BACKGROUND:In Canada, pediatric dermatology faces challenges with workforce shortages, geographic maldistribution, and limited rural access, yet national data on provider distribution are lacking. OBJECTIVES:This study aimed to visualize the geographic distribution of general and pediatric dermatologists across Canada, assess 10 year temporal changes, and examine associations between service availability, rurality, and socioeconomic deprivation. METHODS:Geospatial analysis was conducted using Canadian Institute of Health Information billing data and provincial College of Physicians and Surgeons data. Dermatologists were mapped at the census subdivision (CSD) level or economic region (ER) level in Quebec. Pediatric and adolescent care were defined using billing thresholds. Spatial distribution and Canadian Index of Multiple Deprivation indicators were visualized using a geographic information system (ArcGIS). RESULTS:Eighty-eight of 3879 CSDs nationally contained at least 1 dermatologist, including a single rural CSD. In Quebec, 15 of 17 ERs had at least 1 dermatologist, including 4 rural ERs. Pediatric and adolescent dermatology care was confined to a small number of urban CSDs, with no rural coverage. Over 10 years, growth in the general dermatology workforce was restricted to large metropolitan areas and did not translate into increased pediatric or adolescent care. Known pediatric dermatologists (n = 55) were centralized in urban academic centers, and services were disproportionately located in socioeconomically advantaged areas. CONCLUSION:Pediatric dermatology access is marked by urban concentration, minimal rural availability, and persistent socioeconomic inequities. General dermatology workforce expansion alone has not improved pediatric care access, highlighting the need for equity-oriented workforce planning and improved national tracking.
Inflammatory dermatoses are increasingly linked to systemic metabolic factors. Obesity and insulin resistance create a pro-inflammatory milieu that affects the skin. Adipose tissue functions as an endocrine organ secreting adipokines and cytokines that drive chronic inflammation with notable skewing toward T-helper 1 (Th1)/Th17 signaling. Hyperinsulinemia, elevated insulin-like growth factor-1 promote keratinocyte proliferation, sebum production, and autoinflammation, contributing to a multitude of skin diseases including hidradenitis suppurativa, acne, psoriasis, atopic dermatitis (AD), acanthosis nigricans, hirsutism, scarring alopecias, intertrigo, and chronic idiopathic urticaria. Concomitantly, ultra-processed diets low in fiber and high in additives detrimentally affect the gut-skin axis. Diets rich in emulsifiers, sugars, and fructose alter the gut microbiome and increase intestinal permeability, leading to metabolic endotoxemia and increased systemic inflammation. High-fructose corn syrup in sweetened beverages is metabolized via hepatic fructokinase, promoting de novo lipogenesis and excess uric acid, a cascade implicated in metabolic fatty liver disease and heightened inflammation. These dietary factors have been correlated with aggravated skin diseases, where fast-food intake (≥3× weekly) is associated with increased risk of severe AD in children. Emerging evidence suggests that dietary modifications may help mitigate skin inflammation in select patients. At the same time, the advent of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists may improve metabolic parameters and could represent promising adjunctive therapies in select inflammatory dermatoses. Dermatologists can serve as sentinels, identifying cutaneous signs of insulin resistance (eg, acanthosis nigricans, acrochordons, and other skin diseases driven by insulin resistance) and addressing lifestyle factors as part of routine care.
BACKGROUND:Vulvar lichen sclerosus (VLS) is a chronic inflammatory condition that significantly impacts quality of life (QOL). Despite substantial disease burden, psychosocial support remains limited. In particular, available resources are limited to social media groups, which may lack evidence-based guidelines or structured support. OBJECTIVE:To evaluate whether participation in a dermatologist- and urogynecologist-led virtual support group improves QOL among women with VLS. METHODS:In this randomized controlled trial of women aged ≥18 years with VLS, the intervention comprised 3 monthly, 60 minute virtual support sessions facilitated jointly by a dermatologist and urogynecologist. The primary outcome was change in Vulvar Quality of Life Index (VQLI) scores assessed at baseline and 3 monthly follow-ups, analyzed using mixed-effects linear regression. Secondary outcomes included VQLI domain scores, and qualitative feedback analyzed using inductive thematic analysis. RESULTS:Sixty-eight participants (35 intervention, 33 control) were included. The intervention group demonstrated a significantly greater improvement in total VQLI from baseline to final follow-up compared to control (β = -10.3, 95% CI -14.9 to -5.6; P < .001), and a corresponding shift from Moderate to Mild severity range of impact on QOL. Significant improvements in baseline to follow-up scores were also seen across all 6 VQLI domains in the intervention group compared to the control group. Qualitative themes highlighted that expert facilitation helped empower patients and addressed the need for knowledge sharing. CONCLUSION:Expert-led virtual support groups may offer a potentially impactful, accessible, and scalable adjunct to medical therapy.
BACKGROUND:Literature on onychomycosis prevalence, causative agents, and systemic antifungal treatment efficacy in psoriasis are sparse. OBJECTIVE:The objectives of the study were to determine onychomycosis prevalence in psoriasis patients with nail changes and to evaluate the efficacy and safety of 2 systemic antifungal treatments, terbinafine, and fluconazole. METHODS:Records from the Division of Dermatology at Rabin Medical Center (2012-2022), were retrospectively analyzed, including nail samples from consecutive psoriasis patients referred to the institutional mycological laboratory. RESULTS:One hundred thirty-nine psoriasis patients with suspected onychomycosis were referred for mycological testing (46.8% female, median age 62 years), onychomycosis was diagnosed in 67.6% of cases. Fifty-one point one percent of patients were on systemic psoriasis treatments, 60.6% of them receiving biologic therapies. Trichophyton rubrum was the most prevalent (81.3%) isolated fungi of all positive cultures. Fifty-one patients received systemic antifungal treatment, with 47.1% receiving terbinafine and 52.9% fluconazole. Clinical improvement was observed in 70.8% of terbinafine-treated cases and 40.7% of fluconazole-treated cases (P = .002). No psoriasis flare-ups were attributed to systemic antifungal treatment. CONCLUSION:This cohort provides insights into prevalence of onychomycosis, and the efficacy and safety of systemic antifungal treatment in psoriasis patients, including patients on biologic therapies. Further prospective studies are recommended.
Background: Skin-picking disorder (SPD) is a psychodermatological condition marked by recurrent, compulsive picking of one’s own skin. This study aimed to analyze a large cohort of treatment-seeking SPD patients, focusing on triggers and concomitant diseases through face-to-face evaluations. Methods: A cross-sectional, multicenter study was conducted. Patients meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SPD completed a 23-item semi-structured questionnaire covering demographics, concomitant diseases, triggers, and clinical features. Results: A total of 236 SPD patients were enrolled, and 189 of whom were female. Additional dermatological diseases were identified in 84 participants, and 93 reported a history of primary psychiatric disorder. Mostly cited motivations for engaging in the behavior included itch relief, out of habit, and tension reduction. Picking commonly involved multiple body sites, especially extremities and trunk, with facial picking more frequent in younger patients and those with concomitant dermatological disorders. Over 25% reported more than 20 picking episodes/day, symptoms peaking between 08:00 PM and midnight, often during inactivity. Sensory symptoms included itching and burning. Conclusions: SPD is a multifactorial disorder with diverse clinical features and triggers. Sensory symptoms, body site involvement, and timing of episodes can guide clinicians in recognizing dermatologic and psychiatric comorbidities. Integrated dermatologic-psychiatric care is key for effective management.
