JMIR dermatology最新文献

Background: Scarring has been shown to have adverse health effects on marginalized patient groups. However, experiences of scarring among transgender and gender diverse (TGD) people have not yet been thoroughly characterized. .

Objective: This study aimed to investigate the impacts of scarring related to gender-affirming care and other causes among TGD people.

Methods: Anonymous data were extracted from Reddit, a popular online platform organized into "subreddit" groups based on identities and interests. A combined total of 604 posts and comments that explicitly reference physical scarring were extracted from r/FtM, a subreddit for transmasculine people (449 posts and comments) and r/MtF, a subreddit for transfeminine people (155 posts and comments). Applying inductive thematic analysis, all posts and comments were coded and codes were sorted into overarching themes. .

Results: Among the 604 posts and comments, the scars most discussed were secondary to gender-affirming care procedures, including mastectomy (n=338 posts and comments), hormone administration (n=102 posts and comments), and hair removal (n=38 posts and comments). Nongender-affirming care-related scars, such as those due to self-harm (n=43 posts and comments), were discussed less often. A total of five overarching themes emerged through thematic analysis: (1) concerns about physical outcomes related to scarring; (2) psychological distress related to scarring; (3) societal perceptions of scarring; (4) strategies to prevent, conceal, and minimize scarring; and (5) positive experiences with scarring.

Conclusions: For TGD people, scar complications, visibility, and permanence represent major concerns. While many TGD people ultimately accept scarring as an unavoidable consequence, scarring both related and unrelated to gender-affirming care can present a significant psychosocial stressor for TGD people. Scarring can result in physical health complications, gender dysphoria, and negative body image; visible scarring is also a barrier for TGD people who wish to blend into society. Clinicians should improve communication regarding scarring outcomes and scar-care procedures. Future research should focus on the development of scar prevention, care, and reduction techniques for TGD people.

Background: The integration of artificial intelligence (AI) into patch testing for allergic contact dermatitis (ACD) holds the potential to standardize diagnoses, reduce interobserver variability, and improve overall diagnostic accuracy. However, the challenges and limitations hindering clinical implementation have not been thoroughly explored.

Objective: This narrative review aims to examine the current applications of AI in patch testing, identify challenges, and propose future directions for their use in dermatology.

Methods: PubMed was searched in August 2024 to identify studies involving human participants undergoing patch testing with AI used in the study. Exclusion criteria were non-English and nonoriginal research. Data were synthesized to assess study design, performance, and potential for clinical application.

Results: Out of 94 reviewed articles, 10 met the inclusion criteria. Most studies employed convolutional neural networks (CNN) for image analysis, with accuracy rates ranging from 90.1% to 99.5%. Other AI models, such as gradient boosting and random forest, were used for risk prediction and biomarker discovery. Key limitations included limited sample sizes, variability in image capture protocols, and lack of standardized reporting on skin types.

Conclusions: AI has significant potential to enhance diagnostic accuracy, standardize patch test interpretation, and expand access to patch testing. However, standardized imaging protocols, larger and more diverse datasets, and improved regulatory frameworks are necessary to realize the full potential of AI in patch testing.

Unlabelled: This cross-sectional survey of pediatric dermatology and primary care pediatric providers found that store-and-forward teledermatology is an efficient and educational means of delivering care to a safety-net pediatric patient population.

Background: Skin cancers are the most frequent types of cancer, and the incidence continues to rise. Teledermoscopy is a promising tool in the diagnostic process of potential skin cancer, and new technologies are constantly being developed. However, little information is available on how teledermoscopy affects physicians' time consumption.

Objective: This study aimed to investigate whether teledermoscopy can shorten the diagnostic process for physicians examining skin lesions suspected of skin cancer.

Methods: We recorded the time primary care providers, dermatologists, plastic surgeons, and pathologists spent examining lesions suspected of skin cancer, with and without teledermoscopy. Furthermore, we looked at five different diagnostic pathways, which reflected the most common ways through the Danish health care system for patients with suspected skin cancer, to estimate the total amount of time physicians spent examining these lesions with and without teledermoscopy.

Results: A total of 118 time recordings were obtained. With teledermoscopy, the diagnostic process was significantly shortened for dermatologists (P=.008) but prolonged for primary care providers (P=.03). While the use of teledermoscopy saved time in one of the diagnostic pathways, it increased the time spent in the four others.

Conclusions: Our research suggests that the implementation of teledermoscopy could save time for dermatologists and potentially plastic surgeons and pathologists, provided that a sufficient number of benign skin lesions can be accurately diagnosed and excluded from further examination and treatment. In contrast, the implementation of teledermoscopy might prolong primary care providers' consultation time.

Unlabelled: A large proportion of transgender women in Hyderabad, India (150/223, 67.3%) expressed interest in a wide range of topical, oral, and intravenous medications for skin lightening; however, despite government regulations and the potential health risks, persistent demand for skin lightening underscores the need for better patient education and safer skin care practices for this marginalized community.

Unlabelled: Displaced populations face complex dermatologic challenges. Contributing factors include low immunization rates, poor sanitation, crowded living conditions, and physical abuse. Chronic inflammatory conditions and infectious diseases, including fungal infections and scabies, are prevalent. Research is crucial to reduce the spread of disease, improve care in these populations, and develop sustainable frameworks for long-term dermatologic health care in crisis settings. The paucity of dermatologist support in this field exacerbates the issue. Ethical considerations include nonmaleficence and culturally sensitive practices, and proposed solutions include trauma-informed care training, advocacy for equitable research funding, teledermatology, and the development of shared international screening guidelines. Further research is essential to enhance dermatologic care for displaced populations.

Background: Nonresponse to botulinum toxin type A (BoNT-A) has been reported in both medical and aesthetic applications. Secondary nonresponse (SNR) occurs when BoNT-A is initially effective before failure commences at a later point. Most reported cases involve SNR in aesthetics. Several aspects of this complication remain elusive or controversial.

Objective: We aimed to address unanswered questions regarding the prevalence and etiology of SNR. Additionally, we investigated the immunogenicity of BoNT-A formulations, mainly focusing on the development of neutralizing antibodies that hinder the toxin's pharmacologic effects. Furthermore, we sought to examine the management strategies for SNR.

Methods: The PubMed and Google Scholar databases were searched from inception for articles on nonresponse to BoNT-A therapy. Articles were evaluated based on their contribution to the field. Expert opinions and panel recommendations regarding management and data gaps were also included in the review.

Results: There are limited data on SNR prevalence in aesthetic applications compared to therapeutic uses. Trigger factors of SNR include improper handling of BoNT-A; incorrect injection practices; and impurities present in the formulation, such as clostridial complexing proteins that may increase immunogenicity. Other contributing factors include infection; patient characteristics; and treatment parameters that encompass an increased frequency of BoNT-A injections (ie, <3 months apart), higher cumulative dosages, elevated treatment dosages, and booster injections (retreatment within 3 weeks of the initial injection). Neutralizing antibodies developed with first-generation formulations, such as onabotulinumtoxinA and abobotulinumtoxinA that contain clostridial proteins, but not with second-generation BoNT-As, such as incobotulinumtoxinA and daxibotulinumtoxinA, which lack these proteins. Among patients who developed SNR after using first-generation BoNT-A for aesthetic purposes, switching to incobotulinumtoxinA therapy did not result in the development of immune responses. Switching to a protein-free BoNT-A formulation such as incobotulinumtoxinA upon development of SNR has been advocated. To effectively manage SNR, it is crucial to minimize the identified trigger factors.

Conclusions: Nonresponse to BoNT-A is gaining importance in aesthetic treatments. Considering the potential for immunogenicity is essential when selecting a BoNT-A formulation. Preventing SNR is crucial, given the lack of solid data on effective treatments.