JAMA dermatology最新文献

Importance: Skin-related neglected tropical diseases (NTDs) pose a public health threat, yet despite the establishment of related Sustainable Development Goals (SDGs), systematic analyses of skin-related NTDs SDGs progress are limited.

Objective: To measure the progress and project attainment to 2030 of the skin-related NTDs SDGs and to explore potential associated factors.

Design, setting, and participants: The disability-adjusted life-years (DALYs) data of 6 skin NTDs, including cutaneous and mucocutaneous leishmaniasis, fungal skin diseases, leprosy, lymphatic filariasis, onchocerciasis, and scabies, were extracted from the Global Burden of Disease Foresight Visualization study. The general population and 2 vulnerable subpopulations, school-aged children and women of childbearing age, were analyzed. Data were collected from December 2024 to August 2025, and data were analyzed from March to August 2025.

Main outcomes and measures: Based on the World Health Organization strategic framework, the progress toward the 2030 skin-related NTDs SDGs targeting a 75% reduction in DALYs from 2020 levels was evaluated. The Skin NTDs SDG Index was developed to quantify the progress to meet the target at the national level and evaluate the role of socioeconomic and health care factors and the COVID-19 pandemic.

Results: Globally, between 2020 and 2030, DALYs were estimated to increase for cutaneous and mucocutaneous leishmaniasis, fungal skin diseases, scabies, and onchocerciasis and decrease for lymphatic filariasis and leprosy. Only a limited number of countries were on track to meet the target, with 11 countries projected to achieve the skin-related NTDs SDGs for 1 type of skin-related NTD. The novel Skin NTDs SDG Index revealed substantial national variation in progress, with the highest in Central Europe, Eastern Europe, and Central Asia and lowest in Sub-Saharan Africa. Government health spending per total health spending was a crucial factor for better progress. The COVID-19 pandemic showed complex roles for different skin NTDs in the short term and the long term. Analyses of 2 vulnerable subpopulations revealed divergent trends, with DALYs declining in school-aged children but rising in women of childbearing age, accompanied by unique index distribution patterns.

Conclusions and relevance: In this study, the progress toward attaining the skin-related NTDs SDGs targets has been largely insufficient. Regional inequalities, influenced by health spending levels, the COVID-19 pandemic, and vulnerable group disparities, pose major challenges. Targeted action and sustained health investment are urgently needed.

Importance: Sunscreen use has known benefits, including decreasing the risk of developing skin cancer and photoaging. Previous studies have reported that the amount of sunscreen used decreased with increased unit price and that individuals underapply sunscreen.

Objective: To assess how the cost of recommended sunscreen use varies depending on unit price and the other sun protective behaviors.

Design and setting: In this economic evaluation study conducted from July 14 to August 31, 2025, sunscreen application costs were calculated based on recommended application amounts, use of other sun protection strategies, and 2025 sunscreen prices.

Main outcomes and measures: The primary outcome was the annual cost of applying sunscreen based on recommended application amounts, use of other sun protection strategies, and 2025 sunscreen prices from an online retailer.

Results: For sunscreens with similar ingredients and sun protection factor ratings, the unit price of sunscreen varied by up to 17.5-fold across 3 sunscreens. Cost per application varied from $0.04 to $3.79 depending on wearing different combinations of typical clothing, whereas 1 year of sunscreen use was estimated to cost between $39.28 and $1429.42, a 36-fold difference, depending on unit price and other sun protective strategies used. A single week of sunscreen use at the beach, assuming 2 applications a day, costs approximately $6.57 to $135.82, depending on whether wearing shorts or a bikini and sunscreen unit price.

Conclusions and relevance: These findings suggest that the cost of applying sunscreen at the recommended amounts varies significantly depending on unit price and the concurrent use of other sun protective strategies. Decreasing the potential cost by encouraging the use of other sun protective strategies and lower-priced sunscreens could facilitate compliance and reduction in the risk of developing skin cancers.

Importance: Patient decision aids (PDAs) are tools that facilitate medical discourse between patients and clinicians, enabling patients to make informed choices among treatment options. While PDAs have been developed for other dermatologic conditions, to our knowledge, none exist for adults with atopic dermatitis (AD).

Objective: To develop a PDA that assists adult patients with moderate to severe AD in selecting systemic treatment options.

Design, setting, and participants: For this qualitative study, the PDA was developed per International Patient Decision Aid Standards Collaboration guidelines. The development process used a systematic approach following designated phases: scoping and design, prototype development, alpha testing, beta testing, and finalization. A steering group was used for all stages of development except for beta testing, which used participants outside of the steering group. The study was conducted from 2020 to 2025 at Oregon Health & Science University's Department of Dermatology in both in-person and virtual environments. The steering groups consisted of 10 adult patients with moderate to severe AD and 6 dermatology clinicians for prototype development, 8 patients and 5 clinicians for alpha testing, and 5 patients and 2 clinicians for finalization of the PDA (performed after beta testing, which included 8 new patients and 6 clinicians).

Main outcomes and measures: PDA content and quality assessments occurred through qualitative thematic analysis performed on open-ended feedback question responses from patients and clinicians.

Results: Among the 10 patients in the initial steering group, the mean (range) age was 38.7 (20-74) years, and 8 were female. Patients valued transparent and organized visual formatting, simplified language, and focused content themes, such as efficacy, dosing frequency, route of administration, relevant adverse effects, and relative costs. Dermatology clinicians prioritized laboratory monitoring, efficacy, and adverse effect data. Patients preferred simplicity, whereas clinicians preferred an emphasis on detail. The finalized International Patient Decision Aid Standards Collaboration-adherent PDA used a staged approach to balance these preferences.

Conclusions and relevance: This qualitative study supports prior findings that when formulating PDAs, authors should prioritize simplicity to enable patient comprehension in clinician-led discussions. This study found that a staged approach may help to deliver complex treatment information in a patient-centered manner, enhancing patient-clinician discussions, and facilitating shared decision-making in adults with AD.