Journal of Cutaneous Medicine and Surgery

Sun protection behaviors are shaped by beliefs deeply rooted in culture and traditions. Understanding how beliefs shape sun protection behaviors is crucial for delivering culturally sensitive, congruent care. This is even more important in Indigenous communities where successful health promotion must align with traditional practices and local values. We explored how beliefs, shaped by cultural values, influence sun protection behaviors in Inuit residents of Nunavik.

Qualitative descriptive study using focus groups to collect information was conducted from June to August 2024 in 4 Nunavik communities. Inuit residents of Nunavik were recruited through flyers, word-of-mouth, and health workers’ referrals. Data was analyzed thematically, guided by the theoretical underpinnings of both the health belief model and social cognitive theory.

A total of 106 participants [69 women (65.1%); mean age, 47.1 years (standard deviation 13.3)] took part in 21 focus groups. The “reverse goggles tan” on the face was perceived by participants as a badge of honor and a culturally endorsed marker of identity. This tan pattern, often earned through extended time spent outdoors on the land, was associated with strength, resilience, and a connection to traditional practices such as hunting, fishing, or camping. In this way, visible sun exposure or tan/sunburn was not simply tolerated but valued, impacting clinical approaches to sun safety that define tanning primarily as a health risk.

Sun protection beliefs among Inuit are deeply rooted in cultural identity and land-based practices. Evidence from this study will be used to advance culturally safe, health equity dermatologic care.

Acne is a widely prevalent disorder, with a largely negative impact on the patient’s quality of life. Bacterial etiology and the role of Cutibacterium acne have always been incriminated in in acne pathogenesis. However, in the last decade, deeper understanding of skin microbiome postulates a possible role of other pathogens like Malassezia spp. ketoconazole has shown efficacy to both pathogens.

To study the efficacy of topical ketoconazole 2% in the treatment of acne vulgaris (AV) compared to the standard treatment with adapalene.

Fifty-eight acne patients in 2 groups were asked to blindly apply ketoconazole cream or adapalene gel to the face for 12 weeks. Acne lesion count was performed at baseline, and at the end of the 12 weeks.

At the end of the treatment period, both groups showed significantly similar improvement of comedones, papules, and pustules. Mild side effects were reported that were significantly less among the ketoconazole group.

Topical ketoconazole 2% can provide very promising results as monotherapy in acne comparable to topical retinoid.

Onychomycosis is a fungal infection of the nails. Oral itraconazole inhibits lanosterol-14α demethylase, impairing fungal cell membrane synthesis. The 1064 nm Q-switched Nd:YAG laser produces photothermolytic and photomechanical effects on fungi. Since both act via different mechanisms, their combination may offer additive benefits.

To compare the efficacy of oral itraconazole pulse therapy, 1064 nm Q-switched Nd:YAG laser therapy, and their combination in treating onychomycosis.

Ninety Potassium hydroxide(KOH) mount- and culture-positive patients were randomized into 3 groups: itraconazole pulse (Group A), laser therapy (Group B), or combination therapy (Group C). Patients were followed for 9 months with 3-month interval assessments. Onychomycosis Severity Index (OSI), KOH mount, and culture were evaluated at each visit. Complete cure, clinical and mycological cure, effectiveness, and failure rates were compared.

All groups showed significant OSI reduction from baseline (P < .001), with no significant intergroup differences (P > .05). Clinical cure occurred in 20 patients (74.07%) in Group A, 20 (74.07%) in Group B, and 20 (80%) in Group C. No relapse occurred during follow-up. KOH and culture results did not differ significantly among groups.

Laser therapy, alone or with itraconazole, was as effective as itraconazole pulse therapy. Given its efficacy and absence of systemic side effects, the Nd:YAG laser offers a safe alternative in managing onychomycosis.

Tinea corporis and tinea cruris are frequently misdiagnosed, and studies utilizing deep learning for their diagnosis remain scarce.

This study primarily aimed to develop a deep learning model trained on images from diverse clinical settings to distinguish dermatophytosis from non-dermatophytosis. A secondary objective was to compare its diagnostic performance with that of physicians.

This retrospective diagnostic study analyzed clinical images of dermatophytosis (tinea corporis/cruris) and non-dermatophytosis (eczema, psoriasis, and lichen planus). Dermatophytosis was confirmed by the presence of hyphae, whereas non-dermatophytosis was diagnosed based on clinical and histological findings. The deep learning model utilized a multitask learning approach, integrating classification and segmentation. Adaptive weighting facilitated area-of-interest segmentation, improving attention to relevant features. Model performance was compared with physicians using a 20-image quiz from the test dataset.

A total of 1400 images (600 dermatophytosis, 840 non-dermatophytosis) from 580 Thai patients, predominantly with Fitzpatrick skin types III and IV, were analyzed. In the test dataset, the model achieved an AUC of 0.84 (95% CI: 0.80–0.88), a sensitivity of 0.80 (95% CI: 0.74–0.85), a specificity of 0.71 (95% CI: 0.65–0.76), an accuracy of 0.74 (95% CI: 0.70–0.78), and an F1-score of 0.71 (95% CI: 0.66–0.76). AUC values for deep learning, dermatologists (n = 15), and non-dermatologists (n = 11) on the image quiz were 0.80, 0.78, and 0.75, respectively.

The deep learning model demonstrated effective diagnostic performance for tinea corporis/cruris in Asian skin types, performing comparably to dermatologists as evaluated using a 20-image quiz derived from the test dataset.

To evaluate efficacy and safety of abrocitinib and dupilumab in the treatment of moderate-to-severe atopic dermatitis (AD).

A retrospective analysis of 104 patients with moderate-to-severe AD (January-June 2023) was conducted. Patients received either oral abrocitinib 200 mg/day (n = 51) or subcutaneous dupilumab 300 mg every 2 weeks (n = 53, baseline load 600 mg) for 24 weeks.

At 4, 8, and 12 weeks posttreatment, patients in the abrocitinib group exhibited significantly lower Eczema Area and Severity Index (EASI) scores compared to the dupilumab group (P < .05). Additionally, patients in the abrocitinib group demonstrated significantly lower Numeric Rating Scale for Pruritus (P-NRS) scores at 4, 8, 12, 16, and 24 weeks posttreatment compared to the dupilumab group (P < .05). Furthermore, patients in the abrocitinib group showed significantly lower Dermatology Life Quality Index (DLQI) scores at 4, 8, 12, and 16 weeks posttreatment compared to the dupilumab group (P < .05). Compared with dupilumab group, EASI, P-NRS and DLQI levels in abrocitinib group were more significantly decreased. The incidence of conjunctivitis in dupilumab group was significantly higher than that in abrocitinib group (P < .05). The incidence of nausea in abrocitinib group was significantly higher than that in dupilumab group (P < .05).

Both abrocitinib and dupilumab can significantly relieve pruritus and improve quality of life in patients with moderate-to-severe AD at 24 weeks after treatment, but abrocitinib is more effective in relieving pruritus. Both abrocitinib and dupilumab have high safety, but require attention for gastrointestinal symptoms and conjunctivitis, respectively.

Ultraviolet radiation is responsible for actinic keratoses (AKs) and neoplastic changes surrounding AKs, known as the field of cancerization (FoC). If fields are not appropriately identified and treated, patients remain at risk for developing precancerous lesions and malignant transformation.

To assess the relationship between FoC and the number of AKs.

A cross-sectional study was performed on patients with AKs and FoC. Fields were measured, and field characteristics were recorded.

One hundred patients (mean age 71.2 years; 23% female) with 148 FoC participated. Fields were dry (96%), depigmented (79%), and scaly (88%). Mean number of AKs per field was 6.8 [standard deviation (SD) = 7.3]. Mean FoC size was 75.3 cm² (SD = 75 cm²). One hundred and eleven (75%) of the 148 fields exceeded the Food and Drug Administration recommendations for AK field treatment (≤25 cm²). Number of AKs positively correlated with FoC size (P < .0001). Mean FoC size and the mean number of AKs differed among Investigator Global Assessment (IGA) grades (1-3; P = .0396 and P = .0254, respectively). IGA grade positively correlated with FoC size (P = .0041) and average number of AKs (P = .0022).

When selecting AK therapy, dermatologists may consider FoC size, number of AKs, location, IGA grade, and individual risk factors.

Systemic corticosteroids, particularly oral minipulse dexamethasone (OMP-D), are commonly used to stabilize active vitiligo. Intramuscular triamcinolone acetonide (IMTA), though effective in other dermatoses, has limited studies for vitiligo.

To compare the efficacy and safety of IMTA versus OMP-D in adults with active vitiligo.

This observational study included patients aged 18 to 60 years with clinically active vitiligo. Patients received either IMTA 40 mg monthly or OMP-D 2.5 mg twice weekly for 3 months. Vitiligo extent score (VES) and adverse events were assessed at baseline, months 1, 2, 3, and 6. Biochemical parameters were evaluated at baseline and month 3.

Nineteen patients (9 in the IMTA group and 10 in the OMP-D group) were included. All patients achieved disease stabilization within the first month. The IMTA group showed an earlier onset of repigmentation, evidenced by a significant reduction in VES at month 1. By months 2, 3, and 6, both groups demonstrated significant reductions in VES compared to baseline. Notably, at months 2 and 3, the OMP-D group exhibited a more pronounced decrease in VES (P ≤ .01) than the IMTA group (P ≤ .05). One patient in the IMTA group began to experience vitiligo relapse at month 6. Both treatments were well-tolerated. Cortisol suppression was observed in 1 patient from each group.

IMTA shows promising results, comparable in efficacy and safety to OMP-D for active vitiligo, achieving early disease stabilization and repigmentation. IMTA represents a practical first-line alternative for active vitiligo management.

Lymphatic malformations (LM) are vascular anomalies that can be challenging to manage with new medical therapies emerging. This systematic review examines current medical therapies for pediatric patients with LMs that involve the soft tissues.

MEDLINE, Embase, Cochrane Library, and SCOPUS were searched on April 12, 2024, using variations of the keywords “lymphatic malformation” AND “drug therapy” AND “pediatric.” Language was limited to English, and no date restriction was applied. Treatment success was defined as a reduction in lesion size of over 10%, with complete response (CR) defined as a reduction in size of over 90%.

Our review encompassed 4937 title/abstracts, 436 full-texts and ultimately included 77 studies. Reported success rates were variable, with notable results for alpelisib (oral) (n = 9/9), sirolimus (oral) (n = 257/287), sirolimus (topical) (n = 13/15), acetylsalicylic acid (oral) (n = 18/23), propranolol (oral) (n = 19/29), and sildenafil (oral) (n = 33/71). CR was reported with isotretinoin (n/a) (n = 1/1), cyclophosphamide (iv) (n = 1/2), acetylsalicylic acid (oral) (n = 4/23), sirolimus (topical) (n = 2/15), and sirolimus (oral) (n = 17/287).

Overall, therapies such as alpelisib and sirolimus showed promising results in the reduction of pediatric LM size; however, additional long-term data are needed to validate their efficacy and safety profile. Limitations of our study include heterogeneity and a potential risk of bias.

Hidradenitis suppurativa (HS) is a chronic, immune-mediated skin disorder affecting intertriginous areas, frequently leading to painful nodules, abscesses, sinus tracts, and scarring. In patients with moderate-to-severe disease (Hurley Stages II and III), surgical intervention is frequently required to achieve durable disease control.

To compare and evaluate the surgical interventions employed in Hurley Stage II and III HS by evaluating recurrence rates, postoperative complications, and patient-centred outcomes across different operative modalities.

A comprehensive search of MEDLINE and EMBASE identified studies reporting surgical outcomes in Hurley Stage II and III HS. English-language studies describing postoperative recurrence, complications, and patient-centred outcomes stratified by surgical intervention were included. Of 647 studies screened, 136 studies were included.

A total of 136 studies were included (5,646 procedures). Primary closure had the highest recurrence (38.0%) and complication rates (29.4%). Wide excision (n = 1923) showed moderate recurrence (17.2%) and the highest cosmetic dissatisfaction. Laser-assisted surgery had the lowest complication rate (2.2%) and recurrence rate (5.7%). Flaps and grafts showed higher complication rates but fewer recurrences than primary closure.

Surgical outcomes in advanced HS vary by intervention. Primary closure is associated with the highest rates of recurrence and complications, while wide excision and laser-assisted surgery may offer improved disease control. These findings support individualized surgical planning in Stage II and III HS.