Australasian Journal of Dermatology最新文献

Melasma is a chronic hyperpigmentation disorder that disproportionately affects women and individuals with darker skin types, leading to a significant psychosocial burden. This meta-analysis aims to evaluate the safety and efficacy of the 755-nm picosecond alexandrite laser (PSAL) compared with conventional therapies in the management of melasma. PubMed, Ovid Medline, Embase, Cochrane Library, and Google Scholar were searched from inception to April 10, 2025, in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) assessing PSAL versus control comparators in adults with melasma and reporting Melasma Area and Severity Index (MASI) or Modified MASI outcomes were included. The review was registered prospectively on PROSPERO (CRD420251022381). Risk of bias was assessed using ROB2. Pooled effect sizes were calculated using a random-effects model. Five RCTs (n = 139 patients) were included. Change in MASI favoured triple combination cream (TCC) over PSAL therapy (MD = 1.82, 95% CI: 1.11, 2.52, I² = 0%). Post-inflammatory hyperpigmentation was more common in the PSAL group compared to topical creams (OR = 6.86, 95% CI: 1.47, 32.07, I² = 0%) but had no difference with the Q-switched lasers (OR = 4.09, 95% CI: 0.62, 26.97, I² = 0%). There was no incidence of hypopigmentation or infection reported. PSAL appears inferior to the TCC in reducing MASI scores. Overall certainty is low due to small, heterogenous trials. Low rates of irreversible adverse events with PSAL may support trials in refractory cases, but long-term RCTs with larger sample sizes are required to evaluate durability and recurrence outcomes.

Full-thickness skin grafts (FTSGs) provide superior aesthetic outcomes compared to split-thickness grafts, but harvesting large FTSGs is often limited by donor site morbidity, tension, and tissue waste. In this manuscript, we describe the 'slide-by-side' technique that improves tissue economy, decreases closure tension, and reduces donor site morbidity, enabling reconstruction of large defects with the cosmetic advantages of FTSGs.

Dermatofibrosarcoma protuberans is a rare, locally aggressive cutaneous sarcoma characterised by slow progression and often nonspecific clinical features. Early-stage lesions may resemble benign or pigmented dermatoses, leading to diagnostic delays. We conducted a systematic review of 17 publications reporting dermoscopic findings of DFSP and added three additional histologically confirmed cases from our center, totaling 45 cases. The most common findings included vascular structures (80%), pigmented networks (73%), and a pink background (64%). Nodular lesions displayed a greater variety of dermoscopic patterns, while plaque-type lesions were more frequently associated with pigmented networks. Notably, in Bednar tumours, bluish pigmentation and blue-white veil-like structures were observed more commonly, possibly reflecting melanin-laden dendritic cells and increased collagen content. Atrophic variants occasionally presented with yellowish, structureless areas, potentially due to the enhanced visibility of subcutaneous fat. Although no pathognomonic features were identified, certain dermoscopic patterns were more prevalent in specific subtypes of dermatofibrosarcoma protuberans. The presence of multiple dermoscopic features, particularly in early or non-protuberant lesions, may increase clinical suspicion. Dermoscopy remains a valuable non-invasive tool that aids in the early recognition of skin conditions and informs biopsy decisions.

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease estimated to affect approximately 30% of children and 10%-15% of adults in Australia. Of those with this condition, one in five is estimated to have moderate-to-severe disease. Treatment guidelines for patients with moderate-to-severe AD recommend adding or switching to a targeted systemic medication if the disease is not well controlled with topical treatment. Without access to these medications, healthcare providers are limited in their ability to effectively treat moderate-to-severe AD. Availability of these guideline-recommended targeted systemic agents varies across the globe because of differences in both approval and reimbursement decisions. Patients in Australia should have funded or subsidised access to these highly effective, well-tolerated medications for moderate-to-severe AD. To highlight the importance of this, and to better understand potential barriers to such access in Australia, we conducted a narrative review of health technology assessment processes and the availability of funded/subsidised targeted systemic therapies for moderate-to-severe AD in patients aged ≥ 12 years in Australia and in countries with comparable healthcare systems, such as the United Kingdom, Canada, New Zealand and France. To provide context for this, we summarised current international guideline-recommended treatment for moderate-to-severe AD and considered healthcare resource utilisation in moderate-to-severe AD, both in Australia and internationally. In Australia, patients only have access to a limited selection of medicines launched globally. This suggests that national healthcare systems should consider updating health technology assessment procedures to better align with the current targeted high-cost therapeutics environment.

Vulvovaginal melanoma is a rare malignancy with a poor prognosis and variable clinical presentation. In a 15-year retrospective review, we identified 15 cases where wide local excision was the most common treatment. Serial digital photography was implemented to support early detection, monitoring and clinician education.

This case report describes the successful treatment of a 15-year-old male with severe hidradenitis suppurativa (HS) using bimekizumab. The patient, previously unresponsive to adalimumab, showed significant clinical and psychological improvement after 6 months of treatment, highlighting the potential of bimekizumab as a therapeutic option for paediatric HS.