The phosphoinositide 3-kinase alpha inhibitor alpelisib has been increasingly used in the treatment of venous malformations. In this systematic review of 47 patients with a molecular diagnosis for their venous malformati...The phosphoinositide 3-kinase alpha inhibitor alpelisib has been increasingly used in the treatment of venous malformations. In this systematic review of 47 patients with a molecular diagnosis for their venous malformations treated with alpelisib, a partial or complete radiological response was achieved by 77% of evaluable patients and symptomatic improvement in 98%. Adverse effects were predominantly mild, with hyperglycaemia the most frequent, occurring in 58% of patients with available safety data. TRIAL REGISTRATION: PROSPERO Registration: CRD420261339549.
We present three patients who developed allergic contact dermatitis (ACD) from benzalkonium chloride (BAK) in ophthalmic drops. BAK is a preservative commonly found in ophthalmic formulations and there is a rising trend...We present three patients who developed allergic contact dermatitis (ACD) from benzalkonium chloride (BAK) in ophthalmic drops. BAK is a preservative commonly found in ophthalmic formulations and there is a rising trend of ACD to this allergen. The irritant and sensitising properties of BAK on the ocular mucosa will be discussed. This paper will also explore BAK allergy from eye drops in patients with atopic dermatitis and those using dupilumab.
The traditional Rintala flap is associated with visible forehead scarring and glabellar deformities. We describe the Rintala Advanced Modification (RAM) flap, a novel technique that restricts the flap below the eyebrow l...The traditional Rintala flap is associated with visible forehead scarring and glabellar deformities. We describe the Rintala Advanced Modification (RAM) flap, a novel technique that restricts the flap below the eyebrow line and employs asymmetric Burow's triangles for off-centre defects. Based on 20 patients with nasal basal cell and squamous cell carcinomas, the RAM flap demonstrates superior aesthetic outcomes with no glabellar complications or flap tip necrosis.
Immunotherapy has transformed the management of melanoma and is now a central component of care for patients with high-risk, unresectable, and metastatic disease. Immune checkpoint inhibitors targeting programmed death 1...Immunotherapy has transformed the management of melanoma and is now a central component of care for patients with high-risk, unresectable, and metastatic disease. Immune checkpoint inhibitors targeting programmed death 1 (PD-1), cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and lymphocyte activation gene 3 (LAG-3) enhance antitumour immune responses and have resulted in substantial improvements in survival, with durable disease control in a proportion of patients. In Australia and New Zealand, immunotherapy is routinely used across the melanoma disease continuum, including neoadjuvant, adjuvant, and metastatic settings, supported by evolving regulatory approvals and funding pathways. This review summarises current immunotherapy approaches to melanoma, with a focus on how these therapies are used in routine Australian practice, including mechanisms of action, indications across disease stages, commonly used agents, special melanoma subtypes, benefits and limitations of treatment, immune-related adverse events, particularly cutaneous toxicities, and emerging therapies. The role of dermatologists within multidisciplinary melanoma care is highlighted.
BACKGROUND: Pyoderma gangrenosum (PG) is an ulcerative inflammatory dermatosis that is poorly characterised from a diagnostic and therapeutic perspective. We evaluated the clinical characteristics and healing outcomes in...BACKGROUND: Pyoderma gangrenosum (PG) is an ulcerative inflammatory dermatosis that is poorly characterised from a diagnostic and therapeutic perspective. We evaluated the clinical characteristics and healing outcomes in patients with PG according to ulcer size. METHODS: We reviewed the medical records of patients with PG presenting to a tertiary hospital in Melbourne, Australia, from 20 December 2011 to 11 June 2024. We collected data on demographics, clinical characteristics, and classified cases into small (< 64 cm) or large ulcers (≥ 64 cm or any tendon or muscle on view) according to the size of the largest ulcer during the treatment course. Healing outcomes assessed included rates of initial healing, healing time, recurrence rate, healing after recurrence, level of systemic treatment required, and mortality. RESULTS: 81 cases of PG were identified, including 38 (46.9%) small and 43 (53.1%) large ulcers. Large ulcers were associated with a history of multiple ulcers, peripheral vascular disease, and higher rates of advanced treatment (biologic or intravenous immunoglobulin therapy). After adjusting for age, sex, and peripheral vascular disease, large ulcers remained independently associated with lower rates of initial healing, higher rates of recurrence, lower rates of healing after recurrence, and longer healing times (all p < 0.05). Ulcer size was not associated with age, sex, ulcer location, tissue pathergy, inflammatory bowel disease, haematological malignancy, inflammatory arthritis, or diabetes mellitus. CONCLUSION: PG is a highly morbid condition that is slow to heal and frequently recurs. Ulcer size is an important predictor of healing outcomes. It is thus a meaningful way of stratifying patients and may provide useful prognostic information regarding the expected disease course.
BACKGROUND/OBJECTIVES: Incompletely excised primary basal cell carcinoma (pBCC) is a frequently encountered scenario in clinical practice, yet the significance of the phenomenon is not well described in current literatur...BACKGROUND/OBJECTIVES: Incompletely excised primary basal cell carcinoma (pBCC) is a frequently encountered scenario in clinical practice, yet the significance of the phenomenon is not well described in current literature. Re-excision is recommended for high-risk incompletely excised pBCCs, but recurrence rates post re-excision of pBCCs with Mohs micrographic surgery (MMS) are not currently well documented. METHOD: A retrospective cohort study was undertaken, identifying patients who had undergone re-excision with MMS for pBCC prior to June 2015 from the private practices of two MMS proceduralist dermatologists' practices in Queensland, Australia. Cases required a minimum follow up of 5 years post-definitive treatment. RESULTS: 141 patients were identified, with 104 ultimately being included. 31 patients did not respond, and 6 formally withdrew. 104 incompletely excised pBCCs re-excised with MMS, with some cases receiving adjuvant post-operative radiotherapy (PORT), experienced no recurrence over an average follow up period of 9.2 years. 93 (92.1%) of the 104 cases consisted of an aggressive BCC subtype, and 54 (51.9%) of the cases were in a high-risk anatomical location. Perineural invasion was present in 12 (11.5%) cases, and 6 (5.7%) of the cases received PORT. CONCLUSION: MMS may be an effective treatment option for the management of incompletely excised pBCC in immunocompetent patients. For high-risk cases, PORT is an effective adjuvant therapy in combination with MMS. Future prospective studies with greater participant numbers and the inclusion of recurrent BCCs, as well as BCCs initially treated with non-surgical methods, may provide further insights into the role of MMS in these clinical contexts.
Dupilumab is effective for moderate-to-severe atopic dermatitis, but optimal long-term dosing is unclear. In this single-centre retrospective study, 49 patients underwent dose extension to 300 mg Q3W or 300 mg Q4W, with...Dupilumab is effective for moderate-to-severe atopic dermatitis, but optimal long-term dosing is unclear. In this single-centre retrospective study, 49 patients underwent dose extension to 300 mg Q3W or 300 mg Q4W, with EASI scores remaining low and stable over 18 months. Patients extending for good disease control had higher EASI90 rates. The impact of age, disease severity and therapy duration remains uncertain.
BACKGROUND/OBJECTIVES: Vitiligo is associated with substantial psychosocial burden; however, community-based patient-reported data remain limited, and existing instruments may not fully reflect patients' lived experience...BACKGROUND/OBJECTIVES: Vitiligo is associated with substantial psychosocial burden; however, community-based patient-reported data remain limited, and existing instruments may not fully reflect patients' lived experience. This study explored the psychosocial impacts of vitiligo using social media-based recruitment. METHODS: Adults (≥ 18 years) with physician-confirmed or self-reported vitiligo were recruited via Facebook support groups between December 2023 and February 2024 to complete an anonymous online survey. Quantitative data included demographics and the 15-item VitiQoL questionnaire. Qualitative responses addressing challenges, management, and barriers to care were analysed inductively, with emergent themes integrated with quantitative findings. Descriptive statistics and exploratory independent-samples t-tests were performed. RESULTS: A total of 181 participants responded, predominantly female (81.8%), and mainly from the UK (53.59%) and Australia (29.83%). Qualitative analysis identified stigmatisation and sun exposure as prominent challenges. Head and neck involvement was associated with poorer QoL, including altered grooming behaviours (3.78, SD 2.12, p < 0.001), clothing adaptations (4.42, SD 1.96, p < 0.001), difficulties forming new friendships (2.21, SD 2.01, p < 0.001), and limitations in daily activities (2.93, SD 2.15, p < 0.001). Males reported greater emotional impact (M = 4.27, SD 1.91, p = 0.014) and more difficulty forming friendships (M = 2.85, SD 2.09, p = 0.004) than female participants. CONCLUSION: Vitiligo is associated with significant psychosocial challenges, particularly stigma-related distress, behavioural adaptations, and participation restrictions. These findings highlight the importance of addressing psychosocial wellbeing in clinical care, and the need for comprehensive QoL measures that better capture psychosocial and participation-related impacts.
Darier disease is a rare ATP2A2-related genodermatosis for which therapeutic options remain limited, as acitretin is often constrained by toxicity and teratogenicity. In this retrospective real-world case series of eight...Darier disease is a rare ATP2A2-related genodermatosis for which therapeutic options remain limited, as acitretin is often constrained by toxicity and teratogenicity. In this retrospective real-world case series of eight patients, anti-IL-17 therapy showed a more consistent early signal of clinical benefit than anti-IL-23 therapy, with greater improvement in disease severity and patient-reported outcomes and no reported adverse events. Although limited by the small sample size and attrition over time, these findings support further prospective evaluation of biologic therapies in Darier disease.