Clinics in dermatology最新文献

The use of aesthetic dermatologic procedures in patients with underlying allergic and inflammatory skin diseases is on the rise, but specific safety considerations are often overlooked. Individuals with hypersensitivity to injectables, chronic inducible urticaria, allergic contact dermatitis, atopic dermatitis, or hereditary angioedema may face an increased risk of adverse reactions triggered by mechanical trauma, injected substances, or disruption of the skin barrier. Adverse reactions to local anesthetics are predominantly non-IgE-mediated. Thus, preventive strategies should focus on selecting the appropriate agents and employing proper injection techniques rather than routine pharmacologic prophylaxis. Botulinum toxin, hyaluronic acid fillers, and hyaluronidase can rarely cause immediate or delayed hypersensitivity reactions. This highlights the need for individualized risk assessment and avoidance of re-exposure in confirmed cases. For patients with chronic inducible urticaria, aesthetic procedures can act as physical triggers. Ensuring optimal disease control with pre-procedural antihistamines may help reduce this risk. In cases of allergic contact dermatitis and atopic dermatitis, a compromised skin barrier and exposure to device-related allergens may heighten the chances of developing eczematous or infectious complications. Patients with hereditary angioedema require short-term prophylaxis, preferably utilizing C1-inhibitor therapy. With careful evaluation and tailored preventive strategies, aesthetic dermatologic procedures can be performed safely in patients with allergic and inflammatory skin conditions.

Physician peer-to-peer (P2P) review is the acronym for the physician-level peer to peer review of medical records commonly employed by health plans to determine whether to uphold a denial of coverage. P2P was originally intended as a collaborative mechanism within the prior authorization process to promote evidence-based care while ensuring appropriate resource utilization. In contemporary practice, however, P2P has evolved into an administrative checkpoint that may delay or restrict access to medically appropriate diagnostics and therapies. This is a growing concern, particularly relevant in dermatology amid rapid therapeutic innovation and increasingly complex disease management. The P2P reviewer identity, specialty training, and decision-making criteria are frequently undisclosed, contributing to a process that limits accountability and undermines the physician-patient relationship, with serious ethical implications. Violations of autonomy, justice, and non-maleficence may be further compounded by specialty discordance between treating physicians and payer-appointed reviewers. Greater transparency in reviewer qualifications, specialties, and the rationale for decision-making represents a critical step toward restoring the original intent of P2P as a meaningful ethical clinical dialogue rather than a barrier to care. Aligning appropriate resource utilization while leaving bioethical principles intact is essential in protecting equitable access to dermatologic therapy and maintaining trust within the physician-patient relationship.

Gustav Klimt's The Kiss (1907-1908) is one of the most iconic visual representations of intimacy in Western art. Beyond its aesthetic and symbolic impact, the painting offers a profound meditation on the skin as a sensory, emotional, and symbolic interface. Recent contributions in the field of medical humanities have demonstrated that Klimt's work can be meaningfully explored from biomedical and clinical perspectives, reinforcing the value of interdisciplinary dialogue between art and medicine. This contribution examines The Kiss through a dermatologic humanities lens, focusing on exposed skin, tactile contact, and the metaphorical role of gold as a protective and a separating surface. The visual tension between figurative skin and ornamental covering is interpreted in relation to contemporary concepts of the skin barrier, affective touch, and psychodermatology. In parallel, scientific evidence describing the changes associated with romantic intimacy and skin-to-skin contact is reviewed. By integrating iconographic analysis with current biological knowledge, this contribution highlights how Klimt's painting provides a powerful framework for reflecting on the skin not only as a biological organ but also as a central space for intimacy, identity, and human connection.

Skin aging is increasingly recognized as a process associated with the microbiome, characterized by barrier dysfunction, chronic low-grade inflammation, and degradation of the extracellular matrix. Current evidence suggests that age-related changes in both skin and gut microbiota contribute to "inflammaging" and impaired cutaneous homeostasis through the gut-skin axis. In recent years, probiotics, prebiotics, and postbiotics have emerged as potential modulators of skin aging. Probiotics, in particular, are noted for their ability to modulate the gut-skin axis, decrease inflammation, and promote skin rejuvenation. In this discussion, we highlight current evidence on the role of probiotic-based interventions in skin aging and geriatric dermatoses. Probiotics, prebiotics, and postbiotics modulate skin aging by restoring microbial balance, enhancing barrier integrity, and regulating immune and oxidative pathways, particularly through the gut-skin axis. Topical formulations act locally by reinforcing tight junctions, increasing ceramide synthesis, and suppressing inflammatory mediators and matrix metalloproteinases, whereas oral probiotics exert their effects by modulating gut dysbiosis, reducing systemic inflammation, and improving extracellular matrix homeostasis. Clinical studies have shown improvements in skin hydration, elasticity, wrinkle depth, photoprotection, and wound healing. Although there have been promising results, several challenges remain regarding strain specificity, formulation stability, regulatory constraints on viable organisms, and the paucity of adequately powered randomized clinical trials. Overall, microbiome-targeted interventions hold promise as a strategy for reducing age-related skin changes and managing skin conditions in the elderly.

Ethical conflicts of interest can arise when productivity-based compensation models, particularly relative value units, intersect with clinical decision making in dermatology. Relative value units were designed to standardize physician work and serve as a metric for physician productivity and efficiency; however, they may influence how clinicians navigate treatment choices by prioritizing quantity over quality and incentivizing overuse. These dynamics can increase physician burnout and raise important concerns related to beneficence and justice. We outline these ethical considerations and propose strategies to maintain patient-centered care within productivity-driven systems.

B vitamins play a pivotal role in cellular metabolism and erythrocyte synthesis, serving as essential water-soluble nutrients. Rapid excretion through the urinary system prevents their accumulation, thus mitigating potential toxicity. With minimal storage in the body, the levels of these vitamins are primarily influenced by recent dietary intake, especially in healthy individuals. The B vitamin group comprises eight distinct vitamins: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin (B7), folic acid (B9), and cobalamin (B12). In developed nations, B-complex vitamins are frequently added to foods, reducing the risk of deficiency due to reduced intake alone. Deficiencies often occur in individuals with conditions such as alcohol abuse, chronic inflammatory diseases, or the use of specific drugs such as antiepileptic medications. Interconnected metabolic pathways among B-complex vitamins lead to overlapping mucocutaneous signs in cases of deficiency, necessitating comprehensive diagnostic testing for multiple micronutrients. This study aims to provide an in-depth exploration of key B vitamins pertinent to dermatology. It underscores mucocutaneous manifestations of deficiencies or excess and discusses their relevance in various dermatologic conditions. By emphasizing these aspects, the study seeks to enhance understanding and management strategies for dermatologic conditions associated with B vitamin deficiencies or imbalances.

Vitamins are essential biocatalysts that have wide-ranging functions in supporting cellular metabolism. Vitamin deficiencies can significantly impact oral health, manifesting in oral mucosal and periodontal conditions. Deficiencies in the vitamin B complex are associated with glossitis, angular cheilitis, and recurrent aphthous stomatitis. Vitamin C deficiency leads to scurvy-related periodontal issues, whereas vitamin A insufficiency predisposes to oral epithelial keratinization abnormalities such as dry mouth and susceptibility to Candida. A reduction in vitamin D levels is linked to the risk of periodontal disease, reduced oral immunity, and oral neoplasia. Low vitamin E does not induce oral disease, but vitamin K deficiency causes gingival hemorrhage. Oral mucosal diseases have a huge impact on morbidity. We discuss the diagnostic challenges in identifying vitamin-related oral manifestations and the associated systemic features that may accompany the mucosal changes. This review provides clinicians with insight into the mechanisms that govern oral mucosal pathology and the risk factors related to specific vitamin deficiencies. The role of vitamin supplementation in treating and preventing oral conditions is also addressed.

Nutrition is essential for skin care, whether for rejuvenation, recovery, or regeneration after trauma or surgery; yet it is often overlooked. Although many nutrients have well-demonstrated benefits, others, such as vitamin E, a liposoluble antioxidant used for more than 50 years in dermatology, lack research and proof of their photoprotective and anti-tumorigenic properties. "Vitamin E" is the collective term for tocopherols and tocotrienols, with the main differences being their aliphatic tails and tocotrienols' higher antioxidant effect compared with tocopherols due to their unsaturated, isoprenoid side chains. Given the ongoing exposure of individuals to physical, biological, chemical, and psychological stressors throughout their lives, recent studies have shown that vitamin E provides stress protection or resistance, normalizes cellular homeostasis, and increases resistance to toxic stimuli that cause cellular damage. We discuss the relationship between oral and topical vitamin E and its improvement in many dermatologic and systemic conditions.

Systemic vitamins K1 and K2 exhibit multifaceted functions beyond coagulation, particularly in pseudoxanthoma elasticum and similar conditions. Disturbances in the vitamin K pathway contribute to elastic fiber fragmentation and tissue mineralization. Systemic administration of vitamin K, notably via intramuscular injections, has been associated with a spectrum of adverse cutaneous reactions, from erythematous and eczematous plaques to drug-induced anetoderma and sclerodermoid plaques. The synergistic effect of vitamin K2 and vitamin D on bone mineralization has important implications for dermatologists who may counsel patients on supplementation with vitamins with sun-protective behaviors. In its topical form, vitamin K has been investigated for its wound healing properties, particularly in postlaser purpura resolution as well as prevention of cetuximab-induced dermatitis.