Clinics in dermatology最新文献

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 the 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 finiteness.

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.

Acne vulgaris is the most prevalent chronic skin disorder in the United States, affecting approximately 50 million individuals annually. Despite the availability of effective modern therapies, the evolution of acne treatment remains a rich and understudied topic in dermatologic history. This review traces the historic progression of acne management in the United States, highlighting key therapeutic milestones, shifts in clinical practice, and evolving societal perceptions of the disease. Early approaches to acne worldwide, rooted in humoral theory, included arsenicals, bloodletting, sulfur preparations, and folk remedies. The late 19th and early 20th centuries saw a gradual move toward rational therapies, including dietary regulation, topical antiseptics, and even vaccine and x-ray treatments. By the mid-20th century, dermatology entered a scientific era led by figures such as Dr Marion B. Sulzberger, ushering in antibiotic therapy, keratolytics, and eventually isotretinoin, representing the first treatment to target all major pathogenic factors. This period also marked a cultural shift: acne was no longer seen as a trivial esthetic issue but a condition with significant psychologic implications. The history of acne therapy in the United States illustrates a transition from empiric and often harmful interventions toward evidence-based, patient-centered care. Although treatments have advanced significantly, enduring challenges remain, particularly in addressing the psychologic burden of the disease. Continued innovation, both pharmacologic and psychosocial, is essential to meet the complex needs of acne patients today.

Şerefeddin Sabuncuoğlu (1385 to 1468 or 1470), a physician and surgeon from Amasya in Anatolia, is the author of three major books on pharmacy, medicine, and surgery, as well as the author of the first illustrated surgical textbook in the Turkish-Islamic literature, Cerrahiyyet'ul-Haniyye (Imperial Surgery), written in Turkish. It is the first book to contain colored illustrations of surgical procedures and instruments. Sabuncuoğlu was an unpretentious, curious, and intelligent physician and surgeon, a calligrapher, and a miniature artist. Although the teachers of medicine and the surgeons in Central Anatolia used his book, it was ignored by the Ottoman scientific elite in Istanbul during his lifetime.

Dermatologists routinely care for women with childbearing potential and pregnant women. When the mother or their fetus has a dermatologic disease, the dermatologist is often involved in helping potential parents navigate the complex medical and ethical decisions that are required. Dermatologists also regularly advise patients of childbearing age who require teratogenic medications such as isotretinoin on how to navigate its use safely. As features of some life-threatening dermatologic skin diseases can be identified prenatally and genetic testing enables confirmatory diagnosis before birth, dermatologists should be prepared to ethically support parents considering the options of preparing to care for their child with a devastating skin disease or terminating the pregnancy. Dermatologists also have an ethical obligation to educate their pregnant patient regarding the risks associated with genetically inherited conditions and the potential therapeutic options and prognosis. In view of the recent change in the legal landscape regarding abortion, dermatologists now need to be aware of local ordinance and how to refer to providers knowledgeable on the topic to best support a patient in their pregnancy.