Expert Dermatologists Research Articles

Real-world use of dimethyl fumarate in patients with plaque psoriasis: a Delphi-based expert consensus.

Dimethyl fumarate (DMF) was recently approved by the European Medicines Agency for systemic treatment of moderateto- severe chronic plaque psoriasis. Appropriate management of DMF treatment is required to achieve optimal clinical benefits. 7 dermatology experts gathered online for 3 meetings to identify consensus on the use of DMF in patient selection, drug dosage/titration, side effects management, and follow-up, with the aim to provide guidance on the use of DMF for psoriasis in clinical dermatological practice based on literature data and expert opinion. 20 statements were discussed and voted on using a facilitator- mediated modified Delphi methodology. Strong consensus was reached for all statements (agreement level of 100%). DMF treatment is characterized by dosage flexibility, sustained efficacy, high rates of drug survival, and low potential for drug-drug interactions. It can be used in a broad range of patients, including the elderly or those with comorbidities. Side effects (mainly gastrointestinal disorders, flushing, and lymphopenia) are frequently reported but are generally mild and transient and can be minimized by dosage adjustments and a slow titration schedule. Hematologic monitoring throughout the treatment course is required to reduce the risk of lymphopenia. This consensus document provides clinical dermatologists with answers on the optimal use of DMF to treat psoriasis.

Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review.

Atopic dermatitis (AD) is a chronic, pruritic skin disease caused by a mixture of genetic, immunological, and environmental factors, characterized by periods of inflammation and remission. In Latin America (LA), the prevalence of AD ranges up to 25% in children and 1-3% in adults. The natural history of the disease for most patients is that AD goes into remission in adolescence and adult life. Only 10-30% of patients continue to have symptoms of the disease in adulthood. There are patients (3-4%) who have the onset of AD during adolescence or after adulthood. Those with limited access to healthcare services, such as diagnosis and treatment, have increased difficulties coping with AD. Healthcare disparities are a complex topic that include social, political, racial/ethnic, and geographical factors. Publications about healthcare disparities in AD in LA are scarce. As a result, recognizing and resolving healthcare inequalities is critical to improving the treatment and quality of life (QoL) of individuals with AD. A panel of Latin American experts in dermatology and allergies was provided with a series of relevant questions to address before a multiday conference. During this conference, the entire group discussed and edited each narrative through numerous drafts and rounds of discussion until they reached a consensus. This paper examines the barriers to equal access to care and recommends realistic actions to overcome them. Inadequate disease knowledge, cultural and linguistic barriers, stigmatization, maldistribution of resources, absence of local clinical practice guidelines, arduous patient journey, and limited consultation time were identified as causes of health inequality. Among the suggested solutions are enhanced education for healthcare professionals, patients, and the general public, a focus on underprivileged communities, telemedicine and telementoring, translators, multidisciplinary teams, and local living clinical practice guidelines.

Hybrid convolutional neural networks with SVM classifier for classification of skin cancer

Background: The dermatologist widely uses digital dermoscopy for the detection of melanoma. The accurate detection of melanoma by clinicians is subjective and further depends on their experience. Fully automated computer-aided diagnosis systems are necessary to eliminate the inter-operator variability inherent in the personal analysis of dermoscopy images.Objective: Automated skin lesion classification is challenging because of the fine-grained difference in the appearance of these lesions on the skin surface. Deep convolutional neural network (CNN) have shown great separability across many fine-grained object classes.Methods: This article presents two novel hybrid CNN models with an SVM classifier at the output layer for classifying dermoscopy images into either benign or melanoma lesions. The features extracted by the first CNN and second CNN models are concatenated and fed to the SVM classifier for classification. The labels obtained from an expert dermatologist are used as a reference to evaluate the performance of the proposed model.Results: The proposed models displayed better results over the state-of-the-art CNN models on the publicly available ISBI 2016 dataset. The proposed models achieved 88.02% and 87.43% accuracy, which remain higher than the traditional CNN models.Conclusions: The proposed framework could attain considerable improvement in accuracy to classify dermoscopy images.

Prevalence of Dermatological Problems in Beta-Thalasemic Patients at Al-Khidmat Hospital, Peshawar

Background: Beta-thalassemia is the world's most prevalent single-gene disease with a reduction in the synthesis of hemoglobin b-chain. A lot of skins problems occur in thalassemia patients but, no study have been conducted in Pakistan to determine their prevalence. Objective: To determine the prevalence of dermatological problems in beta-thalasemic patients Methodology: This was cross sectional study carried out at the department of dermatology Al-Khidmat hospital Peshawar for a period of one year from August 2020 to August 2021. All the beta-thalassemia patients were examined for dermatological problems by a single expert dermatologist. All of the data was entered and analyzed by using the SPSS version 20 software. Results: Amongst 150 beta-thalasemic patients, 122 (81.33%) patients were observed with dermatological problems. The most frequent dermatological problem observed in our study was pruritus in 54 (36%) patients followed by xerosis in 34 (22.67%), urticaria in 30(20%), Pigmentary disorders in 33(22%) patient, freckles in 24(16%), tinea infections in 15(10%), pitriasis alba in 13 (8.67%) patients, scars in 13 (8.67%), hypersensitivity to deferoxamine pump in 12 (8%), herpes simplex in 12 (8%), Verruca vulgaris in 10 (6.67%), acne in 8 (5.33%) patients, miliaria in 8 (5.33%) while contact dermatitis was observed in 6(4%) of the patients. Conclusion: Our study concludes that dermatological problems are highly prevalent in beta-thalassemia patients with pruritus as the most common problem followed by xerosis. Keywords: Prevalence; Dermatological problems; Beta-thalasemia; Pruritus; Xerosis.

Content analysis and dermatologic gaps in online patient education materials for graft-versus-host disease.

Graft-versus-host disease (GVHD) is a complex systemic disease which is associated with significant physical and psychological distress in patients. Given the complexity of this disorder and its multifactorial effects, it is important for patients to have access to education and learning about their disease. Patient education has been shown to reduce the uncertainty and stress that follows complex diseases such as GVHD. To our knowledge no studies have evaluated the content of patient education materials on GVHD, especially from a dermatologic perspective. Despite the complexity of GVHD, cutaneous manifestations are common and often require management by dermatology. In this cross-sectional study, a Google search engine was utilized to assess websites for information on GVHD etiology, pathophysiology, symptoms, treatment, coverage of Acute GVHD, Chronic GVHD, cutaneous presentations, dermatologic management, and quality of life. It was evident that there was inconsistent inclusion of cutaneous manifestations of acute and chronic GVHD and dermatologic management of GVHD. Results of this study emphasize the need for more robust integration of skin-specific information guided by expert dermatologist opinion in publicly available patient education materials online.

Dermatological video consultations for German prisons : Experiences from teledermatological consultations 2020to2022

With increasing shortage of medical personnel also in the medical care in German correctional facilities, telemedicine has been used since 2016, initially in projects and then for regular medical care. Since 2019, there is the possibility of dermatological expertise in regular video consultations. The benefits of an interdisciplinary online consultation with video and store and forward technology for dermatological issues are highlighted in terms of efficiency and feasibility. A descriptive analysis of 450 dermatological video consultations for German correctional facilities from February 2020 to July 2022 was carried out with respect to procedures, indications and demand. Requests were made via astandardised form with optional photographs, which were sent via a secure cloud to the dermatology department in store and forward mode. The majority of cases could be presented live in aregular weekly video consultation and only single cases required an acute presentation within 24 h. The spectrum of skin diseases was comparable to cases presenting to adermatology outpatient clinic. The interdisciplinary consultation management together with colleagues from general medicine enabled the transfer of the cases to the medical personnel at the correctional facility on site for follow-up and further medical procedures. Treatment could be started in all cases without delay. Teledermatology represents an important contribution to medical care in German correctional facilities and the interdisciplinary cooperation saves time and resources in the presentation and treatment of skin diseases.

31686 Automatic detection of blue-white veil in melanoma based on multispectral dermoscopy

Blue-white veil (BWV) is an important feature in melanoma detection where it is present as a focal, ill-defined area. In benign lesions BWV typically has a more uniform distribution across the lesion. In this work we analyzed spectral signatures, obtained using multispectral dermoscopy, of pathology proven atypical nevi (n = 30) and melanoma (n = 119) lesions using a retrospectively collected dataset. Using AI techniques, we were able to automatically detect the BWV dermoscopic feature. When only considering darker regions in the lesions, we found a specificity in discriminating melanoma from atypical nevi based on the presence of BWV of 100% at a sensitivity of 34%. When additionally including paler regions, the sensitivity increases to 64% at a slightly reduced specificity of 95%. The main advantage of this automatic BWV detection is that it only relies on the observed spectral signature of the corresponding region of the lesion, without requiring spatial information or relative color compared with the surrounding lesion area. Furthermore, the used technique allows to exactly highlight where the BWV was detected, allowing expert review. Future work will include visual analysis by expert dermatologists of the detected BWV areas, especially since literature shows a BWV prevalence of 18.7% in nevi (and 34.9% in melanoma). The higher specificity of the automatic BWV detector may suggest that the presented technique allows to discriminate BWV correlated with benign nevi from BWV correlated with melanoma. Finally, a prospective study should be performed to prove the benefit of the presented automatic BWV detection in clinical practice.

Whatsapp based visual impression versus actual impression in patients of common skin disorders: A cross-sectional comparative study

: Nowadays with increasing use of social media platforms for each and everything, there is an increasing trend for use of whatsapp based consultation for many diseases. But what’s app base impression has many limitations and may result in error in diagnosis. : To compare Whatsapp based visual impression versus actual impression in patients of common skin disorders. : In this cross-sectional comparative study held at Department of Dermatology of tertiary care hospital and referral centre in central India, 316 patients of common skin disorders attending Dermatology department were enrolled. Photographs of skin lesions in a patient suffering from skin disorders in pre-determined categories were taken and sent to by 2 independent expert dermatologists by Whatsapp and their impression was recorded. Later same patients were independently evaluated by same investigators by actual clinical examination. It was studied whether both evaluations were matched or not. : At the end of study overall, 69% patients’ photographic and clinical impression was matched. Among different groups of disorders, like fungal, bacterial, viral, pigmentary groups, average diagnosis matched in 51% to 80% cases. Highest percentage of diagnosis matched in pigmentary type of disorders at 80% and lowest percentage of diagnosis matched was 51% for papulosquamous disorders. : Whatsapp consultation is frequently sought by patients suffering from various dermatological problems but it’s not accurate and not 100 % reliable. So clinical evaluation always has an upper hand over an impression made over a photo.

Role of teledermatology in the management of dermatological diseases among marine workers: A cross-sectional study comparing general practitioners and dermatological diagnoses.

BackgroundDiagnosis and treatment of skin disease in sea workers is an unmet need. The purpose of this study is to highlight how remote management of dermatological conditions appears inadequate in this scenario.ObjectiveThis study aimed to identify the best epidemiology for seafarers' diseases and analyze the adequacy of medical assistance in the diagnosis of dermatological maritime diseases.Material and methodsA total of 420 cases of requests for dermatological diseases received by the Telemedical Maritime Assistance Service of the International Medical Radio Center (C.I.R.M.). in a referral year were included in this cross-sectional study. All pictures of cutaneous lesions had been submitted to both C.I.R.M. doctors and an expert dermatologist who provided their diagnosis.ResultsThe most frequent diagnosis in both groups was infectious or inflammatory skin diseases. The main differences are represented by the amount of “unclassified dermatitis” or descriptive diagnosis, such as “cutaneous eruption” which were the most frequent diagnosis of C.I.R.M. doctors (p < 0.05 and p > 0.0001). In these cases, Cohen's K was <0.5 consistent with low concordance between dermatologic diagnosis and C.I.R.M. diagnosis.Conclusion and relevanceOur study emphasizes the magnitude of dermatological diseases in the maritime sector, although often underestimated, and highlights the difficulty in their diagnosis for doctors on call that need more training on specific dermatological issues.

Cutaneous manifestations of Coronavirus Disease 2019.

BackgroundCOVID‐19 has been linked to a variety of dermatological conditions.ObjectiveTo determine the presence of various cutaneous manifestations in patients with COVID‐19, also to define their features in relation to the systemic symptoms.MethodsThis research enrolled a total of 1206 lab‐confirmed COVID‐19 individuals at a tertiary care hospital in Karachi, Pakistan. Expert dermatologists assessed patients for COVID‐related skin conditions. COVID‐19 severity was categorized as asymptomatic/mild, moderate, or severe.ResultsOf the 102 (85.7%) patients with only one cutaneous sign, 26.5% developed maculo‐papular/morbiliform/erythematous rash; 14.7% urticaria; 9.85% vesicular/pustular exanthem; 14.7% vascular pattern; 12.7% infections, 7.8% miscellaneous and 9.8% late cutaneous findings A longer‐lasting vascular pattern was related with an older age and a fatal COVID‐19 outcomes (P: 0.000) compared to mild/moderate disease. Most of the retiform purpura presented exclusively with thromboembolic episodes. The moderate severity was correlated with maculopapular/morbiliform/exanthematous phenotype (P: 0.009), whereas urticaria was attributed to asymptomatic/mild disease (0.001) compared to moderate/severe infection.LimitationsSingle‐Centre and observational study.ConclusionVascular lesions were correlated with disastrous COVID‐19 outcomes, whereas retiform purpura was linked to adverse outcomes. The maculopapular/morbiliform/erythematous rash was associated with moderate severity, whilst the urticarial rash was linked to milder course compared to moderate/severe severity infection.

Multidisciplinary panel opinion on the management of bacterial skin infections

AbstractEight hot topics regarding the diagnosis and management of bacterial skin infections were selected and reviewed by five experts from different European countries, chosen based on their expertise in microbiology, infectious diseases, and dermatology. As noninfectious skin diseases/conditions such as atopic dermatitis can be complicated by infections, including Acute Bacterial Skin and Skin Structure Infections (ABSSSI), a collaboration between dermatologists and infectious disease specialists can promote a rational approach to diagnosis and a more functional treatment approach, especially for complicated infections. In addition, an important role would be played by microbiologists as they are crucial for the isolation and classification of the bacterial pathogen to guide clinicians toward the most effective antibiotic therapy. Although there are many therapeutic options for the treatment of bacterial skin infections, including those due to methicillin‐resistant Staphylococcus aureus, these drugs often require multiple daily administrations leading to patient noncompliance and are associated with gastrointestinal adverse events and drug resistance. With their characteristics of being long‐acting, safety and single‐dose regimens, long‐acting antibiotics, such as dalbavancin and oritavancin, represent an effective alternative that could change the management of these infections with a considerable reduction of hospitalisation costs and risks.

A Qualitative Study to Develop and Evaluate the Content Validity of the Vitiligo Patient Priority Outcome (ViPPO) Measures.

IntroductionVitiligo can be associated with a psychological burden, stigmatization and impaired quality of life. Tools to assess the impact of vitiligo exist; however, none were developed in line with the FDA’s patient-reported outcome (PRO) Guidance for Industry. This study aimed to explore the content validity of two newly developed PRO measures to assess the impact of facial and total body vitiligo on how patients feel and function.MethodsDraft PRO measures were developed from existing literature and input from PRO experts, a patient advocate and a clinical expert. Qualitative interviews were conducted with US participants living with vitiligo and international dermatologists with vitiligo expertise. Concept elicitation methodology explored the relevance of concepts in the draft PRO, while cognitive debriefing assessed conceptual relevance and understanding/interpretation. Items were iteratively amended/added throughout the interview study.ResultsThe 60 participants included adults (n = 48, 63% female, 18–62 years old) and adolescents (n = 12, 67% female, 12–17 years old) with Fitzpatrick Skin Types I–VI. Expert dermatologists from the US (n = 8), EU (n = 4), India (n = 1) and Egypt (n = 1) participated. Concept elicitation was utilized to confirm the signs/symptoms of vitiligo and the associated impact on emotional/psychological wellbeing, social functioning, daily life and work/school. Conceptual saturation was achieved. Most participants reported impacts on their emotional/psychological wellbeing (n = 57, 95%), e.g. feeling self-conscious (n = 35, 58%). Participants reported impacts on social functioning (n = 53, 88%), e.g. vitiligo being noticed by others (n = 42, 70%). There was general consensus between participants and expert dermatologists. Cognitive debriefing confirmed that the items were well understood. Most items were conceptually relevant; feeling self-conscious and feeling frustrated were highly endorsed. Items were removed based on low conceptual relevance (feeling abandoned, skin roughness) and expected redundancy (four items), resulting in two measures with three proposed domain scores: Emotional/Psychological Wellbeing; Social Functioning; and Physical Sensation. No comprehension concerns were observed in relation to the 7-day recall period or the item response scale/options. Eight dermatologists reviewed the PRO measures, confirming comprehensiveness and relevance.ConclusionThe draft Vitiligo Patient Priority Outcomes (ViPPO) measures evaluate the impact of facial (ViPPO-F) and total body (ViPPO-T) vitiligo on emotional/psychological and social functioning. The ViPPO measures are well understood, comprehensive and content valid for adults and adolescents with vitiligo.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00772-4.

333 A modified delphi consensus exercise: developing a skin-directed Stevens-Johnson Syndrome/toxic epidermal necrolysis scoring system

While SCORTEN and ABCD-10 are available to provide a patient prognosis in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN), they are not intended to assess the severity, progression, or improvement in disease throughout the hospitalization. A skin-directed instrument is needed. A modified Delphi consensus using RAND/UCLA appropriateness criteria was initiated with a core group of members who have published in the topic. A two-part consensus was determined to be needed to first establish agreement on the optimal design for a cutaneous scoring instrument, terminology, morphologies, and locations of involvement. Fifty-four dermatology hospitalists agreed to participate in this study. After one round for part one, all questions and statements reached consensus. Participants consistently agreed on the need of such an instrument and that certain locations including the head and neck, chest, upper back, ocular mucosa, and oral mucosa were almost always affected by SJS/TEN. Participants also agreed on morphologic terminology and that morphologies could be differentiated into blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions. The second part of the study will establish agreement on time course, progression, and weighting assessments and is in progress. The Delphi consensus has established that there is widespread agreement among expert dermatologists that there is a need for a skin directed scoring system, widespread agreement that specific morphologies can be differentiated consistently on both cutaneous and mucosal surfaces, and that some areas of the body are almost always affected when SJS/TEN occurs. This undertaking has so far revealed best practices as well as areas of uncertainty with SJS/TEN to help develop the framework for an SJS/TEN skin-directed scoring instrument.

Consensus on the Definition of Control and Remission in Chronic Urticaria.

The terms control and remission and other key terms used in chronic urticaria (CU) such as flare-up, relapse, exacerbation, and recurrence have not been fully defined in the literature. Disease monitoring and treatment goals in clinical practice are not well established. After a qualitative appraisal of available evidence, we aimed to find a consensus definition of control and remission, clarify key terminology, provide guidance on how to monitor the disease, and establish treatment goals in clinical practice. A modified Delphi consensus approach was used. Based on a literature review, a scientific committee provided 137 statements addressing controversial definitions and terms, available patient-reported outcomes (PROs), and recommendations on how to measure therapeutic objectives in CU. The questionnaire was evaluated by 138 expert allergists and dermatologists. A consensus was reached on 105 out of the 137 proposed items (76.6%). The experts agreed that complete control and remission of CU could be defined as the absence of signs or symptoms while on treatment and in the absence of treatment, respectively. Consensus was not reached on the definition of other key terms such as flare-up, exacerbation, and recurrence. The panel agreed that the objective of therapy in CU should be to achieve complete control. PROs that define the degree of control (complete, good, partial, or absence) were established. An algorithm for disease assessment is provided. In conclusion, this work offers consensus definitions and tools that may be useful in the management of patients with CU.

805 Segmentation of cutaneous chronic graft-versus-host disease by a deep learning neural network

Surface area involvement is a key measure for staging and tracking cutaneous chronic graft-versus-host disease (cGVHD) but is limited by availability of expert dermatologist visual evaluation. We developed a deep learning algorithm to segment (mark out) skin affected by cGVHD and tested its performance on unseen patients. We took 179 affected and 181 unaffected skin 3D photos from 36 cGVHD patients. As ground truth, a human annotator marked each region affected by cGVHD. A U-Net algorithm was trained and tested in a leave-one-patient-out validation experiment.

Unveiling the true costs and societal impacts of moderate-to-severe atopic dermatitis in Europe.

Atopic dermatitis (AD) is a chronic, auto-immune condition that imposes a high burden on individuals, society, and the healthcare system. Approximately 4.4% of adults and up to 18.6% of children/adolescents have AD in Europe, with 20% of all cases accounting for moderate-to-severe forms. This form of the condition in adults results in annual societal costs across Europe of an estimated €30 billion; €15.2 billion related to missed workdays or reduced work productivity, €10.1 billion related to direct medical costs and €4.7 billion related to personal expenditure of patients/families. AD can also substantially impact physical, emotional, and social quality-of-life. Several studies have shown the debilitating itch-scratch cycle is the main cause of the multifaceted burden, as it causes substantial sleep deprivation and stigmatisation due to the physical appearance of the skin, and confidence issues. These factors lead to psychosocial issues and can cumulate over time and prohibit patients reaching their 'full life potential'. Despite this, many patients with the condition are undertreated, resulting in uncontrolled symptoms and a further strain placed on patients, society, and the economy. The authors of this White Paper comprise the European Atopic Dermatitis Working Group, which is a network of international specialists with expertise in dermatology and healthcare policy decisions. Their programme of action is focused on harnessing their expertise to build consensus, advance research, share knowledge, and ultimately seek to improve AD care outcomes through achieving long-term symptom control. This White Paper presents a systematic evaluation of the overall financial and humanistic burden of moderate-to-severe AD and the current challenges that exist with AD care. It introduces recommendations for how, collaboratively, key stakeholders and policy makers can support improvements in AD management to achieve better disease control, thus reducing the costs and associated burden placed on individuals, society, and the economy.

Management of Atopic Dermatitis in Adults in Saudi Arabia: Consensus Recommendations from the Dermatological Expert Group.

BackgroundAtopic dermatitis (AD) is a long-term, pruritic, recurrent, systemic, inflammatory skin disorder. In the Middle East region, the burden of AD is understudied, and there is a dearth of AD guideline documents for practitioners.MethodsAn expert panel meeting, encompassing 12 dermatologists from the Kingdom of Saudi Arabia (KSA), was congregated to develop evidence- and experience-based consensus recommendations for AD management, especially in adults in KSA. They completed a questionnaire with seven clinical statements, and a consensus was defined when the responses of ≥75% of participants coincided.ResultsThe expert recommendations were as follows: American Association of Dermatology guidelines are to be followed for defining AD; Eczema Area and Severity Index or SCORing atopic dermatitis index may be used to quantify the disease severity; Dermatology Life Quality Index may be used to determine the impact of AD on patients’ quality of life; Atopic Dermatitis Control Tool may be used to assess long-term disease control in AD patients; and the European guidelines are to be followed for the management of AD. In AD patients who are inadequately controlled with topical or systemic therapies, the preferred systemic agent for use either alone or in combination with topical treatments is dupilumab, cyclosporine, methotrexate, phototherapy, or other available systemic treatments that may include mycophenolate mofetil or oral corticosteroids.ConclusionThese expert recommendations assist physicians by providing a reference framework for optimal care of adult AD patients.

Meaningful Changes in What Matters to Individuals with Vitiligo: Content Validity and Meaningful Change Thresholds of the Vitiligo Area Scoring Index (VASI).

IntroductionThis study explored patients’ and dermatologists’ priority outcomes for treatment to address, clinical outcome assessments (COA) for use in vitiligo clinical trials, and perceptions of within-patient meaningful change in facial and total body vitiligo.MethodsSemistructured, individual, qualitative interviews were conducted with patients living with non-segmental vitiligo in the USA and with expert dermatologists in vitiligo. Concept elicitation discussions included open-ended questions to identify patient priority outcomes. Vitiligo COAs were reviewed by dermatologists. Tasks were completed by patients to explore their perceptions of meaningful changes in vitiligo outcomes; dermatologists’ opinions were elicited. Data were analyzed using thematic methods; meaningful change tasks were descriptively summarized.ResultsIndividuals with vitiligo (N = 60) included adults (n = 48, 63% female) and adolescents (n = 12, 67% female). All Fitzpatrick Skin Types were represented. Eight (13%) were first- or second-generation immigrants to the USA. Expert dermatologists (N = 14) participated from the USA (n = 8), EU (n = 4), India (n = 1), and Egypt (n = 1). All individuals with vitiligo reported experiencing skin depigmentation; an observable clinical sign of vitiligo. Most confirmed that lesion surface area (n = 59/60, 98%) and level of pigmentation (n = 53/60, 88%) were important to include in disease assessments. Following an explanation, participants (n = 49/60, 82%) felt that the Facial Vitiligo Area Scoring Index (F-VASI) measurement generally made sense and understood that doctors would use it to assess facial vitiligo. Most participants felt that a 75% (n = 47/59, 80%) or 9 0% improvement in their facial vitiligo would be indicative of treatment success (n = 55/59, 93%). In the context of evaluating a systemic oral treatment for vitiligo, dermatologists perceived a 75% improvement on the F-VASI as successful (n = 9/14, 64%). Regarding the Total VASI (T-VASI) score, n = 30 participants considered 33% improvement as treatment success; an additional n = 10 endorsed 50% improvement and a further n = 5 endorsed 75% improvement. Clinicians most frequently identified 50% (n = 6/14, 43%) or 75% (n = 4/14, 29%) improvement in T-VASI as successful.ConclusionRepigmentation is a priority outcome for patients. The VASI was considered an appropriate tool to assess the extent of vitiligo. A minimum 75% improvement from baseline in the F-VASI and minimum 50% improvement from baseline in the T-VASI were identified as within-patient clinically meaningful thresholds.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00752-8.

Expert recommendations on the assessment and management of complications due to hyaluronic acid soft tissue filler injections in Asians.

The use of hyaluronic acid (HA) fillers for medical aesthetic purposes is increasing worldwide. Nonetheless, adverse events do occur because of patient-specific issues, injection technique, or product factors. It would be mandatory to consider cultural and anatomical features of Asians in preventing and managing the complications of HA injections. Literature search of studies looking at current evidence and guidelines on the management of complications following HA filler injections in Asian patients was conducted. This was followed by an expert group discussion that was convened to reach consensus recommendations on the best clinical practices. The expert panel provided specific recommendations focusing on the safe use of soft tissue fillers in Asian patients, including early identification of adverse events and how to prevent and comprehensively manage these outcomes. Here, we provide consensus statements of Asian experts in dermatology, plastic surgery, ophthalmology, and aesthetic medicine mainly focusing on AEs with higher risk for Asians and can be used to guide physicians in treating Asian population.

A Survey on Deep Learning Techniques for Skin Lesion Classification

Skin problems are common in day-to-day living. Skin lesions cause patients to be emotionally and psychologically burdened, which may be worse than the physical disorders. Skin lesions must be detected early to receive effective treatment. The diagnostic method must be precise and performed within a reasonable time. Many skin lesions look similar, which increases the potential of human error when classifying them. Deep learning's use in disease diagnosis has been a key focus of dermatological research. Skin lesion classification based on deep learning aids in the automatic skin lesion classification by dermoscopy, removing errors caused by naked eye inspection. The goal of this paper is to provide a quick survey on deep learning based skin lesions categorization, and outline the features of skin lesions. The essential stages of skin lesions and elements that affect dermatological diagnosis are reviewed, and the current difficulties and prospects of classification are discussed. The findings suggest that a deep learning-based skin lesion detection technique may beat expert dermatologists in some scenarios, and that there is a lot of room for further study.