Australasian Journal of Dermatology最新文献

Biologic and small-molecule therapies are increasingly used in dermatology for conditions such as psoriasis and atopic dermatitis. Live and live-attenuated vaccines are traditionally avoided in patients receiving these agents due to concerns regarding vaccine-strain infection. We conducted a systematic review to evaluate the safety of live and live-attenuated vaccines in patients receiving biologic or small-molecule therapies used in dermatologic practice. PubMed, Embase (Ovid) and the Cochrane Library were searched from January 2010 to February 2025 for human studies reporting safety or immunogenicity outcomes following live vaccine administration in patients receiving relevant therapies. Of 1104 records identified, nine studies met inclusion criteria, comprising one randomised controlled trial, three cohort studies, three retrospective case series, one cross-sectional observational study and one case report. Vaccines evaluated included measles-mumps-rubella, measles-mumps-rubella-varicella, varicella, live zoster and yellow fever vaccines. Across studies, no cases of vaccine-strain infection or disseminated vaccine-related disease were reported. Mild and self-limiting post-vaccination reactions were described in several cohorts. Where assessed, immunogenicity responses were generally preserved, although data were limited and inconsistently reported. Most included studies involved patients receiving biologic or small-molecule monotherapy, though some cohorts permitted background conventional immunomodulatory therapy. The available evidence, although limited and predominantly observational, suggests that selected live and live-attenuated vaccines may be administered without serious adverse outcomes in carefully chosen patients receiving biologic or small-molecule therapies. Larger prospective studies are needed to better define safety and immunogenicity across newer targeted agents.

Background/objectives: Artificial intelligence (AI) is increasingly relevant to dermatology, yet clinical integration depends on workforce readiness. While the technical performance of AI tools is well described, the perspectives of dermatology trainees, who will shape future adoption, are less well understood. The objective of this study was to investigate Australian dermatology trainees' knowledge, utilisation, and perceptions of AI, and to identify barriers to implementation.

Methods: A national, cross-sectional electronic survey was distributed to all Australian dermatology trainees (n = 118) enrolled with the Australasian College of Dermatologists between February 2025 and June 2025. Outcomes included self-reported familiarity with and use of AI tools, perceived utility across clinical and non-clinical tasks, and perceived barriers to integration.

Results: Sixty-eight trainees responded (57.6%). Most trainees (81.4%) agreed that AI is likely to become an important tool in dermatology over the next 5-10 years. However, 69.1% reported no formal training. 32.4% had used AI tools, most commonly general-purpose generative AI, with use primarily informal and focused on educational, research, and administrative tasks rather than direct patient care. Commonly reported barriers included legal and ethical considerations (60.3%), concerns regarding reliability (54.4%), and limited training or knowledge (52.9%).

Conclusions: Australian dermatology trainees express cautious optimism about AI, recognising its potential while identifying practical, educational, and governance-related challenges. Current use is limited and largely non-clinical, reflecting early-stage adoption. These findings highlight opportunities for structured AI literacy and education to support future integration as evidence, governance frameworks, and clinical applications continue to evolve.

Topical ruxolitinib 1.5% cream is the first approved therapy for repigmentation in non-segmental vitiligo. However, treatment response varies, and reliable predictors of efficacy remain undefined. This narrative review examined clinical trials and observational studies investigating factors associated with response to ruxolitinib cream. A comprehensive search of MEDLINE, Cochrane CENTRAL and ClinicalTrials.gov (through June 2025) identified 14 eligible studies. Anatomical site was the most consistent predictor, with facial lesions showing the highest repigmentation rates and acral areas demonstrating poor response. Early clinical improvement was associated with better long-term outcomes. Long-term data indicated that repigmentation can persist after treatment discontinuation in a substantial proportion of patients. Demographic and disease-related variables, including age, sex, disease duration and phototype, showed mixed results across studies. Adjunctive narrowband UVB improved repigmentation in initial non-responders but provided limited benefit in early responders. Exploratory biomarker data suggested that Th2 cytokine profiles and reductions in CXCL10 levels may be linked to response, although these findings remain unvalidated. Overall, anatomical location and early clinical response appear to be the most reliable indicators of ruxolitinib efficacy. Further studies with standardized endpoints and predictive modelling are needed to guide individualized treatment strategies in vitiligo.

Long wave UVA1 is a critical driver of hyperpigmentation and skin aging in skin of colour. In combination with visible light, it shares a synergistic relationship in amplifying oxidative damage and hyperpigmentation in skin of colour. Disorders of hyperpigmentation affect a large proportion of Australians and have significant psychosocial burden. Photoprotection remains the mainstay of treatment by reducing severity and recurrence. UVA1 photoprotection is critical; however, existing sunscreens in Australia approved by the Therapeutic Goods Administration only provide limited protection, with no approved filters for UVA1 currently available. This review focusses on the critical role of UVA1, alongside other wavebands, in pigmentary disease and skin aging in skin of colour and the protective role of effective photoprotection. As the Australian population becomes increasingly ethnically diverse, it is vital that filters covering this critical waveband are incorporated into photoprotection to protect skin of colour.

Bariatric surgery (BS) can modulate drug pharmacokinetics. This review sought to provide an overview of the available literature and to establish practical recommendations pertaining to the use of drugs commonly used in dermatology in the post-BS setting. PubMed, EMBASE and Cochrane Library databases were systematically reviewed. This study utilised the PRISMA guidelines and was registered on PROSPERO (ID CRD42024505309). Data collection and risk of bias analysis were conducted in duplicate. This review identified 132 eligible studies. Key inclusion criteria included: primary clinical publication, contains information on the implications of BS on medications used in dermatology and full-text availability. Key exclusion criteria included secondary clinical publications, editorials, animal studies and conference abstracts, not providing information on the impact of BS on drugs commonly used in dermatology, articles written in languages other than English and unavailability of the full-text. Oral liquid formulations, crushed tablets, opened capsules or non-oral alternatives may be preferred over solid formulations. Avoidance of enteric-coated and extended-release formulations has been suggested. Dose escalation may be required for highly lipophilic drugs such as acitretin and isotretinoin. Switching to non-oral contraceptive options may be favoured due to reports of reduced efficacy with oral contraception. Avoidance of non-steroidal anti-inflammatory drugs and oral corticosteroids has been recommended due to the risk of gastrointestinal bleeding and marginal ulceration. The use of direct oral anticoagulants may also increase bleeding risk, post-BS. Dose modifications for mycophenolate mofetil may not be required post-laparoscopic sleeve gastrectomy. The bioavailability of oral tyrosine/Janus kinase inhibitors may be decreased; dose escalation may be required in cases of suboptimal treatment response. Consideration of the potential pharmacokinetic effects of BS on drugs used in dermatology is fundamental to ensure optimal patient care. Until more robust data are available, management should be individualised with frequent monitoring of clinical response, laboratory markers and plasma drug levels. Collaboration with a clinical pharmacist is strongly advised.

Background/objectives: Epidermal growth factor receptor inhibitors (EGFRi) commonly cause papulopustular exanthemas that may compromise the success of cancer therapy. While tetracyclines are first-line treatment, data on alternative systemic agents for refractory cases remain limited. This study compares the effectiveness and tolerability of isotretinoin and dapsone for managing tetracycline-resistant EGFRi-induced papulopustular eruptions in a tertiary dermatology service.

Methods: A retrospective review was conducted of patients with EGFRi-induced papulopustular eruptions treated with isotretinoin or dapsone between 2018 and 2024. Clinical data included demographics, malignancy type, EGFRi agent, eruption severity, prior therapies, Physician's Global Assessment, treatment outcomes, time to best response, adverse events, and EGFRi dose modification. Group comparisons used one-way ANOVA and chi-square/Fisher's exact tests.

Results: Sixteen patients were identified (8 isotretinoin, 8 dapsone). Baseline severity was higher in the isotretinoin group. Time to best response was shorter with isotretinoin (mean 14.9 weeks) than dapsone (21.0 weeks). Complete resolution occurred in 62.5% of isotretinoin-treated patients and 50% of dapsone-treated patients. Both agents were well tolerated, with only mild mucocutaneous effects in the isotretinoin group and mild anemia in one dapsone patient. Survival at follow-up was higher among patients who continued EGFRi (with or without dose reduction) than among those who ceased treatment. No significant differences were observed between isotretinoin and dapsone in EGFRi dose modification patterns or overall response rates.

Conclusions: Both isotretinoin and dapsone are effective, well-tolerated options for managing tetracycline-resistant EGFRi-induced papulopustular eruptions. Isotretinoin showed a trend toward faster improvement, while ultimate response rates were similar. Maintaining EGFRi therapy, even at reduced doses, in conjunction with dermatology treatment was associated with superior dermatological outcomes and higher survival at follow-up compared with cessation of EGFRi treatment, highlighting the importance of proactive dermatologic intervention to support oncologic treatment continuity.