Australasian Journal of Dermatology最新文献

The gold standard for medical data extraction has traditionally been manual; however, this approach is very time consuming, labour intensive, expensive and prone to error. Many approaches to automated data extraction have been explored over the years; however, they have required significant technical knowledge and have not been reliably accurate. Large Language Models (LLMs) have been developed at an astronomical pace and have demonstrated incredible accuracy, and they are continuing to evolve and improve. The significant time and cost savings achieved with LLMs will allow for more efficient research and real-time monitoring of patient outcomes. This review explores how LLMs can be used in medical data collection, including the types of data collected and output given, types of LLMs used, amount of training required, the accuracy, speed, and cost of data extraction, types of errors commonly made, and any security concerns. There are still many challenges to overcome, particularly with reducing hallucinations/fictitious content and other common errors, ensuring patient privacy, handling complex tasks and producing output in clean and usable formats. Health professionals and researchers in the field of dermatology must be well trained and upskilled in the use of these new technologies and should continue to explore and build on what has already been achieved to optimise the use of LLMs in the automated data extraction process.

Background: Direct comparison of the adverse effect (AE) profiles of the hedgehog inhibitor (HIs) medications is limited to post hoc analyses of phase III clinical trials.

Objective: Compare the AE profiles between vismodegib and sonidegib in the FDA Adverse Event Reporting System (FAERS).

Methods: Case/non-case analyses were performed in FAERS and reporting odds ratios (ROR) were compared to determine unique and disproportionate AEs between HIs.

Results: Vismodegib had significantly higher ROR for taste symptoms and alopecia. Sonidegib was associated with neutropenia and elevated blood creatinine phosphokinase. Both vismodegib and sonidegib were associated with an increased ROR for cSCC (50.36 [42.36-59.86] vs. 50.28 [27.71-91.23]). This signal persisted despite comparison to an aggregate of other medications used to treat basal cell carcinoma (BCC) (11.56 [9.51-14.05] vs. 9.71 [1.25-75.43]).

Limitations: Retrospective nature predisposed to bias.

Conclusions: Vismodegib has a significantly higher ROR for alopecia and taste symptoms, while sonidegib was associated with neutropenia, which is a novel finding. Both HIs are associated with an increased ROR for cSCC, which persists despite stringent controls and does not parallel total cSCC cases reported to FAERS. These data suggest that HIs increase the risk of cSCC above the baseline expected in this patient population.

Male genital lichen sclerosis (mGLS) is a chronic progressive inflammatory disease with potential complications including urethral strictures and penile cancer. Despite its clinical significance, the molecular mechanisms underlying mGLS remain poorly understood, and male-specific data are limited. This systematic review consolidates current evidence on tissue-based gene and protein expression in mGLS, aiming to identify commonly investigated biomarkers and highlight gaps in the literature. Using the JBI Sumari interface, our research strategy identified a total of 24 studies with considerable variability in targets and methodologies. Only a small subset of 12 genes and proteins was assessed and only one gene, p16, was assessed across multiple studies, limiting the strength of conclusions. QIAGEN Ingenuity Pathway Analysis was used to explore canonical pathways and disease associations linked to reported biomarkers. While preliminary patterns suggest involvement of inflammatory and fibrotic pathways, further research is needed to validate these findings and assess their diagnostic, prognostic or therapeutic potential. This review provides a foundation for future studies focused on improving molecular understanding and clinical management of mGLS.

This study aimed to identify the proportion of patients with vitiligo reporting new-onset disease or changes in disease status following COVID-19 vaccination or infection using an online survey. Among 114 respondents, over half reported no new-onset vitiligo or a change in vitiligo status following COVID-19 vaccination or infection; however, a sizeable minority reported worsening of vitiligo, smaller numbers reported new-onset disease, and few reported improvement. Larger studies are needed to clarify whether these associations are coincidental or reflect underlying pathological processes.

Total Body Photography has undergone substantial technological advancement, now embracing high-resolution digital imaging, 3D reconstruction and the potential applications of artificial intelligence (AI), and mobile interoperability. However, its broader implementation is tempered by logistical hurdles as well as concerns regarding cost-effectiveness. This article traces its historical trajectory, evaluates its current clinical utility, and explores future applications.

Background/objectives: Cutaneous manifestations of Waldenstrom's macroglobulinaemia (WM), a rare B-cell lymphoproliferative disorder, present a diagnostic challenge. The intent of this article is to raise awareness to clinicians of a potentially overlooked condition, particularly in the context of patients with a monoclonal IgM paraproteinaemia, but also to describe the diagnostic complexity of the disease from a clinicopathological perspective.

Methods: We describe the clinical presentation and histopathological findings of two patients with cutaneous involvement of WM.

Results: Cutaneous presentations included erythematous and salmon pink plaques, which were either tender or non-tender. Histopathology analysis in both cases demonstrated direct lymphocytic infiltration by malignant lymphocytes of WM, with case 1 demonstrating aberrant CD10 expression.

Conclusion: The broad cutaneous signs of WM are sparsely described in the literature, and these can even precede formal diagnosis. Ongoing clinical suspicion is warranted from both a clinical and histopathological perspective where patients present with a monoclonal IgM paraproteinemia.

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe mucocutaneous adverse drug reactions associated with high morbidity and mortality. Current treatment regimens are largely supportive, and evidence for adjunctive systemic therapies remains limited. Recent research has implicated the Janus Kinase (JAK) signal transducer and activator of transcription (STAT) pathway in SJS/TEN pathogenesis, raising interest in JAK inhibitors as potential targeted therapies. This scoping review aimed to evaluate the existing literature on the use of JAK inhibitors in the management of SJS/TEN, summarise clinical outcomes and identify key research gaps. This scoping review was conducted in accordance with PRISMA-ScR guidelines. A systematic search of Medline, Web of Science, Embase and Scopus was conducted from inception up to 12 June 2025. Nine studies were included, comprising eight case reports and one translational research study, reporting on 15 patients (median age 45 years) treated with ruxolitinib (n = 7), tofacitinib (n = 5) or abrocitinib (n = 3). Most cases involved severe or treatment-refractory disease. Among the eight cases where time to re-epithelialisation was reported, six described 20%-30% re-epithelialisation by day 7 and one described 95% re-epithelialisation by day 16. No JAK inhibitor-related adverse events were reported. Preclinical studies supported a mechanistic role for the JAK/STAT pathway in keratinocyte apoptosis and inflammation. JAK inhibitors show promise as a novel therapeutic approach in SJS/TEN; however, current evidence is limited by small sample sizes, disease severity, concomitant therapies and potential publication bias. Well-designed prospective trials are needed to determine efficacy, safety and optimal use in this life-threatening condition.