The Dermatologist’s Role in Long-Term Surveillance of Burn Scars for Malignancy
Chronic burn scars represent a unique dermatologic substrate characterized by persistent inflammation, altered immune surveillance, and long-term structural skin changes that may predispose patients to cutaneous malignancy. Squamous cell carcinoma arising in burn scars, often referred to as Marjolin’s ulcer, is a well-documented but frequently delayed diagnosis associated with aggressive behavior and poor outcomes. While acute burn management is typically overseen by burn specialists and reconstructive surgeons, long-term surveillance of healed burn scars often falls outside structured care pathways. Dermatologists are uniquely positioned to identify early malignant transformation within burn scars due to their expertise in skin cancer recognition and longitudinal outpatient follow-up. This mini-review summarizes the epidemiology and pathophysiology of burn scar–associated malignancy, highlights clinical features suggestive of malignant transformation, and proposes a dermatology-centered framework for surveillance and early intervention. Increased awareness of burn scars as oncogenic risk sites may improve diagnostic timeliness and patient outcomes.
DOI: 10.29245/2767-5092/2026/1.1211 View / Download PdfDermatologists’ Role in Interdisciplinary Care for Obsessive-Compulsive Disorder and Body-Focused Repetitive Behaviors
Obsessive-compulsive disorder (OCD) and body-focused repetitive behaviors (BFRBs) are becoming increasingly prevalent in dermatology. Patients presenting with cutaneous concerns may have underlying psychiatric conditions, such as excoriation disorder, trichotillomania, and onychophagia. Despite up to 12% of the population meeting BFRB criteria, these disorders frequently go undetected due to stigma, underreporting, and a primary focus on cutaneous symptoms. Data suggest a substantial overlap in clinical presentation, neurobiology, genetics, and interventions among obsessive-compulsive spectrum disorders. Affected individuals experience elevated risks of comorbid anxiety, depression, and additional compulsive disorders. Dermatologists are uniquely positioned as the first to detect sequelae of these conditions, including alopecia, excoriations, nail deformities, and secondary infections. Validated screening tools, along with dermoscopy and full-body skin examinations, can aid in earlier detection. Treatment interventions for BFRBs remain inconsistent, with behavioral therapies showing more promising results and pharmacologic interventions demonstrating variable efficacy. This review synthesizes the current knowledge of OCD and BFRBs, including their relevance in dermatology and the importance of interdisciplinary collaboration. Increasing awareness and strengthening the dermatology-psychiatry partnership allows practitioners to address both the physical and psychological manifestations accompanying these conditions, ultimately leading to better treatment outcomes.
DOI: 10.29245/2767-5092/2026/1.1210 View / Download PdfFinasteride-Induced Neuropsychiatric Reactions
Finasteride, widely prescribed for androgenetic alopecia and increasingly obtained online, has been associated with persistent neuropsychiatric adverse effects, including depression, anxiety, cognitive impairment, and suicidality. This Mini Review examines the strength of evidence supporting a causal relationship between finasteride and these reactions, evaluates the drug’s benefit–risk balance in cosmetic use, and discusses implications for clinical practice and regulation. Evidence from experimental, clinical, and epidemiological studies across multiple countries fulfills key Bradford–Hill criteria for causality, including temporality, consistency, biological plausibility, and reversibility, with reports of persistent symptoms after drug discontinuation. Mechanistically, inhibition of 5α-reductase reduces neurosteroid synthesis—particularly allopregnanolone—affecting mood regulation, neurogenesis, and neuroinflammatory pathways. Regulatory agencies have responded by updating safety warnings, and some countries now require formal informed consent prior to prescription.
Although finasteride demonstrates short-term efficacy for hair loss, evidence for long-term benefit is limited, while meta-analytic data suggest an approximately 50% relative increase in depression risk. Given the baseline prevalence of depression, this translates into a clinically meaningful absolute risk, with rare but grave outcomes including suicide. Because alopecia is a cosmetic condition with alternative management options, application of the precautionary principle is warranted. Clinicians should ensure comprehensive disclosure of potential neuropsychiatric harms, screen for prior mood disorders, and engage in genuine shared decision-making. In light of persistent adverse effects, limited long-term efficacy data, and broader public health costs, avoidance of finasteride for hair loss and strengthened regulatory oversight should be seriously considered.
DOI: 10.29245/2767-5092/2026/1.1212 View / Download Pdf