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Background: As exposure to UV radiation is the primary modifiable environmental risk factor associated with skin cancer, it remains the principal focus of most prevention strategies. Numerous sun protection campaigns have been implemented worldwide; however, their impact on the actual incidence and mortality rates of skin cancer seems to be limited. To create successful skin cancer prevention campaigns, it is important to have a comprehensive understanding of individuals' attitudes and behaviours regarding sun protection. The aim of the current study was to determine and report on the prevalence of self‐reported attitudes, knowledge and behaviours regarding two of the major sun protection recommendations—avoidance of sun exposure and use of sunscreens—in an international representative sample across five continents. Methods: This cross‐sectional study was conducted in 20 countries using a web‐based online survey. Findings: A total of 50,552 individuals, comprising 25,388 men (50.22%) and 25,164 women (49.78%), participated in the survey. Among them, 83.2% reported having been voluntarily exposed to the sun (for sun‐basking reasons) at least once in the last 12 months, and 47.96% acknowledged being exposed to the sun between the hours of 10 AM and 4 PM. The primary reason for non‐adherence was that these hours were the most convenient times (32.28%). Only 24.05% reported applying sunscreen every 2 h when outdoors. Forgetfulness was the primary reason as provided by 27.79% of participants. Males and older age groups were less likely to adopt sun‐protective behaviours around the world. Forgetfulness and the challenges posed by time constraints seem to be the biggest barriers to proper adherence. Interpretation: These findings should prompt the collaboration with health authorities and the manufacturers to enhance adherence by setting reasonable sunscreen prices and creating formulations that make their application less burdensome. [ABSTRACT FROM AUTHOR]

Background: Cutaneous neurofibromas (cNFs) are a major cause of disfigurement in patients with Neurofibromatosis Type 1 (NF1). However, clinical trials investigating cNF treatments lack standardised outcome measures to objectively evaluate changes in cNF size and appearance. 3D imaging has been proposed as an objective standardised outcome measure however various systems exist with different features that affect useability in clinical settings. The aim of this study was to compare the accuracy, precision, feasibility, reliability and accessibility of three imaging systems. Materials and methods: We compared the Vectra‐H1, LifeViz‐Micro and Cherry‐Imaging systems. A total of 58 cNFs from 13 participants with NF1 were selected for imaging and analysis. The primary endpoint was accuracy as measured by comparison of measurements between imaging systems. Secondary endpoints included reliability between two operators, precision as measured with the average coefficient of variation, feasibility as determined by time to capture and analyse an image and accessibility as determined by cost. Results: There was no significant difference in accuracy between the three devices for length or surface area measurements (p > 0.05), and reliability and precision were similar. Volume measurements demonstrated the most variability compared to other measurements; LifeViz‐Micro demonstrated the least measurement variability for surface area and image capture and analysis were fastest with LifeViz‐Micro. LifeViz‐Micro was better for imaging smaller number of cNFs (1–3), Vectra‐H1 better for larger areas and Cherry for uneven surfaces. Conclusions: All systems demonstrated excellent reliability but possess distinct advantages and limitations. Surface area is the most consistent and reliable parameter for measuring cNF size in clinical trials. [ABSTRACT FROM AUTHOR]

Cutaneous lichen planus is a highly pruritic dermatosis with an unmet need in its management. The aim of this study was to evaluate the short‐term effect and tolerance of high doses of clobetasol propionate 0.05% in cutaneous lichen planus. We conducted a single‐center retrospective cohort study from 2017 to 2021. All adults treated with high‐dose (>5 g/day) clobetasol propionate 0.05% for cutaneous lichen planus were included. Patients with less than 10% affected body surface area at initial presentation or who received concomitant systemic therapy were excluded. The primary endpoint was the rate of complete remission by week 16. Secondary endpoints included maximum daily and median cumulative doses, reduction in pruritus and occurrence of adverse events. Fifty‐seven patients, 60% female, with a mean age of 48 years (min–max,18–83) were included. Cutaneous lichen planus had been present for a median duration of 2 months at initial presentation (min–max, 1–4) and involved a median body surface area of 27%. Pruritus was reported by 55/57 (96%) patients. At week 16, 41/57 (72%) patients had achieved complete remission without treatment modification, among whom 25/41 (61%) had achieved it at week 6. The median daily and cumulative doses were, respectively, 20 g/day (IQR, 10–20) and 560 g (IQR, 320–925). Three patients experienced mild adverse events. No statistical association was demonstrated between the duration of the disease before treatment initiation and clinical response. In conclusion, high‐dose clobetasol propionate 0.05% seems to be an effective, well‐tolerated, and easy‐to‐implement treatment for cutaneous lichen planus. [ABSTRACT FROM AUTHOR]

Background: The skin plays an important role in establishing interpersonal relationships, and thus visible skin disorders, which have a significant impact on physical appearance, influence other people's behaviours and attitudes. Objective: To develop and validate a dermatologic‐specific questionnaire to evaluate stigmatization in individuals with visible skin conditions. Methods: Items were generated by a verbatim report based on qualitative interviews with patients with various dermatologic conditions. Subsequently, a study was implemented for psychometric analysis. A dermatology‐specific stigmatization questionnaire (PUSH‐D) was refined via item reduction according to inter‐question correlations, consensus among experts and exploratory factor analysis. Internal consistency was determined by calculating Cronbach's α. Concurrent validity was determined by calculating the correlation between PUSH‐D and the Dermatology Life Quality Index (DLQI) and the Rosenberg Self‐Esteem Scale (RSES). Results: From a primary list of 22 items, PUSH‐D was reduced to a 17‐item questionnaire, covering two pertinent dimensions based on the exploratory factor analysis. Construct validity was demonstrated, and PUSH‐D showed good internal consistency (Cronbach's α = 0.9). PUSH‐D correlated strongly with the DLQI 0.72 (p < 0.001) and moderately with the RSES 0.49 (p < 0.001). Conclusion: PUSH‐D allows a comprehensive view of the degree of stigmatization in visible skin disorders, as well as the comparability of stigmatization levels across various skin conditions. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Inherited epidermolysis bullosa (EB) is a heterogeneous group of genodermatoses characterized by localized or generalized skin and/or mucosal fragility. The objective of this work was to evaluate in France the burden of disease and out‐of‐pocket (OOP) expenditures for families with a child affected by EB. Material and methods: A digital questionnaire was built and distributed to parents of children with EB in partnership with the patients' association DEBRA France. The questionnaire collected clinical and socioeconomic characteristics including the estimated amount of money caregivers had to pay out of their own pockets. The burden of caregivers was assessed using the validated Epidermolysis Bullosa Burden of Disease (EB‐BoD) tool. Linear univariate regression models were conducted to search for factors associated with higher burden and higher OOP. Results: Between October and December 2021, 77 parents answered the questionnaire. The responder was the child's mother in 77% (n = 59) of cases. Parents represented 40 girls and 37 boys with a mean age of 7.5 years and with different EB types and disease severity. The mean BE‐BOD score was 63.9 ± 20.2. The mean score observed in children with severe EB was 69.0 ± 21 versus 59.0 ± 18.6 for moderate/mild. Similarly, the mean BE‐BOD scores observed in parents performing daily wound care were 67.9 ± 19.6. All parents (100%) reported OOP expenses. The mean annual OOP cost was 4129€ ± 4321€. Linear regression demonstrated that for each one‐point increase in the EB‐BoD score, OOP expense increases by 91.1 euros (35.1–147) p = 0.002. Conclusion: EB places a considerable burden on families' daily lives. This burden is closely associated with OOP expenditures to manage EB which were on average 20 times higher compared with the French population. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the initiation of treatment with an interleukin‐17 inhibitor (IL‐17i) in real life is associated with a higher risk of inflammatory bowel disease (IBD) in patients who had both psoriasis (PsO) and psoriatic arthritis (PsA)/ankylosing spondylitis (AS). Methods: This nationwide cohort study was conducted using the French National Health Data System database. All adult patients with PsO and PsA/AS who were identified as having newly initiated treatment with an IL‐17i during 2016–2019 were included. As controls, patients with PsO and PsA/AS who had newly initiated either 1) apremilast or 2) etanercept (ETN) during this period but had not received IL‐17i were included. The follow‐up end date was September 30, 2019. The primary end point was the risk of occurrence of IBD associated with exposure to an IL‐17i compared to exposure to the other treatments, as determined in a time‐to‐event analysis with propensity score–weighted Cox and Fine‐Gray proportional hazards models. Results: The study included a total of 16,793 new IL‐17i users (mean ± SD age 48.4 ± 13 years, 45% men), 20,556 new apremilast users (age 52.6 ± 15 years, 54% men), and 10,294 new ETN users (age 46.3 ± 15 years, 44% men). New IL‐17i users and new ETN users had received more biologics for their underlying disease compared to new apremilast users. IBD occurred in 132 patients: 72 new IL‐17i users (0.43%), 11 new apremilast users (0.05%), and 49 new ETN users (0.48%). Most IBD cases occurred after 6 months of exposure (82%, 55%, and 76%, respectively). After propensity score weighting, the risk of IBD was significantly greater among patients initiating an IL‐17i compared to those initiating apremilast (weighted hazard ratio [HR] 3.8 [95% confidence interval (95% CI) 2.1–6.8]). No difference in the risk of IBD between new IL‐17i users and new ETN users was observed (weighted HR 0.8 [95% CI 0.5–1.2]). Conclusion: Patients with PsO and PsA/AS who initiate treatment with an IL‐17i do not have a higher risk of developing IBD when compared to patients initiating ETN who display the same severity of underlying disease. These results need to be confirmed in other large studies of patients with PsO and PsA/AS. [ABSTRACT FROM AUTHOR]

Vitiligo is the most common depigmenting disorder affecting 0.1%–2% of the population worldwide. The characteristic white patches result from the selective loss of melanocytes. Sustained recent efforts have resulted in a detailed understanding of the genetic architecture of vitiligo. About 80% of vitiligo risk is attributable to genetic factors; and the rest (20%) is attributable to the environment. Over the past decade, substantial progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Melanocytes from patients with vitiligo are more susceptible to oxidative stress which begets the release of exosomes and inflammatory cytokines that will lead to activation of the innate immune response and subsequently to adaptive immune response through activation of autoreactive cytotoxic CD8+ T cells. These produce interferon‐γ (IFN‐γ) which promotes disease progression through IFN‐γ‐induced chemokine secretion from surrounding keratinocytes to further recruit T cells to the skin through a positive feedback loop. CD8 tissue‐resident memory T cells are in turn responsible for long‐term maintenance and potential relapse of vitiligo in human patients through cytokine‐mediated recruitment of T cells from the circulation. This review summarizes the current knowledge on vitiligo and attempt to give an overview of the future in vitiligo treatment. [ABSTRACT FROM AUTHOR]

Congenital Hemidysplasia with Ichthyosiform nevus and Limb Defects (CHILD syndrome) is a rare X‐linked dominant genodermatosis caused by mutations in the NAD(P) dependent steroid dehydrogenase‐like protein gene. Its defect leads to accumulation of toxic metabolic intermediates upstream from the pathway block and to the deficiency of bulk cholesterol, probably leading to altered keratinocyte membrane function, resulting in the phenotype seen in CHILD syndrome. Symptomatic treatment using emollients and retinoids to reduce scaling has long been used until recently, whereby new therapeutic means based on the pathogenesis‐targeted therapy have been developed. We subsequently chose to use the same pathogenesis‐based therapy using a 2% cholesterol and 2% lovastatin cream with or without glycolic acid in two of our patients. Improvement in CHILD skin lesions was seen as early as 4 weeks after initiation. The addition of glycolic acid helped improve the penetrance of the cholesterol and lovastatin cream into the thick waxy scales. Our study confirms the efficacy of the pathogenesis‐targeted therapy and introduces the possibility of modifying its formula by adding glycolic acid in order to improve the treatment. [ABSTRACT FROM AUTHOR]

Abstract: Background: Mal de Meleda (MDM) is a rare inherited autosomal recessive genodermatosis characterized by palmoplantar keratoderma (PPK) with transgrediens and caused by mutations in the SLURP1 gene. Uncommonly, cutaneous tumors have been found at PPK sites in MDM patients. Objective: To study a Middle Eastern family with MDM with both PPK and skin tumors. Methods: We studied a Middle Eastern (Palestinian) family with clinical features of MDM and cutaneous tumors. Histopathological analysis was performed on biopsies from skin lesions found in the affected individuals. Direct sequencing of SLURP1 was performed in MDM affected members. In silico analysis of publicly available datasets was used to survey SLURP1 mRNA levels in normal and malignant tissues. Statistical analysis was performed in the R statistical language. Results: Affected members from the Middle Eastern family displayed severe forms of PPK consistent with MDM. Histopathological analysis of the skin lesions revealed that the examined affected members exhibited skin squamous cell carcinomas (SCCs) and melanoma. Sequence analysis revealed homozygous SLURP1 mutations (c.82delT) in the affected members. Following analysis of various publicly available expression datasets, SLURP1 mRNA levels were found to be markedly elevated in tissues of epithelial lineage, relative to tissues of other lineages, and significantly suppressed in malignant tumors of epithelial lineage relative to normal or their premalignant counterparts. There was significant decrease in SLURP‐1 expression in melanomas versus melanocytic nevi as well as a highly significant decrease in SLURP‐1 expression in metastatic melanomas as compared to primary melanoma. Conclusion: Our study underscores cases of Middle Eastern MDM with SLURP1 mutations and skin malignancies at PPK sites. Our findings also highlight a plausible epithelial lineage‐specific tumor suppressor role for the SLURP1 gene, as well as a role in the development and metastasis of melanoma and thus a potential molecular signature for melanoma. [ABSTRACT FROM AUTHOR]

This study shows that although Norway and Sweden have rather similar family policies, the seemingly small differences that exist reflect different national ideals of care, and these differences encourage parents to employ different gendered moral rationalities. However, Sweden's ideal of 'equal-sharing/professional care', encourages fathers to take longer leaves than the Norwegian ideal of 'partial sharing plus choosing between professional or parental care'. Given their different national ideals of caring, different gendered moral rationalities emerge. While in Norway the dominant gendered moral rationality among our interviewees is 'man-doing-his-duty', in Sweden two different rationalities arise: the 'breastfeeding-plus-sharing' rationality and the 'male-opt-out'. This conclusion is based on 60 interviews with mothers and fathers in Oslo and Stockholm. [ABSTRACT FROM AUTHOR]

Orf virus (ORFV) is an important pathogen responsible for a highly contagious zoonotic viral infection that threatens those who handle sheep and goats. Orf virus is the prototype of the Parapoxvirus genus, and its resilience in the environment and ability to reinfect its host has contributed to the spread and maintenance of the infection in many species. In healthy humans, the disease usually resolves spontaneously within 3 to 6 weeks. There is no specific treatment and many different approaches such as use of imiquimod, cidofovir, curettage, shave excision, cryotherapy, and electrocautery have all been reported to be successful, without supporting evidence from controlled clinical trials. Throughout its interaction with the different hosts, ORFV has evolved a strategy for immune evasion via the development of an array of virulence factors. The interaction of ORFV with the immune system has been the subject of research for decades. Whole inactivated ORFV has been used as a type of immunomodulating drug; a so called paramunity inducer proposed as both a preventative and a therapeutic immunomodulator across various species. Additional research on the remarkable strategies underlying ORFV infection could lead to improved understanding of skin immunity. [ABSTRACT FROM AUTHOR]

The rise of the adult worker family norm across countries of the Organisation for Economic Co-operation and Development has created challenges for reconciling work and family life as the unpaid work of the female caregiver can no longer be assumed. The article compares childcare arrangements and maternity/parental leave programmes in Sweden, Australia and Canada that attempt to address these challenges. Sweden was an early innovator, establishing the 'gold standard' for such arrangements in the form of publicly funded, universally accessible, centre-based childcare and generously paid parental leave, including a 'daddy quota'. Yet policy development remains open to contestation and change even here. Australia and Canada have shown a preference for market-based solutions although each has taken steps towards Swedish style solutions. In particular, Canadian federalism has left space for such experiments at the provincial scale. The broader institutional arrangements embedded in each country have helped to shape the responses. Yet political contestation, enlivened by the transnational flow of ideas (and ideals), has played an important role in shaping the direction and velocity of change. In the first section we develop this argument, beginning with reflections on how to identify the significance of changes, then moving on to explore the role of institutions, actors and ideas in accounting for these developments. Subsequent sections examine developments first in Sweden then Australia and Canada. [ABSTRACT FROM AUTHOR]

Aim The long-term effects of the ketogenic diet, a high fat diet for treating intractable epilepsy, on resting energy expenditure ( REE) are unknown. The aim of this study was to evaluate the impact of 15 months of ketogenic diet treatment on growth and REE in children with intractable epilepsy. Method Growth, body composition, and REE were assessed at baseline, 3 months and 15 months in 24 children (14 males, 10 females; mean age 5y 6mo [ SD 26mo], range 7mo-6y 5mo), 10 with cerebral palsy [ CP]). Fifteen were identified as ketogenic diet responders at 3 months and continued on the ketogenic diet until 15 months. These were compared to 75 healthy children (43 males, 32 females; mean age 6y 3mo [ SD 21mo] age range 2-9y). REE was expressed as percentage predicted, growth as height ( HAz) and weight ( WAz) z-scores, and body composition as fat and fat free mass ( FFM). Results HAz declined −0.2 and −0.6 from baseline to 3 months and 15 months respectively ( p=0.001), while WAz was unchanged. In ketogenic diet responders, FFM, age and CP diagnosis predicted REE (overall R2=0.76, p<0.001) and REE did not change. REE adjusted for FFM was lower ( p<0.01) in children with CP at baseline (mean [standard error], −143[51] kcals/d) and 15 months (−198[53] kcals/d) compared to the healthy children. Interpretation After 15 months of the ketogenic diet, linear growth status declined while weight status and REE were unchanged. REE remained reduced in children with CP. [ABSTRACT FROM AUTHOR]

Aim: The long-term effects of the ketogenic diet, a high fat diet for treating intractable epilepsy, on resting energy expenditure (REE) are unknown. The aim of this study was to evaluate the impact of 15 months of ketogenic diet treatment on growth and REE in children with intractable epilepsy.Method: Growth, body composition, and REE were assessed at baseline, 3 months and 15 months in 24 children (14 males, 10 females; mean age 5 y 6 mo [SD 26 mo], range 7 mo-6 y 5 mo), 10 with cerebral palsy [CP]). Fifteen were identified as ketogenic diet responders at 3 months and continued on the ketogenic diet until 15 months. These were compared to 75 healthy children (43 males, 32 females; mean age 6 y 3 mo [SD 21 mo] age range 2-9 y). REE was expressed as percentage predicted, growth as height (HAz) and weight (WAz) z-scores, and body composition as fat and fat free mass (FFM).Results: HAz declined -0.2 and -0.6 from baseline to 3 months and 15 months respectively (p = 0.001), while WAz was unchanged. In ketogenic diet responders, FFM, age and CP diagnosis predicted REE (overall R(2) = 0.76, p<0.001) and REE did not change. REE adjusted for FFM was lower (p<0.01) in children with CP at baseline (mean [standard error], -143[51] kcals/d) and 15 months (-198[53] kcals/d) compared to the healthy children.Interpretation: After 15 months of the ketogenic diet, linear growth status declined while weight status and REE were unchanged. REE remained reduced in children with CP. [ABSTRACT FROM AUTHOR]

This article is part of a broader study of women's representation and influence in the corporatist sector of public decision-making in Sweden. In an international perspective, Sweden has a remarkably high proportion of women politicians on all levels (between 30-45%), and women constitute about half of the participants in the labour market and of union members. However, in the decision-making processes of the unions and in corporatist arrangements. women are highly under-represented. And, as this study shows, in some cases women are more under-represented today than they were 30 or 40 years ago. One of the results of the high degree of corporatism in Sweden has thus been that women and women's interests have been more marginalised in corporatist arrangements than in traditional politics. [ABSTRACT FROM AUTHOR]

The article discusses the case of an 8-year-old boy who experienced persistent swelling in his upper lips and hence denied any contact with toothpaste or lip balm. He was diagnosed with Cheilitis granulomatosa after microscopy, which is a rare medical condition. Tuberculosis and allergic reactions to food additives are among the many causes for this condition. He was treated with triamcinolone acetonide intralesional injections and showed improvement after one session.