Clinics in dermatology最新文献

The rise of predatory journals has created a pressing ethical dilemma in academic publishing, exploiting researchers' urgency to publish while prioritizing profits over quality. These journals, characterized by deceptive practices and inadequate peer review, often undermine scientific integrity and disproportionately affect early-career academicians and those from underfunded institutions. While open-access publishing aims to democratize knowledge, its reliance on high processing charges (APCs) poses accessibility challenges, particularly in resource-limited settings. This issue extends beyond predatory journals, as even reputable journals often impose substantial APCs, creating a broader crisis of inequitable access to publishing research findings. The implications of these exploitative practices are far-reaching, potentially compromising patient care (via publication of inferior papers in predatory journals), fostering researcher burnout, and hindering global collaboration. Addressing this requires systemic reform, including increased transparency, reduced costs, expanded funding, and promoting community-led publishing platforms. Ethical publishing practices must prioritize inclusivity and the dissemination of knowledge to preserve the integrity and accessibility of academic research.

The evolution of healthcare payment models has profoundly influenced clinical practices and physician decision-making. While fee-for-service (FFS) models incentivize procedural volume, systems based on Relative Value Units (RVUs) have introduced standardized metrics to compensate physicians based on care complexity and workload. As corporations increasingly own healthcare, financial incentives such as RVUs and procedural quotas raise ethical concerns. Quotas intended to boost efficiency and profitability may prompt corporate entities to pressure clinicians to meet procedural targets, potentially prioritizing financial performance over patient welfare. Such pressures risk leading to overtreatment and unnecessary procedures, challenging the principles of non-maleficence and beneficence, especially when less invasive or non-invasive alternatives are clinically viable. Ethical frameworks, including the AMA Code of Medical Ethics, emphasize the need for compensation models that align with clinical judgment and support patient-centered care.

Dr. Irwin M. Braverman is recognized as an expert on many skin diseases including psoriasis, an immune-mediated disorder that presents with scaly erythematous plaques. The most common clinical subtype is plaque psoriasis, with scalp, inverse, guttate, pustular, and nail psoriasis representing additional subtypes. Psoriasis has been associated with several comorbidities, particularly psoriatic arthritis, which affects up to 30% of those with psoriasis. Psoriasis can have an enormous impact on patients, and Dr. Braverman reflects that "it is hard to think of another disease that can be so destructive or impactful." Over the course of his career, Dr. Braverman treated many patients with psoriasis and observed several significant therapeutic advances, including the widespread use of psoralens with ultraviolet A phototherapy (PUVA) and the introduction of methotrexate. He also contributed to research on the pathophysiology of psoriasis, studying the hallmark dilated capillary loops. Ultimately, Dr. Braverman believes that "taking care of a patient with psoriasis goes into the making of a dermatologist."

Dermatopathology, like dermatology, has evolved in many directions; however, both fields remain true to visual morphology-based diagnosis. Dr Irwin Braverman is a role model for the intersection of these two visual fields. One of his passions is correlating the clinical presentations of disease with histopathologic findings and teaching these skills to others at the bedside and the microscope. Dr Braverman's innovative approach to education is exemplified by his use of paintings to hone the observational skills of trainees. His creative and inquisitive lectures, such as a recent discussion of color blindness in art and medicine, stress that none of us interpret the world in the same way. Interobserver variability has implications for how we approach dermatologic diseases, highlighted herein with the example of reactive versus malignant angioendotheliomatosis. As a master dermatologist and dermatopathologist, Dr Braverman exemplifies how deep and broad knowledge positively influences dermatology and dermatopathology.

In 1859, the New Sydenham Society undertook the publication of an Atlas of Portraits of Diseases of the Skin, having been inspired by Ferdinand Ritter von Hebra's Atlas der Hautkrankheiten. Utilizing information contained in Sir Jonathan Hutchinson's Descriptive Catalogue of the New Sydenham's Society Atlas of Portraits of Diseases of the Skin (published in 1869 and 1875), an exhibit of twenty-five illustrations of cutaneous disorders, along with teaching points, was held at the Harvey Cushing/John Jay Whitney Medical Library at Yale University. It served as an educational tool for dermatologists, dermatology residents, medical students, and even physicians from other specialties.

Disorders of the nail unit can provide important clues to underlying systemic diseases. Onychodystrophy or nail abnormalities include altered nail color, shape, or texture, with morphology and growth patterns often related to local anatomic factors such as edema, vascular supply, and neurologic innervation. Associated pain or loss of function can also affect daily activities. Because nail changes may be due to a range of systemic diseases, we chose to provide a systems-based broad overview of the common nail findings in patients with internal disease.

Dr. Irwin Braverman, a luminary in our field of dermatology, united his love of internal medicine with dermatology to pioneer our understanding of the cutaneous manifestations of systemic disease. His meticulous documentation of physical examination findings in his book Skin Signs of Systemic Disease became fundamental to the training of dermatologists worldwide for decades. In the context of autoimmune connective tissue diseases, Dr. Braverman's powerful observation skills proved pivotal in charting the clinical signs and symptoms of systemic lupus erythematosus and dermatomyositis. His legacy as a trailblazer in clinicopathologic correlation continues to influence younger dermatologists, emphasizing the crucial role of connecting pathologic findings in the skin to systemic pathology in providing outstanding patient care. We highlight some of Dr. Braverman's personal interests and contributions to lupus erythematosus and dermatomyositis.

Sarcoidosis is a multisystem inflammatory disorder that most commonly affects the lungs, lymphatic system, eyes, and skin. Cutaneous involvement is present in approximately 20-30% of patients. Prednisone and corticotropin repositories are the only FDA-approved therapies for sarcoidosis. We review the varied cutaneous manifestations of sarcoidosis and the recommended evaluation for this disease. We also discuss histopathologic findings and outline disease pathogenesis, incorporating newer molecular data. Treatment approaches for cutaneous sarcoidosis and their associated levels of evidence are also delineated.