Clinics in dermatology最新文献

Psychodermatology is an interdisciplinary field of medicine that examines the interrelationships between mental state and skin function. This contribution presents the biologic and theoretic foundations of these relationships, with particular emphasis on the role of stress, the brain-skin axis, and neuroimmunologic mechanisms. The historic development of psychodermatology is discussed, including the evolution of terminology and classification of disorders, as well as the emergence of structures facilitating interdisciplinary collaboration. Attention is drawn to the clinical and psychosocial consequences of chronic skin diseases, including reduced quality of life, anxiety and depressive symptoms, and patient stigmatization. Current challenges facing psychodermatology include the lack of diagnostic standardization and the need for further development of integrated models of care. Psychodermatology is presented as an essential component of a holistic approach to the treatment of skin diseases.

The painting of Cosmas and Damian appears to depict these saints working with angels to transplant a leg in the third century CE. This would be the first composite tissue allotransplantation. There has been much written about this painting, describing what it might have represented in the third century and when it was painted in the 16th century. This manuscript discusses how this painting has additional meaning in our current time, when the stresses of medical practice are more pronounced, and how contemplating it can be helpful today.

The Limberg rhomboid flap, first described in 1928 by the Russian surgeon Alexander Alexandrovich Limberg (1894-1974), represents a milestone in reconstructive plastic surgery. Based on precise geometric principles, the flap has become one of the most versatile and widely used techniques for closing skin defects across various body regions, particularly for treating pilonidal sinus. This contribution revisits the history of its creation, its mathematical planning, its technical and scientific principles, and its contemporary relevance in surgical and reconstructive practice.

Menopause transition or perimenopause is the transitional period preceding menopause, marked by hormonal variability and menstrual irregularity. This period is associated with a wide range of clinical findings due to reduced levels of estrogen. The skin, in particular, is affected by the decline in estrogen, specifically 17β-estradiol and dehydroepiandrosterone, along with an increase in cortisol. The sudden onset of various menopause symptoms can be distressing for many women and significantly impacts their quality of life. The genitourinary syndrome of menopause, a typical result of hypoestrogenism, is characterized by signs and symptoms relevant to urogenital atrophy. In this discussion, we focus on the aesthetically relevant symptoms of perimenopause and the approach to management. Most of these findings, including hot flashes, rosacea flares, worsening skin quality with dryness, sagging, and increased wrinkling, dyschromia, hair thinning, and cellulite, can be effectively managed. The provider should be aware of the emotional changes that occur during perimenopause and ensure that patients have a healthy and balanced motivation for seeking treatment. We discuss valid treatment options such as hormone replacement therapy, minimally invasive procedures, and topical products, including the new dermocosmetic regimens. Because many of these treatments are geared toward maintaining results, consistency is paramount for achieving successful outcomes.

Jugular venous distention, which implies the presence of a superior vena cava syndrome, has been described in Hellenistic sculpture and early modern painting. This is unusual and remarkable considering this was done before the discovery of the true nature of the human circulatory system (1628) or the discovery of superior vena cava syndrome (1757). One has to wonder whether these artists only expressed what they saw or were aware of what they were depicting in their work. Caravaggio is the only artist who demonstrated this condition in his paintings and about whom we know enough to comment. This contribution discusses the influence of Michelangelo, who had anatomic training, on Caravaggio's work. It also discusses Caravaggio's knowledge and his use of messages in his work, as well as what was known about human circulation during his lifetime. This discussion is intended to help us appreciate what Caravaggio could have known and been trying to convey through his art, and in doing so, aid us in the practice of medicine by improving our awareness of life's mysteries.

Melasma is associated with genetic factors, UV-light exposure, and hormonal influences. Because UV exposure is a crucial factor in the pathogenesis of melasma, the preventive effect of sunscreen use has been established. This cross-sectional study investigated the relationship between the clinical features of melasma and sunscreen use among 126 women attending outpatient dermatology clinics at two centers. Patient's age, occupation, body mass index, use of photosensitizer drugs, hormone replacement therapy and/or oral contraceptive, and a family history of melasma were thoroughly documented. Comprehensive information on patients' sunscreen use 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, the mean disease duration was 25.08 months, and the mean MASI score was 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 a sun protection factor > 50. The mean duration of sunscreen use was 23.85 months. MASI scores showed a significant difference based on sunscreen use status (P = .001). Year-round sunscreen use was associated with significantly lower MASI scores (P = .001), whereas daily frequency and reapplication showed no relationship with MASI scores. Melasma location was not associated with occupation or sunscreen use. In multivariate analysis, melasma depth was the strongest independent determinant of sunscreen use, whereas 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 the 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 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 approaches to control and combat the (human) flea inhouse and on the human body from the 16th to 19th century. We provide 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 during 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, which sometimes also included information on medical history, symptoms, diagnosis, and treatment. In this review, we 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 concerns a layman's perspective on illness and death. These printed texts, nevertheless, 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, such as 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 nonmaleficence. 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.