JMIR dermatology最新文献

Unlabelled: Dermal fillers are commonly used for facial augmentation, but delayed complications such as granulomatous inflammation and filler migration can mimic chronic bacterial infections, such as cervicofacial actinomycosis, and lead to diagnostic misdirection. We present the case of a woman aged 56 years with a chronic, draining abscess on the right cheek that persisted for 3 years and was initially suspected to represent cervicofacial actinomycosis. Tissue cultures were negative, and histopathologic analysis following excisional biopsy revealed polymethyl methacrylate microspheres and hyaluronic acid surrounded by granulomatous inflammation and reactive lymphoid aggregates, consistent with a foreign body reaction to dermal filler. The patient experienced complete resolution after surgical excision. This case underscores the diagnostic challenges posed by delayed filler complications and highlights the importance of considering prior cosmetic procedures in patients with chronic facial abscesses.

Unlabelled: In this analysis of dermatology e-consults at a large academic health system, advanced practice providers had nearly threefold higher conversion rates to in-person visits compared to board-certified dermatologists, with potential implications for access and resource utilization.

Background: Atopic dermatitis (AD) has a relapsing and remitting nature, and scheduled clinic visits only provide a snapshot of the skin condition at the moment.

Objective: This study aimed to investigate the quality of patient-taken smartphone photographs of AD skin lesions and characterize patients using smartphone photographs as a tool to assist the physician to show disease activity in between consultations.

Methods: Patients from 2 university outpatient clinics specialized in AD were surveyed. A questionnaire regarding digital readiness was completed, and a previously taken skin lesion photograph on the patients' own smartphone was evaluated.

Results: Between February 2024 and September 2024, a total of 100 questionnaires were completed, 60 (60%) by participants from the capital region of Denmark and 40 (40%) by participants from an urban area, including 62 (62%) men and 38 (38%) women. The mean age of the recruited patients was 33.9 (SD 19.9) years. A total of 78% (78/100) of the patients used a desktop computer, laptop, or tablet often or always, and 86% (86/100) corresponded with the health care system using technology (eg, via email to the general practitioner or contact with hospitals via apps). More than 50% (52/100, 52%) strongly agreed or agreed with the statement that they would prefer a remote online visit with, for example, upload of skin lesion photographs over a routine in-person office visit. Almost 3 out of 4 patients had a photograph of their AD skin lesion on their smartphone, most (38/71, 54%) with the sole intention of presenting it to a physician. The photographs were of good quality in 85% (60/71) of the cases, and most (61/71, 86%) of the smartphone photographs were assessed to be useful for diagnostic and clinical evaluation. Receiving topical monotherapy was significantly associated with increased risk of having taken a skin lesion smartphone photograph (P=.006).

Conclusions: Patients with AD followed up on in an outpatient clinic often took good-quality photographs of their skin lesions before consultations with the intention of presenting them to the physician.

Background: Topical minoxidil and oral finasteride are approved by the US Food and Drug Administration (FDA) for the treatment of male androgenetic alopecia (AGA). However, concerns about adverse events related to the use of oral finasteride have led to some apprehension about the treatment. Topical finasteride, though not FDA-approved, has demonstrated efficacy and safety in a limited number of clinical trials and may be a promising alternative, such that compounding pharmacies and telehealth companies in the United States now offer access to topical finasteride for patients with AGA.

Objective: This real-world, retrospective study is, to our knowledge, the largest study to date aimed to evaluate patient satisfaction and tolerability associated with the novel combinations of topical finasteride and topical minoxidil for the treatment of male AGA.

Methods: We conducted a retrospective analysis of patient data collected during routine clinical follow-up via Hims & Hers, a direct-to-consumer health and wellness platform, between April 1, 2021 and April 30, 2025 to assess the frequency of side effects and other possible medication reactions associated with the use of compounded topical finasteride and minoxidil. Data were gathered from two sources: (1) a follow-up check-in sent to patients approximately 130 days following the initiation of treatment; (2) unprompted communications sent via in-app or web-based messaging from patients to their care team. Data about patient satisfaction with treatment, the frequency of any side effect, frequency of specific side effects, need for a higher level of care, and treatment discontinuation due to a side effect were extracted from the data sources.

Results: A total of 638,629 male patients with AGA received a prescription for a compounded topical finasteride and minoxidil product between April 1, 2021 and April 30, 2025. Of 151,352 (23.7%) patients who completed a follow-up check-in, 121,615 (80.4%) reported being satisfied with treatment and 4034 (2.7%) reported experiencing a side effect. Of all the 638,629 patients, 230 (0.04%) sent their care team a message (outside of check-ins) indicating a side effect or other possible medication reactions. No patient reported seeking a higher level of care or discontinued treatment due to such an occurrence.

Conclusions: Patients prescribed novel formulations of compounded topical finasteride and minoxidil for the treatment of AGA via a national telehealth platform reported satisfaction with the treatment and tolerated it well. The limitations of the study include the use of retrospective data and the lack of a control group, both of which preclude causal inference. Future research should include randomized controlled trials to assess the efficacy, safety, and tolerability of topical finasteride.

Background: Mental health is becoming increasingly recognized as an important part of overall health, especially for patients with cancer. However, the relationship between nonmelanoma skin cancer and mental health has not been widely studied.

Objective: The aim of this study was to examine the association between nonmelanoma skin cancer diagnosis and 2 key mental health outcomes (ie, clinical depression and the number of poor mental health days).

Methods: This study used the 2023 Behavioral Risk Factor Surveillance System, a nationally representative survey of adults in the United States, which included 312,317 participants. Nonmelanoma skin cancer diagnosis, depression, and self-reported mental health days were analyzed. Logistic regression was used to evaluate the association between nonmelanoma skin cancer and depression, whereas Poisson regression was used to model the number of poor mental health days, adjusting for age, sex, race and ethnicity, education, BMI, income, and major comorbid conditions (other cancers, heart disease, lung disease, and kidney disease).

Results: Individuals with nonmelanoma skin cancer (5086/26,552, 19.15%) reported a lower overall rate of depression compared to those without nonmelanoma skin cancer (61,438/285,765, 21.50%; P<.001) but reported more poor mental health days on average (4.54, SD 8.37 d vs 3.20, SD 7.37 d; P<.001). After adjustment, nonmelanoma skin cancer diagnosis was not significantly associated with depression (adjusted odds ratio 1.01, 95% CI 0.98-1.05) and was associated with a slightly lower number of poor mental health days (adjusted rate ratio 0.94, 95% CI 0.91-0.97).

Conclusions: Adults with nonmelanoma skin cancer experienced a meaningful mental health burden, and unadjusted analyses suggested greater day-to-day distress than among adults without nonmelanoma skin cancer. However, these differences were reduced and no longer significant for depression after adjusting for sociodemographic factors and comorbid chronic illnesses. These findings support the need for mental health screenings and support services in dermatologic and oncologic care.

Unlabelled: This cross-sectional survey study (63.5% response rate) characterized how patients with atopic dermatitis (AD) perceive and experience the effects of climate change on their AD. Most participants reported that environmental factors such as heat and air pollution worsened their AD and expressed a desire for climate-health education, yet few had discussed these concerns with their dermatologist. These findings reveal a gap in patient-centered dermatologic care and support the development of tools to integrate environmental health into atopic dermatitis management.

Background: Large language models (LLMs) are becoming increasingly popular in clinical trial design but have been underused in research proposal development.

Objective: This study compared the performance of commonly used open access LLMs versus human proposal composition and review.

Methods: A total of 10 LLMs were prompted to write a research proposal. Six physicians and each of the LLMs assessed 11 blinded proposals for capabilities and limitations in accuracy and comprehensiveness.

Results: ChatGPT-o1 and Llama 3.1 were rated the most and least accurate, respectively, by human scorers. LLM scorers rated ChatGPT-o1 and DeepSeek R1 as the most accurate. ChatGPT-o1 and Llama 3.1 were rated as the most and least comprehensive, respectively, by human and LLM scorers. LLMs performed poorly on scoring proposals and, on average, rated proposals 1.9 points higher than humans for both accuracy and comprehensiveness.

Conclusions: Paid versions of ChatGPT remain the highest-quality and most versatile option of the available LLMs. These tools cannot replace expert input but serve as powerful assistants, streamlining the development process and enhancing productivity.

Background: Understanding the burden of various skin diseases can help guide funding allocation for skin disease research. A 2015 cross-sectional study found a partial correlation between US skin disease burden according to the 2010 Global Burden of Disease (GBD) study and National Institutes of Health (NIH) funding in 2012-2013.

Objective: This study aims to identify trends, correlations, and disparities in US skin disease burden and NIH research funding allocation using the latest data from the GBD 2021 and NIH funding data from the fiscal years 2021-2022.

Methods: A cross-sectional analysis was conducted to compare the disability-adjusted life years for 15 skin conditions from the GBD 2021 with NIH funding for these conditions in 2021-2022. Data were sourced from the GBD Results tool and the NIH RePORTER database.

Results: NIH funding for skin disease research and US skin disease burden according to the GBD 2021 were partially correlated, with several outliers. Malignant skin melanoma and pruritus were relatively overfunded, while psoriasis and urticaria were relatively underfunded.

Conclusions: Disease burden is just one of the many important factors that must be considered when allocating resources, including funding to encourage research efforts to improve patient outcomes and positively impact public health.

Background: Skin cancer is the most commonly diagnosed malignancy in the United States, with rural populations facing disproportionate delays in diagnosis due to geographic isolation, workforce shortages, and limited access to dermatologic care. These delays contribute to higher rates of late-stage diagnosis and poorer outcomes. Teledermatology has emerged as a promising solution to expand access to dermatologic evaluation and treatment in underserved settings.

Objective: The review aims to evaluate the diagnostic performance, implementation challenges, and equity considerations of teledermatology in the context of rural skin cancer care, and to assess its potential to improve clinical outcomes in underserved populations.

Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar to identify studies published between January 2015 and March 2025. Search terms included "teledermatology," "skin cancer," "rural health services," "telemedicine," "diagnostic accuracy," and "health disparities." Studies evaluating diagnostic metrics, time to diagnosis, patient satisfaction, and implementation barriers were included.

Results: Nine key studies spanning various countries and health care settings were included. Diagnostic sensitivity ranged from 41.9% to 100%, and specificity from 46% to 90%, depending on modality and lesion type. Teledermatology consistently reduced time to diagnosis, in some cases by over 75%, and was associated with high patient satisfaction due to increased convenience and reduced travel. Key barriers included technological limitations, inconsistent imaging protocols, and reimbursement variability. Successful implementation was facilitated by standardized workflows, dermoscopy integration, and centralized platforms.

Conclusions: Teledermatology is a viable and effective approach to addressing disparities in rural skin cancer care. It offers diagnostic accuracy comparable to face-to-face evaluations while reducing wait times and improving patient satisfaction. Overcoming technological and systemic barriers is critical to ensuring equitable, long-term integration of teledermatology in rural health systems.

Unlabelled: This narrative review examines the advantages and disadvantages of direct-to-consumer teledermatology for the treatment of male androgenetic alopecia, finding that this treatment modality improves access to care, ensures high adherence rates, and enhances patient satisfaction, while raising concerns about increased drug costs.