Community Dermatology Research Articles

The role of Vitamin D in the pathogenesis of some immune-mediated dermatoses

In recent years, the sunlight vitamin has become extremely popular and almost mandatory to use, especially because of its pleiotropic effects, although until recently its use was limited to the prevention of the development of pathology of the bone system, in particular rickets in children. Being actually a fat-soluble prohormone of a steroid nature, Vitamin D participates in the endocrine, paracrine and autocrine regulation of the body. The pharmacotherapeutic renaissance of calciferol is associated with the discovery of Vitamin D receptors in most cells of the body, and the presence of enzymes synthesizing the active form of Vitamin D extrarenally, in particular, in the skin, has led to renewed interest and broad discussion in the dermatological community. Is the role of non-bone effects of calciferol, mainly its role in the pathogenesis of autoimmune skin diseases, really justified from the point of view of evidence-based medicine, and is the tendency to consume Vitamin D safe?
 This article presents the most up-to-date information about the role of Vitamin D deficiency in the mechanisms of immune response development, in some dermatoses. In addition to generalizing the bone and extra-bone functions of Vitamin D to the macroorganism, the mechanisms of formation of some of the most common dermatoses, such as psoriasis, atopic dermatitis and vitiligo are discussed in detail. The review details the biological effects of Vitamin D in the skin. The article analyzes the legality of the use of Vitamin D-based drugs and their effectiveness in dermatological practice.

The American Academy of Dermatology and International League of Dermatological Societies Monkeypox Registry: Expanding the COVID-19 registry to emerging infections

The World Health Organization declared the global monkeypox outbreak a public health emergency of international concern in July 2022. In response, the American Academy of Dermatology and International League of Dermatological Societies expanded the existing COVID-19 Dermatology Registry to become the “AAD/ILDS Dermatology COVID-19, Monkeypox, and Emerging Infections Registry.” The goal of the registry is to rapidly collate cases of monkeypox and other emerging infections and enable prompt dissemination of findings to front-line healthcare workers and other members of the medical community. The registry is now accepting reports of monkeypox cases and cutaneous reactions to monkeypox/smallpox vaccines. The success of this collaborative effort will depend on active case entry by the global dermatology community.

34678 Demographics of dermatology community health center is reflective of general population

The racial and ethnic composition of the United States is evolving, and dermatologic care must evolve accordingly to address patients’ unique concerns. Prior studies have demonstrated the need for increased exposure, education, and training to gain competence in treating and diagnosing conditions pertaining to skin of color patients. Free clinics provide medical students, residents, and physicians an opportunity to treat a demographically diverse patient population, as well as to become aware of the logistical barriers to patient compliance.

34296 Introduction of BELCOMID: BELgian Cohort study of COVID-19 in Immune Mediated Inflammatory Diseases

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic is turning into a significant wrinkle in the history of modern health care. It remains unclear what the exact risk and impact of COVID-19 is on patients with immune mediated inflammatory diseases (IMIDs). Targeted immune-modulating therapies (TIMT) for treatment of IMIDs could interfere with humoral immune response against COVID-19. To analyze exposure to SARS-CoV2 and to map the effect of TIMT on humoral immune response after COVID-19 infection or COVID-19 vaccination, a Belgian IMID-cohort was founded: all patients with IMIDs of the gut (Crohn’s disease, ulcerative colitis and indeterminate colitis), joints (rheumatoid arthritis, psoriatic arthritis and spondyloarthritis) and skin (psoriasis, hidradenitis suppurativa and atopic dermatitis) in clinical follow-up at the cooperating sites were invited to participate: 2165 patients were included. IMID disease course and SARS-CoV2 exposure were evaluated through questionnaires and seroprevalence of SARS-CoV2 IgG (Spike and Nucleocapsid antibodies). Baseline serum samples were obtained between December 17th, 2020 and February 28th, 2021, before COVID-19 vaccination. Sampling was repeated between July 1st, 2021 and September 30th, 2021. In this poster we present the levels of SARS-CoV2 IgG (Spike and Nucleocapsid antibodies) both at baseline and six months later (after COVID-19 vaccination). We report on the effect of four different treatment groups (JAKi/biologic treatment; conventional/immunomodulatory treatment; combination treatment; systemic steroid treatment) on the degree of COVID-19 humoral immunity after infection and/or vaccination. This poster aims to inform the dermatological community about the effect of commonly used drugs on the humoral immune response after COVID-19 infection and/or COVID-19 vaccination.

34223 Incidence and prognosis of COVID-19 in patients with psoriasis on apremilast: A multicenter retrospective cohort study

Exacerbated systemic signs/symptoms with a SARS-CoV-2 infection (COVID-19) have been linked to a disruption in the balance of pro- and anti-inflammatory cytokines. Investigations continue to determine how immunomodulatory therapies used for immune-mediated inflammatory diseases impact the clinical course of COVID-19. Accordingly, we aimed to quantify the proportion of patients with psoriasis who contracted COVID-19 during treatment with apremilast, an immunomodulatory treatment. Upon approval by the Research Ethics Board, this multicenter retrospective study was undertaken at 5 academic and 5 community dermatology practices in Canada. Inclusion criteria were patients ≥18 years of age with plaque or pustular psoriasis treated with apremilast. Data were collected between January 25, 2020 (1 documented COVID-19 case, zero deaths in Canada) and April 30, 2021 (1,211,083 cumulative COVID-19 cases, 24,169 deaths in Canada). Among the 402 identified patients receiving apremilast, there were no documented COVID-19 cases. These results demonstrate that apremilast use for psoriasis did not increase the risk of contracting SARS-CoV-2 infection compared with the general Canadian population (incidence of 3.2% as of April 30, 2021). Currently, there are no evidence-based guidelines to instruct clinicians on the use of apremilast during the COVID-19 pandemic. Our data suggest that discontinuation of apremilast treatment out of concern for contracting SARS-CoV-2 infection is not supported. In fact, cessation of therapy may lead to a flare of the condition being treated. Overall, apremilast does not increase susceptibility to SARS-CoV-2 infection in patients with psoriasis and can be considered a safe immunomodulatory therapy for this patient population during the pandemic.

Hair loss treatment and restoration: Online interest trends and video-based social media content.

Public interest in hair loss topics and treatments can be observed by examining online trends, such as those monitored by Google Trends. Social media has also gained the interest of the dermatology community. Video-based social media sites are being used to provide the public with informational content related to hair loss and treatments, but it may not always be unbiased or reliable. This research examined the interest in hair loss and treatment related trends in recent years through Google Trends, as well as examined what videos from YouTube and TikTok that the average person may encounter when performing searches related to hair loss and treatments. Google Trends showed that the COVID-19 pandemic had an initial negative impact on interests of hair loss and treatment related topics, both worldwide and in the United States. External events, such as a celebrity receiving a hair transplant, can influence the interests of the general public with the topic. The social media sites showed that there was a high level of interest in the topics, approximately 25% of videos involved a medical professional, and many involved personal experiences or natural remedies. Interest in hair loss and treatments continues to grow. Clinicians should do their best to follow the current public interests and be aware of where patients may be obtaining information. Being aware of general interest trends online can benefit clinicians by allowing them to prepare their clinics for potential influxes.

Economic Burden of Denatured Alcohol-Induced Burns: A 20-Year Retrospective Study.

Burn care has rapidly improved over the past decades, but health innovations are expensive. We present the first study focusing on the economic burden of exclusive denatured alcohol-induced burns. The goal of this study was to determine costs for the public health system due to inpatients’ burn care because of these specific burns. Moreover, we aimed to observe the incidence of methylated spirit-related burns in the past 20 years. We performed an observational retrospective study in our burn unit including all patients with a denatured alcohol-related burn injury from 1 January 2001 to 31 December 2020. A total of 503 patients with a mean burn size of 24% were hospitalized; the mean annual total costs per patient was €43,879, varying from €31,518 to €63,274.00€; the total costs for denatured alcohol-related burns during the period 2001–2020 was €21,145,076. We noted an increasing incidence of denatured alcohol-related burns and related costs over the years, especially in the last decade. Our results highlight that burns by methylated spirits are still a real and expanding problem. Therefore, authorities should focus on sales rules, characteristics of the containers, and education of people who misuse denatured alcohol, based on historical habits of use. To reduce the socioeconomic costs of burns, future intervention strategies and studies from the dermatology community and burn specialists should focus on prevention programs and prompt wound healing to shorten the length of hospital stay, enable quick return to work, and improve the outcomes of patients with burns.

A Review on Cutaneous and Musculoskeletal Manifestations of CLOVES Syndrome.

CLOVES syndrome is a novel sporadic mosaic segmental overgrowth syndrome, currently categorized under the canopy of PROS (PIK3CA-related overgrowth spectrum) disorders. All PROS disorders harbor heterozygous postzygotic activating somatic mutations involving the PIK3CA gene. As an upstream regulator of the PI3K/AKT/mTOR signal transduction pathway, activating mutations of PIK3CA gene commence in uncontrolled growth of cutaneous, vascular (capillaries, veins, and lymphatics), adipose, neural, and musculoskeletal tissues. The excessive growth is segmental, patchy, asymmetric, and confined to body parts affected by the mutation. The term ‘CLOVES’ is an acronym denoting congenital lipomatous overgrowth, vascular malformations, epidermal nevi and spinal (scoliosis) and/ or skeletal anomalies. The syndrome is characterized by an admixture of overgrown tissues, derived mainly from mesoderm and neuroectoderm. Among PROS disorders, CLOVES syndrome represents the extreme end of the spectrum with massive affection of almost the entire body. The syndrome might judiciously be treated with medications hampering with the PI3K/AKT/mTOR signal transduction pathway. This article aims at reviewing the cutaneous and musculoskeletal manifestations of CLOVES syndrome, as the paradigm for PROS disorders. CLOVES syndrome and other PROS disorders are still misdiagnosed, underdiagnosed, underreported, and undertreated by the dermatology community.

Real-world experience with ustekinumab for the treatment of plaque psoriasis in pediatric patients: A retrospective, single-center chart review

Our understanding of the efficacy and safety of ustekinumab for the treatment of pediatric plaque psoriasis is limited to two phase 3 clinical trials.1,2 To evaluate the real-world experience of this biologic in children and adolescents, we conducted a retrospective chart review at a community dermatology practice in Calgary, Canada.

Scalp dysesthesia: a neuropathic phenomenon.

Scalp dysesthesia is an abnormal sensation of the scalp in the absence of cutaneous disease. It is characterized by a burning and/or itching sensation and can be related to a variety of neurogenic or psychogenic causes. This condition is extremely bothersome and is also common- especially among the geriatric population, in women, in patients with diabetes mellitus, and patients with psychiatric history. However, despite its prevalence in many populations, there are limited data about its causes and characteristics. Given its limited cutaneous manifestations, it is also easily misdiagnosed and an underrecognized cause of scalp pruritus in the dermatological community. Therefore, education on scalp dysesthesia is paramount to helping physicians identify and provide appropriate treatment for these patients. This review focuses predominantly on the neurogenic causes (with a brief review of psychogenic itch) of scalp dysesthesia and the therapeutics that have been found to be effective for this condition. Neurogenic causes of scalp dysesthesia occur with damage to the central or peripheral pathways of itch sensation, resulting in modification and heightened sensitivity of nerves that result in abnormal sensations in the absence of or out of proportion to external stimuli. A comprehensive review of etiologies is provided here, ranging from lesions to the central nervous system caused by cervical spine disease, trigeminal trophic syndrome, tumor, stroke, and multiple sclerosis, to small-fiber neuropathies caused by diabetes, brow lifts, keloid, and burn scarring. Recently, there have also been reports of scalp dysesthesias associated with post-infectious COVID-19. Treatment options tailored toward disease severity and different causes of disease will also be discussed. By elucidating the different mechanisms and therapeutic treatments of scalp dysesthesia, we hope to provide clinicians with the tools to identify and treat this condition as well as encourage further research into its etiologies and therapeutics.

Augmented and Virtual Reality in Dermatology—Where Do We Stand and What Comes Next?

As the skin is an accessible organ and many dermatological diagnostics still rely on the visual examination and palpation of the lesions, dermatology could be dramatically impacted by augmented and virtual reality technologies. If the emergence of such tools raised enormous interest in the dermatological community, we must admit that augmented and virtual reality have not experienced the same breakthrough in dermatology as they have in surgery. In this article, we investigate the status of such technologies in dermatology and review their current use in education, diagnostics, and dermatologic surgery; additionally, we try to predict how it might evolve in the near future.

Online Readability Analysis: Mohs Micrographic Surgery Postsurgical Wound Care.

Although various treatment modalities exist for skin cancer care, Mohs micrographic surgery (MMS) is one of the most effective and cosmetically sensitive surgical techniques. The readability of online informational materials specifically related to MMS postsurgical wound care is extremely relevant for patients given the high rates of skin cancer in the US and the number of patients utilizing the internet for information. Investigators conducted Google searches to evaluate the current state of readability on MMS postsurgical wound care using the specific keywords "healing after Mohs surgery" and "wound care Mohs surgery." The readabilities of individual websites were analyzed using the WebFX online software. Health-specific click-through rate was used to select the number of samples assessed. Based on the 33 unique websites evaluated, the aggregate readability of online MMS postsurgical wound care materials was 11.3, corresponding to an 11th-grade reading level by US standards. Although this level of readability is an improvement in online MMS postsurgical wound care information relative to prior literature, there is still considerable work to be done by the dermatologic community in improving the readability of online patient materials regarding MMS.

'We are trained to work safely and within certain parameters'

Dianne Sanderson has a portfolio career, spending part of her week as the senior pharmacist in a primary care network overseeing a team of six pharmacists and three technicians, and the rest of the time in a community dermatology service. Her interest in dermatology was piqued by a study day focusing on common dermatological conditions, […]

Impact of dermoscopy-aided pediatric teledermatology program on the accessibility and efficiency of dermatology care at community health centers

Background There are few studies focusing on pediatric teledermatology, and the impact of a large-scale pediatric teledermatology program on the accessibility and efficiency of dermatology care remains unclear. This study evaluated the impact of a state-wide implementation of a store-and-forward teledermatology program augmented by the incorporation of dermoscopy in pediatric patients visiting community health centers. Methods It was a descriptive, retrospective cohort study of 876 pediatric dermatology referrals. Results In the traditional referral system, only 60 patients (17.6%) were seen by dermatologists with average waiting times of 75 days due to limited access. In comparison, with an implementation of dermoscopy-aided teledermatology, all 536 teledermatology referrals received dermatological care within 24 h, of which only 64 (12%) patients requires face-to-face (F2F) consultation. Patients referred for F2F consultation via eConsults had a much lower no-show rate as compared to the traditional referral system (39% vs. 71%). Side by side comparison between general population and pediatric population has demonstrated shared features in efficiency and access improvement but revealed specific characteristics of pediatric teledermatology in terms of diagnosis and treatment. Conclusion Coordinated store-and-forward teledermatology platform with incorporation of dermoscopy between large community care network and dermatology provider can greatly improve access to pediatric dermatology care especially in underserved population. The efficiency of teledermatology in access improvement for pediatric population is comparable with adult population in eConsults. There are also unique features and challenges in pediatric teledermatology that require further research.

Hyperhidrosis of the residual limb: a narrative review of the measurement and treatment of excess perspiration affecting individuals with amputation.

Hyperhidrosis (HH) is a relatively common disorder involving excessive sweating, typically of the palms or axilla. HH can also frequently occur after limb amputation, where the remaining residual limb excessively perspires, leading to an increased risk of dermatological disorders and functional limitations, such as the inability to comfortably or safely wear a prosthesis. Although many treatments have been proposed to treat HH within the dermatology community, they are not widely known by healthcare providers typically involved in caring for individuals with acquired limb loss. To appraise the current state of quantitative and qualitative assessment of HH within the residual limb and examine existing and future treatment strategies for this problem. Narrative Literature Review. A literature review focused on the assessment and treatment of excessive sweating of residual limbs. There is currently no objective or subjective standard to assess or diagnose HH of the residual limb. Conventional therapies for HH do not always translate to the population of individuals with limb loss. Emerging modalities for treating HH show promise toward a permanent resolution of excess perspiration but require additional studies within people with amputation. Further research is needed to quantify standard values to objectively and subjectively assess and diagnose hyperhidrosis of the residual limb. New and developing treatments for hyperhidrosis require additional studies to assess efficacy and safety in the residual limb.

Dermatology on the global stage: The role of dermatologists in international health advocacy and COVID-19 research.

BackgroundOver the last decade, there has been a surge in interest and funding for global health dermatology. Skin conditions are now recognized as the fourth leading cause of nonfatal disease burden worldwide in disability-adjusted life years. Dermatologists are uniquely positioned within global health because skin conditions are often the presenting sign of severe illnesses, such as neglected tropical diseases and COVID-19.MethodsWe review four major areas of work by dermatologists within global health: i) characterization of global burden of skin disease, ii) advocacy for dermatologic therapies on the World Health Organization's Model List of Essential Medicines, iii) advancements in global programming for skin-related tropical diseases, and iv) the role of dermatologists during the COVID-19 pandemic. For each area of work, the significance and impact on the health of women and girls is briefly highlighted.ResultsDermatologists have led the efforts to quantify and evaluate the global burden of skin disease, the burden of which is disproportionately shared by women. The dermatology community has also championed global efforts to eliminate skin-related neglected tropical diseases, such as scabies. Through national and international policy advocacy, dermatologists have pushed for more dermatologic therapies in the World Health Organization's Model List of Essential Medicines, helping to secure better care for patients with skin disease throughout the world. Since 2020, the dermatology community has worked collaboratively in the fight against COVID-19, establishing a worldwide registry for cutaneous manifestations of SARS-CoV-2 and pursuing research that has allowed colleagues in the house of medicine to better understand this landmark disease.ConclusionThrough the study and promotion of global health, dermatologists have an important role in the house of medicine.

Ophthalmic findings of Mycoplasma-induced rash and mucositis (MIRM) distinct from Stevens-Johnson syndrome

To identify ophthalmic manifestations of Mycoplasma-induced rash and mucositis (MIRM). The medical records of patients with MIRM treated by the inpatient ophthalmology consult service at a single institution over a period of 4 years were reviewed retrospectively. Eye and skin findings, treatment, hospital course, and follow-up findings were documented and reviewed. MIRM was identified in 10 patients, 10-20 years of age (mean, 13.) All presented with oral mucosal findings and a prodrome. On initial examination, conjunctival epithelial defects were present in 2 patients; pseudomembranes, in 3. Five patients experienced progressive ophthalmic manifestations during hospitalization, including a new cornea epithelial defect in 1 patient and a new conjunctival epithelial defect in 3 patients. All were treated with topical steroids and antibiotics. Post-discharge follow-up obtained for 7 patients documented good visual outcomes and lack of significant ocular sequelae without requiring invasive intervention. MIRM, previously referred to as mycoplasma-associated Stevens-Johnson syndrome (SJS) among other names, is now understood to be distinct from SJS in the dermatology community. Our MIRM patients present with mild eye findings and required no surgery, similar to the mild course published in the dermatology literature. Patients with MIRM may have a more benign course than those with SJS.

The risk of COVID-19 infection in patients with atopic dermatitis: A retrospective cohort study

To the Editor: The dermatology community remains concerned about the risk of COVID-19 in individuals with atopic dermatitis (AD). Using Symphony Health-derived data from the COVID-19 Research Database,1 we aimed to assess the risk of contracting COVID-19 in adults with AD while controlling for demographic factors and comorbidities known or speculated to be COVID-19 risk factors and assess the risk of contracting COVID-19 in adults with AD treated with dupilumab.

COVID-19 in patients with psoriasis: A Latin American case series

To the Editor: The impact that COVID-19 has on patients with psoriasis is not completely clear. It has been reported that patients usually experience mild symptoms; however, pneumonia may develop in up to 15% of these patients, and 5% of patients progress to acute respiratory distress syndrome.1 Controversy over the use of human monoclonal antibodies against cytokines (biologics) and other immunomodulatory therapies has increased the interest in the dermatologic community, since it is presumed that these patients may have a greater risk of requiring in-hospital management during acute infection.

Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal.

There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms. However, the acceptance of TSA/TSW as a distinct condition remains controversial within the dermatological community. We conducted a literature search using PubMed, MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science to identify original articles addressing TSA/TSW. We described the definition and reported clinical features of TSA/TSW including its classification into erythemato-edematous and papulopustular subtype. To assess the validity of TSA/TSW, we summarised and objectively appraised the postulated mechanisms for this condition, including tachyphylaxis, dysregulation of glucocorticoid receptors, rebound vasodilation and impaired skin barrier leading to a cytokine cascade. Understanding the evidence including its limitations and uncertainties highlights areas for future research and helps medical practitioners better counsel and provide care to patients who may be experiencing or who have concerns about TSA/TSW.