Clinics in dermatology最新文献

A skin cancer diagnosis imposes not only a psychosocial burden but also significant financial stress due to treatment costs. This stress can intensify dramatically for patients who suddenly lose health insurance coverage, especially considering that uninsured patients are more likely to experience late-stage melanoma diagnoses and face a higher overall incidence of skin cancer than the general population. Dermatology clinics and physicians serving uninsured and vulnerable populations should be equipped with resources and strategies to ensure these patients receive adequate and timely care. We explore the ethical and actual challenges uninsured patients encounter in accessing dermatologic care for skin cancer and offer practical solutions to address and mitigate these barriers.

The smile is a complex human facial expression, most commonly associated with joy. We present a detailed view on Leonardo Da Vinci's painting of Saint John the Baptist, between 1516 to 1516, which illustrates a smiling saint, which has evoked multiple explanations and theories. Discussing Da Vinci's concept of painting as science media and the two merely contradictory painting techniques chiaroscuro and sfumato, we attempt to approach this picture. Chiaroscuro is describing the strong contrasts between light and shadow, while sfumato represents another painting technique for softening the transition between colors. In the context of the positioning of John in the space, the closed smile shown in the picture, is possibly an expression of facing the Sacred.

In dermatology, the art and skill of morphologic assessment is key to generating logical differential diagnoses and understanding disease pathogenesis. Dr. Irwin M. Braverman, Professor Emeritus of Dermatology at the Yale School of Medicine, is a master morphologist and his book, Skin Signs of Systemic Disease, provided key insights into the relationships between cutaneous lesions and internal disease. In an interview with Dr. Braverman, he stressed the importance morphology plays in how dermatologists diagnosis skin disorders. From Dr. Braverman, we learned an approach to the study of morphology through the lens of an art connoisseur, in addition to how to appreciate subtle clues that suggest a diagnosis and how examination of the skin brings us closer to understanding our patient, what ails them, and how we can heal them.

There is a significant amount of research examining the link between psoriasis and common mental health disorders; however, studies on less common psychiatric disorders, such as bipolar disorder (BD), remain limited. We conducted a systematic review of studies in the PubMed and Cochrane databases that explored the relationship between BD and psoriasis. Additionally, we evaluated the impact of lithium on psoriasis in patients with BD and included a quality assessment of all the studies. This review covers five studies that addressed the connection between psoriasis and psychiatric disorders, three studies on medical conditions in patients with BD, and four studies examining the effects of lithium intake on psoriasis in BD patients. We found substantial evidence supporting a link between psoriasis and BD, suggesting that psoriasis is an independent risk factor for BD. Patients with psoriasis are also more likely to use psychotropic medications. A limited number of studies indicate that lithium therapy may trigger or worsen psoriasis. We also explore the mechanisms of lithium-induced or -aggravated psoriasis, highlighting the intricate interplay between lithium treatment, inositol depletion, and psoriasis in patients with BD. In a placebo-controlled, randomized study, inositol supplementation could mitigate psoriasis in patients taking lithium. Additional research is needed to evaluate the efficacy of inositol supplementation for patients with psoriasis who need to continue lithium treatment for their BD.

Media portrayals of medical disorders can influence public beliefs about those disorders. There have been no previous studies about the depiction of dermatological conditions in cartoons. The aim of this study was to describe the portrayal of skin moles in cartoons. The image sections of internet search engines Google, Yahoo, Bing and DuckDuckGo were inspected for single-panel cartoons which referred to skin moles. Each cartoon was examined according to characteristics of the patient, mole(s) and treatment. Sixty-six cartoons were identified. One third of the moles were portrayed as suspicious, a quality often conveyed by a furtive-looking mole creature on the patient. Most cartoons depicted or mentioned a medical doctor; a dermatologist featured in 12 cases. There was discretion in how the moles were managed. Among the treatment options were excision, hitting the mole with a mallet, and observation over time. It was noteworthy that none of the cartoons made specific reference to melanoma. The study findings may creatively inform efforts to educate the public and health professionals about moles and their management.

The rise of predatory journals has created a pressing ethical dilemma in academic publishing, exploiting researchers' urgency to publish while prioritizing profits over quality. These journals, characterized by deceptive practices and inadequate peer review, often undermine scientific integrity and disproportionately affect early-career academicians and those from underfunded institutions. While open-access publishing aims to democratize knowledge, its reliance on high processing charges (APCs) poses accessibility challenges, particularly in resource-limited settings. This issue extends beyond predatory journals, as even reputable journals often impose substantial APCs, creating a broader crisis of inequitable access to publishing research findings. The implications of these exploitative practices are far-reaching, potentially compromising patient care (via publication of inferior papers in predatory journals), fostering researcher burnout, and hindering global collaboration. Addressing this requires systemic reform, including increased transparency, reduced costs, expanded funding, and promoting community-led publishing platforms. Ethical publishing practices must prioritize inclusivity and the dissemination of knowledge to preserve the integrity and accessibility of academic research.

The evolution of healthcare payment models has profoundly influenced clinical practices and physician decision-making. While fee-for-service (FFS) models incentivize procedural volume, systems based on Relative Value Units (RVUs) have introduced standardized metrics to compensate physicians based on care complexity and workload. As corporations increasingly own healthcare, financial incentives such as RVUs and procedural quotas raise ethical concerns. Quotas intended to boost efficiency and profitability may prompt corporate entities to pressure clinicians to meet procedural targets, potentially prioritizing financial performance over patient welfare. Such pressures risk leading to overtreatment and unnecessary procedures, challenging the principles of non-maleficence and beneficence, especially when less invasive or non-invasive alternatives are clinically viable. Ethical frameworks, including the AMA Code of Medical Ethics, emphasize the need for compensation models that align with clinical judgment and support patient-centered care.

Dr. Irwin M. Braverman is recognized as an expert on many skin diseases including psoriasis, an immune-mediated disorder that presents with scaly erythematous plaques. The most common clinical subtype is plaque psoriasis, with scalp, inverse, guttate, pustular, and nail psoriasis representing additional subtypes. Psoriasis has been associated with several comorbidities, particularly psoriatic arthritis, which affects up to 30% of those with psoriasis. Psoriasis can have an enormous impact on patients, and Dr. Braverman reflects that "it is hard to think of another disease that can be so destructive or impactful." Over the course of his career, Dr. Braverman treated many patients with psoriasis and observed several significant therapeutic advances, including the widespread use of psoralens with ultraviolet A phototherapy (PUVA) and the introduction of methotrexate. He also contributed to research on the pathophysiology of psoriasis, studying the hallmark dilated capillary loops. Ultimately, Dr. Braverman believes that "taking care of a patient with psoriasis goes into the making of a dermatologist."