Australasian Journal of Dermatology最新文献

Introduction: Late scar widening is a common but underrecognized complication of dorsal fusiform excisions, especially in young adults with high dermal elasticity and physically active lifestyles.

Objective: To evaluate the effectiveness of Dermo-epidermally Anchored Trapezoidal Excision (DATE), a technique designed to minimise long-term scar diastasis.

Methods: This prospective, two-arm, open-label study was conducted between January 2015 and February 2022 at the "Celio" Military Hospital, Rome, Italy. Healthy adults aged 18-31 years undergoing elective dorsal trunk excisions were allocated by surgical scheduling to either standard fusiform excision (control) or the DATE technique (experimental). Scar widening was evaluated at 12 months using the Scar Diastasis Index (SDI).

Results: A total of 273 patients were enrolled (126 control, 147 experimental), with comparable baseline characteristics. At 12 months, the DATE arm showed a significantly lower mean SDI (22.10 ± 7.05) compared to the control group (63.35 ± 11.52; p < 0.001). Patients in the experimental group experienced temporary swelling along the scar line or small stitch marks, but these resolved within a few weeks.

Conclusions: DATE is a safe, reproducible, and cost-effective technique. In young adults with high aesthetic expectations, it led to significantly narrower scars than the standard fusiform approach and may represent the preferred option for dorsal excisions.

Background/objectives: The Australasian College of Dermatologists implemented a supervisory rotational model project funded by the Commonwealth Government to build capacity, quality, and sustainability of specialist dermatology training in the Northern Territory. This project aimed to contribute to evidence-based literature on rural workforce strategies in Australia,; highlight capacity challenges facing dermatology care in the Northern Territory, and identify opportunities to strengthen training and service delivery.

Methods: A qualitative evaluation, including semi-structured interviews and an anonymous online survey, was undertaken with a non-probabilistic purposive sampling strategy. Fourteen interviews were conducted with visiting consultant dermatologists, trainee dermatologists, and local dermatology staff in Darwin, Northern Territory. Two researchers used inductive thematic coding to analyse interview transcripts and triangulate findings with survey results.

Results: This project increased supervisory and training capacity, produced a documented reduction in dermatology waitlists, enabled increased remote outreach visits and access, and enhanced educational opportunities for junior doctors. Five main themes emerged: (1) acceptability of the supervisory rotational model across different domains; (2) impacts of administrative processes on acceptability of the model; (3) recognition of an 'invisible' cohort of patients and impact on workload; (4) sustainability; and (5) scalability of the supervisory rotational model.

Conclusion: This supervisory rotational model was acceptable for both trainee and visiting consultant dermatologists and enhanced the capacity of dermatology service delivery and training in the Northern Territory. With sustainable funding, this model can support longer-term efforts towards building a homegrown rural workforce and facilitate continuity to provide culturally safe care.

Background/objectives: Convolutional neural networks (CNNs) are known, due to inherent flaws in their design, to be subject to classification error. Many of these shortcomings in classification performance were addressed in 2017 with the introduction of capsule networks (CNs). The objective of this investigation is to determine the classification performance of a CN with respect to dermoscopic images of benign and atypical melanocytic lesions. We implement two kinds of training data for comparison: first, real images; and second, by utilising the CNs' autoencoder, a large number of synthetic images.

Methods: 500 melanocytic lesion images (250 benign and 250 sufficiently atypical to warrant excision) were obtained from ISIC and PH2 Datasets. Images were randomly split equally for training and testing, and equally split between the classification categories. A CN was developed, trained and tested on these data. The CN was then trained on 3000 synthetic images (with an equal number of images in each classification category). The newly trained CN was then tested on the original test images.

Results: The CN trained on the real images yielded a DOR (diagnostic odds ratio) of 51.0, a result which is comparable and, in many cases, superior to those reported for CNNs. The same CN trained on the synthetic images yielded a DOR of 71.3, a result which is significantly higher than the result obtained with real-image training.

Conclusions: Since the effectiveness of automated melanocytic lesion image classification is limited by the difficulty in obtaining large numbers of high-quality training data, our results support the idea that training a classifier utilising synthetic images-where large numbers of quality images can be easily generated-is inherently advantageous. Given its advantages over a CNN, and trained on a very large number of synthetic images of melanocytic lesions, a CN classifier thus has the potential, only limited by computer resources, to yield previously unseen levels of generalisation performance.

Background/objectives: The Royal Brisbane & Women's Hospital (RBWH) in Queensland, Australia provides definitive care for all diagnosed adult patients with SJS/TEN within its catchment. In this retrospective cohort study, we identified all SJS/TEN cases at RBWH over a 10-year period. We assessed disease incidence and the relationship of 3 variables (disease severity, time taken to admission to the definitive tertiary centre and systemic immunosuppressive treatment) to the outcome of mortality.

Methods: Patients were identified via ICU MetaVision dermatology entries, discharge coding and manual admission recording. Age, gender, culprit drug, time to definitive tertiary centre admission, total body surface area (TBSA), SCORTEN, complications, systemic therapy utilisation and mortality were recorded. Relationships between variables were analysed using Spearman's Rank correlations and logistic regression.

Results: Fifty-two cases over 10 years met inclusion criteria (37 TEN, 8 SJS/TEN and 7 SJS). Mortality (9.6%; 5 deaths) was low compared to published rates. Multivariate regression analysis revealed a significant relationship between increased SCORTEN and mortality as expected. There was no significant relationship between systemic treatment and mortality or between 'days to definitive care' and mortality. Modelling accounted for 44% of variance in mortality.

Conclusions: SJS/TEN incidence matched published rates. Severity of SJS/TEN and mortality were correlated. Neither systemic immune suppression nor time taken to be admitted to the definitive tertiary centre correlated with mortality. Expert multidisciplinary care in the RBWH ICU and Burns Unit is likely to contribute to the excellent mortality outcomes found. Limitations of the study included its retrospective cohort design, that it was performed in a single centre, and the relatively small sample size leading to statistically insignificant findings. Our results should bolster growing data to improve understanding of this rare but serious condition.

We report a case of Steatocystoma Multiplex Suppurativa (SMS), a rare condition that can mimic hidradenitis suppurativa (HS). We also present a review of the surgical and medical therapies, including potential biologic agents.