Australasian Journal of Dermatology最新文献

{"title":"Emerging Terbinafine Resistant Trichophyton Dermatophytosis, Testing Options and Alternative Treatments: A Systematic Review.","authors":"Thuvarahan Jegathees, Zachary P Holmes, Catherine Martin, Cindy Kalai, Catherine Voutier, Denis Spelman, Gemma Robertson, Johannes S Kern","doi":"10.1111/ajd.14575","DOIUrl":"https://doi.org/10.1111/ajd.14575","url":null,"abstract":"<p><p>Dermatophytosis is a common superficial fungal infection of the skin, most often caused by dermatophytes from the Trichophyton genus. Terbinafine, which inhibits squalene epoxidase (SQLE), is widely used as first line treatment. However, resistance to terbinafine is increasing globally, including recent reports in Australia, with origins suspected to trace back to South Asia. Antifungal susceptibility testing is not routinely available in Australia, and globally, there are no standardised breakpoints for traditional culture-based methods. Although SQLE gene mutations have been associated with terbinafine resistance, a major research gap exists in the clinical interpretation of these mutations due to a lack of correlation between MIC values, genetic mutations and clinical treatment outcomes. This gap hampers the ability to guide clinical decision-making. Therefore, our objective was to assess the global prevalence of terbinafine-resistant Trichophyton infections, identify the most clinically relevant resistance testing methods, and determine effective alternative treatment options. The study was designed by systematic review. Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews (CDSR), Cochrane's Trials database (CENTRAL), Global Health (CABI), Trials registries, along with Google Scholar and Web of Science (WoS) for the tracking of included articles. Published human studies in English from 2000 to 2023 of Terbinafine-resistant Trichophyton Dermatophytosis with confirmed antifungal susceptibility tests and genotyping of dermatophytes, as well as details of effective alternative treatments. Identified cases were independently screened by two authors on the basis of predetermined criteria. Thirty four studies reported 743 samples for which mutation data of the SQLE gene and minimum inhibitory concentration (MIC) were available. Twenty three studies reported on 149 patients who had used terbinafine with available MIC data. Of these, 94 cases demonstrated evidence of clinical resistance to terbinafine with confirmed SQLE genotyping and MIC data. Seven studies reported on 13 cases of clinical resistance to terbinafine with a reported MIC and a successful alternative therapy. There are no published MIC breakpoints for terbinafine resistance in antifungal resistance testing, creating significant challenges for clinical interpretation. This study suggests that an estimate of a provisional MIC threshold for resistance is calculated to be 1.69 μg/mL. Importantly, SQLE mutation data, particularly the presence of F397L, L393F and A448T shows a robust association with clinical resistance to terbinafine (odds ratio: 7.58; 14.0, 7.78, respectively). Routine SQLE mutation testing in cases of suspected terbinafine-resistant dermatophytosis could enhance diagnostic accuracy and inform more effective, timely treatment decisions. Identifying specific mutations may guide clinicians in selecting alternative antifungal agents earlier in the treatment","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697503","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":"Informing a Position Statement on the Use of Large Language Models and AI Scribes in Dermatology in Australia.","authors":"Liam J Caffery, Monica L Taylor, Lisa M Abbott, Monika Janda, Pascale Guitera, Victoria Mar, Chris Arnold, Stephen Shumack, Tony Caccetta, Robert Miller, H Peter Soyer","doi":"10.1111/ajd.14566","DOIUrl":"https://doi.org/10.1111/ajd.14566","url":null,"abstract":"<p><p>Artificial Intelligence (AI) refers to the ability of computers to mimic human intelligence. In response to the growing interest and impact of AI, the Australasian College of Dermatologists released its first Position Statement on AI in dermatology in 2022. This Position Statement provided guidance for dermatologists on the appropriate use of AI. Since then, the AI landscape has evolved substantially, particularly with the emergence of Large Language Models (LLMs). This article explores key developments in AI driven by LLMs, including the increasing use of AI scribes, and provides updated guidance for dermatologists in Australia.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658243","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":"Recalcitrant Erythema Multiforme Minor Successfully Treated With Apremilast-A Novel Insight.","authors":"Carmen Cánovas Seva, Lorena Martínez Leboráns, Carlos Aliste Santos, Jose Manuel Suárez Peñaranda, Ángeles Flórez","doi":"10.1111/ajd.14564","DOIUrl":"https://doi.org/10.1111/ajd.14564","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641632","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":"Response to Letter by Wallace et al.","authors":"Samantha Ting, Patricia Lowe, Pablo Fernández-Peñas","doi":"10.1111/ajd.14568","DOIUrl":"https://doi.org/10.1111/ajd.14568","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641633","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":"Successful Treatment of Spontaneous Generalised Keloids With Dupilumab: A Case Report.","authors":"Lachlan D W Lau, Nicholas Manuelpillai, Holly Sexton, Laura Scardamaglia","doi":"10.1111/ajd.14572","DOIUrl":"https://doi.org/10.1111/ajd.14572","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641634","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":"Lichen Planus Follicularis Tumidus.","authors":"A I Oloruntoba, Saurabh Prakash, Ryan Toholka","doi":"10.1111/ajd.14545","DOIUrl":"https://doi.org/10.1111/ajd.14545","url":null,"abstract":"","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574756","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":"Ingrown Toenail With Hypertrophic Skin Bridging.","authors":"Karalikkattil T Ashique, Puravoor Jayasree, Feroze Kaliyadan","doi":"10.1111/ajd.14563","DOIUrl":"https://doi.org/10.1111/ajd.14563","url":null,"abstract":"<p><p>Onychocryptosis, or ingrown toenail (IGTN), is a painful condition commonly resulting from improper nail trimming or hypertrophic lateral nail folds. We present a rare variant in which the entire distal nail plate becomes embedded within markedly hypertrophic nail folds, forming a tunnel-like structure. This case was successfully managed with radiofrequency excision followed by chemical matricectomy. This combined approach proved highly effective, offering excellent outcomes with minimal complications.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574755","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":"How Dermatologically Aligned Are Territory Doctors? Assessing Dermatology Referrals in Darwin for Diagnostic and Therapeutic Concordance.","authors":"Nicholas Hayes, Christopher Ross, Crystal Williams, Dev Tilakaratne","doi":"10.1111/ajd.14561","DOIUrl":"https://doi.org/10.1111/ajd.14561","url":null,"abstract":"<p><strong>Background/objectives: </strong>A significant number of dermatological presentations in Australia are managed by general practitioners and non-dermatologist health professionals. This audit examines the agreement between referring physicians and dermatologists in a tropical regional setting to identify opportunities for collaborative education and support.</p><p><strong>Methods: </strong>A retrospective audit was conducted at a privately billing dermatology practice in Darwin, Northern Territory of the referrals for 479 patients from January to March 2022. Particular attention was given to the concordance in diagnoses and treatments initiated. A subset of 131 referrals focused on skin cancer surveillance.</p><p><strong>Results: </strong>Only a third of skin cancer referrals included a provisional diagnosis, but, where provided, this corresponded with the dermatologists' assessments 62% of the time. There was 100% diagnostic concordance for presentations of melasma, molluscum/verruca and hidradenitis suppurativa. For acne, hyperhidrosis, and vitiligo, concordance rates ranged from 72.7%-93%. However, treatment concordance was low across all non-skin cancer conditions, with no treatment prescribed by the referring practitioner for more than one quarter of all patients.</p><p><strong>Conclusions: </strong>This audit identified deficiencies in the diagnosis of skin cancer and the management of other dermatological conditions, indicating opportunities for interprofessional collaboration with targeted education to enhance the management and treatment outcomes of dermatological conditions in the Northern Territory.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567014","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":"Diagnosis of Allergic Contact Dermatitis With the New Zealand Baseline Series.","authors":"Aysha Wilson, Harriet Kennedy","doi":"10.1111/ajd.14555","DOIUrl":"https://doi.org/10.1111/ajd.14555","url":null,"abstract":"<p><strong>Background/objectives: </strong>The New Zealand Baseline Series (NZBS) was developed in 2021 to ensure local patch testing was relevant to the population of New Zealand (NZ). It consists of 30 Core allergens and 30 Extended allergens. The aim of this study was to assess performance of the NZBS in diagnosing allergic contact dermatitis (ACD).</p><p><strong>Methods: </strong>A retrospective review was performed of patients patch tested between February 2022 and December 2023, at a public tertiary dermatology clinic and at a private dermatology clinic in Auckland, NZ. Patient demographics and the positivity rate of each allergen were recorded. Performance of the NZBS in diagnosing ACD was categorised as full detection (all relevant allergens identified), partial detection (some, but not all, relevant allergens identified) and no detection (no relevant allergens identified).</p><p><strong>Results: </strong>In total, 209 patients were included in data analysis; 94 from the public clinic and 115 from the private clinic. In total, 105 patients (50%) were diagnosed with ACD with at least one relevant reaction on patch testing. Of those diagnosed with ACD, testing against the NZBS (60 allergens) had a full detection rate of 66%, partial detection in 21% and no detection in 13%.</p><p><strong>Conclusions: </strong>Patch testing with the NZBS has a good detection rate for diagnosing ACD. However, detection of all relevant allergens requires supplementation with additional series and patients' own products. Regular updates to the series are required to improve diagnostic value in the population. We suggest combining study results, literature review and expert consensus to identify emerging or missed allergens not currently captured by the NZBS.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537946","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 SUNTRAC Tool in Predicting Skin Cancers in Renal Transplant Patients.","authors":"Sarah Seol, Samuel Reddish, Amanda Oakley","doi":"10.1111/ajd.14558","DOIUrl":"https://doi.org/10.1111/ajd.14558","url":null,"abstract":"<p><p>This study evaluates the SUNTRAC tool in guiding initial skin cancer risk stratification among renal transplant patients in New Zealand. Higher retrospectively applied SUNTRAC grades in 219 patients were associated with higher incidence of skin cancer, supporting the tool's effectiveness in guiding initial skin cancer risk stratification in this population.</p>","PeriodicalId":8638,"journal":{"name":"Australasian Journal of Dermatology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526234","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}