搜索结果：Dermatology practical & conceptual

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 Published and unpublished cost-effectiveness evidence on the named technologies, as well as other diagnostic technologies were reviewed.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 An unpublished cost-utility model was provided by Skin Analytics.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.

Core outcome sets (COSs) are agreed outcomes (domains (subdomains) and instruments) that should be measured as a minimum in clinical trials or practice in certain diseases or clinical fields. Worldwide, the number of COSs is increasing and there might be conceptual overlaps of domains (subdomains) and instruments within disciplines. The aim of this scoping review is to map and to classify all outcomes identified with COS projects relating to skin diseases. We will conduct a scoping review of outcomes of skin disease-related COS initiatives to identify all concepts and their definitions. We will search PubMed, Embase and Cochrane library. The search dates will be 1 January 2010 (the point at which Core Outcome Measures in Effectiveness Trials (COMET) was established) to 1 January 2024. We will also review the COMET database and C3 website to identify parts of COSs (domains and/or instruments) that are being developed and published. This review will be supplemented by querying relevant stakeholders from COS organisations, dermatology organisations and patient organisations for additional COSs that were developed. The resulting long lists of outcomes will then be mapped into conceptually similar concepts. This study was supported by departmental research funds from the Department of Dermatology at Northwestern University. An ethics committee review was waived since this protocol was done by staff researchers with no involvement of patient care. Conflicts of interests, if any, will be addressed by replacing participants with relevant conflicts or reassigning them. The results will be disseminated through publication in peer-reviewed journals, social media posts and promotion by COS organisations.

Social Media (SoMe) as a learning tool, though ubiquitous in society and popular within medical education, is often criticised as superficial. Its limitless output has been blamed for encouraging shorter attention spans and shirking in-depth reflection. The evidence base is itself superficial and lacking rigour or meaning. We aimed to consider a theoretical basis for how 'quality' learning may happen on such platforms. Our findings then informed the construction of a taxonomy for SoMe learning. We conducted a qualitative interview study of United Kingdom (UK) medical students using a theory-informed inductive study design. The research question was: 'How do medical students conceptualise quality of learning on social media?'. We purposively sampled participants from responses to a short survey collecting demographic and SoMe usage data. Interview data were analysed using framework analysis and informed by Blooms taxonomy, connectivism and communities of practice (CoP) theories. We received survey responses from 118 medical students across 25 UK medical schools. From these, 13 participants were recruited to individual semi-structured interviews. We constructed three themes through framework analysis of interview data: cognitive hacking, professional identity reflection and safety, control and capital. Quality SoMe learning may be conceptualised as a socially connected process, built upon constantly evolving networks but inexorably influenced by fluctuating hierarchy within learner-centric CoP. Educators and institutions may support high-quality learning for students through engagement which promotes community development, and safe, listening environments which foster professional identity formation.

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.

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。.

The identification of immunogenic peptides has become essential in an increasing number of fields in immunology, ranging from tumor immunotherapy to vaccine development. The nature of the adaptive immune response is shaped by the similarity between foreign and self-protein sequences, a concept extensively applied in numerous studies. Can we precisely define the degree of similarity to self? Furthermore, do we accurately define immune self? In the current work, we aim to unravel the conceptual and mechanistic vagueness hindering the assessment of self-similarity. Accordingly, we demonstrate the remarkably low consistency among commonly employed measures and highlight potential avenues for future research.

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?

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.

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.

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.

Patients with immune-mediated inflammatory diseases are routinely transitioned from originator biologics to biosimilars to reduce healthcare costs. While barriers related to patient and practitioner beliefs and knowledge are well-documented, less focus has been placed on system-level factors that may hinder biosimilar uptake. This review aims to identify system-level factors that impact biosimilar brand transitions for treatment of immune-mediated inflammatory diseases, as reported by key stakeholders involved in real-world brand changes. A scoping review was conducted following the Arksey and O'Malley framework and was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews (PRISMA-ScR). A comprehensive search was performed in APA PsycInfo, Embase, PubMed, Scopus, and Web of Science, and databases for major conferences in rheumatology, dermatology, and gastroenterology. Data from relevant studies were extracted and summarized onto a structured coding sheet before being synthesized. Of 2301 articles screened, 47 journal articles and five conference abstracts were included. Most studies were conducted in the United States and focused primarily on rheumatology. Barriers and facilitators were organized into four overarching themes. These were regulatory and approval processes (e.g., tendering practices, interchangeability policies, prescriber guidelines), healthcare system policies and incentives (including quotas, insurance coverage, reimbursement mechanisms, and rebates), infrastructure and logistics (such as supply chain considerations and storage requirements), and communication and education (including media and expert influence and the involvement of patient organizations). Multiple components of the healthcare system play a role in successful biosimilar transitions. Leveraging regulations, policies, infrastructure, and communication before, during, and after transition offers a practical blueprint for managing brand changes across health systems and therapies.

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.

Remote robotic surgery (RRS) represents a frontier in surgical innovation, integrating robotics, artificial intelligence (AI), and high-speed communication networks. Despite its clinical significance, the global research landscape and conceptual evolution of RRS remain insufficiently mapped. A comprehensive bibliometric analysis of 857 Scopus-indexed documents (1980-2025) was conducted using Bibliometrix (R-package), VOSviewer, and CiteSpace. Analyses covered descriptive trends, country productivity, citation impact, collaboration networks, keyword co-occurrence, Bradford's Law of journal concentration, CiteSpace co-citation clustering, and thematic evolution. Thematic mapping was performed using the Walktrap clustering algorithm (250 words, minimum cluster frequency = 5) to visualize conceptual structures and developmental trajectories. RRS research exhibited an annual growth rate of 10.35%, with strong international collaboration (26.96%). The United States, China, Japan, and France dominated global contributions. Keyword co-occurrence and CiteSpace clustering revealed five thematic domains-robotic systems, telemedicine integration, surgical innovation, AI-assisted imaging, and 5G-enabled connectivity. Bradford's Law identified a small core of specialized journals as primary publication outlets. Thematic evolution (1980-2025) indicated three conceptual eras: foundational simulation and telepresence (1980-2013), technological integration with 5G and AI (2014-2022), and intelligent convergence emphasizing deep learning, blockchain, and ultra-low-latency communication (2023-2025). Thematic mapping further highlighted telesurgery as a basic theme and surgery as a motor theme driving interdisciplinary expansion. This bibliometric synthesis reveals a paradigm shift from early teleoperation frameworks to AI-driven, 5G-powered, and cybersecure surgical ecosystems. Future research should prioritize real-time data fusion, robotic autonomy, and ethical frameworks guiding intelligent telesurgical networks.

The concept of a therapeutic window of opportunity, defined as the period from symptom onset during which treatment initiation yields the most favorable patient outcomes, is applied in routine clinical practice across a range of inflammatory conditions. It has become an increasingly important area of interest in hidradenitis suppurativa (HS), a disease in which recurrent inflammation and accumulating damage can lead to irreversible destruction of skin architecture. Biologic therapies, aiming to suppress the inflammatory burden and prevent disease progression, are currently only permitted in moderate to severe HS. However, as there is no consensus definition of moderate disease, physicians may face uncertainty about when to consider or switch biologic therapy. To identify the boundaries of the window of opportunity within HS, global HS experts have developed frameworks for defining moderate HS and disease progression. It is proposed that prompt medical treatment should be administered to patients with moderate HS, defined as patients with inadequate control of HS symptoms on conventional therapies, or one inflamed skin tunnel (draining/non-draining), or four or more inflammatory lesions (including inflammatory nodules and abscesses) involving two or more anatomic areas. Furthermore, the proposed definition for disease progression is the development of one or more new tunnel(s) and/or the extension of existing tunnels, or development of one or more persistent HS lesions in an anatomical region not previously affected, or any increase in the number of persistent HS lesions in an affected anatomical region. The proposed frameworks aim to provide practical advice to physicians and support targeting the window of opportunity during routine clinical practice.

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.

Sun protection is critical for the prevention and management of skin cancer and other photosensitive dermatoses in South Africa's diverse population. This review expands on previously published sun protection advice for skin cancer prevention by providing tailored advice for individuals with specific dermatological conditions. Recent advances in sunscreen technology, including enhanced protection for long-wave UVA1, visible light, and infrared radiation; inorganic sunscreens with more cosmetic acceptability; and the addition of other active ingredients unrelated to sun protection, are discussed in the context of specific dermatoses. Visible light protection, particularly tinted sunscreens, is particularly relevant for dark to medium skin tones prone to pigmentary disorders, such as melasma and postinflammatory pigmentation. Practical advice is provided for optimizing sun protection in inflammatory conditions, such as acne, rosacea, eczema, and psoriasis, where formulation and tolerability are important for compliance. Photoprotection for photodermatoses and human immunodeficiency virus (HIV)-associated dermatoses is also discussed. Recognizing the economic barriers to sunscreen access, the paper emphasizes the critical role of sun avoidance behaviors, such as sun-protective clothing and seeking shade, in resource-limited settings.

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.

Cervical aging is a multifactorial process affecting skin quality, fat distribution, and platysmal activity, yet existing assessment tools typically address these elements in isolation. A need remains for a comprehensive, intuitive, and clinically applicable classification model to guide diagnosis and treatment planning. To propose a unified anatomical-functional classification system for cervical aging that integrates three independent axes-Skin (S), Fat (F), and Muscle (M)-into a visual mandala model, allowing for personalized treatment strategies. A structured literature review was performed to evaluate existing cervical classification scales and their anatomical foundations. Based on the synthesis of validated criteria, the S-F-M Score was developed, with each axis graded from 0 (normal) to 3 (severe alteration). These scores are combined into a cervical phenotype (e.g., S2-F1-M3) and plotted on a radial diagram to visually guide diagnosis and therapeutic focus. The S-F-M Score enables a modular and reproducible assessment of cervical aging. The visual mandala representation enhances communication and decision-making by highlighting the dominant aging vector. Practical examples demonstrate its application in selecting tailored treatments, such as biostimulators for skin laxity, lipolytic approaches for submental fat, and botulinum toxin for platysmal hypertonia. The S-F-M classification and mandala model offer an integrative and scalable tool for cervical aesthetic evaluation. By aligning clinical diagnosis with anatomical targets, this system supports individualized, layer-specific treatment planning and provides a foundation for standardization in both clinical practice and future research. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Acne vulgaris is one of the most prevalent chronic inflammatory skin diseases worldwide, characterized by marked clinical heterogeneity, fluctuating disease course, and strong sensitivity to environmental and lifestyle factors. The exposome, encompassing lifelong environmental, lifestyle, psychosocial, microbial, and intrinsic exposures, offers an integrative framework for re-conceptualizing acne as an environmentally modulated inflammatory disease. This review synthesizes external and internal exposomal drivers of acne, including pollution, radiation, climate and occupational factors, diet, smoking, cosmetics, psychosocial stress, and microbial ecosystems. We highlight the sebaceous gland as a central exposome sensor that integrates metabolic, immune, microbial, and neuroendocrine signals. Genetic susceptibility, epigenetic reprogramming, and non-coding RNA networks are key modifiers translating environmental exposures into persistent inflammatory and metabolic responses within the pilosebaceous unit. Importantly, adopting a health equity and social determinants of health (SDOH) perspective, we emphasize how structural and socioeconomic inequalities shape exposome burden, disease severity, and access to care. We propose that exposome-informed, low-cost, community-level prevention strategies, combined with evidence-based therapies, offer a pragmatic and equitable approach to acne management. Integrating molecular mechanisms with real-world and equity considerations, this framework advances understanding of acne pathophysiology and supports translation into more inclusive clinical practice.