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The use of prostheses in individuals with limb loss increases the risk of maceration, friction, and pressure-induced skin injuries due to the vulnerability of the residual limb and the close contact with the socket. Poorly fitting prostheses exacerbate these issues, especially for those with immunosuppression or vascular conditions. Skin pathologies disrupt daily prosthetic limb use and impact the independence of those with limb loss. Preventive measures, including proper prosthesis socket fitting and meticulous skin care, are crucial. This review explores residual limb-site skin pathologies and details current mitigation and management strategies., Competing Interests: Disclosure Contents of this study represent the opinions of the authors and not necessarily those of the US Department of Veterans Affairs, the University of South Florida, or any other academic or health care agency or institution. This project was unfunded. The authors declare no conflict of interest., (Published by Elsevier Inc.)

Photobiomodulation (PBM) is an emerging treatment modality in dermatology with increasing office and home-based use. PBM is the use of various light sources in the red light (620-700 nm) and near-infrared (700-1440 nm) spectrum as a form of light therapy. PBM is often administered through low-level lasers or light-emitting diodes. Studies show that PBM can be used effectively to treat conditions secondary to cancer therapies, alopecia, ulcers, herpes simplex virus, acne, skin rejuvenation, wounds, and scars. PBM offers patients many benefits compared to other treatments. It is noninvasive, cost-effective, convenient for patients, and offers a favorable safety profile. PBM can be used as an alternative or adjuvant to other treatment modalities including pharmacotherapy. It is important for dermatologists to gain a better clinical understanding of PBM for in-office administration and to counsel patients on proper application for home-use devices to best manage safety and expectations as this technology develops. PBM wavelengths can induce varied biological effects in diverse skin types, races, and ethnicities; therefore, it is also important for dermatologists to properly counsel their skin of color patients who undergo PBM treatments. Future clinical trials are necessary to produce standardized recommendations across conditions and skin types., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2024. Published by Elsevier Inc.)

Photobiomodulation (PBM), previously known as low-level laser light therapy, represents a noninvasive form of phototherapy that utilizes wavelengths in the red light (RL, 620-700 nm) portion of the visible light (VL, 400-700 nm) spectrum and the near-infrared (NIR, 700-1440 nm) spectrum. PBM is a promising and increasingly used therapy for the treatment of various dermatologic and nondermatologic conditions. Photons from RL and NIR are absorbed by endogenous photoreceptors including mitochondrial cytochrome C oxidase (COX). Activation of COX leads to the following changes: modulation of mitochondrial adenosine triphosphate (ATP), generation of reactive oxygen species (ROS), and alterations in intracellular calcium levels. The associated modulation of ATP, ROS and calcium levels promotes the activation of various signaling pathways (eg, insulin-like growth factors, phosphoinositide 3-kinase pathways), which contribute to downstream effects on cellular proliferation, migration, and differentiation. Effective PBM therapy is dependent on treatment parameters (eg, fluence, treatment duration and output power). PBM is generally well-tolerated and safe with erythema being the most common and self-limiting adverse cutaneous effect., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2024. Published by Elsevier Inc.)

Excimer light is a subtype of NB-UVB that emits a 308 nm wavelength, and can provide targeted phototherapy treatment. The absorption of 308 nm light by skin cells leads to therapeutic response in various common and ultraviolet-responsive skin diseases, such as psoriasis and vitiligo, and photo-resistant skin diseases such as prurigo nodularis, localized scleroderma, genital lichen sclerosis, and granuloma annulare, cutaneous T-cell lymphomas, among others. Excimer light has few adverse reactions and overall is well tolerated by patients, furthermore, it can be performed in places that are difficult to access. This article aims to explain the therapeutic bases and applications of excimer light in current dermatology., (Copyright © 2024 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Proficiency in dermatopathology is important for comprehending the mechanisms of skin diseases and determining efficacious clinical management. Dermatopathology learning is a core requirement for both dermatology and pathology residencies. Many traditional educational methods have been utilized over decades for teaching our residents. In the recent digitized era, technological advances are impacting the study and practice of medicine. Several innovative tools have become available that complement the conventional learning model. This contribution provides guidelines for establishing a robust dermatopathology rotation for residents and insights into the present and future advances in novel educational tools. Dermatopathology is an ever-growing body of knowledge. It takes years to accumulate practical knowledge of this discipline and requires a continuing effort to maintain and keep it updated. This journey of learning starts during the early years of postgraduate medical education. Attaining competency in dermatopathology is vital for both dermatology and pathology residents. The earlier the exposure they receive, the better the foundation and understanding of cutaneous disease processes they develop. Comprehensive training in the subspecialty of dermatopathology is critical for their medical education and the future practice.

Introduction: District hospitals in KwaZulu-Natal Province, South Africa, do not have onsite specialist dermatology services. Doctors at these hospitals use WhatsApp instant messaging to informally seek advice from dermatologists and colleagues before possible referral. They have expressed the need to formalise WhatsApp teledermatology., Aim: To determine the views and perspectives of clinicians on the feasibility and practicality of formalising the current WhatsApp-based teledermatology activities within the KwaZulu-Natal Department of Health Dermatology Service., Methods: Key informant interviews with 12 purposively selected doctors at district hospitals and all 14 dermatologists in the KwaZulu-Natal dermatology service. Their views and perspectives on formalising the current informal use of WhatsApp for teledermatology were recorded, transcribed, and thematically analysed., Results: Five primary themes (communication, usability, utility, process, and poor understanding of legal, regulatory, and ethical issues) and 22 sub-themes were identified. Clinicians wanted WhatsApp teledermatology to continue, be formalised, and be incorporated within the KwaZulu-Natal Department of Health, facilitated by the provision of practical guidelines addressing legal, regulatory, and ethical issues., Conclusions: These findings will be used to develop a policy brief, providing recommendations and proposed guidelines for formalising the teledermatology service. The findings and methods will be relevant to similar circumstances in other countries.

Background: Although the number of teledermatology studies is increasing, not all variables have been researched in equal depth, so there remains a lack of robust evidence for some teledermatology initiatives. This review describes the landscape of teledermatology research and identifies knowledge gaps and research needs. This evidence map can be used to inform clinicians about the current knowledge about teledermatology and guide researchers for future studies., Methods: Our evidence map was conducted according to the Campbell Collaboration checklist for evidence and gap maps. Eight databases were searched (CINAHL, Embase, PubMed, Scopus, Web of Science, Cochrane Library, JBI Database of Systematic Reviews and Implementation Reports, and OpenGray), and only included systematic reviews of teledermatology involving humans published in English; while excluding non-systematic reviews (i.e., abstracts, conference proceedings, editorials, commentaries, or letters). From 909 records, 14 systematic reviews published between 2004 and 2022 were included. Our analysis focused on the systematic reviews' characteristics, dermatological conditions studied, rate of overlap and quality assessment of primary studies reviewed, and main findings reported., Results: Teledermatology was reportedly comparable with clinic dermatology and generally accepted by patients as a mode of care delivery for dermatological conditions. However, there are concerns about privacy, communication, completeness of information transmitted, familiarity with the technology, and technical problems. Healthcare professionals were generally satisfied with teledermatology but found telemedicine consultations longer than face-to-face consultations, and less confident in asynchronous teledermatology than conventional consultations. Teledermatology was reportedly more cost-effective than clinic dermatology; especially considering the distance traveled by patients, referral volume to teledermatology, and clinic dermatology costs. Although patients and providers are satisfied with teledermatology, face-to-face dermatology has higher diagnostic and management accuracy. Teledermatology was also used for training medical professionals. Regarding the validity and reliability of teledermatology outcome measures, no significant discussions were found., Conclusions: COVID-19 spotlighted telemedicine in clinical care, and we must ensure telemedicine continually improves with robust research. Further research is necessary for establishing a standardized outcome set, enhancing accuracy, concordance, cost-effectiveness, and safety, comparing teledermatology with non-dermatologist care, examining its effectiveness in non-Western low and middle-income countries, and incorporating patient involvement for improved study design., Systematic Review Registration: https://www.researchregistry.com/ (Unique Identifying Number: reviewregistry878)., (© 2024. The Author(s).)

Cold atmospheric plasma (CAP) technology has emerged as a revolutionary therapeutic technology in dermatology, recognized for its safety, effectiveness, and minimal side effects. CAP demonstrates substantial antimicrobial properties against bacteria, viruses, and fungi, promotes tissue proliferation and wound healing, and inhibits the growth and migration of tumor cells. This paper explores the versatile applications of CAP in dermatology, skin health, and skincare. It provides an in-depth analysis of plasma technology, medical plasma applications, and CAP. The review covers the classification of CAP, its direct and indirect applications, and the penetration and mechanisms of action of its active components in the skin. Briefly introduce CAP's suppressive effects on microbial infections, detailing its impact on infectious skin diseases and its specific effects on bacteria, fungi, viruses, and parasites. It also highlights CAP's role in promoting tissue proliferation and wound healing and its effectiveness in treating inflammatory skin diseases such as psoriasis, atopic dermatitis, and vitiligo. Additionally, the review examines CAP's potential in suppressing tumor cell proliferation and migration and its applications in cosmetic and skincare treatments. The therapeutic potential of CAP in treating immune-mediated skin diseases is also discussed. CAP presents significant promise as a dermatological treatment, offering a safe and effective approach for various skin conditions. Its ability to operate at room temperature and its broad spectrum of applications make it a valuable tool in dermatology. Finally, introduce further research is required to fully elucidate its mechanisms, optimize its use, and expand its clinical applications., (© 2024. The Author(s).)

Atopic dermatitis, psoriasis, rosacea, seborrheic dermatitis, allergic contact dermatitis, and irritant contact dermatitis comprise a large proportion of chronic inflammatory dermatoses. This paper reviews the clinical presentations, pathophysiology, and therapeutics of inflammatory dermatoses, highlighting recent drug developments such as lebrikizumab for atopic dermatitis as well as deucravacitinib and spesolimab for psoriasis. Chronic inflammatory dermatoses significantly impact patient quality of life and contribute to substantial healthcare costs. Effective management of severe cases often requires systemic therapies and biological therapies. A thorough clinical evaluation with a tailored therapeutic approach is essential for delivering optimal care to individuals with chronic inflammatory skin diseases.

Background: This cross-sectional analysis intends to evaluate trend and outlook of industry clinical research in Italy regarding dermatology and its prospects for the next few years., Methods: A computerized search of ClinicalTrial.gov database was carried out considering the 20-year period 2003-2022 using the following string: "Skin Diseases OR Skin cancer OR Skin Neoplasms OR Skin Infection OR Skin Lesion OR Skin Ulcer OR Skin Laxity OR Skin toxicity OR Dermatologic Complication OR Skin abnormalities"., Results: During the last 20 years 690 Industry Clinical Trials (IndCTs) were conducted in Italy regarding dermatological investigations, almost entirely funded by non-Italian pharmaceutical companies, involving 4497 centers, and recruiting an average of 13.0 subjects per site. The number of controlled and randomized studies has grown quite regularly and in the last 5 years they represented 79.6% of IndCTs initiated. Countries most frequently sharing with Italy international protocols were Spain (75.0%), Germany (71.8%), France (68.5%), the USA (67.4%), and the UK (54.8%). These data point to a historical involvement of Italy in dermatology IndCTs lower than in the major European countries. However, the war in Ukraine has deprived IndCTs of the contribution of Russia, Ukraine, and Belarus, meaning a mean of about 40 new IndCTs per year in a population of 200 million inhabitants. In contrast, many indicators point to Italy as a country with potential in dermatology wider than used in the past: an efficient health care system accessible to any citizen or resident, 4.6 million dermatological interventions per year, low density of IndCTs concerning dermatology, good production of scientific papers in indexed medical journals, relatively low cost of services and labour and geopolitical stability., Conclusions: The European Clinical Trials Information System's (CTIS), mandatory for the EU member states since early 2023 allows common, simplified, and harmonized regulatory procedures over the life cycle of clinical trials in Europe (EMA, 2023) and plays in favor of Italy's greater competitiveness in clinical research.

The cutaneous microbiome represents a highly dynamic community of bacteria, fungi and viruses. Scientific evidence, particularly from the last two decades, has revealed that these organisms are far from being inconsequential microscopic hitchhikers on the human body, nor are they all opportunistic pathogens waiting for the chance to penetrate the skin barrier and cause infection. In this review, we will describe how dermatological diseases have been found to be associated with disruptions and imbalances in the skin microbiome and how this new evidence had shaped the diagnosis and clinical practice relating to these disorders. We will identify the microbial agents which have been found to directly exacerbate skin diseases, as well as those which can ameliorate many of the symptoms associated with dermatological disorders. Furthermore, we will discuss the studies which suggest that bacteriotherapy, either by topical use of probiotics or by bacteria-derived compounds, can rectify skin microbial imbalances, thereby offering a promising alternative to antibiotic treatment and reducing the risks of antibiotic resistance., (© 2024 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Objectives: Teledermatology is a cost-effective and efficient approach to delivering care and is particularly beneficial for patients with limited access to specialized services. Considering the rapid expansion of telehealth, it is crucial to focus on optimization. The purpose of our study was to evaluate the triaging of dermatologic care in an electronic consultation (e-consultation) service in a safety-net hospital., Methods: This was a 2-year retrospective review of a dermatology asynchronous store-and-forward e-consultation service., Results: A total of 1425 patients completed 1502 e-consultation. Of these e-consultations, 46% of the patients had Medicaid and 44% were Black or African American. The top three diagnoses were dermatitis unspecified, neoplasm of uncertain behavior, and acne/rosacea. Most (68%) were managed via e-consultation and did not require an in-person appointment. Children and adolescents were more likely to require an in-person appointment (74%) compared with adults (30%, P < 0.0001). Patients with a chief complaint of hair loss or skin lesion were more likely to require in-person evaluation (58% and 41%, respectively) compared with rash (24%) and acne (18%) ( P < 0.0001). There was no difference found in recommendations for in-person evaluation based on race, non-English-language preference, or insurance status., Conclusions: E-consultation services seem well suited for certain concerns, and underserved populations can be evaluated by teledermatology.

Background: Extracorporeal shock wave therapy (ESWT) enhances extracellular matrix remodeling and tissue regeneration by promoting growth factor release, regulating blood and lymphatic flows, and reducing fat and fibrotic tissues. Focused shock wave therapy (F-SWT), radial shock wave therapy (R-SWT), and combined F-SWT and R-SWT have been used to deliver different patterns of shock energy depending on the characteristics of the target lesions., Methods: We investigated the efficacy and safety of ESWT in patients with dermal and subdermal fibrosis. Fifty-two patients treated with F-SWT and/or R-SWT for dermal and subdermal fibrosis caused due to various reasons were retrospectively analyzed by reviewing their medical records, clinical images, and ultrasound study images., Results: The mean number of pulses administered for F-SWT on the cheek, temple, and chin were 2600.0 ± 1040.8 shocks/session and for R-SWT were 5080.0 ± 2234.6 pulses/session, and the number of treatment sessions were 8.0 ± 4.4. In patients who were treated with ESWT on the abdomen, the mean number of pulses for F-SWT were 2600.0 ± 2408.3 shocks/session and for R-SWT were 8400.0 ± 894.4 pulses/session, and the number of treatment sessions were 3.2 ± 1.6. Most patients were satisfied with the results. Pain during ESWT was well tolerated and post-ESWT edema was more common in R-SWT than in F-SWT., Conclusion: Our data demonstrated that ESWT effectively and safely improved the clinical appearance and functional movement of patients with dermal and subdermal fibrosis caused due to various reasons., (© 2024 The Author(s). Skin Research and Technology published by John Wiley & Sons Ltd.)

Since the development of the artificial intelligence (AI), several applications have been proposed. Among these, the intersection of AI and medicine has sparked a wave of innovation, revolutionizing various aspects of healthcare delivery, diagnosis, and treatment. A review of the current literature was performed to evaluate the possible applications of ChatGPT (OpenAI, San Francisco, CA, USA) in the dermatological field. A total of 20 manuscripts were collected in the present review, reporting several potential applications of ChatGPT in dermatology, ranging from clinical practice to patients' support. The convergence of ChatGPT and dermatology represents a compelling synergy that transcends traditional boundaries of healthcare delivery. As AI continues to evolve and permeate every facet of medicine, ChatGPT stands at the forefront of innovation, empowering patients and clinicians alike with its conversational prowess and knowledge dissemination capabilities.

Chimeric antigen receptor T-cell (CAR-T) therapy, including axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel), has demonstrated significant efficacy in treating refractory or relapsed diffuse large B-cell lymphoma and B-cell acute lymphoblastic leukemia. Though adverse events such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are well characterized, the dermatologic adverse event (DAE) profile is less thoroughly described. This study aims to provide the first comprehensive analysis of DAEs associated with axi-cel and tisa-cel using real-world data from the FDA Adverse Event Reporting System (FAERS) database. FAERS database reports citing axi-cel or tisa-cel in patients aged 16 years or older were included, excluding duplicate reports and off-label indications. Disproportionality analysis by reporting odds ratio (ROR) was utilized to detect increased reporting of drug-adverse event combinations. Of the 11,256,845 reports in the FAERS database, 5559 identified CAR-T therapy as the primary suspected drug. After exclusions, 3,666 reports were analyzed (2,168 for axi-cel and 1,498 for tisa-cel). Among these, 2.7% of axi-cel and 5.1% of tisa-cel cases reported DAEs. There was a statistically significant increased reporting of 2 DAE groups associated with CAR-T therapy: severe cutaneous eruptions (ROR 5.18, 95% CI 1.29, 20.76) and vascular cutaneous (ROR 2.91, 95% CI 1.51, 5.60). The median time to DAE onset was 3 days after CAR T-cell infusion. Death was a reported outcome in 11.9% and 13.0% of axi-cel and tisa-cel DAE cases, respectively, and in 50% and 25% of severe cutaneous eruptions and vascular cutaneous cases, respectively. This study reveals a significantly increased reporting rate of severe cutaneous eruptions and vascular cutaneous DAEs associated with CAR-T therapy, with both event groups associated with high mortality. These results emphasize the importance of monitoring dermatologic toxicities in clinical practice to ensure timely identification and management of potentially severe adverse events., (Copyright © 2024 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

When dysregulated, skin fibrosis can lead to a multitude of pathologies. We provide a framework for understanding the wide clinical spectrum, mechanisms, and management of cutaneous fibrosis encompassing a variety of matrix disorders, fibrohistiocytic neoplasms, injury-induced scarring, and autoimmune scleroses. Underlying such entities are common mechanistic pathways that leverage morphogenic signaling, immune activation, and mechanotransduction to modulate fibroblast function. In light of the limited array of available treatments for cutaneous fibrosis, scientific insights have opened new therapeutic and investigative avenues for conditions that still lack effective interventions.

Background: Fibroblast cells have the ability to improve skin conditions through regenerative medicine and cell-based therapies. The purpose of this scoping review is to assess the contribution of fibroblast cells to skin homeostasis and extracellular matrix deposition in clinical trials involving skin disorders and cosmetic applications., Methods: Using targeted search terms, published publications from January 2000 to August 2023 that addressed fibroblast uses in clinical trials of skin conditions were obtained from bibliographic databases like PubMed, Scopus, and Web of Science (WoS). Precise inclusion and exclusion criteria were used during the screening process. The potential benefits of induction treatment with fibroblasts lead to the choosing of clinical trials for this kind of treatment., Results: Out of the 820 published ppapers initially identified, only 35 studies fulfilled our meticulous eligibility criteria after careful screening. To ensure clarity, we methodically eliminated any duplicate or irrelevant published papers, thereby offering a transparent account of our selection process., Conclusion: This study highlights the advantages of fibroblast therapy in treating skin conditions such as diabetic foot, venous leg ulcers, and cosmetic reasons. Fibroblasts possess remarkable regenerating capabilities, making dermal fibroblast therapy crucial in cell-based and skin regenerative treatments. Nevertheless, additional research is required for more disorders and cosmetic applications., (© 2024. The Author(s).)

Background: Primary endpoint measures in clinical trials are typically measures of disease severity, with patient-reported outcome measures (PROMs) relegated as secondary endpoints. However, validation of some PROMs may be more rigorous than that of disease severity measures, which could provide support for a primary role for PROMs., Objectives: This study reports on 24 peer reviewed journal articles that used the Dermatology Life Quality Index (DLQI) as primary outcome, derived from a systematic review of randomized controlled trials (RCTs) utlizing DLQI, covering all diseases and interventions., Methods: The study protocol was prospectively published on the PROSPERO database, and the study followed PRISMA guidelines. Searches were made using MEDLINE, The Cochrane Library, Embase, Web of Science, Scopus, CINAHL (EBSCO) and PsycINFO databases and records were combined into an Endnote database. Records were filtered for duplicates and selected based on study inclusion/exclusion criteria. Full-text articles were sourced and data were extracted by two reviewers into a bespoke REDCap database, with a third reviewer adjudicating disagreements. The Jadad scoring method was used to determine risk of bias., Results: Of the 3220 publications retrieved from online searching, 457 articles met the eligibility criteria and included 198 587 patients. DLQI scores were used as primary outcomes in 24 (5.3%) of these studies comprising 15 different diseases and 3436 patients. Most study interventions (17 of 24 studies, 68%) were systemic drugs, with biologics (liraglutide, alefacept, secukinumab, ustekinumab, adalimumab) accounting for 5 of 25 pharmacological interventions (20%). Topical treatments comprised 32% (8 studies), whereas nonpharmacological interventions (n = 8) were 24% of the total interventions (N = 33). Three studies used nontraditional medicines. Eight studies were multicentred (33.3%), with trials conducted in at least 14 different countries, and four studies (16.7%) were conducted in multiple countries. The Jadad risk of bias scale showed that bias was uncertain or low, as 87.5% of studies had Jadad scores of ≥ 3., Conclusions: This study provides evidence for use of the DLQI as a primary outcome in clinical trials. Researchers and clinicians can use this data to inform decisions about further use of the DLQI as a primary outcome., Competing Interests: Conflicts of interest A.Y.F. is joint copyright owner of the Dermatology Life Quality Index (DLQI). Cardiff University receives royalties from some use of the DLQI: A.Y.F. receives a proportion of these under standard university policy. J.R.I. receives a stipend as Editor-in-Chief of the British Journal of Dermatology and an authorship honorarium from UpToDate. He is a consultant for AbbVie, Boehringer Ingelheim, ChemoCentryx, MoonLake, Novartis, UCB Pharma and Union Therapeutics, and has served on advisory boards for Insmed, Kymera Therapeutics and Viela Bio. He is co-copyright holder of Hidradenitis Suppurativa Quality of Life, Investigator’s Global Assessment and Patient’s Global Assessment instruments for hidradenitis suppurativa. His department receives income from royalties from the Dermatology Life Quality Index (DLQI) and related instruments. S.S. has received an unrestricted educational grant from GSK and the Centre for Innovative Regulatory Science, is a consultant for Novo Nordisk and produces educational materials for AbbVie. J.V. participated in an Advisory Board for Amgen, has received payment or honoraria from L’Oreal and support from UCB pharma for attending meetings. F.M.A. has received honoraria from AbbVie, Janssen, LEO Pharmaceuticals, Lilly Pharmaceuticals, L’Oreal, Novartis and UCB. His department receives income from royalties from the DLQI and related instruments. J.R.J. has no conflicts of interest to report. His department receives income from royalties from the DLQI and related instruments., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Self-stigma beliefs are common among people with visible chronic skin diseases and can negatively affect their quality of life and psychosocial wellbeing. Hence, evidence-based interventions are urgently needed. The objective for this systematic review was to summarize research on available interventions and evaluate their benefits and limitations. Following PRISMA guidelines, we conducted an electronic database search of four databases (EMBASE, PsycINFO, PubMed, Web of Science). Studies were eligible if they (a) investigated interventions to reduce self-stigma in adults with chronic skin disease, (b) were original empirical articles, and (c) were written in English or German. Two independent reviewers conducted the abstract and full text screening as well as data extraction. The quality of the included studies was evaluated using the Critical Appraisal Skills Programme checklists. The initial search yielded 5811 abstracts; of which, 23 records were eligible. Studies addressed a broad range of skin conditions, and interventions ranged from social skills training, counselling and self-help to psychosocial and behavioural interventions. Overall, interventions had mostly positive effects on self-stigma and related constructs. However, the study quality was heterogeneous, and further efforts to develop, thoroughly evaluate and implement interventions tackling self-stigma in multiple skin conditions and languages are warranted.

Background: Although several digital health interventions (DHIs) have shown promise in the care of skin diseases their uptake in Germany has been limited. To fully understand the reasons for the low uptake, an in-depth analysis of patients' and health care providers' barriers and facilitators in dermatology is needed., Objective: The objective of this study was to explore and compare attitudes, acceptability, barriers, and facilitators of patients, dermatologists, and nurses toward DHIs in dermatology., Methods: We conducted 6 web-based focus groups each with patients (n=34), dermatologists (n=30), and nurses (n=30) using a semistructured interview guide with short descriptions of DHIs described in the literature. A content analysis was performed using deductive constructs, following the unified theory of acceptance and use of technology framework, and inductive categories., Results: Patients identified many positive performance expectancies, such as reduced travel times and improvement in follow-up appointments. Dermatologists also stated positive effects (eg, promotion of standardized care), but also negative implications of health care digitalization (eg, increased workload). All stakeholders reported that a DHI should bring additional value to all stakeholders. A lack of digital competence among patients was identified as the major barrier to adoption by all 3 groups. Nurses and dermatologists want apps that are easy to use and easy to implement into their daily routines. Trust in selected institutions, colleagues, and physicians was identified as a facilitator. Patients reported their dependence on the dermatologists' acceptance. All groups expressed concerns about data privacy risks and dermatologists stated insecurities toward data privacy laws., Conclusions: To ensure successful digitalization in dermatology, apps should be user-friendly, adapted to users' skill levels, and beneficial for all stakeholders. The incorporation of dermatologists' perspectives is especially important as their acceptance may impact use among patients and nurses. DHIs should ensure and be transparent about data privacy. The found barriers and facilitators can be used for implementation strategies., (©Patrick Reinders, Matthias Augustin, Anastasia Fleyder, Marina Otten. Originally published in JMIR Dermatology (http://derma.jmir.org), 03.09.2024.)

Cutaneous chronic graft-versus-host disease (cGVHD) is associated with morbidity, mortality, and impaired quality of life after hematopoietic stem cell transplantation. The clinical features of cutaneous cGVHD are heterogeneous but can be broadly classified into nonsclerotic or sclerotic presentations. This review provides an overview of clinical presentation, diagnosis and differential diagnosis, grading, and treatment of cutaneous cGVHD. Particular attention is given to cutaneous cGVHD in skin of color, which can have unique features and is generally underrepresented in the literature leading to delays in diagnosis. Finally, an overview of long-term skin care for patients with cutaneous cGVHD is provided in order to support patients from a dermatologic perspective as they recover from cGVHD. Multidisciplinary care with frequent communication between transplant specialists and dermatologists is critical to effectively managing cutaneous cGVHD., Competing Interests: Conflict of Interest Statement CRS: Editorial: VisualDX. HKC: Research: Opna. Consulting: Incyte, Sanofi, Abbvie, Actinium. BHK: Research: Biogen, Merck, InflaRx, BMS, Dermatology Foundation, National Psoriasis Foundation. Consulting: Novartis, Novocure, ADC Therapeutics, Elsevier., (Copyright © 2024 The American Society for Transplantation and Cellular Therapy. All rights reserved.)

Platelet-rich concentrates (PRCs), derived from a patient's blood, are being used in various fields of medicine, including dermatology, for an increasing number of indications. Although considered a generally safe procedure for dermatologic indications, there have been reports in the last several years linking this treatment to cases of blood-borne infections including HIV and hepatitis.1 Patient safety should always be the primary focus for physicians and other health care professionals, and systems-based protocols should exist within care settings to minimize errors. Herein, we review our protocol to decrease the risk of complications related to transmission of blood-borne infections and other medical errors related to PRCs. J Drugs Dermatol. 2024;23(9)790-791. doi:10.36849/JDD.8166.

Many patients with chronic wounds have skin changes that can provide important clues as to the etiology of the wound and/or inappropriate treatment. As the largest human organ, the skin is easily accessible for clinical inspection. However, healthcare professional teams currently do not always assess and document these skin changes correctly and consistently. The board of the professional society Initiative Chronische Wunden (ICW) e. V. has therefore decided to draw up a position paper to clarify the most important technical terms for skin changes around wounds. One focus here is on the definition and differentiated description of the wound edge and wound surrounding skin. Atrophies, blisters, eczema, erythema, hemorrhages, hyperpigmentation, hypopigmentation, hyperkeratosis, maceration, necrosis, oedema, pustules, sclerosis and scales are then described in more detail and placed in a clinical context., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: This report evaluates the potential of artificial intelligence (AI) in psychodermatology, emphasizing its ability to enhance diagnostic accuracy, treatment efficacy, and personalized care. Psychodermatology, which explores the connection between mental health and skin disorders, stands to benefit from AI's advanced data analysis and pattern recognition capabilities., Materials and Methods: A literature search was conducted on PubMed and Google Scholar, spanning from 2004 to 2024, following PRISMA guidelines. Studies included demonstrated AI's effectiveness in predicting treatment outcomes for body dysmorphic disorder, identifying biomarkers in psoriasis and anxiety disorders, and refining therapeutic strategies., Results: The review identified several studies highlighting AI's role in improving treatment outcomes and diagnostic accuracy in psychodermatology. AI was effective in predicting outcomes for body dysmorphic disorder and identifying biomarkers related to psoriasis and anxiety disorders. However, challenges such as limited dermatologist knowledge, integration difficulties, and ethical concerns regarding patient privacy were noted., Conclusion: AI holds significant promise for advancing psychodermatology by improving diagnostic precision, treatment effectiveness, and personalized care. Nonetheless, realizing this potential requires large-scale clinical validation, enhanced dataset diversity, and robust ethical frameworks. Future research should focus on these areas, with interdisciplinary collaboration essential for overcoming current challenges and optimizing patient care in psychodermatology., (© 2024 The Author(s). Skin Research and Technology published by John Wiley & Sons Ltd.)

Competing Interests: Conflicts of interest: None declared for Julie Lefrançois. In the last 5 years, Frédéric Sauvé has received honoraria, consulting fees, and/or collaborated with CEVA, Royal Canin, Purina, Zoetis, Elanco, and Vétoquinol.

Thalassemia is an inherited genetic disorder of hemoglobin that affects a large population worldwide, and it is estimated that between 50,000 and 60,000 infants with thalassemia are born each year. The most common treatment for thalassemia is blood transfusion, which leads to iron overload. This in itself is a serious clinical condition, and is commonly managed with iron chelation therapy. However, iron chelators can cause various skin complications, including hyperpigmentation, skin rash, itching, and photosensitivity. These skin side effects can impact patients' quality of life. Therefore, this article provides a comprehensive overview of skin complications caused by iron chelators, along with a proposed comprehensive approach to their management in patients with beta-thalassemia. Key strategies include patient education, regular skin assessment, sun protection measures, symptomatic relief with topical corticosteroids and antihistamines, and consideration of treatment modification if severe complications occur. Collaboration between hematologists and dermatologists, along with psychological support and regular follow-up, is an essential component of this multidisciplinary approach. By implementing these strategies, healthcare providers can optimize skin care for patients with beta-thalassemia treated with iron chelators and improve their quality of life., (© 2024. Japanese Society of Hematology.)

Sustainability is becoming increasingly important in healthcare and has moved into focus at various levels. This article aims to provide an overview of guiding principles, concepts, and target systems of sustainability and to transfer these to occupational dermatology. Current and future starting points are outlined for various levels, e.g., politics, research, industry, and patient care, in order to link sustainability and occupational dermatology in a structured and systematic way and to transform the structures of patient care in occupational dermatology care towards sustainability. Using the specific example of protective gloves, which is a pivotal personal protective measure to prevent work-related hand eczema, starting points, potentials, and challenges are analyzed and specific possibilities and perspectives for more ecologically sustainable action are presented., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Cutaneous graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic stem cell transplantation. Phototherapy has been used to treat cutaneous GVHD, but data on its safety and efficacy are sparse., Aim: Review the current medical literature regarding the efficacy, dosing, and safety of various types of phototherapies for the treatment of cutaneous GVHD., Methods: A systematic review of PubMed, Embase, Cochrane, and ClinicalTrials databases was performed. Publications were screened according to the PRISMA guidelines. Exclusion criteria comprised case reports and case series reporting less than five patients, review articles, and articles not published in English., Results: A total of 28/1304 (2.5%) studies were included. Fifteen studies (n = 267 patients) focused on psoralen and ultraviolet (UV) A (PUVA), in which 65.5% of patients received concomitantly other systemic treatments. The response rate was 89.9%, with a mean of 33.2 treatments. Adverse events were recorded in 54% but were mainly mild. Eight studies, encompassing 95 patients, focused on narrow-band (NB) UVB. A response was observed in 94%, with a mean number of 26 treatments and 8.6% adverse effects. UVA1 was reported in six studies (n = 132 patients). A response was recorded in 89.3% with a mean of 26.2 treatments. Adverse events were noted in 70.1%, with a discontinuation rate of 10.9%. It should be noted that adverse events were recorded during the follow-up period of the studies, which varied significantly, ranging from no follow-up to 31 months., Conclusions: Current data regarding the use of phototherapy for the treatment of cutaneous GVHD are based on retrospective studies and case series. The present report advocates the use of one of the three modalities of phototherapy as an effective and safe adjunctive treatment for cutaneous GVHD, especially NB UVB phototherapy., (© 2024 The Author(s). Photodermatology, Photoimmunology & Photomedicine published by John Wiley & Sons Ltd.)

The integration of teledermatology and artificial intelligence (AI) marks a significant advancement in dermatologic care. This study examines the synergistic interplay between these two domains, highlighting their collective impact on enhancing the accuracy, accessibility, and efficiency of teledermatologic services. Teledermatology expands dermatologic care to remote and underserved areas, and AI technologies show considerable potential in analyzing dermatologic images and performing various tasks involved in teledermatology consultations. Such integration facilitates rapid, precise diagnoses, personalized treatment plans, and data-driven insights. Our explorative study involved designing a GPT-based chatbot named "Dr. DermBot" and exploring its performance in a teledermatologic consultation process. The design phase focused on the chatbot's ability to conduct consultations autonomously. The subsequent testing phase assessed its performance against the backdrop of current teledermatologic practices, exploring the potential of AI and chatbots to simulate and potentially enhance teledermatologic health care. Our study demonstrates the promising future of combining teledermatology with AI. It also brings to light ethical and legal concerns, including the protection of patient data privacy and adherence to regulatory standards. The union of teledermatology and AI not only aims to enhance the precision of teledermatologic diagnoses but also broadens the accessibility of dermatologic services to previously underserved populations, benefiting patients, health care providers, and the overall health care system., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

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., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Geriatric dermatology has gained increasing importance through the years, alongside a steadily aging global population. Simultaneously, artificial intelligence (AI) technologies have become more advanced, and AI has been found to be useful in the general practice of dermatology. Whether or not and how AI can be useful in the practice of geriatric dermatology remains unanswered. We have explored the intricacies and potential roles AI can play in the practice of geriatric dermatology and recommend that physicians should recognize the tremendous potential of AI, in terms of facilitating diagnoses of disease, guiding and personalizing therapeutics, and even expanding therapeutic options, while remaining cautious about AI's current pitfalls and acceptability among its elderly audience., Competing Interests: Declaration of competing interest The author declares no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Artificial intelligence (AI) has the potential to significantly impact many aspects of dermatology. The visual nature of dermatology lends itself to innovations in this space. The robustness of AI algorithms depends on the quality, quantity, and variety of data on which it is trained and tested. Image collections can suffer from inconsistencies in image quality, underrepresentation of various anatomic sites and skin tones, and lack of benign counterparts leading to underperformance of algorithms in contexts other than one in which it is developed. Access to care, trust, rights, control, and transparency all play roles in the willingness of patients and health care providers and systems to collect, provide, and share data. Opportunities to improve data participation for the development of AI include the establishment of data hubs and public algorithms, federated learning strategies, development of renumeration ecosystems for patients and systems, and development of criteria and mechanisms for transparency., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Current drug development strategies present many challenges that can impede drug approval by regulatory agencies. Alternative study models, such as adaptive trial designs, have recently sparked interest, as they provide a flexible and more efficient approach in conducting clinical trials. Adaptive trial designs offer several potential benefits over traditional randomized controlled trials, which include decrease in costs, reduced clinical development time and limiting exposure of patients to potentially ineffective treatments allowing completion of studies with fewer patients. This article explores the current use of adaptive trial designs in non-oncologic skin diseases and highlights the most common types of adaptive designs used in the field. We also review the operational challenges and statistical considerations associated with such designs and propose clinical development strategies to successfully implement adaptive designs. The article also proposes instances where adaptive trial designs are particularly beneficial, and other situations where they may not be very useful., (© 2024 European Academy of Dermatology and Venereology.)

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Declaration of competing interest All authors declare that they have no commercial or other associations that might pose a conflict of interest.

Dermatologic concerns are discussed in about a third of all primary care visits. This review discusses treatments for common dermatologic diagnoses addressed in primary care settings, with an emphasis on new and emerging treatments. Topical, oral, and injectable treatment of common forms of alopecia, facial rashes, atopic dermatitis, psoriasis, seborrheic dermatitis, and stasis dermatitis will be discussed to help increase comfort in prescribing and alert providers to common side effects or complications of more intensive treatments used by dermatologists., Competing Interests: Disclosure The authors have no conflicts of interest to report including no financial conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We have reviewed the current literature focused on the role of artificial intelligence (AI) for underserved populations and health equity in dermatology. Studies evaluating the utility and safety of AI model builds, and how they meet predefined benchmarks, as well as the clinical applications of AI, including decision-support systems and operational management, were the focus of this study. The seven studies included in our review provide an approach that assures underserved populations are the focus when developing and testing AI technology. They provide examples that could guide future studies focused on expanding care to underserved dermatology populations through the use of AI., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)