JMIR dermatology最新文献

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.

Unlabelled: This study analyzes the most commonly mentioned psoriasis treatments on Facebook and Reddit forums, tracking their popularity over time by using Google Trends.

Background: Evidence that artificial intelligence (AI) may improve melanoma detection has led to calls for increased human-AI collaboration in clinical workflows. However, AI-based support may entail a wide range of specific functions for AI. To appropriately integrate AI into decision-making processes, it is crucial to understand the precise role that clinicians see AI playing within their clinical deliberations.

Objective: This study aims to provide an in-depth understanding of how a range of clinicians involved in melanoma screening and diagnosis conceptualize the role of AI within their decision-making and what these conceptualizations mean for good decision-making.

Methods: This qualitative exploration used in-depth individual interviews with 30 clinicians, predominantly from Australia and New Zealand (n=26, 87%), who engaged in melanoma detection (n=17, 57% dermatologists; n=6, 20% general practitioners with an interest in skin cancer; and n=7, 23% melanographers). The vast majority of the sample (n=25, 83%) had interacted with or used 2D or 3D skin imaging technologies with AI tools for screening or diagnosis of melanoma, either as part of testing through clinical AI reader studies or within their clinical work.

Results: We constructed the following 5 themes to describe how participants conceptualized the role of AI within decision-making when it comes to melanoma detection: theme 1 (integrative theme)-the importance of good clinical judgment; theme 2-AI as just one tool among many; theme 3-AI as an adjunct after a clinician's decision; theme 4-AI as a second opinion for unresolved decisions; theme 5-AI as an expert guide before decision-making. Participants articulated a major conundrum-AI may benefit inexperienced clinicians when conceptualized as an "expert guide," but overreliance, deskilling, and a failure to recognize AI errors may mean only experienced clinicians should use AI "as a tool." However, experienced clinicians typically relied on their own clinical judgment, and some could be wary of allowing AI to "influence" their deliberations. The benefit of AI was often to reassure decisions once they had been reached by conceptualizing AI as a kind of "checker," "validator," or in a small number of equivocal cases, as a genuine "second opinion." This raised questions about the extent to which experienced clinicians truly seek to "collaborate" with AI or use it to inform decisions.

Conclusions: Clinicians conceptualized AI support in an array of disparate ways that have implications for how AI should be incorporated into clinical workflows. A priority for clinicians is the conservation of good clinical acumen, and our study encourages a more focused engagement with users about the precise way to incorporate AI into the clinical decision-making process for melanoma detection.

Unlabelled: Our study evaluates the diagnostic accuracy of ChatGPT-4o in classifying various skin lesions, highlighting its limitations in distinguishing squamous cell carcinoma from basal cell carcinoma using dermatoscopic images.

Unlabelled: ChatGPT is increasingly used in healthcare. Fields like dermatology and radiology could benefit from ChatGPT's ability to help clinicians diagnose skin lesions. This study evaluates the accuracy of ChatGPT in diagnosing melanoma. Our analysis indicates that ChatGPT cannot be used reliably to diagnose melanoma, and further improvements are needed to reach this capability.

Unlabelled: In this Google Trends cross-sectional analysis, we aimed to understand the popularity of tender-headedness by analyzing related Google search queries from January 2013 to December 2022. Since 2013, Google searches on scalp-related concerns, especially those regarding tender-headedness in Black hair culture, have increased, thus uncovering an opportunity for dermatologists to utilize culturally relevant language to address scalp concerns in patients with Afro-textured hair.

Unlabelled: Cutaneous atrophy resulting from corticosteroid injections for musculoskeletal indications is an underrecognized adverse effect among orthopedists and dermatologists. We present two cases of cutaneous atrophy following corticosteroid injections for wrist tendonitis. Patients presenting with cutaneous atrophy following orthopedic corticosteroid injections may be misdiagnosed with linear morphea, atrophoderma, or vascular disorders and receive unnecessary workups and delays in appropriate management. Dermatologists play an essential role in the evaluation of these patients.