Scabies is a common parasitic skin infestation caused by Sarcoptes scabiei var. hominis, with an estimated global burden of over 200 million cases annually. Scabies remains underdiagnosed and can often be challenging to manage. Institutional outbreaks, diagnostic delays, and treatment failures contribute to ongoing morbidity. This practical literature review summarizes clinical pearls for community dermatologists, integrating recent diagnostic frameworks, treatment evidence, and evolving considerations related to drug resistance and public health control.

BACKGROUND:Acne vulgaris is an inflammatory skin condition that is associated with poor acne health literacy. Diminished acne health literacy leads to delays in the access of health care, resulting in mismanagement, disfigurement, and psychosocial morbidity. This study evaluates the potential role of early acne education in young adolescent populations to improve acne health literacy and facilitate help-seeking behavior.METHODS:The Acne Education Project is a Canadian medical student-led initiative founded to create evidence-based resources to increase acne health literacy. A 45-min interactive Zoom presentation on acne was created and delivered to 2292 students ages 9-13 in British Columbia, Canada. A quality improvement survey was administered pre-intervention, immediate post-intervention, and 1-month post-intervention to evaluate baseline acne knowledge and knowledge retention to guide presentation and resource development.RESULTS:Responses from 676 unique individuals were collected. Analysis using linear mixed-effects models demonstrated that respondents were significantly more confident in their general knowledge of acne, strategies to prevent acne, identification of psychosocial sequelae of acne, and more willing to seek help immediately post-intervention (p < .001). Differences in scores were not fully preserved in magnitude at the 1-month post-intervention assessment. However, students still scored significantly higher in all categories compared to the pre-intervention baseline (p < .001).CONCLUSION:Our findings suggest that early acne education can improve acne health literacy and promote help-seeking behavior. Given the potential long-term implications, further research is needed to explore the long-term impact of early acne education and the benefit of integrating acne education into the public education curriculum in Canada.

BackgroundGuidelines recommend that patients with melanoma undergo dermatologic examination at least annually. Adherence to follow-up and its impact on survival are unclear.ObjectiveTo determine the level of adherence to annual dermatologic follow-up in patients with primary cutaneous melanoma, identify predictors for better adherence, and evaluate whether adherence was associated with melanoma-related mortality.MethodsRetrospective inception cohort analysis of adults with primary invasive melanoma in Ontario, Canada from 2010-2013 with follow-up until December 31, 2018ResultsAdherence to dermatologic follow-up was variable with only 28.0% of patients seeing a dermatologist at least annually (median follow-up 5.0 years). Younger age, female sex, higher income, greater access to dermatology care, stage 2/3 melanoma, prior keratinocyte carcinoma, fewer comorbidities, and any outpatient visit in the 12 months prior to melanoma diagnosis were predictors for adherence. Greater adherence to annual dermatology visits was associated with reduced melanoma-specific mortality compared with lower levels of adherence (adjusted hazard ratio 0.64, 95% CI 0.52-0.78).LimitationsObservational study design and inability to identify skin examinations performed by non-dermatologistsConclusionAdherence to annual dermatology visits after melanoma diagnosis was low. Greater adherence may promote better patient survival but warrants confirmation in further research including randomized trials.

Acne occurs in up to 90% of young adolescents, but prior research has found that this population exhibits a limited understanding of acne and is vulnerable to myths and misinformation accumulated from family members, friends, and social media. We created a virtual presentation on skin hygiene, acne prevention, and acne‐associated stigma for adolescent youth (aged 9–13) to improve acne health literacy, which was reviewed by three board‐certified dermatologists. A descriptive cross‐sectional study using data collected for quality improvement ( n = 209, total) revealed that approximately half ( n = 102/202, 50.5%) of all students believed that acne could not be treated with medications, only 34.0% ( n = 67/197) believed acne could impact their mental health, and most students incorrectly believed that dirt buildup ( n = 124/209, 59.3%) and poor hygiene ( n = 125/209, 59.8%) were pathogenic for acne. Our results stress the necessity of early evidence‐based educational interventions as a cornerstone to breaking self‐perpetuating myths and misinformation that may lead to acne mismanagement, delayed access to healthcare, and permanent scarring later in life.

Acne vulgaris is a common dermatological condition and typically arises during adolescence. Misinformation may lead to mismanagement of disease and negative long-term sequelae such as scarring and depression. A previous educational intervention for adolescents between ages 12-17 led to improvements in acne-related quality of life.1 However, the value in improving acne health literacy and increasing help-seeking behaviour in pre-pubertal populations has yet to be assessed. An interactive Zoom presentation on acne pathogenesis, prevention, management, and its psychosocial impacts were delivered to 30 grade 5-7 classes by our organization (https://www.acneeducationproject.ca/). We administered QI surveys pre-intervention, immediately post-intervention, and 1-month post-intervention to assess the efficacy and sustainability of benefits. Data from these surveys were used to guide adaptations to future presentations. Responses were analyzed using multivariable linear mixed effects regression models. 676 responses were collected and our respondent age range was 9-13. Results demonstrated that participants were significantly more confident in their knowledge of evidence-based acne prevention strategies, treatment, physical and psychosocial consequences, and more willing to seek help immediately after intervention (p<0.01 for all categories). These benefits were not fully preserved at the 1-month post-intervention assessment. However, students scored significantly higher than pre- intervention baselines in all categories (p<0.01). Assessment of potential associated factors revealed that females were more confident than their male counterparts in acne prevention (p=0.0038) and seeking medical attention (p=0.0021) after intervention. These results highlight the value of early acne educational interventions in improving acne health literacy, which may promote help-seeking tendencies and reduce negative long-term health outcomes.

Patient preferences for psoriasis treatment may affect treatment adherence and disease control; changing topical formulation may improve adherence and patient acceptance of treatment. This study explored dermatologists' reasons for transitioning psoriasis patients from an ointment or gel (Dovobet®) formulation to an aerosol foam (Enstilar®) formulation of calcipotriol and betamethasone dipropionate (Cal/BD), and to assess the success of this transition. Medical records of 81 Canadian patients from 9 dermatologists were retrospectively reviewed for symptoms affecting quality of life, reasons for transitioning treatment, and whether transition was successful. Reasons for transition included efficacy, quality of life, and patient adherence. At follow-up, median psoriasis severity and body surface area affected had decreased from baseline, and patients experienced improved quality of life. Itch and itch-related sleep loss, which were identified as burdensome in 63% of patients at baseline, had resolved in 33% and improved in 54% of patients at follow-up. Dermatologists deemed the transition successful in 85% of patients, with the most common reasons being patient-reported success, clearance of signs/symptoms, and continued prescription refills. Transition from Cal/BD ointment or gel to aerosol foam was generally deemed successful by patients and dermatologists, and was associated with improved quality of life and improved itch control.

Atopic dermatitis (AD) is associated with various quality of life concerns including poor sleep. Sleep impairments in children with AD are associated with increased risk of short stature, metabolic syndrome, mental illness and neurocognitive dysfunction. Although the association between AD and sleep disturbance is well established, the specific types of sleep disturbance in pediatric AD patients and their underlying mechanisms are not fully understood. A scoping literature review was performed to characterize and summarize the types of sleep disturbance in children (less than 18 years of age) with AD. 31 papers met inclusion criteria and extracted data were analyzed in an iterative manner. Two types of sleep disturbances were found to be more prevalent in pediatric AD patients in comparison to controls. One category was related to loss of sleep (increased frequency or duration of awakenings, increased sleep fragmentation, delayed sleep onset, decreased total sleep duration, and decreased sleep efficiency). Another category was associated with unusual behaviors during sleep (restlessness/limb movement/scratching, sleep-disordered breathing including obstructive sleep apnea and snoring, nightmares, nocturnal enuresis and nocturnal hyperhidrosis). Some mechanisms underlying these sleep disturbances include pruritus and induced scratching and increased proinflammatory markers induced by sleep loss. Sleep disturbance appears to be associated with AD. We recommend clinicians to consider interventions that may reduce sleep disturbances in children with AD. Further investigation of these sleep disturbances is needed to elucidate pathophysiology, develop additional treatments, and reduce negative impacts on the health outcomes and quality of life in pediatric AD patients.

Darier's disease (also known as keratosis follicularis or dyskeratosis follicularis) is an autosomal dominant inherited disorder which manifests as hyperkeratotic greasy papules in the first or second decade of life. Aside from symptom management and behavioral modifications to avoid triggers, there are currently no validated treatments for Darier's disease (DD). However, a variety of treatments have been proposed in the literature including retinoids, steroids, vitamin D analogs, photodynamic therapy, and surgical excision. The purpose of this review article is to identify therapeutic options for treating DD and to outline the evidence underlying these interventions. A search was conducted in Medline for English language articles from inception to July 4, 2020. Our search identified a total of 474 nonduplicate studies, which were screened by title and abstract. Of these, 155 full text articles were screened against inclusion/exclusion criteria, and 113 studies were included in our review. We identified Grade B evidence for the following treatments of DD: oral acitretin, oral isotretinoin, systemic Vitamin A, topical tretinoin, topical isotretinoin, topical adapalene gel, topical 5-flououracil, topical calciptriol and tacalcitol (with sunscreen), grenz ray radiation, and x-ray radiation. All other evidence for treatments of DD consisted of case reports or case series, which is considered grade C evidence. Considering the quality and quantity of evidence, clinicians may consider initiating a trial of select topical or oral retinoids first in patients with localized or generalized DD, respectively.

Background Delusional infestation, also known as Ekbom syndrome, is a rare delusional disorder characterized by the fixed belief that one is infested with parasites, worms, insects, or other organisms. Although delusional infestation is a psychiatric condition, patients often consult dermatologists with skin findings, and it is currently unclear what treatments are recommended for this disorder. Objective We aimed to systematically review and describe the treatment and management of patients presenting with primary delusional infestation. Methods A systematic search was conducted using Ovid on MEDLINE, Embase, PsycINFO, and the Cochrane Register of Clinical Trials. Relevant data, including treatment, dosage, response, adherence, and side effects, were extracted and analyzed. Results A total of 15 case series were included, comprising 280 patients (mean age 53.3 years, 65.4% female) with delusional infestation. Overall, aripiprazole had the highest complete remission rate at 79% (11/14), although this was limited to 14 patients. Among drug classes, selective serotonin reuptake inhibitors were the most effective with a 79% (11/14) complete remission rate and 43% (9/21) partial remission rate in patients with comorbid depression, anxiety, or trichotillomania. First-generation antipsychotics and second-generation antipsychotics had similar complete remission rates (56/103, 54.4% vs 56/117, 47.9%, respectively) and partial remission rates (36/103, 35% vs 41/117, 35%, respectively). Conclusions Due to the rarity of delusional infestation, we only found 15 case series. However, we found that first-generation antipsychotics appear to be similar in effectiveness to second-generation antipsychotics for the treatment of primary delusional infestation. Larger studies and randomized controlled trials are needed to evaluate the efficacy of pharmacological therapy for delusional infestation. Trial Registration PROSPERO CRD42020198161; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=198161

Background Microbial strains such as Cutibacterium acnes have been examined as contributors to the pathogenesis of acne. Given the prevalence of the disease among adolescents and adults, the overutilization of antimicrobial agents may breed resistance and alter commensal microflora. Objectives To characterize the impact of acne treatment on the diversity and relative abundance of the cutaneous microbial community, particularly of the bacterial flora Methods An electronic search was conducted of Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) on June 5, 2020. Interventional and observational studies examining patients receiving acne treatment with culture-independent, community-level analysis of the cutaneous microbiome were included. Results Nine studies with 170 treated acne patients were included. Five studies reported a significant change in alpha diversity following treatment, 3 of which examining systemic antibiotics reported significant increases in diversity. Two of 3 studies examining effects of benzoyl peroxide reported a decrease in diversity. However, trends in diversity were heterogeneous among studies. Conclusions While individual variability in microbiome composition, and study-level heterogeneity in study sampling techniques may limit quantitative synthesis, our results support findings that acne treatment, including those not considered to have antimicrobial properties, alters the composition of the cutaneous microbiome. PROSPERO registration: CRD42020190629

Hair removal practices have evolved from adhering to social, cultural, and religious traditions to meeting aesthetic standards. Hair removal methods can be divided into two categories: 1) depilation, which involves removing the hair shaft and includes shaving and chemical depilatories, and 2) epilation, which involves removing the hair shaft, follicle, and bulb, and includes plucking, threading, waxing, sugaring, lasers, intense pulsed light system, electrolysis, and photodynamic therapy. Furthermore, an eflornithine hydrochloride 13.9% cream (Vaniqa®, neither an epilatory or depilatory technique), has been US FDA- and Health Canada-approved to slow the rate of facial hair growth and to be used in combination with other hair removal methods. All methods are temporary except for electrolysis, and each technique has advantages and disadvantages in terms of efficacy and adverse events. Importantly, most studies examining the efficacy of hair removal techniques are limited to darker hair and fairer skin, and further research is required especially for those with light-colored hair.

During the COVID-19 pandemic, prolonged usage of personal protective equipment (PPE) and frequent handwashing has exacerbated or caused skin diseases, particularly amongst frontline workers. Skin conditions, such as atopic dermatitis, irritant contact dermatitis, and hand eczema, affect patients’ quality of life and their ability to work. These conditions can be managed by frequent moisturization and washing with gentle cleansers. In this review, we discuss the properties of effective moisturizers and cleansers for patients with skin diseases related to enhanced infection control procedures.

matologists guidelines for the management of people with vitiligo 2021. Br J Dermatol 2022; 186:18–29. 4 Brouwers M, Kho ME, Browman GP et al. AGREE II: advancing guideline development, reporting and evaluation in healthcare. CMAJ 2010; 182:E839–42. 5 Mohd Mustapa MF, Exton LS, Bell HK et al. Updated guidance for writing a British Association of Dermatologists clinical guideline: the adoption of the GRADE methodology 2016. Br J Dermatol 2017; 176:44–51. 6 Eleftheriadou V, Thomas K, van Geel N et al. Developing core outcome set for vitiligo clinical trials: international e-Delphi consensus. Pigment Cell Melanoma Res 2015; 28:363–9. 7 Ezzedine K, Grimes PE, Meurant JM et al. Living with vitiligo: results from a national survey indicate differences between skin phototypes. Br J Dermatol 2015; 173:607–9.

Objectives The objectives of this study were to determine: 1) the prevalence of lichen sclerosus (LS) and lichen planus (LP) present in association with vulvar squamous cell carcinoma (VSCC), and 2) the incidence and absolute risk of developing VSCC in LS and LP. Methods A search was performed of MEDLINE, EMBASE and CINAHL databases. Three independent reviewers screened articles published before September 1, 2020, first on title/abstract and then on the full text. Women with a history of VSCC, human papillomavirus, smoking, or autoimmune disease were excluded. Newcastle-Ottawa observational study scales were used to assess the risk of bias and methodological quality of the included studies. Of the 3132 studies assessed, 31 were selected for analysis. Due to study heterogeneity, a qualitative synthesis was conducted. Results The prevalence of LS and LP in association with VSCC ranged from 0% (95% CI 0–5) to 83% (95% CI 36–100) and 1% (95% CI 0–7) to 33% (95% CI 4–78), respectively. The incidence of VSCC ranged from 1.16 (95% CI 0.03-6.44) to 13.67 (95% CI 5.50–28.17) per 1000 person-years for LS. The absolute risk of developing VSCC in patients ranged from 0.0% (95% CI 0.0–5.52) to 21.88% (95% CI 9.28–39.97) with LS and was 1.16% (95% CI 0.1–4.1) with LP. Incidence was not calculable for LP owing to study characteristics. Conclusions This review provides evidence that there is an increased risk of developing VSCC in women with LS, while associations with LP are less clear. Early identification, treatment, and long-term follow-up are essential to prevent potential malignant progression of these vulvar dermatoses.

Background: papular elastorrhexis is a rare, acquired disorder of elastic tissue. The etiology of papular elastorrhexis is currently unknown, and few cases have been reported in the literature since the condition was first described in 1987. Papular elastorrhexis is clinically characterized by multiple small asymptomatic white or flesh coloured papules predominately located on the trunk and proximal extremities. Initial lesions are usually detected in the first two decades of life, and the condition has been reported more frequently in females. We present a case of a patient with papular elastorrhexis on her neck.Case Presentation: a healthy Caucasian female in her 30s presented with a four-year history of asymptomatic 0.5 mm white papules on her lateral neck. She had no history of inflammation, acne, or trauma to the area, and had no family history of similar lesions. A full body skin exam was completed and was otherwise unremarkable. A punch biopsy was taken of the lesions on the lateral neck and sent for histopathological examination. Hematoxylin and eosin stains were normal, however, elastic stain showed a focal absence of elastic fibers in the papillary dermis and normal fibers in the reticular dermis consistent with a diagnosis of papular elastorrhexis.Conclusion: the diagnosis of papular elastorrhexis is made based on both clinical and histopathological characteristics. The differential diagnosis of papular elastorrhexis includes papular acne scars, nevus anelasticus, Buschke-Ollendorff syndrome, mid-dermal elastolysis, eruptive collagenoma, and pseudoxanthoma elasticum. Papular elastorrhexis is a benign condition, but cosmetic concerns may be significant in some cases. Unfortunately, given the rarity of this condition, no rigorous data exist supporting the use of a particular treatment. Knowledge of the key and distinguishing features of papular elastorrhexis, as highlighted in this case, is critical to accurately diagnose this rare condition.

OBJECTIVE:To review the current literature on cutaneous diseases associated with the global coronavirus disease 2019 (COVID-19) pandemic, and to provide a general overview for family physicians of dermatologic presentations associated with COVID-19. QUALITY OF EVIDENCE:Google Scholar and PubMed searches were conducted using the terms COVID-19, SARS-CoV-2, pandemic, dermatology, livedoid, chilblain, urticaria, maculopapular, Kawasaki's, and related synonyms. Additional terms were personal protective equipment (PPE), hand hygiene, and psychosocial factors affecting skin diseases. Only English-language literature was reviewed. Evidence ranged from levels I to III. MAIN MESSAGE:Coronavirus disease 2019 is associated with a range of cutaneous presentations through direct infection with severe acute respiratory syndrome coronavirus 2, such as maculopapular, vesicular, pseudo-chilblain, livedoid, necrotic, urticarial, and Kawasaki-like rashes. Indirect presentations secondary to behavioural modifications are associated with use of personal protective equipment and sanitization procedures. Furthermore, psychosocial factors and stress associated with the pandemic also exacerbate pre-existing skin conditions. CONCLUSION:The COVID-19 pandemic has increased rates of dermatologic conditions through direct infection, behavioural changes, and association with psychosocial factors. As the incidence of COVID-19 increases, family physicians should be well equipped to diagnose and manage dermatologic presentations as they change within the context of the pandemic.

Prurigo nodularis (PN) is a chronic, recalcitrant inflammatory skin condition characterized by the presence of pruritic nodules. The exact pathogenesis of the disease is unknown, although immune and neural dysregulation are indicated in driving the itchscratch cycle. Specifically, interleukin-4 and interleukin-31 pathways have been recently implicated in transmission of the pruritic sensation. There are currently no US FDA-approved targeted therapies for the treatment of PN. This article aims to review our present understanding of the disease pathogenesis and treatments, with a focus on emerging therapeutics. Specifically, this article explores the developing use of monoclonal antibodies nemolizumab and dupilumab, opioid receptor modulation and cannabinoids as potential treatments for PN.

Psoriasis is a chronic, immune-mediated skin condition which commonly affects women of childbearing age. Certolizumab pegol (CZP) is an anti-tumor necrosis factor-alpha (anti-TNFα) agent that has demonstrated long-term safety and efficacy in treating moderate-to-severe plaque psoriasis. Previously, there has been limited safety data surrounding its use in pregnancy. The objective of this article is to review pivotal clinical trial data for CZP and explore safety considerations for this agent in pregnancy. This review demonstrates that CZP offers a safe and effective treatment option for women during childbearing years based on pharmacokinetics and available safety data. The observed occurrence of major congenital malformations and miscarriages appears to be no greater than the background occurrence of those in the general population, and risks to the mother are minimal based on its known safety profile. The use of CZP for treatment of plaque psoriasis should be considered and discussed with patients considering childbearing or whom are currently pregnant or breastfeeding.

Atopic dermatitis (AD) is a chronic skin disease characterized by barrier dysfunction and immune dysregulation that affects approximately 20% of children and 2-5% of adults worldwide. Traditionally, AD has been considered a disease of childhood with many cases resolving before adulthood. However, in recent years, the prevalence of adult AD is increasingly recognized to be substantial, but it is uncertain whether this increase is due to increased childhood-persistent or relapsed AD, or new adult-onset AD. This highlights a need for further investigation into the adult AD population and evaluation of phenotypes in the adult-onset cohort. In this literature review, we examine five studies focused on adult-onset AD phenotype, conducted between 2013 and 2017. The most commonly reported body regions affected in adult-onset AD were the hands, eyelids, neck, and flexural surfaces of the upper limbs. These vary from childhood-onset AD findings, which are less specific to body regions other than flexural areas. These findings have implications for diagnostic accuracy and treatment of AD, including considerations for therapeutic choices and inclusion and exclusion criteria in clinical trials.