Critical thinking has always been the silent backbone of medicine. In the Hippocratic tradition, physicians were urged to observe carefully, reason logically, and avoid superstition. Philosophers such as Socrates and Descartes shaped this same spirit of inquiry, reminding us to question assumptions and to embrace doubt as a tool for truth. When a physician pauses to ask, "What else could explain these symptoms?", they are drawing from a lineage of reasoning that stretches back over two millennia.

Medicine's history makes the importance of critical thinking painfully clear. For centuries, bloodletting was accepted as treatment, not because it worked, but because few questioned it. Thalidomide in the 1960s, or more recently, the unchecked use of antibiotics, are reminders that unquestioned consensus can harm as much as it helps. These episodes underline a truth every doctor knows: good medicine requires more than knowledge - it requires disciplined skepticism.

Modern research confirms how easily error slips into practice. Cognitive psychology has shown that even skilled clinicians are prone to biases: anchoring too strongly on the first impression, recalling dramatic cases too vividly, or unconsciously seeking evidence that fits our hunches. Scholars such as Pat Croskerry have shown how these mental shortcuts contribute to diagnostic errors. The solution lies not in ignoring intuition, but in reflecting on it - deliberately slowing down, asking ourselves what might be missing, and keeping alternative explanations alive.

Medical education has long recognized this. Osler's insistence on bedside teaching, problem-based learning, and the tradition of morbidity and mortality conferences all train doctors not just to know, but to think. These settings sharpen judgment by encouraging discussion, questioning, and analysis. In fact, studies show that structured reflection reduces diagnostic errors, proving that critical thinking is not abstract philosophy but a practical skill that saves lives.

Today, the rise of artificial intelligence introduces both promise and new responsibility. Machine learning models can analyze enormous datasets, detect anomalies in imaging, and even outperform specialists in narrow tasks like dermatology or radiology. Yet AI is not a thinker - it is a pattern recognizer. Its insights are only as reliable as the data it has consumed, and it rarely reveals its reasoning. For physicians, this means that the role of critical thinking expands: to interpret, validate, and integrate AI's suggestions into the real-world complexity of patient care.

Philosophically, AI pushes us to revisit timeless questions: What does it mean to "know" something in medicine? How do we justify a decision when technology's reasoning is opaque? Here, critical thinking becomes the safeguard - ensuring that algorithms serve as tools, not oracles. Patients do not need a machine's output alone; they need a doctor's judgment to weigh probabilities, values, and context.

Ultimately, medicine is practiced in the space between certainty and uncertainty. Critical thinking is what allows us to navigate that space responsibly. It connects us to our history, keeps us vigilant against error, and equips us to embrace new technologies without surrendering our professional responsibility. In an era where AI grows ever more powerful, it is this distinctly human skill - the willingness to question, doubt, and reason - that remains the most essential diagnostic tool of all.

Potential benzene exposure occurs as a result of benzoyl peroxide (BPO) drug product use, according to a study published online Oct. 7 in the Journal of Investigative Dermatology.

The carcinogen benzene is a degradation product of BPO and has been reported to form when BPO drug products are incubated at body temperature and elevated temperatures, according to Kaury Kucera, Ph.D., from the Arnold & Marie Schwartz College of Pharmacy and Health Sciences at Long Island University in Connecticut, and colleagues. Kucera and colleagues examined benzene concentrations detected in over-the-counter BPO products.

The researchers found that benzene concentrations (0.16 to 35.30 ppm) were detected in 111 over-the-counter BPO drug products tested and maintained at room temperature. Stability testing of a prescription encapsulated BPO product resulted in no apparent benzene formation at 2 degrees Celsius and in high levels of benzene formation at 50 degrees Celsius. In face model experiments, detectable levels of benzene were found through evaporation, and considerable benzene formation occurred when exposed to ultraviolet light at levels below peak sunlight.

"The results presented here suggest that a substantial portion of the BPO acne treatment market currently contains unacceptably high levels of benzene in products sitting on the shelf and that stabilization techniques like encapsulation do not appear to prevent the formation of benzene in BPO drug products," the authors write. "In the interest of public health, further study and regulatory and industry actions, such as recalls, are warranted."

Several authors disclosed ties to the pharmaceutical industry. The study was funded by Valisure.

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MONDAY, July 24, 2023 (HealthDay News) -- Patterns of melanoma presentation, disease severity, and mortality vary by race, according to a research letter published online July 11 in the Journal of the American Academy of Dermatology.

Jennifer M. Fernandez, M.D., from University of Nebraska Medical Center in Omaha, and colleagues used the National Cancer Database to identify 205,125 cases of primary cutaneous invasive melanoma diagnosed between 2004 and 2018.

The researchers found that primary site differed significantly by race: The most common primary site was the trunk for American Indian/Alaska Native (38.8 percent) and White (35.4 percent) individuals, while the most common primary site was the lower extremity for Black (50.7 percent), Asian (40.5 percent), and Hispanic (26.3 percent) individuals. In Black individuals, the most common histologic subtype was acral lentiginous melanoma versus superficial spreading melanoma in all other groups. Black patients most commonly had advanced disease (stage III or IV; 48.6 percent) versus White (21.1 percent) patients. White patients had the highest five-year overall survival rates at 75.1 percent compared with 51.7 percent for Black patients.

"Black race is consistently an independent predictor of increased mortality risk in melanoma, and this remained the case in our study which only included males, even after adjusting for stage at diagnosis and insurance status," the authors write.

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WEDNESDAY, Feb. 21, 2024 (HealthDay News) -- Treatment of hidradenitis suppurativa (HS) with intravenous ertapenem is associated with improvement in clinical and inflammatory markers, according to a study published online Feb. 19 in JAMA Dermatology.

Avigdor Nosrati, M.D., from the Albert Einstein College of Medicine in New York City, and colleagues conducted a retrospective review of the medical records of 98 patients with HS between 2018 and 2022 to examine optimal course duration, efficacy, and patient satisfaction associated with intravenous ertapenem. Treatment was with 1 g of ertapenem, which was self-administered at home for 12 to 16 weeks.

The mean treatment duration spanned 13.1 weeks; posttherapy follow-up occurred after 7.8 weeks. The researchers observed significant reductions in the mean HS Physician Global Assessment scores from baseline to posttherapy follow-up and in the numerical rating scale for pain, C-reactive protein, interleukin-6, and leukocytes. Overall, 78.0 percent of the patients participated in the telephone survey at follow-up, with 80.3 percent reporting medium-to-high satisfaction. Most patients (90.8 percent) would recommend ertapenem to other patients.

"Larger, prospective, randomized clinical trials are needed to further optimize ertapenem dosing and duration, to evaluate the coadministration of other therapies, and to develop strategies for maintaining therapeutic outcomes," the authors write.

One author disclosed ties to Verrica Pharmaceuticals.

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MONDAY, July 24, 2023 (HealthDay News) -- Vitiligo diagnosis is more common in older adults and in Hispanic/Latino and Asian American patients, according to a study published online July 19 in JAMA Dermatology.

Nicole Mastacouris, from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York, and colleagues estimated the incidence and prevalence of diagnosed vitiligo across age, sex, and racial and ethnic subgroups in a cohort study and cross-sectional study including electronic health records for children, adolescents, and adults across four U.S. census regions.

The incidence analysis included 2,980,778 patients with vitiligo, and the prevalence analysis included 1,057,534 patients. The researchers found that the overall incidence rate of diagnosed vitiligo was 22.6 per 100,000 person-years (PY) after adjustment for age and sex, and prevalence was 0.16 percent. Patients aged 60 to 69 years had the highest sex-adjusted overall incidence rate (22.6 per 100,000 PY), and prevalence was highest among those aged 70 years or older (0.21 percent). Asian American, Hispanic/Latino, those reporting other or multiple races, Black, and White patients had age-adjusted incidence rates of 41.2, 37.3, 31.1, 29.6, and 18.7 per 100,000 PY, respectively. Age-adjusted prevalence was highest among Hispanic/Latino patients followed by Asian American, those reporting other or multiple races, Black, and White patients (0.29, 0.27, 0.24, 0.22, and 0.13 percent, respectively).

"These observations may support improving awareness of vitiligo disease burden in medical and public sectors, informing research agendas, improving enrollment of racial and ethnic minority populations in trials, and developing health policies," the authors write.

One author disclosed ties to the pharmaceutical industry and is co-copyright holder of the HS-IGA and HiSQOL instruments.

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WEDNESDAY, April 17, 2024 (HealthDay News) -- The anticalcitonin gene-related peptide-receptor monoclonal antibody erenumab is effective and safe for treatment of rosacea-associated erythema and flushing, according to a study published online April 17 in JAMA Dermatology.

Nita K.F. Wienholtz, M.D., Ph.D., from Copenhagen University Hospital-Rigshospitalet in Denmark, and colleagues examined the effectiveness, tolerability, and safety of erenumab for treatment of rosacea-associated erythema and flushing in a single-center, nonrandomized trial involving adults with rosacea with at least 15 days of moderate-to-severe erythema and/or moderate-to-extreme flushing. Participants received 140 mg erenumab subcutaneously every four weeks for a period of 12 weeks; safety was assessed at week 20.

Thirty participants were included; 27 completed the study. The researchers observed a reduction of −6.9 days in the mean number of days with moderate-to-extreme flushing, from 23.6 days at baseline. For moderate-to-severe erythema, the mean number of days was reduced by −8.1 from 15.2 at baseline. Adverse events included transient mild-to-moderate constipation, transient worsening of flushing, bloating, and upper respiratory tract infection (33, 13, 10, and 10 percent, respectively). One participant discontinued the study due to a serious adverse event, deemed unrelated to the study, and two withdrew consent due to time constraints.

"The results also suggest that erenumab is generally well tolerated, with mild and/or transient adverse effects," the authors write. "Larger randomized, controlled, double-blind studies are necessary to confirm these findings and to investigate the long-term effects of erenumab treatment."

Several authors disclosed ties to pharmaceutical companies, including Novartis Pharma, which funded the study.

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Long-term intermittent use of ruxolitinib cream is well tolerated and provides disease control in adolescent patients with atopic dermatitis (AD), according to a study published online May 2 in the American Journal of Clinical Dermatology.

Lawrence F. Eichenfield, M.D., from the University of California San Diego, and colleagues assessed the safety and efficacy of 1.5 percent ruxolitinib cream versus vehicle and long-term disease control of ruxolitinib cream among adolescents using pooled data from phase 3 studies. The analysis included 245 adolescents (aged 12 to 17 years) with AD for at least two years.

The researchers found that at week 8, substantially more patients who applied 1.5 percent ruxolitinib cream versus vehicle achieved Investigator's Global Assessment (IGA) treatment success (50.6 versus 14.0 percent), ≥75 percent improvement in the Eczema Area and Severity Index (60.9 versus 34.9 percent), and a 4-point improvement or greater in the itch numerical rating scale (52.1 versus 17.4 percent). During the long-term safety period, mean trough steady-state ruxolitinib plasma concentrations at weeks 12 and 52 were 27.2 and 15.5 nM, respectively. With ruxolitinib, the percentage of patients achieving an IGA score of 0 or 1 was sustained or further increased. Application site reactions through 52 weeks occurred in 1.8 percent of participants applying 1.5 percent ruxolitinib cream at any time. No patients reported serious adverse events.

"Treatment with 1.5 percent ruxolitinib cream in adolescent patients with mild-to-moderate atopic dermatitis had anti-inflammatory and antipruritic effects comparable with those observed in the overall study population," the authors write.

The study was funded by Incyte, the manufacturer of ruxolitinib.

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Sensitive skin (SS) seems to be associated with primary hyperhidrosis (PHH), according to a study published online Sept. 30 in the Journal of Drugs in Dermatology.

Erika T. McCormick, from the George Washington University School of Medicine and Health Sciences in Washington, D.C., and colleagues surveyed 637 PHH sufferers to assess HH and SS symptom burden. The survey was disseminated by the International Hyperhidrosis Society. Random forest machine learning algorithms were used to build a predictive classification model for SS.

The researchers found that 89 percent of the respondents reported SS; and HH and SS severity scores were significantly associated. SS occurred on body sites that were and were not affected by HH. For predicting SS in this cohort, the Sensitive Scale-10 validated questionnaire was most helpful.

"Our study, using machine learning models, confirmed for the first time that someone with primary hyperhidrosis is more likely to have sensitive skin than the general public, even in areas where there is no excessive sweating," lead author Adam Friedman, M.D., also from George Washington University, said in a statement. "This could help prepare dermatologists to better partner with their patients, educate, identify and manage sensitive skin in patients suffering from excessive sweating, and highlight shared disease mechanisms which may help facilitate new treatment approaches."

Several authors disclosed ties to Galderma, which funded the study.

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There are racial differences in the frequency of skin biopsy for psoriasis, indicating diagnostic uncertainty, according to a research letter published online Aug. 7 in JAMA Dermatology.

Fahad Ahmed, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues conducted a cross-sectional study involving adults seen in outpatient dermatology clinics to examine skin biopsy frequency, as an indicator of diagnostic uncertainty, by race and ethnicity among patients with psoriasis. A total of 10,008 patients were included in the study.

The researchers found that 4.8 percent of patients received a skin biopsy for psoriasis. Skin biopsies were performed most frequently among Black patients (9.8 percent), followed by Asian or other Pacific Islander, White, unknown race, Hispanic, and other race patients (4.7, 4.1, 4.0, 3.7, and 1.61 percent, respectively). Compared with White patients, Black patients had significantly higher odds of receiving a skin biopsy for psoriasis in analyses adjusted for sociodemographic and health care utilization factors (odds ratio, 2.03). In sensitivity analyses that evaluated both narrower and broader definitions of a skin biopsy for psoriasis, the findings were robust.

"These findings add to the limited literature on diagnostic uncertainty by patient race and ethnicity in the clinical setting; they confirm similar findings from a small prior study and provide important granularity on the association between specific racial and ethnic groups and the likelihood of skin biopsy for psoriasis," the authors write.

One author disclosed ties to the pharmaceutical industry.

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There is a negative association between travel time to tanning facilities and county-level melanoma incidence rates, according to a study published online Nov. 7 in the Journal of Investigative Dermatology.

Guixing Wei, Ph.D., from Brown University in Providence, Rhode Island, and colleagues examined the association between melanoma incidence and access to tanning bed facilities using data for New England county-level melanoma incidence rates for 2014 to 2018, tanning bed facilities location, demographic data, socioeconomic data, and geographic data.

The researchers found that for every one-minute increase in average travel time to tanning facilities within a 30-minute travel time threshold, there was a decrease in melanoma incidence by 3.46 and 1.92 percent in the same county and across New England, respectively. A negative association was identified between average travel time to tanning facilities and county-level melanoma incidence rate. With respect to county-level melanoma rate, six high-risk clusters and seven low-risk clusters were identified.

"The identification of clusters of melanoma incidence can help inform the strategic targeting of interventions and resources that aim to reduce the burden of melanoma," the authors write.

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COVID-19 is associated with long-term risk for autoimmune and autoinflammatory connective tissue disorders, according to a study published online Nov. 6 in JAMA Dermatology.

Yeon-Woo Heo, M.D., from the Yonsei University Wonju College of Medicine in South Korea, and colleagues conducted a retrospective cohort study to examine the long-term risk for autoimmune and autoinflammatory diseases after COVID-19. The analysis included individuals with confirmed COVID-19 from Oct. 8, 2020, to Dec. 31, 2022 (3,145,388 patients) and controls who participated in the general health examination in 2018 (3,767,039 controls) with an observation period of more than 180 days.

The researchers found that COVID-19 was significantly associated with an increased risk for alopecia areata, alopecia totalis, vitiligo, Behçet disease, Crohn disease, ulcerative colitis, rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, ankylosing spondylitis, and bullous pemphigoid (adjusted hazard ratios, 1.11, 1.24, 1.11, 1.45, 1.35, 1.15, 1.09, 1.14, 1.13, 1.11, and 1.62, respectively). Demographic factors, including male and female sex, age younger than 40 years, and age 40 years and older, showed diverse associations with the risk for autoimmune and autoinflammatory outcomes in subgroup analyses. Higher risk was also seen in association with severe COVID-19 infection requiring intensive care unit admission, the delta period, and not being vaccinated.

"Understanding the specific vulnerabilities and disease patterns among different subgroups is crucial for mitigating the long-term impact of the pandemic on global health," the authors write.

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WEDNESDAY, May 8, 2024 (HealthDay News) -- Trifarotene plus skin care is beneficial for patients with moderate acne vulgaris (AV) and acne-induced hyperpigmentation (AIH), according to a study published online April 29 in the International Journal of Dermatology.

Andrew Alexis, M.D., M.P.H., from Weill Cornell Medical College in New York City, and colleagues conducted a phase IV, double-blind, parallel-group study of patients aged 13 to 35 years with moderate AV and AIH who were treated with trifarotene or vehicle (63 and 60 patients, respectively), plus a skin care regimen of moisturizer, cleanser, and sunscreen for 24 weeks.

The researchers found that compared with vehicle, trifarotene 50 µg/g cream significantly improved the AIH overall disease severity score from baseline (−1.6 versus −1.1) at week 12, but at week 24, scores were comparable. At week 24, there was a better reduction in the post-AV hyperpigmentation index score with trifarotene (−18.9 versus −11.3 percent). At weeks 12 and 24, lesion count reductions were higher with trifarotene than vehicle, as were Investigator Global Assessment success rates. The skin care regimen contributed to less irritation, making adherence to treatment easier. Across all skin types, photography showed improvements in pigmentation and erythema. The vehicle group experienced more adverse events than the trifarotene group (30.2 versus 16.7 percent).

"This study shows that trifarotene cream has a favorable efficacy and safety profile for treating AV and AIH in subjects with all skin types, which likely will translate to overall improved outcomes for AV patients," the authors write.

Several authors disclosed ties to pharmaceutical companies, including Galderma, which manufactures trifarotene and funded the study.

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For patients with prurigo nodularis (PN) and chronic pruritus of unknown origin (CPUO), abrocitinib, a Janus kinase 1 inhibitor, is effective and well tolerated, according to a study published online June 5 in JAMA Dermatology.

Shawn G. Kwatra, M.D., from the University of Maryland School of Medicine in Baltimore, and colleagues examined the efficacy and safety of 200-mg oral abrocitinib administered once daily in a phase 2, nonrandomized controlled trial involving 20 adult patients with moderate-to-severe PN or CPUO (10 with each). All 20 patients completed the 12-week treatment period, and 18 completed the four-week follow-up.

The researchers found that the Peak Pruritus Numerical Rating Scale (PP-NRS) scores decreased by 78.3 and 53.7 percent in PN and CPUO patients, respectively, by week 12. Eight of 10 patients with PN and six of 10 with CPUO achieved at least a 4-point improvement on the PP-NRS from baseline to week 12. Significant improvement in quality of life was experienced by both groups, as demonstrated by percentage change in Dermatology Life Quality Index scores (−53.2 and −49.0 percent for PN and CPUO, respectively). Acneiform eruption was the most common adverse event among patients (10 percent); there were no serious adverse events reported.

"Larger randomized, double-blind, placebo-controlled trials are needed to validate these findings, identify less common adverse effects, allow for subgroup analyses, and identify differences in systemic inflammatory markers between patients who respond to treatment and those who do not," the authors write.

One author disclosed ties to pharmaceutical companies, including Pfizer, which funded the trial and made and supplied the study drug.

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TUESDAY, Jan. 10, 2023 (HealthDay News) -- Survival rates for children and adolescents with melanomas are high, according to a study published online Dec. 9 in the Journal of the American Academy of Dermatology.

Mary-Ann El Sharouni, Ph.D., from the University of Sydney, and colleagues assessed clinicopathologic features and survival of 62 children (aged 11 years and younger) and 452 adolescents (aged 12 to 19 years) diagnosed with melanoma.

The researchers found that melanoma subtypes were conventional melanoma (superficial spreading, nodular, desmoplastic, and acral lentiginous; 428 patients), spitzoid melanoma (78 patients), and melanoma associated with a congenital nevus (eight patients). Ten-year recurrence-free survival (RFS) was similar in children (91.5 percent) and in adolescents (86.4 percent), as was 10-year overall survival (OS; 100 and 92.7 percent, respectively). In adolescents, ulceration status and anatomic site were associated with RFS and OS, while age, sex, mitotic index, sentinel node status, and melanoma subtype were not. Worse RFS was seen with Breslow thickness >4 mm.

"Our data suggest that adolescent melanomas are often similar to adult-type melanomas, whilst those which occur in young children frequently occur via different molecular mechanisms," the authors write. "In the future it is likely that further understanding of these molecular mechanisms and ability to classify melanomas based on their molecular characteristics will assist in further refining prognostic estimates and [possibly] guiding treatment for young patients with melanoma."

Two authors disclosed financial ties to the pharmaceutical industry.

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For patients with atopic dermatitis (AD), dupilumab maintains its clinical effectiveness up to five years and is discontinued by 23.8 percent of patients, according to a study published online Aug. 7 in JAMA Dermatology.

Celeste M. Boesjes, M.D., from the University Medical Center Utrecht in the Netherlands, and colleagues examined clinical effectiveness and reasons for discontinuation of dupilumab treatment in 130 children, 1,025 adults, and 131 older adults with AD with up to five years of treatment.

The researchers found that most adults maintained controlled AD, with an Eczema Area and Severity Index (EASI) score of 7 or lower varying from 78.6 to 92.3 percent and a numeric rating scale (NRS) for pruritus of 4 or lower varying from 72.2 to 88.2 percent for up to five years of treatment; up to 70.5 percent of all patients extended the dosing interval to mostly 300 mg every three or four weeks. After five years of treatment, the mean EASI and NRS for pruritus were 2.7 and 3.5, respectively. After six months of treatment, median thymus- and activation-related chemokine levels decreased considerably, from 1,751 to 390 pg/mL, and remained low. The median eosinophil levels increased temporarily to week 16, then decreased significantly over time. After a median of 54.0 weeks, 23.8 percent of patients discontinued dupilumab, with adverse events and ineffectiveness being the most frequently reported reasons (7.6 and 6.6 percent, respectively).

"This study highlights the importance of multicenter registries to evaluate long-term treatment effects in large daily practice cohorts," the authors write.

Several authors disclosed ties to pharmaceutical companies, including Sanofi and Regeneron, which manufacture dupilumab.

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WEDNESDAY, July 12, 2023 (HealthDay News) -- The prevalence of atopic diseases, including atopic dermatitis, is increased in sexually diverse people, including those who identify as lesbian, gay, or bisexual, according to a research letter published online July 12 in JAMA Dermatology.

Katelyn J. Rypka, from the University of Minnesota Medical School in Minneapolis, and colleagues calculated crude and multivariable-adjusted odd ratios for prevalence of atopic dermatitis, asthma, and allergic rhinitis comparing heterosexual and sexually diverse individuals. Data were included for 27,012 respondents to the 2021 National Health Interview Survey, of whom 25,701 were heterosexual and 1,311 were sexually diverse.

The researchers found that sexually diverse individuals were more likely to report atopic dermatitis (11.1 versus 7.2 percent), asthma (12.0 versus 7.8 percent), and allergic rhinitis (33.7 versus 25.6 percent) compared with heterosexual individuals (adjusted odds ratios, 1.49, 1.39, and 1.30, respectively). In sex-stratified analyses, results were similar.

"This study found higher rates of atopic disease among sexually diverse individuals," the authors write. "Further research is needed to identify factors contributing to these differences, including environmental, socioeconomic, and sociocultural factors and minority stress."

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With respect to their lifetime prevalence of skin cancer, sexual minority (SM) adults differ across racial and ethnic groups and among males and females, according to a study published online July 17 in JAMA Dermatology.

Katelyn J. Rypka, from the University of Minnesota in Minneapolis, and colleagues examined differences in the lifetime prevalence of skin cancer among U.S. adult females and males by sexual orientation in a cross-sectional study using data from the Behavioral Risk Factor Surveillance System from Jan. 1, 2014, to Dec. 31, 2021. Of the 1,512,400 participants studied, 53.2, 2.6, 42.2 and 2.0 percent were heterosexual females, SM females, heterosexual males, and SM males, respectively.

The researchers found that the lifetime prevalence of skin cancer was higher for SM males versus heterosexual males overall (7.4 versus 6.8 percent; adjusted odds ratio [aOR], 1.16), especially among Hispanic males (4.0 versus 1.6 percent; aOR, 3.81) and non-Hispanic Black males (1.0 versus 0.5 percent; aOR, 2.18). Compared with heterosexual females, lifetime prevalence rates were lower among SM females for non-Hispanic Whites (7.8 versus 8.5 percent; aOR, 0.86), while rates were higher among Hispanic SM females (2.1 versus 1.8 percent; aOR, 2.46) and non-Hispanic Black SM females (1.8 versus 0.5 percent; aOR, 2.33).

"Future research and public health interventions should consider race and ethnicity and individual sexual identity when addressing skin cancer and related risk behaviors, with a particular emphasis on Black and Hispanic SM females and males and White gay males," the authors write.

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WEDNESDAY, July 12, 2023 (HealthDay News) -- Confirmatory laboratory testing is only used in one in five cases of suspected tinea capitis (TC), according to a research letter published in the July issue of the Journal of the American Academy of Dermatology.

Jeremy A.W. Gold, M.D., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues calculated TC incidence and described testing and treatment practices for 3.9 million commercially insured U.S. children identified from the Merative MarketScan Commercial Database (July 1, 2016, to Dec. 31, 2020).

The researchers found that the one-year TC incidence was 16.3 per 10,000 person-years, with incidence highest among 5-year-olds (31.6 per 10,000 person-years), boys (20.9), and Southern residents (22.5). Pediatricians made the most diagnoses (54.6 percent), followed by dermatologists (11.7 percent) and family practitioners (10.4 percent). Clinicians infrequently used confirmatory testing (21.9 percent). When used, the most common tests were fungal culture (17.8 percent) and direct microscopy (9.7 percent). Testing was significantly more common for diagnoses by dermatologists (51.0 percent) versus pediatricians (16.4 percent) or family practitioners (11.0 percent). Three-quarters of patients were prescribed an antifungal (61.2 percent an oral antifungal and 14.7 percent a topical antifungal therapy).

"Most patients diagnosed with TC received no confirmatory laboratory testing, which is concerning because visual inspection alone of suspected cutaneous fungal infections can lead to diagnostic errors and unnecessary antifungal use," the authors write.

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