Desquamating or blistering skin conditions may be referred to burns and plastic surgeons owing to the morphological similarity to burn injuries, given an increasing shortage of dermatology inpatient beds within the context of NHS care. Desquamating skin conditions, similar to burn injuries, carry the potential to be severe, debilitating and potentially fatal; however, they present more complexity owing to their underlying aetiologies. These conditions may present with similar physiological challenges, dressing requirements and need for extensive multidisciplinary input as burn injuries, and there is an increasing demand for burns and plastic surgery involvement in their management. In this review, the following blistering skin diseases (BSDs) are discussed: Bullous erythema multiforme, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TENS), pyoderma gangrenosum, impetigo, Staphylococcal scalded skin syndrome, erythroderma, pemphigus vulgaris (PV), bullous lupus, pemphigus paraneoplastica, acute generalised exanthematous pustulosis (AGEP), dermatitis artefacta, linear IgA bullous dermatosis and adverse drug reaction. All patients should undergo a thorough head to toe skin examination, including the mucous membranes, their current and recent medications should be reviewed, and considered for discontinuation if clinically safe. A full panel of blood investigations, including an auto-antibody screen, should be performed to identify the underlying cause and multiorgan disfunction. A single investigation of the greatest diagnostic value is an incision or punch biopsy, which should be sent for histology and immunofluorescence analyses. Antimicrobials and steroids should be initiated by dermatology after review. General care of these patients includes treatment of the underlying cause, management of acute deterioration and symptoms, and appropriate wound care.
To investigate the therapeutic efficacy of silymarin extract on deep second-degree burns in vivo and in vitro and elucidate the underlying molecular mechanisms. A total of 126 Sprague-Dawley rats were randomized into 7 groups using a random number table method (n=18), including normal control (NC), model, vehicle control (Veh), positive control (Mepore Moist Burn Gream, 25 mg/cm2), and low-, medium-, and high-dose silymarin extract groups. All treatments were applied topically twice daily during 1st week and once daily for the subsequent 14 days. Deep second-degree burn model was established using a controlled-temperature scald device in all groups except the NC group. Therapeutic efficacy was evaluated via wound closure dynamics and tissue water content (edema). Histopathological changes, including collagen deposition and structural integrity, were examined using HE and Masson's trichrome stainings. Inflammatory and oxidative microenvironment were characterized by quantifying the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1, malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH) using commercial assay kits. Activation of the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling axis [Nrf2, Kelch-like ECH-associated protein 1 (Keap1), heme oxygenase (HO)-1, and NAD(P)H:quinoneoxidoreductase 1 (NQO1)] was assessed using immunohistochemistry and Western blot, respectively. To corroborate the in vivo findings, HaCaT keratinocytes were treated with Nrf2 inhibitor ML385 to validate pathway dependency. Silymarin extract treatment significantly accelerated wound closure and attenuated tissue edema in the scalded areas (P<0.05 or P<0.01). Histopathological assessment revealed that silymarin extract augmented collagen deposition and remodeling, promoted reepithelialization and regeneration of skin appendages, mitigated inflammatory cell infiltration, and facilitated necrotic tissue resolution (P<0.01). Mechanistically, silymarin extract upregulated the Nrf2 signaling pathway by promoting Nrf2 dissociation from Keap1. This activation potentiated antioxidant defenses (HO-1, NQO1, SOD, and GSH) and suppressed MDA (P<0.05 or P<0.01). Concurrently, silymarin extract significantly downregulated pro-inflammatory cytokines IL-1 and TNF-α (P<0.05 or P<0.01). These protective effects were abrogated in vitro by the specific Nrf2 inhibitor ML385. Silymarin extract accelerates the healing of deep second-degree burns and mitigates oxidative stress-induced tissue injury by activating Nrf2 signaling axis, suggesting its potential as an effective therapeutic agent.
Burn injuries remain a major public health concern, often resulting in extensive tissue damage and life-threatening complications. Among these, burn wound infections are the leading cause of mortality in patients with extensive surface area involvement. This study aimed to compare the wound-healing efficacy of silver sulfadiazine (SSD) cream and povidone-iodine in patients with second- and third-degree burns involving 30 to 50% of total body surface area (TBSA). The primary outcome was wound healing rate (time to graft preparation), while secondary outcomes included pain intensity and the frequency of required dressing changes. In this double-blind clinical trial, 80 patients with second- or third-degree burns involving 30 to 50% TBSA were enrolled and randomly assigned to receive either SSD cream or povidone-iodine (PI). The sample size was determined using a formal power calculation (α = 0.05, power = 80%), resulting in 40 patients per group. Wound healing was assessed based on healing rate, tissue appearance, pain intensity, inflammatory response, and overall recovery, using weekly clinical examinations and photographic documentation. Among the 80 participants (51.2% female and 48.8% male; mean age, 38.1 ± 14 years), the PI group required significantly more frequent dressing changes (P = 0.001) and reported higher pain intensity (P < 0.001). Interestingly, no significant between-group differences were observed in healing rate, number of surgical interventions, or length of hospital stay (P > 0.05). Logistic regression identified pain intensity as the only variable significantly associated with treatment type (P = 0.014). SSD demonstrated superior clinical performance in reducing pain and dressing frequency among patients with moderate-to-severe burns, although overall healing rates were comparable between groups. Larger multicenter studies are recommended to validate these findings and to assess long-term outcomes.Clinical trial registration Iranian Registry of Clinical Trials (IRCT), IRCT20240126060819N1, registered on April 10, 2024.
Patients with large total body surface area (TBSA) burns face significantly elevated risks of morbidity and mortality. Achieving rapid, durable wound closure with minimal risk of infection or systemic compromise is critical to reducing mortality. Biodegradable Temporizing Matrix (BTM) (PolyNovo, Victoria, Australia) offers a synthetic alternative to biological dermal substitutes, providing temporal wound closure and a scaffold for neodermis generation. A 68-year-old woman presented with third-degree flame burns covering 25% TBSA across the right trunk and upper limb following a domestic syncopal episode. After initial stabilization, the patient underwent a 2-stage reconstruction. Stage I (postburn day 4) involved surgical excision to the fascia and immediate application of BTM. Stage II (postburn day 39) involved the delamination of the sealing layer and coverage of the vascularized neodermis using split-thickness skin grafts, meshed at a ratio of 1:1.5. BTM was successfully integrated within 35 days, exhibiting the characteristic uniform pink color of vascular network formation. Complete epithelialization was documented by postburn day 75, with no clinical signs of infection observed throughout the treatment course. Follow-up at postburn day 377 demonstrated satisfactory functional recovery and favorable long-term scar quality, with minimal secondary contracture. BTM provided temporal closure that was less prone to infection, which proved invaluable in managing this extensive burn in a high-risk patient. Successful neodermis regeneration improves the split-thickness skin graft coverage characteristics and supports the use of BTM as an effective reconstructive modality for deep, large-TBSA burns, where minimizing risk of infection and fluid loss is paramount, while simultaneously allowing for improved functional and aesthetic outcomes.
The rapid increase in electric bike (e-bike) use has led to a rise in lithium-ion battery fires, which present significant hazards. Beyond thermal injury, these fires emit toxic gases such as hydrogen fluoride (HF), capable of causing severe chemical inhalation injury. The pulmonary effects of inhaled hydrofluoric acid are not well characterised in the literature. Two cases of severe lung injury occurred following indoor e-bike battery fires. The first patient sustained 32% total body surface area (TBSA) burns and developed acute respiratory distress syndrome with radiological evidence of chemical pneumonitis, necessitating prolonged mechanical ventilation and resulting in persistent pulmonary impairment. The second patient sustained 44% TBSA burns and experienced rapidly progressive respiratory failure that was disproportionate to typical smoke inhalation injury. Despite maximal supportive therapy, including extracorporeal membrane oxygenation, the patient died from catastrophic pulmonary failure. Lithium-ion battery fires present both thermal and chemical hazards, especially in enclosed environments. These cases highlight the importance of maintaining a high index of suspicion for toxic inhalation injury, promptly recognising disproportionate respiratory failure, and monitoring for biochemical indicators of hydrofluoric acid exposure as the prevalence of lithium-ion battery use increases.
Rope friction injuries result from rapid, repetitive contact with coarse ropes or chains, causing combined mechanical and thermal damage. These injuries commonly affect young individuals during activities such as tug-of-war, climbing, air acrobatics, and rope handling. Although superficial and deep burns are most frequent, injuries may also involve vessels, nerves, tendons, and bone. This study presents our experience managing rope friction burns and reviews functional and aesthetic outcomes. We retrospectively reviewed 23 patients with full-thickness hand defects after rope friction injuries. Functional disability was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Scar quality was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Seventeen patients were male and 6 were female. Six patients had bilateral defects and 17 had unilateral defects. The mean defect size was 6.8±1.5 cm². Nine patients had associated vascular, nerve, or tendon injuries. Reconstruction included debridement and primary repair (n=11), full-thickness skin grafting (n=5), local flaps (homodigital rotation-advancement and transposition flaps; n=4), and superficial circumflex iliac artery perforator free flaps (n=3). Functional outcomes improved significantly after reconstruction (mean preoperative DASH: 83.9±4.02 vs. 12-month DASH: 6.65±2.57; P<0.00001). Mean patient and observer POSAS scores were 2.8±0.19 and 2.87±0.17, respectively, with no significant difference (P=0.106845). Rope friction injuries frequently extend deeper than expected and may involve critical underlying structures. Careful evaluation is essential. Most defects can be managed with primary repair, grafting, or local flaps, while free flaps provide reliable functional and aesthetic reconstruction when local options are inadequate.
The healing of severe infected burn wounds is impeded by a vicious cycle of bacterial biofilms, oxidative stress, immune dysregulation, and hypoxia. Existing microneedle (MN) platforms often fail to address these multifactorial barriers due to insufficient mechanical robustness, lengthy fabrication times, and limited therapeutic scope. Our goal was to develop a multifunctional, on-demand MN platform that can simultaneously overcome these challenges by systematically dismantling pathological barriers and activating endogenous regenerative pathways. We developed a multifunctional MN platform based on a semi-Interpenetrating Polymer Network (sIPN) of hyaluronic acid methacrylate (HAMA) and ethoxylated trimethylolpropane triacrylate (ETPTA). This platform was co-encapsulated with a triad of therapeutic agents: a biofilm-dismantling antisense oligonucleotide (ASO) targeting the bacterial gene yycF, nanoceria (CeO₂) for reactive oxygen species (ROS) scavenging and in-situ oxygen generation, and anthocyanin (An) as an antioxidant and anti-inflammatory agent. The therapeutic efficacy of the MN platform was evaluated in a rat model of MRSA-infected full-thickness burns. Healing was assessed through macroscopic observation, histological analysis, and immunofluorescence staining. The underlying molecular mechanisms were investigated using transcriptomic and protein analyses of wound tissues. The fabricated sIPN MNs exhibited exceptional mechanical strength, rapid fabrication time, and strong tissue adhesion. In the rat model, the MNs effectively dismantled biofilms, reduced oxidative stress, alleviated hypoxia, and shifted the immune balance towards M2 macrophage polarization. This comprehensive microenvironment remodeling led to accelerated wound closure, promoted angiogenesis, and encouraged ordered collagen deposition, resulting in higher-quality tissue regeneration compared to control groups. Transcriptomic and protein analyses revealed that this enhanced healing was driven by the significant activation of the epidermal Wnt/KLF5 signaling axis. Our study presents a mechanistically elucidated, multimodal sIPN MN platform that effectively promotes the healing of infected burn wounds. By remodeling the pathological microenvironment and activating the Wnt/KLF5 regenerative axis, this on-demand platform demonstrates significant potential for clinical translation in the management of complex wounds.
Aesthetic tattooing is widely used for decorative purposes, and medical tattooing is established in reconstructive practice. However, decorative tattooing remains an underrecognized option for scar camouflage in burn and trauma patients, with limited clinical guidance regarding patient selection and integration into scar services. We performed a retrospective evaluation of patients treated at a tertiary burns center between 2021 and 2024 who underwent aesthetic tattooing for scar camouflage. Clinical records were reviewed for scar characteristics, prior scar treatments, complications, and patient-reported satisfaction. A focused literature review was undertaken to contextualize current evidence and to inform the development of a proposed management algorithm. Four patients with mature burn or traumatic scars underwent aesthetic tattooing following prior conventional scar therapies, including laser treatment, scar revision, and skin grafting. Tattoos were used to camouflage dyschromia, grafted skin, and extensive visible scarring. All patients reported high satisfaction, improved confidence, and perceived improvement in scar appearance. No tattoo-related complications were reported in this series. Aesthetic tattooing may represent a safe and effective adjunct for selected patients with mature scars when conventional scar therapies have been optimized. It has potential psychosocial benefits and may address aesthetic concerns not fully corrected by standard interventions. We propose a practical clinical algorithm incorporating scar assessment, optimization, temporary tattoo trials, and referral pathways to support integration into multidisciplinary burn and scar services.
Charred Sanguisorbae Radix (CSR) is a well-known traditional Chinese medicine clinically used to treat conditions such as burns and bleeding, with tannins being its main active ingredients. In this study, the tannins (SDT) were isolated and purified from CSR using macroporous resin. Subsequently, SDT was loaded onto a poly(lactic acid) (PLA) nanofiber membrane using electrospinning, and its potential application value as a wound dressing was evaluated. The experimental results demonstrated that the nanofiber membrane loaded with SDT exhibited strong antioxidant activity and favorable antibacterial performance, both of which were enhanced with increasing SDT concentration. Among the tested membranes, the PLA2 membrane with 9% SDT loading (90 mg SDT per 1 g PLA, mass ratio) exhibited excellent biocompatibility and could significantly promote wound closure of L929 fibroblasts in the cell scratch assay. Furthermore, the PLA2 membrane could slowly release gallic acid to continuously exert its therapeutic effect. In summary, the novel SDT-loaded PLA nanofiber membrane shows great potential as a wound dressing, providing a scientific foundation for the further application of CSR in wound healing therapy.
Pediatric burns in Saudi Arabia are predominantly household scalds in young children, causing long-term disability from scarring, contractures, pain/itch, psychosocial distress, and disrupted schooling. This thematic narrative review (2010-2025) synthesizes global and regional evidence, appraises outcome measures with attention to Arabic availability, and translates findings into Vision 2030-aligned policy actions. Evidence supports early, multidisciplinary care anchored in standardized outcome tracking. Pressure-garment therapy remains inconclusive, whereas virtual reality reduces procedural pain and telerehabilitation serves families distant from tertiary centers. A minimum national outcome set is proposed spanning scar quality (VSS, POSAS), joint range of motion, age-appropriate pain and itch scales (FLACC/FPS-R/NRS), HRQoL (PedsQL, PROMIS), and school reintegration. Embedding these indicators in electronic records and registries-with risk adjustment and linkage to utilization and cost-would enable benchmarking, value-based purchasing, and equitable service planning and access. Implemented at scale, this framework can deliver measurable gains in function, participation, and family well-being across the Kingdom.
Cynoglossum clandestinum Desf. (C. clandestinum Desf.) is a wild Moroccan medicinal species traditionally used for wounds, burns, microbial infections, and inflammatory skin disorders. This work aimed to characterize the phytochemical composition of the ethanolic leaf extract of C. clandestinum Desf. and to evaluate its antioxidant, anti-inflammatory, and antidepressant-like activities using in vitro, in vivo, and in silico approaches. Leaves were macerated in absolute ethanol to obtain a reproducible ethanol-soluble fraction. Total phenolic and flavonoid contents were determined, and major compounds were identified by HPLC-DAD. Antioxidant activity was assessed by DPPH radical scavenging and total antioxidant capacity assays. Anti-inflammatory activity was evaluated in the carrageenan-induced paw edema model, and antidepressant-like activity was assessed in the forced swimming test in rats. Major identified compounds were further examined by ADMET prediction and molecular docking. The extract contained 51.25 ± 1.06 mg GAE/g of total phenolics and 41.14 ± 1.81 mg QE/g of total flavonoids. HPLC-DAD identified six major phenolics, with quercetin-3-glucoside (12.08%) and epicatechin (10.17%) as the most abundant compounds. The extract showed strong antioxidant activity (DPPH IC50 = 0.290 ± 0.03 μg/mL; TAC = 295.83 ± 6.71 mg AAE/g), dose-dependent anti-inflammatory activity (63.64% edema inhibition at 400 mg/kg at T6), and a significant reduction in immobility time in the forced swimming test. Docking suggested quercetin-3-glucoside as the best xanthine oxidase binder, whereas quercetin showed the highest affinity for COX-2 and MAO-A. The ethanolic leaf extract of C. clandestinum Desf. is rich in bioactive phenolics and shows promising antioxidant, anti-inflammatory, and antidepressant-like effects. Quercetin-3-glucoside appears to be the main antioxidant-oriented lead, whereas quercetin is the most promising anti-inflammatory and antidepressant-oriented lead. Further studies on isolated compounds, toxicity, and pharmacokinetics are required.
Burn injuries are known as one of the main reasons for hospitalizations across the globe. Scalds, which are considered as wet burns, are more common. Many procedures are used to manage the wound healing process; using silver sulphadiazine 1% is one of those routine ways. However, nowadays, traditional medicine findings, along with modern medications, can cooperate with each other to lead to perfect wound care. Thus, the usage of medicinal plants is suggested for this purpose; so, the aim of the present study is to investigate the beneficial effects of a quadri herb (QH) ointment based on of medicinal plants: Scrophularia striata, Artemisia aucheri, Falcaria vulgaris, and Aloe vera on second-degree burn scald. A total of 42 male Wistar rats were grouped into 7; after induction of burn scald by the use of hot water, treated groups received QH ointment in concentrations of 0.5%, 1%, 2%, and 5% with respect to herbal extracts; the wound healing process was monitored for 16 days and the results were statistically analyzed. On the final day of intervention, rats were sacrificed, and skin biopsies were used for histopathological evaluations. Significant reduction of wound percentage (p ≤ 0.05) among 2% and 5% groups showed that QH ointment performed better in wound healing compared with the control and positive control groups. Histological analysis also revealed significant increases in granulation and vascular-fibroblast density with 5% of QH ointment (p ≤ 0.01). It concludes that QH ointment has remarkable effects in the healing of second-degree burn scalds.
The smile is a fundamental facial expression that is important for emotional wellbeing. Long-term facial nerve palsy leads to an inability to smile, which can have profound effects on mental health. Although numerous techniques exist for facial reanimation, evidence on secondary interventions following a failed primary procedure remains scarce. This systematic review, conducted in accordance with PRISMA guidelines, aimed to identify techniques for secondary smile restoration. A systematic search of PubMed, Scopus, and MEDLINE identified 41 studies; after independent screening using PICOT-based inclusion and exclusion criteria, and a subsequent quality assessment, 4 studies (12 patients) were included. Eight distinct secondary techniques were reported, all of which were associated with improvement in smile-related outcomes and/or facial symmetry, alongside reduced House-Brackmann scores. However, these findings are limited by the small sample size, methodological shortcomings, and incomplete reporting, precluding an indication of the optimal technique. Future high-quality studies, particularly long-term randomised controlled trials with larger cohorts, and comprehensive reporting of patient characteristics and clinical outcomes, are required to establish the most effective method of secondary smile restoration.
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Parenthood regret, a feeling arising from the judgment that the decision to have children was wrong and the belief that an alternative choice would have led to a better life, remains largely underexplored despite its relevance to parental and child adjustment and its likely developmental and environmental roots. Prior work linked childhood disorganization and role reversal to enduring disruptions in caregiving. Simultaneously, the accelerating climate crisis may intensify parenthood regret, especially among parents with unresolved developmental trauma. Yet eco-anxiety has rarely been examined in parents. We tested distinct and interactive effects of childhood disorganization and role reversal, together with eco-anxiety, on parenthood regret in 760 cisgender, heterosexual, primary-caregiving mothers in Italy (Mage = 42.50, SD = 8.96) of preschoolers (Mage = 4.11, SD = 1.63). Higher levels of eco-anxiety over the last two weeks were associated with greater parenthood regret and amplified the impact of developmental risk. Specifically, greater childhood disorganization with one's mother, but not with one's father, was associated with greater parenthood regret when mothers experienced increased eco-anxiety. Findings indicate that early relational trauma and contemporary existential threats jointly shape maternal feelings about parenthood. Clinically and socially, results suggest the value of targeted support for mothers facing complex caregiving demands under climate stress (e.g. trauma-informed parenting interventions, community resources) and of policy actions that address climate-related anxiety and family well-being.
Dissipation of body heat, essential to human life, is largely achieved through sweating. If sweating does not occur normally-as in patients with hypohidrosis (reduced sweating) or anhidrosis (lack of sweating)-the ability to dissipate heat via evaporative mechanisms is overwhelmed. Body temperature may rise, leading to heat-related illness, including heat intolerance, hyperthermia, heat exhaustion, heat stroke, and even death. In patients seen by a dermatologist, anhidrosis may underly and contribute to their symptoms and signs but may be difficult to detect given a limited availability of tools to measure anhidrosis. An association between anhidrosis and skin symptoms including flushing syndromes (eg, facial flushing and erythromelalgia) and widespread skin symptoms (eg, itching, burning, numbness, or tingling, and paresthesias) has recently been described. This review explores the existing dermatologic literature on anhidrosis including clues to the pathophysiology of these disorders, its relationship to skin diseases and symptoms, the tests currently available, and approaches to management. Recognition of an underlying anhidrosis by dermatologists may be important for providing optimal management for patients with heat-related symptoms.
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We conducted a quadruple-blinded, randomized, placebo-controlled trial of metformin for treating acute SARS-CoV-2 infection to prevent long COVID symptoms in low-risk adults. The ACTIV-6 platform evaluated repurposed medications for mild to moderate COVID-19. Between September 19, 2023 and May 1, 2024, 2983 outpatient adults ≥30 years with confirmed SARS-CoV-2 infection and ≥2 COVID-19 symptoms were included within 7 days of symptom onset from 90 sites. Participants were randomized to metformin or placebo for 14 days. Post-acute sequelae of SARS-CoV-2 or death (PASCD) was ascertained by asking whether participants had symptoms they attributed to COVID-19 on day 180. Secondary outcomes included clinician-diagnosed long COVID. The median age was 47 years (interquartile range 38-57); 63% were female; 47% Hispanic/Latino; 83% reported ≥1 prior COVID-19 infections or ≥2 SARS-CoV-2 vaccines. There were no deaths. Overall, 96 (3.2%) reported COVID-19 symptoms on day 90, 101 (3.4%) on day 120, and 79 (2.6%) on day 180. The adjusted risk of symptoms on day 180 was 0.8 percentage points lower with metformin (95% credible interval [CrI] -2.2 to 0.6) with a posterior probability of efficacy [PPE] for preventing symptoms of 0.83, risk ratio 0.79 (95% CrI 0.474 to 1.230). Compared with placebo, the risk of clinician-diagnosed long COVID was 0.7 percentage points lower with metformin (95% CrI -1.5 to 0.1); PPE 0.96; risk ratio 0.495 (95% CrI 0.155 to 0.995). In low-risk adults, most with prior immunity, metformin did not exceed the efficacy threshold of 0.975 for PASC. Metformin reduced the risk of clinician-diagnosed long COVID.
Osteogenesis imperfecta (OI) is a rare heritable disorder of type I collagen that predisposes patients to recurrent fractures and skeletal deformities. Although fracture management in children with OI has been widely described, guidance for adult patients is comparatively limited. This is a report of the case of a 35-year-old man with OI who sustained right-sided sacroiliac diastasis and pubic rami fractures following a high-energy bicycle accident. The injury was treated with percutaneous screw fixation, achieving satisfactory reduction and stable fixation without perioperative complications. The patient advanced to full weight bearing at 12 weeks, and at 2-year follow-up demonstrated near-baseline function with Visual Analog Scale and Majeed Pelvic Scores that closely approximated those reported in non-OI populations. Radiographs showed no evidence of malunion or nonunion, though he continued to experience chronic low back pain. This case suggests that standard fixation strategies may be effective for selected adults with mild OI phenotypes, provided that preoperative planning accounts for the condition's distinctive biomechanical and hemostatic challenges.
Assess knowledge of and adherence to DGA food group recommendations and their associations and evaluate beliefs about whether individuals with SCI/D should follow the same guidelines as those without SCI/D, and how these beliefs relate to adherence. Cross-sectional survey. National Veterans Health Administration SCI/D Centers, Midwest Regional SCI Model System of Care, and Shirley Ryan AbilityLab. Veterans and civilians with SCI/D recruited by mailed invitation letters. Knowledge of, adherence to, and beliefs about DGA applicability for individuals with SCI/D across food groups. Participants were, on average, 58 years old, with a duration of injury of 12 years, and 57% had paraplegia. Knowledge of the DGA recommendation for each food group ranged from 24%-44%. Fewer than one-third adhered to DGA for all food groups. Knowledge was associated with better adherence for most food groups except vegetables. Forty-four percent or fewer believed each food group guideline applied to people with SCI/D; yet a greater proportion of those who did believe also met dairy, grain, protein, and oil guidelines. Knowledge of and adherence to DGA were low, as were beliefs about DGA suitability for individuals with SCI/D. Greater knowledge of DGA and beliefs about suitability were both associated with better adherence to most food groups. Findings underscore the need to clarify the applicability of guidelines in persons with SCI/D and address knowledge gaps once determined.