Specialist Dermatology Research Articles

Investigation of Microvascular Involvement Through Nailfold Capillaroscopic Examination in Children with Familial Mediterranean Fever

Background and Objectives: Familial Mediterranean fever (FMF) is a lifelong autoinflammatory disease characterized by episodes of fever and aseptic polyserositis. Commonly associated with vasculitis, FMF’s impact on microcirculation was investigated by examining nailfold capillaries using capillaroscopy. Materials and Methods: This study included 32 female and 28 male FMF patients diagnosed according to the Tel Hashomer and Yalçınkaya criteria and a control group of 20 female and 10 male age-matched cases. Demographic characteristics, medical history (abdominal pain, fever, chest pain, and joint pain), and physical examination findings of the cases were assessed. FMF gene mutations, acute-phase reactants, urine analysis, and spot urine protein/creatinine ratios were evaluated. Nailfold capillaries were examined via capillaroscopy by the same dermatology specialist. Results: There was no significant age or gender difference between groups. The most common symptoms in the case group were abdominal pain (81.7%) and joint pain (65%). Pathological findings in capillaroscopy, such as microhemorrhages and avascular areas, were significantly more frequent in the FMF case group (p < 0.001; p < 0.001). Physiological findings, including hairpin-shaped capillaries and shortened loops, were significantly more common in the control group (p = 0.001; p = 0.034). No significant relationships were found between kidney involvement, subclinical inflammation, presence of microhemorrhages and avascular areas in capillaroscopy, and disease duration. Additionally, no significant differences were observed in capillaroscopic findings between those with exon-10 mutations in the MEFV gene and those with non-exon-10 mutations. Conclusions: In conclusion, our study demonstrated secondary microvascular findings due to inflammation in FMF patients using capillaroscopy, a cost-effective and safe tool.

O-15 CUTANEOUS SARCOIDOSIS PRESENTING AS ASYMPTOMATIC PTH-INDEPENDENT HYPERCALCEMIA

Abstract Introduction Sarcoidosis is a rare disease primarily affecting the pulmonary system in approximately 90% of cases. (1) Cutaneous involvement occurs in 20-35% of sarcoidosis patients and can present without systemic manifestations (2). The skin is the second most commonly affected organ after the lungs in sarcoidosis (3). Clinical Case We report a unique case of cutaneous sarcoidosis presenting with asymptomatic hypercalcemia. An 81-year-old White British woman with a medical history of type 2 diabetes mellitus, anemia, hypertension, and polymyalgia rheumatica (PMR) was managed for left leg cellulitis. Examination revealed a systolic murmur, clear chest, bilateral erythema, raised temperature, and pitting edema at the infection site. An admission chest x-ray showed a known large hiatus hernia. Routine blood tests revealed adjusted calcium levels of 3.52 mmol/L (2.20-2.60 mmol/L), and PTH levels were low at 0.9 pmol/L (1.6-6.9 pmol/L), indicating PTH-independent hypercalcemia. Further blood tests showed normal vitamin D (129nmol/L, n>50nmol/L), ACE levels (<5 IU/L), and thyroid funct,on tests (TSH 7.17mU/L, n0.30-4.20mU/L, T4 15.6pmol/L, n11.9-21.6pmol/L, TPO antibody<10IU/mL, n0-34). Myeloma screen (no monoclonal bands, Serum Kappa Free Light Chain:31.03 mg/L,n 3.30 - 19.40; Serum Lambda Free Light Chain:22.57 mg/L,n:5.71 - 26.30) and autoimmune screens (IgG:7.8 g/L,n:6.0 - 16.0; IgA:1.26 g/L,n:0.80 - 4.00; IgM*0.41 g/L,n:0.50 - 2.00) were negative. Elevated 1,25-dihydroxy vitamin D (calcitriol) was noted at 246 pmol/L. Occult malignancy was ruled out via normal CT chest, abdomen, and pelvis, gastroscopy with biopsy, and CT head scans. Initial PET CT results were reported as normal. Hypercalcemia management included intravenous fluids, zoledronic acid, denosumab, steroids, and cinacalcet. Subsequent detailed PET CT report revealed extensive moderate FDG uptake in the subcutaneous tissue of both arms. Physical examination identified subcutaneous nodules, and histology confirmed a florid dermal non-necrotizing granulomatous reaction, diagnosing extra-pulmonary cutaneous sarcoidosis. Interestingly, the patient had been on long-term prednisolone (10 mg) for PMR, recently reduced to 4 mg prior to admission. Her calcium levels normalized (2.57 mmol/L) after weaning off prednisolone. Conclusion Hypercalcemia in cutaneous sarcoidosis without pulmonary involvement is rare. Long-term follow-up is essential, as patients with cutaneous sarcoidosis may develop systemic involvement. She was referred to pulmonary and dermatology specialists for further evaluation.

P1159 New onset acne reported in the majority of patients with upadacitinib-treated Inflammatory Bowel Disease

Abstract Background Upadacitinib (UPA), a janus kinase inhibitor (JAKi) with selectivity for JAK-1, is licensed in ulcerative colitis (UC) and Crohn’s disease (CD). Acne was seen commonly in the CD and UC registration studies of UPA. We sought to investigate the prevalence of acne in a real-world cohort of IBD patients using UPA. Methods We performed a retrospective review of all patients who received UPA for UC, CD or IBD-unclassified (IBD-U) between Sep 2022 and Sep 2024 at a large tertiary referral centre. Data were collated from electronic health records supplemented by telephone calls to individual patients. Demographic data, previous advanced treatments, dose and length of time on UPA were recorded in addition to skin related adverse effects. Self-reported acne was considered acceptable as a diagnosis, given that it is easily recognisable by the general public. Results The patient cohort is described in table 1. Out of 159 eligible subjects, 132 (83%) were reachable by telephone, 50 (38%) of whom were females. The indication for UPA was UC (67, 51%), CD (60, 45%), and IBD-U (5, 4%). 14 patients (11%) reported a history of acne at time of starting UPA and 60 (45%) were aware that acne was a potential side effect prior to starting the medication (Table 1). After a median duration of UPA therapy of 10 months (IQR 4-12), acne was reported by 77 (58%) patients (34 (51%) UC and 39 (65%) CD; 50 (61%) male and 27 (54%) female). Acne was reported to have involved the face (n=30, 41%), body (n=7, 9%) or both (n=37, 50%). The majority of UPA-associated acne was reported during the initial higher dose 45mg daily induction period (70, 91%) although acne persisted in 45 (58%) patients after reduction to 30mg. Notably, 35 (45%) patients with UPA-associated acne consulted their general practitioners, and 15 (19%) required specialist input from dermatologists. Importantly, acne-induced UPA dose reduction occurred in 4 (5%) patients and 3 (4%) patients discontinued UPA because of acne (Table 1). Conclusion The study suggests that self-reported acne is very common amongst patients who are receiving UPA for IBD, although acne-driven dose reduction or discontinuation is infrequent. Nearly half of the affected patients required GP assessments, and one fifth needed specialist dermatology input, suggesting substantial patient inconvenience and considerable impact on healthcare resource utilisation. Specific risk factors for acne, as well as potential benefits of dose reduction, should be further explored amongst upadacitnib users in larger, prospective studies.

Outcomes of a fledgling public dermatology clinic in rural Australia.

There is paucity of research available regarding the epidemiological characteristics of patients attending dermatology outpatient services in rural Australia. We performed a retrospective cohort study of patients attending a public dermatology clinic established at Dubbo Base Hospital in rural New South Wales. The broad range of dermatological presentations encountered, coupled with the brisk uptake of services by remote patients, highlights the ongoing need for specialist dermatology services in underserved rural communities.

Evaluation of the Accuracy of Artificial Intelligence (AI) Models in Dermatological Diagnosis and Comparison With Dermatology Specialists.

Recent advances in generative artificial intelligence (AI) have expanded its applications in diagnostic support within dermatology, but its clinical accuracy requires ongoing evaluation. This study compared the diagnostic performance of three advanced AI models, ChatGPT-4o, Claude 3.5 Sonnet, and Gemini 1.5 Pro, with that of board-certified dermatologists, using a dataset of 30 cases encompassing a variety of dermatological conditions. The AI models demonstrated diagnostic accuracy comparable to, and sometimes exceeding, that of the specialists, particularly in rare and complex cases. Statistical analysis revealed no significant difference in accuracy rates between the AI models and dermatologists, indicating that AI may serve as a valuable supplementary diagnostic tool in dermatological practice. Limitations include a small sample size and potential selection bias. However, these findings underscore the progress in AI's diagnostic capabilities, supporting further validation with larger datasets and diverse clinical scenarios to confirm its practical utility.

Geographic tongue, fissured tongue, and angular cheilitis associated with the diagnosis of psoriasis in adult patients: a cross-sectional study

Objective. This work aimed to determine the frequency of geographic tongue, fissured tongue, and angular cheilitis associated with the diagnosis of psoriasis in adult patients. Material and methods. This was a cross-sectional study and was conducted between February and April 2023, including a total of 120 adult patients (60 with psoriasis and 60 without psoriasis) from the Dermatology Service at “Victor Lazarte Echegaray” Hospital. To determine the intra- and inter-rater reliability of the oral clinical measurement, a pilot study was conducted with 22 participants, resulting in Kappa values above 0.91. On the other hand, the diagnosis of psoriasis was made by a dermatology specialist. The Chi-square test was used to analyze results, considering a significance level of 5%. Results. Frequency of fissured tongue was associated with the diagnosis of psoriasis (p=0.023); this association also was found in patients aged 35 to 64 years (p=0.020), nail psoriasis (p=0.037) and late-onset psoriasis (p=0.03). Conclusions. The fissured tongue is associated with diagnosing psoriasis, mainly in patients in the 35-64 age group and with nail psoriasis and late-onset psoriasis.

The management of severe eczema in pregnancy.

Atopic eczema (eczema; also known as atopic dermatitis) is a chronic inflammatory skin condition. The burden of eczema can be very substantial with significant itch, skin pain, secondary infection, sleep disturbance and psychological distress. Eczema is common in pregnancy. It is therefore important to offer effective treatment to pregnant women, especially those with moderate to severe disease where the burden is greatest. When eczema cannot be adequately managed with skin directed approaches such as topical preparations and/or phototherapy, systemic therapy may be required to achieve disease control and requires early input from dermatology specialists. The aim of this short review is to summarise this approach.

Skin lesions and the role of the internist: a series of clinical cases

The skin often acts as an indicator of underlying internal diseases and skin lesions that are difficult to diagnose are one of the reasons for hospitalization in internal medicine departments where patients frequently arrive after a long journey between different dermatology specialists and after ineffective or sometimes responsible for diagnostic delays. In this article, we will illustrate three clinical cases observed in our General Medicine Unit of the Ospedale del Mare in Naples in the last year that are characterized by diagnostic errors that misled our attention, the notable difficulty in the diagnostic classification, and the duration of hospitalization necessary to reach the correct diagnosis. The first case is that of a patient diagnosed with violin spider lesions who, after a 2-week hospitalization, was discharged with the diagnosis of non-Hodgkin’s lymphoma. In the second case, the patient was hospitalized for suspected lesions caused by Burger’s disease and was instead discharged with a lesion caused by mycosis fungoides. The third case is that of a patient hospitalized for suspected vasculitis and discharged with the diagnosis of drug-induced toxic epidermal necrolysis.

Imposter Syndrome in Veterinary Education? How Knowledge and Confidence Affect Treatment of Canine Atopic Dermatitis.

Anecdotal data suggest that clinicians can be confused about the indications, advantages, and disadvantages of treatment options for canine atopic dermatitis (CAD). This may be due to the varying levels of knowledge and confidence among clinicians at different stages of their training and careers. A lack of evidence-based studies of confidence when applying knowledge in veterinary education inspired this research. We surveyed 75 Royal (Dick) School of Veterinary Studies (R(D)SVS) final-year students, 34 general practitioners (GPs), 70 GPs that have undertaken continuing professional development in dermatology, 34 advanced dermatology practitioners (e.g., interns and residents), and 15 dermatology specialists using an online questionnaire with Likert-type scales for each response. Correlations between the levels of education, sources of knowledge about managing CAD, and their understanding of different treatment options were analyzed. p < .001 was deemed significant. The results revealed a significant lack of confidence among students and GPs in treating CAD. In contrast, the groups generally had a similar level of understanding of the management options. The exception to this was a lack of understanding about ciclosporin and antihistamines among students and veterinarians with less dermatology experience. Targets for intervention should therefore aim to improve confidence in clinical application rather than knowledge per se in undergraduate and post-graduate education. Improving confidence in managing CAD will improve the welfare of atopic dogs and their owners.

The so-called Mongolian spots and suspected child abuse - difficulties in differential diagnosis

The assessment of physical violence against children is an important issue in forensic medicine, particularly in the case of infants and toddlers, who, due to their stage of development, are unable to communicate the violence inflicted upon them. This case describes a two-week-old girl of Roma origin, who was transferred from a temporary to a foster family. While changing the child, the foster parents noticed bruises in the sacral area. Based on the initial assessment of these changes at the hospital, the authorities were notified and an investigation was initiated. The first court expert assessing the changes indicated that the image resembled resorbing haemorrhages resulting from trauma. Another team of experts, consisting of specialists in forensic medicine, dermatology and pathology, was appointed. Based on the analysis of medical records and a physical examination using a dermatoscope, pale-blue spots characteristic of the Mongolian spot were found in the lumbar and buttock areas. Mongolian spots are congenital developmental abnormalities classified as melanocytic naevi. In most cases, the changes appear immediately after birth or shortly thereafter. Clinically, a lesion appears as single or multiple spots on the lower back, sacrum, or buttocks. These lesions can range in colour from dark grey to blue-green and take on various shapes, such as round, oval, or irregular. Lesions on the skin of children can morphologically resemble bruises, so their evaluation requires special attention. In case of doubt as to the nature of the lesion, additional examination should be performed. Furthermore, the analysis of medical records and the evaluation by a dermatologist can be helpful.

Inhibition of Small Extracellular Vesicles by GW4869 Does not Disrupt the Paracrine Regulation of Adipose-Derived Mesenchymal Stem Cells Over Keloid Fibroblasts.

Keloid, scar caused by atypical wound repair, represents a significant difficulty for specialists in plastic surgery and dermatology. Adipose-derived mesenchymal stem cells (ADSCs) can regulate fibrotic phenotypes of keloid fibroblasts (KFs) in a paracrine fashion, but whether small extracellular vesicles (SEVs) are the key functional carrier in ADSC paracrine regulation of KFs remains unknown. This study aims to explore whether the regulatory effects of conditioned medium (CM) obtained from ADSCs on KFs can be impaired by decreased SEV content in the ADSC-CM. Clinical specimens were utilized to extract keloid fibroblasts (KFs), normal fibroblasts (NFs), and adipose-derived stem cells (ADSCs). Fibroblasts were cultured with CM obtained from ADSCs untreated or treated with the sphingomyelinase inhibitor GW4869. The features of SEVs derived from ADSC-CM were characterized, and fibroblast proliferation, migration, apoptosis, and expression of ECM proteins were analyzed. The sphingomyelinase inhibitor GW4869 successfully reduced the SEV content in ADSC-CM, and both control ADSC-CM and ADSC-CM with reduced SEV content significantly inhibited KF proliferation, migration, and α-SMA synthesis but not KF apoptosis, whereas only NF proliferation was inhibited by ADSC-CM. The reduced SEV content only affected the inhibition of KF proliferation induced by ADSC-CM. ADSC-CM inhibits various fibrotic phenotypes of KFs, but decreasing the SEV content in ADSC-CM did not significantly alter the antifibrotic effects of ADSC-CM. Thus, SEVs may not be the key mediator of ADSCs paracrine regulation of KFs. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . www.springer.com/00266 .

P12 Post-streptococcal reactive arthritis and panniculitis in pregnancy: a case report

Abstract Introduction Reactive arthritis is an inflammatory condition that can occur following an infection, commonly caused by bacterial pathogens such as Streptococcus. Pregnancy introduces unique challenges in managing autoimmune and inflammatory conditions due to the need to balance maternal and foetal health. This case report highlights the diagnosis and management of post-streptococcal reactive arthritis and panniculitis in a 16-week pregnant patient, focusing on the use of steroids and the resulting impact on her gestational diabetes Case description A 25-year-old woman, 16 weeks pregnant with no known comorbidities, presented with bilateral ankle pain and swelling for the last two weeks, preceded by an episode of tonsillitis. Initially, the pain was localised to her right ankle and left wrist, then involved her left ankle. She was treated with antibiotics for presumed cellulitis, and a doppler ultrasound ruled out deep vein thrombosis. Examination revealed swollen, inflamed ankles with limited range of motion due to pain. The rest of the examination was unremarkable. This was her second pregnancy and had no complications in her first pregnancy. Routine investigations were done; her C-reactive protein (CRP) was 126 and erythrocyte sedimentation rate (ESR) was 56, with a normal white cell count. Autoimmune workup, including rheumatoid factor (RF), antinuclear antibodies (ANA), and HLA-B27, was negative, but her anti-streptolysin O (ASO) titer was borderline positive. She was diagnosed with post-streptococcal reactive arthritis. After discussing the risks and benefits of NSAID use in the second trimester, we started her on prednisolone 20 mg with a tapering plan. The patient showed clinical improvement, but upon tapering the steroids to 5 mg daily, she developed well-demarcated erythema with desquamation and epidermal changes over both ankles. The left ankle was tender on the medial side, but the right was non-tender. Her angiotensin-converting enzyme (ACE) levels were negative, and calcium levels were normal. Her steroid dose was increased again to 20 mg with a slow tapering plan. She also developed gestational diabetes mellitus and was started on insulin by the diabetes team. Her foetal scan was reassuring and was under obstetrician. A dermatology team reviewed her and suggested the rash was likely panniculitis, which had improved significantly with steroids, so a biopsy was not performed. With careful management, her symptoms resolved, and she successfully discontinued steroid therapy as planned. Discussion This case highlights the complex nature of managing post-streptococcal reactive arthritis and panniculitis in a pregnant patient. The initial presentation with a sore throat and subsequent development of arthritis and panniculitis, along with raised inflammatory markers and a positive ASO titer, strongly suggested reactive arthritis triggered by a recent streptococcal infection. Given the foetal risk from NSAIDs, steroid therapy was chosen for its safety profile in pregnancy. While steroid therapy provided symptomatic relief, it led to gestational diabetes, requiring careful monitoring and adjustment of the patient’s diabetic management. The emergence of panniculitis during steroid tapering added another layer of complexity, necessitating collaboration with dermatology specialists for a revised approach. The dermatological team agreed with the recommendation of slow tapering of steroids, which were crucial in managing this complication. This case highlights the importance of a multidisciplinary approach and close monitoring to ensure optimal outcomes for both the mother and the developing foetus. Key learning points • The diagnosis of post-streptococcal reactive arthritis should be considered in pregnant patients presenting with joint inflammation and a recent history of infection. Prompt recognition and appropriate treatment are essential to prevent long-term joint damage. • Careful monitoring of glycaemic control is crucial when initiating steroid therapy in pregnant patients, as it may lead to uncontrolled diabetes and can cause foetal problems. Close collaboration between obstetric and endocrine specialists is necessary to optimise diabetes management while minimising foetal risks. • Collaboration with dermatology specialists can aid in the management of complications such as panniculitis during steroid tapering in pregnant patients. A multidisciplinary approach ensures comprehensive care and improves outcomes for both the mother and the developing foetus.

Prospective evaluation of the store-and-forward teledermatology service (eConsult) delivery at Townsville Hospital: A pilot study.

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.

Multidisciplinary approach to asylum seekers health assessment: a 5-year experience in Modena, Italy

Abstract Background Asylum seekers’ well-being represents a global health issue. They face significant challenges to their physical and mental health due to their migratory path. In the Modena province (Northern Italy), a multidisciplinary approach has been applied to the care of asylum seekers by Department of Public Health (DPH), with a team of specialists in infectious diseases, dermatology, gynaecology, obstetrics, psychology and preventive medicine. Asylum seekers receive a first visit, including medical and psychological assessment and screening for infectious diseases. Ad hoc pathways are also active for asylum seekers who need secondary-level care. This study aims to investigate the health status of asylum seekers referred to Modena Centre. Methods This cohort study enrolled asylum seekers hosted in Modena between November 2018 and May 2023. During the first visit, personal and anamnestic data were collected aided by cultural mediators, along with clinical assessment. Furthermore, Tuberculin-Skin-Test (TST) and blood tests for HBV-HCV-HIV-Syphilis were performed. Results A total of 646 migrants were included, 94% were males with a median age of 26 years (range: 15-50), the majority from Bangladesh (39%). Females were mostly from Ivory Coast (36%), median age of 30 years (range: 17-45). Most conditions were treated at the primary care level and were related to cutaneous disease (22%), only 11% of subjects required second-level diagnostics. Positive TSTs were 41% (N = 265). Of them, 55.5% (N = 147) also tested positive for QuantiFERON-TB. Screening for infectious diseases revealed positivity rates of 4% for HBsAg, 1% for HCVAb, 0.8% for HIV and 1.4% for TPPA+RPR. Conclusions The multidisciplinary approach is the innovative and strength point of this protocol for asylum seekers’ health ensuring prompt management of pathologies after their arrival. Moreover, data collection is useful for improving intake services and implementing public health programs for vulnerable individuals. Key messages • The innovation of this protocol for asylum seekers’ health lies in its multidisciplinary approach. • Clinical data collection will support health policies’ choices to protect vulnerable individuals.

Reproductive health promotion in working individuals. Guidelines

The methodological recommendations have been developed with the aim of grading, systematizing and identifying key areas for the implementation of individual measures or a comprehensive corporate program for reproductive health promotion in working individuals at the employer level, including taking into account international experience.The guidelines describe seven key subprograms aimed at early diagnosis and timely treatment of urinary tract diseases, assessment of reproductive health, improving literacy in sex education and behavior, reducing the negative impact of industrial and external environmental factors on reproductive health, increasing commitment to measures to combat risk factors for noncommunicable diseases, providing support during menopause in women and andropause in men, and creating conditions in the workplace conducive to maintaining a strong family. The guidelines are intended for healthcare and public health organization specialists, heads of state authorities of constituent entities of the Russian Federation in the field of health protection, specialists of regional centers for public health and medical prevention, as well as for heads of organizations in various economic sectors. The materials presented in the guidelines can also be used by medical workers of various specialties (paramedics, general practitioners (family doctors), obstetrics and gynecology doctors, dermatology and venereology specialists, medical prevention doctors, occupational pathology physicians and urologists).

Towards 'Formalising' WhatsApp Teledermatology Practice in KZ-N District Hospitals: Key Informant Interviews.

District hospitals in KwaZulu-Natal Province, South Africa, do not have onsite specialist dermatology services. Doctors at these hospitals use WhatsApp instant messaging to informally seek advice from dermatologists and colleagues before possible referral. They have expressed the need to formalise WhatsApp teledermatology. To determine the views and perspectives of clinicians on the feasibility and practicality of formalising the current WhatsApp-based teledermatology activities within the KwaZulu-Natal Department of Health Dermatology Service. Key informant interviews with 12 purposively selected doctors at district hospitals and all 14 dermatologists in the KwaZulu-Natal dermatology service. Their views and perspectives on formalising the current informal use of WhatsApp for teledermatology were recorded, transcribed, and thematically analysed. Five primary themes (communication, usability, utility, process, and poor understanding of legal, regulatory, and ethical issues) and 22 sub-themes were identified. Clinicians wanted WhatsApp teledermatology to continue, be formalised, and be incorporated within the KwaZulu-Natal Department of Health, facilitated by the provision of practical guidelines addressing legal, regulatory, and ethical issues. These findings will be used to develop a policy brief, providing recommendations and proposed guidelines for formalising the teledermatology service. The findings and methods will be relevant to similar circumstances in other countries.

Drug-Induced Acne in Inflammatory Bowel Disease: A Practical Guide for the Gastroenterologist.

Drug-induced acne is a common side effect to a wide array of pharmacological therapies and is characterized by a monomorphic, papulopustular eruption typically affecting the face, scalp, and the upper thorax. Corticosteroids and Janus kinase inhibitors (JAKi) are commonly used for the treatment of inflammatory bowel disease (IBD) and are known to aggravate a prior tendency to acne or trigger the development of new acneiform eruptions. Recent attention on managing drug-induced acne has been driven by the increasing use of JAKi, an expanding therapeutic class in IBD and several other immune-mediated inflammatory diseases. Both randomized controlled trials and real-world studies have identified acne as one of the most common treatment-emergent adverse events in JAKi. Left untreated, this common skin reaction can significantly impact patient self-esteem and quality of life leading to poor treatment adherence and suboptimal IBD control. This review examines the characteristics of drug-induced acne in IBD treatments, provides a practical guide for gastroenterologists to manage mild to moderate occurrences, and highlights when to seek specialist dermatology advice. Such approaches enable early treatment of a common and often distressing adverse event and optimizes the management of IBD by preventing the premature discontinuation or dose reduction of efficacious IBD drugs.

Development and evaluation of an online training tool to aid in the diagnosis of chronic plaque psoriasis

AbstractBackgroundChronic plaque psoriasis (CPP) is underdiagnosed, undertreated and mistaken for other skin conditions such as eczema, tinea corporis and pityriasis rosea.ObjectivesTo develop and evaluate an online training tool to improve the diagnostic skills of nondermatologists for CPP.MethodsThe study involved: (i) developing an online training tool to improve CPP diagnosis by nondermatologists; and (ii) evaluating the performance of the newly developed training tool by conducting a before‐and‐after exploratory investigation. Participants included three groups of primary care health professionals: general practitioners (GPs); nurses; and pharmacists. The tool contained written recommendations for the diagnosis of CPP in different skin colours and a medical artist's illustrations of psoriasis to overcome the lack of representative images of the disease in skin of colour and to illustrate the salient features more clearly than clinical photographs.ResultsIn total, 60 participants completed the study (20 per participant group). The training tool improved participants' diagnostic skills for CPP. The diagnostic ability of GPs was, on average, higher than nurses and pharmacists before and after training. Participants found the training valuable and relevant to CPP diagnosis in primary care settings.ConclusionsOur findings show that a training tool, using medical illustrations, for nondermatologists can be beneficial in terms of recognition of CPP. This may lead to more timely diagnosis and treatment of psoriasis and support relevant and faster referral to specialist dermatology clinics.

Embodied suffering: Uncovering the illness experiences of patients with severe psoriasis.

The visibility of skin lesions significantly burdens people with psoriasis, leading to social hostility and numerous emotional and psychological problems. These issues adversely affect self-esteem, can result in chronic mental health challenges and cause numerous life problems. This study aimed to explore patients' long-term experiences with severe psoriasis. A qualitative study was conducted with 20 patients with psoriasis (PASI ≥12) recruited from general and specialist dermatology practices in a regional teaching hospital in Taiwan. Interviews lasted 60-90 min and data were analysed using content analysis. A core theme emerged: 'Embodied suffering-life worse than death'. This overarching concept comprised three interrelated themes: (i) Experiencing physical suffering, (ii) Experiencing psychological suffering and (iii) Experiencing the stigma of suffering. This study highlights the holistic nature of suffering among individuals with severe psoriasis. It emphasises the need for healthcare professionals to consider the entirety of a patient's circumstances when addressing their suffering.

Acropustulosis of Infancy in Yemeni Infants and Children Mohammed Abdul Qader Almalmi Consultant of Dermatology and Aesthetic Medicine in Doctor Almalmi Clinic Sanaa Yemen and Specialist Dermatology and Aesthetic Medicine in be you Plus Clinic Dubai UAE

Background: Infantile acropustulosis is a recurrent, self-limited, pruritic, vesicopustular eruption of the palms and the soles occurring in young children during the first 2-3 years of life. Newly described in 1979, it is probably much more common than the scarcity of reports would imply. Objective: The objective of the study was to identify the pattern of pruritic vesicopustular skin eruptions in Yemeni infants. Patients and Methods: Twenty five male and females Yemeni infants patients 1 to 3 years old presented with pruritic erythematous macules or papules that progress into vesicles and then pustules in the palms, the soles, and the lateral surfaces. Lesions may occur on the dorsal aspects of the hands and the feet as well as the trunk, the scalp, and the face. The intensity and the duration of attacks diminish with each recurrence. No other organ systems are involved. They treated with topical Betamethasone cream or ointment and systemic antihistamine. The skin biopsy followed by histopathological examination was not specific. Results: The clinical data and the investigations showed that the 25 Yemeni infants had acropustulosis. Conclusion: Acropustulosis of infancy in Yemeni infants is very common skin disorder. The bad hygiene may play an important role in the etiology or allergic substances. It is not recurrence.