Skin Diseases Research Articles

Current management of skin conditions in Kenya: exploring teledermatology preferences and perspectives among providers

Background: Teledermatology programs may help expand access to care for skin conditions in areas that are underserved by dermatologists such as sub-Saharan Africa, but their success requires input from participating providers. Objective: This study assesses teledermatology preferences among healthcare providers in Kenya. Methods: An anonymous cross-sectional survey of nondermatology providers was conducted in Kenya from January to March 2024 at Aga Khan University Hospital-Nairobi and Kijabe Hospital. Results: Among the 38 providers, 81.6% were physicians. Patient population was primarily Fitzpatrick skin types V and VI. Almost all (97.4%) regularly encountered patients with skin disorders, yet only 5.3% felt comfortable diagnosing and treating 80 to 100% of these disorders independently. Providers anticipated referring cases of rashes (76.3%), unclear diagnoses (63.2%), and infectious diseases (50%), among others, for teledermatology consultation. Only 10.5% reported utilizing teledermatology, although the majority believed it would be useful (91.9%) and improve patient care (89.5%). Preferred response time was <24 hours (81.6%). Most favored submitting cases via personal cell phones (86.8%), with 87.9% preferring submission through WhatsApp. Limitations: Participants owned smartphones. The survey was distributed via WhatsApp. Conclusion: Nearly all providers in Kenya see patients with skin conditions, but few utilize teledermatology services. Teledermatology could be extremely beneficial for patients and providers seeking dermatologic expertise.

Knowledge and awareness in psychodermatology: Findings from a survey among Ibero-Latin American dermatologists

ABSTRACT Background: Psychodermatology is an interdisciplinary field that bridges psychiatry and dermatology, addressing the psychosocial and psychiatric aspects of skin diseases. Managing such cases presents a challenge for both dermatologists and psychiatrists as patients often resist psychiatric consultations, complicating diagnosis and treatment. Aim: This study aimed to assess the level of knowledge and awareness of psychodermatology among dermatologists in Ibero-Latin America, explore their experiences with psychodermatological conditions, and identify the educational needs and challenges in this interdisciplinary field. Materials and Methods: An observational, descriptive, cross-sectional study was conducted through an online survey from December 2023 to March 2024. The survey was distributed through messaging apps and emails and targeted a sample of dermatologists from Ibero-Latin America to explore their experience, training, and perceived challenges in psychodermatology. The participants were selected through non-probabilistic sampling from the staffing records of the Ibero-Latin American College of Dermatology. Results: Of 301 dermatologists, the vast majority (99%) reported a good level of knowledge in the field of psychodermatology; however, only 36.5% had substantial clinical experience with these conditions. Approximately 70.1% did not prescribe psychotropic medications, reflecting hesitancy or lack of confidence in managing the psychiatric issues of dermatological conditions. The study also highlighted a strong preference (86.7%) for a multidisciplinary approach for managing psychodermatological disorders. Significant perceived challenges included limited access to professional training and patients’ reluctance to accept psychological contributions to their dermatological conditions. Conclusion: The level of knowledge in psychodermatology is widespread among Ibero-Latin American dermatologists, even though a significant gap in practical experience and confidence in integrating psychological management into their dermatological practice was found. These findings emphasize the need for enhanced professional training programs and an interdisciplinary approach to effectively address psychodermatological conditions.

Symmetrical drug-related intertriginous and flexural exanthem with itraconazole: The unusual reaction with a frequently used drug

Symmetrical drug-related intertriginous and flexural exanthem (SDRIFE) is a rare, benign and self-limiting cutaneous adverse drug reaction. It presents as an erythematous rash distributed symmetrically on the gluteal and intertriginous areas with no systemic affection. SDRIFE is most commonly reported after exposure to antibiotics, particularly those in the penicillin group. Here, we present a case of SDRIFE associated with itraconazole. A 15-year-old boy presented with a dermatophytic infection for which itraconazole was prescribed. After 10 days of drug intake, he presented with diffuse erythema and scaling over the buttocks. The rash continued to progress to other intertriginous areas and was associated with itching and a burning sensation. On examination, an erythematous scaly macular rash symmetrically involving groins, thighs, neck, axilla, flexural aspect of arms, popliteal fossa and upper part of chest was noted. There was complete resolution of the lesions after 2 weeks of stopping itraconazole. The patient was, thus, diagnosed with SDRIFE due to itraconazole, based on the drug history and clinical profile. Although SDRIFE caused by itraconazole is exceedingly rare, increasing awareness among dermatologists can facilitate early identification and prompt discontinuation of the medication.

Monitoring heart rhythms in adult males with X-linked ichthyosis using wearable technology: a feasibility study.

The rare dermatological condition X-linked ichthyosis (XLI) is associated with a substantially-increased risk of cardiac arrhythmias. Arrhythmias predispose to multiple serious health conditions, and there is a need to identify them at an early stage, ideally using non-invasive, convenient, cost-effective, and reliable wearable technology methods. We tested the feasibility of monitoring heart rhythms using an Apple Watch in five adult males from the United Kingdom diagnosed with XLI. Participants returned routine electrocardiogram (ECG) traces from the watch three times per week for eight weeks (plus any traces associated with 'watch alerts' indicating arrhythmic episodes) for cardiologist review. Participant feedback was also obtained on the perceived usability/wearability of the watch/app, and on the study requirements. Participants were generally happy with the study conduct, found the watch/app straightforward to use, and there was a > 95% data return rate. Minor protocol improvements were suggested. There were few issues reported with wearability of the watch. Three participants exhibited no ECG abnormalities, but two presented with ventricular ectopic beats (VEs). Only one watch 'alert' ECG was returned, and this was considered normal sinus rhythm, suggesting the possibility of 'false positive' calls. Based on our small sample, smartwatch-based screening for cardiac rhythm abnormalities in the high-risk male XLI population appears useful, feasible, and acceptable to patients and a larger-scale clinical trial is warranted. Potentially, such devices may be more suited to detecting persistent abnormalities rather than unpredictable, acute, arrhythmic episodes. The high VE burden in some participants with XLI is consistent with septal defects underlying arrhythmia risk.

Teledermatology: Canadian dermatologists' practice patterns, perceived challenges and future recommendations.

The use of teledermatology has increased significantly in recent years. The objective of this study was to determine Canadian dermatologists' and dermatology residents' perspectives on teledermatology. An online survey was created to determine participants' teledermatology practice patterns and their perception of the challenges, education, training, and research in teledermatology. The survey was distributed through the Canadian Dermatology Association and by administrative staff at Canadian Dermatology departments. There were 33 respondents: 66.7% of respondents started using teledermatology during the COVID-19 pandemic, and 93.8% reported that teledermatology accounted for 0-25% of their practice. Convenience, access, and safety were identified as the primary advantages of teledermatology. Teledermatology was mainly utilized for medication monitoring or refills and to assess, manage, or follow up on dermatitis, other chronic inflammatory conditions, and pre-diagnosed dermatologic conditions. Poor photo quality (32.3%) and the inability to conduct physical examinations or accurately diagnose conditions (74.2%) were reported as significant challenges. Respondents recommended education on the medicolegal considerations of teledermatology and research on how teledermatology compares to in-person consultations. Overall, teledermatology offers convenience, access, and improved safety for patients and healthcare professionals. However, addressing challenges related to physical examinations, accurate diagnoses, and photo quality is essential for optimal care delivery.

T-Cell Receptor Rearrangements in Early Stages of Mycosis Fungoides May Be Associated with Pronounced Copy Number Variations: A Prognostic Factor?

Mycosis fungoides (MF), the most common form of cutaneous T-cell lymphoma, poses significant diagnostic challenges due to its overlap with benign inflammatory skin diseases and the absence of specific symptoms. Accurate early diagnosis and stratification of patients by progression risk are essential for effective treatment. This study proposes a proof-of-concept for integrating T-cell receptor (TCR) clonality analysis with somatic mutation profiling to enhance diagnostic confidence and prognostic accuracy in early-stage MF. This study’s methodology comprised the analysis of nine patients with early MF (stages IA/IB) using whole-exome sequencing and TCR repertoire profiling. The analysis revealed the presence of clonal TCR rearrangements in seven patients, while somatic mutations were identified in two. A notable finding was a recurrent chromosome 7 trisomy in these two cases. The patients were stratified into three molecular profiles: (1) somatic mutations with clonal TCR rearrangement (n = 2), (2) clonal TCR rearrangement without somatic mutations (n = 4), and (3) neither somatic mutations nor clonal TCR rearrangement (n = 3). These findings emphasise the heterogeneity of MF and underscore the limitations of relying solely on TCR clonality or mutation burden for diagnosis. This study underscores the potential of somatic mutations as diagnostic markers to distinguish MF from benign conditions and as prognostic indicators for disease progression. A combined genetic approach may refine treatment decisions, particularly for patients with higher tumor cell fractions and pronounced genetic alterations. Despite the limited size of the cohort, the results advocate for larger, multi-center studies to validate these findings and integrate genetic analyses into routine MF management.

Complete genome sequence of the Staphylococcus aureus NCCP 11854 isolated from a food-poisoning patient in the Republic of Korea.

Staphylococcus aureus is the etiological agent of skin diseases and food poisoning. In this study, we report the complete genome sequence of S. aureus NCCP 11854, which was originally isolated from the pus of a food-poisoning patient in the Republic of Korea in 2009.

Roles of skin microbiota in hidradenitis suppurativa: insights from a two-sample mendelian randomization analysis.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with unique lesional dysbiotic features. However, the role of the microbiology in the pathogenesis of HS remains in dispute. We aimed to conduct a two-sample Mendelian randomization study to investigate the relationship between skin microbiota and HS. A two-sample Mendelian randomization study was performed using the summary statistics of skin microbiota from summary GWAS data of the European descent from two cross-sectional, population-based German cohorts, KORA FF4 (n = 324) and PopGen (n = 273). The summary statistics of hidradenitis suppurativa were obtained from the FinnGen DF10 (1,070 cases and 394,105 controls). Inverse variance weighted (IVW), MR-Egger regression, weighted median, simple mode, weighted mode, and MRPRESSO were used to examine the causal association between skin microbiota and hidradenitis suppurativa. Cochran's Q statistics were used to quantify the heterogeneity of instrumental variables. Our study suggested that genus Corynebacterium in dry skin is significantly associated with HS after false discovery rate (FDR) correction (odds ratio (OR) = 1.04, 95% confidence interval (CI): 1.02-1.06, P = 0.0002, FDR adjusted P = 0.035). Additionally, we found genus Micrococcus in moist skin (OR = 1.10, 95% CI: 1.03-1.18, P = 0.0060, FDR adjusted P = 0.360), species Streptococcus salivarius in dry skin (OR = 1.03, 95% CI: 1.01-1.05, P = 0.0070, FDR adjusted P = 0.360), and species Propionibacterium granulosum (OR = 1.02, 95% CI: 1.00-1.04, P = 0.0460, FDR adjusted P = 0.970) are potentially associated with HS before FDR adjustment. No evidence of the effect in the reverse direction for HS on skin microbial features. This two-sample Mendelian randomization study found that genus Corynebacterium was causally associated with HS. Further studies are needed to clarify the protective effect of prebiotics, probiotics or microbiome transplants on HS.

Project ECHO® dermatology in the deep south: a comprehensive SWOT assessment.

There are nearly 45,000 patients for each dermatologist in the rural State of Mississippi, causing many patients to wait months for an appointment in a city that may be hours away [1]. To address this critical gap, Project ECHO® (Extension for Community Healthcare Outcomes) was launched at the University of Mississippi Medical Center (UMMC) in 2020 to teach rural primary care providers (PCPs) to care for common skin conditions. PCPs present images of their patients in a once monthly video teleconference that provides immediate feedback. A SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) of the UMMC dermatology Project ECHO® was conducted to assess the efficacy of this approach. The greatest strength is the perception of value by attendees which is reflected by growing numbers of primary care physician participants. This engagement is tracked by the number of people who join the teleconference virtually. The greatest threat is the inability to motivate participants to complete post-teleconference surveys for program feedback. This limits the ability of the program to fully assess its efficacy and identify opportunities for improvement. Looking forward, UMMC plans to offer incentives for survey completion and expand Project ECHO's reach by collaborating with other institutions to permit harmonization of metrics and facilitate data analysis for publications and grant applications.

Autosomal dominant SLURP1 variants cause palmoplantar keratoderma and progressive symmetric erythrokeratoderma

Abstract Background Epidermal differentiation disorders (EDDs, a.k.a. ichthyosis and palmoplantar keratoderma) are severe heritable skin conditions characterized by localized or generalized skin scaling and erythema. Objectives To identify novel genetic variants causing palmoplantar keratoderma (PPK) and progressive symmetric erythrokeratoderma (PSEK) phenotypes. Methods We performed whole exome sequencing in a large EDD cohort including PPK and PSEK phenotypes to identify novel genetic variants. We investigated the variant consequence using in silico predictions, assays in patient keratinocytes, high-resolution spatial transcriptomics, and quantitative cytokine profiling. Results We identified three unrelated kindreds with autosomal dominant transmission of heterozygous SLURP1 variants affecting the same amino acid within the signal peptide (c.65C>A, p.A22D, and c.65C>T, p.A22V). One (p.A22V) had isolated PPK, and two others (p.A22D) had PSEK and PPK. In silico modeling suggested that both variants alter pro-SLURP1 cleavage, appending two amino acids to the secreted protein, which we subsequently confirmed with mass spectrometry. In patient keratinocytes we found increased differentiation-induced SLURP1 expression and secretion compared to healthy control cells. Spatial transcriptomics revealed increased NF-κB signaling and innate immune activity which may contribute to epidermal hyperproliferation in dominant SLURP1-PPK/PSEK. Conclusions Our results expand the phenotypic spectrum of EDD due to SLURP1 pathogenic variants. While autosomal recessive Mal de Meleda is due to biallelic loss-of-function SLURP1 variants, our finding of autosomal dominant SLURP1 pathogenic variants in kindreds with PPK and PSEK suggests a novel mechanism of action. We found that heterozygous p.A22V and p.A22D SLURP1 variants append two amino acids to secreted SLURP1, increase differentiation-induced SLURP1 expression and secretion, and upregulate NF-κB signaling in PSEK cases.

Efficacy of bacteriophages with Aloe vera extract in formulated cosmetics to combat multidrug-resistant bacteria in skin diseases

Phage therapy offers a promising alternative to antibiotic treatment for combating illnesses caused by multidrug-resistant bacteria. In this study, pathogenic bacteria Staphylococcus aureus and Pseudomonas aeruginosa were isolated from pus and skin infected fluidsusing selective media. These bacterial isolates were biochemically identified as S. aureus and P. aeruginosa with probabilities of 98% and 99%, respectively, through VITEK2 system, and were confirmed as multidrug-resistant based on minimum inhibitory concentration test using colorimetric reagent cards. Lytic phages specific to these isolates were isolated, identified through plaque assays, transmission electron microscopy and classified morphologically according to the new International Committee on Taxonomy of Viruses classification as members of the Straboviridae, Drexlerviridae, and Autographiviridae families. A cosmetic gel formulation combining Aloe vera extract and the phage cocktail was prepared and tested. This gel significantly enhanced phage longevity and reduced bacterial growth by 95.5% compared to the reductions of 90.5% with Aloe Vera extract alone and 45.7% with the basic cosmetic gel. The phage remained effective for 4 to over 12 weeks after being preserved in the cosmetic formula, maintaining populations ranging from 5 × 103 to 25 × 104 PFU/mL in vitro. These findings highlight the potential of phage-based formulations, such as Vena Skin Gel, as innovative biotherapeutic tools for managing skin infections.

A clinical experience in the management of Eka Kushta - A Case Study

Kushta is the broad spectrum word used in Ayurveda to describe all the skin diseases under one heading, which is mainly classified into Mahakushta and Kshudra Kushta. Ekakushta is one among the Kshudra Kushta. It is of prime importance due to its chronicity and severity which involves larger extent of the body. In contemporary science, Ekakushta can be compared to Plaque Psoariasis, In the present case study, we have reported 39 years old male patient came with the complaints of severe dryness of the skin along with white scaly powdery discharged skin lesions all over the body associated with severe itching. The treatment protocol adopted here are Antah Parimarjana Chikitsa (Shodhana) and Bahir Parimarjana Chikitsa (Sarvanga Pariseka and Jaloukavacharana) and Shamanoushadhis. After treatment, patient got satisfactory results and complaints are reduced by 60-70%.

Characterization of Dermatologic Disease and Challenges in Care of Incarcerated Patients.

Incarcerated individuals face many health care challenges, including limited sanitation, limitations of formularies, and difficulty obtaining routine medical care. This study characterizes skin conditions in incarcerated individuals in the Harris Health System in Houston, Texas. We performed a retrospective health record review on incarcerated inpatients and outpatients between 2011 and 2022, collecting data on diagnostic workups, diagnoses, and interventions. Skin and soft tissue infections and drug reactions (42.9%) were the most common inpatient conditions, compared with papulosquamous and eczematous diseases (34.8%) and neoplasms (31.5%) in outpatients. Many patients demonstrated challenges in management directly related to their incarceration. Overall, the distribution of skin conditions in the incarcerated population shares similarities with that of the general population. Dermatologists should overcome resource limitations, educate patients and jails, and promote improved jail protocols for this vulnerable population.

Would global warming bring an increase of invertebrate-associated cutaneous invasive fungal infections?

Invasive mold-associated cutaneous disease is a rare but potentially catastrophic consequence of trauma. However, invertebrate bites are not well recognized as a mechanism for the inoculation of fungi into subcutaneous tissue that can also result in severe infections. Invertebrates often carry fungi with human pathogenic potential as part of their microbiome, and bites break the skin, providing a conduit for them to penetrate subcutaneous tissues where the establishment of infection can produce serious skin and soft tissue fungal diseases. In this essay, we review the existing data for invertebrate bite-associated cutaneous invasive fungal infections (IBA-cIFIs) and consider the potential consequences of global warming on their epidemiology. Climate changes will be associated with changes in the range of invertebrates and adaptation of their associated microbes to warmer temperatures. Fungal adaptation to higher temperatures can defeat the mammalian protective barrier and be associated with both more and different IBA-cIFIs.

Multi-Classification of Skin Lesion Images Including Mpox Disease Using Transformer-Based Deep Learning Architectures

Background/Objectives: As reported by the World Health Organization, Mpox (monkeypox) is an important disease present in 110 countries, mostly in South Asia and Africa. The number of Mpox cases has increased rapidly, and the medical world is worried about the emergence of a new pandemic. Detection of Mpox by traditional methods (using test kits) is a costly and slow process. For this reason, there is a need for methods that have high success rates and can diagnose Mpox disease from skin images with a deep-learning-based autonomous method. Methods: In this work, we propose a multi-class, fast, and reliable autonomous disease diagnosis model using transformer-based deep learning architectures and skin lesion images, including for Mpox disease. Our other aim is to investigate the effects of self-supervised learning, self-distillation, and shifted window techniques on classification success when multi-class skin lesion images are trained with transformer-based deep learning architectures. The Mpox Skin Lesion Dataset, Version 2.0, which was publicly released in 2024, was used in the training, validation, and testing processes of the study. Results: The SwinTransformer architecture we proposed in our study achieved about 8% higher accuracy evaluation metric classification success compared to its closest competitor in the literature. ViT, MAE, DINO, and SwinTransformer architectures achieved 93.10%, 84.60%, 90.40%, and 93.71% accuracy classification success, respectively. Conclusions: The results obtained in the study showed that Mpox disease and other skin lesion images can be diagnosed with high success and can support doctors in decision-making. In addition, the study provides important results that can be used in other medical fields where the number of images is low in terms of transformer-based architecture and technique to use.

A novel technique for non- invasive diagnosis of different skin conditions herpes virus-related.

Line-field confocal optical coherence tomography (LC-OCT) is a new noninvasive imaging technique that provides high-resolution skin imaging close to histopathology. The aim of this study was to evaluate the usefulness of LC-OCT in the diagnosis of herpes virus skin infections. Patients with a clinical or anamnestic suspicion of herpes virus infection underwent LC-OCT evaluation followed by Tzanck test. The examinations were performed in a blinded manner by different dermatologists. A total of 72 patients (M: 38; F: 34; age range: 13-84) were evaluated. In 57 cases, LC-OCT allowed the recognition of the typical herpetic intraepidermal vesicles containing giant, ballooning/multinucleated cells, as confirmed by Tzanck test. The final diagnosis was herpes simplex in 16 cases, herpes zoster in 31 cases, chickenpox in 8 cases, and Kaposi varicelliform eruption in 2 cases. In the remaining 15 cases, both LC-OCT and Tzanck test excluded the diagnosis of herpetic infections. Although the diagnosis of herpes virus skin infections is generally clinical, in minimal and/or atypical cases, LC-OCT could be a rapid and valid alternative to semi-invasive/invasive and time-consuming procedures, such as Tzanck test, viral cultures, PCR, or histopathology.

Camp Wonder Provides Short-Term Health-Related Quality of Life Benefits for Participants With Chronic Skin Disease.

Chronic skin diseases in children can significantly impair their quality of life (QOL) due to physical discomfort and psychosocial challenges. Disease-focused summer camps, like Camp Wonder (CW), offer a supportive environment for children to engage in activities and build friendships, potentially improving their QOL. This prospective cohort study evaluated the short-term QOL benefits of CW as measured by the Children's Dermatology Life Quality Index (CDLQI). Data were collected from 58 camp participants aged 8-17 years. The CDLQI was administered on the first and last days of CW. The paired sample t-test was used to compare pre-camp and post-camp CDLQI scores. A multiple linear regression analysis examined predictors of QOL improvement, including age, diagnosis category, sex, and initial CDLQI severity. CW participants showed significant improvements in total CDLQI scores (mean change = -3.8 points, p < 0.0001) and in all constituent domains. Participants with "very large" initial QOL impacts experienced an average reduction of 8.4 points, while those with "extremely large" impacts had a reduction of 15.3 points relative to the reference group. Age, sex, and diagnosis were not significant predictors of QOL changes. CW provides significant short-term QOL benefits, particularly for children with severe impairments due to chronic skin disease. These findings suggest that summer camp experiences may be useful as part of a comprehensive care strategy, especially for pediatric patients with severe QOL impacts.

Topical delivery of siRNA to psoriatic skin model using high molecular weight chitosan derivatives: In vitro and in vivo studies.

Psoriasis is a chronic inflammatory skin disease that, like other immune-mediated conditions, may benefit from small interfering RNA (siRNA)-based therapies, which are emerging as a promising alternative by addressing several limitations of current treatments. In this study, topical formulations of chitosan-based vectors were developed to deliver siRNA targeting tumor necrosis factor alpha (TNFα) to inflamed skin. Grafting diisopropylethylamine (DIPEA) and polyethylene glycol (PEG) onto the chitosan backbone enhanced siRNA delivery efficiency under physiological conditions, forming robust polymeric vectors with high structural and colloidal stability. These vectors provided siRNA protection against RNAse degradation and oxidative damage. Additionally, the chitosan derivatives displayed lysozyme-mediated biodegradability comparable to native chitosan, while PEG was released in response to reductive environments, supporting controlled vector disassembly. The PEGylated DIPEA-chitosan/siRNA polyplexes demonstrated positive zeta potentials (up to + 11 mV), particle sizes of 100-200nm, and very low cytotoxicity in keratinocyte and fibroblast cell lines. In vitro, the polyplexes achieved TNFα knockdown levels (65%) in RAW macrophages, comparable to those obtained with Lipofectamine™. Topical formulations showed enhanced interaction of vectors with skin models (Strat-M® and porcine ear skin) compared to naked siRNA. Furthermore, in vivo studies indicated that hair follicles were a key route for polyplexes to penetrate deeper skin layers. A rodent model of psoriasis induced by imiquimod was treated topically with these vectors, resulting in approximately a 50% reduction in TNFα levels at inflammation sites, decreased immune cell infiltration, and preservation of epidermal structure. These findings collectively underscore the potential of DIPEA-chitosan-based vectors for topical siRNA-based therapies.

Path analysis of farmer knowledge, attitudes, and practices toward lumpy skin disease in beef cattle

Lumpy skin disease (LSD) poses a significant threat to cattle populations and the livelihoods of farmers in Thailand. This study uses path analysis to explore the interrelationships among the knowledge, attitudes, and practices (KAP) of beef cattle farmers regarding LSD. A total of 384 farmers provided data on their sociodemographic characteristics and responses to KAP-related questions. Path analysis was employed to examine how KAP components interact and how demographic factors influence these relationships. The analysis revealed strong positive relationships between farmers’ knowledge and attitudes (β = 0.96, p < 0.001) and between attitudes and practices (β = 0.08, p < 0.008). Farmers with greater knowledge of LSD were more likely to adopt positive attitudes toward disease control and implement effective management practices. Additionally, knowledge had a direct influence on farmers’ practices (β = 0.38, p < 0.001), indicating that improved awareness of LSD is linked to better disease management. By strengthening knowledge, these efforts can positively influence attitudes and practices, leading to more effective control strategies. As the first KAP study on LSD in Thailand, this research highlights the critical role of targeted education programs in improving farmers’ understanding of LSD. Ultimately, enhancing disease management through education can help reduce the economic impact of LSD on Thailand’s livestock sector and promote sustainable farming practices.

Acne Vulgaris Management: A Review of First-Line and Advanced Pharmacological Treatments

Introduction and objective: Acne vulgaris is a common chronic inflammatory skin disease affecting hair and sebaceous follicles, characterized by skin lesions most commonly appearing on the face. Several factors predispose individuals to the development of acne, including hormonal imbalances, genetic predisposition, and the use of certain medications. This review aims to evaluate and summarize first-line and advanced pharmacological treatments for acne vulgaris, highlighting their efficacy, safety, and emerging therapies for optimal management. Review methods: The literature review utilized databases covering sources from PubMed, Google Scholar, Scopus, and Web of Science using the search terms encompassing the following keywords: ‘acne vulgaris’ and ‘topical retinoid therapy’, ‘benzoyl peroxide’, ‘azelaic acid’, ‘topical antibiotics’, ‘oral antibiotics’, ‘contraceptive agents’, ‘antiandrogen therapy’, ‘isotretinoin’. Brief description of the state of knowledge: Current treatment methods range from topical therapies (i.e. antibiotics and retinoids) for mild cases to systemic medications (i.e. antibiotics, retinoids, and hormonal) for moderate to severe acne. In most cases, treatment should start with topical therapy. Summary: Early intervention is crucial to mitigate the risk of scarring and psychosocial consequences. Emerging therapeutic strategies have the potential to enhance treatment outcomes.