Clinics in dermatology最新文献

英文中文

Syphilis incidence during the COVID-19 pandemic: systematic review and meta-analysis COVID-19大流行期间梅毒发病率：系统回顾和荟萃分析

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-11-01 DOI: 10.1016/j.clindermatol.2025.09.031

Natalia Welc MD , Aleksandra Anioła MD , Sandra Ważniewicz MD , Michał Michalak PhD , Magdalena Jałowska PhD, MD , Aleksandra Dańczak-Pazdrowska PhD, MD , Andrzej Grzybowski PhD, MD , Ryszard Żaba PhD, MD , Kevin Kavanagh PhD, BSc

The COVID-19 pandemic created a public health crisis that affected mental and physical health. Research examined its effect on sexually transmitted infections, particularly syphilis. Asymptomatic stages and inadequate screening likely delayed detection and increased transmission after restrictions eased. Limited health care access and lockdowns reduced social interactions. Studying syphilis reveals how changes in health care access influenced transmission, showcasing the pandemic as a natural experiment for sexually transmitted infection epidemiology. We used the PubMed database, selecting studies from 2019 to August 2024. The meta-analysis evaluated incidence rate ratios from 2019 to 2020 to assess the pandemic’s global impact on syphilis rates. Published papers were categorized by region for subgroup analysis. Of the 233 studies, 21 were selected for further analysis. A common-effects model was used to calculate the incidence rate ratio with a 95% CI. We assessed publication bias using funnel plot asymmetry and Egger test, examining heterogeneity with the I² statistic. We found a 14% decrease in syphilis incidence in various regions (incidence rate ratio: 1.14; 95% CI: 1.06-1.24, P = .006). Analysis by country and city was inconclusive. This indicates that the impact of the epidemic on syphilis transmission and diagnosis may be multifactorial. Syphilis incidence fell during the pandemic, illustrating that reduced health care access and social restrictions affected transmission. National analyses were inconclusive, suggesting the pandemic’s effects on syphilis may vary by location. These findings emphasize the need for further research on the pandemic’s long-term impact on syphilis trends and the importance of improving sexually transmitted infection surveillance and health care access during recovery.

2019冠状病毒病大流行造成了一场公共卫生危机，影响了身心健康。研究调查了它对性传播感染的影响，尤其是梅毒。无症状阶段和筛查不足可能会延迟发现，并在限制放松后增加传播。有限的医疗服务和封锁减少了社会互动。对梅毒的研究揭示了卫生保健可及性的变化是如何影响传播的，显示了这次大流行是性传播感染流行病学的自然实验。我们利用PubMed数据库，选择2019年至2024年8月的研究。该荟萃分析评估了2019年至2020年的发病率比率，以评估该流行病对梅毒发病率的全球影响，并按地区对文章进行亚组分析。在233项研究中，有21项被选中进行进一步分析。采用共同效应模型计算发病率比，置信区间为95%。我们使用漏斗图不对称和Egger检验评估发表偏倚，用I²统计量检验异质性。我们发现不同地区的梅毒发病率降低了14% （IRR=1.14, 95% CI=1.06-1.24, p=0.006）。对国家和城市的分析尚无定论。这表明疫情对梅毒传播和诊断的影响可能是多因素的。梅毒发病率在大流行期间有所下降，这表明保健机会减少和社会限制影响了传播。全国范围的分析尚无定论，这表明该流行病对梅毒的影响可能因地区而异。这些发现强调需要进一步研究大流行对梅毒趋势的长期影响，以及改善性传播感染监测和康复期间获得卫生保健的重要性。

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引用次数: 0

A rare dermatologic condition: Insights from three cases of circumscribed acral hypokeratosis 一种罕见的皮肤病：从3例局限性肢端角化不足的观察。

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-11-01 DOI: 10.1016/j.clindermatol.2025.09.024

Petro Vavrukh MD, PhD , Shari R. Lipner MD, PhD , Nina Blank MD , Taylor Kalomeris DO , Cynthia M. Magro MD

Circumscribed acral hypokeratosis (CAH) is a rare dermatologic condition primarily affecting acral surfaces, presenting as sharply demarcated, asymptomatic lesions with characteristic histopathological features, notably abrupt hypokeratosis, and variable thinning of the granular cell layer. Typically observed in middle-aged to elderly women as solitary lesions, CAH may occasionally present as multiple lesions, complicating diagnosis and management. We report four illustrative cases emphasizing the clinical and histologic variability of CAH. Case presentations have included lesions with clinical resemblance to psoriasis, fungal infection, and unspecified dermatitis, underscoring the diagnostic challenges associated with CAH. Histologically, all cases demonstrated abrupt transitions to hypokeratotic regions with minimal inflammatory response. Therapeutic responses were varied to topical calcipotriene, tazarotene, antifungal agents, and fractional laser therapy, highlighting the absence of standardized treatment guidelines. The pathogenesis remains uncertain, with proposed mechanisms ranging from acquired epidermal malformation, trauma, human papillomavirus infection, and genetic predisposition to disorders of keratinization and corneocyte adhesion. Notably, fractional laser therapy significantly lessened one refractory case, suggesting a potential novel treatment modality. Because of its benign yet chronic and refractory nature, accurate histopathologic diagnosis is crucial to facilitate appropriate management and surveillance for such rare potential complications as squamous dysplasia. This series underscores the importance of recognizing CAH’s distinct clinicopathologic entity to guide effective clinical management.

局限性肢端角化不足（CAH）是一种罕见的皮肤疾病，主要影响肢端表面，表现为边界明显、无症状的病变，具有典型的组织病理学特征，尤其是突然的角化不足和颗粒细胞层变薄。通常观察到中老年妇女为孤立病变，CAH可能偶尔出现多发性病变，使诊断和治疗复杂化。我们报告了四个说明性病例，强调了CAH的临床和组织学变异性。病例报告包括临床与牛皮癣相似的病变，真菌感染和未明确的皮炎，强调了CAH相关的诊断挑战。组织学上，所有病例均表现为突然过渡到角化程度较低的区域，炎症反应最小。局部钙泊三烯、他zarotene、抗真菌药物和部分激光治疗的治疗效果各不相同，这突出了缺乏标准化的治疗指南。发病机制尚不确定，可能的机制包括获得性表皮畸形、外伤、HPV感染、遗传易感性、角化和角质层粘附障碍。值得注意的是，分次激光治疗显著减少了一个难治性病例，提示一种潜在的新型治疗方式。由于其良性但慢性和难治性，准确的组织病理学诊断对于促进适当的管理和监测诸如鳞状异常增生等罕见的潜在并发症至关重要。这一系列强调了认识到CAH独特的临床病理实体的重要性，以指导有效的临床管理。

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Poems by Nature: A Testimony to Early English Garden Art in Saxony 自然之诗：萨克森早期英国园林艺术的见证。

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-11-01 DOI: 10.1016/j.clindermatol.2025.05.017

Uwe Wollina MD

Landscape as arranged nature reached its preliminary climax in the 18th century with the concept of the English Garden. One of the earliest German examples of an English Garden can be found in the Saxonian valley of Seifersdorf, created by Countess Christina von Brühl between 1781 and 1791. Landscape was designed as a source of health, well-being, mental stimulation, and enlightened education. In context with aspects of modern spatial planning, the oeuvre of Countess von Brühl appears in a new light, ie, as an example of an aesthetic-therapeutic landscape.

景观作为自然的安排在18世纪随着英国花园的概念达到了它的初步高潮。最早的德国英式花园之一可以在萨克森的塞弗斯多夫山谷找到，由伯爵夫人克里斯蒂娜·冯·布尔在1781年至1791年之间创建。景观被设计成健康、幸福、精神刺激和启蒙教育的源泉。在现代空间规划的背景下，伯爵夫人的全部作品出现在一个新的光下，即作为一个美学治疗景观的例子。

引用次数: 0

Risk of overdiagnosis in iconodiagnosis: the example of Rachel Furtado's portrait 影像诊断中过度诊断的风险：Rachel Furtado肖像的例子。

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-11-01 DOI: 10.1016/j.clindermatol.2025.03.014

Brigitte Hillion MD , Nicolas Kluger MD, PhD , Rémi Maghia MD , Antonio Perciaccante MD , Daniel Wallach MD , Philippe Charlier MD, PhD, LittD

The practice of iconodiagnostics requires careful observation, as well as knowledge of the biographic details of the subject and the artist's style, to avoid making excessive diagnoses. We have analyzed the portraits of Rachel Furtado and her husband from the 19th century displayed at the Museum of Art and History of Judaism in Paris. A thorough examination and knowledge of their way of life allows us to distinguish pigment disorders from the painter's stylistic effects and avoid diagnostic pitfalls.

图像诊断的实践需要仔细观察，以及对主题的传记细节和艺术家风格的了解，以避免过度诊断。我们分析了在巴黎犹太教艺术与历史博物馆展出的19世纪雷切尔·弗塔多和她丈夫的肖像。对他们的生活方式进行彻底的检查和了解，使我们能够从画家的风格效果中区分颜料紊乱，避免诊断陷阱。

引用次数: 0

Cover 2 - Editorial Board with barcode 封面二-编委会附条码

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-11-01 DOI: 10.1016/S0738-081X(25)00298-6

引用次数: 0

The rose spots of typhoid fever: The story behind the eponym 伤寒的玫瑰斑：名字背后的故事。

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-11-01 DOI: 10.1016/j.clindermatol.2025.08.004

Leonard J. Hoenig MD , Uwe Wollina MD , Cynthia M. Magro MD , Lawrence Charles Parish MD, MD (Hon), FRCP (Edin)

The eponym rose spots is a clinical feature of typhoid fever, first introduced in 1829 by the noted French physician Pierre Charles Alexandre Louis (1787-1872) in a landmark treatise on the disease. Pierre Louis’s work paved the way for a better understanding of typhoid fever as a disease distinct from other febrile illnesses. This contribution tells the story behind the rose spot eponym, including its etymology, historic background, and clinical features. It also pays tribute to the man who coined the term, Pierre Charles Alexandre Louis.

1829年，著名的法国医生皮埃尔·查尔斯·亚历山大·路易斯（Pierre Charles Alexandre Louis, 1787-1872）在一篇关于该疾病的里程碑式论文中引入了“玫瑰斑”这个名字，这是伤寒的一个临床特征。皮埃尔·路易斯的工作为更好地理解伤寒作为一种不同于其他发热性疾病的疾病铺平了道路。这篇文章讲述了玫瑰斑这个名字背后的故事，包括它的词源、历史背景和临床特征。它还向创造这个词的人致敬，皮埃尔·查尔斯·亚历山大·路易斯。

引用次数: 0

Lipedema and fine arts: From prehistoric times to contemporary art 脂水肿和美术。从史前时代到当代艺术。

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-11-01 DOI: 10.1016/j.clindermatol.2025.09.026

Uwe Wollina MD , Alberto Goldman MD,PhD , Nick J. Levell MD

Lipedema is a chronic disease of subcutaneous tissue located on the extremities, whereas the distal parts are spared. It is almost completely restricted to women. The pathogenesis is poorly understood. Pain is the leading symptom. Patients experience significant impairment of their quality of life. Although underrecognized for decades, lipedema has gained increased interest since the turn of the century. The treatment is complex and includes conservative and surgical methods. We refer to sculptures and carvings in fine art with presentations resembling symptoms of the disease going back to prehistoric Maltese cultures and the land of Punt. Contemporary artists have created sculptures related to this disease.

脂水肿是一种位于四肢皮下组织的慢性疾病，而远端部分则幸免。它几乎完全局限于女性。发病机制尚不清楚。疼痛是主要症状。患者的生活质量受到严重损害。尽管几十年来未被认识到，但自世纪之交以来，脂水肿已获得越来越多的关注。治疗是复杂的，包括保守和手术方法。我们指的是艺术品中的雕塑和雕刻，其表现形式类似于史前马耳他文化和蓬特岛的疾病症状。当代艺术家创作了与这种疾病有关的雕塑。

引用次数: 0

Are systemic sclerosis and localized scleroderma (morphea) part of a common disease spectrum? A systematic review on their coexistence 系统性硬化症和硬皮病/局部硬皮病是常见疾病谱系的一部分吗？对两者共存的系统回顾。

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-11-01 DOI: 10.1016/j.clindermatol.2025.09.032

Carolina De Rosa MD , Giorgia Di Marco MD , Vanessa Bottino MD , Nazario Pesce MD , Antonio Podo Brunetti MD , Giorgio Stabile MD , Stefania Guida MD , Franco Rongioletti MD

Scleroderma encompasses systemic sclerosis (SSc), which may be divided into limited cutaneous and diffuse cutaneous forms, as well as localized scleroderma (LoS), also known as morphea, each with distinct yet overlapping features. Although SSc affects internal organs, LoS (morphea) is typically confined to skin and the underlying tissues. We reviewed the records from 23 studies of 57 patients for coexistence of SSc and LoS (morphea). The majority of patients were women (84%) with a mean disease onset age of 44 years. Limited cutaneous SSc (46%) and nodular morphea (25%) were the most frequent subtypes. Raynaud phenomenon (63%) and sclerodactyly (53%) were common systemic manifestations, with severe complications, such as interstitial lung disease (25%) and esophageal dysmotility (18%), observed in 35% of the patients. Autoantibodies were detected in 67% of the patients, with anti-centromere (28%) and anti-nuclear (23%) antibodies as the most frequent markers. Disease sequencing showed SSc preceding LoS (morphea) in 47% of cases (mean latency: five years), LoS (morphea) preceding SSc in 26% (latency: seven years), and concurrent onset in 26%, often with generalized morphea. The coexistence suggests shared pathogenic mechanisms involving autoimmunity and TGF-β-mediated fibrosis. Treatment data were limited but indicated partial to complete improvement with systemic steroids, immunosuppressants, and other modalities. These findings highlight the importance of monitoring LoS (morphea) patients, particularly those with Raynaud phenomenon or autoantibody positivity, for potential progression to SSc. The overlap supports considering SSc and LoS (morphea) as a continuum rather than distinct entities.

硬皮病包括系统性硬皮病（SSc），可分为局限性皮肤硬皮病（lcSSc）和弥漫性皮肤硬皮病（dcSSc），以及局限性硬皮病（LoS），也称为morphea，每一种硬皮病都具有不同但重叠的特征。当SSc影响内部器官时，morphea/LoS通常局限于皮肤和底层组织。我们回顾了57例SSc和LoS共存患者的23项研究记录。大多数患者为女性（84%），平均发病年龄为44岁。局限性皮肤性SSc（46%）和结节性morphea（25%）是最常见的亚型。雷诺现象（63%）和指硬症（53%）是常见的全身性表现，35%的患者伴有间质性肺疾病（25%）和食管运动障碍（18%）等严重并发症。67%的患者检测到自身抗体，其中ACA（28%）和ANA（23%）是最常见的标志物。疾病测序显示，47%的病例（平均潜伏期：5年）SSc先于morphea/LoS， 26%的病例（潜伏期：7年）morphea/LoS先于SSc， 26%的病例同时发病，通常伴有全身性morphea。这种共存提示了共同的致病机制，包括自身免疫和tgf - β介导的纤维化。治疗数据有限，但表明全身性类固醇、免疫抑制剂和其他方式部分或完全改善。这些发现强调了监测morphea/LoS患者的重要性，特别是那些有雷诺现象或自身抗体阳性的患者，以防止潜在的SSc进展。这种重叠支持将SSc和morphea/LoS视为连续体，而不是不同的实体。

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引用次数: 0

Ethics of reversible dermatologic care in transgender and gender-diverse adolescents under restrictive and ambiguous laws 在限制和模糊的法律下，变性和性别多样化（TGD）青少年的可逆皮肤护理伦理。

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-11-01 DOI: 10.1016/j.clindermatol.2025.02.010

Priya Patel Housley MS , Sami K. Saikaly MD , Neelesh Jain MD , Jane M. Grant-Kels MD

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 (US) have created barriers for TGD adolescents from accessing these treatments; some states have passed new laws that restrict TGD youth access to surgical and even medical gender affirming services as hormone treatment. We explore 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 should 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.

性别焦虑症对跨性别和性别多样化青少年造成严重困扰，往往影响他们的心理健康。以证据为基础的性别肯定干预措施，如激素治疗，已被证明可以减少这种痛苦并降低自杀风险，皮肤病治疗可能有助于减轻性别不安；然而，美国最近各州的具体法律限制和模棱两可的法律为TGD青少年获得这些治疗创造了障碍。我们探讨皮肤科医生的挑战，在自主、慈善、无害和正义的核心伦理原则的背景下，在法律上模棱两可和限制性的状态下，为TGD青少年提供护理。通过典型案例研究，我们讨论了涉及真皮填充物、激光脱毛、毛发生长治疗以及生活在这种状态下的TGD青少年的痤疮管理的伦理困境。我们发现，由于这种治疗在其他地理位置也有，对顺性人也有，而且不一定是永久性的，这违反了正义的核心原则。皮肤科医生必须驾驭这些法律和伦理的复杂性，为TGD青少年提供安全、富有同情心的护理。倡导明确的各州具体指导方针、公平获得医疗服务和正在进行的研究对于支持这一弱势群体至关重要。

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引用次数: 0

Identifying predictors of success in dermatology residency: A multicenter retrospective study. 确定皮肤科住院医师成功的预测因素：一项多中心回顾性研究。

IF 2.2 4区医学 Q2 DERMATOLOGY

Clinics in dermatology

Pub Date : 2025-10-31 DOI: 10.1016/j.clindermatol.2025.10.009

Gabriel Rice, Gabriella VanAken, Steven Daveluy, Yolanda Helfrich

Identifying applicants who will be successful dermatology residents requires a tremendous effort every year. The objective of the current study was to determine if application characteristics are predictive of success in dermatology residency. We conducted a retrospective cohort study utilizing applications of dermatology residents from the University of Michigan (2011-2016) and Wayne State University (2009-2019). The residents' clinical abilities and collegiality were retrospectively assessed by faculty based on a scale from 1 (Problematic, I would not recommend this person as a colleague or physician) to 4 (Great, I would love to have this person as a colleague and would recommend this person to family and friends as a physician). The relationship between faculty ratings and application characteristics was evaluated through multivariable regression. Ninety-one total residents were included in the study, with 48 from University of Michigan and 43 from Wayne State University . Nine faculty from University of Michigan and six faculty from Wayne State University evaluated residents. The average faculty rating of residents was 2.5 ± 0.5. Board examination scores were associated with higher faculty ratings (Step 1, β: 0.007; 95% CI: 0.001, 0.013; P = .03; Step 2, β: 0.008; 95% CI: 0.001, 0.014; P = .02). High level of athletic achievement was also associated with higher average faculty ratings (β: 0.310; 95% CI: 0.051, 0.569; P = .02). Our study suggests that board examination scores and athletic achievement are associated with success in dermatology residency. Further research is needed to fully understand the relationship between these factors and their utility in evaluating prospective candidates.

确定申请人谁将是成功的皮肤科住院医师每年需要巨大的努力。当前研究的目的是确定应用特征是否预示着皮肤科住院医师的成功。我们利用密歇根大学（UM）（2011年至2016年）和韦恩州立大学（WSU）（2009年至2019年）皮肤科住院医师的应用程序进行了一项回顾性队列研究。住院医生的临床能力和合作关系是由教师根据从1（有问题，我不会推荐这个人作为同事或医生）到4（很好，我很乐意有这个人作为同事，并将这个人推荐给家人和朋友作为医生）的等级进行回顾性评估的。通过多变量回归评估教师评分与申请特征之间的关系。共有91名居民参与了这项研究，其中48名来自密歇根大学，43名来自华盛顿州立大学。来自UM的9名教员和来自WSU的6名教员对居民进行了评估。住院医师的平均教师评分为2.5±0.5。委员会考试成绩与较高的教师评分相关（步骤1 Beta: 0.007, 95% CI [0.001, 0.013]， p值：0.03；步骤2 Beta: 0.008, 95% CI [0.001, 0.014]， p值：0.02）。高水平的运动成绩也与较高的教师平均评分相关（Beta值：0.310,95% CI [0.051, 0.569]， p值：0.02）。我们的研究表明，委员会考试成绩和运动成绩与皮肤科住院医师的成功有关。需要进一步的研究来充分了解这些因素之间的关系及其在评估潜在候选人时的效用。

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