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Consensus on the diagnosis and treatment of vitiligo (2024 version)
Pigmentary Disorder Group, Combination of Traditional and Western Medicine Dermatology, Research Center for Vitiligo, Chinese Society of Dermatology, Committee on Pigmentation Disorders, China Dermatologist Association
Chinese Journal of Dermatology    2024, 57 (12): 1065-1070.   DOI: 10.35541/cjd.20240260
Abstract5088)      PDF(pc) (3803KB)(4596)       Save
【Abstract】 Vitiligo is a common autoimmune skin disease, currently believed to be caused by autoreactive T cell-mediated destruction of melanocytes in the skin, mucous membranes, or hair follicles, which can significantly induce psychological distress in patients. The consensus on the diagnosis and treatment of vitiligo (2024 version) was formulated by the Pigmentary Disorder Group, Combination of Traditional and Western Medicine Dermatology, etc., based on the latest international research progress in the diagnosis and treatment of vitiligo and actual situation in China. This version of consensus highlights early intervention, integrative therapy, application of JAK inhibitors in vitiligo, and provides future research directions, aiming to guide the treatment of vitiligo.
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Guidelines for the diagnosis and treatment of refractory chronic spontaneous urticaria in China (2025 edition)
Qi-Quan CHEN Song Zhi-Qiang WANG Gang
Chinese Journal of Dermatology    2025, 58 (6): 485-496.   DOI: 10.35541/cjd.20240674
Accepted: 19 May 2025

Abstract4656)      PDF(pc) (14956KB)(4326)    PDF(mobile) (15121KB)(1474)    Save
【Abstract】 Refractory chronic spontaneous urticaria (CSU) is clinically common and poses significant diagnostic and therapeutic challenges due to resistance to standard or doubled doses of H1 antihistamines or their combination therapies. Current guidelines or consensus statements on urticaria have not met the needs for high-quality standardized management of refractory CSU, highlighting the necessity for specific guidelines for its diagnosis and treatment. Therefore, a guideline working group was established by the Chinese Society of Dermatology and the China Dermatologist Association, and consisted of 29 leading experts in urticaria research in China. Through a comprehensive review and evaluation of existing Chinese and international evidence-based data, and consideration of the situation in China, this guideline was formulated after multiple rounds of deliberation, aiming to provide guidance on the diagnosis and treatment of refractory CSU and to guide clinical practice.
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Guidelines for the treatment of psoriasis with biologics and small-molecule drugs in China (2024)
Chinese Society of Dermatology, China Dermatologist Association, Dermatology & Venereology Specialized Committee of Chinese Association of Integrative Medicine
Chinese Journal of Dermatology    2024, 57 (11): 976-997.   DOI: 10.35541/cjd.20240294
Accepted: 24 October 2024

Abstract3816)      PDF(pc) (27228KB)(488)    PDF(mobile) (27518KB)(51)    Save
【Abstract】 The treatment of psoriasis has entered an era of targeted therapy, and the application of biologics and small-molecule drugs has markedly improved the quality of life of patients, especially in the treatment of moderate to severe, refractory, and special types of psoriasis. In China, biologics that have been approved for marketing and used in the treatment of psoriasis include 9 agents belonging to 5 major categories, namely tumor necrosis factor-α inhibitors, interleukin-12/23 inhibitors, interleukin-23 inhibitors, interleukin-17A inhibitors, and interleukin-36 inhibitors; small-molecule drugs include 4 drugs belonging to 2 categories that inhibit different steps in the inflammatory cytokine pathways, namely phosphodiesterase 4 and Janus kinases (including tyrosine kinase 2). How to use biologics and small-molecule drugs in a rational, effective and safe way has become an issue of great concern in clinical practice. To this end, experts in the field of diagnosis and treatment of psoriasis and related fields in China developed this guideline based on Chinese and international research data, clinical experience, as well as characteristics of Chinese patients with psoriasis after in-depth discussions. This guideline provides specific guidance for clinicians in terms of application principles and methods of major biologics and small-molecule drugs, efficacy and safety profiles, patient screening and monitoring, common problems and solutions, as well as considerations for their application in special populations.
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Prevention and treatment of postinflammatory hyperpigmentation: a Chinese expert consensus statement (2024)
Group on Medical Aesthetics and Cosmetology, Chinese Academy of Aesthetic Medicine
Chinese Journal of Dermatology    2024, 57 (11): 998-1003.   DOI: 10.35541/cjd.20240087
Abstract3793)      PDF(pc) (7626KB)(5549)       Save
【Abstract】 Postinflammatory hyperpigmentation is a hyperpigmentation disorder following skin inflammation or damage caused by various endogenous and exogenous factors, which may result in emotional distress and social difficulties in patients. The Group on Medical Aesthetics and Cosmetology of Chinese Academy of Aesthetic Medicine organized experts in this field to develop this consensus in terms of the epidemiological characteristics, etiology and pathogenesis, clinical manifestations, prevention, and treatment of postinflammatory hyperpigmentation, aiming to provide guidance for its prevention and treatment.
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Expert consensus on diagnosis and treatment of pigmented nevi (2025 edition)
Skin Cancer Research Group, Committee on Dermatology, Chinese Association of Integrative Medicine, Melanoma Society of China Anti-Cancer Association, Society of Integrated Rehabilitation of Skin Tumors, China Anti-Cancer Association
Chinese Journal of Dermatology    2025, 58 (5): 387-395.   DOI: 10.35541/cjd.20240631
Abstract2912)      PDF(pc) (13489KB)(2181)       Save
【Abstract】 To enhance clinicians′ understanding of pigmented nevi and standardize their diagnosis and treatment, a group of experts from the Skin Cancer Research Group, Committee on Dermatology, Chinese Association of Integrative Medicine, the Melanoma Society of China Anti-Cancer Association and the Society of Integrated Rehabilitation of Skin Tumors, China Anti-Cancer Association, adhering to the principles of evidence-based medicine, integrated the latest Chinese and international guidelines, consensuses, and existing research findings to formulate the expert consensus on diagnosis and treatment of pigmented nevi (2025 edition) through two rounds of intensive revisions and discussions. This consensus covers various types of pigmented nevi, including common acquired pigmented nevi, congenital pigmented nevi, recurrent pigmented nevi, and pigmented nevi in special populations (children, pregnant women), and offers detailed recommendations on the key points for the diagnosis and treatment of these types of pigmented nevi, aiming to provide a reference for the standardized diagnosis, treatment, and management of pigmented nevi.
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Epidemiological trends and spatio-temporal distribution characteristics of syphilis in China from 2010 to 2023
Chen Zewei, Liang Shiqing, Yue Xiaoli, Li Jing, Zhang Jiahui, Gong Xiangdong
Chinese Journal of Dermatology    2024, 57 (11): 1045-1050.   DOI: 10.35541/cjd.20240073
Abstract2816)      PDF(pc) (8436KB)(534)       Save
【Abstract】 Objective To investigate the epidemiological trends and spatio-temporal distribution characteristics of syphilis in China from 2010 to 2023. Methods Data on syphilis cases reported from 31 provinces, autonomous regions or municipalities from 2010 to 2023 were collected from the Infectious Diseases Surveillance System of Chinese Disease Prevention and Control Information System. Joinpoint 5.2.0 software was used to analyze the epidemiological trends of syphilis, ArcGIS 10.5 software was used for spatial autocorrelation analysis at the county level, and SaTScan 10.2.3 software was used for space-time scan analysis. Results The national reported incidence rates of syphilis increased from 26.86 per 100 000 in 2010 to 37.60 per 100 000 in 2023, with an average annual percent change of 1.82% (95% CI: 0.81% - 2.89%), and the upward trend in the reported incidence rates was statistically significant (P = 0.002). There was a positive spatial autocorrelation in the reported incidence rates of syphilis at the county level in China (Moran's Ⅰ range: 0.47 - 0.60, all P < 0.001), and all of the Getis-Ord general test statistic Z(G)values were > 1.96, indicating a high-value clustering pattern in the reported incidence rates of syphilis. The local spatial autocorrelation analysis showed that the annual number of hotspot areas ranged from 180 to 294, which were mainly located in Xinjiang, Qinghai, Guizhou, Sichuan and Yunnan. A total of 92 spatio-temporal clusters were identified by space-time scan analysis, which were mainly distributed in Zhejiang, Guangxi, Guangdong and Fujian from 2010 to 2012, in Xinjiang from 2013 to 2017, and in Sichuan, Guizhou, Chongqing, etc., from 2019 to 2023. Conclusions From 2010 to 2023, the reported incidence rates of syphilis in China exhibited a fluctuating increase on the whole, with obvious spatio-temporal clustering characteristics. The hotspot areas were basically consistent with the spatio-temporal clusters, and were mainly distributed in the northwestern, southeastern coastal and southwestern areas. Over time, the spatio-temporal clusters gradually changed from the southeast coastal and northwestern areas to the southwestern areas.
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Expert consensus on the diagnosis, treatment, and rehabilitation of pruritus in the elderly (2025 edition)
Chinese Association of Rehabilitation Dermatology, Working Group on Geriatric Dermatology, Combination of Traditional and Western Medicine Dermatology
Chinese Journal of Dermatology    2025, 58 (1): 1-8.   DOI: 10.35541/cjd.20240407
Abstract1991)      PDF(pc) (10301KB)(2442)       Save
【Abstract】 In recent years, research on pruritus in the elderly has progressed rapidly, deepening the understanding of this condition. In order to standardize the diagnosis, treatment and rehabilitation of pruritus in the elderly, experts from the Chinese Association Rehabilitation of Dermatology, and the Working Group on Geriatric Dermatology, Combination of Traditional and Western Medicine Dermatology organized relevant experts and formulated an expert consensus on the diagnosis, treatment, and rehabilitation of pruritus in the elderly (2025 edition) based on the latest Chinese and international research advancements, with a particular focus on evidence-based medicine. This consensus aims to provide recommendations to address clinical problems, alleviate or eliminate patients′ symptoms and improve their quality of life.
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Guideline on phototherapy for vitiligo (2025 edition)
Dermatology Professional Committee of Chinese Research Hospital Society, China Dermatologist Association
Chinese Journal of Dermatology    2025, 58 (3): 197-208.   DOI: 10.35541/cjd.20240547
Abstract1951)      PDF(pc) (12482KB)(2276)       Save
【Abstract】 Ultraviolet phototherapy stands as a pivotal intervention in the management of vitiligo. To guide and standardize the application of ultraviolet phototherapy in the treatment of vitiligo, and to improve its efficacy and safety, the Dermatology Professional Committee of Chinese Research Hospital Society and the China Dermatologist Association organized Chinese experts in the fields of photomedicine and pigmentary disorders to formulate the “Guideline on phototherapy for vitiligo (2025 edition)” after thorough discussions based on the latest research progress in vitiligo phototherapy in China and other countries in recent years and the clinical experience of experts. This guideline comprehensively delineates core clinical considerations pertaining to phototherapy for vitiligo, including the therapeutic principles, contraindications, individualized phototherapy protocols, strategies for combination therapies, and management of adverse reactions, aiming to further improve the performance of phototherapy in the treatment of vitiligo in China.
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Expert consensus on the treatment of dermatoses with targeted drugs (2025 version)
Committee on Skin Disease and Cosmetic Dermatology, China Association of Medical Equipment
Chinese Journal of Dermatology    2025, 58 (2): 99-125.   DOI: 10.35541/cjd.20240054
Abstract1907)      PDF(pc) (33181KB)(253)       Save
【Abstract】 With the progress in dermatology in recent decades, some new biologic agents and small-molecule targeted drugs have been approved for the treatment of skin diseases, and have showed favorable therapeutic effect, especially in the treatment of complex and refractory dermatoses. However, how to apply targeted therapy reasonably, effectively and safely in the treatment of skin diseases has become a matter of great concern in clinical practice. To this end, the Committee on Skin Disease and Cosmetic Dermatology, China Association of Medical Equipment organized relevant experts to formulate this consensus through multiple in-depth discussions and revisions based on Chinese and international research data, clinical guidelines and consensus, as well as characteristics of Chinese patients. According to the classification of diseases, specific guidance was provided in this consensus for clinicians regarding the clinical application principles and treatment protocols of biologic agents and small-molecule targeted drugs.
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Expert consensus on diagnosis and treatment of port-wine stain in children (2025 edition)
The Consensus Development Expert Group on Diagnosis and Treatment of Port-wine Stain in Chinese Children, Pediatric Dermatologist Committee, China Dermatologist Association
Chinese Journal of Dermatology    2025, 58 (5): 396-404.   DOI: 10.35541/cjd.20240452
Abstract1676)      PDF(pc) (24235KB)(1140)       Save
【Abstract】 Port-wine stain (PWS) is the most common type of low-flow capillary malformations in children. PWS often occurs after birth with a predilection for the face and neck, seriously affecting the physical and mental health of patients and the quality of life of their families. Compared with adults, children are in a growth and development stage. PWS-related syndromes can affect extracutaneous organs, but may only present with mild erythema in the early stage, and is liable to result in misdiagnosis or missed diagnosis. Therefore, early recognition is particularly important. Based on the latest Chinese and international research progress and through extensive discussions, the Consensus Development Expert Group on Diagnosis and Treatment of PWS in Chinese Children formulated the consensus on the etiology, pathogenesis, clinical manifestations, laboratory examinations, diagnosis, differential diagnosis, and treatment of, as well as health education for PWS in children, aiming to provide guidance for clinicians on the diagnosis and treatment of PWS.
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Expert consensus on the diagnosis and treatment of paraneoplastic pemphigus in China (2025 version)
Chinese Society of Dermatology, China Dermatologist Association, Dermatology Branch of China International Exchange and Promotive Association for Medical and Health Care, Rare Skin Diseases Committee, China Alliance for Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases
Chinese Journal of Dermatology    2025, 58 (4): 289-296.   DOI: 10.35541/cjd.20240569
Abstract1654)      PDF(pc) (10103KB)(1111)       Save
【Abstract】 Pemphigus is an autoimmune bullous disease, and paraneoplastic pemphigus (PNP) is a unique subtype of pemphigus. Clinical characteristics of PNP mainly include severe and refractory painful erosions and ulcers of the mucosa, polymorphous skin lesions, and comorbid neoplasms, often accompanied by other systemic involvement (such as bronchiolitis obliterans). Most patients respond poorly to treatment, and in severe cases, it is life-threatening. The diagnosis and treatment of PNP involves dermatology, stomatology, oncology, hematology, respiratory medicine, surgery, anesthesiology, general internal medicine, intensive care unit and other departments. Relevant academic organizations enrolled experts in related fields together to formulate this consensus, to provide guidance for the diagnosis and treatment of PNP. Chinese standards for PNP diagnosis are proposed based on the status of diagnosis and treatment of PNP in China. Treatment suggestions are put forward from the aspects of skin and mucosal involvement, neoplasms, bronchiolitis obliterans, and complications.
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Diagnosis and treatment of bullous pemphigoid: an expert consensus statement (2025 edition)
China Dermatologist Association, Treatment Group, Chinese Society of Dermatology, Dermatology Branch of China International Exchange and Promotive Association for Medical and Health Care, National Clinical Research Center for Dermatologic and Immunologic Diseases, Rare Skin Diseases Committee, China Alliance for Rare Diseases
Chinese Journal of Dermatology    2025, 58 (5): 405-415.   DOI: 10.35541/cjd.20240622
Abstract1574)      PDF(pc) (13758KB)(158)       Save
【Abstract】 Bullous pemphigoid (BP) is an autoimmune subepidermal blistering skin disease that primarily affects the elderly. Clinically, it is characterized by tense blisters and bullae on the local or whole body skin, which can be life-threatening in some patients. The pathogenesis of BP is closely related to anti-BP180 and anti-BP230 antibodies, which cause BP through pathways such as complement activation systems and non-complement systems. This consensus covers clinical characteristics, diagnostic criteria, treatment options, and management of comorbidities associated with BP, with a particular emphasis on the importance of individualized treatment. In terms of diagnosis, a comprehensive approach integrating clinical manifestations, histopathological features, direct immunofluorescence and serological testing results is proposed to improve diagnostic accuracy. In terms of treatment, in addition to traditional glucocorticoids and immunosuppressive agents, new drugs such as biological agents are also recommended, and individualized treatment regimens are formulated according to the disease severity. Additionally, the consensus also pays attention to the management of BP-related comorbidities such as diabetes, kidney disease, and malignant tumors, providing comprehensive guidance for clinicians to improve the treatment outcomes and quality of life of BP patients.
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Chinese expert consensus on clinical severity grading and therapeutic evaluation of acne vulgaris (2025 edition)
Acne Study Group of China Dermatologist Association, Dermatology Professional Committee of Chinese Research Hospital Association, Acne Study Group of Dermatology and Venereology Professional Committee of Chinese Association of Integrative Medicine
Chinese Journal of Dermatology    2025, 58 (8): 709-714.   DOI: 10.35541/cjd.20250034
Accepted: 30 May 2025

Abstract1445)      PDF(pc) (7615KB)(1921)    PDF(mobile) (8925KB)(309)    Save
【Abstract】 Acne vulgaris (abbreviated as acne) is a common aesthetic-impairing dermatological disease that markedly affects appearance, and is characterized by diverse clinical manifestations. At present, there are various grading systems for acne severity, while there is still a lack of unified standards for objectively assessing disease severity to guide treatment selection and scientifically evaluating the efficacy of acne therapies, which are also highly concerned issues for clinicians. To address this, the Acne Study Group of China Dermatologist Association, the Dermatology Professional Committee of Chinese Research Hospital Association, and the Acne Study Group of Dermatology and Venereology Professional Committee of Chinese Association of Integrative Medicine organized a group of experts in the field of acne diagnosis and treatment in China to develop the "Chinese expert consensus on clinical severity grading and therapeutic evaluation of acne vulgaris" after extensive discussions, aiming to provide a reference for dermatologists in clinical practice.
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Expert consensus on the stratified individualized systemic treatment of moderate to severe atopic dermatitis
Immunology Group, Chinese Society of Dermatology, Dermatology Professional Committee of Chinese Research Hospital Society
Chinese Journal of Dermatology    2024, 57 (12): 1071-1078.   DOI: 10.35541/cjd.20240321
Abstract1433)      PDF(pc) (10108KB)(56)       Save
【Abstract】 Atopic dermatitis (AD) is a chronic inflammatory skin disease. In recent years, with the development and application of targeted drugs, the treatment of AD is entering the era of individualization. Stratification of patients based on different dimensions can help realize individualized treatment, but currently there is a lack of stratification strategies for individualized treatment of AD. Therefore, the consensus on stratified individualized systemic treatment for moderate to severe AD was formulated by experts from the Immunology Group, Chinese Society of Dermatology and the Dermatology Professional Committee of Chinese Research Hospital Society, based on the latest research progress in AD in China and other countries as well as experts′ clinical practice experience. The consensus encompasses the individualized comprehensive assessment, systemic therapeutic drugs, selection of therapeutic options according to different dimensions, and the mode of systemic treatment of AD, aiming to guide clinical individualized medication.
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Clinical application of red, blue, and yellow light therapy in dermatology: an expert consensus statement (2025 edition)
Chinese Association of Rehabilitation Dermatology, Chinese Society of Dermatology, Photomedicine Therapeutic Equipment Group, Committee on Skin Disease and Cosmetic Dermatology, China Association of Medical Equipment
Chinese Journal of Dermatology    2025, 58 (3): 209-215.   DOI: 10.35541/cjd.20240354
Abstract1362)      PDF(pc) (10764KB)(1927)       Save
【Abstract】 Red, blue, and yellow light therapy is a type of low-level light therapy commonly used in clinical practice. In recent years, with the development of photomedicine technology, safer and more effective red, blue, and yellow light therapy has been promoted and applied in the treatment of acne, androgenetic alopecia, skin wounds, herpes zoster, and other skin diseases. However, there is no unified standardized treatment protocol. In order to improve the efficacy and safety of the red, blue, and yellow light therapy, the Chinese Association of Rehabilitation Dermatology, the Chinese Society of Dermatology, and the Photomedicine Therapeutic Equipment Group, Committee on Skin Disease and Cosmetic Dermatology, China Association of Medical Equipment organized some experts to formulate the consensus based on Chinese and international literature and clinical guidelines, as well as the current clinical practice in China, aiming to propose specific recommendations for the standardized application of red, blue, and yellow light therapy in dermatology, and provide a reference for clinicians.
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Mutation analysis and observation of long-term treatment with ustekinumab in a case of CARD14-associated papulosquamous eruption
Chen Minfei, Liu Yanting, Feng Cheng, Geng Songmei
Chinese Journal of Dermatology    2025, 58 (3): 254-257.   DOI: 10.35541/cjd.20230613
Abstract1228)      PDF(pc) (21825KB)(178)    PDF(mobile) (10003KB)(17)    Save
【Abstract】 Objective To detect pathogenic gene mutations in a patient with CARD14-associated papulosquamous eruption (CAPE) and his family, and to observe the short-term and long-term efficacy and safety of ustekinumab treatment. Methods Clinical data were collected from a 6-year-old child presenting with erythroderma secondary to pityriasis rubra pilaris and his family members. Peripheral blood samples were collected from the patient, his parents and younger brother, and DNA was extracted from these peripheral blood samples. A next-generation skin-targeted sequencing panel was used to detect gene mutations, and Sanger sequencing was performed for verification. Genomic DNA was also extracted from 100 unrelated healthy controls using the same method. Results A heterozygous mutation c.349+1G>A in intron 6 of the CARD14 gene was identified in the proband and his mother, but was not identified in his father, younger brother or 100 healthy controls, leading to a diagnosis of CAPE in the proband. The patient received subcutaneous injections of ustekinumab at a dose of 45 mg at weeks 0 and 4, and every 12 weeks thereafter. After 1-week treatment, the skin lesions and symptoms improved markedly. No adverse events were reported during the 18-month treatment and follow-up. Conclusion The heterozygous mutation c.349+1G>A in the CARD14 gene may be the cause of the disease in this family, and ustekinumab was effective and safe for the treatment of CAPE.
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Pathogenesis and treatment of seborrheic dermatitis
Wang Di, Zhang Ruijun, Kang Yuying
Chinese Journal of Dermatology    2025, 58 (1): 89-92.   DOI: 10.35541/cjd.20240175
Abstract1220)      PDF(pc) (5169KB)(33)       Save
【Abstract】 Seborrheic dermatitis is a chronic, recurrent, and inflammatory skin disease. Its etiology is intricately related to skin microecological imbalance, dysregulated lipid metabolism, impaired skin barrier function, abnormal immune responses, and genetic predispositions. In recent years, several novel therapeutic approaches have emerged, such as topical phosphodiesterase 4 inhibitors, Janus kinase inhibitors, physical interventions, and chemical peeling, providing more options for the treatment of seborrheic dermatitis. This review summarizes the latest research progress in the pathogenesis and treatment of seborrheic dermatitis.
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Treatment of chronic hand eczema
Bai Lu, Chu Yan, Liu Yuanyuan, Zhu Caiyong
Chinese Journal of Dermatology    2025, 58 (5): 477-480.   DOI: 10.35541/cjd.20220028
Accepted: 06 May 2022

Abstract1175)      PDF(pc) (5150KB)(97)    PDF(mobile) (5142KB)(6)    Save
【Abstract】 Currently, topical glucocorticoids are still the first-line treatment of chronic hand eczema, while systematic treatment is required for moderate to severe chronic hand eczema with no response to topical corticosteroids. Traditional treatments include glucocorticoids, antihistamines, retinoids, immunosuppressants, etc. In recent years, some progress has been made in the treatment of chronic hand eczema with Janus kinase inhibitors, phosphodiesterase 4 inhibitors, biological agents, statins, timolol, daylight photodynamic therapy, etc. This review summarizes recent advances in the treatment of chronic hand eczema, including basic therapy, topical treatment, physical therapy and systemic therapy.
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Expert consensus on clinical use of secukinumab in the treatment of psoriasis
Working Group on “Expert consensus on clinical use of secukinumab in the treatment of psoriasis”
Chinese Journal of Dermatology    2024, 57 (12): 1079-1090.   DOI: 10.35541/cjd.20240226
Accepted: 28 October 2024

Abstract1142)      PDF(pc) (14943KB)(1654)    PDF(mobile) (15089KB)(421)    Save
【Abstract】 Psoriasis is an immune-mediated, chronic, inflammatory and systemic disease that can occur at any age and has a profound impact on patients′ quality of life. Interleukin-17A is a key pro-inflammatory cytokine involved in the pathogenesis of psoriasis. Secukinumab is a fully human anti-interleukin-17A monoclonal antibody. It is approved in China for the treatment of moderate‐to‐severe plaque psoriasis in patients aged 6 years or older, active psoriatic arthritis in adults and ankylosing spondylitis in adults. Since its launch, a large amount of real‐world data on the efficacy and safety has been accumulated in China. To standardize the use of secukinumab in the long‐term management of psoriasis, a systematic review of the literature on the long-term efficacy and safety of secukinumab as well as its treatment strategies and use in special populations was conducted, and an expert consensus was proposed.
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Application of low-dose oral minoxidil in the treatment of androgenetic alopecia
Wang Qin, Ni Chunya, Yang Kai, Lin Jinran, Wu Wenyu,
Chinese Journal of Dermatology    2025, 58 (7): 657-660.   DOI: 10.35541/cjd.20210760
Accepted: 05 September 2022

Abstract1125)      PDF(pc) (5208KB)(24)    PDF(mobile) (5226KB)(0)    Save
【Abstract】 Topical minoxidil has been applied to the treatment of androgenetic alopecia (AGA) in clinical practice for a long time, but some problems still exist, such as unsatisfactory efficacy or poor tolerance. Currently, oral minoxidil is only indicated as second- or third-line therapy for hypertension, but growing evidence has supported the off-label use of low-dose oral minoxidil for the treatment of AGA. This review summarizes possible mechanisms and clinical application of low-dose oral minoxidil in the treatment of AGA.
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Expert consensus on the construction of specialized outpatient clinics and standardized case management of children with atopic dermatitis in China (2025 version)
Group on Children, Chinese Society of Dermatology, Dermatology and Venereology Group, Chinese Pediatric Society, Chinese Medical Association, Chinese Association of Rehabilitation Dermatology, Pediatric Dermatology Group, China Dermatologist Association
Chinese Journal of Dermatology    2025, 0 (4): 20240338-e20240338.   DOI: 10.35541/cjd.20240338
Accepted: 12 March 2025

Abstract1030)      PDF(pc) (21712KB)(1254)    PDF(mobile) (21712KB)(380)    Save
【Abstract】 Atopic dermatitis (AD) is the most common chronic inflammatory disease in dermatology, often beginning in infancy. It can recur and persist into childhood and adolescence, severely affecting sleep, growth and development of children, impairing the quality of life of both the children and their families, and imposing significant social and economic burden. In recent years, the prevalence of AD among children in China has been rising. However, the diagnosis and treatment vary widely across different regions and medical institutions. Meanwhile, there is a lack of evidence?based medicine specific to Chinese children with AD in real?world settings, and the concepts and measures for chronic disease management of AD have not been widely established. To promote the establishment of specialized AD clinics in pediatric dermatology in China, enhance clinical diagnosis and treatment, standardize treatment processes, reduce the disease burden, and improve the quality of life of children and their families, the Group on Children, Chinese Society of Dermatology, the Dermatology and Venereology Group, Chinese Pediatric Society, Chinese Medical Association, the Chinese Association of Rehabilitation Dermatology, and the Pediatric Dermatology Group, China Dermatologist Association organized domestic experts for extensive surveys and discussions. Combining international guidelines with the situation in China, this consensus was formed to provide a reference for the construction of specialized AD clinics in pediatric dermatology in China, and enhance the capability to provide comprehensive care for children with AD throughout the entire disease course.
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Comorbidities in atopic dermatitis
Xie Xinran, Zhang Lu, Du Dan, Li Xiaoxue, Li Yanmei, Jiang Xian
Chinese Journal of Dermatology    2024, 57 (11): 1058-1063.   DOI: 10.35541/cjd.20230099
Accepted: 08 August 2024

Abstract872)      PDF(pc) (7578KB)(33)    PDF(mobile) (7577KB)(0)    Save
【Abstract】 Atopic dermatitis (AD) is a common chronic inflammatory disease that often coexists with atopic diseases such as asthma, allergic rhinitis, and food allergies. In recent years, more and more studies have shown that AD is associated with various diseases such as cardiovascular diseases, autoimmune diseases, and mental disorders, which exacerbate the disease burden on patients with AD and severely affect their quality of life. This review summarizes AD-associated comorbidities reported in previous literature, analyzes their possible common pathogenesis, and explores potential treatments.
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Clinical efficacy of autologous adipose-derived stem cell gel grafting in the treatment of depressed acne scars
Guo Weinan, Wang Junxia, Chen Hui, Hao Junfeng, Li Bing, Wei Jingyi, Zhao Tao
Chinese Journal of Dermatology    2025, 58 (2): 167-169.   DOI: 10.35541/cjd.20210867
Accepted: 31 May 2023

Abstract826)      PDF(pc) (5574KB)(19)    PDF(mobile) (4225KB)(0)    Save
【Abstract】 Objective To investigate the clinical efficacy of autologous adipose-derived stem cell gel (SVF-gel) grafting in the treatment of depressed acne scars. Methods A retrospective analysis was conducted on data collected from 28 patients who underwent SVF-gel grafting treatment for depressed acne scars in the Department of Dermatology, Xijing Hospital, Air Force Medical University from October 2018 to May 2021. There were 17 males and 11 females, aged 17 - 38 (26 ± 4.86) years. As for clinical types, 8 patients were diagnosed with boxcar acne scars, 14 with rolling acne scars, and 6 with acne scars with characteristics of the two types. The clinical acne scar weighted scale (ECCA scale) was used to evaluate the appearance improvement after the treatment, and patients′ subjective satisfaction scores and incidence of adverse reactions were recorded. Results After the SVF-gel grafting, the facial appearance of patients with depressed acne scars significantly improved, and the ECCA scores significantly decreased 6 months after surgery (before surgery: 52.5 ± 15.8 points; 6 months after surgery: 23.8 ± 10.2 points; t = 11.68, P < 0.001). The subjective satisfaction rate of patients was 82.14% (23/28), the incidence rate of adverse reactions was 17.86% (5/28), and 5 patients experienced mild inflammatory reactions after surgery, including 2 with subcutaneous nodules. The secondary grafting rate was 67.86% (19/28). Conclusion The SVF-gel grafting was markedly effective for the treatment of depressed acne scars, which is worthy of clinical promotion and application.
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Expert consensus on the diagnosis and treatment of localized scleroderma (2025 edition)
Chinese Society of Dermatology, China Dermatologist Association
Chinese Journal of Dermatology    2025, 58 (8): 699-708.   DOI: 10.35541/cjd.20250080
Abstract758)      PDF(pc) (12685KB)(973)       Save
【Abstract】 Localized scleroderma (LS) is a rare skin disorder characterized by fibrosis in the dermis and subcutaneous tissues. In severe cases, it can affect patients′ appearance, physical function, and quality of life. Currently, there is a lack of Chinese guidelines or consensus on the diagnosis and treatment of LS, leading to variability in clinical practice. To enhance dermatologists′ understanding of LS and standardize its diagnosis and management, the Chinese Society of Dermatology and the China Dermatologist Association organized a panel of leading experts in the field of dermatology to develop a consensus through systematic literature review and integration of recent Chinese and international research advances. The consensus comprehensively summarized the clinical subtypes, diagnostic criteria, differential diagnoses, and assessment methods of LS, as well as treatment strategies for LS, aiming to provide evidence-based guidance for standardizing the clinical management of LS in China.
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Psoriasiform skin lesions appearing during the treatment with dupilumab in a patient with moderate-to-severe atopic dermatitis
Mao Qiuyu, Yang Xueqi, Jia Yuanyuan, Yang Jingyi, Min Wei
Chinese Journal of Dermatology    2025, 58 (8): 775-776.   DOI: 10.35541/cjd.20220191
Accepted: 12 July 2023

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Evaluation of efficacy of a Chinese herbal mask in the treatment of melanized-type melasma by stereological measurements
Meng Xiao, Wang Junhui, Yan Zhifang, Wang Ning, Cui Bingnan
Chinese Journal of Dermatology    2025, 58 (1): 53-59.   DOI: 10.35541/cjd.20240235
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【Abstract】 Objective To evaluate the efficacy and safety of a Chinese herbal mask in the treatment of melanized-type melasma by stereological measurements. Methods A randomized, controlled, evaluator- and statistician-blind clinical study was conducted. A total of 116 patients with melasma who met the inclusion and exclusion criteria were selected and equally divided into two groups by using a random number table method, with 58 patients in each group. The treatment group received topical treatment with a Chinese herbal mask once a night, while the control group received topical hydroquinone cream in the morning and evening twice daily. The course of treatment lasted 12 weeks, with follow-ups every 4 weeks, and an additional follow-up was performed 12 weeks after discontinuation of treatment. A facial image analyzer and a reflectance confocal microscopy (RCM) were used to collect images before and after treatment. Melasma area and severity index (MASI) scores and RCM scores served as outcome measures, and stereological measurement methods were employed to compare scores before and after treatment; response rates and recurrence rates were calculated, and adverse reactions were observed and recorded. Statistical analyses were performed using the chi-square test and t test. Results A total of 54 patients in the treatment group and 47 patients in the control group completed the study. After 4- and 8-week treatment, there were no significant differences in MASI scores or RCM scores between the two groups (all P > 0.05); after 12-week treatment, the MASI scores and RCM scores were significantly lower in the treatment group (2.91 ± 1.16, 5.48 ± 1.60, respectively) than in the control group (3.99 ± 2.03, 6.66 ± 1.88, t = -3.32, -3.37, respectively, both P < 0.01). After the end of treatment, there was no significant difference in the response rate between the treatment group (44/54, 81.5%) and the control group (34/47, 72.3%; χ2 = 0.12, P > 0.05). Twelve weeks after discontinuation of treatment, 2 patients (3.7%) relapsed in the treatment group, while 15 (31.9%) relapsed in the control group, showing a significant difference in recurrence rates between the two groups (χ2 = 12.34, P < 0.01). Adverse reactions occurred in 2 patients (3.7%) in the treatment group and 6 (11.5%) in the control group, and there was no significant difference in the incidence of adverse reactions between the two groups (χ2 = 1.34, P > 0.05). Conclusions The Chinese herbal mask was safe and effective in the treatment of melanized-type melasma. The application of the facial image analyzer and RCM technology in combination with stereological measurement methods has certain value in reducing the subjectivity in efficacy evaluation for melasma.
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Dupilumab in the treatment of childhood atopic dermatitis
Tian Jing, Liang Yuan, Ma Lin
Chinese Journal of Dermatology    2024, 57 (12): 1157-1160.   DOI: 10.35541/cjd.20210730
Accepted: 02 March 2023

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【Abstract】 Currently, childhood atopic dermatitis (AD) is mainly treated by regular use of moisturisers in combination with topical glucocorticoids or calcineurin inhibitors. For some children with refractory moderate-to-severe AD, systemic glucocorticoids or off-label use of other immunomodulators may be required; however, these treatments usually have some limitations and adverse effects. In recent years, with the discovery of key inflammatory factors in AD, dupilumab, a biological agent targeting interleukin-4/13, has been widely used in clinical practice, and shown certain efficacy. This review summarizes recent clinical studies on dupilumab in the treatment of AD in children.
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A case of ichthyosis bullosa of Siemens misdiagnosed as progressive symmetric erythrokeratoderma
Yuan Mengsha, Liu Ling
Chinese Journal of Dermatology    2025, 58 (7): 640-641.   DOI: 10.35541/cjd.20220755
Accepted: 13 December 2023

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Ultraviolet and androgenetic alopecia
Shen Yuqing, Song Xiuzu
Chinese Journal of Dermatology    2025, 58 (7): 676-678.   DOI: 10.35541/cjd.20210949
Accepted: 20 March 2023

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【Abstract】 Ultraviolet exposure may promote the development of androgenetic alopecia. On the one hand, ultraviolet irradiation can cause perifollicular inflammation through oxidative stress and microecological changes, and can also induce keratinocytes, melanocytes and mast cells to participate in the development of follicular microinflammation; on the other hand, ultraviolet irradiation can cause the aging of hair follicle stem cells, dermal papilla cells and dermal fibroblasts, as well as the increase of elastic fibers. This review summarizes relevant literature in recent years, in order to provide a theoretical basis for advocating protection of the hair and scalp against sunlight to prevent androgenetic alopecia.
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Expert consensus on clinical application of aminolevulinic acid photodynamic therapy in non-melanoma skin cancers (2025 edition)
Chinese Association of Rehabilitation Dermatology, Chinese Association of Photodynamic Therapy and Rehabilitation, Photodynamic Therapy Cooperation Center, Chinese Society of Dermatology
Chinese Journal of Dermatology    2025, 58 (1): 9-19.   DOI: 10.35541/cjd.20240405
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【Abstract】 Non-melanoma skin cancers (NMSCs) are a common type of malignant tumors including actinic keratosis (precancerous lesions), Bowen's disease, cutaneous squamous cell carcinoma, basal cell carcinoma and extramammary Paget's disease. They pose significant health risks and their incidence rates have been increasing year by year. As one of the important treatment methods for NMSCs, aminolevulinic acid photodynamic therapy (ALA-PDT) can be applied throughout the entire treatment process to achieve comprehensive effects involving prevention, treatment, and rehabilitation, and has been widely applied in clinical practice. To provide evidence-based, practical, and standardized guidance for the clinical application of ALA-PDT in treating NMSCs, the Chinese Association of Rehabilitation Dermatology, the Chinese Association of Photodynamic Therapy and Rehabilitation, and the Photodynamic Therapy Cooperation Center, Chinese Society of Dermatology convened a panel of experts from relevant fields, and developed this consensus based on a thorough review of Chinese and international literature, existing consensus and guidelines, expert clinical experience, and the current status of diagnosis and treatment of NMSCs in China.
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Recommendations for the diagnosis and treatment pathway for hereditary angioedema:a dermatology expert group consensus (2025 edition)
Chinese Society of Dermatology, China Dermatologist Association
Chinese Journal of Dermatology    2025, 58 (6): 497-502.   DOI: 10.35541/cjd.20240676
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【Abstract】 Hereditary angioedema (HAE) is a rare autosomal dominant hereditary disorder mediated by bradykinin and characterized by recurrent skin and/or mucosal edema. HAE attacks commonly affect the skin, upper respiratory tract and gastrointestinal tract. Laryngeal edema in HAE patients carries a high mortality rate. Enhancing dermatologists′ ability to diagnose and treat HAE can significantly improve patient outcomes. This consensus was developed based on Chinese and international high-quality literature in recent years and clinical experience of 19 dermatological experts in China, aiming to provide standardized diagnosis and treatment pathway for HAE.
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Relationships between coronavirus disease 2019 and psoriasis
Chen Jiaqi, Zhang Jin, Tang Jun
Chinese Journal of Dermatology    2025, 58 (1): 84-88.   DOI: 10.35541/cjd.20220869
Accepted: 31 July 2023

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【Abstract】 During the coronavirus disease 2019 (COVID-19) pandemic, widespread attention has been paid to the management of psoriasis, and more and more researchers have explored the relationships between psoriasis and COVID-19 from different perspectives. This review summarizes the impact of the use of biological agents on COVID-19 in patients with psoriasis, and the interaction between psoriasis and COVID-19, aiming to provide more reliable guidance on diagnosis and treatment of psoriasis for dermatologists and patients, and to provide a reference for future research.
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A case of livedoid vasculopathy treated with baricitinib
Song Xiaoting, Zhao Zuotao, Wang Aiping
Chinese Journal of Dermatology    2024, 57 (12): 1147-1148.   DOI: 10.35541/cjd.20210904
Accepted: 05 September 2022

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Advances in the clinical research on systemic small-molecule drugs and biologics for the treatment of alopecia areata
Li Xiangqian, Zhang Jianzhong, Zhou Cheng
Chinese Journal of Dermatology    2025, 58 (7): 646-649.   DOI: 10.35541/cjd.20240247
Accepted: 08 February 2025

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【Abstract】 Alopecia areata (AA) is an autoimmune-mediated, hair follicle-targeting, inflammatory, non-scarring hair loss. The treatment of severe AA has long been a focus and challenge. Currently, novel therapeutic agents, such as Janus kinase (JAK) inhibitors, have been increasingly employed in the treatment of severe AA. This review provides an overview of new small-molecule targeted drugs and biologics for AA.
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Expert proposal on apremilast for the treatment of psoriasis (2025 edition)
Committee on Psoriasis, Chinese Society of Dermatology
Chinese Journal of Dermatology    2025, 58 (5): 416-424.   DOI: 10.35541/cjd.20240155
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【Abstract】 Apremilast is the first oral targeted small-molecule drug approved for the treatment of psoriasis in China. Due to mechanisms underlying the specific regulatory effect of apremilast on the balance of inflammation via targeting phosphodiesterase 4, it has been widely used for the treatment of various types of psoriasis. Many studies have confirmed that apremilast is effective in the treatment of mild to severe plaque psoriasis, psoriasis in special areas, psoriatic arthritis, palmoplantar pustulosis, and pediatric psoriasis, with good safety and tolerability profiles. Based on the pharmacological mechanisms of apremilast and clinical data on the treatment of psoriasis, the Committee on Psoriasis, Chinese Society of Dermatology convened relevant experts to develop this proposal to ensure the standardized, reasonable, safe and effective use of apremilast in the treatment of psoriasis.
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Clinical efficacy and safety of biological agents in the treatment of moderate-to-severe psoriasis in 124 elderly patients: a retrospective analysis
Jin Lan, Qiu Yun, Wang Weijia, Kang Xiaojing, Ding Yuan
Chinese Journal of Dermatology    2025, 58 (1): 47-52.   DOI: 10.35541/cjd.20240351
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【Abstract】 Objective To retrospectively analyze the clinical efficacy and safety of biological agents in the treatment of psoriasis in the elderly. Methods A retrospective study was conducted. A total of 124 patients aged ≥ 65 years with moderate-to-severe psoriasis (psoriasis area and severity index [PASI] score ≥ 3 points or body surface area [BSA] ≥ 3%), who were treated with biological agents at the Department of Dermatology and Venereology, People's Hospital of Xinjiang Uygur Autonomous Region, from June 2020 to December 2023, were collected. PASI, BSA, and dermatology life quality index (DLQI) scores were recorded at weeks 0 (pre-treatment), 4, 12, and 24 after the beginning of treatment to evaluate the efficacy. The proportions of patients achieving ≥ 75% and 90% improvements in PASI scores (PASI75 and PASI90, respectively) were calculated, and adverse reactions were recorded. Data were processed using SPSS 29.0 and GraphPad Prism 10.0 software. Normally distributed continuous variables were presented as mean ± standard deviation, while non-normally distributed continuous variables were presented as median with upper and lower quartiles (Q1, Q3). Wilcoxon signed-rank test was used for comparisons of non-normally distributed data between groups, and chi-square test and Fisher's exact test were used for comparing categorical data. Results Among the 124 patients, there were 72 males (58.1%) and 52 females (41.9%), and their ages ranged from 65 to 87 years. Treatment regimens included secukinumab for 86 patients (69.4%), ustekinumab for 15 (12.1%), ixekizumab for 14 (11.3%), guselkumab for 5 (4.0%), and adalimumab for 4 patients (3.2%). The pre-treatment PASI, BSA, and DLQI scores [M (Q1 , Q3)] were 12.2 (7.8, 19.6) points, 16.0% (10.2%, 25.0%), and 16 (11, 20) points respectively, which significantly decreased to 0.8 (0, 1.2) points, 1.0% (0, 2.0%), and 0 (0, 3) points respectively at week 24 after the start of treatment (Z = 9.66, 9.66, 9.63, respectively, all P < 0.01). The proportions of patients achieving PASI75 at weeks 4, 12, and 24 were 42.7%(53/124), 80.6%(100/124), and 93.5%(116/124) respectively, and those achieving PASI90 were 13.7%(17/124), 48.4%(60/124), and 85.5%(106/124) respectively. There were no significant differences in the proportions of patients achieving PASI75 and PASI90 between the subgroups with and without comorbidities, as well as between the early-onset psoriasis subgroup and late-onset psoriasis subgroup at weeks 4, 12, and 24 (all P > 0.05). Among the 124 patients, 42 were followed up for over 2 years, and the proportions of patients achieving PASI75 and PASI90 after 2 years of treatment were 71.4% (30 cases) and 54.8% (23 cases), respectively. Adverse reactions occurred in 13 patients, including upper respiratory infections in 4 patients (3.2%), elevated aminotransferase levels in 3 patients (2.4%), eczematoid dermatitis in 2 patients (1.6%), pruritus in 2 patients (1.6%), nodular prurigo in 1 patient (0.1%), and vitiligo in 1 patient (0.1%). Conclusion Biological agents showed rapid and marked efficacy in the treatment of moderate-to-severe psoriasis in the elderly, with few and mild adverse reactions, suggesting high safety and overall marked efficacy.
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Role of sweat in the pathogenesis of cholinergic urticaria
Zheng Yaxuan, Su Huichun
Chinese Journal of Dermatology    2025, 58 (6): 573-577.   DOI: 10.35541/cjd.20230055
Accepted: 19 June 2024

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【Abstract】 Cholinergic urticaria (CholU) is a special type of chronic inducible urticaria characterized by transient, needle-sized wheals and erythema with stinging pain and/or itching, precipitated by increased core body temperature as a result of exercise or passive heating. Some cases were accompanied by angioedema, which seriously affects their quality of life. The pathogenesis of CholU involves sweat allergy and atopic diathesis, increased histamine release in sweat and the influence of Malassezia, decreased cholinergic receptors in hypohidrotic areas, decreased expression of cholinesterase, serum factors and autoantibodies, etc. Standard-dose and updosed second generation H1-antihistamines are the first-line therapy for CholU. For refractory CholU patients with normal sweating, biological agents, sweat desensitization and other therapies could be further chosen, while patients with severe hypohidrosis could be further treated with glucocorticoid pulse therapy and so on. This review summarizes the pathogenesis, classification, clinical manifestations, diagnosis and treatment of CholU from the perspective of the role of sweat in the pathogenesis of CholU.
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Expert consensus on the diagnosis and treatment of pediatric pustular psoriasis in China (2025 version)
Group on Pediatric Dermatology, China Dermatologist Association, Committee on Psoriasis, Chinese Society of Dermatology
Chinese Journal of Dermatology    2025, 58 (4): 297-306.   DOI: 10.35541/cjd.20240714
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【Abstract】 Pustular psoriasis is a rare subtype of psoriasis, which belongs to the category of autoinflammatory diseases, clinically characterized by erythema and aseptic pustules that may be generalized or localized. Generalized pustular psoriasis is often accompanied by systemic symptoms and is known for its recurrent and prolonged nature. Management strategies for pediatric patients differ significantly from those for adults. Based on the latest Chinese and international consensus, guidelines, and considering the current diagnostic and treatment status in China, 13 key clinical issues related to diagnostic criteria for, clinical subtypes of, disease assessment, and therapeutic methods for pustular psoriasis in children were identified. Following discussions among the expert group, 33 evidence-based recommendations were developed to standardize the diagnosis and treatment of this disease, thereby providing guidance for clinical practice.
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Chinese expert consensus on the diagnosis and treatment of lichen planopilaris/frontal fibrosing alopecia (2025 edition)
Hair Research Group, Chinese Society of Dermatology
Chinese Journal of Dermatology    2025, 58 (7): 583-590.   DOI: 10.35541/cjd.20250092
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【Abstract】 Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are the two most common types of primary lymphocytic cicatricial alopecia in clinical practice, but their treatment poses significant challenges. These conditions are characterized by the replacement of hair follicle-sebaceous gland units with fibrous tissues, leading to irreversible destruction of hair follicles and ultimately resulting in scarring of the follicles. In recent years, with a deepened understanding of these two diseases, new treatment options have emerged in addition to traditional topical medications and systemic oral drugs, including novel topical small molecule drugs such as Janus kinase inhibitors. Based on the latest Chinese and international consensus as well as current clinical practice in China, the Hair Research Group of Chinese Society of Dermatology organized experts to develop a consensus on the etiology, pathogenesis, clinical manifestations, auxiliary examinations, diagnosis, differential diagnosis, and treatment of LPP and FFA after thorough discussions, aiming to further standardize the clinical diagnosis and treatment of these two conditions and provide a more scientific and authoritative reference.
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Expert consensus on outpatient department construction standards for treat-to-target of atopic dermatitis (primary care version 2025)
Chinese Society of Dermatology, China Dermatologist Association
Chinese Journal of Dermatology    2025, 0 (4): 20240296-e20240296.   DOI: 10.35541/cjd.20240296
Accepted: 13 March 2025

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【Abstract】 In order to further promote the construction of outpatient departments for treat-to-target of atopic dermatitis (AD) by combining with the clinical reality of primary hospitals, implementing the treat-to-target concept of AD, standardizing the setting and operation of treat-to-target outpatient departments of AD, and improving the ability of primary medical services, the Chinese Society of Dermatology and the China Dermatologist Association established the expert committee on outpatient department construction for treat-to-target of AD, and formed the construction standards for primary hospitals in China based on “Construction of treat-to-target outpatient department of atopic dermatitis in China (2023)”. This standard puts forward the management requirements and scoring criteria for treat-to-target outpatient departments of AD to primary care dermatology, which is conducive to improving the standardized diagnosis and treatment of AD and making further efforts to facilitate the homogenization of AD management and rationalization of medical resource allocation.
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