The study, led by Timothy Klufas of Bridgeport Hospital and the University of Connecticut Department of Dermatology, together with colleagues at the Icahn School of Medicine at Mount Sinai, Quinnipiac University’s Frank H. Netter MD School of Medicine, and UConn, employed a qualitative research technique called photovoice. Developed in the 1990s by public health researchers Caroline Wang and Mary Ann Burris, photovoice asks participants to photograph aspects of their own lives that illustrate their experiences, then to discuss and interpret those images collectively. The method was originally designed as a participatory needs assessment tool for communities whose voices were rarely heard in policy discussions, and it has since been applied to topics ranging from refugee health to disability advocacy. Its central premise is deceptively simple: people are the experts on their own lives, and images can communicate dimensions of experience that questionnaires and clinical scales routinely miss.

Applying photovoice to hidradenitis suppurativa is a methodologically shrewd choice. The disease’s burden is notoriously difficult to quantify. Objective severity measures such as Hurley stage or the SARTOR score capture the anatomical extent of lesions but say little about pain flares, sleep disruption, wound care routines, or the emotional weight of malodorous drainage. Quality-of-life instruments such as Dermatology Life Quality Index questionnaires compress lived experience into numerical scores that can obscure the texture of daily struggle. Previous systematic reviews, including a 2021 thematic synthesis published in the British Journal of Dermatology, have identified recurring themes among patients, including pain, shame, delayed diagnosis, and frustration with fragmented care, but these syntheses rely on retrospective interviews rather than real-time documentation of daily life.

Photovoice inverts the usual power dynamic of research. Instead of being asked to answer questions formulated by investigators, participants decide what matters. In the context of a stigmatizing disease that affects intimate body regions, this shift carries particular significance. Many patients with hidradenitis suppurativa report years of misdiagnosis, being told their lesions were simple boils or hygiene problems, and a pervasive sense that clinicians underestimate their suffering. By authoring their own visual narratives, patients in the study were able to direct attention to the aspects of the disease that they considered most consequential, whether or not those aspects appear in standard outcome measures.

The technical architecture of the study reflects careful attention to both rigor and ethics. The research received exempt approval from the UConn Health Institutional Review Board under protocol number 25X-256-1, and informed consent was obtained from all participants before each phase of the study through information sheets approved by the University of Connecticut Health Center IRB. Detailed methodology, including the photovoice prompts and analytical framework, is available in supplementary materials deposited in a public Mendeley Data repository, an unusual and commendable degree of transparency for a research letter. The authors report that no external funding was secured for the work, and the investigators declared no competing interests. Study design was led by Klufas, Samir Kamat, and Ksenia Gorbenko, with data collection performed by Klufas and initial analysis and drafting shared among Klufas, Santiago, and Kamat, while Santiago, Albert E Zhou, and Akua Sarfo contributed clinical dermatology insights.

The photovoice approach also has an established pedigree in dermatology specifically. A 2023 study published in the British Journal of Dermatology used the method with people affected by leprosy in Papua, Indonesia, where photographs became advocacy tools that challenged entrenched stigma. That project, titled “The unbreakable journey,” demonstrated that patient-generated imagery could shift public perception and even influence local health communication. The hidradenitis suppurativa study extends this lineage to a disease whose stigma, while less visible to the public, is arguably just as corrosive. Patients frequently describe hiding lesions from partners, family members, and employers, and the resulting social isolation compounds the depression and anxiety that are documented at elevated rates in this population.

What makes visual methods particularly powerful for hidradenitis suppurativa is the disease’s intimate geography. Lesions occur in areas that patients rarely expose and that clinicians may examine only briefly during appointments. A photograph of a carefully arranged wardrobe, a supply of wound dressings, a shower bench, or a car seat cushioned to reduce friction can communicate the logistical architecture of coping in ways that verbal description cannot. The images function as what photovoice practitioners call “shards of light,” illuminating specific moments and objects that anchor broader narratives. When participants then discuss their photographs in facilitated sessions, the collective dialogue generates thematic data that is grounded in concrete, personally chosen evidence rather than abstract prompting.

The findings arrive at a moment of rapid therapeutic progress for the disease. Within the past decade, adalimumab, secukinumab, and other biologics have gained regulatory approval for hidradenitis suppurativa, and clinical trials of additional immunomodulatory agents are expanding the armamentarium. Yet a recurring critique from patient advocates is that trial endpoints and treatment goals often diverge from what patients actually want: less pain, fewer flares, better sleep, and the freedom to plan a life without constant contingency for drainage and dressing changes. A 2024 review in the Journal of the American Academy of Dermatology by Steven Daveluy and Ginette Okoye emphasized that quality of life and the patient journey must be central to care, noting that patients often navigate years of diagnostic delay and fragmented referrals before reaching appropriate treatment. Photovoice data provides precisely the kind of patient-grounded evidence that can help align clinical priorities with lived priorities.

There are also implications for medical education and clinical empathy. Dermatology training emphasizes visual pattern recognition, but typically the images studied are clinical photographs taken by professionals for diagnostic purposes. Patient-generated photography inverts this: the image is not a diagnostic specimen but a testimony. For clinicians, viewing the world through a patient’s camera can be a form of perspective-taking that no lecture on empathy can replicate. Prior photovoice research with Congolese refugee women in the Midwestern United States, published in the journal Health Equity in 2021, showed that longitudinal photovoice combined with interviews could document how participants’ priorities and coping strategies evolved over time, suggesting that the method could similarly track the shifting experience of a relapsing-remitting disease like hidradenitis suppurativa across treatment phases.

The study is not without limitations inherent to its design. As a qualitative research letter, it does not attempt statistical generalization, and the small number of participants typical of photovoice projects means the themes identified cannot be assumed to represent the full diversity of the patient population, which spans differences in disease severity, skin tone, sex, socioeconomic status, and access to care. Photovoice also demands considerable participant commitment, which may select for patients who are already engaged and reflective. Nevertheless, the value of the method lies in depth rather than breadth: it surfaces possibilities and priorities that can then be tested and measured at scale using validated instruments.

The broader significance of the work lies in its demonstration that participatory visual methods deserve a firmer place in dermatology research. As the field moves toward patient-centered outcomes and value-based care, the instruments used to define success must reflect what patients themselves consider success. A photograph, as the study’s title suggests, may indeed be worth a thousand words, but its scientific value is realized only when researchers take the time to listen to those words. By combining a proven community-based methodology with rigorous ethical oversight and transparent data sharing, the investigators have provided a template that other dermatology research groups can adapt for conditions ranging from vitiligo to psoriasis to chronic wounds. For a disease that has historically thrived in silence and shame, the simple act of patients pointing a camera at their own lives and having clinicians and researchers genuinely look may prove to be a quietly transformative form of therapy in its own right.

Subject of Research: Using the photovoice participatory photography method to explore the lived experience of patients with hidradenitis suppurativa

Article Title: “A picture is worth a thousand words”: using photovoice to explore the lived experience of hidradenitis suppurativa patients

Article References: Klufas, T., Kamat, S., Saini, S., Santiago, S., Zhou, A. E., Gorbenko, K., & Sarfo, A. (2026). “A picture is worth a thousand words”: using photovoice to explore the lived experience of hidradenitis suppurativa patients. Archives of Dermatological Research, 318(1), Article 413. https://doi.org/10.1007/s00403-026-04871-6

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04871-6

Keywords: hidradenitis suppurativa, photovoice, dermatology, qualitative research, patient-reported outcomes, quality of life, stigma, participatory research, chronic skin disease, medical humanities, patient experience, skin manifestations

Herpetic whitlow results when herpes simplex virus, most commonly herpes simplex virus type 1, inoculates the skin of a digit through a break in the cutaneous barrier. The virus travels to sensory nerve endings, establishes infection in the distal phalanx, and produces one or more intensely painful vesicles that may coalesce into a larger blister resembling a bacterial felon or paronychia. The infection classically affects the thumb and index finger, though any digit may be involved. In children, autoinoculation from thumb-sucking or finger-sucking during oral herpetic infections is the dominant route of acquisition, while in adults the disease has historically been an occupational hazard among dentists, dental hygienists, and other health care workers exposed to oral secretions before the widespread adoption of gloves.

The historical record captured in the review begins with early observations that established whitlow as a nosocomial threat. Among the foundational works cited is a 1959 Lancet study by Stern and colleagues describing herpetic whitlow as a form of cross-infection in hospitals, a report that helped define the condition’s public health significance at a time when its viral etiology was still being separated from pyogenic infections of the hand. By the end of the twentieth century, larger clinical series such as the 1990 analysis by Gill and colleagues of herpes simplex virus infection of the hand, published in the Journal of the American Academy of Dermatology, had clarified the spectrum of disease in adults and children alike, documenting incubation periods, recurrence patterns, and the substantial morbidity that recurrent infection imposes on patients.

The technical groundwork for the present synthesis rests on several strands of evidence. Case reports of pediatric whitlow, exemplified by the 2001 European Journal of Pediatrics report by Szinnai and colleagues describing multiple herpetic whitlow lesions in a four-year-old girl, illustrate how extensive the lesions can become in young children and how easily the presentation can be mistaken for more common blistering disorders. Occupational case series, including the 2012 report by Browning and McCarthy in the Journal of Esthetic and Restorative Dentistry documenting herpes simplex virus as an occupational hazard among dental practitioners, reinforce the role of exposure routes in shaping who develops the disease. On the therapeutic side, the pharmacological understanding of nucleoside analogs such as acyclovir and its relatives has matured considerably, as summarized in the 2022 PharmGKB review by Maillard and colleagues of the acyclovir and ganciclovir metabolic pathway, which maps how these prodrugs are converted by viral and cellular thymidine kinases into active triphosphate forms that selectively inhibit viral DNA polymerase.

By pooling published case material, the Weill Cornell-led team sought to define the epidemiological and clinical profile of herpetic whitlow with more precision than any single case report could provide. The review’s design reflects a growing appreciation in dermatology that rare or underrecognized conditions accumulate meaningful evidence only when scattered reports are aggregated and analyzed together. The researchers coordinated the project across four institutions, with Vijayvargiya responsible for data collection, Vijayvargiya and Zhou performing the analysis and drafting, Singal contributing to conception, design, and revision, and Lipner overseeing the work and providing final approval. The authors declared no competing interests and reported no external funding for the study, and the paper was accepted on 1 September 2026 and published on 12 September 2026 in volume 318 of the journal.

The clinical importance of distinguishing herpetic whitlow from bacterial infections of the hand cannot be overstated. Misdiagnosis as a bacterial felon or paronychia has historically led to incision and drainage, a surgical intervention that is not only unnecessary for viral infection but potentially harmful, because breaching the skin can introduce secondary bacterial infection or delay appropriate antiviral therapy. Recognizing the characteristic morphology of whitlow, grouped vesicles on an erythematous base with a predilection for the distal phalanx, along with a history of prior oral or genital herpes lesions, exposure to oral secretions, or recent trauma to the digit, allows clinicians to avoid inappropriate surgery and initiate antiviral treatment promptly. Diagnostic confirmation, when needed, can be achieved through viral culture, polymerase chain reaction testing, or Tzanck smear, though the classic presentation in most cases permits clinical diagnosis.

Therapy for herpetic whitlow rests on antiviral agents, principally acyclovir, valacyclovir, and famciclovir, which shorten the duration of viral shedding and accelerate healing when initiated early in the course of infection. The pharmacogenetic pathway described by Maillard and colleagues explains both the selectivity and the limitations of these drugs: acyclovir is preferentially phosphorylated by virus-encoded thymidine kinase, concentrating active drug in infected cells, but resistance can emerge in immunocompromised patients through loss or alteration of the viral kinase, in which case drugs with alternative mechanisms, such as foscarnet, may be required. For immunocompetent patients, most episodes resolve spontaneously within two to four weeks, though recurrent disease can be frequent, painful, and disruptive, particularly for health care workers whose livelihoods depend on unimpaired hand function.

Prevention strategies highlighted across the reviewed literature emphasize simple but effective measures. The dramatic decline in occupational whitlow among dental professionals after routine gloving became standard practice stands as one of the clearest demonstrations that barrier precautions control transmission of herpes simplex virus in clinical settings. In households, parents and caregivers with active oral herpes lesions can reduce transmission to children by avoiding kissing children on or near the mouth, not sharing utensils and towels, and discouraging thumb-sucking in children with active herpetic gingivostomatitis. People with recurrent whitlow can reduce autoinoculation risk by avoiding contact between their lesions and other body sites, particularly the eyes, where herpes infection can threaten vision.

The consolidated picture that emerges from this review serves a dual purpose. For clinicians, it provides an evidence-based reference point for recognizing a condition that, despite its distinctive appearance, continues to be misdiagnosed in emergency departments, pediatric clinics, and dermatology practices. For researchers, it identifies gaps in the literature, including the relative scarcity of prospective studies and randomized treatment trials in both children and adults, since most of the evidence base remains built on individual case reports and small series. As antiviral pharmacology advances and awareness of occupational and household transmission routes deepens, syntheses of the kind now published by the Weill Cornell, Rutgers, and Columbia collaboration help ensure that the accumulated clinical wisdom of six decades of case reporting is not lost but translated into better diagnosis, more judicious treatment, and fewer preventable infections of the hand.

Subject of Research: Herpetic whitlow: a systematic review of published herpes simplex virus infection cases of the fingers

Article Title: Review of published herpetic whitlow cases

Article References: Vijayvargiya, N., Singal, A., Zhou, M. H., & Lipner, S. R. (2026). Review of published herpetic whitlow cases. Archives of Dermatological Research, 318(1), Article 412. https://doi.org/10.1007/s00403-026-04923-x

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04923-x

Keywords: herpetic whitlow, herpes simplex virus, dermatology, acyclovir, occupational infection, pediatric herpes, antiviral therapy, nail and hand infection, case report review, viral infection, dental health workers, autoinoculation

The technology itself is elegant in its approach. Traditional microneedling works by creating controlled micro-injuries in the dermis using fine needles, triggering a wound-healing cascade that deposits new collagen and elastin. Radiofrequency microneedling amplifies this effect by delivering radiofrequency energy directly into the dermis through the needle tips, generating coagulation zones that further stimulate fibroblast activity and neocollagenesis. The devices operate at frequencies typically between 1 and 4 megahertz, with the thermal effect governed by energy per needle measured in joules, pulse width in milliseconds, and needle penetration depth. Unlike ablative lasers that vaporize tissue at the surface, radiofrequency microneedling preserves the epidermis while targeting the dermis beneath it, a distinction that fundamentally shapes its complication profile. Clinical applications now span facial rejuvenation, acne scarring, stretch marks, excessive underarm sweating, melasma, and even androgenetic alopecia, with results that continue improving for six months or more as the skin slowly remodels.

The most common side effects remain reassuringly mundane. Nearly every patient experiences some degree of redness and swelling immediately after treatment, symptoms that typically peak within 24 to 48 hours and resolve within three to seven days without intervention. Pain during treatment averages 5.61 out of 10 on standard scales and intensifies with higher energy settings and deeper needle penetration, underscoring the importance of appropriate topical anesthesia protocols. Dry skin, peeling, pinpoint bleeding, and mild crusting at application sites round out the expected recovery picture. In one real-world study of 126 patients receiving 590 treatments, every single patient experienced temporary redness, a finding the review’s authors cite as evidence of how universal these transient effects are. While rarely alarming clinically, these predictable reactions carry significant weight in informed consent, and the researchers emphasize that thorough pre-procedure counseling about expected downtime and the possibility of prolonged or atypical responses is an essential component of responsible practice.

Post-inflammatory hyperpigmentation emerges from the review as the single most clinically significant complication, particularly for patients with darker skin. The mechanism is well understood: skin inflammation triggers overproduction of melanin, creating discoloration that can persist for months. A systematic review examining radiofrequency microneedling in Fitzpatrick skin types III through VI found that 7 of 35 studies documented temporary hyperpigmentation, one reported mild prolonged pigmentation, and only a single study noted permanent scarring. Among those 126 patients receiving 590 treatments, just one case of hyperpigmentation occurred, resolving within one to three months with proper treatment. Notably, the evidence suggests radiofrequency microneedling causes less hyperpigmentation than fractional micro-plasma radiofrequency, a comparative advantage that matters enormously for patients with Fitzpatrick types IV through VI. Still, the authors caution that the risk for patients with types V and VI remains substantial even with optimal technique, and some experts consider very dark skin types a relative contraindication absent extensive operator experience.

Rarer complications carry heavier consequences. Scarring, though uncommon, can be permanent, with tram-track scarring and linear arrays of small scars at needle placement sites reported in the literature. Risk factors include excessive energy delivery, insufficient healing time between sessions, treatment over active infections, and individual susceptibility to abnormal scarring, with patients who have keloid or hypertrophic scar histories requiring careful consideration. Granulomatous reactions present a different challenge: while not specifically documented with radiofrequency-enabled devices, a systematic review identified 15 patients aged 26 to 74 who developed these inflammatory responses after traditional microneedling, most implicating motorized pens and topical vitamin C applied during treatment. The disrupted skin barrier dramatically increases absorption of topically applied substances, making non-sterile or unapproved products a significant and avoidable risk factor. Once these reactions develop, management is notoriously difficult, requiring intralesional corticosteroid injections that may need repetition at four to six week intervals, adjunctive oral anti-inflammatory agents, and referral to dermatology specialists for recalcitrant cases.

Infections, by contrast, appear largely preventable. In the study of 590 treatments, zero infections occurred, and comparative studies report similar results when proper sterile protocols are followed. The absolute contraindications are clear: active bacterial, viral, or fungal infections must completely resolve before treatment to prevent dissemination, and inflammatory skin conditions in the treatment area must be controlled first. Pregnancy is likewise an absolute contraindication owing to absent safety data and theoretical concern about fetal radiofrequency exposure, though no specific evidence of harm exists. Relative contraindications demand nuanced risk stratification. Nickel allergy deserves particular attention, as recent research found that three of five common microneedle brands contain and release nickel ions during use, potentially triggering allergic reactions in sensitive patients. Bleeding disorders, anticoagulant use, and immunosuppression each require case-by-case evaluation, while patients with pacemakers and defibrillators need cardiology consultation because electromagnetic interference from monopolar systems can cause device malfunction, inappropriate shocks, or resets.

Device selection fundamentally shapes the safety equation. Insulated needles, coated along their shafts with only the distal tip exposed, concentrate thermal energy at a target dermal depth while shielding the overlying epidermis, significantly reducing surface damage and hyperpigmentation risk. A multi-center study of high-energy fractionated radiofrequency with insulated microneedles demonstrated that thermal injury can be delivered to multiple dermal layers with minimal surface damage, making these systems preferable for darker skin. Non-insulated needles, delivering energy along their entire length, create thermal gradients from surface to depth but carry higher risk of epidermal injury. Electrode configuration matters equally: bipolar systems pass current between adjacent microneedles through confined tissue, producing localized, predictable thermal effects with superior safety regarding cardiac device interference, while monopolar systems drive current through deeper tissues with greater risk of unintended thermal effects. Reviews show major complication rates run higher with monopolar than bipolar devices, though both are acceptably safe when properly used.

The physics of energy delivery carries a sobering implication that runs through the review’s long-term safety analysis. Histological studies reveal a striking correlation of r equal to 0.976 between energy per needle and resulting coagulation volume, and radiofrequency energy does not terminate neatly at the needle tip; it diffuses into surrounding tissue, with the zone of thermal effect extending several millimeters beyond at higher energies or longer pulse widths. In a 2025 safety communication, the FDA formally identified subcutaneous fat loss as a reported complication, particularly in the periorbital and malar regions where the dermis-to-fat ratio is small. Risk is likely low at standard facial depths of one to two millimeters but increases with aggressive settings, repeated passes, or anatomically thin patients. Injury to the deeper muscular fascia layer, which lies at five to eight millimeters beyond standard treatment targets, remains speculative, though surgeons operating on previously treated patients have raised concerns that the authors say demand dedicated investigation. Follow-up studies at 90 and 180 days show sustained improvements without delayed complications, and long-term results significantly outperform short-term measures, but robust evidence beyond 12 months remains limited.

Perhaps the review’s most important contribution is its candor about the gap between trial data and clinical reality. An analysis of 114 postmarketing adverse event reports in the FDA’s MAUDE database, encompassing 224 events, found textural changes in 25 percent, pigmentary alteration in 18.3 percent, and fat loss in 11.6 percent, categories that rarely dominate published trial literature drawn from experienced practitioners using standardized protocols and carefully selected patients. The authors frame this divergence not as grounds for alarm but as essential context for counseling and institutional standards of care. Their conclusion is measured: radiofrequency microneedling is an effective, valuable treatment when performed with appropriate technique, particularly for darker skin tones using insulated needle systems, where it holds a distinct advantage over ablative alternatives. But transient complications should not be minimized in patient conversations, permanent complications do occur, and cumulative thermal burden from repeated sessions warrants consideration. Responsible practice, the review insists, rests on meticulous patient selection, conservative parameter adjustment matched to skin type and anatomy, sterile technique, approved topical products only, and comprehensive aftercare protocols, including sun protection and, when pigmentary changes arise, treatments such as topical corticosteroids and hydroquinone.

Subject of Research: Complications and safety of radiofrequency microneedling procedures

Article Title: Complications of radiofrequency microneedling: a comprehensive review

Article References: Varelas, E. A., Varelas, A. N., Kumar, A. T., & Eytan, D. F. (2026). Complications of radiofrequency microneedling: a comprehensive review. BMC Plastic and Reconstructive Surgery, 2(1), Article 21. https://doi.org/10.1186/s44452-026-00031-x

Image Credits: AI Generated

DOI: 10.1186/s44452-026-00031-x

Keywords: radiofrequency microneedling, post-inflammatory hyperpigmentation, insulated needles, bipolar radiofrequency, monopolar radiofrequency, tram-track scarring, granulomatous reactions, FDA safety communication, Fitzpatrick skin types, subcutaneous fat loss, contraindications, dermatology

Dermatology has long been among the most competitive specialties in the National Resident Matching Program. With a limited number of positions, high board scores historically expected, and a lifestyle that attracts large applicant pools, the field has developed one of the most demanding unofficial credential portfolios in graduate medical education. Previous analyses, including work published in JAMA Dermatology, documented a steady rise in the research output of medical students matching into dermatology between 2007 and 2018, a trend some commentators have described as research fever. The new study asks whether that fever intensified once Step 1 scores could no longer differentiate applicants numerically.

The rationale for the investigation rests on a simple structural fact. Before the transition, a high Step 1 score served as a widely used screening filter, allowing program directors to rank candidates quickly and giving applicants a clear, if stressful, way to demonstrate academic strength. When scoring became binary, that signal disappeared. Students who might once have relied on a strong score to compensate for thinner research records suddenly faced a signaling vacuum, and many appear to have responded by accelerating their publication efforts. The SUNY Downstate team set out to quantify whether the applicants entering elite dermatology programs indeed became more research-productive in the immediate aftermath of the change.

Methodologically, the researchers constructed an applicant-level dataset by tracing publication records through PubMed, the publicly accessible bibliographic database maintained by the National Library of Medicine. By linking successful applicants to the top Doximity-ranked dermatology programs with their indexed scholarly records, the team could count manuscripts, characterize authorship positions, and compare productivity across the pre-transition and post-transition eras. The compiled dataset was analyzed to detect shifts in the volume and pattern of research output, with the authors reporting their comparisons in graphical form across two figures in the short report. The use of PubMed as the source of publication records means the analysis captures indexed journal articles, the most verifiable form of student research output.

The study’s central observation is that research productivity among applicants to top-ranked dermatology programs did not decline after Step 1 became pass/fail; rather, the pressure to publish appears to have persisted or grown in the immediate post-transition period. This aligns with what residency directors anecdotally report: when one differentiator is removed from the application, others expand to fill the space. Publications, particularly peer-reviewed manuscripts with meaningful authorship roles, offer a quantifiable, durable signal of initiative, intellectual curiosity, and the capacity to complete a long-term project, qualities that a pass/fail exam can no longer convey with any granularity.

The findings carry particular weight because dermatology sits at the extreme end of the competitiveness spectrum. Prior work by Behbahani and colleagues in the International Journal of Women’s Dermatology analyzed the number of manuscripts in successful dermatology applications and found that publications were a common feature of matched candidates. A related 2025 analysis by Abizadeh and colleagues, which included several of the same SUNY Downstate investigators, documented similar dynamics in ophthalmology, another highly competitive specialty that also experienced the Step 1 transition. Together, these studies suggest a broader pattern across competitive fields: the removal of numerical Step 1 scores has shifted, not lightened, the burden of differentiation onto other parts of the application.

That shift has consequences for equity. Research productivity is not distributed evenly across medical students. Access to mentorship, dedicated research time, institutional funding, and proximity to academic medical centers all shape a student’s ability to publish before applying. Students at resource-rich institutions with established dermatology departments can more easily find projects, co-authors, and submission support, while students at schools without such infrastructure face structural barriers. If publications become the dominant differentiator in the post-pass/fail era, the authors’ findings imply that the transition may have amplified existing inequities rather than reduced them, a concern echoed in a 2023 JAMA Dermatology commentary describing research fever in dermatology as a symptom of a larger problem within the specialty’s selection culture.

The study also speaks to the ongoing debate about holistic review in residency selection. Proponents of the Step 1 pass/fail change argued that it would reduce student stress, discourage rote test preparation, and encourage programs to evaluate candidates on a broader set of attributes, including clinical performance, letters of recommendation, and personal qualities. The SUNY Downstate results suggest that at least one intended consequence, a de-emphasis on credential accumulation, has not materialized in elite dermatology recruitment. Instead, the credential economy appears to have migrated from the exam score to the curriculum vitae, with students responding rationally to the incentives programs continue to reward.

For medical educators and advisors, the practical implications are immediate. Students targeting competitive specialties now need earlier and more deliberate research planning, ideally beginning in the preclinical years, to build a publication record that can withstand comparison in a post-transition applicant pool. Programs, meanwhile, face a choice: continue to reward publication counts, thereby sustaining the arms race, or develop more structured ways to assess the quality and authenticity of research experiences, such as standardized descriptions of the applicant’s actual role and contribution. The authors of the current study, funded by the SUNY Downstate Health Sciences University Dermatology Department, frame their work as a snapshot of a system in transition, and they note that longer-term follow-up across additional match cycles will be needed to determine whether the patterns observed immediately after the change persist, stabilize, or prompt reform in how dermatology programs select the next generation of specialists.

Subject of Research: Research productivity of applicants to top Doximity-ranked dermatology residency programs in the USA before and after the Step 1 pass/fail transition

Article Title: Research productivity among applicants into top Doximity-ranked dermatology programs in the USA before and immediately after step 1 transition to pass/fail scoring

Article References: Research productivity among applicants into top Doximity-ranked dermatology programs in the USA before and immediately after step 1 transition to pass/fail scoring. (n.d.). https://doi.org/10.1007/s00403-026-04893-0

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04893-0

Keywords: dermatology, residency match, Step 1 pass/fail, research productivity, medical education, NRMP, publications, Doximity rankings, USMLE, competitive specialties, PubMed, SUNY Downstate

Skin cancer remains one of the most common cancers in the United Kingdom, and melanoma incidence has been rising for decades. Most patients first present to their general practitioner, whose task is to decide which suspicious lesions need urgent referral to a specialist and which can be safely monitored. That judgement is difficult: benign moles vastly outnumber malignant ones, and distinguishing between them by eye is a skill that varies considerably between clinicians. AI tools trained on tens of thousands of dermoscopic images have shown impressive accuracy in research settings, and several systems are now being trialled in NHS practices as decision-support aids that sit alongside, rather than replace, clinical judgement.

Yet technical performance is only part of the story. If patients distrust the technology, or if certain design choices put them off, even the most accurate algorithm will struggle to achieve its potential. This is the gap the new study set out to address. Rather than simply asking people whether they like the idea of AI, the researchers used a discrete choice experiment, an economic method that presents respondents with a series of hypothetical scenarios in which the attributes of a diagnostic service are varied systematically. By analysing the choices people make across many paired options, the method can quantify how much each attribute matters and how people trade one feature off against another.

The survey was designed to capture the dimensions most likely to shape real-world acceptance. Respondents considered factors such as where the assessment takes place, whether the AI acts as a first reader before a clinician reviews the image or as a second opinion after the doctor has made a judgement, the accuracy of the technology, the speed of the referral decision, and the degree of human oversight involved. Participants were recruited from across the UK to reflect a broad population sample, and their responses were modelled statistically to estimate the relative weight each attribute carried in shaping preferences.

The headline result is one that developers and health planners will welcome: on balance, people are receptive to AI being used to help detect skin cancer in general practice. The technology is not viewed as an unwelcome intrusion but as a potentially useful partner in a diagnostic process that many recognise as imperfect. Importantly, the strength and direction of that acceptance depended on how the system was deployed. Preferences were not uniform across all configurations of an AI-enabled service, which suggests that implementation choices, not just algorithm accuracy, will determine public trust.

One of the clearest signals in the data concerned the role of the clinician. Respondents placed substantial value on scenarios in which a human doctor remains central to the diagnostic pathway, with the AI serving as an aid rather than an autonomous decision-maker. This aligns with a recurring theme in the wider literature on medical AI: people generally support algorithms that support clinicians, but are far more hesitant about systems that appear to bypass human expertise altogether. For skin cancer detection, where a missed melanoma can be fatal, that desire for oversight is perhaps unsurprising.

Accuracy itself also mattered. Respondents preferred services in which the AI, or the combined human-AI process, was described as more reliable in distinguishing harmless lesions from those needing urgent attention. Trade-off analysis allowed the researchers to express these preferences quantitatively, revealing how much additional waiting time, for example, people would accept in exchange for a measurable gain in diagnostic accuracy. Such estimates are valuable because they convert abstract attitudes into concrete quantities that health service designers can weigh against cost and capacity constraints.

The study also found that preferences varied across different groups of respondents. Familiarity with AI, previous experience of skin checks, and demographic factors all influenced how people weighed the attributes of an AI-supported service. This heterogeneity matters for policy. A one-size-fits-all rollout of AI tools could encounter pockets of resistance, whereas a deployment strategy that communicates clearly what the technology does, who oversees it, and how errors are handled is more likely to build broad acceptance. The authors suggest that transparency about the assistive role of these systems should be a central feature of any NHS implementation.

The timing of this research is significant. Health systems around the world are under pressure from rising demand and workforce shortages, and diagnostic backlogs have become a persistent concern. AI triage tools for skin lesions promise to speed up the pathway, potentially allowing low-risk cases to be managed in primary care while ensuring that high-risk lesions reach specialists quickly. Early trials of such tools in the UK have reported encouraging results, but large-scale adoption will depend as much on public confidence as on clinical evidence. By quantifying what patients actually want from these services, this study provides an evidence base for designing AI deployments that people are willing to use.

The broader lesson extends well beyond dermatology. As algorithms enter ever more areas of medicine, from radiology to pathology to general practice triage, understanding the public’s terms of engagement becomes an essential part of responsible innovation. This UK-wide experiment demonstrates that acceptance is conditional, nuanced and measurable. People appear ready to embrace AI that makes skin cancer detection faster and more accurate, provided that clinicians stay firmly in the loop and that the promises made on behalf of the technology are honest ones. In that sense, the study offers not just a snapshot of current attitudes but a practical roadmap for introducing AI into primary care in a way that earns, rather than assumes, public trust.

The discrete choice experiment approach used in this study has a long pedigree in health services research, having been employed to elicit preferences for everything from screening programmes to vaccination schedules. Its strength lies in forcing respondents to make realistic trade-offs rather than simply endorsing or rejecting a technology in the abstract. When people are asked directly whether they support medical AI, many express generic enthusiasm or generic unease; when asked to choose between two concrete service designs, their underlying priorities become visible. This is particularly valuable for technologies at an early stage of deployment, where public attitudes are still forming and where policy decisions made now could lock in patterns of trust or distrust for years to come.

The context for this work is a diagnostic pathway under genuine strain. Melanoma, while accounting for a minority of skin cancer cases, is responsible for the large majority of skin cancer deaths, and its incidence in the UK has increased substantially over recent decades, partly attributed to historical trends in overseas sun exposure and an ageing population. At the same time, urgent suspected cancer referrals have grown faster than dermatology capacity in many parts of the country, creating waiting times that clinicians and patient groups have repeatedly flagged as concerning. Tools that can safely reduce the number of benign lesions progressing along the urgent pathway could free specialist time for those who need it most, which is precisely the promise that has attracted NHS innovation funding to this area.

It is worth noting how the regulatory landscape is evolving in parallel. Software intended to inform clinical decisions about suspected cancer falls within the scope of medical device regulation, and the United Kingdom has been developing its own post-Brexit framework for approving and monitoring such tools. Real-world evaluation is a central expectation of that framework, and studies of patient acceptability complement the technical validation studies that dominate the field. A system may pass accuracy benchmarks in retrospective image datasets yet still fail in practice if the public declines to engage with the service in which it is embedded. Evidence on preferences therefore feeds directly into implementation guidance and commissioning decisions.

The finding that prior familiarity with AI shapes preferences echoes a consistent pattern in the behavioural literature: experience tends to moderate both utopian and dystopian expectations. People who have encountered algorithmic tools in everyday life, whether in navigation apps or online services, often report more calibrated views of what such systems can and cannot do. In the clinical setting, this suggests that early, well-communicated deployments could themselves build the familiarity that supports later acceptance, whereas a poorly explained first encounter could colour attitudes across an entire community.

There are, of course, limits to what any stated-preference study can establish. Hypothetical scenarios do not carry the emotional weight of a real diagnosis, and respondents may behave differently when a genuine lesion of their own is at stake. Discrete choice experiments also require researchers to select which attributes to vary, and unmeasured concerns, such as data privacy or the fear of being deprioritised by an algorithm, may not be fully captured. Longitudinal follow-up of actual deployments, capturing both uptake and outcomes, will be needed to confirm that the preferences measured here translate into behaviour. Nevertheless, by quantifying the conditions of acceptance before widespread rollout, this study offers health planners a rare opportunity to design AI-enabled services around public expectations rather than retrofitting trust after the fact.

Subject of Research: Public preferences for AI-assisted skin cancer detection in UK primary care, measured using a nationwide discrete choice experiment.

Article Title: Preferences for the use of Artificial Intelligence (AI) technologies to help detect skin cancer in primary care settings: a UK-wide discrete choice experiment (DCE)

Article References: Jones, O. T., Walter, F. M., Matin, R. N., Calanzani, N., Emery, J., van der Schaar, M., & Morris, S. (2026). Preferences for the use of Artificial Intelligence (AI) technologies to help detect skin cancer in primary care settings: a UK-wide discrete choice experiment (DCE). British Journal of Cancer. https://doi.org/10.1038/s41416-026-03611-x

Image Credits: AI Generated

DOI: 10.1038/s41416-026-03611-x

Keywords: artificial intelligence, skin cancer, melanoma, primary care, general practice, discrete choice experiment, patient preferences, clinical decision support, dermatology, NHS, diagnostic accuracy, public attitudes