Archives of Dermatological Research最新文献

The use of ChatGPT (Open AI, San Francisco, CA) has risen meteorically since its release in November 2022. While there are concerns about the utility of ChatGPT, the exploration of its use in clinical medicine to decrease administrative burden on physicians and deliver digestible information has begun. Patients or family members who seek information about Mohs Micrographic Surgery (MMS) may utilize platforms such as ChatGPT to better understand the procedure. Our study sought to evaluate if ChatGPT provides valuable and accurate information in addressing patient concerns utilizing the FACE-Q Skin Cancer Module™ – Cancer Worry. We prospectively recruited all willing patients with a new diagnosis of basal cell carcinoma or squamous cell carcinoma who had never had MMS to participate. Upon agreement, patients were given a baseline survey including the FACE-Q Skin Cancer Module™ – Cancer Worry to complete. Then, patients were encouraged to ask up to 3 questions to ChatGPT regarding any part of their diagnosis or treatment plan including intra operative considerations, post operative care, and general dermatologic concerns. After the answers were compiled, patients were given time to read the responses. They were then asked to answer the FACE-Q Skin Cancer Module™ – Cancer Worry a second time. Differences in the baseline and secondary modules were calculated. Subsequently, ChatGPT generated responses were reviewed and analyzed for overall themes and medical accuracy. Our pilot study demonstrated that ChatGPT provided accurate and largely useful information for preoperative patient questions. However, ChatGPT alone cannot replace the consultation and targeted information given by healthcare providers. Instead, questions patients ask ChatGPT may assist providers in understanding patient anxieties, and how best to address these concerns during consultation and surgery.

Oral lichen planus (OLP) is a chronic, immune-mediated disorder affecting the oral mucosa impacting the quality of life. Supplementation with adjunctive vitamin D may accelerate early symptom relief and lesion healing; however, overall efficacy across time points remains uncertain due to limited evidence. We conducted a meta-analysis of randomized controlled trials comparing adjunctive vitamin D plus standard therapy versus standard therapy alone in OLP patients. Data were pooled using common or random effects models, sensitivity analyses assessed heterogeneity, and effects were expressed as mean differences (MD), standardized mean differences (SMD), or risk ratios (RR) with 95% confidence intervals (CI). Four randomized controlled trials including 137 adults with symptomatic oral lichen planus (OLP) were included in the analysis. Adjuvant vitamin D produced significant pain reductions at 2 weeks (MD − 0.85; 95% CI − 1.36 to − 0.35; p < 0.001; I² = 0%), 4 weeks (MD − 1.64; 95% CI − 2.94 to − 0.34; p = 0.014; I² = 80.3%), and 6 weeks (MD − 1.64; 95% CI − 2.98 to − 0.29; p = 0.017; I² = 63.1%). Clinical scores improved significantly at 6 weeks (SMD − 0.58; 95% CI − 1.02 to − 0.15; p = 0.009; I² = 28.1%) but not at earlier or later timepoints. Mucosal healing showed a significant increase (RR 4.04; 95% CI 1.12 to 14.54; p = 0.003; I² = 0%). Salivary TNF-α decreased significantly (MD − 1.76 pg/mL; 95% CI − 2.94 to − 0.57; p = 0.004; I² = 45.7%). Adjunctive vitamin D enhances pain relief, clinical improvement, and reduces inflammation in OLP over a 6-week period; with no clear between-group differences by 8 weeks. These findings support further trials to optimize dosing and evaluate long-term benefits.

Atopic dermatitis (AD) is a chronic inflammatory disease in which systemic corticosteroids (SCS) continue to be frequently prescribed despite guideline recommendations discouraging their routine use because of limited sustained benefit and substantial safety concerns. This expert consensus aimed to define evidence-based thresholds for short- and long-term SCS use in AD and to provide practical recommendations on the role of SCS relative to advanced systemic therapies. A comprehensive literature search of PubMed, Scopus, and Google Scholar identified English-language original studies, systematic reviews, and meta-analyses addressing SCS efficacy, safety, and utilization in AD. Nine dermatologists with extensive AD expertise reviewed eligible articles using Strength of Recommendation Taxonomy (SORT) criteria and, through a modified Delphi process, developed and voted on consensus statements. Of 500 records screened, 27 met inclusion criteria. The panel unanimously adopted 11 consensus statements, eight with SORT strength A and three with strength C. The consensus defines short-term SCS exposure as less than 4 weeks and long-term exposure as 4 weeks or longer, including a single intramuscular dose, and emphasizes that even short courses are associated with serious adverse events and cumulative, dose- and duration-dependent toxicity. Repeated courses are discouraged, and any SCS exposure is considered a systemic therapy trial that should prompt evaluation for transition to advanced systemic therapies, including oral Janus kinase (JAK) inhibitors which offer more favorable long-term benefit–risk profiles and can serve both as rapidly acting, steroid-sparing options for flares and as foundational therapies for long-term disease control. These recommendations provide a pragmatic framework to harmonize clinical practice, reduce unnecessary SCS exposure, and support timely access to advanced systemic treatments for patients with moderate-to-severe AD.

Psoriasis, a chronic inflammatory disease, is associated with metabolic disturbances and oxidative stress. Alpha-lipoic acid (ALA), a potent antioxidant with anti-inflammatory properties, may offer therapeutic benefits, but its effects in psoriasis remain unexplored. This randomized, double-blind, placebo-controlled trial enrolled 40 patients with psoriasis (20 per group) aged 20–60 years. Participants were randomized to receive either 600 mg/day ALA or a placebo for 8 weeks. Serum inflammatory markers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lipoprotein lipase (LPL), malondialdehyde (MDA), liver enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP)), and lipid profiles were measured at baseline and after intervention. Data were analyzed using intention-to-treat analysis with repeated measures ANOVA and ANCOVA adjusted for baseline values, sun exposure, and dietary fat. ALA supplementation was associated with significant reductions in CRP (adjusted p = 0.026) and LPL (adjusted p = 0.005). In contrast, it did not produce any significant changes in lipid profiles or in oxidative stress status as reflected by MDA. Similarly, ESR and liver enzymes showed no significant alterations. Adherence was greater than 80% with no adverse events reported. ALA supplementation for 8 weeks improved inflammatory markers (CRP, LPL) in psoriatic patients but did not affect lipid profiles or oxidative stress. The observed liver enzyme changes appeared confounded by baseline characteristics. These modest reductions in CRP and LPL may reflect improvements in systemic inflammation and lipid metabolism, which are clinically relevant given the increased cardiometabolic risk in patients with psoriasis. Trial Registration: Iranian Registry of Clinical Trials, IRCT20230123057193N3 was registered on 2024.03.29.

Merkel cell carcinoma (MCC) is an aggressive skin malignancy with rising incidence. Prior studies suggest sociodemographic factors influence outcomes, but data in the immunotherapy era are limited. This study evaluates the association between sociodemographic characteristics and MCC presentation, treatment, and survival in the immunotherapy era. We conducted a retrospective population-based cohort study using National Cancer Database data from 2016 to 2020 to evaluate associations between sociodemographic factors, disease presentation, treatment, and survival in MCC during the immunotherapy era. We observed differences in presentation, treatment, and outcomes by race, insurance status, and socioeconomic status. Black patients had 1.52-fold higher odds of presenting with stage II disease (95% CI 1.09–2.12) and 1.41-fold higher odds of stage III/IV disease (95% CI 1.25–1.59) compared to White patients, along with longer median treatment delays (25.5 vs. 19.7 days, p < 0.05). Shorter time-to-treatment was independently associated with improved survival (HR 0.89; 95% CI 0.83–0.95). Overall treatment rates were high (97.41%), but uninsured patients had higher amputation rates (1.47% vs. 0.37%, p < 0.001) and were twice as likely to receive no treatment (5.88% vs. 3.13%, p < 0.001) versus privately insured patients. Five-year survival differed across SES quartiles (45.99% vs. 55.09% for lowest vs. highest, p < 0.001). In multivariable analysis adjusting for age, sex, stage, comorbidity, and treatment, only SES remained an independent predictor of survival, with the highest quartile showing a 17% lower mortality risk (adj-HR 0.83; 95% CI 0.71–0.96). In conclusion, SES was the strongest independent predictor of survival (adj-HR 0.83 for highest vs. lowest quartile) in this national MCC cohort, with additional differences by race, insurance, and geography in disease presentation and treatment patterns. These findings highlight the importance of considering sociodemographic factors in managing MCC in the immunotherapy era.

Hair loss, medically known as alopecia, has a profound effect on the psychological disposition of those who suffer from it, making it a topic of great importance to improve treatment and understand hair biology. This paper will look into baldness’s biological and genetic causes in the quest to give an all-inclusive overview of the classifications and detection techniques. A note on the conventional treatments, including Minoxidil and Finasteride, and innovative therapies, like platelet-rich plasma and stem cell therapy, is also considered. Moreover, the paper discusses technological advancements that play an essential role in early diagnosis, including scalp dermoscopy, trichoscopy, and digital imaging. The rationale behind using machine learning (ML) techniques like Convolutional Neural Networks (CNNs), Support Vector Machines (SVMs), and Self-Regulated Networks like RegNet-64 is their automation capacity in baldness detection and classification. A comparative analysis of these models has further disclosed and revealed their strengths and weaknesses in both clinical and research settings. This review of the prior literature will emphasize the mighty role of Artificial Intelligence (AI) and ML in improving diagnostic precision, facilitating timely interventions, and enhancing patient outcomes in managing hair loss. Comparative analysis of such models has revealed more and further disclosed and exposed their strengths and weaknesses in both clinical and research settings. In this review of earlier literature, the mighty role of AI and ML will be highlighted to improve diagnostic precision, allowing for timely interventions and, thus, improved patient outcomes in managing hair loss.

Psoriasis is a chronic, immune-mediated skin disease characterized by keratinocyte stress and cytokine-driven inflammation. Glycoprotein 96 (gp-96), a heat shock protein 90 paralog located in the endoplasmic reticulum, plays a critical role in the folding of Toll-like receptors and may contribute to the amplification of inflammatory responses. This study investigated serum gp-96 levels in patients with psoriasis compared to healthy controls and explored potential associations with clinical features. A total of 44 psoriasis patients and 44 healthy individuals were enrolled in a prospective case-control study. Serum gp-96 concentrations were quantified using ELISA. Patients’ demographic and clinical data, including PASI scores, nail and joint involvement, and treatment modalities, were collected. Serum gp-96 levels were significantly higher in psoriasis patients than in healthy controls (median 15.92 vs. 9.33 ng/mL, p < 0.001). However, gp-96 levels did not correlate significantly with PASI score, age, disease duration, or other clinical variables. ROC analysis revealed that serum gp-96 has good diagnostic performance in distinguishing psoriasis patients from controls, with an AUC of 0.83 and an optimal cut-off value of 11.57 ng/mL (sensitivity and specificity: 77.3%). A borderline association with nail involvement was observed, suggesting a potential link between gp-96 levels and localized keratinocyte stress. These findings suggest that gp-96 may be a promising diagnostic biomarker in psoriasis, independent of disease severity, and could play a role in the pathogenesis of the disease through its involvement in ER stress and innate immune activation. Further studies with larger cohorts and tissue-level investigations are warranted to validate these results and explore the therapeutic potential of targeting gp-96 in psoriatic disease.

While patient-reported outcome measures (PROMs) provide valuable clinical insights and can complement clinician-reported outcome measures, their use can be limited by completion time and integration barriers. Although item response theory-based Patient-Reported Outcomes Measurement Information System (PROMIS) measures offer advantages, their content validity in skin disease remains unclear. This study evaluates the content validity (i.e. relevance, comprehensibility, and comprehensiveness) of a profile of PROMIS scales among patients with acne, atopic dermatitis, psoriasis, hidradenitis suppurativa, and alopecia areata. Cognitive debriefing interviews were conducted among English-speaking adults with dermatologist-confirmed acne, atopic dermatitis, psoriasis, hidradenitis suppurativa, or alopecia areata. Participants were recruited from Brigham and Women’s Hospital dermatology clinic and National Eczema Association from January 5, 2024, to July 19, 2024. Among 30 participants, mean age was 37.3 years. PROMIS scales ‘Anxiety’, ‘Satisfaction with Participation in Discretionary Social Activities’, ‘Ability to Participate in Social Roles and Activities’, ‘Satisfaction with Social Roles and Activities’, ‘Pain Intensity’ demonstrated sufficient relevance (> 85% items relevant). Scales for ‘General Life Satisfaction’ (77.3%), ‘Depression’ (84.4%), ‘Social Isolation’ (80.0%), ‘Itch Severity’ (83.3%) did not meet this threshold. Comprehensibility and comprehensiveness were high across scales. Some reported seven-day recall may not capture disease fluctuations; and insufficient coverage of romantic relationships, body image, and treatment satisfaction. In this cohort of participants with chronic skin disease, several PROMIS scales demonstrated acceptable content validity, providing insight into suitability for use. Further research evaluating additional measurement properties (e.g., construct validity, responsiveness) is needed.