Dermatologic Care Research Articles

SkinHealthMate App: An AI-Powered Digital Platform for Skin Disease Diagnosis

Accurate diagnosis of skin diseases remains a significant challenge due to the inherent limitations of traditional visual and manual examination methods. These conventional approaches, while essential to dermatological practice, are prone to misdiagnoses and delays in treatment, particularly for conditions like skin cancer. To address these gaps, this paper presents the SkinHealth App, an innovative AI-driven solution that enhances the accuracy and efficiency of skin disease diagnosis. The app integrates a robust ensemble learning model, combining the strengths of EfficientNetB1 and EfficientNetB5 architectures. This ensemble model improves disease classification performance through advanced image processing techniques such as noise reduction and data augmentation. The key contributions of this work include the development of a scalable and secure server-side structure that ensures the safe handling of patient data and efficient processing of diagnostic queries. Experimental results on the HAM10000 dataset demonstrate the model's superior performance, achieving an accuracy of 93%, along with high precision and recall scores, thereby reducing false positives and false negatives. These outcomes clearly establish the app's potential to enhance dermatological diagnosis by providing timely and accurate disease identification. Ultimately, this work bridges the gap between traditional diagnostic methods and modern AI-driven technology, offering a transformative tool for improving patient care in dermatology.

Enhancing patient education and engagement through digital intelligence tools in dermatology

This comprehensive digital health review examines the expanding landscape of digital intelligence tools within dermatology, specifically examining the innovative role of AI-powered applications aimed at educating and engaging patients in managing their skin health. Drawing upon a wide array of existing research, this review scrutinizes the evolution and impact of various digital tools. These include interactive apps that leverage AI algorithms to deliver tailored skincare guidance, considering factors such as skin type, concerns, and environmental factors. Additionally, the review explores the emerging use of immersive virtual reality experiences to deepen patients’ understanding of skin conditions, offering vivid simulations and educational content. These innovative approaches showcase significant promise in not only improving patient outcomes but also fostering greater treatment adherence and overall satisfaction with dermatological care. Looking ahead, future research should prioritize fine-tuning AI algorithms to further personalize patient recommendations, exploring the integration of wearable technology for real-time monitoring, and conducting longitudinal studies to evaluate the sustained effectiveness and scalability of digital intelligence tools in promoting patient education and engagement. Moreover, innovative strategies such as gamification techniques and social support platforms hold considerable potential for enhancing patient empowerment and involvement in managing their skin health. Leveraging digital intelligence tools will eventually redefine the landscape of dermatological care, empowering patients and optimizing treatment outcomes through enhanced education and engagement.

Investigating the Skin Health Benefits of Rosa roxburghii, Punica granatum and Rose: A Randomized Single‐Blind Controlled Clinical Trial

ABSTRACTRecent studies underscore the beneficial impacts of oral natural plant extracts on human skin health, though clinical evidence of their efficacy and safety is limited. This study evaluates the skin health effects of a novel oral supplement containing Rosa roxburghii, Punica granatum, and rose extracts (RPR) 0.70 healthy female participants were randomly assigned to either a control group or an RPR group, with the latter ingesting 20 mL of the RPR supplement daily on an empty stomach over 8 weeks. After 8 weeks, the RPR group exhibited significant enhancements (p < 0.001) in skin hydration, glossiness, elasticity, and skin tone, with increases of 69.02%, 30.48%, 25.97%, and 7.52%, respectively. Concurrently, decreases in skin firmness and melanin levels were observed at 21.17% (p = 0.007) and 25.06% (p < 0.001), respectively. Statistical analysis confirmed that these changes were significantly greater than those in the control group. Image analysis indicated no significant changes in mean optical density of hyperpigmented spots within the RPR group (p = 0.367), but a significant reduction in the areas of hyperpigmented spots, under‐eye fine lines, and crow's feet by 41.50%, 37.55%, and 29.36%, respectively (p < 0.001), whereas no significant changes were detected in the control group. Importantly, no adverse effects were observed. These findings suggest that the combined intake of Rosa roxburghii, Punica granatum, and rose extracts can improve skin health, offering a promising natural alternative for dermatological care.

Роль и место медицинской информационной системы при оказании дерматологической помощи в частной медицинской организации

Dermatological diseases retain statistically significant positions in the structure of modern somatic pathology and are often characterized by severe medical and social consequences. The latter include an unreasonably high number of unsatisfactory treatment results, high level of expenses for diagnostics and treatment, low level of patient satisfaction. Taken together, this allows us to consider the comprehensive quality of dermatological care as a whole insufficient. Medical organizations in the private healthcare segment are no exception in this regard. One of the modern effective directions in improving the quality of a wide variety of types of medical care for the population is the widespread use of the so-called medical information systems (MIS). However, at the level of dermatological organizations in the private healthcare segment, this direction has not been practically worked out to date. Purpose of the study: improving the quality of dermatological care for the population in a private medical organization based on the development and implementation of a medical information system. Materials. The study included 2000 dermatological patients of a private medical organization. The control group (1000 people) consisted of patients in the period before the implementation, the main group (1000 people) – patients in the period after the implementation of the developed system. The duration of the compared periods was 2,5 years. Мethods. To obtain the results, the methods of objective examination, specialized patient questionnaires, simple and extended dermatoscopy, content analysis of medical documentation and databases of the medical organization, pharmacoeconomic analysis were used. The system of integrated assessment of the quality of medical care was applied. The methods of variation statistics were used to analyze the results. The exact level of statistical significance of differences in the results before and after the implementation of the developed MIS was calculated.. Subject. The study is at the intersection of two subject areas: «Organization of dermatological care for the population» and «Medical information systems». Results. As part of this study, a MIS was developed aimed at improving the organization of dermatological care for the population. The system was implemented in a medical organization in the private healthcare segment. The main results of such implementation were: an increase in the number of successful treatment results, the level of patient satisfaction with the quality of dermatological care, the level of its standardization, a decrease in direct economic costs for diagnostics and treatment. The integrated and comprehensive indicators of the quality of dermatological care have been increased.. Conclusion. Improving the quality of dermatological care for the population in a medical organization of the private healthcare segment based on the development and implementation of a medical information system has been achieved. The results obtained have a high level of statistical and medical-social significance.

Psoriasis: a disease beyond the skin.

Psoriasis is a chronic, immune-mediated inflammatory dermatosis with a multifactorial etiology, affecting approximately 3% of the Italian population. This condition not only imposes a substantial burden on physical health but also significantly diminishes the personal and social quality of life of affected individuals. This study aims to assess the critical role of integrated management approaches in psoriasis, focusing specifically on the role of primary care physicians in coordinating multidisciplinary care and addressing comorbidities. A comprehensive review of current therapeutic guidelines, classification systems, and available treatment strategies was conducted. This was supplemented with real-world clinical case studies. The study evaluated intervention approaches at both primary and secondary care levels, involving collaborations between general practitioners and specialists. Special emphasis was placed on the use of clinical assessment tools such as the Psoriasis Area and Severity Index (PASI) to categorize disease severity and guide therapeutic decisions. Our findings underscore the effectiveness of a multidisciplinary and personalized approach in managing psoriasis, particularly in moderate-to-severe cases. The pivotal role of primary care physicians in the early diagnosis, ongoing monitoring, and coordination of care pathways was highlighted, leading to significant improvements in comorbidity management. The clinical cases presented illustrate how tailored therapeutic regimens, supported by close collaboration between general practitioners and dermatologists, can result in the effective resolution of psoriatic lesions and markedly enhance patients’ quality of life. This study reinforces the necessity of a comprehensive, integrated, and multidisciplinary approach in the management of psoriasis, with primary care physicians serving as crucial intermediaries between community-based and specialist care. Depending on disease severity, treatment response, and recurrence patterns, primary care physicians play a central role in directing patients to appropriate secondary care services. The integration of specialist dermatological care with ongoing community-based monitoring optimizes clinical outcomes and mitigates the overall disease burden. We advocate for the establishment of clinical networks that facilitate seamless communication between different levels of care, ensuring holistic and targeted management of both psoriasis and its associated comorbidities. Keywords: Psoriasis, primary care physician, multidisciplinary care, integrated therapy, quality of life, comorbidities.

Challenges in Teledermoscopy Diagnostic Outcome Studies: Scoping Review of Heterogeneous Study Characteristics.

Teledermoscopy has demonstrated benefits such as decreased costs and enhanced access to dermatology care for skin cancer detection. However, the heterogeneity among teledermoscopy studies hinders the systematic reviews' synopsis of diagnostic outcomes, impeding trust and adoption in general practice and limiting overall health care benefits. This study aims to improve understanding and standardization of teledermoscopy diagnostic studies, by identifying and categorizing study characteristics contributing to heterogeneity. Subsequently, the variability and consistency of these characteristics were assessed. A review of systematic reviews regarding the diagnostic outcomes of teledermoscopy was performed to discern reported study characteristics contributing to heterogeneity. These characteristics were thematically grouped into 3 domains (population, index test, and reference standard), forming a data extraction framework. A scoping review on teledermoscopy diagnostic outcomes studies was performed, guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Data pertaining to study characteristics from included studies were extracted and analyzed through descriptive content analysis. Systematic reviews' reference lists validated the scoping review query. The literature search yielded 4 systematic reviews, revealing 15 heterogeneous studies across the population, index test, and reference standard domains. The scoping review identified 49 studies, with 27 overlapping with the systematic reviews. Population characteristics varied, with one-third (16/49, 33%) of studies reporting fewer than 100 samples; most studies (41/49, 84%) reported on the type of lesion, and most (20/49, 41%) teledermoscopy consultations took place in secondary care. One-fifth (11/49, 22%) did not describe inclusion or exclusion criteria, or the criteria varied highly. Index test characteristics showed differences in clinical expertise, profession, and training in dermatoscopic photography, and 59% (29/49) did not report on 1 or more index test characteristics. Image quality and clinical information reporting likewise varied. Reference standard characteristics involved teledermatologists' assessment, but 16 studies did not report teledermatologists' experience levels. Most studies (26/49, 53%) used histopathology as a gold standard. The heterogeneity in the population, index tests, and reference standard domains across teledermoscopy diagnostic outcome studies underscores the need for standardized reporting. This hinders the synopsis of teledermoscopy diagnostic outcomes in systematic reviews and limits the integration of research results into practice. Adopting a (tailored) STARD (Standards for Reporting Diagnostic Accuracy Studies) checklist for teledermoscopy diagnostic outcome studies is recommended to enhance the consistency and comparability of outcomes. We suggest performing a Delphi study to gather consensus on the tailored STARD guideline.

Coronavirus-disease-2019-associated Stevens–Johnsons syndrome in a 15-year-old boy: a case report and review of the literature

BackgroundStevens–Johnson syndrome (SJS) is a life-threatening condition characterized by high fever and severe mucocutaneous lesions, often triggered by drugs or infection. During the coronavirus disease 2019 pandemic, there was a marked increase in Stevens–Johnson syndrome cases, but relatively few cases were reported in children. The present article reports a pediatric case of Stevens–Johnson syndrome due to coronavirus disease 2019 infection and provides a review of the most relevant literature.Case presentationA previously healthy 15-year-old Han Chinese boy from China presented to the hospital with oral ulcers, conjunctival hyperemia, and widespread maculopapular rash. He had a history of fever 9 days prior and tested positive for coronavirus disease 2019 infection. Upon admission, his rash and mucosal lesions worsened, with the development of blisters on the fingertips of both hands, ocular pain, photophobia, and erosive lesions on the genital mucosa with exudation. He was diagnosed with Stevens–Johnson syndrome and received treatment with methylprednisolone, intravenous immunoglobulin, and dermatological and mucosal care. The patient’s condition was managed, and the dosage of high-dose intravenous methylprednisolone was tapered down, followed by a transition to oral prednisolone. He was discharged without sequelae.ConclusionWe should be aware that coronavirus disease 2019 infection is associated with the development of Stevens–Johnson syndrome in children and may lead to a wide spectrum of dermatologic presentations. Although Stevens–Johnson syndrome is a relatively rare condition, given its potentially serious consequences, it is crucial to identify it as early as possible and to take appropriate preventive and therapeutic measures to reduce complications and improve the quality of life for patients.

Effectiveness of Azadirachta indica and Ocimum gratissimum for Acne Vulgaris: A Literature Review

Acne vulgaris is a common dermatological condition characterized by inflammation of the pilosebaceous units, predominantly affecting adolescents and young adults. Its multifactorial etiology involves hormonal imbalances, microbial overgrowth, and environmental factors, leading to increased sebum production and inflammation. Conventional treatments often vary in efficacy and tolerability, driving interest in alternative therapies to reduce the severity and recurrence of lesions and enhance appearance, the acne severity. This literature review explores the therapeutic potential of two herbal remedies, Azadirachta indica (Neem) and Ocimum gratissimum (African basil), known for their antimicrobial, anti-inflammatory, and antioxidant properties. Azadirachta indica is recognized for its rich phytochemical profile, including compounds like nimbin and azadirachtin, which effectively combat acne pathogens such as Cutibacterium acnes. Meanwhile, Ocimum gratissimum exhibits significant antimicrobial and antioxidant activities, contributing to skin healing and sebum regulation. The combined use of these herbs offers a holistic approach to acne management, targeting multiple aspects of its pathogenesis, including inflammation and microbial imbalance. The therapeutic benefits of Azadirachta indica and Ocimum gratissimum highlight their valuable role in advancing dermatological care and offer promising prospects for individuals seeking holistic and plant-based solutions for acne management. This review emphasizes the potential and effectiveness of Azadirachta indica and Ocimum gratissimum in advancing dermatological care and providing effective, plant-based solutions for acne management. Keywords: Acne vulgaris, azadirachta indica, clove basil, neem, ocimum gratissimum, treatment

Integrating generative AI with ABCDE rule analysis for enhanced skin cancer diagnosis, dermatologist training and patient education.

The early detection and accurate monitoring of suspicious skin lesions are critical for effective dermatological diagnosis and treatment, particularly for reliable identification of the progression of nevi to melanoma. The traditional diagnostic framework, the ABCDE rule, provides a foundation for evaluating lesion characteristics by visual examination using dermoscopes. Simulations of skin lesion progression could improve the understanding of melanoma growth patterns. This study aims to enhance lesion analysis and understanding of lesion progression by providing a simulated potential progression of nevi into melanomas. The study generates a dataset of simulated lesion progressions, from nevi to simulated melanoma, based on a Cycle-Consistent Adversarial Network (Cycle-GAN) and frame interpolation. We apply an optical flow analysis to the generated dermoscopic image sequences, enabling the quantification of lesion transformation. In parallel, we evaluate changes in ABCDE rule metrics as example to assess the simulated evolution. We present the first simulation of nevi progressing into simulated melanoma counterparts, consisting of 152 detailed steps. The ABCDE rule metrics correlate with the simulation in a natural manner. For the seven samples studied, the asymmetry metric increased by an average of 19%, the border gradient metric increased by an average of 63%, the convexity metric decreased by an average of 3%, the diameter increased by an average of 2%, and the color dispersion metric increased by an average of 45%. The diagnostic value of the ABCDE rule is enhanced through the addition of insights based on optical flow. The outward expansion of lesions, as captured by optical flow vectors, correlates strongly with the expected increase in diameter, confirming the simulation's fidelity to known lesion growth patterns. The heatmap visualizations further illustrate the degree of change within lesions, offering an intuitive visual proxy for lesion evolution. The achieved simulations of potential lesion progressions could facilitate improved early detection and understanding of how lesions evolve. By combining the optical flow analysis with the established criteria of the ABCDE rule, this study presents a significant advancement in dermatoscopic diagnostics and patient education. Future research will focus on applying this integrated approach to real patient data, with the aim of enhancing the understanding of lesion progression and the personalization of dermatological care.

Keratinocyte Carcinoma: Canadian Landscape and an Evidence-based Approach to Follow-up

Dermatologists play a vital role in the early detection, prevention and effective management of skin cancer in patients with a prior history of the disease. Regular monitoring and timely interventions greatly enhance the overall prognosis and quality of life for patients with skin cancer. Dermatologists possess the requisite expertise to accurately diagnose and oversee the management of cutaneous skin cancers. Skin cancer screening via total body skin exam (TBSE) is often considered one of the safest, easiest, and most cost-effective tests in medicine. Despite dermatologists’ ability to offer such invaluable care for this patient population, offering routine skin checks for all patients with a prior history of skin cancer becomes exceptionally challenging given the high demand for dermatology care across Canada. It is important for dermatologists to maximize the efficiency of care during TBSEs by adhering to evidence-based guidelines when determining the frequency and duration of follow-up. These guidelines also provide a solid foundation for discussions with patients regarding the rationale for discharge back to their primary care provider.

Optimizing Dermatological Care Triage in a Safety-Net Hospital: Retrospective Analysis of Diagnoses and In-Person Referrals.

Teledermatology is a cost-effective and efficient approach to delivering care and is particularly beneficial for patients with limited access to specialized services. Considering the rapid expansion of telehealth, it is crucial to focus on optimization. The purpose of our study was to evaluate the triaging of dermatologic care in an electronic consultation (e-consultation) service in a safety-net hospital. This was a 2-year retrospective review of a dermatology asynchronous store-and-forward e-consultation service. A total of 1425 patients completed 1502 e-consultation. Of these e-consultations, 46% of the patients had Medicaid and 44% were Black or African American. The top three diagnoses were dermatitis unspecified, neoplasm of uncertain behavior, and acne/rosacea. Most (68%) were managed via e-consultation and did not require an in-person appointment. Children and adolescents were more likely to require an in-person appointment (74%) compared with adults (30%, P < 0.0001). Patients with a chief complaint of hair loss or skin lesion were more likely to require in-person evaluation (58% and 41%, respectively) compared with rash (24%) and acne (18%) (P < 0.0001). There was no difference found in recommendations for in-person evaluation based on race, non-English-language preference, or insurance status. E-consultation services seem well suited for certain concerns, and underserved populations can be evaluated by teledermatology.

An Insight into the Mechanism, Safety and Efficacy for Photoprotection and Dermatological Conditions of Polypodium leucotomos Extract

Abstract: Numerous photoprotective techniques have been employed to successfully shield against the harmful effects of ultraviolet radiation. Current photoprotective techniques have limitations due to the amount of topical application, insufficient physical protection, and adverse responses to topical agents. A newer option that offers a promising defense against solar radiation is systemic agents, the well-researched Polypodium leucotomos is significant in this category, and several studies have found to be effective ―oral sunscreenǁ. Polypodium leucotomos (PL) extract has gained significant attention as a potential therapeutic agent in the field of dermatology, particularly in the photoprotection and management of various dermatological conditions. This abstract provides a comprehensive overview of the mechanism, safety, and efficacy of Polypodium leucotomos extract in relation to photoprotection and dermatological conditions. Our primary aim is to review Polypodium leucotomos' photoprotective results from studies that are currently available, and our secondary goal is to describe Polypodium leucotomos' applications in different dermatological conditions. Articles discussing Polypodium leucotomos uses in photoprotection and dermatologic conditions are searched and downloaded from publicly available databases such as PubMed, JSTOR, PLOS, Science Direct, DOAJ, Google Scholar, and Web of Science and evaluate the outcomes of the Polypodium leucotomos effect. Firstly, we delve into the mechanisms underlying the photoprotective properties of PL extract. Extensive research has demonstrated that PL extract exerts its protective effects through multiple pathways, including antioxidant activity, DNA repair stimulation, immunomodulation, and inhibition of inflammatory mediators. These mechanisms collectively contribute to the prevention of photodamage, such as sunburn, DNA damage, and photoaging. Furthermore, we explore the safety profile of PL extract, emphasizing its remarkable tolerability and minimal adverse effects reported in clinical studies. The absence of systemic absorption and its compatibility with other treatments make PL extract a promising option for long-term use in photoprotection and dermatological care. A promising alternative to traditional photoprotection may be Polypodium leucotomos. Additional thorough clinical trials are necessary to ascertain its role and effectiveness more accurately. The efficacy of PL extract in managing various dermatological conditions is also discussed. Multiple studies have demonstrated its beneficial effects in conditions such as vitiligo, melasma, psoriasis, and atopic dermatitis. The anti-inflammatory and immunomodulatory properties of PL extract have shown promise in reducing disease severity, improving skin symptoms, and enhancing the quality of life for patients. Additionally, the abstract highlights the potential future directions and areas of research for PL extract. Investigating its combination therapy with other photoprotective agents, exploring optimal dosage regimens, and further elucidating the molecular mechanisms are areas that warrant attention. In conclusion, this abstract provides an insightful overview of the mechanisms, safety, and efficacy of PL extract in photoprotection and dermatological conditions. The remarkable properties of PL extract, combined with its favorable safety profile, position it as a promising therapeutic intervention in dermatology. Further research and clinical trials are needed to fully exploit its potential and establish its place in the management of various skin conditions.

Comprehensive Assessment of Dermatologic and Dysmorphic Manifestations in Patients With Down Syndrome.

Down syndrome (DS), a common chromosomal anomaly caused by trisomy of chromosome 21, is characterized by a broad spectrum of phenotypic characteristics across multiple organ systems, including cardiac defects and leukemia. Dermatological findings are prevalent among individuals with DS; however, these issues are frequently underrecognized and inadequately researched, resulting in a significant gap in the provision of comprehensive healthcare strategies. Given the increased life expectancy of patients with DS and delayed manifestation of many dermatoses, physicians are increasingly encountering dermatological findings in this population. This study aimed to assess the prevalence and types of dermatological findings in individuals with DS, compare them with those in a control group, and emphasize the necessity of incorporating dermatological evaluations into routine health monitoring. This prospective cross-sectional study was conducted from June 2023 to June 2024 and involved 100 genetically confirmed individuals with DS and 100 age- and sex-matched controls. Comprehensive demographic, clinical, and karyotype data were collected for the DS group, and all the participants underwent detailed morphological evaluations. The DS group had a mean age of approximately 6.37 years, whereas the controls were around 7 years old, with no significant differences in age or sex distribution between the groups. Karyotype analysis showed that trisomy 21 was present in 92% of the cases, mosaicism in 6%, and translocation in 2%. Common dermatological findings in the DS group included xerosis cutis (49%), thin and sparse hair (48%), dental caries (34%), delayed tooth eruption (28%), nail dystrophy (25%), fissured tongue (23%), and cheilitis (18%). Significant differences were noted in the prevalence of scabies, bacterial infections, and café au lait macules between the DS and control groups (p < 0.01). Dysmorphic findings in the DS group included epicanthal folds (97%), upslanted palpebral fissures (97%), brachycephaly (91%), and single transverse palmar crease (89%). Significant gender differences were noted in the prevalence of brachycephaly and the sandal gap (p < 0.01). This study highlights the importance of regular dermatological care in enhancing the health management and quality of life of individuals with DS due to the prevalence and variability of dermatological conditions.

Alitretinoin versus phototherapy as the first-line treatment in adults with severe chronic hand eczema: the ALPHA RCT.

Hand eczema is common and a cause of morbidity and occupational disability. When education, irritant/contact allergen avoidance, moisturisation and topical corticosteroids are insufficient to control chronic hand eczema, ultraviolet therapy or systemic immune-modifying drugs are used. There is no treatment pathway generally accepted by UK dermatologists. Compare alitretinoin and ultraviolet therapy as first-line therapy in terms of disease activity at 12 weeks post planned start of treatment. Prospective, multicentre, open-label, two-arm parallel group, adaptive randomised controlled trial with one planned interim analysis, and an economic evaluation. UK secondary care dermatology outpatient clinics. Patients with severe chronic hand eczema unresponsive to at least 4 weeks of treatment with potent topical corticosteroids. Natural logarithm of the Hand Eczema Severity Index + 1, 12 weeks post planned start of treatment. Participants randomised 1:1 by minimisation to alitretinoin or ultraviolet therapy for 12 to 24 weeks. Blinded primary end-point assessor. Intention-to-treat population: 441 (100.0%) participants; 220 (49.9%) alitretinoin and 221 (50.1%) ultraviolet therapy. At least one dose was received by 212 (96.4%) alitretinoin and 196 (88.7%) ultraviolet therapy participants. The unadjusted median (interquartile range) relative change in hand eczema severity index at 12 weeks was 30% (10-70%) of that at baseline for alitretinoin compared with 50% (20-100%) for ultraviolet therapy. There was a statistically significant benefit of alitretinoin compared with ultraviolet therapy at 12 weeks, with an estimated fold change or relative difference (95% confidence interval) = 0.66 (0.52 to 0.82), p = 0.0003 at 12 weeks. There was no evidence of a difference at 24 or 52 weeks, with the estimated fold change (95% confidence interval) equal to 0.92 (0.798 to 1.08) and 1.27 (0.97 to 1.67), respectively. Fifty-nine per cent allocated to alitretinoin and 61% allocated to ultraviolet therapy achieved a clear/almost clear assessment during the trial period. Differential treatment compliance observed: 145 (65.9%) alitretinoin and 53 (24.0%) ultraviolet therapy participants confirmed compliance (≥80% received, no treatment breaks > 7 days during first 12 weeks). High levels of missing data were observed. One hundred and thirty-five reportable adverse events across 79 participants, 55 (25.0%) alitretinoin and 24 (10.9%) ultraviolet therapy. Four serious adverse events (two alitretinoin, two ultraviolet therapy). Four pregnancies reported (three alitretinoin, one ultraviolet therapy). No new safety signals were detected. As a first-line therapy, alitretinoin showed more rapid improvement and superiority to ultraviolet therapy at week 12. This difference was not observed at later time points. Alitretinoin is cost-effective at weeks 12 and 52. Ultraviolet therapy is cost-effective after 10 years, with a high degree of uncertainty. Hand eczema severity index may be a useful primary outcome measure for hand eczema trials; ALPHA results will inform future trials. Treatment compliance was poor for ultraviolet therapy. Regular twice weekly treatment was not received by most patients. Assessment of long-term effects of randomised treatments was complicated by use of second-line treatments post treatment phase. Further analysis of substudies and pilot data will provide valuable information for future studies. A clear need for better therapeutic approaches for severe chronic hand eczema remains. Future studies will need to further address long-term benefits of treatments given. This trial is registered as ISRCTN80206075. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/186/01) and is published in full in Health Technology Assessment; Vol. 28, No. 59. See the NIHR Funding and Awards website for further award information.

Knowledge, Attitude, and Practice Patterns on Psychodermatology among Filipino Dermatologists: A Cross-sectional Study.

Psychodermatology is a field that focuses on the interaction of the skin and the mind. Psychodermatology patients are often challenging to manage because they often lack insight and are not amenable to psychiatric treatment or referral. Therefore, it is important that dermatologists become aware of the psychosocial impact of cutaneous disease and be knowledgeable in the fundamentals of psychodermatologic diagnosis and therapy. However, studies done in several countries report a general lack of perceived knowledge, awareness, and confidence in the management of psychodermatology disorders among dermatologists. This study aims to determine the knowledge, attitudes, and practices of Filipino dermatologists towards psychodermatology using a self-administered questionnaire. This is a mixed methods study using qualitative and quantitative measures. A self-administered questionnaire was validated and disseminated among the dermatologists in the country. Descriptive analysis was done. Of the 153 participating dermatologists, majority (70.59%) reported psychodermatologic patients comprised <10% of their practice. While more than half (56.2%) have a clear understanding of psychodermatology and are comfortable (57.52%) in approaching patients with these conditions, only 58 (37.91%) participants are able to demonstrate adequate knowledge on psychodermatology. Patients with primary psychiatric disorders are less frequently encountered than dermatologic disorders with psychiatric component or secondary psychiatric disorders. Most commonly prescribed medications are anti-histamines. Other psychotropic medications are rarely or never prescribed by the participants. All participants agree that psychodermatology is important in the practice of dermatology; 127 (62.1%) have attended at least one Continuing Medical Education (CME) on psychodermatology and 114 (74.51%) expressed willingness to attend CME training in psychodermatology. One hundred nine (71.24%) participants think that the best practice approach is a multidisciplinary approach to psychodermatology. The top recommendations for better healthcare delivery in psychodermatology were better access to mental health specialists (86.27%), more training opportunities and better training during residency (75.16%), and increase collaboration with psychiatrists (71.9%). The knowledge score was found to be associated with the duration of dermatology practice and attendance in CME proceedings but was not associated with the perceived adequacy of knowledge gained during training. Longer duration of practice may be associated with the knowledge score owing to the greater exposure to cases and more access to training opportunities. There are many challenges to providing psychodermatologic care in the Philippines but the positive attitude towards psychodermatology, coupled with increased access to education and training opportunities, and the multidisciplinary approach to these cases may improve the quality of dermatologic care that we provide.

Ethical Issues Regarding Dermatopathology Care for Service-Members: A Review.

Dermatologic care within the military faces unique ethical challenges. Service members are stationed across nationally and globally diverse settings, and therefore, dermatologic care rendered ranges from within resource-rich, advanced military medical treatment facilities to austere, resource-limited, deployed field environments. Additionally, military service members are often at unique risk for dermatologic disease, given occupational, environmental, and geographic exposures not commonly faced by their civilian counterparts. This review explores topics in dermatoethics via case analyses of ethical considerations within the scope of dermatologic care for military service members.

Evaluation of Skin of Color Curricular Content for Physician Assistant Education.

Physician assistants (PAs) are often members of dermatologic care teams. Adequate knowledge of dermatologic conditions in skin of color (SOC) is crucial to proper diagnosis, treatment, and patient satisfaction. The objective of this study was to increase PA students' objective knowledge of and comfort level with evaluating dermatologic conditions in SOC. Eligible participants included 36 PA students at a major metropolitan medical center during the 2022 to 2023 academic year. A preintervention survey, immediate postintervention survey, and 7-month follow-up postintervention survey were administered before and after a SOC lecture. The surveys concluded with a 10-question, image-based, multiple-choice examination. There was a significant increase in accurate diagnoses of acne scarring, eczema, psoriasis, rosacea, and seborrheic dermatitis in SOC (59.4% preintervention to 76.9% postintervention, P = .029). Student confidence, as rated on a scale of 1 (minimally confident) to 5 (extremely confident), in diagnosing these conditions increased from 2.97 to 3.52 (P = .036). Implementation of a SOC-specific dermatology lecture significantly increased the accuracy and confidence with which PA students diagnosed dermatologic conditions.

Comparative Effectiveness of Teledermatology Versus In-person Consultations: A Systematic Review of Diagnostic Information Elements

Context: Teledermatology is delivered through two primary methods: Live video conferencing, which enables real-time interaction between patients and doctors, and the store-and-forward technique, where images of skin lesions are sent over the internet for later examination. Objectives: This systematic review evaluates the concordance between in-person and telemedicine follow-up methods in dermatology. Methods: In February 2024, a comprehensive literature search was conducted across PubMed, Medline, ISI Web of Science, and the ACM Digital Library. Keywords such as "teledermatology," "telemedicine," and "mobile health" were used, following the PICOS criteria. Results: Initially, 716 articles were identified from the databases, along with four studies from the gray literature search. After removing duplicates, screening studies, and applying the inclusion and exclusion criteria, 21 studies were selected for the final review. These studies detailed follow-up procedures and assessed both direct and indirect costs and effectiveness. The consensus indicates that teledermatology reduces costs and satisfies both patients and healthcare professionals. Conclusions: Teledermatology has been shown to potentially increase the efficiency of follow-up care compared to traditional methods. However, further research is needed to develop standardized evaluation protocols and to more accurately measure and validate key variables. Publications suggest that teledermatology is cost-effective, reduces patient wait times, extends access to dermatological care in remote areas, and enhances satisfaction among patients, doctors, and nurses.

AI-Enhanced Teledermatology: Bridging the Gap in Access to Dermatological Care in Rural Areas

AI-Enhanced Teledermatology: Bridging the Gap in Access to Dermatological Care in Rural Areas

Exploring ethnic disparities in pediatric molluscum contagiosum in Southern Israel

Molluscum contagiosum (MC) is a common skin infection affecting children globally, including in Israel, which has a diverse population comprising mainly Jews (73.2%) and Arabs (21.1%). Despite documented disparities in various diseases between these groups, research on differences in dermatological care is scarce. This study aimed to investigate MC as a potential differentiator between Arab and Jewish children. A retrospective analysis of MC cases among children (0–18 years) from 2013 to 2022 was performed at Soroka University Medical Center, a tertiary hospital serving over a million patients. 615 patients participated in our study, with 95.2% Jewish and 4.8% Arab. Both groups showed similar characteristics in lesion quantity (P = 0.535), diameter (P = 0.341), inflammation markers, and lesion location. Additionally, management, treatment response, and outcomes were found to be similar between the two groups. In conclusion, the Arab representation in the study was disproportionately low compared to their population in the area. While Jewish patients may rely more on medical specialists, we believe Arabs may prefer self-management practices, such as the use of traditional medicine, possibly hindering effective physician-led care. Understanding such disparities could improve dermatological care by tailoring approaches to diverse populations.