Paper Mills in Dermatology: A Cross-Sectional Study of Retracted Publications

Paper mills represent a growing threat to research integrity, producing fabricated manuscripts for sale at scale and infiltrating the biomedical literature. While this phenomenon has been described in other fields, its impact within dermatology remains poorly characterised.

To describe the landscape of paper mill-associated retractions in dermatology, raise awareness of their prevalence, and identify features that may facilitate early detection.

A cross-sectional analysis was conducted using the Retraction Watch Database and reported in accordance with STROBE statement for cross-sectional studies. (OSF registration: doi:10.17605/OSF.IO/382PT). Dermatology-related records were identified using pre-defined keywords. Only articles explicitly labelled as "paper mill" in the retraction reason were included. Data extracted included study design, topic, research integrity indicators, country of origin, journal metrics, publisher, and reasons for retraction. Time to retraction was analysed using Kaplan-Meier methods and compared using the log-rank test.

A total of 118 paper mill-associated articles (9.8%) were identified among 1,209 dermatology retractions. No cases were observed prior to 2018, followed by a rapid rise peaking in 2023 (>50 retractions). Studies were predominantly experimental (67%) and focused on cutaneous oncology (47%). No paper-mill articles reported data availability or protocol pre-registration, and 79% lacked ethics approval. China accounted for 86% of cases. Articles were published across 50 journals, most in the first or second SCImago Journal Rank quartile (80%), with a mean impact factor of 3.0. The mean time to retraction was 957 days, with no significant difference compared with non-paper mill articles (P = 0.53).

Paper mill activity in dermatology has emerged rapidly and is characterised by consistent deficits in research integrity, particularly in data transparency and ethical oversight. Strengthening editorial screening, mandating data availability statements, and collaborating across publishers and wider research ecosystem will be essential to mitigate the impact of paper mills and protect the reliability of the dermatology evidence base for patient benefit.