Clinics in dermatology最新文献

Melasma is associated with genetic factors, exposure to ultraviolet light, and hormonal influences. Because UV exposure is a crucial factor in the pathogenesis of melasma, the preventive effect of sunscreen use is established. This cross-sectional study investigated the relationship between the clinical features of melasma and the use of sunscreen among 126 women attending outpatient dermatology clinics in two centers. Patient's age, occupation, body mass index, use of photosensitizer drugs, hormone replacement therapy and, or oral contraceptive, and family history of melasma were thoroughly documented. Comprehensive information about the patients' sunscreen usage was also recorded. Melasma location and depth were evaluated, and the melasma severity index (MASI) score was calculated. The mean participant age was 39.67 years, mean disease duration 25.08 months, and mean MASI score 5.22. Fitzpatrick phototype III was the most common phototype. Melasma was widespread and dermal in most patients. Thirty-one percent of patients did not use sunscreen with SPF >50. The mean duration of sunscreen use was 23.85 months. MASI scores showed a significant difference based on sunscreen use status (P = 0.001). Year-round sunscreen use was associated with significantly lower MASI score (P = 0.001), whereas daily frequency and reapplication showed no relationship. Disease location was not associated with occupation and sunscreen use. In a multivariate analysis, melasma depth emerged as the strongest independent determinant of sunscreen use, whereas the year-round sunscreen use was independently associated with lower MASI scores.

There is a long-term relationship between humans and the human flea Pulex irritans. The invention of the microscope in the late 1500s was a turning-point for scientific investigation of the flea. Microscopists like Robert Hooke (1635-1702) or Antony van Leeuwenhoek (1632-1723) became most attracted. Leeuwenhoek discovered the sexual reproduction of fleas. During the Victorian period their role as vectors of disease was scientifically determined and recorded, which was stimulated by the plague epidemic of 1894 in Canton and in Hong-Kong. The flea's position as an annoying but harmless housemate underwent a change, as the (human) flea was now also perceived as a vector of deadly infectious diseases. We review the different appraches to control and combat the (human) flea inhouse and on the human body from the 16.-19. Centruy. We proviode a short review on repellents and early insecticides, mainly made by herbs. We also refer to flea traps made from animal skins, wool or woods, ivory up to the manufactory production of the 19th century.

The heyday of printed funeral sermons dates to the period between 1550 and 1750 in the German speaking countries with the Reformation movement. The modern funeral sermon did not focus on the salvation of the soul of the deceased. It was aimed at the bereaved, proclaimed the gospel to them and strove to comfort, edify and instruct them. The printed sermons consisted of various parts including a curriculum vitae of the deceased that sometimes also contained medial information about medical history, symptoms, diagnosis and treatment. In this review, we will focus on the documentation of cutaneous findings and skin diseases in printed funeral sermons from two German towns, Ulm and Rudolstadt. In most cases, it is about a layman's perspective on illness and death. Nevertheless, these printed texts provide a unique opportunity to study the course and treatment of skin diseases.

Religion plays a significant role in shaping patients' values, behaviors that can impact health, and decision-making which can position physicians at the intersection of medical responsibility and spiritual sensitivity. Although most religions with fasting traditions, like Islam and Judaism, prioritize health and therefore exempt the ill, elderly, or those needing medications from fasting, some devout individuals are adamant about fasting. Fasting introduces complex clinical and ethical challenges in dermatology, where optimal therapies may depend on consistent dosing, nutritional intake, and hydration. These factors influence treatment adherence, pharmacologic efficacy, and patient-physician communication. Such interactions generate ethical tensions between respecting patient autonomy and fulfilling the obligations of beneficence and non-maleficence. Herein we explore how religious observances can affect dermatologic therapeutic outcomes, particularly when pharmacokinetics or dosing schedules conflict with religious observance. We examine strategies for ethically navigating situations in which faith-based practices or commitments conflict with medical recommendations, emphasizing transparent communication, informed consent, and interdisciplinary collaboration. Through culturally sensitive dialogue and cooperative decision-making, dermatologists can uphold medical integrity while honoring patients' spiritual identities and promoting patient-centered, ethically sound care.

Skin reflects not only the biologic processes of aging but also the personal, social, and cultural history of the individual. Francisco de Goya's paintings Old Women (also known as Time) and The Young (The Letter) provide a profound dialogue between youth, old age, and temporality, offering insight into aesthetics, identity, and the ethics of aging. This contribution examines the visible cutaneous signs in both works, relating them to biologic mechanisms of skin aging, including cellular senescence, collagen disruption, and photoaging. The philosophic and ethic implications of contemporary aesthetic rejuvenation procedures are also explored, emphasizing the tension between accepting aging and undergoing medical transformation. Goya's works serve as a critical mirror, highlighting that interventions in aged skin must consider not only biologic aspects but also memory, identity, and human finitude.

Botulinum toxin type A (BoNTA) is an established treatment for focal hyperhidrosis of the axillae and palms, but its use has recently expanded to include craniofacial, facial, and scalp hyperhidrosis. This systematic review with narrative synthesis evaluates the clinical use of BoNTA for focal hyperhidrosis across multiple anatomical sites. A structured search of PubMed/MEDLINE, Embase, and Scopus was conducted for English-language human studies published between 2000 and 2025. Original clinical studies reporting outcomes related to sweat reduction, disease severity, quality of life, duration of effect, or adverse events were included, while reviews and non-original publications were used only for background and citation tracking. A total of 33 original clinical studies met inclusion criteria. Evidence was strongest for axillary hyperhidrosis, where randomized controlled trials consistently demonstrated substantial reductions in sweating and sustained patient-reported benefit. Palmar hyperhidrosis showed reliable efficacy, although treatment was limited by injection discomfort and transient weakness. Evidence for craniofacial, facial, and scalp hyperhidrosis consisted primarily of small cohorts and case series, which nevertheless reported meaningful symptom improvement and acceptable safety profiles despite heterogeneity in dosing and injection techniques. Overall, BoNTA remains a cornerstone therapy for focal hyperhidrosis, and while evidence beyond the axillae is less robust, available data support its use in selected patients and underscore the need for larger, standardized studies in craniofacial and scalp hyperhidrosis.

Access to biologic therapies for psoriasis remains uneven among uninsured or underinsured patients, despite safety-net systems and manufacturer assistance. A retrospective cohort study examined all patients treated for psoriasis at the Psoriasis Biologics Clinic at Jackson Memorial Hospital (Miami, Florida) from January 2020 to May 2025. With no exclusions, the cohort reflected the full clinic population. The study assessed eligibility and initiation of biologics within a model combining hospital financial assistance and manufacturer support. Among 187 patients (mean age 52.7 years; 55.6% women), 67.4% were prescribed biologics. Most identified as Hispanic, with smaller African-American and non-Hispanic White groups. Adalimumab and secukinumab were the most common therapies. Insurance sources included government programs, hospital assistance, and underinsured plans. Barriers to starting biologics were reported in 15.5% of patients, mainly due to insurance denials or lapses. Nearly all patients had no copay, and those using the Jackson Financial Assistance Program received biologics at no cost. Although this safety-net model enabled most patients to access biologics, ongoing racial and insurance-related disparities indicate the need for broader structural and policy solutions to achieve durable equity in care.

There has been an increasing demand for hand rejuvenation procedures. Hand evaluation is critical before any such procedure, and recently proposed five-point scales, including the Merz Hand Grading Scale and Allergan Hand Volume Deficit Scale, provide an objective assessment of volume loss of soft tissues. Dermal fillers, including hyaluronic acid (HA), calcium hydroxylapatite (CaHA), and poly-L-lactic acid, can address volume loss, contour irregularities, and texture changes associated with aging. Our literature review includes 12 studies with HA, seven with CaHA, and two with poly-L-lactic acid fillers. One study used a hybrid HA-CaHA filler. The superficial lamina contains minimal vascular or neural structures, making it the safest plane for filler placement. Techniques such as proximal-to-distal fanning allow smooth and homogeneous filler placement with minimal trauma. A blunt cannula is often preferred to minimize vascular injury. All fillers discussed here-HA, CaHA, and poly-L-lactic acid-have a good safety profile and provide acceptable aesthetic outcomes associated with high patient satisfaction. HA fillers provide instant volume restoration and hydration, whereas CaHA and poly-L-lactic acid are advantageous for improving texture and skin quality. Patient counseling on available options and selecting the most suitable filler that aligns with patient expectations are crucial to achieving successful outcomes.

Dissemination of research findings is a crucial part of academic progress; however, many barriers to publishing in dermatology may prevent equitable researcher involvement and representation. The term "independent journal" (IJ) is not yet widely established in the academic literature. IJs refer to self-initiated and potentially self-sponsored journals. IJs are typically initiated by individual clinicians or small groups rather than well-established organizations or commercial entities and have the goal of disseminating new research ideas or filling a current gap in the literature. Although many IJs in dermatology have gained respect and contribute meaningfully to the field, there are ethical concerns regarding potential founding-sponsorship bias, peer-review protocols, and the resources used to ensure academic quality. To avoid potential ethical concerns regarding IJs' credibility, the goals of the journal and the peer-review processes should be clearly delineated. IJs offer the opportunity to make research more accessible and transform the publishing industry. Herein, we define and delineate IJs from other journals, while exploring ethical issues and directions for clinicians to consider when studying or creating journals.