American Academy Of Dermatology Research Articles

Translating the 2020 AAD-NPF Guidelines of Care for the Management of Psoriasis With Systemic Nonbiologics to Clinical Practice.

In 2020, the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) released a set of guidelines for the management of psoriasis in adults with systemic nonbiologic therapies, including acitretin, apremilast, cyclosporine, fumaric acid esters, methotrexate, and tofacitinib. This review addresses dosing, efficacy, toxicity, drug-related interactions, and contraindications alongside evidence-based treatment recommendations for each systemic therapy. Important considerations for treatment such as drug selection, initiation of therapy, drug monitoring, and patient management also are discussed. Physicians are encouraged to use these recommendations to guide treatments based on individual patient needs and disease characteristics.

National trends in gender and ethnicity in dermatology training: 2006 to 2018

To the Editor: Sex and race concordance between physicians and patients is associated with improved perceptions of clinical care.1Street R.L. O'Malley K.J. Cooper L.A. Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity.Ann Fam Med. 2008; 6: 198-205Crossref PubMed Scopus (341) Google Scholar In 2017, 48.9% and 64.5% of dermatology attendings and residents, respectively, were female.2Bae G. Qiu M. Reese E. Nambudiri V. Huang S. Changes in sex and ethnic diversity in dermatology residents over multiple decades.JAMA Dermatol. 2016; 152: 92-94Crossref PubMed Scopus (41) Google Scholar Academic dermatology leadership positions are underrepresented in sex and ethnic diversity.3Jayakumar K.L. Lipoff J.B. Trends in the dermatology residency match from 2007 to 2018: implications for the dermatology workforce.J Am Acad Dermatol. 2019; 80: 788-790Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar,4McDonald T.C. Drake L.C. Replogle W.H. Graves M.L. Brooks J.T. Barriers to increasing diversity in orthopaedics: the residency program perspective.JB JS Open Access. 2020; 5: e0007PubMed Google Scholar We examined sex and ethnicity trends of dermatology residents and fellows compared to other medical and surgical trainees. Demographics of dermatology residents and fellows and other of medical/surgical trainees were obtained from the Accreditation Council for Graduate Medical Education annual census, 2006 to 2018. Underrepresented minority (URM) was defined as Black/African American, Hispanic, or Native American. A 2-sample z-test was used to compare sex and ethnicity proportions in 2006 and 2018 (α level, <.05). Female representation in dermatology residency was stable at approximately 60% (Supplemental Table I; available via Mendeley at https://doi.org/10.17632/m3hs3dyr2n.1), and the overall residency census national average increased from 44% to 46% (P < .01) during the study period. Proportions of women in procedural dermatology and dermatopathology increased from 27% to 44% and from 46% to 54%, respectively (P > .05) (Fig 1). Female representation increased in all fellowship comparator groups; however, proportions of female fellows were consistently less than those of corresponding residencies in internal medicine, plastic surgery, and general surgery (Supplemental Table II; available via Mendeley at https://doi.org/10.17632/m3hs3dyr2n.1). All fields trended toward a narrowing of residency-fellowship gender gaps. Average URM representation in the overall residency national census increased from 12.5% in 2006 to 13.6% in 2018 (P < .05) (Supplemental Table I). URM representation in dermatology residency and fellowship increased from 8.2% to 9.3% and decreased from 9.5% to 3.1% (P > .05), respectively. URM representation in dermatology residency was consistently below the national average (Fig 2). URM residency-fellowship disparities persist in other fields (Supplemental Table II); however, only dermatology experienced a downward trend of URM fellowship representation over time. This study is limited by use of self-reported data and unknown rates of fellowship application by candidates of differing gender/ethnicity. We did not have access to pediatric dermatology fellowship data or total number of dermatology residency/fellowship positions. Our study showed significant narrowing of female residency-fellowship gaps and persistent URM dermatology residency underrepresentation and residency-fellowship gaps compared to the national average. Physician diversity is essential in addressing health care disparities.5Pritchett E.N. Pandya A.G. Ferguson N.N. Hu S. Ortega-Loayza A.G. Lim H.W. Diversity in dermatology: roadmap for improvement.J Am Acad Dermatol. 2018; 79: 337-341Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Lack of URMs in leadership positions, mentorship, racism, and implicit bias have been cited as barriers for URMs pursuing subspecialties. Female and URM residents should be encouraged to seek mentorship from leaders of concordant and discordant gender and ethnicity. Mentorship programs, through the American Academy of Dermatology and Women's Dermatologic Society, which support URM medical students interested in pursuing dermatology and female resident dermatologists pursuing subspecialties, likely contributed to some of the upward trends observed. The Perry and student to resident institutional vehicle for excellence initiatives, Nth Dimension programs, and near-peer mentors have been successful in encouraging URMs to apply for competitive fields, subspecialties, and academic faculty positions. Similar initiatives should be adopted for dermatology. Early exposure of URMs to dermatology, updated curricula including skin of color topics, and rethinking residency selection criteria are also essential.5Pritchett E.N. Pandya A.G. Ferguson N.N. Hu S. Ortega-Loayza A.G. Lim H.W. Diversity in dermatology: roadmap for improvement.J Am Acad Dermatol. 2018; 79: 337-341Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Our study highlights positive trends for women in dermatology residency/fellowships and significant deficiencies in URM representation in dermatology residency/fellowships. Increased efforts are needed to understand barriers to pursuing subspecialties and initiatives taken to promote mentorship and guidance to underrepresented groups. None disclosed.

Phototherapy in dermatology: care, concerns and best practice amidst COVID-19 pandemic

Phototherapy is an essential and useful therapeutic procedure wherein the properties of ultraviolet light are used to cure certain dermatological conditions like psoriasis, vitiligo, and atopic dermatitis. This is usually an office-based procedure dependent on the accurate use of sophisticated phototherapy units. Since the advent of the COVID-19 pandemic, phototherapy practices were shut down as they were considered as non-essential services. Here, we attempt to analyze how COVID-19 has affected phototherapy and seek to formulate a working guideline for safe phototherapy operations in these taxing circumstances. We used search engines like PubMed, Google Scholar, and Embase to retrieve articles and guidelines regarding phototherapy in dermatology, using the pertinent search terms. There was a paucity of data with only a couple of research letters and guidelines by the British Association of Dermatology and the American Academy of Dermatology, as well as general guidelines issuedby the Indian Association of Dermatologists, Venereologists and Leprologists. After a careful study of various modalities of phototherapy and viral inactivation, we collated a set of guiding instructions toward the appropriate utilization of phototherapy amidst the COVID-19 pandemic. Phototherapy is a viable option for selected patients even amidst the COVID-19 pandemic. However, local and national guidelines have to be followed while selecting the patient and operating the phototherapy machine with adequate protective measures for both the patient and the healthcare worker. Home phototherapy units and PUVASOL are good options for those patients who are unable to attend the phototherapy center due to various reasons.

Unconscious gender bias: A look at speaker introductions at the American Academy of Dermatology

To the Editor: Gender bias, conscious or unconscious, has been shown to exist in physician speaker introductions at large meetings.1,2 An analysis of an internal medicine grand rounds at the Mayo Clinic found that male introducers of female speakers used professional titles 49% of the time, whereas female introducers of male speakers used professional titles 95% of the time.1 Similarly, at the 2017 and 2018 American Society of Clinical Oncology annual meeting, male introducers of female speakers used professional titles 53% of the time, whereas female introducers of male speakers used professional titles 82% of the time.

Topical therapy for atopic dermatitis: A review

Background: Pediatric atopic dermatitis(AD) is very common, but its management is frustrating for the dermatologist, child and parents alike as this chronic inflammatory skin disease is marked with numerous difficult to control flares. Although country specific guidelines for AD exist, there is paucity of data with respect to dedicated topical care regimens for AD management in pediatric population. Purpose: This is a broad based review exploring various topical practices and management options to manage pediatric AD during flares and in remissions. Scope: The PubMed database was searched (to 1 June 2020) for English-language articles containing the keywords atopic dermatitis, atopic eczema, topical calcineurin inhibitor(TCI), topical corticosteroid(TCS), topical phosphodiesterase inhibitors, crisaborole, topical therapy. Articles focusing on topical managment for children with AD were chosen for further review. A limitation is that this is not a systematic review of the literature. We have relied heavily on The Indian Dermatology Expert Board Members 2019 Management Guidelines on AD and the 2014 American Academy of Dermatology (AAD) guidelines, soon to be updated. In our review, we focus on Skin directed therapies to repair and maintain healthy skin barrier, suppress inflammatory response, control flares, control itch and manage infectious triggers. Topicals can be used as first line therapy in mild AD, adjuvant for moderate-severe AD or as maintenance to keep the disease in remission. Topical therapy in AD is not limited to TCS, TCI, Crisaborole or newer molecules but also involves moisturization, emollient care and bathing practices; which have been discussed. Conclusion: Multiple topical therapies and practices have been successfully used to treat children with AD. An understanding of the available treatment options will help dermatologists striving to achieve best practice in the management of pediatric AD.

Cutaneous Malignant Melanoma: A Synthesis on Updated Guidelines for the Primary Care Perspective.

Description Cutaneous malignant melanoma (CMM) is a condition wherein malignant cells form in the melanocytic cells. CMM is a potentially lethal form of skin cancer, commonly found in sun-exposed areas of the body. There are multiple risk factors for disease development, such as genetic mutation and UV radiation among others. Diagnosis and staging is important in determining disease morbidity and mortality. The United States Preventive Services Task Force (USPSTF) and the American Academy of Dermatology (AAD) have their respective guidelines and consensus on diagnosis, staging and treatment. It is imperative to delineate and educate primary care physicians on CMM, as they serve as the first line of defense in disease diagnosis. The purpose of this article is to provide a concise educational synopsis for primary care physicians.

Overview of TikTok's most viewed dermatologic content and assessment of its reliability

Overview of TikTok's most viewed dermatologic content and assessment of its reliability

Do we need topical antibiotics for simple excision or the dressing after a skin wound?

We often use topical antibiotics for simple excisions or the skin after minor wounds. This is a long-standing practice to minimize scarring by preventing wound or surgical site infection to promote wound healing. Is this old practice the right way for today? Is there a scientific basis for it and can it persist? These questions are related to the increase in antibiotic-resistant bacteria in Korea. Currently, the guidelines for the use of oral antibiotics have been established and are being applied relatively well-controlled to prevent overuse and misuse, while discussions for evaluating the adequacy of the prophylactic use of topical antibiotics or establishing correct guidelines are lacking. Based on related research data, American Academy of Dermatology has been continuously campaigning against the abuse of prophylactic antibiotics by the public and doctors, following the increase in the abuse of topical antibiotics since 2013. Therefore, we discuss the necessity of using topical antibiotics for the prophylaxis based on literature evidence. Now is the time to make efforts to prevent the increase of antibiotic-resistant bacteria through the correct use and by reducing the prescription of topical antibiotics in Korea.

Pediatric teledermatology: A review of the literature.

Skin complaints are common among pediatric patients, yet as of 2020, fewer than 400 board-certified pediatric dermatologists currently practice in the United States. Pediatric teledermatology may address barriers to dermatologic care in children, assisting with distant geographic locations and long wait times. A review of the literature was conducted to synthesize important features of teledermatology for pediatric dermatologists. We summarize types of telemedicine platforms, common dermatologic conditions seen by pediatric teledermatologists, diagnostic accuracy and concordance, and guidelines from the American Academy of Dermatology and the American Telemedicine Association regarding teledermatology. This report highlights the utility of pediatric telemedicine in both the outpatient and inpatient dermatology setting to increase access to high-quality dermatologic care.

Basic Nutrition for Sports Participation, Part 2: Vitamins and Minerals.

Basic Nutrition for Sports Participation, Part 2: Vitamins and Minerals.

2020 Update on sunscreen compliance with American Academy of Dermatology recommendations

2020 Update on sunscreen compliance with American Academy of Dermatology recommendations

Fair-y Tales: An analysis of children's books about sun safety.

Skin cancer prevention should ideally begin with healthy sun protection habits during childhood. Children's books can be effective tools to introduce healthy habits early in life and should be targeted toward all children regardless of skin tone. This study examined sun protection guidelines and the representation of skin tones in commercial children's books. We performed internet searches for children's books about sun protection. We compared content from these books to current sun protection guidelines from the American Academy of Dermatology (AAD). We assessed books for reading level, author profession, and skin tone representation. Seventeen books met study criteria. Of 19 factors surrounding sun protection provided by the AAD, the median number of factors mentioned within children's books was nine (range 3-13). Of the 13 books with color illustrations of people, one (7.6%) book depicted people with dark skin tones on the cover, and three (23.1%) books depicted people with dark skin tones within the story. Commercial children's books about sun protection incorporate some, but not all, of the AAD guidelines, and there is an inadequate representation of darker skin tones within and on the cover of these books.

Translating the 2019 AAD-NPF Guidelines of Care for the Management of Psoriasis in Pediatric Patients.

In November 2019, the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) released their recommendations regarding management of psoriasis in pediatric patients. The guidelines include information on quantification of disease severity, identification of triggers, assessment of comorbidities, and therapeutics specific to children with psoriasis. This review aims to highlight the most clinically significant considerations for dermatologists when managing pediatric psoriasis.

Analysis of Skin Color on the American Academy of Dermatology Public Education Website.

Access to health information online has resulted in increased internet use to !nd medical education resources.1,2 The United States (US) population is comprised of 60.1% Whites, 18.5% Hispanics or Latinos, 13.4% Blacks or African Americans, with trends toward increasing diversity. Our objectives were to analyze skin color distributions on the American Academy of Dermatology (AAD) public education website.

Novel insights in Erdheim-Chester disease using in vivo reflectance confocal microscopy

© 2020 by the American Academy of Dermatology, Inc. Published by Elsevier, Inc. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Therapeutic challenges in managing pediatric psoriasis.

BackgroundEach year, 20,000 patients aged <10 years are diagnosed with psoriasis. Pediatric-onset psoriasis has many similarities to adult-onset disease, and previous studies suggest that the incidence might be increasing in both populations.ObjectiveThe challenges that arise when treating patients with psoriasis, especially those age <12 years, are summarized, as well as the limited available treatment options for treating pediatric patients with psoriasis and the evidence supporting each of them.MethodsRecently published guidelines by the American Academy of Dermatology and the National Psoriasis Foundations, as well as guidelines published by the German Society of Dermatology, provide considerable insight in managing patients who have this condition. The latest studies on pediatric psoriasis treatment were reviewed, including recent and current clinical trials with U.S. Food and Drug Administration approved and nonapproved medications, case reports, case series, and reviews. The authors also reviewed American and European guidelines, as well as recommendations from expert panels.ResultsCurrently, only six medications are approved by the U.S. Food and Drug Administration for the treatment of pediatric psoriasis: three biologics and three topical. Many off-label topical treatments have been used in pediatric psoriasis, with variable effectiveness and safety profiles. Data from adult clinical trials, as well as case reports and series from pediatric patients, suggest that other biologic medications are effective for pediatric psoriasis.ConclusionMany questions remain unanswered, leaving clinicians facing multiple challenges when encountering pediatric patients with psoriasis. This summation will help provide an overview of current on- and off-label medications for pediatric psoriasis. Pediatric clinical trials should be implemented to obtain data that can result in expanding the therapeutic spectrum for this population, parallel to their adult counterparts.

Dermatological Practice in Nepal during COVID-19 Crisis: Recommendations of National Panel of Experts

Introduction: Novel Coronavirus disease has caused a substantial halt to the ongoing world in every aspect. There are medical and social implications of the disease. Cutaneous manifestations have been reported to be a part of the disease as well. Dermatologists globally are in dilemma with the clinical practice because of the fear of acquiring the disease.&#x0D; Objectives: This article aims to recommend best practice measures that can be followed in local scenario for re-opening up of dermatological services in the context of Nepal.&#x0D; Materials and Methods: A preliminary draft for guidance on Dermatological services based on recommendations of American Academy of Dermatology, International league of Dermatological societies, National recommendations from Ministry of Health, Nepal was sent to a panel of national experts to determine the level of consensus in first week of April, 2020. A preliminary survey was sent to all the members of Society of Dermatologists, Venereologists, and leprologists of Nepal on first week of June and a second draft was subsequently formed which was sent again to experts and revised based on the opinions of national experts.&#x0D; Results: A total of 19 experts participated in the preparation of draft and reached a national consensus after a series of revisions in preliminary draft.&#x0D; Conclusion: Agreements regarding the opening of practice in dermatology discipline have been summarized. Recommendations have been made for opening of dermatological services – opening of outpatient department, performing dermatosurgical and cosmetic procedures as well as strategies on triage of patients and use of masks.

Dermatologists' Perceptions and Confidence in Cosmetic Care for Male Patients.

Despite a growing interest in nonsurgical cosmetic procedures in men, the utilization of aesthetic treatments remains comparatively low, suggesting the presence of barriers to care. To describe barriers to cosmetic intervention for male patients from the perspective of dermatologists. An anonymous, online survey was distributed through a listserv made available by the American Academy of Dermatology. Dermatologist respondents perceived a low utilization of cosmetic services in male patients (5%) and a lack of opportunity (72.3%) to provide such services. Respondents also perceived a lack of sufficient education/training (40.9%), experience (20.5%), and a lack of evidence in the field (20.5%) for dermatologists as potential barriers to cosmetic care for male patients. Presence of targeted messaging and in-office educational materials for male patients was found to be associated with increased utilization of cosmetic treatments by male patients (p = .012, p = .012, respectively). Dermatologists reported strong confidence in delivering various noninvasive cosmetic treatments to male patients. Despite dermatologists' reported confidence in performing cosmetic procedures in men, many perceive insufficient education/training and experience with this population which may create barriers to cosmetic care for male patients. Increasing educational materials and targeted messaging to male patients may decrease barriers for patients to receive desired cosmetic care.

Skin cancer in skin of color: A cross-sectional study investigating gaps in prevention campaigns on social media

Skin cancer in skin of color: A cross-sectional study investigating gaps in prevention campaigns on social media

COVID ‐19: An opportunity to build dermatology's digital future

In addition to the public health and economic calamity, the coronavirus disease 2019 (COVID-19) pandemic has had multifaceted effects on the practice of dermatology. However, times of great crisis are also times of transformative change. Over the last 2 months, more progress has been made in the adoption of teledermatology than over the last two decades—the Centers for Medicare and Medicaid Services (CMS) has provided compensation parity for teledermatology visits and waived potential penalties for health insurance portability and accountability act (HIPAA) violations when treating patients through modalities such as FaceTime and Skype.1 Similarly, the American Academy of Dermatology has issued guidelines to practices for implementing teledermatology workflows.1 In effect, dermatologists have embraced a digital future. Just as telemedicine represents one pillar of dermatology's digital future, augmented intelligence (AuI), otherwise known as artificial intelligence, represents another promising component of dermatology's digital future. Recent advances in AuI have generated both hype as well as hope that AuI algorithms will be able to detect and diagnose skin disease.2 For example, numerous direct-to-consumer smartphone apps have been developed to evaluate lesions for potential melanoma. However, a recent systematic review noted high rates of false negatives and wide variability in accuracy, with sensitivities ranging from 7% to 73% and specificities ranging from 37% to 94%.3 This substantial variation in performance highlights the caution we must exercise in embracing new technologies. Dermatologists should critically appraise AuI applications in the same way we appraise any new medication or procedure. However, this does not mean dermatologists should ignore AuI. Rather, dermatologists should reimagine how AuI can be used. Although AuI is not yet capable of automating diagnoses, AuI is capable of streamlining administrative tasks. For example, Mayo Clinic has developed an AuI algorithm to automatically organize dermatology images stored within the institution's electronic health record.4 This enables researchers to quickly assemble a cohort of specific image types for research rather than manually sift through individual patient encounters. Another algorithm could be used to ensure patients are taking sufficient quality images for store-and-forward teledermatology. In light of the COVID-19 pandemic, many patients find themselves using teledermatology for the first time. Therefore, an assistive algorithm could alert patients if the image they have uploaded is blurry or does not have adequate lighting. Similarly, dermatologists face significant administrative challenges as they look to reopen their in-person practices amidst the pandemic. AuI algorithms could utilize electronic health record data to stratify patients based on their risk factors and assist in triaging patients for in-person vs virtual visits. Furthermore, this would provide dermatology practices valuable information to optimize scheduling and staffing. Although less awe-inspiring than automated diagnoses of melanoma, AuI applications for administrative tasks would still provide significant efficiency gains for our health care system. Dermatologists have a long-standing history of pioneering advances in digital medicine, dating back to at least 1972 when the first teledermatology platform was implemented in the United States.5 Therefore, as we emerge from the pandemic, dermatologists are uniquely positioned to lead a digital transformation in health care. This transformation has the potential to reduce administrative burdens and to improve patient care. The authors declare that they have no conflicts of interest. All authors contributed to the conception, critical revision, and drafting of this manuscript. Data sharing is not applicable to this article as no new data were created or analyzed in this study.