Australasian Journal of Dermatology最新文献

Sycosis barbae (SB) is a chronic, potentially scarring alopecia that primarily affects the beard. We report a unique case of refractory SB in a 31-year-old male successfully treated with bimekizumab, a dual inhibitor of interleukin (IL)-17A and IL-17F. Significant clinical improvement was observed after the second injection, with complete remission achieved after 4 months, highlighting the potential of this novel therapeutic approach for SB.

Over 5000 patients are newly diagnosed with Alopecia areata (AA) in Australia each year. AA severity varies from a single small patch to complete loss of scalp hair, body hair including eyelashes and eyebrows. Approximately 40% of affected individuals experience only a single patch and achieve spontaneous, complete and durable remission within 6 months (acute AA). A further 27% develop additional patches but still attain complete remission within 12 months (chronic AA). Chronic persistent AA (CPAA) is defined by an episode duration of > 12 months and occurs in approximately 33% of patients. Without systemic treatment, 55% of individuals with CPAA will have persistent multifocal relapsing and remitting disease, 30% will progress to alopecia totalis (AT) and 15% will ultimately develop alopecia universalis (AU). The physical disfigurement, unpredictable course, social isolation and rejection contribute to the psychological distress attributable to AA. A wide range of topical, intralesional and systemic agents used to treat AA were evaluated in the 2018 Australian expert consensus statement. In 2020, the international Alopecia Areata Consensus of Experts (ACE) publication stated that if reimbursed, Janus Kinase inhibitors (JAKi's) would be an ideal systemic treatment for adults with AA. TGA approval of baricitinib in 2023 and ritlecitinib in 2024 for severe AA is the first step on the pathway for these systemic medications to be reimbursed on the Australian Government Pharmaceutical Benefits Scheme (PBS). Reimbursement would significantly transform the Australian therapeutic landscape for AA. The purpose of this 2025 Update on the Australian Expert Consensus Statement on the treatment of chronic, moderate to severe AA is to augment the 2018 treatment algorithm to include these TGA-approved medications and to address indications for initiation, continuation and dose titration of systemic JAKi treatment, appropriate choice of agent, satisfactory outcome measures and to provide guidance on when to discontinue successful or unsuccessful treatment.

Nested melanoma, a relatively new subtype of melanoma first reported in 2012, is characterised by neoplastic cells organised into nests. We present a unique case of yellow nested melanoma, detailing its clinical, dermoscopic, RCM, and, for the first time to our knowledge, LC-OCT features. Alongside a comprehensive review of the literature, our findings challenge the traditional associations with advanced age and sun-damaged skin, advocating for the term ‘nested melanoma’ to better reflect its characteristics.

A systemic review was completed of primary research articles reporting patient outcomes in paradoxical psoriatic alopecia in association with biologic therapy. Our search strategy identified 96 patients from 45 studies in addition to our own case. Our review indicates a higher prevalence of paradoxical psoriatic alopecia in younger female patients, most commonly secondary to TNF-alpha inhibitors. Unlike alopecia secondary to psoriasis vulgaris, a mixed inflammatory infiltrate featuring lymphocytes, plasma cells and eosinophils was observed. Remission was observed in most patients, including approximately a third of whom continued biologic therapy.

Trial Registration: PROSPERO registration number: CRD42023471174

In 2020, [the Australasian College of Dermatologists] released its first teledermatology practice guidelines for Australia, with a commitment to regular updates. This article presents the revised guidelines, aimed at educating dermatologists on the benefits and limitations of telehealth, while promoting safer, higher-quality patient care. The updated guidelines harmonise with the Medical Board of Australia's 2023 telehealth guidelines. They address the growing use of telephone consultations—boosted by Medicare subsidies introduced during the COVID-19 pandemic. The latest guidelines provide recommendations on the appropriate choice of modality (telephone versus video) for teleconsultation. They also include updated guidance on clinical image acquisition. The guidelines are divided into two parts: (1) core recommendations and (2) supporting notes for practical application. Topics covered include teledermatology modalities, patient selection and consent, imaging standards, quality and safety, privacy and security, communication, and documentation, including image retention.