Clinics in dermatology最新文献

Cutaneous T cell lymphoma (CTCL) is a form of non-Hodgkin lymphoma that can involve the skin, along with lymph nodes and blood. The two most common subtypes of CTCL are mycosis fungoides and Sézary syndrome. Since the initial description of mycosis fungoides by Dr Jean-Louis Alibert in 1806, there have been significant advances in our understanding of the pathogenesis of CTCL, its diverse clinical and histologic variants, and the evolving treatment landscape. One major contributor to this story has been Dr Irwin Braverman, former vice chair of Dermatology at the Yale School of Medicine. Herein, we provide tribute to his discoveries, teaching, mentorship, and clinical care that have influenced our insights into CTCL and emerging treatments for this challenging malignancy.

Dr Irwin M. Braverman has advanced our understanding of cutaneous manifestations of autoimmune connective tissue diseases (AI-CTD). Before the era of molecular diagnostics, Dr Braverman's careful clinical observations and detailed descriptions of patients with AI-CTD in his textbook Skin Signs of Systemic Disease provided insights into disease characterization, progression, and evolution. Patients from Dr Braverman's career who did not fulfill criteria for a single clinical entity but rather were diagnosed with undifferentiated connective tissue disease or mixed connective tissue disease are discussed. In addition, key observations of Dr Braverman into the cutaneous manifestations of Sjögren syndrome and the systemic complications of urticarial vasculitis are highlighted.

Although rare, life-threatening dermatoses encompass various inflammatory, infectious, vasculitic/vasculopathy, paraneoplastic, and neoplastic skin diseases. Complications include skin barrier dysfunction, secondary infection, and internal organ involvement. Skin signs may serve as a critical window into systemic disease. Life-threatening dermatoses are typically associated with "red flag" clinical signs or symptoms, which inform the dermatologist about the severity of the disease and mandate a thorough history, review of systems, physical examination, and laboratory evaluation. This contribution highlights severe cutaneous adverse reactions, infections, vasculitides and vasculopathies, and paraneoplastic eruptions. Dermatologists should recognize life-threatening dermatoses and have a framework for rapid diagnosis and management.

Irwin Braverman, MD has had a lifelong interest in and appreciation of fine art and the importance of close observation as an essential skill in clinical medicine. These passions converged in his development, with Linda Friedlaender, Head of Education at the Yale Center for British Art, of a workshop for Yale medical students that brought them to the museum to examine paintings much as one would a patient with an unknown disorder. Needs to be longer.

Dermatology faculty are responsible for the undergraduate education of all medical students, most of whom will not become dermatologists but will, nonetheless, encounter skin disease throughout their careers, and for dermatology residents' intensive, specialized graduate education. Over the past 75 years, dermatology faculty have grappled with determining what comprises the fundamental curriculum and how to teach it effectively, grumbled about time limitations, and eloquently debated the fundamental role of dermatology in general medical education. While dermatology trainee education continues to evolve, fundamentals still focus on observational skills developed through clinical and nonclinical experiences. We highlight major trends and turning points in undergraduate and graduate dermatology education that have occurred during the career of Dr. Irwin M. Braverman, many of which Dr. Braverman himself influenced, and reflect on the current state of dermatology education at our institution.

Scleroderma is a heterogeneous disease with various clinical findings involving immune dysregulation, vasculopathy, and fibrosis. Biological and genetic studies over recent decades have elucidated molecular mechanisms of scleroderma pathogenesis. Genetic association studies have identified interferon and other immune regulatory genes as strongly linked to scleroderma risk, highlighting the immune system as a fundamental determinant of disease. Human and murine biological studies have identified growth factor signaling as a central feature linking tissue damage to the clinical phenotype. Growth factors activated in vascular endothelial cells overlap with those of other diseases having vascular abnormalities, such as hereditary hemorrhagic telangiectasia. Activated growth factor receptors in fibroblasts drive excessive collagen expression in the skin and lungs. Because growth factor signaling is overactivated in multiple malignancies, biological insights and therapeutic approaches may be translated from oncology to understand scleroderma better. Enhanced understanding of the molecular drivers of scleroderma pathogenesis has given greater insight into patient phenotypes and new therapeutic approaches, including those that target immune and growth factor signaling.

In 1822, France's Ministry of the Interior, concerned about dropping vaccination rates among the population, commissioned the French artist Constant Joseph Desbordes (1761-1828) to create an artwork that would educate the public about the benefits of the smallpox vaccine. The painting that resulted is entitled: "La Vaccine" ("The Cowpox Inoculation") and a copy of it is entitled "La Vaccine au Chateau de Liancourt" ("Performing the Vaccination against Smallpox in the Chateau of Liancourt").The highlight of the painting is its central figure, one of France's most distinguished physicians, Jean-Louis Alibert (1768-1837) performing, in dramatic fashion, the arm to arm method of smallpox vaccination that was common at that time. The painting was highly praised for bringing together, on opposite sides of the painting, persons from lower and upper socioeconomic classes, with Alibert serving as a bridge between them. The setting for the painting is a chateau and there is no evidence that a smallpox vaccination ever took place there. Thus, this painting is not a record of a specific, real-life vaccination but a celebration of vaccination itself, in an idealized artistic representation. The painting honors Alibert, a strong advocate of vaccination and demonstrates how art can impact patient education.

The proliferation of medical spas has led to an increase in misleading advertising practices, particularly relating to the qualifications of practitioners and the risks of cosmetic procedures. Estheticians manage many spas without having the extensive and rigorous training that board-certified dermatologists undergo. By advertising physician oversight when there is none and promoting procedures as minimally invasive, these facilities create a false sense of security for patients. Procedures such as laser therapies and injectables require specialized expertise to avoid and, if necessary, treat potentially dangerous complications. The ethics of misleading advertising in dermatology must be considered due to its impact on patient decision-making (autonomy), safety (beneficence), and confidence regarding the medical profession.