Clinics in dermatology最新文献

{"title":"Prediction Markets in Dermatology: Ethical Considerations for Physicians.","authors":"Anshu Jonnalagadda, Amar D Desai, Albert E Zhou, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.09.001","url":null,"abstract":"<p><p>Prediction markets increasingly allow participants to take financial positions on biomedical outcomes, including clinical trial results and US Food and Drug Administration decisions. Dermatologists may possess specialized expertise that helps them interpret emerging therapeutic data, but physician participation raises concerns about conflicts of interest, material nonpublic information, patient trust, and professional responsibility. These concerns are particularly relevant for physicians involved in clinical trials, regulatory activities, peer review, or industry consulting. We discuss the ethical implications of physician participation in prediction markets and propose principles to distinguish acceptable use of publicly available information from inappropriate trading based on privileged professional knowledge.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-like Peptide-1 Receptor Agonist-Associated Injection Site and Dermatologic Reactions.","authors":"Dareen Elgindi, Vesna Petronic-Rosic","doi":"10.1016/j.clindermatol.2026.08.012","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.08.012","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for type 2 diabetes mellitus and obesity, with expanding therapeutic applications. Although gastrointestinal adverse events are the most recognized toxicities, Cutaneous adverse events constitute a large burden of total adverse reactions.</p><p><strong>Objective: </strong>To review the prevalence, clinical features, mechanisms, and management of non-immunologic Injection Site and Dermatologic Reactions associated with GLP-1RAs.</p><p><strong>Methods: </strong>A review of clinical trials, pharmacovigilance studies, and case reports and series was performed. In addition, adverse event reports for tirzepatide, semaglutide, liraglutide, exenatide, dulaglutide, and lixisenatide were extracted from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). Injection-site events were combined with skin-related adverse events to generate an adjusted \"Skin and Injection-Site Reactions\" category for comparison across agents.</p><p><strong>Results: </strong>Among 442,567 FAERS reports, 137,412 (31.0%) involved skin and injection-site reactions, representing the third most frequently reported adverse event category. Exenatide demonstrated the highest proportion of skin and injection-site reports (53.1%), followed by dulaglutide (33.5%), tirzepatide (32.6%), liraglutide (17.1%), semaglutide (12.2%), and lixisenatide (6.9%). Common reactions included pain, bleeding, erythema, bruising, mass, pruritus, and swelling. Additional adverse events included dysesthesias, nodules, granulomatous reactions, bruising, and hyperhidrosis. Most reactions were mild to moderate and generally managed symptomatically without requiring treatment discontinuation.</p><p><strong>Conclusions: </strong>Non-immunologic cutaneous adverse events comprise a substantial proportion of reported GLP-1RA-associated adverse events with differing rates among individual agents. Recognition of these reactions and appropriate supportive management may improve patient outcomes. Prospective studies are needed to better define their adverse event risk rates, mechanisms, and optimal management strategies.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where the Future Lies: GLP-1 Receptor Agonists as Therapeutics for Dermatologic Comorbidities.","authors":"Mikaela DeCoster, Shanthi Narla","doi":"10.1016/j.clindermatol.2026.08.013","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.08.013","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of obesity, type 2 diabetes mellitus, and cardiometabolic disease through effects on weight reduction, glycemic control, and systemic inflammation. Their varied immunometabolic actions have generated increasing interest in dermatology, where chronic inflammatory skin diseases frequently coexist with obesity, insulin resistance, metabolic syndrome, and cardiovascular disease. Emerging evidence from clinical trials, observational studies, and real-world analyses suggests that GLP-1RAs may improve outcomes in psoriasis and hidradenitis suppurativa while simultaneously reducing the burden of associated metabolic and cardiovascular comorbidities. In psoriasis, combination therapy with tirzepatide has demonstrated enhanced skin clearance, substantial weight loss, and reduced risk of psoriatic arthritis. In hidradenitis suppurativa, GLP-1RAs have been associated with improvements in cardiometabolic outcomes and reductions in systemic complications. Collectively, these findings support an evolving paradigm in which the greatest therapeutic utility of GLP-1RAs in dermatology may lie not in direct modulation of cutaneous inflammation but in addressing the metabolic dysfunction and chronic systemic inflammation that drive disease severity and multimorbidity. We review the current clinical evidence and propose a conceptual framework positioning GLP-1RAs as immune-metabolic therapies that target the systemic comorbidities of inflammatory skin disease, which may provide future opportunities for cutaneous disease modification and integrated dermatologic care.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Considerations in Standardized Letters of Evaluation for Dermatology Residency Selection.","authors":"Haya Alkiswani, Umayr R Shaikh, Christopher G Richter, Leela K Raj, H William Higgins Ii, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.08.015","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.08.015","url":null,"abstract":"<p><p>The introduction of dermatology's specialty-specific Standardized Letter of Evaluation (SLOE) for the 2026-2027 residency cycle aims to improve fairness, comparability, and reduce bias in applicant assessment. Although standardization may reduce differences in writing style and interpretation, it does not eliminate subjectivity and may redistribute how and where bias affects the process. Rating inflation, ceiling effects, and interrater variability have been reported in dermatology and other specialties, while evidence that standardized ratings predict residency performance remains limited; furthermore, standardizing evaluation does not standardize opportunity: ratings of research, professionalism, and communication may reflect differences in mentorship, resources, clinical exposure, and evaluator relationships. Programs should, therefore, avoid interpreting small numerical differences as precise measures of ability and instead consider SLOEs within a holistic review. Ethical implementation will require ongoing assessment of rating inflation, interrater variability, demographic disparities, and predictive validity. Ultimately, the SLOE's value will depend on whether it improves comparability and transparency without creating false precision or masking unequal opportunities.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical considerations in suspected isotretinoin nonadherence and/or diversion.","authors":"Lauren Fleshner, Timothy Klufas, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.08.014","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.08.014","url":null,"abstract":"<p><p>Isotretinoin is an effective acne therapy but highly regulated due to its potential teratogenicity and serious side effects. Isotretinoin distribution is currently monitored through the Food and Drug Administration- (FDA)-mandated iPLEDGE Risk Evaluation and Mitigation Strategy System (REMS). Safe prescribing depends not only on FDA and physician oversight, but also on patients taking the medication as prescribed and adhering to established safeguards, such as frequent pregnancy tests and routine monitoring. Concerns regarding nonadherence or potential medication diversion in the setting of apparent treatment failures raise ethical tensions, particularly if the provider cannot definitively assess how the medication is being used. We outline the ethical obligations of providers when there is credible suspicion for isotretinoin nonadherence or diversion.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aesthetic and Dermatosurgical Education at Dermatology Congresses: a 2025 Cross-Sectional Audit.","authors":"Mustafa Tümtürk, George Kroumpouzos, Nazli Caf, Ümit Türsen","doi":"10.1016/j.clindermatol.2026.08.010","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.08.010","url":null,"abstract":"<p><p>Nonsurgical aesthetic procedures have become increasingly prominent in dermatology education; yet, the distribution of cosmetic, dermatosurgical, and medical content within continuing medical education (CME) programs has not been systematically quantified. This study established a 2025 cross-sectional baseline of CME course distribution and a framework for monitoring changes in aesthetic content over time. Dermatology-related events scheduled for 2025 were identified through a national specialty calendar in Turkey; 52 eligible national, regional, and international events were included. Courses were classified as cosmetic procedure courses (CPC), dermatosurgery courses (DSC), or medical education courses (MEC). Descriptive statistics were calculated, and event-scope comparisons were interpreted cautiously given the small international subgroup. Among 114 identified courses, MEC was the largest category (52/114; 45.6%), followed by CPC (42/114; 36.8%) and DSC (20/114; 17.5%). DSC was offered at 15/52 events (28.8%). CPC represented 40.0% of courses at international events versus 36.0% at national/regional events, although only six international events were included. Exploratory correlations were positive between CPC and DSC (r=0.59), CPC and MEC (r=0.45), and DSC-MEC (r=0.32), although these associations may partly reflect overall event size. CPC therefore comprised more than one-third of identified CME courses, whereas dermatosurgery was less frequently represented. Potential downstream effects on trainee career choices and practice patterns warrant longitudinal evaluation. Repeated annual audits using a consistent sampling frame and coding framework are necessary to determine whether dermatology congress education will shift toward greater aesthetic content over time.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alopecia Areata Universalis in Leonardo da Vinci's Mona Lisa: A Systematic Retrospective Iconodiagnosis.","authors":"Luigi Laino","doi":"10.1016/j.clindermatol.2026.08.011","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.08.011","url":null,"abstract":"<p><p>The face of Leonardo da Vinci's Mona Lisa (ca. 1503-1519) has attracted several medical presentations, most recently the hypothesis of frontal fibrosing alopecia (FFA) masquerading as Renaissance fashion. I present a systematic retrospective iconodiagnosis grounded in an explicit methodological framework, in the technical literature on the painting - including thirteen-band multispectral imaging - and in the documented biography of the sitter, Lisa Gherardini (1479-ca. 1542). Four reproducible findings are legible on the panel: complete bilateral absence of the eyebrows; complete bilateral absence of the eyelashes; a frontal hairline without a transition zone; and intact, non-scarred periocular and frontal skin. Tested against these findings, Renaissance cosmetic depilation, FFA, secondary syphilis, lepromatous leprosy, telogen effluvium, and trichotillomania each fail on at least one cardinal sign, whereas alopecia areata universalis accounts for all four without exception. The single supraciliary hair detected by multispectral analysis, previously read as the relic of a vanished painted eyebrow, is reinterpreted as a faithfully depicted solitary surviving terminal hair - a recognized expression of incomplete, asynchronous follicular involvement in alopecia areata, illustrated here by a clinical photograph of an eight-year-old patient with an identical finding. The sitter's documented age (24 years in 1503) and biographic stressors are congruent with the early-onset epidemiology of extensive alopecia areata. Limitations of retrospective diagnosis are addressed and explicit criteria for disproof are also stated. The most contemplated face in Western art is reframed as a dignified Renaissance document of alopecia areata universalis.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Issues Surrounding Maternity/Paternity Leave.","authors":"Carlie J Reeves, Joshua R Jennings, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.08.009","url":null,"abstract":"<p><p>As parental leave becomes increasingly common in dermatology residency programs, ethical questions arise regarding redistribution of clinical responsibilities. We examine whether requiring co-residents to cover additional on-call duties during colleagues' parental leave is ethically justified using the principles of autonomy, justice, beneficence, nonmaleficence, and honesty. While residents have an autonomous right to parental leave, programs should recognize the impact on co-residents. Temporary redistribution of duties may be necessary to maintain patient care, but justice requires that added workloads be distributed fairly and mitigated to avoid burnout, compromised education, and threats to patient safety. Residency programs should implement transparent parental leave policies, engage residents in policy development, and adopt equitable scheduling strategies rather than relying solely on peer coverage. Ethical parental leave policies should balance support for residents taking leave with fairness to their colleagues while maintaining resident well-being, educational quality, and patient care.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Responsibilities of Phyisician Inventors: Access and Justice.","authors":"Janice Kim, Ali Aljassabi, Tarek Zieneldien, Sophia Ma, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.08.008","url":null,"abstract":"<p><p>Dermatologist-inventors have ethical responsibilities extending beyond demonstrating that an innovation is helpful, accurate, and safe. Diagnostic technologies can be a positive influence on access to care, healthcare equity, and patient trust, particularly when these technologies are intended for rural and resource-limited communities. Ethical development of novel dermatologic diagnostic technologies requires consideration of beneficence, justice, transparency, accessibility, and responsible commercialization. Physician-inventors should evaluate whether a technology addresses a meaningful clinical need, performs adequately across diverse patient populations, and can be integrated into real-world clinical settings. Accessibility should also be considered during the design process rather than after development. Eliminating unnecessary cold-chain requirements may improve the feasibility of distributing diagnostic technologies to rural and low-resource settings where refrigeration and temperature-controlled transportation might be limited. These design strategies should be supported by appropriate analytical and clinical validation to ensure that accessibility does not compromise diagnostic performance. Such validations could lead to perpetuating inequities in underserved communities, where low cost technologies are most likely to have the biggest impact.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genital Herpes Counseling: Ethical Considerations in Confidentiality, Disclosure, and Psychosocial Harm.","authors":"Tarek Zieneldien, Selene M Kizy, Sophia Ma, Bernard Cohen, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.08.007","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Genital herpes is a common, recurrent, chronic sexually transmitted infection that is frequently encountered in dermatologic practice, and one in which the psychosocial burden often exceeds the physical, as many affected individuals are asymptomatic or experience only mild symptoms. Shame, fear of rejection, anger, depression, and anxiety surrounding disclosure can diminish quality of life more than the herpes infection's physical manifestations. These concerns are compounded by practical threats to confidentiality, especially for adolescents whose explanation-of-benefits statements are insured under a parent's plan. Using two cases, we examine the ethical tensions that a diagnosis of genital herpes can create for the dermatologist. In the first, a patient requests omission of the diagnosis from her record, and in the second, the same patient declines to notify an identifiable partner. In genital herpes, ethical management requires balancing confidentiality against truthful documentation and the interests of identifiable partners, while attending to stigma, relational autonomy, truthfulness, beneficence, informed consent, and psychologic morbidity alongside antiviral therapy. Genital herpes is a sexually transmitted infection (STI) with a high worldwide prevalence and is frequently encountered by dermatologists&lt;sup&gt;1&lt;/sup&gt;. Uniquely, the psychosocial burden of genital herpes often exceeds that of its physical manifestations, with many patients reporting feelings of shame, embarrassment, fear of rejection, anxiety surrounding disclosure, and concerns regarding future intimate relationships, all of which may substantially affect quality of life.&lt;sup&gt;1&lt;/sup&gt;&lt;sup&gt;,&lt;/sup&gt;&lt;sup&gt;2&lt;/sup&gt; These psychosocial concerns may be compounded and exacerbated by practical barriers to maintaining confidentiality. For example, adolescents insured under a parent's health plan or a spouse insured under their partner's policy may fear inadvertent disclosure through pharmacy records, billing notifications, or electronic patient portals. Professional organizations, including the Society for Adolescent Health and Medicine, have recognized that explanation of benefits and other insurance communications may compromise confidentiality for adolescents and young adults seeking such sensitive healthcare and continue to emphasize that confidentiality is an essential component of high-quality care for these patients&lt;sup&gt;3&lt;/sup&gt;&lt;sup&gt;,&lt;/sup&gt;&lt;sup&gt;4&lt;/sup&gt;. Although the medical management of genital herpes is generally straightforward, such scenarios illustrate ethical challenges dermatologists may encounter when counseling patients with highly stigmatized conditions. Navigating these situations requires more than treating the viral infection itself; rather, it necessitates thoughtful consideration of confidentiality, truthful documentation, stigma reduction, partner welfare, and compassionate counseling that supports patient autonomy, informed consent, harm reduction (beneficence","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}