JEADV clinical practice最新文献

The burden of dermatologic conditions is increasing worldwide and this rise is closely related to the interplay between epidemiologic trends and etiologic influences. The global population is experiencing an unprecedented increase in the proportion of older people. An aging population may be more susceptible to the effects of pollution and lifestyle-induced skin changes due to age-related declines in skin barrier function. Climate change alters the onset and progression of skin conditions through factors such as sunlight exposure, temperature, humidity, and extreme weather. In general, their effects have been associated with an increased incidence of various skin conditions. Environmental pollution, occupational and lifestyle factors not only exacerbate existing skin conditions but also contribute to the development of new dermatologic diseases. Urbanisation leads to increased exposure to pollutants that can induce oxidative stress and inflammatory responses in the skin, contributing to diseases such as atopic dermatitis and psoriasis. Lifestyle factors such as diet, stress, sleep patterns and skin care affect the skin's physiological processes, microbiome and immune response, influencing the onset and progression of various skin conditions. Advances in medical treatments, while improving disease outcomes and prolonging lifespan, are creating new dermatologic challenges that are exacerbated in vulnerable populations. As complexity and prevalence of skin conditions increase due to the intricate interactions of epidemiologic and etiologic factors, dermatologists and healthcare providers must rise to the challenge with understanding and innovation. This special issue will provide a dive deep into transformative strategies and groundbreaking paradigms that are reshaping the future of dermatological practice.

Integration of digital technologies in dermatology is revolutionising patient care by increasing accessibility, accuracy and personalisation. This review explores the impact of emerging digital technologies in dermatology, including teledermatology, artificial intelligence (AI), mobile applications, wearable devices and 3D imaging and printing. Teledermatology, using real-time videoconferencing and store-and-forward imaging, has expanded since the COVID-19 pandemic, improving access to dermatologic care in underserved areas. AI-powered algorithms are being increasingly used, particularly in skin cancer detection, by helping clinicians make faster and more accurate diagnosis and treatment decisions in diverse clinical settings. AI is also improving clinical workflows, increasing automation and reducing documentation burden. Mobile health applications, including AI-based tools, are transforming patient self-management and monitoring. Wearable devices enable continuous monitoring of skin health and environmental factors, providing real-time insights into conditions like atopic dermatitis and melanoma. In addition, advances in 3D imaging and printing technologies are enabling for more precise grafts and early detection of skin cancer, leading to improved clinical outcomes. Despite these advancements, significant challenges remain, including automation bias, the need for standardised validation protocols and equitable access across diverse populations. Successful integration of these technologies into clinical practice will require addressing these issues and ensuring data security, improved digital literacy and clear guidelines for their use. Future research should focus on assessing the real-world effectiveness of these technologies and ensuring their equitable use in diverse geographies and patient populations.

The skin−brain link is increasingly recognized as a key subject in the emerging fields of psychodermatology and psychoneuroimmunology. This link represents the complex talk and bidirectional relationship between the skin and the mind, reflecting intricate physiological and psychological connections that directly impact the understanding and treatment of skin diseases. This comprehensive review explores the biological basis of the skin−brain axis, an anatomic and functional connection that explains how psychological factors influence skin health, and how skin conditions, in turn, affect psychological well-being. The review highlights the profound impact of skin conditions beyond their visible manifestations, including social stigma, emotional distress and economic burden. Evidence supports integrative management strategies involving multidisciplinary care, psychotherapeutic interventions, patient education and lifestyle modification. Professional training, public awareness and robust support systems are essential to advance psychodermatologic care and prevention. Promising developments such as psychoneuroimmunologic therapies, telemedicine innovations and interdisciplinary training programs offer significant opportunities to improve outcomes in this evolving field, including the potential for precision medicine-based approaches. This review provides data on promising strategies that can be integrated in dermatologic practice, addressing both the dermatologic and psychological dimensions of skin disorders to optimize patient care and quality of life.

Mycosis fungoides is a cutaneous T-cell lymphoma with a classically relatively good prognosis, mostly diagnosed in men over the age of 50. It classically manifests as erythematosquamous plaques, but can take a variety of forms. Here we describe four cases of mycosis fungoides diagnosed in children, with psoriasiform palmoplantar keratoderma as the main symptom.

Biologic therapies have transformed the management of atopic dermatitis (AD) and prurigo nodularis (PN), yet paradoxical adverse events such as dupilumab-induced psoriasiform eruption (DPE) are increasingly recognized. We report a 48-year-old Japanese man with long-standing AD and PN who developed scaly, erythematous plaques on the elbows, hands, and trunk 5 months after initiating dupilumab. While prurigo nodules had markedly improved, the new lesions resembled psoriasis clinically. A biopsy from the elbow revealed features consistent with psoriasiform dermatitis—regular acanthosis, thickened granular layer, and perivascular lymphocytic infiltration without neutrophils—suggesting DPE rather than true psoriasis. Topical vitamin D3 and corticosteroids were ineffective, prompting a switch to tralokinumab, an IL-13–specific inhibitor. Following this transition, psoriasiform lesions on the trunk and hands resolved, and PN did not recur. However, plaques on both elbows persisted for over a year and remained after tralokinumab discontinuation. Histologically, these lesions lacked features of psoriasis and were more consistent with PN, suggesting a Th2-driven relapse mimicking psoriasiform disease. This case highlights the potential of tralokinumab to manage DPE while sustaining PN control but also underscores the heterogeneity of psoriasiform eruptions during type 2 biologic therapy. Not all lesions represent Th1/Th17-mediated processes; some may reflect residual Th2-driven disease such as PN with atypical morphology. Histopathological evaluation is essential for distinguishing true paradoxical reactions from overlapping or relapsing dermatoses and for guiding optimal treatment selection in patients receiving targeted immunomodulators.

Mycosis fungoides (MF), the most common type of cutaneous T cell lymphoma, is uncommon in children. De la Vega et al present the largest series so far of children 0 to 18 years with MF, consisting of 123 retrospectively analyzed cases in Mexico City. The median age at diagnosis was 12 years, and all patients presented with early clinical stages (IA or IB). The hypopigmented type of MF was the most common, followed by classical, hyperpigmented, papular, folliculotropic, and other types. Most cases were treated with phototherapy, with a remission rate of 36%. No cases of disease progression were observed, and relapse occurred in 15% of cases. The overall survival rate after median follow-up of 19 months was 100%.