Perniosis (chilblains) is an uncommon inflammatory condition characterized by erythematous to violaceous papules or plaques typically affecting acral surfaces. The pathogenesis remains poorly understood, and its management remains challenging due to the limited evidence available. This comprehensive review examines evidence-based therapies for primary and secondary perniosis, informed by observational studies, case series, and trials on similar conditions such as Raynaud's phenomenon. We synthesize treatment options for managing inflammation, alleviating symptoms, and preventing recurrence, including topical and systemic vasodilators, corticosteroids, selective serotonin reuptake inhibitors (SSRIs), antimalarials, and antithrombotic therapies. A focus is placed on systemic vasodilators, including nifedipine, and topical therapies like nitroglycerin, which have shown efficacy in improving peripheral perfusion. Additionally, corticosteroids are used to address inflammation, although their effectiveness is debated in randomized controlled trials. Antimalarials and SSRIs, notably fluoxetine, also show promise, particularly for secondary perniosis. Despite the absence of high-quality randomized controlled trials, therapeutic recommendations have emerged from case reports and studies on related vascular conditions. The role of botulinum toxin, though under investigation, remains inconclusive for primary perniosis, but may be considered in cases of secondary perniosis or coexisting vascular issues. This review underscores the need for individualized treatment approaches and highlights the importance of future research to refine management strategies and enhance patient outcomes.

Prior studies have highlighted significant challenges in the readability of patient educational materials in dermatology, which may represent a barrier to optimal treatment outcomes. As newer Janus kinase inhibitors (JAKi) gain FDA approval and are integrated into treatment regimens, it is crucial for patients to understand their usage, risks, and benefits. We evaluated the readability of FDA-approved JAKi medication guides to see if lessons from prior readability studies have been incorporated into these newer materials. Our analysis revealed that JAKi guides often exceed the sixth-grade readability level recommended by the American Medical Association. We found that the instructions on how to use the medication were more difficult to read than the discussion of side effects, a concerning disparity as proper medication administration prevents complications from misuse.

The rise of artificial intelligence (AI) has prompted discussions about its utility in the medical field. Patients are increasingly turning to the internet for medical information, and the use of AI represents the next step in this trend. One AI-powered natural language processing platform that has gained widespread popularity is ChatGPT. Prior work evaluating the use of the ChatGPT-4 model in answering melanoma-related inquiries found that responses were generally accurate and sufficient for clinical practice but displayed low comprehensibility. Given the prevalence of common skin conditions such as acne and atopic dermatitis, particularly among the more technologically inclined younger demographic, we aimed to assess whether ChatGPT is effective in addressing frequently asked questions about these conditions. To better align with the usage patterns of the public, we utilize the subscription-free ChatGPT-3.5 model for our study. After inputting 15 commonly asked questions for both acne and atopic dermatitis into ChatGPT, two board-certified dermatologists independently evaluate the accuracy and completeness of responses. When both dermatologists assign the same rating, it is considered final. If their ratings differ, a third dermatologist's input acts as a tiebreaker. In cases of unanimous disagreement, the raters collaborate to reach a consensus rating. Additionally, we assess the readability of ChatGPT-generated responses using the standardized Flesch Reading Ease Score. Ultimately, our study evaluates the utility of ChatGPT for addressing patient inquiries about acne and atopic dermatitis, which may provide valuable insights for improving patient education and healthcare decision-making.

We conducted a retrospective review of patients with systemic sclerosis, finding that nailfold capillary abnormalities are significantly associated with more aggressive treatment of Raynaud phenomenon, specifically the use of calcium channel blockers and other vasodilators compared with topical therapy or no treatment. This relationship indicates that routine nailfold capillary examination may assist in Raynaud phenomenon risk stratification. It also highlights the need for further research on whether nailfold capillaries may be a noninvasive marker of more severe vascular complications within systemic sclerosis.

Calcinosis cutis is commonly seen in conjunction with autoimmune connective tissue diseases (ACTD) and can lead to functional impairment.1 We sought to complete an in-depth analysis identifying the most commonly affected locations and evaluate if this, as well as extent, impact and complications (eg ulceration) varies by the specific underlying ACTD. 43 patients were identified with the diagnosis of calcinosis cutis adequately documented in their chart. 100% of patients with the diagnosis of lSSc described their lesions as painful and functionally limiting, compared to 84.6% of those with dermatomyositis, and 76.9% of those with scleroderma. 54.5% of patients with lSSc, 46.2% of patients with dermatomyositis, and 38.5% of patients with systemic sclerosis indicated ulceration in sites with calcinosis cutis.

Calcinosis cutis is a condition that is commonly associated with autoimmune connective tissue diseases. It is characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue, which can cause pain, impair function, and have significant impacts on quality of life. Calcinosis cutis is difficult to manage because there is no generally accepted treatment: evidence supporting treatments is mostly comprised of case reports and case series, sometimes yielding mixed findings. Both pharmacologic and procedural interventions have been proposed to improve calcinosis cutis, and each may be suited to different clinical scenarios. This review summarizes current treatment options for calcinosis cutis, with discussion of recommendations based on patient-specific factors and disease severity.

Background Board-certified dermatologists experience diverse practice gaps. Objective Identify the top self-selected focused Practice Improvement (fPI) modules completed over time by board-certified dermatologists during the program’s first 8 years. Methods Cohort study of dermatologists certified by the American Board of Dermatology (ABD) completing fPI modules from 2016 to 2023. This descriptive analysis reports modules completed by topic, subspecialty, relevance, and self-reported changes to subsequent patient care related to modules. Results About 19,143 fPI modules were completed by 7378 unique ABD diplomates, representing 48.8% of all current ABD-certified dermatologists (n = 15,118). Modules were rated relevant by 18,917 participants (99%). Care gaps requiring improvement efforts and performance remeasurement occurred in 2919 (15.2%) completed modules. Acne and medication-related laboratory monitoring were popular topics requiring improvement. Diplomates reported care improvements resulting from completing modules in 8397 instances (43.9%), and improved patient outcomes in at least one patient 5310 times (27.7%). Finally, diplomates stated they would recommend fPI modules to peers 18,633 (97.3%) times. Limitations Dermatologists who started but did not complete modules would not have rated the module. Attribution bias on care impact is possible and potentially overestimated. Conclusion The ABD fPI program is helping board-certified dermatologists identify and improve gaps in care with reported patient outcome improvements.

In this study, we evaluated ChatGPT 3.5 responses to common patient questions about acne and atopic dermatitis. While ChatGPT generally provided accurate and comprehensive answers, its readability was at the college level, which is above the recommended grade for patient materials. Significant information gaps were also noted, including omissions of newer treatments, probably because of the model's training limitations up to mid-2021. Despite these limitations, ChatGPT can be a valuable resource, especially in regions where dermatological expertise is scarce.

The United States Food and Drug Administration (FDA) issues Warning Letters when it finds manufactures have violated FDA regulations.1 Given many dermatology offices compound their own products, participate in skincare product development, or are asked about products by patients, we sought to analyze the content and common trends of these Warning Letters specific to topical skin care, hair care and cosmetic concerns. We identified 55 distinct cosmetic skin and hair preparation Warning Letters (1.7%) that violate drug claims from 2015-2020. Only 25 of the 55 (45.5%) Warning Letters had a corresponding close-out letter. The average amount of time from the date of issue of the Warning Letter to the close-out letter was 731 days. The most common nonconformities identified in the Warning Letters were unapproved drugs (85.5%), misbranding (63.6%), and labeling (41.8%) issues. The most common products identified in the Warning Letters were creams/lotions (69.1%), serums (32.7%), eye-specific creams (27.3%), and oils (21.8%) (Table 1). This analysis of cosmetic dermatologic products with drug claims highlights common trends and concerns regarding products sold to patients and consumers. It is concerning that less than half of products with Warning Letters had a corresponding close-out letter. Additionally, the majority of products without Warning Letters are still available for purchase. More severe consequences to companies should be initiated to deter false claims and dermatologists should be aware of these warning letters given we daily recommend, and some practices sell, products.