Howa Yeung

Patient-reported outcomes (PROs) help dermatologists better understand patient perspectives to facilitate shared medical decision-making. Despite merit-based incentive payment system (MIPS) measure to collect quality of life assessments at least once every 12 months for patients with chronic skin diseases, routine PRO collection remains uncommon in clinical practice. This semi-structured interview study aimed to elicit key preferences, facilitators, and barriers for routine PRO collection in dermatology practices. Clinicians were recruited from Emory Dermatology, which has implemented routine PRO collection. Verbatim transcripts were coded and analyzed deductively using the Theoretical Domains Framework to generate salient themes. We interviewed nine dermatologists and one advanced practice provider (APP). Professional roles of all interviewed clinicians aligned with PRO collection. Memory, attention, and decision-making requirements for PRO collection by clinicians were minimized via institutional automation in the electronic health record (EHR). Skills in navigating EHR were needed to retrieve PRO data. Environmental factors affecting PRO collection included patient portal access, IT support for EHR integration, institutional interest in PROs, limited clinician oversight on PRO collection by other staff members, and high patient volume in dermatology clinics. Social support between staff could allow workflow division and maximized opportunities for PRO collection, while clinician perceived patient survey fatigue and skepticism on PRO utility affected PRO collection. This study was limited to clinician perspectives in a single clinic. Automating PRO collection and utilization in EHR, demonstrating PRO value, establishing institutional support, and streamlining workflow are needed to broadly implement routine PRO data collection.

This study aimed to identify barriers and facilitators influencing transgender individuals’ participation in teledermatology-based acne research and their perceptions of artificial intelligence use in acne research. This was a qualitative study conducted between 2021 and 2023. Transgender and gender diverse individuals who received gender-affirming hormone therapy and had acne were recruited from a public safety-net hospital and from academic endocrinology and dermatology clinics. Semi-structured interviews exploring factors influencing teledermatology-based acne research participation were analyzed using thematic analysis. Among 32 participants, 17 (53%) identified as transgender men, 11 (34%) as transgender women, and 4 (13%) as non-binary or other gender identities. Mild or lower acne severity was reported by 21 (66%) participants, while 11 (34%) reported moderate-to-severe acne. Access to equipment and comfort in photographing sensitive areas determined capability of participation in hypothetical teledermatology research. Accessibility, flexibility, and reduced transportation cost of remote research, and in-clinic recruitment from established clinicians presented opportunities for participation. Motivating factors included trust in research team members, privacy concerns, and improving acne treatment for transgender individuals. Perspectives on artificial intelligence were mixed and included concerns regarding security and potential for bias. Teledermatology offers opportunity to improve recruitment and retention of transgender individuals in acne research. Incorporating perspectives of transgender individuals can inform the design of future teledermatology research on acne in the context of gender-affirming hormone therapy.

Purpose of Review Transgender and gender-diverse (TGD) adolescents often face dermatologic concerns during gender-affirming care but may face limited access to dermatologists. This review aims to provide practical guidance for pediatricians on managing common dermatologic needs in TGD adolescents, including acne, hair growth promotion or removal, and post-surgical scarring within the context of gender-affirming care. Recent Findings Acne management should consider the impact of testosterone therapy and chest binding, with treatment options including topical retinoids, benzoyl peroxide, oral antibiotics, combined oral contraceptives, and spironolactone. Topical minoxidil may be considered for the promotion of facial, and scalp hair growth. Hair removal methods and complications such as pseudofolliculitis barbae should be discussed with TGD adolescents seeking temporary or permanent hair removal. Hypertrophic scarring and keloids may occur after gender-affirming chest reconstruction, with management involving topical silicone gel and adhesive silicone sheeting. Summary TGD adolescents may struggle to identify specialists trained in gender-affirming dermatologic care and may delay or avoid care due to past mistreatment in clinical settings. Pediatricians play a key role in managing the dermatologic concerns of TGD adolescents by creating a gender-affirming, safe, and supportive care environment and facilitating early dermatology referrals when appropriate.

Sexual and gender minority (SGM) cancer survivors face unmet care needs in accessing cancer health information and social support despite high satisfaction with treatment. SGM patients often delay care due to concerns of discrimination in healthcare settings, though the care experiences of SGM skin cancer survivors are less known. SGM individuals, particularly sexual minority men, report higher skin cancer prevalence and related risk behaviors than heterosexual men. This study aims to describe SGM skin cancer survivors’ perceptions of the care environment and availability of SGM-specific survivorship resources. We conducted a secondary analysis of data from the OUT: National Cancer Survey conducted from September 2020 to March 2021. Among 2,528 survey respondents, 96 self-reported a history of skin cancer, with 33% having keratinocyte carcinomas (KC) only and 67% having melanoma. While 69% reported treatment in welcoming environments, 91% noted the absence of welcoming cues. Only 23% used social support specific to cancer survivorship, despite 62% valuing access to LGBTQI+-inclusive survivorship support. KC survivors reported less access to SGM-specific cancer information compared to melanoma survivors. These findings highlight gaps in dermatologic care for SGM skin cancer survivors. Dermatologists can address these needs by developing targeted health education resources, integrating identity-affirming information into care plans, and establishing inclusive environments through visible LGBTQI + cues and training staff in identity-affirming care. While limited by a small sample size, underrepresentation of gender and racial-ethnic minorities, and reliance on unvalidated survey tools, this study highlights the significant lack of data on SGM skin cancer survivors’ experiences. We provide valuable insights into the unmet care needs of SGM skin cancer survivors. Future research should build on this foundational evidence to further examine differences in care experiences across skin cancer types and treatment settings, aiming to optimize support for SGM patients.

Introduction Acne impairs quality of life, often leads to permanent scars, and causes psychological distress. This review aims to update dermatologists on the Federal Drug Administration (FDA)-approved and off-label use of combined oral contraceptives (COC), clascoterone, spironolactone, and emerging hormonal therapies for acne treatment. Methods We reviewed current literature on hormonal acne treatments and discussed common patient concerns, barriers to care, and individualized care needs. Results Different brands and dosings of COC have generally similar efficacy in treating acne. Dermatologists should discuss contraceptive options and provide individualized shared decision-making with patients based on patient preferences, contraceptive needs, comorbidity profile, access, and cost. Spironolactone is an effective acne treatment with clinical trial data to support its use as a first-line acne treatment for women with acne. Potassium monitoring is of low value for patients on spironolactone unless patients have specific risk factors for hyperkalemia. Clascoterone is a safe and effective topical anti-androgen for the treatment of acne in men and women with limited systemic effects on reproductive hormones. Conclusion Hormonal therapies are essential strategies to treat acne. Clinicians should expand the use of existing and emerging hormone therapy as part of their acne treatment strategies.