Clinics in dermatology最新文献

{"title":"Cutaneous manifestations of carcinoid tumor and syndrome","authors":"James Mackenzie MS,&nbsp;George G. Kels,&nbsp;Mary Kate Staunton BS,&nbsp;Jane M. Grant-Kels MD","doi":"10.1016/j.clindermatol.2026.07.016","DOIUrl":"10.1016/j.clindermatol.2026.07.016","url":null,"abstract":"<div><div>Carcinoid syndrome refers to the signs and symptoms a patient experiences secondary to a carcinoid tumor or another well-differentiated neuroendocrine tumor, which secretes serotonin and other peptides that enter the bloodstream; only 10% of patients with carcinoid tumors experience carcinoid syndrome. Common findings include facial flushing, tachycardia, and shortness of breath. Carcinoid tumors usually originate in the gastrointestinal tract. They are slow growing but can metastasize to the liver, lymph nodes, and elsewhere. Primary or metastatic cutaneous carcinoid tumors present as pink, fast-growing dermal or subcutaneous nodules. The diagnostic workup includes a thorough history and physical examination of the entire body, including a urinary 24-hour 5-hydroxyindoleacetic acid and serum chromogranin A tests. Management of carcinoid syndrome initially includes the use of somatostatin analogs, diet, medication regulation, and clinical monitoring. More aggressive treatment, such as peptide receptor radionuclide therapy or everolimus, a mechanistic target of rapamycin (mTOR), may be required.</div></div><div>Carcinoid syndrome refers to the signs and symptoms a patient experiences secondary to a carcinoid tumor or another well-differentiated neuroendocrine tumor, which secretes serotonin and other peptides that enter the bloodstream; only 10% of patients with carcinoid tumors experience carcinoid syndrome. Common findings include facial flushing, tachycardia, and shortness of breath. Carcinoid tumors usually originate in the gastrointestinal tract. They are slow growing but can metastasize to the liver, lymph nodes, and elsewhere. Primary or metastatic cutaneous carcinoid tumors present as pink, fast-growing dermal or subcutaneous nodules. The diagnostic workup includes a thorough history and physical examination of the entire body, including a urinary 24-hour 5-hydroxyindoleacetic acid and serum chromogranin A tests. Management of carcinoid syndrome initially includes the use of somatostatin analogs, diet, medication regulation, and clinical monitoring. More aggressive treatment, such as peptide receptor radionuclide therapy or everolimus, a mechanistic target of rapamycin (mTOR), may be required.</div>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 753-759"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700940","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":"Paraneoplastic syndromes: Part I","authors":"Jane M. Grant-Kels MD","doi":"10.1016/j.clindermatol.2026.07.014","DOIUrl":"10.1016/j.clindermatol.2026.07.014","url":null,"abstract":"","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 685-687"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648430","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 using advanced practice providers to expand dermatologic access in rural and underserved areas","authors":"Katie Lu MS,&nbsp;Shari R. Lipner MD, PhD","doi":"10.1016/j.clindermatol.2026.05.002","DOIUrl":"10.1016/j.clindermatol.2026.05.002","url":null,"abstract":"<div><div>As patient demand continues to outpace the supply of dermatologists, advanced practice providers are increasingly delivering dermatologic care. Outside metropolitan areas, advanced practice providers outnumber dermatologists. This raises an ethical question of balancing expanding access with equitable quality of care. We examine this through the ethical principles of distributive justice, beneficence, nonmaleficence, and autonomy. Key data are discussed, including workforce distribution, collaborative care models, and quality of care. To realize the full potential of advanced practice provider utilization, there must be improved incentives to practice in rural and underserved areas, mandated supervision of advanced practice provider colleagues, and informed patient consent about the scope of practice. Without these safeguards, efforts to expand access may inadvertently compromise the quality of care and deepen existing inequities.</div></div>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 851-853"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959692","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 scientific rationale for long-acting biologics in dermatology","authors":"Mohamad Goldust MD,&nbsp;Marina Landau MD,&nbsp;Jane M. Grant-Kels MD","doi":"10.1016/j.clindermatol.2026.04.015","DOIUrl":"10.1016/j.clindermatol.2026.04.015","url":null,"abstract":"<div><div>The evolution of biologic therapies in dermatology increasingly emphasizes extending drug half-life to optimize pharmacokinetics and therapeutic durability. Mechanisms such as FcRn-mediated recycling, Fc engineering, albumin binding, PEGylation, and amino acid polymer technologies enhance systemic persistence and stabilize drug exposure. These advances enable sustained inhibition of key inflammatory pathways, including IL-23/T-helper 17 and IL-4/IL-13, reducing disease relapse and improving long-term outcomes. Extended half-life biologics also improve adherence, reduce immunogenicity, and lessen treatment burden through infrequent dosing. Collectively, these innovations represent a shift toward precision pharmacology, matching drug kinetics with disease biology to enhance efficacy, patient satisfaction, and health care efficiency in chronic dermatologic conditions.</div></div>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 843-846"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834312","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":"Necrobiotic xanthogranuloma","authors":"Madeleine Tessier-Kay MPH,&nbsp;Akua Sarfo MD, PhD","doi":"10.1016/j.clindermatol.2026.07.022","DOIUrl":"10.1016/j.clindermatol.2026.07.022","url":null,"abstract":"<div><div>Necrobiotic xanthogranuloma is a rare non-Langerhans histiocytosis often associated with paraproteinemia or hematologic disease. Necrobiotic xanthogranuloma is usually characterized by yellow-orange, reddish-brown, or violaceous papules and nodules that may progress to form infiltrative plaques, with lesions often occurring in a periorbital distribution. Histopathologic study typically demonstrates bands of inflammatory granulomatous tissue separated by zones of necrobiosis, with the dermis and subcutaneous tissue most commonly affected. Historically, diagnosis has been made based on consistent clinical and histologic findings, although diagnostic criteria have recently been proposed. Research on necrobiotic xanthogranuloma is limited due to the condition’s rarity, making comparisons of therapeutic agents difficult. Numerous systemic and localized treatments have been documented, with varying responses.</div></div>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 742-746"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700978","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":"Yellow nail syndrome","authors":"Rachel A. Wetstone MD, MPH,&nbsp;Brett Sloan MD","doi":"10.1016/j.clindermatol.2026.07.025","DOIUrl":"10.1016/j.clindermatol.2026.07.025","url":null,"abstract":"<div><div>Yellow nail syndrome (YNS) is a rare disorder defined by the triad of yellow nail discoloration, lymphedema, and respiratory tract disease. Only two of the three signs should be present to diagnose YNS; however, this can be challenging as patients often do not exhibit all three signs concurrently. The association between YNS and malignancy has led to the hypothesis that YNS may be paraneoplastic. Treatment may include oral vitamin E for nail discoloration, serial thoracenteses for pleural effusions, and compression garments along with bandaging for lymphedema.</div></div>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 781-785"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590896","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":"Erythema elevatum diutinum","authors":"Seda Grabauskas BS,&nbsp;Campbell L. Stewart MD","doi":"10.1016/j.clindermatol.2026.07.019","DOIUrl":"10.1016/j.clindermatol.2026.07.019","url":null,"abstract":"<div><div>Erythema elevatum diutinum (EED) is a rare and chronic form of cutaneous vasculitis often associated with systemic diseases including such hematologic malignancies as immunoglobulin A monoclonal gammopathy, multiple myeloma, and non-Hodgkin lymphoma, as well as such autoimmune disorders and infections HIV and streptococcus. Clinically, EED presents as symmetrical red-to-brown papules, plaques, or nodules, primarily on extensor surfaces including the elbows, knees, and hands. These lesions may be asymptomatic or associated with burning, tenderness, or pruritus, and their chronic nature often leads to fibrosis and discoloration over time. Histologically, EED exhibits leukocytoclastic vasculitis associated with neutrophilic infiltration in the upper and mid-dermis with sparing of the papillary and periadnexal dermis, fibrin deposition, and progressive dermal changes, including granulation tissue and fibrosis in late-stage lesions. Although no cure exists, the first-line treatment is dapsone. Corticosteroids and immunosuppressive agents are employed for resistant cases. Early diagnosis and management are essential, particularly given the condition’s potential to signal serious underlying systemic diseases. Although EED lesions may persist for decades, treating the underlying conditions can influence the disease course, offering a pathway to improved outcomes.</div></div>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 723-729"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599816","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":"Discovery of an intravenous drug injection site: A meticulous cutaneous examination provides the forensic dermatologic clue to a diagnosis of homicide","authors":"Philip R. Cohen MD, MS","doi":"10.1016/j.clindermatol.2026.06.001","DOIUrl":"10.1016/j.clindermatol.2026.06.001","url":null,"abstract":"<div><div>An unsuspected homicide in a decedent was considered when the meticulous cutaneous examination of the deceased resulted in the discovery of an intravenous injection site. A 24-year-old woman was found dead in her home. Initial assessment by the crime scene investigator and detective could not determine either the cause or the manner of death. Law enforcement personnel returned to the scene after the assistant medical examiner found a single intravenous needle puncture site during her cutaneous examination of the left antecubital fossa of the dead woman. Additional evidence located near the deceased woman’s home included a bag with a butterfly needle and its plastic cap, a syringe with blood stain on the inside, and two empty vials of propofol. The investigators were able to identify the nurse who had obtained the propofol vials, and the forensic pathologist recommended that propofol be included among the other drugs routinely being evaluated during the toxicology studies. The discovery of an intravenous needle mark led to further evaluation of the death scene, resulting in the appropriate toxicology studies being ordered, which revealed that the cause of death was due to propofol, making it a homicide. A meticulous and thorough examination of the cutaneous and mucosal surfaces may provide an essential forensic dermatologic clue to the cause of death, the manner of death, or both.</div></div>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 879-883"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply to “Rising trends in dermatology publications using large-scale databases”","authors":"Delaney D. Ding BS","doi":"10.1016/j.clindermatol.2026.06.005","DOIUrl":"10.1016/j.clindermatol.2026.06.005","url":null,"abstract":"","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 886-888"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351133","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 BS,&nbsp;Selene M. Kizy BS,&nbsp;Sophia Ma BS,&nbsp;Bernard Cohen MD,&nbsp;Jane M. Grant-Kels MD","doi":"10.1016/j.clindermatol.2026.08.007","DOIUrl":"10.1016/j.clindermatol.2026.08.007","url":null,"abstract":"<div><div>Genital herpes is a common, recurrent, chronic sexually transmitted infection that is frequently encountered in dermatologic practice, and in which the psychosocial burden often exceeds the physical manifestations, 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 physical manifestations of the herpes infection. 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; 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.</div></div>","PeriodicalId":10358,"journal":{"name":"Clinics in dermatology","volume":"44 5","pages":"Pages 858-861"},"PeriodicalIF":3.5,"publicationDate":"2026-09-01","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}