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Simplifying assessment of dimensions of oral lesions using a syringe and "impression planimetry" with printer paper To measure a lesion, the tuberculin syringe was placed across the lesion without further mucosal stretching, with the zero mark on the posterior margin of the lesion and the barrel of the syringe lying across the dye-stained anterior margin (Fig. A change in lesion dimensions can be assessed using both methods as they are reproducible by different operators; the sole disadvantage is the inability to measure lesion depth/height. [Extracted from the article]

The British Association of Dermatologists (BAD) have issued an AI position statement to highlight that safe, ethical and effective AI interventions should be adopted through a robust regulatory framework.[1] The BAD website provides a range of resources on AI in healthcare.[2] Dr Rubeta Matin, who leads the AI Working Party Group at the BAD, will be the Guest Editor for this special issue. REFERENCES 1 British Association of Dermatologists Position Statement on Artificial Intelligence (AI) Interventions. Here at I Clinical and Experimental Dermatology i , we are seeking submissions for a special issue on artificial intelligence (AI). [Extracted from the article]

Lentigo maligna (LM) is a melanoma in situ with distinct clinical features and histology. It commonly affects men after the sixth decade of life. Incidence rates of LM have increased based on early 21st century data from different countries; however, data are suboptimal. Data from England show a plateauing crude incidence between 2013 and 2019. By comparison, invasive melanoma and other types of melanoma in situ commonly appears in younger age groups (median age 58 and 67 years old, respectively) and incidence is rising. The most important risk factors for LM include fair skin and cumulative ultraviolet solar radiation exposure. Although LM is limited to the epidermis and connected skin adnexa, it may progress to invasive LM melanoma. The reported rate of malignant progression varies, reflecting a challenge for LM epidemiology research as often lesions are removed on diagnosis. LM poses a challenge in diagnosis and management. Although it can be diagnosed clinically or dermoscopically, histopathological assessment of biopsied skin tissue remains the gold standard. Reflectance confocal microscopy allows for better appreciation of the complexity of LM at a cellular level, often progressing beyond clinical margins. Management of LM may involve Mohs micrographic surgery or excision, although recurrence may occur even with 5 mm clinical margins. Imiquimod cream may be effective, but incomplete treatment and recurrence has been reported. Conservative management with observation or radiotherapy may be used in selected patients' cases. Five-year net survival rates are excellent. This paper reviews the natural history, epidemiology, aetiology, pathogenesis, diagnosis and management of LM. [ABSTRACT FROM AUTHOR]

Background Emollients are universally recommended for atopic dermatitis/eczema ('eczema'), to improve the skin barrier and reduce symptoms. However, our knowledge of the frequency and nature of adverse effects associated with their use is limited. Objectives We sought to determine how well adverse events are reported in randomized controlled trials (RCTs) of emollients for eczema. Methods MEDLINE was searched from inception (1946) to May 2022. Inclusion criteria were RCTs of moisturizers or emollients used as a leave-on treatment (as the intervention or control) in adults or children with eczema. Exclusion criteria were non-RCTs; patients with other diagnoses included; use of emollient as bath additives, soap substitutes or as preventative; and not published in English. References of eligible papers were reviewed for any additional, relevant research. Data were extracted into an Excel spreadsheet and analysed descriptively. An assessment of study quality was carried out using the Joanna Briggs Institute tool for RCTs. Results From 369 potential papers, 35 papers (reporting on 34 studies) were included. Most research was conducted in research centres or hospitals (unclear in 34%). In total, 89% reported collecting data on adverse events related to emollient treatment use but the methods used were poorly reported (40% unclear). Four papers used patient questionnaires/diaries. However, it was unclear how and what was collected as only two studies showed the questionnaires used. Conclusions Reporting of adverse events related to emollient use in trials of patients with eczema is poor and inconsistent. Agreement should be reached on how and what adverse events should be collected, to standardize reporting across studies. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. The effect of probiotic administration on the severity of AD in adults has shown inconsistent results. Objectives: To determine the effectiveness of probiotic supplementation as a therapeutic tool for adult AD. Methods: PubMed, Scopus and Embase were systematically searched to collect data from studies in which probiotics were administered to treat adult AD. Results: Out of 413 publications, 9 papers were included in the meta-analysis. Significant differences in the ScORing Atopic Dermatitis tool favouring probiotics were observed [relative risk (RR) –5.93, 95% confidence interval (CI) –8.43 to –3.43]. Lactobacillus salivarius presented with largest effect size (RR –9.79, 95% CI –13.04 to –6.54), followed by L. acidophilus (RR –5.77, 95% CI –10.82 to –0.72) and L. plantarum (RR –3.76, 95% CI –6.36 to –1.16). No benefit was observed with L. fermentum. Based on the severity of AD, probiotics showed better results in people with moderate-to-severe AD (RR –9.12, 95% CI –12.17 to –6.08) than in individuals with mild disease (RR –2.67, 95% CI –4.67 to –0.66). Serum levels of IgE and eosinophil count remained significantly unchanged after the probiotic intervention (RR 0.25, 95% CI –0.10 to 0.60; RR –0.27, 95% CI –0.68 to 0.13, respectively). Conclusions: Current evidence supports a role for some probiotics as a therapeutic tool for the treatment of adult AD, particularly in patients with severe AD. The efficacy of probiotics is strain specific, with L. salivarius and L. acidophilus having the largest clinical benefit. Such benefit is apparently independent of IgE levels and eosinophil count. Despite these encouraging results, the decrease in AD severity did not translate into a clinically meaningful better quality of life as assessed by the Dermatology Life Quality Index. There currently is not enough reliable data to reach conclusions about the optimal dose and duration for probiotic treatment. Our meta-analysis supports the role of some probiotics as a therapeutic tool for the treatment of adult atopic dermatitis (AD), particularly in those with severe AD. Efficacy of probiotics is strain specific, and Lactobacillus salivarius and L. acidophilus confer the largest clinical benefit. This benefit is apparently independent of IgE levels and eosinophil count. Despite these encouraging results, the decrease in AD severity did not seem to translate into a better quality of life as assessed by the Dermatology Life Quality Index. [ABSTRACT FROM AUTHOR]

Erythema multiforme (EM)-like contact reactions are induced by exposure to various chemicals. We report two industrial workers from a paper mill who presented with generalized EM-like lesions 17 and 10 days, respectively, after accidental exposure to liquid-formulated 2,2-dibromo-3-nitrilopropionamide (DBNPA) 20%. The EM-like lesions appeared as subepidermal blisters associated with many necrotic or apoptotic keratinocytes and dense lymphocytic infiltration in the epidermis. Most of the infiltrating cells in the epidermis were CD8-positive T lymphocytes expressing cytotoxic molecules, including T cell-restricted intracellular antigen (TIA)-1, granzyme B and granulysin. Steroid pulse therapy failed to suppress the development of the lesions sufficiently, but ciclosporin 2.5–3 mg/kg successfully controlled the disease. DBNPA-induced, generalized EM-like eruptions may be mediated by cytotoxic T-lymphocytes. [ABSTRACT FROM AUTHOR]

Introduction Alopecia areata (AA) is a nonscarring alopecia with an estimated global prevalence of 2% and limited data on the efficacy of current treatment. Clinical practice guidelines (CPGs) provide recommendations based on best available evidence. It is unclear how many AA CPGs are available globally. Aim To systematically search for and identify CPGs on AA and to critically appraise their quality using validated tools. Methods We performed a literature search to identify CPGs published between October 2014 and April 2021, using the following databases: MEDLINE, Embase, National Institute for Health and Care Excellence (NICE), Guidelines International Network, Emergency Care Research Institute guidelines trust, Australian CPGs, Turning Research Into Practice database and DynaMed. The systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Three critical appraisal tools were used: Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, Lenzer's red flags and United States Institute of Medicine's (IOM) criteria of trustworthiness. Results In total, six AA CPGs from seven manuscripts (one CPG was in two parts published in separate papers) were included. The majority (four of six) of the CPGs focused on treatment. Four CPGs (total of five papers) were in English and two CPGs were only available in the original language (one Russian and one Japanese). All AA CPGs demonstrated low quality in several domains in the AGREE II appraisal, including stakeholder involvement and applicability, with the latter being deemed the worst domain for all CPGs, with an average of 29%. The mean (SD) number of Lenzer's red flags for the included CPGs was 3.4 (1.5) out of a total of 8 possible red flags, while the IOM criteria showed 1.6 (0.8) 'fully met' criteria and 3.1 (1.2) 'not met' out of a total of 9 criteria. Conclusion We found a limited number of AA CPGs, all of which had significant methodological deficiencies. We encourage guideline development groups to use validated checklists/tools to develop reliable and trustworthy CPGs. [ABSTRACT FROM AUTHOR]

PLACK syndrome is a relatively recently defined generalized peeling skin syndrome that has been reported with major skin manifestations and sometimes atypical features. We report the case of a 5-year-old boy with PLACK manifestations. Whole exome sequencing and subsequent Sanger sequencing identified a putative splice variant c.1209+2T>G in CAST (NM_001042440.5). Moreover, mRNA sequencing confirmed the abnormal alternative splicing of the CAST gene, leading to the addition of one nucleotide to the correct open-reading frame at the mRNA level. Segregation and expression analysis revealed that this loss-of-function via mRNA nonsense-mediated decay could be the causative pathogenic mechanism responsible for this patient's phenotype. This study extends our understanding of the various phenotypic and genotypic features of PLACK syndrome. Here we report a case of a patient with PLACK syndrome born in an isolated population with multiple consanguineous marriages. Whole exome sequencing and subsequent Sanger sequencing verified the splice variant c.1209+2T>G in the CAST gene. The mutation described in this paper is a very rare example of a splice-site mutation that, in addition to damaging the normal splice site, creates a new splice site and changes the open-reading frame at the mRNA level. Our analysis has confirmed a loss-of-function mechanism via mRNA nonsense-mediated decay as are result of this mutation. [ABSTRACT FROM AUTHOR]

This review presents and discusses the evidence for MMS to treat cutaneous squamous cell carcinoma (cSCC). The MEDLINE, Embase and Cochrane databases were searched; 39 papers were identified for recurrence and 2 papers for cost‐effectiveness. We included all clinical trials and observational studies, including retrospective reports, and excluded editorials and systematic reviews or meta‐analyses. We categorized the evidence under the following headings: tumour recurrence, specific site outcomes (ear, lip, scalp and periocular), cSCC with perineural invasion, and cost‐effectiveness. Although there are many observational studies indicating the potential benefits of MMS in the management of certain cSCCs, no randomized controlled trials (RCT) were identified. The evidence from comparitor studies suggests that MMS has a lower recurrence rate than that of other treatments for cSCC, including standard excision. Many studies identified were single‐armed, but did demonstrate a low to very low recurrence rate of cSCC following MMS. A single recent study suggests MMS for intermediate cSCC is highly cost‐effective compared with wide local excision when all‐in costs are considered. Since the overall quality of included studies was mixed and highly heterogeneous, further methodologically robust studies with comparator arms or comprehensive long‐term registry data would be valuable. It would be ideal to employ a definitive multicentre RCT but given the evidence to date and multiple advantages to MMS, the lack of clinical equipoise makes this difficult to justify. Comparison with current modalities would likely not be ethical/achievable on a like‐for‐like basis given MMS provides 100% margin assessment, enables histological clearance prior to reconstruction, and minimizes the removal of uninvolved tissue. Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Pseudofolliculitis barbae (PFB) is a chronic inflammatory condition characterized by follicular and perifollicular papules and pustules primarily affecting the beard and neck area. PFB is a condition that predominantly affects patients with skin of colour. The objective of this paper is to review the epidemiology, pathogenesis and presentation of PFB, and assess the most recent evidence-based treatment options and recommendations for PFB. This is important to increase the quality of care given to target patient populations and to address the prominent disparity in healthcare management of patients with skin of colour. A literature review was conducted utilizing PubMed and Cochrane Library. The key term 'pseudofolliculitis barbae' was used. Search parameters were set to search from 1987 to the present. Results were further narrowed by limiting the literature review to published observational studies, case studies, case series, randomized control trials and case–control studies. Effective treatment for PFB requires a multifaceted approach that targets various aspects of the pathogenesis. Current treatments include preventive measures, antibiotics, corticosteroids, keratolytics, chemical depilatories and/or laser treatments. Topical therapies are currently the mainstay treatment. However, laser hair removal has become a potential long-term treatment option, and additional studies are warranted to understand its long-term efficacy and permanency. [ABSTRACT FROM AUTHOR]

Skin surgery ranges from small biopsies to Mohs micrographic surgery and excisions necessitating complex skin flap design or grafting. For all dermatology doctors in training there is a need to acquire competence to perform skin surgery safely, in an appropriate timeframe and with minimal complication rates. There exist a range of different methods, with varying reliance upon advancing technology, to teach skin surgery and to refine surgical skills before procedures are performed on patients. We searched PubMed, MEDLINE and SCOPUS databases to identify all papers relevant to postgraduate dermatology skin surgery teaching and training published in the past 10 years in English (see Appendix S1 in the Supporting Information for our search strategy). This yielded 440 results, for which all abstracts were screened. Manuscripts related to aesthetic surgery training, such as robotic hair transplantation training are excluded. [ABSTRACT FROM AUTHOR]

Summary: Background: Chronic bullous dermatosis of childhood (CBDC) is a rare autoimmune subepidermal blistering disease, which can develop following vaccination or medication, or with an autoimmune condition or illness, among other causes. Aim: To identify and better understand the clinical features of CBDC by performing a systematic review, in line with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines. Methods: Eligible studies included publication since 1980, CBDC diagnosis, case studies, subjects aged < 18 years, clinical features and no language restriction. A database search was conducted including Embase, MEDLINE and Scopus on 14 July 2021 (see Appendix for search terms). Data were assessed for risk of bias. Jamovi was used for statistical analysis. Age and sex were compared with mucocutaneous involvement, cutaneous involvement, other symptoms, human leucocyte antigen type and lesion descriptions. Results: After removing duplicate references using Endnote, 351 papers were identified, of which 91 met the inclusion criteria. These papers included 130 cases of CBDC: 110 children and 20 neonates. The ratio of male : female patients was 19 : 1 for neonates and 74:55 for children. χ² analysis with 1 degree of freedom showed that CBDC in neonates was associated with facial (χ²(1) = 9.67, P < 0.01), mouth (χ²(1) = 31.0, P < 0.001), upper airway (χ²(1) = 52.7, P < 0.001), oesophageal (χ²(1) = 34.6, P < 0.001), ophthalmic (χ²(1) = 6.27, P = 0.01) involvement and with respiratory distress (χ²(1) = 22.7 P < 0.001). CBDC in children was associated with genital (χ²(1) = 3.96, P < 0.05), arm (χ²(1) = 6.99, P < 0.01) and leg (χ²(1) = 7.03, P < 0.01) involvement. CBDC in male patients was associated with facial (χ²(1) = 7.01, P < 0.01), scalp (χ²(1) = 5.96, P < 0.02) and perianal (χ²(1) = 7.22, P < 0.01) involvement. Conclusion: Neonates with CBDC are more likely to have a mucocutaneous distribution of lesions, whereas children are more likely to have cutaneous lesions. The limitations of this study include selection bias, and the small neonate sample size makes the study unrepresentative of the population. The review highlights the need for further research into the clinical features of CBDC in neonates. [ABSTRACT FROM AUTHOR]

Https://doi.org/10.1093/ced/llac079 Dear Editor, We read with interest the paper published in I Clinical and Experimental Dermatology i by Kurihara I et al i . describing a patient with diffuse plane xanthoma arising from regressed tumours of folliculotropic mycosis fungoides (MF). PUVA might have accelerated galectin-7 expression and rendered the lesions ready to generate NCXs 74 F Normolipaemic Tumour-stage MF 1 year Diffuse plane xanthomas around brownish-red nodules MF lesions; foamy histiocytes After PUVA treatment. 20121137 M Hypercholesterolaemia and hypertriglyceridaemia Patch-stage MF 10 years Yellowish discolouration of MF patches; foamy histiocytes Yellowish discolouration of MF patches developed gradually over the previous 2 years before MF diagnosis. PUVA might have accelerated galectin-7 expression and rendered the lesions ready to generate NCXs 74 F Normolipaemic Tumour-stage MF 1 year Diffuse plane xanthomas around brownish-red nodules MF lesions; foamy histiocytes After PUVA treatment. [Extracted from the article]

The purpose of education and training in dermatology ranges from increasing knowledge and skills to improving confidence or enhancing patient outcomes. Specification of the purpose of the education and training is vital so that evaluation can be aligned to purpose, and thus provide evidence on effectiveness. Further, the quality and quality improvement of education and training can be enhanced by a careful specification of how they are expected to achieve their purpose. Multiple theories and methods can be used to evaluate both the process and the outcome of education and training. In this paper, we summarize some of these and focus particularly on the use of behavioural science to evaluate education and training. We illustrate these theories and methods with an example in dermatology. [ABSTRACT FROM AUTHOR]

The discovery of immune checkpoint inhibition (ICI) sparked a revolution in the era of targeted anticancer therapy. However, although monoclonal antibodies targeting the cytotoxic T‐lymphocyte antigen‐4 and programmed death‐1 axes have improved survival in patients with advanced cancers, these immunotherapies are associated with a wide spectrum of dermatological immune‐related adverse events (irAEs), ranging from mild to life‐threatening. Several publications have addressed the clinical and histopathological classification of these skin‐directed irAEs, their impact on anti‐tumour immunity and survival, and the critical role of supportive oncological dermatology in their management. In this paper, we review the current understanding of the mechanistic drivers of immune‐related skin toxicities with a focus on inflammatory, immunobullous and melanocyte/pigment‐related reactions. We detail the specific immune‐based mechanisms that may underlie different cutaneous reactions. We also discuss potential mechanisms as they relate to extracutaneous irAEs and the lessons learned from these, the potential overlap with cutaneous irAEs, techniques to study differences in immune‐related vs. de novo skin reactions, and how treatment of these AEs impacts cancer treatment, patient quality of life and overall survival. An improved understanding of the mechanistic basis of cutaneous irAEs will allow clinicians to develop and use blood‐based biomarkers that could help ultimately predict onset and/or severity of these irAEs, and to implement rational mechanistic‐based treatment strategies that are targeted to the irAEs while potentially avoiding reducing the anti‐tumour effect of ICIs. [ABSTRACT FROM AUTHOR]

Primary cicatricial alopecia (PCA), also known as scarring alopecia, comprises a diverse group of hair disorders that cause permanent destruction of the pilosebaceous unit, resulting in disappearance of the follicular ostia. Lichen planopilaris (LPP) is a subtype of primary lymphocytic cicatricial alopecia. There is an urgent need to identify novel molecules that successfully target specific pathogenic pathways in LPP to inhibit and reverse disease progression. Recent studies into LPP pathogenesis have discovered that follicular stem cells undergo epithelial–mesenchymal transition (EMT). We sought to identify drugs that target molecules involved in EMT to repurpose these drugs for treatment of LPP. We identified 8 molecules and 15 drugs that target these EMT molecules. Only four of these drugs (pioglitazone, tofacitinib, barcitinib and apremilast) have been reported in individual cases or case series of patients with LPP and controlled studies are missing. We describe each drug and mechanism of action target EMT in detail. Although previous studies have demonstrated the efficacy of EMT inhibitors in anticancer therapy, there are, to our knowledge, no studies using EMT‐attenuating drugs for the treatment of LPP. The treatment molecules discussed in this paper provide a new platform for clinical studies and controlled trials in LPP. [ABSTRACT FROM AUTHOR]

In most surgeries, the primary aim, for both surgeons and patients, is the success of the operation being undertaken. A secondary aim is for optimal wound healing with minimal scar formation. The normal wound‐healing process involves four distinct but overlapping stages: haemostasis, inflammation, proliferation and remodelling. In some patients, the cellular process involved in the proliferation and remodelling stages can be deranged, resulting in the formation of hypertrophic or keloid scars, a phenomenon more frequently seen in skin of colour. The first report of excessive scarring is thought to be the Smith papyrus about 1700 BC. In the 20th century, both Mancini and Quaife (in 1962) and Peacock et al. (in 1970) classified excessive scarring into hypertrophic and keloid scar formation. Clinicians can minimize the risk of these pathological scars developing by using good preoperative, perioperative/intraoperative and postoperative surgical practices. This paper reviews the wound‐healing processes in association with good surgical principles and practice, discusses how implementing these principles in practice helps in this prevention and management of pathological surgical scars such as hypertrophic scars and keloid scars. and offers a practical step‐by‐step clinical guide that can be used by any clinician. [ABSTRACT FROM AUTHOR]

Summary: This study summarizes the use, since its inception, of the Cutaneous Lupus Disease Area and Severity Index (CLASI) as an outcome measure in clinical studies. We systematically searched the MEDLINE, PubMed, EMBASE and Cochrane databases for papers including the term 'cutaneous lupus disease area and severity index' and its abbreviations up to August 2017, identifying 205 abstracts. Following shortlisting, two independent physicians critically reviewed 71 papers for data extraction. We found that a limited number of high‐quality studies used the CLASI scoring as an outcome measure. We concluded that further validation is necessary to identify the effectiveness of the CLASI in the assessment of cutaneous lupus erythematosus subtypes. The use of standardized core patient‐ and physician‐reported outcome measures may reduce heterogeneity and allow comparisons between patients enrolled in clinical trials. This would improve the relevance within clinical practice, where the use of CLASI is currently limited. [ABSTRACT FROM AUTHOR]

Presents blister device for separation of viable epidermis from dermis. Concept of harvesting an epidermal draft bearing melanocytes; Implications on the improvement of several hypertrophic scars; Inclusion on diverse aspects of vitiligo.

Discusses the language of disability, the use of comprehensible language understood by patients. Role of Margaret Agerholm in influencing the author to use the language of disability; Reasons for using the language of disability in the authors publications; Collaborations with the nursing profession.

Summary: Keloids are the result of aberrant tissue scarring typically occurring in injured skin, and are caused by the overgrowth of granulation tissue or collagen type III during the healing process. There is a genetic component, thus a predisposition can be genetically transmitted. Keloids are difficult to treat because of their postexcisional recurrence, and they have an impact on patient quality of life due to psychological distress caused by cosmetic concerns and functional disability. Treatment ranges from classic corticosteroid therapy to multimodal approaches such as injections, cryotherapy, laser, radiation, radiofrequency ablation and extracorporeal shockwave therapy. Recent discoveries into the pathogenesis of keloid have enabled clinicians to expand the therapeutic options for treatment. The aim of this paper was to review the literature, clarify the general concept of keloid development, and assess emerging treatment options such as stem cell therapy, mitomycin C, bleomycin, interferon, botulinum toxin type A, calcium channel blockers, angiotensin‐converting enzyme inhibitors and fat grafting, and the evolutionary advancement towards epigenetic modifications and gene therapy. [ABSTRACT FROM AUTHOR]

Summary: Scalp dysaesthesia, considered a variant of the cutaneous dysaesthesia syndrome, is characterized by chronic sensory symptoms, including pruritus, pain, burning and stinging in a well‐defined location, without objective findings. Its aetiology is not well elucidated and treatment options are limited, thus it can be challenging and frustrating for both patient and physician. It can be associated with lichen simplex chronicus. In this paper, we review the literature on the pathogenetic factors, diagnostic methods and therapeutic options in the management of scalp dysaesthesia. Dissociation, cervical spine disease and muscle tension seem to be the most important pathogenetic factors. Trichoscopy, reflectance confocal microscopy and biopsy are all helpful for the diagnosis of the disease. Therapies include high‐potency topical or intralesional corticosteroids, capsaicin and topical anaesthetics, sedative antihistamines, tricyclic antidepressants, transcutaneous electric nerve stimulation, botulinum toxin and vitamin B12. [ABSTRACT FROM AUTHOR]

Summary: Background: Recurrent bleeding episodes are often a cause of significant anxiety in patients with pyogenic granuloma (PG). The idea of using common salt for the treatment of PG arose from the need for a relatively safe and effective treatment because of the recurrent nature of the lesion. Methods: A prospective open‐label uncontrolled study of 50 patients was conducted. All cases were treated with ordinary table salt from a commercially available package. White soft paraffin was first applied over the perilesional skin, then sufficient salt to cover the entire lesion was applied and the area was occluded with surgical adhesive tape. All patients were followed up for any complications or recurrence. Results: Complete resolution of the lesion without any residual scar was seen in 100% of the cases, and 94% reported a decrease in the bleeding tendency of the lesion as an immediate response. The mean time to complete resolution was 14.77 days. Recurrence was noted in one patient after 11 months of resolution. Conclusion: Owing to the relative ease in application, lack of scarring and excellent response, we consider salt application to be an ideal treatment for PG lesions, especially in children and anxious patients reluctant to undergo any procedure. [ABSTRACT FROM AUTHOR]

Summary: Curcuma and its derivatives are associated with anti‐inflammatory and antioxidant activities in the skin. They exhibit beneficial effects in wound healing and prevention of chronic ultraviolet B damage and may prevent facial redness such as rosacea and flushing. This review aims to provide an up‐to‐date and rigorous synthesis of studies that demonstrated the clinical efficacy of curcuminoids in the skin. We evaluated studies published in the MEDLINE–PubMed/PMC (National Library of Medicine) databases, and followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for this review. This search included papers published in the past 10 years in controlled clinical trials, double‐blind and randomized controlled studies, and case studies. The search resulted in 12 studies published in the past 10 years. Curcuma species (Curcuma longa and Curcuma aeruginosa) and curcumin were found to produce various dermatological effects, including influencing antioxidant and anti‐inflammatory processes in the production of hyaluronan, increasing skin moisture, and reducing axillary hair growth. Curcuma was also found to reduce thickness, erythema, pruritus, burning and pain in psoriasis lesions and to improve radiodermatitis lesions. Our review results show that Curcuma species may play a role in skin health management and may exhibit various dermatological effects, thus it could be a new therapeutic arsenal for dermatology professionals. Nevertheless, more clinical trials should be conducted with humans to establish the optimum delivery method and dosages for different dermatological conditions. Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Summary: In 2017, health and social care organizations contributed 6.3% of carbon emissions in England. Efforts to reduce the environmental footprint of the National Health Service (NHS) have been broadly focused on reducing demand, through prevention and patient empowerment, and modifying supply side factors by focusing on lean care systems and low carbon alternatives. This narrative review concentrates on supply side factors to identify sustainable practices with a focus on actions that could be implemented in dermatology departments. For this study, a literature review was conducted In MEDLINE in April 2020. The search terms included 'environmental sustainability' and 'climate change' with 'dermatology', 'telemedicine', 'NHS', 'surgery' and 'operating theatres'. Out of 95 results, 20 were deemed relevant to the review. Although the review showed that there is clearly growing interest in environmental sustainability, the identified literature lacked examples of comprehensive implementation and evaluation of initiatives. The literature discussed distinct areas including transport, waste management and procurement as part of a lean healthcare system. A number of papers highlighted the potential contribution of carbon‐reducing actions without citing verifiable outcome data. This narrative review highlights the need for detailed environmental impact assessments of treatment options in dermatology, in tandem with economic analysis. In conclusion, we have identified a clear need for evidence‐based guidance setting out implementable actions with identifiable benefits achievable within local clinical teams. This will require engagement between clinicians, patients and healthcare organizations. [ABSTRACT FROM AUTHOR]

Summary: Narrative fallacy is a problematic heuristic that leads us to make inaccurate cause–effect relationships. They are a particular issue in case reports because of the limited scope of these papers, the perpetuated biases they proffer and the misperception of 'black swan' events. This article highlights the negative effects of these fallacies in dermatological practice through three case studies: the use of epinephrine with lignocaine at distal sites, the difference between once‐daily and twice‐daily application of topical steroids, and the effect of sterile gloves for skin surgery on infection rates. Awareness of the biases in case reports and the employment of metacognition may help us to avoid falling victim to narrative fallacies. Given the potential problems with this heuristic, Clinical and Experimental Dermatology (CED) utilizes case reports to further medical education and offer different clinical perspectives, rather than as a driver of medical knowledge. [ABSTRACT FROM AUTHOR]

Summary: In this two‐part report, we review and critically appraise 'Dermatological games' by J. A. Cotterill, a seminal article published in 1981, which attempted to explain the interaction between dermatologists and patients using Berne's game theory. Part 1 described and critically appraised the educational value of Cotterill's original list of games in relation to how they apply to dermatology practice. In Part 2, a list of new 'games' that might be observed in current dermatological practice is introduced. The relevance of Cotterill's paper and an explanation for why his article remains relevant to dermatology practice and training today is scrutinized, in order to stimulate discussion and improve patient care. [ABSTRACT FROM AUTHOR]

Summary: 'Dermatological games' by J. A. Cotterill was a seminal article published in 1981, which attempted to explain the interaction between dermatologists and patients using Berne's game theory. In Part 1 of this series of two reviews, we review Cotterill's original list of games and how they applied to dermatology in the context of when they were written. We then critically appraise Cotterill's article and arguments. Although the article was deliberately provocative, we found Cotterill's arguments to be well‐structured and logical, and the 'games' described are well‐conceived. Cotterill's candid analysis of doctors' motivations and the potential impact on the patient is refreshing and insightful. It is striking that, 40 years on, many of the original 'games' described remain recognizable in current practice. In Part 2, a list of new 'games' that might be observed in modern dermatological practice is introduced. The relevance of Cotterill's paper and an explanation for why his educational article remains relevant to dermatology practice and training today is scrutinized in order to stimulate discussion, promote education and improve patient care. Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

In this paper, we aimed to assess the quality, understandability and evidence-based content of YouTube videos discussing hidradenitis suppurativa (HS) treatments. Consulting "Dr YouTube": a content analysis of YouTube® videos related to hidradenitis suppurativa treatments We assessed the quality, understandability and evidence-based content of YouTube videos discussing hidradenitis suppurativa treatments, categorized by source: dermatologists, other healthcare professionals, or patients. [Extracted from the article]

Adults with eczema and parents of children with eczema attending hospital dermatology outpatient clinics and a nurse-led community dermatology clinic were invited to complete a paper-based questionnaire. 2 TableRECap for AtoPic eczema scores by categorized Patient Reported Eczema Severity and self-reported eczema control. The Harmonising Outcome Measures for Eczema (HOME) initiative seeks to standardize outcome measures in trials of eczema treatments.1 The RECap for AtoPic eczema (RECAP) questionnaire is a seven-item HOME-recommended patient-reported outcome measure of eczema control.2 The total score of RECAP is from 0 to 28, with higher scores indicating poorer eczema control. [Extracted from the article]

Summary: Hidradenoma papilliferum (HP) is a rare, slow‐growing, benign adnexal tumour with apocrine differentiation. It usually affects the anogenital region in adult women and is clinically polymorphous, mimicking other benign or malignant neoformations. The dermoscopic features of vulval HP have not been reported yet. We report the clinical and dermoscopic features in a case series of histopathologically proven vulval HPs. Dermoscopy may be a useful tool for the diagnosis of vulval HP. To our knowledge, our paper represents the first report of dermoscopic findings in a series of vulval HPs in a multiracial population. [ABSTRACT FROM AUTHOR]

Summary: Misinformation is one of the greatest threats to global health. Atopic dermatitis (AD) is a common skin disorder with a complex multifactorial aetiology, rendering it susceptible to misinformation. Little is known about the content of misinformation regarding AD online. We performed a review of AD‐related misinformation available online, via PubMed for scientific papers and Google for nonscientific websites. Key areas of misinformation were identified, including 'simple cures' for AD, diet, chemicals, dust, vaccines, red skin syndrome and alternative therapies. Patients with AD and their families are vulnerable to misinformation given the severe impact of AD on quality of life. Dermatologists must be aware of the false AD‐related content being shared online, and be prepared to refute and rebut misinformation by providing appropriate evidence. [ABSTRACT FROM AUTHOR]

Summary: Background: There is a paucity of published evidence of established teledermatology (TD) services in the UK. An in‐house TD service using store‐and‐forward technology was set up at a large regional dermatology department in 2004. Aim: To review the TD service at our centre, including teleconsultation numbers, coding of diagnoses and patient outcomes. Methods: Retrospective data were retrieved using the electronic patient database, from 31 July 2004 to 31 July 2018. More detailed information on patient outcomes was obtained from patient notes and histology records. A paper questionnaire was distributed to 100 patients to obtain patient feedback. Results: In total, 40 201 teleconsultations were made over 14 years, and 64% of cases were coded (n = 25 555), of which 77% were lesions. The most common coded lesions were benign naevus (25%), seborrhoeic keratosis (22%) and basal cell carcinoma (19%). Of the total number of cases, 50% were discharged to their general practitioner with advice, 34% were booked for surgery and 16% were booked for a face‐to‐face appointment. In the survey, 82% of patients surveyed felt that the service was 'good' or 'very good'. A detailed study between 1 January 2015 and 1 January 2016 showed that there were 383 patients (10%) with no diagnosis made following teleconsultation, suggesting diagnostic uncertainty. Reasons for this included lack of diagnostic features, possibility of malignancy and service factors. Within this cohort, there was 68% diagnostic concordance. Conclusions: We have set up a successful TD service at a UK centre, which has prevented 16 282 face‐to‐face appointments over 14 years. Patient feedback has been very good. Review of cases with diagnostic uncertainty provides important information for service improvement and has not previously been documented. [ABSTRACT FROM AUTHOR]

Summary: The autoimmune blistering disorders present with variable frequency in the oral cavity. Recognition of their key clinical features at presentation is important, as there are many causes of oral ulceration. Careful history‐taking, clinical examination, an understanding of pathogenesis and appropriate investigations are essential. With the exception of the rare genodermatoses that may lead to blistering and oral ulceration, the majority of patients have an acquired disorder. These include the rare autoimmune blistering diseases mucous membrane pemphigoid (MMP), pemphigus vulgaris (PV), linear IgA disease, epidermolysis bullosa acquisita and paraneoplastic pemphigus. Important clinical differential diagnoses include erythema multiforme, which may be mistaken for PV in appearance, while oral lichen planus may be indistinguishable from MMP. Angina bullosa haemorrhagica may also present with tense haemorrhagic bullae, and in the absence of diagnostic tests, requires an astute clinical diagnosis based upon the history. Newer laboratory techniques have facilitated identification of target antigens and epitopes in the autoimmune blistering diseases, particularly in MMP. Current interest is in whether these relate to clinical presentation and outcomes. There have also been recent investigations into the use of saliva as an alternative medium to serum for the diagnosis of oral vesiculobullous lesions. Assessment of disease severity and measurement of quality of life at presentation and subsequent follow‐up is paramount to interpreting therapeutic response. Furthermore, combining these scores with serological and/or salivary biomarkers is valuable in the assessment of clinical response. In this paper, we discuss MMP and its important differential diagnoses. Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Although Byrne-Davis I et al i .[1] offer a diverse framework to plan and evaluate the quality of teaching interventions, there is currently a paucity of high-quality dermatology education studies,[3] especially those that are valid, relevant to all and generalizable. While we found the paper to be an excellent exploration of key methods in educational evaluation, we would like to highlight that educational studies must be interpreted in the context of their validity, quality, relevance and generalizability. [Extracted from the article]

Social media could be used by doctors to communicate evidence-based advice for patients to reliable online sources of patient-friendly information, rather than a focus on paper information sheets. Internet and social media use in dermatology patients: Search behavior and impact on patient-physician relationship. [Extracted from the article]

J Eur Acad Dermatol Venereol 2022; 36: 172 - 80. 11 Potestio L, Villani A, Fabbrocini G, Martora F. Cutaneous reactions following booster dose of COVID-19 mRNA vaccination: what we should know. Several strategies have been adopted in the fight against the COVID-19 pandemic.1,2 We read with great interest the recently published paper in I Clinical and Experimental Dermatology i by Oh I et al i .,3 reporting the case of a 47-year-old woman who developed superficial morphoea 3 weeks after the second dose of the Pfizer-BioNTech vaccination.3 The authors also suggested three pathogenetic mechanisms that could explain the correlation between vaccination and morphoea development, but they did not explain which of these they thought would be the most likely.3 Subsequently, Sookaromdee and Wiwanitkit4 responded to Oh I et al i .,3 posing some interesting thoughts that we would like to explore further. Furthermore, cutaneous reactions related to COVID-19 vaccination have also been reported following the booster dose.9-11 To date, there are still too few reports about the occurrence of post-vaccination morphoea. [Extracted from the article]

Summary: Zika virus (ZV) is an important emerging infection. Rash is a key feature, but the summative literature lacks description of the rash beyond 'maculopapular'. Our aim was to identify the cutaneous features described in the published literature. A literature search using defined terms for ZV cases reports and series was performed on the OVID, Clinical Key and University of Dundee's e‐library journals databases in December 2016; a later case report was included while the paper was under review. Diagnosis in all cases was via PCR. Exclusion criteria were Zika cases without rash or omitting any description of the rash. Ocular features (conjunctivitis) were not included. In total, 42 publications with 66 cases met the criteria. The most frequent descriptive features included maculopapular (59%), lower limb petechial purpura (11%) and erythematous/red (9%). Pruritus was described in 44% and tenderness in 3%. Lesions were located on the trunk (29%), limbs (5% arms, 11% both arms and legs), face (17%) and extremities (14%) or were diffuse/generalized (12%). There was facial sparing in 3%. Other features were centrifugal spread (6%), palmar and/or plantar involvement (6%), palmoplantar desquamation (2%) and malar erythema with oedema (2%). Mucosal features included gingival bleeding (11%), oral haemorrhagic blisters (8%) and painful blisters/vesicles (4%). Oedema/swelling was described in the upper limbs (5%), lower limbs (5%) and both (3%). Mean rash duration was 6 days (range 3–11 days). The ZV exanthema is most frequently maculopapular, pruritic, sometimes with centrifugal spread from the trunk to extremities. This may include lower limb petechial purpura, palmoplantar lesions, oedema of limb extremities, and gingival bleeding or painful oral bullae. As ZV becomes more prevalent, recognition of the clinical features will enable earlier diagnosis and appropriate testing. Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Summary: Background: The incidence of Kaposi sarcoma (KS) has reduced as a result of the introduction of antiretroviral therapy. It is currently considered a rare disease in developed countries, and there has been a paucity of clinical papers on the subject in recent years in Europe. Aim: To analyse the clinical features and evolution of the different clinical forms of KS in the past 30 years. Methods: Patients with cutaneous lesions of KS diagnosed during the period 1987–2016 at Bellvitge Hospital (an 800‐bed university referral centre in Barcelona, Spain) were enrolled. Data recorded included age, sex, ethnicity, involved site, number of lesions, extracutaneous involvement, leg oedema, treatment, blood haemoglobin level, and blood cell (leucocyte, lymphocyte and CD4) counts. Results: Cutaneous lesions of KS were diagnosed in 191 patients (167 men, 24 women, mean ± SD age 51.95 ± 20.16 years). Clinical forms identified were classic KS (n = 53), acquired immunodeficiency syndrome (AIDS)‐associated KS (n = 118), immunosuppression‐associated KS (n = 18), and African endemic KS (n = 2). The number of patients diagnosed annually reached a maximum in the 1990s because of the AIDS epidemic, and has decreased since 2000. However, both classic KS and immunosuppression‐associated KS doubled from the first to the second half of the analysed period. Cutaneous lesions involved the legs in 137 cases, and extracutaneous lesions were detected in 32 patients. In 46 of 118 patients with AIDS, the diagnosis of KS was simultaneous to the detection of human immunodeficiency virus infection. Conclusion: After a decrease in incidence since the middle of the 1990s, AIDS‐associated KS continues to occur in Europe, and the number of annual cases of classic KS and immunosuppression‐associated KS is increasing. [ABSTRACT FROM AUTHOR]

Summary: Acquired dermal melanocytosis of the face and extremities (ADMFE) is an unusual form of acquired dermal melanocytosis (ADM). In this paper, we report a case of ADMFE and review the published literature. Our review highlights several clinical differences between ADMFE and ADM: (i) more frequent involvement of the nasal alae in ADMFE than in ADM, (ii) less frequent involvement of the cheeks in ADMFE than in ADM, (iii) limbs affected in all cases of ADMFE but in few cases of ADM, and (iv) frequent involvement of conjunctiva and/or gingiva in ADMFE but very rare involvement in ADM. These findings strongly support the hypothesis that ADMFE is clinically distinct from the classic form of ADM, and gaining an understanding of its phenotype will enable accurate diagnosis and early intervention by Q‐switched laser therapy, which should benefit those patients with disease‐related cosmetic issues. [ABSTRACT FROM AUTHOR]

References 1 Raahimi M, Sheppeard R, Livesey A. Monitoring for methotrexate induced liver fibrosis in many UK dermatology centres is out of date and needs reform. Comment on: 'Monitoring for methotrexate-induced liver fibrosis in many UK dermatology centres is out of date and needs reform' Dear Editor, I read with great interest the recent paper by Raahimi I et al i . in I Clinical and Experimental Dermatology i on the subject of noninvasive monitoring for methotrexate-induced liver fibrosis.1 The British Association of Dermatologists (BAD) guidelines, which advocate monitoring of Type III procollagen peptide (PIIINP) in patients taking methotrexate, are out of alignment not just with the British Society of Gastroenterology (BSG)2 but also with the European Association for the Study of the Liver (EASL)3 and the American Academy of Dermatology (AAD)4, all of which recommend serial measurement of the Fibrosis (Fib)-4 score for patients at risk of liver fibrosis. [Extracted from the article]

This paper reports on cases of nummular eczema (NE) occurring at the sites of surgical scars, thought to be a result of isomorphic Koebner response (KR). Nummular lesions appeared on the surgical scar in five cases, extended far beyond the surgical scar in one case and developed on a drain insertion scar in one case. Three patients developed nummular lesions on areas other than their surgical scar as well. [Extracted from the article]

Summary: Background: Behçet disease (BD) is a chronic inflammatory disease. Adipokines are synthesized in adipose tissue, and have been reported to play important roles in the pathogenesis of autoimmune and inflammatory diseases, including BD. Aim: To evaluate the relationship between circulating blood adipokine levels and BD. Methods: We conducted a meta‐analysis of papers reporting on serum/plasma resistin, leptin, adiponectin and visfatin levels in patients with BD and in healthy controls (HCs). We identified 82 relevant studies using electronic and manual search methods, and selected 16 studies for full‐text review based on the title and abstract. Two of these were later excluded (one was a review, one had no data), leaving 14 articles that met the inclusion criteria for this meta‐analysis. Results: The 14 included studies assessed 637 patients with BD and 520 HCs. Compared with the HCs, the BD group had significantly higher levels of leptin [standardized mean difference (SMD) = 0.68, 95% CI 0.15–1.21, P = 0.01]. Levels of resistin (SMD = 0.51, 95% CI 0.92–0.918, P = 0.02) and adiponectin (SMD = 0.31, 95% CI 0.06–0.56, P = 0.02) were significantly higher in the BD group after adjustment for age, sex and body mass index (BMI), but not without such adjustment (resistin: (SMD = 0.38, 95% CI −0.18 to 0.93, P = 0.19; adiponectin: SMD = −0.59, 95% CI −2.23 to 1.06, P = 0.48). A significantly lower visfatin level was found in the BD group with adjustment (SMD = −1.70, 95% CI −2.14 to −1.25, P < 0.001) but not without adjustment (SMD = 0.31, 95% CI −0.21 to 0.82, P = 0.24). Conclusions: Our meta‐analysis revealed significantly higher circulating resistin, leptin and adiponectin levels and lower visfatin levels in patients with BD than in HCs, indicating that adipokines probably play an important role in BD pathogenesis. [ABSTRACT FROM AUTHOR]

Comment on 'Method of Assessing Skin Cancerization and KeratosesTM (MASCK™): development and photographic validation in multiple anatomical sites of a novel assessment tool intended for clinical evaluation of patients with extensive skin field cancerization' Labelling a patient as having field cancerization in the absence of a documented burden of frank malignancy is nonsensical. Https://doi.org/10.1093/ced/llac067 Dear Editor, We congratulate Baker I et al i . on their attempt to develop a quantitative assessment tool for "extensive skin field cancerization" (ESFC), as reported recently in I Clinical and Experimental Dermatology i .[1] In the paper, ESFC is defined as '...an area or "field" of sun-damaged skin that contains multifocal clinical and subclinical disease arising from ultraviolet (UV) damage'. [Extracted from the article]

Systemic treatment options for moderate to severe atopic dermatitis in pregnant patients are significantly limited due to safety concerns and lack of evidence. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period. [Extracted from the article]

References 1 Lim PN, Wylie G. Symmetrical drug-related intertriginous and flexural exanthema like eruption associated with COVID-19 vaccination. COVID-19 vaccination and exanthema-like eruption Dear Editor, We read with interest the paper by Lim and Wylie1 published recently in I Clinical and Experimental Dermatology i , in which they proposed a possible association between an exanthema-like eruption of the skin and the administration of the ChAdOx1 nCoV-19 (AstraZeneca-Oxford) COVID-19 vaccine. [Extracted from the article]

For some time, there has been a suspicion that the number of articles published by UK-based authors in dermatology has declined. This probably reflects a reduction in the publication output of dermatology departments generally. We identified articles with British authorship in the British Journal of Dermatology between 1970 and the present date, and compared the journal with the three most commonly cited dermatological journals: Archives of Dermatology, Journal of Investigative Dermatology and Journal of the American Academy of Dermatology. Later, we expanded this search to include a further 33 dermatological journals. Despite an increase in the total number of published papers by the British Journal of Dermatology, there was a decline in the number of British-authored papers, from 97 (57%) in 1970 to 80 (22%) in 2005. The trend was also seen in the Journal of the American Academy of Dermatology, with 16 papers (5%) in 1989 and 7 (2%) in 2005. In Journal of Investigative Dermatology, British papers increased from 10 papers in 1975 to 17 in 2005, with a percentage decrease from 7% to 4%. Overall, despite an increase in the total number of publications in dermatological journals from 2745 in 1985-5034 in 2005, British publications increased from 271 in 1989 to only 289 in 2005, which represents a percentage decrease from 10% to 6%. Despite a three-fold increase in dermatology consultants and registrars in UK, a three-fold increase in dermatological journals and a four-fold increase in dermatological papers published, the overall number of British papers has remained static over the years. [ABSTRACT FROM AUTHOR]

We present a rare condition, hyperkeratosis of the areola, induced by vemurafenib. Only a few papers have described an association of BRAF inhibitors with hyperkeratosis of the areola and/or nipple. Vemurafenib is a selective BRAF inhibitor used in patients with unresectable or metastatic melanoma who are positive for the V600 mutation. This drug has been associated with numerous cutaneous side effects, both benign and malignant. We report a male patient with vemurafenib-induced hyperkeratosis of the areola managed successfully with a topical retinoid, and describe for the first time a treatment for this side effect. [ABSTRACT FROM AUTHOR]

A 2006 survey of dermatologists showed that home phototherapy should be used with caution, and that general, nonevidence-based opinions were widespread about this form of therapy. This led to a randomized controlled trial to assess the safety and efficacy of home phototherapy vs. outpatient phototherapy by the same authors in 2009, which concluded that a lower burden of treatment and increased patient satisfaction were associated with home phototherapy. In the UK National Health Service, with a single exception, phototherapy is currently carried out exclusively in hospital. This contrasts with the Netherlands, where home phototherapy is now widely available. NHS dermatology services in the UK have yet to adopt home phototherapy as a treatment option, despite the strong evidence base and robust service models established elsewhere. In this review, we discuss evidence-based papers on home phototherapy, its advantages and disadvantages, economic effectiveness, and a suggested model for service sustainability. [ABSTRACT FROM AUTHOR]