A new model for categorizing cognitive biases and debiasing strategies in dermatology.

Cognitive biases are a significant cause of medical error. They arise from "system 1" thinking, which depends on heuristics to make quick decisions in complex situations. Heuristics make us "predictably irrational," distorting our ability to accurately assess probabilities in clinical scenarios. It is well reported in the literature that metacognition, the art of reflecting on one's thought processes, is the optimal way to deal with cognitive biases. However, it is unclear how this can be consistently implemented in dermatological practice. Our debiasing attempts thus far have been sporadic at best. This article categorizes important cognitive biases according to each stage of the doctor-patient interaction (history taking, clinical examination, investigations, diagnosis, and management). We hope that providing this clinically relevant framework can foster metacognition and a platform for algorithmic debiasing. This will enable us to engage "system 2" (analytical thinking) in a targeted way, thereby avoiding excessive cognitive load. Organization-level interventions should also be implemented to free up the cognitive capacity of an individual and to enable them to employ system 2 thinking more regularly.

The role of calcineurin inhibitors in the management of lichen sclerosus.

Lichen sclerosus is a chronic inflammatory disorder with a propensity to affect the mucocutaneous anogenital area. Topical corticosteroids remain the treatment of choice for this condition and constitute an effective therapeutic modality. However, in patients with corticosteroid-resistant disease, when long-term remission is not sustainable, or in those intolerant to these agents, topical calcineurin inhibitors may be considered. Studies have demonstrated their efficacy and tolerability; however, concerns remain with regard to their malignant potential with long-term use. As lichen sclerosus is a potentially precancerous dermatosis, topical calcineurin inhibitors should be used with caution in this disorder.

Hair abnormalities in genetic disorders of junctions.

The desmosomes form the basis of intercellular support structure within the epidermis. However, various junctions, including gap junctions, adherens junctions, and tight junctions play an important part in the intercellular bridges that are vital for cell-cell interactions and structural stability. Numerous mutations can affect the genetic structure that make up these junctions and in turn cause disease. Most of these conditions have hair abnormalities and this article will briefly elucidate the various manifestations in the hair. As these junctional elements are found in other organs like the heart, liver, and eye, there could be serious systemic associations along with the hair changes.

Hydroa vacciniforme with oral mucosal involvement.

We report the occurrence of oral ulcers in a 6-year-old girl with hydroa vacciniforme. This finding has not hitherto been reported in the literature.