Clinics in dermatology最新文献

{"title":"Forensic Dermatology of Tattoos: Part 1. Epidemiology of Tattoos in a Forensic Setting.","authors":"Philip R Cohen","doi":"10.1016/j.clindermatol.2026.09.010","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.09.010","url":null,"abstract":"<p><p>A tattoo is a form of body modification that is created by inoculating pigment into the skin. Forensic dermatology involves the medical and legal assessment of the skin, mucosa, hair and nails to evaluate injury or death. Tattoos can have an integral role in a forensic dermatology evaluation. The forensic dermatology of tattoos is presented in four contributions. Part 1) discusses the epidemiology of tattoos in a forensic setting. 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 cancers with tattoos in a forensic setting. The fourth paper in the series (Part 4) discusses the forensic aspects of tattoos. The prevalence of tattoos, the composition of tattoo ink, the reasons for acquiring a tattoo, and the groups of individuals associated with tattoos are presented in this contribution. It has been estimated that 20% to 33% of the population have at least one tattoo. The motivation for electively acquiring a tattoo is variable. Motivating factors to have a tattoo are multifold: beauty, art, and fashion, individuality, personal narratives, physical endurance, group affiliations and commitment, resistance, spirituality and cultural tradition, addiction, sexual motivation, and lastly no specific reason. In some individuals, the acquisition of a tattoo is not an elective decision. Gangs, military personnel, prisoners, and victims of personal atrocity are some of the groups of individuals who have tattoos. A complete understanding of the forensic significance of tattoos is essential not only for the forensic pathologist but also for other individuals who assess those with tattoos.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955165","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":"Modified morals: Ethical challenges in proposed changes to Modifier-25.","authors":"Robert Adler, Jessica Lori Feig, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.09.008","DOIUrl":"10.1016/j.clindermatol.2026.09.008","url":null,"abstract":"<p><p>Proposed changes to Medicare reimbursement for Modifier-25 raise ethical concerns regarding patient-centered care, access, and healthcare resource stewardship. Although reducing inappropriate or duplicative billing is justified, a broad 50% payment reduction for additional same-day services may penalize legitimate, medically necessary care. Because dermatology commonly combines evaluation and procedures in a single encounter, the policy could incentivize fragmented visits, increasing patient costs, delays, and barriers to care, particularly for underserved populations. Reduced reimbursement may also threaten the sustainability of independent and rural practices. Targeted education and oversight of inappropriate billing may better balance responsible resource use with beneficence, nonmaleficence, and justice. Payment policy should discourage misuse of Modifier-25 without creating financial incentives that undermine efficient, accessible, and patient-centered care.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944236","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.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.clindermatol.2026.09.003","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, hidradenitis suppurativa, and atopic dermatitis 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 and atopic dermatitis, 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 only in direct modulation of cutaneous inflammation but also 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, highlighting future opportunities for disease modification and integrated dermatologic care.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944199","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 menopause supplement gold rush: Ethical obligations in dermatology.","authors":"Jenny Chung, Shari R Lipner","doi":"10.1016/j.clindermatol.2026.09.004","DOIUrl":"10.1016/j.clindermatol.2026.09.004","url":null,"abstract":"<p><p>The menopause care market is experiencing unprecedented growth, with unregulated dietary supplements representing one of the largest segments despite knowledge gaps. Menopause-related dermatologic changes can substantially affect quality of life, making menopausal women primary targets of direct-to-consumer dietary supplements and health claims on social media platforms. This raises an ethical question about how to provide high-quality dermatologic care to menopausal women, which can be examined through the ethical principles of beneficence, nonmaleficence, justice, and respect for autonomy. Dermatologists have an ethical obligation to offer evidence-based recommendations and engage in shared decision-making that aligns patient goals with realistic expectations about dermatologic changes in menopause.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918856","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":"High-resolution ultrasound in alopecia: Principles, sonoanatomy, and imaging patterns.","authors":"Claudia Gonzalez, Carolina Palacios, Paola Macías, George Kroumpouzos","doi":"10.1016/j.clindermatol.2026.09.006","DOIUrl":"10.1016/j.clindermatol.2026.09.006","url":null,"abstract":"<p><p>High-resolution ultrasound with Doppler (HRUD) is an emerging imaging modality that enables noninvasive visualization of hair follicles, perifollicular structures, and vascular changes. Recent studies have identified characteristic ultrasonographic findings in nonscarring and scarring alopecia, expanding ultrasound's role in clinical evaluation. This narrative review summarizes HRUD principles, sonoanatomy of the hair, scanning techniques, indications, and representative imaging findings in alopecia. PubMed and Scopus were searched to identify publications describing HRUD applications in alopecia, and ultrasonographic images and illustrative cases from the authors' collections were included to demonstrate key findings. Across alopecias, HRUD shows recognizable imaging patterns that may support diagnosis and clinical assessment. Reported findings include follicular miniaturization in pattern alopecia, drop-like follicular widening in alopecia areata, perifollicular inflammatory changes and increased vascularization in scarring alopecia, follicular fusion in folliculitis decalvans, and fistulous tracts in dissecting cellulitis of the scalp. HRUD may also facilitate assessment of disease activity, treatment response, and clinicopathologic correlations. In conclusion, HRUD provides clinically useful structural and vascular information on alopecia and may complement clinical examination and trichoscopy. Standardizing imaging protocols and conducting further clinical studies may help define its role in diagnosis, monitoring, and research.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910926","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 of cosmetic glucagon-like peptide-1 receptor agonist prescribing in dermatology.","authors":"Anshu Jonnalagadda, Weston P Lowry, Gaurav N Pathak, Erik Choi, Albert E Zhou, Jane M Grant-Kels","doi":"10.1016/j.clindermatol.2026.09.002","DOIUrl":"10.1016/j.clindermatol.2026.09.002","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists are increasingly used beyond approved metabolic indications, including for elective weight loss and aesthetic optimization. Dermatologists may receive requests to prescribe these agents and patients may experience downstream consequences such as facial volume loss and telogen effluvium. Although prescribing these medications for hidradenitis suppurativa or psoriasis can be medically justified and helpful, elective prescribing raises ethical concerns about nonmaleficence, scope of practice, prescribing cascades, patient autonomy, justice, and stewardship of limited resources. We discuss the ethical responsibilities of dermatologists considering prescribing glucagon-like peptide-1 receptor agonists for cosmetic purposes and propose practical guardrails to balance patient preferences with professional judgment and avoid iatrogenic harm.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910979","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 in dermatology: ethical considerations.","authors":"Chelsea Deitelzweig, Fatima Rahim, Benjamin K Stoff","doi":"10.1016/j.clindermatol.2026.08.016","DOIUrl":"10.1016/j.clindermatol.2026.08.016","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have generated growing interest in dermatology for their potential anti-inflammatory and immunomodulatory effects on skin disease, in addition to their metabolic benefits. As their use expands beyond established indications for type 2 diabetes and obesity, important ethical challenges have emerged. This review explores the ethical considerations surrounding GLP-1 RA use in dermatology through the principles of autonomy, beneficence, non maleficence, and justice. Notable issues include disparities in access and affordability, compounded formulations, social media misinformation, scope-of-practice considerations in prescribing, and informed consent. Evidence suggests that racial, ethnic, socioeconomic, and insurance-related disparities limit access to GLP-1 RAs, while increasing off-label and cosmetic use may worsen medication shortages and inequitable distribution. Compounded agents may improve access but introduce concerns about product quality, safety, counterfeit medications, and inadequate patient counseling. Social media and direct-to-consumer marketing contribute to misinformation, unrealistic outcome expectations, and demand-driven shortages. Emerging dermatologic evidence supports potential benefits of GLP-1 RAs for hidradenitis suppurativa and psoriasis, raising questions about appropriate prescribing authority and side effect monitoring responsibilities for dermatologists. Limited long term safety data for off-label GLP-1 RA use highlights the importance of transparent patient counseling and shared decision-making when prescribing these agents. As GLP-1 RA use continues to expand, dermatologists must balance potential therapeutic benefits with broader societal considerations. Ethical stewardship through evidence based prescribing, informed consent, adverse effect monitoring, patient education, and advocacy for equitable treatment access is essential to maximizing patient benefit, minimizing harm, and preserving fair access.</p>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910930","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":"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":"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 United States 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":"10.1016/j.clindermatol.2026.08.012","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists 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. To review the prevalence, clinical features, mechanisms, and management of nonimmunologic injection site and dermatologic reactions associated with glucagon-like peptide-1 receptor agonists. 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 United States Food and Drug Administration Adverse Event Reporting System. Injection-site events were combined with skin-related adverse events to generate an adjusted skin and injection-site reactions category for comparison across agents. Among 442,567 Food and Drug Administration Adverse Event Reporting System 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. Nonimmunologic cutaneous adverse events comprise a substantial proportion of reported glucagon-like peptide-1 receptor agonists-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":"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}