Clinics in dermatology最新文献

Gender dysphoria causes significant distress in transgender and gender-diverse (TGD) adolescents, often impacting their mental health. Evidence-based gender-affirming interventions, such as hormone therapy, have been shown to reduce this distress and lower suicide risk, and dermatological treatments may help alleviate gender dysphoria; however, recent state-specific legal restrictions and ambiguous laws in the United States have created barriers for TGD adolescents from accessing these treatments. We explore the dermatologists' challenges in providing care to TGD adolescents in legally ambiguous and restrictive states in the context of the core ethical principles of autonomy, beneficence, nonmaleficence, and justice. Using exemplary case studies, we discuss ethical dilemmas involving dermal fillers, laser hair removal, hair growth treatments, and acne management for TGD adolescents living in such states. We find that as such treatments are available in other geographic locations, available for cis-gender individuals, and not necessarily permanent, there is a violation of the core principle of justice. Dermatologists must navigate these legal and ethical complexities to provide safe, compassionate care for TGD adolescents. Advocacy for clear state-specific guidelines, equitable access to care, and ongoing research are essential to support this vulnerable population.

The rise of social media has significantly influenced how younger generations engage with skincare, exposing them to trends that may not be developmentally appropriate. Platforms like TikTok have fueled the popularity of skincare among tweens, leading to increased use of products often unsuitable for their skin. This trend has raised ethical concerns about 1) transparency and informed consent, 2) premature and inappropriate beauty standards, and 3) financial exploitation. Dermatologists report a rise in young patients experiencing adverse skin reactions due to inappropriate product use, while mental health professionals note growing anxiety related to beauty dysmorphia. The lack of regulation leaves young consumers vulnerable. Addressing this issue requires collaboration among parents, educators, dermatologists, and influencers to promote responsible skincare education and ethical marketing. Stricter oversight and informed guidance are essential to ensuring young consumers develop healthy, age-appropriate skincare habits.

Psoriasis is a frequently misunderstood condition that is associated with significant stigma. Media portrayals of skin disorders can influence public beliefs about those disorders. This study aimed to describe the portrayal of psoriasis in cartoons to inform education campaigns about the condition creatively. The image sections of internet search engines Google, Yahoo, Bing, and DuckDuckGo were inspected for single-panel cartoons that specifically referenced psoriasis. Each cartoon about psoriasis was then examined according to an instrument with categories for describing the treatment, outcome, impact of diagnosis, nature of the cartoonist's intended humour, and apparent messages about psoriasis. Twelve cartoons were identified. There is scope for more positive and imaginative portrayals of psoriasis in cartoons. The phrase heartbreak of psoriasis was commonly used by cartoonists, and this medium has overlooked various treatment options for psoriasis.

In recent decades, rising healthcare prices and high out-of-pocket expenses have left patients with outstanding medical debt and increasing concerns about the costs associated with accessing medical care.¹ The repercussions of patients failing to pay for medical services and incurring medical debt are encountered by patients, hospitals, clinics, and private practices. To combat delinquent payments, some healthcare entities have adopted point-of-service collections (POSc), requiring partial (co-pays) or full payment for services not covered by insurance before medical services are rendered.² POSc are associated with significant financial and ethical implications. POSc can ensure timely payments for hospitals, clinics and offices as well as provide price transparency for patients; however, POSc can also result in challenging access to medical care for patients who cannot afford steep, upfront out-of-pocket payments. A practical application of POSc should ideally consider patients' needs, streamlining a mixed-payment model and sliding scale fees.³ We discuss the financial and ethical implications of POSc and recommend a pragmatic approach to POSc in healthcare.

Claws and nails belong to the epidermal skin appendages, with nails developing later than claws during primate development. Both have also been depicted in fine arts. Claws can be found in illustrations of the cavemen and the devil. Nails became a subject of painting and sculptures during the Renaissance. We discuss several examples of fine arts from a dermatologic point of view, involving nail afflictions associated with ergotism, lichen planus, trachyonychia, and onychogryphosis.

There has been a trend In the United States of both consolidation and corporatization of solo and small practices into larger groups. Many of these larger groups are owned by either hospital consortiums or private equity. Such larger practices often have their own Mohs surgeon to whom general dermatologists within these corporatized dermatology practices (CDP) have been mandated to refer surgical patients. The ethics of these requisite referrals raises concerns about physician autonomy and whether patient care or profit is the primary motivator.

Professional ethics prohibit physicians from dating current patients due to risks of exploitation, compromised objectivity, and power imbalances, conflicting with obligations of beneficence and non-maleficence. Online dating applications or apps complicate these boundaries, as a physician's online presence may inadvertently enable patient encounters outside professional contexts. To maintain ethical standards, physicians should avoid sharing identifiable information on dating platforms, ensure patient care is transferred before pursuing romantic relationships, and adhere to institutional policies that mitigate risks and uphold transparency.

Background: Fitzpatrick Skin Type (FST) is a classification for skin color, ranging from FST I (lightest skin tone) to FST VI (darkest skin tone). The FST has been studied regarding risk and outcomes of cutaneous melanoma. Ocular melanoma includes primary melanoma in the eye region, including the conjunctiva and the uvea. There is little literature on the relationship of FST with ocular melanoma. Herein, we summarize the published literature on the relationship of FST in 540 eyes with conjunctival melanoma and in 854 eyes with uveal melanoma.

Methods: Literature review.

Results: There have been 4 retrospective cohort studies from a single ocular oncology center on the topic of FST regarding ocular melanoma. In respect to conjunctival melanoma, one study evaluated 540 eyes with conjunctival melanoma and found that patients most often demonstrated FST I or II (85%). A comparison between FST I vs. II vs. III-VI in this cohort showed that in FST I, the melanoma was detected at an older age (63.9 vs. 60.7 vs. 51.1 years, p<0.001), more often in females (68% vs. 44% vs. 42%, p<0.001), with lesser thickness (2.1 vs. 2.8 vs. 3.6mm, p=0.01), and less eyelid involvement (13% vs. 13% vs. 28%, p=0.02). FST did not impact 5-year outcomes of metastasis, or death. Regarding uveal melanoma, three separate studies evaluated 854 eyes with uveal melanoma and FST data. The first study explored the relationship of FST (FST I vs. II vs. III-V) to iris pigmentation, and patients with FST III-V and brown iris color were found to have larger mean tumor thickness (6.7 mm vs. 5.5 mm vs. 7.3 mm, p=0.003) and basal diameter (13.2 vs. 11.8 vs. 14.3 mm, p=0.001). The second study identified that patients with FST I demonstrated more high-grade tumor genetic mutations (The Cancer Genome Atlas (TCGA) Group D, odds ratio (OR) 2.34, p=0.002) whereas those with FST III-V demonstrated low-grade tumor genetic mutations (TCGA B, OR 2.26, p=0.002). The third report revealed patients with FST I showed greatest 10-year risk for metastasis (25% vs. 15% vs. 14%, p=0.02) and death (9% vs. 3% vs. 4%, p=0.04), perhaps related to advanced tumor genetic mutations.

Conclusion: FST plays a role in predicting clinical features of conjunctival melanoma, and to some degree, metastatic risks in uveal melanoma. Specifically, patients with FST I were more likely to have high-grade tumor genetic mutations (TCGA Group D) and greater 10-year risk for melanoma-related metastasis and death.