almost all nonmelanoma skin cancers. Despite its proven potential, the implementation of Mohs surgery in Africa faces various limitations. This commentary seeks to provide insights into the current threats and opportunities surrounding the execution of Mohs surgery in African healthcare systems. The role of governments, healthcare professionals, and international organizations is also highlighted in this paper. Methods: A literature search was conducted by retrieving articles from PubMed and Google Scholar. Previous articles that discuss skin cancer, Mohs surgery, and cancer in Africa were analysed to understand the implementation aspects of Mohs surgery in Africa. Results: The implementation of Mohs surgery in Africa is very limited due to challenges such as inadequately trained healthcare professionals, costs associated with the surgery, and cultural beliefs and misconceptions. Nevertheless, telemedicine has been used in surgical consultations regarding the postoperative management of patients who undergo Mohs surgery. Conclusion: Despite advances in medicine, African dermatological health care remains underdeveloped. Therefore, increased investment in healthcare training, infrastructure development, and more African-based skin cancer studies are necessary and paramount factors for the expansion and accessibility of Mohs surgery in Africa. [ABSTRACT FROM AUTHOR]

Context: Merkel cell carcinoma diagnosis is often based on microscopic examination by pathologists. While histopathologic diagnosis primarily hinges on conscious and analytical cognition, the pathologist's decision‐making process is also influenced by a rapid "gist" or "gestalt" approach. In this study, using cases of Merkel cell carcinoma as a model, we aim to assess how pathologists' viewing short videos containing conceptual clues and visual aids, in conjunction with reading an original article as a reference, may enhance their diagnostic performance. Method: Sixteen pathologists were included in the present work. After participants had read the original article, their ability to distinguish Merkel cell polyomavirus (MCPyV)+ and MCPyV− Merkel cell carcinoma cases was evaluated on a first preliminary series of 20 cases. Following this test, the participants watched the video and then evaluated a second "experimental" series of 20 independent cases. Results: After reading the original article, for each case, a median number of 12 participants (75%, Q1–Q3: 10–13) classified the specimen in the correct category (92 incorrect answers in the whole series). An important interobserver variability was observed in this setting (Kappa coefficient = 0.465). By contrast, following the video, all cases were correctly classified by most of the participants, with only 12 incorrect answers on the whole series and excellent interobserver reproducibility (Kappa coefficient = 0.846). Conclusion: Our study demonstrated that providing a short video together with an original article may enhance pathologists' performance in diagnosing Merkel cell carcinoma. [ABSTRACT FROM AUTHOR]

Background Scabies and impetigo cause direct health effects and contribute to severe infectious and immune-mediated complications. Ivermectin-based mass drug administration can reduce scabies and impetigo prevalence in island settings with high prevalence, but the effectiveness in moderate-prevalence settings is not known. Methods We conducted a single-arm, before–after community intervention trial. Mass drug administration was offered to the entire population of 4 villages in Uttarakhand, India. The treatment consisted of 2 doses, given 7 days apart, of oral ivermectin (∼200 μg/kg), or topical 5% permethrin if ivermectin was contraindicated. The primary outcome was the prevalence of scabies at 12 months compared with baseline, as diagnosed using clinical assessment and the 2020 International Alliance for the Control of Scabies criteria. Secondary outcomes included the prevalence of impetigo at each time point. The trial was registered with the Australian and New Zealand Trials Registry (ACTRN12619001712190). Results In January 2020, 1211 participants were enrolled (100% of the estimated village population). Treatment coverage was high—1204 (99.4%) and 1177 (97.2%) received 1 and 2 doses, respectively. Scabies was diagnosed in 91 participants (7.5%) and impetigo in 15 (1.2%). In February 2021, 1190 (98.3% of baseline) participants re-enrolled, and of these 11 had scabies (0.9%; relative risk reduction, 87.7%; 95% CI, 77.1%–93.4%) and 5 had impetigo (0.4%; relative risk reduction, 66.1%; 95% CI, 7.0%–87.6%). Conclusions A single round of ivermectin-based mass drug administration substantially reduced the prevalence of scabies and impetigo in this setting with moderate scabies prevalence in northern India. [ABSTRACT FROM AUTHOR]

The pivotal roles of acetylcholine (ACh) in physiological processes encompass both the nervous and non‐neuronal cholinergic systems (NNCS). This review delineates the synthesis, release, receptor interactions, and degradation of ACh within the nervous system, and explores the NNCS in depth within skin cells including keratinocytes, endothelial cells, fibroblasts, macrophages, and other immune cells. We highlight the NNCS's essential functions in maintaining epidermal barrier integrity, promoting wound healing, regulating microcirculation, and modulating inflammatory responses. The potential of the NNCS as a therapeutic target for localized ACh regulation in the skin is discussed, though the translation of these findings into clinical practice remains uncertain due to the complexity of cholinergic signalling and the lack of comprehensive human studies. The review progresses to therapeutic modulation strategies of the NNCS, including AChE inhibitors, nicotinic and muscarinic receptor agonists and antagonists, choline uptake enhancers, and botulinum toxin, highlighting their relevance in dermatology. We highlight the impact of the NNCS on prevalent skin diseases such as psoriasis, atopic dermatitis, rosacea, acne, bullous diseases, hyperhidrosis and hypohidrosis, illustrating its significance in disease pathogenesis and therapy. This comprehensive overview aims to enhance understanding of the NNCS's role in skin health and disease, offering a foundation for future research and therapeutic innovation. [ABSTRACT FROM AUTHOR]

Objectives: Astragalus plants and their derivatives have been used historically for the treatment of various conditions, and they have recently been used to treat dermatological diseases and as topical cosmetic enhancers. In this consolidated systematic review, we analyzed current peer-reviewed publications regarding the topical effects of Astragalus derivatives on the treatment of dermatological diseases and whether the current market claims of its benefits and harms are substantiated. Methods: A systematic review using PRISMA criteria was conducted, and two independent reviewers selected and collected data from 9 papers that met the inclusion criteria. Results: Findings from these papers demonstrated that topical Astragalus derivatives were effective in the treatment of alopecia, atopic dermatitis, wound healing, contact dermatitis, dermatophytosis, and psoriasis. The beneficial effects of Astragalus in these dermatological conditions were attributed to its immunomodulatory mechanisms. Conclusion: The wide availability of this product allows its easy use for treating common dermatological issues. However, these articles are limited by their assessment of use on non-human mammals, the short duration of trials, and unclear mechanisms of action that limit research development. Future research is needed to close these gaps before the development of Astragalus-based pharmaceuticals for dermatological conditions. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case demonstrated with importance of recognizing DRESS syndrome presenting without the typical eosinophilia due to possible cross‐reactivity between amoxicillin and the well‐documented inciting medication lamotrigine. Steroid tapering is an effective treatment, but medication avoidance should be stressed to avoid symptom recurrence. [ABSTRACT FROM AUTHOR]

The bond between humans and dogs is precious and has been treasured since ancient times. Dog ownership is linked to numerous health benefits, such as increased physical activity and social functioning and decreased depression and cardiovascular events. However, dogs can transmit zoonotic diseases to humans, many of which present with cutaneous findings. This review summarizes the dermatologic manifestations, transmission routes, diagnosis, and treatment of zoonotic diseases transmitted by dogs, including vector‐borne, bacterial, viral, fungal, and parasitic infections. This review emphasizes the significance of clinicians obtaining a comprehensive exposure history when patients exhibit a rash of unknown origin. Such an approach can provide valuable epidemiological clues related to diagnosing a zoonotic disease transmitted by a pet dog. Furthermore, identifying the dog as an infection source and subsequent veterinary treatment can help prevent recurrent infections in dermatologic patients. [ABSTRACT FROM AUTHOR]