Clinics in dermatology最新文献

The Accreditation Council of Graduate Medical Education (ACGME) requires ethics education for dermatology trainees; yet, less than half of American dermatology residencies currently include ethics in their curriculum. ^{1, 2} Barriers to establishing ethics curricula in dermatology residences include time restraints, lack of useful resources, and lack of faculty with expertise in dermatoethics.² We suggest a hybrid education model, involving a mix of virtual, lecture-based, and case-based didactics to incorporate ethics education longitudinally in dermatology residencies. Subject matter should align with the American Academy of Dermatology subcommittee's six domains of ethics education.

Neisseria gonorrhoeae, a Gram-negative intracellular pathogen, causes gonorrhea. While usually sexually transmissible, it can be acquired by direct inoculation. Untreated gonococcal infections have deleterious impacts, including adverse pregnancy outcomes, ectopic pregnancy, infertility, and even blindness. Extended-spectrum cephalosporins remain the mainstay of therapy, and gonococcal culture is essential to determine susceptibility to these agents. Antimicrobial resistance is a global public health concern, and few new agents are in the pipeline. Gonorrhea control programs rely on health education, access to diagnostic testing (where possible), effective therapy, and partner notification. Introducing inexpensive, sensitive, and specific point-of-care tests will aid antimicrobial stewardship efforts in countries utilizing the syndromic management approach. Targeted vaccination of higher-risk populations with cross-protective outer membrane vesicle-based meningococcal B-vaccines could reduce N. gonorrhoeae transmission in the future. Doxycycline post-exposure prophylaxis may further reduce gonococcal incidence in the short term; however, its long-term impact on the human resistome/microbiome remains unknown.

Dr Heinrich Lahmann was a German physician and health reformer who was especially active in Dresden and the surrounding area during the first half of the 20th century. He was born on December 11, 1860, in Bremen and died in Dresden in 1941. Lahmann was especially well-known for his efforts to improve general health care, promote naturopathy, and his role as a sanatorium director. His work and the institutions he established had a far-reaching impact on the medical landscape of his time. His sanatorium attracted patients from Europe and beyond, where he also tried to apply his therapeutic approach to sexually transmitted diseases and chronic dermatitis.

Chlamydia trachomatis and Mycoplasma genitalium share many similarities, but as much differentiates these two organisms as unites them. These common sexually transmitted bacteria are strongly associated with several acute syndromes in the genito-urinary tract. Although the long-term severe sequelae of Chlamydia trachomatis are well accepted, the data underpinning the complications of Mycoplasma genitalium are less specific and largely observational. Efforts to control Chlamydia trachomatis with comprehensive, large-scale testing programs have yielded limited results, and the control paradigm will shift in the coming years. As diagnostic capabilities for detecting Mycoplasma genitalium have improved, this organism is more widely diagnosed, and the emergence of complex antimicrobial resistance has complicated therapy options. This contribution describes the two organisms' epidemiology, clinical manifestations, and management, and explores new approaches to their control and prevention.

Donovanosis usually causes genital ulcers with a distinct clinical appearance. The condition has been a problem in many developing countries, but recent years have seen a significant global decline in prevalence. It is well on the way to being eradicated. Donovanosis has been known under many different terminologies, and there is still debate about how the causative organism should be classified. Recent news agency and social media reports of an increase in the "flesh-eating infection donovanosis" have been false and unhelpful, only leading to hyperbole and increased stigma among those infected. Donovanosis is a progressive, mildly infectious bacterial infection usually involving the genital area. The causative organism is a gram-negative bacillus, Calymmatobacterium granulomatis. A proposal that the organism be reclassified as Klebsiella granulomatis comb nov was put forward in 1999; however, a consensus is yet to be reached about the definitive nomenclature of the causative agent.¹.

Mpox, a zoonotic orthopoxvirus, originally identified in 1958, exhibits two distinct genetic strains or clades, clades 1 and 2. Before 2022, mpox was predominantly isolated in the endemic regions of West and Central Africa. Sporadic outbreaks of travel-associated clade 2 mpox had previously occurred in nonendemic areas, but persistent human-to-human transmission within nonendemic regions had not been documented until recently.

Herpes simplex virus (HSV) is the most common cause of anogenital ulceration worldwide. There are two distinct viruses: HSV-1 associated with oro-labial cold sores and genital infection and HSV-2 associated with genital infection. Infection is lifelong, and typically presents with painful anogenital ulceration, which may recur after periods of latency. Asymptomatic shedding is common and may lead to transmission to sexual partners. Antiviral suppression with aciclovir, valaciclovir, or famciclovir is useful to treat initial painful episodes or troublesome recurrent infection. Suppressive antiviral therapy, condoms, selective abstinence, and disclosure to sexual partners have all been demonstrated to reduce the risk of transmission.

Kaposi sarcoma (KS) is an angioproliferative tumor that is associated with human herpesvirus 8 or Kaposi sarcoma-associated herpes virus infection. KS typically presents in the skin as isolated or multiple, violaceous macules or papulonodular lesions or plaques. The four different KS clinical categories-classic, endemic, epidemic, or AIDS-related and iatrogenic KS-are heterogeneous in epidemiology, manifestations, and complications. Clinical features, diagnostic modalities, and therapeutic regimens for all types of KS are summarized in this review. It is important for clinicians to promptly recognize and approach the treatment of KS in a multidisciplinary fashion for optimal therapeutic outcomes. Newer targeted therapies based on its pathogenesis are being studied. Kaposi sarcoma (KS) is a vascular tumor associated with human herpesvirus 8 (HHV-8), also known as Kaposi sarcoma-associated herpesvirus (KSHV) infection. KS was first documented in 1872 by Moritz Kaposi, (1837-1902) a Hungarian dermatologist and physician, who described five cases of an atypical tumor that primarily affected the skin of the lower extremities of elderly men.¹ He described the tumors as "idiopathic multiple pigmented sarcoma of the skin," and this form of the disease later became known as sporadic or classic KS.¹.

Human papillomaviruses (HPV) comprise a group of DNA viruses with more than 450 types identified. HPV represents one of the most common viral infections globally. HPV can cause a wide spectrum of clinical disease depending on type, including benign lesions (cutaneous or anogenital warts), premalignant lesions (intraepithelial neoplasia), and anogenital cancers; however, infection may also frequently remain subclinical. Even though the role of HPV in the pathogenesis of penile, vulval, and anal intraepithelial neoplasia and other cutaneous diseases has been recognized, robust evidence for the role of screening and effective management is often lacking. The implementation of prophylactic vaccination for young people and at-risk adults in high-income countries has proven successful, and now there is growing interest in postexposure vaccination.