Liu ZF, Yang H, Lin L
… +6 more, Tyagi A, Sylivris A, Shastry A, Kuruvilla NS, Gin D, Chew CY
Australas J Dermatol
· 2026 May · PMID 41792871
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Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe skin reaction with high mortality, most often triggered by medications. Early identification of patients at risk is essential for guiding tr...Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe skin reaction with high mortality, most often triggered by medications. Early identification of patients at risk is essential for guiding treatment. The SCORTEN score, comprising seven clinical and laboratory variables, is widely used to predict mortality but may have limitations across different populations. We conducted a systematic review and meta-analysis to assess SCORTEN's predictive accuracy and identify additional blood biomarkers associated with mortality in SJS/TEN. The primary aim was to evaluate the prognostic performance of individual SCORTEN parameters in adult SJS/TEN patients. The secondary aim was to explore modified SCORTEN cut-offs and identify additional laboratory biomarkers associated with mortality. We searched Medline, Embase and the Cochrane Library up to March 2024 for relevant studies. Eligible studies were assessed for quality and pooled analyses were conducted using a random-effects model. A total of 45 studies with 3467 patients were included. All seven SCORTEN variables were significantly associated with in-hospital mortality. Additionally, elevated serum creatinine, a marker of kidney function, was independently associated with increased risk of death. Other biomarkers showed potential, but data were insufficient for pooled analysis. Our results reinforce the value of SCORTEN and suggest serum creatinine may enhance risk prediction. Improved prognostication in SJS/TEN could support earlier intervention and better use of critical care resources. Further research is needed to validate new biomarkers. Trial Registration: PROSPERO registration number: CRD42022344691.
BACKGROUND: Vulval Lichen Sclerosus (VLS) is a chronic inflammatory condition requiring lifelong management to prevent severe complications including malignancy. A shared care model between general practitioners (GPs) an...BACKGROUND: Vulval Lichen Sclerosus (VLS) is a chronic inflammatory condition requiring lifelong management to prevent severe complications including malignancy. A shared care model between general practitioners (GPs) and public non-GP specialists (dermatologist or gynaecologist) for patients with stable LS would alleviate the demand on public vulval services. This study aims to assess GPs' level of comfort in performing vulval examinations for patients with VLS which would underpin the feasibility of shared care. It also explores GPs' level of confidence in vulval health, preferences for future vulval training and perspectives on rapid access pathways which would enable a successful shared care approach. METHOD: Online survey invitations were sent to GPs across South Australia via email, GP social media groups and health network newsletters between October and December 2024. Survey questions focused on GPs' prior training, confidence in assessing LS, preferences for additional training and referral pathways. Descriptive statistics were used to describe survey responses while Chi-squared and Fisher's exact test statistical methods were used to identify associations between explanatory variables and outcome variables. Additional binary logistic regression analysis was used to model odds ratios, confidence intervals and corresponding p-values for associations between the dependent and independent variables. RESULTS: A total of 132 complete responses were received. 74% of GPs were comfortable undertaking vulval examinations for patients with VLS while 26% were not. Stage of training, scope of practice and previous additional training in women's health had statistically significant associations (p < 0.05) with this outcome. Detecting malignancy and performing vulval biopsy were skills with lower reported levels of confidence. Most GPs desired future upskilling in vulval health, particularly in the form of specialist led face-to-face and webinar-based education, while the most preferred rapid access pathway was an e-referral (or email) with a phone call to the specialty registrar as needed. If additional training, resources and rapid access pathways were provided, most GPs (91%) were inclined to participate in shared care. CONCLUSION: Most GPs in this study were comfortable in undertaking vulval examinations for patients with VLS and expressed an inclination to participate in shared care. Further efforts are required to provide GPs with additional training and rapid access pathways for specialist input to facilitate a safe and effective shared care model.
BACKGROUND/OBJECTIVES: Post-inflammatory hyperpigmentation (PIH) is a frequent sequela of acne in patients with skin of colour (SOC). While sunscreen is widely recommended for PIH prevention, little is known about real-w...BACKGROUND/OBJECTIVES: Post-inflammatory hyperpigmentation (PIH) is a frequent sequela of acne in patients with skin of colour (SOC). While sunscreen is widely recommended for PIH prevention, little is known about real-world sunscreen practices in this group. This study aimed to evaluate sunscreen use, barriers and factors influencing adherence in SOC patients with acne-related PIH. METHODS: A cross-sectional survey was conducted on 51 SOC patients (FST III-VI) who attended a dermatology clinic in Australia between February and June 2025. An investigator-developed questionnaire assessed sunscreen use frequency, reapplication, application amount, tinted sunscreen uptake, and perceived barriers. Associations were examined using chi-square/Fisher's exact tests and logistic regression analyses. Analyses were exploratory. RESULTS: Daily sunscreen use was inconsistent, with 39.2% applying occasionally (< 3 times/week) and only 33.3% applying daily. Reapplication was inadequate, with 57.5% (23/40) reapplying only when outdoors for prolonged periods. Most patients (79.5%, 31/39) applied less than one finger-length to the head and neck. Tinted sunscreen uptake was low, though shade match was a key determinant of adherence among users. Few patients recognised sunscreen's role in PIH prevention (19.6%), with professional advice emerging as an important factor associated with correct belief (no advice vs. advice, OR 0.04, p = 0.01). CONCLUSIONS: Sunscreen use among SOC patients with acne-related PIH was suboptimal, with inadequate daily use, reapplication, and quantities applied. Clinician-led education was a key factor in influencing patient beliefs, highlighting the need for targeted counselling. Expanding shade-diverse, cosmetically elegant, tinted formulations may further improve adherence in SOC populations.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are typically triggered by systemic medications but can also result from topical agents. In this systematic review of SJS/TEN cases caused by topical ag...Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are typically triggered by systemic medications but can also result from topical agents. In this systematic review of SJS/TEN cases caused by topical agents, the drug culprits, disease characteristics, and outcomes were comparable to systemic cases. Our findings highlight that topical formulations, though generally considered safer, can induce SJS and TEN, underscoring the need for clinician awareness, early recognition and accurate reporting.
In 2024, a 75-year-old Chinese man presented with a complex dermatological case involving features of both disseminated superficial porokeratosis (DSP) and bullous pemphigoid (BP). The patient exhibited a long-standing h...In 2024, a 75-year-old Chinese man presented with a complex dermatological case involving features of both disseminated superficial porokeratosis (DSP) and bullous pemphigoid (BP). The patient exhibited a long-standing history of pruritic annular brownish plaques with hyperkeratotic borders, alongside recent blistering eruptions on his hands, feet and trunk. Diagnostic investigations revealed distinct histopathological and immunological markers characteristic of both conditions. Treatment with intravenous methylprednisolone, topical corticosteroids and tretinoin cream led to rapid improvement of BP lesions but also DSP plaques, culminating in complete resolution without new eruptions during corticosteroid tapering. Dermoscopic examination unveiled unique features, including the 'double-track sign', dilated capillaries and a central yellowish translucent area with haemorrhagic crusts, underscoring the diagnostic utility of dermoscopy in elucidating this rare co-presentation. This case highlights the diagnostic challenges and therapeutic considerations in managing concurrent DSP and BP, shedding light on potential exacerbating factors and treatment outcomes deserving further exploration in dermatological research.
Australas J Dermatol
· 2026 May · PMID 41772818
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Cutaneous melanomas arise through a number of causal pathways, all of which involve exposure to sunshine or artificial ultraviolet (UV) radiation to some extent. Their initiation also depends on host factors that determi...Cutaneous melanomas arise through a number of causal pathways, all of which involve exposure to sunshine or artificial ultraviolet (UV) radiation to some extent. Their initiation also depends on host factors that determine susceptibility to melanoma, and whether the UV exposure is intermittent or chronic. The question of whether occupational sun exposure causes melanoma has important implications for employees, employers and litigants. This review assessed the evidence linking melanoma development to occupational exposure to sunlight. Electronic literature searches of Medline, Embase and Cochrane CENTRAL to 6 May 2025 were conducted using terms for occupational solar exposure and melanoma. The reviewed observational studies of occupational sun exposure and melanoma development reported both increased and reduced risk. Many of these studies had limited sample sizes and few considered important details such as anatomical site and age, preventing exploration of features that might explain the differing results. The most robust pooled analysis suggested a 45% increase in the risk of melanoma with occupational exposure when studies included the lentigo maligna melanoma (LMM) subtype (relative risk (RR) 1.45, 95% CI 1.08-1.94). When studies excluded LMM the risk of melanoma was reduced (RR 0.69, 95% CI 0.55-0.86). Very few studies have considered occupational sun exposure in the context of the acknowledged causal heterogeneity for melanoma, with the role of chronic sun exposure now understood to differ by anatomical site of tumour, age at diagnosis, and other features. Large-scale cohort studies reporting risks for the various melanoma subtypes and stratifying for other important risk factors are required. Until the results of such studies are available the contribution of occupational sun exposure to melanoma development in any given patient will continue to require considered, personalised assessment.
BACKGROUND/OBJECTIVES: The Australasian College of Dermatologists implemented a supervisory rotational model project funded by the Commonwealth Government to build capacity, quality, and sustainability of specialist derm...BACKGROUND/OBJECTIVES: The Australasian College of Dermatologists implemented a supervisory rotational model project funded by the Commonwealth Government to build capacity, quality, and sustainability of specialist dermatology training in the Northern Territory. This project aimed to contribute to evidence-based literature on rural workforce strategies in Australia,; highlight capacity challenges facing dermatology care in the Northern Territory, and identify opportunities to strengthen training and service delivery. METHODS: A qualitative evaluation, including semi-structured interviews and an anonymous online survey, was undertaken with a non-probabilistic purposive sampling strategy. Fourteen interviews were conducted with visiting consultant dermatologists, trainee dermatologists, and local dermatology staff in Darwin, Northern Territory. Two researchers used inductive thematic coding to analyse interview transcripts and triangulate findings with survey results. RESULTS: This project increased supervisory and training capacity, produced a documented reduction in dermatology waitlists, enabled increased remote outreach visits and access, and enhanced educational opportunities for junior doctors. Five main themes emerged: (1) acceptability of the supervisory rotational model across different domains; (2) impacts of administrative processes on acceptability of the model; (3) recognition of an 'invisible' cohort of patients and impact on workload; (4) sustainability; and (5) scalability of the supervisory rotational model. CONCLUSION: This supervisory rotational model was acceptable for both trainee and visiting consultant dermatologists and enhanced the capacity of dermatology service delivery and training in the Northern Territory. With sustainable funding, this model can support longer-term efforts towards building a homegrown rural workforce and facilitate continuity to provide culturally safe care.
INTRODUCTION: Late scar widening is a common but underrecognized complication of dorsal fusiform excisions, especially in young adults with high dermal elasticity and physically active lifestyles. OBJECTIVE: To evaluate...INTRODUCTION: Late scar widening is a common but underrecognized complication of dorsal fusiform excisions, especially in young adults with high dermal elasticity and physically active lifestyles. OBJECTIVE: To evaluate the effectiveness of Dermo-epidermally Anchored Trapezoidal Excision (DATE), a technique designed to minimise long-term scar diastasis. METHODS: This prospective, two-arm, open-label study was conducted between January 2015 and February 2022 at the "Celio" Military Hospital, Rome, Italy. Healthy adults aged 18-31 years undergoing elective dorsal trunk excisions were allocated by surgical scheduling to either standard fusiform excision (control) or the DATE technique (experimental). Scar widening was evaluated at 12 months using the Scar Diastasis Index (SDI). RESULTS: A total of 273 patients were enrolled (126 control, 147 experimental), with comparable baseline characteristics. At 12 months, the DATE arm showed a significantly lower mean SDI (22.10 ± 7.05) compared to the control group (63.35 ± 11.52; p < 0.001). Patients in the experimental group experienced temporary swelling along the scar line or small stitch marks, but these resolved within a few weeks. CONCLUSIONS: DATE is a safe, reproducible, and cost-effective technique. In young adults with high aesthetic expectations, it led to significantly narrower scars than the standard fusiform approach and may represent the preferred option for dorsal excisions.
Australas J Dermatol
· 2026 May · PMID 41736182
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BACKGROUND/OBJECTIVES: Convolutional neural networks (CNNs) are known, due to inherent flaws in their design, to be subject to classification error. Many of these shortcomings in classification performance were addressed...BACKGROUND/OBJECTIVES: Convolutional neural networks (CNNs) are known, due to inherent flaws in their design, to be subject to classification error. Many of these shortcomings in classification performance were addressed in 2017 with the introduction of capsule networks (CNs). The objective of this investigation is to determine the classification performance of a CN with respect to dermoscopic images of benign and atypical melanocytic lesions. We implement two kinds of training data for comparison: first, real images; and second, by utilising the CNs' autoencoder, a large number of synthetic images. METHODS: 500 melanocytic lesion images (250 benign and 250 sufficiently atypical to warrant excision) were obtained from ISIC and PH2 Datasets. Images were randomly split equally for training and testing, and equally split between the classification categories. A CN was developed, trained and tested on these data. The CN was then trained on 3000 synthetic images (with an equal number of images in each classification category). The newly trained CN was then tested on the original test images. RESULTS: The CN trained on the real images yielded a DOR (diagnostic odds ratio) of 51.0, a result which is comparable and, in many cases, superior to those reported for CNNs. The same CN trained on the synthetic images yielded a DOR of 71.3, a result which is significantly higher than the result obtained with real-image training. CONCLUSIONS: Since the effectiveness of automated melanocytic lesion image classification is limited by the difficulty in obtaining large numbers of high-quality training data, our results support the idea that training a classifier utilising synthetic images-where large numbers of quality images can be easily generated-is inherently advantageous. Given its advantages over a CNN, and trained on a very large number of synthetic images of melanocytic lesions, a CN classifier thus has the potential, only limited by computer resources, to yield previously unseen levels of generalisation performance.
BACKGROUND/OBJECTIVES: The Royal Brisbane & Women's Hospital (RBWH) in Queensland, Australia provides definitive care for all diagnosed adult patients with SJS/TEN within its catchment. In this retrospective cohort study...BACKGROUND/OBJECTIVES: The Royal Brisbane & Women's Hospital (RBWH) in Queensland, Australia provides definitive care for all diagnosed adult patients with SJS/TEN within its catchment. In this retrospective cohort study, we identified all SJS/TEN cases at RBWH over a 10-year period. We assessed disease incidence and the relationship of 3 variables (disease severity, time taken to admission to the definitive tertiary centre and systemic immunosuppressive treatment) to the outcome of mortality. METHODS: Patients were identified via ICU MetaVision dermatology entries, discharge coding and manual admission recording. Age, gender, culprit drug, time to definitive tertiary centre admission, total body surface area (TBSA), SCORTEN, complications, systemic therapy utilisation and mortality were recorded. Relationships between variables were analysed using Spearman's Rank correlations and logistic regression. RESULTS: Fifty-two cases over 10 years met inclusion criteria (37 TEN, 8 SJS/TEN and 7 SJS). Mortality (9.6%; 5 deaths) was low compared to published rates. Multivariate regression analysis revealed a significant relationship between increased SCORTEN and mortality as expected. There was no significant relationship between systemic treatment and mortality or between 'days to definitive care' and mortality. Modelling accounted for 44% of variance in mortality. CONCLUSIONS: SJS/TEN incidence matched published rates. Severity of SJS/TEN and mortality were correlated. Neither systemic immune suppression nor time taken to be admitted to the definitive tertiary centre correlated with mortality. Expert multidisciplinary care in the RBWH ICU and Burns Unit is likely to contribute to the excellent mortality outcomes found. Limitations of the study included its retrospective cohort design, that it was performed in a single centre, and the relatively small sample size leading to statistically insignificant findings. Our results should bolster growing data to improve understanding of this rare but serious condition.
We report a case of Steatocystoma Multiplex Suppurativa (SMS), a rare condition that can mimic hidradenitis suppurativa (HS). We also present a review of the surgical and medical therapies, including potential biologic a...We report a case of Steatocystoma Multiplex Suppurativa (SMS), a rare condition that can mimic hidradenitis suppurativa (HS). We also present a review of the surgical and medical therapies, including potential biologic agents.
BACKGROUND/OBJECTIVES: Management of close or involved margins following non-melanoma skin cancer (NMSC) excision remains variable in Australia. While national guidelines emphasise complete excision, they provide limited...BACKGROUND/OBJECTIVES: Management of close or involved margins following non-melanoma skin cancer (NMSC) excision remains variable in Australia. While national guidelines emphasise complete excision, they provide limited direction when margins are close or involved. We aimed to validate a structured, evidence-informed algorithm to guide decision making and reduce recurrence risk. METHODS: This retrospective cohort study was conducted across two tertiary centres in Brisbane, Australia. Adult patients who underwent excision of biopsy-proven basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (cSCC) between 1 April 2018, and 1 July 2021, were included. Of 828 excised lesions, 89 had close or involved margins. Management pathways and 2-year recurrence-free survival (RFS) outcomes were analysed. Superficial lesions (intra-epidermal carcinoma and superficial BCC) were excluded from recurrence analysis. Fisher's exact test was used to assess differences in recurrence rates. RESULTS: Eighty-seven of 89 lesions (97.8%) were managed in accordance with the proposed algorithm. These cases achieved a 2-year RFS rate of 98.8%. The two cases managed outside algorithm recommendations both recurred. This difference was statistically significant (p = 0.002). Outcomes compare favourably with published Australian data. CONCLUSIONS: This algorithm-based, risk-stratified approach supports consistent and safe management of NMSC lesions with close or involved margins. Its real-world application achieved high RFS. Broader implementation and prospective validation may contribute to optimising outcomes and guiding future practise.
Whilst Reactive Infectious Mucocutaneous Eruption (RIME) displays a low mortality rate, the condition results in significant morbidity and resource allocation, including prolonged hospital admission. As such, early diagn...Whilst Reactive Infectious Mucocutaneous Eruption (RIME) displays a low mortality rate, the condition results in significant morbidity and resource allocation, including prolonged hospital admission. As such, early diagnosis and optimisation of treatment is imperative. A retrospective review of paediatric patients in South Australia suffering with RIME across 2023 and 2024 was conducted, analysing trends in aetiology, diagnosis, management and long-term outcomes. Our findings emphasise the need for early input from a specialist paediatric dermatologist and highlight the need for vigilance during times of Mycoplasma pneumoniae outbreak.
BACKGROUND/OBJECTIVES: The rising incidence of skin cancer places a significant burden on Australia's health workforce. To support workforce planning, we estimated the supply of dermatologists and general practitioners (...BACKGROUND/OBJECTIVES: The rising incidence of skin cancer places a significant burden on Australia's health workforce. To support workforce planning, we estimated the supply of dermatologists and general practitioners (GP) working in skin cancer medicine, service demand and need across Queensland in 2023. METHODS: We built a supply-, demand- and needs-based health workforce model using publicly available data. We collated data on the numbers of clinicians and clinical full-time equivalents (FTE), Medicare-reported skin cancer services and melanoma incidence. We quantified health workforce supply and clinical workload, clinical FTE per 100,000 population, number of Medicare claims for skin cancer services per clinical FTE and incident cases of melanoma per clinical FTE for all of Queensland and across 19 Level 4 Statistical Areas. RESULTS: Queensland had 7179 GPs (852 adjusted FTE) and 124 (71 adjusted FTE) dermatologists servicing 5,527,369 residents, with an estimated 17 FTE skin cancer clinicians per 100,000 population. Ten (53%) SA4 areas had no dermatologists, with none residing in central or western Queensland. Seven of the nine SA4 levels with dermatologists were in southeast Queensland (78%), and 47% of all FTE dermatologists practised in Brisbane Inner City. GPs were well distributed relative to population size. CONCLUSIONS: Access to dermatology services is limited for Queensland residents living outside the southeast region, with few providers available within reasonable proximity. GPs are managing a growing skin cancer workload in Queensland. This could be eased by increased use of telemedicine, upskilling other health professionals in skin cancer medicine and improving care efficiency.