Clinics in dermatology最新文献

{"title":"Part III: Navigating an encounter with a trafficked person in the dermatology clinic.","authors":"Kathyana P Santiago Mangual, Eryn Patin, McKamie Chandler, Jane M Grant-Kels, Laura J Lederer, Arianne Shadi Kourosh","doi":"10.1016/j.clindermatol.2024.09.026","DOIUrl":"10.1016/j.clindermatol.2024.09.026","url":null,"abstract":"<p><p>Patients experiencing or having experienced trafficking frequently interact with the health care system, highlighting the need for health care providers to be equipped with the appropriate tools to serve these patients effectively. The third part of this series focuses on navigating encounters with trafficked persons within the dermatology clinic, emphasizing the importance of trauma-informed, patient-centered care. We reviewed the barriers trafficked patients face and mechanisms to overcome them, the importance of comprehensive needs assessments, and the implementation of effective health care protocols. We additionally review the role of dermatologists in mandatory reporting and the use of appropriate International Classification of Diseases, Tenth Revision codes for documenting a potential trafficking victim encounter in the electronic medical record. We conclude with recommendations for specialized training, emphasizing the critical role dermatologists play in identifying and supporting trafficked patients within the health care system.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342831","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":"Part II: Skin signs of human trafficking and intervention by dermatologists.","authors":"Eryn Patin, Kathyana P Santiago Mangual, McKamie Chandler, Jane M Grant-Kels, Laura J Lederer, Arianne Shadi Kourosh","doi":"10.1016/j.clindermatol.2024.09.025","DOIUrl":"10.1016/j.clindermatol.2024.09.025","url":null,"abstract":"<p><p>Human trafficking is a pervasive global health and human rights issue. The skin often bears the early and most visible signs of abuse and exploitation. Despite the visible nature of their trauma, affected patients frequently go unrecognized within health care settings due to a lack of standardized guidelines for identifying the dermatologic manifestations of trafficking. Herein, we address these challenges by equipping dermatologists and health care teams with the necessary tools to recognize, treat, and report the skin signs of human trafficking. In doing so, we hope to emphasize the importance of early identification and intervention, as well as bring awareness to critical signs, including dermatologic evidence of abuse, infectious diseases, sexually transmitted infections, substance use, and branding. In understanding this, we can bring awareness to dermatologists' critical role in caring for this patient population and their associated cutaneous manifestations. By advancing knowledge in this area, we hope to enhance the capacity of dermatologists to support trafficked individuals.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342830","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":"Regulatory Considerations for Safe and Ethical Use of Augmented Reality and Virtual Reality in Dermatology.","authors":"Mohamad Goldust, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2024.09.023","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2024.09.023","url":null,"abstract":"<p><p>Dermatology is beginning to investigate the uses of virtual reality (VR) and augmented reality (AR) to enhance residency education and to provide patients with comprehensive and interactive experiences. Although the applications of VR and AR to improve patient clinical care are exciting, these technologic advances may have implications about regulatory considerations, patient safety, informed consent, and privacy. We review how using artificial intelligence, VR, and AR can enhance patient care and deliberate the complex issues surrounding these potential innovations.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342832","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":"Advancing Care for Psychocutaneous Disorders: The Role of Artificial Intelligence and Virtual Reality.","authors":"Mohammad Jafferany, George Kroumpouzos, Mohamad Goldust","doi":"10.1016/j.clindermatol.2024.09.022","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2024.09.022","url":null,"abstract":"","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307251","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":"Potpourri IV.","authors":"Franco Rongioletti, Vesna Petronic-Rosic, Leonard Hoenig","doi":"10.1016/j.clindermatol.2024.09.021","DOIUrl":"10.1016/j.clindermatol.2024.09.021","url":null,"abstract":"","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281338","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":"Congenital melanocytic nevi and risk of melanoma.","authors":"Larissa M Pastore, Rodolfo Valentini, Ashfaq A Marghoob","doi":"10.1016/j.clindermatol.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2024.09.004","url":null,"abstract":"<p><p>The presence of congenital melanocytic nevi (CMN) is determined in utero. The location, size, and number of CMN may be of cosmetic concern with significant psychosocial implications. They may also be associated with symptoms such as pruritus, eczema/xerosis, and skin fragilit; however, the most medically concerning issue is the association of CMN with the risk of developing cutaneous melanoma, extracutaneous melanoma, and neurocutaneous melanocytosis (NCM). Patients with CMN are currently risk-stratified based on the projected adult maximum diameter of the largest CMN and the number of CMN (satellites) present. In small and medium CMN the absolute risk of developing cutaneous melanoma is estimated to be approximately 0.3% with a relative risk of 9.5. While patients with large CMN are at increased risk for developing primary cutaneous melanoma within the CMN, they are also at increased risk for developing primary melanoma within the central nervous system (CNS) in association with CNS melanocytic deposits, an entity known as NCM. The absolute risk for developing melanoma in patients with large CMN is estimated to be between 1.25-10% with a relative risk between 52-1046. Regarding the risk for the presence of NCM, the risk correlates with the number of CMN, with the lowest risk in those with a single CMN and with risk escalation as the number of CMN increase. We have provided an overview of the existing evidence about the risk of melanoma and NCM in patients with CMN. The role of the clinical examination, dermatoscopy, MRI scanning of the CNS, and the role of surgery in the management of CMN of varying sizes is discussed.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281329","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 utility of the normal thin section skin biopsy in the assessment of systemic/extracutaneous disease and small fiber neuropathy.","authors":"Cynthia M Magro, Carla Stephan, Taylor Kalomeris","doi":"10.1016/j.clindermatol.2024.09.020","DOIUrl":"10.1016/j.clindermatol.2024.09.020","url":null,"abstract":"<p><p>Diseases reflective of multiorgan vascular injury of diverse etiology, peripheral nerve disease, dysautonomia syndromes, and intravascular lymphoma may exhibit abnormalities on a normal skin biopsy that may be instrumental in establishing a diagnosis. A retrospective review of our database was conducted to uncover cases where a normal skin biopsy was performed to rule in or out such systemic diseases as complement-driven thrombotic microvascular disease (including atypical hemolytic uremic syndrome, posttransplant thrombotic microangiopathy, and severe or critical COVID-19), systemic capillary leak syndrome, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) intravascular B cell lymphoma, small fiber neuropathy, dysautonomia syndromes, and mast cell activation syndrome. Among the special studies were immunohistochemical staining to detect C5b-9, CD56, and myxovirus resistance protein A, as well as mast cell, B and T cell markers. Characteristic patterns were critical in establishing diagnoses such as : increased C5b-9 microvascular deposition in the deltoid area (atypical hemolytic uremic syndrome, posttransplant thrombotic microangiopathy, catastrophic antiphospholipid antibody syndrome, and severe or critical COVID-19); enhanced type I interferon signaling (systemic capillary leak syndrome); ultrastructural arteriopathic changes (CADASIL); reduced cutaneous autonomic innervation in the lower extremities (small fiber neuropathy and postural orthostatic tachycardia syndrome); presence of intravascular lymphocytes on biopsy of abdominal, thigh, and buttock skin (intravascular B cell lymphoma); and a higher than normal density of mast cells in the absence of other inflammatory cell types (mast cell activation syndrome). The skin is clearly a critical window for understanding extracutaneous disease, a concept well exemplified by the myriad of diseases suggested by the microscopic and/or ultrastructural examination of clinically normal skin and therefore establishing the normal skin biopsy as an important tool for understanding certain extracutaneous reactive, neoplastic and paraneoplastic syndromes as well as small fiber neuropathy.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281343","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":"Melanoma in situ and low risk pT1a melanoma: Need for new diagnostic terminology.","authors":"David E Elder, Raymond L Barnhill, Megan Eguchi, Joann G Elmore, Kathleen F Kerr, Stevan Knezevich","doi":"10.1016/j.clindermatol.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2024.09.006","url":null,"abstract":"<p><p>Melanoma incidence has risen rapidly, at least until recently, while mortality has changed only a little, a phenomenon suggestive of overdiagnosis, which can be defined as the diagnosis as \"melanoma\" of a lesion that would not have had the competence to cause death or symptoms even if it had not been excised. Overdiagnosis has been attributed to efforts at early diagnosis (\"overdetection\"), and to changes in criteria resulting in diagnosis as melanoma of lesions previously termed nevi (\"overdefinition\"). In terms of overdefinition, there is evidence that criteria for the histopathologic diagnosis of melanoma has changed over a period of approximately two decades. Specialization may play a role in overdefinition; research has shown that when pathologists interpret the same lesion, dermatopathologists are more likely to diagnose low stage (AJCC T1a) melanomas and general/surgical pathologists are more likely to diagnose atypical nevi. An important subset that contributes to overdiagnosis is those melanomas that lack the property of tumorigenic vertical growth phase, thus lacking metastatic competence, and perhaps not warranting diagnosis as overt melanomas. Studies have defined subsets of patients with very low stage lesions diagnosed as melanomas in which observed survival has been 100%. In the past, many of these lesions would have been diagnosed as nevi, constituting overdefinition. Other key characteristics for very low risk (or no risk) lesions that are currently termed invasive \"melanomas\" include low Breslow thickness, Clark's level II invasion, absence of mitoses, and clinically, lack of observed or experienced dynamic changes. We propose a provisional terminology for diagnosing extremely low risk subgroups as \"Melanocytic neoplasms of low malignant potential\", aimed at reducing the negative personal and social effects of a cancer diagnosis for patients whose health and wellbeing are in reality not affected by an overdiagnosed \"melanoma\". With additional confirmation and appropriate consensus, it is likely that some of these subgroups can be reclassified as atypical or dysplastic nevi.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281335","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":"Psoriatic nail involvement in Malaysia: A 14-year registry review (2007-2020).","authors":"Wen Foong Tan, Suganthy Robinson, Min Moon Tang","doi":"10.1016/j.clindermatol.2024.09.017","DOIUrl":"10.1016/j.clindermatol.2024.09.017","url":null,"abstract":"<p><p>Nail psoriasis affects 20% to 30% of psoriasis patients and is an early predictor of psoriatic arthritis (PsA). We evaluated the prevalence, clinical characteristics, and impact on quality of life of patients with nail psoriasis. We conducted a multicenter retrospective cohort study of patients registered with The Malaysian Psoriasis Registry from January 1, 2007 to December 31, 2020. Of the 24,147 patients, 13,081 (54.2%) had nail psoriasis. Patients with nail psoriasis had later onset of psoriasis (34.0 ± 16.6 years vs 32.9 ± 17.6 years, P < .001) and longer disease duration (11.4 ± 10.5 years vs 8.5 ± 9.4 years, P < .01), with a man-to-woman ratio of 1.2:1. They were more likely to have a family history of psoriasis, cardiometabolic diseases, smoking history, higher body mass index, severe disease, PsA, face and scalp involvement, and higher mean Dermatology Life Quality Index scores (9.36 ± 6.84 vs 8.87 ± 6.60). Systemic treatment and biologics were more commonly prescribed in this cohort (25.0% vs 13.2%, P < .001). Overall, 54.2% of the Malaysian Psoriasis Registry patients had nail involvement. Nail psoriasis was associated with longer duration of psoriasis, older age of onset, male sex, and a family history of psoriasis. It proved to be an important predictor for PsA, severe psoriasis, face and scalp involvement, increased cardiometabolic risk, and a greater impairment of quality of life.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281314","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":"Spectrum of blue nevus-like lesions, including blue nevus, pigmented epithelioid melanocytoma & animal-type melanoma.","authors":"Elvira Moscarella, Andrea Ronchi, Gabriella Brancaccio, Camila Scharf, Giulia Briatico, Renato Franco, Giuseppe Argenziano","doi":"10.1016/j.clindermatol.2024.09.003","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2024.09.003","url":null,"abstract":"<p><p>Blue nevus-like lesions constitute a category of melanocytic lesions clinically identified by their blue coloration. Histologically, they exhibit two primary features: a dermal location and intense pigmentation. The latest World Health Organization (WHO) classification categorizes blue melanocytic lesions into benign entities (dermal melanocytoses, blue nevus, and deep penetrating nevus), melanocytic tumors with low to intermediate malignant potential (pigmented epithelioid melanocytoma, PEM), and malignant lesions (blue nevus-like melanoma and melanoma arising in blue nevus). Clinically, blue nevi are enduring and stable lesions, displaying a structureless blue pigmentation both clinically and dermatoscopically, with a straightforward histologic diagnosis. Conversely, lesions with recent onset and/or rapid growth are more commonly associated with diagnoses falling within the intermediate part of the spectrum or with melanoma. These lesions often present with a blue color along with additional features such as black blotches, irregular vessels, and irregular pigmented globules. They typically emerge de novo without recognizable precursors, they pose significant challenges for patient management. Melanoma on a blue nevus is an exceedingly rare entity with only a few cases described to date. Histologically, differentiating between lesions with intermediate malignant potential and melanoma is always challenging, necessitating a comprehensive evaluation of all morphologic findings of the lesion.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281340","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}