搜索结果：Dermatology research and practice

Acne vulgaris is a chronic inflammatory condition primarily caused by Cutibacterium acnes, which disrupts skin homeostasis, thereby triggering immune responses and sebum metabolism. Dysbiosis is an imbalance in the skin and gut microbiota identified as a significant factor contributing to acne progression. Standard therapy often relies on antibiotics, but the long-term use has increased antibiotic resistance, including in Indonesia. Consequently, alternative methods, such as probiotics and mesenchymal stromal cell secretomes, are gaining attention for immunomodulatory and regenerative properties. These novel therapies have shown promising results in modulating the skin and gut microbiota while reducing inflammation. A phase 2 double-blind randomised controlled trial will be conducted using a parallel group design with four arms, namely: (1) standard therapy with oral probiotics and topical secretome (placebo), (2) standard therapy with oral probiotics (placebo) and topical secretome, (3) standard therapy with oral probiotics and topical secretome and (4) standard therapy with oral probiotics (placebo) and topical secretome (placebo). Sixty-four patients with mild to moderate acne vulgaris will be randomly allocated to these groups. Interventions will be administered over a period of 8 weeks, with outcomes to be measured at baseline and post-therapy. This study will be conducted at the Dermatology and Venereology Department of Bali Mandara General Hospital (RSBM). The primary outcome will be the reduction of comedones and inflammatory lesions, assessed using the Yolov8 method. Secondary outcomes will include gut and skin health parameters, such as tryptophan metabolites, collagen, pH, moisture, sebum levels and IL-6, to explore the relationship between microbiome balance, skin condition and inflammation in acne. This study will be conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and the International Conference on Harmonisation-Good Clinical Practice guidelines. Ethical approval has been granted by the Health Research Ethics Committee of Bali Mandara Regional Hospital (Approval Reference Number: 060/EA/KEPK.RSBM.DINKES/2024). All participants will provide written informed consent prior to enrolment. Data confidentiality and participant safety will be upheld throughout the trial. The results of this study will be disseminated through journals, scientific conferences and relevant academic platforms to ensure wide accessibility and to support further research and clinical application in the field of dermatology, particularly in addressing antibiotic resistance and microbiome-based acne therapies. NCT06925386.

Hand-foot syndrome (HFS) is a common side effect of chemotherapy drugs such as 5-fluorouracil and capecitabine, impairing daily function and quality of life. This study aimed to compare international clinical guidelines regarding assessment and management of HFS to identify areas of consensus and divergence and evidence gaps. Guidelines were identified through PubMed (from inception to February 2025), with a supplementary search on Google. Only the most recent versions of English guidelines were included. Data extraction focused on the guideline methodology and recommendations on the prevention, assessment, and management of HFS. Each guideline was critically appraised using the AGREE II checklist. Six guidelines were identified authored by the following cancer agencies: British Columbia Cancer (BCC), European Society of Medical Oncology (ESMO), Cancer Institute NSW (eviQ), Oncology Nursing Society (ONS), United Kingdom Oncology Nursing Society and Acute Oncology (UKONS AO), and United Kingdom North Cancer Alliance (UKNCA). Regarding prevention, five of six guidelines (83%) advised avoiding chemical and physical stressors to the hands and feet and using alcohol-free moisturizer. Only ESMO, BCC, and eviQ recommended oral celecoxib to prevent capecitabine-induced HFS. ESMO and ONS recommended cooling procedures to prevent taxane-induced HFS. Likewise, BCC and eviQ recommend cooling procedures for all agents. All guidelines except ONS recommended dose suspension with grade 2 or 3 HFS and continuation when resolved or improved. ESMO and BCC recommended topical corticosteroids for grade 1 HFS, ESMO for grade 2 or 3, and eviQ for prophylactic use. Finally, BCC and ESMO suggested to consider oral dexamethasone for PEGylated doxorubicin-induced HFS. While general skin care and dose modification guideline recommendations were consistent, pharmacological recommendations varied. Guidelines are key for healthcare professionals in supporting patients with HFS. Therefore, regular updates with emerging evidence for interventions such as topical diclofenac are needed to ensure the quality of care.

Biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) have transformed outcomes for juvenile idiopathic arthritis (JIA). However, contemporary understanding of real-world treatment selection, and access across the United Kingdom (UK), remains limited. Commissioning pathways, service configuration, and age- and specialty-based prescribing frameworks may contribute to variations in care. We describe current perspectives of paediatric and adolescent rheumatology multidisciplinary teams (MDTs) on the selection and access to b/tsDMARDs for JIA across the four UK nations. A 26-question survey was distributed to MDTs across UK paediatric and adolescent rheumatology centres via national networks. Data on MDT composition, b/tsDMARD choice, commissioned pathways, dosing constraints and barriers to access were analysed by JIA subtype, UK region, age, and specialty pathway. Heatmaps and non-parametric permutation testing were used to quantify treatment patterns. Free-text responses underwent qualitative thematic analysis. Responses were received from 13 of 17 (76%) tertiary and quaternary centres across the four UK nations, representing 123 MDT professionals. Adalimumab was most commonly used first-line for all JIA subtypes except systemic JIA (sJIA)/Still's disease. Tocilizumab was frequently used second-line across multiple subtypes, including polyarticular disease and uveitis, and was widely used first- and second-line in sJIA/Still's. Interleukin-1 inhibition with anakinra was commonly used in sJIA, particularly in macrophage activation syndrome (MAS). In England and Wales, access to canakinumab for sJIA was unavailable despite supportive trial evidence, and adalimumab was the only commissioned therapy for JIA-associated uveitis. Paediatric access to anti-IL-17 agents for enthesitis-related arthritis (ERA) was limited. Broader therapeutic choice and higher biologic dosing were more accessible via dermatology or gastroenterology pathways, for example, for psoriatic JIA and inflammatory bowel disease (IBD)-associated arthritis. Adult/adolescent rheumatologists reported wider biologic access, though reclassification to adult diagnoses was sometimes required. Biosimilars were universally adopted, but specialist pharmacy support for implementation was inconsistent. External advice was sought for refractory disease, including consideration of haematopoietic stem cell transplantation and combination biologic therapy. Selection and access to effective b/tsDMARD therapies for JIA varies considerably across the UK, shaped by commissioning structures, age thresholds and specialty pathways rather than clinical need. National alignment of services is urgently required to ensure equitable, timely access to evidence-based therapies for children and young people with JIA.

Wound microbial burden and infection can delay wound healing, increase complications and rapidly progress to spreading or systemic infection, particularly in high-risk patients. Early diagnosis and appropriate treatment are essential for improved outcomes and reduced antimicrobial resistance (AMR). AMR is a growing concern in wound care due to reported inappropriate use of topical antiseptics, as well as systemic antibiotics. A recent survey found 41.8% of healthcare professionals used antimicrobial prophylactically, against recommendations, while 37.2% did not follow antimicrobial stewardship (AMS) guidance, indicating a potential gap in best-practice treatment. The primary aim of this document was to provide evidence-based guidance on the role of microbial-binding dressings (MBDs) in managing microbial burden, preventing infection and reducing the need for antimicrobial intervention in both surgical incisions and hard-to-heal wounds. The secondary aim was to summarise key findings in four clinical pathways. This guideline was developed according to AGREE II with a pragmatic literature review with GRADE assessments and a modified Delphi process for developing evidence-based statements. The literature search asked: 'In adults with a wound or surgical incision, do MBDs, compared with standard care, reduce surgical site infections, microbial burden, signs of infection, antibiotic use, antiseptic dressing use, time to healing or complication rates?'. For the statements, a 10-member expert panel scored agreement from 1 to 5, over three rounds (two remote and one in person), with acceptance at a mean score of ≥4.00 (SD ≤1.00). The literature review returned 12 studies on surgical incisions and 17 on hard-to-heal wounds, varying in evidence level and certainty. From 13 original statements, strong agreement was reached for 14; nine in round one, two in round two and three in round three (in-person meeting), with one statement split into two prior to agreement. The statements fit three themes: challenges of wound infection and AMR; benefits of MBDs for infection prevention and control (IPC); and early IPC in future AMS strategies. The guideline presents each statement with supporting evidence and detailed guidance for implementation in practice. This is followed by four easy-to-use AMS clinical pathways to support practical implementation, decision-making and consistency in care, currently under evaluation, with further validation studies expected. This guideline identifies and aims to meet a clear need for evidence-based best practice to enhance AMS in wound care. A paradigm shift towards infection prevention, early intervention and first-line treatment using MBDs should be considered an opportunity in everyday practice to minimise progression of infection, limit antimicrobial requirements and thus tackle the global threat of AMR.

Invasive cutaneous squamous cell carcinoma (CSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS)-Dermatology Venereology, and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update guideline recommendations on CSCC (previous version 2023), based on current literature and expert consensus. Part 1 of the guidelines addresses diagnostics and prevention in immunocompetent as well as immunosuppressed patients. CSCC may be classified as easy-to-treat (vast majority) or difficult-to-treat, common primary CSCC, and is further defined as low risk or higher risk depending on the risk of recurrence or metastasis. A new classification of five groups of difficult-to-treat CSCC (DTT-CSCC) is proposed, published in 2025 by EADO experts and reflecting the commonly encountered clinical challenges. Difficult-to-treat (DTT) CSCC includes DTT-common CSCC groups 1 and 2 (which correspond to a subgroup of common CSCC that are complex to treat due to tumor and/or patient characteristics or multiplicity), DTT-CSCC group 3 corresponding to locally advanced CSCC, and DTT-CSCC groups 4 and 5 corresponding to CSCC with locoregional or distant metastases, respectively. The first step of diagnostics is based on clinical and dermatoscopic features, and is always confirmed by histopathology. The presence of risk factors characterizes higher risk CSCC, and the more risk factors, the higher the risk. After the histological diagnosis of CSCC has been established, the second step includes staging procedures, such as physical examination and, when indicated, imaging. In the third and final step, the clinical, histologic and radiologic findings are incorporated into staging systems. The more widely used staging systems are the American Joint Committee on Cancer 8th edition (AJCC8) and the Brigham and Women's Hospital (BWH) systems. Prevention strategies include oral nicotinamide and sun protection measures.

Chronic wound assessment remains largely subjective and time-consuming. Although advances in biosensors and smart dressings enable objective, continuous monitoring of key parameters, with earlier detection of complications and improved efficiency in wound management, their translation into clinical practice remains limited. This systematic review synthesises current evidence on advantages, barriers and facilitators influencing the adoption of biosensor-based and smart dressing technologies for chronic wound monitoring, using an implementation science perspective. A systematic search of PubMed and Scopus (launched on October 30, 2025) identified peer-reviewed clinical studies assessing biosensors or smart dressings for chronic wound monitoring. Two blinded reviewers independently conducted study selection and data extraction per PRISMA guidelines. Eligible studies included adults with chronic wounds, technologies measuring physiological or biochemical wound parameters and outcomes related to usability, advantages, barriers or implementation processes. Data were synthesised using a narrative and thematic approach. The protocol was prospectively registered on the Open Science Framework (OSF) on October 24, 2025 (Registration DOI: 10.17605/OSF.IO/QVMKY). The six included studies (n = 122 participants) evaluated a wide range of technologies, including temperature sensors, plantar stress systems, bioimpedance arrays, pH/oxygen luminescent biosensors and a smart dressing detecting matrix metalloproteinase-9 (MMP-9). Reported advantages included high sensor accuracy, usability, continuous monitoring capability, non-invasiveness, remote data transmission and potential for early detection of wound deterioration. Key barriers comprised incomplete data acquisition, technical malfunctions, workflow complexity, learning curves for users and safety concerns (e.g., nanoparticle cytotoxicity). Key facilitators were wireless connectivity, washable and flexible materials, automated cloud-based alerts, wound-specific design and compatibility with existing wound care protocols. Current evidence remains limited by small sample sizes, technological heterogeneity and implementation barriers. Future research should prioritise large pragmatic trials, evaluating clinically meaningful endpoints and cost-effectiveness, regulatory-grade clinical validation, EHR and telemedicine interoperability, validated patient-reported outcomes and AI-enabled personalised monitoring to support translation into routine clinical practice.

Despite global commitments to eliminate mother-to-child transmission of HIV and syphilis, political and resource prioritization remains uneven across low- and middle-income countries. This has led to disparities in financial investment, policy implementation, and health outcomes. This study examines the factors shaping political prioritization of prevention of mother-to-child transmission (PMTCT) in Ghana, Mozambique, and Sudan using the Shiffman and Smith framework to understand how political, institutional, and contextual forces interact to influence national responses. A qualitative, cross-country comparative policy analysis was conducted based on document review from 3 data sources. Across countries, we included 21 government documents, 22 documents from non-governmental organizations, and 15 peer-reviewed articles selected through theoretical sampling. Both inductive and deductive thematic analyses were applied, with the latter guided by the Shiffman and Smith framework. Political prioritization of PMTCT was influenced by interrelated domains including actor power, ideas, political context, information systems, and financial resources. Ghana and Mozambique achieved higher prioritization through cohesive advocacy networks, effective issue framing, strong political commitment, reliable data, and sustained donor support. In contrast, Sudan's limited progress reflected low political commitment due to fragmented leadership, weak coordination, inadequate data, and chronic resource constraints. The findings illustrate that progress depends not only on individual determinants but also on their interaction within national policy systems. Political prioritization of PMTCT results from the interaction of multiple interlinked factors rather than any single determinant. Strong advocacy, effective framing, reliable data, and sustained funding within supportive political environments foster commitment, as seen in Ghana and Mozambique. Coordinated advocacy, credible evidence, and predictable investment are essential to strengthen the PMTCT program by translating the global elimination goals into actionable national strategies.

Mycosis fungoides (MF) and Sézary syndrome (SS), forms of cutaneous T-cell lymphoma (CTCL), manifest an indolent course in early stages, making symptom control and quality of life (QoL) paramount. Clear and actionable patient education materials may support improved QoL; however, no standardized educational intervention exists for patients with MF/SS. This single-arm pilot study aimed to develop a novel patient guide and assess its readability, actionability, feasibility, and exploratory patient-reported outcomes. The "Managing Cutaneous T-cell Lymphoma: A Patient's Guide" (MCLPG) was iteratively developed to enhance clarity, readability, and actionability. Sixteen patients with MF/SS were recruited and underwent a standardized education session using the MCLPG learning tool. Study enrollees completed baseline, midpoint (30-50 days), and final (90-110 days) follow-up surveys evaluating QoL, patient satisfaction, illness perception, material usefulness, and self-efficacy. The MCLPG understandability score increased from 76% to 94%, and the actionability score rose from 66% to 83% during the revision process. The reading grade level improved from a 9th to a 7th-grade level. At the midpoint, 100% of participants reported the MCLPG as useful, and 82% still endorsed its usefulness at the final follow-up. No statistically significant changes were observed across the patient-reported outcomes. Skindex-16 emotion, symptom, and functioning scores trended toward improvement over time but were not statistically significant. The novel patient education materials were well received by patients with MF/SS. Further research is necessary to clarify the efficacy and generalizability of the MCLPG in clinical practice. The MCLPG may serve as a feasible adjunct educational resource in clinical settings, but its efficacy on patient-reported outcomes requires additional evaluation.

Interleukin (IL)-17 and IL-23 inhibitors have transformed psoriasis care, delivering high clearance rates and quality-of-life gains. Nevertheless, inadequate response or adverse events can lead to treatment discontinuation or biologic switching. Dose modifications are also commonly implemented in routine practice to optimize efficacy, safety, and cost. The objective of this study is to characterize real-world outcomes of dose adjustment and switching of IL-17 and IL-23 inhibitors in Thai patients with psoriasis. We retrospectively reviewed 173 treatment courses with IL-17 inhibitors (secukinumab, ixekizumab, and brodalumab) and the IL-23 inhibitor guselkumab, documenting loading regimens, maintenance dosing, efficacy to Week 52, and switching events. At Week 12, full loading and standard maintenance dosing were associated with higher response rates in most cases. Ixekizumab was least often given with a full loading dose or standard maintenance dosing. By Weeks 24 and 52, reduced-dose regimens achieved comparable or better outcomes, suggesting careful patient selection. Thirty courses underwent biologic switching, predominantly for secondary failure. Intraclass switching among IL-17 inhibitors predominated. Switching from IL-23 to IL-17 inhibitors potentially outperformed both intraclass IL-17 switching or IL-17-to-IL-23 transitions. Erythrodermic psoriasis and higher baseline disease severity predicted switching, whereas incomplete loading doses and dose reductions did not. In conclusion, full loading and standard maintenance regimens facilitate early treatment response, while dose reduction in carefully selected patients can sustain long-term disease control without increasing the risk of switching.

Chronic and recalcitrant dermatophytosis has become increasingly problematic in dermatology practice, largely due to emerging antifungal resistance, affecting not only terbinafine but also azoles. Among the causative agents, Trichophyton indotineae has emerged as a key pathogen associated with treatment failure, extensive disease, and frequent relapse, even in immunocompetent patients. This study aimed to evaluate and compare two rapid molecular diagnostic approaches: A commercial multiplex qPCR assay (DermaGenius Resistance Multiplex PCR, DermaGenius RMP) and a T. indotineae-specific in-house qPCR assay, focusing on their practical value for early detection of recalcitrant dermatophyte infections and terbinafine resistance in routine dermatology practice. Sixty-four dermatophyte isolates obtained from patients with chronic or treatment-resistant dermatophytosis in T&#xfc;rkiye wereanalysed. Species identification and detection of squalene epoxidase (SQLE) gene mutations associated with terbinafine resistance were performed using DermaGenius RMP and the in-house T. indotineae-specific qPCR assay, with confirmatory ITS/SQLE sequencing and CLSI microbroth dilution antifungal susceptibility testing. Overall concordance between the two qPCR methods was 93.8% (&#x3ba;&#x2009;=&#x2009;0.74, z&#x2009;=&#x2009;5.99, p&#x2009;<&#x2009;0.001) for T. indotineae identification. Most recalcitrant cases were caused by T. indotineae, and SQLE mutations were detected in >&#x2009;90% of these isolates, consistent with the observed clinical resistance. DermaGenius RMP enabled rapid, standardised detection of terbinafine resistance-associated mutations suitable for routine diagnostics, whereas the in-house qPCR provided highly specific identification of T. indotineae. Notably, 10&#x2009;T. indotineae isolates harboured the SQLE F397L substitution despite terbinafine susceptibility. Rapid molecular diagnostics, particularly qPCR-based assays, provide actionable information early in the course of infection. In this study, both assays showed comparable performance for T. indotineae detection. Prompt identification of T. indotineae and associated resistance mutations may help avoid ineffective antifungal therapy, reduce chronicity, and support rational treatment decisions in routine clinical practice.

Neutrophilic dermatoses, including pyoderma gangrenosum (PG) and Sweet syndrome (SS), are inflammatory disorders characterized by neutrophilic infiltration without infection. Conventional therapies are often inadequate. We aim to evaluate the efficacy and safety of JAK inhibitors (JAK-I) in the treatment of PG and SS. The study was registered (PROSPERO-CRD420251113331), and a relevant search was conducted on PubMed/MEDLINE, Scopus, Web of Science, and Embase until July 27, 2025. Included studies were English language reports describing PG or SS treated with any JAK-I or cases of JAK-I-associated SS. Reviews, animal studies, and reports with insufficient clinical data were excluded. Four reviewers independently screened records. Data extraction included demographics, comorbidities, treatment regimens, outcomes, and adverse events. Risk of bias was assessed using the National Heart, Lung, and Blood Institute and Murad et al. tools through discussion-based consensus. Due to heterogeneous outcome definitions and small sample sizes, only descriptive synthesis was performed. Fifty-four reports, including 70 patients (59 PG, 5 SS) treated with JAK-I and 6 JAK-I-associated SS, were included. Across 43 PG studies, five JAK-Is-tofacitinib, upadacitinib, baricitinib, abrocitinib, and ruxolitinib-produced 33 complete and 26 partial responses. Twenty-six patients (44.1%) received monotherapy. Most patients (51/59; 86.4%) had at least one comorbidity. Adverse events occurred in 6 (10.1%), including anemia, hypertension, renal dysfunction, fatigue, and acneiform eruption. Among 11 SS reports, all 5 treated patients achieved complete resolution with baricitinib, ruxolitinib, or filgotinib. Six additional cases described ruxolitinib-associated SS, generally improving with corticosteroids or drug withdrawal. Most studies were rated good quality. Evidence is limited to small cases with heterogeneous outcome definitions, variable dosing, and inconsistent follow-up. JAK-Is are associated with clinical improvement in PG and selected SS cases and may serve as useful adjunct therapies, though caution is needed in patients with hematologic malignancies. Larger controlled studies are needed.

HIV post-exposure prophylaxis (PEP) is effective when initiated promptly and used correctly, but uptake remains limited partly because potential users and future providers may not recognize when or how PEP should be used. Medical students are relevant for assessment because they represent future clinicians and may also encounter occupational exposure during training. Evidence on PEP-specific knowledge and attitudes among Chinese medical students remains limited. We conducted a multi-center cross-sectional survey between March and August 2025 among 1,382 medical students at three medical schools in China. A structured 54-item online questionnaire assessed PEP knowledge, PEP attitudes, and HIV-related stigma. Knowledge and attitude scores were analyzed as continuous outcomes. Multivariable linear regression models were used to examine factors associated with knowledge and attitudes. The mean PEP knowledge score was 12.1 (SD&#x202f;=&#x202f;4.3) on a 0-20 scale, and the mean attitude score was 52.8 (SD&#x202f;=&#x202f;8.6) on a 15-75 scale. Knowledge was highest for basic PEP definition, the 72-h initiation window, and the 28-day regimen, but lower for delaying PEP until a baseline HIV test result is available, the HIV testing window period, and cost-related access. In adjusted analyses, higher knowledge was associated with academic year (beta&#x202f;=&#x202f;0.26), prior PEP training (beta&#x202f;=&#x202f;0.22), formal HIV curriculum exposure (beta&#x202f;=&#x202f;0.12), and attendance at Site 1 relative to Site 3 (all p&#x202f;<&#x202f;= 0.004). More favorable attitudes were associated with higher knowledge (beta&#x202f;=&#x202f;0.28), prior PEP training (beta&#x202f;=&#x202f;0.15), clinical rotation completion (beta&#x202f;=&#x202f;0.09), female sex (beta&#x202f;=&#x202f;0.07), and attendance at Site 1 relative to Site 3 (all p&#x202f;<&#x202f;= 0.022). Knowledge and attitude scores were positively correlated (r&#x202f;=&#x202f;0.29, p&#x202f;<&#x202f;0.001). In this large multi-site convenience sample, PEP knowledge was uneven and was weaker for applied clinical details than for general facts, whereas attitudes toward PEP were broadly favorable. Prior PEP-specific training was consistently associated with stronger scores. Because recruitment relied on institutional WeChat distribution rather than probability sampling, the findings should be interpreted as evidence from participating schools and should not be generalized directly to all medical students in China.

Global mpox outbreaks have exposed healthcare inequities in testing accessibility. Socioeconomic disparities and medical discrimination and distrust influence testing service utilization among vulnerable populations. We examined how medical discrimination and distrust affect testing intention across socioeconomic strata among men who have sex with men (MSM) in China. We conducted a nationwide cross-sectional study across six regions of China (November 2023 to March 2024). MSM aged &#x2265;&#x202f;18 years who reported male sexual partners within previous six months were recruited through local Centers for Disease Control and Prevention and community-based organizations. Participants completed anonymous questionnaires measuring medical discrimination and distrust (DS), structural determinants, behavioral factors, psychosocial factors, and mpox testing intention. Path analysis was used to examine the effects of medical discrimination and distrust on testing intention, stratified by socioeconomic status (SES). 50.7% of 2403 participants reported high testing intention. Path analysis revealed that medical discrimination and distrust were associated with testing intention through distinct mechanisms across SES groups. For high-SES participants, positive indirect associations were found between medical discrimination and distrust and testing intention (&#x3b2; = 0.061, P&#x202f;<&#x202f;0.001) mediated by voluntary HIV counseling and testing services, social support and depression. For low-SES participants, medical discrimination and distrust demonstrated a negative direct effect (&#x3b2; = -0.218, P&#x202f;<&#x202f;0.001) and indirect effects through social support, depression, and mpox prevention-related self-efficacy (&#x3b2; = -0.028, P&#x202f;<&#x202f;0.001). Social support emerged as a crucial mediator among low-SES groups, while depression served as the crucial mediator among high-SES groups. Healthcare inequities manifest through socioeconomically patterned pathways affecting mpox testing intention. Our findings suggest differentiated intervention strategies: integrating services with existing healthcare infrastructure for high-SES populations while strengthening community-based support for low-SES groups. These insights inform efforts to address healthcare disparities in infectious disease responses, particularly in resource-limited settings.

Dermaroller-mediated microneedling is a minimally invasive modality used to induce controlled cutaneous injury and promote hair follicle regeneration. Unlike automated microneedling devices, dermarollers are manually operated, introducing variability in technique and treatment parameters. To evaluate the efficacy, safety, and procedural variability of dermarolling as a monotherapy for hair loss. A literature search of PubMed through September 2025 was performed using terms related to dermarolling and hair loss. Studies were included if they specifically evaluated dermaroller devices. Data regarding study design, patient population, treatment parameters, and outcomes were extracted. Three studies met inclusion criteria, including two human clinical studies and one animal model. One clinical study demonstrated a statistically significant increase in hair count and thickness, whereas another reported no significant improvement in hair density or scalp coverage. The animal study showed enhanced hair regeneration, with optimal effects observed at needle lengths of 0.25-0.5 mm. Considerable variability existed across studies in needle length, treatment frequency, duration, and procedural endpoints. Reported adverse effects were generally mild and transient, though improper technique may increase the risk of epidermal injury and scarring. Evidence supporting dermaroller monotherapy for hair loss remains limited and inconsistent. Lack of standardized protocols likely contributes to variable outcomes. Further large-scale, randomized controlled trials are needed to define optimal treatment parameters and establish the safety and efficacy of dermarollling in clinical practice.

The Wound Care Collaborative Community (WCCC) presents this proposed addendum to the 2006 US Food and Drug Administration (FDA) guidance for industry on chronic cutaneous ulcers and burn wounds, with this addendum reflecting nearly 2 decades of scientific and clinical progress. Key gaps in the original guidance have emerged with advances such as the Wound Reporting in Animal and Human Preclinical Studies (WRAHPS) reporting standards and the FDA Biomarker Qualification Program. This proposed addendum updates preclinical recommendations by emphasizing standardized bioassays for biologics, improved animal model selection using WRAHPS criteria, and acknowledgment that animal studies primarily assess safety rather than predict clinical efficacy. Clinical study design recommendations incorporate digital wound assessment technologies; standardized photographic documentation; expanded biomarker use; and innovative umbrella, basket, and platform trial designs to better address biological heterogeneity in chronic wounds. While reaffirming complete wound closure as the most clinically meaningful end point, the addendum also supports the development of validated alternative end points, including patient-reported outcomes. Additional updates include biofilm detection strategies, point of care diagnostic tools, and recognition of differences between clinical trial populations and real world patients. These evidence based recommendations aim to accelerate development of safe and effective wound care products while ensuring alignment with modern regulatory standards.

Limited research explores dermoscopy use among physician associates (PAs), outside of one prior study examining dermoscopy in PA student education. This study sought to investigate dermoscopy use among practicing PAs and its impact on their overall diagnostic confidence, including in darker skin tones, when differentiating between benign and malignant skin lesions. An anonymous survey was developed in 2023 with input from experts in dermoscopy and survey creation to assess PA confidence in skin lesion evaluation as well as PA dermoscopy knowledge and use, perceptions, barriers to use, and prior education. The dermoscopy survey was included as an optional module in the 2024 American Academy of Physician Associates (AAPA) Salary Survey. Of 3174 invited PAs, 995 (31.4%) responded. Most had never used dermoscopy in practice (81%) but knew or recognized the term (71%). A majority (53%) believed PAs should be trained in dermoscopy during PA school, and 26% reported no interest in future dermoscopy use. Dermatology PAs reported more frequent dermoscopy use and generally greater confidence in evaluating skin lesions, both overall and in darker skin tones, than PAs in other specialties. PAs in surgical (OR = 0.2, 95% CI 0.1-0.6) and medical (OR = 0.3, 95% CI 0.2-0.5) subspecialties were less likely to use dermoscopy at least annually compared with PAs in primary care. PAs in rural areas were more likely to feel confident in differentiating skin lesions than those in urban areas (OR 2.9, 95% CI 1.7-5.0). Dermoscopy use is associated with higher overall skin lesion assessment confidence. Wider adoption, especially outside dermatology, requires training, increased advocacy, and expanded education.

Therapeutic management of systemic sclerosis (SSc) has evolved considerably in recent years. However, contemporary treatment patterns and prescribing determinants remain poorly characterized. Data from the German Network for SSc (DNSS) cohort containing 6,583 patients were analyzed to describe trends in vasoactive, immunomodulatory, and antifibrotic therapy; assess variation between centers and specialties; delineate co-prescription patterns; and identify clinical predictors of treatment. Use of endothelin receptor antagonists and prostanoids / prostacyclin receptor agonists increased from 3.0% [95% confidence interval (CI): 1.5%-5.3%] in 2005 to 28.4% [25.5%-31.3%] in 2025, whereas prescription of calcium channel blockers and phosphodiesterase-5 inhibitors remained stable. Immunomodulatory therapy shifted away from cyclophosphamide towards mycophenolate mofetil, rituximab, and nintedanib, accompanied by a marked decline in glucocorticoid use (50.0% [31.9%-68.1%] in 2000 to 18.1% [11.8%-25.9%] in 2025). University or rheumatology centers prescribed immunomodulators and antifibrotics more frequently than non-university or dermatology centers. Co-prescription patterns showed common combination therapy with tocilizumab or rituximab and methotrexate. Nintedanib was commonly co-administered with mycophenolate, but also with cyclophosphamide or methotrexate. Rituximab was most commonly combined with mycophenolate and tocilizumab with methotrexate. Multivariable mixed models identified modified Rodnan skin score, interstitial lung disease, heart involvement, and care in a university, particularly rheumatology, center as major determinants of immunomodulatory and antifibrotic therapy. SSc treatment has evolved over the past 25 years, with prescribing patterns increasingly reflecting evidence and guideline recommendations. However, differences between specialties and care settings highlight the need for broader implementation of multidisciplinary, guideline-based care.

Biologic therapies have transformed the management of moderate-to-severe psoriasis; however, long-term treatment requires optimization strategies to maintain efficacy, minimize adverse effects, and improve cost-effectiveness in real-world practice. This narrative review summarizes current evidence on biologic optimization in psoriasis, including dose adjustment strategies (dose reduction and escalation), interval modification, switching between biologics, and treatment tapering. The role of therapeutic drug monitoring and immunogenicity in guiding treatment decisions is also discussed, along with emerging approaches such as combination biologic therapy. In addition, evolving biomarkers and computational tools, like machine learning, may enable the prediction of treatment response and guide personalized therapy. A structured literature review of published clinical trials, real-world studies, and review articles was undertaken to evaluate existing evidence and identify gaps in current practice. Biologic optimization should follow an individualized, mechanism-based approach integrating clinical response, pharmacokinetic variability, and patient-specific factors. While current evidence is heterogeneous, future research focusing on validated biomarkers, therapeutic drug monitoring, and artificial intelligence-driven models will be critical in advancing precision medicine and improving the optimization, durability and cost-effectiveness of biologic therapy.

Ruxolitinib cream (1.5%) has demonstrated efficacy and safety in patients aged &#x2265;&#xa0;2 years with mild-to-moderate atopic dermatitis. We aimed to further investigate the safety and efficacy of ruxolitinib cream in adolescents with atopic dermatitis in an open-label study. Patients aged 12-17&#xa0;years with atopic dermatitis, an Investigator's Global Assessment score of 2/3, and 3-20% affected body surface area applied twice-daily 1.5% ruxolitinib cream for an 8-week continuous treatment period, followed by a 44-week long-term safety period in which ruxolitinib cream was applied twice daily as needed. Safety was the primary endpoint. Secondary endpoints included plasma trough concentrations of ruxolitinib. Affected body surface area, &#x2265;&#xa0;75% improvement from baseline in Eczema Area and Severity Index, achievement of Investigator's Global Assessment score of 0/1, and &#x2265;&#xa0;4-point improvement from baseline in the itch Numerical Rating Scale were exploratory endpoints. Of 103 patients, 59.2% had a baseline Investigator's Global Assessment of 3. Mean baseline body surface area and Eczema Area and Severity Index scores were 8.9% and 6.4, respectively. Over 52 weeks, 42 patients (40.8%) had treatment-emergent adverse events, most commonly upper respiratory tract infection (10.7%) and nasopharyngitis (8.7%). Three patients (2.9%) had grade &#x2265;&#xa0;3 treatment-emergent adverse events; all were considered unrelated to treatment by the investigator. Steady-state ruxolitinib plasma concentrations during the continuous treatment period were low (geometric mean [geometric coefficient of variation], 14.2 [169] nM), consistent with the lack of observed treatment-emergent adverse events associated with systemic Janus kinase inhibition. Clinical improvements occurred during the continuous treatment period and were maintained or improved with as-needed treatment through the long-term safety period to week 52 (mean affected body surface area, 1.3%; &#x2265;&#xa0;75% improvement from baseline in Eczema Area and Severity Index, 87.0%; Investigator's Global Assessment 0/1, 82.6%; &#x2265;&#xa0;4-point improvement from baseline in&#xa0;itch Numerical Rating Scale, 41.7%). Ruxolitinib cream (1.5%) was well tolerated and efficacious with long-term as-needed use in adolescents with mild-to-moderate atopic dermatitis, consistent with safety and efficacy findings reported in previous phase III studies in adolescents and adults. Clinicaltrials.gov identifier, NCT05456529 (registered 13 July, 2022).