Clinics in dermatology最新文献

{"title":"Ethical issues surrounding maternity and paternity leave.","authors":"Carlie J Reeves, Joshua R Jennings, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.08.009","DOIUrl":"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 coresidents to cover additional on-call duties during colleagues' parental leave is ethically justified using the principles of autonomy, justice, beneficence, nonmaleficence, and honesty. Although residents have an autonomous right to parental leave, programs should recognize the impact on coresidents. 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 physician 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":"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, health care 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 in which 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 greatest 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":"Glucagon-like peptide-1 receptor agonists and related incretin therapies in dermatology: Patient selection and shared decision-making.","authors":"Somto Ndubisi, Peter Lio","doi":"10.1016/j.clindermatol.2026.08.005","DOIUrl":"10.1016/j.clindermatol.2026.08.005","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists and related incretin therapies have moved rapidly from second-line diabetes agents to widely prescribed cardiometabolic medications, and dermatologists increasingly encounter patients who are already taking them. Obesity is common among dermatology patients and is particularly prevalent in psoriasis and hidradenitis suppurativa, yet most eligible patients are not receiving glucagon-like peptide-1 receptor agonist therapy, and nearly all prescriptions originate outside dermatology. This positions dermatologists at the intersection of two distinct clinical questions: how to manage the cutaneous consequences of therapy in patients already receiving these agents, and when to raise the possibility of treatment in patients who may benefit. This narrative review examines patient selection, including the metabolic and inflammatory phenotypes most likely to see dermatologic benefit, and the practical demands of therapy that influence whether treatment succeeds. It reviews the dermatology-relevant adverse effects that patients most often notice, including facial volume loss, hair shedding, and gastrointestinal intolerance, along with a monitoring approach suited to the dermatology visit. Throughout, it argues that shared decision-making offers a useful framework for an area where the evidence is still evolving and where treatment can reshape how patients look and feel.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700934","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":"When skin disease affects intimacy: The ethical duty for dermatologists to screen for sexual dysfunction.","authors":"Tarek Zieneldien, Sophia Ma, Farah Succaria, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.08.006","DOIUrl":"10.1016/j.clindermatol.2026.08.006","url":null,"abstract":"<p><p>Sexual health is central to quality of life; yet, its relationship to dermatologic disease remains insufficiently studied. Skin conditions can directly contribute to sexual dysfunction through pruritus, scarring, pain, and body-image distress, and genital involvement is common but often overlooked. We present two cases to examine the ethical implications for dermatologic practice. In the first, a patient with vulvar lichen sclerosus reports avoiding intimacy, but the dermatologist does not explore the concern further. In the second, a patient with well-controlled plaque psoriasis never discusses the effects of genital involvement because the dermatologist does not initiate the conversation. These cases show how silence may perpetuate unrecognized suffering and restrict meaningful patient autonomy. Ethical dermatologic care for sexual manifestations of skin disease requires sensitivity; permission-based, trauma-informed inquiry that prioritizes the patient's control, safety, and agency by asking for consent before discussing sensitive topics; equitable screening; treatment of modifiable cutaneous contributors; and appropriate referral when concerns extend beyond dermatologic management.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697239","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":"Mechanism of action: Glucagon-like peptide-1 receptors in skin biology.","authors":"Shilpa Mehta","doi":"10.1016/j.clindermatol.2026.08.004","DOIUrl":"10.1016/j.clindermatol.2026.08.004","url":null,"abstract":"<p><p>This review provides an overview of current evidence on the presence, distribution, and physiologic role of glucagon-like peptide-1 receptors in skin tissue. Although glucagon-like peptide-1 receptor agonists are primarily used to treat type 2 diabetes mellitus and obesity, growing evidence suggests they may also directly affect the skin. It includes available research on glucagon-like peptide-1 receptor expression in major skin cell types, including keratinocytes, dermal fibroblasts, and the cutaneous microvascular endothelium. The strength of the evidence is evaluated according to the species studied, the experimental model used, and the method of receptor detection, including gene expression, protein identification, and functional activity. Differences in findings across animal models, cultured cells, and human tissue are also considered. In addition, this review distinguishes between skin effects likely mediated by direct activation of glucagon-like peptide-1 receptors in cutaneous tissue and those that occur indirectly through systemic metabolic improvement or modulation of immune and inflammatory pathways.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697168","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":"The ethical role of dermatologists in smoking cessation counseling.","authors":"Tarek Zieneldien, Selene M Kizy, Elise Coberly, Sophia Ma, Ali Aljassabi, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.08.002","DOIUrl":"10.1016/j.clindermatol.2026.08.002","url":null,"abstract":"<p><p>Smoking has been associated with increased disease severity, poorer treatment response, and adverse outcomes in several dermatologic conditions, including hidradenitis suppurativa, psoriasis, cutaneous lupus erythematosus, and chronic wounds. Although smoking cessation counseling is traditionally viewed as the responsibility of primary care clinicians, dermatologists frequently encounter patients whose skin disease may be influenced by tobacco use. This raises an important ethical question: when does counseling aboutlifestyle behaviors fall within the scope of dermatologic practice? We discuss the ethical justification for dermatologists to engage in smoking cessation counseling using the principles of beneficence, autonomy, and justice. Beneficence supports counseling when tobacco use is relevant to disease severity, treatment response, procedural outcomes, or prevention. At the same time, counseling must respect patient autonomy and avoid approaches that may contribute to emotional distress, perceived judgment, or damage to the therapeutic alliance. Justice further requires recognition of the social and structural barriers that can make smoking cessation difficult for many patients. More broadly, smoking serves as a model for addressing other modifiable health behaviors that may affect skin health, including obesity, alcohol use, and vaccination status. Dermatologists are not obligated to comprehensively manage all lifestyle factors; however, they have an ethical/professional responsibility to discuss behaviors that have meaningful implications for patient outcomes.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688676","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":"The paradigms of female beauty: From antiquity to the contemporary era. A historical and evolutionary perspective.","authors":"Alberto Goldman, Leonard J Hoenig, Lawrence Charles Parish, Uwe Wollina","doi":"10.1016/j.clindermatol.2026.07.028","DOIUrl":"10.1016/j.clindermatol.2026.07.028","url":null,"abstract":"<p><p>Throughout history, the perception of female beauty has been shaped by cultural and historical values as well as evolutionary patterns. Understanding these paradigms is essential to grasping these concepts and their evolution, and to applying them to contemporary treatments. This comprehensive review aims to synthesize historical, evolutionary, and anthropometric data regarding female beauty, tracing its evolution to modern clinical applications in aesthetic medicine. We analyze the various standards of beauty from antiquity-spanning ancient Egypt, ancient Greece, and Rome-up to the present day. From a biological perspective, evidence shows that certain characteristics-such as facial symmetry, sexual dimorphism, skin characteristics, youthful appearance, and signs of health-are consistently perceived as attractive and as indicators of beauty. Throughout the history of civilization, beauty has demonstrated an interplay between evolutionary biology, culture, psychology, history, and technology. Standards of beauty remain highly variable and continue to evolve. Social media and \"influencers\" are among the key factors shaping beauty standards today. A balanced, evidence-based, and safety-conscious approach to understanding beauty and treatments is essential in the field of aesthetics.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683915","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":"Integrating glucagon-like peptide-1 receptor agonists into dermatology practice: Safety and monitoring strategies.","authors":"Shanthi Narla, Radhika R Narla","doi":"10.1016/j.clindermatol.2026.07.030","DOIUrl":"10.1016/j.clindermatol.2026.07.030","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have rapidly expanded beyond the treatment of type 2 diabetes mellitus and obesity, with increasing relevance to dermatologic practice as more patients present while receiving these therapies. This medication class now includes oral formulations including oral semaglutide and the first non-peptide oral GLP-1RA, orforglipron as well as next-generation triple agonists such as retatrutide, which demonstrated up to 24.2% body weight reduction in phase 2 trials and a favorable body composition profile, with preferential fat over lean mass loss. Although GLP-1RAs provide substantial metabolic and weight reduction benefits, their growing use has introduced a broad spectrum of systemic and cutaneous adverse effects that dermatologists must recognize and monitor. This review summarizes the current evidence regarding the safety profile of GLP-1RAs with emphasis on dermatologic implications and interdisciplinary monitoring considerations. Common adverse effects include gastrointestinal intolerance, nutritional deficiencies, gallbladder disease, pancreatitis, and loss of lean body mass. Other rarer potential side effects include anemia, neuropsychiatric, and sexual health effects. Emerging data also suggest associations with ophthalmologic complications, skeletal fragility in older adults, and alterations in body composition that may influence cosmetic and procedural outcomes. Dermatologic adverse events include alopecia, eczematous and hypersensitivity eruptions, bullous and pustular dermatoses, acneiform eruptions, hyperhidrosis, and significant facial volume loss (\"Ozempic face\"). Current evidence regarding GLP-1RA use in pregnancy remains limited and evolving, with recommendations generally advising discontinuation before conception. Given the increasing overlap between metabolic disease management and dermatologic care, dermatologists should understand contraindications, screening strategies, nutritional monitoring, and counseling considerations associated with GLP-1RA therapy. A multidisciplinary approach involving primary care physicians, endocrinologists, ophthalmologists, dietitians, and dermatologists is essential to optimize patient safety while maintaining the substantial therapeutic benefits of these medications.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683906","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":"Ethics of scope, safety, and informed consent in invasive cosmetic dermatology.","authors":"Tarek Zieneldien, Elise Coberly, Sophia Ma, Janice Kim, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.07.029","DOIUrl":"10.1016/j.clindermatol.2026.07.029","url":null,"abstract":"<p><p>With the growth of the global cosmetic dermatology market size, a small number of dermatologists have begun to offer invasive aesthetic procedures that have traditionally been associated with plastic surgery. This raises ethical questions not about whether dermatologists may perform these procedures, but whether they do so with adequate training, transparency, and safeguards. Currently, available comparative outcome data remain limited, reinforcing the need to evaluate safety according to procedure-specific competence, practice setting, and complication-management capacity. Grounded in the principles of nonmaleficence, beneficence, and patient autonomy, we discuss the roles of credentialing, fellowship training, informed consent, and honest advertising, using body contouring as an illustrative case. Additionally, we argue that one-year fellowships confer procedure-specific competence rather than surgical breadth, placing an ethical obligation on institutions to define what their training qualifies their graduates to do at the time of graduation and in the future if no additional future training is undertaken and certification. Cosmetic surgery performed by dermatologists is ethically acceptable when matched by competence, disclosure, and a commitment to patient safety over procedural expansion.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677611","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":"Beyond appropriate use criteria: Ethical considerations when forgoing Mohs micrographic surgery.","authors":"Justin Ong, Jessica Lori Feig, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.07.027","DOIUrl":"10.1016/j.clindermatol.2026.07.027","url":null,"abstract":"<p><p>Mohs micrographic surgery is a safe and effective treatment for nonmelanoma cutaneous carcinomas, but clinical indications alone do not establish ethical appropriateness. Social barriers, treatment, functional limitations, and patient preferences can complicate an otherwise straightforward treatment recommendation. Using three cases, we examine challenges that arise when Mohs micrographic surgery is not pursued despite meeting appropriate use criteria. The first considers a physician's responsibility when substantial social barriers disrupt continuity of care, and a patient defers treatment decisions to the medical team. The second addresses how procedural burden, frailty, and surrogate insight should inform treatment decisions in geriatric patients. The third explores treatment refusal shaped by a patient's lived experience and misconceptions about alternative treatments. In each case, physicians should balance tumor control with patient autonomy, nonmaleficence, quality of life, and responsible use of health care resources. Ethical Mohs practice requires recognizing when advocacy for definitive treatment remains appropriate and when individualized care should take precedence.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668627","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}