Dermatology Practice Research Articles

Current Insights on Treatment Adherence in Prevalent Dermatological Conditions and Strategies To Optimize Adherence Rates.

Adherence to prescribed medication regimens is crucial for treatment efficacy and patient safety, but it remains a challenge in the medical field, particularly in dermatology, where adherence to prescribed treatments is being intensively evaluated and improved. This narrative review provides a comprehensive overview of adherence behaviors in dermatological diseases, including fungal skin infections, psoriasis, acne, atopic dermatitis, and chronic urticaria, aiming to update scientific information on adherence patterns and management strategies in these highly prevalent conditions. Furthermore, the importance of a holistic approach that integrates patient-centered and physician-centered strategies to optimize treatment outcomes and enhance adherence in dermatological care is highlighted. The role of technological advancements in promoting adherence is also discussed, with an emphasis on the potential for digital solutions to facilitate medication management. Future perspectives underscore the need for targeted interventions to address the multifaceted barriers to adherence, including treatment complexity, healthcare accessibility, and patient-provider communication. By addressing these challenges, healthcare providers can enhance patient satisfaction, improve therapeutic outcomes, and mitigate the adverse consequences of non-adherence in dermatological practice.

50720 Application of Lean Six Sigma in Dermatology Practice

50720 Application of Lean Six Sigma in Dermatology Practice

49080 The effect of social media on dermatological self-treatment practices in relation to University-age populations and the adverse reactions associated with "at-home” treatments

49080 The effect of social media on dermatological self-treatment practices in relation to University-age populations and the adverse reactions associated with "at-home” treatments

54250 Assessing the Performance of ChatGPT in Answering Dermatology Practice Questions

54250 Assessing the Performance of ChatGPT in Answering Dermatology Practice Questions

50906 Adverse Event Tracking and Reporting in an Academic Dermatology Practice

50906 Adverse Event Tracking and Reporting in an Academic Dermatology Practice

Clinical and Molecular Insights into Buschke-Ollendorff Syndrome: A Comprehensive Review of Osteopoikilosis and Dermatofibrosis Lenticularis Disseminata

Buschke-Ollendorff Syndrome (BOS) is a rare genetic disorder characterized by the concurrent manifestation of osteopoikilosis and dermatofibrosis lenticularis disseminata. The syndrome is caused by mutations in the LEMD3 gene, leading to the dysregulation of TGF-β signaling pathways, which play a critical role in both bone and skin homeostasis. Clinically, BOS presents with asymptomatic, radiographically detectable osteopoikilosis—small, round, sclerotic bone lesions—and multiple yellow-brown papules distributed over the trunk and extremities, indicative of dermatofibrosis lenticularis disseminata. This review aims to provide a detailed exploration of the genetic and pathophysiological mechanisms underlying BOS, with an emphasis on the clinical manifestations, diagnostic approaches, and current management strategies. Additionally, this article discusses the implications of BOS for differential diagnosis in orthopedic and dermatologic practice, highlighting the importance of recognizing the syndromic association to avoid misdiagnosis. The potential for targeted therapies that address the underlying molecular defects in BOS will also be examined.

Skin health of Aboriginal children living in urban communities.

Skin concerns are frequent among urban-living Aboriginal children, yet specialist dermatology consultations are limited with studies highlighting the need for improved cultural security. Through newly established paediatric dermatology clinics at two urban Aboriginal Community Controlled Health Organisations (ACCHOs), we aimed to describe clinic and patient data, including disease frequencies and associations, to inform dermatology service provision and advocacy. A prospective cohort study of Aboriginal children and young people (CYP, 0-18 years) attending Aboriginal Health Practitioner (AHP) co-ordinated paediatric dermatology clinics at two urban ACCHOs. Data were collected from 32 clinics over 19 months, with 335 episodes of care and a mean attendance rate of 74%. From 78 new patients, 72 (92%) were recruited into the study, only one of whom had previously received dermatologist assessment. Eczema, tinea or acne accounted for 47% (34/72) of referrals, and 60% of patients received their first appointment within 4 weeks of referral. In 47/72 (65%) consultations, the GP referral and dermatologist diagnosis concurred. The most frequent diagnoses (primary or secondary) at first consultation were atopic dermatitis (26%, 19/72), dermatophyte infections (25%, 18/72), acne (21%, 15/72), bacterial skin infections (18%, 13/72) and post-inflammatory dyspigmentation (18%, 13/72). Three categories of the 2022 Australasian College of Dermatologists curriculum (infections, eczema/dermatitis, pigmentary disorders) accounted for 59% of all diagnoses. This study highlights the specialist dermatology needs of urban-living Aboriginal CYP. ACCHO-embedded dermatology clinics co-ordinated by AHPs demonstrated benefits for Aboriginal CYP in accessing care. Opportunities to embed dermatology practice within ACCHOs should be prioritised.

Sjögren’s syndrome: pathophysiological basis of dermatological manifestations

Sjogren’s syndrome is a chronic autoimmune disease with a predominant involvement in the pathological process of secreting cells of the glands and their excretory ducts, which is accompanied by the development of generalized dryness of the skin and mucous membranes. This syndrome is one of the most common systemic diseases, but in dermatological practice it remains undiagnosed in almost half of patients with clinical manifestations. The article discusses current aspects of the pathogenesis of dermatological manifestations of Sjögren’s syndrome, which will allow a deeper understanding and systematization of the various mechanisms of development of this pathology for the formation of the correct clinical tactics with the choice of pathogenetically based treatment approaches, determining the individual prognosis for the patient, as well as helping to alleviate the course of the disease and in many ways improving the quality of life of patients.

Advancements in laser technologies for skin rejuvenation: A comprehensive review of efficacy and safety.

Laser technology has fundamentally transformed the landscape of dermatology, offering nuanced solutions for skin rejuvenation and resurfacing. This paper aims to explore the spectrum of laser technologies, from ablative to non-ablative and fractional lasers, their mechanisms, benefits, and tailored applications for diverse skin conditions. As we delve into the intricacies of each technology, we also consider the scientific advancements that have made these treatments safer and more effective, promising a new horizon in skin rejuvenation. This comprehensive analysis seeks to evaluate recent advancements in laser technology for skin rejuvenation, focusing on efficacy, safety, and patient satisfaction. The selection criteria for studies in this publication focused on recent, peer-reviewed articles from the last 20 years, emphasizing advancements in laser technologies for skin rejuvenation. Our comprehensive review involved searches in PubMed, Cochrane, Scopus and Google Scholar using keywords like "skin rejuvenation," "laser technology," "efficacy," "safety," and "dermatology." This approach focused on inclusion of recent research and perspectives on the efficacy and safety of laser treatments in the field of dermatology. Our literature review reveals advancements in laser skin resurfacing technologies, notably fractional lasers for minimal downtime rejuvenation, ablative lasers for precise tissue vaporization, and non-ablative lasers for coagulation effect promoting collagen with reduced recovery. Hybrid and picosecond lasers are highlighted for their versatility and effectiveness in addressing a wide array of skin concerns. The findings also emphasize the development of safer treatment protocols for ethnic skin, significantly reducing risks like hyperpigmentation and scarring, thus broadening the scope of effective dermatological solutions. This extensive review of advancements in laser technologies for skin rejuvenation underscores a remarkable evolution in dermatological treatments, offering an expansive overview of the efficacy, safety, and patient satisfaction associated with these interventions. Furthermore, the exploration of combination treatments and laser-assisted drug delivery represents a frontier in dermatological practice, offering synergistic effects that could amplify the therapeutic benefits of laser treatments.

Wait times for scheduling appointments with hospital affiliated dermatologists in New York City

Patients’ experience accessing dermatologic care is understudied. The purpose of this cross-sectional study was to examine current wait times for new patients to receive dermatological care in NYC. Websites at 58 accredited private and public hospitals in the five boroughs of NYC were reviewed to identify dermatology practices. Office telephone numbers listed on each website were called to collect information pertaining to whether the physician was accepting new patients, type of insurance accepted (public, private, both, or none), and the number of days until a new patient could be seen for an appointment. Data pertaining to the time kept on hold and availability of web-based booking were also collected. Mean waiting time for an appointment was 50 days [standard deviation, SD 66] – nearly 2 months, but the distribution was considerably skewed. The median waiting time was 19.5 days [Interquartile range, IQR 4–60]. The time kept on hold to make the appointment was negligible at about 1 min (63 s, SD = 77) but could take up to ~ 7 min. Two-thirds of dermatologists accepted private, Medicare, and Medicaid insurance (n = 228, 66%); a small number accepted only private insurance (n = 12, 4%) or no insurance at all (n = 16, 5%). The median waiting time for an appointment for the 228 providers that accepted Medicaid was 30.5 days (IQR = 5.0-73.25) while for providers who did not accept Medicaid (n = 116) the median wait time for an appointment was 13.0 days (IQR = 3.0–38.0). Just over half (56%) of the dermatologists allowed for appointments to be booked on their website (n = 193). This research highlights the necessity of incorporating new strategies into routine dermatology appointments in order to increase treatment availability and decrease healthcare inequality.

Natural language processing in dermatology: A systematic literature review and state of the art.

Natural Language Processing (NLP) is a field of both computational linguistics and artificial intelligence (AI) dedicated to analysis and interpretation of human language. This systematic review aims at exploring all the possible applications of NLP techniques in the dermatological setting. Extensive search on 'natural language processing' and 'dermatology' was performed on MEDLINE and Scopus electronic databases. Only journal articles with full text electronically available and English translation were considered. The PICO (Population, Intervention or exposure, Comparison, Outcome) algorithm was applied to our study protocol. Natural Language Processing (NLP) techniques have been utilized across various dermatological domains, including atopic dermatitis, acne/rosacea, skin infections, non-melanoma skin cancers (NMSCs), melanoma and skincare. There is versatility of NLP in data extraction from diverse sources such as electronic health records (EHRs), social media platforms and online forums. We found extensive utilization of NLP techniques across diverse dermatological domains, showcasing its potential in extracting valuable insights from various sources and informing diagnosis, treatment optimization, patient preferences and unmet needs in dermatological research and clinical practice. While NLP shows promise in enhancing dermatological research and clinical practice, challenges such as data quality, ambiguity, lack of standardization and privacy concerns necessitate careful consideration. Collaborative efforts between dermatologists, data scientists and ethicists are essential for addressing these challenges and maximizing the potential of NLP in dermatology.

Chatting Ethically: Practical Recommendations for Ethical Use of Large Language Models in Dermatology Practice, Research, and Education.

As large language model (LLM) utilization increases, developing ethical standards for their applications to supplement dermatologists is critically important. Here, we summarize primary applications of LLMs in dermatology, their ethical implications, and recommendations for appropriate use.

Review and Therapeutic Approach to Malalignment of the Great Toenails: A Common Condition That Is Uncommonly Diagnosed.

Malalignment of the great toenails is a common nail disorder that is uncommonly recognized in general practice. Review available literature on lateral malalignment of the great toenails to increase awareness of this underdiagnosed condition and provide management recommendations. A PubMed search was conducted using the terms "congenital malalignment toenail" and "malalignment great toenail". All articles were reviewed, and all relevant articles were included in this analysis. Thirty-four distinct articles encompassing 117 patients with similar clinical findings: lateral deviation of the great toenails with yellow brown dyschromia, thickening, and scalloping. Description of malalignment and terminology can vary, which may have led to exclusion of some relevant articles. Lateral malalignment is a common nail condition that is underappreciated and often misdiagnosed in general dermatologic and medical practice. This review aims to increase awareness to facilitate better care of these patients.

Frequency of Skin Biopsies for Psoriasis by Race and Ethnicity

This cross-sectional study evaluates the frequency of skin biopsies, as an indicator of diagnostic uncertainty, by race and ethnicity among patients with psoriasis seen in an academic dermatology practice.

Detection of terbinafine-resistant Trichophyton indotineae isolates within the Trichophyton mentagrophytes species complex isolated from patients in Hue City, Vietnam: A comprehensive analysis.

The Trichophyton mentagrophytes complex comprises a group of dermatophyte fungi responsible for various dermatological infections. The increasing drug resistance of this species complex, especially terbinafine resistance of Trichophyton indotineae, is a major concern in dermatologist practice. This study provides a comprehensive analysis of T. mentagrophytes complex strains isolated from patients in Hue City, Vietnam, focusing on their phenotypic and genetic characteristics, antifungal susceptibility profiles, and molecular epidemiology. Keratinophilic fungi from dermatophytosis culture samples were identified morphologically and phenotypically, with species and genotypes confirmed by internal transcribed spacer sequencing and phylogenetic analysis. Antifungal susceptibility testing was carried out to evaluate their susceptibility to itraconazole, voriconazole, and terbinafine. The 24% (n=27/114) of superficial mycoses were phenotypically attributed to T. mentagrophytes complex isolates. Trichophyton interdigitale, mainly genotype II*, was predominant (44.4%), followed by T. mentagrophytes genotype III* (22.2%), T. indotineae (14.8%), T. tonsurans (11.2%), and T. mentagrophytes (7.4%). While all isolates were susceptible to itraconazole and voriconazole, half of T. indotineae isolates exhibited resistance to terbinafine, linked to the Phe397Leu mutation in the SQLE protein. This study highlighted the presence of terbinafine-resistant T. indotineae isolates in Vietnam, emphasizing the need to investigate dermatophyte drug resistance and implement effective measures in clinical practice.

Identification of piRNA Expression Profiles in Vitiligo

Objective: Vitiligo is a systemic dermatological disorder characterized by skin depigmentation due to melanocyte damage and dysfunction. The treatment of vitiligo remains a challenging aspect in dermatological practice. PIWI-interacting RNAs (piRNAs), approximately 24–32 nucleotides in length, are crucial in the epigenetic regulation of developmental processes. However, research on piRNA expression profiling in vitiligo is limited. This study aimed to identify and characterize piRNAs in skin tissues from vitiligo patients and healthy controls. Methods: We compared and analyzed piRNA expression profiles of human vitiligo skin by RNA sequencing. Results and Discussion: Our findings revealed a pronounced preference for uridine (U) at the 5′ end of piRNAs, predominantly originating from repeat and other genomic regions. Notably, we detected 73 differentially expressed piRNAs between the patient and control groups, with 40 piRNAs upregulated and 33 downregulated in vitiligo patients. Bioinformatics analysis indicated that the genes responsible for piRNA production were more prevalent in metabolic processes and implicated in regulating the PI3K-Akt and AMPK signaling pathways. Conclusions: The elucidation of piRNA expression profiles enhances our understanding of their functional roles in the pathogenesis of vitiligo.

Advantages and Disadvantages of Using AI in Dermatology

ABSTRACTIntroductionArtificial intelligence (AI) in dermatology is both promising and challenging. This is important for clinicians to recognize most up‐to‐date knowledge and advancements.ResultsAdvantages include timely detection and diagnosis, enhanced accuracy, efficient triage, workflow automation, personalized treatment, outcome prediction, education support, telemedicine aid, research facilitation, cost‐efficiency, scalability, and drug development. However, limitations include generalizability issues, image quality variations, data requirements, interpretability concerns, patient acceptance, liability, multidisciplinary coordination challenges, data bias risks, lack of explainability, potential loss of clinical skills, security and privacy risks, resource intensiveness, integration challenges, validation and regulation gaps, and limited clinical assessment. Bridging these gaps requires robust ethical frameworks, interdisciplinary collaboration, education, regulation focusing on patient safety and privacy, standardized data sets, transparency, and human oversight.ConclusionDespite the challenges, AI holds significant potential to revolutionize dermatology practice, improving patient outcomes, healthcare accessibility, and research advancements. Further research and interdisciplinary collaboration are crucial to maximize AI's benefits and address its limitations effectively.

Ethics of dynamic and differential pricing for cosmetic procedures

Patient demand for procedures has increased in the evolving landscape of cosmetic dermatology. This has been fueled, in part, by social media and the growing normalization of cosmetic enhancements, developments that have led some patients to have potentially unrealistic expectations and place undue pressure on dermatologists to meet these often unrealistic demands. This pressure is exacerbated further by patients who are seen as difficult, demanding, and time-consuming and who may require extensive counseling. Physicians may adopt dynamic or differential pricing strategies to offset the additional time and effort that these patients require. We discuss the ethical concerns surrounding these pricing strategies in the cosmetic sphere, highlight the importance of transparency in pricing, and offer suggestions to promote clarity and fairness in cosmetic dermatology practices.

Categorizing Dermatological Malignancies Via Computational Methods

In this study, a machine learning model is developed to classify different types of cancer using convolutional neural networks (CNNs) for image processing. The core objective is to achieve a performance level comparable to that of dermatologists. The model is trained on a substantial dataset of medical images, enabling it to learn and recognize various characteristics indicative of different cancer types. By leveraging the power of CNNs, the model can process these images effectively, identifying subtle patterns and features that are often challenging to detect with the naked eye. The training process involves feeding the CNN with labelled images, enabling it to differentiate between benign and malignant cases with high accuracy. Through rigorous testing, the model demonstrates competence on par with experienced dermatologists, both in terms of sensitivity and specificity. This equivalence in performance is particularly significant as it underscores the model's potential to aid in clinical settings, providing reliable second opinions and enhancing diagnostic workflows. A user interface is also developed to allow input images to be analysed by the trained CNN model. This interface not only displays the model’s predictions but also provides essential metrics such as confidence scores and probability distributions. These metrics offer valuable insights into the model's decision-making process, aiding clinicians in understanding and trusting the AI's assessments. Overall, the findings suggest that convolutional neural networks hold substantial promise for improving cancer diagnosis. The model's high performance in classification tasks demonstrates its viability as a tool for supporting dermatologists in clinical practice. By reducing diagnostic errors and accelerating the identification process, this technology has the potential to significantly impact patient outcomes and advance the field of medical imaging and diagnostics. Keywords: Convolutional Neural Networks (CNNs); Cancer Classification; Medical Image Processing; Dermatology AI; Diagnostic Accuracy

Unmasking Acne: Azithromycin Edges Out Doxycycline in Randomized Trial at Tertiary Care Centre

Background: Acne vulgaris, a prevalent global condition, often necessitates antibiotic therapy. Doxycycline has been a mainstay treatment; however, recent research suggests azithromycin might be superior. Conflicting data and a lack of local studies regarding their comparative efficacy warrant further investigation. Objectives: This study aimed to compare the efficacy of oral azithromycin with oral doxycycline in treating acne vulgaris at a tertiary care hospital in Islamabad. Methods: A randomized controlled trial was conducted. Patients aged 14-30 years (n=190) were enrolled and randomly assigned to either azithromycin or doxycycline treatment groups. Baseline and post-treatment (12 weeks) Global Acne Grading System (GAGS) scores were assessed. Percent reductions in GAGS score were categorized into four groups (<25%, 25-50%, 51-75%, and >75%) for intergroup comparison. Written informed consent was obtained from all participants. Results: The mean patient age was 21.30±4.93 years, with a female predominance (male:female ratio 1:1.2). Most patients had Fitz-Patrick Skin Type-V (64.7%) compared to Type-IV (35.3%). Baseline GAGS scores were comparable between groups (p=0.612). Notably, post-treatment GAGS scores were significantly lower in the azithromycin group (p<0.001), demonstrated by a greater mean change (19.33±3.03 vs. 17.70±2.99; p<0.001) and percent reduction (81.87±8.74 vs. 75.97±11.12%; p<0.001) compared to doxycycline. Additionally, 75.3% of patients achieved an excellent reduction in GAGS score, with a significantly higher proportion observed in the azithromycin group (87.4% vs. 63.2%; p<0.001). Similar significant differences were observed across subgroups based on age, gender, and skin type. Conclusion: This study suggests that azithromycin demonstrates superior efficacy to doxycycline for acne vulgaris management, regardless of patient demographics or skin type. Its established better safety profile further supports its potential as a preferred therapeutic option in future dermatological practice. Keywords: Acne Vulgaris, Azithromycin, Doxycycline, Percent Reduction in GAGS Score