Clinics in dermatology最新文献

{"title":"Nose, sex, and sexuality.","authors":"Uwe Wollina, Leonard J Hoenig, Lawrence Charles Parish","doi":"10.1016/j.clindermatol.2026.09.030","DOIUrl":"10.1016/j.clindermatol.2026.09.030","url":null,"abstract":"<p><p>The nose is a prominent structure of the human midface with an individually varying shape and size. It fulfills physiologic functions through breathing, smelling, and immune surveillance. But is the nose also involved in sex and sexuality? We analyzed the history of physiognomy and its myths from Greek and Roman times through the Middle Ages, Renaissance, and Enlightenment. Sigmund Freud stimulated further research on this topic through psychoanalysis. At the turn of the 19th to the 20th century, otolaryngologists Wilhelm Fließ (1858-1928) in Berlin and John Noland Mackenzie (1853-1925) in Baltimore created the concept of a nasal reflex neurosis in women, which was later abandoned. Analysis of chemical components of body odor starting in the 20th century identified sex-specific substances involved in attraction and arousal. The search for pheromones in humans was stimulated by groundbreaking studies in insects and other animals. The first identified pheromone was bombykol, isolated in 1959. Whether human pheromones exist remains a matter of debate. The vomeronasal organ is found in most human adults, but its role in sexuality is questionable. Recent studies suggest that it has no function in chemoreception, representing an atavistic and vestigial structure.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058754","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":"Skin in the frame: The educational value of historic art in dermatology.","authors":"Emma N Dang, Eliot N Mostow","doi":"10.1016/j.clindermatol.2026.09.027","DOIUrl":"10.1016/j.clindermatol.2026.09.027","url":null,"abstract":"<p><p>Historic artworks constitute a visual corpus for dermatology education; however, the literature has not been systematically evaluated against contemporary educational standards. This review characterizes published artworks depicting dermatologic disease and assesses their curriculum alignment, clinical accessibility, and skin tone diversity. This was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across four databases. Studies were included if they analyzed dermatologic conditions depicted in historic art and provided clinical diagnoses. Data were extracted on artwork characteristics, presence as per the American Academy of Dermatology Basic Dermatology Curriculum, availability in a clinical decision support system (VisualDx), and estimated skin tone using the monk skin tone scale. Forty eight studies met the inclusion criteria, encompassing 77 unique artworks. Oil paintings comprised the dominant medium. A total of 34 distinct dermatologic diagnoses were identified, with alopecia-related conditions being the most depicted. Only 40.3% of the artworks depicted conditions represented in the American Academy of Dermatology Basic Dermatology Curriculum. In contrast, all artworks had their depicted conditions available in the clinical decision support system. Skin tone assessment revealed that 06 of 10 monk skin tone scores were represented; however, the distribution was heavily skewed toward lighter skin tones, with monk 01 to 03 accounting for 81.2% of all ratings. The historic art literature in dermatology is diagnostically broad and accessible through contemporary clinical reference tools, yet misaligned with the formal dermatology curriculum and underrepresents darker skin tones. Intentional curation toward curriculum-prioritized topics and skin tone diversity would be needed for this work to serve as an educational and investigative resource across the full spectrum of dermatologic practice and research.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036743","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":"Biopsy-guided cytokine profiling as a tool for precision medicine in psoriasis.","authors":"Victoria Soto, Sammya Mufarrej, Simonetta I Gaumond, Laura Dalla Rosa Prati, Franco Rongioletti, Ivan Jozic, Paolo Romanelli","doi":"10.1016/j.clindermatol.2026.09.021","DOIUrl":"10.1016/j.clindermatol.2026.09.021","url":null,"abstract":"<p><p>Psoriasis is a clinically heterogeneous inflammatory dermatosis characterized by diverse subtypes with variable therapeutic responses. Although biologic therapies targeting tumor necrosis factor-α, interleukin (IL)-17, IL-23, and IL-36 pathways have transformed disease management, treatment selection remains largely empirical and is not routinely guided by tissue-level immune profiling. In this study, we performed quantitative immunohistochemical analysis of key cytokines, IL-17A, IL-17F, IL-23p19, IL-36γ, and tumor necrosis factor-α, across five psoriasis subtypes (guttate, inverse, palmoplantar, plaque, and pustular) using formalin-fixed paraffin-embedded skin biopsies. Cytokine-positive dermal cell populations were quantified using digital pathology, enabling subtype-specific comparison of inflammatory signatures. Distinct cytokine patterns were observed across subtypes. Pustular psoriasis demonstrated a prominent IL-17F and IL-36γ-dominant profile, whereas plaque psoriasis exhibited broad cytokine expression with relative IL-17A predominance. Palmoplantar psoriasis showed a mixed IL-17/IL-36 signature, while guttate and inverse subtypes displayed comparatively attenuated inflammatory profiles. Because cytokine expression was quantified within the dermal compartment, these findings should be interpreted as dermal inflammatory patterns rather than as measures of total tissue cytokine expression, particularly for IL-36γ, which is also strongly associated with keratinocyte-derived epidermal responses. These findings provide tissue-level evidence of immunologic heterogeneity across psoriasis subtypes and support the concept of cytokine-driven disease endotypes. Biopsy-based cytokine profiling may represent a promising, hypothesis-generating approach for characterizing lesion-specific inflammatory patterns and potentially informing individualized therapeutic strategies, although prospective studies linking tissue profiles with treatment response are required to establish clinical utility.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036805","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 when teledermatology employs tape-stripping molecular diagnostics.","authors":"Alyssa M Iurillo, Albert E Zhou, Brett Sloan, Philip E Kerr, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.09.023","DOIUrl":"10.1016/j.clindermatol.2026.09.023","url":null,"abstract":"<p><p>Teledermatology has narrowed geographic gaps in dermatologic care, but pigmented lesions are difficult to evaluate remotely. Mailed adhesive tape-stripping kits offer a potential noninvasive molecular adjunct, but their promised benefits (including fewer in-person visits, biopsies, and costs) remain largely unproven in practice. Herein we discuss the ethical pros and cons of tape-stripping in this setting and compare it with alternative investments such as primary care dermoscopy training and teledermoscopy. There remain unresolved concerns regarding tape-stripping cost, evidence of actual practice change, commercial oversight, data governance, and confidentiality in home specimen collection.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030040","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":"Diagnostic orphaning: The dermatologist and the uninsured patients: What happens after the biopsy.","authors":"Ikenna Nebo, Laura E Levin, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.09.025","DOIUrl":"10.1016/j.clindermatol.2026.09.025","url":null,"abstract":"<p><p>Uninsured patients may receive an accurate dermatologic diagnosis and an appropriate recommendation, yet remain unable to obtain treatment because diagnostic and therapeutic services are often delivered by separate entities. We term this \"diagnostic orphaning\": the patient has a diagnosis, a clinician, and perhaps a referral, but no feasible route to care. This contribution proposes an adequate pathway as an ethical standard for determining when efforts to address financial barriers constitute an adequate treatment plan. An adequate pathway preserves clinical integrity, is reasonably feasible, and includes accountable follow-through. Clinical integrity requires disclosure of the preferred treatment, reasonable alternatives, and consequences of delay or nontreatment. Less costly care is ethical only when medically acceptable and its limitations are transparent. Practical feasibility requires assessing whether a receiving site will accept the patient, whether care can be delivered within an appropriate interval, and whether the full episode of care is affordable. Accountable follow-through requires verifying subsequent handoffs and having a contingency plan if a referral fails. These obligations should reflect disease urgency, the likely harm from delay, and the potential benefit of further coordination; they do not require clinicians to guarantee access or personally finance the treatment plan. Practices and health systems should support referral coordination and comprehensive financial assistance, whereas professional organizations and the government should address barriers beyond individual clinicians' control. Pathway adequacy distributes responsibility according to each stakeholder's capacity to help patients obtain care.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030014","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":"Decision-relevant transparency in the dermatology residency match.","authors":"Ikenna Nebo, Esther Nwozo, Ananya Eeraveni, Rachel Ma, Rolando Perez-Lorenzo, Alexandra Flamm, Jane Grant-Kels, Kristen I Lo Sicco","doi":"10.1016/j.clindermatol.2026.09.026","DOIUrl":"10.1016/j.clindermatol.2026.09.026","url":null,"abstract":"<p><p>Program signaling and the financial demands of dermatology residency applications make transparency increasingly consequential. Applicants need clear guidance before committing resources, whereas programs need discretion to assess varied strengths and fulfill their educational missions. We propose decision-relevant transparency as an ethical standard for reconciling these interests. Information warrants disclosure when it could reasonably change whether or where an applicant applies, signals, rotates, interviews, or ranks. Programs should distinguish eligibility rules from established preferences and explain expectations concerning applicant backgrounds, research years, visiting rotations, and signaling. These expectations should be public, understandable, and current before applicants act on them. The obligation is strongest when a policy would exclude an applicant from consideration and should extend to commitments that involve substantial applicant time or money. Programs need not disclose confidential deliberations, rank lists, or exact scoring weights, nor provide individualized feedback to every unsuccessful applicant. Responsibility for implementation rests with programs that control selection information, national organizations that can coordinate reporting, mentors who help students interpret disclosures, and applicants who use them. Structured advising is particularly important for students without a home dermatology program. This approach seeks to reduce reliance on private access to information while preserving holistic review, applicant privacy, and a reasonable workload for selection committees.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030035","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":"Synthetic patients as a new validation standard for artificial intelligence in dermatology.","authors":"Mohamad Goldust, Marina Landau, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.09.019","DOIUrl":"10.1016/j.clindermatol.2026.09.019","url":null,"abstract":"","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024172","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":"Workplace accommodations for alopecia areata: A framework for dermatologists.","authors":"Catherine S Taghizadeh, Carolyn Goh, Shari R Lipner","doi":"10.1016/j.clindermatol.2026.09.022","DOIUrl":"10.1016/j.clindermatol.2026.09.022","url":null,"abstract":"<p><p>Alopecia areata may impair occupational functioning through psychosocial distress, disease visibility, concerns regarding hair-prosthesis displacement, and unwanted disclosure. Importantly, occupational impairment may not parallel the extent of visible hair loss. Workplace accommodations can reduce barriers to employment, but dermatologists may face uncertainty regarding when accommodation is appropriate, what information to provide employers, and how to balance immediate support with long-term adaptation. We propose a practical five-step framework for evaluating workplace accommodation requests in alopecia areata: (1) identify the occupational barrier; (2) establish its relationship to alopecia areata, its treatment, or associated psychosocial burden; (3) consider a proportionate accommodation; (4) promote documenting functional limitations without dictating employment decisions; and (5) reassess the need for continued accommodation. Such an individualized approach allows dermatologists to advocate for patients while maintaining appropriate professional boundaries and supporting privacy, autonomy, and sustained occupational participation.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024092","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":"GLP-1 receptor agonists in dermatology: Prescribing frameworks, access, and the emerging pipeline.","authors":"Alina G Bridges","doi":"10.1016/j.clindermatol.2026.09.018","DOIUrl":"10.1016/j.clindermatol.2026.09.018","url":null,"abstract":"<p><p>The rapid expansion of glucagon-like peptide-1 receptor agonist (GLP-1 RA) approvals has created a complex regulatory and practice environment for dermatologists. No GLP-1 RA currently holds a United States Food and Drug Administration (FDA)-approved dermatologic indication; all prescribing for cutaneous conditions-including psoriasis, hidradenitis suppurativa, and wound healing-remains off-label. This chapter examines the regulatory frameworks governing GLP-1 RA use in dermatology, encompassing the current FDA-approved landscape, legal and professional standards for off-label prescribing, obesity medicine certification as a competency pathway, the compounding controversy, and access, cost, and reimbursement barriers. Particular attention is given to the Anti-Kickback Statute implications of manufacturer copay cards for Medicare beneficiaries, the Treat and Reduce Obesity Act, and evolving patient assistance strategies. Multidisciplinary collaboration, adverse event surveillance, the next-generation incretin pipeline, and ethical and equity considerations are also addressed. Practical recommendations are provided to guide dermatologists in navigating prescribing authority, reimbursement, pharmacovigilance, and the evolving evidence base.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029969","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":"Forensic Dermatology of Tattoos: Part 2. Types of Tattoos that can Present in a Forensic Setting.","authors":"Philip R Cohen","doi":"10.1016/j.clindermatol.2026.09.020","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.09.020","url":null,"abstract":"<p><p>A tattoo is created by inoculating pigment into the skin. It is a form of body modification. Tattoos are an essential feature in forensic dermatology. The forensic dermatology of tattoos is presented in four contributions. Part 1) discusses the epidemiology of tattoos in a forensic setting (Clin Dermatol 2027; xxx.xxx). Part 2) examines the types of tattoos that can present in a forensic setting. The third contribution in the series (Part 3) considers the cutaneous diseases, infections, lesions, and malignancies with tattoos in a forensic setting. The fourth paper in the series (Part 4) discusses the forensic aspects of tattoos. Forensic-associated tattoos can present as medical tattoos, breast cancer-associated tattoos, mucosal tattoos, and cosmetic tattoos. Medical tattoos can provide crucial insight into a person's health history. Radiotherapy tattoos, nipple-areola-complex tattoos, and post-mastectomy tattoos are breast cancer-associated camouflage. The cornea, gastrointestinal tract, lips, and oral mucosa are potential locations of mucosal tattoos. The forensic evaluation may reveal one or more cosmetic tattoos; the presence of a cosmetic tattoo may assist in identifying an unknown decedent. Comprehension of the forensic significance of tattoos is important for forensic investigators who evaluate those with tattoos.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029998","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}