搜索结果：Dermatology practical & conceptual

For over a century, dilute sodium hypochlorite (NaOCl), historically recognized as the antiseptic component of bleach, has been well established in wound care, primarily owing to its broad antimicrobial activity and ability to penetrate soft tissue and necrotic debris. NaOCl has been increasingly utilized and studied in clinical dermatology owing to its broad ranging antimicrobial, skin healing, and more recently described anti-inflammatory properties. This scoping review (Open Science Network; osf.io/6hyru) synthesizes current evidence of NaOCl's applications in skin care, highlighting mechanistic insights, clinical trends, and knowledge gaps. A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov was conducted from inception through November 2024. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 6959 deduplicated records, 222 studies published between 1915 and 2024 were identified for final inclusion. Four key clinical themes for NaOCl use emerged upon analysis of these publications: antimicrobial properties (n = 57), wound care (n = 64), eczematous skin disease (n = 78), and noneczematous inflammatory skin conditions (n = 23). NaOCl exhibits broad-spectrum activity against various organisms, notably Staphylococcus aureus and Pseudomonas aeruginosa, contributing to its effectiveness in treating chronically infected burns, ulcers, and other wounds. Limited studies also suggest NaOCl's potential role in modulating critical processes that support wound repair. In addition, the anti-inflammatory effects of NaOCl have supported its utility in treating eczematous and noneczematous skin disorders. Current literature provides broad and extensive evidence supporting NaOCl's role in wound-healing, antimicrobial, and anti-inflammatory activity. However, considerable heterogeneity exists in recommended concentrations, preparation methods, and usage instructions across studies. There is a need for more randomized controlled trials and standardized protocols to better define the efficacy, safety, and optimal use of NaOCl in dermatologic practice.

Dermatological delusional disorders, such as delusional infestation (DI), are a unique type of psychosis in which the patient experiences specific delusions, such as parasites or inorganic materials that come out of their skin. Originally, this type of "encapsulated psychosis" was thought to be unresponsive to antipsychotic agents. However, over the past half a century, several medications with antipsychotic properties have been found to be effective in the treatment of these conditions in the USA, especially pimozide and risperidone. Despite effective treatments, several challenges may arise for clinicians in successfully treating patients with these conditions. These challenges include selecting an efficacious medication and skillfully practicing diplomacy and empathy while guiding patients toward effective management. Navigating interactions with patients with DI and their frequent denial of a psychiatric component to their condition often poses additional challenges to patient-provider rapport and proper and timely management. In the USA, many patients with DI are opposed to trying the conventional approach of psychiatric care and immediate trial of antipsychotic medications. This manuscript represents a single-center psychodermatology perspective on managing dermatologic delusional disorders. This article synthesizes clinical experience from a US clinic and situates that experience within the available evidence. High-quality comparative data are limited. Therefore, this paper highlights pragmatic engagement strategies, pharmacotherapy principles, essential safety monitoring, and research priorities. Experience-based recommendations are clearly labeled as such.

Skin cancers are some of the most common types of cancer. Dermatology services receive about 1.2 million referrals a year, but only a small minority are confirmed skin cancer. Artificial intelligence may be helpful in the diagnosis of skin cancer by identifying lesions that are or are not cancerous. To investigate the clinical and cost-effectiveness of two artificial intelligence technologies: DERM (Deep Ensemble for Recognition of Malignancy, Skin Analytics) and Moleanalyzer Pro (FotoFinder), as decision aids following a primary care referral. A rapid systematic review of evidence on the two technologies was conducted. A narrative synthesis was performed, with a meta-analysis of diagnostic accuracy data. Published and unpublished cost-effectiveness evidence on the named technologies, as well as other diagnostic technologies were reviewed. A conceptual model was developed that could form the basis of a full economic evaluation. Four studies of DERM and two of Moleanalyzer Pro were subject to full synthesis. DERM had a sensitivity of 96.1% to detect any malignant lesion (95% confidence interval 95.4 to 96.8); at a specificity of 65.4% (95% confidence interval 64.7 to 66.1). For detecting benign lesions, the sensitivity was 71.5% (95% confidence interval 70.7 to 72.3) for a specificity of 86.2% (95% confidence interval 85.4 to 87.0). Moleanalyzer Pro had lower sensitivity, but higher specificity for detecting melanoma than face-to-face dermatologists. DERM might lead to around half of all patients being discharged without assessment by a dermatologist, but a small number of malignant lesions would be missed. Patient and clinical opinions showed substantial resistance to using artificial intelligence without any assessment of lesions by a dermatologist. No published assessments of the cost-effectiveness of the technologies were identified; three assessments related to skin cancer more broadly in a National Health Service setting were identified. These studies employed similar model structures, but the mechanism by which diagnostic accuracy influenced costs and health outcomes differed. An unpublished cost-utility model was provided by Skin Analytics. Several issues with the modelling approach were identified, particularly the mechanisms by which value is driven and how diagnostic accuracy evidence was used. The conceptual model presents an alternative approach, which aligns more closely with the National Institute for Health and Care Excellence reference case and which more appropriately characterises the long-term consequences of basal cell carcinoma. The rapid review approach meant that some relevant material may have been missed, and capacity for synthesis was limited. The proposed conceptual model does not capture non-cash benefits associated with demand on dermatologist time. An assessment of the likely budget impact and resource use could not be provided. DERM shows promising diagnostic accuracy for triage and diagnosis of suspicious cancer lesions in selected patients referred from primary care. Its impact on the diagnostic pathway and patient care is, however, uncertain. Moleanalyzer Pro shows promising accuracy for diagnosing melanoma, but its evidence base is limited. While artificial intelligence has the potential to be cost-effective for the identification of benign lesions, further research addressing the limitations in the diagnostic accuracy evidence is necessary. Without comparative evidence on the diagnostic accuracy of artificial intelligence technologies, their value will remain uncertain. This study is registered as PROSPERO CRD42023475705. This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR136014) and is published in full in Health Technology Assessment; Vol. 30, No. 10. See the NIHR Funding and Awards website for further award information. Skin cancers and suspicious skin lesions are very common. People with moles or lesions that might be cancerous are referred to a skin cancer specialist (a dermatologist) to make a diagnosis. This places a very high burden on dermatology clinics and, as a result, there can be delays in seeing a dermatologist and getting a diagnosis. Artificial intelligence systems could potentially use a high-quality photograph to identify which lesions do not need to be seen by a specialist. This could be done by the artificial intelligence system alone, or in combination with remote review by a dermatologist. This project investigated whether two artificial intelligence technologies: DERM (Skin Analytics) and Moleanalyzer Pro (FotoFinder) could be useful in reducing the burden on dermatology services while helping to identify skin cancer. The evidence was reviewed to investigate whether the technologies can accurately identify skin cancer cases, and whether their use might improve the diagnosis process for patients. We also designed a theoretical model in which the economic value of artificial intelligence technologies for the diagnosis of skin cancer could be assessed. As part of this process, we sought to outline what further evidence would be needed to implement a full assessment. The evidence we reviewed suggests DERM could potentially reduce by half the number of patients that would be referred to specialist dermatologists, while still identifying 95% of all skin cancers. Moleanalyzer Pro could identify about 85% of malignant melanomas. This appears to be a similar accuracy to that achieved by using a remote view of the lesions by dermatologists alone. How DERM or Moleanalyzer Pro use would impact diagnosis and treatment for patients in practice, and the burden on clinicians, is currently unclear. Because of limitations in the evidence on the diagnostic accuracy of artificial intelligence technologies, a full assessment of their economic value is not possible at this time. Further research should focus on better establishing the diagnostic accuracy of both artificial intelligence technologies and current service provision.

Immune-mediated inflammatory diseases (IMID) are a group of chronic, systemic inflammatory diseases caused by immune dysregulation. IMID often involve multiple organs or systems, are characterized by complex clinical manifestations and significant overlap across different diseases, and may coexist as multiple comorbidities, significantly increasing the disease burden and complicating diagnosis and management. To promote the standardized management of IMID in China, Specialty Committee on Prevention of Rheumatologic and Immunologic Diseases, Chinese Preventive Medicine Association, Chinese Society of Dermatology, Chinese Medical Association and Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association organized experts in rheumatology, dermatology, gastroenterology, and pharmacy. Based on domestic and international research advances from the past decade and integrated with clinical practice experience, they developed this consensus document. This consensus systematically summarizes the conceptual origin, disease burden, pathogenesis, diagnostic and treatment models, and therapeutic agents for IMID. It establishes a multi-disciplinary team (MDT) diagnosis and treatment system for IMID and provides systematic management recommendations and medication selection strategies for common IMID and their related comorbidities in the fields of rheumatology, dermatology, and gastroenterology. The purpose of this consensus is to provide a comprehensive, standardized, and operable diagnosis and treatment framework for IMID patients in China, aiming to optimize clinical practice and improve long-term outcomes. 免疫介导炎症性疾病（IMID）是一类由免疫失衡引起的慢性炎症性、系统性疾病。IMID常累及多个器官或系统，具有临床表现复杂、疾病间共性明显的特点，并可伴随多病种共存，显著增加了疾病负担和诊治难度。为推动我国IMID的规范化管理，中华预防医学会风湿免疫病预防专委会、中华医学会皮肤性病学分会、中华医学会消化病学分会炎症性肠病学组组织风湿免疫、皮肤、消化及药学等领域专家，基于国内外近十年研究进展，结合临床实践经验，制订本共识。共识系统总结了IMID的概念来源、疾病负担、发病机制、诊疗模式、治疗药物等，制定IMID多学科团队（MDT）诊疗体系，并针对风湿免疫科、皮肤科、消化科常见IMID及其相关合并症提出系统化管理建议和药物选择方案。共识旨在为IMID患者提供全程、规范、可操作的诊疗框架，促进临床实践优化并改善长期结局。.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent nodules, abscesses, and sinus tracts that lead to significant morbidity and impaired quality of life. Although both biologic therapies and surgical interventions are effective when used independently, their combined use has gained increasing attention. This systematic review aimed to evaluate the efficacy and safety of combining immunomodulatory therapy with surgical procedures in HS. A conceptual framework was applied that distinguished three modalities of combined treatment according to the temporal relationship between biologic therapy and surgery: pre-biologic surgery, post-induction surgery, and concomitant approaches. A comprehensive search identified eight eligible studies, including 508 patients. Most studies were retrospective and of low methodological quality. Across studies, combination therapy (particularly with adalimumab, secukinumab, or bimekizumab) was generally associated with improved clinical outcomes compared to biologic monotherapy, including higher response rates (Hidradenitis Suppurativa Clinical Response [HiSCR]; 55% reduction in the International Hidradenitis Suppurativa 4 [IHS4-55]), greater reductions in pain, disease flares, and Dermatology Life Quality Index scores. Safety profiles were comparable between groups, with no consistent increase in postoperative complications or serious adverse events. However, key outcomes such as wound healing time were poorly reported. Substantial heterogeneity in study design, treatment protocols, and timing of interventions limited comparability and precluded meta-analysis. Overall, the available evidence preliminarily supports combined medical and surgical treatment as a potentially beneficial and well-tolerated strategy for moderate-to-severe HS, in line with current expert practice. However, given the low quality and substantial heterogeneity of the included studies, these findings should be considered exploratory and require confirmation in higher-quality prospective studies that adopt standardized definitions of combination therapy and report wound healing as a core outcome.

Regenerative medicine is a rapidly evolving field focused on restoring tissue form and function by harnessing the body's intrinsic reparative mechanisms. In dermatology, regenerative strategies include both cellular therapies (e.g., stem cells) and acellular products (e.g., biostimulatory polymers and exosomes), emphasizing the need for responsible translation from conceptual innovation to clinical application. The 21st Century Cures Act has accelerated the development of regenerative therapies through the Regenerative Medicine Advanced Therapy (RMAT) designation, which supports products that address serious diseases or unmet medical needs. Guided by the "from the patient to the patient" paradigm, this article reviews the regenerative medicine lexicon, evolving biotechnologies, and strategies for patient management. As many current therapies enhance healing rather than achieve full tissue regeneration, careful distinction and evidence-based evaluation are critical. Regenerative biotherapeutics hold promise to transform dermatologic care by targeting root causes of disease and advancing skin health.

Modern oncologic therapies, including immune checkpoint inhibitors (ICIs), targeted kinase inhibitors (TKIs), antibody-drug conjugates (ADCs), bispecific antibodies, and adoptive cellular therapies, have transformed cancer care while introducing diverse cutaneous adverse events (cAEs). This review summarizes recent advances in the mechanistic understanding, clinical patterns, and management of dermatologic toxicities associated with contemporary cancer therapeutics. Emerging evidence indicates that therapy-associated cAEs often reflect distinct biological mechanisms rather than nonspecific drug reactions. These toxicities can be conceptually organized into four major mechanistic paradigms: immune disinhibition, epithelial signaling inhibition, cytotoxic epithelial injury, and cytokine-driven immune activation. While immune checkpoint inhibitors remain the most extensively characterized model, newer therapeutic platforms, including ADCs and immune-engaging cellular therapies, have introduced additional toxicity patterns that are only beginning to be systematically characterized. Recent clinicopathologic studies have clarified cytotoxic epithelial injury patterns associated with ADCs, while early clinical series suggest cytokine-mediated inflammatory eruptions may occur during cellular immunotherapies. At the same time, advances in immunopathologic profiling have supported the development of mechanism-directed management strategies, including targeted cytokine blockade for steroid-refractory immune-mediated dermatoses. Cutaneous adverse events associated with modern cancer therapies increasingly represent mechanism-based toxicities linked to therapy-specific biological pathways. Integrating clinical morphology with treatment class and immunologic mechanisms provides a practical framework for diagnosis and management. Mechanism-directed dermatologic care, including early recognition, targeted immunomodulation, and multidisciplinary collaboration, may improve toxicity control while preserving oncologic efficacy.

Atopic dermatitis (AD), is a chronic, relapsing inflammatory skin disorder that can pose a significant burden to patients and their caregivers and decrease their quality of life. Although substantial advances have been made in the safety and effectiveness of treatments for moderate to severe AD, opportunity for improvement remains. To better understand the patient journey and to consider the management of both current and emerging treatments, AMCP Market Insights virtually convened an expert panel of managed care stakeholders in November 2025. This article provides a qualitative summary of the panel discussion. Key insights include that delayed diagnosis and limited access to dermatology specialists are top gaps in the provision of equitable care in moderate to severe AD and that despite treatment advances, more effective and affordable options are needed. Additionally, treatment adherence and positive outcomes in moderate to severe AD are multifactorial and may be affected by elements such as timely access, care coordination, disease severity and variability, and medication coverage and costs. Emerging agents show promise for a more durable response with less frequent dosing than current therapies, but payers are waiting for additional data to demonstrate long-term safety and efficacy and real-world outcomes. These findings can support informed clinical and coverage decisions, can offer practical actions for payers, and may inform future work.

Atopic dermatitis is the most prevalent chronic inflammatory skin disease, classically defined by its eczematous lesions and relapsing course. However, growing evidence over the past decade has revealed that this disease is in fact far more heterogeneous than previously thought - both in its clinical manifestations and in the underlying molecular and immunological mechanisms. This short review explores the evolving conceptual framework used to analyze atopic dermatitis, encompassing clinical presentations (phenotypes), immune polarization profiles (immunotypes), and the background disease-related and context-related factors that shape them. The aim of this review is to highlight how such heterogeneity influences disease severity, progression, and therapeutic response, particularly in the context of increasingly personalized treatment strategies. By synthesizing accumulated scientific and clinical insights, this short review provides clinicians with a practical guide to navigating the complex spectrum of AD and its underlying therapeutic targets. Recognizing and interpreting this multidimensional variability is essential for understanding disease course and optimizing treatment selection.

Acne vulgaris is one of the most common dermatological disorders worldwide, affecting both adolescents and adults. It frequently leads to significant psychosocial and physical sequelae, including acne-induced hyperpigmentation and scarring. Beyond pharmaceutical therapies, dermocosmetics-topical formulations enriched with active ingredients in cosmetically elegant vehicles-have emerged as essential partners in acne management. They optimize clinical outcomes by supporting skin barrier repair, reducing irritation associated with conventional treatments, and targeting key pathogenic pathways in acne. However, no region-specific guidance exists to inform the effective use of dermocosmetics in South African patients, particularly those with skin of color. To develop expert consensus recommendations for the use of dermocosmetics in acne vulgaris management within the South African context. This consensus was developed through structured expert meetings and a targeted literature review of current international and local evidence. The panel synthesized clinical experience and research findings to identify key principles for selecting and integrating dermocosmetics into acne treatment regimens. The consensus highlights the multifaceted role of dermocosmetics in addressing core acne pathogenic factors, supporting epidermal barrier function, mitigating treatment-related adverse effects, and managing acne-induced hyperpigmentation in skin of color. Practical recommendations are provided for their use as adjunctive therapy, monotherapy in mild cases, and maintenance therapy to sustain remission. This South African consensus provides a practical, evidence-informed framework for incorporating dermocosmetics into acne management, with particular attention to the needs of patients with skin of color. Adoption of these recommendations may enhance treatment outcomes, adherence, and patient satisfaction across diverse skin types.

The concepts of Professional Identity Formation (PIF)/Professional Identity Development (PID) evolved in English-speaking countries with varying emphases. They serve as a starting point for the design of medical education, further education, and continuing training. The aim of this project was to obtain a discursive clarification of the conceptual understanding of PIF/PID in medical education research and curriculum development in German-speaking countries. A shared understanding of the concept was developed using a structured discourse process (two workshops, an online survey, and a group Delphi). Individuals with different disciplinary backgrounds took part in the discourse. This was part of their work in a working group of the German-speaking Society for Medical Education (Gesellschaft für Medizinische Ausbildung, GMA). The analyses of the survey and the group Delphi were conducted by applying descriptive statistics and an argument-based analysis. The group agreed upon the following understanding of the concept: "The professional identity development (Professionelle Identitätsentwicklung, PID) of physicians is an ongoing process in all phases of professional education and work. A professional identity develops in the interaction between person and environment. The process takes place both consciously and unconsciously. It is subject to internal and external influences that can be addressed and shaped in medical education, further education, and continuing training. In this process, individuals should acquire knowledge, skills and, in particular, develop a (self-)reflective attitude in the context of the norms and values of their profession." This conceptual understanding of PID, which is compatible with medical education, further education, and continuing training, as well as with teaching and learning research, highlights the processual and influenceable nature of PID. Three follow-up questions arose from the discussions: (i) To what extent is PID a malleable process?, (ii) To what extent does PID pursue a normative claim?, and (iii) What is the relationship between PID and competence? Die Konzepte der „Professional Identity Formation“ bzw. der „Professional Identity Development“ entwickelten sich im angelsächsischen Raum mit unterschiedlichen Schwerpunktsetzungen. Sie dienen als Ausgangspunkt für die Gestaltung der ärztlichen Aus-, Weiter- und Fortbildung. In diesem Projekt wurde die diskursive Klärung des Begriffsverständnisses für den deutschsprachigen Raum im Forschungs- und Praxisfeld der Medizindidaktik angestrebt. In einem Diskursverfahren (zwei Workshops, Online-Befragung und Gruppendelphi) wurde ein gemeinsames Begriffsverständnis erarbeitet. Am Diskurs nahmen Personen mit unterschiedlichen disziplinären Hintergründen im Rahmen ihrer Mitarbeit in einer Arbeitsgruppe der Gesellschaft für Medizinische Ausbildung (GMA) teil. Die Auswertungen der Befragung und des Gruppendelphis erfolgten anhand deskriptiver Statistik und einer Analyse der Argumente. Folgendes Begriffsverständnis wurde konsentiert: „Die professionelle Identitätsentwicklung (PIE) von Ärzt:innen ist ein fortdauernder Prozess in allen Phasen der berufsbezogenen Ausbildung und Tätigkeit. Die professionelle Identität entwickelt sich in der Interaktion zwischen Person und Umwelt. Der Prozess verläuft sowohl bewusst als auch unbewusst. Er unterliegt inneren und äußeren Einflüssen, die in der ärztlichen Aus-, Weiter- und Fortbildung aufgegriffen und gestaltet werden können. In diesem Prozess sollen Personen im Kontext der Normen und Werte ihrer Profession sich Wissen aneignen, Fertigkeiten erwerben und insbesondere eine (selbst-)reflexive Haltung entwickeln.“. Das an die Aus-, Weiter- und Fortbildung sowie die Lehr-Lernforschung anschlussfähige Begriffsverständnis betont die prozesshafte und beeinflussbare Entwicklung professioneller Identität. Durch die Diskussionen ergaben sich drei Anschlussfragen: (i) Inwieweit ist PIE ein gestaltbarer Prozess? (ii) Inwiefern wird mit PIE ein normativer Anspruch verfolgt? (iii) Wie gestaltet sich das Verhältnis von PIE und Kompetenz?

Medical mycology is a traditional field of medicine that has developed over a long history through the contributions of numerous researchers and clinicians. This paper focuses on the most influential individuals, discoveries, and inventions within the field, examining the development of medical mycology from the perspective of a return to its origins, including on-site investigations. This return to origins is not merely a historical retrospective but also an effort to reevaluate and deepen our understanding through practical research, aiming to explore the foundational studies that marked the beginning of medical mycology and its related disciplines. Furthermore, this paper highlights the conceptual meaning of the "light and shadow" of medical mycology. While the field has made substantial progress, it has often been overshadowed by the remarkable achievements of other disciplines, such as botany, symbolized by Linnaeus, and bacteriology, represented by Koch. This study attempts to reassess the history and significance of medical mycology. Additionally, it examines the resurgence of medical mycology and the dramatic paradigm shift triggered by a single publication from the United States. Through these considerations, this paper aims to provide a long-term and multidimensional reexamination of the progress of medical mycology.

Pathological scars manifest as firm, elevated, erythematous plaques, or nodules after skin injury. As challenging wound-healing complications, hypertrophic scars and keloids significantly compromise aesthetics while causing functional impairment and psychosocial distress. Consequently, their management remains a central focus in dermatology. The skin punch has undergone substantial technical advancements, emerging as a promising therapeutic modality. To evaluate the efficacy of punch-based techniques in managing pathological scars, we conducted a comprehensive literature search using Boolean logic across electronic databases, with the core search strategy built upon the following terms: ("skin punch" OR "punch excision" OR "punch volume reduction") AND ("pathological scar" OR "hypertrophic scar" OR "keloid"). Additional relevant studies were identified through citation tracking of the retrieved articles. This review systematically examines recent advancements in punch-assisted scar management, with particular focus on the mechanistic basis, diverse therapeutic modalities, clinical efficacy, and associated complications. This systematic appraisal of punch volume reduction for pathological scars affirms its robust efficacy in restoring aesthetic contour and functional integrity, while concurrently revealing substantial interpatient heterogeneity in therapeutic response and protracted convalescence intervals. Although the technique's clinical value is well-established, a critical deficit persists in stratified evidence across scar phenotypic spectra and temporal disease dynamics, with no codified protocols to direct therapeutic application. Confronted by the profound quality-of-life impairment attributable to pathological scars and accelerating clinical necessities, forthcoming research mandates large-scale prospective cohorts with prolonged surveillance, emphasizing technical innovation, preemptive complication management, and individualized treatment algorithms. The consolidated insights presented herein deliver both actionable guidance for contemporary evidence-based practice and a foundational conceptual architecture for future technological evolution in scar therapeutics.

BACKGROUND: Beyond the physical symptoms of leprosy, persons affected by leprosy (PAL) continue to face stigma and discrimination, also in the low-endemic setting of Pakistan. Leprosy-related stigma and misinformation impacts treatment adherence and health-seeking behavior of PAL, ultimately increasing risks of disability and increased disease transmission. Healthcare workers (HCW) play a pivotal role in detecting, diagnosing, counseling and supporting PAL. Their insights are essential in developing effective interventions to combat the stigma and improve the overall well-being and confidence in healthcare of those affected. METHODS: Twenty-one in-depth individual interviews were conducted with dermatologists, dermatology residents, general physicians, leprosy technicians and nurses. A combined inductive-deductive thematic analysis approach was applied based on a “conceptual framework of the dimensions of stigma, its manifestations and impact on health outcomes” developed by Mukerji and Turan. RESULTS: The study revealed that stigma and misinformation were shaped by contextual factors, including the absence of a national leprosy program, limited public awareness, patriarchal gender norms and socio-economic disadvantages. HCW reported frequent delays in diagnosis, psychological distress, limited awareness and socio-economic burden due to leprosy and its stigma among PAL. Although HCW demonstrated strong medical knowledge, low levels of leprosy exposure outside specialized centers reduced diagnostic confidence of non-dermatologists. Trust-building, psychosocial counseling and sensitive handling of disclosure proved essential for treatment adherence. Gender dynamics also affected care: women were more likely to hide symptoms due to the anticipated stigma, whereas men were more likely to comprise treatment adherence due to economic responsibilities. CONCLUSIONS: In low-endemic settings like Pakistan, stigma, misinformation, and structural barriers intersect to drive diagnostic delay and limited access to care. Strengthening leprosy care requires (1) Increasing public awareness and reaching broader audiences through social media and digital health tools (2) collaboration with local and alternative medicine providers to reduce misdiagnosis (3) targeted training for HCW on psychosocial counselling and gender responsive care; and (4) evaluating and improving care interventions through close collaboration with PAL and community leaders. Further, integrating leprosy control into national programs and mental health services would improve comprehensive care and support stigma reduction. CLINICAL TRIAL NUMBER: Not applicable.

Ritlecitinib, an oral selective inhibitor of Janus kinase 3 and the TEC family of kinases, has recently been approved for the treatment of severe alopecia areata, but real-world data are still limited. The aim was to evaluate the effectiveness and tolerability of ritlecitinib 50 mg/day after 24 weeks in patients with severe alopecia areata in clinical practice. We performed an Italian observational, retrospective, multicentre study with 24 weeks of follow-up. Patients ≥ 12 years of age with severe alopecia areata (Severity of Alopecia Tool [SALT] ≥ 50) and a disease duration ≥ 6 months who were candidates for systemic therapy were enrolled. Ritlecitinib 50 mg/day was administered according to national guidelines. The primary endpoint was to evaluate the achievement of SALT ≤ 20 at week 24. Secondary endpoints included achievement of SALT ≤ 10; mean change in SALT; trichoscopic improvement; quality of life; psychological impact; efficacy in eyebrows, eyelashes, and nails; and safety profile. A total of 102 patients were included. At week 24, 40.2% of patients achieved SALT ≤ 20, with a greater response in adolescents (48.6%) than in adults (21.9%). The mean SALT score decreased from 86.2 ± 18.5 to 40.8 ± 37.1. Significant improvements were observed in trichoscopic signs and quality of life. The treatment was also effective on eyebrows, eyelashes, and nails. Adverse events were mild (e.g., acne, headache). Ritlecitinib had to be discontinued in only one case of severe anaemia. In this multicentre real-world study, ritlecitinib 50 mg/day was an effective and well-tolerated treatment option for severe alopecia areata. Alopecia areata is a common autoimmune disease that causes hair loss on the scalp and other parts of the body, such as eyebrows, eyelashes, and body hair. It affects people of any age, including adolescents, and often has a strong psycho-emotional impact, reducing quality of life. A new medication for severe alopecia areata, called ritlecitinib, was approved in 2023. Ritlecitinib is a Janus kinase inhibitor that modulates the immune response involved in the pathogenesis of the disease, promoting hair regrowth. However, data on its efficacy in everyday clinical practice have remained limited. To address this, we carried out a retrospective clinical study in Italy involving 20 university dermatology departments. We evaluated 102 adults and adolescents (≥ 12 years) with severe alopecia areata, treated with ritlecitinib 50 mg/day for 24 weeks. After 6 months of treatment, about 40% of patients had major hair regrowth on the scalp (with 80% of the scalp covered by hair). The treatment worked better in adolescents than in adults (48.6 vs 21.9%). Significant improvements were also noted in eyebrows, eyelashes, nail involvement, and quality of life parameters. Ritlecitinib was generally safe and well tolerated. Adverse effects were mild, and only one patient stopped treatment because of anaemia. Overall, our study showed that ritlecitinib was an effective and safe treatment for severe alopecia areata in real-world practice, particularly among adolescents.

Existing skin health assessments predominantly focus on single topics or diseases, making it difficult to cover the complete "Knowledge-Self-efficacy-Attitudes-Behaviors (KSAB)" continuum. To develop and validate a skin health knowledge, attitudes, and behaviors questionnaire for the general population. A cross-sectional online survey was conducted among the general population between October and November 2025. The questionnaire was developed based on a conceptual structure incorporating four dimensions: knowledge, self-efficacy, attitudes, and behaviors. Content validity was assessed by 13 experts, and the Item-level Content Validity Index (ICVI) and modified Kappa (K*) were calculated. Construct validity was examined using confirmatory factor analysis (CFA). Item-level evaluation was performed using item response theory (IRT), including the two-parameter logistic (2PL) model for dichotomous items and the graded response model (GRM) for ordered items. A total of 865 individuals were enrolled (men: women = 1.24:1). Content validity was good (ICVI = 0.846-1.000, K* = 0.845-1.000). The five-factor model from CFA showed a good fit (CFI = 0.969, TLI = 0.960, RMSEA = 0.070, SRMR = 0.095). IRT analysis indicated that K1-K5 had acceptable discrimination (a = 0.59-2.40) and difficulty parameters ranging from -3.63 to -1.33. However, items K6, K7 and S1 were excluded due to insufficient threshold coverage. The proportion of women reporting frequent sunscreen use was higher than that of men. Self-efficacy levels showed a decreasing trend with age. Furthermore, individuals in service/manual labor occupations exhibited lower proportions on certain items. This study developed and validated a KSAB questionnaire on skin health knowledge, attitudes, and behaviors, showing good validity and item-level performance. The findings support targeted health promotion for men, older adults, and service/manual workers.

Primary cutaneous cryptococcosis (PCC) is a rare, localized fungal infection caused by Cryptococcus species, typically following direct inoculation of the yeast into the skin in immunocompetent individuals. Unlike disseminated cryptococcosis, which is more common in immunocompromised hosts, PCC remains confined to the skin and often arises after minor trauma or environmental exposure. Although traditionally associated with Cryptococcus neoformans (C. neoformans), Cryptococcus gattii (C. gattii) is also increasingly recognized in immunocompetent hosts. Dermatologists are crucial in the early identification of PCC, as its clinical presentation can resemble other dermatologic conditions such as bacterial cellulitis, pyoderma gangrenosum, or atypical mycobacterial infections. This review provides a comprehensive overview of the epidemiology, clinical features, diagnostic methods, and management strategies for PCC. It emphasizes the importance of differentiating PCC from disseminated cryptococcosis and other mimicking conditions. Treatment with oral azoles, such as fluconazole, is typically effective, with a favorable prognosis for most immunocompetent patients. The review also includes practical diagnostic algorithms to assist clinicians in the accurate and timely management of PCC, ultimately improving patient outcomes and reducing unnecessary interventions.

Atopic dermatitis is a chronic immune-inflammatory skin disease that significantly impairs quality of life, with itch representing a key, but not exclusive, contributor to this burden. We aimed to evaluate itch relief and quality-of-life improvements with abrocitinib or dupilumab for 16 weeks alongside topical therapy in patients with moderate-to-severe atopic dermatitis. This post hoc analysis included pooled data from patients who received abrocitinib (200 mg/day) or dupilumab (300 mg/every 2 weeks) in phase III JADE COMPARE and JADE DARE. Assessments included proportions of patients achieving a ≥ 4-point improvement from baseline in Peak Pruritus Numerical Rating Scale (PP-NRS4), itch-free state (PP-NRS 0/1) by baseline itch severity, and proportions of patients with residual itch achieving Dermatology Life Quality Index score of 0/1 (DLQI 0/1), total Patient-Oriented Eczema Measure (POEM) score ≤ 2, SCORing Atopic Dermatitis (SCORAD) sleep loss visual analog scale score of 0/1 (SCORAD sleep loss visual analog scale 0/1), and POEM sleep item score of 0 (POEM sleep 0). Among 1196 patients (abrocitinib, n = 588; dupilumab, n = 608), those with greater baseline itch severity experienced greater atopic dermatitis severity and worse quality of life than patients with less severe itch. At week 16, numerically more patients achieved PP-NRS4 (67% vs 63%) and PP-NRS 0/1 (36% vs 27%) with abrocitinib versus dupilumab, respectively, regardless of baseline itch severity, although 95% confidence intervals overlapped for both measures. Median time to achieve PP-NRS4 (11 vs 29 days) and PP-NRS 0/1 (57 vs 139 days) was shorter with abrocitinib versus dupilumab, respectively. Numerically greater proportions of patients achieving PP-NRS 0/1 also achieved DLQI 0/1, POEM ≤ 2, SCORAD sleep loss visual analog scale 0/1, or POEM sleep 0 than patients with residual itch (PP-NRS ≥ 2). In this post hoc pooled analysis of the JADE COMPARE and JADE DARE trials, the proportion of patients with moderate-to-severe atopic dermatitis achieving clinically meaningful itch responses, including an itch-free state, was generally higher with abrocitinib compared with dupilumab. Median time to achievement of both PP-NRS4 and an itch-free state was shorter with abrocitinib than with dupilumab. Patients who achieved an itch-free state experienced greater improvements in quality of life and sleep compared with patients with residual itch. JADE COMPARE (NCT03720470; registration date: 2018/10/24); JADE DARE (NCT04345367; registration date: 2020/04/10).

Ivermectin, a widely used antiparasitic drug, gained global attention during the COVID-19 pandemic for its proposed antiviral effects. This study explores how ivermectin research evolved between 2020 and 2025, identifying key trends, emerging topics, and thematic changes. A data-driven bibliometric and informatics-based analysis was conducted using the Scopus database. Original articles were examined through advanced co-citation, co-word, and bibliographic coupling techniques. We employed artificial intelligence-enabled clustering algorithms, including Walktrap and hierarchical models, using tools such as VOSviewer and Bibliometrix (R package), to explore the conceptual landscape and research dynamics. A total of 1,041 ivermectin-related articles were included. Research topics shifted from antiparasitic and veterinary uses to newer areas like COVID-19 treatment, drug repurposing, oxidative stress, and vector control. We identified 12 thematic clusters and six co-word clusters. Although citation impact declined after 2021, interest remained strong in molecular and pharmacological mechanisms. Key authors, journals, and studies were also identified. This is the first AI-enhanced bibliometric mapping of ivermectin literature in the post-pandemic era. The findings uncover underexplored but promising research directions-such as apoptosis, immunomodulation, and nanodelivery-and highlight the added value of machine learning tools in uncovering complex thematic transitions and research frontiers. This approach offers deeper insights than traditional bibliometric methods by uncovering nuanced thematic transitions through AI-powered clustering.