Academic Dermatology Department Research Articles

Trichophyton soudanense, Trichophyton violaceum, and Trichophyton tonsurans in Munich: Travel- and Migration-Related Cutaneous Fungal Infections

Introduction: Trichophyton soudanense, Trichophyton violaceum, and Trichophyton tonsurans are considered rare pathogens in Germany. They are presumed to infect people from Germany when they are traveling to tropical and subtropical areas. The incidence and the mode of infection with these three fungal pathogens in Munich were investigated to assess their significance for clinical practice. Methods: This monocentric study was conducted at a large European academic dermatology department in Munich from January 1, 2011, till August 30, 2020. We performed a retrospective analysis of medical data of all out- and inpatients presenting at our hospital with a suspected cutaneous fungal infection. Results: A total of 87,229 swabs were collected from 48,916 patients; 11,513 (13.2%) cultures confirmed a fungal infection. One of the three aforementioned dermatophytes was detected in 247 (2.1%) samples. The average patient age was 15.5 years (0–84 years, SD: 15.6) at the time of infection. T. tonsurans was the confirmed pathogen in 137 (55.5%) samples with increasing frequency over time. T. tonsurans spread in 11 cases through close contact with humans (kindergarten, martial arts, accommodation for asylum seekers). T. violaceum was detected in 88 (35.6%) samples with a peak in 2016 and 2017. T. soudanense was detected in 22 (8.9%) samples. A total of 46.7% of all tinea capitis cases were caused by one of these pathogens. Conclusion: In case of tinea capitis, a travel history should be performed and rare fungal infections should be considered in the differential diagnosis.

53786 A Review of Patient Portal Communication Workflow and Workload in an Academic Dermatology Department

53786 A Review of Patient Portal Communication Workflow and Workload in an Academic Dermatology Department

Epidemiological overview of mucocutaneous fungal infections in Munich.

Knowledge about the current spectrum of dermatomycoses is important for diagnosis and therapy. A retrospective, monocentric analysis of mucocutaneous fungal infections diagnosed at a large European academic dermatology department in Munich was conducted; 87,229 samples from 48,916 patients from January 1, 2011, to August 30, 2020, were included. Fungi were detected in 11,513 samples from 48,916 (23.54%), and 36 different species were identified. Candida (C.) albicans was the most common pathogen (5,055 detections; 43.91% of all positive samples), followed by Trichophyton (T.) rubrum (3,076 detections; 26.72% of all positive samples) and Candida parapsilosis (923 detections; 8.02% of all positive samples). Rare pathogens such as Trichophyton raubitschekii were also detected. Coinfections with multiple species were detected in 44 cases. Even though C.albicans, T.rubrum, and C.parapsilosis were confirmed as the most common pathogens, rare pathogens should also be considered in clinical practice. The predominant spectrum of fungi differed from that reported in other countries. Furthermore, a difference in the pathogen spectrum could be observed depending on the age group and body site.

Central centrifugal cicatricial alopecia in males

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia seen primarily in women of African descent but rarely reported in men. The etiology of CCCA is unknown, but genetic variants, type 2 diabetes mellitus, and bacterial infections may play a role. We aimed to characterize the demographics, medical histories, and clinical findings of male patients with CCCA with the hypothesis that features may differ from women. This was a case series of adult male patients with biopsy-confirmed CCCA seen at an academic dermatology department between 2012 and 2022. In total, 17 males had a scalp biopsy and clinical findings consistent with CCCA. The average age was 43years, and 88.2% of cases identified as Black race. Scalp pruritus was the most common symptom, and few patients endorsed high-risk hair care practices. None of the cases had diagnosis of type 2 diabetes mellitus, but 17.6% had history of latent tuberculosis, and 47.1% had a positive family history of alopecia. We observed 8 patients with atypical CCCA, and 29.4% had an overlapping scalp diagnosis. This study is limited by the single center, retrospective design and small sample size. It is important to consider CCCA in the differential diagnosis of alopecia in adult Black males.

Perceptions and attitudes regarding HIV pre-exposure prophylaxis (PrEP) among dermatology clinicians and trainees.

In 2020, over 1.2 million people were at risk of acquiring human immunodeficiency virus (HIV), though only 25% were prescribed pre-exposure prophylaxis (PrEP). Given the multitude of dermatologic manifestations of HIV and other sexually transmitted infections, dermatologic care can serve as the entry point to the HIV care continuum. Currently, there is limited data on specialists' perspectives on HIV PrEP prescribing. We aimed to survey clinicians and trainees in an academic dermatology department about HIV PrEP-related knowledge, attitudes, and practices. Survey questions were adapted from existing literature on HIV stigma and PrEP-related knowledge, attitudes, and practices. Composite scores for each domain were averaged and compared between clinicians and trainees using Wilcoxon's signed rank test or Fisher's exact test. Of 135 providers invited, 31 (23%) completed the survey (11 clinicians and 20 trainees). Of the 31 participants, 16 (52%) had specialized HIV experience and training. When asked about discriminatory beliefs, nine participants (29%) agreed that HIV infection is a "consequence of irresponsible behavior." PrEP knowledge was low, with 13 (42%) participants answering zero out of 3 PrEP knowledge questions correctly. Additionally, 10 (91%) clinicians reported poor knowledge of PrEP side effects, and eight clinicians (73%) indicated they were "not comfortable at all" in prescribing PrEP. No participant had prescribed PrEP, and 22 (70%) participants had never discussed PrEP with patients. Dermatology clinicians and trainees reported some levels of HIV stigma. Substantial gaps in PrEP knowledge and discussion were reported despite prior HIV discrimination training and HIV-related practice experience. Study limitations include a small sample size and a modest response rate. Addressing stigma among dermatologists and improving HIV PrEP education is vital to enhancing the healthcare outcomes of people living with HIV.

Understanding downstream service profitability generated by dermatology faculty in an academic medical center: a key driver to promotion of access-to-care.

Hiring new dermatology faculty at academic medical centers (AMCs) can be a difficult process. Academic dermatology departments, however, must have the financial freedom to nimbly respond to the needs of their community. To determine the downstream revenue and profitability produced by dermatology faculty, a retrospective review of charges and expenses downstream of professional services was performed to assess dermatology faculty and nurse practitioners from January 2019 to December 2020 at a single AMC in the southern United States. The downstream revenue per dermatology faculty was calculated using institutional data based on the number of services performed and the exact compensation per service. When this was not possible, the Medicare Allowable Charge was used to estimate the compensation for the service provided. Revenue was included from internal referrals to dermatopathology, Mohs surgery and repairs, chemistry and microbiology labs, radiology, and phototherapy. Profitability was calculated using institutional cost data to estimate the expense of each additional unit of services performed. The most valuable source of downstream income was dermatopathology services, which generated $85,395/provider in 2019 and $102,746/provider in 2020. Mohs surgery was also a significant source of downstream revenue contributing $92,715 in 2019 and $96,599 in 2020. Repairs after Mohs surgery internal referrals generated $30,036 in 2019 and $36,507 in 2020. The total contributions of chemistry and microbiology labs, radiology, and phototherapy were considerable but less impactful overall. The total downstream revenue calculated from these services for 2019 was $228,304/provider and $255,549 in 2020. The total downstream profitability for these services was calculated to be $112,597/provider in 2019 and $92,344/provider in 2020. In conclusion, faculty of academic dermatology departments produces a great deal more revenue and profitability for AMCs than the sum of their professional charges.

Participation in Clinical Trials Among Academic Dermatologists Affiliated With Veterans Affairs Hospitals: Survey Study.

BackgroundClinical trials have led to the development of new and effective therapies for many dermatologic conditions. To our knowledge, there is no published study that has quantified and described the degree of involvement in clinical trials among academic dermatologists and their university affiliates.ObjectiveThe purpose of this study was to characterize the involvement of academic dermatology departments in clinical trials research.MethodsAn online survey was sent to 211 Veterans Affairs (VA)–employed dermatologists. It comprised 20 questions related to the number of clinical trials, support staff dedicated to clinical research, skin diseases studied, and the effect of the COVID-19 pandemic on conducting clinical research. Three rounds of survey invitations were sent over a 3-month period (March to May 2021). Data from all survey responses were reviewed for quantitative and descriptive analyses of the key outcome measures.ResultsA total of 48 dermatologists completed the survey and provided their university affiliations and details of involvement in clinical trials research. Over half of participants (n=25, 58.1%) with a university affiliate reported that their affiliated dermatology department had a dedicated clinical trials unit. Basal cell carcinoma was the most frequently studied skin condition (n=9, 18.8%), followed by atopic dermatitis and psoriasis (n=4, 8.3% each); 66.7% of participants reported no current clinical trials participation. Of those conducting clinical trials, 87% (n=18) noted that COVID-19 was a barrier to conducting trials, with 52.2% (n=11) citing disrupted or decreased trials due to the pandemic.ConclusionsAlthough many dermatologists with university affiliations reported having a dedicated clinical trials unit at their institution, a majority of those surveyed reported not taking part in any active trials. Overall, the diseases investigated in academic clinical trials appear to follow national trends, though some of the top dermatological diseases are underrepresented in clinical trials research. A key limitation of our study was the low response rate (~23%) and that the survey responses from the sample of VA-based dermatologists may not be generalizable to all academic dermatology departments in the United States. The effect of the COVID-19 pandemic appeared to play a significant role in disrupting active trials.

334 Clinical data registries as a vital tool for academic dermatology

Clinical data registries (CDRs) store data pertaining to diseases, patients, treatments, or procedures. We investigated the use of CDRs in academic dermatology departments. A REDCap survey was distributed to departments nationally. Parameters collected include CDR use for research, internal vs. external development, types of data stored, CDR format, and challenges and benefits of use/management. Results were analyzed using descriptive statistics. Responses were obtained from 21 institutions across the United States.

Mark, magnify, map: Improving biopsy-site photography

To the Editor: In 2020, the Joint Commission reported that wrong-site surgery accounted for 8.6% of all sentinel events in medicine.1 In dermatology practices, wrong-site surgery is the most commonly reported severe error.2 High-quality biopsy-site photography is recognized as the gold standard for preoperative site identification in skin surgery.3,4 Herein, we describe BLSi (Better Lesional Site identification; pronounced “bullseye”), a quality improvement (QI) project to increase the rate of high-quality biopsy-site photographs and show how QI methodology, including rigorous measurement, can be successfully used to address this performance gap in a large academic dermatology department.

Systemic comorbidities of rosacea: practice gaps among dermatologists.

Rosacea is a chronic inflammatory skin condition that is associated with multiple systemic comorbidities, with the strongest evidence linking rosacea to hypertension, dyslipidemia, inflammatory bowel disease, and anxiety and depression. To assess dermatologists' awareness of and screening practices for rosacea comorbidities, we developed a survey that was distributed to attendings and residents across four academic dermatology departments in Massachusetts. A total of 73 dermatologists with varying experience participated in the study. Findings demonstrated significant knowledge and practice gaps among academic dermatologists in managing systemic comorbidities in rosacea. In addition, dermatologists' awareness of rosacea comorbidities was negatively correlated with number of years out of residency training, highlighting the need to address this knowledge gap through increased continuing medical education. Importantly, we observed a low screening frequency despite a high awareness of the association between rosacea and ocular comorbidities, suggesting that additional financial, institutional, or practice barriers likely contribute to the low screening rate.

The Tam formula: A pilot study for a new treatment for melasma.

Melasma is a common hyperpigmentation disorder with numerous, but often unsatisfactory treatment options. A pilot study to evaluate the efficacy and safety of a novel topical combination of 12% hydroquinone, 6% kojic acid, and 5% vitamin C cream for melasma. A pilot study of 6 women with melasma was conducted at an academic dermatology department and a private dermatology practice to evaluate the efficacy of a topical combination of 12% hydroquinone, 6% kojic acid, and 5% vitamin C cream, entitled the "Tam Formula." Two blinded evaluators calculated Melasma Area and Severity Index (MASI) Scores before and after treatment to evaluate change from baseline, and statistical analysis was performed. Treatment with this combination topical cream resulted in an average 63.77±22.10 percent reduction in MASI scores. While there is a need for further investigation, this pilot study indicates the Tam Formula may provide an alternative treatment option for melasma.

Review of Dermatology at a Glance , 2nd edn (MMU Chowdhury, RP Katugampola, AY Finlay)

I am a recently graduated medical student, soon to begin Foundation Year 1, with an interest in dermatology. The book I am reviewing is Dermatology at a Glance by Mahbub M. U. Chowdhury, Ruwani P. Katugampola and Andrew Y. Finlay, which is immediately recognizable by its cover as a dermatology-related book. The authors' credentials are exceptional: both Dr Chowdhury and Dr Katugampola are involved in medical education and training at Cardiff University, with published articles and book chapters; Dr Chowdhury was the Academic Vice President of the British Association of Dermatologists (BAD) and Chair of the BAD Education Subcommittee; and Professor Finlay was Head of the Academic Dermatology department at Cardiff University and was President of the BAD.

Patient and physician perspectives on teledermatology at an academic dermatology department amid the COVID-19 pandemic

To the Editor: In the era of COVID-19, dermatology practices have rapidly adopted teledermatology.1,2 Prepandemic research showed physician and patient satisfaction; however, these studies included groups who chose the telemedicine medium.3,4 Pandemic-related restrictions on in-person care catalyzed a broader adoption of telemedicine among both physicians and patients. This study examines the experiences of both groups with teledermatology during the COVID-19 pandemic.

US Dermatology Department Faculty Diversity Trends by Sex and Underrepresented-in-Medicine Status, 1970 to 2018

Faculty diversity has important implications for improving the cultural competency and diversity of medical students and residents. However, dermatology is one of the least diverse fields in medicine. To measure faculty diversity by sex, race, and ethnicity in academic dermatology departments in US medical schools and to evaluate how this representation compares with the diversity of the US population, medical students, department chairs, and faculty in other clinical departments. In this cross-sectional study, data from the Association of American Medical Colleges Faculty Roster were evaluated to differentiate full-time faculty by sex and designation as a minority underrepresented in medicine (URM; currently including black, Hispanic, American Indian/Alaska Native, Native Hawaiian, and Pacific Islander individuals). Trends in female and URM representation among academic dermatology departments were analyzed from 1970 to 2018. The numbers and proportions of US dermatology department faculty by sex, race, and ethnicity. The number of full-time US dermatology department faculty increased from 167 in 1970 to 1464 in 2018. The number of female faculty increased from 18 (10.8%) in 1970 to 749 (51.2%) in 2018; the number of URM faculty grew from 8 (4.8%) in 1970 to 109 (7.4%) in 2018. Proportions of female and white dermatology department faculty were similar to the US population in 2018; however, like other clinical departments, the proportion of URM faculty was lower than in the general population. There was an inverse association between increasing faculty rank and the proportion of female faculty overall, but this was not the case among URM faculty. At every rank, there was a proportionately low number of URM faculty represented. Across all specialties, department chairs were least diverse, with white individuals representing 79.7% (n = 2856 of 3585) of all chairs in 2018 and women representing 19.4% (n = 694 of 3585) of all chairs. Expansion of faculty in US dermatology departments over the past half century has led to greater female representation, now similar to that in the general population. Higher-ranking faculty is associated with lower diversity. Although dermatology department faculty diversity by sex, race, and ethnicity has partially improved over the past 49 years, continued attention to the lagging representation of URM faculty should be a priority for the field of academic dermatology.

Income inequality between male and female clinical faculty at public academic dermatology departments

Income inequality between male and female clinical faculty at public academic dermatology departments

Assessment of health-related quality of life in psoriasis patients in Hungary

The health status and health-related quality of life (HRQoL) of patients with psoriasis in Hungary are understudied. To assess HRQoL in psoriasis patients, to compare HRQoL of psoriasis patients to that of the general public in Hungary and to identify predictors of HRQoL. Between 2012 and 2016, two cross-sectional surveys were carried out among psoriasis patients at two academic dermatology departments. HRQoL was assessed by EQ-5D-3L, EQ Visual Analogue Scale (EQ VAS) and Dermatology Life Quality Index (DLQI). Predictors of HRQoL were analysed by multivariate linear regression. 434 patients were enrolled (mean age 49 years, 65% male, 81% moderate-to-severe psoriasis, 43% treated with biologics). Mean EQ-5D-3L, EQ VAS and DLQI scores were 0.74 ± 0.28, 69.06 ± 20.98 and 6.78 ± 7.38, respectively. Overall, 54%, 43%, 40%, 32% and 15% of patients indicated at least some problems in pain/discomfort, anxiety/depression, mobility, usual activities and self-care. EQ-5D-3L index scores in patients were lower compared to the age- and gender-matched general population in Hungary. The difference was statistically significant for the age groups 25-34 and 45-64 in males, and 18-64 in females (p<0.05). Female gender (p = 0.042), psoriatic arthritis (p<0.001) and palmoplantar psoriasis (p = 0.031) were associated with lower EQ-5D-3L index scores. On the contrary, employed and highly educated patients reported higher EQ-5D-3L index scores (p<0.001). We were the first to assess HRQoL in psoriasis patients by using EQ-5D questionnaire in Hungary, and more broadly in Central and Eastern Europe. Our findings are useful for cost-effectiveness modelling of psoriasis treatments and decision-making in healthcare. Orv Hetil. 2018; 159(21): 837-846.

The effects of electronic health records on triage and closing times: A continuous observation time motion study in an academic dermatology department

The effects of electronic health records on triage and closing times: A continuous observation time motion study in an academic dermatology department

Ranking predatory journals in dermatology: distinguishing the bad from the ugly.

The scientific community depends on high-quality peer-reviewed research, which is being polluted with pseudoscience published in fake journals that have exploited the open-access model. This "predatory publishing" has made its way into the field of dermatology. In a recent study, we identified and listed these journals. The "predatory rate" was calculated for 76 journals in order to rank the journals based on specific criteria associated with unethical publishing. Of the 76 journals, 89.5% were classified as predatory journals and the remaining as journals involved in predatory practices. The field of dermatology is not immune to predatory publishers. This study validates Beall's list as well as other previous studies. Strategies to a solution include spreading awareness throughout academic institutions and dermatology departments as well as avoiding publishers that are involved in predatory practices. However, some journals may be able to make necessary adjustments and become legitimate contributors to the field.

Lesion Morphology in Multifocal Infantile Hemangiomas.

Multifocal infantile hemangiomas (MIHs; previously called neonatal hemangiomatosis) can be associated with extracutaneous hemangiomas. We observed different morphologic types of hemangiomas in children with MIHs and sought to find out whether they are related to the clinical course. This was a retrospective study of 103 infants with MIHs and a control group of 261 age-matched patients with solitary focal infantile hemangiomas (IHs) seen at an academic pediatric dermatology department between 2004 and 2014. Two morphologic subtypes of hemangiomas were identified: miliary focal hemangiomas (MFHs; small, lens shaped) in 58 of 103 MIH patients (56.3%), and classical nonmiliary focal IHs (NMIHs; larger, irregularly shaped) in 17 of 103 patients (16.5%). MIHs featuring both types (mixed type) were observed in 28 of 103 patients (27.2%). MFH lesions were significantly smaller (mean 5.3mm [range 1-20mm] vs 22.0mm [range 2-100mm]), more numerous (23.4±27.3 [range 5-175] vs 7.4±2.8 [range 5-15] p<0.001), and occurred up to an older age (6.0±5.8months [range 0-27months] vs 3.8±2.6months [range 0-9months]) than NMIHs. There was a weakly positive correlation between the number and presence of extracutaneous IHs in children with MFHs. Significantly more children with MIHs were delivered preterm than those with solitary IHs. The number of IHs correlates inversely with their size. MFHs follow a clinical course different from that of classical IHs, are associated with prematurity, and may confer greater risk of extracutaneous hemangiomas. Miliary hemangiomas thus appear to present a separate IH subset requiring special attention.

Social Media Use in Pediatric Dermatology.

Social media is predicted to become increasingly important in dermatology because of its potential to serve as a platform for public health campaigns, aid in participant recruitment for clinical trials, increase public engagement in health care, and facilitate scientific discourse. No study of social media use in pediatric dermatology has been performed, so we analyzed the use of the seven leading social media platforms in pediatric dermatology, with a focus on patient advocacy groups, professional societies, research journals, and research institutions. We observed that 89% of patient advocacy groups, 100% of professional societies, 62.5% of research journals, and 0% of academic pediatric dermatology departments maintained one or more social media accounts. Our observations suggest that all stakeholder groups, and in particular members of the research community, have the potential to further their engagement, connections, and communications through social media.