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Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonisation with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear. Other factors such as diet have been implicated, but not proven. Facial scarring due to acne affects up to 20% of teenagers. Acne can persist into adulthood, with detrimental effects on self-esteem. There is no ideal treatment for acne, although a suitable regimen for reducing lesions can be found for most patients. Good quality evidence on comparative effectiveness of common topical and systemic acne therapies is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics when used in combination usually improve control of mild to moderate acne. Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne usually need oral antibiotics combined with topical benzoyl peroxide to decrease antibiotic-resistant organisms. Oral isotretinoin is the most effective therapy and is used early in severe disease, although its use is limited by teratogenicity and other side-effects. Availability, adverse effects, and cost, limit the use of photodynamic therapy. New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.

Numerous population-based studies have documented high prevalence of scabies in overcrowded settings, particularly among children and in tropical regions. We provide an estimate of the global burden of scabies using data from the Global Burden of Disease (GBD) Study 2015. We identified scabies epidemiological data sources from an extensive literature search and hospital insurance data and analysed data sources with a Bayesian meta-regression modelling tool, DisMod-MR 2·1, to yield prevalence estimates. We combined prevalence estimates with a disability weight, measuring disfigurement, itch, and pain caused by scabies, to produce years lived with disability (YLDs). With an assumed zero mortality from scabies, YLDs were equivalent to disability-adjusted life-years (DALYs). We estimated DALYs for 195 countries divided into 21 world regions, in both sexes and 20 age groups, between 1990 and 2015. Scabies was responsible for 0·21% of DALYs from all conditions studied by GBD 2015 worldwide. The world regions of east Asia (age-standardised DALYs 136·32), southeast Asia (134·57), Oceania (120·34), tropical Latin America (99·94), and south Asia (69·41) had the greatest burden of DALYs from scabies. Mean percent change of DALY rate from 1990 to 2015 was less than 8% in all world regions, except North America, which had a 23·9% increase. The five individual countries with greatest scabies burden were Indonesia (age-standardised DALYs 153·86), China (138·25), Timor-Leste (136·67), Vanuatu (131·59), and Fiji (130·91). The largest standard deviations of age-standardised DALYs between the 20 age groups were observed in southeast Asia (60·1), Oceania (58·3), and east Asia (56·5), with the greatest DALY burdens in children, adolescents, and the elderly. The burden of scabies is greater in tropical regions, especially in children, adolescents, and elderly people. As a worldwide epidemiological assessment, GBD 2015 provides broad and frequently updated measures of scabies burden in terms of skin effects. These global data might help guide research protocols and prioritisation efforts and focus scabies treatment and control measures. Bill & Melinda Gates Foundation.

The Global Burden of Disease (GBD) Study 2010 estimated the GBD attributable to 15 categories of skin disease from 1990 to 2010 for 187 countries. For each of the following diseases, we performed systematic literature reviews and analyzed resulting data: eczema, psoriasis, acne vulgaris, pruritus, alopecia areata, decubitus ulcer, urticaria, scabies, fungal skin diseases, impetigo, abscess, and other bacterial skin diseases, cellulitis, viral warts, molluscum contagiosum, and non-melanoma skin cancer. We used disability estimates to determine nonfatal burden. Three skin conditions, fungal skin diseases, other skin and subcutaneous diseases, and acne were in the top 10 most prevalent diseases worldwide in 2010, and eight fell into the top 50; these additional five skin problems were pruritus, eczema, impetigo, scabies, and molluscum contagiosum. Collectively, skin conditions ranged from the 2nd to 11th leading cause of years lived with disability at the country level. At the global level, skin conditions were the fourth leading cause of nonfatal disease burden. Using more data than has been used previously, the burden due to these diseases is enormous in both high- and low-income countries. These results argue strongly to include skin disease prevention and treatment in future global health strategies as a matter of urgency.

High-quality epidemiological studies evaluating the burden of cutaneous leishmaniasis worldwide are lacking. We compared the burden of cutaneous leishmaniasis in each country to the overall global burden and assessed the equality of cutaneous leishmaniasis burden across different countries and regions. Data were extracted from scientific literature, hospital sources, country reports, and WHO sources on the prevalence of sequalae of both acute and chronic cutaneous leishmaniasis. Prevalence data were combined with a disability weight to yield years lived with disability. Disability-adjusted life-years (DALYs) are a sum of the years lived with disability and years of life lost (or mortality, assumed to be zero). We compared DALYs due to cutaneous leishmaniasis for 152 countries using standard Z score analysis with Bonferroni correction (p<0·003) and generation of Lorenz curves with a Gini coefficient. In 2013, the global mean age-standardised DALYs for cutaneous leishmaniasis was 0·58 per 100 000 people. Nine countries had significantly greater DALYs from cutaneous leishmaniasis than the mean: Afghanistan (87·0), Sudan (20·2), Syria (9·2), Yemen (6·2), Iraq (6·0), Burkina Faso (4·8), Bolivia (4·6), Haiti (4·1), and Peru (4·0). The Gini coefficient was 0·89. Andean Latin America, North Africa and Middle East, western sub-Saharan Africa, and south Asia had the highest DALYs from cutaneous leishmaniasis. Among males, Palestine had the highest incidence rates (616·2 cases per 100 000 people) followed by Afghanistan (566·4), Syria (357·1), and Nicaragua (354·8). Among females, Afghanistan had the highest incidence rates (623·9) followed by Syria (406·3), Palestine (222·1), and Nicaragua (180·8). Similar proportions of males and females had cutaneous leishmaniasis in most countries with a high incidence. The burden from cutaneous leishmaniasis mainly falls on countries in Africa and the Middle East. Global and national data on the burden of cutaneous leishmaniasis disease are pivotal to promote field studies and initiate behavioural change. Bill & Melinda Gates Foundation.

In 2023, JMIR Dermatology embraced papers treating all topics related to diseases of the skin, hair, and nails. This editorial aims to bring attention and recognize reviewers, staff, and authors for their contributions to the journal. JMIR Dermatology updated the Research Letter format and introduced the In Memorium article type to feature and celebrate highly accomplished and internationally recognized leaders in dermatology. We also summarize the 3 JMIR Dermatology publications from 2023 with the highest Altmetric scores and share what we look forward to in the coming year.

Although cancer mortality has declined among the general population, the incidence of melanoma continues to rise. While identifying high-risk cohorts with genetic risk factors improves public health initiatives and clinical care management, recognizing modifiable risk factors such as social-environmental risk factors would also affect the methods of patient outreach and education. One major modifiable social-environmental risk factor associated with melanoma is ultraviolet (UV) radiation. However, not all forms of melanoma are correlated with sun exposure or occur in sun-exposed areas. Additionally, UV exposure is rarely associated with tumor progression. Another social-environmental factor, pregnancy, does not explain the sharply increased incidence of melanoma. Recent studies have demonstrated that alcohol consumption is positively linked with an increased risk of cancers, including melanoma. This perspective review paper summarizes epidemiological data correlating melanoma incidence with alcohol consumption, describes the biochemical mechanisms of ethanol metabolism, and discusses how ethanol and ethanol metabolites contribute to human cancer, including melanoma.

Pathogenesis of seborrheic dermatitis involves lipid secretion by sebaceous glands, Malassezia colonization, and an inflammatory response with skin barrier disruption. Each of these pathways could be modulated by diet, obesity, and nutritional supplements. Current treatment options provide only temporary control of the condition; thus, it is essential to recognize modifiable lifestyle factors that may play a role in determining disease severity. This study aimed to summarize published evidence on diet, nutritional supplements, alcohol, obesity, and micronutrients in patients with seborrheic dermatitis and to provide useful insights into areas of further research. A literature search of Scopus, PubMed, and MEDLINE (Ovid interface) for English language papers published between 1993 and 2023 was conducted on April 16, 2023. Case-control studies, cohort studies, and randomized controlled trials with 5 or more subjects conducted on adult participants (>14 years) were included, case reports, case series, and review papers were excluded due to insufficient level of evidence. A total of 13 studies, 8 case-control, 3 cross-sectional, and 2 randomized controlled trials, involving 13,906 patients were included. Seborrheic dermatitis was correlated with significantly increased copper, manganese, iron, calcium, and magnesium concentrations and significantly lower serum zinc and vitamin D and E concentrations. Adherence to the Western diet was associated with a higher risk for seborrheic dermatitis in female patients and an increased consumption of fruit was associated with a lower risk of seborrheic dermatitis in all patients. The prebiotic Triphala improved patient satisfaction and decreased scalp sebum levels over 8 weeks. Most studies find associations between regular alcohol use and seborrheic dermatitis, but the association between BMI and obesity on seborrheic dermatitis severity and prevalence is mixed. This review sheds light on specific promising areas of research that require further study, including the need for interventional studies evaluating serum zinc, vitamin D, and vitamin E supplementation for seborrheic dermatitis. The negative consequences of a Western diet, alcohol use, obesity, and the benefits of fruit consumption are well known; however, to fully understand their specific relationships to seborrheic dermatitis, further cohort or interventional studies are needed. PROSPERO CRD42023417768; https://tinyurl.com/bdcta893.

Introduction There is a growing body of evidence that ultraviolet (UV) tanning, whether practiced in indoor tanning salons or outdoors in the sun, is not only linked to detrimental health outcomes but is also addictive through both psychological and physiological mechanisms. In clinical practice, it can be challenging to determine which patients will continue tanning despite being at high risk for developing skin cancer. Our study seeks to identify all available screening questionnaires for tanning addiction that could be used in clinical practice and report on published measures of validity for each screening questionnaire. Methods An exhaustive literature search of EMBASE, PubMed, PsycINFO, and Scopus was performed using search criteria including the concepts “UV” and “Addiction.” The most recent search was performed in March 2024 and included all articles from database inception to the time of the search. Studies were included if they reported on screening questionnaires for UV addiction. Articles were excluded from the study if they did not report primary data or did not report on measures of questionnaire validity. Methodology was created using best practices for scoping reviews. Results After identifying 171 articles, 106 articles underwent full‐text review, and 26 were included in data extraction. We identified nine questionnaires for tanning addiction, with the modified Cut‐down, Annoyed, Guilty, Eye‐opener (mCAGE), and modified Diagnostic and Statistical Manual of Mental Disorders (mDSM) being most frequently reported on, and the Behavioral Addiction Indoor Tanning Screener (BAITS) being the most promising for future use. Conclusions This information should be used to choose questionnaires to be studied against a “gold‐standard” of a panel of psychologists. After defining accuracy of diagnostic tests, studies can be designed to examine interventions for treating tanning addiction, so at‐risk patients can receive specialized therapy, reducing the overall burden of skin cancers.

RRa (95% Cl) Outcomes Effect size: pooled ORb (95% CI) Rituximab vs intervention Prednisolone (1mg/kg vs 0.5 mg/kg) Steroid alone 1 Not estimable Disease control —c 2 0.7 (0.43 to 1.14) Relapse 0.38 (0.12 to 1.15) 3 Not estimable Withdrawal due to adverse event 0.05 (0 to 0.083) Pulsed oral dexamethasone vs placebo Steroid alone 1 1.91 (0.68 to 5.33) Relapse (after discontinuing or stopping) — 2 2.45 (0.31 to 19.74) Withdrawal due to adverse event — Azathioprine vs glucocorticoid (prednisolone) alone 1 1.04 (0.8 to 1.36) Remission 14.45 (4.71 to 43.68) Steroid alone 2 –3.91 (–6.71 to –1.12) Cumulative glucocorticoid dose –11.10 (–14.08 to –9.57) Steroid alone 3 2 (0.19 to 20.9) Withdrawal due to adverse event 0.02 (0 to 0.56) Azathioprine Cyclophosphamide vs glucocorticoid (prednisone/prednisolone) alone Azathioprine 1 0.96 (0.71 to 1.28) Remission 10.10 (2.67 to 38.23) 2 0 (0) Disease control — 3 0.5 (0.05 to 4.67) Relapse 0.60 (0.10 to 3.63) 4 –3.35 (–6.14 to –0.56) Cumulative glucocorticoid dose –8.79 (–11.60 to –5.98) 5 0.33 (0.01 to 7.87) Withdrawal due to adverse events — Cyclosporine vs glucocorticoid (prednisone/methylprednisolone) alone Cyclophosphamide 1 0 (0) Remission 9.59 (2.42 to 37.96) 2 1.06 (0.86 to 1.32) Disease control — 3 0.92 (0.23 to 3.65) Relapse 0.42 (0.08 to 2.28) 4 –0.05 ( –0.18 to 0.081) Cumulative glucocorticoid dose –9.36 (–12.16 to –6.55) 5 0 (0) Withdrawal due to adverse event 0.10 (0 to 4.20) Dapsone vs placebo Cyclophosphamide 1 1.85 (0.61 to 5.63) Remission ( < 7.5 mg prednisone) at 12 months — 2 0.37 (0.05 to 2.95) Withdrawal due to adverse event — Mycophenolate vs glucocorticoid (prednisolone) alone Dexamethasone-cyclophosphamide (6 and 12 months) 1 0.91 (0.67 to 1.24) Remission 47.11 (4.99 to 445.07), 6 months 2 –1.83 (–4.94 to 1.28) Cumulative glucocorticoid dose — 3 1.0 (0.07 to 15.26) Withdrawal due to adverse events 0.06 (0 to 7.06), 6 months Plasma-exchange vs control Dexamethasone-cyclophosphamide (6 and 12 months) 1 7.43 (0.43 to 129.55) Death — 2 1.12 (0.70 to 1.78) Disease control (study definition involving relative healing time) — 3 44.38 (–222.43 to 311.19) Reduction antibody titer (baseline to end protocol, mean difference) — 4 7.2 (0.42 to 124.08) Withdrawal due to adverse events — Azathioprine vs cyclophosphamide 1 1.09 (0.82 to 1.44) Remission 5.48 (0.71 to 42.02), 12 months Dexamethasone-cyclophosphamide (6 and 12 months) 2 1.8 (0.89 to 3.64) Disease control (healing of > 50% of lesions and/or occurrence of < 5 blisters/month) — Dexamethasone-cyclophosphamide (6 and 12 months) 3 1.0 (0.53 to 1.88) Relapse 0.67 (0.04 to 11.13) Dexamethasone-cyclophosphamide (6 and 12 months) 4 1.0 (0.53 to 1.88) Relapse 0.063 (0.12 to 3.47) Mycophenolate 5 –5.64 (–1.04 to –0.79) Cumulative glucocorticoid dose — Mycophenolate 6 3.91 (0.45 to 33.66) Withdrawal due to adverse events 0.05 (0 to 1.18) Mycophenolate Azathioprine vs mycophenolate Mycophenolate 1 1.14 (0.85 to 1.53) Remission 10.80 (3.07 to 38.05) 2 0.72 (0.52 to 0.99) Disease control — 3 –2.07 (–3.54 to –0.60) Cumulative glucocorticoid dose –11.10 (–13.70 to –8.49) 4 3.01 (0.48 to 18.97) Withdrawal due to adverse events — Cyclophosphamide vs cyclosporine 1 0 (0) Remission ( < 10 mg prednisone equivalent) at 5 years — Mycophenolate 2 0 (0) Disease control — Mycophenolate 3 0.4 (0.04 to 3.66) Relapse 0.81 (0.05 to 13.72) Cyclosporine 4 0 (0) Withdrawal due to adverse events 0.04 (0 to 5.92) Cyclosporine Cyclophosphamide vs mycophenolate Cyclosporine 1 1.05 (0.76 to 1.44) Remission 11.96 (1.92 to 74.49) 2 –1.52 (–2.98 to –0.056) Cumulative glucocorticoid dose –11.77 (–14.04 to 9.51) 3 0.33 (0.01 to 7.87) Withdrawal due to adverse events — Topical epidermal growth factor vs placebo 2.35 (1.62 to 3.41) Time to control (hazard ratio) — Cyclosporine Traditional Chinese Medicine 0.75 (–1.12 to 2.62) Antibody titer — Cyclosporine aRR: relative risk. bOR: odds ratio. cThe 2021 network review assessed withdrawal due to adverse events, remission, relapse, and cumulative glucocorticoid dose. The meta-analyses revealed that some interventions were superior for certain outcomes: improved disease remission with mycophenolate relative to azathioprine, a steroid-sparing effect with azathioprine and cyclophosphamide, and a decreased time to erosion control with topical epidermal growth factor (Table 2). Therapeutic Secondary outcome Mycophenolate mofetil Improved disease control compared to azathioprine (RRa 0.72, 95% CI 0.52 to 0.99; NNTb 3.7) Azathioprine Decreased the cumulative glucocorticoid dose (MWDc –3919 mg prednisolone, 95% CI –6712 to –1126) Cyclophosphamide Deceased the cumulative glucocorticoid dose compared to prednisolone alone (MWD –3355 mg prednisolone, 95% CI –6144 to –566) Topical epidermal growth factor Decreased time to erosion healing compared to the control intervention (HRd 2.35, 95% CI 1.62-3.41) aRR: relative risk. bNNT: number needed to treat. cMWD: difference in means. dHR: hazard ratio. DM is also the cocreator of the Pemphigus Disease Area Index and the creator of the Autoimmune Bullous Disease Quality of Life (ABQOL) and Treatment Autoimmune Bullous Disease Quality of Life (TABQOL) questionnaires.

Clear identification of evaluator expertise is essential to ensure meaningful results. [...]additional evaluation of the use of formal algorithms may benefit clinicians in varying levels of care. Abbreviations BCC: basal cell carcinoma CNN: convolutional neural network KC: keratinocyte carcinoma SROC: summary receiver operating characteristic VI: visual inspection --- Edited by CC Chi; submitted 03.08.22; peer-reviewed by H Shakshouk, C Sibbald, J Solomon, V Long; comments to author 23.02.23; revised version received 18.07.23; accepted 03.02.24; published 07.03.24. Jones CM, Athanasiou T. Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests.