搜索结果：International journal of women's dermatology

Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050. Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer. In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3). Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment. Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.

Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. In 2023, 60·1 million (95% UI 59·0-61·1) deaths occurred globally, of which 4·67 million (4·59-4·75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35·2% (32·2-38·4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66·6% (65·8-67·3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67·7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53·9% and 40·1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61·2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51·2 (50·6-51·7) years for females and 47·9 (47·4-48·4) years for males in 1950 to 76·3 (76·2-76·4) years for females and 71·4 (71·3-71·5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6-74·8) years for females and 69·3 (69·2-69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0-76·6] years for females and 71·5 [71·2-71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. Gates Foundation.

Accurate classification of dermatologic conditions using International Classification of Diseases (ICD) codes is essential for research that uses large administrative datasets. Misclassification can be associated with biased epidemiologic estimates and misleading conclusions in population-based studies. To systematically identify and evaluate validated classification approaches for dermatologic conditions using ICD codes in US-based administrative, claims, or electronic health record data. A systematic review was conducted that was registered with PROSPERO (CRD420250654233) and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Ovid MEDLINE, Embase, Web of Science, and CINAHL was conducted for studies published from January 1, 2000, to October 21, 2025. The data were analyzed in October 2025. Eligible studies evaluated International Classification of Diseases, Ninth Revision (ICD-9) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes used to identify dermatologic conditions in US-based datasets and reported at least 1 classification metric (eg, positive predictive value). To minimize selection and extraction bias, all screening and data extraction were performed independently by 2 reviewers, with discrepancies resolved by consensus. A total of 59 studies met inclusion criteria. Most reported positive predictive value, with few reporting sensitivity or specificity. Classification accuracy varied widely by condition and coding strategy. Studies included inflammatory and autoimmune conditions (eg, acne vulgaris, perioral dermatitis, psoriasis, palmoplantar pustulosis, hidradenitis suppurativa, atopic dermatitis, prurigo nodularis, dermatomyositis, cutaneous lupus erythematosus, pyoderma gangrenosum, cutaneous sarcoidosis, pemphigus, pemphigoid, granuloma annulare, alopecia areata, and vitiligo), actinic keratosis and skin cancer, pigmentary and hair disorders (eg, androgenic alopecia, cicatricial alopecia, lichen planopilaris, and melasma), drug reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis), and infections (eg, herpes zoster, herpes simplex virus, and cellulitis or abscess). Classification algorithms that incorporated 2 or more codes, dermatologist attribution, or treatment/procedural data often achieved the highest accuracy. Conditions lacking validated algorithms included seborrheic dermatitis, rosacea, fungal infections, and specific alopecia subtypes. This systematic review provides a summary of the most accurate classification approaches to identify various dermatologic conditions in large administrative datasets. These results may inform study designs when using these datasets. In addition, some common conditions lack validated classification approaches, highlighting important areas for future research. As administrative and electronic health record data increasingly support dermatology research, use of rigorously validated algorithms will be essential for generating trustworthy findings.

Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.

Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.

Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.

The global burden of sepsis, a life-threatening dysregulated host response to infection leading to organ dysfunction, remains challenging to quantify. We aimed to comprehensively estimate the global, regional, and national burden of sepsis, including the impact of the COVID-19 pandemic and underlying causes of sepsis-related deaths with co-occurring infectious syndromes. We used multiple cause-of-death, hospital, minimally invasive tissue sampling, and linked death certificate and hospital record data representing 149 million deaths, covering 4290 location-years with mortality estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to capture explicit and implicit sepsis cases and deaths. We estimated age-location-sex-specific fractions of sepsis-related deaths from 195 underlying causes of death and 22 infectious syndromes from 1990 to 2021 using binomial logistic regression models, and estimated sepsis-related deaths using GBD cause-specific mortality estimates. Using 250 million hospital admissions and 7·82 million deaths from hospital data, representing 1310 location-years, we modelled case fatality rates by use of binomial logistic regression, applied to sepsis death estimates to estimate sepsis incidence by age, location, and year. In 2021, we estimated 166 million (95% uncertainty interval 135-201) sepsis cases and 21·4 million (20·3-22·5) all-cause sepsis-related deaths globally, representing 31·5% of total global deaths. Sepsis-related deaths decreased between 1990 and 2019, followed by a surge in 2020 and 2021. As of 2021, individuals aged 15 years and older experienced increases across incidence (230%) and mortality (26·3%) since 1990. Those aged 70 years and older had the highest sepsis-related mortality in 2021 (9·28 million [8·74-9·86] deaths). Sepsis-related deaths from infectious underlying causes decreased from 11·8 million (11·1-12·5) in 1990 to 8·34 million (7·72-9·01) in 2019, then increased by 86·4% to 15·5 million (14·7-16·4) in 2021. Sepsis-related mortality due to non-infectious underlying causes of death increased from 4·69 million (4·35-5·05) in 1990 to 5·81 million (5·40-6·25) in 2021; the leading non-infectious underlying causes of death with sepsis were stroke, chronic obstructive pulmonary disease, and cirrhosis. In 2021, bloodstream infections inclusive of HIV and malaria (3·08 million [2·83-3·35]) and lower respiratory infections inclusive of COVID-19 (11·33 million [1·20-1·47]) were the most prominent infectious syndromes complicating sepsis-related deaths from non-infectious underlying causes, representing a consistent trend since 1990. The global burden of sepsis increased in 2020 and 2021, reversing progress from 1990. Sepsis incidence and mortality increased in people aged 15 years and older, especially those aged 70 years and older, and as a complication of non-infectious underlying causes of death such as stroke, primarily through bloodstream infections and lower respiratory infections. The global burden of sepsis is substantial, and sepsis is increasingly a complication of non-infectious causes of death. Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.

BACKGROUND: Standardized definitions of autoimmune disease (AD) are lacking. Therefore, we aim to propose a definition of AD for register-based research and estimate the burden of AD in Sweden as registered in the National Patient Register (NPR) from 1980 to 2023. METHODS: Leveraging the NPR, we defined AD as having at least two relevant International Classification of Diseases (ICD) codes representing AD. These codes could either represent the same disease or two different diseases. Age-standardized and age-specific incidence rates (IRs) of AD were calculated, along with prevalence on December 31, 2023. RESULTS: From 1980 to 2023, the mean age-standardized IR of AD was 318 cases per 100,000 person-years (95% CI: 294–342). The IR decreased with the introduction of ICD-10 (1997), but then sharply increased in 2001 following the addition of specialized outpatient data to the NPR that year, likely reflecting improved case ascertainment rather than a sudden true rise in incidence. As of December 31, 2023, the prevalence of AD in Sweden was 6.6% overall, 7.9% in adults, and 1.5% in children. CONCLUSIONS: In a nationwide study spanning more than 40 years, the IR of AD was 318 per 100,000 person-years but with substantial variation correlating to administrative changes in coding and content of the NPR. In 2023, the point prevalence of AD in Sweden was 1 in 15 individuals across all ages, 1 in 13 adults, and 1 in 67 children.

Academic dermatologists manage a broad array of responsibilities, often extending beyond clinical duties to include education, research, mentorship, and administrative work. This study aimed to quantify the scope of paid and unpaid responsibilities among academic dermatologists in the United States and identify disparities based on gender, career stage, and geography. A cross-sectional survey of 63 board-certified academic dermatologists from 12 institutions collected data on demographics, workweek allocation, after-hours tasks, compensation, burnout, and resilience from January to May 2025. Respondents reported spending 58.3% of their time on clinical care, 15.9% on administrative duties, 13.8% on education, and 11.9% on research. Nearly half received 11 to 50 daily patient messages via the clinical inbox, and over 80% took hospital call duties, with most receiving no extra compensation. Burnout affected 63.5% of respondents and was significantly more prevalent among women, early-career physicians, and those in the Mid-Atlantic and Northeast regions. Resilience scores were lower among women. Consulting opportunities, often associated with supplemental income and career advancement, were more common among male and senior physicians. Parental leave policies were inconsistently applied and poorly understood; nearly 20% of respondents had 8 or fewer weeks of paid parental leave. Study limitations include the relatively small sample size and overrepresentation of the Northeast region, potentially hindering generalizability. Additionally, no significant race-based differences were observed, which may be due to insufficient sample sizes within comparator groups. These findings highlight the cumulative burden of undercompensated labor, inadequate institutional support, and gender disparities in workload and opportunity. Structural changes in compensation transparency, workload distribution, recognition of academic labor, and support for early-career and female physicians are essential to fostering sustainability and equity within academic dermatology.

Patients with skin of color (SOC) experience increased rates of atopic dermatitis (AD) than the general population and suffer from more severe disease. In addition, patients with SOC experience higher sensitization rates to particular allergens and are patch tested less frequently. Because of these factors, there is a need to assess whether allergic contact dermatitis (ACD) contributes to the higher disease severity in SOC patients with AD. The goal of this review is to systematically evaluate the potential association between ACD and AD in the SOC population. A systematic search of PubMed (date of last search: July 2025) was performed to identify studies of patients with SOC referred for patch testing to various allergens for suspected ACD. AD prevalence and clinical outcomes were required for inclusion. Data collected and provided in table format included: author, type and year of study, race/ethnicity of subjects, eczema prevalence, patch test positivity, specific allergen sensitivities, and allergen source. Four out of the 8 manuscripts meeting inclusion criteria provided evidence for a higher eczema prevalence in patients with SOC who were referred for patch testing; however, larger, well-designed studies are required to fully elucidate the true associations among patients with SOC, AD, and ACD. The limited number and heterogeneity of studies and the potential underreporting of both ACD and AD in patients with SOC may contribute to potential bias. Further, this is a scoping review and does not provide additional data analysis to support any particular conclusion. Dermatologists must continue to counsel SOC patients with AD regarding potential disease-modifying ACD-related exposures.

Pathologic response is an emerging surrogate marker for therapeutic efficacy and long-term patient outcomes. Updated guidelines for pan-tumor pathologic response assessment have recently been adopted for ongoing clinical trials and routine clinical care. The goal of this study was to prospectively evaluate the interobserver variability among pathologists in assessments of treatment response across tumor types, anatomic locations, and specimen types. A multi-institutional, international study led by the Society for Immunotherapy of Cancer was carried out to assess the concordance of pathologic response assessment using the pan-tumor criteria in neoadjuvant-treated resection specimens and on-treatment biopsies. Online lecture-based modules for scoring were developed, and 14 pathologists from multiple institutions were trained. The pathologists then assessed 42 specimens representing 12 different tumor types (total of n = 362 hematoxylin-eosin-stained slides) for the three tissue classes that are assessed: %residual viable tumor (RVT), %regression, and %necrosis. Pathologists were also surveyed regarding interest in and barriers related to pan-tumor pathologic response assessment, as well as quality and effectiveness of the training materials. Scoring of pathologic response using the pan-tumor system was highly reproducible, irrespective of disease location (primary tumor versus lymph node) or specimen type (resection versus biopsy), with intraclass correlation coefficients (ICCs) > 0.8 for %RVT, %regression, and %necrosis. Subset analyses also showed strong reproducibility of %RVT within almost all individual tumor types evaluated (ICC all ≥ 0.86). The poststudy survey completed by the participating pathologists was used to refine the training materials, and the revised modules are provided as a resource to the wider pathology and oncology communities. This highly reproducible scoring system enables quantitative assessment of treatment response in pathology specimens across multiple tumor types, anatomic sites, disease stages, and therapies, akin to RECIST for radiographic assessment. We identified potential barriers to implementation and highlight strategies to overcome these challenges.

Allergic rhinitis (AR) impacts quality of life, work and school productivity. Over the last years, an important body of evidence resulting from mHealth data has led to a better understanding of AR. Such advances have motivated an EAACI-endorsed update of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines (ARIA 2024-2025). This manuscript presents the ARIA 2024-2025 recommendations for intranasal treatments, one of the mainstays for AR management. The ARIA 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgments and recommendations, including systematic reviews, evaluation of mHealth and pharmacovigilance data, as well as a survey of experts on costs. Eleven guideline questions concerning intranasal treatments for AR were prioritized, leading to recommendations. Overall, these questions concern the choice between different classes of intranasal medications-most notably, intranasal corticosteroids (INCS), antihistamines (INAH), fixed combinations of INAH+INCS and decongestants-or between different individual medications within each class. Four questions had not been evaluated in previous ARIA guidelines, while for the other three there was a change in the strength or directionality of recommendations. Overall, recommendations point to the suggested use of INAH+INCS over INAH or INCS and INCS over INAH. This ARIA 2024-2025 article supports patients, their caregivers, and healthcare professionals in choosing an intranasal treatment. However, decisions on AR treatment should consider the clinical variability of the disease, patients' values, and the affordability of medications.

While randomized clinical trials (RCT) confirmed superiority of Mepitel Film (MF) in reducing acute radiation dermatitis (ARD) compared to standard-of-care (SoC), the incremental cost difference has limited its use. A cost-effectiveness analysis (CEA) was conducted from a Canadian healthcare payer's perspective to guide policy decisions. A decision model was constructed to perform a CEA for MF compared to SoC (moisturizers) for prevention of grade 2 or higher ARD following adjuvant hypo-fractionated whole-breast radiotherapy (RT) based on a Canadian multicentre RCT. Direct and indirect cost data were collected from two oncology centers in Canada. Quality-of-life (QoL) utility values were derived from mapping Dermatology Life Quality Index (DLQI) scores for patients with grade 2 or higher ARD at week 6 of RT to EQ-5D. A willingness-to-pay (WTF) threshold of CAD 50,000 per quality-adjusted life years (QALY) gained was used. Deterministic and probabilistic sensitivity analyses were performed to address uncertainty in decision model assumptions. Base case analysis demonstrated that MF is cost-effective in preventing grade 2 or higher ARD as compared with SoC with an incremental cost-effectiveness ratio (ICER) of CAD 3366 per QALY gained. When indirect costs were included, MF resulted in an ICER of CAD 2823 per QALY gained. One-way sensitivity analysis showed that the results were most sensitive to the QoL utility value for ARD. Probabilistic sensitivity analysis confirmed that MF demonstrates 100% probability of cost-effectiveness at a $50,000 per QALY threshold. MF is a cost-effective intervention for preventing high-grade ARD and should be recommended for patients with breast cancer undergoing adjuvant RT.

Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.

Given the lack of head-to-head studies of approved biologic therapies in hidradenitis suppurativa (HS), a chronic, recurrent inflammatory skin disease, a systematic literature review (SLR) and network meta-analysis (NMA) were conducted to provide insight into their comparative short-term efficacy. To assess the relative efficacy of approved biologic therapies (bimekizumab 320 mg every 2 weeks [Q2W], secukinumab 300 mg Q2W and every 4 weeks [Q4W] and adalimumab 40 mg every week [QW]) at Week 12-16 in moderate-to-severe HS. A clinical SLR identified randomised controlled trials until 3rd July 2024 for inclusion in Bayesian NMAs. Two evidence networks (predominantly biologic-naïve and biologic-experienced) were constructed to represent populations with differing biologic treatment histories. Outcomes of interest were improved HS Clinical Response (HiSCR; ≥50%/≥75%/≥90%/100%), change from baseline (CFB) in International Hidradenitis Suppurativa Severity Score System (IHS4) and improvement from baseline of ≥55% (IHS4-55). Percentage CFB in abscess and inflammatory nodule (AN) count and CFB in absolute draining tunnels (DT) count were also assessed. The NMA included nine trials. Bimekizumab ranked as the most efficacious treatment across all predefined efficacy outcomes in both predominantly biologic-naïve and biologic-experienced networks, showing consistent response levels. In the predominantly biologic-naïve network, bimekizumab Q2W compared with secukinumab (Q4W) demonstrated significantly higher odds of response for all HiSCR outcomes (odds ratio [OR]: HiSCR50 = 1.69; HiSCR75 = 1.85; HiSCR90 = 1.62; HiSCR100 = 1.88) and IHS4-55 (OR = 1.91), and for HiSCR75 (OR = 1.60) and HiSCR90 (OR = 1.56) compared with adalimumab QW. Similar results were observed for secukinumab Q2W and both secukinumab dosing regimens in the biologic-experienced network. Note, adalimumab studies did not report the proportion of biologic-experienced patients. Systematic review of safety data is required for full benefit-risk assessment and decision-making. This NMA, the first to adjust for intercurrent events in moderate-to-severe HS across multiple efficacy outcomes, assessed up-to-date data, with estimates demonstrating bimekizumab's favourable efficacy among approved biologics.

Striae distensae (SD) (stretch marks) are common dermal scars resulting from rapid skin stretching during puberty, pregnancy, or weight changes and disproportionately affect women. Management remains challenging, particularly in individuals with darker skin tones, due to variable efficacy and the risk of postinflammatory hyperpigmentation with certain therapies. To review current and emerging treatment modalities for SD across all Fitzpatrick skin types, with an emphasis on efficacy, safety, and the role of combination therapies. A comprehensive literature review was conducted using peer-reviewed clinical trials, observational studies, and dermatologic reviews evaluating topical, procedural, laser-based, and combination therapies for SD. Treatments were analyzed based on mechanism of action, clinical outcomes, skin type suitability, and reported adverse effects. Topical tretinoin demonstrated modest efficacy dependent on concentration and treatment duration. Laser-based therapies, including ablative and nonablative fractional lasers, improved collagen remodeling and stretch mark appearance, with nonablative lasers showing better tolerability in darker skin types. Microneedling and fractional microneedling radiofrequency were effective and cost-efficient options across skin types. Combination therapies, particularly those integrating microneedling, radiofrequency, platelet-rich plasma, or fractional CO2 lasers, yielded superior outcomes compared with monotherapy, especially for striae alba. Striae rubra generally responded more favorably than striae alba across treatment modalities. Heterogeneity among studies, including inconsistent outcome measures, variable treatment protocols, and limited long-term follow-up, restricts direct comparison of therapeutic efficacy. Additionally, many studies included small sample sizes and lacked standardized assessment tools such as a uniform visual analog scale and Dermatology Life Quality Index scoring. Multiple therapeutic options exist for the management of SD, with treatment selection influenced by striae stage and Fitzpatrick skin type. Combination therapies demonstrate the most promising results, particularly for treatment-resistant striae alba and patients with darker skin tones. Standardization of outcome measures and further high-quality comparative studies are needed to optimize individualized treatment strategies.

The skin, as the body's largest organ, reflects the passage of time through wrinkles, fine lines, uneven skin tone, and solar lentigines (commonly known as age spots). While chronological aging, defined by the inevitable progression of time, is well understood, biological aging also significantly impacts the skin. Examine and highlight iron's historically overlooked role, as it has now emerged as a pivotal factor in biological aging, influencing skin tone, aging, and photoaging. A literature review from PubMed was conducted to address a significant gap in understanding the role of iron in skin aging, photoaging, and skin tone. We focused on key discoveries that highlight iron as a critical upstream factor influencing these processes. Increasing evidence demonstrates that the buildup of excess iron in the skin is likely linked to the formation of oxidants and discoloration, leading to dull, uneven skin tones and contributing to the aging process. Iron, which remains in the skin for 60 days-twice the typical skin turnover period of 26 days-could lead to iron accumulation as we age. More clinical trials are necessary to establish a cause-effect relationship between iron and skin tone, aging, and photoaging. Addressing iron-related discoloration and oxidative stress is crucial for improving skin health and appearance, providing a more comprehensive approach to skincare and treatment.

Nipple conditions in postmenopausal women are numerous and challenging to diagnose, requiring multidisciplinary collaboration. There are no large cohort studies detailing the epidemiology, symptoms, diagnoses, and disease trajectories for postmenopausal women with nipple complaints. This single-institution retrospective study aimed to describe postmenopausal nipple complaints, associated symptoms, diagnoses, and involved medical care teams. Medical charts of female patients over 49 years old with nipple-related diagnoses were reviewed. Data on demographics, symptoms, medical specialties, diagnostics, final diagnoses, and treatments were collected. Physician-patient encounters (N = 296) for 174 unique patients ages 50 to 92 (average 70) were analyzed. Nipple inversion, pain, and dermatitis were the most common diagnoses. Primary care physicians (PCPs) cared for the majority of patients (73% first seen by PCP), with dermatologists, surgeons, and breast health specialists involved in over 25% of encounters. PCPs often referred patients to specialists when patients presented with a nipple rash with ulceration or an inverted nipple with discharge. Most patients (63%) received reassurance about benign or self-limited conditions, while others were treated with oral antibiotics, topical medications, or surgical management depending on the diagnosis. This is a single institution retrospective chart review. Most postmenopausal women with nipple complaints are diagnosed with inversion, pain, or dermatitis. This retrospective chart review highlights the need for multidisciplinary care of these patients, with the primary care provider serving as the frontline care provider for women with skin conditions of the nipple-areolar complex.

Many older adults, particularly older women, use over-the-counter supplements for antiaging benefits, including for hair and skin. The supplement industry is unregulated by the Food and Drug Administration, and the interactions between supplements and medications are often overlooked by both patients and physicians. This article discusses the proposed mechanism of action, common misconceptions, possible benefits, and potential side effects of the most commonly used antiaging skin supplements by women, including biotin, nicotinamide, hyaluronic acid, collagen, zinc, vitamin C, vitamin A, vitamin E, and other antioxidants. Supplements may also interfere with common blood tests, such as biotin with the thyroid and troponin cardiac enzyme tests, which patients and their clinicians must be aware of and account for when interpreting lab results. Other supplements, such as zinc, are commonly taken in excess and may result in deficiencies in the absorption of other minerals, such as copper. Over-supplementation of fat-soluble vitamins, such as vitamin A and vitamin E, can result in toxic levels since excess is not excreted in the urine. The clinician caring for older patients' skin and nails must ask older patients about supplement use and be aware of the potential harms of these supplements in some patients.