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Objectives: To describe disease burden in individuals with moderate‐to‐severe atopic dermatitis (AD) in Australia and New Zealand (ANZ) and compare it with other geographic regions. Methods: This multicentre, cross‐sectional, observational study (MEASURE‐AD) recruited consecutive adolescent and adult patients attending dermatology clinics in 28 countries. Data collected included scores of pruritus, disease severity, sleep, pain, disease control, work and quality of life. Results: This study included 112 ANZ participants (Australia n = 72; New Zealand n = 40) from December 2019 to December 2020. Treatments included topicals (85.7% of patients), non‐biologic systemic therapy (28.6%), phototherapy (9.8%) and dupilumab (4.5%). Mean Eczema Area and Severity Index (EASI) score was 22.3 (95% CI 19.6–25.0) and Patient‐Oriented Eczema Measurement (POEM) score was 18.4 (95% CI 16.8–20.0). Pruritus Numerical Rating Scale (NRS) was 6.0 (95% CI 5.5–6.6) (50% had severe pruritus) and Dermatology Life Quality Index (DLQI) 14.3 (95% CI 12.8–15.8). ADerm‐Impact sleep domain score was 15.1 (95% CI 13.2–16.9). ADerm‐Symptom Scale worst skin pain domain score was 5.0 (95% CI 4.3–5.6). Work Productivity and Activity Impairment (WPAI) percentages indicated work and productivity impairment. Inadequately controlled AD was self‐reported by 41%, with 9.7 flares in the past 6 months. Scores of pruritus, disease severity, sleep, pain, disease control and quality of life in ANZ were often the highest of all the geographic regions studied. Conclusion: ANZ patients with AD have a high disease burden, which extends across multiple facets of daily life. Many are inadequately controlled with existing therapies. [ABSTRACT FROM AUTHOR]

This article discusses the development of artificial intelligence (AI) algorithms for the diagnosis of skin cancer. The authors conducted a review of peer-reviewed journal publications on this topic and found that while many studies reported technical properties of data and algorithm development, they often lacked critical clinical information. Only 10.4% of the studies complied with the CLEAR Derm guidelines, which raises concerns about the clinical relevance of these AI models. The article proposes a translational framework for successful integration of AI into clinical practice, emphasizing the need for standardization, transparency, and high-quality reporting. The authors also highlight the importance of ethical and legal frameworks and the assessment of AI models for clinical efficacy and safety. [Extracted from the article]

Introduction: The Virtual Lesion Clinic (VLC) of Waitematā District Health Board (WDHB) improves melanoma assessment and treatment using teledermatology. The VLC is reserved for pigmented lesions referred as suspected melanoma from primary care but indeterminate at the initial triage. Objectives: To assess the efficacy of the VLC diagnosis of melanoma. Methods: A retrospective audit of suspected melanoma referrals (1 January 2012 to 31 December 2016) was conducted. Lesions were referred to the VLC if diagnostic uncertainty remained at the initial triage. VLC patients attended MoleMap imaging centres, a dermatologist reviewed history and images remotely and suggested a diagnosis and management plan. Post VLC provisional diagnosis of melanoma, all lesions subsequently excised were reviewed. A positive predictive value (PPV) was calculated using concordance between VLC diagnosis of melanoma and histopathological diagnosis of melanoma. Number needed to excise (NNE) for melanoma was derived, as well as an invasive to in‐situ melanoma ratio (IM:MIS) and false negative rate (FNR). Results: The VLC received 1874 referrals for 3546 lesions during the 5‐year study period. Six hundred and seventy‐nine lesions were recommended excision/biopsy or specialist face‐to‐face assessment, and 504 lesions were subsequently excised. The PPV was 62%, NNE 1.62 and IM:MIS 0.76 for lesions suspected to be melanoma at VLC assessment. The VLC had a melanoma‐specific FNR of 7%. Conclusions: The VLC is effective in early diagnosis of melanoma with a high positive predictive value, low number needed to excise and low false negative rate amongst lesions referred as suspected melanoma. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has disrupted the practice of medicine. Dermatologic laser and energy‐based device (EBD) treatments carry a potential risk for the transmission of SARS‐CoV‐2 both for the patient and the practitioner. These risks include close practitioner to patient proximity, the treatment of higher viral load areas such as the face, the potential for infective bioparticles being carried by generated plumes and aerosols, and the direct contact between device, practitioner and patient. Objectives: SARS‐CoV‐2 is a highly infective respiratory pathogen transmitted by respiratory droplets, respiratory/mucosal secretions, medically generated aerosols and via its transfer from contaminated fomites. This requires a review of the appropriateness of infection control protocols in regard to dermatologic laser and energy‐based device treatments. Methods: A critical evaluation of patient skin preparation including skin asepsis, device disinfection, laser and electrosurgical plume management and PPE in regard to SARS‐CoV‐2 was performed. Results: The adherence to a high standard of skin preparation and asepsis, device disinfection, laser and electrosurgical plume and aerosol management and appropriate PPE should help mitigate or reduce some of the inherent treatment risks. Head and neck treatments along with aerosol and laser plume generating treatments likely carry greater risk. Conclusions: COVID‐19 needs to be considered in the clinic set‐up along with the planning, treatment and post‐treatment care of patients utilising EBD procedures. Some of these treatment precautions are COVID‐19 specific; however, most represent adherence to good infectious disease and established laser and EBD safety precautions. [ABSTRACT FROM AUTHOR]

Chronic hand/foot eczemas are common, but treatment is often challenging, with widespread dissatisfaction over current available options. Detailed history is important, particularly with regard to potential exposure to irritants and allergens. Patch testing should be regarded as a standard investigation. Individual treatment outcomes and targets, including systemic therapy, should be discussed early with patients, restoring function being the primary goal, with clearing the skin a secondary outcome. Each new treatment, where appropriate, should be considered additive or overlapping to any previous therapy. Management extends beyond mere pharmacological or physical treatment, and requires an encompassing approach including removal or avoidance of causative factors, behavioural changes and social support. To date, there is little evidence to guide sequences or combinations of therapies. Moderately symptomatic patients (e.g. DLQI ≥ 10) should be started on a potent/super‐potent topical corticosteroid applied once or twice per day for 4 weeks, with tapering to twice weekly application. If response is inadequate, consider phototherapy, and then a 12‐week trial of a retinoid (alitretinoin or acitretin). Second line systemic treatments include methotrexate, ciclosporin and azathioprine. For patients presenting with severe symptomatic disease (DLQI ≥ 15), consider predniso(lo)ne 0.5–1.0 mg/kg/day (or ciclosporin 3 – 5 mg/kg/day) for 4–6 weeks with tapering, and then treating as for moderate disease as above. In non‐responders, botulinum toxin and/or iontophoresis, if associated with hyperhidrosis, may sometimes help. Some patients only respond to long‐term systemic corticosteroids. The data on sequencing of newer agents, such as dupilumab or JAK inhibitors, are immature. [ABSTRACT FROM AUTHOR]