The implementation of teledermatology, as with other telehealth services, varies across settings. The aim of this study was to use a modified realist review methodology to synthesise factors that lead to successfully implementing and running teledermatology services. PubMed was searched in July 2025 to identify articles published internationally from 2020 to 2025 that provided a description of a teledermatology service and contained the authors' interpretation as to what contributed to the success of the service. The search returned 992 articles and 100 were included in the review after screening. Data was extracted independently by two authors who discussed terminology and interpretation of the independent data extracts. The authors modified the extracted data to ensure consistency in concepts and wording. From the included articles, 45 success factors were identified and coded using qualitative methods into eight themes: (1) Technology and imaging; (2) Hybrid model-of-care; (3) Communication; (4) People and staffing; (5) Quality of information; (6) Education and training; (7) Optimisation; and (8) Funding. The top three factors from each theme are explained in detail in this paper, and a full list of all items attributed to successful services is included in Supporting Information. The most common factors mentioned were having high quality images and using a comprehensive referral template. Some factors, such as the broader funding landscape, were acknowledged as contributing to success and represent opportunities for further advocacy. Our findings can be used to develop guidance on future teledermatology service implementation and optimisation.
Lentigo maligna has occasionally been noted to have the capacity to invade and repigment grey hairs. We present a case of a 78-year-old male who presented with a patch of brown hair on the vertex of the scalp in an area of previously white hair. The patient had previous radiotherapy to the site as a child for the treatment of tinea capitis. Initial histology revealed a lentigo maligna in situ subtype and the patient underwent surgical excision with split thickness skin graft. An invasive component was identified on histological examination of the entire lesion. This case highlights not only the rare entity of hair repigmentation as a sign of malignancy but also highlights past scalp radiotherapy as a possible risk factor in the development of melanoma.
The prevalence of adolescent and adult atopic eczema (AE) in New Zealand is not known. This study estimates the prevalence and epidemiology in Auckland, New Zealand, from 2017 to 2019, before the COVID-19 pandemic. Every primary health care organisation in Auckland provided diagnostic codes for AE for those aged greater than 15 years. Codes were matched with dispensing records for topical eczema treatments. Active disease was defined as having at least two dispensing events for AE-related treatment within any 12-month period. Data were matched to the National Health Index, which is a unique health identifier assigned to each person receiving health care in New Zealand. Population estimates were derived by linear interpolation from census data for 2013, 2018, and 2023. From 2017 to 2019, the average annual prevalence of AE per 100,000 (95% CI) was 1991 (1968-2015) for all ethnicities, 4625 (4565-4685) for Pacific peoples, 3501 (3440-3561) for Māori and 1296 (1280-1311) for Europeans. Compared to the European population, prevalence rates were higher in Pacific, Māori, and Asian populations (p < 0.001). The most deprived individuals had a higher prevalence per 100,000 population (95% CI) of 3466 (3424-3509) compared with 1737 (1706-1767) in the least deprived, p < 0.001, and the prevalence was highest in the youngest age group, 15-29 years (2766/100,000). There is a higher prevalence of adult AE in Māori, Pacific, and Asian populations compared to the European population, particularly in poorer communities and younger age groups.
Pyoderma gangrenosum (PG) is an ulcerative inflammatory dermatosis that is poorly characterised from a diagnostic and therapeutic perspective. We evaluated the clinical characteristics and healing outcomes in patients with PG according to ulcer size. We reviewed the medical records of patients with PG presenting to a tertiary hospital in Melbourne, Australia, from 20 December 2011 to 11 June 2024. We collected data on demographics, clinical characteristics, and classified cases into small (< 64 cm2) or large ulcers (≥ 64 cm2 or any tendon or muscle on view) according to the size of the largest ulcer during the treatment course. Healing outcomes assessed included rates of initial healing, healing time, recurrence rate, healing after recurrence, level of systemic treatment required, and mortality. 81 cases of PG were identified, including 38 (46.9%) small and 43 (53.1%) large ulcers. Large ulcers were associated with a history of multiple ulcers, peripheral vascular disease, and higher rates of advanced treatment (biologic or intravenous immunoglobulin therapy). After adjusting for age, sex, and peripheral vascular disease, large ulcers remained independently associated with lower rates of initial healing, higher rates of recurrence, lower rates of healing after recurrence, and longer healing times (all p < 0.05). Ulcer size was not associated with age, sex, ulcer location, tissue pathergy, inflammatory bowel disease, haematological malignancy, inflammatory arthritis, or diabetes mellitus. PG is a highly morbid condition that is slow to heal and frequently recurs. Ulcer size is an important predictor of healing outcomes. It is thus a meaningful way of stratifying patients and may provide useful prognostic information regarding the expected disease course.
Immunotherapy has transformed the management of melanoma and is now a central component of care for patients with high-risk, unresectable, and metastatic disease. Immune checkpoint inhibitors targeting programmed death 1 (PD-1), cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and lymphocyte activation gene 3 (LAG-3) enhance antitumour immune responses and have resulted in substantial improvements in survival, with durable disease control in a proportion of patients. In Australia and New Zealand, immunotherapy is routinely used across the melanoma disease continuum, including neoadjuvant, adjuvant, and metastatic settings, supported by evolving regulatory approvals and funding pathways. This review summarises current immunotherapy approaches to melanoma, with a focus on how these therapies are used in routine Australian practice, including mechanisms of action, indications across disease stages, commonly used agents, special melanoma subtypes, benefits and limitations of treatment, immune-related adverse events, particularly cutaneous toxicities, and emerging therapies. The role of dermatologists within multidisciplinary melanoma care is highlighted.
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Epidermolysis bullosa (EB) is an inherited mechanobullous genodermatosis caused by a mutation in genes encoding proteins integral to skin integrity. Premature termination codon readthrough therapies, such as gentamicin, have promise in facilitating full-length protein expression in patients with EB. We conducted a systematic review of the effectiveness and adverse effects of gentamicin for wound healing in EB. Six databases were searched to 01 September 2025 for clinical trials investigating gentamicin for EB. Risk of bias was assessed using the ROBINS-I tool, and data were synthesised descriptively. This study was registered with PROSPERO (CRD42024496582). Five studies involving 24 patients with junctional EB or dystrophic EB were included; four were open-label and one was double-blinded. Nineteen of the 24 patients had a known nonsense mutation. Gentamicin was administered topically (two studies), intravenously (two studies) and both topically and intradermally (one study). Wound healing was heterogeneously measured across studies, with all but one showing improved outcomes. All patients demonstrated increased expression of glycoprotein or collagen in skin biopsy specimens after gentamicin treatment. No adverse events were noted. However, four of five studies were at serious risk of bias on ROBINS-I, primarily owing to lack of blinding and absence of control groups, increasing the risk of bias for subjective outcomes such as wound healing. The available evidence suggests gentamicin may improve wound healing in EB caused by nonsense mutations, but the small number of heterogeneous studies precludes high-level evidence. Larger, blinded, randomised trials are required to confirm efficacy and long-term safety.
Biologic therapies have transformed the management of inflammatory dermatologic conditions, including atopic dermatitis, psoriasis, hidradenitis suppurativa, and chronic spontaneous urticaria. However, studies in Australia and abroad highlight reduced uptake in regional areas, underscoring the need to address inequities in access. A retrospective audit was performed of adult patients prescribed Pharmaceutical Benefits Scheme (PBS) subsidised biologics for severe atopic dermatitis, chronic plaque psoriasis, hidradenitis suppurativa, or chronic spontaneous urticaria between 1 January 2022 and 31 July 2025. Complete biologic treatment histories were collected for all identified patients, including prescriptions initiated before or continuing after the study period. A total of 372 patients received PBS-subsidised biologic medications for severe atopic dermatitis (42.7%), chronic spontaneous urticaria (25.8%), chronic plaque psoriasis (22.0%), and hidradenitis suppurativa (9.4%). Approximately 17% of all patients lived in regional/remote areas (Modified Monash Model [MMM] 3-5). Dupilumab (n = 159) and omalizumab (n = 96) were the most commonly prescribed first-line biologics overall. While wait times for appointments and biologic initiation were comparable across rurality classifications (median 72-77 days to first appointment, 226-304 days to first biologic), patients from MMM 3-5 regions faced significantly higher costs per appointment (MMM 3-5 $110, MMM 2 $53 and MMM 1 $36). This study highlights regional disparities in biologic therapy access within an Australian tertiary dermatology service. Addressing these inequities is vital to achieving equitable and sustainable dermatologic care.
Darier disease is a rare ATP2A2-related genodermatosis for which therapeutic options remain limited, as acitretin is often constrained by toxicity and teratogenicity. In this retrospective real-world case series of eight patients, anti-IL-17 therapy showed a more consistent early signal of clinical benefit than anti-IL-23 therapy, with greater improvement in disease severity and patient-reported outcomes and no reported adverse events. Although limited by the small sample size and attrition over time, these findings support further prospective evaluation of biologic therapies in Darier disease.
Vitiligo is associated with substantial psychosocial burden; however, community-based patient-reported data remain limited, and existing instruments may not fully reflect patients' lived experience. This study explored the psychosocial impacts of vitiligo using social media-based recruitment. Adults (≥ 18 years) with physician-confirmed or self-reported vitiligo were recruited via Facebook support groups between December 2023 and February 2024 to complete an anonymous online survey. Quantitative data included demographics and the 15-item VitiQoL questionnaire. Qualitative responses addressing challenges, management, and barriers to care were analysed inductively, with emergent themes integrated with quantitative findings. Descriptive statistics and exploratory independent-samples t-tests were performed. A total of 181 participants responded, predominantly female (81.8%), and mainly from the UK (53.59%) and Australia (29.83%). Qualitative analysis identified stigmatisation and sun exposure as prominent challenges. Head and neck involvement was associated with poorer QoL, including altered grooming behaviours (3.78, SD 2.12, p < 0.001), clothing adaptations (4.42, SD 1.96, p < 0.001), difficulties forming new friendships (2.21, SD 2.01, p < 0.001), and limitations in daily activities (2.93, SD 2.15, p < 0.001). Males reported greater emotional impact (M = 4.27, SD 1.91, p = 0.014) and more difficulty forming friendships (M = 2.85, SD 2.09, p = 0.004) than female participants. Vitiligo is associated with significant psychosocial challenges, particularly stigma-related distress, behavioural adaptations, and participation restrictions. These findings highlight the importance of addressing psychosocial wellbeing in clinical care, and the need for comprehensive QoL measures that better capture psychosocial and participation-related impacts.
Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting over 200 million people globally. Emerging IL-4Rα-targeted monoclonal antibodies have demonstrated strong efficacy and safety in clinical trials, warranting comparison with dupilumab, the current systemic standard. This meta-analysis synthesises available evidence on their efficacy and safety. PubMed, Embase and Cochrane Library were systematically searched in April 2025 for randomised controlled trials (RCTs) comparing IL-4Rα-targeting monoclonal antibodies versus placebo in moderate-to-severe AD, with EASI-75 as the primary outcome. Non-RCTs and trials using concomitant corticosteroids were excluded. Risk of bias was assessed using the Cochrane RoB-2 tool. Analyses were performed in R (v4.5.0), with heterogeneity evaluated by Cochran Q and I2 statistics. Nineteen RCTs comprising 4465 patients met inclusion criteria. At week 16, IL-4Rα inhibitors showed sustained efficacy across EASI-50/75/90, IGA 0/1 and pruritus reduction. Dupilumab remained the most validated agent, with durable effects, low heterogeneity and favourable safety. Among novel biologics, stapokibart and rademikibart demonstrated the most promising results, achieving superior EASI-90 and ≥ 4-point PP-NRS responses: stapokibart (OR 4.94; 95% CI 3.20-7.61) and rademikibart (OR 4.61; 95% CI 1.68-12.65), though the latter showed higher odds of adverse events. Other agents (MG-K10, GR1802, 611, AK120) provided encouraging but limited data. IL-4Rα inhibitors represent effective and safe therapies for moderate-to-severe AD. Dupilumab remains the reference standard, while stapokibart and rademikibart emerge as promising next-generation options. Further large, long-term, head-to-head RCTs are warranted to confirm their comparative performance. PROSPERO Registration: CRD420251129343.
In Australia, population-level early skin cancer detection is limited because dermatology service capacity is insufficient to meet demand. Digital skin check models, which combine total body photography by nurse melanographers with remote dermatologist review of clinical and dermoscopic images, may improve triage of suspicious lesions and prioritise access to in-person assessment. In this retrospective audit of 1577 reports, we evaluated the performance of one such service, DermScreen, as a triage tool to expedite in-person dermatologist review for suspicious lesions and to support more efficient use of limited dermatology resources by reducing unnecessary consultations and enabling more targeted biopsy decisions.
The traditional Rintala flap is associated with visible forehead scarring and glabellar deformities. We describe the Rintala Advanced Modification (RAM) flap, a novel technique that restricts the flap below the eyebrow line and employs asymmetric Burow's triangles for off-centre defects. Based on 20 patients with nasal basal cell and squamous cell carcinomas, the RAM flap demonstrates superior aesthetic outcomes with no glabellar complications or flap tip necrosis.
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Alopecia areata (AA) is a non-scarring, immune-mediated hair loss disorder with substantial psychosocial impact in children. Robust paediatric real-world evidence regarding Janus kinase inhibitors (JAKi) for this disease is limited. In this study, we describe real-world clinical outcomes and safety of JAKi for paediatric AA. We conducted a retrospective, observational multicentre study across 11 Spanish hospitals including patients aged 0-18 years who initiated a first JAKi (baricitinib, tofacitinib, or ritlecitinib) in routine care. The primary outcome was Severity of Alopecia Tool (SALT)-50. Secondary outcomes included the absolute SALT trajectory, eyebrow/eyelash responses, adverse events, and switching to a second JAKi. Forty-six patients were included (baricitinib 22/46 [47.8%], tofacitinib 14/46 [30.4%], ritlecitinib 10/46 [21.7%]; mean age 11.3 ± 4.0 years). Eight patients (21.6%) achieved SALT-50 at weeks 4-8, 21 patients (58.3%) at week 16, 20 patients (80.0%) at week 48, and 14 patients (82.4%) at week 72. Eyebrow and eyelash responses improved concordantly. At week 16, higher baseline SALT reduced the odds of response (β = -0.061, SE 0.029; p = 0.034). Unadjusted response rates varied across drug groups; however, treatment allocation was non-random, and groups were markedly imbalanced at baseline, so drug-level comparisons are exploratory and likely confounded by indication. Response was lower in universalis (unadjusted p = 0.008). Adverse events occurred in 16 of 46 patients (34.8%), mostly mild, with two patients (4.3%) discontinuing treatment. A second JAKi was used in seven patients (15.2%): Three complete, two partial, and two absent responses occurred post-switch. In real-world paediatric practice, we observed improvements in scalp, eyebrow, and eyelash involvement with JAKi use, with a generally favourable tolerability profile. Given the observational design, baseline imbalances, and missing data, causal inference and between-drug comparisons are not supported.
This Australian retrospective cohort analysis of 1977 patients investigates and expands on correlates of telangiectasia in systemic sclerosis to determine whether this cutaneous sign is a potential surrogate marker for disease progression and prognosis. We found that pulmonary arterial hypertension and digital ulcers were significant correlates of telangiectasia, which was also an independent risk factor for mortality. Careful monitoring of telangiectasia may provide an indicator for more severe vasculopathy, with increased morbidity and mortality in systemic sclerosis.
Dupilumab is effective for moderate-to-severe atopic dermatitis, but optimal long-term dosing is unclear. In this single-centre retrospective study, 49 patients underwent dose extension to 300 mg Q3W or 300 mg Q4W, with EASI scores remaining low and stable over 18 months. Patients extending for good disease control had higher EASI90 rates. The impact of age, disease severity and therapy duration remains uncertain.
We present a case of BRAFV600E+ primary cutaneous Langerhan cell histiocytosis (LCH), with corresponding circulating cell free DNA (cfDNA), which responded to treatment with dabrafenib, and simultaneously saw corresponding BRAFV600E cfDNA become undetectable. A concomitant diagnosis of chronic myelomonocytic leukaemia (CMML) was suspected with identification of TP53, TET2, RAS and CBL variants identified through molecular testing on the initial skin biopsy, and CMML later confirmed on bone marrow biopsy. Whilst the link between LCH and several haematological malignancies is documented, the mechanism is still unclear. In this case, the LCH most likely developed from an already abnormal myeloid compartment and highlights the need for clinical vigilance and appropriate investigation, where effective treatments for these conditions exist.
Dupilumab-associated erythema multiforme and lichenoid eruptions have been previously reported as rare dermatological adverse events. We present an atypical paediatric case of a dupilumab-associated erythema multiforme-like eruption in a 5-year-old male eczema patient, who developed erythematous targetoid papules and plaques over the upper and lower limbs, with a biopsy suggestive of a lichenoid interface reaction. Dupilumab was discontinued, and the side effect was managed with topical corticosteroids, leading to resolution of the lesions with mild residual post-inflammatory skin hyperpigmentation.
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