Dermatology

A Joint Venture: Advancing Health Equity for Underserved Communities Through Integrated Dermatology–Rheumatology Clinics (2025)

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Type of publication:

Poster presentation

Author(s):

*Zal Canteenwala; *Dimple Jain; Roshan Amarasena; Joseph Thevathasan; Heli Baho; Kunal Amin

Citation:

British Journal of Dermatology, Volume 193, Issue Supplement 1, July 2025

Abstract:

Autoimmune conditions with overlapping dermatological and rheumatological manifestations present significant management challenges in rural healthcare settings. The aim of this study was to evaluate whether a newly established combined dermatology–rheumatology clinic could improve healthcare access and patient satisfaction while maintaining clinical effectiveness. This service was delivered through cross-trust collaboration between two hospitals situated approximately 30 miles apart, serving a geographically dispersed population with significant access barriers. A 6-month prospective quality improvement initiative was conducted from April to October 2022. Monthly combined consultant-led clinics were evaluated using structured questionnaires assessing patient satisfaction, operational efficiency and educational impact. The service integrated specialist care between distinct National Health Service trusts, centralizing care delivery at a single site to enhance healthcare equity for traditionally underserved rural populations. Data collection included both quantitative metrics and qualitative responses from patients attending these integrated clinics. Data were analysed using descriptive statistics, with 95% confidence intervals (CIs) calculated for key metrics. Qualitative responses were coded thematically to identify common patterns. The study demonstrated unanimous patient satisfaction at 100% (49 of 49, 95% CI 92.7–100) with the combined clinic format. Healthcare access improved significantly, with 92% (45 of 49, 95% CI 78.1–98.3) reporting reduced travel costs and 96% (44 of 46, 95% CI 85.5–99.5) citing streamlined appointment coordination. This impact is particularly significant given the region’s poor public transport infrastructure, which has seen a substantial decline in bus services over the past decade. Employment impact analysis revealed that while 31% (15 of 49, 95% CI 17.7–43.5) of patients previously required time off work for separate appointments, the combined clinic significantly reduced this burden. Qualitative analysis identified consistent themes of improved comprehensive care delivery and enhanced time efficiency. The clinic proved particularly beneficial for managing complex conditions such as psoriatic arthritis and systemic lupus erythematosus, where concurrent specialist evaluation facilitated more precise diagnostic formulation and therapeutic planning. Educational benefits were noted among participating medical students, who reported enhanced understanding of interdisciplinary care and complex disease management. In conclusion, the combined dermatology–rheumatology clinic demonstrates significant efficacy in addressing healthcare inequities in rural settings, with high patient satisfaction and operational efficiency. This cross-trust collaborative model shows particular value in managing complex autoimmune conditions requiring multispecialty input while simultaneously reducing travel burden and improving care coordination. These findings support the broader implementation of integrated specialty clinics across geographically dispersed regions, with potential applications for other specialty combinations.

DOI: 10.1093/bjd/ljaf085.095

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A Joint Venture: Advancing Health Equity for Underserved Communities Through Integrated Dermatology-Rheumatology Clinics (2025)

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Type of publication:

Journal article

Author(s):

*Canteenwala, Zal; Thevathasan, Joseph; Baho, Heli George; Amin, Kunal; *Jain, Dimple; Amarasena, Roshan

Citation:

Cureus 17(10): e94590. doi:10.7759/cureus.94590

Abstract:

Background
Patients with immune-mediated disease often need both dermatology and rheumatology input. Separate appointments can increase travel and delay decisions, particularly in rural settings. We evaluated a monthly combined clinic in a rural UK catchment.

Methods
We conducted a prospective service evaluation (April-October 2022) of a consultant-led, co-located dermatology-rheumatology clinic. Forty-nine consecutive adult attendees completed an anonymous post-visit questionnaire on perceived usefulness, satisfaction, avoided appointments, travel costs, and prior time off work; free-text responses were thematically analysed by two reviewers. We report proportions with exact Clopper-Pearson 95% confidence intervals (CIs), with denominators varying due to item non-response.

Results
We analysed 49 questionnaires. All respondents viewed the joint appointment as a good idea (49/49; 100.0%; 95% CI 92.7-100.0), and all were satisfied (47/47; 100.0%; 95% CI 92.5-100.0). The clinic avoided an additional appointment for 44/46 (95.7%; 95% CI 85.2-99.5) and reduced out-of-pocket travel costs for 39/40 (97.5%; 95% CI 86.8-99.9). Among employed respondents, 19/36 (52.8%; 95% CI 35.5-69.6) reported previously needing time off work for separate specialty visits.

Conclusions
In a rural, cross-trust NHS setting, a combined dermatology-rheumatology clinic was feasible and associated with high patient-reported usefulness and satisfaction, fewer duplicate visits, and lower travel costs. Findings support continued provision and motivate comparative and economic evaluations using routine utilisation and cost data.

DOI: 10.7759/cureus.94590

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Comprehensive Review on Hair Loss and Restorative Techniques: Advances in Diagnostic, Artistry, and Surgical Innovation (2025)

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Type of publication:

Journal article

Author(s):

Mendoza, Luis A; Ocampo, Genaro G; Abarca-Pineda, Yozahandy A; Ahmad Khan, Mubashir; *Ahmadi, Yasmin; Brown, Najaee; Deowan, Denyse; Nazir, Zahra.

Citation:

Cureus. 17(4):e82991, 2025 Apr.

Abstract:

Hair loss, or alopecia, is a complex disorder that impacts individuals worldwide, frequently resulting in significant psychological and social consequences. This review analyzes the multifactorial etiology, recent diagnostic innovations, and emerging treatment alternatives for hair loss management. Alopecia is classified into the cicatricial (scarring) and non-cicatricial (non-scarring) forms, each having a unique underlying pathogenesis, ranging from autoimmune dysregulation, androgenetic mechanisms, and environmental factors. Recent advancements in diagnostics, such as artificial intelligence (AI)-enhanced imaging and biomarker analysis, have improved precision and individualization of treatment. Novel therapies, such as low-dose oral minoxidil (LDOM), topical 5-alpha reductase inhibitors, and Janus kinase inhibitors (JAKi), offer a range of promising options for hair loss management. Non-invasive therapies, such as low-level laser therapy (LLLT) and platelet-rich plasma (PRP) injections, have demonstrated synergistic benefits with existing treatments. Surgical advancements, especially AI-assisted robotic
follicular unit extraction (FUE), enhance precision and outcomes. Emerging trends in regenerative medicine, especially stem-cell-based therapies and AI integration, are influencing the future of customized hair restoration. This review serves as a comprehensive guide, highlighting the use of innovative technologies and therapies in enhancing the accuracy and customization of hair loss treatment.

DOI: 10.7759/cureus.82991

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A Comprehensive Review of the Role of UV Radiation in Photoaging Processes Between Different Types of Skin (2025)

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Type of publication:

Journal article

Author(s):

Brar, Gurjasan; Dhaliwal, Anoop; Brar, Anupjot S; Sreedevi, Manasa; *Ahmadi, Yasmin; Irfan, *Muhammad; Golbari, Rebecca; Zumarraga, Daniela; *Yateem, Dana; Lysak, Yuliya; Abarca-Pineda, Yozahandy A.

Citation:

Cureus. 17(3):e81109, 2025 Mar.

Abstract:

Ultraviolet (UV) radiation significantly contributes to photoaging, with its effects varying among different Fitzpatrick skin types. Light skin (Types I-III) has a natural sun protection factor (SPF) of only 3.3, making it particularly vulnerable to DNA damage, collagen degradation, and skin cancer. Darker skin (Types IV-VI) has a natural SPF of 13.4, providing greater photoprotection while elevating the risk of post-inflammatory hyperpigmentation and delaying skin cancer diagnosis. UVA penetrates deep into the dermis, promoting collagen degradation, whereas UVB causes DNA mutations, increasing the risk of cancer. Eumelanin in darker skin mitigates oxidative stress, while pheomelanin in lighter skin functions as a pro-oxidant, increasing vulnerability to photoaging. Although incidence rates are lower, melanoma is identified at more advanced stages in those with darker skin, resulting in poorer outcomes. Protective measures, such as broad-spectrum sunscreens, antioxidants, and hydration, are crucial for all skin types but necessitate customized strategies. Individuals with lighter skin benefit from SPF 50+ and DNA-repairing compounds, whereas those with darker complexion necessitate SPF 30-50 and pigmentation-focused skincare. Comprehending the biological mechanisms and variations in UV damage facilitates the creation of customized photoprotection solutions, enhancing skin health and mitigating long-term UV-related issues for all skin types.

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Alopecia Areata: Understanding the Pathophysiology and Advancements in Treatment Modalities (2025)

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Type of publication:

Journal article

Author(s):

Abarca, Yozahandy A; Scott-Emuakpor, Renee; Tirth, Jhanavi; Moroz, Oksana; Thomas, George Pandarakalam; *Yateem, Dana; Golbari, Rebecca; Aphia, Ninigail; Lysak, Yuliya; Narasimhan, Niketa; Siddiqui, Humza F.

Citation:

Cureus. 17(1):e78298, 2025 Jan.

Abstract:

Alopecia areata (AA) is an autoimmune condition that presents with non-scarring hair loss affecting multiple patients worldwide during their lifetime. It ranges from well-defined patchy to diffuse total hair loss, impacting all hair-bearing areas of the body. AA most commonly predominantly manifests on the scalp. The pathophysiology of AA is complex and multi-faceted. The findings of our review article were consistent with the recent literature, delineating autoimmunity, genetic susceptibility, and environmental aspects to be the contributing factors. One of the main causes of AA is believed to be the disruption in the immune privilege of the hair follicles. Multiple genetic loci involved in hair follicle maturation and immune process have been linked to the development of AA as evidenced by several studies. It has been postulated that psychological stressors, smoking, alcohol consumption, sleep disturbances, gut microbiota, and drugs play a role in the pathogenesis of AA by exacerbating the immune response against the hair follicles. AA is a clinically diagnosed disorder. Topical, intra-lesional, and oral corticosteroids, topical and oral minoxidil, cyclosporine, and other immune therapy drugs are widely accepted first-line treatment options, although incomplete remission and relapses are common. Recently JAK-2 inhibitors and mesenchymal stem cell exosomes have shown promising results, potentially treating severe and refractory hair loss. AA has a bidirectional relationship with psychological symptoms as it can lead to social anxiety and depression, which in turn can aggravate hair loss. Hence, it is crucial to implement a holistic approach to managing AA including topical and systemic therapies, psychological counseling, and lifestyle modifications. It is imperative to fully declinate the pathophysiological mechanisms of the disease and formulate therapies in future research to help clinicians and dermatologists devise definitive guidelines to treat the condition for long-term remission.

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Sounds fishy: a case of Mycobacterium marinum infection secondary to infliximab infusion (2024)

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Type of publication:
Conference abstract

Author(s):
*Khan A.; *Jain D.

Citation:
British Journal of Dermatology. Conference: 104th Annual Meeting of the British Association of Dermatologists, BAD 2024. Manchester United Kingdom. 192(Supplement 1) (pp i157), 2024. Date of Publication: July 2024.

Abstract:
Mycobacterium marinum is a waterborne, atypical mycobacterium that is known to cause infection in fish, mice and bats. M. marinum in humans is rare and can manifest as a skin/soft tissue infection following exposure of damaged skin to polluted water from aqueous environments such as swimming pools, wells, rivers and fish tanks. We report the case of a 73-year-old White man with a history of collagenous colitis on treatment with infliximab. He presented with pustules, ulcerated plaques and nodules on his left wrist and left deltoid as well as some nodules on the right forearm in a sporotrichoid distribution following a second infliximab infusion. A skin biopsy revealed prominent dermal abscess formation with extension of acute inflammation into the subcutis with fat necrosis. Small granulomas were also seen at the edges without caseating necrosis. Numerous acidfast bacilli were present on a Ziehl-Neelsen stain in keeping with mycobacterial infection. He was started empirically on rifampicin, ethambutol and clarithromycin; however, minimal improvement was noted. A subsequent mycobacteria microscopy, culture and sensitivity revealed sensitivity to ciprofloxacin, and fortunately his skin responded well to this. Tumour necrosis factor (TNF)-alpha inhibitors such as infliximab are widely used treatments in managing chronic inflammatory dermatoses as well as inflammatory bowel disease. These agents increase the risk of granulomatous disease. A diagnosis of M. marinum is challenging and multiple biopsies and tissues cultures may be necessary for identifying the correct diagnosis. Although this case did not have any typical exposures to M. marinum, it highlights the importance of screening and educating patients regarding the risks of certain environmental exposures prior to commencing anti-TNF treatments.

Treatment of periorbital veins with vascular laser: A systematic review and retrospective case series. (2024)

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Type of publication:
Systematic Review

Author(s):
Mandavia, Rishi; Ahmed, Muhammad; *Parmar, Dilen; Cariati, Massimiliano; Shahidi, Sepideh; Lapa, Tatiana.

Citation:
Journal of Cosmetic Dermatology. 2024 Apr 24.

Abstract:
INTRODUCTION: Vascular lasers may represent a promising treatment option for periorbital veins. This article aims to: (1) systematically review the literature on the safety and effectiveness of vascular laser treatment for periorbital veins and (2) assess safety and effectiveness through a retrospective case series. METHODS: Systematic review: Articles that assessed the safety and effectiveness of vascular laser treatment for periorbital veins were included and quality assessed using the Downs and Black checklist. CASE SERIES: Patient records were retrospectively reviewed from January 2020 to November 2023 to identify all patients who underwent laser treatment for periorbital veins. Outcomes assessment included percentage improvement, patient overall satisfaction and adverse effects. RESULTS: Systematic review: Three articles were included, discussing treatment of blue, periorbital veins using a 1064 nm Nd:YAG laser. Patient Fitzpatrick skin Types I-IV were treated with high patient satisfaction rates and complete clearance of treated veins. Adverse effects included pain, erythema, mild oedema, urticaria and blister formation. Quality of included studies ranged from 7 to 14 out of 21 points. CASE SERIES: Thirty-four patients with skin Types I-V were included. Blue and red periorbital veins were treated using 1064 and 532 nm wavelengths respectively. Mean percentage improvement was 4.8 (complete resolution) and patients' overall satisfaction was ranked 3 (completely satisfied). Adverse effects included erythema, oedema, and bruising. CONCLUSION: Treatment of red and blue periorbital veins using 532 and 1064 nm vascular lasers appears a safe treatment option. The procedure has a short recovery time, with patients able to resume normal activities within 1 day of treatment.

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Mastering the Art of Dermatosurgery: Aesthetic Alchemy in Medical Excellence (2023)

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Type of publication:
Journal article

Author(s):
*Ekomwereren, Osatohanmwen; Shehryar, Abdullah; Abdullah Yahya, Noor; Rehman, Abdur; Affaf, Maryam; Chilla, Srikar P; Kumar, Uday; Faran, Nuzhat; I K H Almadhoun, Mohammed Khaleel; Quinn, Maria; Ekhator, Chukwuyem

Citation:
Cureus. 15(11):e49659, 2023 Nov.

Abstract:
Dermatosurgery, a specialized branch within dermatology, has traversed an extraordinary journey through time, shaped by ancient practices, technological leaps, and shifting societal perceptions. This review explores the evolution of dermatosurgery, highlighting its profound transformation from addressing solely medical concerns to seamlessly integrating aesthetics. From its roots in ancient civilizations, where cultural traditions laid the foundation for modern techniques, to the twentieth-century technological renaissance, marked by innovative tools and enhanced understanding of skin anatomy, dermatosurgery has emerged as a dynamic field. Societal notions of beauty and health have significantly influenced dermatosurgery, blurring the lines between medical necessity and elective aesthetic procedures. The delicate balance between satisfying aesthetic desires and upholding medical ethics is a central challenge that
dermatosurgeons face today. Open dialogue between practitioners and patients as well as psychological support plays a pivotal role in navigating this terrain. The training and ethics associated with dermatosurgery have evolved to meet the increasing demand for specialized procedures. Maintaining a focus on patient safety and satisfaction remains paramount as commercial pressures and disparities in access to care loom. Upholding best practices and standards in the field is essential for ensuring consistent, high-quality care for all patients. Looking ahead, dermatosurgery stands on the brink of a transformative era, marked by non-invasive techniques, artificial intelligence (AI) integration, and personalized medicine. The field's ability to harmonize medical science with aesthetic artistry is evident in various case studies, showcasing the intricate balance dermatosurgeons strike between addressing medical concerns and fulfilling aesthetic desires. As dermatosurgery continues to evolve, it promises to provide patients with even more precise, tailored treatments that enhance both their physical well-being and aesthetic satisfaction.

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A study analyzing the clinical, histopathological and immunological profile of patients with cutaneous vasculitis: IgA vasculitis and IgA-negative vasculitis (2023)

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Type of publication:Journal article

Author(s):Kakroo S.N.; Khan M.A.; Beg M.A.; *Kakroo B.

Citation:Journal of Pakistan Association of Dermatologists. 33(4) (pp 1562-1568), 2023. Date of Publication: October 2023.

Abstract:Background Skin is frequently involved in small-vessel vasculitis. Based on immunofluorescence studies, it can be IgA type (Henoch-Schoenlein purpura) or IgA-negative type i.e. leukocytoclastic vasculitis. Clinically, palpable purpura is the hallmark of the disease. Both subtypes can be associated with variable systemic involvement. Objective To compare the clinical, histopathological and immunological profile of patients with IgA and IgA-negative vasculitis with special reference to renal involvement. Methods Seventy-five patients presenting to the outpatient clinic of a tertiary care hospital with a clinical diagnosis of palpable purpura were enrolled in the study. All patients had a thorough clinical examination and detailed history, and results were documented on a pre-made proforma. Results On direct immunofluorescence findings, 40 patients had IgA vasculitis and 35 IgA-negative vasculitis. The mean age of presentation was 38.8 years in IgA vasculitis and 54.3 years in IgA-negative vasculitis. IgA vasculitis presented with frequent cutaneous (n=27, 67.5%, itching or pain) and systemic symptoms (n=18, 45%, abdominal and joints) seventeen (42.5%) as compared to IgA-negative subgroup (25.4% and 11.4%, respectively). Morphologically, palpable purpura was seen in both groups, but 11.4% patients in IgA-negative vasculitis group presented with ulcerated lesions. Patients of both groups had vessel wall fibrin deposition and necrosis, inflammatory infiltrate in the vessel wall, erythrocyte extravasation, unclear dust and endothelial swelling in descending frequencies. Complement 3 (C3) was the commonest immunoreactant (n=71; 94.7%) followed by fibrinogen (n=59; 78.7%) and immunoglobulin A (IgA) [n=40; 53.3%]. Abnormal urine microscopy findings were detected in (n=28; 70%) patients with IgA vasculitis and in (n=2; 5.7%) with IgA-negative vasculitis. Serum creatinine was raised in 12 (30%) patients with IgA vasculitis and 7 (20%) patients with IgA-negative vasculitis. Other laboratory tests had similar frequency in two groups. Conclusion IgA vasculitis was seen in a relatively younger age group in comparison to IgA-negative vasculitis. C3 was the commonest immunoreactant staining the blood vessel wall followed by fibrinogen and IgA. Renal involvement occurred more frequently in the IgA vasculitis.

A case of disseminated herpes zoster in an immunocompetent child (2023)

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Type of publication:
Conference abstract

Author(s):
*Jacob M.A.; *Kelly S.

Citation:
British Journal of Dermatology. Conference: 103rd Annual Meeting of the British Association of Dermatologists. Liverpool United Kingdom. 188(Supplement 4) (pp iv156-iv157), 2023. Date of Publication: June 2023

Abstract:
Herpes zoster (HZ) caused by the reactivation of varicella-zoster virus (VZV) affects mainly the adult population. The incidence is low in children (0.45 cases per 1000 individuals annually), especially in the immunocompetent. It is said to be disseminated when there are >20 lesions outside the primary and adjacent affected dermatome. We present this case to highlight a rare complication of cutaneous dissemination in a previously healthy child with HZ, following in utero exposure to varicella at 28 weeks' gestation. A 15-year-old boy presented with painful blisters in the T2 dermatome of 1 week's duration, which later spread to trunk, extremities and face. This was associated with fever and neuralgia. There was no previous history of varicella and no recent contact history. He had no significant past medical history and was not on any medications. Antenatal history revealed that his mother had varicella at 28 weeks' gestation and was treated with aciclovir. He was febrile on admission (39degreeC). There were coalesced vesiculopustules and crusted lesions with marked perilesional erythema in the T2 dermatome. In addition, disseminated vesicular lesions were seen on the trunk, extremities and face. Remaining systemic examination was unremarkable. C-reactive protein was elevated. Complete blood count and renal function tests were normal. Liver function tests, namely alanine transaminase and 7gamma;-glutamyl transferase were elevated. Blood culture showed no growth. Varicella-zoster IgG was positive. Viral swab (polymerase chain reaction) from the skin lesions was positive for varicella-zoster DNA. Infectious serology for HIV, hepatitis B and hepatitis C was negative. Antinuclear antibody and antineutrophil cytoplasmic antibodies were negative. A clinical diagnosis of HZ with cutaneous dissemination was made, and he was treated with intravenous aciclovir. Intravenous antibiotics were added for suspected secondary bacterial infection. Disseminated zoster is less common in children and mainly occurs in patients with underlying immunodeficiency like HIV, immunosuppressive drug use or malignancy. In immunocompetent children, this can happen when primary infection (varicella) has occurred in utero or the first year of life due to the low response in specific varicella-zoster virus immunity. Complications like cutaneous dissemination due to viraemia are rare in healthy children, but can affect 2-10% of immunocompromised patients. It occurs 3-4 days after the onset of dermatomal lesions. It is important to look for other complications, especially in the immunocompromised, as viraemia can affect the brain, kidneys, lung and liver. Sequelae like postherpetic neuralgia is rare, but it is important to follow-up these children to look for its development.

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