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ABSTRACT Background Aim Methods Results Conclusions Radiant skin is a common patient request and the result of multiple contributing factors. Currently, there is no standardized methodological approach that facilitates assessment of skin quality from a holistic perspective.To develop a holistic methodological process to assess skin quality using a scale that helps identify treatment priorities, facilitates conversation with the subject, and helps manage expectations, supports long‐term treatment plans, and tracks treatment progress over time.Ten global experts (dermatologists and esthetic physicians) identified the main measurable aspects that contribute to skin quality, and these were combined to form the Skin Quality Assessment Scale (SQS). The scale comprises four overarching skin quality domains containing nine measurable aspects: texture (pores, lines, scars); discoloration (redness, pigmentation, dullness); firmness (laxity); and hydro‐lipid balance (oiliness, dryness). Each aspect is graded on a 4‐point severity scale (0 = none to 3 = severe). The SQS was validated by a large group of practicing clinicians.Practicing clinicians (> 40, 78% dermatologists) were surveyed; prior to reviewing the scale, 67% did not use any scale but 81% believed a holistic SQS was needed. After reviewing the scale, 100% agreed the scale provides a holistic assessment of skin quality. In addition, 95% agreed the scale helps assess all key aspects of skin quality with subjects and 98% deemed it valuable for their clinic.The SQS represents a holistic assessment tool that engages with and manages subjects' expectations, identifies treatment priorities, creates a long‐term treatment plan, and visualizes the skin quality improvement over time. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is an ulcerative inflammatory disorder affecting the lower legs in 80% of patients. The use of biologic medications to treat PG is increasing, although there is a limited evidence base to guide treatment choices. In some health systems, such as the UK National Health Service, limitations are placed on biologic prescribing for PG, leading to wide variations in prescribing. A survey of mainly UK clinicians showed that prednisolone remains the first-line treatment for PG (90%, 34/38). Biologics have been used by 66% (25/38) of clinicians as second-line therapy, but 19% (7/38) have had prescribing requests declined. Further research is needed to determine optimal treatment strategies for PG. [ABSTRACT FROM AUTHOR]

Background: Reliable, objective measures to assess facial characteristics would aid in the assessment of many dermatological treatments. Previous work utilized an iOS application‐based artificial intelligence (AI) tool compared to the "gold standard" computer‐based and a physician assessment on five skin metrics (British Journal of Dermatology, 2013, 169, 474). The AI tool had superior agreement for all skin metrics except pores and subsequently underwent an algorithm update for its pore detection system. Aims: This comparative analysis assessed the performance of the updated AI tool's pore scores across all Fitzpatrick skin phototypes to determine whether the AI tool more accurately represents a dermatologist's assessment of pores. Patients/Methods: Frontal facing photographs in uniform lighting conditions were taken of each participant. Percentile scores were generated by each of the four self‐learning models of the updated AI tool. The pore percentile scores generated by the original and updated AI tool were used to rate "worse" pores among participant pairs. These ratings were compared to pore assessments performed by a "gold‐standard" device and a board‐certified dermatologist. Results: Compared to the original pore detection tool and the computer‐based program, models A and D had the highest concordance with the physician's pore assessments for Fitzpatrick skin phototypes III‐IV and V‐VI, respectively. Conclusions: The AI tool's pores detection update was successful in its ability to accurately detect pores on all Fitzpatrick skin types, improving on the performance of the AI prior to the update. Responsibly developed AI tools that can accurately and reliably detect skin metrics across diverse Fitzpatrick skin types can facilitate dermatologic evaluation, individualize treatment, and determine treatment response. [ABSTRACT FROM AUTHOR]

Background: Nailfold capillaroscopy is recommended to diagnose primary or secondary Raynaud's phenomenon (RP). Capillaroscopy is normal in primary RP, which is the most frequent. Screening for RP capillary anomalies with nailfold dermoscopy has been promising. Objective: To determine whether normal nailfold dermoscopy—based on the absence of five criteria that define a sclerodermic pattern—is able to predict normal capillaroscopy with good positive‐predictive value (PPV). Methods: Prospective, 2‐phase (monocentre and multicentre) study on patients at first consultation for RP undergoing nailfold video capillaroscopy (NVC) and nailfold dermoscopy by two different 'blinded' trained observers, respectively, a vascular specialist and a dermatologist, not familiar with capillaroscopy. The five criteria noted were as follows: disorganization, megacapillaries, low capillary density, avascular areas and haemorrhages. Results: Based on 105 patients, the dermoscopy PPV for a normal NVC was 100% (p = 0.015), with 37.9% sensitivity, when no criterion was observed. Excluding haemorrhages, the PPV remained 100% (p < 0.0001), with sensitivity rising to 73.7% and 100% specificity. Conclusions: Normal nailfold dermoscopy with the absence of four easy‐to‐observe criteria predicts normal NVC with an excellent PPV. [ABSTRACT FROM AUTHOR]

Multidisciplinary care is essential for the management of patients with psoriatic disease (PsD), considering the great range of cutaneous and musculoskeletal symptoms and the potential for associated comorbidities and extraarticular manifestations. Consequently, combined rheumatology/dermatology clinics represent a gold standard model of care for patients with PsD. Many challenges are associated with the establishment of these clinics in routine clinical practice. In this report, we describe the thoughts and debates within a collaborative care breakout session during the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting. The breakout discussion focused around 3 main topics: (1) challenges of dermatologist-rheumatologist collaboration; (2) innovative approaches to encourage collaboration; and (3) how to identify patients with psoriasis at high risk of developing PsA. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Methods Results Conclusion Facial erythema from acne, vascular rosacea, or photoaging is a common difficult–to‐treat dermatologic challenge.The objective of this study was to examine the role of lapachol in alleviating facial erythema associated with a variety of common dermatologic conditions.Twenty‐five healthy female and male subjects 35–65 years of age of Fitzpatrick skin types I–II with mild‐to‐moderate stable facial erythema from acne, rosacea or photoaging were enrolled in a single‐site monadic study. Subjects received the study cream for twice daily application and were assessed at baseline, Week 4, and Week 8. The dermatologist investigator and subjects assessed efficacy and tolerability and facial photographic images were taken of all subjects at each visit. Noninvasive erythema assessments of the face were conducted using a colorimeter at baseline, Week 4, and Week 8 to document improvement in facial erythema.Twenty‐five out of 25 subjects successfully completed the study without tolerability issues including 12 subjects with rosacea, 6 subjects with photoaging and 7 subjects with acne. After 8 weeks of use, the investigator rated a 44% decrease in facial erythema while the subjects rated a 40% decrease. Facial erythema was also noninvasively assessed with a colorimeter and dermaspectrophotometer (DSP). There was a 26% decrease in skin redness at Week 4 and a 31% decrease in skin redness at Week 8 on the colorimeter L*a*b* scale. This finding was collaborated by the DSP which registered a 29% decrease on the erythema scale at Week 8.Lapachol in a moisturizer formulation was found to be effective in reducing facial erythema from acne, rosacea, and photoaging. [ABSTRACT FROM AUTHOR]

Objective: The goal is to determine if the implementation of dermoscopy improves the accuracy, specificity, and sensitivity rates of skin cancer detection among dermatology clinicians and identify the optimal training method for dermatology clinicians to become proficient in dermoscopy. Methods: A comprehensive search through the A.T. Still Memorial Library, including the electronic health databases PubMed, Scopus, UpToDate, and CINAHL, was performed. Google Scholar search results were sorted by relevance, and the first 30 pages were included within the search due to the large quantity of results. The search keywords included "skin cancer diagnosis," "accuracy," "detection," "dermoscopy," and "dermatologists." The search was performed in July 2023. The date limitations used within the search parameters ranged from 2017 to 2023 to review the past seven years of publications. The search evaluated reference lists and encompassed those that met the inclusion and exclusion criteria. Dermatologists, dermatology physician assistants, dermatology nurse practitioners, and primary care practitioners were eligible for inclusion. The search included literature from any country. The English language was the only language permitted within the search. Gray literature was included in the search using news, press release, and MedRxiv. Results: A total of 28 articles met the inclusion criteria. All of the articles included were from peer-reviewed sources and in the English language. The articles came from 10 different countries of origin and were published from 2017 to 2023. The main results of the scoping review discovered that the use of dermoscopy improves the accuracy of skin cancer diagnosis. The results also demonstrated that dermoscopy training is highly variable; multiple different types of diagnostic algorithms are used in the professional medical education systems of the 10 countries included within the scoping review. The dermoscopy training algorithms recommended include pattern analysis, 7-point checklist, Menzies method, Triage Amalgamated Dermoscopy Algorithm, Australasian College of Dermatology Dermoscopy Course, 3-point checklist, ABCD rule, Skin Imaging College of China, and no particular algorithm. Of these, the three most commonly recommended included the 7-point checklist, Menzies method, and pattern analysis. Conclusion: The results demonstrated that dermoscopy improves the accuracy of skin cancer diagnosis for dermatology clinicians and primary care providers. Key implications of these findings for practice include earlier skin cancer detection, which can lead to reduced rates of morbidity and mortality, reduced overall healthcare costs, reduced number of benign lesions biopsied, and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Real‐world experience using an allograft adipose matrix (AAM) (Renuva) is presented as a series of seven cases demonstrating successful use of the matrix by nine expert cosmetic physicians across the United States. AAM is donated tissue that is aseptically processed without terminal irradiation into a transplantable adipose matrix that functions as a natural, versatile, and nonimmunogenic cushioning and volume‐restoring tissue. When injected, the adipose matrix is replaced with the body's own fat cells and provides the cellular scaffold required for volume restoration and retention. Methods: Nine expert dermatologists were selected to share and discuss real‐world patient cases using AAM. The experts discussed a variety of cases and selected 7 cases that demonstrated successful, novel use of AAM to present in this manuscript. Results: Experts agreed that the novel AAM is an easy‐to‐use, effective, and safe alternative to traditional fillers and fat grafting. Conclusion: The use of the AAM is recommended for the face, hands, and other adipose tissue‐containing parts of the body. The presented real‐world cases provide guidance on how to identify ideal candidates to ensure optimal volume restoration results. [ABSTRACT FROM AUTHOR]

Background Aim Methods Conclusions Lasers and other energy‐based devices are increasingly becoming popular in aesthetic practice. Many centers employ doctors or technicians to perform these procedures where treating doctor and operating doctor may be different. Hence the need for standard operative protocols, to be followed while performing these procedures to avoid mistakes, complications and to get optimum results. In the current review article, group of doctors who have worked with these energy‐based devices over many years worked together and suggested the protocols to be followed for the most commonly used energy‐based procedures.To provide Standard operating protocols for the operator and staff to ensure, efficacy, safety, for the patient and for the devices.The following protocols have been drafted based on the best practices followed by the authors in their clinics and reflect their consensus opinion. The objective is to provide operating protocols in a standard format, which can be of use by practicing dermatologists and their staff. The protocols include both general guidelines for the laser room and specific protocols for different machines. The draft follows the following schema: General instructions for all the energy‐based devices. Specific protocols for different devices: Laser hair removal, fractional lasers, Q‐switched lasers, fractional microneedling radiofrequency and cryolipolysis. The protocols proposed help to maintain the uniformity and avoid complications. However, these instructions are generalized and not machine or lesion specific. There may be variations in the protocols depending on the treatment lesion and treating doctor as well as machine. [ABSTRACT FROM AUTHOR]

Asynchronous teledermatology (TD) has shown promise in improving access to dermatological care, yet studies reveal varied methodologies and results. This study aimed to design a mobile app using the store-and-forward model, marking a pioneering effort in Iran to facilitate written documentation of patient history and skin lesion imagery for accurate diagnosis. Conducted from July 2022 to July 2023, this study involved the development and implementation of a smartphone app to collect clinical data and photographs from 89 patients at a dermatology clinic. Diagnoses made at the clinic served as the gold standard. Three dermatologists independently reviewed the app-recorded data, providing diagnoses that were compared to in-person assessments using the Kappa coefficient and agreement percentage. Lesions were predominantly located on the whole body (47%), with psoriasis (19.1%), acne vulgaris (11.2%), and eczema (10%) being the most common. The overall inter-observer Kappa value demonstrated excellent agreement at 0.856. The study's findings endorse the use of a mobile app for TD as an effective adjunct in regions with scarce dermatological services, such as Iran. To promote the broader application of TD, ongoing research is essential to further establish its reliability and practicality. [ABSTRACT FROM AUTHOR]

Antisemitism, the hatred of or prejudice against Jews, was a core component of the Nazi regime's ideology. We review the chronology of events against the Jews and Jewish physicians in Germany and their conquered territories from 1933 to 1945. The complicit role that German physicians played in these events and the devastating impact on Jewish dermatologists and our specialty will be recounted. Finally, we will address the antisemitism in the United States during that same approximate period and now. [ABSTRACT FROM AUTHOR]

This study evaluates the clinical accuracy of OpenAI's ChatGPT in pediatric dermatology by comparing its responses on multiple‐choice and case‐based questions to those of pediatric dermatologists. ChatGPT's versions 3.5 and 4.0 were tested against questions from the American Board of Dermatology and the "Photoquiz" section of Pediatric Dermatology. Results show that human pediatric dermatology clinicians generally outperformed both ChatGPT iterations, though ChatGPT‐4.0 demonstrated comparable performance in some areas. The study highlights the potential of AI tools in aiding clinicians with medical knowledge and decision‐making, while also emphasizing the need for continual advancements and clinician oversight in using such technologies. [ABSTRACT FROM AUTHOR]

Introduction: Suboptimal access to dermatologic care is dependent on patient location and insurance type. Although there have been attempts to address access issues, barriers to providing excellent dermatologic care to all patients at the right time still exist. The objective of this study was to investigate the clinical impact of Dermatology Extension for Community Healthcare Outcomes (ECHO) project participation on primary care providers' diagnostic and treatment tendencies and accuracy. Methods: This was a retrospective cohort study constructed using Dermatology Extension for Community Healthcare Outcomes case and recommendation data from November 2015 to June 2021. The University of Missouri-based Dermatology Extension for Community Healthcare Outcomes specialty hub team offers regularly scheduled live interactive tele-mentoring sessions for primary care providers who practice in rural and underserved areas. 524 patient cases presented by 25 primary care providers were included in the analysis. Of those, 449 cases were included in diagnostic concordance, and 451 in treatment concordance analysis. Results: Less than 40% of all diagnoses were fully concordant with an expert panel. Over 33% of patients were misdiagnosed, and over 26% received partially correct diagnosis. Only 16% of all treatment recommendations were fully concordant with an expert panel. Discussion: Diagnostic and treatment accuracy of participants is low, and Dermatology Extension for Community Healthcare Outcomes platform ensured patients received correct diagnosis and treatment quickly. Although tele-dermatology models are effective, they continue to be underutilized. Dermatologists in practice and training should be encouraged to adopt innovative clinical educational models, like Dermatology ECHO, to expand access to dermatologic expertise for the most marginalized populations. [ABSTRACT FROM AUTHOR]

Simple Summary: Early detection of melanoma and differentiation from benign nevi can be challenging even for the most experienced dermatologists. To improve melanoma detection, artificial intelligence algorithms incorporating dermoscopy have been developed, but lack transparency and therefore have limited training value for healthcare providers. To address this, an automated approach utilizing imaging biomarker cues (IBCs), logical features extracted from images that mimic expert dermatologists' dermoscopic pattern recognition skills, was developed. This study excluded deep learning approaches to which IBCs are complementary or alternative. Ten participants assessed 78 dermoscopic images (39 melanomas and 39 nevi) first without IBCs and then with IBCs. Using IBCs significantly improved diagnostic accuracy: sensitivity increased significantly from 73.69% to 81.57% (p = 0.0051) and specificity increased from 60.50% to 67.25% (p = 0.059). These results indicate that incorporating IBCs can significantly enhance melanoma diagnosis, with potential implications for improved screening practices. Further research is needed to confirm these findings across a variety of healthcare providers. Incorporation of dermoscopy and artificial intelligence (AI) is improving healthcare professionals' ability to diagnose melanoma earlier, but these algorithms often suffer from a "black box" issue, where decision-making processes are not transparent, limiting their utility for training healthcare providers. To address this, an automated approach for generating melanoma imaging biomarker cues (IBCs), which mimics the screening cues used by expert dermoscopists, was developed. This study created a one-minute learning environment where dermatologists adopted a sensory cue integration algorithm to combine a single IBC with a risk score built on many IBCs, then immediately tested their performance in differentiating melanoma from benign nevi. Ten participants evaluated 78 dermoscopic images, comprised of 39 melanomas and 39 nevi, first without IBCs and then with IBCs. Participants classified each image as melanoma or nevus in both experimental conditions, enabling direct comparative analysis through paired data. With IBCs, average sensitivity improved significantly from 73.69% to 81.57% (p = 0.0051), and the average specificity improved from 60.50% to 67.25% (p = 0.059) for the diagnosis of melanoma. The index of discriminability (d′) increased significantly by 0.47 (p = 0.002). Therefore, the incorporation of IBCs can significantly improve physicians' sensitivity in melanoma diagnosis. While more research is needed to validate this approach across other healthcare providers, its use may positively impact melanoma screening practices. [ABSTRACT FROM AUTHOR]

Introduction: Limited evidence is available on real-world management of atopic dermatitis (AD) among Asian adults. This cross-sectional study aimed to assess current approaches in AD diagnosis and management in Asia. Methods: Practising dermatologists regularly treating patients with moderate-to-severe AD were recruited from eight Asia–Pacific territories, namely Mainland China, Hong Kong, India, Japan, Singapore, South Korea, Taiwan, and Thailand. A survey was administered to eligible dermatologists after screening and taking informed consent. Data from fully completed submissions were analysed using descriptive statistics. The study was reviewed by the institutional review board in each territory. Results: Data from 271 dermatologists were included for analysis. About one-third (31.7%) reported that they referred to the Hanifin and Rajka criteria during diagnosis. The majority of dermatologists used clinical impression when assessing AD severity and treatment response. Reduction of eczema and pruritus was the primary treatment objective when managing both acute (98.1%) and chronic (69.1%) AD. More than half of dermatologists preferred adding systemic anti-inflammatory medication for patients who did not respond to maximized topical treatment, while 43.6% would switch to another systemic medication for those failing to respond to maximized systemic treatment. Topical corticosteroids were frequently selected by dermatologists. For systemic therapies, oral corticosteroids were most frequently used, followed by cyclosporin and dupilumab. Narrow-band ultraviolet B was the most common phototherapy reported (84.9%). There was considerable variation in estimated average and maximum durations of therapies used to treat AD. Conclusion: This study has provided insights on the real-world management of moderate-to-severe AD in the Asia–Pacific region. The diverse approaches in diagnosis and treatment highlight the multifactorial nature of AD, reliance on clinical judgement, and importance of personalized care. To improve outcomes in patients with AD, it will be crucial to develop biomarkers for diagnosis, reduce subjectivity in assessment, as well as promote access to newer and effective therapies. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The objective of this study is to assess the correspondence, in live conditions, between clinical gradings of facial aging signs by three dermatologists and those afforded by an automatic AI‐based algorithm that analyses smartphones' selfie images of Chinese subjects.In total, 125 Chinese subjects of both genders, aged 18–62y, took a selfie using their own smartphones and were immediately viewed by three dermatologists. The latter graded the severity of 15 facial signs in women and 9 in men, using the standardized values afforded by a Skin Aging Atlas referential dedicated to Asian skin. The data issued by both methodologies were then statistically compared.The absolute gradings of the automatic system were found highly correlated with clinical assessments, with lower values in most cases. In women, large differences in absolute values were found on the gradings for size of isolated spot, cheek fold, spread macules, and texture of mouth contour women. Analysis of the Mean Absolute Errors (M.A.E) revealed that these rarely exceed 0.6 grading units in women and to a lesser extent in men.The present study confirmed the value of the automatic system towards an extended use towards large human cohorts as a surrogate of clinical evaluations and allowed to detect the points where improvements must be brought to the system. [ABSTRACT FROM AUTHOR]

Background: TikTok is one of the fastest‐growing social media platform, and its short‐form videos have become a widely used source of health information. "Dermarolling" is a form of roller microneedling often practiced at home, and patients may be using TikTok to inform their decision to pursue this treatment and their practice of it. Aims: This study assessed the informational content quality, source, and engagement of TikTok dermarolling videos to highlight potentially harmful social media trends. Methods: On a predetermined date, "dermarolling" was searched on TikTok. The top 75 results were screened. Number of views, creator type, type of video, and whether risks were discussed were recorded. Information quality was assessed using the DISCERN tool. The data were stratified by creator type, and statistical analysis was performed using R version 4.3.2. Median viewership and DISCERN scores were compared using Kruskal–Wallis tests with post hoc pairwise Wilcoxon tests. Fisher's exact test was used to compare rates of risk discussion between groups. Results: Sixty‐one of the reviewed videos met the inclusion criteria. Influencer videos engaged the largest overall audience and had higher median viewership than other creators. Physicians, primarily dermatologists, created exclusively educational content and influencers created mostly experience‐based content. Overall content quality was generally low‐moderate, with a median (IQR) DISCERN score of 30.5 (26.5–33.5). Physician content had higher median DISCERN scores than influencers (p = 0.004) and others (p = 0.004). Physicians were more likely to discuss risks compared to influencers (p = 0.02). Conclusions: TikTok content on "dermarolling" was of relatively low quality, and nonphysicians command a large viewership. Physician‐created content is often of higher informational quality, and dermatologists should escalate their efforts to engage patients in this space to mitigate the effects of potential misinformation. [ABSTRACT FROM AUTHOR]

Background: Pattern hair loss, the most common form of hair loss, affects millions in the United States. Americans are increasingly seeking health information from social media. It would appear that healthcare professionals contribute relatively minimally to pattern hair loss content, thereby posing serious concerns for credibility and quality of information available to the general public. Objectives: This study evaluates popular pattern hair loss‐related content on Instagram, TikTok, and YouTube, aiming to understand effective engagement strategies for healthcare professionals on social media. Methods: The top 60 short‐form videos were extracted from Instagram, TikTok, and YouTube, using the search term "pattern hair loss" and inclusion of USA‐based accounts only. Videos were categorized by creator type (healthcare vs. non‐healthcare professional), content type (informational, interactional, and transactional), and analyzed for user engagement and quality, using engagement ratios and DISCERN scores, respectively. Conclusions: Healthcare professionals, especially dermatologists, play a crucial role in delivering credible information on social media, supported by higher DISCERN scores. Multi‐platform presence, frequent activity, and strategic content creation contributes to increased reach and engagement. Duration of short‐form videos does not impact engagement. The "Duet" or "Remix" options on TikTok, Instagram, and YouTube serve as a valuable tool for healthcare professionals to counter misinformation. Our study underscores the importance of optimizing educational impact provided by health care professionals at a time when the public increasingly relies on social media for medical information. [ABSTRACT FROM AUTHOR]

Objectives This study contributes to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)'s effort to define 'difficult-to-treat' PsA (D2T-PsA), leveraging insights of healthcare professionals who are GRAPPA members. The primary objective is to inform GRAPPA's D2T PsA project, ensuring the consensus definition reflects clinical experience and expertise. Methods An online survey was conducted among GRAPPA's healthcare professionals managing PsA patients. The survey covered demographic details, structured questions, and open-ended queries to gather comprehensive insights into the experts' viewpoints. Results About 223 physicians completed the survey, comprising 179 (80.2%) rheumatologists and 40 (17.9%) dermatologists. The majority, 184 (82.5%), favoured establishing distinct definitions for D2T-PsA and complex-to-manage PsA (C2M-PsA). Furthermore, 202 (90.5%) supported a definition that includes objective inflammation signs (clinical, laboratory, imaging, among others). However, opinions varied on the criteria for prior treatment failures, with most (93, 41.7%) favouring a definition that includes at least one conventional synthetic disease-modifying anti-rheumatic drug and two or more biological- or targeted-synthetic-DMARDs with different mechanisms of action. Conclusion The survey reveals a majority opinion among GRAPPA experts favouring the differentiation between D2T-PsA and C2M-PsA, and the inclusion of objective inflammatory markers in these definitions. However, there is less than 50% agreement on the specific treatment failure criteria, particularly regarding the number of therapies needed to classify PsA as D2T. These findings suggest a need for continued discussion to reach a more unified approach in defining D2T-PsA, reflecting the complexity of the condition. [ABSTRACT FROM AUTHOR]

Automated segmentation algorithms for dermoscopic images serve as effective tools that assist dermatologists in clinical diagnosis. While existing deep learning-based skin lesion segmentation algorithms have achieved certain success, challenges remain in accurately delineating the boundaries of lesion regions in dermoscopic images with irregular shapes, blurry edges, and occlusions by artifacts. To address these issues, a multi-attention codec network with selective and dynamic fusion (MASDF-Net) is proposed for skin lesion segmentation in this study. In this network, we use the pyramid vision transformer as the encoder to model the long-range dependencies between features, and we innovatively designed three modules to further enhance the performance of the network. Specifically, the multi-attention fusion (MAF) module allows for attention to be focused on high-level features from various perspectives, thereby capturing more global contextual information. The selective information gathering (SIG) module improves the existing skip-connection structure by eliminating the redundant information in low-level features. The multi-scale cascade fusion (MSCF) module dynamically fuses features from different levels of the decoder part, further refining the segmentation boundaries. We conducted comprehensive experiments on the ISIC 2016, ISIC 2017, ISIC 2018, and PH2 datasets. The experimental results demonstrate the superiority of our approach over existing state-of-the-art methods. [ABSTRACT FROM AUTHOR]

Background/Objectives: Lentigo maligna (LM) and lentigo maligna melanoma (LMM) are significant subtypes of melanoma, with an annual incidence of 1.37 per 100,000 people in the U.S. These skin tumors, often found in photo-exposed areas such as the face, are frequently misdiagnosed, leading to delayed treatment or unnecessary excisions, especially in the elderly. Facial melanocytic skin tumors (lentigo maligna—LM/lentigo maligna melanoma—LMM) and their simulators (solar lentigo, pigmented actinic keratosis, seborrheic keratosis and lichen planus-like keratosis) often affect the periocular region. Thus, their diagnosis and management can involve different medical figures, mainly dermatologists and ophthalmologists. This study aimed to evaluate the ability of ophthalmologists to diagnose and manage pigmented skin lesions of the periorbital area. Methods: A multicentric, retrospective, cross-sectional study on a dataset of 79 periorbital pigmented skin lesions with both clinical and dermoscopic images was selected. The images were reviewed by six ophthalmologists and two dermatologists. Descriptive statistics were carried out, and the accuracy, sensitivity, and specificity, with their 95% confidence interval (95% CI), were estimated. Results: Ophthalmologists achieved a diagnostic accuracy of 63.50% (95% CI: 58.99–67.85%), while dermatologists achieved 66.50% (95% CI: 58.5–73.8). The sensitivity was lower for ophthalmologists in respect to dermatologists, 33.3% vs. 46.9%, respectively. Concerning the case difficulty rating, ophthalmologists rated as "difficult" 84% of cases, while for dermatologists, it was about 30%. Management was also consistently different, with a "biopsy" decision being suggested in 25.5% of malignant lesions by ophthalmologists compared with 50% of dermatologists. Conclusions: Ophthalmologists revealed a good diagnostic potential in the identification of periorbital LMs/LMMs. Given progressive population ageing and the parallel increase in facial/periorbital skin tumors, the opportunity to train new generations of ophthalmologists in the early diagnosis of these neoformations should be considered in the next future, also taking into account the surgical difficulty/complexity of this peculiar facial area. [ABSTRACT FROM AUTHOR]

Evaluation of vitiligo relies on accurate segmentation of lesions, and traditional segmentation methods mainly focus on near-field images. This study proposes a deep learning-based model for accurately segmenting lesions in wide-field vitiligo images. In this study, a dataset of 1267 wide-field vitiligo images was established to train and evaluate segmentation models. A Swin R-CNN model, which combined a Swin Transformer tiny network with a watershed algorithm, was proposed for segmenting lesions. The performances of the Swin R-CNN model and five other models were evaluated and compared through visual and quantitative perspectives. Additionally, the Spearman rank correlation test was performed to analyze result consistency between the Swin R-CNN model and dermatologists in measuring lesion area. The Swin R-CNN model accurately segmented lesions in the wide-field vitiligo images, surpassing other models in both visual and quantitative performance, with an average precision of 84.72% and an average recall of 77.81%. The correlation coefficients between the evaluation results of the Swin R-CNN model and three dermatologists were 0.88, 0.94, and 0.91, respectively. The Swin R-CNN model accurately segments lesions in the wide-field vitiligo images and quantifies lesion area at the dermatologist level. The Swin R-CNN model can provide reliable analytical results for the vitiligo evaluation. [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a chronic inflammatory skin condition that affects millions of individuals worldwide, impacting their physical and emotional well-being. The management of psoriasis requires effective communication and a strong physician–patient relationship. Objective: We aim to develop a novel algorithm to enhance patient well-being and care in moderate-to-severe psoriasis, considering the time constraints that dermatologists have in public hospitals. Methods: This project employed a multidisciplinary approach, involving collaboration between 14 experienced dermatologists (referred to as Key Opinion Leaders: KOLs) and a psychologist. During three separate meetings (an initial virtual session, a face-to-face meeting, and a final virtual meeting), an algorithm (Embracing Patients' Well-being in their Journey of Moderate-to-Severe psoriasis: EMPATHY), describing the patient's reception through the entire first visit and follow-up visits, was developed and refined. Results: The EMPATHY algorithm provides a step-by-step approach from the moment the patient arrives at reception, through the first visit and on to subsequent visits. This algorithm fills a critical gap in the existing guidelines by specifically addressing how to foster empathy during psoriasis patient visits within time-limited consultations. The algorithm outlines patient-centered strategies at each visit. Key aspects include creating a welcoming environment, active listening, respecting privacy, tailoring communication styles, and managing patient expectations. Conclusions: The EMPATHY algorithm represents a novel and promising approach to improving patient care and well-being in moderate-to-severe psoriasis. Developed together by dermatologists and a psychologist, this algorithm offers healthcare providers practical guidance for managing both initial and follow-up patient visits. While further validation is necessary, the potential for adapting the EMPATHY algorithm to diverse healthcare settings and patient populations holds promise for improving patient outcomes across various chronic conditions. [ABSTRACT FROM AUTHOR]

Objective There is growing interest in the early identification of patients with axial PsA (axPsA). We aimed to evaluate whether a dermatology-based screening strategy could help to identify axPsA patients. Methods The dermatologist-centred screening (DCS) questionnaire was administrated by dermatologists to consecutive patients fulfilling the inclusion criteria [(i) age ≥18 years and (ii) clinical diagnosis of psoriasis made by a dermatologist] to identify patients eligible (affirmative answers 1–3c of the DCS) for rheumatological evaluation. Clinical, laboratory, genetic and imaging data were collected from all referred patients. Results Among the 365 patients screened, 265 fulfilled the inclusion criteria and 124/265 (46.8%) were eligible for rheumatological referral. Diagnosis of axPsA, with or without peripheral PsA (pPsA), was made in 36/124 (29.0%) patients; pPsA without axial involvement was found in 21/124 (16.9%) patients. Back pain at screening was recorded in 174 (66%) patients, with 158 (60%) reporting a back pain duration longer than 3 months and 140 (53%) reporting back pain onset before the age of 45 years. Active inflammatory and/or structural post-inflammatory changes in the sacroiliac joints and/or spine were observed in all axPsA patients. Patients with PsA showed a numerically longer duration of back pain and higher CRP levels in comparison with patients with psoriasis without PsA. Conclusion The DCS tool proved to be a valuable screening strategy for detecting and characterizing patients with axPsA in a real-life cohort of psoriasis patients in a dermatological setting and helped to identify a substantial number of patients affected by undiagnosed pPsA. [ABSTRACT FROM AUTHOR]

OBJECTIVE: There is little consensus regarding the nomenclature and prognostic implications of synchronous melanomas. Here, we present a case of synchronous cutaneous melanoma and perform a systematic review of similar cases in the literature. METHODS: Pubmed and EMBASE databases were queried for relevant English-language articles published from inception until 2023. Cases of "multiple primary cutaneous melanomas" that occurred within a time frame of three months or less were included. Exclusion criteria included non-cutaneous melanomas and cases without specific time intervals or those occurring beyond a three-month period. Data including patient age, sex, risk factors, cutaneous melanoma (CM) anatomic location, CM clinicohistologic features, and prognosis were extracted from relevant articles. RESULTS: Nineteen case reports/series documenting 22 patients with multiple primary melanomas (MPM) occurring within a three-month interval. Overall, 66 melanomas were diagnosed, with an average of three (SD±2.1, median: 2) per patient. A majority (63%) of patients had one or more risk factors for skin cancer. Subsequent CM found within three-month interval were thinner than the first found (index) CM, more likely to be melanoma in situ (MMis) and have highest degree of anatomic concordance if the index lesion was first found on the trunk (50%). Two retrospective cohort studies (n=4,703; n=13) of melanomas occurring within three-month interval found similar results. LIMITATIONS: Limitations to our review included inconsistent reporting in the literature and use of terminology and a limited number of case reports and case series found in the literature. CONCLUSION: Synchronous primary cutaneous melanomas are a heterogenous collection of terminologies that may limit the ability of dermatologists to accurately diagnose, prognosticate, and treat high-risk patients. Given lack of guidelines, we recommend the use of the term "synchronous" to delineate additional primary cutaneous melanomas found within a three-month interval. [ABSTRACT FROM AUTHOR]

The inclusion of participants from underrepresented and underserved groups is lagging in dermatology clinical trials. Through dissemination of a pilot survey at a community skin health fair, knowledge, participation, and perspectives of clinical trials were evaluated in an urban, medically underserved community in Washington, DC. Clinical trial-related questions were derived from the Health Information National Trends Survey 5 Cycle 4. This cross-sectional survey analyzed responses from 39/55 attendees (71% response rate). Most respondents were female (23/37 [62.2%]), between the ages of 25 and 54 (19/38, [50.0%]), and self-identified as non-white (35/39 [89.7%]) with a majority self-identifying as Black (16/31 [41%]). Most respondents self-reported knowing "little" to "nothing" about clinical trials (26/35 [74.3%]), and even more were unaware of the federal resource clinicaltrials.gov (30/37 [81.1%]). Few respondents discussed clinical trials as a treatment option with their healthcare provider (8/35 [22.9%]), yet having a discussion was significantly correlated with clinical trial participation (p = 0.0302). Self-reported level of knowledge was not significantly associated with participation in a clinical trial (p = 0.3035). Healthcare providers were the preferred first source of clinical trial information, followed by an internet search. Respondents rarely cited mistrust or skepticism as a barrier to participation (2/34 [5.9%]). Subjective positive healthcare experiences were significantly correlated to positive expectations with clinical trial participation (p = 0.0242). The findings of this study suggest the essential role healthcare providers, including dermatologists, play in clinical trial education and recruitment of underrepresented populations, and that patient mistrust may be present but is a rarely cited barrier to clinical trial participation. [ABSTRACT FROM AUTHOR]

The lack of access to dermatological care is a global health crisis, with skin diseases being the fourth leading cause of nonfatal disease burden worldwide. To address this issue, the GLODERM international mentorship program was launched by the International League of Dermatological Societies – International Foundation for Dermatology. The program pairs dermatology trainees and clinicians from low- and middle-income countries with experienced mentors in global health dermatology. The program includes monthly meetings, virtual lectures, and personalized professional development opportunities. The first cohort of mentees reported improvements in leadership skills and the ability to train healthcare providers and serve patients in underserved areas. The program aims to build a network of dermatology leaders to improve access to skin health globally. [Extracted from the article]

Background Biologic therapies have led to increasing numbers of patients with psoriasis who have clear or nearly clear skin. It is current practice to continue biologic therapy indefinitely in these patients, which contributes to a substantial long-term drug and healthcare burden. 'As needed' biologic therapy in psoriasis may address this; however, our understanding of patient and clinician perceptions of this strategy is limited. Objectives The aim of this mixed-methods study was to gain insight into the perspectives of both patients and clinicians regarding the acceptability of an 'as needed' approach to biologic therapy in psoriasis, including potential barriers and enablers to implementation in routine care. Methods We first conducted UK-wide online scoping surveys of patients with psoriasis and dermatology clinicians to explore their views on 'as needed' biologic therapy. Using topic guides informed by these survey findings, we then carried out qualitative focus groups with patients and clinicians. Themes were identified using reflexive thematic analysis. Results Of 67 patients and 27 clinicians completing the scoping surveys, 67% (43 of 64 patients) and 78% (21 of 27 clinicians) supported the use of 'as needed' biologic therapy, respectively. Respondents highlighted advantages such as a reduction in healthcare burden and greater ownership of care. Challenges included logistics of 'as needed' drug provision and potential risks of disease flare and drug immunogenicity. Focus groups comprised 15 patients with psoriasis [9 female patients (60%), average disease duration 32 years (range 9–64)] and 9 dermatology clinicians [8 female clinicians (89%), average dermatology experience 20 years (range 8–33)]. Both patients and clinicians felt that an 'as needed' treatment approach will deliver a reduction in treatment burden and present an opportunity for patient-led ownership of care. Both groups highlighted the importance of ensuring ongoing access to medication and discussing the potential impact of psoriasis recurrence. Patient preferences were influenced by their lived experiences, particularly previous difficulties with medication delivery logistics and establishing disease control. Clinician perspectives were informed by personal experience of their patients adapting their own dosing schedules. Clinicians highlighted the importance of targeted patient selection for an 'as needed' approach, ongoing disease monitoring, and prompt reaccess to medications upon psoriasis recurrence. Conclusions These data indicate that 'as needed' biologic therapy in psoriasis is acceptable for both patients and clinicians. Formal assessment of clinical effectiveness and cost-effectiveness is warranted to enable the real-world potential of this approach to be realized. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Although rare, crusted scabies can affect immunocompetent individuals with no identifiable risk factors. A high index of suspicion, regardless of an individual's immunological status or absence of traditional risk factors, should be maintained by health professionals to facilitate prompt referral to a dermatologist. Crusted scabies is an uncommon variant of human scabies characterized by extensive crusted and scaly hyperkeratotic papules, and plaques resulting from profound proliferation of mites in the skin. It is highly contagious and typically occurs in immunocompromised individuals. Reports of cases in healthy adults are rare. It is often resistant to routine treatment. We report a case of a 30‐year‐old immunocompetent male who presented to us with an extensive pruritic papular rash that started in the inter‐digital web spaces of his hands. Within 3 months from onset, the lesions progressed, and became hyperkeratotic, scaly, non‐pruritic, spreading to involve his entire body (sparing his face only). Crusty scabies was eventually diagnosed and treated by a dermatologist after months of misdiagnosis at peripheral facilities. Although rare, crusted scabies can affect immunocompetent individuals. A high index of suspicion is required, regardless of immunological status. Among immunocompetent individuals, a thorough search for traditional risk factors is imperative. [ABSTRACT FROM AUTHOR]

This document is an interview with Professor John McGrath, a prominent figure in the field of dermatology and venereology. The interview provides information about McGrath's academic education, professional career, memberships in various societies, and awards and honors he has received. McGrath discusses his journey into dermatology, his most important teachers and mentors, his best publications, and his achievements and disappointments in his professional life. He also shares his thoughts on the future of dermatology, the next breakthroughs in the field, and offers advice to younger colleagues. [Extracted from the article]

Background Objective Methods Results Conclusions Despite the widespread off‐label use of methotrexate (MTX) for the treatment of atopic dermatitis (AD), there is limited high‐quality evidence on dosing regimens and existing guidelines do not provide clear recommendations regarding dosing strategies.The aim of this study was to achieve international consensus among AD experts to standardize the dosing regimen for MTX treatment in adults and children with AD.An electronic Delphi (eDelphi) study was conducted from October 2021 to September 2022. Recruitment was conducted through dermatology societies and AD interest groups. Participation was open to dermatologists and dermatology residents experienced in treating AD patients with MTX. The study consisted of three online rounds. The first round was informed by a systematic review of relevant literature, and subsequent rounds were adjusted based on the results of the previous round. Participants voted on 19 proposals using a 9‐point scale (1–3 disagree, 4–6 neither agree nor disagree, 7–9 agree). Consensus was achieved when at least 70% of participants agreed, and less than 15% disagreed. Proposals that did not reach consensus in the first three rounds were discussed in a consensus meeting, where consensus was defined as less than 30% disagreement.In total, 152 participants completed Round 1, 104 (68%) completed all survey rounds, and 43 (28%) joined the consensus meeting. Consensus was achieved on 7 proposals in Round 1, 4 in Round 2 and 6 in Round 3. The final 2 proposals reached consensus during the consensus meeting. Consensus topics include test dose, start dose, maximum dose, administration route, dosing schedule, management of stopping treatment, treatment duration and folic acid supplementation.This eDelphi study achieved consensus on 19 proposals related to MTX dosing for adults and children with AD. These results aim to guide prescribing decisions and encourage a standardized global approach to MTX use in AD. [ABSTRACT FROM AUTHOR]

This article discusses the integration of narrative medicine into dermatology residency training. Narrative medicine is the practice of recognizing and interpreting the stories of illness, allowing for a more holistic understanding of patients and their experiences. The article emphasizes the importance of listening, empathy, and non-judgment in building a narrative from patient interactions. It also explores how narrative medicine can complement the use of artificial intelligence in healthcare. The article highlights the significance of understanding the individual stories of those with skin diseases and calls for the implementation of a narrative medicine curriculum in dermatology training. It provides goals for such a curriculum, including enhancing observational skills, incorporating arts and humanities, and exploring social and cultural issues affecting skin health. The article suggests a pedagogic approach to developing narrative competence and addresses challenges and solutions for integrating narrative medicine into healthcare. It concludes by emphasizing the transformative power of narrative medicine in patient care and the need for a more inclusive and understanding medical practice. [Extracted from the article]

Background: There is a huge demand–supply gap between the incidence of genital dermatoses (including sexually transmitted infections and non‐venereal genital dermatoses) and physicians trained to manage them. Objectives: To find out the performance of an artificial intelligence (AI)‐based mobile application in the image diagnosis of genital dermatoses, and to compare it with primary care physicians (PCPs) and dermatologists. Methods: Photos of the genital diseases of consecutive patients presenting to the STD and genital diseases clinic were included. The gold standard diagnosis was established by the consensus of two certified dermatologists after examination and one positive investigation. Image diagnoses by the DermaAId application, two PCPs, and two dermatologists were recorded and compared to the gold standard diagnosis and to each other. Results: A total of 257 genital disease images, including 95 (37.0%) anogenital warts, 60 (22.2%) lichen sclerosus, 20 (7.8%) anogenital herpes, 15 (5.8%) tinea cruris, 14 (5.4%) molluscum contagiosum, 9 (3.5%) candidiasis, 8 (3.1%) scabies, 6 (2.3%) squamous cell carcinomas, were included. The top‐1 correct diagnosis rate of the application was 68.9%, compared to the 50.4% of the PCPs and 73.2% of the dermatologists. The application significantly outperformed PCPs with regard to the correlation with the gold standard diagnosis (P < 0.0001), and matched that of the dermatologists. Conclusions: AI‐based image diagnosis platforms can potentially be a low‐cost rapid decision support tool for PCPs, integrated with syndromic management programs and direct‐to‐consumer services, and address healthcare inequities in managing genital dermatoses. [ABSTRACT FROM AUTHOR]

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Deep learning can exceed dermatologists' diagnostic accuracy in experimental image environments. However, inaccurate segmentation of images with multiple skin lesions can be seen with current methods. Thus, information present in multiple-lesion images, available to specialists, is not retrievable by machine learning. While skin lesion images generally capture a single lesion, there may be cases in which a patient's skin variation may be identified as skin lesions, leading to multiple false positive segmentations in a single image. Conversely, image segmentation methods may find only one region and may not capture multiple lesions in an image. To remedy these problems, we propose a novel and effective data augmentation technique for skin lesion segmentation in dermoscopic images with multiple lesions. The lesion-aware mixup augmentation (LAMA) method generates a synthetic multi-lesion image by mixing two or more lesion images from the training set. We used the publicly available International Skin Imaging Collaboration (ISIC) 2017 Challenge skin lesion segmentation dataset to train the deep neural network with the proposed LAMA method. As none of the previous skin lesion datasets (including ISIC 2017) has considered multiple lesions per image, we created a new multi-lesion (MuLe) segmentation dataset utilizing publicly available ISIC 2020 skin lesion images with multiple lesions per image. MuLe was used as a test set to evaluate the effectiveness of the proposed method. Our test results show that the proposed method improved the Jaccard score 8.3% from 0.687 to 0.744 and the Dice score 5% from 0.7923 to 0.8321 over a baseline model on MuLe test images. On the single-lesion ISIC 2017 test images, LAMA improved the baseline model's segmentation performance by 0.08%, raising the Jaccard score from 0.7947 to 0.8013 and the Dice score 0.6% from 0.8714 to 0.8766. The experimental results showed that LAMA improved the segmentation accuracy on both single-lesion and multi-lesion dermoscopic images. The proposed LAMA technique warrants further study. [ABSTRACT FROM AUTHOR]

The role of vertical ex vivo dermoscopy relevant to clinical diagnosis has not been investigated yet. Study objectives were defining, describing, and determining the importance of the structures visible using vertical ex vivo dermoscopy in the diagnosis of malignant skin lesions, as well as determining their accuracy in the assessment of tumor margins. A prospective, descriptive study was conducted in two University centers. Digital images of completely excised skin lesions, fixed in formalin, before histopathological diagnosis were used for analysis. BCCs had the most diverse dermoscopic presentation on the vertical section, while SCCs showed a similar presentation in most cases. Vertical dermoscopy of thin melanomas was almost identical, unlike nodular melanomas. Thickness accuracy assessed by dermatologist was 0.753 for BCC, 0.810 for SCC, and 0.800 for melanomas, whereas assessment by pathologist was 0.654, 0.752, and 0.833, respectively. The accuracy of tumor width assessment was 0.819 for BCCs, 0.867 for SCCs and 1.000 for melanoma as estimated by a Dermatologist. Interobserver agreement was 0.71 for BCC, 0.799 for SCC and 0.832 for melanomas. Vertical ex vivo dermoscopy may contribute to the distinction between BCCs, SCCs, and melanomas. Moreover, regardless of the doctor's specialty, it enables a good assessment of the tumor's margins. [ABSTRACT FROM AUTHOR]

Scars (Acne, Burn, and Surgical) originate in the site of tissue injury may cause distress to patients. To decide the viability of nonablative fragmentary laser (NAFL) and ablative partial laser (AFL) to creating appearance of scars.A Eighty-three patients had a scar due to acne, a trauma or surgery. Every portion of the scar at 4-week is treated by AFL or NAFL then, at that point, utilizing the size of Patient and Onlooker Scar and a fulfillment score by understanding and utilizing the size of Manchester Scar and visual simple by dermatologists. Scar appearance reported by dermatologists had no statistically significant difference. But, it had an improvement of scar appearance detailed by patients (p < .0001). In any case, two laser treatments revealed by patients and dermatologists had no genuinely critical proof (p = .3173 and p = .2513, separately). High tolerant fulfillment for Scar treatment with AFL or NAFL. Yet, dermatologists didn't decide improvement in scar appearance. [ABSTRACT FROM AUTHOR]

Skin melanoma is a potentially fatal form of cancer. If left untreated or allowed to spread, it can lead to death or serious disability. Therefore, early diagnosis is crucial for improving patient prognosis and outcomes. Recent advances in machine learning (ML) and deep learning (DL) have greatly contributed to the categorisation and identification of melanoma. The goal of this survey is to evaluate 60 publications that have been submitted in order to create an overview of the melanoma detection process. It examines several feature extraction techniques.The evaluation concentrates on different melanoma detection methods, including 'deep learning (DL)' and 'machine learning (ML)' models. The analysis includes performance metrics and a review of the results obtained from the PH2 dataset, which achieved a high accuracy of 96.5%. Finally, the survey addresses research gaps to facilitate future investigations into melanoma identification strategies. [ABSTRACT FROM AUTHOR]

This article offers an up-to-date overview of resources tailored for dermatology residents in the United States preparing for their board certification exams. We have assembled a comprehensive list of exam preparation resources categorized by cost, alongside recommendations from attending and resident physicians regarding the most effective resources for each exam. Although examinations are only one facet of the training involved in becoming a competent dermatologist, these exams help residents focus on learning crucial aspects of medicine. This review aims to furnish a concise summary of available resources for dermatology residents, organized by cost. The average cost of a paid dermatology question bank resource in this review was approximately $279, reflecting the need for review resources for board exam preparation that can fit a resident physician's budget or are free to use. [ABSTRACT FROM AUTHOR]

Xerosis is highly prevalent in the population aged over 50 years and substantially impacts quality of life due to the associated stigma, related pruritus, and potential sequelae. We propose that the term mature xerosis be used for subjects over 50 who suffer from age‐related xerosis and replace senile xerosis to describe the phenomenon. The etiology of xerosis depends on genetic and environmental factors that affect stratum corneum hydration and skin barrier function. Skincare to restore barrier function is essential in xerosis treatment and is relevant for maintaining and preventing its progression. Many moisturizers and cleansers are available for xerosis; however, they are underutilized by patients with mature xerosis. A panel of eight global dermatologists reviewed the unique aspects of xerosis in mature skin and discussed the specific needs, relevance, and considerations for skincare selection to prevent, treat, and maintain skin with mature xerosis. The panel selected five statements based on evidence from a literature review and the panel's clinical experience to provide clinical considerations and recommendations for dermatologists and other healthcare providers treating patients with mature xerosis. Increased recognition of the burden of xerosis in mature skin is warranted. Gentle cleansers and barrier‐restoring ceramide‐containing moisturizers are essential to xerosis management, reducing signs and symptoms of xerosis, including associated pruritus. [ABSTRACT FROM AUTHOR]

Atypical presentations of cutaneous leishmaniasis include sporotrichoid leishmaniasis (LS), clinically described as a primary ulcer associated with lymphangitis and nodules, with or without ulcerated lesions along its course. In a city like Rio de Janeiro, where both leishmaniasis and sporotrichosis can coexist, this poses a significant challenge for dermatologists. Atypical presentations of cutaneous leishmaniasis include sporotrichoid leishmaniasis (LS), clinically described as a primary ulcer associated with lymphangitis and nodules, with or without ulcerated lesions along its course. In a city like Rio de Janeiro, where both leishmaniasis and sporotrichosis can coexist, this poses a significant challenge for dermatologists. [ABSTRACT FROM AUTHOR]

Introduction: Teledermoscopy supports and enhances the early detection of skin lesions by general practitioners in primary practice through remote consultation with dermatologists. Teledermoscopy has been a regular health service in Dutch primary care since February 2009. Teledermoscopy quality and performance outcomes on Dutch general practitioner primary care 11 years after its implementation were assessed. Methods: Dutch primary care teledermoscopy consultation data was retrospectively analysed on timestamps and responses on non-mandatory evaluation questions posed to the general practitioner and teledermatologist during the teledermoscopy consultation process. Anonymized data (February 2009–February 2020) was extracted from a Dutch teledermoscopy service database. The timestamps and evaluation questions data were subject to the teledermoscopy quality and performance outcomes. A limited cost evaluation was performed. Results: A total of 18,738 teledermoscopy consultations were sent by 1341 general practitioners (February 2009–February 2020). For 3908 (31.9%) teledermoscopy consultations, the general practitioner requested second opinion advice which led to 712 (18.2%) extra teledermoscopy referrals of patients who would not have been referred without teledermoscopy, including skin cancer teledermoscopy diagnoses. The general practitioner followed the teledermatologists' advice on patient referral for 8813 (88.5%) patients, reported 97.3% of the teledermoscopy consultations as helpful and 95.1% as instructive, referred 68.0% less patients with teledermoscopy availability, referred overall 59.4% less patients, and needed 5.4 minutes (median) for sending a teledermoscopy consultation. Teledermatologist's median answer and response time was 2 minutes and 2.4 hours, respectively. The estimated cost reduction was €144.18 ($164.65) (50.2%) per teledermoscopy patient. Discussion: Teledermoscopy is a useful service in general practitioner practice for requesting dermatologist advice in primary care settings to support the detection of skin lesion at an early stage and at lower costs. Teledermoscopy could also decrease the burden of secondary dermatology care since general practitioners reported that they did not refer the majority of patients to a dermatologist after the teledermoscopy consultation compared to their initial referral decision. General practitioners reported the teledermoscopy system as helpful and instructive which could contribute to enhancement of their dermatological knowledge. [ABSTRACT FROM AUTHOR]

Introduction: One of the challenges faced by the Colombian Health System is to improve access to health services for the dispersed and isolated rural population, particularly in the field of dermatology. This article examines the implementation of a teledermatology service using a PC and camera versus smartphone technology. Methods: A total of 542 teledermatology visits were conducted, involving 478 patients, in addition to 64 visits for clinical follow-up for patients as per the dermatologist's recommendation. Out of the 478 patients, 461 met the inclusion criteria and agreed to participate in the study. The data collection instrument from the general practitioner or referring provider covered three consultation moments: (1) sending an initial consultation, (2) providing a response to the patient, and (3) sending a follow-up consultation. Seven hundred forty-seven records were completed by the general practitioner for the three consultation moments. Furthermore, 372 consultations were documented by the dermatologist or referring provider for two moments: (1) response to the initial consultation by the dermatologist, and (2) response to the follow-up consultation by the dermatologist. After validating the information reported in the instruments, a descriptive analysis of the data was conducted, utilizing absolute frequencies and percentages for qualitative variables and measures of central tendency (mean, median, standard deviation, and interquartile range) for quantitative variables. The data were analyzed from 747 records of the referring provider instrument related to 461 patients, between 18 and 98 years of age, with a predominantly female representation. Results: The results indicated that for teleconsultations conducted using a mobile device, the average total duration of the teleconsultation was longer on the traditional platform compared with the mobile device (13.03 vs. 8.27 min). Additionally, it was observed that the time taken to store, send, and capture a single image (clinical or dermoscopic) using the mobile device was three times lower than that on the conventional platform (25 vs. 75 s). Similar findings were noted for teleconsultations carried out by the dermatologist, predominantly utilizing a mobile device. The average consultation time was shorter for the mobile device compared with the traditional platform (8.14 vs. 12 min). Conclusions: The cost reduction suggests that the operation of the service is more efficient with smartphone technology in comparison to the use of a PC and camera. Teledermatology with smartphones provides a streamlined, efficient, and technically sound process for obtaining clinical and dermoscopic images. [ABSTRACT FROM AUTHOR]

The article discusses efforts to expand education on skin lightening products. Topics include how skin lightening products are marketed in the U.S., impact of the Coronavirus Aid, Relief, and Economic Security (CARES) Act on over-the-counter (OTC) skin lightening products, and factors that drive the consumer motivation to use skin lightening products.