Dermatology practical & conceptual最新文献

Introduction: Androgenetic alopecia (AGA) is a common cause of hair loss worldwide. Accurate patient education may improve treatment adherence and outcomes.

Objective: To compare the accuracy, readability, and user experience of ChatGPT 4.0, Gemini 1.5 Flash, and Deepseek R1 in answering common patient questions about AGA.

Methods: In February 2025, a cross-sectional study was conducted using 12 frequently asked patient questions on AGA, sourced from online platforms. The questions were submitted to ChatGPT 4.0, Gemini 1.5 Flash, and Deepseek R1. Two dermatologists independently assessed responses using a validated 4-point accuracy scale. Readability was measured with the Flesch-Kincaid Grade Level and Flesch Reading Ease Score. User experience was evaluated based on response speed, presence of visual aids, citation usage, and overall satisfaction. Inter-rater reliability was analyzed via Cohen's kappa, and statistical comparisons were made between models.

Results: ChatGPT 4.0 and Gemini 1.5 Flash successfully answered all 12 questions, with most responses rated as "satisfactory with minimal corrections." Deepseek R1 answered only five questions and frequently provided inaccurate content, especially when differentiating between AGA and cicatricial alopecia. It also lacked warnings about potential misinformation. Gemini 1.5 Flash included visual aids and citations, improving interpretability. All models generated responses at a high school reading level. In terms of user experience, ChatGPT 4.0 and Gemini 1.5 Flash outperformed Deepseek R1.

Conclusions: ChatGPT 4.0 and Gemini 1.5 Flash provided accurate, readable, and user-friendly responses on AGA-related questions, making them promising tools for patient education under physician guidance. Deepseek R1's limitations highlight the need for cautious implementation.

Introduction: Psoriasis is a chronic relapsing inflammatory disease. and approximately 20% of psoriasis patients also develop psoriatic arthritis (PsA).. Interleukin 23 (IL-23) plays a crucial role in maintaining the T-helper (Th) 17 cell population derived from naïve Th1 cells as well as in sustaining inflammation at the enthesis and joints, acting as a pathogenic effector in PsA. Among anti-IL-23 monoclonal antibodies, ustekinumab, guselkumab, and risankizumab are approved in Europe for both psoriasis and PsA for psoriasis and PsA treatment. Tildrakizumab, another IL-23p19 inhibitor, is currently approved only for plaque psoriasis but has shown favorable safety in patients with metabolic comorbidities and potential efficacy in PsA.

Objectives: To retrospectively assess the efficacy of tildrakizumab on psoriatic arthritis manifestations in patients treated according to real-world clinical practice.

Methods: We conducted a retrospective analysis of eight patients affected by psoriasis, early PsA, and metabolic comorbidities, treated with tildrakizumab 100 mg every 12 weeks after induction. Descriptive and inferential statistical analyses were performed. Efficacy and safety were evaluated using standard clinimetric indices over a 28-week follow-up period.

Results: After 28 weeks, a significant mean reduction was observed in Psoriasis Area and Severity Index (-81.3%, P<0.001), Pain Visual Analogue Scale (-85%, P<0.002), Nail Psoriasis Severity Index (-78%, P<0.002), Dermatology Life Quality Index (-86%, P<0.001), Physician Global Assessment (-73%, P<0.0003), and Disease Activity Index for PsA (-82%, P<0.000023). No adverse events were reported.

Conclusions: Tildrakizumab confirmed its efficacy in reducing signs and symptoms of early PsA, with high safety profile in our psoriasis patients also affected by multiple metabolic comorbidities.

Introduction: The recent WHO classification of melanocytic tumors introduces a refined molecular and histopathological framework suggesting distinct pathways and precursor lesions for all melanoma subtypes. While conceptually appealing, its clinical applicability is increasingly questioned.

Objectives: This review critically examines the transformation theory from benign nevi to melanoma, highlighting inconsistencies between the proposed models and real-life practice.

Methods: Through illustrative cases and key epidemiological evidence, we evaluated the validity of current models proposing intermediate lesions in melanoma development.

Results: We argue that most melanomas arise de novo and that the so-called intermediate lesions, such as dysplastic nevi and atypical Spitz tumors, may mimic melanoma but are not true biological precursors.

Conclusions: We propose a simplified, clinically oriented reclassification of melanocytic lesions based on morphologic ambiguity and actual behavior, aiming to guide therapeutic decisions and reduce diagnostic overinterpretation.

Background: Infantile hemangioma is the most common vascular tumor in infants, affecting 4% to 10% of this population. It typically appears as a solitary cutaneous hemangioma but can also be multifocal or segmental. The condition progresses through rapid growth, a plateau phase, and gradual involution. Key risk factors include low birth weight, prematurity, female sex, multiple gestations, and family history. Clinical presentation varies among individuals.

Objective: This study aimed to analyze the clinical characteristics of patients with infantile hemangioma at our hospital, focusing on age at onset, presentation, location, size, type, and complications.

Methods: A retrospective analysis of medical records of infants diagnosed with infantile hemangioma was conducted. Data were collected for statistical analysis on demographics, lesion characteristics, and complications.

Results: The study reviewed 694 hemangiomas in 500 patients, with 50% having a precursor lesion at birth. A significant female predominance (72%) was noted, with most patients (72%) delivered at term. The strawberry mass was the most common morphology (74%), primarily located in the head and neck (42%). Of the hemangiomas, 45% were superficial, and 88% showed progressive growth. Ten patients with periocular hemangiomas experienced amblyopia, while other complications included PHACES syndrome, ipsilateral breast hypertrophy, and arteriovenous malformations.

Conclusion: This study highlights the diverse manifestations, anomalies, and risk factors associated with infantile hemangioma in a tertiary care setting.

Introduction: Dermatophytoses are the most frequent fungal infections of the skin. It has been reported that dermatophyte infections resistant to antifungal medications have increased in recent years. Therefore, superficial fungal skin infections that are difficult to treat have become a major health problem worldwide. Trichophyton indotineae is a newly described dermatophyte species that has been mainly isolated from patients with dermatophytosis characterized by widespread skin lesions and resistance to antifungal treatment and that causes outbreaks. T. indotineae leads to a pruritic rash that affects the large areas of the body surface such as the trunk, groin, and extremities, even in immunocompetent patients. Moreover, these patients usually do not respond to systemic terbinafine, which is the first-line treatment for dermatophyte infections and has fungicidal effects.

Objectives: Our aim was to determine the body sites affected by T. indotineae infection, the types of tinea caused by T. indotineae, the drugs to which it is particularly resistant, and the treatment regimens to which it responds.

Methods: Articles in the PubMed database published between December 2020 and September 2024 were investigated by searching the word "Trichophyton indotineae".

Results: We reviewed 39 studies in the PubMed database that reported patients with T. indotineae infection to identify treatment regimens to which it is resistant or responsive.

Conclusion: Treatment guidelines should be established to select the appropriate alternative antifungal medication and determine the adequate drug dose and duration in treatment-resistant fungal skin infections caused by T. indotineae. Nevertheless, the data required to develop standard treatment regimens are insufficient.

Introduction: Mucous membrane pemphigoid (MMP) is a rare autoimmune bullous dermatosis which predominantly affects the mucous membranes and, occasionally, the skin. The exact pathogenesis of MMP remains unclear and should be considered as a unique phenomenon, which involves the formation of subepithelial blisters and fibrosis.

Objectives: This narrative review aimed to summarize the pharmacological agents which showed efficacy in the management of MMP but that are not included in the guidelines.

Methods: We conducted a search on Google Scholar, PubMed, and the Web of Science databases concerning articles published in English on the management of MMP between January 2000 and February 2025; all the sourced articles were full-text reviewed.

Results: We included 13 articles. The studied pharmacological agents are classified as immunosuppressive agents (leflunomide, sirolimus, daclizumab) and biologics (daclizumab, dupilumab, omalizumab, bevacizumab, aflibercept, cenegermin); the immunosuppressant leflunomide and the antimalarial agent hydroxychloroquine are also classified as disease-modifying antirheumatic drugs. Other pharmacological agents (colchicine, corticotropin, varenicline, lifitegrast) exert miscellaneous mechanisms.

Conclusion: Considering the severity of the condition, progressive fibrosis, and resistance to therapy, more research is required in relation to the pathogenesis of MMP and the efficacy and safety profile of novel pharmacological options. Pharmacological agents should provide the achievement and maintenance of remission with minimal adverse effects. A broader spectrum of pharmacological agents will allow a personalized approach and more alternatives, in particular for recalcitrant cases, failure of the previous therapy, and in patients with MMP and malignancy.

Introduction: There is a widespread clinical practice of avoiding oral isotretinoin administration during the sunny season due to its purported photosensitizing effect. However, this approach is not supported by solid evidence.

Objective: The aim of this study was to assess the safety and effectiveness of administering oral isotretinoin at a reduced daily dosage during the sunny period in a real-world clinical setting.

Methods: This retrospective cohort study included all acne patients treated with oral isotretinoin at our Acne Clinic (January 2014 - December 2023) who had received the drug between June and September, when UV index exceeds a threshold of 6. Conventionally, oral isotretinoin daily dosage is reduced by approximately half during these four sunny months and then increased again. We compared the occurrence of side effects or treatment discontinuation between sunny and non-sunny periods. The therapeutic response was explored in relation to the daily dosage.

Results: 359 patients (61.3% males, with a mean age of 19.0 years, standard deviation (SD) 6.7) were included. Adverse events were reported by 39.2% and 28.3% of patients during the non-sunny and sunny months, respectively. The incidence of treatment discontinuation was negligible. The reduction in acne severity was independent of the daily dosage of oral isotretinoin.

Conclusions: The study results support the lack of any necessity to suspend or refrain from administering oral isotretinoin during sunny seasons. The preventive reduction of its daily dosage during sunny periods does not negatively affect the drug's effectiveness. Oral isotretinoin can be taken, at a slightly reduced dosage, during sunny months.